If you decide to visit St. Mary’s Hospital
in Taitung, be advised that you
might find that most of the employees
are out doing fieldwork.
Bright and early at 8:30 one morning
a group comprising a nun, a doctor,
and a nurse are en route to care for patients
in Taiyuan Village. A delivery
truck bearing meals for the elderly follows
not far behind. At 10 a.m. over at
a day-care center in Jinfeng Township’s
Jialan Village a team of social workers
and aromatherapists are tending to several
dozen elderly Aboriginal women,
leading them in activities and invigorating
them with massages. That afternoon,
internist Lin Jui-hsiang lectures
in the community on diabetes prevention
and care, and the hospital’s associate
administrator, Jennifer Chen, graciously
leads visitors on a tour of the
“health farm” and learning center, Pei-
Tse Institute, both of which are scheduled
to open in the near future.
How is it possible then that a clearly
flourishing institution has come close to
shuttering its doors twice in the past
seven years, was all but given a death
sentence by experts, and had even its
most ardent church supporters resigned
to accepting its closure as the will of the
Almighty?
But this little hospital has undergone a
resurgence and transformation that is
nothing short of miraculous as they
continue to build upon their dreams of
being both a quality hospice and health
center for all of eastern Taiwan.
Its story goes back half a century to
the pioneering efforts of two European
missionaries.
A beacon in the mountains
In Switzerland at the end of the 19th
century, a French minister named Rev.
Pierre-Marie Barral founded the Bethlehem
Institute, later renamed the Societas
Missionaria de Bethlehem in Helvetia
(SMB), an international missionary
training academy. According to the
society’s founding precepts, the graduates
of the school were obliged to do
missionary work overseas in remote areas
without any Christian presence.
Moreover, they were to make every effort
to integrate themselves into the local culture
and to minister to the needs of
marginalized people.
In 1953, two of the society’s members,
Rev. Jacob Hilber and Rev. Lukas
Stoffel, relocated to Taitung after being
expelled from China, which following
the Communist Revolution
had become inhospitable towards foreign
missionaries. They recruited others
to come assist them with preaching
the gospel in Aboriginal villages, and
also poured their energies into health
care, education, social work, and even
linguistic and cultural studies.
In 1961, after receiving funding
from overseas, they built Taitung St.
Mary’s Hospital. In the beginning,
there was only one clinic and four
beds. Today, the original edifices can
be seen in the interior court, a small
two-story white building that is a dormitory
for nuns and a chapel.
At that time, Taitung had only one
hospital under the auspices of the Department
of Health. Medical personnel
and equipment were in extreme short
supply. Taiwanese doctors were reluctant
to practice in remote rural areas. As a
result, in the beginning St. Mary’s funding
came entirely from overseas donations,
and the hospital was staffed by foreign
missionary doctors who donated
their services. They also recruited two
Irish nuns from the Medical Missionaries
of Mary to take charge of obstetrics.
Since Taitung is home to a number
of diverse ethnic groups, many languages
are spoken there, including
Mandarin, Taiwanese, Hakka, Japanese,
and six different Aboriginal languages.
Recognizing this as a serious
challenge, the nuns and brothers of
the hospital began training locals as
nursing assistants from day one.
Though they have been working for
over 40 years, three assistants Zhong
Guangmei, Shi Xiuying, and Huang
Qiuzhen (nicknamed “Old Huang”)
still remember the early days. In the
1970s, they earned NT$4,000 a month,
with room and board provided by the
hospital. Curfew was at 9 p.m. sharp.
Every week the nuns taught two nursing
classes and two English classes. In
the daytime, they worked in the clinic
giving shots, preparing prescriptions,
helping administer anesthesia, and assisting
with deliveries.
The nuns and brothers would schedule
leisure activities to provide relief
from the tightly regimented work schedule.
Sometimes the group of more than
10 young ladies would go for a drive and
a picnic, or on their afternoon break they
would all take the bus to Shanyuan
Beach to escape the heat by swimming.
