Mountain Rescue in Yilan: Our Scary Hiking Story and why Taiwan's National Health Insurance Rules (and America Sucks)

Near that waterfall is the water hole that Brendan fell into - this is us swimming before it happened

So, last Sunday (just about one week ago), my husband, a friend and I took a hike/river tracing excursion to Yuemeikeng waterfall: we wanted to show our friend the falls and I was eager to return with a better camera and take more photos. Plus, I wanted to try the hike in something better than sports sandals, and bought river tracing shoes for this trip as well as future ones.

We set off alright, following the directions I remembered, and made it a good ways up the river. Then we came to a deep swimming hole carved out by a powerful waterfall of moderate height. We took a swim, and then tried to figure out how to get over it. We weren't going to make ti by climbing, that was for sure. I remembered their being a side trail over this fall from our last hike, and started up it - but the ropes that had been there were gone and the ground was steep and slippery. This was almost certainly a result of the typhoon that had blown through recently. I was almost certain to fall into the gorge below - and not necessarily in deep water - if I continued. Other river tracers made it over the waterfall or had their own climbing equipment for that section of trail.

We searched for alternate trails and found none on the same side - I found what I thought was an alternate, in an area I vaguely remember walking around in on the last trip, and started up it, with the understanding that if this didn't work out, we'd either turn back or take the high trail, which might give us a view of the waterfall but probably no safe way down.

The trail seemed overgrown and in places not really a trail - but I saw some footprints, which made me believe that it was a good route up and over the falls, and we continued far past where we really should have.

Our friend said she was starting to believe this path wasn't safe - I wanted to look ahead to confirm that but was also within a few minutes of agreeing to turn back. We were maybe 20 meters above the gorge at this point.

Before that could happen, Brendan - who was hiking between us, shouted as a large section of ground gave out beneath him. I had just climbed the same bit of ground, but clearly two people clamoring over it was more stress than it could take. We heard his interminable fall down, grunting and yelping as he was hitting trees and underbrush on the way down in a manner not dissimilar from this (after Homer starts falling).

Twenty meters of that - later on we learned that he'd lost his glasses and his wedding ring in the fall - and twenty meters of us gasping in terror has he took the worst fall of his life, as well as the worst fall any of us have ever personally seen anyone take.

Then, silence. It was about ten meters after that straight down into the water, with nothing but a slick rock face in between.

And then, a loud splash.

We heard shouts, and then nothing. I was terrified and started shrieking - but I was also stuck. I had just climbed over the ground that had given out under Brendan. How would I get around that safely and back down? Could I get up to the trail at the top safely? Probably not and almost certainly not.

I told our friend, who was behind me, to go see about Brendan first while I figured myself out - I figured I could stay up there almost indefinitely (provided the ground didn't give beneath me too) whereas Brendan almost certainly needed immediate aid.  I still didn't know what had happened - I didn't know where in the river he'd fallen. I didn't know if he had a lot of cuts, some broken bones, a concussion, or worse. He might have been dead. The thought of that final possibility terrified me - imagine not knowing if your best friend, your beloved spouse, a person who is so good that they're like gold to their core, a person who, if they leave this world while young, then the world is not fair and any god that may exist is uncaring, and knowing it was your idea to take the trail up - and not knowing how you are going to get down to find out. Feeling like you, for deciding to check a little further ahead, should have been the one to go down with that chunk of dirt. For feeling like there might be a hole that just got ripped out of your heart and soul, and a person you are pretty much of the other half of, gone - and you don't even know yet if that's true.

Like that. I couldn't even cry, but I couldn't stop crying - it was that much of a shock. Obviously, it was a bigger shock from him, but I can only write knowingly about my perspective.

So as Brendan lay below - possibly OK, possibly not - and Emily tried to get to him, I spent the next few minutes figuring out how to get back down, or back up, or decide to wait for help, or somewhere or something. After several minutes of what seemed like careful deliberation but was really my adrenalin-fueled lizard brain making decisions for me, I swung carefully over the crumbled ground, hanging on by roots and prayers to a god I don't believe in to make it down to my husband at the bottom of the gorge.

Two-thirds of the way down, Emily came back and said two words: "He's alive". She also said "his leg's pretty bad and he's bleeding from the head, but he's talking and conscious and he's alive".

