@ Aeromedical Service in Reformed Mongolia by Michael C. Walker and Robert A. Farrick, Ph.D. The nation of the Republic of Mongolia is a large (over twice the size of the state of Texas), land-locked, country situated between China and the former Soviet republic of Kazakhstan. The geography of Mongolia is very rugged, with vast expanses of desert contrasting with steep mountains and arid steppe. Around a quarter of the populace lives in metropolitan areas (mainly the capital of Ulaan Baatar) and there are many scattered settlements in remote locations throughout the nation. For the past 70 years, Mongolia has been under Communist rule in a situation very similar to that of the former U.S.S.R. In 1990, Mongolia severed its long-standing relationship with the U.S.S.R. and started to reform its political and economic structure. While this reformation seems to be a positive action, the infrastruc- ture of transportation, administration, and health care that the Soviet system created has collapsed and no tangible sub- stitute has come into its place [1]. In the days of Communist rule, the government completely provided for health care, including emergency medical trans- port, which was more often than not in the form of an aeromedical helicopter. MIAT, the Mongolian national air carrier, in conjunction with the Mongolian Air Force, ad- ministered all aeromedical operations [2]. Most helicopters seemed to have been the property of MIAT but since nearly all aircraft were provided on a "loan" basis from the Soviet Union; the "ownership" of individual aircraft has always been an ambiguous matter. The most commonly used aircraft were Russian-built Kamov Ka-26s (NATO Hoodlum) and Ka-27s (NATO Helix) with Mil Mi-17s (NATO Hip-H)[3] and Mi-6s (NATO Hook) augmenting the fleet. Occasionally, the giant Mil Mi- 26s (NATO Halo) were used in aeromedical roles, but these large aircraft were not well suited to landing at scenes and were reserved for disaster relief and mass evacuation opera- tions [4]. For those of us who have spent our entire flying careers in the United States; it is hard to comprehend the Soviet system of providing helicopters and other aircraft to the Communist nations which the U.S.S.R. offered aid. The helicopters would be assigned to Mongolia as part of either a "military assistance" or "civil improvement" package (in which case they would stay in the country indefinitely), or they would be given to the government on a "loan" basis for a set period of time (after which they were to return to the U.S.S.R.) [5]. The problem with this situation was that the Mongolian agencies using the aircraft did not have any motivation to care for their helicopters and the aircraft often went without required maintenance for long periods of time. Parts and trained mechanics were hard to come by and there was little incentive for pilots to refresh their training or improve on their skills. A Soviet pilot serving in Mongolia was unlikely to be happy with his assignment and might perform poorly while a Mongolian pilot would be apt to have inadequate training. The same was largely true for the medical staff who served aboard the helicopters. The system never worked nearly as well as the Soviet propaganda made it appear to function [6]. Upon the demise of the Soviet Union and Mongolia's removal from most forms of Russian support, the Russian military pilots and other aeromedical staff assigned to Mongolia returned to Russia. This, with the great unavailability of repair parts and fuel [7], lead to a marked decay of aeromedical service from even the previous Soviet standards. MIAT was having great difficulty making ends meet on all fronts and mostly abandoned its aeromedical operations to fend for themselves [8]. Although the availability of aeromedical services is insuf- ficient, the need for such services is great. Most regions of Mongolia are so isolated from hospitals capable of providing trauma care and roads are often in such disrepair that aeromedical helicopter service is the only means of providing emergency care to much of the population. The need for hospital-to-hospital transport is also significant as only one hospital in the entire nation may have the staff or equipment needed for a certain procedure [9]. From Tristan Aerospace's investigation of the status of Mon- golian aeromedical services, it has been determined that if the existing system is privatized and comes into the over- sight of outside investors, the country has a good chance of rebuilding a national program of aeromedical transport that exceeds the standards of Soviet operations of the mid-1980s. A level of adequate care for most regions could be reached in five years if the reformation is conducted in a com- prehensive and educated manner [10]. The first objective would be to provide new aircraft as most of the existing fleet are in need of repair and parts cannot be obtained. Several different models of aircraft have been suggested but it is clear