Nobody knows anything about coronavirus, and there are two reasons why

Source: Facebook (I've seen it in several places, I have no idea who to credit for creating it)

I noted in my last post that "we know nothing" about coronavirus, and I want to expand on that a little and talk about why.

...the international media is taking government data as gospel, which people in China know right now not to do. We don’t know what the fatality rate is because nobody knows how many people died before being diagnosed because they couldn’t get care. China keeps reporting “2.1%”, a number I don’t think anyone in China believes. We have no idea how contagious it is, either. We know nothing.

Let me be clear when I say "we don't know anything" - we don't know the fatality rate, as I noted. We also don't know yet where it came from (though as SARS originated in a wet market, coronavirus probably did too). We don't know how contagious it is, because if we don't know how many people have it, and how many have died from it, how can we know how easy it is to get?

We probably know that it's transmitted through aerosolized body fluids - that is, droplets of saliva from normal breathing - and you can get it by getting it on your hands and touching sensitive membranes in your face. At least, we think we know - that information also comes from China, but it seems highly plausible, even likely. In fact, it's hardly groundbreaking, that's how most colds and flus spread. 

In fact, if you're going to be worried about anything, don't let it be coronavirus. If you are not in China, you probably will not catch it (even if you are in China, you might be fine). Be afraid that we don't know anything about anything, the people fighting it don't really know anything, and even if the CCP did know, they'd probably lie about it.

But why? We can blame two factors - the first is that the Chinese government and health care "system", such as it is, is completely overwhelmed and it's likely they themselves don't have a clue what these data actually are. The second is that the Chinese government thinks it can decide what is true, and attempts to push a political agenda even to their own detriment, as well as the world's. 

So there are two layers of unreliability: the CCP is lying about data it doesn't even know itself. 

The first reason isn't entirely China's fault. I mean, it is absolutely their fault that they covered up the initial outbreak, allowing it to get worse. If they've learned anything from SARS, it's manifested in a slightly faster path from "pretending this doesn't exist and punishing anyone who says otherwise" to "admitting we have a problem", not in eliminating the first stage altogether. It is also their fault that they've allowed the nation's lackluster health care - which is absolutely not "free" or even "public" as many Westerners believe - to fester for so long.

But it is not their fault that the virus broke out there; these things happen around the world. So it's not their fault that they are the epicenter, nor that they had to be the first to fight it, while the rest of the world got a heads-up and some time to prepare.

The second - their consistent lies and cover-ups when SARS should have been a lesson against such behavior - obviously is their fault. That should not need to be explained. The lying, yes, but also their consistent opposition to Taiwan's participation in the WHO and other international organizations (such as ICAO) where their expertise and superlative health care and responsiveness to the epidemic could be of great help in combating it.

With all that in mind, let me hazard a few speculations about these things we don't know. 

First: coronavirus probably is highly contagious - we just don't know to what extent. We don't have enough data to compare it to the common flu, so please stop doing that. But the flu exists in China, and hasn't created an epidemic like this in previous years. If people going out for hot pot can infect much of their family and it's possible to contract it just transiting through Hong Kong, that points to potentially high contagion rates. It's possible that China is overreacting by locking down entire cities, but I doubt they'd self-destruct their own economy - through two sources I know that even Shenzhen is in full-city quarantine, which would be economically devastating - if they didn't have reason to worry.

But - how much of that contagion is simply because it is highly contagious, compared to how much is potentially caused by overwhelmed health care systems in China and poor public hygiene in general? I contracted bronchial pneumonia twice in one year in China; this is almost certainly a contributing factor. How much of it is due to an inability to practice appropriate epidemic-fighting hygiene protocol because masks, sanitizer and alcohol cleaner are all impossible to get, in a contagion zone?

I have no idea, but the fact that the virus seems to be spreading slowly and is basically under control in most of the rest of the world means that it probably can be contained, and isn't necessarily going to be a global pandemic. You might want to keep people in China in your thoughts, however. They don't deserve this and with every Chinese system on overload, it's probably going to get worse.

How much of the unknown fatality rate is caused by those same factors - an overwhelmed system, shortages of necessary hygiene supplies and poor general public hygiene, as well as paranoid quarantine policies that put people in non-virus-related danger and have resulted in at least one death?

It's impossible to say, but the fact that a lot of people are dying from coronavirus in China (though we don't actually know how many) and very few have died abroad shows that the environment and poor government response in China are factors. 

That brings me to my final points - first, I don't even know how much to blame China for actions which seem malicious. That charter flight meant to bring at-risk Taiwanese back to Taiwan, that ended up being full of wives and children of evacuees (who also deserve to be flown out, but not at the expense of at-risk people)? You know, the one which ended up containing at least one confirmed coronavirus carrier? Some have accused China of purposely putting infected people on that plane as an attack on Taiwan, but I honestly think, in conditions that have been described as "wartime", that it's far more likely that they didn't have the wherewithal to intentionally put a carrier on that plane, and just let a person who'd bribed their way into a seat take what they'd paid for.

