(courtesy of the Noordhoff Craniofacial Foundation)
One can’t help but feel tender affection for an eight-month-old baby boy from Kiribati, his wide eyes looking about innocently as his mother holds him snug in her arms. Having been born with a congenital heart defect, the little boy has been flown over 9000 kilometers to Taiwan to undergo surgery at MacKay Memorial Hospital.
The Republic of Kiribati is listed by the United Nations as one of the least developed countries in the world, and it is also one of the poorest. Through a medical cooperation program between Taiwan and Kiribati, since 2007 more than 350 people with serious conditions have been referred across the sea to Taiwan for surgery, extending their lives and giving them new hope.
A long line of Cambodian patients come for a free clinic offered by MacKay Memorial Hospital. (photo by Lin Min-hsuan)
Deeply rooted assistance
Overseas medical assistance by MacKay Memorial Hospital can be traced back to the year 2000, when they sent personnel to the remote mountains of the Golden Triangle in northern Thailand to provide healthcare education. Since then, the hospital’s mobile medical teams have left their mark in a number of countries of Oceania, Asia, and Africa including Fiji, Cambodia, and the Gambia.
Moreover, in 2006 MacKay and the Tungaru Central Hospital in Kiribati signed a “sister hospitals” agreement. As part of their “Taiwan Medical Program,” which in 2019 entered its 13th year, teams from MacKay provide free treatment of patients and training of healthcare personnel.
Crystal Wan-ti Hsu, vice director of the International Medical Service Center at MacKay, says that the hospital’s team brings ultrasound scanners and other medical devices along on each medical mission. After confirming the list of patients eligible for overseas referral—the majority of whom suffer from heart disease—they arrange their transfer to Taiwan for surgery. Many patients who come from Kiribati for medical care feel that Taiwan is like Heaven, and some even want to stay here and not return home.
Yu Fa-chang, an attending cardiologist at MacKay Memorial Hospital, offered free clinics in Kiribati and provided clinical training to local doctors. (courtesy of the International Medical Service Center, MMH)
But in fact for cardiologists, Kiribati is a paradise for the practice of their specialization. Because rheumatic heart disease was eradicated in Taiwan in the 1980s, local cardiologists have only seen it in textbooks, and have never personally diagnosed it. When MacKay began its work in 2007, in that first year 40 people with rheumatic heart disease were screened out of 120 patients, indicating a prevalence higher than that reported in the medical literature. The cardiologists on the team were excited to meet the challenge of diagnosing and treating this disease, for patients with rheumatic heart disease show a wide range of heart symptoms, meaning that the doctors could put all of the knowledge they had studied in medical school through its paces in the course of a single medical mission.
MacKay began doing large-scale annual screenings of children and young people in Kiribati aged nine through 19. When they began, the prevalence of rheumatic heart disease was 22 per thousand, a very high level. This is because local sanitary conditions are poor, and bacterial infections with a “group A beta-hemolytic streptococcus” (GABHS) may lead to rheumatic fever. Over time this can evolve into rheumatic heart disease, which may ultimately lead to heart failure and death.
To date they have identified 4,000 cases. When youngsters are screened as positive, interventions such as penicillin injections ensure that these future masters of their country do not become disabled or die young as a result of rheumatic heart disease; this also raises the average life expectancy for Kiribatians.
The Noordhoff Craniofacial Foundation and Chang Gung Memorial Hospital have cooperated in offering volunteer clinics in nine countries, providing free surgery to over 1900 poor patients.
Aid recipients become aid givers
MacKay Memorial Hospital even set up Kiribati’s first adult intensive care unit in 2016. The moving force behind this project was Niu Kuangyu, a doctor of emergency medicine who had been dispatched to Kiribati for a long-term stay. On his first day on the job, a pregnant young woman came in suffering from acute pulmonary edema, and he immediately began treating her, initiating advanced cardiac life support as called for by the standard operating procedures of medical centers in Taiwan. However, in the end, because Kiribati lacked respiratory care equipment and emergency resuscitation medicines, this patient, who could have been saved in Taiwan, died right before his eyes, ending two lives. This blow made Niu determined to set up an intensive care unit in Kiribati.
Since 2017 MacKay has also been cooperating with the International Cooperation and Development Fund (TaiwanICDF) to implement the “Capacity Building Project for the Prevention and Control of Diabetes” in St. Vincent and the Grenadines.
Because diabetes is the second leading cause of death in St. Vincent, MacKay Memorial Hospital, with its experience in integrated care, has trained doctors, nurses, and dietitians from St. Vincent to act as seed personnel for the project. After returning to St. Vincent, they have organized community health education activities to raise awareness and improve citizens’ ability to manage their own health.
MacKay Memorial Hospital donated a CT scanner to Kiribati. It was the first CT scanner to work properly in the South Pacific, and local medical practitioners have been trained to operate it. (courtesy of the International Medical Service Center, MMH)
Sylvia Lin, division chief in the Humanitarian Assistance Department at the TaiwanICDF, notes that St. Vincent’s health minister, Luke Browne, specially emphasized the importance of this diabetes prevention plan to St. Vincent when he spoke at a technical briefing on chronic disease prevention at the World Health Assembly in 2019. Minister Browne has spoken up on Taiwan’s behalf for three straight years at the WHA, arguing that Taiwan should not be excluded from the World Health Organization. People in Taiwan have been very touched by this show of friendship in the face of injustice.
