Wednesday, 21 December 2016

2016 Mackay Memorial Hospital GP department: the wind blows 1


30 November 2016

Ran around to many places today, and did so many things!
The plane touched down at 4:30 am. Cindy from TIHTC picked me up from the airport and took me to the dorm at Taipei Hospital in Xinzhuang. It’s a nice big dorm with 2 big beds! And not forgetting the red big tong cooker!
Then I went to Tucheng to visit my grandma and treat her for lunch!
In the afternoon I went to Taiwan’s popular government protest zone to check out what’s going on, visited a famous Presbyterian church in this protest zone, and prayed there. My personal devotional today came from the Stream in the Desert, “…this is my doing…” (1Kings 12:24).
Then I went to book myself for some exercise and cooking classes!
I visited Barnabas School of Missions in the evening and was greeted warmly by my friend Rui Rui, who even gave me a worship music CD! The speaker today, elder Zhang, is very well known, and the topic was on “The Apostolic Church”. At the end, elder Zhang prayed for the students at BSM saying, “those who are present tonight aren’t here by chance”. When he prayed for me he said, “Be strong and courageous. Do not be afraid. The Holy Spirit will lead you, to complete this task/doing (note these are the same word in Chinese).”















1 December 2016

This was my first day at Mackay Hospital. There are many differences between the health system in Australia and Taiwan. First of all, there are GP outpatient clinics in public hospitals in Taiwan, whereas GPs in Australia work in private clinics. The terminology of who’s who in the hospital is also very different. Clerk=6th year medical student, Intern=7th year medical student, PGY1=R0, then R1, R2, R3, Chief Resident=R4.

I had lunch with several senior Mackay Medical School medical students who were interested in Australia in the restaurant on the 16th floor of the hospital! Something of interest to note is that this medical school is the newest medical school in Taiwan, with its first batch of students graduating last year. Yet, it is the top medical school in the preference rankings amongst the private medical schools. There is a museum of the history of Mackay Hospital on that floor. I learnt more about the tough life of the missionary Dr. George Leslie Mackay, where he was often mocked by the people and attacked with pig faeces!

In the afternoon I sat in with one of the GPs, and saw that they use the SOAP format in their electronic records. (Subjective findings, Objective Findings, Assessment (Past Medical History), Plan, Progress notes, Pharmaceuticals, ADR). The doctors all wear masks when they see patients. I am not used to wearing masks and felt very deoxygenated. The GP kept giving patients free flu vaccines because it is towards the end of the year and the leftover vaccines will be thrown away if they don’t get used up. There is 1 nurse to 1 doctor in every consultation room. There are also health educators that can be called in to educate patients about their medical conditions, which is quite different from Australia where it is the doctors who educate the patients.

In the evening I visited my grandpa who lives right next to the hospital. For dinner, I tried out ramen noodles at 7-11.







2 December 2016

Listened to a community health talk given by a GP in YWCA. Giving such talks in the community is actually part of the work roster of hospital GPs! The lovely GP who gave the community talk and I went to Tim Ho Wan for lunch and it tastes better than the one in Sydney! Coincidentally this GP is also a Christian and she goes to the Presbyterian church which I prayed at on the day of my landing in Taiwan! She told me that R4 is the final year of the GP training here, and most GPs leave the hospital to go to community group practices. Work is tough, as GPs often work until 10pm and only get a 7-day holiday each year.

I went to the GP department meeting, and saw that a pastor actually exhorts the doctors at the start of the meeting! At the end of the meeting they told me to introduce myself and asked me to give a talk about Australia’s health care system in two weeks’ time!

A local doctor took me to the doctors’ library on the 15th floor. I was delighted to find a few treasures: a coffee machine that gives free coffee daily, and the diaries of the missionary Mackay! I saw how Mackay kept getting sea sick and vomited on the boat. I just can’t imagine when people have to go on boats for weeks! I always get motion sickness on boats! No wonder so many people die from sicknesses on these long boat trips! I also saw the earliest known photo of Mackay where he didn’t have his big beard. And when Mackay was preaching the gospel, there were many people that went to beat him up and threaten to slay him!

In the evening I went to have a haircut, and saw the hairdresser’s cute 8-month old baby! Then I went to the TOD prayer meeting, which was full of fire in preparation for the anti-gay marriage protest on 3Dec. I was deeply touched when they sang the song “Baruch Haba Beshem Adonai”, which I previously heard on Mount Carmel in Israel!























3 December 2016
200,000 people standing up for the #family in #Taiwan (Taipei, Taichung, Kaohsiung)!







4 Dec
Went to visit my aunt in Linko for lunch on Sunday. Attended a baptist congregation there right before lunch and coincidentally the female pastor speaker had the same name as my aunt! This baptist church is quite open to the work of the Holy Spirit and had a lively worship. Quite different from the Chinese baptist church in Australia! There's a dermatology clinic below the church and their work schedule is pretty full on!