All I really heard was "he's alive" - I didn't remember the rest until later. I took Bigfoot steps through the bit of shallow river to where he was - some river tracers had seen him fall and gotten him out of the deep water.

Fortunately, he'd fallen in that one section of river carved out by the waterfall that was so deep that we, when diving down, couldn't reach the bottom. Ten meters straight down, and all I can say is that he was extremely lucky that that's where he landed. Ten meters into any other portion of that river and it could have been much worse. He was sitting on a rock, blood running down the back of his head (he patted it to show me that there was no brain coming out), back cut up pretty bad, huge gash in his knee.

We had no cell reception - nobody, not those with Da Ge Da, Fareastone or China Telecom, had any signal. Emily knows First Aid, so she watched for signs of shock, broken bones, trauma etc. as she used her teeth to cut apart the cheap towels we'd brought and tie them to his bleeding. We got him food and water, and I took off with just some money, my phone and sandals down the river to get to an area with reception and call for help.

Truth be told, I wanted to be there with my husband in his time of need, but this made sense: I speak Chinese and know the trails and river better, having hiked a few times in this area before. Emily knows First Aid. It was smarter to send me for help and leave her with Brendan. A group of river tracers helped us to the best of their abilities, but went back to their activity when they saw he was basically OK, and probably going to be OK. Emily tore apart towels with her teeth (her teeth!) and tied them to his head and leg with shoelaces to staunch the bleeding, and looked for signs of shock, broken bones, head trauma, hypothermia and other injuries.

I got to a juncture where I still had no reception but had to take off my river tracing shoes and put on sandals. As I was doing so, a Taiwanese couple came by and I asked them if they had reception - I didn't, but they had China Telecom and did. They helped me call 119 - I thanked them and said I wouldn't mind if they went on their way, but they stayed with me. I had forgotten to bring food and water, and was starving and thirsty - they asked me if I was hungry and thirsty and gave me a sarsparilla soda and raisin bread, which I wolfed down like a thieving Labrador who'd just stolen it.

Sitting, wet and covered in mud and silt, by the bridge, waiting for the EMTs to arrive, while still racing on panic, guilt, worry and adrenalin felt like someone had trapped me in aspic - I couldn't leave, I had to wait for the EMTs - but I couldn't sit still. Brendan was probably fine, but I still had a curdling stomach (which didn't stop me from shoving an entire loaf of bread down my gullet, mind you) and a sense of urgency. No....URGENCY.

Five guys showed up - a local lookin' dude in blue and white plastic shoes and faded clothes, a guy in a black EMT shirt with some ropes and a walky-talky, and two men in burgundy shirts with something wilderness-y embroidered on the pockets.  One had a pallet and huge Emergency First Aid bag. One wore dress shoes. At first I was really worried - this was mountain rescue in Taiwan? A dude in sandals and another in dress shoes?

I led them to the river, put on my tracing shoes and was all "OK, LETS GO NOW" but they stood around for what felt like the same amount of time it took for the Roman Empire to fall, discussing amongst themselves in Taiwanese.

I tried to implore them to just go through the damn river already, my husband is hurt and you need to go NOW. I was perhaps a little more hysterical sounding than I should have been. The younger of the two burgundy shirts said he understood my worry, but Sandal Guy was an experienced mountain guide in these parts, and carrying my husband back through the river was more dangerous than a trail. If a trail could be cut, they'd try that instead.

"But there are no trails! We were just there! He fell because I thought it was a trail but it wasn't a trail and WE NEED TO GO NOW!!11!!1".

One of them said (in Chinese) "I know, this is your husband and you are really worried, but trust us, we know what we are doing and we'll get him out." That calmed me down, because even I could see that he was right.

I should have shut my mouth, or shoveled in some more raisin bread - the EMTs clearly knew what they were doing and the mountain guide got them down through a trail they cut themselves. I waited at the top - I'd be more trouble than I was worth at this point, and I finally realized this and stayed out of the way - while they descended to the river below with ropes, pullies, the pallet and the aid kid. Ages later, they carried, dragged and prodded my husband up the "trail" from where he was sitting in the river.

At first I was horrified that they'd make him walk in that condition - we called 119 in the first place because he couldn't walk and was feeling faint - but also contrite, so I waited to ask Emily why they'd decided to pull him up - at times making him walk by basically forcing him along and shouting at him in Taiwanese - rather than put him on a stretcher.

