LAANBAATAR, Mongolia — For the moment, Dr. Robert Greenburg is a spectator. He stands at the feet of a patient--a nude, unconscious woman shaved for surgery--and watches as a nurse daubs the abdomen with an iodine-based sterilizing solution. The liquid glistens yellowish-orange under the intense lights, the smell mixing with ammonia disinfectants to fill the operating room with a curdling stench.
It is the same smell, Greenburg says, that filled American operating rooms in the 1960s.
But this is the capital of Mongolia in the summer of 1997. The tools match the Mongolian doctors' skills: Both are functional but out of date.
Greenburg's job is to condense time, to bridge that gap between the way Mongolian doctors treat cervical cancer and the way it's done in Southern California.
Lives hang in the balance.
"There's absolutely no reason for women to die of this disease," says Greenburg, 52, a retired Newport Beach obstetrician-gynecologist. "It's a matter of allocating resources, which are very dear in this part of the world. But we feel we can make an immediate impact by giving women hope that if they have this disease, they have the opportunity for a cure.
"I'm not saying that I'm Albert Schweitzer, but this is wonderful work, and I'm lucky to be able to do this."
It's a common sentiment among Greenburg's colleagues.
Two teams of American doctors--13 in all, mostly pediatricians and oncologists from Southern California--have come here to watch and help Mongolian physicians work in three of Ulaanbaatar's 15 hospitals, and in three villages in the countryside.
During the week, the doctors will stumble across diseases they've rarely seen, such as rickets and diphtheria. They will work with equipment that could double as medical artifacts. And they will see difficult surgeries pulled off despite limitations in training, supplies and basic operating tools.
They will also witness the tragic consequences of misdiagnoses and limited access to equally limited health care.
By the time they leave, the doctors will have examined nearly 200 patients and consulted on dozens more cases. They will have directly saved the lives of several people, improved treatments for scores of others and passed along innovations that will help Mongolia's doctors better deal with such ancient but curable killers of children as respiratory infection and diarrhea.
And the American doctors have only just begun.
Back home, the two teams of doctors could open their own medical plaza.
The first team is a group of nine pediatric specialists assembled by Dr. Richard MacKenzie, director of the Division of Adolescent Medicine at Childrens Hospital Los Angeles, which arrives a week early to explore the area around Ulaanbaatar (pronounced OO-lahn-bah-TAR).
In some ways, Mongolia is defined by where the people aren't. Just over half the nation's population of about 2.4 million live in cities, some 650,000 in Ulaanbaatar alone. The rest lead traditional semi-nomadic lives, moving their gers--canvas-and-felt houses resembling quilted igloos--with their herds of cattle, horses, sheep and goats over an area of about 600,000 square miles, slightly larger than California, Nevada, Utah, Arizona and New Mexico combined.
The natural beauty of Mongolia and the romance of nomadic life hide some very real agonies.
In the nephrology department, Dr. Francine Kaufman finds that the supply of insulin is sporadic at best, which makes it nearly impossible for the young diabetic patients to maintain proper levels of blood sugar.
"They keep running out," she says. "It's incredible. We throw it away like water."
After returning to Los Angeles, Kaufman will begin a program that will ask the families of her department's 600 young diabetic patients to donate insulin, needles and old equipment for measuring blood-sugar levels.
The supplies are critical if the young Mongolian patients are to survive.
"They're just not growing," Kaufman says. "They're not entering puberty. They're developing cataracts, swollen livers and stiff joints and the early onset of kidney disease. If we can't reverse that, it's like a death sentence in 10 years."
Greenburg's team of doctors is smaller than the pediatric crew, and is focused specifically on cervical cancer. The team is part of Medicine for Humanity, a Newport Beach-based organization that Greenburg formed two years ago with his mentor--Dr. Leo LaGasse of Cedars-Sinai Medical Center in Los Angeles--in hopes of eradicating cervical cancer in developing countries. The group--whose 100 volunteers include doctors, nurses and counselors--has already worked in the Philippines, South Africa and Mexico. The week after the Mongolia project, they would head to Malawi.