2007 Reported by “Taiwan Review”, issued by the Government Information Office, R.O.C.
Helping a Friend in Need
A Taiwanese medical mission to Somaliland allows Taiwan to show some of its “soft power.”
One day in May 2005, Liu Chi-chun, founder of Taiwan Root Medical Peace Corps, received an email, saying, “We both are orphans in the international community. Nevertheless, you have 20 some friends and you are rich, we only have one friend and we are poor. And the things you do are what my people need. Can you come to help us?
The sender was farah Ali from the Republic of Somaliland, a de facto independent republic located in the Horn of Africa. The people of Somaliland declared independence after the central government of Somalia collapsed in 1991. Somaliland has not, however, been formally reognized by any countries other than Ethiopia, or internaional organizations, including the United Nations, so far.
Liu, a dentist, has long been dedicated to humanitarian relief work. In 1995 he started organizing volunteer service teams to offer monthly free clinics and educational materials to Taiwanese, mostly aboriginals, living in remote and inaccessible mountain villages.
In 1999, he was asked by Taiwans Ministry of Foreign Affairs to set up a field hospital at a Kosovar refugee camp in Macedonia, the first of his group’s international missions. Since then, his teams have provided free medical care to isolated populations and treated victims of natural disasters in Asia, Africa, the Caribbean and Latin America.
Liu made a fact-finding tour to the African country last year. “Somaliland needs assistance in almost every aspect- infrastructure, education, water supply and industrial development. In terms of medical care, the country is just starting from scratch. But, viewed from another angle, this makes it easier for us to offer help,” he says, pointing out that, where there was established health bureaucracies, it can be difficult to introduce new ideas.
On that visit, Liu contacted Somalilad’s Ministry of Health and Labor (MOHL), Hargeisa Group Hospital and the Faculty of Medicine (established in 2002) in the University of Hargeisa to find out what was needed. Accordingly, he decided to organize training programs for local nurses, dentists and surgeons.
Through the arrangement of Taiwan Root, Cristina Chen, a lecturer at Tzu Chi College of Technology’s Department of Nursing, headed to Somaliland in August last year to implement a hospital management project. During her six-month stay, Chen helped establish a filing system for patient records, schedule nursing rounds and track hospital equipment inventory, in addition to teaching in a local school.
Taking a Team
In late February this year, Liu led a 24-member team, including dentists, pediatricians, physicians, surgeons, pharmacists, nurses, laboratory techicians and general workers, to the African country for a two-week medical mission.
“We have been hoping for this mission for a long time. We’re isolated, not only politically but also in regard to humanitarian aid. Taiwan is the first country to offer such a service here.” MOHL, Minister Aldillahi Iman said, “Just as Somaliland was once a British colony, Taiwan experienced colonial rule as well. Such historical similarities should enable the Taiwanese to understand our situation better than anybody else.”
Iman says his countrys infrastructure and health-care system were seriously damaged as a result of a civil war between 1988 and 1991 and have yet to be rebuilt. He is glad to see Taiwan Root providing medicines and training for medical workers. “We hope to expand cooperation with Taiwan from health to other sectors like education and esploitation of natural resources, as well as relationships between nongovernmental organizations (NGOs) like Taiwan Root and the government,” he says.
Yassin Abdi, director of the Hargeisa Group Hospital, says that for the time being his hospital is the sole national establishment, and there are five regional hospitals. Everywhere there is a chronic lack of medical personnel.
At his hospital, for example, there are only 10 doctors, partly due to budget constraints. “Most doctors here are working in the private sector as they can earn US$50 an hour, compared to US$50 a month in the national hospital,” he says. “We have shortages even in the city. How can we provide medical care in the countryside?
Abdi adds that the doctors working in his hospital are largely in their mid-40s like himself. Increasing the number and quality of young medical professionals is at the top of his list. “Our priorities are the training of new nurses and doctors both in the university and hospital levels as they are the future of our country,” he stresses.
There is a huge gap between war-ravaged Somaliland and much of the rest of the world, none of it made easier by the country’s lack of international recognition. Internet connectivity, for instance is expensive and limited. “We can only access a few Web sites as many of them require free-based membership. Actually it is not the charge of US$10 or $20 that is the problem, but the way of making payment through a credit card, because we don’t have a credit card system here,” he says. “That makes our information collection and procurement of books difficult.”
Furthermore, Somalilanders wishing to pursue advaced studies overseas find innumerable obstacles in their way. “Besides the financial problem, our people have difficulty in obtaining visas as our passports aren’t accepted by most countries.”
Dearth of Know-how
As a result, Abdi says, his country needs experienced instructors who can introduce up-to-date medical knowledge and techniques to both teachers and students.. He is grateful to Taiwan Root for launching nursing training and administrative management projects in his hospital.
Likewise, Derie Ereg, dean of the Faculty of Medicine at the University of Hargeisa, wanted to thank team members for their mobile medical services in outlying districts. His students also joined the team’s mission to learn how Taiwanese doctors make diagnoses and prescriptions.
“It’s a nice job that we will never forget. Not only my students appreciate it, but also the public you’ve treated. For many of them, probably, its the first time they have ever seen a doctor,” he says. “Moreover, I can imagine how tough it is for you to be in a place where there is no running water, no entertainment and no good-looking things.”
