The Power of Friendship

Taiwan’s Public Health Diplomacy

Esther Tseng　/　photos Lin Min-hsuan　/　tr. by Robert Green

July 2018

中文日本語

At Taiwan’s Far Eastern Memorial Hospital, medical personnel from Belize practice how to avoid infection when inserting dialysis catheters. (photo by Lin Min-hsuan)

Taiwan has gained an international reputation for its public health assistance and medical missions in Latin America, Africa and the South Pacific. Whether combating kidney disease in Belize or working to lower maternal and infant mortality rates in the Kingdom of Eswatini (formerly Swaziland), Taiwan’s medical assistance initiatives have expanded beyond providing free clinics and building hospitals. Taiwan’s capabilities in the field include health expertise and technology, allowing detailed programs to be tailored to local needs, such as training medical personnel, designing medical computer software and donating equipment.

International assistance efforts represent a hand extended in friendship and the winning of hearts and minds among the populations of diplomatic allies, factors more important than levels of assistance spending.

In the dialysis unit of Taiwan’s Far Eastern Memorial Hospital (FEMH) two nurse trainees, Kathy and Lenisha, practice inserting catheters into a dummy training arm. Tall in stature and with their braids tucked neatly away, the two women brim with confidence while the head nurse explains in English how to avoid infection during the procedure. The women are nursing “seed instructors” from Belize who are taking part in a capacity building program for the prevention and control of chronic renal failure, established by the International Cooperation and Development Fund (TaiwanICDF) and FEMH.

At Taiwan’s Far Eastern Memorial Hospital, medical personnel from Belize practice how to avoid infection when inserting dialysis catheters.

Chronic kidney failure in Belize

“Before arriving in Belize I had no idea that mortality from chronic kidney disease was so high!” says Peng Yu-sen, director of internal medicine at FEMH. It ranks fifth among the top ten causes of death in the country, and is prevalent in middle-aged men throughout Latin America. In Belize the widespread use of herbal medicines might be an additional cause for the disease.

Moreover, among Belize’s population of just over 360,000, obesity affects 60% of people. Chronic kidney disease is often caused by high blood pressure and diabetes, but insufficient medical resources prevent treatment through hemodialysis in the late stages of the disease. Kidney disease therefore causes considerable anxiety among the public. After considering the constraints of the medical system in Belize, the FEMH team decided that the best course of action was to manage the disease at its earliest stages.

Belizean medical personnel will return home to pass on their training in their own communities.

Winning hearts and minds

The government of Belize, however, lacked accurate estimates of the condition’s prevalence, and many people were unaware that they had kidney problems. Before the disease could be tackled, therefore, FEMH had to get an accurate picture of how widespread it was. It did this by initiating community screenings and surveying the populace.

The Belize Ministry of Health and the Statistical Institute of Belize dispatched local personnel to implement the health survey, under the direction of TaiwanICDF project manager John Lin. From 2016 to January of 2018 testing was conducted nationwide. Screenings reached about 5% of all households and included taking blood samples and measuring blood sugar and blood pressure. In total, 7,834 people were tested for cholesterol levels and kidney function. The survey resulted in Belize’s first comprehensive database for kidney disease control and case management. During the survey, Taiwan’s flag adorned posters and small gifts presented to participants. This healthcare diplomacy conducted at grassroots level helped win the gratitude of the public.

In 2016 a medical team from Far Eastern Memorial Hospital visited Belize’s Karl Heusner Memorial Hospital to observe classes taught by instructors trained in Taiwan. (courtesy of TaiwanICDF)

New directions for medical aid

FEMH also initiated a program to send clinical staff from two large hospitals in Belize to Taiwan for training as seed instructors. The participants then returned to Belize to pass on their skills to other healthcare personnel. FEMH also provided training in Taiwan for information specialists in the use of Virtual Studio software for case tracking and management.

A trainee named Yum, for example, studied a new programming language in Taiwan and learned how to manage a database. “This was amazingly helpful,” he said. “I mastered new skills and now feel like I can help improve my country’s healthcare system. The techniques could also benefit neighboring countries in the Caribbean.”

