CHIAYI CHRISTIAN HOSPITAL 1968-1971
An American physician’s perspective
我曾經以醫生的身分在嘉義基督教醫院服務過兩段時間。第一段時期是1968年到1971年，我當時是一個剛結束實習的年輕醫師，主要的工作是協助葛銳之醫生。他是一個五十幾歲的外科專科醫師，他要求在他執行手術時，我要為他的病人麻醉。我知道來嘉義服務要執行麻醉工作，在美國實習時就特別接受麻醉的訓練，包括使用開放式滴入乙醚全身麻醉，及操作標準麻醉機執行Halothane氣體插管麻醉。
I was a doctor at Chiayi Christian Hospital during two periods. The first period was from 1968 to 1971 when I was a young physician who had just finished his internship. My main role at this time was to provide support to Dr. Robert Gruys, a Board Certified Surgeon in his 50’s, who had requested that I give anesthesia to his patients during surgery. Knowing that I would be doing anesthesia in Chiayi I had done a special rotation in anesthesia during my internship. This included special instruction for me in the use of open drop ether general anesthesia as well as the standard endotracheal halothane anesthesia through an anesthesia machine.
在我結束達拉斯兒童醫學中心和德州大學西南醫學院四年的小兒科住院訓練之後，再回到嘉基。1975年到1979年是我在嘉基的第二段時期，當時的角色任務是在嘉基建立小兒科。
My second period at Chiayi Christian Hospital was from 1975 to 1979 following 4 years of pediatric residency at Dallas Children’s Medical Center and the University of Texas Southwestern Medical School. My role during this period was to establish a department of Pediatrics at Chiayi Christian Hospital.
今天我想談談我在嘉基的第一段時期—從1968到1971年，因為我覺得在這段時間，戴醫師一開始想要在嘉義興旺一所基督教醫院的那幅願景，幾乎快要消失不見。在座只有少數人曾參與在那段時期。
Today I would like to talk about the first period from 1968 to 1971 because I feel that it was during this period that Dr. Ditmanson’s vision of a thriving Christian Hospital in Chiayi was almost lost. A few of you participated in this period.
1968年嘉基面臨了一個艱困的時刻。醫院才剛從40床擴建至118床，戴醫師離開醫院回美國學習骨科，醫院的佔床率只有45%，醫院的財務狀況不佳。當時懷抱著熱情，已經來台服務兩年的美籍外科葛銳之醫師，對醫院可用來協助他工作的設備感到非常失望。當時沒有血庫，捐贈者要在醫院長廊等候，當需要的時候才抽血；還有開刀台無法正常使用，麻醉是開放式的乙醚，只有紗布口罩。X光機已經有25-35年了，心電圖儀(EKG)不是每次都能用。葛醫師說，「真是難以置信，好像乘坐四張海報板拼湊成的床就想要飛上月球！」
In 1968 Chiayi Christian Hospital had reached a critical time. It had recently expanded from 40 beds to 118 beds. Dr. Ditmanson had left for his Orthopedic Residency in the United States. The hospital occupancy was only about 45%. The financial situation of the hospital was dismal. Dr. Robert Gruys, an enthusiastic American surgeon, had arrived for a two year commitment but was very disappointed with the hospital facilities available to help him do his work. There was no blood bank. Donors waited in the hall and blood was only drawn if it was needed. The operating table did not work properly. Anesthesia was open drop ether through a gauze mask. The X-ray equipment was 25 to 35 years old. The EKG machine did not always function. Dr. Gruys said, “It is unbelievable. Like trying to go to the moon on a four poster bed.”
當時的張一正院長、總務主任黃宗川與護理部主任傅珍珠寫了一封信到台灣醫院協會和支持我們的美國信義會教會，急迫地表達需要一筆專款來購買所需的醫療器械。他們覺得醫院如果沒有必備的器械，就沒有辦法提供適當的醫療照護，也無法彰顯基督的樣式。
Together with Dr. I.C. Chang (Superintendent), Mr James Huang (Business Manager) and Miss Margaret Friberg (the new Director of Nursing) a letter was sent to the Taiwan hospital board and the supporting American Lutheran Church urgently requesting a special grant to buy needed medical equipment. They felt that without the needed equipment the hospital would not be able to provide adequate medical care and would not provide a Christian example.
