In a hospital examination room an elderly woman is asked what dialect she speaks. Upon her reply a hospital technician, accustomed to his patients' broad range of dialects, patiently explains the examination procedure in the woman's native tongue.

In another room 82-year old Chang lays on a bed awaiting an endoscope exam. As a long black tube is inserted into his mouth, Chang is comforted by the soothing words of the doctor.

Chang and his wife left Taiwan 20 years ago to live with their son in California. At their son's suggestion they came back to Taiwan for a two day full physical examination. During their two days at the hospital they had the chance to chat with many of the other patients being examined, and discover that a considerable number of them had also returned from abroad for the exam.

According to a previous estimate, 25% of the 20,000 physical exam patients at Taipei's Veterans General Hospital are Chinese living abroad. Most are from Hong Kong and Macau. Others are from Southeast Asia, America and Canada.

The phenomenon of overseas Chinese coming to Taiwan for a physical examination began when hospitals decided to provide physical exams which required that the patient stay at the hospital for a number of days. According to Dr. Wang Cheng-yi of the National Taiwan University Hospital (T'aita), physical examinations in Taiwan may be grouped into two categories: in-hospital exams and outpatient exams. The simpler outpatient exams, used mainly for health certificates and various applications, include blood pressure, eyesight and colorblindness tests, and determination of blood type. They may also involve a blood test, urine test and chest x-ray. Such exams are given at physicians' offices, hospitals and public health clinics.

The more complete in-hospital exam such as that given to the Chang's began in 1963 when T'aita set up a physical examination ward. Dr. Hsu Ch'eng-jen, the man responsible for its establishment explains that in-hospital exams were originally given in the internal medicine ward. The practice of mixing healthy examinees with sick patients was popular with neither party. At that time in-hospital exams were extremely time-consuming, often requiring that the patient stay in the hospital for two or three weeks. Because the patient had to wait in line with all the other patients for each separate exam, length of stay could be neither predicted nor controlled. It eventually became clear that such a system was not only an uneconomical use of hospital beds, but a great inconvenience to working patients as well.

After consideration and planning, T'aita arranged for six first-class hospital rooms to be used solely for physical examinations, and patients' length of stay was reduced to six days. Patients were pleased with this arrangement, and as their numbers grew, so did the number of hospitals offering this type of in-hospital exam.

At that point an interesting phenomenon occurred. For many years, overseas Chinese returning to Taiwan to see friends and family have also taken the opportunity to see to their physical ailments. This is partly because treatment standards in Taiwan are among the highest in east Asia, and fees are much lower than in Japan, Europe or the U.S. Patients soon realized that staying and eating at the hospital for the week during a physical examination was cheaper than staying in a hotel. Some would check into the hospital as soon as they stepped off the plane. At night and in-between exams they would go out to visit friends, buy gifts or run errands. After a week of socializing, with business completed and gifts purchased, they were ready to leave the hospital and fly home.

But seven years ago, such a vacation was no longer possible. With pressures of time and patient numbers, exams became more concentrated and the hospital stay was reduced to three days. In the last three years hospitals have adopted more efficient examination rotation procedures to further reduce the time to two days.

As the two day stay allows more working people the opportunity to have an in-hospital exam, demand has steadily grown. Most appointments require about a two week wait. During the fall, however, when the number of Chinese returning from abroad is particularly high, patients must make their appointments as early as four months in advance.

In-hospital examinations include tests of the functioning of all the major organs. All hospitals on Taiwan test basically the same things, although their methods may vary. In general, a complete exam includes a statement of medical history, examinations of eyes, ears, nose and throat by specialists in these areas, a kidney test, urinalysis, blood test for blood sugar, white blood cells, platelets and hepatitis B, x-rays of the chest, abdomen and gall bladder, endoscope, sigmoidoscope, electrocardiogram and blood pressure tests, and a gynecology or urology exam.

In terms of test results, dental problems rank the highest of all patient maladies. 90% of those examined are determined to have tooth calculus, gingivitis or caries. 60-70% of all those examined suffer from hemorrhoids. High blood pressure and atherosclerotic heart disease are also not uncommon.

Less than 1% of those examined are found to have serious diseases. Some feel that the minute number of serious diseases discovered is not worth the time and money invested on exams. But Dr. Lai Mei-shu of T'aita points out that as Taiwan does not use a family practice system, few people will see the same doctor from childhood to old age. Their records (if still available), are spread out over a number of clinics and hospitals. As doctors aren't aware of their patients' complete physical condition, specific health problems may be overlooked without regular general examinations.

Current fees for a complete two day in-hospital physical exam run from around US$275 to US$325. Although it may not seem low to a common wage earner in Taiwan, it is considerably lower than in the U.S., where the same tests may run over $800 (the cost of a flight to Taiwan plus the exam). Because of the lower price and the chance to see relatives, many overseas Chinese choose to be examined in Taiwan.

There are also other reasons for the choice. One is language. Most people prefer to discuss their ailments in their native tongue. In addition, certain illnesses particularly common to Chinese, such as those related to the liver and naso-pharynx, tend to receive extra attention in a Chinese hospital. All these factors help to explain why those who have come to Taiwan for a physical examination will continue to return again and again.

(Jill Ardourel)

[Picture Caption]

1. A patient discusses health care with a nurse in the courtyard outside his room. 2. Another patient has a gall-bladder x-ray. 3. An experienced internal medicine physician leads a first-year resident in an endoscope exam.

The physical examination ward is equipped with instruments and equipment for examinations by various specialists: 1. an ear, nose and throat examination 2. an eye examination.

Before leaving the hospital, patients are visited by a doctor who informs them of the general results of the examination.

2. Another patient has a gall-bladder x-ray.

3. An experienced internal medicine physician leads a first-year resident in an endoscope exam.

The physical examination ward is equipped with instruments and equipment for examinations by various specialists: 1. an ear, nose and throat examination.

2. an eye examination.

Before leaving the hospital, patients are visited by a doctor who informs them of the general results of the examination.