Ilan's Albert Schweitzer: Hsu Wen-cheng

In the same era, as Taiwan recovered from the wounds of World War II, an idealistic young doctor walked away from a high salary and prestigious teaching job to work in his hometown, a backward place stricken by cholera. In 2006, after 60 years of difficult work, Hsu Wen-cheng, now 84, founder of the Lotung Poh-Ai Hospital, was named an Honored Alumnus of National Taiwan University, one of a group that included well-known businessmen such as Barry Lam and Lee Kun-yao. This was a milestone in the history of medicine in Taiwan.

For the last two years, on the second and fourth Monday morning of each month, alongside the groups of patients just inside the Lotung Poh-Ai Hospital you will also find physically and mentally disabled people proudly selling boxes of their handmade gift soaps. They are students of the Chiamin Center for Special Education, run by the Catholic Order of St. Camillus. Small though these cakes of soap may be, they are an important road to independence for seriously disabled people and also a symbol of renewed collaboration, after over half a century, between Lotung's two major hospitals, Poh-Ai and St. Mary's.

Hsu Wen-cheng emphasizes that "managers' attitudes and outlooks will decide the level of healthcare services." He hopes that in the new century Lotung Poh-Ai Hospital will become "Taiwan's Mayo Clinic."

A childhood dream

In the palm of your hand, the soap gives off a mild floral fragrance. It takes Hsu Wen-cheng back to when he was 12 years old, carrying a suitcase and bedroll, sitting on the steerage deck of a boat from Keelung and bound for a new life as a student in Japan. At such a young age, Wen had only vague ideas of what Japan, then Taiwan's colonial ruler, was really like. Nonetheless, he was completely set on becoming a doctor.

"When I was young, medical services in Ilan were very backward. You could only find optometrists, pediatricians, and dermatologists. Even at Ilan Hospital, the region's most comprehensive care center, the only surgery they could do was appendectomies-for any other serious conditions, patients were sent to Taipei." Just to seek treatment for her asthma, one of Hsu's aunts had to make monthly trips from Lotung to Ilan for a five-or six-hour train ride to Taipei. Because of situations like this, Hsu's father and aunt both hoped he would study medicine.

After graduating from Lotung Public Elementary School in 1935, Hsu Wen-cheng went to Japan, arriving in Kyushu after a four-day steamer trip. Hsu laughs as he thinks back on the journey he took some 70 years ago: "Even though I was so seasick that I could hardly eat or sleep, I was filled with such delight and curiosity on this first trip abroad that I forgot all the hardships. It also gave me some training for when I went to work among the indigenous peoples of Taiwan. No matter how many curvy, bumpy mountain roads we drove on, I never got carsick."

At that time, the Japanese school system required students who wanted to study at a college of medicine to first be accepted into an upper secondary school. Wen studied at the private Jinsei Gakuen Middle School in Kagawa Prefecture, Shikoku. With a limited number of places available at only 34 upper secondary schools in Japan, Hsu put tremendous effort into his studies, sometimes splashing ice water on his face to keep himself awake as he worked late into the winter night. He finally won acceptance to Fuji Upper Secondary School on the central island of Honshu, becoming only the third Jinsei Gakuen student in 50 years to be accepted to an upper secondary school.

Bright, open spaces in the Lotung Poh-Ai Hospital boast an artistic design and provide a comfortable environment.

A difficult history

In Ilan County, the Order of St. Camillus's St. Mary's Hospital and the Lo Hsu Foundation's Lotung Poh-Ai Hospital are located right next to one another. Both are top regional teaching hospitals. They usually see one another as competitors, and rarely go in for collaborative projects. To understand the history between these two organizations, we have to look back 56 years.

In 1950, after graduating from National Taiwan University College of Medicine, Hsu Wen-cheng went back to his hometown to work, establishing the Lo-Hsu A-long Poh-Ai Clinic, which he named after his father. In 1952, when the leadership of the Chinese Catholic Church fled from Yunnan Province to Taiwan, its Order of St. Camillus looked to establish bases of operation throughout Taiwan. The order decided to set up in the little town of Lotung, then one of the most backward places in Taiwan. It purchased Hsu Wen-cheng's clinic and opened the Lotung St. Mary's Hospital. The new hospital's doctors included Hsu Wen-cheng in internal medicine; John Jane?z, a general surgeon from Yugoslavia; and a female obstetrician, Lo Tsai.

