a lifeline in the remote mountains Deep in Taiwan's central mountains, Puli Christian Hospital cares for dialysis

patients who live in one of the country's most remote areas.

To the patients at Puli Christian Hospital, nurse Chang Hsiang-fen and the other nurses are a part of an extended family.

by Macabe Keliher

photos Kuo Cheng-chang

T hey have a saying in Puli:"We When they get sick, they have Puli can take care of ourselves and Christian Hospital to take care of them -exist isolated from the rest of even dialysis patients, of which there are

the world." They haven 't much choice. more than 200 in the surrounding area, Puli is a small, remote town buried in Tai- not counting those who have moved to wan's central mountain range where the the cities to receive care . only road in is the only road out. Resi­dents produce everything they need there, from honey to tomatoes.

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The nearest metropolis isTaichung, two hours away over mountain roads."This makes our clinic indispensable to the

community," says Gaudi Hsu, chief techni­cian in the hospital's hemodialysis center.

Established by missionaries An American missionary established the main hospital in the 1930s as a clinic to treat people in the central mountain region who had no other access to med­ical services. Under the guidance of Nor­wegian missionaries, the clinic moved to its present location in the town of PuB in 1960.The hemodialysis center

was set up in July 1996 to meet the needs of the community and make PuB Christian truly a "hospital that can treat all patients."

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mar Lu, medical director of the hemodialysis clinic."There are many patients who cannot come until evening and we are able to accommodate them ."

Dr. Lu and his staff see patients once every two days, or about three times a week.

Gambro machines The clinic's 25 beds are all equipped with Gambro machines. Hsu describes the relationship between Gambro and Puli Christian Hospital as cooperative. Gambro provides the clinic with sup­plies and machines, while the hospital provides all care and services.

patients.The hospital cannot take on more patients, so other dialysis patients either use one of the other hospitals or must live or commute elsewhere for treatment.

The hospital is bUilding a larger and more comfortable clinic. Scheduled for completion in October, the new clinic will have 48 beds."Although the other hospitals are not full, our services are better and we have more patients than we can handle right now," saysTsai .

Enthusiastic about care Patients are very enthusiastic about the care they receive at Puli Christian Hospital.

"The nurses here are very good and very friendly. It's like one big family." Kao Hong-bing, patient

Although Puli has two other hospitals that offer hemodialysis treatment,Puli Christian Hospital has far more capacity. It handles more than three-quarters of the area 's patients and is the only clinic to offer night dialysis services.

"We work in three shifts of four to four and half hours each," says Dr. Ing-

Patient Chung Vi-cheng: "I am glad to be back in Puli."

6 Gambromliqrlline

"We put our faith in these machines because they take care of the patients," says head nurseTsai Ming-fen.

Currently the clinic crams 23 perma­nent beds plus two moveable beds into a small room in the left wing of the hos­pital.Although space is tight, the clinic can accommodate more than 140

"The nurses here are very good and very friendly. It's like one big family," says 60-year-old Kao Hong-bing, who has been receiving treatment for 10 months.

Huang Chin-tsen, who has been receiving treatment for 15 years, came back to Puli when the clinic opened in 1996. He had moved toTaichung to receive treatment.

"It has been nice to come back and live in the mountains," says Huang."I love it here and the clinic has made it possible."

Huang travels two hours by bus to receive treatment, and his story is simi­lar to those of many of the other patients. Many live in the hills surround­ing Puli and travel up to half a day over narrow mountain roads to get treat­ment. Nurse Chang HSiang-fen relates stories of patients who have had to walk out of the mountains when the roads are washed out by seasonal typhoons.

"These conditions tend to make peo­

ple very pessinlistic . Part of our job is to be cheery and uplifting," Chang says with a smile.

Fruits and vegetables Because many of the patients are farm­ers, Chang says it is not uncommon for

Members of Puli's team: (Front row from left) head nurse Tsai Ming-fen, Dr. Ingmar Lu and chief tech­nician Gaudi Hsu.

patients to bring them fruits and vegeta­bles from their farms.

"I am quite embarrassed most of the time because these patients will walk three hours from their farms carrying big boxes of fruit to give to us, when they shouldn't be lifting anything at all;' Chang says.

When the new clinic opens, its larger area will give patients more private space as well as allow the hospital to take on more patients. Puli Christian Hospital, already deeply rooted in the community, will become more indis­pensable than ever.

Nurse Chang Hsiang-fen with patient Kao Hong-bing.

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Decades of service: Puli Christian Hospital's front entrance.

Coping with an earthquake

On the night of Sept. 21, 1999, mountains moved -literally. An earthquake

destroyed nearly the entire town of Puli and transformed the geological

landscape of the surrounding hills, trapping many people in need of dialysis

treatment.

"What a horror. After three days we still could not get down and I had not

received treatment. I didn't know what was going to happen to me," said Tien

Meung, who lives in the mountains about two hours from Puli.

No roads

All the mountain roads were either covered by landslides or had just disap­

peared. Even the main road to Puli was inaccessible. The hospitals resorted to

airlifting dialysis patients to save their lives. Because Puli Christian Hospital was

without power, patients were taken either to nearby Taichung or farther south to

Tainan.

"It's a big hospital and I didn't know any of the nurses. It was very uncomfort­

able and I couldn't get used to life in the city," said Tien, who stayed in Tainan for

three weeks before returning to his home of more than 50 years.

More patients

The earthquake did more than just frighten dialysis patients trapped in the hills;

it created a few, too.

"The shock of the quake seems to have sped up the need for treatment in

some patients who already had weak signs of the disease," said Dr. Ingmar Lu,

medical director of the hemodialysis clinic at Puli Christian Hospital.

Patients like Chung Vi-cheng discovered they needed treatment after the

earthquake. "I went to Taichung right away for treatment and stayed there for

two weeks. I am glad to be back in Puli, but I am too afraid to return home to the

hills where I used to live," Chung says.

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