Shwedagon Pagoda 仰光大金塔
A Single Tread in the Tapestry
What does it take to make a
difference? An important reason why I chose to become a doctor is to help
others, the ones who need others’ help. I see several homeless people on the
streets, may it be at the underground crossroads, outside of the hospital or
out on the streets. A good Samaritan or fellow citizen would give them some
change or a bill to ease their miseries. Some even took the extra step and post
on the internet for more people to notice. I gave them some spare change a
couple of times. And I was delighted to find out that some are genuine.
However, I also saw some who used the money to buy alcohol or cigarettes and
some who faked their medical conditions. I was disappointed and went out to
search for other ways to help the truly miserable people.
After
doing some research, I found out that there are volunteer organizations out
there offering cooked food, medical treatments and health education to the less
fortunate living in the rural regions of Taiwan. I hesitated before joining. I thought that my role would be minimal and could not contribute much due to the
lack of profession. Moreover, my future plans got the best of me. I spend most
of my free time doing translational research and planning ahead. Only after I
graduated from National Taiwan University that I decided to get involved with
volunteering. I feel more matured and prepared after seven difficult years of
college and a year of medical internship.
Then, I signed up for my first medical relief mission, Sri Lanka.
Sri Lanka is a country that I would
probably not have visited in college. It is simply not on the list of popular
tourist destinations. But I learned to appreciate it after my mission. Sri
Lanka spends approximately 3.1% of its Gross Domestic Product (GDP) on
healthcare. For comparison, Taiwan spends around 7% of its GDP. Like Taiwan,
Sri Lanka provides free universal healthcare to its citizens and can go directly
to a government or private hospital, to the family doctor or directly see a
specialist with no third-party reference. Local clinics are readily available
in towns, and hospitals are situated in major towns and cities with laboratory
and imaging facilities. Ease of access to medical resources and similar
healthcare systems probably resulted in the similar characteristics between
Taiwanese and Sri Lankan patients. For example, patients tend to be finicky and
request reading glasses with the designs to their liking. And many without
presbyopia argued to get a pair of reading glasses. Some patients bargained on
the use of oral medications or topical creams. And a few cut in line or request
to be seen first. I thought I was in Taiwan for some moments…oh sweet memories.
Nevertheless, Sri Lankans are very passionate and nice. They actively helped us
translate, explain to the patients, align them in lines, and maintain order.
This mission was also my first
clinic duty; I was responsible for an internal medicine clinic. In Taiwan,
clinic duties were given solely to chief residents and attending physicians. So
I had no experience at all. Yet, I applied what I have learned and ask my
supervisors for assistance when necessary. After seeing more than a hundred of
patients after a week, I have a whole new respect for attending physicians.
Around 60 or more patients per shift with no break in between is tiring. Then,
there is sometimes another shift in the afternoon. I remembered that each
clinic has seven or eight patients in the U.S. Each new patient gets scheduled
for one hour. For subsequent visits, time is allocated depending on the
purpose. Also, pediatricians deserve a lot of respect. They have to sedate the
patients, examine them despite the tantrums, educate the patients and the
parents, calculate the suitable dose of medications, and determine the
prognosis. Thankfully, we were joined by friendly and hardworking pediatricians
who saw the patients promptly.
I embarked on another mission to
Myanmar this month, hoping to broaden my views even more. After taking this
trip, I am grateful that I went. Myanmar is an entire different country to Sri
Lanka. The GDP spent on healthcare was among one of the lowest in the world.
The top three countries that spend the lowest are Qatar, Myanmar, and Pakistan
with 1.8%, 2% and 2.2%.
Last year, Myanmar increased its GDP to 3.9%. Myanmar has an entirely
private healthcare system, and is unevenly distributed. Most health services
continue to be concentrated in larger towns and cities, the majority of their
people has to travel miles to seek medical treatment. Also, under-the-table
payments are frequently expected as a means to ensure quality care. And because
the total healthcare costs are so expensive, many just do not seek assistance
at all. That perhaps led to Myanmar to have some of the worst health indicators
in the world. Life expectancy is 56 years, 40% of all Burmese children under
the age of 5 are moderately stunted. In addition, Burma has more than 50% of
all malaria-related deaths in Southeast Asia. While the increase in GDP is
promising, Burma still faces a number of challenges when it comes to improving
its healthcare. Key challenges include ensuring designated funds reach intended
recipients, providing reliable health indicators, addressing the needs of
resource-starved rural health clinics and hospitals, and tackling corruption.
The
Burmese patients are like the patients one would see in rural areas; pure,
impecunious, and humble. For many, we were probably the first doctors they have
seen in their lives. We took the time to treat them holistically, and tried to
resolve all their medical problems. They were very thankful for our efforts and
willingly accept the treatment plans we gave them. They were blissful if we gave
them a longer period of medications and health supplements. Very little
bargaining was noted. Myanmar has a high prevalence of autoimmune diseases,
including rheumatoid arthritis and ankylosing spondylitis. These diseases
require discrete adjustments of medications and health education. We do not
have DMARDs so we gave them two weeks of prednisolone. I also saw a person with
bilateral pedal edema and was diagnosed with nephrotic syndrome. I was more
confident this time having been through the rigorous training last time in Sri
Lanka.
The Myanmar mission allowed me to see what I
could have not in National Taiwan University hospital or Taiwan. Sri Lanka
serves as a good comparison. Now I have
greater appreciation for healthcare, patients, medical profession, and myself.
Healthcare is an important quality indicator of a developed and successful
country, as shown by the U.S., United Kingdom, Denmark, Norway, etc. The
urban-rural gap is also smaller. Furthermore, our teachers always say that
patients are the best teachers. They teach us real-time medicine,
doctor-patient relationships, flaws of current healthcare, and communication
skills. Their families are also an important part of the healthcare team. We
need to learn to work with them to understand what matters and improve our
primary care. The medical profession because now I comprehend that we play an
essential role in providing healthcare and distributing medical resources. And myself not only due to my medical profession,
but also that I can serve as different roles in the team.
Speaking
of roles, there should be no ranking among them. Traditional values put
physicians at the very top, as they served as leaders in healthcare. After
these missions, I learned more thoroughly that physicians are merely a part of
the team. Other medical staff like the nurses, physician assistants, dentists, pharmacists and social workers are integral to a successful and efficient
medical team. Other non-medical personnel are important to make documentaries
and to dig deeper into their cultures and language. For instance, our
photographer developed good friendships with the local workers and learned
their ways of life, some vocabularies, and thought processes. I focused more on
healthcare, and what she learned complemented my learning. Therefore, everyone
is equally important. This also brings up an important point. One does not need
to wait until one feels ready to go volunteering; one will learn a perspective
and can equally contribute once one decides to go on this journey. Everyone is
a single tread in the tapestry, and he can never see its purpose in the pattern
of the grand design until he takes action.
Just like the stone at the very top of the mountain; it has the same
importance as the stones that form the base. I have found a new purpose and a
whole new appreciation for developing countries, everyone on our team, and the
patients whom we have helped. I will continue to join these medical relief missions
and hopefully contribute more in the future. Thank you Taiwan Root Medical Peace
Corps for providing these precious opportunities and serving the role of
healthcare provider in the world.
TRMPC Mission #291 Sri Lanka: Group Photo before
Returning to Taiwan
TRMPC Mission #294 Myanmar: Group photo with the NGO
Noble Compassionate Volunteering Group
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