Windows with frames painted light green, pink, yellow and red flood the interior of the new National Taiwan University Children's Hospital (NTUCH) with light and color. Inside, children gaze wide-eyed at art installations and large Lego toys and take turns playing with stuffed animals.
"It's incredible," says Lu Hong-ji, a doctor who is often referred to by his colleagues as the "father of Taiwan's pediatrics." Lu is also a professor, the former chairman of the Department of Pediatrics at National Taiwan University Hospital (NTUH) and currently the superintendent of Saint Mary's Hospital Luodong in Yilan County, northeastern Taiwan. More to the point, it was Lu who submitted the proposal in 1984 calling for the building of a hospital especially for children. Lu had to wait 24 years before his proposal became a reality when NTUCH opened in December 2008. "It's really amazing that my dream has finally come true," Lu says. "It's hard to believe that after starting from zero, this hospital is now in operation. We can now take care of our sick children in a very, very caring way."
A palpable sense of excitement and hope emanates from those involved in the planning of the hospital, which rises above the dense landscape of downtown Taipei. What is missing, at least visibly, is any of the doubt, worry and sometimes heated debate that characterized the project as it developed. In 1991, seven years after Lu submitted his first proposal, the Department of Health under the Executive Yuan organized a preparatory committee to look into establishing a national children's hospital. The members of the committee found the going difficult as they confronted questions about the location, budget, status, exterior and interior designs and name of the proposed facility.
The project faced an even more uncertain future when the government capped its budget. "When you first begin planning something like this, it's impossible to tell exactly what the final cost will be," says Huang Shier-chieg, a doctor, professor, former head of the NTUCH preparatory committee and currently the superintendent of NTUH's Yunlin branch. "And the cost of this project just continued to climb. Although the government agreed to supply two-thirds of the budget for the hospital's construction and operations, we had to conduct a lot of fundraising activities to come up with the other third. In Taiwan, it's easy to get support from devotees to build hospitals connected to religious organizations, but it's hard to drum up support for public hospitals."
Slow Launch
Disagreements among planners also served to slow the launch of the project. "The designs for the interior of the hospital were changed time and time again due to differences of opinion among the executives involved," Huang says. Although there are bound to be disagreements among the principals involved in any large project, one of the factors behind the concern about the design of the hospital was the feeling among those involved that, due to the difficulty of raising funds and other support, they felt as if they had "only one chance to get things right," he adds.
Two architectural firms worked together to create the final design for NTUCH, with US architecture firm NBBJ responsible for the building's overall exterior design, while a team from Taiwan's C. C. Hsu & Associates of Architects and Engineers was responsible for fine-tuning the interior. Design input also came from doctors, nurses and other healthcare workers, as well as Taiwan's Raising Children Medical Foundation and Rich Art and Culture Co., which assisted with interior design and supplied artwork. Huang Chi-chung, an architect with C. C. Hsu, says that "NBBJ's concept was centered on the theme of a 'sky castle' for children, a place where they could experience the peaceful feeling of being in a forest or enjoy seeing circus animals. The idea was to help them forget their suffering."
"With a floor space of 22,346 Taiwanese pings [73,870 square meters], 460 beds and 26 stories [four located below ground level], the building's design was based on sensory analysis, color theory and spatial and form analysis," Huang Chi-chung says. "Each floor was given a specific color so that patients and their families wouldn't get lost in such a big building. We wanted families who were really stressed and under pressure to feel positive and at home, which is why we emphasized the views and the light. The most important thing we wanted to accomplish was to give them something that would catch their attention right away, to make them feel like, 'Hey, this is a cool place we're in.' That's the wow factor. When you walk in and you go 'wow!'--it truly distracts you from what you're there for."
Although it opened less than half a year ago, NTUCH has already become Taiwan's busiest maternity hospital. (Photo by Chang Su-ching)
Once the final design was hammered out, rising construction costs posed the next threat to the project's success. "Just before construction was to start in 2003, a shortage of building materials occurred and prices began to soar," NTUH's Huang Shier-chieg says. "In such an environment, no construction company wanted to tender a bid. The situation didn't really begin to improve until 2004, when the government increased the budget."
"After all was said and done, the cost of constructing the facility came to about NT$4 billion (US$127 million)," says Chen Ming--fong, the overall superintendent of the NTU hospital system. "That's a lot of money, but it was designed to be at the forefront of pediatric care, to provide a state-of-the-art, family-focused environment for pediatric services."
