Pear-shaped

Something about this sculpture from Thailand being just a few body parts feels apropos

Content note: this post contains some descriptions of a health issue and its treatment. If such things make you uneasy, you may not want to read ahead. 

“In Taiwan this would have been resolved by now,” I huffed. “Fixed in less than a day. Ouch…ew!”

Brendan mumbled in agreement but did not look; only parents of sick young children and trained medical professionals should have to witness the drama playing out on my right thumb. We were in Portland, Oregon, at the dining room table of our friend’s mother-in-law, and I was doing some very gross things with my miniature medical mis-en-place. 

During the Las Vegas segment of our Great West Coast Tour (to New Englanders like us, Vegas counts as “West Coast”) I developed what appeared to be a mild case of paronychia. An infection around the nail. By the day of my brother-in-law’s wedding it was clearly not resolving itself. I bandaged it for our trip to the Grand Canyon because it hurt to touch anything without warning. 

When we reached Portland, the side of my thumb had puffed from pink to a furious red. My basic travel medical kit didn’t have the means to deal with this; I needed antibiotics.

“I just really don’t want to deal with the American medical system,” I said, even though we had travel medical insurance. 

We flew to Portland to visit old college friends. Someone produced Epsom salts; I submerged my thumb as Brendan cut up a dinner salad, my friends and I complained about politics and we all kept an eye on the kids. 

When I lifted my thumb out of the hot Epsom mug, my thumb had puffed up to sci-fi proportions. My finger had quite literally gone pear-shaped. A little white bulb of pus had gathered under the skin next to the nail.

My friend’s recommended urgent care clinic didn’t seem to be covered by our travel insurance. I called the insurer for a recommendation and was given a code to use for another one; it didn’t work. The provider tried to help, but ultimately sent us back to the insurance company, who confirmed that it never actually works and we’d have to pay out of pocket and submit a claim. We weren’t looking at huge sums of money, but I didn’t really want to submit something after the fact when it might get rejected. We tried another in-network provider and set up an online appointment for the next day, but then once again found that they couldn’t actually locate our provider information. At that point I was desperate — I could barely type. 

The whole affair took an entire evening, just to find a provider and make an appointment.  

The online consultation was fairly straightforward: I clearly had a paronychia, and I needed antibiotics. The nurse practitioner prescribed some and recommended I either come in to have it lanced, or I do it myself at home. 

“What does it cost to come in?” I asked. 

“It starts at $99,” she said. On top of the hundred bucks I paid for the consultation. 

 

That’s how I found myself at a dining room table laying out alcohol wipes, cotton pads and needles on a bed of tissues. I sterilized a needle and gently lanced the white bit. It didn’t hurt, which was probably a bad sign. 

The pus came out in fat yellow drops, staining the cotton pads a freaky green color. The pharmacy wouldn’t open until 11am, giving me plenty of time to relieve as much pressure as possible on my poor pear-shaped thumb. The result felt weirdly hollow, like a drained blister, but deeper under the skin. 

With our friend’s husband working the next day, we couldn’t fit into her car with the two children’s car seats. So we took an Uber to CVS while she drove the kids to a nearby cafe with big couches, with plans to meet there once I’d procured the antibiotics. 

Total time spent: six days from when I would have seen a doctor in Taiwan to when I actually saw one in the US. As I write this, the infection has not completely cleared; I feel like I have a shrinking cystic zit under my thumb pad. 

Total money spent: $140 US dollars, including the online consultation, two Uber rides and antibiotics. That’s on top of an insurance premium for three weeks of coverage that cost four times what we pay in Taiwan each month for National Health Insurance, and their actually covering it is not yet assured. 

Here’s how it would have gone in Taiwan: the same day I realized the infection wasn’t resolving itself as expected, I would have likely seen a doctor within walking distance or a short ride away on public transportation. In a hurry, I might have taken taxis for a total of about US$10. I would have immediately been given antibiotics and the doctor likely would have done a better job lancing it than I had. 

There would have been no question of National Health Insurance covering it. That’s why it exists. The appointment and the antibiotics would have cost about US$5. 

In the US we were lucky to be staying with friends for most of our trip (which is, of course, how we could afford it). We thus had immediate access to basic medical supplies. However, there should have been no need to wait that long to decide medical attention was necessary — letting the infection get a little out of control — spend that much time finding a provider, spend that much money and then lance it myself. 

In Taiwan it would have been a non-issue.

The mundanity of all this is the point: I’m telling you this gross little story exactly because it’s so banal. My only personal experience with the American medical system in 18 years was, in fact, not terrible. I needed medical care and got it, and the cost was something I could afford. That’s frankly unusual, and I was extremely lucky. 

