Floating hospital in Korea reaches out to isolated patients

Patients from Jangbyeongdo Island, one of 138 remote Korean islands that do not have any medical facilities, arrive on a state-run hospital ship by boat on May 20.

MOKPO, Korea ― Located in the southwestern part of the Korean peninsula, South Jeolla Province is home to 1,965 islands ― 62 per cent of all islands in the country. Of them, only 276 are inhabited.

One among them is Jangbyeongdo Island, which is about two hours away from its closest port of Mokpo. There are currently 91 people residents, 26 of them aged 65 or older. Most of them make a living by digging for octopus in the mudflats and seaweed farming.

Jangbyeongdo, only about 1.63 square kilometers in size, is also one of the 138 islands of South Jeolla region that have no medical facilities, pharmacies or resident health care workers. For them, seeing a doctor means having to travel to Mokpo, or wait for the "floating hospital" ― a state-run ship that functions as a medical facility ― that visits about five times a year.

The island doesn't even have berths for ships to anchor. When the ship arrives near the island, patients take turns to board a small boat that takes them to the floating vessel in the ocean.

The Hospital Ship Jeonnam 512, one of the five hospital ships run by the government that is based in Mokpo, offers dental care, general medicine services and traditional Korean medicine.

The ship also houses a little pharmacy and a room for X-ray screenings and simple medical tests. There is one general physician, one dentist, and one traditional Korean medicine doctor. All treatments and prescribed drugs are free.

Patients from Jangbyeongdo Island, one of 138 remote Korean islands that do not have any medical facilities, arrive on a state-run hospital ship by boat on May 20. (The Ministry of Health and Welfare)

On May 20, some 40 residents of the island ― almost half its entire population ― were on board, waiting for their turn to see the doctors.

One of them was Jeong Oh-rae, a 77-year-old diabetic patient. Her doctor, Lee Kyung-ho, seemed concerned about her blood sugar level.

It was over 300 milligrams per deciliter (mg/dL), an extremely high rate considering the normal level is 150 mg/dL. She was experiencing blurry vision, which is one of the typical symptoms of high blood sugar.

"You need to take more insulin. I'll prescribe it for you," Lee told Jeong. "I can't see you often enough to check on you regularly. Take the prescribed insulin, and make sure you tell your doctor in Mokpo about your blood sugar level the next time you see him."

Dr. Lee, 31, joined the team of Jeonnam 512 in April, as part of his public medical service that substitutes for his mandatory military duty. Having spent most of his life in Seoul, Lee said he wanted to gain experience in medically underserved communities.

"This is a rare opportunity for any doctor," he told The Korea Herald. "There are only five state-run hospital ships in the country, and each carries only one general physician. It's meaningful to be somewhere totally different from where I was trained as a doctor and give back what I learned."

For patient Jeong, the floating hospital visits are something she does not want to miss. "I get everything here, including eye drops and pain relief patches," she said. "They make me feel safe until the ship's next visit."

The ship's 15 staff, including three doctors, two nurses and two medical technicians, are onboard more than 180 days a year. South Jeolla Province runs two hospital vessels, including Jeonnam 512, as the region has the highest number of medically underserved islands. Each of the two ships visit about 150 islands annually.

A patient from Jangbyeongdo Island, one of 138 remote Korean islands that do not have any medical facilities, talks to a doctor on a state-run hospital ship that visits her island about five times a year. (The Ministry of Health and Welfare)

Being on the ship isn't always easy and sometimes poses unique challenges.

For traditional Korean medicine doctor Kim Jin-hoo, the challenge is to practice acupuncture when the ship is pitching on the waves.

Since a large number of residents of remote islands are the elderly, acupuncture treatments are especially popular among the patients who suffer from chronic back or nerve pain.

And sometimes, the treatment is a little too popular.

"I'm getting used to the pitching now, but practicing acupuncture on a floating ship is still a challenge," the 26-year-old doctor said. "One of the other challenges is that many of the patients don't want to leave the treatment room mostly because they want to talk more about their condition. But I have to ask them to leave because other patients are waiting in line. Things aren't as efficient as hospitals in cities, but I don't always mind because it lets me learn more about the patients at the same time."

Sometimes motion sickness is hard to handle, even for health care professionals. "I just have to lie down sometimes," said Park Jung-sun, a nurse. "Some days we are lucky, and some days we are not. It really depends on the weather."

The South Jeolla Province spends about 2.9 billion won (S$3.5 million) annually to run the two hospital ships. The central government supports 800 million won every year.

"The biggest burden is the fuel oil, which costs 1.2 billion won a year," said Kang Young-koo from the provincial government. "We would appreciate more support from the central government."

To improve medical services in remote regions in the country, the Health Ministry plans to introduce telemedicine, the use of information technology through devices such as smartphones in order to provide clinical health care at a distance.

The move has been fiercely opposed by the nation's largest group of physicians, who claim that it would lower the quality of medical services and jeopardize the operations of small local clinics and regional hospitals.

However, Dr. Ryu Jae-kwang, director of Mokpo Hankook Hospital who receives patients from remote islands across South Jeolla, said telemedicine is very much needed in his region, especially during medical emergencies which often require air ambulance services.

The Korean government currently only operates four air ambulances, much fewer than other countries as Japan, which runs 46.

"Telemedicine isn't just between doctors and patients. It is needed between medical staff," Ryu said.

"In emergency situations where the patient is in a critical condition, it is important to make the right diagnosis as soon as possible.

Telemedicine between experienced doctors and emergency staff decreases the chances of misdiagnosis and lets the patient receive the best possible care even when he or she is being sent to the right medical facility.

"South Korea has the best Wi-Fi system in the world," he continued. "It makes no sense that telemedicine isn't already happening."