Print

Mail

wiki links

FEATURE: Island communities face paucity of medical resources

The Liouciou marine ambulance is pictured docked at the harbor in Liouciou Township, Pingtung County, on Monday. The speedy and convenient vessel will soon be retired from service, forcing local residents to lobby the central government for money to buy a replacement. PHOTO: CNA

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.

“I have chosen to stay out of my love for my beautiful home and its people. If I left, I couldn’t imagine who else would be willing to take my place.” — Chen Chao-lung, a doctor at Green Island health station

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.

“Both local and central governments have devoted a lot of energy to addressing the problems, but there’s still a long way to go to satisfy the medical needs of the islanders,” Lu said.

Lu does not begrudge those medical personnel who leave the islands for better opportunities, but he feels the government could do more to solve the issues.

For one thing, he said, it could offer young doctors trained under the medical education program for islanders more incentives to stay beyond the mandatory service period, including offering more opportunities to pursue advanced training and study.

Another step could be to increase the frequency of visits by specialists from major supporting hospitals to the remote islands, Lu said.

Lu’s office, for example, is looking into the feasibility of arranging for dentists to visit Lanyu every weekend. At present, a dentist from a teaching hospital in Taitung County visits the island only on the first and third weekend of every month.

The high turnover rate also extends to nurses.

Chang Ming-lung (張明龍), director of the Lanyu health station, who himself is a government-sponsored doctor and will leave his post once his service requirement is fulfilled, said only two of the eight nurses at his station have worked there for more than five years.

In many cases, he said, nurses are reassigned just as they are becoming familiar with their work and living environment.

“This frequent reassignment of nurses is yet another obstacle to upgrading service quality,” he said.

The paucity of medical resources also adds to the pressures faced by nurses working on the islands, and some have complained about having to provide emergency services without adequate equipment.

“We have to take oxygen equipment with us and perform CPR from time to time. The work is very stressful,” said one Lanyu nurse, who spoke on condition of anonymity.

Liouciou is the only small outlying island that has a marine ambulance, but even that will soon have to be taken out of service and the township office is lobbying the central government to provide NT$30 million (US$909,090) for a new one.

The Department of Health (DOH), however, is considering hiring a private helicopter company to offer emergency transport services at a cost of about NT$1 million per month.

That option is less than appealing to local residents, who have grown attached to the lifeline provided by the vessel’s 20 trips to Taiwan proper per month.

Their reservations were heightened last week when a helicopter owned by a private company that was returning to Kinmen after delivering a patient to Taipei for emergency treatment crashed into the sea, killing two.

The issue has yet to be resolved.
This story has been viewed 854 times.