The Power of Companionship: An Interview with Dr. Sang-Ju Yu on Home Healthcare

2024/11/20

“If you think something is not going well or needs change, the best way to change it is to first show an ideal model to society. This is part of what I have learned from The Alliance Cultural Foundation (ACF) Chair Stanley Yen,” said Dr. Sang-Ju Yu, founder of the Home Clinic Dulan in Taitung. Dr. Yu talks about home healthcare, a model that allows patients to receive medical treatment in the comfort of their homes. He says that what often accelerates an elderly person’s decline is not just the illness, but loneliness. In the face of the declining population in rural areas, through community mutual aid and the companionship between caregivers and those receiving care, these lives can rediscover value, becoming the vital force in rural areas.

Dr. Yu, who graduated from Kaohsiung Medical University and the National Cheng Kung University Department of Public Health, gave up a stable and high-paying job in the hospital to serve in rural areas. He says, “My biggest act of rebellion was choosing to become a home healthcare doctor.” Dr. Yu’s Japanese wife, Yukiko Igarashi, a Ph.D. candidate at National Taiwan University’s Graduate Institute of Building and Planning, has not only worked alongside Dr. Yu to promote home healthcare but also assisted him with translation during visits to Japan. She became a catalyst for inclusive/symbiotic society. Between 2014 and 2016, they visited Japan several times, bringing back the concepts of home healthcare and inclusive/symbiotic society to Taiwan. In 2016, Dr. Yu joined the home healthcare team at Taitung’s St. Mary’s Hospital, where he served as the attending physician. He volunteered to serve in the resource-poor Taiyuan Village. He moved to Taitung with his family and, in 2017, established Taiwan’s first home healthcare-centered clinic, the Home Clinic Dulan.

The Arrival of an Ultra-Aging Society: From Japan to Taiwan

In a broad sense, home healthcare refers to doctors or health professionals personally visiting patients’ homes to provide medical care and support their health and healthcare needs at home. In rural areas, many elderly people are unable to seek medical care due to inconvenient transportation or because their children cannot take time off to accompany them. This can lead to interruptions in chronic disease medications, and some elderly patients require palliative care when nearing the end of life – all of these are areas where home healthcare can assist. Dr. Yu says, “It’s about helping you live well in a familiar environment.”

Since 1995, Japan, which had entered an aging society, began actively addressing the challenges of population aging and long-term care. Dr. Yu’s views aligned with those of a renowned Japanese community designer who proposed community design that integrates regional healthcare and social welfare support. Dr. Yu learned a slogan from Japan – Home healthcare is community building. Taiwan will enter an ultra-aging society in 2025, where one in every five people will be over 65 years old. In response to aging and population decline, home healthcare is not only part of alleviating healthcare capacity but also plays a crucial role in stabilizing local revitalization.

Through Healthcare to Achieve a Inclusive/Symbiotic Society

“Healthcare is an easier way to practice a symbiotic society because the impact of healthcare is so strong. There’s no one who doesn’t need it.” Dr. Yu adds, “When doctors enter patients’ homes, they often find that what patients need is not just medical care, but help with various daily difficulties. At that moment, we can connect them with community resources to assist on various levels.”

One of the most important goals of local revitalization is to balance the population distribution. It’s not only about attracting people to return to their hometowns or moving from other places, but Dr. Yu’s work focuses more on optimizing resources ensuring that elderly people are not moved to cities by their children out of concern for their safety or lack of medical resources.

In recent years, there have been many initiatives encouraging young people to return to their hometowns. However, Dr. Yu observes, “If one or two young people move back but ten or more elderly people leave, the population remains unbalanced.” When the population declines, demand disappears, much like setting up a service industry without customers.

“Those in their fifties and sixties who return to care for their families are a great asset to the community. They have rich social experience and understand the local language. Not only do they know how to care for their families, but they also know how to survive in society.”

Many of them are retired, each with their own expertise, but Dr. Yu observes that many people returning to rural areas are unable to find their role in the community or make use of their skills. He observed that while there is employment counseling, there is no system for matching jobs or volunteer opportunities. If this support can be enhanced in the future, many people willing to contribute to rural areas will be able to weave a larger network of mutual aid. “To assess the value of a community’s symbiosis, we can look at how actively the residents assist each other.”

In Dulan, a form of “Dulan currency” has become popular. Although unrelated to healthcare, Dr. Yu shares it as part of his message. “Dulan currency” is based on the concept of time currency, where residents exchange time or skills to help each other. For example, carpooling, taking out the trash, fixing things, feeding dog, etc. Through these small daily acts, everyone becomes more proactive in caring for their neighbors. Because one day, we will all grow old, and if such a mutual aid network allows people to rely on each other, it will achieve the ideal of a symbiotic society.

Hospital Festival

In the 1950s, in Nagano, Japan, due to local farmers’ lack of understanding of hospitals, they feared that once they entered, they would never come out. As a result, many farmers delayed seeking treatment until it was too late. To break this barrier, the director of Saku Central Hospital personally visited patients’ homes, becoming one of Japan’s earliest examples of home healthcare. Later, the hospital initiated a “hospital festival,” where the director wrote scripts, and medical staff performed in plays to educate farmers about tuberculosis, stroke symptoms, alcohol abuse, parasites, and more.

