2012 / 11月
29歲、來自太平洋馬紹爾群島的牙技師Joshua Drake Lanki，正在台北馬偕醫院學習做齒模，來台一個多月的他，已會講「謝謝」、「不客氣」等簡單且發音標準的中文。他表示，在馬紹爾少有人會治療蛀牙、製作齒模、架牙橋等技術，當地人牙齒有問題多直接拔除了事，民眾因缺牙造成臉部變形、影響腸胃消化等問題嚴重。
另一位來自加勒比海島國聖文森、32歲的心臟內科醫師Najaj Jhuneile Peters，被安排在新北市的署立台北醫院受訓。
Chang Chiung-fang /photos courtesy of Jimmy Lin /tr. by Jonathan Barnard
Taiwan has long been held in high esteem for the level of its medicine. After half a century in which ROC agricultural assistance teams have been going to nations in Central and South America, Africa and elsewhere, medicine has become an important part of the international aid provided by the Republic of China. And that assistance is not only being provided on foreign soil: At home in Taiwan, too, the ROC is fully meeting its duties as a member of the international community by extending a helping hand to allied nations.
Throughout the year local hospitals are hosting visiting professionals from around the world who come to Taiwan to learn the latest medical techniques. And every day patients from many different nations are seeking treatment at Taiwanese hospitals in this age of borderless medicine….
Dental technician Joshua Drake Lanki, 29, hails from the Marshall Islands in the northern Pacific. He is currently studying at Taipei’s Mackay Memorial Hospital. He explains that very few people in the Marshall Islands can treat tooth decay, make tooth molds, or build dental bridges. Dental problems are typically handled by pulling teeth. The subsequent lack of teeth leads to facial deformation, digestive tract issues and other serious problems. He’s studying in Taiwan for six months. He will then return home to help his fellow countrymen keep their teeth.
Najaj Jhuneile Peters, 32, from Saint Vincent and the Grenadines in the Caribbean, has been sent to get training at the Taipei Hospital of the Department of Health. On the recommendation of the ROC embassy in St. Vincent, Peters came to Taiwan to study echocardiography (the use of sonograms in making heart diagnoses). Unfortunately, the hospital she works for doesn’t have equipment for heart ultrasounds. She plans on putting in an application to obtain that equipment when she gets back home.
It’s estimated that currently 17 foreign doctors from the Philippines, Mongolia, Gambia, Israel, India, Tibet and elsewhere are now in Taiwan under the Taiwan International Medical Training Program.A medical pilgrimage
Lin Shoei-loong, superintendent of the Department of Health’s Taipei Hospital, notes that since the Taiwan International Healthcare Training Center (TIHTC) was established in 2002, it has trained 713 medical professionals from 41 nations.
Generally speaking, European doctors are interested in studying acupuncture and traditional Chinese medicine, whereas medical professionals from South America and the Middle East come to focus on public health and universal-health-care-system administration. Africans, on the other hand, mostly study pediatrics, obstetrics, and medical administration.
“The export of medical services offers opportunities to introduce the outside world to Taiwanese culture and to strengthen bonds of friendship,” says Lin. For nations with which the ROC lacks formal diplomatic relations, these kinds of exchanges allow both sides to cultivate and deepen friendships. For instance, Mongolia has already sent more than 100 medical professionals to Taiwan. Even after returning to Mongolia, they still periodically gather to discuss their experiences in Taiwan.
Apart from the medical professionals from allied nations that come to Taiwan with grants from the International Cooperation Development Fund, many others pay their own way.
Chang Hang, president of the Taiwan Joint Commission on Hospital Accreditation, points out that providing training to foreign medical personnel is one of the items in hospital evaluations, so medical centers here are generally eager to be on board.
In 1992 National Taiwan University Hospital, Taiwan’s leading research hospital, began cooperating with Vietnam to raise the level of its medical techniques and technology. NTUH has sent its own doctors to Vietnam to teach local doctors how to perform kidney, liver, heart and bone marrow transplants, as well as other major medical procedures. The hospital has held seminars for Vietnamese doctors on topics such as neurology, cardiology, rheumatism, and minimally invasive surgery. In 2010 the NTUH-HOPE Program between Taiwan and Vietnam was launched. It has provided grants for 21 doctors to visit Hanoi’s Viet Duc Hospital and provide guidance about diagnosis, treatment and clinical practices. In 2009, NTUH began to work with Mongolia, signing exchange agreements and helping to train Mongolian doctors and other medical personnel.
The Chang Gung Memorial Hospital group has likewise spared no effort in training foreign medical personnel. Cheng Ming-huei, a vice superintendent of Chang Gung Memorial in Linkou, points out that there are more than 50 foreign doctors from various European, Central Asian and Southeast Asian nations currently receiving training at the hospital, mostly in plastic surgery, craniofacial surgery, dentistry, cardiology, and obstetrics.Another Taiwan Miracle
With the deep roots put down by ROC medical teams stationed in foreign nations and the free assistance provided by mobile medical teams, as well as the positive personal experiences of foreign medical personnel who have received training here and foreign patients who have received treatment here, Taiwan is developing a well-earned international reputation for high-quality medical care.
In April of 2010, an ROC medical team in São Tomé and Príncipe learned about two badly burned seven-year-old children with adhesions. If not handled immediately, there was a fear that amputations would be required or the children’s lives would be put at risk. With a lack of burn specialists locally, the Ministry of Foreign Affairs arranged for the children to be brought to Taiwan for treatment. It also arranged for training in aftercare and rehabilitation for medical personnel that came with the children.
Marc Hsu, the director of the Bureau of International Cooperation at the Department of Health, points out that transnational medical treatment is unimaginably expensive, making the steps taken for those two children exceptional.
