It Is the Sick Who Need a Doctor

If people say Taipei residents can't afford to buy homes and envy Singaporeans their own HDB flats (public housing), then when it comes to healthcare, it should be Singaporeans who envy Taiwan. Singapore's healthcare system is widely praised as "cheap and excellent," but in keeping with the vision of the late Prime Minister Lee Kuan Yew, it has never been free to the public. This discourages overuse or abuse of the system and makes people responsible for their own health.

The Singapore government offers three tiers of healthcare coverage, and employers also provide health insurance for those with jobs. But for the unemployed and disadvantaged, medical costs can be unaffordable. A few years ago, a young man receiving social assistance couldn't afford the roughly NT$180,000 in medical costs for his father's lung cancer, so he altered the amount on his assistance check — and was sentenced to four months in prison. He had been receiving NT$4,600 a month in assistance.

How good is Taiwan's National Health Insurance (NHI)? One of our mission's missionaries taught at a Taiwanese university for over thirty years and paid into NHI for more than a decade. Before retiring, he thought he'd "wasted" all those years of premiums since he was so healthy he never saw a doctor. Then, just a few months before he was due to return home, he was hospitalized several times for kidney stones — and only then discovered how good NHI really was. Had the same thing happened after he returned to the United States, it might have bankrupted him.

Many of us have heard stories from the years before NHI existed, when parents who couldn't afford medical care delayed treatment for their children until it was too late. Now, almost every person in Taiwan has NHI coverage. Even homeless people know that hospitals are obligated to treat anyone who comes to the emergency room — although hospitals aren't always welcoming to such patients. Three years ago,

A-Yu

was bleeding heavily from a severe uterine tumor, and Pearl Home's Tera and Yi-Jun took her to the hospital. The nurses wouldn't touch her, so

Tera and Yi-Jun

had to change her clothes and bathe her themselves. Her blood pooled on the floor, and they had no choice but to wipe it up with tissue, bare-handed. Though the nurses complained about her hygiene during her stay, A-Yu underwent radiation and chemotherapy, and her tumor shrank considerably — she is still alive and well today.

Sadly, some people in poverty simply don't have access to this kind of information, and never receive the help they're entitled to. Lawyer Lu Chiu-yuan once wrote on Facebook about a taxi driver who was found outside the Miaoli District Court, suffering from bronchiectasis, tuberculosis, and possibly lung tumors or pulmonary embolism. His condition worsened until he began coughing up large amounts of blood, which blocked his airway, and he died from the resulting asphyxiation. Because he hadn't paid his NHI premiums for years, his health insurance card had been locked, and he had only been treating himself with over-the-counter medicine. Lawyer Lu remarked with sorrow: "For people this poor, the National Health Insurance Administration does have assistance programs available — but these people never hear about them, because this is a kind of 'Silent Poverty' (Silent Poor)."

Is Ignorance a Blessing?

In our years of service in Wanhua, I've found that close to ten percent, or perhaps more, of the women we serve — especially those in their fifties and sixties who are financially disadvantaged — have gone years without paying their NHI premiums. Xiao-Ju is one of them. Her health has been steadily declining, and she is often short of breath. I've urged her to see a doctor, but she says, "Don't you know? The medicine NHI covers doesn't work! I never go to the doctor." Even with signs of heart disease, she chooses to bury her head in the sand — as if not knowing means nothing is wrong. To her, there's no such thing as "prevention is better than cure" — only "ignorance is a blessing."

One day I got a call from Xiao-Ju. She was terrified: "My nose won't stop bleeding, what do I do?" I thought to myself, "It's just a nosebleed, that shouldn't be serious." I told her to lie down, and prayed for her over the phone.

Later, a volunteer told me that a few days earlier, Xiao-Ju had bought a chicken to "build up her strength," using large amounts of sesame oil, ginger, and rice wine to make chicken soup. As it turned out, her body couldn't handle such a rich tonic, which was why her nose started bleeding. Xiao-Ju thought she was dying, which is why she was so frightened.

A-Hua, in her seventies,

was walking out of Longshan Temple MRT Station when someone accidentally dropped a glass bottle, and a shard flew into her eye.

She said she wiped it with a tissue at the time — just one drop of blood — so she assumed it was nothing. Fortunately, she has NHI, and her son took her to see a doctor. Unfortunately, to save money, A-Hua wouldn't listen to the doctor's advice and refused surgery, choosing instead to just apply medicine — and as a result, went blind in one eye. Yet she remains fully confident in her own medical judgment and often shares home remedies with friends. When she cut her foot on glass, she casually applied a paste of sesame oil and flour to the wound, and boasted to everyone: "I got better without ever seeing a doctor!"

