| Medical Care for an Underserved Area | ||||||||||
| Text and Photos by Jiang Jia-yu Translated by Tang Yau-yang | ||||||||||
The eastern seaboard of Taiwan is a relatively remote area, where it is difficult for some inhabitants to access medical care. Three Tzu Chi hospitals in the region are filling in the gap the best they can.
The East Rift Valley is a narrow strip of land that stretches for about 180 kilometers (110 miles) down the eastern coast of Taiwan—roughly from Hualien City in the north to Taitung City in the south, the largest cities in the valley. In the old days, that long stretch of Taiwan had no sizeable medical facilities. People needing urgent care or suffering more serious conditions had to be driven to either Hualien or Taitung, near the two ends of the valley, for medical attention. Optimal treatments were often delayed or missed entirely because patients spent the most precious moments for treatment in a vehicle rather than in a hospital. Tzu Chi set out to reduce that distance by opening Yuli and Guanshan hospitals around the midriff of the valley. Yuli Tzu Chi Hospital in Yuli Township, Hualien County, opened on March 15, 1999. Guanshan Tzu Chi Hospital in Guanshan Township, Taitung County, began operation exactly one year later, on March 15, 2000. When Tzu Chi opened Hualien Tzu Chi Hospital in Hualien City in 1986—now a major medical center in eastern Taiwan—it experienced a lot of difficulty recruiting and retaining medical professionals because of its relatively remote location. Yuli and Guanshan are even more remote than Hualien, so it is no surprise that those hospitals had difficulties recruiting doctors too. Even today, two decades later, they struggle to recruit and retain doctors. In response, Hualien Tzu Chi Hospital has mobilized its own doctors to support its two sister hospitals. Physicians in various specialties travel to Yuli or Guanshan once or twice a week to help out. The three hospitals work together to serve the medically underserved population in the valley. Hospital staffers need dentists too Physicians sent by Hualien Tzu Chi Hospital to help staff the Yuli hospital include members of the general surgery, orthopedics, neurological surgery, cardiology, dentistry, gastroenterology, urology, and psychiatry departments. Dr. Wang Ji-hung (王志鴻), cardiologist and vice superintendent of Hualien Tzu Chi Hospital, has supported the Yuli hospital since its inauguration. In November 2017, to make sure that the two smaller hospitals had the full support of Hualien Tzu Chi Hospital, Master Cheng Yen urged the Hualien hospital to do all it could to support the two hospitals. In response, Dr. Lin Shinn-zong (林欣榮), superintendent of Hualien Tzu Chi Hospital, asked the head of Human Resources to survey the unmet needs of those two hospitals. The superintendent of Yuli Hospital at the time, Dr. Chang Yuh-lin (張玉麟), pointed out the need for more dentists, because even his staff, not to mention the general public, were having to wait too long for dental appointments. There are 90 dental practices in Hualien County, but only 11 of them are located south of Guangfu Township. This means that over 80 percent of dental resources are concentrated in the northern half of the county. Likewise, of the 48 dental practices in Taitung, 40 are in the county’s southern half. The uneven distribution of dental practices makes it inconvenient for residents in the midriff of the East Rift Valley to get dental care. This is the very area that the Yuli and Guanshan hospitals strive to serve. In the early days, the Yuli hospital had only one full-time dentist, Dr. Cai Rui-feng (蔡瑞峰). After Dr. Cai fell ill, Dr. Huang Ming-jie (黃銘傑), head of dentistry at Hualien Tzu Chi Hospital, began traveling south regularly to help sustain dental services at the Yuli hospital. The request from Superintendent Chang for more dentists there prompted Huang to throw the strength of his entire department behind Yuli. As a result, since 2017, Yuli Tzu Chi Hospital has been able to offer dental service Monday through Friday. This has been a godsend for area residents, and for people who worked at the hospital. Hospital staffers had been hard pressed to get dental care because there were just a few dental practices in Yuli and by the time the staffers got off work, those clinics might be closed for the day. Tang Jing-hui (湯景慧), an administrative worker at Yuli Tzu Chi Hospital, pointed out that oftentimes dental care involves multiple clinical visits. The expanded dental services at the Yuli hospital mean that she and her colleagues can now get dental care at their workplace and take less time off work to get their teeth looked after. For example, it is now unnecessary for them to travel to Hualien for dental care—they can get it right there at the hospital. Yuli staff members enjoy this added convenience and are understandably very grateful.
