Friday, September 28, 2012

The Chinese Government Is Full Of Liars

Also, lying businesspeople - but I am sure at least some number of businesspeople in China are basically honest - as honest as anyone can be in business (which, in my "bring down the man!" view, is not much).

No other comment, except to say that when the Chinese government "steadfastly denies" something like hacking for corporate and economic espionage, they are lying. Because they're lying liars who lie.

Tuesday, September 25, 2012

Waiting For The White Horse

Medium-good or slightly above average luck, waiting patiently afte preparing things diligently and in great detail: this fortune is just about right.

Two things today.

One, I have learned the value of not reading too quickly and then jumping to conclusions on comments when the commenter is someone who has offended you in the past. So chalk that up to two mistakes this month (the other was taking that stupid "this isn't actually a trail" trail up a mountain). Next time I'll read more carefully rather than seeing a commenter's name and assuming things.

Two, I was a part of a program that took students from one of the Big Four accounting firms to Longshan Temple today. The purpose was to train them in explaining interesting things about the temple to foreign visitors, so they'd have something to say in English about the things they already know in Chinese (plus some things they didn't know!).

During the program, the students practiced their English by going with me to draw a fortune stick. First you pray (apparently this is not strictly necessary, though), then you throw the fortune blocks (those crescent-moon shaped blocks) to ask the god if you may ask a question - if they land one side up, one side down, the answer is yes ("no" is two sides down, and "later" is two sides up - the god is laughing). You ask your question, and draw a stick. Then you throw again to see if it's the right stick (if not, you draw another). You take the stick to get a corresponding scroll with your fortune on it - the fortune is usually a poem, riddle or otherwise difficult to decipher message.

I got two "yes" answers and went to get my scroll, and ended up with 中吉, meaning "neutral luck", but my students said that it was not so much "neutral" as "medium good" - it was in the middle but still above average. I've had generally above average luck for most of my life, but not amazing luck (although I guess you could say that being born in the middle class of a developed nation in a peaceful region - even if the USA is not really a 'peaceful' country - to loving and supportive parents is amazing luck, which I guess it is from a global perspective). So...this made sense.

The little poem or message is something along the lines of preparing everything in great detail, and having the preparedness to deal with any problem. At that point, all one can do is "wait for the white horse to return in the sunset" or something along those lines.

So, slightly above average luck, you've prepared everything to the best of your ability, now calm down, be patient and wait.

I've been assured by my students that it's fine to post the fortune here, and even to admit what I asked for (it won't alter the fortune or render it invalid). So I can say here that I asked if my permanent residency application would go through.

Considering the headache I got preparing the documents, and the headache NIA gave me when they lost my records for 2007-2008 (and all I had to prepare to prove to them that I did, in fact, have an ARC at that time), this sounds just about right.

So...I just need to be patient. I've done all I can. It's been five weeks, though - I'm wondering when that white horse is ever going to show up.

Sunday, September 23, 2012

Mountain Rescue in Yilan: Our Scary Hiking Story and why Taiwan's National Health Insurance Rules (and America Sucks)

Near that waterfall is the water hole that Brendan fell into - this is us swimming before it happened
So, last Sunday (just about one week ago), my husband, a friend and I took a hike/river tracing excursion to Yuemeikeng waterfall: we wanted to show our friend the falls and I was eager to return with a better camera and take more photos. Plus, I wanted to try the hike in something better than sports sandals, and bought river tracing shoes for this trip as well as future ones.

We set off alright, following the directions I remembered, and made it a good ways up the river. Then we came to a deep swimming hole carved out by a powerful waterfall of moderate height. We took a swim, and then tried to figure out how to get over it. We weren't going to make ti by climbing, that was for sure. I remembered their being a side trail over this fall from our last hike, and started up it - but the ropes that had been there were gone and the ground was steep and slippery. This was almost certainly a result of the typhoon that had blown through recently. I was almost certain to fall into the gorge below - and not necessarily in deep water - if I continued. Other river tracers made it over the waterfall or had their own climbing equipment for that section of trail.

We searched for alternate trails and found none on the same side - I found what I thought was an alternate, in an area I vaguely remember walking around in on the last trip, and started up it, with the understanding that if this didn't work out, we'd either turn back or take the high trail, which might give us a view of the waterfall but probably no safe way down.

The trail seemed overgrown and in places not really a trail - but I saw some footprints, which made me believe that it was a good route up and over the falls, and we continued far past where we really should have.

Our friend said she was starting to believe this path wasn't safe - I wanted to look ahead to confirm that but was also within a few minutes of agreeing to turn back. We were maybe 20 meters above the gorge at this point.

Before that could happen, Brendan - who was hiking between us, shouted as a large section of ground gave out beneath him. I had just climbed the same bit of ground, but clearly two people clamoring over it was more stress than it could take. We heard his interminable fall down, grunting and yelping as he was hitting trees and underbrush on the way down in a manner not dissimilar from this (after Homer starts falling).

Twenty meters of that - later on we learned that he'd lost his glasses and his wedding ring in the fall - and twenty meters of us gasping in terror has he took the worst fall of his life, as well as the worst fall any of us have ever personally seen anyone take.

Then, silence. It was about ten meters after that straight down into the water, with nothing but a slick rock face in between.

And then, a loud splash.

We heard shouts, and then nothing. I was terrified and started shrieking - but I was also stuck. I had just climbed over the ground that had given out under Brendan. How would I get around that safely and back down? Could I get up to the trail at the top safely? Probably not and almost certainly not.

I told our friend, who was behind me, to go see about Brendan first while I figured myself out - I figured I could stay up there almost indefinitely (provided the ground didn't give beneath me too) whereas Brendan almost certainly needed immediate aid.  I still didn't know what had happened - I didn't know where in the river he'd fallen. I didn't know if he had a lot of cuts, some broken bones, a concussion, or worse. He might have been dead. The thought of that final possibility terrified me - imagine not knowing if your best friend, your beloved spouse, a person who is so good that they're like gold to their core, a person who, if they leave this world while young, then the world is not fair and any god that may exist is uncaring, and knowing it was your idea to take the trail up - and not knowing how you are going to get down to find out. Feeling like you, for deciding to check a little further ahead, should have been the one to go down with that chunk of dirt. For feeling like there might be a hole that just got ripped out of your heart and soul, and a person you are pretty much of the other half of, gone - and you don't even know yet if that's true.

