This was the second visit of the charity to one of the most remote countries in the world. The team was Andrew Kingsnorth, John Schumacher Shaw (so-called by our hosts as he was the fastest scalpel in history), Alan Cameron, and Frank MacDermott. We had the unique privilege of having Tsetsegdemberel Bat-Ulzii Davidson (Tsetske) as our translator unique because although Mongolian, she is undergoing surgical training in the UK. As on the previous mission, we had the smooth, efficient and capable organizational skill of Mrs Enkhtuvishin of the Swanson Charitable Foundation.

Andrew Kingsnorth wrote about the first Mongolian visit in last year s report so I am doing this account as a novice to both Operation Hernia and to Mongolia. Before going further I must say that this mission was one of the most enthralling, worthwhile and fun things I have ever done. I was hugely impressed by the dedication of the Mongolian doctors and nurses; here in the UK we seem to have interminable delays in theatres, but in Mongolia the organization was superb (which did also mean we were kept busy in theatres all day!). And the anaesthetists skill with spinals was amazing. The Mongolian people were friendly and charming, and the scenery was stunning.

We arrived at Chinggis Khan airport -everything in Mongolia is named after their marauding hero and were loaded into 4x4s to travel down to Mandalgobi, our base for the first week. First surprise was the absence of any road for nine-tenths of the 260km journey; just tracks through the steppe. Seemingly relying on celestial navigation we arrived long after dark!

Mandalgobi is a one-horse settlement of 11,000 people on the edge of the Gobi. The hospital had been through some bad times after the fall of communism, but seemed to be improving rapidly under the able direction of Dr Dolzodmaa, who was herself a surgeon. We spent a very happy week operating on a mixture of adults and children. The equipment was fine and the theatre environment very satisfactory (although I was amazed to find that one of the couches had been manufactured in my home town of Ipswich). We had the usual somewhat stilted dinner with the deputy provincial governor, but Andrew s explanation of the purpose of the visit was well-received.

At the end of the week the whole team decamped (literally; the nurses came with us and brought the food and drink) for a bit of sightseeing so we were taken hundreds of miles into the Gobi to look at spectacular rock formations. We had two nights in ger camps out in the vast stillness of the desert before getting to the chaos of urban Ulaanbator.

The capital is a sprawling mass of pollution and congestion with some of the worst traffic in the world, but fortunately the 2nd hospital was within walking distance of the hotel. (John Shaw went to the paediatric hospital during this week). So we were on duty early for a post-operative ward round, followed by seeing the new cases, and then operating all day. There were attentive medical students, and lectures after the lists. We had again a mixture of incisional and inguinal cases. The operating lists were tightly-organized, with Andrew in one theatre and me in the other. So we were able to do cases ourselves or assist the Mongolians surgeons as appropriate (Andrew had met and taught many of them in 2010 and they were keen to show off newfound skills). We had a couple of evening social events, but there was actually no time for sightseeing in UB I don t think we missed much because the steppes had been wonderful and were a hard act to follow.

The success of this mission was due to the enthusiasm of our two professors, AK in the UK, and Tsagaan Narmandakh in Mongolia. There was a great feeling of teamwork at all levels and in the two weeks I felt we had achieved a great deal. In simple terms the team did 124 cases (58 children) cases, but more importantly we supervised the local surgeons who can hopefully build on this teaching. Mongolia is the ideal place for this kind of mission because the infrastructure exists to carry on the work after the visiting surgeons have left. Before I signed up Andrew told me this would be the most worthwhile holiday ever; he was wrong about the holiday bit, but it was certainly worthwhile in every other sense.