But here’s the thing — even a not-terrible, incredibly boring (yet pus-filled) outcome was still worse in the US than it would have been in Taiwan. It’s easy to point to medical horror stories in the US and compare them to the rest of the developed world: impossible bills, long emergency room waits, avoiding ambulances because you can’t afford them, drugs you break the bank to pay for, long appointment lead times. 

Comparing a fairly good US outcome to Taiwan and still seeing the US come up short? I think that says something. Even when the American medical system basically works, it can’t compete with a small island nation that only recently developed and democratized. You don’t need a horror story to prove this. What is so thoroughly wrong with the US that it can’t even treat a simple paronychia without undue expense and stress?

We were ultimately charged for the consultation, and now have to figure out whatever complicated procedure is required to submit a claim, which may or may not be rejected. 

This should not happen, and in Taiwan it would not happen.

The US delivered a thoroughly acceptable treatment for my messed-up hand, and it was still more expensive, time-consuming and complicated than the same thing would have been in Taiwan. Frankly, that looks really bad for the US. 

China's Drug War: Coming Soon to a Taiwanese Hospital Near You

                    

Hey look it's an accurate cover photo and you know it. 

If you're wondering where I've been these past few weeks, it's still the same old thing: moving all of my work online means I'm in front of a computer all day, and I just get tired of it. I want to read a paper book or look at something that's not a screen.

I've also been working on that longer project with Brendan comparing every general history book about Taiwan available in English. It took some time, but look for it to be coming out soon.

But, as usual, something got stuck in my head that won't get out. So here we are. 

About two weeks ago, the Taipei Times published this piece on China snapping up the Taiwan distribution rights to almost a third of all new pharmaceuticals. It was a good article, and important warning -- and seems to have been largely overlooked: 

In a report dated Monday, the Legislative Yuan’s Judiciary and Organic Laws and Statutes Bureau decried the arrangement as unreasonable.

“Requiring South Korea to purchase vaccines through a North Korean distributor or Israel to go through a Palestinian firm would be preposterous,” the report said.

Granting exclusive distribution rights in a nation to its political and military adversary is ethically problematic, it said.

Due to the antagonism and mutual distrust between the two nations, it is highly unlikely that they would complete a contract and instead use it as a tool for political manipulation, it added.

This would further hinder transactions and jeopardize the right to healthcare of the “represented country,” the report added.

I would switch Israel and Palestine in that analogy, personally, but the point holds. This is terrifying, and you should be terrified. It is not crisis-mongering. It's an actual crisis in the making. 

Imagine a future in Taiwan where about a third of new drugs on the market are difficult to get or simply not available because China holds the distribution rights, but it would be political suicide to buy from China (not to mention playing directly into CCP hands).

Now, expand that thought: not just you at the doctor's office unable to get the drugs you need. Imagine millions in that same position, and how angry they'd be. Imagine the political crisis that would create: we already saw it with the BNT vaccines. Visualize that, but with a huge percentage of all new drugs on the market. 

Consider as well the opportunities for malicious actors and disinformation purveyors, populists riling up the people who are rightfully mad because they can't get medicine, sharpening that public anger into a poison spear and throwing it at exactly the wrong target. Not China, whose fault this is, or even those in Taiwan who insist China can be dealt with reasonably and warmer relations are possible without undermining one's own position. Rather, the protests would be directed at those trying to protect Taiwan from Chinese interference and annexationism -- the people who best understand that Taiwan needs to stand up for itself. 

Think of the destabilization: a KMT that wins, and caves in to buying medicine through Chinese channels, whose own supporters voted them in so that they could do this, and a furious opposition. Or DPP in power, but furious KMT voters who blame the DPP, not China, for the existence of the problem. Imagine a DPP who cannot cave (it would be political suicide with their own base) but has trouble withstanding that kind of pressure. It's not hard to imagine, because that's already what they do! 

With a segment of the population -- albeit a shrinking one -- who still does not understand that it is impossible for Taiwan to deal with China without China trying to undermine the country, it would be...well, a crisis. It would be difficult to have a functioning democracy in a country who can't access a huge portion of the latest medicines.

Let me make it worse. Consider as well that there are always two players in these games. China's gonna China, that's how the CCP rolls. Subjugation-happy assholes to the last. But those pharmaceutical companies agreed to those terms. They didn't see anything wrong with selling the rights to the Taiwan market to Taiwan's biggest existential threat. 

Taiwan watchers have been talking a lot recently about the good press and stronger support Taiwan has been getting. I admit, I've been glad to see it too. But while we've been celebrating, entire vital sectors of the economy have been quietly turned against Taiwan by the CCP. And those international entities let it happen. 

