Some of my latest work for Ketagalan Media

As y'all know, I like to update here on what I'm writing elsewhere. Well - I have two pieces out - now a few weeks old - in Ketagalan Media and one in the latest issue of Taipei Magazine. I especially enjoyed writing the Taipei Magazine one, an interview with Taipei-based illustrator and activist Ai ee mi, the sort of work I enjoy but don't get to do very often.  

I was going to wait until the Taipei Magazine one was available online through Taiwan Scene, but that seems to be taking awhile, so I'll just put this out there now.

First, I expanded on my earlier post about Taiwan being the most successful Asian Tiger, adding a few new sections, updating a little data, and streamlining the whole thing. You can read it here. It's chock full of numbers that I think make a convincing case.

Then, I took a look at the proposed abortion ban referendum by a Christian group, and pointed out that our strategies in dealing with the ant-equality referendums were not successful, so we need to counter this new proposal with new tactics updated now that we know how the conservatives operate, and we need to do it soon.

Enjoy! 

No, China is not more gender-equal than Taiwan

I don't have a relevant cover photo so enjoy this picture of an antique shop in Taipei

People often ask me why I've chosen to settle in Taiwan, or why I've stayed here so long but only spent a year in China.

I point out that while I have always found people in China to mostly be friendly and hospitable, the food ridiculously good and culturally and historically it's fascinating, there are a few things I just can't stomach which make it difficult for me to live there. One is political freedom (including practical matters like easily getting online to access the open Internet, or just being able to speak your mind publicly without fear). Another is the pollution. Still another, I say, is sexism.

"Wait, China is more sexist than Taiwan?" is a common reply. "But everyone knows women in Shanghai have more power than men!" But "Mao said that 'women hold up half the sky'"? But "there are more women in STEM fields in China than Taiwan!" And once, memorably - "but it's much easier to get reproductive health care in China!" (In Taiwan both birth control and abortions are available but one isn't covered by national health insurance and the other is somewhat restricted). 

Without denying that these claims are true - except possibly that stereotype about Shanghai - I still say that China is absolutely less gender-equal or even friendly to women than Taiwan. Why?

Let's start here: a few hard numbers.

Taiwan tops Asia in gender equality (meaning it's ranked higher than China), as a higher literacy rate (98% with a 2% gap between men and women as opposed to China's 96.3% with a larger gender gap, if that number can be trusted). The wage gap in China is (likely) around 22%, whereas it's around 14.5% in Taiwan. So just by the numbers China is simply not more gender-equal than Taiwan. 

* * *

Yet the arguments persist, so let's take a look at them, starting with the oft-repeated "but Mao said women hold up half the sky!' and 'whatever male comrades can do, women can too!"

He did say those things, though it takes a lot of soft-focus wishful thinking to think that those goals were fully realized, or that they have brought about a contemporary China that is "more" gender-equal than Taiwan.

And it's true that women's participation in the workforce skyrocketed under Mao, with more women doing traditionally masculine jobs. And as universal primary education (which included girls) was a goal of the CCP under Mao, and that goal was eventually met, we can surmise that literacy rates improved as well (on a tight schedule I can't find anything specific about this but it seems to be a safe assumption - and as far as I can tell there isn't any clear gender equality data from that era). However, even then there was great variation in literacy rates. As late as the 1980s, rural and older women sometimes had literacy rates below 3%. And the Marriage Law of 1950 did seek to end concubinage, promote freely-chosen (read: love) marriage and allow divorce (but don't think that's the end of that story).

Beyond that, what you get when you try to defend this position is propaganda-tinged, oversimplified and not wholly justifiable. It is not an obvious conclusion that Mao's reforms would necessarily include gender equality, as Marxism and Leninism are all about eradicating class differences and don't necessarily say anything about the patriarchy as male domination (in fact, the number of self-styled Communist men I've met who are sexist as hell and don't even realize it is...less surprising than you'd think.) In any case, one of the greatest obstacles to setting up Mao's ultimately disastrous 'ideal' was the resistance to ending traditional gender roles.

It's even been argued - and I'd agree - that discourses that have been touted as 'ensuring gender equality' in Communist China were actually used to silence discussions of gender, depoliticize gender as an issue, and make it difficult or impossible to debate or acknowledge gender inequality or advocate for improvements. Rather than make male and female equal, the point was to erase the female. In any case, it's hard to say that the CCP ever really stood behind gender equality when, through its entire rule in China, women have never been at the helm of power. That's not the case in Taiwan.