Like that. I couldn't even cry, but I couldn't stop crying - it was that much of a shock. Obviously, it was a bigger shock from him, but I can only write knowingly about my perspective.

So as Brendan lay below - possibly OK, possibly not - and Emily tried to get to him, I spent the next few minutes figuring out how to get back down, or back up, or decide to wait for help, or somewhere or something. After several minutes of what seemed like careful deliberation but was really my adrenalin-fueled lizard brain making decisions for me, I swung carefully over the crumbled ground, hanging on by roots and prayers to a god I don't believe in to make it down to my husband at the bottom of the gorge.

Two-thirds of the way down, Emily came back and said two words: "He's alive". She also said "his leg's pretty bad and he's bleeding from the head, but he's talking and conscious and he's alive".

All I really heard was "he's alive" - I didn't remember the rest until later. I took Bigfoot steps through the bit of shallow river to where he was - some river tracers had seen him fall and gotten him out of the deep water.

Fortunately, he'd fallen in that one section of river carved out by the waterfall that was so deep that we, when diving down, couldn't reach the bottom. Ten meters straight down, and all I can say is that he was extremely lucky that that's where he landed. Ten meters into any other portion of that river and it could have been much worse. He was sitting on a rock, blood running down the back of his head (he patted it to show me that there was no brain coming out), back cut up pretty bad, huge gash in his knee.

We had no cell reception - nobody, not those with Da Ge Da, Fareastone or China Telecom, had any signal. Emily knows First Aid, so she watched for signs of shock, broken bones, trauma etc. as she used her teeth to cut apart the cheap towels we'd brought and tie them to his bleeding. We got him food and water, and I took off with just some money, my phone and sandals down the river to get to an area with reception and call for help.

Truth be told, I wanted to be there with my husband in his time of need, but this made sense: I speak Chinese and know the trails and river better, having hiked a few times in this area before. Emily knows First Aid. It was smarter to send me for help and leave her with Brendan. A group of river tracers helped us to the best of their abilities, but went back to their activity when they saw he was basically OK, and probably going to be OK. Emily tore apart towels with her teeth (her teeth!) and tied them to his head and leg with shoelaces to staunch the bleeding, and looked for signs of shock, broken bones, head trauma, hypothermia and other injuries.

I got to a juncture where I still had no reception but had to take off my river tracing shoes and put on sandals. As I was doing so, a Taiwanese couple came by and I asked them if they had reception - I didn't, but they had China Telecom and did. They helped me call 119 - I thanked them and said I wouldn't mind if they went on their way, but they stayed with me. I had forgotten to bring food and water, and was starving and thirsty - they asked me if I was hungry and thirsty and gave me a sarsparilla soda and raisin bread, which I wolfed down like a thieving Labrador who'd just stolen it.

Sitting, wet and covered in mud and silt, by the bridge, waiting for the EMTs to arrive, while still racing on panic, guilt, worry and adrenalin felt like someone had trapped me in aspic - I couldn't leave, I had to wait for the EMTs - but I couldn't sit still. Brendan was probably fine, but I still had a curdling stomach (which didn't stop me from shoving an entire loaf of bread down my gullet, mind you) and a sense of urgency. No....URGENCY.

Five guys showed up - a local lookin' dude in blue and white plastic shoes and faded clothes, a guy in a black EMT shirt with some ropes and a walky-talky, and two men in burgundy shirts with something wilderness-y embroidered on the pockets.  One had a pallet and huge Emergency First Aid bag. One wore dress shoes. At first I was really worried - this was mountain rescue in Taiwan? A dude in sandals and another in dress shoes?

I led them to the river, put on my tracing shoes and was all "OK, LETS GO NOW" but they stood around for what felt like the same amount of time it took for the Roman Empire to fall, discussing amongst themselves in Taiwanese.

I tried to implore them to just go through the damn river already, my husband is hurt and you need to go NOW. I was perhaps a little more hysterical sounding than I should have been. The younger of the two burgundy shirts said he understood my worry, but Sandal Guy was an experienced mountain guide in these parts, and carrying my husband back through the river was more dangerous than a trail. If a trail could be cut, they'd try that instead.

"But there are no trails! We were just there! He fell because I thought it was a trail but it wasn't a trail and WE NEED TO GO NOW!!11!!1".

One of them said (in Chinese) "I know, this is your husband and you are really worried, but trust us, we know what we are doing and we'll get him out." That calmed me down, because even I could see that he was right.

I should have shut my mouth, or shoveled in some more raisin bread - the EMTs clearly knew what they were doing and the mountain guide got them down through a trail they cut themselves. I waited at the top - I'd be more trouble than I was worth at this point, and I finally realized this and stayed out of the way - while they descended to the river below with ropes, pullies, the pallet and the aid kid. Ages later, they carried, dragged and prodded my husband up the "trail" from where he was sitting in the river.

At first I was horrified that they'd make him walk in that condition - we called 119 in the first place because he couldn't walk and was feeling faint - but also contrite, so I waited to ask Emily why they'd decided to pull him up - at times making him walk by basically forcing him along and shouting at him in Taiwanese - rather than put him on a stretcher.

Apparently they'd examined him, bandaged him, and saw injuries that would require stitches but no head trauma and likely no broken bones, and decided it would be smarter to get him up partly on his own two feet (well, his own one foot) and put him on a stretcher on the trail rather than have men haul him up on something not designed to be hauled in that way. Brendan had been sitting in the river - cold, flowing water - for almost an hour by then and was shivering. The cold water certainly helped keep swelling down, but there was a risk of infection that the emergency room doctor later warned us about. His shirt was ruined, and his spare soaked, so Emily put him in my spare t-shirt, which obviously looked ridiculous on him, but you gotta do what you gotta do.

A strange omen of things to come?

A few things amazed me about this part of the ordeal.

First, what a strong person Brendan is. I mean, I knew that, but Emily remarked later how amazed she was that Brendan sat there bleeding profusely for almost an hour and didn't complain or freak out. That, while in obvious pain, he made it up the mountain with those guys shouting at him in Taiwanese. He didn't understand them, but when it was clear he needed to move, pain or no pain, he moved. He stayed in good humor even as they got him to the main trail and put him on a stretcher.

