June 28, 2018 6:26 AM EDT

It’s 11 below (-24C) outside but the stove is burning and baby Almasbek Toltalkhan is warm in his family’s yurt. His mother, Nursaule, scoops him from a crib engraved with pictures of coconut palms and joggles him on her knee while the doctor readies his shot.

At 11 months old, Almasbek is just past the nebulous state of babyhood. He cannot say ‘mom’ or ‘dad’ but knows bainuu, the greeting with which Mongolians answer the phone, and he wears tartan felt pajamas. He also has a pug-like wheeze on every out-breath and has been hospitalized eight times since birth.

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