Second, if you are not in China, please stop freaking out. Taiwan's response has been exemplary - this is what open information and quick responses can accomplish. Japan has done a good job as well; Singapore is pretty good at this sort of thing. In fact, it seems that even if this coronavirus is highly infectious and highly fatal, that a strong public health response can keep it in check. Again, it's not China's fault that it was the epicenter - only that it spread in a government-imposed information vacuum.

That the rest of Asia has done a brilliant job of organizing a strong response before it could spread further is good news for the world.

This is probably not the last epidemic virus that will originate in China - the huge population, generally poor public health care, poor public hygiene (think bad plumbing, undrinkable tap water, rarely-cleaned public toilets, public spitting - though that has decreased markedly in the last decade) and prevalence of wet markets almost guarantee it. I certainly hope for the people of China that coronavirus is brought under control, though I also hope that they can overthrow that useless CCP and create a government more capable of responding to such outbreaks.

In other words, sunlight is in fact the best disinfectant. Open information, strong public health and quick action seem to be pretty effective in combating coronavirus, and they are protecting entire populations. I can only hope China figures out those three coronavirus 'vaccines' sooner rather than later. 

But the ability of much of the rest of Asia to coordinate a containment response and share what information they have freely is good news for the rest of the world. Forget the "first island chain" and South Korea in terms of traditional defense - warships, airstrips, bases and whatnot. This is the front line when major epidemics originate in Asia, and rather than excluding a key node in that defensive chain from organizations like the WHO, maybe the world should stop pretending the CCP is a true ally, and start realizing that the rest of Asia - including Taiwan - should get more credit. 

Let's talk about sex education in Taiwan

It's a popular expat pastime to point out ways that Taiwan is different from one's home country - you know, the typical "back home we have churches but here we have temples" type of narrative. I do it myself sometimes. There's nothing wrong with that type of story - vive la difference and all - but it's interesting sometimes to look at ways in which countries on two different ends of the world are more alike than they are different - for better or worse. And sometimes both.

This is one of those "both" times - an interesting article appeared on NPR pointing out Taiwan's forward thinking sex education curriculum (although implementation is far from perfect, as teachers incorporate it into other subjects as they see fit) as well as opposition to it. Both good (the modern, pragmatic curriculum content) and bad (anti-gay groups saying the same-sex relationship education is 'improper') are quite similar to the debate over this issue that goes on in my own country.

I've long been critical of sex education in the USA - as the article points out, what is taught (if anything) is state rather than federally mandated, so American children in different states might graduate with wildly different knowledge about sex and reproduction. More age-appropriate knowledge is always better in this regard (with "age appropriate" meaning "a strong knowledge base before a young person becomes sexually active, and whatever knowledge they are curious about regardless of age"), so it is never a good thing for a student in one state to have less knowledge than a student in another. When sex ed is taught, as it was in my school, I wonder about the content. I learned about sexually transmitted diseases and reproduction, but did not learn much about female anatomy - I had to inquire on my own to learn that one can pee with a tampon in, for example, and that's just unfortunate as it should have been taught - and nothing at all about physically and emotionally healthy sexual relationships (with the emotional part especially ignored). I learned that from a combination of talking with my mother, reading a book she'd given me, and honestly, learning on my own.

Imagine if I hadn't had a good upbringing or open-minded mother. Imagine what I might not have known about healthy sexuality simply because I was born into a more conservative family or state. Imagine how much of a problem that might have been for me as an adult - even with a pretty good education in these matters from home, I still made (relatively minor) mistakes. What sorts of bigger mistakes might I have made without this healthy upbringing?

And, frankly, I think it's just stupid to pretend sex - and how to enjoy it in a healthy way - is somehow a shameful topic that we must avoid talking about to children or even in (some) polite company. Everyone is either doin' it, will do it, or wants to do it. It makes about as much sense to pretend it doesn't exist as not building public bathrooms (we all excrete, too) or not eating in public or even talking about eating or admitting we eat. I also think it's stupid to consider basic health education, including how to have healthy relationships in general, as inappropriate for children. If you're old enough to notice that you have sex organs, you are old enough to know what they're for. If you're old enough to know how and why you poop, you are old enough to know how babies are made. If you're old enough to know that your parents (hopefully) have sex, you're old enough to know the good things and dangers of doing it yourself.

And if you're old enough to ask, you're old enough to deserve an answer.

So, yeah, not too happy with my own country on this front. If we could stop being so terrified of a basic (and fun!) biological function, maybe we could have a happier and healthier population as a whole. If we could do that, maybe we could understand this biology in a more evidence-based way, which would lead to less misogyny and gender discrimination and less homophobia and anti-gay fearmongering.