With much bigger dreams for his career in medical service, however, Hsu Wen-cheng did not agree with the philosophy behind the Camillians' work. In 1953, he established the Lotung Poh-Ai Hospital next door to St. Mary's, subsequently developing it from a 30-bed clinic to its present status as a multiservice hospital with over 1000 beds. After decades of work, the collaboration with the Chiamin Center is the first time both hospitals have joined hands to work together.

According to Hsu, the Chiamin Center, established in 1976, is the first center for special education on Taiwan's east coast. With a long record of service to people with serious mental and physical disabilities, it has made a major contribution to all people in Taiwan, and its founder, Italian-born Father Giuseppe Didone, is one of the people Hsu admires most. As a long-time sponsor of public service activities, Poh-Ai Hospital readily agreed to provide a place for the center's students to work.

Known as "Ilan's Albert Schweitzer," 60 years ago Hsu Wen-cheng walked away from a high salary and prestigious teaching job to work in primary healthcare in his hometown of Lotung. After decades of enthusiastic, humble work, Hsu was named one of the first six Honored Alumni of National Taiwan University.

The world at war

Before he could ever think of saving a life, this devoted medical student from Taiwan had to look death in the face. In his third year at Fuji, the Pacific was engulfed in war, and the Japanese military sent many older students in the humanities division to serve in "kamikaze" suicide attack squadrons. Older students in the science division were sent for half a year to work in military factories and "provide help and encouragement."

"Because new students had to live on campus, there was real camaraderie," recalls Hsu. He saw many brilliant, successful students go into the kamikaze squadrons never to return-an experience that showed him the cruelty and senselessness of war.

The next year, Hsu enrolled in the medical school of Nagoya Imperial University. Not long after the end of the war, he returned to Taiwan to continue his studies as a third-year student at the Medical College of National Taiwan University, taking classes with well-known professors such as Tu Tsung-ming, Tung Ta-cheng, Wei Huo-yao, and Yeh Shu. Yeh Shu, who had taught at Chiba Medical College, maintained a demanding but open style of teaching that left a deep impression on Hsu.

Professor Yeh was known for his rigorous teaching style, and few students were able to pass his courses in their first try, leaving the rest to retake his examinations. When Hsu Wen-cheng sought out Yeh to retake his examination, he found him just as he was about to drive home. Yeh had Hsu ride home with him and take an oral exam in the car-much to his surprise, it was on this ride that Hsu passed his course in pathology.

Tough years of battling epidemics

Right after the end of the war, many Japanese with technical and professional training were forced to return to Japan, emptying out many important fields of work in Taiwan. Moreover, the war destroyed many parts of the country's infrastructure and wrecked local economies. In this environment, gaps developed in Taiwan's ability to attend to public health services and meet the challenges presented by new outbreaks of communicable diseases that had been kept under control during the period of Japanese rule, such as tuberculosis, malaria, cholera, Japanese encephalitis, and plague. When he saw a serious cholera epidemic racing through his hometown in 1947, Hsu Wen-cheng organized a dozen classmates from National Taiwan University into a team that assisted other NTU doctors based at Ilan Provincial Hospital with work in examining patients, promoting public education, and disinfection and disease prevention.

"Out in front of Poh-Ai Hospital's current location there used to be an irrigation channel where everyone would wash their clothes. They had no idea that this was only spreading the cholera virus all the faster, and within two or three days the outbreak was out of control," recalls Hsu. The terrible state of affairs in his hometown in those days-followed only the next year by an outbreak of rabies-spurred on Hsu's resolve to serve others.

At that time, a medical degree from NTU guaranteed a good reputation, a high salary, and very high social status. Many NTU-trained doctors stayed on at National Taiwan University Hospital (NTUH) as clinicians or teachers. Others followed Tu Tsung-ming to work at Kaohsiung Medical University, while some went to the United States and Japan for more advanced training. Only a handful of graduates went back to their home areas to put their knowledge to work.