Second, that mountain rescue came quickly and was free of charge - we paid the emergency room fees later on, but the actual rescue and ambulance didn't incur extra expense. It was as good as I'd imagine mountain rescue to be in any Western country. I would absolutely, if I were caught in an emergency in the mountains, trust these guys with my life. Dress shoes or no. I don't really know how it works - whether they're on call and in uniform at certain times or just always on call, but they got there in 20 minutes - on a trail that's not that well-known yet (many people in Jiaoxi have never heard of it).

Third, the disparity between the locals who helped me so much, and the group of river tracers later on (the group that was there when Brendan fell did their best to help us out). As they were trying to figure out how to get to Brendan, a group of them was returning down the trail with all sorts of equipment. The mountain rescue guys asked if they'd stick around and help if necessary, and they said no. They were within their rights to do that, but I was surprised. I guess I would have stuck around. I have noticed when enjoying Taiwan's great outdoors (and how great it is!) that other individuals and small groups or families totally have your back. They'll chat with you, help you out, share snacks with you (and I do share with them), even give you a ride. The large, organized groups, however, never do. They'll make sure you don't die but that's about it. Again, within their rights, but being within your rights is not always synonymous with being kind. I remember a story told by a friend who climbed Jade Mountain and hiked from the bus stop to the first cabin (back when that was a 14km hike with no public transport). It was dark and raining and they were being followed by dogs, but nobody with a vehicle would give them a ride - all organized hiking groups. Contrast that to when a friend and I got stuck at the Laomei waterfall trailhead - a 2km, no streetlight walk back to any main road through farms where dogs lived. We quite easily scored a ride to the nearest bus stop from another leisurely day hiking couple. In this situation, the most helpful non-professionals were the couple who lent me their phone and fed me their soda and raisin bread, and stuck with us until Brendan was in the ambulance. I never learned their name (but I did thank them), and they'll have my eternal gratitude for taking care of me when I needed someone to help me help Brendan.

Fourth, I have not yet figured out how our band of three, plus the couple that helped me and the rescuers (fewer than ten) turned into a parade of approximately 30 people as we got to the end of the trail. I honestly have no idea where most of these people came from - two guys on scooters, a guy with blue hair, a few other day hikers, and about twenty other completely random people. My best guess is that word got out among people at wherever mountain rescue hangs out and the base of the trail that "some dumb foreigners had an accident in the mountains, why don't we go see what's up?" "OK, I've got nothin' else going on, let's check it out".

At the end, I thanked everyone including the Taiwanese couple and the EMTs got Brendan into an ambulance and sent us to National Yangming University Hospital in Yilan (I told them "the best nearby hospital" and that's the one they chose). It was my first and hopefully only ambulance ride not only in Taiwan, but ever. And yes, I Facebooked the whole way there, once it was clear that Brendan would be fine (obviously I would not have done that had he not been OK). It's not often that you get to be tagged in a photo like this:

Don't worry, Brendan's the sort of person who sees humor in such photos, assuming the person is not in any danger.

At the emergency room, he got a CAT scan and an X-ray, care for his less serious wounds, stitches and a dry hospital gown.

The X-rays and CAT scan confirmed that he managed to slide 20 meters and fall straight down for another 10 or so without breaking any bones or suffering any head trauma. Not even a mild concussion.

Which means that the fifth thing to amaze is that I am apparently married to Clark Kent. I think he may fly around saving lives and stopping criminals while I sleep. If a fall like that doesn't break a bone, I am not sure anything will (knock on wood).

Then they gave him an IV to make sure he didn't dehydrate, gave him some painkillers and observed  him for a few hours to make sure he didn't have some trauma they'd missed (nobody wants this), and a chance to rest. The care he received was as good as any you'd get in an American emergency room - no, better. He didn't have to wait. The ER was a little busy, but not understaffed. He got the attention he needed immediately - something you may not get in an ER in the West. I remember cutting my knee badly enough that I needed stitches one year at summer camp, and waiting two hours in the ER before a doctor was free to see me.

Emily and I went to a nearby hotel that has a deal with the hospital to provide discounts to patients and their family - we got a room for three hours (NT$500) and took showers and a rest. I frequently walked back to the hospital to check on Brendan, and 7-11 to buy him some sort of shirt. He had no clean, dry, non-ripped and non-bloody shirts to wear. He ended up with undershirts, but they'd do. He felt faint, but probably from exhaustion and shock more than anything, and I helped him hobble very slowly to our hotel room. Once there, he said he didn't think he'd make it back to Taipei that night, so we sent Emily home, paid a bit more for a full night, put a towel down on the pillow and slept in Yilan. We both canceled work the next day. Him because he was in no condition to teach, me because I needed to get him back to Taipei and then help him at home.

Some things I learned from the whole ordeal:

- I do realize just how lucky Brendan is. I do attribute it to luck: if anything, the fact that some people are not so lucky at all, and people do die hiking, mountain climbing and river tracing just because they didn't manage to fall into deep water, has made me feel that no, this is not the result of a higher power watching out for us. If it were, people just as deserving of a happy ending as Brendan would get it. So this hasn't caused any sort of religious epiphany.

- I will never, ever, EVER again make fun of people who take what seem like too many safety precautions when hiking or river tracing. I do understand the need for climbing gear, a wetsuit and a helmet for serious, challenging river tracing, but I felt that the Yuemeikeng trail was so easy - I mean, even I have done it, and I'm hardly Olga Outdoors - that a helmet was really not necessary. Well, no. Brendan was fine, but he might not have been, and had he fallen a few meters to the left, a helmet might have saved his life. In this case, a helmet would have meant no stitches in his head. So kids, listen to Auntie Jenna: wear a helmet when river tracing.

- Just because something has footprints and looks like a trail does not mean it is a trail you should be taking, or a real trail at all. I don't care how those footprints got there, if you feel like it's not a good trail, don't take it. Just don't. Even if you have to turn back. I have learned my lesson.

- I am really not interested in hiking or river tracing right now. I will surely hike again in the future, but for the forseeable future I am going to stick to safe trails. I had the jeebus scared out of me and I'm not interested in it happening again.