The biggest lesson they gleaned
from all that time working in close cooperation
with their teachers was, “to
put the patients first and to cultivate a
compassionate heart.”
Going where others fear to tread
In 1975 a French missionary organization,
the Daughters of Charity, assumed
stewardship of the hospital,
which by that point, thanks to the dili-gence
of the hospital staff, had matured
into a women’s hospital with 30 beds.
Under new management spearheaded
by American nun Sr. Agnes
McPhee, who served as the hospital’s
second administrator, and another
American nun who came in 1979, Sr.
Patricia Aycock, St. Mary’s broke new
ground by introducing a domiciliary
care program that is still in use today.
Back in the 1970s there was a huge
disparity between urban and rural resources,
and transportation was underdeveloped,
as well. Sr. Agnes frequently
made boat trips out to outlying Lanyu to
educate the residents on health matters;
when patients came to St. Mary’s from
Lanyu for treatment, Agnes would see to
their meals and accommodations.
Sr. Patricia, who specialized in anesthesiology
as a nursing student, was the
first person to implement the “clinic on
wheels” approach, though she modestly
denies credit for the idea, simply stating
that she was the only sister who knew
how to drive. She would spend entire
days driving from village to village, her
car loaded up with medicines, patient
files, and medical equipment. She faced
the challenge of being both pilot and
navigator on these trips, and moreover,
as the anesthesia expert, she had to be
ready to return to the hospital at a moment’s
notice. “I used to borrow the
phones in the village churches to check
in with the hospital—if there was an urgent
operation waiting, I’d have to hurry
back immediately,” she says.
Among Patricia’s homecare patients
are numerous poor Aborigines who became
paraplegics after suffering road accidents
while young due to either drinking
or fatigue. Attending to them requires
combining aspects of nursing
(cleaning bedsores, physical rehabilitation,
and even helping with laundry and
cleaning) with those of social work (securing
financial assistance and helping
children attend school), as well as ministering
to their spiritual needs.
“The nuns are always reminding
everybody: it’s our job to do what others
don’t and to go where others won’t,”
says Sense Chen, who came aboard at
the end of 2006 as the hospital’s CEO.
Whereas the great majority of hospitals
view domiciliary care in remote regions
as a costly, tenuous undertaking, St.
Mary’s has picked up the slack, throwing
itself headlong into the daunting task.
The program has expanded to the point
that their operational scope now extends
from as far north as Changbin Township
at the border of Hualien and Taitung
Counties all the way down south to the
Taitung–Pingtung junction of Daren
Township, a meandering 190-kilometer
stretch of coastal highway. This, of
course, does not include the tribal villages
tucked away in the mountains
that are an hour-and-a-half drive’s distance,
nor does it include the 150 visits
per year that the hospital’s staff
make out to the peripheral islands of
Lanyu and Green Island.
Mending disparities
While the advent of comprehensive
national health insurance in the
1990s did much to make health care
affordable for most Taiwanese, the
conditions in remoter regions nevertheless
lagged far behind.
According to statistics published in
1995, Taitung County’s mortality rates
per 100,000 residents—irrespective of
the cause of death—were considerably
higher than other parts of Taiwan. Taitung
also topped the lists in another unfortunate
category: the incidence of malignant
tumors. Even in recent years, 600
county patients enter the late stages of
cancer annually, and their mean residual
life expectancy is more than 10 years less
than that of Taipei City residents.
Moreover, in Taitung County the
number of deaths of people in their
prime due to accidents is high, as are instances
of heart disease, kidney ailments,
and other chronic illnesses. This suggests
that many carry a heavy burden
of toil and stress in their struggle to
make ends meet, and highlights the
great impact of social and economic
inequality on health and wellbeing.
To make matters worse, in the mid-
1990s, St. Mary’s Hospital, long a beacon
of hope for an impoverished
community, began unraveling financially,
seemingly no longer able to
keep up with the times.
