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2009 The 15th   Taiwan-Japan-Korea Christian Hospital Top Managers Conference

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A General Introduction to Puli Christian Hospital
  Puli Christian Hospital was founded in 1956. The Hospital started as a Christian Clinics in the most mountainous town, Puli, in central Taiwan. The development of PCH was under the contribution of many overseas and local missionaries and medical staff. Until present day, 50 years later, PCH is now a hospital with modern facilities and with the mission of whole person caring.

Superintendent: Wun-Tsong Chaou, M.D., Ph.D. (Pediatric Neurology)

Hospital Accreditation: District Hospital / Teaching Hospital

Department of General Medicine:

Divisions of Surgery Department:
General Surgery, Orthopedics, Urology, Obstetrics and Gynecology, Colon-Rectal Surgery, Neurosurgery

Divisions of Internal Medicine Department:
Pediatrics, Neurology, Cardiology, Allergy-Immunology-Rheumatology, Gastroenterology, Pulmonary Medicine, Nephrology, Infectious Disease

Other Divisions:
Radiology, Anesthesiology, Rehabilitation, Ophthalmology, Dermatology, Psychiatry, Dentistry, Emergency Medicine

Department of Community Medicine
Family Medicine, Physical Examination Centre, Mobile Clinics

Medical Facilities:

Department

Bed

General Acute Care

273

Intensive Care Unit

32

ER Observation

42

Baby Room

22

Neonatal Ward

15

Pediatric ICU & Newborn ICU

8

Respiration Care Ward

40

Hemodialysis

45

Recovery Room

8

Quarantine Unit

19

Chronic Illness Care

23

Psychiatric Day Care

28

Nursing Home

50

Hospice Palliative Care

4

Total

609

Operation Room

5

Deliver Room

2

Stories on the 921

Love in the Mountainous Town of Puli

by Dr. David W. Wong, the former Superintendent

of Puli Christian Hospital

Translated by the Christian Fellowship of Academia Sinica

  On the National Day of the Double Tenths, exactly twenty days after the Great Chi-chi Earthquake, I went back to my home in Taichung for the first time after the event. My family hoped I could relax my tense and anxious mind. However, I simply could not escape from the heart-rending sadness; I was filled with gratitude for a chance to reflect and anxious for the opportunity to convey my thoughts to others. I felt compelled to sit at my desk and promptly write this article.

A Disaster in Process: The Puli Christian Hospital in the Midst of an Earthquake

  On the night of the 20th of September, the Glorious Chorus was performing at the National Concert Hall in Taipei to raise fund for the Puli Christian Hospital. After the performance, eight of us, including my colleagues and I, returned from Taipei to Puli. Before embarking on the journey, my colleagues asked me to invite them to have supper at a restaurant in Taipei. This delayed our return for an hour. When we reached Puli, it was already early in the morning (1:47 am) of the 21st. When our driver (Little Chiu) parked the van, we felt a sudden, violent tossing up and down. This repeated three times and was followed by a series of strong sideways rocking motions. In the wake of being violently shaken, we saw a rotten tree in front of us split up in the middle and fall into two halves, breaking windshields and the rooftops of nearby parked cars. When we opened the doors of our van and stepped out on the ground, we felt certain there had been a great earthquake.

  When the earthquake subsided, we discovered that family members of hospital staff who were living in the hospital housing were gathering together in front of the apartment buildings. I immediately rushed to the front of the Main (Medicine and Diagnosis) Building to direct the work of evacuating the patients from the building.  

  By this time, medical personnel and technicians, as well as administrative staff, had already rushed into this seven-story building, helping to evacuate the patients out onto the parking lot. (Later I learned that during the actual earthquake, some nurses had already rushed into the building to support those nurses working the night shift.) It goes without saying that those colleagues in the General Affairs Department who accompanied me on our return to Puli followed me immediately to take part in the rescue. We helped those patients who were capable of walking to descend the stairs to the ground floor. Those patients incapable of moving had to be carried on stretchers. When there were no more stretchers available, we resorted to using blankets to enfold patients and carry them by relay to the ground floor and outside to safety.

