Introduction The political economy of Mongolia has changed gradually since the elimination of the socialist political economic system and the shift to a market economy. This political and economic transition has affected the country’s health care as well. The economic transition has led to deteriorating health indicators. The transformation of the health care system from an essential social service of government to a commodity has affected health status, particularly among the poor. Though national health insurance reforms and the development of a universal primary health care system has improved health care access considerably, particularly in urban areas, the system focuses primarily on essential care for women and children, and not on chronic disease care and management among older Mongolians. Little is known about chronic illness experiences such as stroke in the aging segments of the population. Hypertension rates are very high among urban-dwelling Mongolian adults, due most likely to high sodium intake and obesity. Hypertension has led to an epidemic of cerebrovascular accidents (CVA), or stroke. Mongolia like many other developing countries has been experiencing health transition, which represents the shift in morbidity and mortality from infectious diseases to non-communicable diseases such as diseases of circulatory system, cancer and injury. Stroke or CVA is becoming a leading cause of disability and an economic social burden for the families of victims. The local meanings given the illness have a significant impact on people’s sense of self, and their roles in family and kin groups. Furthermore, the impact of stroke on victims, psychologically and socially, can have an effect on their rehabilitation. Individuals within the first six months after a stroke can make considerable progress in recovering neurological function. Factors that affect the person’s willingness, motivation, and drive to seek rehabilitation services can thus have an impact on their prospects for recovery. It is thus important to chronicle the local meanings of stroke. How do stroke survivors in Mongolia define, construct, and respond to the experience? How do these factors affect health care utilization, social relationships, and, ultimately, rehabilitation? This study proposes to illustrate how this particular social and cultural setting shapes stroke as an illness. We ask how the “illness meanings” (Kleinman 1988) of stroke are related to a decision to seek health care, access to relevant health care services, and the impact of stroke on individuals and families. The article presents findings from an interview study conducted with stroke survivors and their caregivers in current Mongolian political economic context. The interview study adopted a phenomenological approach to focus on the lived experience of illness as a culturally constituted reality (Good & Good, 1994; Kleinman, 1988).