(right) In the 1960s Hsu Wen-cheng (center) brought together members of the local medical association to provide mobile medical care for Aboriginal and poor people in remote areas. Their work could be seen even on the barely accessible Turtle Mountain Island.

A childhood dream

In the palm of your hand, the soap gives off a mild floral fragrance. It takes Hsu Wen-cheng back to when he was 12 years old, carrying a suitcase and bedroll, sitting on the steerage deck of a boat from Keelung and bound for a new life as a student in Japan. At such a young age, Wen had only vague ideas of what Japan, then Taiwan's colonial ruler, was really like. Nonetheless, he was completely set on becoming a doctor.

"When I was young, medical services in Ilan were very backward. You could only find optometrists, pediatricians, and dermatologists. Even at Ilan Hospital, the region's most comprehensive care center, the only surgery they could do was appendectomies-for any other serious conditions, patients were sent to Taipei." Just to seek treatment for her asthma, one of Hsu's aunts had to make monthly trips from Lotung to Ilan for a five-or six-hour train ride to Taipei. Because of situations like this, Hsu's father and aunt both hoped he would study medicine.

After graduating from Lotung Public Elementary School in 1935, Hsu Wen-cheng went to Japan, arriving in Kyushu after a four-day steamer trip. Hsu laughs as he thinks back on the journey he took some 70 years ago: "Even though I was so seasick that I could hardly eat or sleep, I was filled with such delight and curiosity on this first trip abroad that I forgot all the hardships. It also gave me some training for when I went to work among the indigenous peoples of Taiwan. No matter how many curvy, bumpy mountain roads we drove on, I never got carsick."

At that time, the Japanese school system required students who wanted to study at a college of medicine to first be accepted into an upper secondary school. Wen studied at the private Jinsei Gakuen Middle School in Kagawa Prefecture, Shikoku. With a limited number of places available at only 34 upper secondary schools in Japan, Hsu put tremendous effort into his studies, sometimes splashing ice water on his face to keep himself awake as he worked late into the winter night. He finally won acceptance to Fuji Upper Secondary School on the central island of Honshu, becoming only the third Jinsei Gakuen student in 50 years to be accepted to an upper secondary school.

Before he graduated, Hsu was faced with a tough decision of whether to return home to work or to take on a clinical and teaching post at NTUH. Just a few words from his father settled the matter: "Your hometown needs you!" Hsu resolved to return to Lotung to practice basic, primary-level medical care and, with the support of his family, to start a new hospital.

Innovating in treatment and research

At this time, Ilan had a desperate shortage of medical workers and virtually no specialized care-no medical technologists, no anesthesiologists, and certainly no trained nurses. Doctors had to do it all, shouldering these different tasks at once.

Many people suffered from tuberculosis in the 1940s and 1950s, and primitive traditional methods of diagnosis by listening to breathing often meant that patients were not diagnosed until they were seriously ill. To provide early treatment, Hsu Wen-cheng got together the money to buy a mobile X-ray machine. He provided accurate diagnoses using X-ray films, and also brought in equipment to perform blood, urine, and fecal tests to monitor the effectiveness of antibiotic treatments.

At that time the road and rail network in eastern Taiwan was undeveloped and many people were too poor to afford medical care. Thus few doctors were willing to work in the area. In 1954, in response to the Ministry of National Defense's demand for physicians, the Taiwan Medical Association required doctors at regional hospitals to periodically serve in the military. During one of these stints Hsu invited doctors from the National Defense Hospital and Veterans Hospitals to help out at Poh-Ai.

With the assistance of Hsu Tzu-chiu, then director of Taiwan's Department of Health, in 1962 Poh-Ai Hospital started a three-year cooperative education project with Kyoto University to improve healthcare standards. This was one of the first efforts to promote international cooperation with hospitals in Taiwan. Kyoto University sent lecturers in obstetrics, thoracic surgery, orthopedics, and general surgery. Thanks to this exchange program, Poh-Ai was the first hospital in Taiwan to perform endoscopies and became a leader in this type of examination.

