In fact, this "beacon of Eastern Taiwan" has existed in Hualien for half a century. Today, as Taiwan's health care resources are growing ever more abundant, how will the Mennonite Hospital change? And as the health care system moves towards competition and commercial-style management, how will it uphold its beliefs and principles?
When we come to the Mennonite Christian Hospital in early December, a huge Christmas tree stands in the middle of the foyer of the newly completed hospital building. At the registration counter, in the consulting rooms, at the payment counter, at the pharmacy and even in the staff offices, everywhere is festooned with colored streamers, snowflakes and fairy lights. Instead of the cold, depressing atmosphere usually associated with hospitals, the place is full of the warm and festive spirit of Christmas.
If the surroundings at the Mennonite Hospital have a religious flavor, its people are even more of a religious bent.
Acts of sacrifice and giving are part of everyday life at the Mennonite Hospital, not anything out of the ordinary. The seven doctors and nurses who have received the Department of Health's Medical Dedication Award over the years, and former superintendent Dr. Roland Brown, who received the rare honor of the Order of the Brilliant Star with Violet Grand Cordon from President Lee, are all indicative of the Mennonite Hospital's "house style."
The Mennonite Church is one of the many branches of Protestant Christianity. It advocates peace and stresses a life of "service to the Lord." In keeping with these principles, the missionary doctors and nurses who come here see the Mennonite Hospital as an "altar of devotion" and all work quietly to do good. Dr. Roland Brown, the hospital's American founder, dedicated his whole career to poor, remote Hualien. It was only four years ago that he finally retired and returned to the United States at the age of 68.
Half a century
Mennonite medical missionaries have been in Taiwan for half a century-since 1948, when the Mountain Area Evangelism Committee of the Presbyterian Church in Taiwan invited the General Conference Mennonite Church in the US to organize a medical team to come and do relief work among Taiwan's aboriginals.
Fifty years ago, they started out as a mobile medical team, then opened a clinic in a rented former aluminum foundry; later, they built a 35-bed hospital. Today, the Mennonite Christian Hospital is a regional teaching hospital with 300 acute care beds, 200 long-stay beds and over 600 medical staff.
For five decades the Mennonite Hospital has grown with Taiwan, while giving it the most practical help.
In the first eight years of its existence, the hospital adopted a "dollar a patient" policy. For any consultation or treatment, up to and including surgery, the charge was NT$1. Luo Chi-mei of the hospital's development office explains that the reason for making this symbolic one-dollar charge, rather than simply providing free treatment, was to foster an attitude of not wasting limited medical resources.
In those difficult years, especially in the poor mountain areas of Hualien County, malnutrition was widespread. In 1961, the Mennonite Hospital set up "milk stations" in many villages, and the more than 10,000 children who passed these milk stations on their way to school each morning could all get a glass of milk to supplement their diets.
In 1973, to carry its services to aboriginals living deep in the mountains, the hospital set up a medical station in the remote mountains of Yuli Township, to strengthen health education and so improve conditions in the community.
Mennonite vs. Tzu Chi
Combining medicine with evangelism has always been one of the Mennonite Hospital's aims. But with economic prosperity and social progress, standards of medical care in Taiwan have risen continuously, with the trend towards specialization and commercialization. This has inevitably created difficulties for many Christian hospitals which are founded on religious principles and regard themselves as charitable institutions.
Because of Taiwan's growing prosperity, financial assistance to the Mennonite Hospital from the Mennonite Church in the US has continuously been reduced. And once the foreign missionaries began to grow old and return home, yet with most local Taiwanese doctors unwilling to go to out-of-the-way Hualien, patients also gradually began to turn away from the hospital, with its aging facilities and obviously stretched personnel.
Ten years ago, a brand new 1000-bed teaching hospital-the Tzu Chi Buddhist General Hospital-was built in Hualien County. The 30-year-old, three-story Mennonite Hospital building, with its leaking roof and moldy walls, appeared decrepit and cramped by comparison.
Long-serving nurse Hsu Jen-hsiu recalls how at that time, because of the state of the Mennonite Hospital's facilities, many people deserted it in favor of the Tzu Chi Hospital, even some medical staff. "Ambulances would take patients to the Tzu Chi without even asking," she says. At that time, it was more or less only gynecology and pediatrics patients who stayed loyal to the Mennonite Hospital.
The hospital's principles sometimes bring it into conflict with the world around it. In some cases these conflicts have been insuperable, and over time they have grown more acute. One such clash led it to close down its nursing school.