  The Care Center for the Seriously Disabled (as commissioned by the Nantou County government) is located on the Seventh Floor of the main building. Here there were more than ten patients who were either incapable of walking, standing, or even sitting. These were carried out on the backs of our colleagues without any complaint or mishap. After just over ten minutes, all patients were evacuated, except five of them staying in the intensive care unit who could not be detached from respirators upon which they relied. These had to be taken care of by nurses who risked their own lives by staying inside the building.

  The Hospital was scheduled to run a combined exercise on mass causalities and fire alarms on the afternoon of September 21st. We were forced by the earthquake to fulfill our responsibility earlier than expected. Now I considered that there would soon be many casualties arriving at the hospital. Doctors, nurses, technicians, as well as administrative staff, had already gathered in front of the Building waiting for orders, while those who lived outside the hospital area also rushed back to the Hospital as soon as possible.

  As expected, within five to ten minutes, casualties were flooding in. The situation was not what we could have ever anticipated and one that we will never forget. The maimed and injured were arriving soon after one another, either via car, or in a van that honked its way through the crowds in a rush, or carried on the back or in the arms of a friend or loved one. These were all streaming into a small courtyard of the Hospital. Some of the injured had had their legs and arms broken under crushing weights; others lost an entire leg. Some were covered in blood; others were covered with dust. Some were seriously burned; others had internal bleeding in their skull, some also with their stomach or chest bleeding. Still others had their neck-bones broken. Some were no longer breathing and some no longer had a heartbeat but still had the warmth of life. Those colleagues responsible for triage repeatedly called for cardiopulmonary resuscitation (CPR) to be performed on those near death. Patients who suffered slightly less serious injuries had to be temporarily put aside for later treatment. More than twenty doctors, and even more nurses, were divided into several groups to deal with both CPR and emergency measures on those casualties having heavy bleeding on the very spot of the driveway near the courtyard in front of the main building. Not long after casualties were rushed in, the head of the Puli Office of Health (埔里衛生所)Director Jun-Chi Li (黎俊奇主任)also arrived to help out. The scene was filled with the wailing of family members calling out at the loss of their loved ones, mingled with the groaning and grieving of the injured.

  I started to worry about my family in Taichung, but could only pray to God to take care of them. I believed my colleagues present at the scene felt the same. But our concern for our families did not slow down our pace and effort of doing emergency care. During this time, aftershocks continued. I was so afraid that the Hospital main building would collapse and would injure not only the patients but also all the medical staff. We therefore made every possible effort to relocate those patients who could move to the Hospital parking lot. Pastor Cheng from Ta-Nan Church was right beside me assisting me in directing the move more efficiently.

  Some doctors practicing medicine in Puli joined us in our emergency care, yet I knew this situation could not be handled solely by the medical staff of Puli. We needed to seek assistance. Both telephone lines and cellular phones didn't work. Even the wireless exclusively used for the Emergency Medical Care Network failed. We were alone, helpless, and had nowhere to turn for help. A brave young lady, Mei-Fen (玫芬), working at our Research Center for Aboriginal Health Care, risked her life by getting to the operator room in the basement of the main building where she called out to the air by a HAM radio. She kept paging: "Disaster in Puli from an earthquake; we cannot handle the situation alone. Please help out...." It took her about an hour to finally get hooked up with a HAM operator who promised to spread the news for us. We were very grateful to this man whose name we still do not know. An hour later we got in touch with him again. He told us he had delivered this message to the outside world.

  We again asked him to pass on a list of first-aid supplies urgently needed. Ambu bags were on the top of the list. For patients who cannot breathe by themselves, an electric respirator will do the job for them. When relocating these patients, an ambu bag will be applied to keep them breathing. Air is forced by hand into the ambu bag. Our hospital had 16 ambu bags that were more than enough under normal conditions. But all of them were being used at that moment. Patients without an ambu bag would have to rely on their family members and medical staff to blow air into their trachea tube. Besides ambu bags, we were running out of epinephrine and trachea tubes. We were extremely anxious as we waited for news of supplies or assistance.