當醫院的管理階層提出主要的經費援助需求，得到美國信義會教會的回應，就是聘請一名顧問來評估現況。1969年的秋天，來自美國的McGilvray先生應世界教會協會的基督教醫療委員會之邀，前來嘉基兩天做評估，隨後，McGilvray先生將兩天來訪的感想，寫成一篇相當長的報告。
This request was met with a response which is common when hospital administrations ask for more capital funds. This was to hire a consultant to evaluate the situation. Dr. James McGilvray of the Christian Medical Commission of the World Council of Churches was asked to do the evaluation. He came for two days in the fall of 1969 and subsequently wrote a fairly lengthy report.
在報告中提到：
1. 這所醫院蓋在一個錯誤的地方，如果要蓋，應該是以下三種情況：在這個地區只有這一家醫院；或者這是一家已經在市區有聲譽，但需要擴充空間的後送醫院；又或者地點不重要，因為醫生的名氣或醫院擁有特殊的設備，吸引病人不管距離遠近或其他的不便，都願意前來。後者情況最成功的例子就是明州的梅約聯盟醫院，不過也要達到像梅約這樣的等級，才有成功的可能。
2. 醫院還未成熟到可以從40床擴充到118床。
3. 外籍員工人數太多(6位)，並且需付較高的薪資。
4. 醫院全體員工數太多。
5. 每二十四小時照顧一個病人的成本太高(在1968年的成本是美金4.47元)。
6. 巡迴醫療和小兒麻痺病房花費太昂貴，且耗盡醫院的財源。
Among other things in his report he said:
1. “This hospital is in the wrong location…Such a location should only commend itself under three conditions, namely, that it is the only hospital facility in the general area; that it is a transfer of an existing hospital which has already achieved some reputation inside the city itself but now requires room for expansion; or that the location is immaterial because the reputation of the doctors or some special facility in the hospital will attract patients regardless of distance or any other inconvenience. This latter condition was successfully met in the case of the Mayo brothers, but one needs the equivalent of the Mayo’s to make it work.”
2. The expansion of the hospital from 40 to 118 beds was premature.
3. There were too many expatriate staff (6) and they were very expensive.
4. The total staff of the hospital was too large.
5. The cost of caring for 1 patient per 24 hours (US $4.47 in 1968) was too high.
6. The mobile clinic and polio ward were too expensive and were a drain on hospital finances.
McGilvray先生最後的結論說道，「客觀分析後的結論，在嘉義的醫療事工是冒險且計畫不週的，當初根本就不應該開始。」
In conclusion Dr. McGilvray said, “An objective analysis might lead to the conclusion that this venture into medical work was ill-conceived and should not have started in this way in the first place.”
這個報告出爐後，醫院的員工不但沒有喪氣，不論本地或外籍員工的精力似乎更充沛。張一正院長和員工們迅速地回應，寫了一封抗辯信給美國信義會教會的中華顧問委員會。
Following this report, rather than being discouraged, the hospital staff, both Chinese and expatriate, seemed energized. Superintendent Dr. I.C. Chang and his staff quickly responded and wrote a rebuttal letter to the China Advisory Commission of the American Lutheran Church.
針對嘉基的位置，員工一致看法都是理想的。醫院坐落在省道上，交通方便；因為不在市中心，所以價格較便宜，可同時一次買下大片土地，作為未來醫院擴充之用。並提到台北的馬偕醫院也是建立在稻米田中間。
In regard to the hospital location, they said it was ideal. It was located on the main highway with convenient transportation. The lower cost of land away from the center of the city of Chiayi made it possible to buy a piece of land large enough for future hospital expansion. hey mentioned that when Mackay hospital was built it also was in the middle of the rice paddies.
關於「醫院近期的擴充還未達成熟時機」的看法，聯名寫信的員工表示若沒有從原本的40床擴充，就沒有病床得以應付平均每天45名病人，或尖峰時期65名病人。
In regard to the “premature” recent hospital expansion, they noted that if the hospital had not expanded from 40 beds there would be no room to place the current average 45 patient census or the peak recent census of 65 patients.