Taking Comfort
The result of all the time, money and effort is a hospital where children and their families can feel relaxed and secure. Patient rooms are big enough to accommodate mothers and newborn babies if the mother so desires. Colorful sofas fill waiting rooms so that children can lie or sit comfortably on them. Small play areas can be found on the first, second and third floors, and a storytelling house welcomes young patients with Western and Taiwanese fables. There is also a special room designed to promote emotional healing that provides essential oils for aromatherapy and soothing music.
"We feel uplifted when we stay here," says Lu Yi-jun, the mother of a boy receiving treatment for thalassemia, a form of anemia, at the hospital. "There are more comfortable seats available than in children's departments at other hospitals. My child also has more options to do what he wants to do, things like chatting or playing cards with other children, or just doing his homework by himself."
"It's prettier than other places," Lu's son says. "It doesn't look like a hospital. And I can talk to other kids who have my condition when we get blood transfusions."
"The children's hospital takes its role in advancing healthcare technology seriously," says superintendent Chen Ming-fong. "We are teaching the next generation of healthcare workers and providing clinical care and advocacy for all children in Taiwan."
"Working here has made us really think about what this hospital should represent," says Su Li-mei, a physician at NTUCH. "I think it's a symbol of who we want to be as a community, of our care for children. It represents an attitude toward life that spares no expense or effort to help children and their families meet the challenges of serious illness."
Play areas can be found on the hospital's first, second and third floors. (Photo by Chang Su-ching)
One of the principal concepts behind the hospital is the recognition among medical professionals that children tend to receive better care when it is focused only on them. According to NTUCH nurse Chen Mei-hua, a growing number of children are being referred to the hospital as more local clinics and other hospitals come to recognize that the new facility can provide a superior standard of care for young patients. "When I made the difficult decision about where to seek care for my child, my family doctor recommended this place and the people here," says Sun Jian-fa, a father watching his son play in the story house while waiting for a doctor's consultation. "I have found much-needed help and support here, and my hope is that every child who needs the expertise and the facilities of this hospital will be warmly received for many years to come."
Taiwan's low birth ratio of just 8.92 babies born for every 1,000 members of the population in 2007, one of the lowest rates in the world, would seem to be a cause of concern for the future of children's hospitals such as NTUCH. However, many factors have contributed to the increasing emphasis being placed on children's healthcare services around the world, including the rising standard of care sought by parents, the increasing emphasis on children's rights, changes in childhood disease patterns and the development of new preventive medicines. As Republic of China Vice President Vincent Siew said at the ribbon-cutting ceremony for NTUCH on December 27, 2008, "Despite the falling birth rate, the government has not scaled back its support for children's welfare. Instead, it has expanded its medical and healthcare services for them."
Lu Hong-ji, the submitter of the original proposal for NTUCH, says that "pediatric medicine and surgery are ever-new and ever-changing fields. In general, it's much more complicated to care for young patients, especially in the case of premature birth. Childhood cancers and transplant surgeries are also becoming more common."
According to a study on NTUCH's corporate strategies by Kuo Meng-fai, who wrote her thesis on the topic while attending graduate school at NTU, future demands for the hospital's services are expected to continue. Kuo's analysis appears to be confirmed by the fact that seriously ill children are not the only ones seen at NTUCH these days, as it has also become the island's busiest maternity hospital. Although it opened less than half a year ago, NTUCH's growing reputation has already put it at the head of the pack for expectant mothers. This marks a significant achievement, as competition among hospitals to attract expectant mothers has risen as the birth rate has fallen.
With the hospital operating and establishing a strong position in the healthcare industry, those involved in its genesis are pondering the next step. "Establishing NTUCH is a good start for improving children's healthcare," says Lu Hong-ji. "However, in comparison with adults, children are a disadvantaged minority. If children and adults' health resources are mixed, adults will end up taking most of them. In the future, the children's hospital should be made independent of the NTUH system and have its own management, research center and government funding."
Realizing Lu's dream of creating an independent children's hospital may happen some day, but it will not be easy. A great amount of time, work, funding and sheer willpower was involved in the 24-year gestation period that led to the creation of NTUCH in its present configuration. "NTUCH is like a newborn baby," says hospital physician Su Li-mei. "We have to keep its head above water and build its reputation by providing excellent and safe care. We need to make sure everything is working well before taking the next step. A full-service and independent children's hospital can come when it has grown up a bit more."
Write to Tso Lon-di at londi@mail.gio.gov.tw