Tales from Taiwan

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Post-term nursing unit

Dr. Shinkafi-Bagudu at a medical facility

BY Zainab Shinkafi-Bagudu

Sometime in April 2016, I received a call from the Senior Special Assistant (SSA) to the Wife of the President, Dr. Hajjo Sani, informing me that Her Excellency’s program the ‘Future Assured Initiative’ had been offered two slots on a two-week training workshop on Maternal and Child Health by the Taiwanese Government under its Ministry of Foreign Affairs and organized by the International Cooperation and Development Fund (ICDF). It was fully sponsored and participants would experience the Taiwanese healthcare system first hand.

Dr. Hajjo went on to inform me that Her Excellency had nominated me as one of the representatives. I was delighted and honored. I told her I would seek permission from my husband and get back with a response. In his usual supportive way, he agreed and I commenced necessary travel arrangements. The other participant was Dr. Kamal Mohammed, a public health specialist, coordinator Future Assured Initiative and personal physician to the Wife of the President. The added advantage for me was that I would be able to bank the course as part of my Continuous Professional Development (CPD) to keep up my registration with my regulatory body, the Nigerian Medical Council for the year. I must admit it’s been a struggle since becoming ‘Wife of Governor’ and it was getting harder to attain the required points. Hence my added joy to be going on this trip.

I have never been to Taiwan and so I learnt not just about the health systems and hospitals, but also about the people, what they eat, what they wear and the culture. It took 16 hours of traveling by air to reach this beautiful corner of Asia populated by just over 23 million people, a tedious but worthwhile journey. My fellow course mates for the training were 18 health professionals from Africa, South Pacific and the Caribbean.

One of the first things we learnt about the health system was its funding. It had both public and private funds with a strong insurance component. The hospitals are squeaky clean and well equipped in terms of both human and technical resources. Every year, out of every 100,000 pregnancies only 6.6 women die. Compared to the 814 women that die (from pregnancy and related causes) in Nigeria. This is amazingly low. Taiwan has been unable to push its maternal mortality rate further down because the 6.6 that die do so mainly from unpreventable and undiagnosed genetic conditions. The National Breastfeeding rate is 50% which is above the WHO recommended rate of 38%. In Nigeria it is 17%. This statistic coupled with a strict healthy lifetime diet, lifestyle and vigilant health surveillance gives the Taiwanese a life expectancy above 80years. On the other hand, malnutrition and growth stunting is rife in Nigeria, with the Northwestern States contributing the most.

Taiwanese like us have strong cultural beliefs. We immediately noted the absence of the Number 4 in floor numbers and even hospital bed numbering. This, we were told, was because the Number 4,”stu” in Mandarin, is homophonous with death, so it’s considered an unlucky number especially in hospitals where death is a dreaded word in any language.

Another odd practice I encountered was leaving the baby and cord attached to the placenta after delivery, in some cases, for up to 7 hours. This practice known as Lotus Birth is said to allow the mother take over caring for her baby from the placenta, which had been doing the job for 9 months. I wondered about the effects of this on the fetal circulation and possibility of infection. Although it was only being practiced in some parts, it emphasized the importance the Taiwanese culture placed on motherhood and women.

Gender equity was very obvious in many aspects. A part of me feels this equity was forced by the ‘one couple, one child’ policy introduced between 1978 and 1989 to curb exploding population rates. This meant son or daughter, both the government and parents have to strive hard to make that one child a success story. So gender lost relevance and opportunities given became balanced. However, that policy is being phased out from 2015. My view on Gender equity in Taiwan was reinforced when Tsai Ing Wen led her party to a landslide victory during an election held shortly before our workshop held. With a 56% win, she became Taiwan’s first female Prime Minister and was sworn in the day I left.

As a Paediatrician, one of the personal high points of the workshop was visiting the National Taiwan University Children’s Hospital, NTUCH. It was the first fully dedicated children’s hospital built in Taipei in 2013.

Twenty-two floors high, I was, understandably, quite impressed. Every aspect was developed with the primary interest of the child in mind. Premature birth rate was low at 6-8%. The Neonatal intensive care unit was not only as high-tech as I had seen in other developed countries, but also highly innovative. We saw specially designed and adapted transport incubators as well as strong support services and facilities for children, especially those with special needs.

The special needs children facility was interesting to me and is one I hope to be able to explore further because in Nigeria we have no effective system for caring for such children. The whole process of diagnosis, investigating and treating special needs children in Nigeria is very weak, leaving many families at a loss as to what to do. It’s not often apparent because we have a strong family support network that care for the daily needs of such children. By this labor of love, we often fail to allow children with special needs achieve their maximum capability.

