tag:blogger.com,1999:blog-14685215638917779222024-03-18T11:03:46.653+08:00醫周刊發行單位:台灣醫療勞動正義與病人安全促進聯盟【醫勞盟】醫周刊http://www.blogger.com/profile/00037161558472297523noreply@blogger.comBlogger147125tag:blogger.com,1999:blog-1468521563891777922.post-43861133623539580922016-03-25T13:03:00.002+08:002016-03-25T13:05:35.634+08:00小故事告訴你,不要選公費!一文續文/ Rupert<br />
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也許,有人認為,「小故事告訴你,不要選公費」一文太過偏頗。那麼,這篇文章能夠更精確的告訴你,沒有背景沒有錢,千萬不要選公費!<br />
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小明是一個工人,在他18歲那年,他與老闆大衛簽了一份工作合約。在他25歲畢業後,準備要去大衛的偏鄉工廠工作,履行合約義務。到底,小明是如何被分派到東部的工廠?<br />
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小明畢業那一年,老闆大衛發了一封電子郵件,通知所有跟他簽約的工人,準備參加一個號稱「公平、公正、公開」的分發大會。今年與大衛簽約的畢業工人有六位,剛好有六個工廠特別缺人,分別是馬祖東莒、東引、金門烈嶼、台東、蘭嶼及綠島。<br />
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在工廠缺額公告後,工人們人心惶惶,因為其中有一個東部工廠的朱廠長非常「出名」,據說是他在台中工廠曾經被投訴鴨霸的八大罪狀,後來又轉調到東部工廠。而東部工廠沒有盈餘,工人們都過得非常痛苦。<b>因為工作量大,月薪僅剩其他工廠的三分之一,連夜班的值班費都只有時薪20元不到。</b>還聽那裡的工人說,他們每次向朱廠長問到為何薪水這麼低的時候,朱廠長總說:「你去問大衛啊!<b> 當年你18歲時,我有逼你跟他簽約嗎?</b>」<br />
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廠務會議中,廠長口頭喊著要共體時艱,但他卻能買名牌車接送上下班,到比利時參與每人30萬「牽馬散步,與馬對話」的課程。他寧願與馬對話,也不願與工廠的工人溝通,讓工人們心裡很不是滋味。<br />
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有鑒於此,小明在分發大會前,便積極的前往他所嚮往的綠島工廠向林廠長毛遂自薦,並期盼林廠長願意讓他在綠島工作。林廠長見小明相當認真誠懇,便口頭允諾,絕對會讓小明在分發大會上金榜題名!分發大會當天,六個工廠的廠長到齊,幫六位畢業工人進行「公平、公正、公開」的面試。三個小時的面試結束,大衛與六個廠長到了會議室,討論著最終工人們分配到各工廠的名單。<br />
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開完會後,大衛在講台上唱名:「綠島工廠,分發工人小芹。」小明驚嚇過度,還以為自己聽錯了,「林廠長不是說要選我嗎?」 從天堂掉進了地獄,因為他的綠島工廠沒有考上,最後抽籤的結果,他得去東部工廠工作...<br />
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小明會後難過的詢問綠島林廠長,為什麼沒有選他?<br />
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林廠長無奈的說:「小明,我知道你很優秀,我也很希望你能來我們綠島工作。但…<b>小芹找了政府官員,打了通電話給大衛之後,大衛就要我一定要選他…</b>唉…真的很抱歉!」分發大會之後,小明間接的聽到,原來小芹不是唯一的例子,其他工人也都有找長官去向大衛引薦。更有甚者,有些人是拿了一筆錢給有力人士,好讓他去心儀的工廠工作,於是,像小明這種沒有背景又沒有錢的,最終去了大家都不想去的東部工廠……<br />
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<span style="color: #666666;">PS 文中的工人為公費醫師,大衛為衛福部,廠長為署立醫院院長。</span><br />
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<b><span style="color: #073763;">大衛雖然在小明18歲時,提供100萬的學費與生活費。</span></b><br />
<b><span style="color: #cc0000;">但在小明服務的這六年,他虧損了500萬元。</span></b><br />
<b><span style="color: #cc0000;">六年中,小明時常流下悔恨的眼淚,但他一想到違約需罰款1500萬元且拿不回他的執業證書,他就只能默默的做,等待合約期滿,迎接自由的天空!</span></b><br />
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<br />醫周刊http://www.blogger.com/profile/00037161558472297523noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-22947799920036263752016-03-19T16:42:00.000+08:002016-03-20T09:23:16.049+08:00小故事告訴你,不要選公費!<br />
文/Balenge (公費醫師)<br />
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小明是一個工人,這一天,他來到了老闆大衛指派的工廠工作,想不到是這番慘況...<br />
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故事要回推到小明18歲那一年,因緣際會下認識了老闆大衛。當時小明家很窮,沒有錢去大公司進修,他在大衛的提議之下,與大衛簽了一份工作合約。大衛表示:「小明啊,我知道你經濟有困難,要找一個師傅帶領你去打拼事業也不容易,但是只要你以後願意到我偏鄉的工廠工作,我可以免費提供你六年的學費還有生活費喔!」 小明聽的心花怒放,算起來六年的學費大概可以為家裡省下100萬。<br />
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但為了謹慎起見,小明還是問了一下大衛,之後會去哪個偏鄉工廠,還有工作內容、薪資等等。 大衛說:「<b>我的工廠很多啦,你會指派到哪裡的話,會根據你那一年的狀況而定喔! 哪個工廠缺人就會請你過去幫忙囉~ 薪水的話,就看到時候你去那個工廠的安排啦!</b>安啦,到時候有問題都可以問我喔!」於是不疑有他,小明與大衛簽了合約。合約中另外寫著,小明以後必須去大衛的工廠<b>上班六年,如果不做的話就要罰款1500萬</b>。小明心想:「大衛也是個成功的生意人,應該是有信用的吧! 即使是鄉下的工廠,應該也都經營的不錯!」<br />