As for Taiwan, frankly, I'm not sure what to make of sex ed here. I know a curriculum exists, and I have seen with my own eyes attempts at public service campaigns on the topic: I once had a culture shock moment in the MRT as I watched a safe sex commercial play on the televisions that announce the time of the next train. And yet, I'm  surprised by how often I come across straight-up head-scratcher beliefs. For example:

- That you cannot or should not use a tampon if you are a virgin
- That if you merely sleep in the same bed as a person of the opposite sex, you might get pregnant
- That if you drink cold drinks on your period, the menstrual lining will "harden" and stop flowing out (I know this one comes from older Chinese beliefs, but to me, hearing it is akin to hearing a Westerner talk about the healing properties of leeches)
- That homosexuality leads to AIDS epidemics
- That the percentage of LGBT people would decrease if we'd only raise children a certain way
- That it is "not normal" to be gay (often backed up with painfully flawed historical or demographic arguments)
- That criminalizing sex work will stop it
- That teaching abstinence or withholding education will stop young people from having sex
- That men "always" want to have sex but women "usually don't"
- That sex is a female "duty" to her husband


...so, basically, aside from the whole no-cold-drinks-on-yer-period thing it's more or less just like the US. As I don't think the US's sex education programs are particularly praiseworthy, I also have to wonder if Taiwan's national program is effective as so many of the same myths and misconceptions persist. It's even the same people - those anti-gay, usually religious types who are a few conspiracy theories shy of thinking the Earth is flat, who want to impose their ridiculous and frankly made-up morality on the rest of us - causing trouble and spreading lies.

A little slice of America in the Far East. In the worst possible way.

It's a shame, because unlike the US where a Puritanical past coupled with (pun intended) waves of immigrants who, while they bring diversity to the US, might not exactly bring a cutting-edge understanding of sexuality, this never had to be the outcome in Taiwan. Taiwanese culture is often dismissed as "conservative" and "repressed" by foreigners who don't know better, but the reality is a lot more complicated than that, and is not necessarily always conservative by Western standards. There is room in Taiwanese culture to be open about these things.


And then there's hilarity like this:





This brochure is outdated now, but I still think it proves a point. I had originally thought of it as a good thing: an attempt to educate, albeit a flawed one. Now, I'm not so sure. Why is it in English? I don't remember seeing a similar on in Chinese (although one might exist). Do they think foreigners need to be educated to avoid "seductions in cities"? Are we seen as the problem? That's a problem in itself, but the childish presentation and straight-up hilarious English - why on Earth did they think that "工欲善其事，必先利其器" was a good idiom to use? This alone renders it useless and ineffective for even this misguided goal.

What's more, instead of all the useful information they could have put on the back, they chose "avoid seductions", "flowers with dazzling beauty can take your life" and...sharpening tools?

Despite all that talk of a progressive national sex education curriculum, is this really what it boils down to?

I don't know, as I don't work in a public school, I don't research this issue and although I've had friends tell me they had very little or no sex education in school, they are all old enough that their observations would not necessarily reflect today's reality.

So I'm not sure what to think, but I do know that Taiwan can, and should, improve in this area. It is entirely in keeping with local culture that it do so.

An untitled mess

Editor's note:

Although I'm on vacation, for some reason this seems to be the week for long, difficult reads on Lao Ren Cha. This isn't as long as my last post, but it was far harder to write and will probably be far more difficult to read. I don't even have a title for it. 

One week before Brendan and I left for a trip that would have me out of Taiwan for over two months, a friend and I sat in the basement-level clinic of the psychiatric ward of National Taiwan University Hospital. Yvonne (not her real name) had been struggling with mental health issues for years, but they had recently gotten worse: she'd been in and out of the ward as a resident several times over the past six months. She hadn't shown up for a planned coffee date, canceled on a small group dinner, was calling or chatting online with a small group of friends, including me but failing consistently to show up in person. I wasn't angry, I was worried about her.

Yvonne was a good friend - health issues aside, she was intelligent (she completed her undergraduate degree at prestigious American liberal arts college and gone on to do a Master’s in Linguistics in Taiwan), loyal and caring. I considered her a good friend - I listened to her, and she to me. When she had an English teaching job and struggled with classroom management, I sat down and gave her a crash course in it, with the idea that as she picked up the basics, more would follow. She pushed me to look seriously into doing a Master’s degree, pointing out that I was full of excuses when the only things really holding me back were nervousness (I'm terrified of people I respect thinking I'm stupid) and money. She was right. We’d met as coworkers at an absolutely horrid “management consulting” company, and spent many an hour excising our bad memories together, stopping when we felt it was starting to get unhealthy. We supported each other and had fun together.

When a mutual friend tipped me off that she had also been skipping her doctor's appointments, I was worried. I feared she'd also been skipping her medication because it interfered with drinking, and I knew she wasn't getting the support she needed. What was scarier was that I wasn't sure what kind of support could reach her.

She was happy to accept my offer to accompany her to her next appointment, which was on a rainy Tuesday morning. I got there first, shook out my umbrella and waited in the old NTU hospital building, the beautiful Japanese-era one. I'd taught a few seminars here once. I'd figured she was less likely to skip an appointment if she knew I'd be there too, and the first step towards some sort of normal that could hold was ensuring she was in regular contact with professionals and taking her medication.

The psychiatry department at NTU is labyrinthine, as are many departments in many hospitals across Taiwan. You go to one window and register, take your registration to the doctor, take something from the doctor's assistant back upstairs, get a number and then wait. There are more papers, trips up-and-down, numbers and queues for payment and medication. I'm not sure how a very ill person - mentally or physically - would be able to manage it alone: most would have to have family, friends or a domestic worker/health aide accompany them. The system is simply not built well for people who are on their own.

