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Chin Liang (left) and Yan (right) pictured with their supervisor, paediatric specialist Dr Lee Hsing-Yuen.

Chin Liang at the cardiac catheterization centre.

Yan (left) pictured with her supervisor, family medicine specialist Dr Chang Hsiao-Ting.

Yan pictured with the hospice care team.

Our elective posting took place at the Taipei Veterans General Hospital which is located in Beitou District in Taipei city, Taiwan. Founded in 1958, the hospital is a first-class national medical center which provides tertiary healthcare services across the northern Taipei city and New Taipei city. Being a teaching hospital, it also provides undergraduate medical education and residency programmes. 

During our elective period, we spent our first two weeks in the paediatric cardiology department, and another two weeks in the family medicine department. We were under the supervision of paediatric specialist Dr Lee Hsing-Yuen and family medicine specialist Dr Chang Hsiao-Ting respectively. 

The paediatric cardiology team consists of a total of four paediatric cardiologists, two medical and two house officers. We spent most of our time in morning meetings, morning and evening ward rounds, clinic attachments and lastly, the cardiac catheterization centre. 

Morning meetings were basically case discussions of the newly admitted patients, progress and management plans of certain patients in the ward. We were given opportunities to participate in their discussions and it was a very good experience for us. During the clinic sessions, we were able to perform physical examinations on many children, while observing the cardiologists perform echocardiography to detect any cardiac lesions. 

During our clinical years in Malaysia, we have limited chances to observe procedures that are done to correct cardiac abnormalities as most of the patients with cardiac abnormalities will be referred to Institut Jantung Negara (IJN) for correction surgery. In Taipei, we were able to observe some of these procedures that are done on paediatric patients, namely ventricular septal defect repair, atrial septal defect repair for patients with ventricular septal defect and atrial septal defect respectively. We were also able to observe the cardiologist performing electrophysiology test and subsequent cardiac ablation for patients with arrhythmias. 

On Humanity 

Hospice and palliative care is mainly provided by oncology units in most of the hospitals in Taiwan but surprisingly, we were informed that this service is provided by the family medicine department in Taipei Veterans General Hospital on the first day of our posting. We were totally unprepared for this upcoming challenge. 

In Malaysia, hospice care (palliative medicine) is a relatively new field within the Ministry of Health and as a medical student we have no exposure to the services. Taiwan's quality of death and end-of-life care was ranked as the first in Asia and so it had been a great honour to be part of the team. 

This was our first time getting involved in the terminal life care of a patient and we learned what holistic care truly is. The team, which included a hospice physician, nurses, social workers, trained volunteers, physical therapist, all worked together to develop individualised care plans depending on each patient's physical, mental and spiritual needs. 

Besides medical knowledge on pain and symptom control, we discussed the medical ethics involved on a case-by-case basis with the doctors and nurses. We were given the chance to join the patient's family meeting whenever there were new cases admitted and when we were discussing the patient's current condition, treatment options available, family expectations on the outcome and patient preferences regarding the management of their care. We were so lucky to be able to join one of the home visits with the hospice nurses before our elective ended. 

We learned a lot of things in medical school but death wasn't one of them. No doubt, we improved our soft skills through the conversations held with family members and the patients who were facing their final stage in life. We visited them every day, expressed our compassion, listened to their stories and life experiences. There were times when we felt tearful: when we watched a video made by a mother for her children just days before she passed away; when we sang with the team during a music therapy session and the paralysed patient had tears running down his face. As a medical student, all these are precious experiences for us as we do not have such chances back in Malaysia. 

Conclusion 

Taiwan is a beautiful place, with friendly people, wonderful scenery and delicious food. The city is convenient with different methods of transportation. There are plenty things to explore and it is a fun place to be in. It was definitely a wonderful experience to be in Taipei Veterans General Hospital, not just as exposure to their advanced medical care, but a journey that taught us about humanity from a doctor's perspective. 

Oon Chin Liang and Chong Yan are alumni of SMJK Jit Sin, Pulau Pinang and SMK Skudai, Johor.