Swansea University Research visit to explore paediatric healthcare and congenital heart disease management
In November 2024 Emma Rees, PhD FBSE (Associate Professor of Healthcare Science, Swansea University), along with PhD student Megan Morecroft, went on a transformative and impactful research trip to Mongolia. During their trip they engaged in a rich cultural exchange, enhancing their understanding not only of the country’s paediatric healthcare system and congenital heart disease (CHD) management, but of the country’s incredible culture of kindness and respect. Emma Rees tells us more:
We were hosted by Dr Ulziikhishig Byambabayar (Dr Ulzii), consultant paediatric cardiologist at 1st Maternity Hospital in Ulaanbaatar. The primary goal for our trip was to gain valuable knowledge about a prototype medical device being tested by Dr Ulzii and her clinical team, as well as to grow a personal understanding of the challenges of using a new device in a low-resource, remote medical environment. We also aimed to develop international ties and foster a new collaboration corridor between Wales and Mongolia, opening the door for reciprocity and exciting future projects.
We were accompanied on the trip by consultant paediatric cardiologist Professor Orhan Uzun, innovation academic Dr Nalaie De Mello, and members of the medical device company Bloom Standard, who we are supporting in their development of a novel ultrasound screening device. We were able to observe Bloom Standard’s prototype being used by Dr Ulzii within an approved study on infants. This proved an invaluable opportunity to take notes on device use and any areas for continued improvement in future prototypes. Having the whole team on site facilitated many great discussions between us and Bloom Standard, shaping our clinical investigation plans going forward and allowing us to maximise our support in their device development.
In Mongolia, the under-5 mortality rate is higher than in many other countries. The government and clinicians are working to reduce the rate of premature births and to improve healthcare for newborns born with heart defects and other congenital abnormalities.
During our time in Mongolia, we were fortunate enough to visit 5 hospitals located in the capital Ulaanbataar and the Töv countryside province. In each hospital we were given the opportunity to hear from the hospital directors and staff about their local population and birth rates, facilities, and challenges they face during their clinical work. All staff were enthusiastic and accommodating, allowing us to tour facilities including intensive care, and discuss their experiences.
Hearing about local population statistics, staff triumphs and challenges, and seeing facilities first-hand was a unique learning experience for all on the trip. Not only did these visits provide ample learning opportunities for shaping our clinical investigations of the new device, but they opened the floor for several future collaborative projects between the clinical staff in Mongolia and Swansea University.
For example, we have a shared interest in the impact of air quality on pregnancy outcomes and newborn health. Given that Mongolia has recently migrated to a country-wide eHealth system, there is also potential to undertake comparative studies with our own population-level data held within the SAIL databank to better understand health issues facing both countries.
Yes, we were honoured to be invited to visit both the Ministry of Health and the Presidential Palace to discuss our work on screening for congenital heart disease in children and how it fits with the healthcare priorities of Mongolian leadership.
At the Ministry of Health (MoH), the Head of MoH Research shared details on their nationwide X-ray screening programme initiated in 2022 which has screened 1.4 million people to date. The MoH team faced several challenges relating to the country’s large geographical spread and human resource shortages, which they are addressing in part with the addition of AI to the screening pathway. However, they still face ongoing challenges sending X-ray data between hospitals with incompatible or non-existent e-Health software.
At the Presidential Palace we met with the Health, Sports and Social Policy Advisor to the President of Mongolia, Munkhsaikhan Togtmol, and his team. Mr Togtmol shared how public health and national screening programmes are now an important focus for the presidential office, especially in early life. He described the government’s recent pilot screening programme that uses echocardiography to screen 6-year-old school children for undiagnosed heart defects. Their next goal is to expand the pilot team to facilitate greater screening capacity.
Yes, I hope so. The field notes on healthcare practices and device use taken by the team have been transcribed and analysed by PhD student Megan Morecroft, contributing to her PhD thesis. In taking the field notes and immersing herself in a low-resource healthcare system, Megan has gained valuable skills and a unique perspective from which to develop her research and defend her thesis at the end of her PhD. We will disseminate the outcomes of the analysis with a wider audience via publication and abstract/poster presentation at future conferences, sharing the lessons learned about low-resource device development to Wales and beyond.
As part of the exchange, we were able to host a visit from both Dr. Ulzii and Dr. Bolormaa. A key objective of the visit to Wales was for Dr. Ulzii and Dr. Bolormaa to experience maternal and children’s healthcare in Wales with a view to sharing innovations and best practice with their colleagues in Mongolia.
We were able to provide observation opportunities at several hospitals in Wales including the University Hospital in Wales (Cardiff) and Singleton Hospital (Swansea). During the visit, Dr. Ulzii and Dr. Bolormaa frequently noted that they were learning about many aspects of care which they hoped to apply in Mongolia to improve healthcare for infants. We are sincerely grateful to all colleagues in NHS Wales who extended a warm Welsh welcome to our international visitors. Their kindness and collegiality will be fondly remembered by Dr. Ulzii and Dr. Bolormaa.
