"Nurses would sit in narrow carts used for transporting coal in underground mines to reach the remote areas," said Su Chih-chao, director of the Health Center of Sansia Township in Taipei County. Discussing the hard work of health workers from decades ago at the exhibition on Relics of Public Health Service in the health center, Su said that these hardworking women's largely unsung contributions to the development of Taiwan deserved to be documented.
As a lover of antiques, Su collected nothing but old medical equipment and documents in the health center, regarding them as treasures and proof of the development of health care in Taiwan. "In the 1960s, there were no cases of malaria on the island," he said. "This was because of our committed nurses."
The director explained that were it not for this group of dedicated professionals distributing and administering vaccine to people living in hard-to-reach locations, disease transmission rates could never have been controlled given the government's limited resources in those days. "The power of a state is closely connected with its quality of public health. Only when the health care system is ready and people are enjoying a better life can they be more productive and boost the economy," Su said. Health workers thus played an integral role in the local community and their dedication prevented vulnerable children and adults alike from contracting cholera, infantile paralysis, measles, mumps and rubella.
This achievement did not rely solely on the magic hands of these "white angels," but the assorted types of vaccine administered orally and by injection. Su gestured toward a jar of stainless spoons. "One day I found a collection of spoons in the warehouse and wondered why a health center needed almost 200 of these items," he said. After asking retired nurses and searching through documents, he found the answer in a black-and-white file photograph.
"The spoons were used to orally administer Sabin vaccine to prevent polio," Su explained. After studying the picture, he observed a nurse feeding medicine to a child with a spoon and checking its condition.
To measure the proper dose of the vaccine, the nurses used the spoon to differentiate the amounts for adults and children, Su explained. As the pace of technology accelerated, the efficiency of sublingual vaccine improved dramatically and doctors only needed to put two or three drops of the liquid under the tongue to generate the same effect.
After giving out the vaccine, all the utensils needed to be sterilized and reused as resources were scarce and disposable syringes were not yet available. Gesturing at a steel pot that was used for sterilization, Su said that without this simple piece of equipment, stainless steel needles could never have been reused because of the risk of contaminated blood transfusions.
According to Su, the repeated use of medical equipment demanded the highest standards of hygiene and the use of high-quality equipment. For example, Chen Jhong-jhou--a local ophthalmologist--donated a 1935 stethoscope with its chest piece made out of horn, which was extremely rare in those days. Protected in a felt-lined wooden box, the stethoscope was passed down from his father and today remained in good condition.
In addition to the stethoscope, Chen had also donated some hand-written medical textbooks from his father's school days. The paper had turned brown and was too fragile to be exposed to the natural light. Su kept them in the moisture-proof box.
Even though preserving the fragile relics took an enormous amount of time and effort, Su enjoyed putting the collection together and showing them to visitors. Sometimes, in order to match stamps and containers of herbal medicines, he would travel to other health centers to try and obtain wooden cupboards that dated back to the correct era. For instance, he exchanged an iron shelf with the health center in Taishan Township, Taipei County for a medicine cabinet so he could display the official stamps imprinted on the health certificates.
A wooden stamp that verified a family "qualified" was proof of a household's good hygiene. "In the 1960s and 1970s, many people could not afford to buy basic hygiene commodities, so the nurses needed to visit the families and make sure they had at least one towel, one toothbrush and one steel cup." Only when the requirement was met could the family receive a passing stamp and certificate. The process could never be used today to check how many toothbrushes a family possessed, but remained as a lasting reminder of the progress of sanitary conditions in Taiwan, Su claimed.
Items that people felt were too old to keep were of great value in Su's eyes. He kept such items that dated back even earlier than official records. "For instance," he said, "this license from Dr. Chen shows the ratification of the private clinics' opening and takes pride of place among my exhibits. Even the National Archives Administration used to borrow it for exhibition purposes." The document framed in glass and hung on the wall is a duplicate, while the original issued in 1946 was still stored with the doctor's other belongings. "The stamps in the corner are receipts of the application fee."
Before the Environmental Protection Administration under the Executive Yuan was established, medical relics and documents were the responsibility of local health centers. By working in the center, Su was able to observe a wide array of traditional equipment that was used in his parents' generation, like double needles.
Su explained that the needles had to be sharpened with sandpaper, but grains of sand often got stuck inside and required another thinner instrument to push them out. Storing the needles in a small transparent box, the director used them as teaching materials when elementary school students visited his center on field trips.
"We do not merely keep health antiques for posterity's sake, "Su said. "The educational purpose is more important. That is the main target of local health centers now." In addition to providing treatment and health checks, Taiwan's health centers focused on teaching people how to prevent the illness by changing their living habits. For instance, an increasing number of people suffer from the illnesses of civilization, such as cardiovascular disease, diabetes, cancer and obesity. Su believed that through regular exercise and a balanced diet, it was not difficult to manage these disorders.
In particular, there was high percentage of hepatitis B and C in Sansia and the center advocated giving blood tests and assisting in the admission of serious cases to receive further medical treatment in hospital.
Providing this service based on individual needs in the community was the goal of local health centers nationwide. To maximize the utility of his center, Su renovated a health clinic 10 kilometers from the middle of town to provide dental care for students in Chajiao Elementary School due to their difficulty in reaching the main center.
"The facility only needed a table, one computer and an air conditioner and it was ready to begin seeing patients." Cooperating with a local dentist, the clinic opens once a week and offers dental treatment free of charge. A tourism resort in the neighborhood also contributed to the effort by providing a free shuttle bus and filtered drinking water. The results were exhilarating too, with cases of tooth decay dropping by 50 percent in a year. The county health bureau was so impressed; it planned to extend the project for another three years.
To make medical services more accessible to the public has long been the primary goal of Su. His 93-year-old grandfather's sister had visited numerous homes during her 60-year career as a nurse, helping deliver more than 10,000 children. Compared with the distances she had covered in the course of a day, Su's actions paled in comparison. But for recipients today, it saves them the cost of a meal, lost time and energy in the journey of life.
Write to Sandra Shih at sandrashih@mail.gio.gov.tw