Apparently they'd examined him, bandaged him, and saw injuries that would require stitches but no head trauma and likely no broken bones, and decided it would be smarter to get him up partly on his own two feet (well, his own one foot) and put him on a stretcher on the trail rather than have men haul him up on something not designed to be hauled in that way. Brendan had been sitting in the river - cold, flowing water - for almost an hour by then and was shivering. The cold water certainly helped keep swelling down, but there was a risk of infection that the emergency room doctor later warned us about. His shirt was ruined, and his spare soaked, so Emily put him in my spare t-shirt, which obviously looked ridiculous on him, but you gotta do what you gotta do.

A strange omen of things to come?

A few things amazed me about this part of the ordeal.

First, what a strong person Brendan is. I mean, I knew that, but Emily remarked later how amazed she was that Brendan sat there bleeding profusely for almost an hour and didn't complain or freak out. That, while in obvious pain, he made it up the mountain with those guys shouting at him in Taiwanese. He didn't understand them, but when it was clear he needed to move, pain or no pain, he moved. He stayed in good humor even as they got him to the main trail and put him on a stretcher.

Second, that mountain rescue came quickly and was free of charge - we paid the emergency room fees later on, but the actual rescue and ambulance didn't incur extra expense. It was as good as I'd imagine mountain rescue to be in any Western country. I would absolutely, if I were caught in an emergency in the mountains, trust these guys with my life. Dress shoes or no. I don't really know how it works - whether they're on call and in uniform at certain times or just always on call, but they got there in 20 minutes - on a trail that's not that well-known yet (many people in Jiaoxi have never heard of it).

Third, the disparity between the locals who helped me so much, and the group of river tracers later on (the group that was there when Brendan fell did their best to help us out). As they were trying to figure out how to get to Brendan, a group of them was returning down the trail with all sorts of equipment. The mountain rescue guys asked if they'd stick around and help if necessary, and they said no. They were within their rights to do that, but I was surprised. I guess I would have stuck around. I have noticed when enjoying Taiwan's great outdoors (and how great it is!) that other individuals and small groups or families totally have your back. They'll chat with you, help you out, share snacks with you (and I do share with them), even give you a ride. The large, organized groups, however, never do. They'll make sure you don't die but that's about it. Again, within their rights, but being within your rights is not always synonymous with being kind. I remember a story told by a friend who climbed Jade Mountain and hiked from the bus stop to the first cabin (back when that was a 14km hike with no public transport). It was dark and raining and they were being followed by dogs, but nobody with a vehicle would give them a ride - all organized hiking groups. Contrast that to when a friend and I got stuck at the Laomei waterfall trailhead - a 2km, no streetlight walk back to any main road through farms where dogs lived. We quite easily scored a ride to the nearest bus stop from another leisurely day hiking couple. In this situation, the most helpful non-professionals were the couple who lent me their phone and fed me their soda and raisin bread, and stuck with us until Brendan was in the ambulance. I never learned their name (but I did thank them), and they'll have my eternal gratitude for taking care of me when I needed someone to help me help Brendan.

Fourth, I have not yet figured out how our band of three, plus the couple that helped me and the rescuers (fewer than ten) turned into a parade of approximately 30 people as we got to the end of the trail. I honestly have no idea where most of these people came from - two guys on scooters, a guy with blue hair, a few other day hikers, and about twenty other completely random people. My best guess is that word got out among people at wherever mountain rescue hangs out and the base of the trail that "some dumb foreigners had an accident in the mountains, why don't we go see what's up?" "OK, I've got nothin' else going on, let's check it out".

At the end, I thanked everyone including the Taiwanese couple and the EMTs got Brendan into an ambulance and sent us to National Yangming University Hospital in Yilan (I told them "the best nearby hospital" and that's the one they chose). It was my first and hopefully only ambulance ride not only in Taiwan, but ever. And yes, I Facebooked the whole way there, once it was clear that Brendan would be fine (obviously I would not have done that had he not been OK). It's not often that you get to be tagged in a photo like this:

Don't worry, Brendan's the sort of person who sees humor in such photos, assuming the person is not in any danger.

At the emergency room, he got a CAT scan and an X-ray, care for his less serious wounds, stitches and a dry hospital gown.

