The Social Holocaust of Taiwan

“What do you think of the declining growth of Taiwan?” is the question I asked a select group of people. Beyond having no major concern, I hear comments like “A declining population rate is the norm in advanced societies.” and “Why would people want to have a child in todays society?”. What if I told you that, at the current rate Taiwan would slip from over 23 million people to just barely 21 million in the next 10 years? What if I told investors that in 20 years there would be an unavoidable GDP loss of NT$1603244606976 (US$50,101,393,968) for no other reason than a reduction in the workforce (Assuming the annual average GDP US$16,392 per capita in Taiwan as listed by the 2009 International Monetary Fund)? What if I told contractors that they should stop expanding the housing market, but rather only rebuild 2 in 3 decrepit houses? What if I told you that the only reason that the birthrates are this high is because 1 in 8 babies in Taiwan are born to a non-Taiwanese mother? What if I told you that in 40-50 years, it will be impossible for Taiwan to cover the cost of their older generation? But this question is about much more than money.

Where does this problem stem from? Unfortunately with the resources that I have at hand I can only make assumptions based on educated guesses. But at the root of any growth rate problem is an issue with relationships and decisions to have children. So lets take a quick look at some of the reasons why there would be less children based on existing relationships today. Well, tolerance and acceptance for same gender relationships would be an immediate response. Netherlands, Belgium, Spain, Canada, South Africa, Norway, Sweden, Portugal and Iceland all accept same sex marriages (I am not saying Taiwan accepts this, but I am saying it is becoming more tolerant). Well all of these countries have lower birthrates, but no severe shifts after accepting same sex marriages, so that probably isn’t a major reason. There is an interesting article written by Time Magazine that very superficially covers this issue. They go on to suggest that selfishness is one of the core reasons. They have an interesting survey (of only 100 people) in Taiwan between the ages of 20 and 40 about their family plans. One-third didn’t plan to have any children for fear of losing two precious things: money and freedom. I do not think its that simple, and even if selfishness were the core reason what are the drivers for this selfishness?

Here are some of the obstacles I see in relationships in Taiwan. Lets take a quick look at what I call the ‘da jia’ mentality. There is a concept foreign to western cultures that all people are part of a big family. The saying in Chinese ‘da jia ni how’ is equivalent to Hello Everyone, but the literal meaning is big family you how. Any foreigner who lives in a Taiwanese family will be able to verify that there is no sense of privacy, nothing is sacred or private. I like to think of this as a holdover from a more socially tolerant society where members of a village shared food, shelter clothing etc. in order to survive in times of poverty. If you look at Taiwanese and Chinese times of poverty, and there are a lot of examples, you will find this generally true. Even further, today I like to visit small isolated villages in southern Taiwan. Where this mentality is still partially visible. In reality, the open and friendly ‘da jia’ mentality is all but dead in anything other than its reference to social politeness and historical understanding of the term. Lets evaluate the dating scene in Taiwan. An unofficial uncounted poll of mine has lead me to believe that the primary ways men and women meet up are by; work or school acquaintances, the internet or friends of friends. Meeting someone at the bookstore, or in the MRT are very rare examples. But in general it is socially unacceptable to try to meet people on the move (i.e. while commuting, while at a store, while with family and while with friends). Severely limiting the places and ways that it is acceptable to meet people. Now, lets take a quick look at the parent approval process in Taiwan. Taiwanese in many cases live with their parents for a good portion of their life. It is typical to live with their parents until they are well into their 30’s, and many will care for their parents when they get older. Things like sex are taboo (to the parents) without marriage, and the introduction between a partner and the parents typically does not occur until marriage is proposed. Forcing most relationships into the closet. Many Taiwanese, unless they can financially afford to move out of their parents house and have some financial stability, put off the decision to have a baby until their 30 something marriage. So having a baby at 32, does not leave much time for the decision to have another.

In summary, I would suggest that the loss of an extroverted nature in practice and in culture makes meeting the right person very challenging. Coupled with the facts that romantic relationships are heavily strained by the family and financial burdens for housing are high typically place generally acceptable ages for children into the twilight of child bearing years. This places an additional burden on society considering that this late birthing entry brings heightened chances for genetic defects. Ultimately these generally accepted facts bring about what I call the Social Holocaust of Taiwan. Unless a major shift in this philosophy occurs, a financial devastation of profound magnitude will occur in my lifetime. However, it must be noted that bringing Taiwan back to such levels of poverty may increase the birthrates once again.

