GHP Taiwan - Touro University Californiacom.tu.edu/globalhealth/2014 Global Health-Taiwan...
Transcript of GHP Taiwan - Touro University Californiacom.tu.edu/globalhealth/2014 Global Health-Taiwan...
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GHP Taiwan
Vincent Chou, Jonathan Go, Christine Le, Megan Lung, Arthur Ng, Heidi Pang, Angela Shih, David Tseng, Anny Xiao OMS-II, College of Osteopathic Medicine
Touro University California Site Coordinator: Dr. Athena Lin, Ph.D.
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Resources ● TUCOM Global Health Program Website
o http://com.tu.edu/globalhealth/taiwan.html ● 2) Taiwan GHP Blogs
o http://globalhealthtaiwan.blogspot.com/ o http://tucomtw2013.wordpress.com/ (Class of 2016)
● 3) tustudentlife Forums
http://www.tustudentlife.com/forums/ >> Taiwan ● 4) Taipei Hospital
o http://www.ptph.doh.gov.tw/english/
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Why should I go? 1. Program Goals
1. Rotations
1. Extracurricular activities
● Rural medicine: Guanshan, Taiwan Root
● Scholarly activities
1. National Health Insurance 1. Social/Cultural
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Program Goals ● Gain experience in aspects of medicine beyond the core curriculum
● Gain knowledge of diseases that are uncommon in USA
● Observe and develop existing clinical skills
● Broaden public health knowledge
● Recognize and understand the relationship between medicine and society
in another culture (medical problems, medical ethics, law, health care system, etc)
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Taiwan ● Population:
o 23,374,000 (2014) ● Ethnic group:
o 98% Han Chinese o 2% Aborigines
● Official Script: o Traditional Chinese
● Religion: o Buddhism/Taoism (70% of
the 80% religious)
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Cultural Differences
Patient attitude toward healthcare &
Healthcare worker attitude toward patients vs.
U.S. healthcare system
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National Health Insurance ● Taiwan’s National Health Insurance (NHI)
o Instituted in 1995 promised equal access to health care for all citizens ● Financed through tax, out-of-pocket payments and direct government
funding ● Low cost for patients
o Increased patients visits causing limiting visit time o ~ 2 to 8 mins per patients o How do you establish a human connection if you only have five
minutes?
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Taipei Hospital ● Located in New Taipei City
● Medium-sized community hospital
○ 375 general beds/162 specialty beds ● 10 minute walk from the metro
○ 30-minute metro ride to Taipei’s most bustling areas
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Rotations Emergency Medicine
Ob/Gyn
Pulmonology
Traditional Chinese Medicine
General Surgery
Cardiology
Nephrology Hematology/Oncology
Endocrinology
Gastrointestinal
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2014 Rotation Schedule Name Week 1 Week 2 Week 3 Week 4
Vincent Chou Nephrology
Pulmonology Hem-Oncology TCM
Jonathan Go Pulmonology Hem-Oncology General surgery
Cardiology
Christine Le Pulmonology Cardiology Ob/Gyn Hem-Oncology
Megan Lung Nephrology TCM Pulmonology Hem-Oncology
Arthur Ng Pulmonology Cardiology Hem-Oncology Nephrology
Heidi Pang TCM Hem-Oncology General Surgery
Hem-Oncology
Angela Shih Hem-Oncology Pulmonology Ob/Gyn Nephrology
David Tseng Hem-Oncology General Surgery
Cardiology
Gastroenterology
Annie Xiao Cardiology
General Surgery
Nephrology Endocrinology
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Rotation - Pulmonology
← Thoracocentesis
Pneumothorax →
● H1N1 ● XRAB ● Tuberculosis ● Pneumonia ● X-RAYS!
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Rotation - Traditional Chinese Medicine ● Acupuncture - used a lot for
post-rehabilitation (stroke, spinal injury)
● musculoskeletal manipulative technique with Dr Ho
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Rotation - General Surgery Laparoscopic procedures (e.g. appendectomy)
Coronary artery bypass graft →
Laparoscopic APR
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Rotation - Cardiology
Catheter lab →
← Ultrasound
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Rotation - Hematology/Oncology
Out-Patient
In-Patient
ONE attending physician of hem/onc - Dr Chen!!!
- smaller patient population due to size of the hospital and limitations to treatment
- some oncology patients are managed by the general surgeons
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Rotation - Nephrology
Hemodialysis Center Peritoneal Dialysis Training
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Rotation - Endocrinology
Ultrasound Thyroid Ultrasound
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Rotation - Gastroenterology Gastroscopy (~5 min) & Colonoscopy (~10 min)
● basic idea = same
● Usually WITHOUT sedatives
● Look for ulcers and polyps
● similar recommendations as U.S.
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Rotation - Ob/Gyn and OPD ● Pap smears and Ultrasounds
● Cervical cone biopsy
● Myoma
● Rectocele
● Condyloma removal
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Rotation - Emergency Medicine ← Intubation
Femur Fracture →
← Lumbar Disk Herniation
Mechanical CPR →
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Scholarly activity BMI as an indicator of serum albumin and its role as a prognostic factor for Taiwanese patients with ESRD on hemodialysis
● Measured BMI of 131 ESRD patients receiving regular hemodialysis
● Cross-sectional analysis of correlation between BMI and serum albumin
● BMI in the overweight range (25-29.9 kg/m2) was positively correlated with serum albumin levels
● Patients in the overweight BMI group had the highest average serum albumin levels
Taiwanese Cultural Beliefs Prolonging Intubation ● Gathered data from 19 patients from RCW
and EICU ● Standard evaluation period 7-10 days in the
US ● Average 25 days on intubation in Taipei
Hospital ● Longest intubation 282 days ● Cultural beliefs & values are a factor in
intubation times
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Extracurricular: Guanshan
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Extracurricular: Guanshan
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Extracurricular: Guanshan
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Extracurricular: Taiwan Root
● Who? Taiwan Root Medical Peace Corps--a private, non-sectarian, non-profit organization dedicated to improving quality of life through provision of medical services and health education: ALL VOLUNTEERS (doctors, dentists, kitchen staff, drivers, etc.)
● What? free medical care as well as educational health material to the local population ● When? every month ● Where? different mountain areas of Taiwan ● Why? to improve the local communities’ current conditions and offers resources for developing
self-reliant healthcare systems. ● How?
o http://www.taiwanroot.org/ o apply EARLY
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Can I go? 1. Requirements
1. Logistics
1. Expectations
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Requirements ● Elective in the spring
● Applications (internal and external)
o LOR o Letter of Intent o Resume
● For full details, please see TUCOM Public Health website &/or Dr. Lin
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Logistics ● Time frame
o 4 weeks o beginning of June to beginning of July
● Cost o flight: ~$1350-1600 (roundtrip SFO-TPE) o food: as low as ~$3-5 per meal o housing: free! (dormitory right next to hospital) o local transportation: ~$5 a day by MRT (going to the city)
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Expectations ● Language
o Mandarin Chinese and Taiwanese Not required but can be very helpful
o Most preceptors speak English!
● Other o Community service event (rural) o Daily blog o Presentation to site’s local administrators (final presentation on last
day of rotation) weekly reports final monthly report
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Take aways
Cultural Competency
Clinical knowledge
Global Health Perspectives
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Activities
Night markets, Taipei Zoo, FOOD food FOOD!!!!
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Questions?
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Dr Hwang, Pulmonology
Dr Chen, Cardiology
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