Lending a Hand

We've also encountered another kind of person who refuses medical care. Abi has a severe mental disability and is often incoherent; the moment she sees someone, she blurts out, "Want to be a customer?" She has no home, relying on other women to feed her, and occasionally goes with clients to a hotel. One day, her neck and legs were covered in abscesses, and we were worried it might be cellulitis, so we took her to a small clinic. The doctor said she needed to go to the hospital for tests, but whether Abi refused or simply didn't understand, she grabbed the ointment and ran off. The social worker told us that unless someone is a danger to themselves or others, they cannot be committed for treatment against their will — so there was nothing more we could do.

Some patients won't spend money where they should, yet spend freely where they shouldn't. Mrs. Chen is an elderly woman living alone. After a car accident injured her left leg so badly it nearly required amputation, she was hospitalized for over three months and underwent several surgeries. After recovering at home for a while, her doctor recommended she pay out of pocket for a material to set the bone, instead of using a plaster cast. She didn't want to spend the money — but instead, trusting an underground radio advertisement, spent over NT$10,000 on Chinese herbal medicine supposedly good for strengthening bones.

Poor financial judgment is also part of the problem. Miss Tseng is a single mother who bought herself a stack of insurance policies but had no money left to pay her NHI premiums. I explained to her patiently, again and again, that she had the order backwards — basic healthcare coverage should come first, and worrying about extra costs for serious illness in old age should come second.

Sex workers are more likely than the general population to suffer from certain health conditions, including gynecological problems, spinal injuries, and depression. Because these occupational injuries are so common, we strongly encourage the women to keep up their NHI payments. To help women deal with the challenge of long-term medical costs, Pearl Home established a Medical Assistance Program. We work with social workers at the YWCA Wanhua Women's Center, who assess each woman's financial situation. If a woman qualifies, she can bring her receipt after seeing a doctor to apply for assistance. The subsidy covers seventy percent of medical costs, up to NT$1,000 per month. To encourage the women to take responsibility for their own health, we only cover seventy percent of the cost rather than the full amount. Women who need to pay off years of overdue NHI premiums may also apply for this assistance.

Body and Soul Healing

While doing outreach on the streets, I got to know Ding-Dang. She rides a bicycle to and from work. Perhaps because of her age and declining eyesight, she's had several accidents and injured her shoulder. She very much wants to leave the teahouse where she works, but her old injury keeps flaring up, so she can't take on physical labor. I encouraged her to deal with her overdue NHI premiums and get to a doctor and start rehabilitation as soon as possible. I expected her to hesitate, but instead she was very proactive — she went to the NHI Administration herself to arrange an installment payment plan, and even asked the local borough chief to issue her a certificate of financial hardship.

Ding-Dang can't read, but she is brave. She showed me just how resilient these women are — they are capable; we only need to give them a hand. I hope this kind of practical help lets them feel God's love, for He is our ever-present help (Psalm 46:1).

God has great compassion for people in such hardship. Through the Medical Assistance Program, Xiao-Wen has been working hard, paying off years of overdue NHI premiums in installments. One day, Xiao-Wen brought me an official document. I read it and could hardly believe it, so I asked the social worker, "How could there possibly be such good fortune in this world?" It turned out that Xiao-Wen qualified as a low-income household, and the Taiwan Lottery Corporation was covering the overdue NHI premiums for certain disadvantaged groups. I told Xiao-Wen: "You don't need to gamble — God will provide for your needs. His ways are higher than our ways, and His thoughts higher than our thoughts." Xiao-Wen experienced God's faithfulness, and her trust in Him kept growing.

My teachers, Bob and Gracie Ekblad, went to Honduras to share the gospel in their early twenties. Bob had just graduated from university with a degree in history, and his wife Gracie had a degree in English — she didn't feel she had any skill that could help the local people. They became friends with farmers there and discovered the locals lacked basic health knowledge; nearly every family had suffered the tragedy of losing a child. The farmers had resigned themselves to it, believing it was simply God's will — to them, God felt distant, unable to change their actual circumstances. My teachers started community health classes, teaching the women how to treat common illnesses without spending a lot of money. As the farmers' health improved, they stopped blaming God, and their view of Him changed dramatically — giving the missionaries an opening to share the gospel.

Wei Wai-yang, a writer who studies the history of Christianity in China, once said: "People may question the meaning of the cross, but they will not scoff at the benefit brought by the surgeon's scalpel." Although Taiwan is now a country with advanced medical care that no longer needs medical missionaries, the church can still play a part in promoting community health education and helping the medically underserved.