You might not be mad about the airlines caving to China. Perhaps you're not mad about the major language proficiency tests doing it (still, fuck IELTS). Maybe you couldn't work up sufficient anger over exclusion from international organizations, "Chinese Taipei", the end of actual Taiwanese representation in the Taiwanese representative office in Hong Kong or the BNT fiasco. In a lot of cases, it's a name change, purely aesthetic, or it's one medication. Those international organizations are pretty useless sometimes, it seems.

But all of those slights, all of those insults, all of those successful attempts to undermine Taiwan: they were always leading up to bigger, bolder plans for forced subjugation. 

That's what this is. 

I hope you were mad before. If not, I hope you're furious now. 

This proves without a doubt that the Shanghai Fosun deal with BNT (Shanghai Fosun, as a large company in China, is ultimately beholden to the CCP) was not an unfortunate accident, an oversight, a one-off. It was a direct attempt to harm Taiwan, and BNT let it happen. They agreed to it. Everyone who said it wasn't a big deal, that the DPP were wrong for declining to consider working with Shanghai Fosun, that the distribution rights were above board and negotiated in good faith, not an attack on Taiwan...you were wrong. Your opinion was bad and you should feel bad. 

I've said it before and I'll say it again: the weird workaround of letting Terry Guo, TSMC and Tzu Chi buy the doses was not some odd accidental outcome. I have thoughts about TSMC's role that I won't share, and not much of an opinion on Tzu Chi (though I dislike religious organizations generally), but I stand firm on this: Terry Gou is a gamepiece. Perhaps he knows it to some degree, but I'm not sure if he realizes the extent to which is is a CCP pawn.

It also proves that the only way to deal with China is to refuse to play. If Taiwan bends over and accepts drugs through Chinese distribution channels -- as the torch-and-pitchfork types are likely to scream that the country should do -- then it'll be more drugs next time. Then something else. And another thing. And soon the CCP plan to get its claws inextricably into Taiwan will actually have worked. 

There is no way to talk to China, no way to negotiate, no way to warm up relations. They will always try this. They will never come honestly to the table. They will always try to undermine you. It's like trying to have an honest relationship with a narcissist, abuser or compulsive liar. It's not possible. If you take this punch, if you let that comment slide, if you try to placate them, they only escalate. It never works. 

The only way to win is not to play. 

Finally, this proves that a basic understanding of Taiwan among the general international community actually does matter. I've heard people say that only policymakers matter, only politicians, only officials. There's no point in trying to reach a wider audience of people who are not in a position to effect change, because, well, they can't do anything. 

That attitude is wrong. 

You know who's sitting in that "general audience" section? Businesspeople. Talent that Taiwan might recruit. Several million people who might intentionally choose a Taiwan-made product over a Chinese one. Writers and newscasters who don't focus on Taiwan normally but at the Olympics, might take a stand and just call Taiwan by its name, rather than Chinese Taipei. Creators who might re-think what peddling their products in China will ultimately cost them, and ask if it's worth the market access. 

And, of course, another important segment of that audience: pharmaceutical executives. 

Not the people who are considered particularly important in Taiwan discourse. And yet, looking at those numbers, I sure do wish more international pharma execs were more knowledgeable about Taiwan. I wish we'd tried harder to reach people like that: not just in the drug industry, but all industries. Because today it's medicine, tomorrow it'll be something else. It always is.

Perhaps it wouldn't make a difference. Perhaps they'd have signed away Taiwan's distribution rights to its biggest enemy regardless. Perhaps there is nothing one can do to make them care. 

But perhaps not. Perhaps actually knowing what one is doing might cause one to choose a different option.

You honestly never know.

This is a great reason to sign my petition for Last Week Tonight to do a show about Taiwan, by the way. The whole point is to reach a general audience. Now available in Mandarin!

Bits and Bobs - River Tracing Accidents and Post-Typhoon Orchid Island

Sorry I've barely updated, but we've been busy.

A good friend from Australia is visiting, so there's that. Then, Brendan had to be carried out of the mountains by Jiaoxi on a stretcher - we went river tracing back at Yuemeikeng , but the bit of trail we needed was washed out. We tried an "alternate route" that quickly turned to bushwhacking, and just before we all agreed to turn back (I was the most reticent, I admit), the ground beneath Brendan gave out and he went plummeting back down toward the river, freefalling the last ten meters or so. Fortunately, he fell into a pool of very deep water, which meant he was (mostly) unhurt. He had to get stitches and a CAT scan, but remarkably, had no broken bones. He's still having trouble walking and moving his left leg, but he's on the mend.

