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<title>How Taiwan Frontline Medical Workers Response To The Epidemic - Doublethink Lab</title>
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<h2>How Taiwan Frontline Medical Workers Response To The Epidemic</h2>
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<p class="txt"><b>Emily Liao</b><br>Secretary General, Taipei Doctors Union</p>
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<h3>Interview</h3>
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<p class="txt"><b>Can you briefly introduce yourself and explain the goals of the Taipei Doctors Union?</b></p>
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<p class="txt">I’m Emily Liao, and I’m a graduate of Fu Jen Catholic University’s Department of Public Health. At the time, I got to know many medical students and doctors, and through them I came in contact with the subject of application of medical labor laws and working hours. After graduation, I went to work for the union. The Taipei Doctors Union was founded in July, 2019. Currently, 75% of our union members are from large medical institutions, and the other 25% are from clinics.</p>
<p class="txt">At present, the union focuses on three things:</p>
<ul class="decimal">
<li>To tackle the overworking of doctors and to appeal for a rationalization of their working hours. Most doctors in Taiwan are specialist attending doctors (42,000 out of 50,000 doctors) and are not regulated by the Labor Standards Act; as for resident doctors, working hours must not exceed 320 hours over a four-week period. </li>
<li>Improving the design of the health insurance system: self-financed medical items.</li>
<li>Dealing with medical disputes such as on-site violence, and so forth.</li>
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<p class="txt"><b>What kinds of fake news have you been hearing during the pandemic?</b></p>
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<p class="txt">It can be divided into three categories: The number of confirmed cases, methods of prevention or cure, and China-related. </p>
<p class="txt">On the number of confirmed cases, LINE social media groups or anonymous Facebook accounts spread numbers of “confirmed cases” in particular locations, causing panic among the public and even sometimes medical personnel. For example, it was rumored that a cluster outbreak had occurred at a medical center in Taoyuan. At the time, a reporter contacted the union to verify the story, and we were able to confirm through our Taoyuan members on the ground that the story was false. </p>
<p class="txt">Regarding the methods of prevention or cure, we’ve come across some extreme cases of misinformation, such as that cyanide is very poisonous so therefore it can kill the virus. With respect to masks, falsehoods such as "toilet paper is made of the same material as masks" and "some countries distribute masks for free but the Tsai administration is making money off it” have circulated. Because the knowledge threshold of drugs and poisons is low, non-specialist doctors need to spend time to learn how to make a determination, but as long as they ask the right medical staff working at the hospital, they are able to get the correct answers to help them carry out their duties. After all, the entire medical team hopes that the pandemic will end soon.</p>
<p class="txt">With China-related issues, examples include people saying “they are helping smuggle immigrants in from China,” passing off fake official documents to claim the virus is a man-made bioweapon, and so on. </p>
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<p class="txt"><b>When medical personnel get false medical information, do they take the initiative to clarify or respond to it?</b></p>
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<p class="txt">If it involves medical information, they will clarify it. For instance, if a doctor puts their name to a clarification matching a specific instance, it will be widely disseminated. However, whether the clarification reaches the original source of the rumor we have no way of knowing. It is fundamental that when a medical team comes across misinformation they will correct it with the facts and put great effort into quashing rumors. The Central Epidemic Command Center (CECC) also found a fair number of doctors to record infomercials with, and many doctors were very willing to cooperate. They felt very pleased to be on TV.</p>
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<p class="txt"><b>As far as you know, why do people believe misinformation and what is reflected behind it?</b></p>
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<p class="txt">It’s easy for people to panic. Our previous SARS experience was really tough. A hospital had to be quarantined due to failure in handling disease prevention measures properly, which led to the deaths of many medical professionals in the line of duty. There is a basic level of knowledge for prevention of the spread of infectious diseases, with basic examples being wearing a face mask or washing your hands. However, with high-level medical expertise, such as knowing how to treat Covid-19 and what actions to take, the public either doesn’t understand or will get information from unknown sources without making the effort to verify it and will just believe it.</p>
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<p class="txt"><b>From the union’s perspective, what was the situation like on the ground during the pandemic?</b></p>
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<p class="txt">In general clinics, because people were avoiding going to medical facilities, clinic outpatient volumes were dismal from January to March.For large hospitals, the workload can be divided into outpatient services and wards.</p>
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For outpatient services originally the responsibility was with the attending physician, but due to the pandemic situation patients were prevented from leaving and entering the hospital, resulting in a sharp drop in volume. The attending physicians were transferred to support temperature screening stations at exits or to front-line emergency rooms. As for the wards, many patients rely on hired foreign caregivers for their personal care, but during the pandemic because of strengthened controls at the entrances requiring registration with proper ID (National Taiwan University Hospital and Taipei Veterans General Hospital), many undocumented foreign caregivers were unwilling to show up at the hospital. Before, these caregivers handled everyday care tasks such as helping patients turn over in their beds and wiping their backsides. This has led to a situation where family members should step up and take responsibility for helping patients go to the bathroom, but instead it has led to nurses having to handle additional responsibilities instead of concentrating on their medical duties. Although we don’t have any hard statistics, when doing our rounds it is common to see patients alone and unattended in the wards. The union has initiated discussion on this and is planning and working closely with a foreign laborer NGO to disseminate the message that the entrance controls are for preventing the coronavirus from spreading, not a convenient method for catching undocumented foreign workers. Unfortunately it’s been too rushed. We regret not being able to communicate it as widely as we would have liked.
