During my trip from the Taoyuan International Airport into Changhua city， I couldn't help but wonder what the outcome of this medical training would be for me. All I was thinking of was my family back home and the 100’s of ‘what ifs’ which flooded my mind. Nonetheless， I had my objectives set out to accomplish and my goal was to do just that.
Monday was the first day to be out in the field， after our initial orientation to the CCH Mission， I was then taken to my assigned clinical area. I was warmly greeted by staff although a lot of them did shy away from me I guess because of the language barrier. Patients as well as their relatives were also very friendly and extended warm greetings. The hemodialysis department was the area where most of my training / experience would take place.
The next day I went in early so I could witness the beginning of the hemodialysis shift. I observed the various processes and compared in my mind how similar or different they were from our processes back home. There were many similarities especially with machine operations because we use the same brand of dialysis machines back home but different models. By the afternoon of that day I was able to sit with the head nurse Feng-Mei Wu to discuss the various objectives which I had for my training.
My view of CCH is that it is a hospital of excellence. A lot of thought goes into processes before they are implemented and they are made as efficient as possible. I am very impressed with the Information Technology system in particular. Although very complex， it is very user friendly， individualized and flexible and it is amazing to know that all of the CCH branch hospitals are connected via this robust network. The other thing which makes me regard CCH as a center of excellence is their technological advances. They boast a collection of top of the line medical equipment which facilitates better diagnosis， treatment and care of patients and clients for example Computer Tomography， Magnetic Image Resonance， powerful neurosurgery microscopes， Fluoroscopy， the impressive Deviance Surgical Robotic system to name a few. CCH is driven by standards. They pride themselves in establishing policies， guidelines， protocols and procedures to guide processes and are high on evidence-based practices and ensuring quality. Their high standards and excellence have awarded them several prestigious certifications and titles internationally such as the Joint Commission International (JCI) consecutive accreditations， College of American Pathologists (CAP) certifications as well as local titles such as Symbol of National Quality (SNQ) awards and Taiwan Healthcare Indicator Series (THIS) awards to name a few.
During my experience I was able to observe some other forms of renal replacement modalities apart from hemodialysis and peritoneal dialysis. These include Continuous Renal Replacement Therapy (CRRT)， usually used for acute patients in the ICU and patients dialyze for 24 hours， Sustained Low Efficiency Daily Infiltration (SLEDD-f) which can also be used for acute patients in the ICU and can be given between 6 and 12 hours. I also observed various types of apheresis such as therapeutic plasma exchange and different types of plasmapheresis.
The area I looked forward to most of all was the Peritoneal Dialysis (PD) unit because this not a service we presently provide in St Lucia and I very much wish we did. It would mean that more patients would get a chance to live longer lives. There are many CKD patients in stage 5 waiting to begin hemodialysis and because of limited machine numbers; patients are dying while waiting to begin treatment. In-center PD is not provided at CCH. Most of the PD patients do Continuous Ambulatory Peritoneal Dialysis (CAPD) while a smaller percentage of them have PD machines at their homes and do Automated Peritoneal Dialysis (APD) mostly at night while they sleep. Despite of that I was still able to get a wealth of knowledge on the specialty area. I was also able to witness the insertion of a peritoneal dialysis catheter in the Operating Room.
The Diabetes E Institute was more exciting than I thought it would have been. Mr Liu was very knowledgeable in his field and made me feel quite comfortable and involved in his activities. Although all of the interactions with his patients are in Chinese he was able to fill me in in-between patient consultation.
Now for the play part. The culture of Taiwan is quite different to that of St Lucia and the food is what I enjoyed most of all out of the hospital. My culinary experience would have been even more extensive if so many of the dishes had not contained pork. The culture of drinking tea， juice and coffee without sugar was something my tastebuds soon became habituated with and so much so I think I will continue the custom back home. The night markets were also something very new and fascinating for me. The games and vending of everything imaginable was quite interesting for me. As the days went by instead of feeling discomfort I became quite accustomed with the stares and lingering gazes of the locals particularly the children as we went through the streets.
My experiences at the different departments were all great! I was acknowledged and welcomed by the staff at the various departments and my supervisors ensured that I was given the information I needed. I am grateful for haven been given the opportunity to witness the various dialysis related procedures especially. I do not think I would otherwise even begin to have the appreciation for them as much as I do now. It is one thing to read about a case or procedure in a text book but observing the actual application in real life makes that knowledge more profound. Looking back four weeks later， I am happy to say that my expectations were met and surpassed and indeed my objectives were met. Thanks to all those who were instrumental in making it possible; the Lord， CCH Mission， St Jude Hospital， my supervisors， the various staff members and my SJH colleagues also in training for their support.
Thank You!