Between Life and Death: Physician Accounts Near Sukhbaatar Square

Mongolia's medical traditions include an ancient heritage of Mongolian traditional medicine based on Tibetan medical principles (Sowa Rigpa) and indigenous steppe healing practices. Traditional Mongolian medicine, known as Mongol emiin uhaan, draws from the vast pharmacopoeia of the steppe — animal products, minerals, and the medicinal herbs of the Mongolian grasslands. The Tibetan Buddhist medical tradition, formalized in texts like the Four Tantras (Gyüshi), was widely practiced in Mongolia's monasteries, where monk-physicians combined herbal medicine, dietary guidance, and spiritual practices.

The Soviet period (1924-1990) brought modern Western medicine to Mongolia, establishing a comprehensive public healthcare system that achieved dramatic improvements in life expectancy and reduction of infectious diseases. However, the transition from Soviet to market economy in the 1990s severely strained the healthcare system. Today, Mongolia's medical infrastructure is concentrated in Ulaanbaatar, with rural areas — particularly the vast steppe and Gobi regions — facing significant access challenges. The Mongolian National University of Medical Sciences trains the majority of the country's physicians. Mongolia has experienced a revival of traditional Mongolian medicine alongside Western practice, with the government establishing a National Center of Traditional Medicine that integrates traditional and modern approaches. The country's unique health challenges include extremely cold winters, air pollution in Ulaanbaatar (among the worst in the world), and providing healthcare to nomadic herding communities.

Mongolia's ghost traditions are rooted in the ancient Turkic-Mongol shamanistic tradition known as Tengerism (worship of the Eternal Blue Sky), which predates the later arrival of Tibetan Buddhism and remains a powerful cultural force. Mongolian shamanism holds that the world is populated by spirits (ongon) inhabiting every natural feature — mountains, rivers, trees, and rocks — and that the spirits of deceased ancestors maintain an active presence in the lives of their descendants. The böö (male shaman) or udgan (female shaman) serves as the intermediary between the human and spirit worlds, entering trance states through drumming, chanting, and dancing to communicate with spirits, diagnose illness, and guide the souls of the dead.

The Mongolian concept of süns (soul) is complex: each person is believed to possess multiple souls, some of which may wander during sleep or illness, causing physical and mental distress. The shaman's primary healing function involves retrieving lost or stolen souls and negotiating with spirits that have caused illness. Ancestral spirits (ongon) are venerated through offerings of milk, airag (fermented mare's milk), and fat placed at ovoo (oboo) — sacred stone cairns found throughout the Mongolian landscape, particularly at mountain passes and other liminal spaces. Travelers traditionally circle ovoo three times and add a stone or offering before continuing, a practice observed even by modern Mongolians driving trucks across the steppe.

The revival of shamanism in Mongolia since the end of Soviet-era suppression (1924-1990) has been remarkable. Shamanic organizations have been formally established, and shamans now practice openly in Ulaanbaatar and across the countryside, conducting healing ceremonies, divination, and rituals to appease spirits. Tibetan Buddhism, which became Mongolia's dominant religion from the 16th century, incorporated many shamanistic elements, including spirit propitiation rituals and protective ceremonies. The Buddhist concept of hungry ghosts (birit, from the Sanskrit preta) was absorbed into the existing Mongolian spirit worldview, and many modern Mongolians maintain both shamanistic and Buddhist spiritual practices.

Mongolia's miracle traditions draw from both its shamanistic and Buddhist heritage. Shamanistic healing ceremonies, performed by böö (shamans) who enter trance states to diagnose and treat illness, include accounts of dramatic recoveries attributed to the shaman's intervention in the spirit world. Buddhist miracle traditions center on revered lamas and rinpoches whose spiritual attainment is believed to confer healing powers. The Gandantegchinlen Monastery in Ulaanbaatar, Mongolia's largest functioning Buddhist monastery, is a major site for healing blessings and protective rituals. The tradition of consulting oracles — spiritual practitioners who channel protective deities — for medical guidance remains practiced in Mongolian Buddhist communities. During the Soviet period, when both shamanism and Buddhism were suppressed, spiritual healing went underground but never disappeared entirely, and the post-1990 religious revival has brought these traditions back into open practice.

County fairs near Sukhbaatar Square, Ulaanbaatar host health screenings that reach populations who would never visit a doctor's office voluntarily. Between the pig races and the pie-eating contest, fairgoers get their blood pressure checked, their vision tested, and their cholesterol measured. The fair transforms preventive medicine from a clinical obligation into a community event—and the corn dog they eat afterward is part of the healing, too.

The Midwest's tradition of barn raisings—communities gathering to build what no individual could construct alone—finds its medical equivalent near Sukhbaatar Square, Ulaanbaatar in the fundraising dinners, charity auctions, and GoFundMe campaigns that pay for neighbors' medical bills. The Midwest doesn't wait for insurance to cover everything. It passes the hat, fills the plate, and does what needs to be done.