The X-rays and CAT scan confirmed that he managed to slide 20 meters and fall straight down for another 10 or so without breaking any bones or suffering any head trauma. Not even a mild concussion.

Which means that the fifth thing to amaze is that I am apparently married to Clark Kent. I think he may fly around saving lives and stopping criminals while I sleep. If a fall like that doesn't break a bone, I am not sure anything will (knock on wood).

Then they gave him an IV to make sure he didn't dehydrate, gave him some painkillers and observed  him for a few hours to make sure he didn't have some trauma they'd missed (nobody wants this), and a chance to rest. The care he received was as good as any you'd get in an American emergency room - no, better. He didn't have to wait. The ER was a little busy, but not understaffed. He got the attention he needed immediately - something you may not get in an ER in the West. I remember cutting my knee badly enough that I needed stitches one year at summer camp, and waiting two hours in the ER before a doctor was free to see me.

Emily and I went to a nearby hotel that has a deal with the hospital to provide discounts to patients and their family - we got a room for three hours (NT$500) and took showers and a rest. I frequently walked back to the hospital to check on Brendan, and 7-11 to buy him some sort of shirt. He had no clean, dry, non-ripped and non-bloody shirts to wear. He ended up with undershirts, but they'd do. He felt faint, but probably from exhaustion and shock more than anything, and I helped him hobble very slowly to our hotel room. Once there, he said he didn't think he'd make it back to Taipei that night, so we sent Emily home, paid a bit more for a full night, put a towel down on the pillow and slept in Yilan. We both canceled work the next day. Him because he was in no condition to teach, me because I needed to get him back to Taipei and then help him at home.

Some things I learned from the whole ordeal:

- I do realize just how lucky Brendan is. I do attribute it to luck: if anything, the fact that some people are not so lucky at all, and people do die hiking, mountain climbing and river tracing just because they didn't manage to fall into deep water, has made me feel that no, this is not the result of a higher power watching out for us. If it were, people just as deserving of a happy ending as Brendan would get it. So this hasn't caused any sort of religious epiphany.

- I will never, ever, EVER again make fun of people who take what seem like too many safety precautions when hiking or river tracing. I do understand the need for climbing gear, a wetsuit and a helmet for serious, challenging river tracing, but I felt that the Yuemeikeng trail was so easy - I mean, even I have done it, and I'm hardly Olga Outdoors - that a helmet was really not necessary. Well, no. Brendan was fine, but he might not have been, and had he fallen a few meters to the left, a helmet might have saved his life. In this case, a helmet would have meant no stitches in his head. So kids, listen to Auntie Jenna: wear a helmet when river tracing.

- Just because something has footprints and looks like a trail does not mean it is a trail you should be taking, or a real trail at all. I don't care how those footprints got there, if you feel like it's not a good trail, don't take it. Just don't. Even if you have to turn back. I have learned my lesson.

- I am really not interested in hiking or river tracing right now. I will surely hike again in the future, but for the forseeable future I am going to stick to safe trails. I had the jeebus scared out of me and I'm not interested in it happening again.

- I do realize how lucky we are that this happened in Taiwan and not, say, Nicaragua, Sri Lanka, or Indonesia...or even China. Yilan County had the facilities to come to our aid quickly. I don't want to think about how much longer Brendan might have sat in that cold water, bleeding had this happened in a less developed country, or one in which we didn't have a cell phone (we generally don't travel with one), or I didn't speak the language, or had subpar hospitals. I am not too interested in seeing how good Nicaragua Mountain Rescue is, or how good their hospitals are. Lesson: don't do risky hikes in places where you don't have access to emergency services. Get a guide or don't go. It sounds obvious, but you'd be surprised.

- Take a First Aid course. I will. Again, it seems obvious, but it hadn't really occurred to me. Emily did a lot to keep Brendan safe while I went to find help, and I'd like to have the knowledge to be able to do something similar should I ever need to.

This was our final destination - I'd been there before. We never did make it. I'm not sure I'll go back. Too many bad memories now.

