Taiwan Today

Taiwanese health care professionals are regaining passion for the job by participating in international medical assistance initiatives.

Ruby Tsai (蔡季君), director of the Tropical Medicine Center at Kaohsiung Med-ical University Hospital (KMUH) in southern Taiwan, is a strong believer in combining medical professionalism with altruism, compassion and enthusiasm. Tsai, who has been practicing medicine for 23 years, puts that belief into action by participating in international health care missions. Since 2009, she has made seven visits to the Solomon Islands in the South Pacific to provide medical services, take part in research on dengue fever and work on a parasite screening and prevention project for local students.

“Providing medical services in places with poor basic infrastructure—inadequate supplies of electricity, water, drugs and diagnostic equipment—is a challenge,” she says. “Nevertheless, we are constantly heartened by the warm welcome local villagers give us and the deep gratitude they show after receiving our services.”

Taiwan has been sending medical teams overseas since 1962, when medics were dispatched to Libya to improve facilities at a military hospital. Since then, Taiwan has provided medical aid through mobile teams and multi-year missions to diplomatic allies, partner nations and developing countries, with some of the most recent long-term efforts taking place in Africa and the South Pacific.

The Solomon Islands is a South Pacific nation comprising six major islands and approximately 900 smaller ones, many of which have few or no roads and are reached primarily by canoe. The country’s major economic activities are farming and fishing. About 585,000 people live in the Solomons, but they are served by only about 100 doctors, half of whom work at National Referral Hospital (NRH) in Honiara on Guadalcanal Island, the country’s capital.

Solomon Islanders, Tsai says, generally find Taiwan’s medical care to be quite advanced and thus tend to trust and respect doctors from Taiwan. “When I’m working there, I always feel cheerful and enthusiastic despite spending long hours in a difficult environment,” Tsai says. “I guess it’s the cordial doctor-patient relationship and the gratification that comes from helping those in need that motivate my work there.”

Taiwan has offered various forms of aid to the Solomon Islands since the two countries established diplomatic ties in 1983. In the area of medical assistance to the islands, one of Taiwan’s biggest contributions began in 1989, when construction of NRH got underway with funding provided by the Republic of China (ROC) government. The hospital, which commenced operations in late 1993, has become the most important health care facility in the Solomons. NRH currently has around 45 doctors, 260 nurses and more than 300 beds.

KMUH was commissioned by the ROC embassy in the Solomon Islands to plan an NRH renovation project in 2006 and an expansion project in 2007. So far, new facilities built during those projects include a conference room,  a library and offices, with an administrative building and outpatient clinics to follow.

Since 2006, KMUH has also participated in mobile medical missions to the Solomon Islands organized by the International Cooperation and Development Fund (ICDF). The fund is sponsored by the ROC government and is dedicated to offering a wide range of assistance to developing partner countries. The ICDF’s services include launching public health initiatives, providing medical treatment via mobile and permanent teams, training health care specialists and participating in cooperative health projects.

The ROC government has also played a more direct role in providing medical aid to its Pacific ally. The ROC Department of Health (DOH), for example, signed a health cooperation agreement with the Ministry of Health and Medical Services of the Solomon Islands in December 2004 and a memorandum of understanding in April 2008 for the establishment of the Taiwan Health Center at NRH. KMUH, meanwhile, received support from the DOH and ROC Ministry of Foreign Affairs (MOFA) in forming a sister-hospital relationship with NRH in 2006. As a result, the Kaohsiung hospital has been entrusted by the DOH to run the Taiwan Health Center at NRH since 2009.

Martin Hsiao (蕭世槐), a senior public health specialist at KMUH, says projects at the Taiwan Health Center are tailored to local needs. Since the very beginning of KMUH’s collaboration with NRH, Hsiao has been involved in planning and coordinating projects including equipment installation, health education, hospital management, research on neglected tropical diseases and non-communicable diseases, and personnel training.

The projects have yielded positive results over the years, Hsiao says. The success of the Taiwan Health Center’s parasite screening and prevention plan captured the attention of the media in the Solomon Islands, he notes, while research on dengue fever led the World Health Organization (WHO) office in Honiara to express interest in a collaborative effort to control the disease.

