The public address vehicle of Liouciou Township (琉球) health station was the bearer of bad news as it made its way around the island off the southwest coast.
“Your attention please. The township’s marine ambulance is undergoing major repairs and regular maintenance,” the announcement blared.
Hung Ta-fa, a secretary at the Liouciou Township office, knew exactly what the message meant.
“They’re warning us not to get seriously ill right now as there won’t be a marine ambulance to take us to Taiwan proper for emergency medical treatment,” Hung said.
The announcement and the potentially life-threatening impact of the breakdown highlight the medical woes faced by people living on Taiwan’s small islands, where doctors, facilities and financial resources are in short supply.
Liouciou, an island of about 12,000 residents, has a doctor-to-population ratio of 5.58 per 10,000 people, far lower than the 15.93 doctors per 10,000 national average.
In addition to the government-run health station, it has four private dental and pediatric clinics, but none of them are equipped to treat major or acute diseases, which means patients with serious ailments and even pregnant women have to take a half-hour boat ride to Taiwan proper to receive medical attention or give birth.
Residents of two small islands off the southeast coast — Green Island (綠島) and Lanyu (蘭嶼) — face a similar plight. Neither island has a private clinic and each has only a single public health station.
The doctor-to-population ratio is 8.3 per 10,000 for Lanyu, home to more than 3,000 Tao Aborigines.
The island’s health station was originally manned by three doctors, but one of them has been in detention since late May for corruption and the station now has only two doctors to maintain the round-the-clock operation.
The doctor-to-population ratio on Green Island, at 6.34 per 10,000, is even lower than Lanyu’s, but its medical services are believed to be the best and most stable of the three small outlying islands.
The island’s health station is headed by Chen Chao-lung (陳照隆), a Green Island native who has worked at the station for 30 years.
Chen was among the first batch of young people from outlying islands or remote mountainous regions who trained as doctors under a government-sponsored medical education program in exchange for serving between seven and 10 years in areas assigned by the government.
He is one of only a few, however, who have forgone the chance to practice medicine on Taiwan proper after fulfilling that service requirement.
“I have chosen to stay out of my love for my beautiful home and its people,” said Chen, who received the Medical Contribution Award last year for his dedication and who is respected by the locals as their lifesaver. “If I left, I couldn’t imagine who else would be willing to take my place.”
The lack of interest among medical personnel in working on the islands has led to a high staff turnover rate that has stymied efforts to improve the quality of healthcare.
“Frequent personnel turnover hampers on-the-job training and accumulation of experience,” Chen said.
Lu Chiao-yang (呂喬洋), director of Taitung County’s Public Health Bureau, which is responsible for healthcare on Green Island and Lanyu, shares Chen’s view, adding that the scarcity of dedicated medical staff and a lack of convenient transportation are the two thorniest problems in improving medical services on the sparsely populated islands.