Czech freethinker communities near Sukhbaatar Square, Ulaanbaatar—immigrants who rejected organized religion in the 19th century—created a secular humanitarian tradition that functions like faith without the theology. Their fraternal lodges built hospitals, funded medical education, and cared for the sick with the same communal devotion that religious communities display. The absence of God in their framework didn't diminish their commitment to healing; it concentrated it on the human.

Evangelical Christian physicians near Sukhbaatar Square, Ulaanbaatar navigate a daily tension between their faith's call to witness and their profession's requirement of neutrality. The physician who silently prays for a patient before entering the room is practicing a form of faith-medicine integration that respects both callings. The patient never knows about the prayer, but the physician believes it matters—and the extra moment of centered attention undeniably improves the encounter.

Amish and Mennonite communities near Sukhbaatar Square, Ulaanbaatar don't typically report hospital ghost stories—their theology doesn't accommodate restless spirits. But physicians who serve these communities note something that might be the inverse of a haunting: an extraordinary stillness in rooms where Amish patients are dying, as if the community's collective faith creates a zone of peace that displaces whatever else might be present.

The Midwest's one-room schoolhouses, many of which were converted to medical clinics before being abandoned, have seeded ghost stories near Sukhbaatar Square, Ulaanbaatar that blend education and medicine. The ghost of the schoolteacher-turned-nurse—a Depression-era figure who taught children by day and dressed wounds by night—appears in rural medical facilities across the heartland, forever multitasking between her two callings.

Christina Maslach's Burnout Inventory, developed in 1981 and refined over subsequent decades, remains the most widely used and validated instrument for measuring occupational burnout. The MBI assesses three dimensions—emotional exhaustion, depersonalization, and reduced personal accomplishment—using a 22-item self-report questionnaire that has been administered to hundreds of thousands of workers across professions. Maslach's original research, conducted among human service workers in California, identified healthcare as a high-risk profession, a finding that subsequent decades of research have confirmed with depressing consistency.

The application of the MBI to physician populations has revealed important nuances. Physicians score particularly high on the emotional exhaustion and depersonalization subscales, reflecting the intensity of clinical encounters and the protective emotional distancing that many doctors develop in response. Interestingly, physicians in Sukhbaatar Square, Ulaanbaatar, and nationwide often score relatively well on personal accomplishment—they know they do important work—even while scoring in the burnout range on other dimensions. This pattern suggests that burnout in medicine is not a failure of purpose but a corruption of the conditions under which purpose is pursued. "Physicians' Untold Stories" reinforces the accomplishment dimension while addressing exhaustion and depersonalization through stories that reconnect physicians with the extraordinary potential of their work.

The epidemiology of compassion fatigue among physicians in Sukhbaatar Square, Ulaanbaatar, draws on the foundational work of Charles Figley, who defined compassion fatigue as the "cost of caring" for those in emotional pain. Figley's model distinguishes between primary traumatic stress (from direct exposure to trauma) and secondary traumatic stress (from empathic engagement with traumatized individuals), arguing that healthcare providers are vulnerable to both. The Professional Quality of Life Scale (ProQOL), developed by Beth Hudnall Stamm, operationalizes this model by measuring compassion satisfaction, burnout, and secondary traumatic stress as three interrelated dimensions.

Research using the ProQOL in physician populations has revealed a consistent pattern: compassion satisfaction—the positive feelings derived from helping others—serves as a significant buffer against both burnout and secondary traumatic stress. Physicians who maintain high compassion satisfaction, even in high-acuity specialties, report lower overall distress. This finding has important implications: interventions that increase compassion satisfaction may be as effective as those that reduce stressors. "Physicians' Untold Stories" is precisely such an intervention. Dr. Kolbaba's extraordinary accounts increase compassion satisfaction by reminding physicians in Sukhbaatar Square of the profound privilege of their work—a privilege that manifests most clearly in the moments when medicine transcends the ordinary and touches something inexplicable.

Research on the relationship between meaning in work and burnout has identified a paradox specific to physicians: despite consistently reporting that they find their work meaningful (85% in a 2019 JAMA study), physicians also report among the highest burnout rates of any profession. This 'meaning-burnout paradox' suggests that meaning alone is not protective against burnout when working conditions are sufficiently toxic. However, the research also suggests that meaning serves as a buffer — physicians who report high meaning in their work are less likely to leave practice, even when burned out, than physicians who report low meaning. Dr. Kolbaba's book directly enhances physicians' sense of meaning by demonstrating that medical practice is connected to something transcendent. For physicians in Sukhbaatar Square who feel trapped between the meaningfulness of their calling and the misery of their working conditions, the book offers not an escape but a lifeline — proof that the meaning is real, even when the conditions are brutal.