I recalled the time when my mother, after having seemingly recovered from the cancer in her lungs, found out that it had spread to her lymphatic system and now she had "months". I was gutted, made plans to return to the US, and thought it would be smart to talk to a grief counselor, or any counselor. I couldn't go to the Community Services Center in Tianmu, because they're only open during weekday business hours and I am simply not able to go to Tianmu during those hours on a regular basis. I found another center closer to home that offered services in English, but they wouldn't let me make an appointment until I chose someone from the list of counselors on their website. Even that was too much of a hurdle, I wasn't in a good state to attempt it. I read through the biographies several times, but kept getting flustered, tired and more depressed. I never called back, and worked through the grief on my own.

If that small stone in the tracks could derail my search for fairly-straightforward counseling when I wasn't even battling a mental illness, just deep grief, imagine the sort of obstacle the back-and-forth of visiting a doctor in a psychiatry ward at a hospital could present to someone in a much more unstable condition.

While we got this upstairs-downstairs workout, we chatted. Yvonne mentioned that she was only able to see a doctor perhaps once a month or for prescription refills, and that today was actually her physician's day to meet new patients. He'd agreed to see her because she'd skipped her last appointment and didn't seem well. She mentioned that she'd tried therapy, but it didn't seem to be yielding fast enough results, and she couldn't afford to keep it up: it's several thousand NT dollars per session, and she was unable to work.

She agreed when I asked her if I could write about her situation, without using her real name, in a post about why mental health services in Taiwan are so deeply lacking. Something needed to be said, but I didn't want to write it while excising the story that caused me to see the problem, and I didn't want to include the story without her consent.

Due to the events that have transpired since then, there is so much more to say. 

On one of our trips back down the stairs, I mentioned that her doctor seemed to be a good professional to have in her corner, as he'd agreed to see her on a day when he did not normally see existing patients. She agreed, but pointed out that during one of her stays in the ward, they'd assigned her a junior doctor who only wanted to talk about her alcoholism. She'd requested a change and the ward had refused - so she drank detergent.

I gasped.

"Well I wanted to make a point. Anyway, I knew it wouldn't kill me," she replied.

A bell should have gone off in my mind then, but didn't. I gathered my composure enough to point out gently that, in fact, drinking detergent could well kill a person.

Back downstairs, waiting for her number to be called, we talked again about therapy. It seemed to be simple common sense that regular contact with professionals - both doctors and counselors, at more frequent intervals than hospital visits could provide - would be a good idea. I didn't have the professional credentials to support Yvonne in the way she needed it, but I hoped I could be supportive in getting her in regular contact with people who did.

She revealed that her boyfriend, who chiefly supported them, was on a leave of absence from work and had his own issues. Although she could not work and was legally classified as 'disabled' and as a result received a small monthly sum from the government, this was just about enough to cover the cost of food and doctor's visits under National Health Insurance. It would not cover therapy, nor a place for her to live when things were not going well with her boyfriend, with whom she'd broken up and gotten back together with several times.

In short, more regular contact with professionals was not something she could afford. National Health Insurance didn't cover it and she had no other means to pay for it. That she desperately needed it - that it might have saved her life - didn't change the cold hard reality of her empty wallet.

The next day, I would speak with a friend who is a psychiatrist, but in an entirely different sub-specialty. She pointed out that, in fact, National Health Insurance does cover therapy in cases like Yvonne's, but the government rate paid to therapists who accept the insurance is something like NT500/hour. This for a professional with graduate-level training. So, clearly, few if any therapists wanted to go through the insurance system. Offering private, non-insured care only, they could charge exponentially more. Unfortunately, this sort of rationalization means that important mental health support is only available to those with means.

As a result, people who need help but can’t afford it like Yvonne have no access. In that way, it’s not that different from the USA, where people do die from lack of access to health care. Praise for Taiwan’s healthcare system is common, especially when compared to the near-total lack of a consistent system in the US, but in this particular way, Taiwan has failed. Family and friends can, in most cases, help someone connect to the right professionals, but consistent access to those professionals is key. If it is not affordable, it is not accessible.

My friend went on to say that, as a result, a lot of psychiatrists whose job would ordinarily be to see a patient in order to determine what sort of medication to prescribe and nothing more - certainly they weren’t paid for more - kept tabs on their patients the way Yvonne’s doctor seemed to be keeping tabs on her. That’s noble, and is one bright light in an otherwise dark landscape, but it really shouldn’t have to come down to that. The care Yvonne and those like her needed shouldn’t have been sparingly provided, at the discretion of a doctor who decides whether or not they’re willing to devote the extra time. That Yvonne had a doctor who did step up is an individual compliment but not praise of Taiwanese healthcare: it speaks to a breakdown of the system that he felt he had to do so in the absence of any other option.

I considered what sort of financial outlay would have been required to band together as friends and just pay for it, but it quickly became clear that it would be too much to ask of mutual friends, with costs approaching what many of them pay for rent each month, for something Yvonne wasn’t very motivated to do. I could give her money (I don’t loan money to friends: I give it, and if I get it back that’s fine. If not, that’s fine too) but not enough to supplant a needed income. 