More on that later - I am mentally composing a post that outlines what mountain rescue is like in Taiwan if you need it, along with a comparison of what the whole ordeal cost us in Taiwan (less than $100 US including overnight in a hotel in Yilan) vs. what it would have cost with and without insurance in the USA (hint: more than that). Just, you know, in case you still don't think nationalized health coverage is a good thing.

And now we're on Orchid Island - Brendan was healthy enough to make the trip, but he won't be doing any snorkeling or hiking. We almost cancelled after hearing about the typhoon damage, but the Lanyu police station and our reserved homestay both assured us it was fine, so we came anyway. We're happy we did - there's some damage, a few landslides (the road is clear), and the coral took a hit, but it's mostly fine. It's not the desperate wasteland that news reports would have you believe.

More on that later, too. I'm not going to spend a perfectly lovely day on Orchid Island blogging. I love you guys (well, most of you), but no.

So, there are two posts to look forward to, but you'll have to wait until Sunday at the absolute earliest for either of them.

Loose Leaf Tea

Before I begin, I just want to point out that I was all over the airwaves last night. If you were watching TVBS (argh - I hope you weren't) or another channel, both interviewed me in Chinese about watching the firewalking ceremony at Bao'an Temple yesterday. So that rain-dampened white girl you saw on TV who really needs to work on her tones and punctuates strong opinions with "diu啊！" (not "對啊") - that was me.

As you know if you read one of my previous posts, I had my wisdom tooth removed last week. It was my first one and quite a shock. At some point I mentioned this to a friend, who said "stick some dampened bags of green tea in the fridge and then press them against the sensitive area - it helps". This surprised me, so I did some Google-fu and found out that it was, in fact, true - the tannins in tea reduce blood flow and help stem bleeding and so biting on a moist tea bag does actually have an effect.

Taiwan is famous around the world for its teas, especially its oolongs, and people (locals and expats alike) flock to teahouses regularly to drink it or make it at home: I don't know about you, but we have a full 功夫 tea set - albeit with purposely mismatching cups - at home and a little portable stove to prepare it on. So you'd I'd be able to just run to the kitchen and grab a teabag, no?

Well, no. We do have teabags - some herbal teas, South African Rooibos, some Taj Mahal Indian black tea for chai - but nothing that would make a suitable tannic acid filled bag of tea to press against sensitive, bloody gums. I did eventually use the black tea, but the taste of Taj Mahal is so strong and difficult to swallow when not brewed in a cup that I couldn't take it for long. A nice, light green or oolong would have been better.

That said, I don't know anyone who drinks oolong or green tea from teabags in Taiwan, unless they're at work and it's those Ten Ren teas that every office provides in the break room (I go to different offices for work, so I've seen a lot of breakrooms and drunk a lot of second-rate office coffee and Ten Ren tea).

Instead, we all drink looseleaf tea, because duh, it's better. It just is. I know technically tea in a teabag doesn't have to be inferior to loose leaf tea, but it seems like that's always the case: the fact that it's in a bag makes manufacturers feel as though they can add extra junk to it or simply use lower quality tea, and nobody will notice. I think Lipton's entire product line is based on that principle - "second rate tea for people who don't care". The Taiwanese I know, if they're not in the office and if they're going to drink tea at all, will either do it in 功夫/老人茶 (my namesake!) style, or will brew it in a big pot with a filter and drink it in a cup. The thing that never changes: it's always loose leaf tea. Always.

That right there is a cultural shift I'd never considered until the moment when my friend said, offhand, "just use a wet green tea bag" as though of course I would have green tea bags lying around the house, because I love tea and live in a country famed for its tea - and it neither occurred to her that I wouldn't drink good tea in a bag, nor to me that people actually do keep tea bags on hand, and that some in fact consider them indispensable to a proper cuppa. To me, a proper cuppa is brewed in a little pot and poured piecemeal into miniature cups, or brewed in a big filter and poured in a mug. It is definitely not dunked in a little paper receptacle straight into a cup.

"But loose leaf tea is so complicated!" folks back home say.

"No, you just...put some in the pot, then add water and quickly wash it out, then add more water and let it steep but not for too long, then pour it through this filter into a little pitcher and then pour it into these glasses, and you can use these tools to do it. See, easy!"

"Umm, that's not easy!"
"Sure it is!"

"No it isn't - first, how do you use those tools? Then, you always have to steep, pour and drink quickly enough so that the tea isn't too strong and doesn't get cold, and all you get is barely a mouthful at a time..."

"...do you need more than a mouthful at a time?"
"Maybe I do, yes, and then what do you do with the leaves?"
"Put them in a bowl until you're done and ready to throw the whole lot out."
"Why not just boil or even microwave some water and just add a tea bag?"
"Because it's not the saaaaaame."