Devoted doctors Like their dentist colleagues, doctors in other departments of Hualien Tzu Chi Hospital have also traveled to Yuli to support the hospital there. For example, gastroenterologist Yi Chih-hsun (易志勳) travels once a week to Yuli Hospital to treat patients. After his morning rounds at the Hualien hospital, Yi takes a two-hour shuttle bus ride to Yuli. After attending to patients there, he rides back to Hualien. He has been doing this for 15 years. One day, an older woman, Ms. Zhang, came to Yi’s clinic at Yuli. “You must have a gastroscopy done, ma’am,” Yi said to the patient. “Your ulcer is so big that it worries me, even if you don’t seem concerned.” Yi gently patted her shoulder as he urged her to get treatment. Apparently this wasn’t the first time the two of them had had such a conversation. Zhang said that she cried the last time Yi suggested that she have a gastroscopy. She had been so scared of the procedure that she had planned to travel to Hualien Tzu Chi Hospital, where she could get general anesthesia. Dr. Yi said to her softly, “Since you’re already at Yuli, let’s just do it here. Don’t spend that extra money to travel to Hualien. Rest assured, I’ll be extra gentle when I do the gastroscopy.” Yi managed to convince the woman and save her some money. Afterwards, considering the severity of her ulcer, he again reminded her of the importance of a proper diet. Later that day, Yi had an appointment with Lin Wan-mei (林完妹), a long-time patient. He was scheduled to perform a colonoscopy on her husband soon. Lin asked when her husband had to stop eating. She also asked the doctor about other dos and don’ts before the procedure. Yi patiently explained to her all the details. Both Lin and her husband were long-time patients of Yi’s. They lived in Ruisui, about 20 miles to the north. They have used the medical services at Yuli Tzu Chi Hospital for at least ten years. “We used to go to Hualien to see doctors,” Lin said, “but the Yuli hospital has become our hospital since it opened. It’s been very convenient for us.” She also pointed out that Dr. Yi was very nice and kind to his patients, and she was thankful to him for relieving her acid reflux problem. Dr. Yi recalled his early years of involvement with the Yuli and Guanshan hospitals. At that time, Hualien Tzu Chi Hospital sent two of its doctors to provide gastroenterologist services at these two hospitals. Yi, one of those two physicians, had just been promoted to attending physician. His trips to Yuli enticed him to stay to take care of its inpatients, outpatients, and emergency department. He even took on the responsibility of supporting Guanshan Tzu Chi Hospital. His days were thus booked solid Monday through Friday. He only returned to his home in Hualien on Saturdays, after his morning rounds. Yi hustled like that for a year. Thinking back, he admits it was a crazy lifestyle. “I lived the life of an iron man back then,” he said with a smile. At that time, the two Tzu Chi hospitals in Yuli and Guanshan each had two gastroscopes, but they weren’t enough to meet the needs of their patients. To compensate, Yi often carried two extra gastroscopes, one in each hand, when he traveled between Yuli and Guanshan. He badly wanted to have more equipment that would enable him to treat more patients more efficiently. “There’s a need for my service here, and since I’m already doing it, I might as well keep at it,” Yi said of his continued support of the Yuli hospital. He pointed out that gastroenterologists are scarce in the area, so patients have had to go to Hualien for treatment, incurring more expenses and spending more time on the road. His trips to Yuli bring medical service to patients and save them time and money. In April 2018, Hualien Tzu Chi Hospital expanded its support to Yuli Tzu Chi Hospital to cover the staffing needed to offer a urological clinic Monday through Saturday. Urologist Li Zheng-lin (李政霖) has supported the Yuli hospital for more than two years. Li said that his patients there often tell him about their own families and their lives. Small talk like that makes it easier for them to build their doctor-patient relationships, which in turn helps physicians gain better insight into patients’ conditions at home and in life. A physician can offer whole-person care when they know the whole person better.
