守護南迴的心跳

超人醫師徐超斌
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2019 / 5月

文‧鄧慧純 圖‧林格立


「身為醫界的一員:我鄭重地保證將奉獻一切為人類服務;病人的健康與福祉將為我的首要顧念。」──2017年〈日內瓦宣言〉

台灣的偏鄉有如此一位醫師,恪守著「病人的健康與福祉是醫師的首要顧念」,甚至燃燒自己,將生命全然投入,在工作崗位中風倒下後,他仍撐著尚能運動的右半側繼續行醫,他是南迴地區的超人醫師——徐超斌。

 


 

「超人醫師」名稱其來有自。在南部人北漂,台東人逐工作而居,東西南北亂漂時;畢業於台北醫學院,經歷奇美醫院急診室完整歷練的徐超斌卻選擇東漂回故鄉,用精湛的醫術守護故鄉的族人。看見部落的欠缺,他像超人一般拚搏的用生命看護家鄉族人的健康;像超人一般奔馳巡迴各地診治醫療,一個星期的車程逼近環台一周的里程數1,173公里。

那些關於南迴地區的數字

在徐超斌服務的偏鄉,時間和交通的概念與都會很不同。在南迴地區,常常說到隔壁一趟,是翻過一個山頭的意思,去一趟7-11,開車要半小時。部落裡沒有公共運輸,上市場買菜包車單趟500元,到鄉公所辦事收費700元,到台東市區看病要價1,500元。

南迴公路全長一百多公里無一間醫院。2002年徐超斌回鄉服務時,達仁鄉的人口數計4,141人,醫生僅他1位。當地居民繳交與都市相同的健保費用,但周間晚上和周六、周日不能生病,因為沒有看診服務。

2006年,在徐超斌的努力下,總算在南迴公路上的大武鄉成立了第一間24小時急救站,但他依舊維持著一個月400小時的超人工作時數;2006年9月19日凌晨1點,徐超斌已經連續值班80個小時,他在大武急救站處理完最後一位病人,準備稍事休息時,卻在值班室中昏眩倒下,再次醒來時,身體左半側已癱瘓失去功能,那年他才39歲。

學醫是為了回家

出身台東縣達仁鄉土坂部落,徐超斌10歲被父親送到都市求學,直到35歲才回故鄉,但他與部落的臍帶未曾被切斷。他算是另類的隔代教養案例,父親忙於工作及照顧體弱的母親,徐超斌被託給外公外婆照顧,「我的教育環境是父母親給我的,但人格教育則來自外公外婆。外婆是排灣族的巫醫,她告訴我排灣族的神話故事,我們是很有智慧的民族,讓我因身為排灣族而驕傲,外公教導我,做人要勇敢、要謙卑、要善良,是他給我的身教。」也因此,徐超斌總是自信且驕傲,不覺得原住民就矮人一截。

從求學到工作,徐超斌都是團體中的風雲人物,長得帥氣,熱情風趣,能彈吉他唱歌帶動氣氛,又是運動健將,還醫術高明,待人和善,徐超斌不諱言,當年的他很自負,「大家都會覺得這個傢伙很臭屁,卻不讓人討厭,就因為有真本事。」徐超斌這樣形容當年的自己。

在台南奇美醫院5年的歷練,徐超斌也是奇美醫院第一位內外科兼修的急診專科醫師,人生正處最顛峰的時期;但徐超斌卻辭了西部收入豐厚的醫院工作,決定回到東岸的家鄉。

「其實我掙扎有半年之久。我也是普通人,我知道薪水、生活環境的落差非常大。」但想起當醫師的初衷,「我是為了要回家才學醫的」,那年他才7歲,二妹因為送醫不及而過世,年幼的他對著黑夜發誓,「將來我要當醫生,不再讓族人在送醫途中枉死。」

視病如親的醫病關係

回到家鄉,任職台東縣達仁鄉衛生所,他發現部落急需夜間及假日看診服務,便開始以建置24小時急救站為目標,並在夜間、周末加開門診,延長診療時間,方便民眾就醫。偏鄉醫生只有一位,幾乎所有的班表都他一個人包辦,他自恃年輕,一個月工作超過400小時。問他怎能操勞至此,徐超斌卻反問,「你有徹夜看金庸小說的經驗嗎?常常一入迷,驚覺就已經凌晨4、5點了。」滿懷壯志也「樂在其中」的徐超斌,終於在2006年成立24小時的大武急救站,讓偏鄉的夜晚,病人不再求助無門。