Finally, for all of you out there who still think America's craptacular private health insurance "system" is superior to a nationalized system like Taiwan's, I can assure you that National Health Insurance saved our butts. I am a big fan of Taiwan's nationalized insurance, which covers everyone but allows private hospitals and clinics to open alongside government-run hospitals. It means everyone is covered, but you don't have to wait for care because the private clinics help ensure that everyone gets quick attention. It's expensive, but not any more expensive than what you lose in productivity when you have a population that can't afford to seek medical treatment before it becomes dangerous/unavoidable. It's not perfect - people complain of perfunctory visits and ridiculous regulations on what can be prescribed when, and what is and isn't covered - but it's a hell of a lot better than America's horror.

Here's a breakdown for you:

Mountain rescue
Taiwan: free
USA: Usually free, but not always (It's hard to say if we'd have been found "negligent" and possibly charged for the cost on the USA: in retrospect we shouldn't have been on that "trail", but at the time, seeing those footprints, it seemed like, if not a great idea, that at least it wouldn't end as it did). Had we been hiking in Maine, Brendan's home state, the government would have been legally allowed to bill us for the cost of the rescue.

I'd say the level of training and competence evident in Yilan is comparable to what I'd expect in the rest of the developed world.

EMTs and Ambulance
Taiwan: free
USA: It depends - but usually not free
It may be ree if it is publicly funded, but it's not always. Private or fee-based ambulance services can be quite expensive (I know, Yahoo! Answers is not a good source, but in this case I believe it is accurate). Private insurers may or may not cover it: if they deem it wasn't medically necessary (Brendan technically could have been transported by car, but we didn't know that at the time), or are out-of-network, or take you to a hospital that the insurer won't improve. The ambulance may be covered but take you to an out-of-network hospital. Or your insurance may only cover you in your region. Let's say $500 as many sources agree this is the typical fee, and with all the weird rules and ways to reject a claim, there's a fair chance we'd have been stuck with that fee. However, let's assume everything goes according to plan and you pay a $50 co-pay for the ambulance ride.

Emergency Room
Taiwan: NT$500 (US $20 or so)
USA: OH GOOD FREAKING GOD
My old insurance plan paid for ER visits with a $50 deductible, some charge up to $250. I think the mean is about $100 so let's say $100 (this coverage plan confirms that). Without insurance or if insurance deemed that his visit was not medically necessary (it was, but private insurers seem to work on a plane of logic devised from their own sense of whimsy coupled with sadism) it could have been several thousand. Brendan needed more care than the child in this article's first anecdote, but like the child, got stitches for a deep wound. Let's say without insurance it would have been a similar amount - about $5500. I'll be generous and assume that includes X-rays.

CAT scan
Taiwan: Free with ER visit
USA: $300-$1500 (confirmed here - could even be more)
I'll go with $1500 here as he had CAT scans with contrast dye of his head, pelvis, leg, foot and possibly other parts - he may have gotten a shoulder and abdominal ones as well. I'm really not sure. It could have been much more than that, up to $3000 or even higher. Insurance usually asks for a 20% deductible for such tests, which would be $300 for a $1500 scan, or $600 for a $3000 scan.

X-rays
Taiwan: free with ER visit, very cheap (like maybe $10 USD) otherwise
USA: $200-$500 (check the comments)
Let's be generous, though, and assume in our range that the huge ER bill included the X-rays, stitches, doctor check and pain medication - I'll include this cost in a range, but it may not be a separate charge.

Follow-Up Visits
With stitches in wounds as deep as Brendan's, he'd need at least one follow-up to remove them, or more than one to make sure everything was healing alright. He'll probably have to see an orthopedist soon to check for soft tissue damage.

Taiwan: NT$200 (US$6), typically, no waiting - we paid more for one visit but it wasn't strictly necessary to go back to the hospital in Yilan before returning to Taipei
USA: US$50 with insurance, typically (it varies), or $200 or so (again, it varies) without insurance - that'd be for a doctor to check/remove the stitches and again to see the orthopedist (a specialist - plans in the USA vary).

Total: 4 visits so far in Taiwan (NT$800 or about $25 USD), we'd probably go to the doctor less were we in the USA. 2 visits at $50 copays is US $100, or without insurance $400 USD.

Walking Cane
Taiwan: free - the ER gave us one, but if we'd had to pay, maybe NT$300 (US $9)
USA: let's say US $20, although that is a generously low estimate

Medication
Taiwan: Free
USA: assuming ER medication was free but medication given later on prescription had to be paid for: my estimate (I have no way of verifying this accurately, but I can make a good guess) would be $20 with insurance, up to $60 or more without. Let's be charitable and stick with $60 for some basic Neosporin-type stuff and some antibiotic cream.