"Sure it is."

But no, it's really not. The quality just isn't there. Forgetting all the meditation /peace/beauty/solemnity/whatever of the Old Man's Tea ceremony (though I won't deny that it's beautiful), it just feels nicer. It's not as hurried, it's more sociable and it's still very much a way of life in Taiwan. When we spent a few nights in Donggang to catch the beginning of the King Boat Festival, the owners of the hotel invited us to drink tea with them at their big old tree stump table. When we stay in Lishan, the owner of the homestay we like has his own tree stump table and makes lao ren cha for his buddies, while guests make tea and cavort outside. When we stayed with Sasha's family in Dashe, her father made lao ren cha on the coffee table two nights in a row.

I feel like, when doing this, that what I'm getting for all my time and effort is quality - good tea from small manufacturers (I'm a big fan of Wang's, and 來自台灣ㄟ好茶, a company that makes Lishan and other high mountain teas has some nice selections, and you can buy Pinglin tea here if you don't feel like going to Pinglin) that pride themselves on freshness and location.

What I'm trying to say, I guess, is that drinking looseleaf tea is so much more than just drinking tea - it's a connection to an entirely different way of doing things. It's a connection to products of a proud local origin and not just a brand name on a flimsy box. Do you know the name of the town in which Red Rose or Lipton is grown? Could you find the farmer if you wanted to? Probably not, but in Taiwan you can locate the town in which the tea was grown and often it's possible to find the farm itself. It's easier than you'd think to buy tea right from the farmer who grew it (you can do this in Pinglin if you are judicious about your tea purchases). You're getting connections to all sorts of things - not just flavor, but there is that, too - by drinking looseleaf tea that you'll never get by chucking a paper packet in a microwaved cup.

Thrills! Chills! Taiwanese dentistry!

So, right on the heels of this post (yeah, I know, I'm linking it but it's right below, whatevs) I started to feel a vague ache in my jaw. I figured, as usual, it was a wisdom tooth coming in and so it'd hurt a bit for a few days and then go away, just like with the other ones, which came in normally.

By the end of Brendan's birthday party it was a bit more serious, but I'd had three cocktails and could still eat, though it was hard to open my mouth fully, so I figured I'd sleep on it (not that I had much choice; by that time there were no realistic medical options beyond an emergency room run for prescription pain medication). Deep down I knew that this was more serious, but didn't really want to admit it. I'm the author of this old Lonely Planet classic from 2003 and as a result of that experience I'm a bit wary of dentistry generally, at least when it involves more than a filling.

This morning it was worse, and by 2pm I was seeking out a dentist, with a growing fear in my heart that this would not end well. And it didn't: I did have an impacted tooth, I did need it removed, and the pain wouldn't go away until it was removed. So I had it taken out. Once again, I didn't have much choice: it was so bad I could barely eat, and if I wanted the full general anesthetic I'd have to make an appointment and go to the hospital, which would have to wait until Monday at the earliest.

This brought me in touch with yet another aspect of Taiwan's health care, so I figured I'd write about it here.

The bad parts were (mostly) not the fault of the Taiwanese system or the dentist:

- I had it done with just Novocaine (or whatever they use now), not general anesthesia. Apparently that's normal for fully erupted wisdom teeth. I'd assumed that one got put under because, hey, it's a pretty medieval procedure when you think about it. It's basically the same thing as Ye Olde Tooth-Puller, except more sterile and with local anesthetic instead of local moonshine. This surprises me - if I ever have to get this done again, goshdarnit, I'm going under! Waking up from general anesthesia is not as horrible as being fully conscious when they do...that...that...twisting forcep thing to you.

- My tooth was more firmly embedded than most, so it took longer and was more painful than it normally would be.

- The ginormous forceps. The pressure. The blood. That crunching sound as they widened the socket and maneuvered the tooth out - I admit that I started sobbing. I'm not even embarrassed about that. It was thoroughly horrifying. (I have kind of a fear of crunching bone and have never had to face it, as I've never had a broken bone, so there's that too). Why don't people go under for this?

- I had to do it all in Chinese. My regular English-speaking dentist closes at noon on Saturdays so I went to the first dentist I could find, and he didn't really speak English. Considering the circumstances I think I did pretty well. With a wad of bloody gauze in my mouth, I managed to say "給我你們最強的藥。鴉片，大媽 － 都可以！"

- The horror of the procedure was kind of low-balled, in my opinion. I was told "It's OK to get it without general anesthesia. It's a little uncomfortable but I promise it doesn't hurt". Yeah, uh, it's true that it's not "painful" but they clearly have a different threshhold of what constitutes acceptable discomfort! I thought "OK, maybe that means the tooth just comes out" but no, it means "we get to squish your skull and move the tooth around in the socket, which causes bone trauma, before extracting it with the biggest forceps you've ever seen, and you'll feel it in your EYEBALLS".