- I do realize how lucky we are that this happened in Taiwan and not, say, Nicaragua, Sri Lanka, or Indonesia...or even China. Yilan County had the facilities to come to our aid quickly. I don't want to think about how much longer Brendan might have sat in that cold water, bleeding had this happened in a less developed country, or one in which we didn't have a cell phone (we generally don't travel with one), or I didn't speak the language, or had subpar hospitals. I am not too interested in seeing how good Nicaragua Mountain Rescue is, or how good their hospitals are. Lesson: don't do risky hikes in places where you don't have access to emergency services. Get a guide or don't go. It sounds obvious, but you'd be surprised.

- Take a First Aid course. I will. Again, it seems obvious, but it hadn't really occurred to me. Emily did a lot to keep Brendan safe while I went to find help, and I'd like to have the knowledge to be able to do something similar should I ever need to.

This was our final destination - I'd been there before. We never did make it. I'm not sure I'll go back. Too many bad memories now.

Finally, for all of you out there who still think America's craptacular private health insurance "system" is superior to a nationalized system like Taiwan's, I can assure you that National Health Insurance saved our butts. I am a big fan of Taiwan's nationalized insurance, which covers everyone but allows private hospitals and clinics to open alongside government-run hospitals. It means everyone is covered, but you don't have to wait for care because the private clinics help ensure that everyone gets quick attention. It's expensive, but not any more expensive than what you lose in productivity when you have a population that can't afford to seek medical treatment before it becomes dangerous/unavoidable. It's not perfect - people complain of perfunctory visits and ridiculous regulations on what can be prescribed when, and what is and isn't covered - but it's a hell of a lot better than America's horror.

Here's a breakdown for you:

Mountain rescue
Taiwan: free
USA: Usually free, but not always (It's hard to say if we'd have been found "negligent" and possibly charged for the cost on the USA: in retrospect we shouldn't have been on that "trail", but at the time, seeing those footprints, it seemed like, if not a great idea, that at least it wouldn't end as it did). Had we been hiking in Maine, Brendan's home state, the government would have been legally allowed to bill us for the cost of the rescue.

I'd say the level of training and competence evident in Yilan is comparable to what I'd expect in the rest of the developed world.

EMTs and Ambulance
Taiwan: free
USA: It depends - but usually not free
It may be ree if it is publicly funded, but it's not always. Private or fee-based ambulance services can be quite expensive (I know, Yahoo! Answers is not a good source, but in this case I believe it is accurate). Private insurers may or may not cover it: if they deem it wasn't medically necessary (Brendan technically could have been transported by car, but we didn't know that at the time), or are out-of-network, or take you to a hospital that the insurer won't improve. The ambulance may be covered but take you to an out-of-network hospital. Or your insurance may only cover you in your region. Let's say $500 as many sources agree this is the typical fee, and with all the weird rules and ways to reject a claim, there's a fair chance we'd have been stuck with that fee. However, let's assume everything goes according to plan and you pay a $50 co-pay for the ambulance ride.

Emergency Room
Taiwan: NT$500 (US $20 or so)
My old insurance plan paid for ER visits with a $50 deductible, some charge up to $250. I think the mean is about $100 so let's say $100 (this coverage plan confirms that). Without insurance or if insurance deemed that his visit was not medically necessary (it was, but private insurers seem to work on a plane of logic devised from their own sense of whimsy coupled with sadism) it could have been several thousand. Brendan needed more care than the child in this article's first anecdote, but like the child, got stitches for a deep wound. Let's say without insurance it would have been a similar amount - about $5500. I'll be generous and assume that includes X-rays.

CAT scan
Taiwan: Free with ER visit
USA: $300-$1500 (confirmed here - could even be more)
I'll go with $1500 here as he had CAT scans with contrast dye of his head, pelvis, leg, foot and possibly other parts - he may have gotten a shoulder and abdominal ones as well. I'm really not sure. It could have been much more than that, up to $3000 or even higher. Insurance usually asks for a 20% deductible for such tests, which would be $300 for a $1500 scan, or $600 for a $3000 scan.

Taiwan: free with ER visit, very cheap (like maybe $10 USD) otherwise
USA: $200-$500 (check the comments)
Let's be generous, though, and assume in our range that the huge ER bill included the X-rays, stitches, doctor check and pain medication - I'll include this cost in a range, but it may not be a separate charge.

Follow-Up Visits
With stitches in wounds as deep as Brendan's, he'd need at least one follow-up to remove them, or more than one to make sure everything was healing alright. He'll probably have to see an orthopedist soon to check for soft tissue damage.

Taiwan: NT$200 (US$6), typically, no waiting - we paid more for one visit but it wasn't strictly necessary to go back to the hospital in Yilan before returning to Taipei
USA: US$50 with insurance, typically (it varies), or $200 or so (again, it varies) without insurance - that'd be for a doctor to check/remove the stitches and again to see the orthopedist (a specialist - plans in the USA vary).

Total: 4 visits so far in Taiwan (NT$800 or about $25 USD), we'd probably go to the doctor less were we in the USA. 2 visits at $50 copays is US $100, or without insurance $400 USD.

Walking Cane
Taiwan: free - the ER gave us one, but if we'd had to pay, maybe NT$300 (US $9)
USA: let's say US $20, although that is a generously low estimate

Taiwan: Free
USA: assuming ER medication was free but medication given later on prescription had to be paid for: my estimate (I have no way of verifying this accurately, but I can make a good guess) would be $20 with insurance, up to $60 or more without. Let's be charitable and stick with $60 for some basic Neosporin-type stuff and some antibiotic cream.

I won't even get into the cost of acquiring a hotel room ($30 US in Taiwan, probably $100 US in the USA), food while in a different city (negligible in Taiwan, probably $50 or so in the USA with three people eating a few meals, even if we ate cheaply), transport back to Taipei (we would have paid that anyway), and taxi to the bus station and then apartment (total $300NT or $9 US, would have been more like $40 in the USA), and getting Brendan shirts (about US $5 here, probably would have cost me more in the USA).