I won't even get into the cost of acquiring a hotel room ($30 US in Taiwan, probably $100 US in the USA), food while in a different city (negligible in Taiwan, probably $50 or so in the USA with three people eating a few meals, even if we ate cheaply), transport back to Taipei (we would have paid that anyway), and taxi to the bus station and then apartment (total $300NT or $9 US, would have been more like $40 in the USA), and getting Brendan shirts (about US $5 here, probably would have cost me more in the USA).

Total cost in Taiwan:

Mountain Rescue - Free
Ambulance - Free
$20 ER
CAT scan - Free
X-rays - Free
$25 follow-up visits
Cane - free
Medication - free
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$45 USD for the entire thing

Total cost in the USA if you are lucky and have insurance

Mountain rescue - free
Ambulance - $50 co-pay
Emergency room - $100 with insurance
CAT Scan - $300-$600 with insurance
X-rays - charitably, let's assume this is covered by the emergency room fee. If not, maybe $100
Follow-up visits: $50 for two follow-ups and $50 to see an orthopedist = $150
Walking Cane $20
Medication $20

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$640 - my minimum estimate with insurance, $1040 as a maximum total cost even if you are lucky and insured!

Total cost in the USA if you are one unlucky bastard

Mountain rescue - free (you're not that unlucky)
Ambulance - $500
Emergency room - $5500
CAT scan - $1500-$3000
X-rays - let's say this isn't covered by the ER bill and estimate it at $200 (which is being generous!)
Follow-up visits - $600 for two follow-ups and one orthopedist appointment (note that in Taiwan you'd have had four visits)
Walking cane - $20
Medication - $60

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= may as well file for bankruptcy now

Or, $8,380 if you are only a little unlucky
and $9,880 if your CAT scan was on the more expensive end of things

Just in case you're not furious yet, here's the cost in Taiwan even if you don't have insurance:

Mountain rescue: free
Ambulance: not sure, but the EMT told me it was actually free no matter what (will double-check or someone can correct me in the comments if I'm wrong)
Emergency room: from my sister's visit, NT$800 or about $25
CAT scan - no idea - can anyone help? I'll ask some doctor friends soon
X-rays - NT$300 (from my own experience) or $9 USD
Follow-up visits - NT$400 each for 4 visits = NT$1600 or about $48 USD
Orthopedist without insurance - NT$1000 (estimated from what it's cost me to see a chiropractor and an OB/GYN that didn't take national health insurance) or US $30
Walking cane - NT$300 maybe (US $9)
Medication - let's estimate a total of NT $500 (US $20), which is overstating it

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= USD $141 (not including CAT scan)

IN CONCLUSION

Poor Americans shouldn't go hiking. If you're poor, and American, or even not poor but lack insurance, don't just stop hiking - stop EVERYTHING. Just go live in a bubble. If you're in an accident, and live, your life is still over. If you can afford the bubble. Which you probably can't. You're fucked, because a bunch of "meh meh meh let's spend all our money on wars we don't need to be fighting and tax cuts for people who don't need them and then balance the budget on the backs of the poor and elderly and tell those poor and elderly that they're the moochers who won't take personal responsibility"folks.

And, also, clearly nationalized health insurance works, and clearly even setting the insurance issue aside, medical care costs too much in the USA and I have to ask why. Costs in Taiwan are about 1/2 to 2/3 that of the USA, so why is the difference more like several orders of magnitude just in the case of medical care? When medical care in Taiwan is comparable to that in the USA (in the case of emergency rooms, it's better)?

Note that the expenses listed in Taiwan are generally one line each - because it's all very simple. There's about a paragraph per expense under the US section, because it's complicated, and easy to get screwed (out of network, ambulance brings you to the wrong place, insurance says something was not necessary even though doctor said it was etc.). That right there says a lot about how screwed up the American system is. It shouldn't be that way. It should cost $X, at all times, for everyone, under every insurance plan.

And also, note that I put "in Taiwan with no insurance" at the end - because while it's possible to go through this in Taiwan with no insurance, almost everyone is insured. Youd've been insured, almost certainly. The exceptions are few and far between. In the USA, it is absolutely not a guarantee that you'd be insured.