Odonchimeg Batsukh, GPJ Mongolia
Enkhtsetseg Tumur plays with her son, Nyamdelger Bat-Ochir, in Erdenebulgan, Arkhangai province, Mongolia. Two months after her son’s birth, Enkhtsetseg underwent breast surgery to remove an abscess caused by mastitis.
ERDENEBULGAN, ARKHANGAI PROVINCE, MONGOLIA — Two months after giving birth to her first child, Enkhtsetseg Tumur began experiencing an intense, burning pain in her left breast. The next day, her breast turned red and swollen and soon she developed a high fever.
Frightened, Enkhtsetseg called her mother-in-law, who attributed the pain to an “unfulfilled expectation” and suggested a cure: “Ask your husband to play a prank on you and then give you something delicious,” she said.
Her husband, Bat-Ochir Altangerelbold, who is a traditional Mongolian medicine doctor, urged her instead to go to the hospital, but Enkhtsetseg wanted to follow her mother-in-law’s advice. Bat-Ochir complied by giving her an empty chocolate bar wrapper followed by her favorite sweets: chocolate and cookies.
But the pain didn’t subside. Enkhtsetseg took analgesics for two weeks to manage it while hoping that the prank method would take effect. When the discomfort started interfering with her ability to sleep and breastfeed, she finally decided to see a doctor, who diagnosed her with mastitis, a type of breast inflammation in which the milk ducts clog, pressure builds up, and the surrounding tissue becomes inflamed. Usual symptoms include a lump, swelling and redness on the breast, pain and fever.
If left untreated, an abscess can develop in the breast, which needs to be surgically removed. This was Enkhtsetseg’s case. Two cups of pus were removed from her breast, she says. She was able to breastfeed her baby after surgery, but has a 4-centimeter surgical scar on her breast and a lump roughly the size of a walnut. She also must do a breast exam every six months for the next five years.
A prank is only one of the many home remedies some Mongolians believe can cure mastitis. Going through a little emotional rollercoaster, the belief goes, will cause a woman’s milk ducts to expand back. But resorting to such remedies alone can prevent women from getting adequate care — and waiting too long, like Enkhtsetseg did, can lead to serious complications.
“I wasted quite a bit of time trying to heal my breast using a home remedy, which made my pain worse,” Enkhtsetseg says.
Mastitis affects around 13% of nursing mothers and is more common in first-time mothers, according to a 2014 research review by the World Health Organization. About 10% of cases can lead to abscesses, which then need to be surgically removed. Causes include nipple cracking from incorrect breast latching, extended periods without nursing, poor hygiene and weakened immune systems. Nine out of 10 mastitis cases occur in nursing mothers. Smoking, diabetes and obesity are the main risk factors for mastitis in women who are not nursing.
For Munguntsetseg Khuyag-Ochir, a pediatrician and lactation consultant, mastitis “has nothing to do with emotions” but is one of many breast disorders that can occur due to breastfeeding problems in both mother and baby after birth. “If the mother and the child are suffering from feeding problems, it is possible to prevent mastitis by contacting a specialist early and taking measures to identify the problem,” she says.
Cultural traditions
Traditional medicine is deeply rooted in Mongolia’s cultural and historical heritage and continues to be widely practiced today, including within the public health care system. A study conducted in 2007 revealed that 23.6% of the Mongolian population had received traditional health care, which encompasses various branches such as different massage therapies and the use of animal-based materials and herbs.
Home remedies are not typically employed in the public health care system, but many Mongolians still practice it, particularly as a first-aid method. These remedies are locally known as “Dom therapy” and encompass many folklore and ancient customs.
Dom therapy methods for mastitis also include drawing a fish on the breast, dabbing the swollen area clockwise with socks belonging to twin babies, and combing the breast forward with a hair comb or bear paw.
Like many inflammations, some mastitis cases can resolve on their own without the need for medical intervention. Whenever that happens, patients and their families often attribute their healing to the use of Dom therapy.
A week after giving birth to her third child, Binderiya Norovbadam expected a gift from her sister-in-law, Chuluuntsetseg Purevsuren. After Chuluuntsetseg visited without a gift, Binderiya says her breast and armpit swelled and felt hot that evening.
When she told her sister-in-law about it, Chuluuntsetseg gave her newspaper-wrapped horse manure and told her to stop expecting things from others. Afterward, Chuluuntsetseg gave Binderiya some chocolate cake and a bag of candy. She also combed her swollen breast forward, in the direction of the nipple.
The next morning, her breast pain went away “as if a thorn was removed,” Binderiya says. “I felt happy [for Binderiya], and the comb method seemed magical,” Chuluuntsetseg says.
Dr. Munkhtuya Bavuusuren, a general practitioner at the Breast Care Center in Ulaanbaatar, defends the use of Dom remedies in the initial inflammation stages. “We do not reject [the effectiveness of these] remedies, even [if] there are no comprehensive, scientific reasons,” she says. “The psychology of women and their breasts are strongly related.”
But if inflammation progresses, she recommends medical attention. She also advises against breast massage, another method favored by some Mongolian mothers to cure inflammation. Massaging can cause pus to spread to other areas of the breast, Munkhtuya says.
She highlights that mastitis is not an individual issue but also connected to social factors, such as lack of adequate public places for women to breastfeed or pump milk as needed. “Family members should understand the newborn mothers’ emotions more than before, and support them,” she says.
Odonchimeg Batsukh is a Global Press Journal reporter based in Mongolia.
TRANSLATION NOTE
Enkhgerel Erdenechimeg, GPJ, translated this article from Mongolian.