Total cost in Taiwan:

Mountain Rescue - Free
Ambulance - Free
$20 ER
CAT scan - Free
X-rays - Free
$25 follow-up visits
Cane - free
Medication - free

$45 USD for the entire thing

Total cost in the USA if you are lucky and have insurance

Mountain rescue - free
Ambulance - $50 co-pay
Emergency room - $100 with insurance
CAT Scan - $300-$600 with insurance
X-rays - charitably, let's assume this is covered by the emergency room fee. If not, maybe $100
Follow-up visits: $50 for two follow-ups and $50 to see an orthopedist = $150
Walking Cane $20
Medication $20

$640 - my minimum estimate with insurance, $1040 as a maximum total cost even if you are lucky and insured!

Total cost in the USA if you are one unlucky bastard

Mountain rescue - free (you're not that unlucky)
Ambulance - $500
Emergency room - $5500
CAT scan - $1500-$3000
X-rays - let's say this isn't covered by the ER bill and estimate it at $200 (which is being generous!)
Follow-up visits - $600 for two follow-ups and one orthopedist appointment (note that in Taiwan you'd have had four visits)
Walking cane - $20
Medication - $60


= may as well file for bankruptcy now

Or, $8,380 if you are only a little unlucky
and $9,880 if your CAT scan was on the more expensive end of things

Just in case you're not furious yet, here's the cost in Taiwan even if you don't have insurance:

Mountain rescue: free
Ambulance: not sure, but the EMT told me it was actually free no matter what (will double-check or someone can correct me in the comments if I'm wrong)
Emergency room: from my sister's visit, NT$800 or about $25
CAT scan - no idea - can anyone help? I'll ask some doctor friends soon
X-rays - NT$300 (from my own experience) or $9 USD
Follow-up visits - NT$400 each for 4 visits = NT$1600 or about $48 USD
Orthopedist without insurance - NT$1000 (estimated from what it's cost me to see a chiropractor and an OB/GYN that didn't take national health insurance) or US $30
Walking cane - NT$300 maybe (US $9)
Medication - let's estimate a total of NT $500 (US $20), which is overstating it


= USD $141 (not including CAT scan)


Poor Americans shouldn't go hiking. If you're poor, and American, or even not poor but lack insurance, don't just stop hiking - stop EVERYTHING. Just go live in a bubble. If you're in an accident, and live, your life is still over. If you can afford the bubble. Which you probably can't. You're fucked, because a bunch of "meh meh meh let's spend all our money on wars we don't need to be fighting and tax cuts for people who don't need them and then balance the budget on the backs of the poor and elderly and tell those poor and elderly that they're the moochers who won't take personal responsibility"folks.

And, also, clearly nationalized health insurance works, and clearly even setting the insurance issue aside, medical care costs too much in the USA and I have to ask why. Costs in Taiwan are about 1/2 to 2/3 that of the USA, so why is the difference more like several orders of magnitude just in the case of medical care? When medical care in Taiwan is comparable to that in the USA (in the case of emergency rooms, it's better)?

Note that the expenses listed in Taiwan are generally one line each - because it's all very simple. There's about a paragraph per expense under the US section, because it's complicated, and easy to get screwed (out of network, ambulance brings you to the wrong place, insurance says something was not necessary even though doctor said it was etc.). That right there says a lot about how screwed up the American system is. It shouldn't be that way. It should cost $X, at all times, for everyone, under every insurance plan.

And also, note that I put "in Taiwan with no insurance" at the end - because while it's possible to go through this in Taiwan with no insurance, almost everyone is insured. Youd've been insured, almost certainly. The exceptions are few and far between. In the USA, it is absolutely not a guarantee that you'd be insured.

Monday, September 17, 2012


So I officially turn into a Mom-jeans wearing member of the Uncool Club today at the ripe old age of sometime over 30 but younger than 35.

A true friend would get me a Taiwanese guy in a white mankini as a gift. 

By the way, when someone ordered this video for the KTV party, the Taiwanese guests all sang along happily - happy birth-a-day, 哈哈哈嘿嘿嘿" - while the foreigners looked on with raised eyebrows and dropped jaws.

Or something like this: O_o

Sunday, September 16, 2012

Orchid Island (Lanyu / 蘭嶼) - some observations

Continued from my last post, which was full of photos.

Blogger tends to make photos that are fine on my computer look darker - you can't see it as well here, but in the original, there's a line of goats down that gray mound in the foreground staring at me.
Flying into Orchid Island
So this past week we spent three days total on Orchid Island (Lanyu / 蘭嶼) off the southeast coast of Taiwan. We'd planned this trip quite some time ago - you have to if you want to coordinate three people's schedules and fly in. The prop planes that fly into Lanyu seat maybe 15 people, maybe 20, so although there are several flights a day, they tend to book out. It doesn't hurt that they're cheap (NT$2600 round trip) and the ferry trip tends to induce seasickness in even the sturdiest of stomachs. I get seasick very easily - carsick and airsick too, although I rarely throw up - and really wasn't into tempting the Gods of Heaving Over The Side Or Into A Bag. 

Sikang Chai's shop suffered typhoon damage, but otherwise, elsewhere on the island, it was there but it seemed quite minimal.

We were worried at first that it was a bad time to go to Lanyu, despite our plans: typhoon damage there made the news across Taiwan, and the Community Services Center not long ago held a drive for blankets, clothes, canned goods and more to help those affected. While I would have happily gone and volunteered, I'm not exactly skilled in the things such volunteers need to be skilled in, and generally speaking well-meaning but hapless Westerners in disaster zones often don't contribute much to a relief effort (there are exceptions, of course, especially among those with the proper skills), and I didn't want it to go down that way. I also stood ready to get there and donate, our homestay owner insisted it really wasn't necessary, and when we got there it sure didn't seem it.

I figured our best bet was to make sure the island could still handle tourists - and wanted them at that particular moment (tourism is great for the economy, unless all you've got is rice, fish, taro and instant noodles and not enough of those. Then it's not so great), so I called the local police station and a homestay to ask about the situation. The police assured me it was fine, there was plenty of food and shelter, and the roads, harbor, gas station and airport would be repaired by the time we arrived. The homestay owner was ecstatic about taking our reservations, so I figured her ability to feed and shelter us was not in doubt. As such, we went: in those conditions, tourism dollars can only help.

That's not to say there was no damage. The seawall near the gas station had clearly taken a hit. It was still there, but parts of it looked worse for wear. There were a few spots along the island where landslides had obviously taken out now-repaired sections of road. There are only two main roads on Orchid Island, and one of those roads is really secondary, so the impetus is there to get the main artery cleared as soon as possible. In one area it looked like a slice of mountain had been carved off like so much birthday cake. 