In fact, by 1953, here's where Mao's China was in relation to gender equality:

...the government realized that the economy could no longer absorb the amount of labor power that it had mobilized. Besides, the implementation of the new
Marriage Law, unlike the Land Law, brought about strong and widespread opposition from male members of the society. Murder and suicide of women who sought to
terminate their marriage reached such a high level that the government decided that collective stability rather than individual freedom, particularly freedom of women, was
now to be given priority. 

For the next several years, there were more stiff regulations about divorce, and the government advocated women’s domestic duties and the importance of harmonious family life. Campaigns were launched to encourage women to be socialist housewives and model mothers, emphasizing the domestic responsibilities of
women. 

The situation did improve from there, with women brought back into the workforce soon after (though mostly to do work more typically associated with women - think caregiving work, kindergarten teaching etc.) This persisted - discussed in the link above - through the Cultural Revolution. Overall gains can be seen but they were "mixed" and "inconsistent". (From there this source starts to sound like it's trying to prove that Mao-style Communism was better for women than...not that, and that's where I get off that train.)

In any case, looking at the legacy of Mao-era China, it doesn't seem like it's done modern China much good. Female leaders? Nah. Wage equality? As a link in the next part shows....nah. As late as the 1990s, it hadn't put women on truly equal footing in education or employment. Workplace equality remains a massive issue. As of today, women in China are sometimes - perhaps often - treated more like sex objects or a dating market in Chinese workplaces. Education equality? Mostly yes, until you hit the PhD level, which is another way of saying "not entirely". The article gets it just right: being educated (up through Master's level) is a plus in East Asia, and desireable in 'wives' in more affluent circles. Getting a PhD, however? Well then you're just a terrifying, genderless freak who scares men away and clearly doesn't prioritize family and children. (This can be a problem in other countries too - it's not unique to China).

I'm sorry, but I just find the notion that because Mao said a thing one time, that this thing was true of China in his time, or is true of China now.




* * *

Although it's arguably the least meaningful of the arguments listed above, I want to talk about the whole "Superwomen of Shanghai" stereotype next. Even if it were true, one exceptional city doesn't make up for an entire nation of patriarchy. And I have serious doubts that it's true. The marriage market (a literal, physical market) in Shanghai is famous, and filled parents and grandparents trawling for spouses for their offspring. I could accept that as a 'cultural thing', but it's clear that the offspring in question aren't entirely pleased about it: 

"Does your daughter know you're here?" I ask. 

"Yes. But she hates it. She tells me to go on the dates myself. Kids these days hate parental involvement in these matters," Tsai says.

And there's no denying that these marriages are not actually based on people the younger generation might actually want to marry, but something more oriented to the family and their reputation:

Marriage already is such an important part of a Chinese family's reputation but parents these days only have one chance to get their future planned out right.

That too, I could accept if it were a way of doing things that every generation - including the one being married off - had signed on for. But it clearly isn't. While most Chinese women probably do just want to find love and have a family like most people around the world - it's a very human desire - but it seems clear to me that these sorts of tactics (among others) aren't 'traditional' so much as 'last resort' aimed more at fulfilling specific life goals (such as wanting a family) and societal expectations, as well as making older relatives happy than at actually finding love. In any case, I'm not convinced marriage is a good deal for women in most parts of the world, and China is no exception.

(If you're wondering how I can say that as a happily married woman, it's because I happened to get ridiculously lucky. My expectations of a feminist, egalitarian marriage are stratospherically high and the chances of finding a man who'd be on board with them, whom I otherwise loved and loved me back, were actually quite slim.)

So it's hard for me to agree that Shanghai is some beacon of women's equality when one of the most unfeminist events in the world takes place there. Besides, while I've heard that line a lot, it's always been anecdotal and from an 'orientalist' perspective (as this is), not proof of a real trend.  I haven't seen any data to back it up, nor is it clear that any exists. If anything, I've seen the opposite - the gender wage gap may be narrower in Shanghai, but it still exists. There seems to be a lot of talk about how "Shanghai husbands do housework" but no research into whether or not this is actually true.

What there is a lot of, however, is propaganda without any real proof: 

Because come on, it's not like we can trust Global Times, Shanghai Daily or China Daily (I wouldn't trust The Star, which is Malaysian, either.)

It sounds to me like perhaps Shanghai's relatively urban and international culture as compared to the rest of China has maybe (maybe) resulted in a slightly better social contract for women, and that was turned into this whole thing where "in Shanghai, women have it better than men!" because apparently giving women something just a little bit better than utter garbage is equivalent to giving them the sun, moon and stars more making them "superior". And it surely doesn't mean the rest of China is doing particularly well:

The current situation of gender equality can be read with certain global indicators. China’s Gender Development Index is situated in Group 2 out of five groups of countries, and estimates its Gender Gap at 0.945 on a scale of 0 to 1, 0 being the most unequal and 1 the most equal. The female Human Development Index is at 0.718 and the male’s HDI is at 0.753 (United Nations Development Programme, Human Development Reports Table 4: Gender Development Index). Life expectancy and years of schooling roughly reflect the same reasonable difference between Chinese men and women. However, the discrepancy in the estimated gross national income per capita is of no less than 5,125$ (10,705$ for women vs 15,830$ for men). 