- I do feel that partly because of the language barrier, I wasn't given enough prep on what to do afterwards. For example, they didn't tell me not to drink from a straw, so I started out doing that (then found out I wasn't supposed to, and stopped). They told me not to spit, but they didn't tell me how to properly brush my teeth and rinse. They didn't tell me about the importance of not dislodging the blood clot. They didn't tell me to avoid solid foods for two days (although I kind of assumed that). They did say "only eat food you feel you can comfortably eat. If you feel wary, don't eat it", but that's it.

- The painkillers they gave me? Yeah, so not strong enough. I've been supplementing with Panadol.

...but there were some good parts, too - somewhat attributable to the Taiwanese healthcare system.

- The entire thing cost three US dollars. Yes, $3. US. No missing zeroes. Fo' shizzle, to steal an outdated '90s slang term. A friend of mine broke her ankle in January and it's not healing, and has to have surgery. She is currently waiting for insurance approval to have the procedure and is living a very limited existence while that approval goes through. She'll still be in the bag for several hundred, if not thousand, after it's approved (which it had better be). I walk into the dentist, no appointment, pay THREE DOLLARS, and get a wisdom tooth out. It really throws the two systems into stark relief, when you put it that way, and it's clear which system comes out on top.

- General anesthesia is a covered option: I'd have to go and stay in a hospital and it would be delayed and take longer generally, as well as cost me a bit more, but it is a possibility. I'm hoping there's no next time, but if there is, I'll take this option. No way will I be conscious if those terrifying tongs of terror come near me ever again. Not every American insurance plan offers that for an erupted tooth.

- I was able to make a follow-up appointment for Monday. Not all American dentists do that - if you think you're healing fine they don't worry about checking on you a few days later. You only go back if there's a problem. In Taiwan, I'll go back on Monday, pay another $3 and get checked to make sure it's healing smoothly, which is a good way to help prevent possible dry socket, something I'm at elevated risk for.

- No appointment necessary! Try THAT in the USA without a severe emergency (mine was an emergency in that I couldn't eat, but not so severe that an American dentist wouldn't have minded if I'd shown up without calling first).

- My sweet and wonderful husband, who came immediately out to the dentist's when I texted him with the news, was there when I started sobbing (which I did - that crunching bone sound really freaks me out and I think I'm going to have nightmares about those massive glinting forceps), went out to buy me more gauze, soft food and Panadol, made me a smoothie and has generally taken great care of me.

- Millions of people suffer from far worse pain than this and have chronic conditions, or can't afford treatment (ahem USA....ahem), or have no access to treatment (much of the Third World). I have led a relatively pain-free life with the one exception of my severe slipped disc, and really, I'm quite lucky. So please don't take this post as pure complaining.

Anyway, my advice: no matter whether the tooth has erupted or not, go ahead and get general anesthesia. This is one heck of a traumatic procedure when you're conscious.

Let's Talk About Abortion in Taiwan

I intended to include this in a longer post about National Health Insurance, but that was far too big a topic to bite off in one post and I'll instead cover it in several, with a focus on women's health, but discussing the system as a whole (summary: it's a great system, certainly better than the "system" - heh - in the USA, but still needs some work and has flaws that ought to be addressed. That said, it's one of the best in the world).

I'm covering abortion first because I have more concrete information - I'm still looking into other aspects of women's health including contraception, health treatments and preventative medicine.

Anyway, abortion in Taiwan. No, not for me! I'm writing about this because it's a women's issue in Taiwan and it deserves some more recent coverage - most of the discussions and articles I found on the issue were severely dated and, honestly, didn't delve into the topic in nearly enough depth - the exception being a paper I found by David Sho-Chao Hung - a law student who may well have graduated by now - that discusses abortion law in Taiwan compared to the USA. The paper is not dated, however. Only Hung's paper discusses the moral, cultural and feminist issues surrounding the abortion issue, as well.

It is amazing how much misinformation there is among the general public in Taiwan. As I've mentioned before, my work brings me into the offices of many pharmaceutical companies, some government offices and other people whose positions could lend a general assumption that they are familiar with how abortion law works in Taiwan.

Sadly, that is not true. I've never been so shocked by public misconception of abortion in Taiwan since I started asking people about it.