There was some debris here and there - but it was hard to tell if it was typhoon debris or the usual "piles of stuff" you often see around Taiwan. Orchid Island is less developed than the "mainland", so if anything it'd be more prone to natural piles of stuff. At least one well-known establishment took a hit: the roof of Sikang Chai's shop and gallery was clearly patchwork-repaired, and the inside looked like it'd taken a hit.

The coral off the coast also took a hit: we did some snorkeling, but really the coral was there in patches. It was not a full living reef. Few fish and no sea snakes. The water was full of polyps, though, and you could hear the crackling sound that live coral gives off: our snorkel guide told us it would be back to normal in about 6 months. Humans kill coral at an alarming rate, but it has an amazing ability to survive and reform after a typhoon hit.

Still, we didn't see much, if anything, in the way of destroyed homes (what might have been damaged was mostly already repaired). The underground homes in Dongqing looked basically as pictures indicated they would: if they'd taken a hit, they've already been repaired. There were a bunch of smashed-up boats by the harbor, but again, it wasn't clear whether those had always been there or were the result of the typhoon. Some of them looked rather too old and derelict to be typhoon-destroyed. The airport, harbor, gas station and road - all the main stuff - was repaired by the time we got there. Food and water was plentiful, wireless Internet and the one cell tower were up, and things seemed to be basically back to normal.


Flying in was fantastic - the water out there is so clear and blue that on a calm, sunny day, you can see to the bottom across much of the expanse between Taiwan and Lanyu, and approaching Lanyu the water turns such a deep-dyed blue that it's almost blinding, like blue if blue had four dimensions. I strongly recommend it for the views alone - for the 1pm flight I'd say the left side is better, you get a bluer sea.

Flying back was terrible - typhoon Sanba is far off the coast but with no land in between us and it, gusts from it affected the weather all the way out to Lanyu, and the turbulence was stomach-curdling and, honestly, kind of terrifying (I kept telling myself that we were at a low altitude so if we went down I'd probably survive. I'd stil fly again rather than take the ferry.

The cement guardrail along much of the western side of the island seemed repaired and repainted (that white paint sure looks fresh to me), with anti-nuclear slogans already graffiti'd on. Lanyu was once a dumping point for Taiwan's nuclear waste, something the island's locals (mostly aborigines called Dawu, Yami or Tao depending on who you ask) obviously did not appreciate and have not forgotten.

The guidebooks - and other blog posts, I'm sure - can tell you all of the other basics: flying fish and taro are food staples (as is a jelly-like mushroom fungus that grows in taro fields), people here don't like their photos taken, nor photos of their houses, that the island retains a far stronger aboriginal tradition than you'll find in most of the rest of Taiwan and Yami is regularly spoken along with Chinese and some Taiwanese, that Orchid Island is relatively underdeveloped, that the snorkeling is good (except for now, it seems), that you need to rent a car or scooter to get around, or at least a bike. I won't take up this space repeating all that with details. Instead, some observations.

First, that as "less developed" as it is, kids here clearly know how to use the latest technology. Here are two young Yami (I'm using Yami because in chatting with people, they called their language "ya mei hua" or Yami language, so I assume that's the term they prefer) kids in a coffeeshop deftly using our various smartphones to play games. The back of my iPhone is now covered in stickers they put on there. I think I'll leave them there.

Also, don't come expecting a totally undeveloped backwater. There's wifi, there's 3G at least on some of the island (Hongtou and Yuren at least). Thanks to tourism, and some local demand, it is perfectly possible to get real coffee (think lattes, flavored coffee, siphon coffee, espresso with condensed milk, sea salt coffee, and I got a millet wine coffee that was surprisingly delicious and very popular locally, according to the owner) and other amenities. A few beachside bars and cafes as you might expect in more touristy areas have popped up, mostly locally-owned. Enough that you can enjoy your beer or coffee on the coast in a comfortable spot, but not so much that it's overwhelming. They dot the island sparsely, but they are there. As a caffeine addict who can't think straight without a large mug of the stuff in the morning, this was important to know.

Just keep in mind that most spots offering such amenities, with one exception, open at 10:30am or later, and the free breakfast at most homestays will include tea but not coffee. There's one place you can go as early as 8am for coffee in Hongtou (the island's main "town") - 藍海屋 (Lan Hai Wu or Blue Ocean House) outside the southern edge of Hongtou (just keep driving past the hospital). They also offer diving and snorkeling, have a passable gravelly beach and pretty nice rooms to stay in across the road - call 0932-250-063 to inquire.

Kids playing with our smartphones at 漂流木餐廳 - a coffeeshop in the main northern hub of Hongtou.
Another observation - while adults tended to speak with each other in Yami, some obviously Yami people communicated with each other in Mandarin. Kids often did, too - these two siblings talked with each other in Chinese as much as they did so with us. Orchid Island has about half the population of the town where Brendan grew up (a small town in Maine) - if kids are using Mandarin to communicate with each other, then as strong as aboriginal culture and tradition is on Orchid Island, I worry about the fate of the Yami language.

On the other hand, most of my local interactions felt more like two non-native but pretty fluent speakers of Chinese communicating in Chinese - rather a big change from the usual native speaker and me, a fairly fluent non-native speaker, communicating in Chinese. My friends in Taipei say that Lanyu has a local accent - well, it does, but not in the way that native speakers from different areas have accents in the same language. More in the way that non-native speakers of one language who are native speakers of another have a similar accent in the second language.

These two have a younger brother, and are all the children of the owner of the Chinese-style hole in the wall restaurant next door. I noted first that one of the workers in the cafe basically treated them like her kids (going so far as to tell the younger misbehaving one "Don't make me get angry at you!"), and that she just kicked the kid out when he was causing trouble. As in, opened the door and pushed him outside, right onto the road (the main road, such as it is, can be seen from this photo - it's hardly a dangerous highway). The kid couldn't have been older than two. He wandered off down the street - which was considered totally fine. It takes a village, I guess!