"The doctors sent from Kyoto University went on rounds and discussed issues at least twice every week," says Hsu. "We learned so much from them." With clinical experience, Hsu wanted to expand his knowledge of theoretical research. Because he often went into mountainous areas to do medical work, especially in Nan-ao and Tatung townships inhabited by Atayal tribal groups, in 1966 Hsu decided to apply to NTU to reasearch the anthropology of the Atayal people, working under the guidance of Yu Chin-chuan, a professor of anatomy.

In his three and a half years of research, every Saturday and Sunday he took the winding Taipei-Ilan Highway to Taipei for classes. "At lunchtime on the weekends, I would buy two boxed lunches, and take turns at the wheel with the driver while we both ate." In 1969 he published an article titled "Anthropological Researches on the Atayal Tribe." An anthropological study written by a medical professional, it was a rare work of scholarship. At that time, Taiwan had no procedures for approving doctoral dissertations, so Hsu sent the work to Japan's Nagasaki University, which awarded him a PhD in medicine.

Turning to public service

Taiwan's government instituted a workers' health insurance system in 1950 and extended coverage to military, public sector, and educational personnel in 1958. Although these policies led to a large-scale expansion of healthcare work in Taiwan, many people still had no access to these types of insurance, and many people still suffered for lack of money to pay for healthcare. Working with his elder brother and fellow doctor Lo Wen-tang, Hsu Wen-cheng decided to expand the scope of Poh-Ai Hospital's charity and pro bono services. Hsu even donated the inheritance left to him by his father to establish in 1969 a charitable organization he called the Lo Hsu Foundation.

Beyond medical care, the foundation increased work on services to low-income clients, community health education, and medical subsidies. It also provides free hospital in-patient care for poor children, and brings together members of the local medical association to provide mobile medical care for Aboriginal and poor people in remote areas. Their work could be seen even in the barely accessible Turtle Mountain Island

Lo Wen-tang and Hsu Wen-cheng are respected members of the medical profession and political world in Ilan; Lo was once selected by President Chiang Ching-kuo as one of his ten "friends among the people." But people often ask why, as brothers, they have different surnames. Hsu explains that when their paternal grandfather married, he went to live in the home of his wife's family. (Traditionally, the bride lives with the groom's family.) Since his wife's family was surnamed Lo, their son (Hsu Wen-cheng's father) was given the name Lo-Hsu A-long. During the era of Japanese rule in Taiwan, however, the authorities would not allow a person to use two surnames, so their father gave his sons different surnames depending on their birth order: odd numbers were named Lo, and even numbers were named Hsu.

In 1962 Poh-Ai Hospital started a cooperative education project with Kyoto University, a breakthrough for such international projects among hospitals in Taiwan. Hsu Wen-cheng (right) personally met doctors from Kyoto University at the train station.

The world at war

Before he could ever think of saving a life, this devoted medical student from Taiwan had to look death in the face. In his third year at Fuji, the Pacific was engulfed in war, and the Japanese military sent many older students in the humanities division to serve in "kamikaze" suicide attack squadrons. Older students in the science division were sent for half a year to work in military factories and "provide help and encouragement."

"Because new students had to live on campus, there was real camaraderie," recalls Hsu. He saw many brilliant, successful students go into the kamikaze squadrons never to return-an experience that showed him the cruelty and senselessness of war.

The next year, Hsu enrolled in the medical school of Nagoya Imperial University. Not long after the end of the war, he returned to Taiwan to continue his studies as a third-year student at the Medical College of National Taiwan University, taking classes with well-known professors such as Tu Tsung-ming, Tung Ta-cheng, Wei Huo-yao, and Yeh Shu. Yeh Shu, who had taught at Chiba Medical College, maintained a demanding but open style of teaching that left a deep impression on Hsu.

Professor Yeh was known for his rigorous teaching style, and few students were able to pass his courses in their first try, leaving the rest to retake his examinations. When Hsu Wen-cheng sought out Yeh to retake his examination, he found him just as he was about to drive home. Yeh had Hsu ride home with him and take an oral exam in the car-much to his surprise, it was on this ride that Hsu passed his course in pathology.