Then had a really heavy lunch, followed by a short hike, then a really heavy dinner! I was also quite impressed to find that my 80y.o. grandma is using a smartphone now and knows how to take photos with it!









5 December 2016

Started my week at Tamshui Mackay Hospice. Initially I couldn’t find the hospital and had to ask people on the street. The place is a bit isolated. I can’t remember receiving much exposure to Palliative Care and Hospice during my medical training. This is the first time for me to have such close up encounters with so many people who are close to their deaths, and it’s rather sad. Strangely, a journalist called Dr. Huang, the head of department, wanting to interview him on the topic of euthanasia. He was puzzled by this phone call because he couldn’t understand what’s this got to do with hospice.

Started cooking class with Jason the chef! 4 lessons (hard to translate the dishes into English)! 1. Prawn and mushroom tapas, Paella. 2. Rose smoked salmon salad, black pepper crunchy chicken drumsticks. 3. Prawn and seafood steamed egg, tuna ham sandwich. 4. Maple syrup banana, cheese pork ribs. It’s pretty fun. Lately I feel like I am temporarily living a different life!






6 December 2016

Dr Huang is very nice. However, the hospice is too quiet. There was nothing to do in the afternoon, so I took the courtesy bus back to Taipei Mackay, and climbed 15 stories up to the library. Got this piece of info: if I want to get a GP qualification in Taiwan, I just need to pass a written and oral exam and I can obtain the qualification without having to go through any hospital residency years.

7 December 2016

Listened to the hospital psychologist teach about narrative therapy. It was very interesting. Then I had Japanese for lunch with the people from this department.
Took the courtesy bus to Tamshui Mackay, very quiet again.

Went to the Barnabas School of Missions in the evening and the topic was on missions for the nations. The speaker talked about the silk road and how the hospital will spread from the ends of the earth back to Jerusalem, and Jesus will enter through the east gate of the temple.

8 December 2016

There was a web conference for the hospices across Taiwan at 7:30. It was very quiet afterwards. In the evening I went to new Beitou and met up with a friend from church whom I haven’t been in contact with for 5 years. Interestingly, instead of avoiding the military service like other overseas Taiwanese, he actually came back to Taiwan especially to do military service! This is pretty unusual (but then some people would also think I am quite unusual in taking 1 month off work to come back to Taiwan). When I prayed for him, I was surprised to hear that no one’s prayed for him for 5 years! Then I visited my cousin’s new pharmacy.

9 December 2016

A quiet day at the hospice. Went for a dance lesson in the evening!

10 December 2016

First visit to the Wesley Methodist Church in Taiwan, to attend a funeral in the morning, a life with great testimony. Had lunch with group G from the Israel tour last year, had a great time and listening to many interesting testimonies. It was an honor to meet the group leader’s son Ken! Their touching testimony can be seen on GoodTV:
Wei Wei from the group was invited to give a sermon in Taichung the following day. This was the sermon content:

In the evening I had dinner with a new friend at the East Gate (Dongmen). This is a doctor who’s a great drawer and pays attention to current affairs, and the interaction had been interesting!



11 December 2016

Went to Linko again. Very touched by the Sunday worship. This church is actually quite charismatic and the sermon was on the “Apostolic church”:
When we first became Christians, the church seemed so glorious. Once we serve in ministry, we start asking, “where is the glorious church?”
However, the church continues to improve and is very different from 40 years ago.
In the church, many parts of the body are weak, but every part is important and precious.
We need to build each other up, or else we’d fall.
The solo pastor can only care for 50-60 people.
Revival begins with a compassion for the weak.
A little analogy about the body of Christ: The mouth eats and talk. The rest of the body thinks it’s useless, so they refuse to let it eat. One day later, the stomach started feeling uncomfortable. Then the eyes became dizzy, and the limbs became weak. When one part of the body is not good, the rest of the body gets impacted.
David: His family did not think he was important and told him to tend the flock when the prophet Samuel came to anoint the king. Yet, it was David who got anointed.
The pastor talked about praying for the sick: Initially whenever he tried to pray for the sick, none of them got better. He continued to do so, and now has a high percentage of healing rate!

Met a nice new friend who’s very sporty and knows very well where to exercise in Taipei. So I discovered a community exercise center close to my accommodation! More exercise options in addition to climbing 15 stories in Mackay Hospital and dance lessons.