This guy's pants are on fire

Another thing I noted is that a lot of the cafe workers in the more upscale spots didn't look Yami, they looked and talked like Taiwanese. I am sure some are local, but some might well be not locally hired or seasonal. I do hope this changes and more locals start getting such jobs - one man (who offered to marry our friend Emily) told us the same story you can hear in any rural or wayside place - forgotten by main avenues of commerce, adults grow old here and their kids go off to "Taiwan" for school and work. There's a lot of brain drain and the economy suffers. With unemployment comes alcoholism, and then others from more prosperous areas poke fun at locals for their laziness and their drinking, but small wonder why, no? This isn't unique to Orchid Island, of course, but it is why I hope we can start seeing more Yami or other locals engaged in local work. On an island so small that you can drive around it in an hour, there aren't a lot of jobs to be had.

So much gorgeous blue water, and no real beaches to speak of. A pity, or a cause for celebration?
In that sense, I wonder if it's a blessing or a curse that Orchid Island, with its wealth of other beauty, lacks good beaches. There are places where you can swim, to be sure, but the Rough Guide's calling of one beach "fine white sand" was a joke: you get some light-colored dirt-like sand in some spots, and some darker, gravelly sand in others, but while the snorkeling may be good, this isn't a place where you go to hang out on a beach. You can sit on a balcony and enjoy, climb a mountain, get on a boat or drive around and enjoy, drive to a headland or promontory and enjoy, but you're not going to be laying out a towel and soaking up sun and sand. 

And that right there is one major reason why Orchid Island is not a huge tourism draw. It's got the stunning inland scenery, the coral, the blue waters and the relative accessibility, but not the beaches. It's like the gods overlooked one crucial part of being an island paradise.


But then, if Orchid Island were dotted with fine white sand beaches like the Philippines, and then could offer it all: snorkeling, diving, boating, hiking, beaches and aboriginal culture, and it saw the major tourism numbers that Boracay or even Bohol or El Nido (in Palawan) get, would local culture disappear faster? Would catching boatmaking, catching flying fish and growing taro take a backseat or disappear altogether as locals opened beachfront cafes, sunglass shops and soul-crushing luxury resorts?  Would locals prefer that (I might prefer working in a beachfront cafe to growing taro, personally)? Or worse, would outsiders snatch up good property for development, would the mountains be cut off from the beach by hotels and restaurants, would property rates skyrocket as locals are forced off their land, and would all the most profitable places be owned by non-locals, with little and less money going into the local economy?

Probably - I saw it in Boquete (local coffee farmers unable to compete with gated retirement communities for wealthy Americans), in the Philippines (although I stayed away from most of the areas where beaches were fronted by nothing but hotels), in Indonesia (all the best spots taken up by resorts that no local could afford to stay in, let alone own). Even Kenting, massively popular with expats and Taiwanese alike, is a place I don't care for, and the beach isn't even that great (it's OK, but only OK).

I'd say whether that'd be a good or bad thing would be up for locals to decide, but it seems that when one has all you need to create a hot resort destination, that locals rarely if ever get to decide anything at all.

Anyway, some more observations. I did notice that most people referred to the main island of Taiwan not as "the main island of Taiwan" or "the mainland", but rather as just "Taiwan". Nobody disputes that Orchid Island is a part of Taiwan, but in the local parlance that's not conveyed: they treat it like a separate country.

"Who can blame us?" said one local we chatted with. "They don't pay attention to us, why should we pretend to be so close to them? We are Taiwan, but they are Chinese and we aren't."

I also noticed a distinct lack of people paying for things. I mean, we paid for things, but a lot of locals sort of wandered in and out of restaurants and other places. They ate, drank and made merry, and then wandered off without paying a dime. "Local economy," my husband noted, and I think he's right. I really didn't see a lot of money changing hands between locals - any money, come to think of it, even between locals of Chinese descent and locals of aboriginal descent. We were treated to beer and snacks in several places by locals, which the person treating didn't seem to ever actually pay for. I get the feeling that the entire island is running on one extremely complex system of tabs.

I also noticed that nothing was locked - not doors, not cars. Theft is really not a problem - especially for cars. "They could steal it," my homestay owner said, "but where could they go?"

It helps that everyone seems to know each other - the grilled delicious things stand owner knew the customer who proposed to Emily. The owner of the hotel we waylaid at in Taidong knew some guy on Lanyu and told us "if you need anything ask for him - I don't have his number but just ask, he's famous". As my husband noted, "it doesn't take much to be famous on Lanyu". Someone in another town knew our homestay owner and everything about her.

Remember back when I posted about how I offered an apple from my snack stash to the Atayal owner of a homestay I like in Hsinchu County? And how it was a bit of culture shock that she just took the apple an clearly wanted it (and didn't try to hide that) without the usual three refusals and two thank you's, or whatever is deemed necessary in Chinese culture?

Well, something I noticed on Orchid Island is how much more frank people are about certain things. Like, well, how our friend Emily got four (five?) marriage proposals in three days, and I am pretty sure at least a few of them were serious. Nobody harassed us - although one half-cut guy on a sitting platform in Dongqing got a bit too touchy so we had to leave - but upon learning that Emily was single, plenty of guys were totally willing to change her relationship status. Even if they were joking (which I am sure many of them were) the jokes were more frank, more ribald, more "hey baby" than I ever hear in Taiwan, where it might take a guy several months to even express indirectly that he likes you.

At one restaurant - Chinese style but Yami-owned - we were being treated to beer. It was maybe 11am but whatever. We ordered some tea eggs with our noodles, but the people who invited us to sit with them still had a bunch of quartered tea eggs on their table. “你可以吃,沒關係,不用客氣,隨便啦” ("go ahead and have some, don't be shy") one guy said. The laobanniang (owner, who was female) said "哈哈,妳可以吃他的蛋!" ("Haha, you can eat his eggs!"). It was a fairly mild joke by modern standards, but to three new foreign customers, from a woman, without hesitation, it was quite different from what I've grown accustomed to in Taiwan.

Finally, I noted that drinking and driving isn't the social sin it is in Taiwan. Not that I ever do so - I don't even drive much, but if I did I wouldn't drink - but here it's perfectly normal to down a few beers or even half a bottle of rice wine, and then get on your scooter and drive home. Without a helmet. It helps that there's only one road. You won't face much danger from traffic turning in ahead of you, but still, I wouldn't really say it's safe to do this, but nobody seemed to think much of it. The owner of the "grilled delicious things" place we ate at in Yeyou made sure Emily was good to drive (she had had some Taiwan beer, but stopped early and we felt she was OK to drive), but otherwise it didn't raise the eyebrows it would in Taiwan proper, where my Taiwanese friends are even more circumspect about drinking and driving than my American ones (and my American ones are all pretty careful).