This observation hints at the fact that gender equality might have improved in certain areas, while stagnating or perhaps even declining in others, as a result of Post-Mao economic and social reforms.

* * *

"But...there are more female engineers in China than Taiwan!" or "China has a huge number of women in STEM!"

Does it, though?

While I won't defend the male-dominated nature of STEM fields in Taiwan (or most of the world), I can't find any data to support that point, though I feel like I've seen some before. If anyone knows of any such data, please pass it along. In any case, pretty much every source points out that women's participation in STEM in China is actually lower than it should be, and sexism is rampant. China is not listed as a country where women have achieved parity in STEM by the World Economic Forum (and if you think "well they probably just hate China and don't understand it's 5000 years of culture, in a recent crap video they put out they listed Taiwan as "Taiwan, China", so...).

So I'm honestly just not sure this is true, or if it is I can't find any proof.

* * *

As for women and reproductive health, come on. The sources above already detail how historically, the CCP has used women - their bodies, their labor, their roles in society and the family - in whatever way suited them and "the country" (but really just them). That's just as true today. When the needs of the party happened to bear a passing resemblance to feminist objectives of greater gender equality, they latched onto that as a justification for their authoritarian nation-building that Westerners might be sympathetic to. In other words:

China has some of the least restrictive abortion laws in the world, but that has nothing to do with state support for bodily autonomy—it’s because abortion coincided with the government’s desires. Female bodies have always been treated as state property that yielded what the country needed....

Mao Zedong’s famous quote, “Women hold up half the sky,” is often touted by those who cite China’s high female employment rate (reaching its peak in the late 1970s at 90 percent employment for working-age urban women) or number of self-made female billionaires as evidence of significant progress toward gender equality....

But beneath this apparent commitment to empowering women, much of the feminist messaging has always been propaganda more concerned with boosting the labor force than actually promoting women.

This was true in the past and it's still true now. Women's reproductive rights in China follow a similar trajectory.

Meanwhile, the popular narrative has gone from “delayed motherhood is beneficial for women’s health” [the official message in state media when they wanted to convince people of the so-called sensibility of the One Child Policy to meet national goals of controlling the population] to “pregnancy during university improves employment chances in the future.” “Painless abortion” ads were seamlessly replaced by “painless childbirth” ads. Huang Xihua, a National People’s Congress representative who is outspoken on women’s topics, has condemned the high number of abortions that she blames for damaging women’s health, and she has also recommended that the marriage age for women be lowered to 18. All of these narratives are wrapped around the will of the party itself, which is that “giving birth is not only a family matter but also a national issue." 

The new natalism has the old skeleton of state control, molded with fresh flesh. 

When the CCP wants women to have fewer babies, they aim their propaganda cannons that way. When they want them to have more babies (or decrease the labor force while increasing the population), they get pointed another way. It never had anything to do with women's reproductive freedom. How could it have, from a government so blithely unconcerned with the notion of 'freedom' in general? 

The “one child” propaganda of yesteryear is being condemned for “morbid unluckiness” and supplanted by a celebration of traditional family values and natural feminine roles of daughter, wife, and mother. Banners, newspapers, TV shows, industry experts—every available medium is being turned into part of a propaganda machine touting the benefits of giving birth for the nation.

(The rest of that article is fascinating, by the way, and you should read it.)

Don't ever forget - China may have easy access to abortion (for now - do finish reading that article), but that has also led to forced abortions. As you would expect, those who suffer the most from being coerced into abortions are not wealthy, married or Han. They're the poor, unwed, rural or ethnic minorities. The CCP doesn't just want to decide whether people should be having more children or fewer - they want to control who has what they would consider 'high-quality' (affluent, in wedlock, Han) children.

Just try and tell me that this is 'reproductive freedom' in any sense. It's just another way to control female bodies for state benefit.

* * *

I'm not trying to pretend that Taiwan is some sort of utopia for women - it's not. So much needs to be done, from wage equality to fixing reproductive health care (to make it affordable and accessible to all women) to fixing the divorce and adultery laws, and enforcing the gender equality laws that are already in effect. We need to make sure that women actually get access to everything the law affords them. We need to change societal attitudes to be more modern, and this is entirely possible within a Taiwanese context.