In 1953 the Mennonite Hospital opened a nursing school which recruited over 200 local Hualien people-mostly aboriginal girls-to train, free of charge, as nurses. But although the school would have had the dual advantage of supplying the hospital with qualified nurses and helping local aboriginal girls, because the hospital was unwilling to register it with the government, it had to close down.
Development office director Chou Tien-hung explains that at that time, regulations required government-registered schools to include military training in their curricula. But this went against the Mennonite principle of pacifism, and since there was no way to reconcile this principle with the regulations, the hospital saw no other choice than to close the school, thus losing its own source of nurses.
With shrinking funds, falling patient numbers and reduced human resources, and with founding superintendent Roland Brown about to retire and return to the USA, if the Mennonite Hospital was to survive, its managers had no choice but to pay great attention to cost and efficiency, and this caused disappointment to many people. Hsu Jen-hsiu recalls that five or six years ago, the hospital moved towards implementing commercial management techniques, and cost became a consideration in everything. The former ideals of being guided by faith in Jesus and putting the patient first were all gone.
For example, says Hsu, for patients' convenience the hospital used to do vaccinations on Sundays and holidays just as on other days, but later this generous practice was abandoned to give doctors and nurses their days off. Hsu, who at the time was nursing supervisor, disagreed so strongly with the direction the hospital was taking that she left temporarily in disgust.
Redefining its mission
For a time, closing the hospital down was even considered. Chou Tien-hung says this was discussed for five years, but in the end they saw there was a need in society for geriatric and chronic care. This enabled the Mennonite Christian Hospital to redefine its mission, and it decided to update its facilities and make a new start.
"The places society leaves out in the cold are precisely the places a church hospital should bring its warmth to." Chou Tien-hung says that because National Health Insurance payments for long-stay beds are rather low, most hospitals are unwilling to provide them, since they operate at a loss. Therefore the Mennonite Hospital planned to expand its original 300 beds to 500, with the additional 200 beds all being long-stay beds; the shortfall in finance for long-stay care would be covered by the operating surplus from the acute outpatients department.
Furthermore, the Hualien and Taitung area has an aging population, with senior citizens accounting for over 10%, the third highest proportion in Taiwan. In response to this need, the Mennonite Hospital also plans to build a "Mennonite Retirement Community" for the old people of the Hualien area.
Medical vice-superintendent Chang Kuang-hsiung observes that the hospital's goals for the future are different from its past ones. In the past, when most people couldn't afford medical treatment, the church hospital bridged the gap; now that the National Health Insurance system is in place, in a situation where most hospitals base their operating policy on the NHI payment rates for different treatments, the non-profit-oriented Mennonite Hospital can concentrate on medical work which others are not interested in doing, which the government does not see the need for, but which society needs.
After the Mennonite Hospital set itself these new development goals, its superintendent, Dr. Roland Brown, went back to the US on a fundraising mission, but with limited success. After the new OPD building was finished in 1991, there was no money to continue with the rest of the planned building works, so they could not be started.
To overcome this problem, the hospital changed its old "softly softly" approach, and began asking the outside world for donations.
In 1991 the Mennonite Hospital set up a department devoted to fundraising-the development office-and began fundraising activities within the ROC. To raise funds, Dr. Brown reluctantly began accepting media interviews, in order to raise public awareness of the hospital. But it was not until 1993, when Huang Sheng-hsiung, an eminent neurosurgeon at Philadelphia's Thomas Jefferson University Hospital, returned at Dr. Brown's request to take over as superintendent, that the Mennonite Hospital's fortunes began to revive.
Looking for a way forward
Huang Sheng-hsiung, a Christian himself, first became involved with the Mennonite Hospital in 1986. Then an associate professor in neurosurgery at Thomas Jefferson University, he worked there for a month as a volunteer. That short stay was an experience unlike any he had had before, and also planted the seeds of his returning to work in the ROC seven years later.
Huang says that previously when he had gone to work or teach in countries with low standards of medical care, he had always stayed in hotels or missionaries' homes. It was only at the Mennonite Hospital that he was given a domitory room, on the fourth floor. Drenched in sweat after struggling up four flights of stairs with his luggage, on opening the door he was met by a blast of hot air: in the heat of August, the only cooling in the room was an electric fan. "For the first time I felt I was on an equal footing with everyone else, and that I had not come to give alms," says Huang.
He recalls how one day he was invited for a meal by Dr. Brown, and Mrs. Brown asked him to open a can for her. It was then that he discovered that because of Hualien's damp air, Mrs. Brown had rheumatism, and with swollen joints in all her fingers she had no strength in her hands; Dr. Brown also had painful hands. "That they, who are not related to us in any way, could devote themselves to us in this way, was both moving and shaming for me." Huang says this was when he made a quiet decision that he would not go on being a "deserter," but that one day, sooner or later, he would come back to serve in Taiwan.