Overcoming cross-cultural obstacles
The Noordhoff Craniofacial Foundation (NCF) launched its program of international medical assistance in 1998, thanks to the warmhearted assistance of a Taiwanese businessperson in Vietnam. They began their “Seed Medical Practitioner Training Program,” which has flourished around the globe.
However, when they began the training program, they faced cross-cultural differences.
A Filipino youth named John, who received free reconstructive surgery for cleft lip and palate from an overseas mission of the Noordhoff Craniofacial Foundation many years ago, has grown up to be a healthy and optimistic young man.
High-ranking hospital staff in beneficiary countries like Vietnam and Cambodia were unwilling to develop their own craniofacial surgical teams, because countries like the US, France, and Japan were giving direct subsidies (such as U$50 per operation), which was straightforward and simple.
It took an adjustment period of a few years before beneficiary countries finally realized that “we sincerely wanted to help them.” Rebecca Wang, CEO of the NCF, says that it was only after several years of visits and evaluations that anesthesiologists at the National Pediatric Hospital in Cambodia revealed that they didn’t dare to do craniofacial surgery because they didn’t have adequate skills in anesthetizing young children for complex operations. As you might expect, the first time a volunteer surgical team went to Cambodia, the hallways were packed with patients wanting treatment. In four days the volunteers conducted over 50 operations, exhausting the doctors and nurses.
With the aim of making it possible for children elsewhere with cleft lip or cleft palate to receive the same treatment as children in Taiwan, as of May 2019 the NCF, in cooperation with Chang Gung Memorial Hospital (CGMH), has made 83 visits to nine countries to offer free surgery to 1,994 poor patients. They have also trained 173 seed medical professionals (including surgeons, orthodontists, and speech therapists) from 21 countries, and guided the founding of more than 20 craniofacial centers or teams overseas. They have achieved a great deal for Taiwan in terms of “medical diplomacy,” and their reputation has even drawn requests from doctors in Russia to come to Taiwan for training.
The Noordhoff Craniofacial Foundation mends “those things God did not have time to finish” with volunteer clinics and love.
Seed training vision
In fact, the vision for the seed training program came from the experiences of the Taiwan support team for the NCF’s founder, Dr. Samuel Noordhoff.
When Noordhoff came to Taiwan in 1959, MacKay Memorial Hospital was in crisis due to a shortage of skilled personnel. As superintendent, Noordhoff sent doctors in specialisms such as cardiology and nephrology to the USA for training, and the skills and knowledge they brought back raised the standard of medical care in Taiwan. For Noordhoff himself, as a general surgeon, complex craniofacial surgery was a great challenge, so he too went back to the US for two years of advanced training.
Seed doctor Bona Lotha (right) has learned the latest skills in cleft lip and palate reconstructive surgery from the medical team led by Lo Lun-jou (left), chairman of the Department of Surgery at Chang Gung Memorial Hospital. (photo by Lin Min-hsuan)
Noordhoff became the first superintendent of CGMH in 1979, and at the time he had great ambitions, hoping to turn Taiwan into a world leader in plastic surgery. He and his star students Wei Fu-chan and Chen Yu-ray were named Maliniac Lecturers, the highest honor of the American Society of Plastic Surgeons, while Chang Gung’s Linkou branch has become world famous for its reconstructive microsurgery and is a major training center for doctors from around the globe.
Bona Lotha, a doctor from India who is currently training at CGMH, says: “Children in Taiwan with cleft lip or cleft palate are really lucky. The reconstructive skill level of the Chang Gung craniofacial surgery team can give them lips that are even more beautiful and harmoniously shaped than those of ordinary people.” He is very touched by the patience shown to seed doctors by the medical team led by Lo Lun-jou, chairman of the Department of Surgery, as well as their willingness to unreservedly share their most advanced reconstructive techniques for cleft lip and cleft palate.
Although the children of Kiribati are lacking in material wealth, they are innately optimistic and active. (courtesy of the International Medical Service Center, MMH)
Dr. Lotha worked as a surgeon in Yemen for 17 years, so he is already very experienced. In 2003 he founded the organization Yemen Smile to provide free treatment to people with cleft lip or cleft palate throughout the country. However, civil war broke out in Yemen in January of 2015. Sixteen bombs fell close by his clinic, and military forces began a large-scale slaughter in the area. Assisted by the Indian military, he was able to escape to the Republic of Djibouti in East Africa, and has not been able to return to Yemen since.
Because of the impact of the civil war, Lotha faced a low point in his career and even considered giving up medicine to go into business. He says that what he has learned at CGMH has reawoken his initial dream of engaging in healthcare education, and reminded him that his heart “is still in the Arabian Peninsula.”
Dr. Noordhoff, who passed away in 2018, once said, “Defects that can be repaired are no longer defects.” He also said, “I will mend with love those things God did not have time to finish.” In the same spirit, overseas medical assistance spreads the power of Taiwan’s healthcare expertise to countries in need, and that power is without limit.