In the evening I went to Barnabas School of Missions’ Mission Builder Dinner, and Ross Paterson reminded us that a burden needs to be accompanied by action, because in the Chinese language, the Chinese term for burden is comprised of two elements, touch and move. Met more new friends, and the new friends made arrangement for me to meet more new friends again next week! This is a fresh experience for a person like me who’s used to living a very independent lifestyle. Even though I’ve only been back for less than two weeks, my schedule is already full for this month!








12 December 2016

Returned to Taipei Mackay, observed how they do clinic. It is very interesting to view the doctor-patient relationship from the perspective of an observer. It made me notice many things that I did not notice before. One patient with poorly controlled diabetes was really funny. He had numb hands so the doctor said she’s worried about his nerves (in Chinese, the term for nerves is the same as the laymen term for psychosis). The patient misinterpreted this and exclaimed, “What? I’ll become crazy if my diabetes is not well controlled?!” There is also an elder lady whose husband had recently passed away. The patient’s daughter cried as she thanked the doctor for caring for her parents so well, and the doctor shed a few tears too!

I went for the GP department meeting in the afternoon. Couldn’t control myself from nodding off to sleep because my schedule was too full on the weekend and didn’t get enough rest. When I regained consciousness, I realized the talk was on dementia. They showed several videos about dementia which made me feel like crying.
Tomorrow’s memory:
Still Alice:
Alzheimer’s Disease:
Dementia Village:
It’s really sad not knowing who you are. Are you still alive if you have no memory of yourself? This made me think about my paternal grandpa, who seems to have signs of dementia.

Went for cooking class again in the evening. Some classmates were different. Maybe people can go in place of other people in this class! It was a pleasure to receive feedback that the stuff I made actually made people feel hungry!

13 December 2016

In the morning clinic session, I asked the doctor why Taiwanese doctors wear masks when they see patients. She was very surprised and asked, “Don’t you wear masks in Australia?” She said it’s mainly to protect against contagious infections, but also serves other protection purposes, such as not getting recognized by her patients on the streets. However, sometimes when she actually wears a mask on the street, she gets recognized by the patients!

Did a presentation on GP in Australia during the GP department meeting. Met a new doctor friend who attends the Wesley Methodist Church which I just went to last week for the funeral! He invited me to a talk about the refugees and the homeless! Interestingly, he did his military service as medical service in a developing nation.

14 December 2016

This morning I went to a nursing home which is located in a rather remote region. There is a pick up van from Tamshui station, but no stop sign, which made me nervous. Anyway, the van came and I got there successfully. This nursing home is well decorated and looks more like a home than an institution. On arrival an elderly lady speaking in Hakka kept trying to give us a red packet. The residents come from high socioeconomic status, and their children tend to be pretty well off, eg. Doctors, people living abroad, etc. This nursing home’s waiting period is 30+ years! The medical student and I went to the dementia area to interview some residents. The elderly lady assigned to the medical student started yelling so he had to change to another resident. The elderly lady assigned to me still remembered how many children she has and that her parents already passed away. When I asked about her activities of daily living, she claimed she’s independent. When I asked her about her mood, she said it’s fine. When I asked her age, she initially said she was 80, then 90. When I asked her questions about orientation, she couldn’t answer it and simply said she doesn’t follow through with those things because they’re not important. She thinks she is in a friend’s house and this is a place where people sing and dance. When I tried to do the MMSE, she couldn’t comprehend most of the instructions. The staff aid this lady gets agitated with noise and can hit people with her walking stick when that happens. She also has a delusion that people are always out there wanting to steal her things, so she always asks the staff to lock her door well. Then another elderly lady came, and the first lady said this second lady is her friend. However, the first lady speaks Mandarin while the second lady speaks Taiwanese, Japanese, and a bit of English, so they actually have a communication barrier. Nevertheless, they are quite compatible and often sit together. When I did the MMSE on the second lady, the result was similar to the first lady. Then I saw the second lady’s artwork, which was very pretty. During the conversation I found out the second lady is a Christian and her name is very similar to my aunt, so there was a sense of closeness. She happily prayed together with me.

At noon, I had lunch with the medical student and went to visit the place where the missionary Dr. George Leslie Mackay came ashore onto Taiwan! The waves were big that day and the water kept splashing ashore!

In the afternoon I had a happy time coughing up with some of my friends from Sydney. Had a nice hot pot in Dapinglin and went for class at Barnabas School of Missions. The speaker was Dr Ching-Feng Lin, a doctor from the Ministry of Health and Welfare, who’s the head of the National Pension Supervisory Committee. The topic is on career missions, which I found quite helpful.

























15 December 2016

Went for morning clinic session. Had dinner with Dr Hsu and the medical student.