Four years ago, before Dr. Brown retired as superintendent, he approached Huang Sheng-hsiung. With little hesitation, Huang promised to take over.
When Huang took over, the Mennonite Hospital was in the middle of a crisis of survival. The first problem he had to face was where the huge sum of NT$600-700 million for the building projects was to come from. He recounts: "Dr. Brown wrote 26 letters to international charitable organizations asking for funds, but 25 of them wrote back saying: 'We want to spend our money somewhere poorer, but we wish you every success.'" Huang realized that seeking help from overseas was not a workable option, and he would have to look for another way forward.
It was when Huang was invited onto Chang Hsiao-yen's TV variety show that he found this way forward. Chang asked him why it was that in the past she had never heard of the Mennonite Hospital. Huang replied that the Bible says "don't let your right hand know what your left hand is doing," so for many years the hospital had been doing the Lord's work unobtrusively, without blowing its own trumpet. But Chang Hsiao-yen said: "That's no good, it's too selfish. You should give everyone a chance to participate."
"I was very grateful to her for pointing this out!" Huang says that social resources are "public," and the Mennonite Hospital's appeals for donations are based on need. Also, he wants to be "fair" and "open," so apart from a small amount of necessary expenditure on publicity, all the money raised must be put to medical use.
Striving to localize
After the National Health Insurance system came into effect, the Department of Health required all church hospitals to be incorporated. Hence not only would their finances and assets be open to scrutiny, but also the number of foreign nationals on their boards of directors could not exceed one third. This has given church hospitals no choice but to follow the path of "localization."
Dr. Roland Brown was always reserved and unwilling to trouble others, but at his retirement party he could not help saying: "Before I go I have one request. I've given my whole life to the Chinese, and my father gave 40 years to the Chinese too. Are you willing to give a little money for your own brothers, to let this hospital keep on helping poor patients?"
Not only funding had to be localized: as the missionary doctors grew old and returned home, the hospital would have to look for its staff locally too.
At present the Mennonite Hospital has around 30 full-time attending physicians; eight of these have been recruited back from the US by Huang Sheng-hsiung over the last two years. "Recruiting doctors from the US is a short-term strategy," says Huang-the real solution is to find local people to take over the work, and to pass responsibility for the hospital into the hands of local people.
Taitung's Logefeil Memorial Hospital, another Christian hospital, once put out an appeal with the slogan "Taiwan's Christians, where are you?" It insisted on employing only Christian doctors, and would rather go short-staffed than break this rule.
In Huang Sheng-hsiung's view, religious belief is certainly not obligatory for physicians wanting to work at the Mennonite Hospital. "If you love God and want to spread His gospel, that's all the more reason to work together with different people."
Although the Mennonite Hospital does make not faith a requirement, it has nonetheless long suffered a continuous shortage of staff. In its internal newsletter Living Waters, one can often see such words as these: "Everyone please keep on praying for a solution to our shortage of surgeons." Chou Tien-hung says that at present, apart from a serious lack of surgeons, the hospital is also short of internists.
Huang Sheng-hsiung says with emotion that interns from American medical schools come all the way to Taiwan to gain experience at the Mennonite Hospital, but Taiwanese doctors regard Hualien as the back of beyond, and even interns are none too willing to come to the hospital. "In fact, we have an excellent medical team which can train them very well," says Huang with deep regret.
Help us to help you
With Huang Sheng-hsiung's intense effort and encouragement, over the last two or three years eight Taiwanese doctors have returned from the US to work at the Mennonite Hospital, and this has gone a long way to relieving its shortage of physicians. The public fundraising campaign has also bolstered its finances, so it can go on pursuing its goals.
It seems that after going through a rough patch, the Mennonite Christian Hospital, once known as the "beacon of Eastern Taiwan," is working hard at its own renaissance. Yet in the view of some long-standing members of its staff, the old spirit which they love to speak of is gradually fading.
OPD nursing supervisor Chen Hsiu-lien has deep and fond memories of the hospital's past. "In the old days our doctors and nurses treated the patients like family, but now there are so many people you don't recognize someone even if you've seen them before." Chen says that in the early days, the nurses washed, dressed and fed the patients, but from the 1970s onwards these tasks were gradually given over to patients' families.
"Times have changed," says Chen Hsiu-lien, unable to suppress a sigh. In the past, the doctors were in the hospital 24 hours a day, but now it is sometimes hard to get hold of the on-call doctors; in the past, if blood was in short supply doctors and nurses would give their own, but now there is no longer that kind of spirit. . . .