But, come on. Let's not pretend that because Mao said a thing about women one time that sounded progressive, that China is doing better than Taiwan. Wage inequality is less severe here. Women are more likely to be literate (by a small margin). Nobody is forcing women to have abortions (though forcing women to bear children they don't want because they can't access abortions is another story). Although parents still meddle in their children's affairs - "the Lins are coming for dinner and their handsome son who is studying to be a doctor will join them! Won't it be nice to meet him? Do wear something nice!" - there aren't news stories about marriage markets full of grandparents that their grandchildren are horrified to hear about.

So please, stop pretending China's beating Taiwan in this regard. It simply is not. 

Updated post: English-speaking OB-GYN in Taipei

Just wanted you guys to know that I've updated my post on an English-speaking OB-GYN in Taipei, as my old clinic has closed and Dr. Wang seems to have stopped practicing (I suspect she retired). You can get information for Dr. Hsieh here - I've just edited the old post as the old information was no longer relevant.

If anyone else has other recommendations or experiences to share, feel free to comment or contact me personally (I'm pretty easy to find on Facebook). 

Gym Recommendation: The Key

Over the past few months I've been gearing up to write my dissertation, and was feeling a bit blue about having lots of reading to do because I didn't want to sit like a slug on the couch doing it. A friend recommended The Key, them my husband joined and liked it, and I thought: there are surely exercise machines I could use while reading, even if it's just a bit of light elliptical or stationary bike.

I knew I could do this at the local municipal gym (which is not far from my house), but never seemed to make it down there - in part because the one in my district is in an odd location that isn't too close to anything else I need or want to do. Before The Key, none of the paid gyms really appealed to me either: either they always seemed crowded, or they were too heavily skewed toward weight training, or they were too expensive and only had annual memberships available (I travel often so don't necessarily want to pay for a month when I won't be around.)

Or, in one memorable instance, I had already heard some concerning things about the management at another gym and they way they treated people and interacted with the expat community - only to have those concerns abundantly validated recently. I didn't want to give money to a place that wasn't welcoming to everyone.

So, I joined The Key. From their Facebook page:

It currently costs NT$1500/month (renewable monthly so you cancel if you won't be in town and then return), is conveniently located near other places I often go (just north of Zhongxiao Dunhua) and at the nexus of useful transport hubs, has a big-enough room of cardio exercise machines (not just a preponderance of weight training equipment, which isn't useful to me while I'm trying to get reading done) and has a decent cafe on-site - with discounts for members - as well as a comfortable rooftop relaxing space accessible to members.

I certainly recommend it for everyone, but especially for women. Most importantly, I've never once felt judged or unwelcome as a...um, plump woman who isn't even necessarily there to lose weight the way I have at gyms in the past. Management is friendly and always accessible if you have questions or issues and they make a real attempt to remember their clients' names and faces. Overall it's just a place where I think women can feel comfortable. It's hard to put that sense of 'comfort' into words, but it's there.

The space is nicer and more inviting than the municipal gyms (though I'm happy those exist), with big windows looking out over leafy Dunhua Road. The actual gym portion of the space is above the cafe starting on the 2nd floor, so nobody on the street can see you huffing and puffing away but you can look out at the scenery. There's good wifi and free water. There are lockers (bring your own lock) including ones you can rent longer-term as well as changing rooms and showers which are clean and well-maintained.

Most of the cardio machines come with televisions and USB plugs, so you can watch TV or Netflix while you work out if you're not a hardcore nerd like me. The displays can be set to a number of languages, including English, and are fairly easy to use. They have classes where you can learn how to use the weight-training equipment (and other classes too, as well as personal training, but I'm there to work out as I read so I haven't explored those yet). There are English speakers on staff.

The space is tall and narrow as it's designed to fit into the building it occupies, but they make the most of it with an elevator so changing floors isn't too much of a pain.

So yay, The Key! If you're looking for a place where you can work out without feeling judged or potentially discriminated against or just want a place that's more conveniently-located, this is the place for you.

Note: I was not asked or paid to write this post. The opinions expressed in this review are my own.

Taiwan does a tiny hop over a very low bar to be the most gender-equal country in Asia

I've said a zillion times before - though Google isn't giving me my old post on this - that Taiwan has the best gender equality in Asia, and is easily the best country in Asia to be a woman (either foreign or local).

And apparently my view on this has been corroborated by statistics!

But, I've also been quite clear in the past that Asia isn't exactly a region known for having a fantastic record on gender equality, so saying that Taiwan is "the best" in the region doesn't mean much. I mean, this ranking from a different source rated the Philippines as the 'most gender equal country in Asia' in 2018, and...um. It's a country where one can't get divorced (divorce being a right that helps all genders and is necessary in any country working towards gender equality) and can't get an abortion (an essential right of women to control their own bodies). It is not possible to say with a straight face that a country has gender equality when basic rights such as divorce and abortion are not permitted.