但同年,徐超斌也因過勞導致腦中風,雖被救回一命,卻失去了身體左半邊的自主。

僅休息半年,心情還是在谷底,徐超斌卻心繫故鄉的族人,回到工作崗位。但他躊躇、忐忑,擔心病患看到肢障的醫師心裡做何感想;卻沒想到迎來的是一張張期盼、關切的臉,一樣的信任,一樣的依賴,甚至有人指名找徐超斌動手術,話至此,徐超斌苦笑:「我都不知道到底是我太勇敢,還是他們太無懼。」為此,他還努力在工作之餘,訓練自己單手縫合。「是這些病人教會我如何當一個好醫師,我又怎能不用生命去回應他們呢?」

採訪當天,是徐超斌的休假日,我們跟著他走訪位在土坂部落的達仁鄉老人日間照顧服務中心,該中心承辦中重度長者的日間照顧工作。只見徐超斌以排灣族母語跟一位高齡八十多歲的阿嬤親切對談,形同祖孫,兩人不時笑得燦爛。再續往更偏遠的新化文化健康站,此處是他任職衛生所巡迴醫療必經的點,我們抵達時已近中午,許多長者都準備騎車回家了,聽到徐超斌來訪,又把車頭迴轉。阿公阿嬤迎來劈頭就問:「徐醫師,你怎麼那麼久沒來?」大家一起跟徐超斌練習要上台表演的歌曲,空氣中充滿歡笑聲,還一起拍了徐超斌的獨門姿勢「歪頭裝可愛」,長者們口中唸唸有詞的要徐超斌答應至少一個月來社區一次,才一歡而散。

這樣親如家人的醫病關係,讓人動容。在都會區,一名醫生少則看診上百位病人,又要擔心醫療糾紛;但在偏鄉,我們卻親身見證人與人之間最單純的信任與託付。徐超斌問診時,總是親切地與病人聊天問候,話家常,許多病人只吃他開的藥,已經搬到台中的患者還會翻過半個台灣,來找徐超斌看診,「我重視的是他們的生活品質,怎麼樣提高他們的生活品質比平均餘命更重要。」

病後的徐超斌更能感同身受病者的苦痛,更能夠體會病人的焦慮跟無助,他自言:「我更能夠從病人的角度來看待醫病關係,是病後的自己最大的不同。」

「健康是身體的、心靈的、社會的穩定狀況。」徐超斌解釋,在都市,健康是單純的醫療問題,但在偏鄉,健康議題其實是複雜的社會問題,可能包含資源不足、交通、生活習性、文化衝突、低社會地位等因素。而他夢想中的南迴醫院,「是一個與民眾生活息息相關的社區型醫院,它或許買不起昂貴精密的儀器,但它絕對是一個溫暖的空間,讓每一個前來祈求醫治的病體,不僅能解除病痛,更能獲得心靈的撫慰。」

徐超斌超越徐超斌

復健的過程中,徐超斌不只一次問上帝,「為什麼不晚一點?為什麼不等到我完成南迴醫院、完成更多的夢想後再讓我倒下?」他探究上帝的旨意,覺得上帝是要他停下腳步好好思考。他開始不去想他僵硬的左半側,而將眼光放到還靈活的右手右腳。除了繼續在部落巡迴診治外,徐超斌在鍵盤前,用還靈活的右手一字一句敲出他生命的故事,出版《守護4141個心跳》,在社會上掀起大大的迴響。

原本風流倜儻的他,因為過去的鋒芒,不願意出來拋頭露面,卻被編輯的一句話「怎麼不趁這個機會把偏鄉的需要讓更多人知道」所勸動,他開始接受採訪、四處演講,讓偏鄉的困境讓更多人知道。「上帝知道靠我一個人的力量是有限的,祂希望我用社會大眾的愛心跟力量來去完成南迴醫院。」

曾經想放棄嗎?「幾乎每天」,徐超斌說。「我每天都在掙扎,但只要太陽升起,我照鏡子看,發現自己還是很帥,還是可以為部落做一些事情,可以發揮我的剩餘價值,就又能重新奮起,繼續努力。」總是稱自己是最帥的徐超斌,不改幽默。

他發動籌建南迴醫院的計畫,成立「社團法人台東縣南迴健康促進關懷服務協會」(簡稱「南迴協會」),為「醫療財團法人南迴基金會」募款。偏鄉常見的高齡化、隔代教養問題,南迴協會都一肩扛起,執行居家照護服務,陪伴獨居的長者;成立長照中心,對中重度失能的居民提供全日照護;打造方舟教室,進行學童課後輔導,讓部落孩子在面對全球化的大海嘯時,能藉由更豐富多元的課後學習培養自信。

徐超斌從孤身一人,到成立南迴協會,募集了更多人投入南迴地區的照護工作,「我以前再怎麼厲害就是一個醫術還不錯的醫師,願意服務,可是一個人的能力就是有限,現在我可以吸引更多的力量,一起來挹注南迴地區,一起提升醫療、教育的水平,這是以前的我做不到的。」