  The doctors were tired and their hands were sore from performing CPR, but they couldn't give up on any patients, no matter how hopeless the case seemed to be. Every time when death was announced, family members would keep begging: "Please do more....aren't you saving him any more?...." No one could ever take away such pain and sorrow of losing, in just a flash, one's beloved parents or children. Coworkers of our Pastoral Department kept the grieving company and comforted them. Ever since the earthquake, whenever I recall this scene during the night when all is quiet, I cannot help shedding tears.

  At dawn, my colleagues and volunteers for the Hospital set up a big canopy in the parking lot. They also set up a command center, an area for seriously injured patients awaiting transfer, and an emergency care area in front of the main building. Staff in charge of General Affairs and Administration as well as the hospital security guards made their best efforts to move beds and medical supplies, to transfer patients, and to direct the traffic efficiently.

  By dawn, there were fewer patients arriving than earlier in the night. The death toll hit 33. More than 300 patients were treated. Doctors were discussing the transfer of severely wounded patients to large hospitals in the central part of Taiwan. Meanwhile, we heard from the radio that the earthquake had reached 7.3 on the Richter scale and the epicenter was located around the Sun-Moon Lake area. We also heard that the Chungtang Highway was damaged and blocked off. In the morning, operator Kuo-Huey (國惠)gave us some good news - helicopters were arranging to come. We were then all anxiously waiting for the helicopters to come and transfer these critical patients.

The Arrival of Helping Hands from Other Medical Teams

  It was about eight o'clock when Vice President Lian arrived. I made a damage report to him, and pointed out that without helicopter support, more patients would die. The most seriously injured patients were immediately sent to Taichung Veterans General Hospital by three helicopters arriving with Vice President Lian. On their way back, the helicopters brought the first five surgeons from Taichung Veterans General Hospital to help Puli Veterans Hospital and Puli Christian Hospital. My wife Dr. Shih-Chu Ho (何師竹醫師), also the chairperson of the Department of Obstetrics and Gynecology, was among them. As she said, it was quite a complicated feeling when we met each other. On the one hand, we were so happy to see each other after the disaster but on the other hand, we felt so sad for the tragedy of Puli's residents. Helicopters also brought us water and food so we were slightly relieved.

  All morning, we tried our best to take care of the patients that we could not handle before dawn. When the medical teams of Tzu-Chi Volunteers and Taichung Veterans General Hospital arrived, they took over some of the care of the patients with wounds that could not be sutured earlier and bone fractures that had not been set.

  Some electricity cables were broken so we could not use our X-ray machine. The operating rooms had backup power but no water. The condition of gas pipelines for surgery was unclear. Even if we could perform surgical operations, caring for the recovering patients in the open space would be a big problem. Therefore, we decided to transfer patients who needed surgery immediately to equipped hospitals in the central part of Taiwan.

  We started to make contact and arranged for helicopter transportation. There was a disagreement on the best landing spot for the helicopters. In the meantime, we made arrangement for ambulances by borrowing vans from outside. (It is heartbreaking that Bao-Yuan (寶源), our dear volunteer ambulance driver and all five members of his family died in the earthquake.) We went through long hours of waiting and worrying but finally helicopter transportation started in the afternoon. With the help of the Seagull Squad of the Army, about seventy patients were sent to other hospitals before dark. During the first day of the earthquake, we took care of approximately six-hundred to seven-hundred patients not including those who were slightly injured and did not officially sign in.

  Since all communication equipment failed, the Department of Health stationed in Nantou Rescue Headquarter realized that Puli was cut off from outside world. Many medical teams were dispatched to Puli on September 21st. The Mackay Memorial Hospital medical team headed by vice superintendent Dr. Chun-Hsiung Huang (黃俊雄副院長)arrived at 8pm. Their arrival gave us great encouragement and support. Some of the surgeons felt incapable of doing much about the situation because there was not a proper operating room or equipment and, at this time, there was not a large quantitiy of injured still coming. They helped our pediatrics and nursing departments, which had always been short of medical staff, and also relaxed the tension of our exhausted medical staff. We did not know whether there would be any big strong aftershocks.

