Taiwan is home to a wide range of medical services and world-class healthcare that would seem to promise long, healthy lives for the 23 million people who comprise its population, but despite the abundance of these resources, not everyone has equal access to them.
There is a gap in the nation’s medical resource distribution system that is leaving many locals without adequate care, even as Taiwan has started promoting medical tourism to foreign visitors.
The disparity in access to healthcare can be seen in doctor-to-patient ratios in urban versus rural areas. For example, in Taipei there is one doctor for every 62 people, but on the other side of the country, the approximately 4,000 residents of the remote township of Daren (達仁) in Taitung County have to rely largely on one physician.
The physician, Hsu Chao-pin (徐超斌), is a member of the area’s Paiwan tribe and puts in 400 hours of work a month at the Daren Township Public Health Center.
Hsu often goes to his patients because most of them are elderly or impoverished and going to see him is a luxury in the 300km2 township.
He has to cover mountainous terrain to get to his patients and travels enough kilometers in one week to equal the circumference of Taiwan. All that hard work contributed to the 46-year-old suffering a stroke nearly eight years ago.
Despite Hsu’s great efforts, some of his patients have nearly given up hope of getting the care they need.
“If you can’t treat me, I would rather die,” said an elderly man surnamed Chu (朱), whose lung tumor remains untreated because he cannot spend the time or money it would take to be treated at an appropriate hospital.
The Daren center is open Monday to Saturday, but patients with emergencies or serious conditions have to make the 60km trip to Taitung City to seek care.
Making the trip more arduous is the lack of public transport over the mountains from Daren to Taitung. Left with no other choice, residents in need of emergency or serious care can only hire taxis at a cost of up to NT$3,000, which is about a month’s living expenses for some. Given this, many township residents choose not to make the trip.
For those used to the convenience of life in the cities along Taiwan’s western coast, having to take a long trip to a hospital is unimaginable, but a lack of resources is the norm in Taitung.
As of 2012, Taipei squeezed 24 metropolitan-level hospitals into 272km2 of land. At 13 times that size, Taitung has only one metropolitan hospital and five smaller community-level hospitals, all of which are concentrated in Taitung City.
Yet if medical care is scarce in Taitung City, the four southern townships of Taimali (太麻里), Jinfeng (金峰), Dawu (大武) and Daren are veritable healthcare deserts.
Sandwiched between mountains and sea, the 18,000 residents of these townships can only pray that they do to fall ill at night, on weekends and holidays, when the local healthcare facilities are closed.
Exacerbating these problems is the county’s relative poverty, with statistics showing that its annual income per household in 2011 was NT$673,000 (US$22,200), far below the national average of almost NT$1.16 million that year.
Taitung County is also home to one-third of the nation’s Aborigines, many of whom are struggling with poverty and unemployment.
Thanks largely to this lack of facilities and medical staff, the county has earned the dubious title of Taiwan’s cancer capital.
In 2012, 630 of the county’s 226,000 residents died of cancer and its incidental mortality rate was more than twice that of Taipei’s.
Illustrating the gravity of these medical care shortcomings is the case of a university student who died during an outbreak of the H1N1 avian influenza virus six years ago because the hospital treating him lacked the extracorporeal membrane oxygenation (ECMO) equipment needed to save his life.
Even when the county borrowed an ECMO machine from a Taipei hospital to prevent the tragedy from recurring, an expectant mother died of the same virus because none of the doctors in Taitung knew how to operate it.
After that, the Ministry of Health and Welfare subsidized a NT$3 million ECMO machine for the county’s Mackay Memorial Hospital.
Yet other problems remain unsolved. Few doctors are willing to move to the rural area and any time a cardiologist is needed there, they have to be flown in from Taipei.
Despite offering a monthly salary of NT$350,000, it took Mackay Memorial — the county’s largest hospital — years to find a cardiologist willing to relocate to Taitung.
The entire county has just three doctors specializing in emergency care and no resident surgeons for intensive or burn care units.
There is limited private sector support for solving these problems, as businesspeople see no profit in building a hospital for a generally poor populace, Hsu said.
“This is the coldest corner in the world,” the physician added.
Hsu, who stepped down as head of Daren health center last month after failing to reduce the region’s high cancer rate, plans on building the “South-Bend Hospital” to meet the county’s medical needs.
His plan is to raise NT$150 million over the next three years to finance the construction of a 20-bed hospital for emergency care.
While the government is willing to help out with Hsu’s project, Chang Yu-chun, a section chief at Taitung County’s Public Health Bureau, said that he has not submitted a detailed plan yet.
The bureau also plans to build a combined hospital and health center, Chang added.
The central government has earmarked a budget of more than NT$130 million to construct a center in Dawu to treat those in critical condition or with chronic illnesses.
“What we need most is not a hospital, but a more sophisticated support network,” ministry spokesman Wang Je-chau (王哲超) said, adding that with its population distributed sparsely among vast areas, Taitung Coutny is at a natural disadvantage when it comes to delivering medical care.
The ministry has also launched a series of programs to train medical professionals, organize medical missions and set up temporary emergency stations during holidays.
“Building a hospital is not as easy as you may think,” said Lee Wei-chiang (李偉強), head of the ministry’s Department of Medical Affairs.
“Finding workers who want to be stationed there will be the first challenge,” he said, adding that even Mackay Memorial relies on staff loaned by at least three medical institutions in Taipei to operate.
“We plan to first work on expanding the services at local health centers and then focus on educational programs offering scholarships for young medical professionals in Taitung in the hopes that one day they will come back to practice in their hometowns,” Lee said.
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