Another Taiwan Miracle
With the deep roots put down by ROC medical teams stationed in foreign nations and the free assistance provided by mobile medical teams, as well as the positive personal experiences of foreign medical personnel who have received training here and foreign patients who have received treatment here, Taiwan is developing a well-earned international reputation for high-quality medical care.
In April of 2010, an ROC medical team in São Tomé and Príncipe learned about two badly burned seven-year-old children with adhesions. If not handled immediately, there was a fear that amputations would be required or the children’s lives would be put at risk. With a lack of burn specialists locally, the Ministry of Foreign Affairs arranged for the children to be brought to Taiwan for treatment. It also arranged for training in aftercare and rehabilitation for medical personnel that came with the children.
Marc Hsu, the director of the Bureau of International Cooperation at the Department of Health, points out that transnational medical treatment is unimaginably expensive, making the steps taken for those two children exceptional.
Based on humanitarian considerations, the ROC provides medical assistance to allied nations as a matter of course, but Taiwanese medicine, due to its high quality and low cost, has also long attracted many foreign patients who pay their own way.
NTUH has treated significant numbers of foreign patients since 1990. Chen Ming-fong, the superintendent of NTUH, explains that early on most of these patients were overseas Chinese from Southeast Asia. In recent years they’ve been coming from all over the world.
Most of the foreigners seeking treatment at the hospital last year were from Asia and mainland China (59%), the Americas (25%) and Europe (7.5%).
In October of 2011, an 18-month-old baby from Ho Chi Minh City in Vietnam suffering from biliary atresia (congenital obstruction of the bile ducts) was brought to Taiwan for treatment. Her parents had originally planned to bring the girl to Singapore for a liver transplant, but gave up on that plan when they learned it would cost the equivalent of nearly 10 million NT dollars. On a friend’s introduction, they went to NTUH for the procedure instead. The operation was extremely successful and it only cost one-third of what it would have cost in Singapore.
The Chang Gung Memorial Hospitals, which are known for their advanced medical care, have treated the most foreign patients.
Cheng Ming-huei of the group’s flagship hospital in Linkou notes that the hospital treats several thousand foreigners as outpatients and nearly 1000 as inpatients each year. These represent about 5% of the hospital’s patients. Linkou CGMH has an excellent international reputation and frequently provides infertility treatments, endoscopic surgery, umbilical cord blood transplants, and plastic surgery (including lymphatic reconstruction, breast reconstruction, and repairs of cleft palate and microtia) to foreign patients.
A professor of plastic and reconstructive surgery, Cheng was the first doctor to use vascularized lymph node transfer to prevent lymphedema after the removal of cancerous lymph nodes. The paper he authored on the topic for Plastic and Reconstructive Surgery, a major international journal, attracted even more foreign patients to seek treatment with him.
Cheng explains that treatment for breast or cervical cancer may require the removal of lymph nodes (lymph node dissection) or radiation treatments that lead to tissue fibrosis. These results may in turn cause blockages that prevent the lymphatic system from returning the interstitial fluid to the thoracic duct and then to the bloodstream, where it is recirculated back to the tissues. Instead, the fluid builds up locally, leading to swelling in the upper or lower limbs that impedes patients’ capacity to move and exercise. With vascularized lymph node transfer, wherein a flap of skin is transplanted along with three or four lymph nodes, the “pumping action” that spurs the circulation of the lymphatic system returns.
Jaing Tang-her, a hematology-oncology specialist in the Pediatric Department at Linkou CGMH, is well known for his expertise with cord blood transplants.
In 2003 the Hematology-Oncology group at CGMH obtained the DOH’s permission to proceed with human trials in carrying out umbilical cord blood transplants between non-relatives. In 2005 the prohibition on human trials for cord blood transplants was lifted, and in the years since the team has performed 96 of these procedures, using non-relative cord blood transplants to treat thalassemia, leukemia, acquired immunodeficiency syndrome, osteopetrosis, and aplastic anemia. Quite a few of these patients were foreigners who were transferred from hospitals overseas.
Jaing points out that CGMH’s rate of success with cord blood transplants is nearing 90%. Every year about 10 patients come from each of Malaysia, mainland China and India. “The Indian patients come on the recommendations of Indian doctors who have come to Taiwan for training,” explains Jaing. “Malaysian patients, on the other hand, are coming via word of mouth from patients who have been successfully treated at the hospital.” Currently, there are three foreign patients at the hospital who have already successfully had the procedure, and another seven who are waiting for transplants.
A 10-year-old boy from Malaysia first came to the hospital in February 2012 for a cord blood transplant. It was unsuccessful, but his family wasn’t discouraged and they came in September for a second transplant. This time it was extremely successful, and he will leave the hospital soon, when his condition fully stabilizes. His mother, overjoyed that her child is leaving behind a life of constant blood transfusions and shots, exclaims, “Dr. Jaing, thank you so much for letting my son be reborn!”
Stories like these play out frequently at Taiwan’s major hospitals.
In the National Geographic Channel’s documentary Taiwan’s Medical Miracle, one-year-old Iya from Dubai, who was suffering from biliary atresia, flew to Kaohsiung CGMH for a liver transplant. Meanwhile, an Egyptian surgeon named Solimen, who lost his ability to operate after losing portions of two fingers to a stray bullet during the Arab Spring, came to Linkou CGMH for microsurgery that reconstructed the fingers with material taken from his feet.
A leader in foreign medical aid
“Whether from the standpoint of meeting global responsibilities or of raising national visibility, the medical community here should be providing international medical assistance,” argues Chen Ming-fong, superintendent of NTUH. Taiwan has a lot of experience worth sharing with other nations, including in areas such as infectious disease control, acute care, assessments, medical records management, and so forth.
But Chen admits that there are potential pitfalls: “Providing international services is something that medical centers ought to be doing, but if you put too much emphasis on it you run the risk of being attacked for not focusing enough on your main mission of meeting the medical needs of Taiwan. You’ve got to strike the right balance.”
“Taiwan is the priority,” says CGMH’s Cheng Ming-huei, who believes that providing international medical services need not diminish domestic medical resources. “In fact, with the payment structure imposed by the National Health Insurance system, the possibility of providing care to foreigners outside of that framework will help to keep good doctors in Taiwan!”
NTUH’s Chen explains that Taiwan’s hospitals are not allowed to advertise their medical services. “Nevertheless, foreign medical assistance is like an intangible form of advertising that informs people about the high level of medical care in Taiwan,” he notes proudly. “Exporting medical services is an ideal representation of Taiwan!”