  Soon the National Taiwan University (NTU) medical team headed by the vice superintendent Dr. Fang-Yu Lin (林芳郁副院長)arrived. At that moment, we had sufficient medical staff to take care of our patients. I suggested to our vice superintendent Ms Li-Hsueh Lin (林麗雪副院長)to go to Puli Veterans Hospital to see whether they needed any help. After evaluating the situation, the NTU medical team decided to set up a clinic center for the shelter in Puli Junior High School to take care of thousands of residents living in tents there. It was midnight when Chang-Gung Memorial Hospital medical team arrived in our hospital. We suggested that they either return to the Kuo-Hsing Office of Health or go to Jen-Ai Township, where the situation was unknown, to see whether residents there needed help. One of the doctors said at the end of day, ``I did not even treat a patient yet.'' I felt deeply sorry that they were on the run for a whole day and yet I believed their love, concern and effort would still benefit residents in Nantou County in the days to come.

  Many medical teams came to help including church hospitals such as: Mennoite Christian Hospital, Changhua Christian Hospital, Chiayi Christian Hospital, Ping-Tung Hospital, St Paul’s Hospital, and other hospitals such as Shin-Kong Wu Ho-Su Memorial Hospital, Cheng Ching Hospital, Jen-Ai Hospital, Tzu Chi General Hospital and Chiayi Veterans Hospital, and Keelung Municipal Hospital. In addition, medical teams from non-government organizations also came to help, including Taoyuan Medical Association and Taiwan Roots Medical Association. Many individual medical doctors and nurses from abroad and from Taiwan also came to our hospital to help. On the the third day (September 23rd), Cardinal Tien (Keng-Shin) Hospital medical team took over the emergency care formally handled by the Changhua Christian Hospital medical team. Some of these medical teams and individual medical staff stayed in our hospital to help. Some went to set up clinic centers in several shelters located in primary schools and junior high schools to take care of residents there. This was a great assistance to the Nantou residents who lost their vehicles in the earthquake and did not have convenient access to medical care.

Prayers: Peace in Aftershocks and Typhoons

  On the morning of September 22nd we experience a strong aftershock. Several houses in town collapsed. Immediately, about twenty of the injured were rushed to the Hospital. Some had spinal injuries. On this day, we sent out more than seventy patients by helicopters. Among them were forty patients desperately in need of kidney dialysis.

  The bodies of seventy-two patients who had died in the Chi-Chi earthquake were being stored at the hospital motorcycle parking area for simple sheltering. After broadcasting the plea via mass media, we finally received a large freezer for storing the corpses. This relieved the crises posed by the impending decay and decomposition of the bodies and the spread of disease that could result. Our coworkers in the Pastoral Department comforted family members who lost their loved ones. Because of unavoidable delays in the arrangement of funeral services, family members were hurt and angry. It was difficult to appease these family members who had lost so much. A memorial service for the dead was held, and Pastor Wen-Ping Chang (張文彬牧師)gave the sermon with running tears. I too could not help myself from being flooded with tears.

  On September 23rd, the medical care was performed in a field hospital under a canopy. After Director Chin-Shui Shih (施金水主任)of the General Affairs Department and Director Chin-Kang Chen (陳錦康主任)of the Medical Affairs Department carefully reviewed the safety of the main building, we decided to begin repairs. On the same day, a group of patients who were seriously ill and needed kidney dialysis were sent out of Puli for treatment.