During their mission to the northwesst region, Taiwan Root volunteers had to traverse dusty, bumpy roads that seemed to stretch out in all directions and endure the heat inside vehicles for hours to reach the villages where they were to provide treatment, only to have set off for another destination before nightfall to avoid the dangers and difficulties of traveling at night.
The convoy consisted of jeeps and vans, as well as trucks loaded with generators and a abig water tanker, in addition no medical supplies. By the end of the day, tea members were each given a barrel of water to shower themselves and had to prepare their own food and find a place to rest in their sleeping bags.
Often, long before the arrival of the Taiwanese medical team at the temporary stations, local residents had already swarmed in and formed long queues.
Khadra Mohamed, a farmer and father of 10, was among them. “Our village chief told us a few weeks ago that a medical team from Taiwan was coming here to offer free care. So I’m here with my children, who have diarrhea. And I myself have had muscle pain for year.” he says.
“We need to travel for four hours to the city to see a doctor. But it’s not just the distance, it’s the medical costs as well-it’s simply too expensive for us.”
Thirty-year-old Roun Maxamed had suffered from a severe headache and consequent insomnia since 1997. “It’s hard for me to fall asleep because of the headache,” she told the medical team. “It’s great that you are here to help me and our community. Please come back again.”
Volunteer Hwang Cheng-lung, a physician, was surprised to find so many patients there had chronic pain, were seriously ill and had received no medical assistance.
Lack of Apparatus
One girl, aged 19, for instance, had been sick for two years, with a gross, swollen rumore in her leg. She had to have a CT scan and the tumor tissue analyzed first to see if the rumor was maligant before anything could be done. But there is no such apparatus anywhere in Somaliland.
Another case involved an 18-month-old infant, who had a fever and was short of breath. Hwang discovered his lungs were congested with sputum, likely cased by pneumonia. But since suction and oxygen machines were not available, he was unable to treat the young boy. The next day, Hwang was told the bay had died.
“If these patients were in Taiwan, it’s very unlikely that their illness would deteriorate to such a fatal level,” he says. “The lack of medical facilities and a referral syste for continuous treatment and followups makes us feel helpless as we only can make diagnoses and give medicines to relieve their symptoms temporarily.”
Hwang thinks the most significant task the team does is to equip the medical students with more know-how, the better to serve their countrymen after the team has left.
Keen to Learn
Chang Yu-tai, an associate professor in endocrine and oncologic surgery and emergency room director, says in Somaliland he can sense the drive among students and hospital staff to upgrade their medical standards, something he did not feel on previous visits to other African countries.
“As the saying goes, it’s better to teach a man how to finsh than to just give him fish. I feel we can better develop our functionality in this country, given their initiative in improving their medical care,” he says. “Meanwhile, we’re highly respected there. That is a boost to our self-con-fidence.”
Chang adds that, while traveling to less-developed areas like Somaliland, he gets the chance to study tropical diseases such as malaria and paasitic infections. He hopes to bring such knowledge back to help promote Taiwan’s skills in epidemiology.
You Jy-haw, a senior ophthalmologist, says Somalilanders who need cataract operations are aged 60 on average, compared to 70 in Taiwan. The scorching sun throughout the year and lack of health education are to blame. There is only one eye specialist for every 200,000 people in Somaliland, compared to one for every 20,000 in Taiwan.
“Current medical conditions in Somaliland are similar to those of Taiwan back in the 1960s. The country has a serious shortage of surgeons and medical quipment,” he says. “And due to its emphasis on general practitioners, its lack of specialists is particularly acute.”
In Somaliland, You came into contact with many conditions he had never seen, despite more than 20 years of experience in Taiwan. “Some patients, for instance, suffered from extremely weak vision or had turned blind because of infection or trauma that could have been eased or prevented if only they’d received immediate treatment.”
Nevertheless, you helped some out by conducting more han 20 operations in Hargeisa Group Hospital, while demonstrating his techniques to local doctors, as well as lecturing students. “We’ve come at the right time. The first bunch of medical students are scheduled to graduate next year. It’s good we can give them clinical training and help them better prepare themselves,” he says.
Participating in an international mercy mission, you adds, gives another dimension to a doctor’s life, and he is glad to contribute his expertise to different ethnic groups. “Initially, local doctors and patients seemed to have some doubts about my professioal skills, but they were soon dispelled as I was asked to conduct as many operations as possible,” he says. “This confirms my belief that medical services can eliminate cultural barriers in a short time to build mutual trust and interaction.”
Indeed, the trust and interaction that Taiwan Root haas fostered with the Somaliland government has benefited both sides. During the medical mission, founder Liu Chi-chun was asked to help two fisherman, on Taiwanese and one Vietnamese, who had been detained by Somaliland Immigration for nearly six months, due to a fishery dispute. Previously, their Taiwanese ship owner had sought assisance from Taiwan’s commercial office in Dubai as well as the Chinese Embassy in kenya, but to no avail.
After negotiations with local officials, Liu successfully helped gain the fishermen’s release. “This incident is a good example, demonstrating the role and accomplishments of civic power, particularly in the absence of formal diplomatic ties,” Liu says. “Sometimes, NGOs can even build more subsantive external relations than diplomatic channels can. I’m happy to see my organization doing this through the credibility it has gained in the international community over time.”