Finding a Different Form of Rural Medicine in Southern Taiwan

Brendan Ross, Medical student, McGill University

While inhabiting a different hemisphere and climate than Canada, Taiwan presents a fascinating case study for comparing rural and Indigenous healthcare practices across societies. Taiwan presently has 400,000 to 800,000 indigenous people who make up 3.4% of the national population, a number comparable to Canada’s Indigenous population of 1.7 million or 4.9% of the national population. Taiwan’s comprehensive National Health Insurance system, founded in 1995, also provides a useful comparative lens to examine how shared resources and health programs are directed toward unique Indigenous populations in different settings.

I traveled to Taiwan this winter with a classmate to explore how Taiwanese healthcare considers Indigenous populations in rural areas. We focused our research on interviews with primary care physicians at small clinics in rural areas. We ended up spending most of our time in the area of Taitung prefecture in southeast Taiwan, which has a large Indigenous population.

Our project aimed to better understand how Taiwanese doctors consider and support Indigenous communities in rural areas. We found our discussions to be very pertinent to a new interpretation of Global Health that tries to focus on local learning and works to be less paternalistic and top-down and more focused on learning from both sides, across cultures, countries, and contexts.

Several aspects of Taiwan’s approach to Indigenous populations stood out. We learned that city hospitals in Taiwan have a unique system for sending senior specialists to rural clinics, where they do one shift at a rural site one day per week. This allows rural Indigenous people the option of seeing a cardiologist or a pediatrician down the street rather than in an urban center. While some similar practices like this exist in rural northern Canada, the great distances between communities in Canada may render this option impractical here. Regardless of distances, however, I believe that offering the services that a community needs is a way of respecting disadvantaged populations and addressing their challenges.

We also learned that global health work and community service holds its own unique appeal for Taiwanese doctors. In their case, the work was often driven by convictions of faith. One infectious disease physician from a Christian hospital in Taitung, Taiwan, Dr. Chi-Kin Lan, had established a teaching clinic in rural Myanmar in the 1990s. His experience in rural Taiwan had taught him that the best way to serve a less-developed community was to provide local young adults with the tools and expertise to study medicine and support themselves going forward. He had trained a line of physicians and nurses in Myanmar who then continued to graduate new classes of healthcare workers for many years following the conclusion to his service.

If our medical institutions can support endeavors like these without requiring an expected research output, we can perhaps support the needs of other communities more directly and sincerely. Stories like Dr. Lan’s remind me that sometimes the most valuable resource we can provide others is our undiluted time, without career or academic considerations.

Over the course of our time in Taiwan, we also spoke with Indigenous healthcare workers and patients. We learned that Taiwan has a very different relationship with its Indigenous populations. Part of that different dynamic relates to the local context. In Taiwan, there is a different colonial history—the Japanese colonized Taiwan for over 50 years in the first half of the 20th century, and as a result, the Taiwanese are not implicated in the same role as the historic (and present) oppressor. They are often seen as a partner and fellow inhabitant of the island.

We were pleasantly surprised to find that Taiwanese doctors strive to maintain a kind and open approach to Indigenous health problems. We spoke to many doctors and local people about the use of betel nut, a carcinogenic green nut that is chewed by many people to stay focused while at work. It is also an important part of Indigenous traditional life in Taiwan. Doctors knew the stimulant causes cancer, but they tried to remain open-minded and gracious with patients when they discuss betel nut, because they know it is a major part of the local Indigenous economy and culture.

Through this medical placement in Taiwan, we learned how medical services can be applied in a humane and thoughtful way. Doctors should strive to provide the care that people need but also care that recognizes and values the unique sets of beliefs of other communities and individuals.

About the author

Brendan Ross is a 2nd year medical student at McGill hailing from St. Louis, Missouri. Prior to coming to Montréal for medical school, he spent three years studying, teaching, and interpreting in China and Taiwan. During his time at McGill, he has worked closely with institutions in both Mainland China and Taiwan on projects related to mental illness and public health. This past December, he traveled to Taiwan under the auspices of the McGill Global Health Program through the generosity of a Alex W. Strasberg MD CM 1921 and Harvey M. Weinstein MD CM 1967 Global Health Award.