While waiting for Yvonne’s appointment, I tried to say as gently as I could that the junior doctor who’d wanted to talk about her alcoholism seemed to certainly have had a bad ‘bedside manner’, and I could understand that anyone would be put off by that and by the idea of stopping drinking, but he wasn’t wrong. She did struggle with alcoholism, and it was affecting her medication. Without the medication, however, her mental health would not improve.

Although I’m not a doctor, it did seem clear that, while figuring out her relationship, living and financial situation were important, none of it would hold if she didn’t consistently manage her health.

Yvonne took this well, to my relief. I wondered why the doctor who brought up the subject with her to begin with could not have also broached the topic in a way that she’d have been more likely to be receptive to.

This is not unique to Taiwan: around the world you will find doctors who are empathetic, caring and understanding and can reach patients, and those who don’t make those connections as easily. In Taiwan, that means for every doctor like the one who’d agreed to see Yvonne on an atypical day, and who took care to keep tabs on her situation knowing she had no other professional support, there is likely one whose manner does not meet a patients’ needs.

Yvonne was living with her boyfriend, but it was clear from the instability of that relationship that she would at least need an alternative open to her if it ever did end. Again, Taiwan failed her. She could have stayed with me - and I offered, with Brendan’s support, and gave her a key that she could use anytime - but we both knew it wouldn’t be a good idea to make that permanent. Her disability payments were not enough to cover housing, and her family, who lived in central Taiwan, had long since rejected her (I will not go into their relationship here - I had Yvonne’s consent to write about her situation, but I never asked if I could include her family history, so I won’t).

The disability payments seem designed for people who cannot work but have a place to stay - generally, it is assumed, with family. Although homeless shelters exist, and there are welfare organizations such as Harmony Home for people with specific illnesses (in Harmony Home’s case, HIV/AIDS), a long-term sponsored or subsidized living option does not appear to be available (or widely available - while options may exist, even after several searches I was unable to locate any) to people in Yvonne’s situation. A mutual friend and I discussed whether group living options were available, perhaps with flexible work opportunities for those who might not be able to be reliable as traditional employees, but neither of us could find such a place.

In short, when you have no family to take you in, but no ability to earn enough income to live on your own, there are few if any options available to you in Taiwan. It almost feels as though the healthcare system is designed with the assumption that everyone has family to support them, or with the unconscious belief that if your family has disowned or rejected you, it must somehow be your fault. From simply finding the right care to navigating the hospital system to living day-to-day to paying for services that NHI doesn’t cover, it is assumed you have a support network.

If you don’t…

Yvonne seemed to be in a good mood, or at least a clear mood. We talked about things other than her illness: her cats, her boyfriend, her family, our mutual former employer and how awful they were (they were a part of the reason she was in such a bad financial situation). Music she liked. When we’d meet next, perhaps for dinner or coffee. I pointed out that I was leaving in a week, and it’s likely we wouldn’t be able to meet before then, but if she really needed someone she could always come over, or if she couldn’t manage that, I’d send a taxi to pick her up.

She repeated that she agreed with me that she was going to have to stop drinking and start taking her medication. I knew it wouldn’t be as cut-and-dried as that - wrangling alcoholism and medication rarely are - but as we started to say goodbye, I hoped that at least it was a path she was ready to start down. 

“I really think I’ll be OK, y’know,” she said jus before we parted ways. “Maybe I don’t even need therapy. It’s not like I have suicidal ideation or anything like that.”

At the time I’d been happy to hear a clear indication that she was not considering taking her life. Of course, looking back, that statement was the reddest of flags.

We chatted online a few more times before I left, mostly about nothing terribly important. She said she was feeling up, and other friends agreed she seemed to be doing a bit better. I didn’t reply immediately to her chatty messages, but I did reply. She asked if she was bothering me with ‘chatter’. I said no, I was just working is all, but I’d always respond when I was free. It was true. 

Mutual friends talked about how to support her while I was away, and we thought it’d be okay, at least for the summer. The system was failing her, her family was failing her, her relationship was rocky, but she had us and while we couldn’t replace the full support system she needed, we could do our best to create a basic safety net.

The next week, Brendan and I left for the airport early in the morning. It was May 24th - I would not be back in Taiwan until August 9th. We flew first to Greece, where we enjoyed ourselves as well as seeking out an important piece of my family history.

On our second day there, we were sitting in the cafe near our Airbnb drinking Greek coffee and reading. I was working out how we were going to get to the Athens suburbs the next day. We’d gone to the Acropolis that morning and were sunburned, got lost trying to find a post office, and were planning to go to the Acropolis museum that evening.

Then, I got a message from one of those mutual friends - Yvonne had committed suicide on either May 22nd or 23rd. It would later be determined that she’d taken a number of pills with alcohol.

I sat there, shocked, not knowing how to even begin to process it. For those of you who know me on Facebook, if I sounded unemotional or as though I were unaffected in my upbeat travel posts, it was because my brain went into overtime compartmentalizing, unsure of how to react let alone handle what had happened. 

I’m still not sure how to process it. It feels unreal, as though it didn’t really happen. As I’m not in Taiwan right now, it feels as though I’ll return in August and Yvonne will still be around. I suspect when I return is when the real processing will begin.

