By Dr Thawaneswaaran
ICOE Trainer, O&G Registrar HUKM
(Published in AOFOG Newsletter July 2023, Volume 3/2023)

I have been an ICOE trainer since 2019 and it has taken me to several countries, including Laos in February 2019. My second experience abroad was my Mongolian journey in May 2023. When Dr Tang Boon Nee, the Director of ICOE contacted me, I agreed right away to this incredible opportunity. I have always been passionate about empowering and training local doctors in obstetric emergencies and a trip to Mongolia surged excitement to my veins. The course was comprehensive for Obstetrics and Gynaecology professionals: Training of the Trainers (TOT), Simulation of Difficult Caesarean Section, and an Obstetric Conference by the Mongolian Federation of O&G (MFOG). The vibrant country with its iconic Mongolian countryside and chilly temperatures, drew me to accept the challenge.

The journey from Kuala Lumpur was filled with fascinating encounters and awe. The Malaysian team consisted of Dr Michael Hoong (team leader), Dr Khoo Kong Beng, Dr Voon Hian Yan, Dr Hii Ling Yien and myself. We all met up at KLIA where the excitement was palpable. After boarding on time, we had a long-haul flight to Incheon, followed by another flight before finally arriving in Ulaanbaatar. The first thing we all experienced was the cold weather. We were warmly greeted by Dr Sansar and Dr Tuya, which made for a great start to our trip.
Upon arriving in Ulanbaatar, we visited the Nursing School of the Medical Science University of Mongolia. We were left speechless as we walked into the Simulation Centre of the Nursing School, which had impressive array of manikins neatly assembled. After settling in, our Malaysian and Mongolian teams familiarized ourselves with the schedule for the following day’s Training of Trainers (TOT), assigned the trainers appropriately, and set up the course venue for TOT. The productive day at the simulation centre ended with an amazing dinner with generous hosts, delicious fusion cuisine before finally settling in at Holiday Inn UB

On May 25, 2023, the ICOE TOT commenced at noon. The 30 attendees, composed of both junior and senior OBGYN specialists, were all who attended ICOE workshop previously, hailed from various hospitals. The event started with opening speeches from distinguished figures such as Dr Tsedma (Past-President of MFOG), Dr Urje (MFOG President), and Dr Voon (AOFOG Ultrasound chairperson), who spoke about their experience and shared their insights on the ICOE program. After the speeches, the Malaysian team took the stage and delivered a series of lectures, which were translated to Mongolian by the good-hearted Dr Naraa and Dr Batnaa. It was an enriching session that offered invaluable knowledge and skills to all attendees. Following the lectures, the ICOE TOT program proceeded with three breakout stations: “Scenario (eclampsia)”, “Skills (Shoulder Dystocia)”, and an station on “Feedback and Debriefing”. I was in charge of the skills station, and I was thrilled to see the enthusiastic participation of the attendees, who were all open-minded and willing to learn. What impressed me the most was how even the senior attendees showed no qualms about learning from me, a trainee. It was an unforgettable experience full of willing participants, eager to add, improve and develop their skills.

At the end of the day, all the attendees gave us positive feedback about the Training of Trainers program, stating that it helped them reinvigorate their interest in ICOE. With the TOT successfully concluded, we began preparing for the Complicated Caesarean Section workshop the next day. The workshop consisted of six skill assessment stations, including skin and uterine incision, uterine tear repair, abnormal fetal lie handling, uterine compression sutures, second-stage Caesarean sections, and internal iliac artery ligations. After completing the preparations, our Mongolian hosts, Dr Urje, Dr Tsedma, Dr Anu, and Dr Azaa treated us to a traditional Mongolian dinner at the Modern Nomad restaurant. Dr Krishnendu Gupta (AOFOG Deputy Secretary General) and his wife Dr Simran also joined us for delicious food and lovely conversations.

On May 26, 2023, with temperatures of 1 degree Celsius we commenced ICOE Simulation on Complicated Caesarean Section workshop, with 30 registered participants raring to learn. Dr Tsedma, Dr Urje, and Dr Krishnendu gave the opening remarks. The Malaysian trainers took center stage once again, delivering three lectures and six breakout stations covering the various aspects of managing complicated C-sections. I was given the responsibility to oversee the skin and uterine incision skills, and I must say their practices were consistent and similar. It was fascinating to learn from their shared experiences, and it helped me improve on my knowledge and skills as well. I was surprised that, at one point, I didn’t feel the language barrier was an issue because the attendees were so involved and engaged.