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<p class="txt"><b>At the beginning of the pandemic the government issued a decree banning medical personnel from leaving the country. What is your take on that?</b></p>
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<p class="txt">The general public tended to support the CECC on this, but most doctors and nurses were opposed to it. The ban had three levels, ‘red’ countries indicated a complete ban, while the hospitals were allowed to reject allowing any leaves of absence to ‘orange’ and ‘yellow’ countries. In normal times to take a special leave of absence only required a half day’s notice. Now the decision is completely up to the hospital, covertly giving hospitals more authority to make policy decisions.
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<p class="txt"><b>At the beginning of the pandemic the government issued a decree banning medical personnel from leaving the country. What is your take on that?</b></p>
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<p class="txt">The general public tended to support the CECC on this, but most doctors and nurses were opposed to it. The ban had three levels, ‘red’ countries indicated a complete ban, while the hospitals were allowed to reject allowing any leaves of absence to ‘orange’ and ‘yellow’ countries. In normal times to take a special leave of absence only required a half day’s notice. Now the decision is completely up to the hospital, covertly giving hospitals more authority to make policy decisions.</p>
<p class="txt">There was no paper decree when the order was issued in February, it was issued as a verbal statement by Health Minister and head of the CECC Chen Shih-chung at a press conference. At the time, some medical staff were already abroad or had taken time off to go abroad, and they didn’t know the corresponding compensation. That evening the union issued a statement. First, the basis in law for this was unclear, the Communicable Disease Control Act stipulated that when at work one must uphold their professional duty, but after work is private time. If there are restrictions, there must be corresponding compensation. On February 25 the CECC responded saying that certain articles in the bill in the act gave them the authorization to do this, but the union maintained this was not clearly enough defined. Later, due to related news leaking out, the Ministry of Health and Welfare sought our union out for a meeting.
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<p class="txt"><b>What are the reactions or thoughts from those in the medical profession on the recording of personal travel history in the National Health Insurance card?</b></p>
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<p class="txt">In the beginning, when travel history to Hubei Province [note: Wuhan City, where the pandemic started, is in Hubei, China was recorded on National Health Insurance cards, medical professionals were all for it. However, when it came to recording people’s profession, for example whether to record someone as being a medical professional, there were two points of view on that. One was that protecting people in the profession was a good thing. The other questioned why it only applied to people in the medical profession, and questioned why people who worked in hospital administration or planning departments, or outsourced cleaning staff, weren’t recorded. In one case, a medical center checked a nurse’s card to see if she had a travel history. This made a lot of nurses think: We are complying with the government’s policies and staying at work to fight the pandemic, and we’re being doubted? So the union released a statement calling this into question, calling attention to the issue of whether recording peoples professions goes too far.</p>
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<p class="txt"><b>What sorts of difficulties and challenges were encountered during the pandemic?</b></p>
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<p class="txt">Last year I reported to city councillors that Taipei City Hospital was making salary deductions, but during the pandemic I was worried that putting up a fight on this would lead to an adverse reaction from the public, so we didn’t continue with our public efforts on this. The problem here is, before the pandemic erupted medical professional’s view was that we need to fight to get the labor rights available to the average worker. However, during the pandemic they became an emblem of a kind of sacred mission, so they couldn’t continue this battle for fear of a public backlash. In the wake of the pandemic slowing down, however, we’ve decided to continue to focus on the issue of medical professional labor rights.</p>
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<p class="txt"><b>How does your organization view the government’s pandemic prevention efforts?</b></p>
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<p class="txt">In terms of outcome, the results were very good. Whether it was quickly getting a grasp on the changing contingencies of the pandemic, or tracking the international or local population pandemic prevention efforts, it was all done fairly well. In addition, with respect to the use of communications tools, tying in people from the medical world to jointly create publicity--and in several languages--was very effective. As for the early concerns about the insufficiency of face mask reserves, due to the domestic production and prioritization in requisition the problem was effectively solved. In terms of areas that need to be strengthened and improved, regarding the CECC’s hospital and related policies, it should be largely left to senior scientists, with everyone else not adding too many opinions. However, with regards to personal rights, prohibition policies and compensation allowances, labor organizations should be at the table, but they haven’t reached out to us.</p>
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<p class="txt"><b>Does your organization have any plans to cooperate with non-governmental organizations?</b></p>
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<p class="txt">Strictly speaking, no--the pandemic arrived with such urgency. In regards to doctors and nurses travel restrictions, allowances, protective hardware and software, we maintain relationships with medical journalists and let them know the situation facing medical professionals. However, if it doesn’t involve patient safety or there is no simple way to illustrate a point, reporters have trouble understanding the issues. We did get a lot of feedback and suggestions from reporters at the time, though. Additionally, at the time we were lobbying the legislature quite a bit. On the one hand about regulatory restrictions, on the other we hoped to be able to participate in the CECC’s pandemic prevention policymaking, so we sought out legislative assistants or the offices of legislators that paid attention to medical professional labor rights.</p>
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<p class="txt"><b>In what way did you raise the visibility of labor rights during the pandemic?</b></p>
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<p class="txt">Taiwan has very strict regulations on negotiations with employers and organizations. For example, more than half of physicians need to join in order to negotiate. The target of our appeals is government agencies, not specific hospitals. The most important thing during the pandemic was the protective hardware and software facilities (including protective gear) for doctors and nurses, subsidizing fever screening stations and so on, to demonstrate to doctors and nurses the capabilities of our union in bringing forth results.</p>
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