「你不覺得我已經超越以前那個只能做醫療的我嗎?」採訪結束後,徐超斌的這句話一直盤旋在耳邊。南迴醫院的申請案還在審查途中,但他始終相信台灣民間的力量,能支援南迴醫院的夢想成真。                                                                 

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EN

Guarding Southern Heartbeats

"Super-Doctor" Hsu Chao-pin

Cathy Teng /photos courtesy of Jimmy Lin /tr. by Geof Aberhart

“As a member of the medical profession: I solemnly pledge to dedicate my life to the service of humanity; the health and well-being of my patient will be my first consideration.”—The Declaration of Geneva, 2017

In a remote township in Taiwan there is a doctor who has dedicated his life fully to making the health and well-being of his patients his first consideration. Despite having lost the ability to move his left side after a stroke, he remains as committed to his patients as ever. He is the “super-doctor” of southern Tai­tung County, Hsu Chao-pin.

 


 

To refer to him as a “super-doctor” is hardly without cause. In an age when people from southern Taiwan were drifting northward and those from Tai­tung were heading all over for work, Hsu was an exception. After graduating from Tai­pei Medical University, he headed south to work in the emergency room of Tai­nan’s Chi Mei Hospital before choosing to return home to Tai­tung to put his formidable medical skills to use benefiting the people there. Seeing the indigenous communities suffering a lack of healthcare resources, he made the heroic decision to dedicate himself to the protection of the people’s health, rushing around southern Tai­tung at a nearly super­human rate to provide care. In an average week, he would drive almost the circumference of Taiwan, some 1,173 kilometers.

Southern Taitung by numbers

In serving these far-flung communities, Hsu found both time and distance to be very different concepts from in the cities. In Taitung’s four southernmost townships—Tai­mali, Jin­feng, Dawu and Da­ren—what people call “next door” can be on the other side of a mountain. With no public transportation to speak of in the Aboriginal villages, buying groceries can be a NT$500 taxi ride, going to the township office can cost NT$700, and heading into Tai­tung City to see a doctor can be as much as NT$1,500.

The South Link Highway, connecting Ma­lan in Tai­tung City with Feng­gang in Ping­tung, runs for just over 100 km, and outside of Taitung City there is not a single hospital along the way. When Hsu returned to Tai­tung to work in 2002, the population of Da­ren, the county’s southern­most township, was 4,141, with a single doctor serving them—him. Despite paying the same National Health Insur­ance premiums as their compatriots in the cities, these rural resid­ents couldn’t even see a doctor on weekends or at night because there simply wasn’t anyone there to see.

Thanks to Hsu’s hard work, in 2006 a 24-hour emergency station was set up along the South Link Highway in Dawu Township, but even so, he continued spending a super­human 400 hours a month working. Then, at 1 a.m. on September 19, 2006, having spent 80 hours on duty and just after finishing with his last patient at the emergency station, Hsu collapsed. When he regained consciousness, he found he had lost the use of the left side of his body, having had a stroke at just 39 years old.

Bringing it back home

Born in the Pai­wan village of Tjua­bal (Chinese name Tu­ban) in Da­ren Township, Hsu Chao-pin was sent to the city for school by his father when he was ten years old. He only made it back at age 35, but even after all that time, the ties with home were still strong. “My parents gave me my educational environment,” he says, “but it was my grandparents that taught me who I am. My grandmother was a Pai­wan shaman. She told me the old Pai­wan myths, and taught me that we are a wise people and to be proud to be Pai­wan. My grandfather, meanwhile, taught me to be brave, to be humble, and to be kind.”

Handsome, athletic and personable as well as being a skilled medical practitioner, Hsu was always the center of attention, whether at school or at work.

During his five years at Chi Mei Hospital, he became their first ER specialist to practice both internal medicine and general surgery. He was at the top of his game, but rather than settle for a high-paying hospital job in western Taiwan, he chose to go back to his home in the east.

“Honestly, I struggled with the decision for a good six months,” he says. But in the end, he remembered that he “had studied medicine with the intention of coming home.” When he was just seven years old, one of his younger sisters passed away because she couldn’t get to the hospital in time. He swore to the night skies that he would become a doctor, and that in the future no one else in the village would die needlessly on the way to the hospital.

Treating patients like family

When he got back home, Hsu took up work at the Da­ren Township Public Health Center. He soon realized that local people were in urgent need of nighttime and weekend medical services, and began working toward setting up a 24-hour emergency station, as well as extending his own clinic hours into the night and weekends. Being the only doctor serving in Tai­tung’s four southernmost townships, he had to fill the entire roster himself, but confident in his youth, he would work over 400 hours a month. In 2006, he was finally able to get the Dawu 24-hour emergency station up and running, meaning that those in need at night would no longer be left without help.