that the helicopters to be chosen must be able to withstand the detrimental effects of wind- blown sand and extremes of climate. The durability of the aircraft must be the primary concern, even above cost. It is important to realize that few, if any, manufactures will be willing to directly lease aircraft to the Mongolian govern- ment considering MIAT's past record in paying for leased goods [11]. The only viable option for getting the aircraft into Mongolia is to incorporate a dedicated enterprise within the nation that is devoted to the procurement and management of aeromedical aircraft. This corporation could also oversee the operation of the aircraft in aeromedical service and could possibly contract the pilots and medical staff needed [12]. Finding qualified pilots within Mongolia may not be any easy task, but will turn out to be much more effective in the long run than importing pilots from other nations. For one thing, most Mongolian professionals are fluent in both Mon- golian and Russian, but few speak English. Conversely, not many people outside of Mongolia speak Mongolian [13]. The best solution seems to have Mongolian pilots trained in the operation of their new aircraft by flight instructors who possess a working command of the Russian language. Any Mon- golian pilot who has flown Russian-made aircraft will have fair knowledge of Russian technical terminology. Some incen- tive should be given to these pilots to upgrade their ratings and improve their skills. Within ten years time, a new generation of pilots will be coming into the profession and should find aeromedical service to be the most challeng- ing and lucrative area of aviation available to them [14]. Obviously, the procurement of aircraft, restructuring of ad- ministration, improvement of facilities and training of per- sonnel will all require extensive funding. Fortunately, both the dollar and the yen are in immense demand in Mongolia. Several Japanese financial institutions have expressed in- terest in investing in "civil aid and reforming projects" [15]. The World Bank has already overseen the beginning of a "Transport Rehabilitation Project" through the Ministry of Roads, Transport, and Communications [16]. Considering this level of interest in Mongolian business opportunities; prospects for funding a large aeromedical reformation program may well be rather good. Where other Asian nations emerging from Communist rule are concerned (i.e.- Vietnam); the expectations for Western investment appear considerable. Right now, Tristan Aerospace and several other research and marketing corporations are looking into the political aspects of foreign investor-supported aeromedical reform in Mongolia. From the preliminary research, it appears that the prospects are very favorable. Notes [1] "State Department Consular Information Document for Mongolia", United States Department of State, Washing- ton, D.C., 29 July 1994 [2] Various internal documents provided by the Mongolian Ministry of Defense; also supported by reports in In- teravia [3] Encyclopedia of Military Aircraft, Michael Taylor, Gal- lery Books, New York, 1987 [4] eye-witness reports of Captain Yuri Stolkin, Aeroflot, 1986; supported by extensive field reports [5] "Fleet Supplements to Mongolian People's Republic- 1986", Soviet military logistical report (translation), Moscow, 1987; supported by extensive records and first- hand accounts [6] "Situation of Pilots Engaged in Medical Rescue Field Assignments", MIAT report to the Mongolian Air Force (translation), Ulaan Baatar, 1988 [7] accounts of travelers and business people in Mongolia; supported by trade records and government admissions to a scarce supply of aviation fuel [8] MIAT document "18002-H-JA" detailing suspension of aeromedical services in 70% of Mongolia due to finan- cial hardships (translation), MIAT, Ulaan Baatar, 1992; supported by first-hand accounts [9] Mongolian Ministry of Health documents; supported by United States Department of State and World Health Organization reports on Mongolia [10] Feasibility Report: Restructuring of Mongolia's Aeromedical Services through Private Investment", Tristan Aerospace International, Irkutsk and Istanbul, 1995 [11] "Provisions for Aircraft in Mongolian National Service" Gespar Talkinoff, Aeroflot document (translation), Mos- cow, 1988; supported by MIAT records and the records of other agencies providing aircraft to MIAT [12] "Feasibility Report: Restructuring of Mongolia's Aeromedical Services through Private Investment", Tristan Aerospace International, Irkutsk and Istanbul, 1995 [13] Mongolia: Politics, Economics, and Society, Alan Sanders, Frances Pinter, London, 1987 [14] "Feasibility Report: Restructuring of Mongolia's Aeromedical Services through Private Investment", Tristan Aerospace International, Irkutsk and Istanbul, 1995 [15] Mongolian Ministry of Finance reports and World Bank documents [16] "Transport Rehabilitation Project", funding analysis report, the World Bank, 1994