First train in, last train out Further south at Guanshan Tzu Chi Hospital, services such as orthopedics, traditional Chinese medicine, family medicine, and ENT are offered. Thanks to physicians from Hualien Tzu Chi Hospital, Guanshan also offers treatments in general surgery, cardiology, gastroenterology, neurology, urology, psychiatry, physical therapy, ophthalmology, and hematological oncology. The support physicians take the first southbound train out of Hualien at just past 6:00 a.m. to reach the Guanshan hospital in time to start their clinics at nine. Dr. Wang Po-kai (王柏凱), who heads the Department of Anesthesiology and Pain Management at Hualien Tzu Chi Hospital, is one of the physicians supporting the Guanshan hospital. He said that older people in the Guanshan area used to forgo doctor visits because of the long trips required. Now they don’t have to travel far to see a doctor at a hospital. They can conveniently go to Guanshan Tzu Chi Hospital to have their diseases or discomforts treated. Lin Xiang (林香) lives in Taitung City. After hip replacement surgery, the wound on her left hip continued to ache. It was painful to the touch, and when it got worse, it hurt even when she was still. She tried medicine, but the pain persisted. A friend recommended that she go to Hualien Tzu Chi Hospital, about 200 kilometers (125 miles) to the north. She did and became a patient of Dr. Wang. He injected medicine directly into the affected area to help the adhesive nerves relax. After four injections, Lin’s pain improved. “Dr. Wang is very skillful and friendly,” Lin said. “He listens carefully to us and takes good care of our problems.” When Wang learned that Lin lived in Taitung, he suggested that she see him at Guanshan Tzu Chi Hospital instead of traveling the long way—about five times as far—to Hualien. If she saw him at the Guanshan hospital, it would save her a lot of time on the road. In addition to outpatient duty, Wang also provides anesthesia support in the operating room of the Guanshan hospital. He often takes the first southbound train out of Hualien in the morning and the last train of the day northbound to go home after a long day of service. His dedication does not go unnoticed. His patients often thank him by giving him rice they have grown themselves. “We’ve rarely needed to buy rice now since I came here to support Guanshan,” Wang smiled. It is understandable and inevitable that Wang at times feels tired from all the travel. On that he said that if his treatments are apparently effective and are instrumental in improving patients’ quality of life, then all his efforts are well rewarded. That has motivated him to continue to serve Guanshan.
My savior Hualien Tzu Chi Hospital cardiologist Zhu Xin-kai (朱新凱) has also been a stalwart supporter of the Guanshan hospital for years. “Dr. Zhu saved my life,” said Zhang Su-ying (張素英). Ten years earlier, while visiting relatives in Chishang, Taitung, her jaw became so sore and numb she felt that it was falling off. She was rushed to Guanshan Tzu Chi Hospital in the middle of the night for emergency care. Doctors there determined she had suffered a heart attack. She was rushed to Hualien Tzu Chi Hospital, where Dr. Zhu treated her and saved her life. Zhang experienced cardiovascular problems twice after that, and she sought Zhu’s help both times. Now she visits the doctor for follow-ups every three months at Guanshan Tzu Chi Hospital. “Dr. Zhu not only saved my life,” she said. “He was most considerate. He printed out my condition on a small card for me to carry around.” Zhang said that it has become her habit to see Dr. Zhu. Her friends, and even Zhu himself, have recommended that she see other physicians nearer her home in Pingtung County, which is about three and a half hours by car from Guanshan, but she refuses to take their advice. Apparently, Zhu has won her over with his friendliness and trustworthiness. She has even recommended the Tzu Chi hospital to her friends and neighbors.
Dr. Tsai Hsin-chi (蔡欣記), director of psychiatry for seniors at Hualien Tzu Chi Hospital, has supported the Guanshan hospital for more than 14 years. Many patients have seen him for over a decade. Tsai said that many patients have become like friends after a few visits. They trust him enough to share with him things about their families, so it doesn’t take long before he knows all about everyone’s family situation. As his patients open their hearts to him, his clinic becomes more than a medical clinic—it’s like a cozy chat room. Visiting him becomes a solace for his patients. Patients show up “to see the doctor and to let him see me,” as some aptly describe their appointments. Tsai has also taken on an additional task that is quite out of the ordinary. On Thursday mornings, he goes to the Taitung Drug Abuser Treatment Center in Luye Township, Taitung County, to treat inmates. Though he is a psychiatrist, he sees inmates with all types of medical issues. He has even treated toothaches. When he is unsure of what to do with a patient, he refers the patient to doctors who are in a better position to deal with the case. Tsai tries to make it as easy as possible for inmates to receive treatment. He has found that his interactions with the inmates have had a calming effect on them, making his visits an important part of life behind bars for some of them. Having witnessed physicians from Hualien Tzu Chi Hospital brave the long trips to support Guanshan Tzu Chi Hospital, local volunteer Chen Rui-xian (陳瑞賢) said, “These doctors are really devoted to patients here. Many patients and their families have told me that they feel good to have Guanshan Tzu Chi Hospital in the area, and they are grateful to the doctors who come all the way from Hualien.” Guanshan, Yuli, and Hualien Tzu Chi Hospitals form a network of medical services for residents of and visitors to the East Rift Valley, guarding people’s health and saving their lives. |
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