Taitung: a desert of medical care

By Maia Huang, CNA staff reporter Taiwan is home to a wide range of medical services and world-class healthcare, promising long and healthy lives for its 23 million people. But despite the plentiful resources, not everyone has equal access. Unbeknownst to many, there is a gap in medical resource distribution that leaves many at home without proper care, even as Taiwan has begun promoting medical tourism among foreign visitors. In Taipei, there is one doctor for every 62 people. But on the other side of the country, the 4,000 or so residents of the remote and mountainous township of Daren, Taitung County, have had to rely largely on just one physician. Hsu Chao-pin, a doctor and member of the area's indigenous Paiwan tribe, puts in 400 hours of work a month at the Daren Township Public Health Center. Hsu brings the doctor to the patients because most of them are elderly or impoverished, and being able to visit a doctor is a luxury in the 300-square kilometer township. He has to cover the mountainous terrain to get to them, and the distance he travels in a week is enough to drive the circumference of Taiwan. All of the hard work ended up causing the 46 year old to suffer a stroke nearly eight years ago. Despite his efforts, some patients who find themselves in need of medical attention have nearly given up hope. "If you can't treat me, I would rather die," said an elderly man surnamed Chu, whose lung tumor remains untreated because he cannot afford to spend the time or money it would take to get to a proper hospital. The Daren public health center is open Monday to Saturday, but patients with emergencies or more serious conditions need to make the 60-kilometer trip to Taitung City. There is no public transport over the mountains from Daren to Taitung. Left with no other choice, residents in urgent need can only hire taxis at up to NT$3,000 (US$100) there and back -- about a month's living expenses for some residents. Many choose not to make the trip. "The hospitals are just too far and too expensive for them," Hsu said. For those used to the convenience of urban life in the cities along Taiwan's western coast, that distance is unimaginable. Countrywide, it takes about 11 minutes on average for an ambulance to arrive. But a lack of resources is the norm in Taitung County, home to one-third of Taiwan's aboriginal population, much of which today is still struggling with poverty and unemployment. The county's annual income per household was NT$673,000 in 2011, far below the national average of almost NT$1.16 million. As of 2012, Taipei City, the capital, squeezed 24 metropolitan-level hospital into 272 square km of land. At 13 times that size, Taitung County had only one metropolitan hospital and five smaller community-level hospitals, all of which were concentrated in Taitung City. If medical care is scarce in Taitung, its four southern townships of Taimali, Jinfeng, Dawu and Daren are a veritable desert of medical services. Sandwiched between mountains on one side and sea on the other, the 18,000 residents in this vast area can only pray not to fall ill during the nighttime or on weekends and holidays, when the small local health facilities are closed. Thanks largely to the lack of facilities and medical staff, Taitung County has earned the dubious title of Taiwan's cancer capital. In 2012, 630 of Taitung's 226,000 people died of cancer. Its incidental mortality rate meanwhile was more than twice that of Taipei. A university student in Taitung died during an outbreak of H1N1 six years ago because the hospital treating him lacked the necessary Extracorporeal Membrane Oxygenation (ECMO) equipment needed to save his life. Even when an ECMO machine was borrowed from a Taipei hospital to prevent similar tragedies, an expectant mother died of the same virus because no doctors knew how to properly operate it. The Ministry of Health and Welfare has since stepped in to subsidize an NT$3 million OECM equipment in the county's Mackay Memorial Hospital. But other problems remain. No doctors have been willing to move to the vast rural area, and any time a cardiologist is needed there he or she has to be flown in from Taipei. Despite offering an enticing monthly salary of NT$350,000, it took years before Mackay Memorial managed to find a retired cardiologist willing to to make the move out. The entire county has only three doctors specializing in emergency care and no resident surgeons for intensive or burn care units. There is limited support, as businessmen see no profit in building a hospital for the generally poor populace, Hsu said. "Here is the coldest corner in the world." Hsu, who stepped down as the head of the health center of Daren earlier in January for failing to reduce the high cancer rate in the area, plans on building a "South-Bend Hospital" to meet medical demands in the remote region. The ambitious plan aims to raise NT$150 million over the next three years to finance construction of the 20-bed hospital for emergency medical services. While the government is willing to help out with the project, Chang Yu-chun, a section chief from the Public Health Bureau of Taitung County, said that Hsu has not submitted a detailed plan. At the moment, the bureau has its own plans for a combined hospital and health center, Chang told CNA while visiting a piece of land next to Dawu Township Health Office slated for a 24-hour emergency unit. The central government has earmarked a budget of more than NT$130 million to construct the emergency center to treat patients in critical condition or with chronic illnesses that require long term care. "What we need most is not a hospital but a more sophisticated support network," Wang Je-chau, the director of the public relation of the Ministry of Health and Welfare said. Wang admitted that with its population distributed among mountainous areas, Taitung is at a natural disadvantage when it comes to medical resources. Apart from the Dawu project, the ministry has launched a series of programs to train medical professionals, organize medical missions and set up temporary emergency stations during holidays to help overcome the difficulties faced there. "Building a hospital is not as easy as you might think," said Lee Wei-chiang, head of the ministry's Department of Medical Affairs, about the push for medical care. "Finding medical workers stationed there will be the first key challenge," he said, noting that even Mackay Memorial, the biggest hospital in the county, relies on staff on loan from at least three medical institutions in Taipei to fill its shortage. "We will first work on expanding the services at local health centers and focus on educational programs to offer scholarships for young medical professionals in Taitung in the hopes that one day they can come back to their hometown to serve its people," he said. Wang expressed a similar commitment to decoupling the idea of better medical care from plans to build hospitals. "The last thing the government wants is to construct an empty building with no doctors inside."