Based on humanitarian considerations, the ROC provides medical assistance to allied nations as a matter of course, but Taiwanese medicine, due to its high quality and low cost, has also long attracted many foreign patients who pay their own way.
NTUH has treated significant numbers of foreign patients since 1990. Chen Ming-fong, the superintendent of NTUH, explains that early on most of these patients were overseas Chinese from Southeast Asia. In recent years they’ve been coming from all over the world.
Most of the foreigners seeking treatment at the hospital last year were from Asia and mainland China (59%), the Americas (25%) and Europe (7.5%).
In October of 2011, an 18-month-old baby from Ho Chi Minh City in Vietnam suffering from biliary atresia (congenital obstruction of the bile ducts) was brought to Taiwan for treatment. Her parents had originally planned to bring the girl to Singapore for a liver transplant, but gave up on that plan when they learned it would cost the equivalent of nearly 10 million NT dollars. On a friend’s introduction, they went to NTUH for the procedure instead. The operation was extremely successful and it only cost one-third of what it would have cost in Singapore.
The Chang Gung Memorial Hospitals, which are known for their advanced medical care, have treated the most foreign patients.
Cheng Ming-huei of the group’s flagship hospital in Linkou notes that the hospital treats several thousand foreigners as outpatients and nearly 1000 as inpatients each year. These represent about 5% of the hospital’s patients. Linkou CGMH has an excellent international reputation and frequently provides infertility treatments, endoscopic surgery, umbilical cord blood transplants, and plastic surgery (including lymphatic reconstruction, breast reconstruction, and repairs of cleft palate and microtia) to foreign patients.
A professor of plastic and reconstructive surgery, Cheng was the first doctor to use vascularized lymph node transfer to prevent lymphedema after the removal of cancerous lymph nodes. The paper he authored on the topic for Plastic and Reconstructive Surgery, a major international journal, attracted even more foreign patients to seek treatment with him.
Cheng explains that treatment for breast or cervical cancer may require the removal of lymph nodes (lymph node dissection) or radiation treatments that lead to tissue fibrosis. These results may in turn cause blockages that prevent the lymphatic system from returning the interstitial fluid to the thoracic duct and then to the bloodstream, where it is recirculated back to the tissues. Instead, the fluid builds up locally, leading to swelling in the upper or lower limbs that impedes patients’ capacity to move and exercise. With vascularized lymph node transfer, wherein a flap of skin is transplanted along with three or four lymph nodes, the “pumping action” that spurs the circulation of the lymphatic system returns.
Jaing Tang-her, a hematology-oncology specialist in the Pediatric Department at Linkou CGMH, is well known for his expertise with cord blood transplants.
In 2003 the Hematology-Oncology group at CGMH obtained the DOH’s permission to proceed with human trials in carrying out umbilical cord blood transplants between non-relatives. In 2005 the prohibition on human trials for cord blood transplants was lifted, and in the years since the team has performed 96 of these procedures, using non-relative cord blood transplants to treat thalassemia, leukemia, acquired immunodeficiency syndrome, osteopetrosis, and aplastic anemia. Quite a few of these patients were foreigners who were transferred from hospitals overseas.
Jaing points out that CGMH’s rate of success with cord blood transplants is nearing 90%. Every year about 10 patients come from each of Malaysia, mainland China and India. “The Indian patients come on the recommendations of Indian doctors who have come to Taiwan for training,” explains Jaing. “Malaysian patients, on the other hand, are coming via word of mouth from patients who have been successfully treated at the hospital.” Currently, there are three foreign patients at the hospital who have already successfully had the procedure, and another seven who are waiting for transplants.
A 10-year-old boy from Malaysia first came to the hospital in February 2012 for a cord blood transplant. It was unsuccessful, but his family wasn’t discouraged and they came in September for a second transplant. This time it was extremely successful, and he will leave the hospital soon, when his condition fully stabilizes. His mother, overjoyed that her child is leaving behind a life of constant blood transfusions and shots, exclaims, “Dr. Jaing, thank you so much for letting my son be reborn!”
Stories like these play out frequently at Taiwan’s major hospitals.
In the National Geographic Channel’s documentary Taiwan’s Medical Miracle, one-year-old Iya from Dubai, who was suffering from biliary atresia, flew to Kaohsiung CGMH for a liver transplant. Meanwhile, an Egyptian surgeon named Solimen, who lost his ability to operate after losing portions of two fingers to a stray bullet during the Arab Spring, came to Linkou CGMH for microsurgery that reconstructed the fingers with material taken from his feet.A leader in foreign medical aid
“Whether from the standpoint of meeting global responsibilities or of raising national visibility, the medical community here should be providing international medical assistance,” argues Chen Ming-fong, superintendent of NTUH. Taiwan has a lot of experience worth sharing with other nations, including in areas such as infectious disease control, acute care, assessments, medical records management, and so forth.
But Chen admits that there are potential pitfalls: “Providing international services is something that medical centers ought to be doing, but if you put too much emphasis on it you run the risk of being attacked for not focusing enough on your main mission of meeting the medical needs of Taiwan. You’ve got to strike the right balance.”
“Taiwan is the priority,” says CGMH’s Cheng Ming-huei, who believes that providing international medical services need not diminish domestic medical resources. “In fact, with the payment structure imposed by the National Health Insurance system, the possibility of providing care to foreigners outside of that framework will help to keep good doctors in Taiwan!”
NTUH’s Chen explains that Taiwan’s hospitals are not allowed to advertise their medical services. “Nevertheless, foreign medical assistance is like an intangible form of advertising that informs people about the high level of medical care in Taiwan,” he notes proudly. “Exporting medical services is an ideal representation of Taiwan!”