  During these past weeks, in addition to the dedication of all medical personnel, technicians and administrative staff worked day and night. One tremendous source of help for the hospital was the enthusiastic involvement of many volunteers. For example, the family of Brother Lo, who was in charge of cooking in the Nutrition Department, risked their lives to cook rice soup in the kitchen located in the basement of the main building for the exhausted and hungry staff on the night of the earthquake. Volunteers of Tzu-Chi Foundation arrived on the following morning and worked together with Brother Lo to provide meals for more than five or six hundred people in the hospital area in the next few days. Later on, volunteers of the Benevolent Institution of Tien-Hsien Temple, Keelung took over this task for one week. The Shin-Dian Covenant Church, Taipei is helping provide food this week.

  Volunteers from non-governmental organizations and religious groups arrived at the hospital one after another. They were extremely helpful to us in building shelters, moving supplies around, taking care of miscellaneous tasks, and later, even restoring and cleaning the main building. They also generously brought various commodities and supplies, even more than what was necessary to meet the needs of patients, family members, and staff. We asked World Vision Taiwan and various churches to deliver excess supplies to distant aboriginal villages and residents who were not able to get supplies from Puli disaster relief centers because they did not have transportation.

  The fourth day after the earthquake was the Mid-Autumn Festival and many more friends and organizations came. We organized a special Mid-Autumn party for patients, their relatives, hospital staff and volunteer groups at our field hospital square. Pastor Ming-Ta Du (杜明達牧師)preached and a joint choir from several churches sang. What an unusual Mid-Autumn Evening! No one will forget this special occasion. We enjoyed the privilege of having peace in the midst of adversity and thanksgiving in the midst of exhaustion.

  On the same day, we followed the suggestion of public health officials to track down any possible epidemic diseases. Dr. Chih-Cheng Chen (陳志成醫師)of the Pediatrics Department, National Taiwan University Hospital and Dr. Chih-Kuei Lee (李智貴醫師)of our hospital designed an epidemic disease case history form to track the geographic location and treatment of epidemic diseases in disaster areas. Fifty-thousand copies of the forms were soon printed in Taichung to be used in our hospital and other medical stations. With the aid of helicopters, we resumed medical service in mountain villages of Jen-Ai Township.

  By the evening of September 25th, some of the damaged wards were repaired. Many patients who had been staying outside the main building could be moved into the building. Native Puli patients were happy to return to our kidney dialysis center for treatment. However the aftershock on the morning of the 26th, measuring 6.8 on the Richter scale caused us to again evacuate. Considering the fear of aftershocks, we decided to transfer serious patients out of Puli and to begin building sturdy temporary wards for patients in the parking lot.

  The Hospital received generous support from Gong-Hsin (工信)Construction, Gong-Chu (工礎)Construction, BES Engineering Cooperation, and TECO Electric and Machinery. With their help, and the hard work of our General Affairs Department, the very first air-conditioned container ward in Taiwan began service on September 29. By now, all in-patients have moved to the container wards. A 32-year-old hospital building was declared a "dangerous building". Therefore, the Administration Department and Outpatient Clinics had to temporarily move to the first floor of the main building. Staff and patients were crowded together, but felt relieved and secure in the main building.

  There have been an uncountable number of aftershocks since September 21. We developed the skill of accurately estimating the scale of an aftershock by observing the sway of clocks hanging on the wall. Thankfully, the number of strong aftershocks was gradually decreasing. All of us in Puli Christian Hospital started our day with one accord in prayer .

  In the past week, the Weather Bureau forecasted that Typhoon Dan was on its way to Taiwan. We were very concerned for the residents living in tents all over the earthquake area. Our colleagues thus prayed earnestly for the weather. Although the sky of Puli was darkened by clouds every afternoon, it turned out the expected heavy rain never came. Thankfully, the severe weather warning for Typhoon Dan was later rescinded. The moderate-scale typhoon landed instead in Mainland China and there it became a low-scale one. It appeared the typhoon had taken several detours, as if it was avoiding Taiwan, and finally landed at the originally predicted spot in Mainland China. My heart just cannot help but be filled with awe and the fear of the Lord. Events such as these cause me to truly believe that the rehabilitation of Taiwan lies in the Lord’s hands.