I’ve been circling this for a week, unsure of how to write about it, although I knew I wanted to, and know Yvonne had wanted me to write about the system that had so profoundly failed her. I’ve probably painted myself to be an angel in this story, but honestly, I don’t feel I was. I’m neither looking for, nor do I want, sympathy for the pain of losing a friend nor the guilt of feeling like I could have done more. It’s just the truth and ought to be said. I had laid down a boundary that I did not want phone calls after midnight or before 8am (Yvonne had a habit of calling at odd hours and talking for a very long time) - would things have been different if I’d just taken those calls? Or if I’d responded to those final messages more promptly? If I’d searched just a little bit harder for affordable therapy, group living options or anything else that could have helped Yvonne? If I’d been more insistent that I wanted her to stay with us? If I’d given her a bit more money so her financial situation didn’t seem so hopeless? (I’d given her some, not more than I could afford to lose).

Intellectually I know none of these things would have changed much - she needed more help than a few chat messages could have provided - but emotions are slow to follow what the intellect knows.

Or - and this is the key - would it have changed anything if I’d not been so blind to the obvious red flags? Someone seeming like they’re doing a bit better is not a sign that they’re not about to take their life. In fact, it could be a sign that they are. Mentioning twice, unbidden, in one conversation that one is not contemplating suicide is also a clear sign something is wrong. If I’d stopped for half a second to think about it I might have seen that for what it was.

The painful fact remains, however, that the health care system we praise so much - praise which is often, but not always, deserved - failed Yvonne, and it cost her her life. In Taiwan if you don’t have the means to pay for needed treatment that NHI either doesn’t cover or doesn’t cover adequately, and don’t have family to support you, it is a difficult road indeed getting the level of care you need. This is true in terms of physical illnesses - in Taiwan, the hospital staff doesn’t care for you the way they would in other countries (of course, in the US you might not be able to afford a hospital bill). What do you do if you’re in the hospital and have nobody to take care of you, but can’t pay a nurse to care for you either?

It is also true, if not doubly true, for mental illnesses. What do you do if you are so physically or mentally ill that you cannot navigate the maze of windows, queues and numbers at the hospital and have nobody to go with you? What do you do if you need consistent psychological or psychiatric support but cannot afford specific therapies that might be beneficial? What do you do if you can’t work, but have no family to live with? To some extent, these are questions one might face in other countries, especially the USA. The difference is that, unlike the US, Taiwan has a healthcare system that is consistently praised and looked at as a source of national pride.

Looking back, I can see how hopeless Yvonne must have felt. No family, nowhere to live permanently, no way to make money, no way to be independent, insufficient help from the system. Friends who tried to do their best but were ultimately not able to make up for these gaps in the social fabric.

The base assumption really does seem to be that either you are financially independent and can afford what you need on your own, or (more likely) you have family who can do it for you. At the very least, it seems to be assumed that you can live with relatives.

This is not the basis for a modern healthcare system or social welfare system. I’ll always remember Yvonne, but I can’t help but think the system couldn’t have cared less about her. As a result, Taiwan lost one of its smartest, kindest, most loyal citizens, and I lost a good friend. 

Unmarried women can't receive fertility treatment in Taiwan, and that is stupid.

As I've written before, living in Taiwan as a woman can often feel like having a split personality (skip to #11 here). On one hand, I feel safe walking around at night and don't get cat called on the street (though honestly as a 35 year old frumpy lady I rarely get cat called in the US either, which is a welcome relief from my twenties - the myth that you miss it once it stops happening to you is false, at least for me). It is the most progressive country in Asia for women, women are highly participatory in politics and can expect a measure of equality in their lives, most of the time. When they don't receive it, they usually have some access to potential recourse. It's not perfect - neither is the USA or any country really - but it's not bad, as things go.

On the other hand, every once in awhile you learn something that makes you sit up in horror. A short history of things that have caused this reaction in me:

- Learning that a host of important women's rights initiatives weren't passed or modernized until 1998 or 2000 (right around the time the KMT lost power for the first time). That is a shockingly short time ago.

- Finding out that abortion, while legal, must be accompanied by the consent of the husband if the woman is married, and must come with one of four "acceptable" explanations if she is not  

- Knowing that the lack of no-fault one-sided divorce was originally aimed at protecting women from husbands who might abandon them, but now keeps women equally trapped in marriages they don't want to be in, can't get consent from their spouses to leave, but can't prove any fault to push for a unilateral divorce.

- Knowing that, as adultery is still (somehow) a crime, it is rare but not unheard-of for a woman to refuse to grant a divorce to a philandering husband while at the same time pursuing criminal charges against his mistress

- Pointing out that while birth control is available over the counter (apparently - I have been told this but I have never seen it sold), higher-end birth control not generally found in pharmacies but gotten from an OB-GYN is not covered by National Health Insurance. This means that women who can't tolerate over-the-counter pills, can't afford the prescription stuff and can't for whatever reason use condoms (see: controlling/abusive partner, latex allergies) are SOL just because of a misguided idea that covering birth control under NHI would hinder attempts to increase the fertility rate (which I am not all that sure needs to be increased - the population is already too dense and the money spent on promoting child-bearing should be used to help this generation of senior citizens manage their affairs as we reset to a lower overall population).