The rest of the list is just as much of a joke. None of these countries are places where women, generally, are treated equally or where women have the same opportunities as men.

So, for Taiwan topping the rankings - as determined by an outside body as Taiwan is not in the UN, meaning that no UN statistics where Taiwan would rank significantly are accurate - is nice, but it's not so much clearing a hurdle as doing a little skip in a hopscotch game.

Sure - Taiwan has a high rate of female political representation, higher than many Western countries. The gender discrimination laws for the workplace are quite clear, and when enforceable they actually seem to mean something. Abortion is legal and so is divorce (though the divorce laws are not exactly fully modern). The government is trying to push gender equality. Anecdotally, women seem to have a stronger presence in accounting and finance here than in Western countries. There is a pay gap, but it's less than other Asian countries. 

The streets are generally safe for women. Being pressured into an arranged marriage would be exceedingly rare, and resources do exist for abused women. It's not even that odd now for women to choose to remain single or not have children. And, of course, we have a female president - something the US has never had. And she's unapologetically single and wore pants at her inauguration: something I'm not sure many Americans would accept, even in 2019.

But.

Domestic violence is a real problem. We have no idea what actual rape statistics are, because most women don't report when they are raped. It's difficult to speak out about sexual violence without pressing charges thanks to Taiwan's insane libel laws. There is a gender wage gap and nobody is really sure how big it is (and it's uneven across different industries). Many women can't afford birth control because it's not covered by national health insurance (even for treatment of other medical issues - not that that should matter!). Unmarried women can't receive fertility treatment, there are some ridiculous laws surrounding abortion (e.g. needing the husband's consent) and divorce (it's difficult to get one if both parties don't agree, with the party who wants the divorce often having to prove their partner did something to justify their ending the marriage). 

Even when serving in some of the nation's highest offices, one might be subjected to utterly preposterous sexist remarks. Women's issues are used by both ends of the political spectrum to score points, without any real desire to see through justice for said women. Important gender equality reforms are often ignored.  There is no rape shield law, at least since the last time I researched that issue. Adultery laws are a straight-up horrorshow. Religious practices often include ingrained sexist beliefs.

And those are just the obvious issues.

So yeah. Great. Okay. We're the most gender equal country in Asia. Woohoo!

But Asia is a pretty gender-unequal place. Female infanticide, the gender pay gap, the employment gap, education gaps, domestic violence, lack of access to basic health and reproductive care: these are all endemic issues in Asia. So, that distinction doesn't exactly mean that Taiwan is killing it in terms of treating women well.

It just means we're treating women a little less badly than other places.

All I can say is that, to be fair, the entire world is a pretty gender-unequal place: women's political participation, for example, is lower in Germany, the US and the UK than it is in Taiwan.

So we treat women a little less badly than most of the rest of the world.

That's good, but we still need to do better.

From The Island of Women to #MeToo: my latest for MyTaiwanTour

Years ago, I was an administrative assistant at a perfectly okay company. Every year our perfectly okay branch president gave us generous gifts - usually fairly hefty gift certificates - for "Administrative Professionals' Day", which is the rebranded way of saying Secretary's Day without it coming off as quite so demeaning. Because I was not well-paid - I could barely pay my rent and couldn't save at all until I got a second job - I couldn't afford a quality professional wardrobe, so I always used my gift certificate on that.

It was nice enough to receive recognition for the okay job I did (I was no all-star, mostly because I just didn't like the work very much, but that's on me) at this okay company. I was grateful for the gift itself.

But on some level, regarding the holiday, it felt like a consolation. Sorry you're doing a job you don't want for low pay. Sorry that most corporate jobs are just "okay". Sorry that, while there is room for growth, none of the  jobs you might get promoted to are great either. Sorry that to even get those better jobs you still don't want, you have to not only do amazing work at a job you are not suited for, but you also have to pretend you love it. Sorry you can't save anything so you can't afford to do us and yourself a favor and quit so we can find someone who wants the job and you can find work you care about. Sorry that what you actually want to do, despite being more meaningful, doesn't offer the same route to financial security. Sorry. Here's a gift certificate. 
I didn't want to be recognized for Administrative Professionals' Day. I didn't want the day to apply to me at all, because I didn't want to be an "administrative professional".

Yes, this sounds whiny, but I was in my early twenties. Life is better now.

I'm telling you this because I often get the same feeling about Women's Day, which was yesterday.

So, I didn't write anything about it here yesterday because, to be honest, I just wasn't feelin' it. I know all the arguments for the existence of the day, I don't disagree, and I even went to last year's march.