As an incentive to doctors, the Mennonite Hospital has introduced a "payment by results" system. Apart from a small number of newly recruited doctors who have guaranteed salaries, most are paid according to their workload. In other words, the more patients they treat, the higher their salaries.
But the hospital's last remaining US missionary doctor, Christopher Luez, is dubious of this system. He believes it must inevitably affect the quality of treatment and lead to patients' rights being disregarded, and that it also goes against what has always been the Mennonite Hospital's basic spirit, that of putting the patient first.
In order to find a middle path between idealism and pragmatic considerations, says development office director Chou Tien-hung, the hospital is now seeking to redress the balance by working out limits for the number of patients doctors treat.
Eternal pressure
"This is one of the dilemmas facing Christian hospitals today," says Chou Tien-hung. Some believe they should not give up the religious principles of loving and helping others; but others feel they ought to adjust their management style in accordance with social demands. But although there are conflicts and doubts, Chou says: "The existence of these tensions and conflicts is a good thing"-he believes they show that during the process of change which the hospital is undergoing, its staff are continuously thinking about the role they should be playing.
Over the past 50 years, several dozen foreign missionary doctors and nurses have dedicated their youth and their love to the Mennonite Hospital, but today there is only one missionary left there. With fewer and fewer "role models," it is evidently getting harder and harder to motivate people with appeals for "sacrifice."
"Although the spirit of sacrifice and dedication is growing ever weaker, we hope it will not disappear too quickly," says Chou Tien-hung. Though the Mennonite Christian Hospital is changing from a "charitable institution" to a "medical institution," many of its staff hope that its missionary spirit can survive forever.
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In December, the Mennonite Christian Hospital is full of the festive atmosphere of Christmas, expressing its thoroughly Christian spirit.
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As the health care environment changes, church hospitals are inevitably confronted with a conflict between their missions as "charitable institutions" and as "medical institutions." The Mennonite Hospital is no exception.
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The Mennonite Hospital's founding superintendent Dr. Roland Brown dedicated his whole career to Hualien. Here he is seen as a young man, treating a patient. (courtesy of the Mennonite Christian Hospital)
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Returning to Taiwan to take over the administration of the Mennonite Hospital in a time of crisis, Huang Sheng-hsiung was faced with the dual challenge of raising funds to finance the hospital's expansion plans, and recruiting doctors onto its staff.
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Faced with the scarcity of resources in the mountain regions, the mobile medical team often had to perform operations in the open air. (courtesy of the Mennonite Christian Hospital)
The missionaries' will to serve could not be thwarted by even the most rugged terrain. In the early days, to bring medical relief to remote areas, they often scaled mountains and forded rivers. (courtesy of the Mennonite Christian Hospital)
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In the early days the missionary doctors mainly treated aboriginal patients and had no fixed clinic facilities-they could only provide mobile treatment services. (courtesy of the Mennonite Christian Hospital)
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In an age of advertising and publicity, the Mennonite Hospital cannot be left out. Here is a series of ads for its planned retirement community.
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To carry its services to aboriginals living deep in the mountains, the Mennonite Hospital gradually set up medical stations all around the area. The one pictured here is at Hejen on the Su-ao to Hualien Highway.
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"On this fair coast edged by foaming waves, We will sing of mountains high and rivers long." This has been the Mennonite Hospital's promise to Hualien for half a century.
Returning to Taiwan to take over the administration of the Mennonite Hospital in a time of crisis, Huang Sheng-hsiung was faced with the dual challenge of raising funds to finance the hospital's expansion plans, and recruiting doctors onto its staff.
Faced with the scarcity of resources in the mountain regions, the mobile medical team often had to perform operations in the open air. （courtesy of the Mennonite Christian Hospital）
The missionaries' will to serve could not be thwarted by even the most rugged terrain. In the early days, to bring medical relief to remote areas, they often scaled mountains and forded rivers. （courtesy of the Mennonite Christian Hospital）
In the early days the missionary doctors mainly treated aboriginal patients and had no fixed clinic facilities--they could only provide mobile treatment services. （courtesy of the Mennonite Christian Hospital）
In an age of advertising and publicity, the Mennonite Hospital cannot be left out. Here is a series of ads for its planned retirement community.
To carry its services to aboriginals living deep in the mountains, the Mennonite Hospital gradually set up medical stations all around the area. The one pictured here is at Hejen on the Su-ao to Hualien Highway.
"On this fair coast edged by foaming waves, We will sing of mountains high and rivers long." This has been the Mennonite Hospital's promise to Hualien for half a century.