Food Handling

Okay, Taiwan is full of undercooked meat, eggs and poultry. In fact asking to have food cooked properly typically gets a raised eyebrow or the kitchen help laughter as to why would this idiot want his food overcooked. Raw eggs on top of Italian noodles, to semi warm meat on your plate to sashimi. Poor safe handling (I.E. raw meat cut in the same place as vegetables to be served raw) in every form imaginable is practiced almost everywhere you go. Meat (cow and pork namely) is moved in large blue trucks with the meat swinging in the air picking up road dust in 30+degree heat, brought to stores, markets and left on plates exposed to flies and people walking by, casually placed on the same cutting board that hasn’t been cleaned in days and frequently is made out of wood where even when cleaned still has bacterias. Another day or three pass by in the markets without air conditioning or cold storage as the meat is purchased, and the only safeguard between you and that meat is how well you cook it. Nobody complains, thinks it strange or out of place, and they wonder why botulism and salmonella are frequent. In fact one popular medicine for ‘bad stomach’s’ in Taiwan comes from Japan. That medicine is actually used to fight dysentery when Japanese soldiers would go to war in undeveloped countries. But here its just another over the counter medicine like asprin (which is actually now regulated and has to be sold by a licensed dispenser of medicines). This is one of the few places where Taiwan does not excel over China in sanitation, and being compared to a country where little kids play in the open septic ditches when they are bored is not a good thing. Telling the waitress there is a hair in your food elicits a casual finger in your food to remove the offending object, and fighting the cockroaches from your plate is not unheard of. I have been served a cockroach before that was cooked in the food. I have also been served rice with weevils. In fact, it prepared me for spending time in India, as I did not get an upset stomach eating the local fruit, vegetables and vendor foods.

Here Taiwan have a link, its on me.
Safe Food Handling

The Good, the Bad, and the Ugly – Healthcare in Taiwan

I spent some time a few years ago and detailed facts, figures and reports from the NHI about insurance in Taiwan on Wikipedia. It seems not even a remnant of my work is left, but rather a 3 paragraph stub of worthless information on the NHI. Since I do not not want to re-invest that time at the moment, I will stick with superficial information.

As brief overview, National Health Insurance (NHI) is the socialized health care system in Taiwan. It is compulsory for every Taiwanese.

The Good

In the frontier of civilized medicine moderated by large pharmaceutical companies and unethical costs, Taiwan has missed out on a lot. That is not to say their knowledge, equipment or practices are sub-par (quite the contrary actually), but the big money pharmaceutical companies have found little purchase in the heavily regulated and politically controlled industry. The bottom line is that health care in Taiwan is extra-ordinarily cost effective, filled with highly competent doctors, and can provide you the best treatment money can buy anywhere in the world.

The Bad

Because of the low-cost nature doctors are encouraged to use low cost drugs, and try to stick with a small selection of drugs. This means that on the whole, sometimes less effective treatments are provided to save money. This also means that the government stockpiles (not always renewing or maintain these as needed) drugs like Tamiflu and H1N1 vaccinations.

The Ugly

While there are many good aspects to health care, one of the great weaknesses is that there is little effort in time with the doctor and proper diagnoses of a condition. Most doctor visits I have been to are less than 4 minutes and the clinical diagnosis is based primarily on a very brief inspection. The problem is that I have had many very incorrect assessments. I know first-hand people who were treated for cancer that they never had, and children incorrectly diagnosed with life crippling diseases in these brief assessments.

Taken from telegraph.co.uk

Taiwanese doctor rebuked for 84-second diagnoses
A doctor has been rebuked by the Taiwanese government after an investigation revealed that he took just 84 seconds, on average, to diagnose each patient.

Published: 1:12PM BST 20 May 2010

The orthopedist diagnosed 61,366 patients last year, according to an investigation by the Control Yuan.

He diagnosed up to 339 outpatients a day, taking an average of 84 seconds, the investigation showed, triggering a request to the health ministry that he spend more time on his patients in the future.

Local media identified him as Wu Ming-feng of the private Minsheng hospital in south Taiwan’s Kaohsiung city, with TV stations showing footage of him defending his work style.

“If the government wants to restrict the daily number of patients, it’s OK with me. I don’t even want to have so many patients. I just thought it would be unfair not to see them,” Mr Wu said on the CTI television channel.

I would like to say congratulations to Dr. Wu for his dedication to his work. I would also like to think that the reason for his clientele is due to repeat visitors. Just because an 84 second diagnoses was made does not mean it was the wrong one. But the trouble lies in the fact that Taiwanese people will not complain if they are incorrectly diagnosed, so we will probably never know if Dr. Wu is a dedicated hard working professional or a dedicated hard working person who had little care for the end result of his work.