After working at National Taiwan University Hospital (NTUH) in Taipei, I transferred to the hospital’s Yunlin branch, where I soon learned that many farmers take great care of their crops, but not such good care of their health. I also discovered that there is a difference between having an awareness of Taiwan’s medical landscape and experiencing it.
I knew that Taipei is home to an aging population, but when I worked at the Taipei hospital, I saw that most elderly people arrived at the hospital clinic under their own power.
However, my first impression in Yunlin was that most elderly patients that come into my consulting room were senile and in a wheelchair, or are even arrived lying in a hospital bed, with oxygen equipment to help them breathe.
They might look old, but they are often a dozen-or-so years younger than most of the elderly patients I saw in Taipei. Seeing that they aged so rapidly surprised me and I wanted to find the reason for this.
One day, shortly after I started practicing at Yunlin, the nurse in the consulting room said to me: “Excuse me, but you need to please check each patient a bit faster.”
Hearing that gave me a strange feeling — I have always been careful to spend quality time with patients. The condition of the patient determines how much time I spend consulting and treating them, and no one needs to discuss with me the length of time that I spend with them.
Smiling, I asked the nurse: “What’s the hurry?” She solemnly told me: “Transportation in the Yunlin area is inconvenient. Bus service from the coastal areas to the hospital is only available twice a day — in the morning, a bus brings passengers here, and in the afternoon, another one takes them home. A patient who misses the afternoon bus will have to spend the night sleeping in a chair in the hospital waiting room, and catch the bus home in the morning.”
I was stunned — I would never have imagined that seeking medical treatment in Yunlin could be such a long and arduous journey.
Yunlin has the second-biggest population of elderly people, but county residents generally travel 16km to a bus stop, whereas a bus stop is typically only 300m away in Taipei, New Taipei City and Taichung.
A nurse in Yunlin once told me: “One day when I was on my way into the consulting room to talk with a doctor, a farming woman wearing a head scarf stopped me and asked if she could see the doctor first, because her bus was due to arrive in 20 minutes. If she had missed it, she would have needed to wait until 3pm.”
As a result, elderly Yunlin residents never go see a doctor for a minor ailment — when they do see a doctor, it is because they have a serious condition. When patients only go to see a doctor when it is too late, the doctor often only gets to treat patients who are terminally ill.
This is not only a sad state of affairs, but it is also gut-wrenching.
I began to consider whether there were other ways to offer medical services. People have such difficulty getting to the hospital, why not use advancements in telecommunications to take medical services to where the patients are?
Limited Internet access and slow network speeds used to hamper telemedicine, but the 5G era could mark the beginning of a new generation of elderly care.
This is also the idea that lies behind National Taiwan University Hospital’s Houston-Apollo Model, a telehealth project launched at the Yunlin branch two years ago. This project, the first of its kind in Taiwan, aims to bring medical resources to patients with the help of advanced telecommunications.
Liou Horng-huei is deputy director of National Taiwan University Hospital’s Yunlin branch and a professor of neurology at National Taiwan University’s College of Medicine.
Translated by Lin Lee-kai
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