Right after the end of WWII, gaps developed in Taiwan's disease prevention efforts. When a cholera epidemic broke out in Lotung, this irrigation channel in front of Poh-Ai Hospital was a major conduit for spreading the deadly virus.

In the course of his work, Hsu saw that healthcare policy in Taiwan often favored large hospitals over small and cities over small towns, and that private clinics that provided primary care regularly lacked resources and could not meet the needs of their patients, which meant that even small illnesses could become serious problems for lack of timely treatment. In his two terms as speaker of the Ilan County Council and in his work in the 1980s as a member of the Control Yuan, Hsu often gave input to the Department of Health on rural healthcare issues, and contributed to the passage of the Medical Treatment Act.

The enactment of the Medical Treatment Act in 1986 finally gave the government the legal basis on which to regulate healthcare organizations throughout Taiwan. The act was particularly important in providing the legal framework for regulating the development of, and allocating resources to, primary care clinics, and also laid the foundation for a national healthcare system.

Facing new challenges

In 1987, after stepping down from his post in the Control Yuan, Hsu Wen-cheng took up new projects to serve his hometown, actively seeking out new healthcare resources for Ilan.

In the early years after WWII, Taiwan enjoyed very strong relations with Saudi Arabia, with Taiwan frequently sending agricultural and medical care teams there. Cessation of formal diplomatic relations in 1986 meant that NTU medical teams' plans to travel to Saudi Arabia were cancelled. Seeing an opportunity, Hsu Wen-cheng invited the NTU team to Lotung Poh-Ai Hospital, and the following year signed a cooperation plan with NTU. These efforts greatly improved healthcare standards in Ilan and the surrounding areas and brought a complete set of specialized medical services to the region. In 1994, for example, Poh-Ai Hospital completed the first cornea transplant at a hospital in the Ilan region. The hospital has also undertaken a series of collaborations with national-level teaching hospitals such as Taipei Veterans General Hospital, Chang Gung Memorial Hospital, and National Yang-Ming University Hospital. All of this work has made it possible for patients in the Ilan region who suffer from serious conditions to seek medical treatment near their home, rather than traveling long distances for such care.

In 1994, the introduction of the National Health Insurance (NHI) program completely changed Taiwan's healthcare environment. "In the past, the relationship between doctors and patients was very simple," says Hsu. "Saving lives and curing sickness was the doctor's only job. In this new healthcare environment, however, doctors' roles moved in new directions. Hospitals were charged not only with providing patients with the best medical services, but also with undertaking business management, cost analysis, and resource conservation. Only by meeting the strict payment standards enforced by the NHI program could hospitals find a way to develop."

The NHI system places a variety of restrictions on hospitals. The completion of the Hsuehshan Tunnel in June 2006 made travel between Ilan and Taipei much easier-but the results could be double-edged for Ilan's healthcare professionals.

The medical community generally agrees that most patients with medical emergencies need to be treated as soon as possible. With the long and arduous trip from Ilan reduced to a few hours' trip by car, however, patients could easily be sent to major treatment centers in Taipei once their condition stabilizes. This new system could present real challenges to medical institutions in Ilan.

Hsu Wen-cheng sees things differently, however. He argues that the completion of the tunnel means that specialists from Taipei will be more willing to travel to Ilan to provide treatment, which, in turn, would increase the quality of local healthcare. "If the quality of healthcare can be improved, then even though 20% of patients with serious illnesses will come to Taipei for treatment, patients from eastern Taiwan will still go to Ilan for treatment. Moreover, with better transportation, there will be more tourists and visitors, and some of those people will end up needing to seek treatment in Ilan. In any case, we will have our work cut out for us."