Thanksgiving: Love from the Medical Community and Fellow Countrymen Poured into Puli

  I thank God for His mercy and grace, allowing me to return to my post in time with my administrative staff. Chiu, my colleague who was driving us back home the night of the earthquake, told me I should thank him as he was driving up to 130 Km/hr while I was asleep on our way back from Taipei to Nantou. If it weren’t for this we would have been shut off from Puli outside the collapsed tunnel. Of course, thanks to God are also warranted, for as the big tree fell near our van during the quake we were miraculously unhurt, allowing us to engage in the emergency care immediately.

  I thank God for such noble, courageous, and self-sacrificing colleagues at Puli Christian Hospital. Most of them are not Puli natives. Some left jobs as supervisors in large hospitals and came to Puli without thinking of the personal wealth and prestige they left behind. Many of them lived with their families in the hospital dormitory, thus enabling them to deliver immediate care to the injured at the point in time when they were most vulnerable.

  That night, all of us forgot about our own safety, taking no account of the threats to our own well being. I learned later that some doctors performed mouth to mouth artificial respiration despite the patients’ mouths being filled with blood. These doctors included Dr. Kuan-Bao Lai (賴官寶醫師)from our Anesthesiology Division and Dr. Wen-Shih Tsai (蔡文石醫師), an expert in Infectious Diseases, and others. Many of the doctors grieved and grappled with intense sorrow as they continually offered first-aid to the injured and dying. Some had to wail aloud before they could go on. They shared in the grief that their patients’ families felt, the unwillingness to let go, the unwillingness to accept the tragic loss of life. Even now the grief and irrational guilt over not saving more people lingers on among the medical and nursing staff. From the night spent rendering endless emergency care, up until now when we face the tremendous task of restoring the hospital, none of the Puli natives who work in our Hospital have left their posts. Some come to work in the morning from their new residences, simple tents replacing their homes destroyed in the quake.

  Colleagues from each division demonstrated their love, determination, clear thinking and coordination, all of which were far above my expectation. I am so proud of this team. That night, when dozens of the wounded rushed in, doctors who practiced medicine in Puli joined in the emergency care one after another. Dr. Yu-Ren Yang (楊育仁醫師), a neurosurgeon in town, gave us confidence in diagnosing patients suffering from intercranial hemorrhage (bleeding inside the skull). Director Li of the Puli Office of Health rushed to assist us from the very beginning. He told us in modesty that he was here "reporting for duty." In the following days, he coordinated the Relief Headquarters, directing each hospital and medical station. He issued causes of death for death certificates. Not long after the disaster, he started the epidemic prevention program by supervising insecticide spraying in town to prevent the proliferation of flies and other pests. Dr. Deng-Shen Hsueh (薛燈盛醫師), Dr. Nieh (聶醫師)from Shui-Li Township, Dr. Kuang-Hong Tseng (曾光宏醫師), Dr. Jun Lo (羅均醫師)from Taichung County, and many more, all extended their assistance to us in providing medical treatment that very day and later. We deeply appreciate and admire their efforts.

  I would like to thank every individual and official institute who helped us move the severely injured out of Puli. The superintendent of Taichung Veterans General Hospital (TVGH) Dr. Shiu-Hsiung Chao (趙秀雄院長)cancelled all elective surgeries to help the seriously injured who were sent to his hospital. The entire hospital made every effort to rescue the patients. Because there were an insufficient number of surgeons at TVGH, even senior doctors of obstetrics and gynecology and internal medicine came to help serve as assistants for their surgeons. I believe that other hospitals in the central part of Taiwan did the same; with tears they gave all they could to help the patients from Puli. The people of Puli equally appreciated the generosity and concern of those who were unable to come to Puli.