Chen examines the causes behind
the hardship. Beginning in the 1980s,
St. Mary’s, in keeping with the Catholic
faith’s traditional self-reliance, began
gradually weaning themselves off
of foreign donations—domestic contributions
have always been sporadic.
Moreover, the restructuring of the
medical system based on enterprise
and market principles had shaken the more public-service-minded St.
Mary’s, even threatening their once reliable
obstetrics department.
Seventy-six-year-old Sr. Matilde Sansolis
Serneo, the recipient of the 12th
Medical Devotion Award (conferred by
the Department of Health) in 2003, recalls
that with the enacting of the hospital
accreditation program in the 1990s,
the majority of the hospitals had to
scramble to fall in line with the new standards.
St. Mary’s was found to have a
number of inadequacies; among them
were disorganized management, the
failure to prepare and archive their medical
billing and records according to the
International Classification of Diseases,
substandard quality of care (including
the fact that the nurses were not properly
licensed), and the building was old and
not in compliance with fire codes.
The plainspoken Sr. Matilde takes a
curt view of the situation. “When they
asked me to explain the organizational
structure of the hospital, I didn’t really
know what to say,” she says. “I just
told them that we use flat management.
I told them we all have a number
of hats to wear and that we take
our responsibilities very seriously.”
All of the nuns, she recalls, were
scurrying about frantically to make
the necessary improvements: one person
burned the midnight oil sorting
through all the medical files, another
started learning how to use a computer,
and yet another attended classes at the
fire department. In order to get their
already veteran nurses past the licensing
hurdle, they arranged for teachers
from nursing cram schools in northern
Taiwan to come every weekend to
teach. In the end, their efforts paid off:
the hospital received accreditation on
the third evaluation.
The hospital weeps
Ironically, between 1990 and 2001,
the Department of Health singled out
no less than six of St. Mary’s employees
for distinguished service awards, making
the hospital the most frequent recipient
of public commendation in all of Taiwan.
But in 2003 its financial woes
boiled over, and they found themselves
unable to pay the workers’ salaries; they
had finally hit rock bottom and were
forced to decide whether to fight on or to
close the hospital’s doors forever.
Chen Shih-hsien well remembers the
air of desperation permeating the hospital
during that troubled hour. A private
hospital offered to buy St. Mary’s, but
was only interested
in the hospital buildings
and the physicians;
the remaining
80 employees were
to be left to fend for
themselves. The hospital
director could
not abide so inhumane
a proposition.
On one inclement
day, as rain poured down on the hospital’s
dark empty corridors, the ceiling
began to leak. Orthopedist Shih
Shao-wei, a dedicated, irreproachably
loyal physician, let out a sad sigh:
“The hospital is weeping.”
At this critical juncture, two important
church figures, Bishop Huang
Chao-ming, the newly appointed head
of the Hualien Diocese, and Sr. Cheng
Yun, the former director of St. Mary’s,
provided invaluable support, and more
significantly, practical counsel. The
hospital needed to capitalize on its
strengths—its warm familial atmosphere
and concern for patients’ spiritual,
as well as physical wellbeing—
and focus on becoming a leader for the
Taitung region in the emerging fields
of preventative and hospice care.
In 2004, St. Mary’s established the
first hospice care center in Taitung, inviting
former Taipei Medical University internist
Fu Shan-shan and Huang Kuanchiu,
another internist with ample experience
in private practice, to serve as codirectors.
That very year, the Department
of Health recognized their outstanding
contribution. In addition,
Dr. Chao Co-shi of National Cheng
Kung University Hospital, the woman
considered to be the mother of Taiwanese
hospice care, has frequently
lauded the quality of care at St. Mary’s.
Reaping what they have sown
The change of focus made it possible
for St. Mary’s to be reborn. Beginning
in 2005, the hospital received
commendation from the Taitung
County Government four consecutive
years for the quality of their domiciliary
care. Then in 2008 the hospital became
the recipient of the 18th Medical
Devotion Award in the group category,
the first time in the award’s history
that it was given to a hospital.