But this year it feels like a consolation prize - like, "we can't stop the world from being so horribly sexist, so here's a holiday for you? Sorry? Now let's talk about some inspirational women who were also crushed under the eternal wheel of patriarchy."

Eh. I don't want a holiday. I don't want a radio program about inspirational women who were never recognized by a sexist society, because I want such cases to cease to happen in the future.  I want there to be no need for one on the first place.

With that in mind, but trying to be a bit more upbeat - lol - I did write something for MyTaiwanTour's Taiwan Scene. I like the final product more than I thought I would - It's not overly optimistic but tries to find the gold amid the rubble, which just about reflects how I'm feeling these days.

"The Island of Women" was once meant to be an insult, a backhanded way to call a place uncivilized or savage (as compared to the "civilized" repressive patriarchy of China, especially from the late Han dynasty onward). Now, I hope Taiwan can take that heritage, passed down from indigenous women who had more autonomy and routes to leadership than their Chinese counterparts have historically had, and use it to its advantage to lead Asia in the fight for women's equality.

I have my doubts at times, though - the old democracy movements were heavily influenced by women, but I don't see the same number or visibility of female luminaries in contemporary social movements and activist circles.

So...#metoo? We'll see.

If you're a foreign working woman in Taiwan planning to have kids, you're probably going to get screwed

I'll be expanding this more in the coming weeks, but I feel like I need to say something now, however short and underdeveloped.

If you are a foreign woman working in Taiwan, and you are intending to have children here, there is a very high possibility that you're not only going to get screwed by your employer, but that it's already happening.

A huge percentage of foreign workers here - even the "foreign professionals" - work jobs that pay an hourly rate. The vast majority of these jobs are cram school/buxiban jobs (some of which pay a salary, but many/most don't.) (Most of these jobs are not remotely professional, even though they ought to be, and are poorly paid by real professional standards, but that's a different discussion.)

We're already getting screwed out of benefits we're meant to have, such as paid typhoon days and national holidays. Employers - private language schools, mostly - just don't provide them, and good luck leaving and finding another job that does.

Well, here's another benefit workers - even foreign workers on hourly pay - are meant to have: paid maternity leave. Your employer is meant to calculate your estimated hourly pay during your absence and, well, pay you that.

But how much you get paid for maternity leave depends partly on how long you've been employed there, and partly on labor insurance, or 勞保. To get the paid maternity leave benefit, you must be signed up for labor insurance.

And most private language schools that employ foreign teachers never do this.

I have heard varying accounts of whether labor insurance is required by law for foreign employees. Notably, however, it is absolutely not true that an employer can choose not to offer it. An employer telling you "we don't offer labor insurance", and then insisting they don't have to, even if you want it, is lying to you. They typically try to evade the issue by simply not telling you it's an option, hoping you'll never find out that if you ask for it, by law they have to register you.

If you do ask...well, results vary. I typically say good things about my various employers, save one really bad experience I had. They've been, for the most part, a cut above the typical clown academy here in Taiwan. But I'm going to go ahead and say a few critical words now:

At one school where I taught exam prep classes (I've since left for unrelated reasons), I was first ignored when I asked about labor insurance, then told they "don't offer it". I replied that they had no choice, they ignored me again. I said that if I was not signed up for it, I would report this issue to the government. I didn't particularly want to report anything to anyone, but I kept getting stonewalled when trying to access my rights. Then they acted as though this made me the "problem" or "high-maintenance" employee (it didn't - I just wanted what I was legally entitled to and kinder, more private entreaties were ignored.) I got my labor insurance. Others are not so lucky - I can handle being unfairly thought of as "difficult", because at least I won, but not everyone wins.

The problem is, most foreigners either don't know they are entitled to this, think it's something the company can "offer" rather than something that cannot be denied them, or don't realize that it matters. So most working foreign women here have a safety net they don't necessarily even realize they ought to have.

So if you're a foreign woman here, and you decide to pop out a screamer, whether or not you get paid maternity leave - which you are entitled to by law even if you are on an hourly wage - depends entirely on whether or not you signed up for labor insurance. If you didn't sign up, no paid vagina-healin', baby-wranglin' time for you. If you let the issue slide when your employer refused to sign you up, same deal. You just got screwed.

What's worse is that even if you are signed up for labor insurance, a huge number of schools underreport income (my former exam prep institute employer sure did). You might think this isn't a big deal, that "that's how it is here", but your labor insurance is based on your reported income, so if you get pregnant and take maternity leave, the pay you are entitled to matches the craptastic income that's been reported for you, not what you actually earned.

I have also heard stories of schools being reluctant to grant maternity leave even if their employees have labor insurance, although that hurdle can often be gotten over if you are willing to call (or threaten to call) some relevant authorities. They might try to screw you in other ways, though (e.g. extending your probation for vague reasons that don't quite make sense to justify paying you less).

