Taiwan and Swaziland Linked by Love: The Story of the TMU Medical Mission

Medical resources are extremely scarce in the landlocked southern African country of Swaziland. There are less than 10 hospitals of appreciable size in the whole country, and the sole university there offers only nursing and midwifery programs. With no medical school, most of the country's doctors are brought in from abroad.

Taiwan and Swaziland enjoy close ties. The currently reigning monarch, King Mswati III, has visited Taiwan 12 times over the last 14 years. And in September 2007, the two countries signed a medical cooperation agreement in Taipei, in which Taiwan promised to station a full-time medical mission in Swaziland starting in 2008 to help elevate the quality of healthcare in the country.

The program is run by the International Cooperation and Development Fund. It assigns medical staff to address the urgent healthcare-needs list provided by Swaziland's Ministry of Health and the Mbabane Government Hospital. The ROC Embassy, meanwhile, provides local guidance and direction. The Taiwanese medical mission was at first organized by the Changhua Christian Hospital, but in 2009 the responsibility was taken over by Taipei Medical University. Currently there are 12 members: five doctors, one nurse, one secretary, and five young men who have chosen overseas aid work as an alternative to their compulsory military service.

In addition to everyday clinical healthcare services, this Taiwan-Swaziland medical technology cooperation program offers rural mobile medical services, childhood nutrition improvement, and parasite checkup programs, and helps develop and promote public health work. Each year it also sends three Swazi medical personnel to TMU to undergo professional training, nurturing the seeds of improved healthcare for Swaziland.

As a Swazi child holds a soccer ball donated by Taiwan, his face breaks out into a hearty smile.

Though many aspire to take part in this international healthcare program, it's not an easy proposition. This stems from several challenges. First, Swaziland is over 11,000 kilometers from Taiwan, requiring transfers in Hong Kong and Johannesburg, making for a long, arduous journey of well over 24 hours. Also, for the medical mission to be stationed permanently, the members need to sign contracts for a minimum of six months, unable to return to Taiwan and be with their families during the entire period.

What's more, because of the rampant HIV situation there, the medical staff are exposed to a high degree of risk.

"Before coming to Swaziland, I didn't know what part of the world it was in," says TMU Hospital orthopedist Shih Ying-chieh, who served two stints in Swaziland during an 18-month period in 2009 and 2010. He admits that the first time he joined the medical mission, he was less than enthusiastic about it.

At that time, Shih had just passed the orthopedist licensing exam, and was quite ecstatic about it, thinking that after 10 years of study and perseverance he had finally become a fully fledged attending physician. But just as he was anticipating exhibiting his skills, he was asked by TMU Hospital's director of orthopedics if he was willing to accept assignment to the medical mission.

He knew this was a great opportunity, but didn't know what changes it would create in his future. Compounding this were the great distance between the two countries, the risk of HIV infection, and the opposition of his girlfriend and mother, making the decision extremely hard. In the end, not wishing to break with TMU Hospital, where he had already spent eight years as a medical student, Shih accepted the position, and served for nine months.

Wu Yanting, a family practitioner and member of the TMU medical team, examines and treats a local child.

Knowing that Swaziland is in Africa, one may think of sweltering 40-50°C summer heat and barren desert vistas. But the reality is quite different. Swaziland, known as the "Switzerland of Africa," boasts a pleasant four-season climate and stunning vistas.

But behind its superb geography and scenery, this landlocked country, sandwiched between South Africa and Mozambique, has the world's highest HIV carrier rate.

Amid this crisis, frontline medical staff who come into contact with patients must be mindful at all times of self-management of health and hygiene. In practice, Taiwanese medical staff members have no choice but to assume that the patient thay are working with is a carrier. Entering the operating room is like going into a war zone: each time they have to prepare as if going to battle. After scrubbing down with soap and iodine, they don two layers of surgical gloves, put on waterproof plastic bibs to guard against sprays of blood, wear full-cover safety glasses and slip on high-top rubber rainboots, all to prevent accidental infection.

Despite these precautions, some TMU medical mission members have endured harrowing HIV infection scares.

Mission leader Tu Chi-cheng, who has served in Swaziland for three years, was suturing a patient after cranial surgery when he accidentally jabbed his hand with the needle. This was a cause of great anxiety for him. And when Shih Ying-chieh was implanting a bone pin in a teenage girl, he pricked his finger, leading to a two-week bout of fear and depression.

Surgeon Mu Xiaochong was treating a man who had a deep laceration on the bridge of his nose. When cleaning the wound, the patient suddenly sneezed, spraying Mu's eyes with blood. He rushed to wash his eyes thoroughly with clean water, and treated himself with preventive drugs. And once, head nurse Ji Lihua, though always a punctilious sort, got liquid splashed into her eyes when washing surgical equipment, prompting her to immediately rinse them out with large quantities of clean water.

Thankfully, after being screened and waiting for the appropriate time window to elapse, none of the team members turned out to be infected.

