Healthcare Facility:

• Mongolia-Japan Hospital of MNUMS (Mongolian National University of Medical Sciences)
• Located in Ulaanbaatar, the capital city.
• Tertiary hospital.

The health care system in Mongolia is stratified into primary care (local doctors and health services), secondary care (regional or provincial hospitals, one for each of Mongolia’s 23 provinces), and tertiary care (major hospitals, all in Ulaanbaatar). There exists a parallel private health care system. The major tertiary hospitals in Ulaanbaatar are all independent of one another and collaboration between hospitals is limited. Each major hospital has its own surgical specialties, e.g. State 1st Hospital is the transplantation and neurosurgical centre, State 2nd Hospital is the major laparoscopic centre, State 3rd Hospital is the cardiothoracic and vascular centre, National Cancer Hospital is the major surgical oncology centre etc. MJH aims to incorporate all of these fields into one university / teaching centre.

The Challenge: A Rising Burden of Vascular Disease

The assessment highlighted the prevalence of vascular conditions in the Solomon Islands, with three of the top four causes of death— ischemic heart disease, stroke, and diabetes—linked to vascular disease. While NRH provides essential surgical services, dedicated vascular imaging and treatment options remain limited.

Embarking on the Collaborative Road to Fiji (2019)

The foundation of vascular surgical collaboration in Fiji began with Dr Iman Bayat’s (Vascular and Endovascular Surgeon, Melbourne) visit to Colonial War Memorial Hospital (CWMH) in Suva from 23/09/2019 to 4/10/2019. During his time at CWMH, Dr Bayat worked alongside the general surgical team, providing hands-on training through live surgeries, including vascular access creation and venous stripping procedures, while also conducting dedicated vascular clinic sessions.

Recognising the gaps in vascular services and the rising burden of diabetic foot complications in Fiji, Dr Bayat drafted a formal proposal outlining the need for a structured vascular program. This proposal was submitted to the Fiji Ministry of Health, advocating for vascular surgical training pathways, improved multidisciplinary management of diabetic foot disease, and expanded vascular imaging services.

By the end of the trip, a WhatsApp group was established between vascular surgeons at Northern Hospital and their counterparts at CWMH, facilitating ongoing case discussions, knowledge exchange, and continued support for local surgeons. This first step paved the way for future training initiatives, including the development of Fiji’s first dedicated vascular service.

Returning home as trained vascular surgeons, Dr Sela Koyamaibole and Dr Ronal Kumar are set to transform vascular care in Fiji—saving lives and limbs with their expertise.

“We would like to setup Vascular units in Lautoka and CWM Hospital over the next year and rapidly bring about endovascular Surgery over the next few years. I envisage the next couple of trainees that are trained abroad will change the way we manage vascular patients and especially diabetic foot care not just for Fiji but the Pacific region. We hope to centralise Vascular Surgery in Fiji and train more people, not just Surgeons but Nurses, Radiology and Support staff to ensure continuity of care. The future is bright for us, we had to start somewhere and are thankful to GVC for showing us the path.” – Dr Ronal Kumar

“Our vision is to provide exceptional vascular surgery and care, saving and enhancing the lives of our patients by offering the most effective techniques available.”, – Dr Sela Koyamaibole

“Understanding all the challenges that come with establishing a new specialty, the primary objective is to implement all the knowledge gained over the past 2.5 years at the Northern Hospital into the Fiji Health System. A significant challenge is the need for a shift in mindset, especially considering the limited resources that Fiji, as a developing nation, has. It will require a gradual approach, taking one case at a time, and a lot of hard work and collaboration. However, with the support of GVC, the TNH Vascular Unit, and the networks established over the years, the future for vascular services in Fiji appears promising.”

Looking ahead, the focus is on establishing a dedicated vascular and endovascular service at CWMH in collaboration with Dr Koyamaibole and our healthcare partners in Fiji. This will be a progressive and sustainable approach to improving vascular surgical capacity in the region.

The Need for Vascular Surgery in Ethiopia

JUMC possesses robust surgical infrastructure – including a hybrid theatre shell under construction with a fixed C-arm for fluoroscopy – but lacks trained vascular and endovascular surgeons. Currently, only basic varicose vein procedures and renal access surgery are performed, and there is no formal endovascular training pathway for vascular specialists in the country.

• Increasing Vascular Disease Burden  –
  Diabetes, peripheral arterial disease, and venous insufficiency are common, but specialist care remains extremely limited.
• Lack of Comprehensive Vascular Surgical Training  –
  No established endovascular surgery training programs exist for general surgeons.
• Existing Infrastructure Without Specialists  –
  Despite adequate operating facilities and imaging technology, there is a critical shortage of trained personnel to perform advanced vascular and endovascular procedures.

First Steps Toward a Vascular Service in Barbados

Since Nina’s return, Barbados has seen significant progress in vascular care, supported by international collaboration and ongoing mentorship.

Future Vision: Strengthening Barbados’ Vascular Surgical Services

With a long-term goal of establishing a structured vascular program, the focus now shifts towards sustainability and training.