A Taiwan Mayo Clinic

Tough years of battling epidemics

Right after the end of the war, many Japanese with technical and professional training were forced to return to Japan, emptying out many important fields of work in Taiwan. Moreover, the war destroyed many parts of the country's infrastructure and wrecked local economies. In this environment, gaps developed in Taiwan's ability to attend to public health services and meet the challenges presented by new outbreaks of communicable diseases that had been kept under control during the period of Japanese rule, such as tuberculosis, malaria, cholera, Japanese encephalitis, and plague. When he saw a serious cholera epidemic racing through his hometown in 1947, Hsu Wen-cheng organized a dozen classmates from National Taiwan University into a team that assisted other NTU doctors based at Ilan Provincial Hospital with work in examining patients, promoting public education, and disinfection and disease prevention.

"Out in front of Poh-Ai Hospital's current location there used to be an irrigation channel where everyone would wash their clothes. They had no idea that this was only spreading the cholera virus all the faster, and within two or three days the outbreak was out of control," recalls Hsu. The terrible state of affairs in his hometown in those days-followed only the next year by an outbreak of rabies-spurred on Hsu's resolve to serve others.

At that time, a medical degree from NTU guaranteed a good reputation, a high salary, and very high social status. Many NTU-trained doctors stayed on at National Taiwan University Hospital (NTUH) as clinicians or teachers. Others followed Tu Tsung-ming to work at Kaohsiung Medical University, while some went to the United States and Japan for more advanced training. Only a handful of graduates went back to their home areas to put their knowledge to work.

Before he graduated, Hsu was faced with a tough decision of whether to return home to work or to take on a clinical and teaching post at NTUH. Just a few words from his father settled the matter: "Your hometown needs you!" Hsu resolved to return to Lotung to practice basic, primary-level medical care and, with the support of his family, to start a new hospital.

"Managers' attitudes and outlooks will decide the level of healthcare services," says Hsu. After devoting his entire life to medicine, Hsu hopes that Lotung Poh-Ai Hospital can follow the path of the United States' Mayo Clinic-another hospital created by small-town doctors that became a world-renowned institution-to become Taiwan's Mayo Clinic.

According to Hsu, the Mayo Clinic was founded in the late 1800s by William Worrall Mayo and his sons. Beginning in a small town in the state of Minnesota, after more than a century of careful management the Mayo Clinic is now the best-established, most highly specialized, and largest-scale comprehensive hospital system in the world, with a staff of 45,000 that includes a variety of healthcare specialists and scientists.

Poh-Ai is similar to Mayo in many respects, and in the future it will expand its range of services to include medical care, teaching, research, and other health-related activities, with the hope of achieving the same high level of performance.

After an interview lasting over three hours, the 84-year-old Hsu Wen-cheng is sharp as ever, enough to make one wonder how he stays in such good health. He says, "If you want to stay alive, you have to keep moving." In the past few decades, he has kept up his usual regime of jogging for 30 to 60 minutes a day, and often runs from his house to work at the hospital. When it rains, he uses a treadmill at home.

His persistence is much like his desire to serve his hometown. Even if new eras present new problems, Hsu's boundless enthusiasm as a doctor gives him the energy to overcome any new challenge.

This man, known as the Albert Schweitzer of Ilan, not only opened the most modern hospital in the Ilan region with the highest standards of care, but also provided a model for the next generation of doctors to plant the seeds of positive change.

Innovating in treatment and research

At this time, Ilan had a desperate shortage of medical workers and virtually no specialized care-no medical technologists, no anesthesiologists, and certainly no trained nurses. Doctors had to do it all, shouldering these different tasks at once.

Many people suffered from tuberculosis in the 1940s and 1950s, and primitive traditional methods of diagnosis by listening to breathing often meant that patients were not diagnosed until they were seriously ill. To provide early treatment, Hsu Wen-cheng got together the money to buy a mobile X-ray machine. He provided accurate diagnoses using X-ray films, and also brought in equipment to perform blood, urine, and fecal tests to monitor the effectiveness of antibiotic treatments.

At that time the road and rail network in eastern Taiwan was undeveloped and many people were too poor to afford medical care. Thus few doctors were willing to work in the area. In 1954, in response to the Ministry of National Defense's demand for physicians, the Taiwan Medical Association required doctors at regional hospitals to periodically serve in the military. During one of these stints Hsu invited doctors from the National Defense Hospital and Veterans Hospitals to help out at Poh-Ai.