We concluded the program with a post-skill test, which demonstrated marked improvement in the scores of our trainees. The participants were respectful, attentive, and eager to learn, which made the whole experience much more rewarding. After the close, we proceeded to pack up the equipment in suitcases, which were then safely stored back at the hotel. After a tiring yet fulfilling day, we completed our tasks and had a relaxing dinner. Knowing we had a significant day ahead, attending the MFOG Obstetric Conference, we retired to our hotel rooms.

On the much-awaited date of May 27th, 2023, the entire OBGYN fraternity gathered at the esteemed Holiday Inn Ulaanbattar in Mongolia for the much-anticipated MFOG Obstetrics Scientific Conference. The conference serves as a platform for OBGYN trainees to share their research, experiences and knowledge, learn about the latest advancements in obstetric. The conference began with an opening speech by Dr Urje, , followed by a Dr Krishnendu Gupta.

During the conference, the MFOG reached out to ICOE trainers to deliver four plenary lectures on behalf of the Obstetrical and Gynaecological Society of Malaysia (OGSM). This was a significant honor and privilege for us as we were able to contribute to this esteemed event and share our expertise with fellow professionals. Dr Voon (AOFOG Ultrasound chairperson) spoke about pre-eclampsia and intrapartum ultrasound, delivering an insightful and incredible lecture that had the audience in awe. Dr Hii tackled the topic of difficult C-section and ultrasound in postpartum haemorrhage, and Dr Michael’s talk revolved around twin pregnancy. His storytelling talent captivated the audience and made for an engaging presentation. The lectures were well-received. Through the lectures we delivered, we were able to engage with attendees and provide them with valuable insights from our years of experience in the field.

Overall, the MFOG Obstetrics Scientific Conference was a massive success, with the well-organized event completing its agenda while providing a space for attendees to network and connect with peers from Mongolia. After the conference, we had a small meeting to celebrate the fantastic event’s success, which had run for the past three days. This gathering was a beautiful way to celebrate the incredible cooperation and teamwork that took place throughout the program.

After attending the ICOE workshop and conference, we had a day before our flight and we had the chance to go on a countryside tour courtesy of the local host. It was the most incredible countryside tour that I had the opportunity to experience. The Chinggis Khaan Statue Complex had an incredibly majestic statue of the conqueror. The museum in the complex was just as fascinating and taught us so much about Mongolian history. The highlight was horse riding in the countryside which felt being in a Mongolian horse race. We bravely held a massive eagle which surreal! The view of the Terelj National Park was unbelievable. Lunch was at a Ger while admiring the natural beauty of the landscape. We visited the famous Turtle Rock, a massive granite rock formation that was simply awe-inspiring.

We left for the airport at 05:00 on May 29th, 2023. Dr Sansar, Dr Naraa, and Dr Tuya were kind enough to accompany us to the airport and ensured that our check-in process went smoothly. The Mongolian team went out of their way to make sure that we were well taken care and I could feel the love and warmth throughout the entire experience.

I found myself reminiscing the memories. I was left feeling rejuvenated and inspired after witnessing the beauty, nature, and culture of the country. All of the great experiences kept making me smile and feel blessed to have had this opportunity. I am grateful to the ICOE for organizing this training and workshop.

The trip to Mongolia and the ICOE training and workshop, was an excellent reminder of why it is essential to step outside our comfort zones and take on new challenges in life. There is so much to learn and gain by interacting with individuals from different backgrounds and experiences. It is an excellent platform to gain a wealth of knowledge, network with professionals, build relationships, and take the first step towards achieving your goals in life. I encourage and recommend all the trainee to attend it. In conclusion, the Intensive Course in Obstetric Emergencies is not just a course but a life-changing experience. Finally, I would like to express my sincere gratitude to OGSM and ICOE for providing us with this fantastic opportunity to broaden our horizons, learn new things and enhance our skills. The experience was truly invaluable, and I’m grateful to have been a part of i