Finally, one thing I really felt was that the culture here was not only not very Taiwanese, but that it reminded me far more of my time in the Philippines than Taiwan. The blue waters, the language I don't speak (although I can now say "cheers" and "thank you" in Yami - milum and ey-OY respectively), the flora and fauna, the slow pace of local island living, the grilled seafood, the more Austronesian/Pacific Islander culture rather than Chinese cultural influence, the more lax social norms. If anything Orchid Island is more Filipino than it is Taiwanese - but really, all that aside, it's just plain unique.

Delicious grilled things - flying fish, pork and more.
I might come back and add some more observations, but that's it for now. For the rest of the post, I'm going to make some recommendations.

First, you can see my recommendations above for coffee. For food, The Epicurean Cafe (mentioned in Rough Guide) really is great, but it's not where the Rough guide Map says it is. There's a road going up and then along a hill parallel to the main road on the north end of Hongtou - it's along the flat portion of that road, not the main road.

Otherwise, in Yeyou, just as the road turns there's a fairly innocuous restaurant with some outdoor seats advertising flying fish in Chinese. Across the street is a more sizeable restaurant advertising draft Taiwan beer. The grilled stuff restaraunt will change your life it is so good. We got pork, squid, flying fish, stinky tofu and chicken and it was all ridiculously good (we ended up getting two flying fish, ahd the chicken was amazing). That and a pitcher of draft beer from across the street is a great way to finish the day. Locals hang out here - you can chat with them fairly easily if you make this your dinner stop.

Blue Ocean House (above) offers standard Taipei cafe fare, but it was pretty good as cafe food goes. If you want some easy comfort food this is your place. Also, great patio out back.

The "small eats" restaurant in Hongtou near Lanyu Local Hotel (蘭與民宿) is open past the regular lunchtime when everything else closes and serves basic Chinese fare. A good choice if you were out driving too late past lunchtime and need some food, or need something quick before heading to the airport or harbor.

From the weather station at the top of the mountain road

Second, you could rent a car or scooter - renting a scooter means it'll be harder to get up the mountain road (I wouldn't want to do that on a scooter), but possible to get up to the lighthouse for sunset, and you are closer to the environment around you than you would be in a car. I definitely recommend going up to the lighthouse if you can (we couldn't).

If you can't or you're running late - leave at around 4:30pm from Hongtou if you want to see the sunset at the lighthouse - the smaller watchtower behind the gas station, near the harbor, is a good place to enjoy the sun going down. You can drive there and walk up the easy steps.

Definitely make the drive up to the weather station. There are some great panoramas up here, a picnic spot, an aboriginal-style stilted lounge area, a cool abandoned building and windy, gorgeous views.

Abandoned building at the weather station

An ideal picnic spot at the weather station

Dongqing Night Market...such as it is

The caves on the north coast don't sound like much, but they're worth a stop for a few good photos, if photos from caves are your thing. The photos in my last post of cave mouths were taken here. Definitely worthwhile is Dragon's Head Rock (above) - in fact, one of the best parts of visiting is to just drive or scooter around the island stopping where you like to take photos or enjoy the view.

Set meal at The Epicurean Cafe, which serves aboriginal-influenced local fare.

The Epicurean is a good place to hang out after hours for drinks - they make some drinks pretty well although their gin is quite rough (according to Emily). They close at 11, but are walkable to many hotels in Hongtou. Or you could continue the party at the bar/cafe across the street from the local hospital in central Hongtou (Hongtou is quite spread out down the main road). No ocean views but open late and a nice vibe, although we didn't go in.

You could go after you drive out to a viewing platform or to Dragon's Head Rock - or farther - to enjoy the stars. Definitely make time to do that - Lanyu's starry skies are really a sight to behold, with the Milky Way shining clearly across the sky.

We stayed at the Lanyu Local Hotel (蘭與民宿 in Rough Guide, 海波浪民宿 on their business cards - 089-732669) and would recommend it. The owner is from Taichung. She's very friendly, can arrange short (like 1.5 hour) snorkeling trips and boat trips if the weather is good. Breakfast, wifi, computer use and downstairs TV privileges for those who stay. Beds are Taiwanese-style on the floor beds and are quite firm, but clean and the rooms are spotless and air conditioned. Bathrooms are shared.

Caves on the north coast

Anti-nuclear power signs

Boats - damaged by time or the typhoon: it's unclear

I would also definitely recommend snorkeling while here. If you've never done it before, don't worry - you can arrange for someone to take you out and show you where to go and guide you as you both hang on to a life preserver. I enjoy snorkeling on my own, but this was fine as we only had one other person in our group (a Taiwanese woman - Brendan couldn't join us due to his injuries).  If it's a large group, try to arrange to go out on your own at some point as so many snorkelers in one place, with their hands, feet and bodies all around you, does tend to ruin the experience. 

Making a new boat

Driving around Orchid Island is one of the best parts of the trip
All in all I can say that I really enjoyed the trip - it was one of the most rewarding trips I've taken in Taiwan. I've done all there is to "do" on Lanyu except for possibly more hiking and snorkeling (two things we had to either do in moderation or skip altogether due to Brendan's injuries), but I'd go back just to relax and show friends around. If you're looking for a good getaway in Taiwan and want something different without going abroad, Orchid Island is just the place.

Saturday, September 15, 2012

Orchid Island (Lanyu / 蘭嶼): First Photos

I don't have time for a full post on our trip to Lanyu (Orchid Island - 蘭嶼島) right now but I do have about 200 pictures I'd like to share - I won't post all of them here, of course, but I figured I'd do this in two posts: one with some of my favorite pictures, and one with more narrative and some more good pictures, for maybe 40 shots total.

Here is a sample of shots to enjoy while I consider what to write for the narrative post, and also wait for some free time to pop up.

You will note the dearth of photos of people - that's because on Lanyu, many locals are wary of having their photo taken, or (so I'ved read) downright hostile towards those who try. As such, we didn't really try. I got a few shots, but not nearly as many people photos as I'd normally take.