It was in the special needs unit I was struck by two similarities between Taiwanese culture and ours. The first is that the Asian culture gives a lot of respect and reverence to constituted authority, and hold achievements in high esteem especially in the academic sector. I trained in a western environment where I was encouraged to address 60-year-old professors by their first name. It was a shock to my system when I first started but I eventually got into it.

In Taiwan, like in my country, this is not acceptable. A professor isn’t only addressed as such, one is expected to stand up and bow in reverence to him. The other thing was socio-cultural stigmatization. Something about the way our instructor spoke made me ask about this. My question to her was are children with congenital abnormalities or conditions like seizure disorders stigmatized by the society? She admitted it existed albeit a bit better than it was 30 years ago when even teachers turned back such children from mainstream schools.

However with improved forced awareness and education, such children are now increasingly being assimilated into society. Here was all the proof I needed to buttress my belief that Nigeria could only emerge as a leading nation when we attack the disease plaguing us,’illiteracy’. Nigeria and Taiwan have strong traditional beliefs, practices and institutions, but with education, Taiwan has been lifted into the cadre of an industrialized nation.

Education in Taiwan is not free but it is compulsory to complete secondary school. There are public and private streams at all levels. Even at primary level, there are no completely free schools. However those who can’t afford to pay can apply for scholarships but are bonded to work for the government until the debt is paid. I must admit I didn’t get to see much of the schools beyond the medical ones. Here, we were told about training programs for foreign health professionals especially at post graduate level. It is my hope that we will be able to use the links we have forged and work with the Taiwan mission in Nigeria to establish links and foster bilateral ties.

During a trip to a midwife clinic in the Northern district of IDA, I noticed the absence of gardens in homes. Instead each house had a vast rice field behind it. Everyone was a farmer. Apart from local consumption, rice is exported and there is little need to import food. Inflation is low, with only 1.5% of its population living below the poverty line.

As Asia’s fifth largest economy, Taiwan is considered advanced. Her financial success is also due to export of electronics,technology and petrochemical products. Its main export partner is China. Many computer chips originate here and are used worldwide. Major companies include Hon Hai, Asustek and Formosa.

In Taiwan I experienced my first earthquake. Measured at 5.9, it was initially a frightful experience. However when we had 4 more over the next couple of days, I got used to it and stopped feeling just fear. Instead I reflected on the awesome phenomenon that disrupts our terra firma and started to thank God for His many blessings that we so often take for granted. In Nigeria, we don’t have earthquakes and hurricanes yet we moan endlessly about so many little things forgetting to count our many blessings. Fabi’ayyi ’iRabbikumTukadhdhibn? Which of your Lords blessings will ye deny? (SuratulRahman Quran Chapter 55).

I shared not because I want you to be just enthralled by this far land, but in the hope that something will touch you and you will pick something to emulate and replicate in your life and immediate environments. It is possible to do this within our own religious and sociocultural context.

The hospitals are clean not just because the cleaners are better, but also because everyone that walks in contributes to keeping it so. They don’t litter the floor, mark walls with their hands or stick gum under tables. Such simple self-disciplinary habits will go a long way to create the standard of living I found in Taiwan. The discipline, determination and the hard work of the Taiwanese was obvious from the moment we landed.

The course coordinators were strict with time and gave no room for absenteeism. We were closely monitored from wake up call to bedtime in a way I wasn’t even in secondary school. It was initially tasking especially with the jet lag but everyone soon fell into place.

Another take home message for me was the urgent need to domesticate the primary healthcare under roof and universal health insurance coverage laws. This has to be considered in all states, including our Kebbi. It is the only avenue to improve our healthcare delivery systems especially in the rural areas. 80% of Nigerians living in rural areas are the major contributors to our disheartening health indices. It will be expensive to start, but in the long run it will work out cheaper, reduce out-of-pocket spending and, most importantly, deliver a reasonable standard of healthcare to the poorest of the poor.

One cannot expect returns without investing. For the Nigerian government to improve our amenities, citizens should also put in something. Only then will the social contract balance out. By investing, I don’t mean just contributing a part of our monthly earnings, but also conducting ourselves in a manner that reflects discipline, pride and cleanliness always.

I thank Her Excellency, the Wife of the Nigerian President, Mrs. Aisha Buhari, and the Government of Taiwan for making this opportunity available to me. I hope many more will benefit in the coming years. However, despite 24-hour power supply, free high-speed Internet access across all nooks and crannies of Taipei, ‘Dunlop’ roads, clean working hospitals, and all the rest, I am glad to be heading home. I’ve missed the air in my country, my loved ones, my work, and I can’t wait to do justice to a plate of hot Kebbi rice and stew or tuwo with dry okra soup? I really can’t decide just yet.

–Dr. Zainab Shinkafi-Bagudu, a paediatric consultant, is wife of Kebbi State governor