- Reading about how certain issues, like the China Airlines strike, are often dismissed (or the opposition attempts to dismiss them) if the protesters and activists happen to be young, often attractive, women. 

- Watching (awesome) women protest and ultimately win against sexist rules at university dormitories (the part that causes me to despair is that the rules existed in the first place)

- Reading ridiculous coverage of the fact that our new president wore pants at her inauguration as though that is important in any way at all 

- The lack of acknowledgement of the most important issue in the discussion of Taiwan's low marriage and birth rate: that sexist family expectations are keeping a lot of women from marrying or having children because they don't want to get stuck on that road - it seems like everything BUT this key central issue is trotted out as a reason

It can lead one to have wildly disparate feelings, on a day-to-day basis, about the state of women's rights in Taiwan. That's true of course for any country but I happen to live here, and I would argue the two sides of this issue are more polarized than in many other countries.

And then there's this: unmarried women in Taiwan may adopt, but they may not receive fertility treatment. 

I would take a stab at explaining why but I really can't. I can't even go the "some people feel children need to be raised by a couple" route (not that I agree with it, but a lot of people feel that way) because it's OK to adopt!

This makes no sense whatsoever. This, like forcing women to justify their reproductive decisions vis-a-vis a non-sentient ball of goo in their uterus, has no place in a modern society. Taiwan, with its newly-elected progressive female president, can, should and must do better. It has a unique opportunity in Asia as a free and - for the region - progressive society to lead the way in a whole host of social issues, from LGBT rights to historical preservation to women's rights. This is a stone-age law, not fit for a modern society and frankly, the Taiwanese government should be embarrassed and ashamed that it is still on the books at all.

At least this time there is something you can do - sign the petition! Get it in front of President Tsai. Help make this happen, so that one small thing in a whole host of issues Taiwan is still facing might be re-examined and hopefully changed.

A Day in the Tri-Service Hospital ER, and links

I've been sick and recently come around the bend after a week of getting sicker, so haven't had the energy or mental with-it-ness to devote to actual blogging. By "sick" I mean "I spent a day in the ER because I was puking up water, pooping my intestines out and still had a bronchial infection", not at home with the sniffles.

Which, hey, gotta say - once again I'd like to thank Taiwan National Health Insurance for being super awesome. You guys are great - I will never, ever return to the American system as it currently is, even under the ACA. I realize the government is worried that they won't have enough money to maintain the system - I say that a healthy populace requires an investment, and that the money comes back to you in other ways (a healthier populace is also a more productive populace, and one that needs to return less often for follow-up treatment or relapses), and that whatever it may cost, it can't possibly be more than the US currently wastes on those who need medical care and can't afford it (both in coverage of ER/hospital bills they can't pay, ER visits that could have been avoided with a trip to the doctor, which they also couldn't afford, and missed work due to illness you can't afford to treat, not to mention covering only the sick, old and veterans, meaning that you have no risk pool of generally healthy people to help offset the cost) in our "more efficient" (heh heh) mostly-privatized system. Taiwan is so much better, and is a true model for good socialized health insurance (although it is not perfect). Why so many people assume the problem-ridden European/Canadian/Australian systems - especially the British one - are the only way to do socialized coverage is beyond me. Take a look around the world, and see that a better world is possible.

Fortunately, even if we did leave Taiwan, we wouldn't have to return to the American system. Because...

TA-DAAA!

Guess who's Canadian now? That's right - my husband. Ah, Canada, where people are generally reasonable. If we ever left Taiwan for the West (and not another country farther away), I'd hit up Canada so fast that we'd be there before you could say "where's the Tim Horton's, ey?"

Otherwise, I haven't been doing much, having been sick and all. I've spent some time on Christmas gifts, because this year's crop is handmade - I'll post about that later. So on Taiwan, I have little to say as I haven't been truly engaged with the outside world for a few weeks, and have been feeling under the weather since Halloween.

Also, we got our invitation to our good friends' wedding:

My Taiwanese friends are all either single, not interested in marriage, can't marry right now (income/visa/long-distance issues), not ready for marriage or gay, it seems, so this is the first Taiwanese wedding we'll be attending, even after 6 years in Taiwan. You'd think wed've gone to one sooner, but no. I'm excited, and so happy for them!


So...a few links:

Woman denied abortion dies in Ireland - 唉！我歸懶趴火！！This just makes me so angry. Part of me wants to say "we need a national, no, a global dialogue about this", and part of me wants to say "if you're anti-choice, go eff yourself".