Of course, Taiwanese women face massive issues accessing maternity leave too, something that seems to be rarely written about. Most of what I see in English consists of lavish praise of Taiwan's maternity leave policies - and at least compared to the USA (which is a legitimate horror show in this regard) - which rarely includes the uncomfortable truth that, while employers can't exactly deny their employees this leave, they can and do pressure them to take as little of it as possible and find other passive-aggressive ways to punish female employees who don't comply. Plenty of Taiwanese women don't feel they can access their full legally-entitled maternity leave either.

There is a difference, though: Taiwanese women know this is a problem. They are at least aware of what they are supposed to be getting. There is a foundation there for fighting back.

Foreign women in Taiwan? They may not even realize they're getting screwed. But chances are, they are.

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.

...that's a lot of rapists

Focus Taiwan reported yesterday that a special operation that took place from March to May resulted in the apprehension of 31 fugitive rapists.

While this ought to be good news - 31 is a lot of rapists - it raises more questions than it answers.

First of all, would a "special mission" have been necessary if the Taipei City police had paid more attention and allocated more resources to catching rapists generally? I don't think anyone knows how many people in a city the size of Taipei would, on average, be rapists, but...this just seems like a lot, no?

Assuming we should not be nervous that there even were 31 rapists to apprehend - again, I have no idea how many any given Taipei-sized city would typically have on the files - I have to wonder how they managed to catch so many in 3 months. Could it possibly be because they had some idea who these people were, and therefore once it was made a "special mission" with "extra resources", finally bothered to go out and nab them?

Could they not have apprehended any of these fugitives sooner? Because really, I cannot emphasize this enough: 31 rapists is a lot of rapists.

I know I'm supposed to be applauding the police, but I can't shake the feeling that they were sitting on their hands before, not taking rape cases seriously when it was even remotely challenging - or perhaps not even challenging - to find an accused rapist and take him (or her - but usually him) into custody.

Let's keep in mind that the rape law in Taiwan was only changed in 1999, which is a very long time to wait for a change in such a law. Until then, the old law was written to define rape as an offense against women, in which the offender used force so that she "could not resist", and was a "crime against public decency" (it is now a "crime against sexual autonomy"). Under the old law, men were not included, and not all types of coercion or non-consensual pressure or activity were covered. The 1999 change was an improvement, but I have to wonder if its being less than 20 years old has anything to do with current attitudes towards rape: not that I think the police don't care, but that they don't care enough to devote resources to finding offenders, or perhaps still think of rape as an issue of "chastity", or something that is perhaps, to them, not as much of a crime if the use of force was not as violent as they might expect.

I know that's a pretty strong accusation to make, and to be fair, every police officer is an individual, and I am sure many of them take rape reports seriously. However, if there is no truth to it, why is it that it took until May of this year to apprehend so many rapists, and how were they apprehended so quickly?

Finally, I fear that the general attitude of law enforcement is laid bare in the final paragraph of the Focus Taiwan article, and it is deeply problematic.

Although the mission has ended, police efforts to crack down on sexual assaults will continue, Taipei City Police Department Commissioner Chen Chia-chang (陳嘉昌) said. He also urged women to take precautions for their own safety, such as avoiding walking alone in remote areas and always locking their car doors after getting in. 

Ahem - excuse me?

First, this ought to cause any woman in Taipei to question the old belief that the city is completely safe for women.

Secondly, while I understand the impulse to warn women to be careful, I can assure you that more or less every woman is already well aware that the world is a more dangerous place for her than for men. By admonishing women with something we already know, Chen is not only being condescending, but drawing very close to victim-blaming.

Instead of telling women how to be safe, Commissioner Chen, how about working to make Taipei safe for women? How about continuing to spend the resources necessary to apprehend rapists in a timely manner rather than waiting for a "special mission" so that women can safely walk alone in remote areas and don't have to fear being chased into their cars? You know - so that we can walk around safely and not feel nervous whenever we get into said car?

A woman being as safe as a man on the streets of most Western cities is often considered a distant dream, but it is possible in Taipei, which is generally regarded as safer. I walk around in Taipei, alone, at all times of night. Just this past Saturday I walked from my sister's apartment to my own - Brendan had gone home early - at 2:30am and did not feel unsafe.

Taipei could be a city where women are safe in public as men are, but it won't happen if it takes a special mission to capture all of those rapists - really, let's just consider one final time how many rapists that is - and it certainly won't happen if the police themselves, rather than allocating resources to keeping women safe, admonish women that Taipei is not safe. 

What is one rape worth?

A harsh question, but here's the problem.

