In a Taiwan hospital, a group of non-uniformed workers weave back and forth among the hospital rooms pushing wheelchairs, turning patients, making their beds and assisting with their bath and meals. They are neither professional nurses nor errand runners, but rather private aides who are hired by the patients' families. Often family members themselves go to the hospital to care for the patient. Otherwise aides are hired to administer the non-professional care that is not customarily provided by the hospital.

Taiwan's system of patient care is different from that of the West, where aides are employed by the hospital itself. Chinese aides are not hospital employees. They were originally hired by wealthy families to accompany a family member in the hospital. An aide would be recommended by another aide or a hospital messenger. The first hospital aides were neither organized nor managed. Their ability and qualifications were often uncertain, and their actions at times questionable. Aides were sometimes known to be rude to patients, or steal their money or belongings.

To protect their reputations, hospitals began in the seventies to organize offices which would control, manage, and sometimes help train privately hired hospital aides. In addition, with a recent rise in the number of families which can afford to hire aides, hospital aide centers have been established to recommend aides. Taipei now has over 29 centers, managing over 2000 aides. Among these, Christian Friends, Enkuang and Junghsin are the largest, each managing around 400 to 500 aides.

When a patient needs an aide, the patient or family provides the center with details of the illness, and the age, sex, language, etc. of the patient in order to match them with an appropriate worker. Patients may speak Mandarin, Taiwanese, Japanese or English, and are thus matched with aides who speak the same language. As Ch'en Tsai-ming, president of the Christian Friends aide center explains, young adults get along best with aides of similar age. Elderly people most appreciate assistance from a sweet, amiable type aide, while children are best matched with motherly types. If the patient is large and heavy, and will require frequent turning or transport, male aides are recommended.

Ch'en feels that women aides naturally tend to be more careful. In addition, the families of female patients tend to request female aides. Thus, most hospital aides are women.

Established in 1967, Christian Friends was the earliest of Taiwan's hospital aide centers. Ch'en Tsai-ming explains that the motivation for its establishment came when his wife was sent to the hospital with cancer. While tending to his wife, Ch'en was outraged at the impatient attitudes demonstrated by some of the hospital aides toward their patients. When his wife passed away Ch'en, then retired from military service, organized a group of 18 fellow Christians to go to hospitals and act as aides free of charge for those patients without families or the means to hire aides.

Ch'en gradually expanded the group, and recruited non-affiliated, paid workers. The center soon became a well administered and regulated organization which served to introduce paid hospital aides to patients, collecting a small percentage of their earnings. Some aides are still provided free of charge to those with sufficient proof that they do not have family or friends to care for them, nor the means to hire an aide.

Aside from aides, most hospital aide centers also provide special nurses. Trained, licensed and experienced, they are qualified to give injections, take blood pressure and do other tasks which require special training. As such professional services are already provided by hospitals, special nurses are most frequently hired to care for the patient after leaving the hospital.

Hospital aides may be given twelve hour day shifts, twelve hour night shifts or 24 hour shifts according to their preference. As family members usually care for the patient at night after work, day-shift hospital aides are in greatest demand. Most aides themselves prefer day shifts, but some may choose the night shifts, which tend to be more relaxed.

Wages for a patient's care are paid every three days, directly to the aide. Five percent is paid to the hospital aide center, and five percent to the hospital. Although the work is tiring, three day shifts allow for a rest period in between.

Because of their constant exposure to illness and bacteria, aides must maintain their health and resistance. While working hours are long, it is important that they get an adequate amount of rest when they go home. Many centers require their aides to have periodic health examinations.

Many hospital aides are housewives whose children have grown up, leaving them time to seek employment. They usually take on the work out of financial necessity. The only requirements for being an aide are a primary school education and an age between 20 and 50.

As hospital aides require neither professional training nor capital, many view their work as a part-time, temporary or side job. Thus, the job turnover rate is high, and quality of work difficult to regulate.

Recently, in order to better regulate hospital care and insure patient safety, many hospitals have contracted with the larger-scale aide centers. When patients need an aide they go directly to the center for referral. The center is then responsible for the attitudes and behavior of its workers.

While not all hospitals have formal contracts with hospital aide centers, they all advise patients to call a reputable center for a reference. Smaller, self-advertising centers are not always reliable. Similarly, aides usually prefer to find work by the convenient means of an aide center.

Because hospital aide centers are directly responsible to the hospital for the actions of their aides, center regulations are numerous. For example, aides are prohibited from bringing friends or children to the hospital while they are working in order to prevent them from disturbing the patients. They are not allowed to interfere with the domestic affairs of the patient, or openly discuss the nature of the patient's illness. The larger centers also have dress regulations.

To enforce regulations and maintain service quality, hospital service centers send investigators to the hospitals to make out reports on the attitudes and service of each aide. Most reports are based on observations made by hospital nurses, patients and patients' families.

Taiwan has seen an increase in hospital management and training of aides. This has been accompanied by the growth of hospital aide centers which serve to organize and regulate workers. Both represent concerted efforts to provide Taiwan's hospital patients with reliable, quality care.

(Jill Ardourel)

[Picture Caption]

1. An aide affectionately chats with a patient. 2. Taiwan University Hospital aide, Huang Man-tzu has cared for brothers Chung Jen and Chung I for the past five years.

1. Feeding ill or infirmed patients is one of the hospital aide's duties. 2. A hospital aide assists in a patient's finger therapy exercise. 3. An aide covers a patient's eyes as part of a reaction test.

Infirmed patients need the constant attention and care of aides.

2. Taiwan University Hospital aide, Huang Man-tzu has cared for brothers Chung Jen and Chung I for the past five years.

1. Feeding ill or infirmed patients is one of the hospital aide's duties.

2. A hospital aide assists in a patient's finger therapy exercise.

3. An aide covers a patient's eyes as part of a reaction test.

Infirmed patients need the constant attention and care of aides.