The general idea seems to be that in Taiwan, abortion is "illegal", except in cases of medical danger to the mother or the child, but that it is quite common for women with healthy pregnancies to get abortions at "illegal" clinics or through legal clinics willing to engage in ethically gray practices - or through pills purchased illegally at dispensaries. One person I know described it as an "abortion wave" at the end of every summer, where young women go to clinics for abortions despite them being technically "illegal" (as I'll show later, they're not actually "illegal", just very highly regulated with a lot of workaround room, though not nearly enough), to doctors found through a social network or by distraught parents, often paid for by parents who want to make the problem go away.

A problem that could be greatly ameliorated if there was better sex ed in Taiwan in the first place. The solution to the "abortion wave" at the end of every summer is not to make abortions easier to get (even though I do support the freedom of choice) but to educate tweens and teens about safe sexual practices...I'd like to see the abortion rate go down to zero, but not at the expense of women's rights - but I digress.

This shocking misconception can be somewhat explained by different interpretations of the law, although that doesn't entirely excuse it.

The law in Taiwan is, in summary, that abortions are legal for:

1.) medical reasons - danger to the mother or fetus including deformities and defects - this includes psychological trauma to the mother

2.) rape or incest (which must, apparently, be "proven")

3.) "seduction" - meant to cover statutory rape but can technically be used as a reason by a woman of any age

4.) mental/psychological issues of the parent(s) that could be passed on to the child

...but are not a guaranteed right for all women, are not constitutionally protected, and are meant to be performed only in the extreme cases above.

That's where the misinterpretation may come in: women seeking abortions quickly learn that they are available - if you're single, it's fairly easy to claim "seduction" (it was meant to cover statutory rape but there is nothing stopping a grown woman from claiming it) or "psychological stress" due to inability to properly care for or raise the baby, or even claim an onset of depression (which is very morally gray).

It's harder for married women, even though there might be ways to slither around the provision.

I could see how someone who is not seeking an abortion and will never (or may never) seek an abortion (such as a man, or woman beyond childbearing age or a woman who would carry an unexpected pregnancy to term rather than terminate it) might interpret the above is "it's illegal unless it's a medical issue or rape/incest issue" - it wouldn't necessarily occur to them to claim "psychological stress" or "seduction" because they're not in that position, and so their view is more literal. I could see how making such claims could be interpreted as "illegal" under the spirit, though not the letter, of the law (I'd argue that the spirit of the law is sexist and wrong, so it's OK).

I'd go so far as to say that there is nothing wrong with claiming "psychological stress": I do trust that any woman making the drastic decision to have an abortion is a mature person - even if she may have been forced to become mature very quickly - who has agonized and considered every aspect of this decision before making her final choice. Abortion is serious business, and I do believe that any woman considering it knows this. Therefore, if she decides in the end to terminate her pregnancy, then she would know better than anyone that carrying it to term would cause her undue psychological stress.

Single women can get an abortion for any of the above reasons, mentally handicapped women need the consent of a guardian, an underage girl needs the consent of her parents and - most disturbingly - a married woman needs (or needed) the consent of her husband.

I say "needs or needed" because it's unclear: Mr. Hung's paper and other discussions online have mentioned that a married woman needs to obtain her husband's consent, and yet this Taipei Times article from 2006 mentions specifically that a husband's consent is not required (though he must be informed).

And yet in this 2009 article, it states that spousal consent is, in fact, required and that the age after which a young woman doesn't need parental consent is 20 (20!! Really! So we're all adults at 18, except for women, who are still children at 20).

That's almost - but not quite - worse. It's not even clear from a few hours' worth of Internet research whether or not a married woman can seek an abortion independently. How could that NOT be readily available information? What kind of oversight is that?

The information - at least in English - doesn't appear to be available, and yet it is something that every woman in Taiwan has a right to know.

If it is true, then argh. I don't know how it could get more sexist, patriarchal and paternalistic than that. You are free to disagree with me, and I respect that people have different views, but that's my opinion. It's of paramount importance to protect the autonomy and rights of a woman over her own body.

The possibility that - as mentioned in the Forumosa discussion linked above and below - any man could show up and sign a consent paper and nobody will check to see if it's truly the husband/assumed father doesn't really make it better. It does provide married women in abusive marriages with an option. By the way, I count any marriage in which the woman's autonomy is compromised and controlled by a "head of the household" as abusive. That doesn't include women who enter freely and purposely into marriages in which their husband takes charge, because presumably if she had a problem later on and the marriage were healthy, she would still have autonomy to deal with it. That said, the fact that the signature of a man - potentially any random man (I have no idea if the Forumosa discussion is based in truth or not) - is more important than the decision of the pregnant woman is unconscionable. I...I just....I 受不了！NO! NOT OK. How is that NOT sexist?