  I would like to also thank those executives in the Nantou Rescue Headquarters who dispatched medical teams to Puli. Even though there was not enough equipment for surgeons to fully demonstrate their expertise, their presence encouraged us and met other medical needs in Puli and neighboring areas after the quake. The Taipei Pharmaceutical Association, Cheng-Hsin Rehabilitation and Medical Center, Taoyuan Medical Association and Christian hospitals all over Taiwan collaborated with my colleagues to work in the Hospital and other medical stations. Even now, most of them are still with us.

  Emergency specialist Dr. Chao-Chun Chen (陳昭娟醫師)from California, Dr. Chi-Fang Wei (魏績舫醫師)from Houston Chinese Church, Drs. Ying-Ming Chang (張英明醫師), Yuan-Ching Lin (林元清醫師)and Chun-Jay Chiu (邱俊杰醫師)from North American Medical Association of Taiwanese came a long way to rescue lives. They joined us in venturing deep into the mountains to Wu-Sher and Fa-Chi Village without any hesitation. It was Dr. Wei who rushed to rescue survivors involved in a fatal accident killing eight and injuring five on the way from Jen-Ai Township to Li-Hsing Village. A Taipei Veterans General Hospital osteology specialist, Dr. Kuang-Shen Lee (李光申醫師), who had been working on his Ph.D. in Britain, returned to Taiwan soon after the earthquake to offer assistance. Although this probably delayed the completion of his degree, he did not want to be absent from the scene when his people needed him most. I believe that the unreserved devotion of the medical community during this national crisis will change the community’s view of the role of medical professionals in the future.

  After the earthquake, the sincere brotherly love, which was manifest throughout the disaster areas, greatly comforted those suffering among us. Many organizations, religious groups, private enterprises and church pastors traveled great distances to Puli, bringing along all manners of supplies with them. Some even stayed to serve as volunteer workers. Many of my former classmates came by themselves or led medical teams to our hospital to help. My former teacher, Superintendent Shao-Hua Han (韓韶華院長)of Taipei Cheng-Hsin Rehabilitation and Medical Center, sent his vice superintendent, Dr. Chen-Chung Fu (符振中副院長), to bring a large amount of cash for our emergency use. It is impossible for me to exhaust the list of all those who have helped. However, I would like to take this opportunity to express my hearty appreciation to all of them.

  Our good neighbor, Ai-Lan Presbyterian Church, kindly allowed us to use all its space to accommodate our patients and our staff who lost houses in the quake. Moreover, the pastor and his wife and all of the church members offered their help around the clock. May God remember their love for us and bless this church.

Suggestions: What to Do If Another Major Earthquake hits

  The damage caused by this earthquake has impacted the administrative systems of the government as well as other professions in many different ways. Lately I've been wondering, “If we have another major earthquake today, or in a month or two, would there be fewer causalities than this time?” Currently in Puli most of the residents no longer dwell in concrete buildings, and therefore it is less likely that many would be injured. But what if the earthquake hits the areas that are far and remote? Would it be possible to rescue more people?

  How helpless and desperate we were that night, with no communication to the outside world, as the wounded just kept pouring in! More than ten hours had passed, but the only knowledge that the Nantou Rescue Headquarter had about Puli was still a "no response". This inability to communicate our evolving needs was the reason why some members of the medical rescue teams complained about not being of any help, or not even seeing a single patient after traveling great distances on dangerous roads to get to Puli. I wonder whether the rescue teams encountered the same problem and had the same regrets upon their arrival in other areas of Nantou County and Taichung County where residents received assistance much later than we did.

  We realize now what we most urgently need a satellite communication system that would not be affected by any natural disasters. Any hospital, especially those in the remote areas, should possess this kind of equipment in order to send out SOS's as early as possible so as to obtain the correct amount of timely aid. It would also enable the Department of Health to obtain the most current updates on the disaster. In the past two weeks, we have made many contacts hoping that a satellite communication system could be set up for the hospital for any future possible disaster.

  Next, we need to establish a nationwide emergency medical system with a helicopter team for emergency transit, which will land the medical staff in the scenes of disaster in the shortest period of time (thirty minutes to an hour). This emergency helicopter team would also be responsible for promptly sending patients to a safe area for treatment when the number of wounded was too large for the facility or there were insufficient supplies for treatment at the stricken areas.

