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