As Japan’s neighbor, Taiwan was quick to offer emergency assistance after it was hit by a massive earthquake on March 11. The Tri-Service General Hospital organized teams for disaster relief. When natural disaster hits, emergency rescue is key.
The earthquake that shook Taiwan on Sept. 21, 1999, occurred in the early hours of the morning with its epicenter in Nantou County. The quake caused serious damage, destroying the bridges linking Jhushan (竹山) and Caotun (草屯) townships and the tunnel linking Puli Township (埔里) with the outside world. Immediate emergency assistance was provided by many local community hospitals. The hospital that took in the most emergency patients — Yumin Hospital in Caotun — treated more than 1,000 patients in the first 24 hours after the quake, 80 percent of whom entered the hospital in the first eight hours after the quake hit. The Department of Health (DOH) then organized support teams from medical centers in all major universities. The first of those teams to arrive at the Yumin emergency room was a team from Kaohsiung Medical University, a full 15 hours after the quake.
When many medical disaster relief teams later entered the disaster zone, many of the teams complained that there wasn’t much work to do, but I and the other medical workers in the affected communities were very grateful as they gave us huge moral support and the chance to rest for a while and eat something. In post-disaster reviews, emergency medical care received a lot of praise, which clearly shows the importance of local community hospitals.
A recent Control Yuan report on the National Health Insurance system expressed urgent concern over the falling numbers of local general hospitals and the hollowing out of the four major departments of internal medicine, surgery, pediatrics and obstetrics and gynecology. Data from the Bureau of National Health Insurance included in the report shows that only 229 of more than 500 local general hospitals remain and that services have been drastically cut.
In a 1989 survey — part of the planning for the national health insurance program — there were still more than 750 local general hospitals. The rapid disappearance of these hospitals, which are closest to township communities, is depriving relatively disadvantaged residents of basic medical and emergency care. Who will offer immediate assistance if a major disaster occurs in the future?
Taiwan has lately experienced a spike in influenza-like illnesses and the emergency rooms of larger hospitals have been so busy they can barely cope with the influx of patients. This is another consequence of the rapid disappearance of local hospitals and is nothing new.
During the SARS epidemic, many medical centers quickly collapsed, and even National Taiwan University Hospital had to close its emergency room. Hospitals did not accept new patients and were essentially closed down. Medical services for serious illnesses for which there is no substitute stopped immediately and were unable to provide important manpower and technological backup.
On the surface, medical treatment is clearly stratified and includes larger hospitals like medical centers, regional hospitals dealing with serious ailments and diseases and local hospitals and clinics that handle less severe conditions. The National Health Insurance Act (全民健保法) also has clear regulations about stratified medical treatment, but this has been distorted by the implementation of the national health insurance program, forcing both small and large hospitals and clinics to stand on the front line.
Because large hospitals can accommodate more patients, people from local areas flock to them, which in turn exposes these organizations to more pandemics than local hospitals and clinics. This makes it all but impossible to effectively contain a disease locally and stop it from spreading further. When a pandemic hits, the medical centers and major hospitals that should provide backup for other hospitals are often the hardest hit.
A former senior official of the Bureau of National Health Insurance recently published an article criticizing the Control Yuan’s report, saying authorities had long known about the problem.
The implication was that such big and expensive surveys were superfluous. However, despite knowing full well the systemic problems and the uneven distribution of resources, we merely stand by and watch as Taiwan is divided into two worlds, turning the many people living in disadvantaged local communities, townships and villages into second-class citizens.The application of a symmetrical payment system has also eroded internal medicine, surgery, pediatrics, and obstetrics and gynecology departments, the main foundation of local hospitals and the medical care provided by health insurance.
What I find most difficult to understand are things like how government officials knew the ceiling of the pub in Taichung that recently burned down was made of flammable material and yet acted like there was nothing wrong.
This attitude is the cause of frequent public disappointment and is an example of government incompetence. As such it falls to us to ask whether the government really is ready to deal with the next natural disaster or pandemic to hit Taiwan.
Hsieh Wen-hui is the honorary chair of the ROC Community Hospital Association.
TRANSLATED BY DREW CAMERON
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