關於「醫院雇用太多的外籍員工」，他們提醒McGilvray先生曾在兩年前的「台灣基督徒醫療進展」報告中提到，「他(戴醫師)渴望再加一名外科或小兒專科的外籍醫師來穩固醫療服務，我們衷心的贊成這項請求。」當時也是6名外籍員工。
In regard to the claim that the hospital had too many expatriate staff, they reminded Dr. McGilvray that he himself in a report two years earlier on “Christian Medical Progress in Taiwan” had written “He (Dr. Ditmanson) is anxious to secure the services of an additional expatriate doctor with a specialty particularly in surgery or pediatrics and we heartily approve this request.” At that time there were also six expatriate hospital staff.
關於 「每二十四小時照顧一個病人花費美金4.47元，成本太高了」，醫院員工指出馬偕醫院同年度的花費是美金8.1元。
In regard to the excessive cost of US $ 4.47 to care for one patient for 24 hours, the staff noted the cost at Mackay hospital during the same year was US $8.10.
而提到 「停止巡迴醫療及小兒麻痺的計畫」，醫院員工堅信此時這些計畫對於醫院的宣教工作是不可或缺的，不能因為無法自行達到收支平衡就取消這些計畫。
In regard to discontinuing the mobile clinic and polio programs, the staff insisted these programs at that time were integral to the mission of the hospital. They could not be discontinued just because they were not self supporting.
而說到 「醫院雇用太多員工」，張院長和員工回應，若病房的佔床率為60個病人，那醫院則是1.4個員工對一個病人。當時彰基若滿床，是1.4個員工對一個病人，而馬偕醫院則是2.1個員工對一個病人。
In regard to the hospital being overstaffed, Dr. Chang and his staff responded that if one assumed a bed occupancy of 60 patients, then the hospital had 1.4 staff per patient. Changhwa hospital if 100% full would have 1.4 staff per patient and Mackay hospital had 2.1 staff per patient.
張院長和員工們在結論中樂觀的指出，若能提供嘉基這筆經費，擁有台灣其他醫院等同的設備，並且維持現有外籍員工數，嘉基未來有很好的機會成為自足自給的機構，可以提升更有基督樣式的醫療照護能力。
Dr. Chang and staff concluded optimistically that if funds were provided to equip the hospital similar to any general hospital in Taiwan and if expatriate staff could be maintained, at least for the present, then there was a good chance that the institution could become self supporting in the future. Its ability to provide Christian medical care would be enhanced.
美國信義會教會，在陸續接到McGilvray和嘉基員工的報告後，拒絕了McGilvray大部分的評估，並決定照著張院長與嘉基員工的提案。美國信義會教會更撥下一筆為數不少的資金，許多需要的醫療器材陸續抵達，讓剛擴建的醫院順利在更完善的設備中繼續營運。
After receiving both Dr. McGilvray’s report and the hospital staff response, the American Lutheran Church rejected most of Dr. McGilvray’s assessment and decided to follow the proposal of Dr. Chang and his staff. A sizable capital grant was given by the American Lutheran Church. Much needed medical equipment was obtained to complete the newly expanded hospital.
接下來的幾年，更多本地的醫護人員成為醫院員工，手術量顯著的成長，麻醉的設備逐漸進步，開放式乙醚技術已成為過去式，X光的使用次數增多，醫院的赤字隨之減少了。
Over the next few years more Chinese health care workers and doctors joined the hospital staff. The number of surgical procedures increased significantly. Anesthesia support improved. Open drop ether became a thing of the past. The number of X-rays taken increased. The hospital deficit decreased.
差點失去了戴醫師對這所基督教醫院在嘉義地區所懷抱的異象，這個經歷讓美籍與本地的同工更加同心努力於維持醫院運作，嘉基在本國籍院長的領導以及本地醫師─例如：陳博憲醫師的協助下，嘉義民眾口中的「美國仔病院」也漸漸成為「嘉義基督教醫院」。
The threat of losing the vision that Dr. Ditmanson had for a Christian Hospital in Chiayi diminished. American hospital staff and Chinese hospital staff worked even closer together to make this hospital function. With the hospital under the leadership of a Chinese Hospital Superintendent and with the medical support of hospital physicians such as Dr. B.S. Chen, the community gradually stopped calling Chiayi Christian Hospital “The American Hospital.”
醫院繼續成長為現在我們眼中美好的樣子，對於曾在醫院的成長中參與過一小部分，我感到很驕傲。
The continued growth toward the amazing hospital we see today had begun! I am proud to have been a small part in that growth.
[註] 2008.4.24倪安華醫師於嘉基五十週年院慶之全院演講會中分享全文。