Also, another reminder that Ireland's got it wrong, as do the religious fundies in the USA (note: not all religious people are crazy fundies, let's not group them all together): one person's religion should not ever dictate the life and choices legally available to someone not of that religion. It should never, ever, not ever be the basis of a law, set of laws or a government - the only exception being if everyone in that country is a member of that religion (which is rarely true - maybe Saudi Arabia? But even they have foreign workers). This includes laws on abortion, contraception and gay marriage among others. It is not right and not ethical to create a law based on a religion and then expect people not of that religion to follow it, in a country where religious tolerance is supposed to be the norm. This is why I am so against the Catholic church arguing that they shouldn't have to provide contraception coverage to women employed and insured by them: their religion gives them no right - zero right whatsoever - to determine what is and is not a basic health benefit under a normal health plan. If I were a boss and my religion told me that cancer "didn't exist"or was a punishment by Satan and must be endured, or could be cured with rosewater or whatever, that wouldn't give me the right to only offer insurance that didn't cover cancer treatment. If I believed that people with allergies were liars, that wouldn't give me the right to only offer a plan that didn't cover allergy treatments. If they don't like it, they shouldn't be employers. Or better yet, let's take health care away from the purview of employers and make it available to all independent of their job.

What happens to women who are denied abortions? Well, some of them die (see above). Others fare...not so well. As a commenter on another site put it, they don't generally happily raise the baby and move to a nice suburb in Missouri where they become contented Republican voters.

Don't Google this. Just don't. Someone once told me that "women have been historically oppressed, but so have men. What women faced wasn't any worse than what society forced upon men". BULLSHIT.

Pink Science Kits From the 1950s

A much-needed primer on cultural appropriation - I don't agree with everything in this article. I really don't - some of it is dead-on and some of it is...well...not. I'll write more about it later.

Just for fun - The Hater's Guide To The Williams-Sonoma Catalog. One funny comment:

Everyone go to your nearest Williams-Sonoma store and grab every catalog (do they call it a catalogue?) they have. Carry at least one around at all times, so the next time any person starts talking about repealing Obamacare and how the government has no place telling rich people how to spend their money, just hand them one of these.

I disagree with this, but...haha. I totally want to be that asshole.

Have a happy, sunny day!

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

-------------------

= 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

---------------------

= 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.

Big Pharma

Cyanide & Happiness @ Explosm.net


Back in the USA I hated Big Pharma.

Now I work (in part) for them.

My reasons back home were due to, well, events like those discussed in this article - affording drugs is a problem around the world, and a two-pronged issue. On one side you've got areas so poor that even low-priced drugs cost too much, and on the other you've got the USA, where people generally have more money, yet drugs are so astronomically expensive that many still can't afford them despite their exponentially better overall standard of living.

From people I know in Big Pharma back home, I can say that the argument does ring true: drugs are sold in the USA at exorbitant prices, and at far lower prices elsewhere, because companies both want to recoup clinical testing costs and make a tidy profit (a little too tidy if you ask me), and feel that the USA is the market to milk, because we can apparently "afford it". Except we can't.

It also bothers me that they throw so much money behind lobbying the government in their own interests, which mostly counter the interests of the American people, but pretty much all industries do that.

Working at a lot of pharmaceutical companies in Taiwan, though, makes me dislike the whole industry a lot less. I wouldn't go so far as to say "like" or "trust", so I'll stick with "dislike less".

I think it has a lot to do with regulation. I know the health system in Taiwan is imperfect, but it's about ten kachillion times better than the travesty of a "system" in the USA. Don't even bother arguing with me on this, I have a mother who is facing cancer that is not going to go away, and the possibility of losing her company-backed health insurance and very few options after that, so seriously, do not even start. I will tear you to shreds.

Here, we have our imperfect-but-wonderful national health insurance, and a heavy hand in regulating drug prices. I don't agree with some of the laws: the idea that doctors are forced to give certain medications first and others can only be tried later, and that some can't be tried until certain symptoms or issues occur or criteria are met, ties doctors' hands unfairly: it takes away from them what should be their expert judgment regarding what would be best for the patient and puts it in the hands of people who can't necessarily make that call: either because they're bureaucrats, not doctors, or because even if they are doctors, they're not there with that individual patient assessing that patient's needs.

The price regulations, however, I support completely. A dearth of price regulation in the USA has brought unconscionable drug prices for things people need - seriously, it's not like you have a choice sometimes, so supply and demand doesn't apply - prices people can't afford and insurance companies don't want to pay. Regulations in Taiwan have kept most prices for the same drugs at reasonable levels.

You can argue this hurts the company, and many who work in pharmaceuticals in Taiwan would agree, but the fact is that those companies are still in Taiwan, still making a profit and still see being in the Taiwanese market as something worth doing. The price controls haven't scared them away. If it were truly unbearable, companies would pull their products and shutter their offices and Taiwan would be SOL. That hasn't happened.

Those same people in the industry, while they might tell you that the price controls are an issue, would generally not argue that there shouldn't be any regulation or any cost control. In my experience (and I have a lot of experience talking to people in many different firms), while they'd like more freedom, they'd agree that keeping drugs affordable is important, and that wouldn't be lip service: they mean it. They wouldn't say it the way a PR schlub for Big Pharma back home would rattle it off a press release and then look the other way as "reasonable prices" became "$1000+ for what should be a $30 compound".

Even if they would - business is business & all - the regulations are there, and it keeps things reasonable. Not perfect, but reasonable. People get their medicine, companies make a profit, and it becomes an industry that does not inspire so much hatred and animosity. Everybody wins.

So what is all this anti-regulation hullaballoo back home? Phooey.