Inspired by this, Dr. Yu organized a “clinic festival” in the first year of the Home Clinic Dulan. The clinic festival this year, on December 14, will be held at Dulan Elementary School with the theme of sports because many people mistakenly think that labor equals exercise. “The ‘festival’ is about everyone coming together to have fun,” Dr. Yu says with a smile. “Fun is important.” Through this collective participation, health and illness become as natural as everyday life. They have held such events in different places in Taitung, such as Xingchang, Longchang, and Taiyuan villages. Over the past eight years, they have organized these events with buses bringing residents, and about 200-300 people participate each year, with some even traveling from other regions.

Becoming the Place that Makes Doctors

Many people ask Dr. Yu if practicing home healthcare means he is constantly busy and has no time to rest. He responds, “Actually, it’s not like that. The residents of Taitung have great respect for medical personnel, and I feel like we’re returning to a healthier doctor-patient relationship.” Moreover, doctors are no longer constrained by office hours, and there are no patients coming simply for reassurance or to get prescriptions. Sometimes, remote consultations and timely follow-ups are enough to monitor a patient’s condition. Japan has already implemented a time difference system in home healthcare. For example, since Europe’s daytime is Japan’s nighttime, Japanese doctors in Europe can handle remote consultations from Japan during the night.

The Shared Decision Making (SDM) model used in home healthcare also helps reduce doctor-patient disputes. SDM allows patients to decide on their treatment path, with doctors and medical teams evaluating resources based on that decision to help patients achieve their ideal treatment goals.

Talking about his life, Dr. Yu says his leisure activity in Dulan is seeing patients. While it may sound unbelievable at first, for him, doctors can be themselves, and patients can be themselves. When he faces patients who are feeling depressed and say, “Why doesn’t God take me sooner?” Dr. Yu jokes, “If you pass, our clinic will have to close!” The trust between doctors and patients is purer in rural areas. Many medical professionals from other regions come to Taitung and find it to be a place to recharge. Dr. Yu even tells the directors of other hospitals, “If anyone wants to leave their job, send them to us, and we’ll help them recharge!”

Helping Every Corner of Rural Areas Live Well

When discussing the future, Dr. Yu described it as a journey of moving forwards as we solve challenges. They discover problems and try to improve them, ensuring that community care truly takes root. This year, they began planning a Hospitality Home Project, inspired by hospitality expert Patrick Su, which emphasizes care and respect when serving others. The goal of Hospitality Home (款待之家) is not just to provide institutional-like medical care but to revitalize old houses, and create a home atmosphere, providing three meals a day and daily care, allowing each resident to live comfortably while also giving them the motivation to keep going. When doctors visit to provide medical services, other long-term care units will assist with daily care. 

Compared to Japan, in Taiwan, healthcare and local revitalization currently exist on parallel tracks. Dr. Yu’s aspiration for Local Revitalization 2.0 is to integrate healthcare connections and amplify their impact, complementing local revitalization efforts. 

Have you encountered any setbacks along the way? Optimistic as always, Dr. Yu responded, “Probably, but my poor memory has forgotten them all. When faced with challenges, you can’t remain stuck; life must move forward.” Last year, Dr. Yu’s wife successfully applied for funding under the 10th New Immigrant and Children Program. She used all the funding to organize a Football All-Star Game this year for Salimpo Primary School, Chenggong Elementary School, Fugang Elementary School, and the Chi-Hsin Brave Football Club. A total of 70 children signed up for the event. In addition to elementary school students, the event also invited four players from the National Taitung University Affiliated Physical Education Senior High School’s (NTUAPESHS) women’s football team as coaches and seven players from National Taitung Junior College (NTJC) football team to serve as referees. The children not only experienced the joy of football but also learned about teamwork. 

During this process, Dr. Yu and his wife gained a deeper understanding of the children’s family situations. Some lacked hot water or did not have breakfast prepared. The couple connected with other support systems, such as after-school tutoring, character-building camps, and online distance learning programs. They used the power of the community to support these gifted but under-nurtured children. Yukiko Igarashi remarked, “My son and I were simply ‘dreaming.’ Without the support of the Ministry of the Interior National Immigration Agency, Home Clinic Dulan, the Take You Home Association volunteers, team coaches, principals, directors, teachers, parents, and the players from the NTUAPESHS and NTJC football teams, we wouldn’t have been able to realize this dream.” 

Dr. Yu’s initiative echoes what ACF Chair Yen proposes in his Total Solution: A Blueprint for the Tribe’s Future. “When the issues of education, employment, and caregiving are solved simultaneously, it becomes possible to support fragile and endangered tribal cultures.”

2024 Home Clinic Dulan Festival

  • Date: 2024/12/14
  • Location: Dulan Elementary School
  • Details: Follow the Home Clinic Dulan Facebook

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