Unique Vantage Point

The 24 visits Hsiao has made to the Solomon Islands since 2006 give him a unique vantage point on the nation’s problems. “What does this country need? Frankly speaking, it’s in need of everything. I always think about how we can help,” he says. “Personally, I’m keen to help promote public health [in the Solomons] by relying on successful experiences in Taiwan. Being able to contribute what I’ve learned to improve the well-being of the poor makes me feel great.”

As it happens, Hsiao says working on medical aid projects has been conducive to his career, as he has received invitations to attend international conferences and worked with experts from major organizations such as the United Nations Children’s Fund, WHO and World Bank. “Working together with specialists from around the world toward a common objective—health care across borders—rekindles my passion for public health and consolidates my knowledge and skills in the field,” he says. “Plus, these exchanges have broadened my worldview and taught me how to integrate resources to deliver more effective aid.”

Eddy Lin (林裕超) is a registered nurse from KMUH and has led the Taiwan Health Center in Honiara since early 2011. He was first drawn to working in the Solomon Islands by a photo that showed the innocent smiles of local children at a recruitment briefing held at KMUH, and decided to sign up for the hospital’s overseas service program.

“When I first heard the name Solomon Islands, I had no idea where the country was located, and I think many Taiwanese are the same,” Lin says. “The living conditions in the archipelago are completely different from those in Taiwan. Most households still have no access to electricity, potable water or modern toilets. People’s homes can be primitive, with wood walls and roofs thatched with sago palm leaves.” Access to health care is extremely limited on many of the outlying islands, Lin says, adding that as churches often serve as community centers in such locations, the Honiara health center frequently contacts them to assess local needs before dispatching medical personnel.

Alarming Problem

The lack of clean water and sanitary facilities, generally poor hygiene, inadequate nutrition and humid, tropical climate in the Solomons combine to increase the prevalence of diarrhea, fungal and parasitic infections, malaria and skin problems. The parasitic infection rate among local students, Lin notes, is alarming, reaching as high as 80 percent. To address that problem, the Taiwan Health Center has conducted several rounds of mass drug administration for schoolchildren and held lectures in schools and communities to introduce good hygiene habits.

Diabetes has become another serious health threat in the Solomon Islands, with the number of diabetic patients in the country surging from less than 1,000 in 2000 to nearly 4,500 in 2011, Lin says. To tackle that growing problem, the Taiwan Health Center launched a diabetes prevention program in 2009 that includes training local medical staff to identify and treat symptoms, as well as mounting publicity campaigns to inform the population about diabetes prevention and control through diet, exercise and lifestyle management.

Lin says the center’s other main objective is reducing maternal and infant mortality in line with a proposal made by ROC President Ma Ying-jeou (馬英九) on his state visit to the Solomon Islands in 2010. Giving birth is especially risky in the country’s rural areas, where most women deliver children without the assistance of health professionals or proper medical facilities. To reduce the risks associated with childbirth, the Taiwan Health Center has arranged a series of workshops for nurses and birth attendants on obstetric and newborn emergencies as well as maternal and neonatal care.

Like Tsai, Lin says he enjoys helping people in need and learning about a new culture despite the challenges posed by the working environment. “We have to tackle numerous problems in regard to language, [medical] facilities and transportation, as well as cope with the hot, rainy weather,” he says. “Still, the feeling of being needed and knowing that I can do something for them make me enthusiastic about my work.”

Taipei Medical University (TMU) is another health institution that participates in ROC government initiatives to offer international medical services. In 2009, TMU accepted the ICDF’s invitation to provide medical services to Swaziland and São Tomé and Príncipe, two of the ROC’s diplomatic allies in Africa. Swaziland is a landlocked country in southern Africa, while the island nation of São Tomé and Príncipe lies near the equator off the continent’s west coast.

Jenny Su (蘇維文), director of TMU’s International Healthcare Center, says the university now has around 6,300 students and three hospitals in the Taipei area—TMU Hospital, Wan Fang Hospital and Shuang Ho Hospital. That institutional growth has been accompanied by an increasing sense of social responsibility. “We encourage our students and medical personnel to share their knowledge and experience with less-developed countries and become responsible global citizens,” Su says.