Peng Yu-sen shared the program’s achievements at a forum in Geneva timed to coincide with the 71st World Health Assembly, held in May 2018, which helped publicize the dedication and achievements of Taiwan’s overseas public health assistance.

Lee Pai-po, TaiwanICDF deputy secretary general, notes that Taiwan’s medical assistance programs have shifted focus from sending teams of medical volunteers to provide treatment, to “capacity building” intended to improve public health delivery. This type of medical aid is also in line with the United Nations’ sustainable development goals and allows Taiwan to contribute to global health initiatives. Taiwan moreover is well known for its expertise in both public health and information technology, and can help recipients of its aid programs by developing medical technology and by training personnel. As a result, when the medical missions wrap up their work, local health professionals can take over the training initiatives.

Sibongile Simelane (center), Eswatini’s minister of health, tries out medical equipment donated by Chia-Yi Christian Hospital. (courtesy of TaiwanICDF)

Reducing infant mortality

This kind of “teach a man to fish” philosophy is also evident in Taiwan’s approach to its aid to Eswatini. Beginning in 2016 TaiwanICDF partnered with clinicians at Chia-Yi Christian Hospital (CYCH) to work to reduce maternal and infant mortality half way around the world in southern Africa.

Eswatini, which has a population of only 1.3 million (2016), has a maternal mortality rate of 389 deaths per 100,000 live births and a mortality rate in children under five years old of 53 deaths per 1,000 live births. By comparison, Taiwan has maternal mortality of 11.6 per 100,000 and under-five child mortality of 2.4 per 1,000. Eswatini ranks toward the bottom in global rankings, behind even North Korea. Reducing these mortality rates is therefore a major priority for the kingdom.

Eswatini, where polygamy is widespread, also has the highest HIV/AIDS rate in the world. In response, AIDS prevention and treatment resources have been provided free of charge by the international community, notes Solomon C.C. Chen, superintendent at Heng Chun Christian Hospital. This has dramatically reduced AIDS-related mortality overall and lowered mortality from maternal transmission to 2%. Through its efforts to reduce maternal and infant mortality in Eswatini, Chen observes, Taiwan hopes to demonstrate the efficacy of its medical assistance programs to its diplomatic partners and raise its profile in global health circles.

CYCH medical missions have repeatedly visited Eswatini since 2016 and have discovered that prenatal examinations are rare in the country, making it difficult to intervene in high-risk pregnancies and so raising the risk of mortality and premature birth. Moreover because the country’s hospitals often discharge mothers 24 hours after birth due to inadequate medical resources, there is a high risk of hemorrhaging and other dangers that increase the incidence of maternal death.

Faced with such a weak system of maternal care, the CYCH medical team adopted an empowerment-based approach. It trained seed instructors who in turn trained up 240 women as “community health promoters.” Because they are familiar with their local communities, they can visit pregnant women in their homes to educate them and encourage them to go to clinics for prenatal exams, where they can also collect free nutritional supplements to reduce premature births and hydrocephalus (the buildup of cerebrospinal fluid in the brain). The community health promoters also identify high-risk pregnancies and remind mothers to seek out prenatal treatment. This reduces complications for both mother and child and helps reduce mortality. Each child saved represents the saving of a whole new life.

A doctor in Eswatini vaccinates a newborn baby. (courtesy of TaiwanICDF)

Goodwill the world over

Both Eswatini and Belize have expressed gratitude for Taiwan’s medical assistance. Wang Hung-tzu, director of TaiwanICDF’s Humanitarian Assistance Department, says that according to health ministry officials in Eswatini, many countries have promised aid but Taiwan is the only one that has implemented programs in the country; and health professionals in Belize remarked that many countries have provided funds for training programs, but only Taiwan has implemented long-term on-the-ground training. Effective aid is based in true consideration of local needs and a genuine desire to improve others’ lives.

Yao Wei-jen (second right), superintendent of Chia-Yi Christian Hospital, emphasizes that the hospital’s overseas medical assistance is delivered according to the needs of the people in the host countries.