With the assistance of Hsu Tzu-chiu, then director of Taiwan's Department of Health, in 1962 Poh-Ai Hospital started a three-year cooperative education project with Kyoto University to improve healthcare standards. This was one of the first efforts to promote international cooperation with hospitals in Taiwan. Kyoto University sent lecturers in obstetrics, thoracic surgery, orthopedics, and general surgery. Thanks to this exchange program, Poh-Ai was the first hospital in Taiwan to perform endoscopies and became a leader in this type of examination.

"The doctors sent from Kyoto University went on rounds and discussed issues at least twice every week," says Hsu. "We learned so much from them." With clinical experience, Hsu wanted to expand his knowledge of theoretical research. Because he often went into mountainous areas to do medical work, especially in Nan-ao and Tatung townships inhabited by Atayal tribal groups, in 1966 Hsu decided to apply to NTU to reasearch the anthropology of the Atayal people, working under the guidance of Yu Chin-chuan, a professor of anatomy.

In his three and a half years of research, every Saturday and Sunday he took the winding Taipei-Ilan Highway to Taipei for classes. "At lunchtime on the weekends, I would buy two boxed lunches, and take turns at the wheel with the driver while we both ate." In 1969 he published an article titled "Anthropological Researches on the Atayal Tribe." An anthropological study written by a medical professional, it was a rare work of scholarship. At that time, Taiwan had no procedures for approving doctoral dissertations, so Hsu sent the work to Japan's Nagasaki University, which awarded him a PhD in medicine.

Turning to public service

Taiwan's government instituted a workers' health insurance system in 1950 and extended coverage to military, public sector, and educational personnel in 1958. Although these policies led to a large-scale expansion of healthcare work in Taiwan, many people still had no access to these types of insurance, and many people still suffered for lack of money to pay for healthcare. Working with his elder brother and fellow doctor Lo Wen-tang, Hsu Wen-cheng decided to expand the scope of Poh-Ai Hospital's charity and pro bono services. Hsu even donated the inheritance left to him by his father to establish in 1969 a charitable organization he called the Lo Hsu Foundation.

Beyond medical care, the foundation increased work on services to low-income clients, community health education, and medical subsidies. It also provides free hospital in-patient care for poor children, and brings together members of the local medical association to provide mobile medical care for Aboriginal and poor people in remote areas. Their work could be seen even in the barely accessible Turtle Mountain Island

Lo Wen-tang and Hsu Wen-cheng are respected members of the medical profession and political world in Ilan; Lo was once selected by President Chiang Ching-kuo as one of his ten "friends among the people." But people often ask why, as brothers, they have different surnames. Hsu explains that when their paternal grandfather married, he went to live in the home of his wife's family. (Traditionally, the bride lives with the groom's family.) Since his wife's family was surnamed Lo, their son (Hsu Wen-cheng's father) was given the name Lo-Hsu A-long. During the era of Japanese rule in Taiwan, however, the authorities would not allow a person to use two surnames, so their father gave his sons different surnames depending on their birth order: odd numbers were named Lo, and even numbers were named Hsu.

In the course of his work, Hsu saw that healthcare policy in Taiwan often favored large hospitals over small and cities over small towns, and that private clinics that provided primary care regularly lacked resources and could not meet the needs of their patients, which meant that even small illnesses could become serious problems for lack of timely treatment. In his two terms as speaker of the Ilan County Council and in his work in the 1980s as a member of the Control Yuan, Hsu often gave input to the Department of Health on rural healthcare issues, and contributed to the passage of the Medical Treatment Act.

The enactment of the Medical Treatment Act in 1986 finally gave the government the legal basis on which to regulate healthcare organizations throughout Taiwan. The act was particularly important in providing the legal framework for regulating the development of, and allocating resources to, primary care clinics, and also laid the foundation for a national healthcare system.

Facing new challenges

In 1987, after stepping down from his post in the Control Yuan, Hsu Wen-cheng took up new projects to serve his hometown, actively seeking out new healthcare resources for Ilan.