That same year, though, Hsu suffered his stroke, caused by overwork. While he made it through alive, he was para­lyzed on the left side of his body.

After taking just six months off to recuperate, and despite still being at a psychological low, he returned to work, as dedicated to serving the people of his home as ever. He was nervous and worried about how patients would take to a physically disabled doctor, but he was met with the same trust and confidence as ever, with some people even specifically asking for Hsu to do their surgeries. “I don’t know if it was me being too courageous or them being too fearless,” he remarks with a wry smile. “These patients were the ones who taught me how to be a good doctor; how could I not dedicate myself to repaying that?”

The day Taiwan Panorama met with Hsu was his day off. We accompanied him on a visit to the public elderly daycare center in Tjua­bal, where we watched as he chatted in Pai­wan with an octo­genarian woman, the two laughing and smiling like grandparent and grandchild. From there, we set off to the Culture and Health Station in Ku­va­leng (Xinhua in Chinese). As we arrived, around noon, a crowd of elderly residents were getting ready to head home, but turned their scooters around on hearing that Dr. Hsu was visit­ing. They immediately launched into asking why it had been so long since his last visit, and took photos with him as he struck his trademark cutesy, cocked-head pose, all the while insisting that he promise to come back at least once a month before they left happy.

Watching doctor and patients interacting like family is certainly a touching scene. In the cities, a doctor can see hundreds of patients a day and has to constantly worry about being hit with a malpractice suit, but out here in the countryside, we see a more trusting relationship between people. During consultations, Hsu always chats ami­ably with his patients, asking how they’re going and how things are at home. A number of people will only take drugs if he prescribes them, and there’s at least one person who has moved out to Tai­chung but still makes the trip half way around Taiwan to consult with Hsu. “I value their quality of life. Improving quality of life is more important than average life expectancy.”

Since his stroke, Hsu is even better able to relate to his patients’ situations and see the ­doctor‡patient relationship from their perspect­ive. “Health is about physical, mental, and social stability,” he explains. In the city, health tends to be looked at as a purely medical matter, but in the country, health issues can be complex social problems. South Link Hospital, an institu­tion Hsu dreams of one day establishing, will be “a community hospital tied in closely with the people’s lives. It might not have the most expensive, sophisticated diagnostic equipment, but it will be warm and inviting, somewhere everyone who comes to seek healing can get not only relief from their illness, but also a measure of spiritual comfort as well.”

Beyond Hsu Chao-pin

During his rehabilitation process, Hsu asked God more than once why the stroke couldn’t have come later, why He couldn’t have waited until the South Link Hospital was established before taking him out. Wondering at God’s will, he began to focus less on his now-stiff left side and more on his still-nimble right arm and leg. As well as continuing visiting the villages and providing consultations, Hsu began tapping away at the keyboard with his right hand, eventually publishing his life story under the title Protecting 4,141 Heartbeats. The book was warmly received around Taiwan and opened many people’s eyes to the situation in rural communities. “God knows I can only do so much on my own, so He wanted me to harness the love and power of the public to help get South Link Hospital going.”

Did he ever consider throwing in the towel? “Almost every day,” Hsu says. “Every day is a struggle, but as long as the sun rises and I can look in the mirror and see that I’m still looking good, still have some things I can do for the villages, and still have some value left, I can pull myself back together and forge ahead.”

He launched a project to get the South Link Hospital built, establishing the Association of South-Link Health Care Promotion for Taitung County to raise funds for the South Link Foundation. The association works in various ways to address common issues in rural communities like aging populations and grandparents having to raise grandchildren while the children’s parents head elsewhere for work. They provide home-care services and visit elderly people who live alone. They have also established a long-term care center that offers 24-hour care for people with severe disabilities, and created the “Ark classrooms” to give children after-school tuition and help them develop the knowledge and confidence to thrive amid the onslaught of globalization.

Hsu Chao-pin has gone from working alone to bringing people together to provide care in southern Taitung through the South Link Association. “No matter how good I might have been before, I was still nothing more than a pretty good doctor, and one person can only do so much. Now I’ve been able to attract more power to focus on improving medical care and education in southern Taitung. That’s something I could never have done before.”

“Don’t you think I’ve gone beyond the old me who could just do medicine?” After we finish our interview, this comment by Hsu continues ringing in our ears. The application to set up South Link Hospital is still being reviewed, but Hsu has faith in the people of Taiwan and their ability to provide the support needed to make his dream hospital a reality.        

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