Then rushed over to Andy’s accounting firm to listening to an evangelical sharing by Donna Chiu, a singer who was very famous in the 1980s! The content of her testimony is similar to this video:
The food was also pretty good, but I already had dinner. 13 people accepted Christ. Got some Donna Chiu CDs at a discounted price, and there was a prophetic team praying for each individual. This team was no joke: when they prayed for my friends and I, we all find the accuracy rate to be extremely high!
“There seems to be a bag on the ground. She’s dropped a few things and have to pick them up in order to be used by God even more greatly. In facing her career, family, etc. she needs more wisdom from God. There is a rock, not big, not small, but it is a barrier she needs to overcome.”

16 December 2016

Early morning awakening to go to a semi-rural place called Shimen! Left at 6am, arrived at Tamshui station 7am, then took a bus with the Chief Resident doctor for 1 hour to Shimen! So isolated! One patient came for her scripts then there were no patients, so I walked over to the local tour attraction by the sea and saw that the waves were pretty big. Then I ate a rice dumpling. When I returned from the tourist attraction, the CR was only seeing his 2nd and 3rd patient. Then came 1-2 other patients, and that was it for the day! The health department is promoting people to get their flu vaccines and giving out free snack packs when people are compliant! Chatted with the CR on the bus, and was quite surprised that he’s heard his Christian friends talk about the term “filled by the Holy Spirit”!

The faculty meeting talked about the new Gardasil 9 vaccine. They mentioned that even virgins can get cervical cancer (although it’s extremely rare). So, should virgins get PAP smears? Then I went to the Taipei Hospital to see what “health educators” do. They told me that there are a lot of chronic conditions where doctors can do a multidisciplinary plan for (similar to the GP management plan in Australia), but the doctors have to do additional work to get qualifications for each condition in order to do such plans!











17 December 2016

Went to Barnabas School of Mission to listen to Dr. Allen Lien, a famous evangelist/ medical doctor in Taiwan who went to Africa.
When Dr. Lien talked about how Pastor Philip Mantofa suddenly yelled at him prophetically, “Don’t waste your time in Hualien!” I could imagine Pastor Philip yelling at me, “Don’t waste your time in Taipei!” Seriously, more than half of my holidays have already passed in a blink of an eye! Pastor Vera Huang summarized the whole meeting, “Pick up the lost tradition of getting down on your knees to break the ground with the groundbreaking prayer!” This reminded me of the prophetic words a few days ago about picking up the things I’ve dropped!

A good friend of mine from middle school came with me to the meeting, so I had a great time catching up with her. At the same time, I was quite sad to hear that another middle school friend whom I haven’t been in contact with for quite some time became very unwell. Nevertheless, this unfortunate friend is wonderful living testimony for Christ.

I had dinner with my paternal side of the family. My grandfather is phobic of everything! When people try to bath him, cut his hair and nail, he just yells out in pain. He doesn’t dare to swallow tablets, so he chews on them and refuses to take the bitter tablets. The relatives think he must have had severe of childhood trauma of some sort. It’s not hard to imagine. After all, he lost his father at the age of 7 and became orphaned at the age of 9. Prayed for him and he seemed happy with that.

18 December 2016

The schedule had been really full on for the last few days so I arranged a morning of rest. I went to Wesley Methodist Church to listen to a seminar on refugees and the homeless. This seminar was organized by a new doctor friend I met in Mackay. I think it was great of him to organize this talk. The media in Taiwan is really crappy, unbalanced, and never report on things that’s got depth to it. It just gives people tunnel vision and creates division.

In the evening I went with Rui Rui for a Muslim meal, had gelatinous rice balls, then prayed together in the 24hour prayer center! Walked along Shinshen (New Life) South Road all evening and passed by many churches on this road.











19 December 2016

In the morning I went with a resident doctor to see what they do in the health checkup center. At noon there was free lunch in the GPs’ office, and I chatted with several GPs in there, including three VS (visiting staff/specialist GPs). They asked me which year “V” am I, and I realized I am V6! I felt so senior! There was another V who looks and talks like a child, so I asked her which year “V” is she, and she said she’s a young V, V3! So there is a distinction between young V and experienced V! Then she told me she’s just doing some odd jobs, learning from experienced Vs, and some academic research. She’s only one year younger than me, but already has a 1 year old baby, so it seems like Australian GPs complete training faster. The GPs started complaining about how bad the work environment is in Taiwan, and started talking about a previous colleague who went off to do cosmetic medicine and how good her life seems. Then the handsome CR (Chief Resident) said he wanted to do cosmetic medicine!

During the GP department meeting, we learned kinesio taping method. This is not something we get to learn in Australia! I went to the library to search for the family medicine monthly magazine and was shocked to see a very clever design where there are additional magazines hidden behind the magazine displayed!











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