In the early years after WWII, Taiwan enjoyed very strong relations with Saudi Arabia, with Taiwan frequently sending agricultural and medical care teams there. Cessation of formal diplomatic relations in 1986 meant that NTU medical teams' plans to travel to Saudi Arabia were cancelled. Seeing an opportunity, Hsu Wen-cheng invited the NTU team to Lotung Poh-Ai Hospital, and the following year signed a cooperation plan with NTU. These efforts greatly improved healthcare standards in Ilan and the surrounding areas and brought a complete set of specialized medical services to the region. In 1994, for example, Poh-Ai Hospital completed the first cornea transplant at a hospital in the Ilan region. The hospital has also undertaken a series of collaborations with national-level teaching hospitals such as Taipei Veterans General Hospital, Chang Gung Memorial Hospital, and National Yang-Ming University Hospital. All of this work has made it possible for patients in the Ilan region who suffer from serious conditions to seek medical treatment near their home, rather than traveling long distances for such care.

In 1994, the introduction of the National Health Insurance (NHI) program completely changed Taiwan's healthcare environment. "In the past, the relationship between doctors and patients was very simple," says Hsu. "Saving lives and curing sickness was the doctor's only job. In this new healthcare environment, however, doctors' roles moved in new directions. Hospitals were charged not only with providing patients with the best medical services, but also with undertaking business management, cost analysis, and resource conservation. Only by meeting the strict payment standards enforced by the NHI program could hospitals find a way to develop."

The NHI system places a variety of restrictions on hospitals. The completion of the Hsuehshan Tunnel in June 2006 made travel between Ilan and Taipei much easier-but the results could be double-edged for Ilan's healthcare professionals.

The medical community generally agrees that most patients with medical emergencies need to be treated as soon as possible. With the long and arduous trip from Ilan reduced to a few hours' trip by car, however, patients could easily be sent to major treatment centers in Taipei once their condition stabilizes. This new system could present real challenges to medical institutions in Ilan.

Hsu Wen-cheng sees things differently, however. He argues that the completion of the tunnel means that specialists from Taipei will be more willing to travel to Ilan to provide treatment, which, in turn, would increase the quality of local healthcare. "If the quality of healthcare can be improved, then even though 20% of patients with serious illnesses will come to Taipei for treatment, patients from eastern Taiwan will still go to Ilan for treatment. Moreover, with better transportation, there will be more tourists and visitors, and some of those people will end up needing to seek treatment in Ilan. In any case, we will have our work cut out for us."

A Taiwan Mayo Clinic

"Managers' attitudes and outlooks will decide the level of healthcare services," says Hsu. After devoting his entire life to medicine, Hsu hopes that Lotung Poh-Ai Hospital can follow the path of the United States' Mayo Clinic-another hospital created by small-town doctors that became a world-renowned institution-to become Taiwan's Mayo Clinic.

According to Hsu, the Mayo Clinic was founded in the late 1800s by William Worrall Mayo and his sons. Beginning in a small town in the state of Minnesota, after more than a century of careful management the Mayo Clinic is now the best-established, most highly specialized, and largest-scale comprehensive hospital system in the world, with a staff of 45,000 that includes a variety of healthcare specialists and scientists.

Poh-Ai is similar to Mayo in many respects, and in the future it will expand its range of services to include medical care, teaching, research, and other health-related activities, with the hope of achieving the same high level of performance.

After an interview lasting over three hours, the 84-year-old Hsu Wen-cheng is sharp as ever, enough to make one wonder how he stays in such good health. He says, "If you want to stay alive, you have to keep moving." In the past few decades, he has kept up his usual regime of jogging for 30 to 60 minutes a day, and often runs from his house to work at the hospital. When it rains, he uses a treadmill at home.

His persistence is much like his desire to serve his hometown. Even if new eras present new problems, Hsu's boundless enthusiasm as a doctor gives him the energy to overcome any new challenge.

This man, known as the Albert Schweitzer of Ilan, not only opened the most modern hospital in the Ilan region with the highest standards of care, but also provided a model for the next generation of doctors to plant the seeds of positive change.