According to Focus Taiwan, new laws meant to strengthen protections for foreign workers include provisions punishing labor agents and employers (such as the people who employ home aides to care for their elderly parents) who sexually assault, abuse or traffic foreign workers:

In addition, the official said, if a labor agent is found guilty of sexually abusing, sexually harassing or engaging in the trafficking of foreign workers, a fine of NT$300,000-NT$1.5 million will be handed down and the individual banned from working as a labor agent.

That's a start, though I'm not convinced the fine is high enough. The article doesn't make it clear, there are also laws that carry prison sentences already on the books. 

But then there's this: 

If employers or care recipients are found guilty of sexually abusing or engaging in the trafficking of foreign workers, they will be ineligible to employ such workers for 2-5 years, and repeat offenders will be ineligible for life.

Emphasis mine, because excuse me?

There are surely also sexual assault laws that would see any one of these employers go to prison if convicted which are not mentioned in this article, but how is it that someone convicted of sexually abusing or trafficking a foreign worker might be allowed to employ another one in the future?

How is it that one assault is not enough to see them not only pay their debt to society in terms of jail time, but also be banned for life from hiring foreign workers?

How about one rape? Is it somehow more acceptable to sexually abuse than to rape, or do they face the same weak penalty?

Remember, almost - but not all - of the foreign workers whom this law would specifically protect are women who work in homes as domestic helpers and home health aides. It is already a very personal situation, to live in someone's home as their employee. Do the people drafting these new protections really think that someone who has abused such a worker should be allowed to bring another into his (or her) home?

Is there really a calculus for this? One assault isn't enough, that was just one rape you guys, five whole years ago! We should totally trust this guy to hire another worker in the same situation because come on bro, statistics surely don't show that rapists are likely to be repeat offenders, right?

Oh, they actually are?

Oops. 

According to foreign labor regulations, raping one woman is not enough, but two...well, two rapes means something. Authorities apparently can't do anything to prevent that second woman from being raped, because to them it's not a real problem until it happens twice.

So rapists are like children who are put in the time-out chair for stealing cookies?

Seriously, though. We obviously can't repeatedly punish the same crime - you serve your sentence, and you get another chance. That's how it works - but that doesn't mean criminals should have a totally clean slate. I support giving ex-convicts work and allowing them to live more or less normally, but I would not give a convicted thief or embezzler a job in a bank or finance company. I would not give a rapist, child abuser, child pornographer or pedophile a job in a school. I would not give an arsonist a job at a gas station and I certainly would not let a murderer work in a gun store. I wouldn't even let a Taiwanese fishing boat operator convicted of forcing his foreign employees to work without pay - which does happen - hire them to work on a fishing boat again.

It follows that a convicted rapist, especially one who likely specifically raped a woman living in his home who was under his employ, should be barred from bringing another woman into his home, under his employ.

How is it that one rape is not enough to make that official?

It's not even as difficult as when to bar an ex-convict from a certain type of work: it's barring someone from employing someone else for in-home services. This shouldn't be difficult.

I have to ask. are the women these one-time-rapists allowed to hire going to be told of their new employer's history? Will they have any way of knowing they are being hired by someone who was once convicted of raping someone just like them, under the same circumstances? I doubt it.

If only this were surprising: this is the same country where an Indonesian domestic worker taped herself being raped after none of the authorities she spoke to took action - her brokerage firm even saying "do what you want" (as though it were consensual!), "just don't get pregnant." She later tried to commit suicide - she'd been raped so often that authorities could not determine how many times it was. That same story was picked up by Liberty Times who made it all about how this was such a loss of face for Taiwan, rather than about what the woman had suffered and bringing her rapist employer to justice. Reporting elsewhere on this incident was hardly better, with much of the focus of the story being on the woman's "emotional irritability" and "extreme instability", which apparently made it hard for police to get a full statement.

Of course she'd be extremely irritable and emotional after not only having been raped repeatedly, but also treated dismissively by the brokerage firm. How many rapes did it take for her to be able to make that video and finally, slowly, start to seek justice? How bad was it, that she tried to kill herself? And yet, the press makes it all about Taiwan, almost implying that her "emotional instability" was part of the problem when the case came to light.

What if she'd been raped once, and hadn't made that video, because nobody expects to be raped by their employer?

Would that have been enough, or would one rape not be worth the currency needed to get the attention of authorities.

Would her rapist be allowed to hire another Indonesian care worker after a few years, bringing them into the same situation, if he'd only raped her once?

How can anyone think such an attitude is acceptable?

As much as I tout Taiwan as being ahead of the curve when it comes to women's rights and women's equality in Asia, we still have a long way to go, including - perhaps especially - in the way society treats foreign female labor.

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.