To prevent HIV infection, the Taiwanese medical staff have to prepare as if going to battle, donning two layers of surgical gloves, wearing full-cover safety glasses and surgical masks, and slipping on high-top rubber rainboots, all to prevent accidental infection. To the right is ear-nose-and-throat specialist Lee Fei-peng.

Swaziland has a severe shortage of medical resources. The wards of Mbabane Government Hospital, the country's biggest hospital, lag behind Taiwan's county hospitals by three decades: there are not enough surgical supplies, materials or equipment, and no MRI scanners. The only CAT scanner is one donated by Japan 20 or 30 years ago, but it had been inoperable for who knows how many years; after the TMU medical mission found it languishing in the corner of a storeroom, covered with dust, it was refurbished and put back to use.

To the Taiwanese doctors, who are used to using high-precision instruments and tests, the greatest challenges of practicing medicine in shortage-wracked Swaziland are figuring out how to exercise the imagination and being able to respond to unforeseen circumstances.

When he had just begun serving at the Mbabane Government Hospital, Tu Chi-cheng, a neurosurgeon, was preparing to perform surgery on a patient with a head injury, but after searching through the entire hospital he was unable to find the proper instrument for drilling holes in the skull. Fortunately, he had been stationed in Malawi beforehand, so he was familiar with medical shortages in Africa and had prepared a box of medical instruments to carry around with him. In the box he had a hand drill, a hacksaw and a scalp clamp.

So Tu bored the required holes in the patient's skull with the hand drill. He experienced muscular fatigue after drilling all four holes, but he pushed himself to complete the surgery, which, thankfully, was successful. Not long afterwards, the patient recovered and was released from the hospital. Later, Tu bought an electric masonry drill, which he practiced repeatedly with back at the dorm on a thin wooden board while also training his physical strength. He uses it now during surgery.

The hospital also lacked specially made ligature thread, so Mu Xiaochong had no choice but to use more expensive surgical thread. He cut it into short lengths to economize.

As for the frequent gallstone patients, ideally all that would be needed is to open three or four one-centimeter incisions in the abdomen, and remove the gallbladder with an endoscope. But Mbabane Government Hospital lacks the requisite equipment, so Mu has to resort to traditional cholecystectomy, making a long incision in the abdomen, removing the gallbladder, and then closing the incision.

When Shih Ying-chieh first arrived, he often treated patients with degenerative arthritis, but was hampered by Mbabane Government Hospital's lack of components for artificial joints.

One day, Shih and the hospital's head nurse searched the storeroom and found a box of materials left behind by European doctors over a decade before. Inside were over a dozen cobalt alloy artificial hip joints, but the medium sized ones had been used, leaving only large and small ones. He sterilized these materials and carefully used them in eight artificial hip replacement surgeries, alleviating the pain suffered by chronic arthritis patients and restoring their ability to walk.

Given Swaziland's lack of medical resources, residents of remote villages line up early to see the doctor whenever they hear of a visit by the Taiwan medical team.

Swazis who live in remote villages often have to make arduous journeys to see the doctor, walking two or three hours to a local clinic. Afterwards, it will often be late in the day, and with no money for the ride home, they end up sleeping in the hospital corridor, recovering strength overnight and going home the next day. One patient with an untreated broken femur lay in the hospital for three months without moving; it was only after the TMU medical mission arrived and treated him that he was able to go home.

The Mbabane Government Hospital had no system for managing medical histories. So the TMU medical mission specially designed a computerized medical history system for them, with data for each Swazi patient, including name, sex, birthdate, village headman, an ID number, and medical history including which specialists (oral surgery, neurology or neurosurgery, general surgery, infectious diseases, etc.) they have seen. This has been a major undertaking in Swaziland's healthcare history.

In his book Under The White Gown, Taiwan's ambassador to Swaziland, Peter Tsai, notes that if a Swazi citizen has to undergo cranial or open heart surgery due to serious illness, he or she must be sent by ambulance to Johannesburg, 400 km away, for treatment, a journey of at least four hours and often at a total cost of over NT$1 million. This is a substantial burden for the Swazi government.

In the three-plus years that the Taiwan medical mission has been stationed in Swaziland, the team completed Swaziland's first full artificial hip replacement and cervical disc resection. Medical mission leader Tu Chi-cheng is the only neurosurgeon in the region able to insert a ventriculoperitoneal shunt, and so far has carried out over 200 cranial surgeries.

Indeed, the Taiwan medical mission is so highly trusted that they have been assigned to monitor the health of the king, the king's mother and other members of the royal family. Furthermore, TMU Hospital has donated 80 hospital beds, an EKG machine, and computers to Mbabane Government Hospital.

The efforts of the Taiwan medical mission members have not only boosted Swaziland's medical resources, but have also communicated the spirit of sacrifice and contribution of these white-gowned heroes from Taiwan, cementing the two countries' strong ties with love. This is illustrated by the lyrics of "We Are Now Family": "No matter where we come from, we are here together." Love has shortened the distance between the peoples of these two lands.

Orthopedist Shih Ying-chieh treats a Swazi patient suffering from degenerative arthritis.