Su explains that besides patient treatment, TMU’s overseas programs emphasize education and training for health care workers in those countries. “The workforce that we can post to countries [that require aid] is finite, so we stress training local medical practitioners. By offering seminars and workshops, we give local care providers better tools to help their own people,” she says. “We think that approach will have a positive, long-term effect on their health care practices.” TMU has also arranged for talented medical workers from Swaziland and São Tomé and Príncipe to visit Taiwan for further training.

For very serious or specialized medical cases, TMU doctors working in Africa hold video conferences with hospital staff in Taiwan. In 2010, one of those video conferences led to two seriously burned São Toméan children being sent to Taiwan’s Wan Fang Hospital for treatment.

Huang Yao-hsien (黃祐賢), a neurologist at TMU’s Shuang Ho Hospital, volunteered to serve at Mbabane Government Hospital in Mbabane, the capital of Swaziland, from 2009 to 2011. “I just felt like doing something different as I could see I was falling into a rut in Taiwan,” the 36-year-old attending doctor says. “Plus, I thought I could escape the pressures of seeing so many patients and publishing research that Taiwanese doctors are generally burdened with, and simply focus on taking care of patients.”

The reality of Africa’s tough working environment and scarce health care resources soon became all too apparent to Huang, however. Initially, he felt disturbed by the way that local medical staff did not appear to act aggressively enough to save the lives of some patients. Later on, he came to realize that they did so to conserve limited medical resources that would help save patients with a better chance of surviving.

“Swaziland’s medical development differs greatly from Taiwan’s, so we can’t apply all of our concepts to our practices there,” Huang says. “During my stay there, I learned to be flexible and overcome obstacles to serving patients.” He recalls examining X-rays by holding them up to the light of a window, for example, as there was no dedicated viewing device in his examination room.

On the other hand, Huang liked working in Swaziland because he could spend as much time as he wanted to communicate with patients and earn their trust. In Taiwan, doctors have only a few minutes to examine and talk to a patient, he says.

Huang also felt needed, as the Mbabane Government Hospital lacked several dedicated departments, including neurology. As the only neurologist on staff, he took comfort in seeing his patients regain their health after receiving the proper diagnosis and medication.

John Lin (林建璋), who currently works as a public health and administrative manager at TMU’s Taipei office for the medical programs in São Tomé and Príncipe, served at Água Grande Clinic Center and Central Hospital in São Tomé, the nation’s capital, from 2009 to 2011. The main reason that health care can be difficult to find there is that few locals work in the profession, as the country has only one nursing school and not a single medical school, Lin says. Most of the doctors practicing medicine in São Tomé and Príncipe are natives of Cuba, Portugal and Russia.

The ICDF began working to improve access to health care in São Tomé and Príncipe in 1998, when the fund began assisting in the management of Água Grande Clinic Center. In the following years, the ICDF set up departments at the center for acupuncture, dentistry, pediatrics and obstetrics. In 2009, the ICDF handed management of Água Grande to the São Tomé and Príncipe government, but the ROC government remains actively involved in medical work in the African country. For example, a renewed cooperative agreement from this year to 2015 has been implemented by the Ministry of Health of São Tomé and Príncipe and the ROC.

In addition to helping renovate the emergency department at Central Hospital, the TMU medical team in São Tomé has performed cataract, debridement and skin graft surgeries, as well as provided training sessions on basic life support, John Lin says. Kerosene lamps are a major source of lighting in the country and multitudes of local children suffer burns when they are knocked over, he explains, while many adults develop cataracts due to significant sun exposure, as most are engaged in farming and fishing.

John Lin says there are few specialty medical services available even at the country’s major hospitals. As a result, this year TMU is placing greater emphasis on sending anesthesiologists, dentists, family practitioners, neurologists, ophthalmologists and surgeons from Taiwan to work in São Tomé and Príncipe for three months at a time, instead of two to three weeks as in the past. The new approach is designed to provide better services to local patients and promote the development of specialty clinics.

Despite the hardships, John Lin says helping the underprivileged through compassionate health care gives him a greater sense of achievement. “One time, while I was visiting a local community to offer health services, an old man I’d met before walked straight up to me. He clasped my hands tightly and told me how thankful he was to Taiwanese doctors,” he recalls. “I felt so gratified because he used to suffer from cataracts and needed to be guided around, but his sight was restored through surgery performed by a Taiwanese medical team.”

Write to Kelly Her at kher@mofa.gov.tw