  Since the distance between towns and cities is usually moderate in Taiwan, in my opinion, the enormous number of injured should be transferred out of the stricken areas immediately, which would be much more efficient than sending bulky surgical equipment there. The latter could be applied to minor disasters.

  Every second lost in transferring the injured costs the lives of those who could be rescued. A delay of a few hours can result in rescuers missing the “golden period” when the most lives can still be saved. The health administrative department should be able to dispatch an emergency air transport system in the minimum of elapsed time. To achieve this, the government has to assign places for helicopters to land and take off and to plan the available flights prior to the disaster. In addition, reducing the transportation time and the number of transfers necessary for patients should be taken into consideration. Since not all disasters occur in the daytime, nighttime navigation systems for helicopters are essential.

  The medical and rescue teams that rushed to the stricken areas including the Seagull Squad, the air-police, and the military aircraft that helped transfer patients in this disaster could be organized as a task force that is immediately available whenever disaster strikes. Perhaps the formation of such a task force now would be the best way to console the family members of patients whose lives were lost due to lack of manpower. Perhaps such an act could put at ease the minds of those nurses and doctors who arrived later on only to find, regretfully, that they were too late to be of any help.

  We have learned from this catastrophe that it's necessary to reinforce the safety requirements of hospitals. Not only does the building have to be shockproof and the interior decoration fixed to the building, but protection of electrical wiring is also essential. In this way the hospital can still function fully even if disaster strikes. Ideally one could set up an independent building as the emergency medical unit (preferably a one-story building) in addition to the hospital, which would enable the medical crew to safely concentrate on the rescue even in the setting of frequent severe aftershocks. Major district hospitals must have sufficient supplies of medicine and equipment that are inventoried periodically. In addition, disaster drills should be practiced regularly. Since I am not an emergency medical expert, I would like to have an opportunity to share and discuss my thoughts from this painful experience with scholars and specialists of this field.

  The quality of medical care in Taiwan is comparable to the United States and European countries. However, the lack of medical resources in the remote villages is still a problem for those poorer residents who are most likely to get sick or become critically ill.

  Something precious about democracy is that one can choose freely where to practice medicine according to one's own wishes. However, the current unequal distribution of medical services in Taiwan, in which excess resources are available in urban areas while resources in rural areas are chronically insufficient, is a situation that is in no one’s best interest.

Conclusion

  Forty years ago, foreign missionaries came from afar to Puli, a mountainous town in rural Taiwan, to build up the Hospital for Puli residents and the aboriginal people living there. Deeply inspired by the love of these missionaries poured out upon our people, my colleagues and I came to work in this beautiful town to guard the health of residents in Puli and the neighboring, large mountainous regions of Ren-Ai, Hsin-I, Yu-Tsu and Kuo-Hsing Townships. As we now walk through the "Valley of Baca" with the refugees of the 921 Chi-Chi Earthquake, we sense again the limitations and helplessness we felt immediately after the quake. We sincerely hope that in the future medical care resources can be distributed more effectively in Taiwan through careful planning and legislation. In this way good medical care can be made accessible to those who have lost their loved ones and possessions and yet would rather stay in this area than leave.

  The 921 Chi-Chi Earthquake affected many families and homes; the whole town awaits to be rehabilitation. Like a spring thunder awakening all life from its winter hibernation, our needs have roused the hidden love of our countrymen and medical community. I wish that some of the friends coming to support us could see the need of the remote country and could stay and work with us. Let us continue the first desire of the founders of the Hospital – pouring out love upon our people. Let the love remain forever. I truly believe that these wishes will come true.

Medical Service

Medical Service

Monday to Friday:
Morning consultation: 9:00~12:00
Afternoon consultation: 14:00~17:00
Evening consultation: 18:30~21:00

Saturday:
Morning consultation only: 9:00~12:00

For emergency help, the PCH Emergency Department provides care 24 hours everyday.