There are so many reasons for my views on this (I'm tempted to say it's not even my views, it's just true whether you like it or not) which are very well-addressed in Mr. Hung's paper - if I were to elaborate, I'd be basically parroting his excellent reasoning.

If it is not true, then the government has done a shockingly poor job of disseminating valuable information on women's rights. Also NOT ACCEPTABLE.

Don't even get me started on the fact that you have to "prove" rape or incest (pregnancy by anyone with whom marriage would be deemed illegal - which basically means incest) in order to get an abortion on those grounds. How traumatic! How heartless! How completely soulless and sick! Forcing a woman to produce evidence (what evidence, exactly, is what I'd like to know) of such a thing is like taking the trauma sticking in her heart like a poisonous arrow and plunging it deeper. It completely de-humanizes the woman and displays an unacceptable lack of empathy for women in such a situation. It makes my blood boil and my hands shake.

Taiwanese society has changed a lot since the law was enacted in 1985. There is still a lot of sexism and there are still patriarchal attitudes in the culture, but things have evened out considerably, to the point where I'd say that Taiwan is the most female and feminism friendly country in Asia. It's the most egalitarian regarding gender issues and is ages ahead of Korea, Japan, China or really any other country in Asia. A lot of the attitudes about husbands making decisions that impact their wives in such a cutting manner have been eradicated, and women are generally accorded respect, rights and a general assumption that they can make their own decisions and run a household as well as a man (at least in urban areas - the countryside is surely different). This is a generalization, of course, and there are certainly still lawmakers and citizens of urban Taiwan who still cling to outdated beliefs about a woman's place, but I'm conjuring the generalization because it is generally true.

There is, as a result, no reason for this law to continue in the manner in which it has. Attitudes are changing and the societal notions that helped frame the legalization of abortion in 1985 are no longer quite so valid. The law, therefore, needs to change alongside these cultural sea changes.

And yet, problems continue - as late as 2006, lawmakers wanted to add waiting periods and mandatory counseling to the abortion law for any woman seeking an abortion (I found a lot of news regarding the proposal and none regarding whether or not it was passed - if someone has info on that please let me know but I can hopefully assume that the proposal did not pass).

Give women in Taiwan true freedom of choice - allow them to seek an abortion without having to put up a weak claim to a medical reason, and clarify, publicly, whether married women require spousal consent. If they do, change the law - give them the ability to choose for themselves.

I do realize that abortion is not the hot topic of debate in Taiwan that it is in the USA. The deep conservative/liberal divide we have back home doesn't exist as such here. That said, it surprises me, as well, that more women's groups haven't been taking up this issue - the public misconceptions, the lack of accurate information and the ridiculous strictness of the law are all begging to be fought tooth-and-nail by feminists and women's rights advocates in this country.

Oh yes, and abortions are not covered under National Health Insurance, as far as I could find (again, the information is not clear

Here are some links for you, organized into one place from the spatter of linkings above:

PubMed

An excellent paper by David Sho-Chao Hung

Short discussion on the issue on Forumosa

Women's rights report on women in Taiwan

Women's rights activists fight abortion proposal

Decision over abortion should belong to women

I want to finish by saying that yes, I am pro-choice, and I have many reasons for that, which I don't feel I need to justify as that's not the point. I do respect that other people have other views and am not trying to force my opinion on them - someone who is pro-life is just as able to fight for his/her beliefs as I am for mine. As someone who believes that there are more gray areas in the moral and ethical realm than black-and-whites (though there are some of those, too), I do realize that my opinion is not the only one. I welcome your comments and civil debate.

Note: More thoughts in the comments section.

English speaking OB/GYN in Taipei

Edit 05/2019:

Zhongxiao Xingfu - my previous recommendation - has permanently closed, but I've been referred to Dr. Hsieh at this address:

3F #311 Zhongxiao East Road Section 4
台北市忠孝東路四段311號3樓
(02) 2772-8300

Dr. Hsieh is efficient and no-nonsense, speaks good English and I felt like I could trust her. I've only visited her once but that's enough for me to recommend her here. 
The clinic is small but clean, and is near MRT Sun Yat-sen Memorial Hall. I was able to see her quickly, barely having to wait even though it was around 5pm (which is often a busy time). She was able to pull up my old file from Zhongxiao Xingfu and helped me exactly as I needed without my having to explain too much, including giving me choices and a recommendations.

I appreciated especially that when I said I didn't have kids, she did not ask me "why not?" (I'd been asked that before, before Dr. Wang) or assume I was planning to have them. She just took that information with no comment, which is perfect.