“Depending on your perspective, I
suppose this award could be called the
‘fool’s award,’ because only a fool would
persist in doing what we’ve been doing
under the conditions that we’ve been
doing it—a normal person wouldn’t
have anything to do with it,” jokes Chen.
But in a capitalist society dominated
by utilitarian thinking, this quixotic
spirit is even more compelling, which
is why it always succeeds in attracting
talent and material support.
For example, five years ago Cardinal
Tien Hospital’s authority on diabetes,
Professor Lin Jui-hsiang, flew
down to Taitung on his own coin for a
few days every month to help St. Mary’s
set up a diabetes support group, as
well as to promote healthy living. He
has since become a resident physician
at St. Mary’s. No less prestigious an individual
than the former head of neonatal
intensive care at Cathay General
Hospital, Yuh Yeong-Seng, was willing
to assume directorship of St.
Mary’s in 2008 after the previous director
Shih Shao-wei died of cancer.
Early in 2009, the executive director of
Catholic Sanipax Socio-Medical Service
and Education Foundation, Jennifer
Chen, officially took up the post
of associate administrator after volunteering
for the hospital for more than
20 years.
Unexpected windfalls arrived in
bunches. In 2006, after making repeated
entreaties, Jennifer Chen succeeded in
convincing a Taitung native by the name
of Shunzi to set up and run a health club
on a vacant space within the hospital
campus. Shunzi was the proprietor of a
bed and breakfast in the area, as well as a
stellar cook; Chen pursued him because
she admired the relaxed, congenial atmosphere
of his homestay. Shunzi’s interest
in the venture was 12 years of management
rights of the club, under a
“build, operate, transfer” arrangement.
Much to everyone’s amazement, the
perfectionist Shunzi exceeded all expectations
in building a club that fused
seamlessly with the hospital. In the design
phase, the blueprint became more
elaborate with each rendition. Construction
took longer than anticipated, so
Shunzi sold his homestay and invested
the NT$30 million profit into the new
project. Two years later, a club much
grander and more beautiful than anyone
initially expected was completed. Even
more unexpected was when Shunzi announced
that he was relinquishing his
12-year interest in the club, saying, “Why
should helping people have to wait 12
years?” Thus, St. Mary’s assumed immediate
ownership of the club (though
they did finally reimburse Shunzi NT$9
million in gratitude for his generosity)
which now provides county residents
with organic food and healthy living
classes at an affordable price.
More good fortune was to follow. In
2007, a patient was attending a clinic for
diabetics on managing blood sugar.
The patient, Michael Liu, was a landscaper
by profession, and the affinity
he felt for the hospital was so powerful
that he volunteered four months of
his time working on a therapeutic garden
replete with a stream and a gazebo
so that patients and visitors alike
may enjoy a soothing respite.
“It seems that if we maintain the
desire to serve the people in our
hearts, kind people and good deeds
will be visited back upon us,” smiles
the kindly and gregarious Associate
Administrator Chen.
This positive energy is more than
just the reward of compassionate
seeds planted a half-century ago: it
represents a yearning in contemporary
Taiwanese society for a more
humane model of medicine. This is
perhaps why when St. Mary’s sought
financing to help them become an
incorporated foundation (land appreciation
tax alone cost NT$16 million)
in April of 2009, the hospital
raised an astonishing NT$89 million
from generous contributors in
just eight days, far in excess of the
projected goal of NT$30 million.
As St. Mary’s continues its march towards
a shining future, it is clear that it
belongs not only to Taitung—nor is it
simply a hospital—it is a glowing example
of the never-ending project to
build a kinder, more humane society.
(Chen Hsin-yi/photos by Chuang
Kung-ju/tr. by Josh Aguiar)
July 2010 Taiwan Panorama 91
文章定位：