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=========於是,8年過去了,小明學得一身功夫,準備到大衛的工廠工作======<br />
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這一天,他接到大衛的指派來到了東部的工廠。<br />
這個工廠有很多機器與設備,裝潢的也非常漂亮。但是工廠內卻異常的冷清,小明眉頭一皺,發現這個工廠裡僅剩下十幾位工人,他們很努力的工作,但是看不到工人們的笑容……。這時候,一名小華工人過來了,「請問你是新來的小明嗎?你也是跟大衛簽約過來的嗎?」小明:「是啊!」小華說:「唉~這個工廠營運不好,薪水低能走的工人都走得差不多了!<b> 我現在是一個人做兩三人的事情,然後月薪是其他工廠的三分之一……</b>。還有呀,因為工人太少,廠長從外面找支援的工人,而且薪水是我們的好幾倍喔! 這個地方啊,不給高薪有誰會來呢? 除非是像我們這種綁約的,就算給22K還是得做啊,違約是要罰1500萬耶!」<span style="color: #999999;">(註一)</span><br />
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小明嚇了一跳,這是當初大衛完全沒有告訴他的事情!趕緊打電話去問大衛該如何處理?<br />
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大衛說:「唉啊~工廠本來就是要自負盈虧的嘛! 我把這個工廠交給廠長負責啦!還有,我知道你們有困難,去年我有在撥錢下去給你們補助啊~」<b> </b>然而,這些錢進到工廠的大水庫中,跑去哪了?<b>眼看著工廠機器一個一個買(機器快比工人多了),地板重鋪,廁所翻新,外援工人越請越多,工廠的設備及人事支出越來越多,最近還聽說廠長想要把工廠重新翻修,建一個新工廠耶 (預計耗資三億)!</b><br />
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小明看見工廠支出遠大於成本,營運狀況慘烈,工人不斷流失,再次與大衛聯繫。大衛說: 「好啦好啦!我再撥錢下去給你們,不要再吵囉~」<span style="color: #999999;">(註二)</span>然而,這樣的事件一而再,再而三發生……工人們每次向大衛求救後,就有一筆補助金下來,反而肥了廠長讓工廠繼續做建設,錢…卻始終進不到小明的口袋……。<br />
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========六年後,小明一群工人與大衛合約到期,黯然離開東部工廠==========<br />
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大衛的合約在2009年因為效果不佳,信用大減而退出市場。然而,在2016年7月又要重新召開此不平等條約,因為他的偏鄉工廠沒有工人在幫他工作,而再度缺人……。<br />
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<h4>
<span style="color: blue; font-size: large;">各位看倌們,看出問題了嗎?</span></h4>
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<ol>
<li>大衛與小明<span style="color: #990000;"><b>簽約時,從未討論過以後會如何被分發到各個他屬下的工廠。 </b></span>工廠的工作內容、薪資等等,一概不知。詢問大衛,大衛總是以<span style="color: #990000;"><b>「依當年度工廠缺額逕行分發,相關內容請洽大衛」</b></span></li>
<li>大衛旗下雖然有許多工廠,然而必須自負盈虧。針對業績不好的工廠,<span style="color: #990000;"><b>大衛從來沒有找到業績不好的根本原因,而對症下藥。</b></span></li>
<li>廠長本身握有一定比例的獎金分配權,不斷購買設備攤平成本的狀況下,工廠以沒有盈餘為由,不發布獎金。<span style="color: #990000;"><b>營運不佳了還增加支出,廠長不用負責?</b></span></li>
</ol>
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<b>PS: 文中的工人就是公費醫師,大衛就是衛福部,廠長就是署立醫院院長。</b><br />
<span style="color: #666666;">註一: 2016/03/15 偏鄉薪資低 留不住公費醫生 政院東辦室允協助改善</span><br />
<span style="color: #666666;">註二: 2016/03/18 臺東醫院公費醫師薪資過低案,衛福部回應說明</span><br />
<span style="color: #666666;">(ㄧ) 臺東醫院105年將再增加補助款至1.5億元,作為醫院推動公共衛生及營運維持費用。</span><br />
<span style="color: #666666;">(二)105年將由本部統籌款中提撥1,370萬補助該院醫師獎勵金,以協助提升醫師合理待遇。 </span><br />
<span style="color: #666666;">(三) 臺東醫院獎勵金提撥數將由現行醫院財務之總淨餘數80%增加至95%。</span>醫周刊http://www.blogger.com/profile/00037161558472297523noreply@blogger.com1tag:blogger.com,1999:blog-1468521563891777922.post-47531158477884988592015-07-09T08:40:00.000+08:002015-07-09T10:47:32.546+08:00塵暴事件 反思 檢討 呼籲 <div dir="ltr" style="text-align: left;" trbidi="on">
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◎文: 姜冠宇醫師<br />
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<span style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">那天馬偕淡水與台北兩個院區已經呈現被癱瘓的狀態<span lang="EN-US">, </span>除了嗆傷要插管的病患必須自己硬扛下外<span lang="EN-US">, </span>一堆人都沒有床當場就分流到其他醫院這次人數實在太多<span lang="EN-US">, </span>以淡水馬偕為例就有超過<span lang="EN-US">70</span>個病患一次湧入<span lang="EN-US">, </span>在<span lang="EN-US">EOC</span>(災難應變中心)啟動時有沒有達到當時需求<span lang="EN-US">, </span>答案非常明顯<span lang="EN-US">, </span>第一時間的判斷力就不太成熟<span lang="EN-US">, </span>而現在狀況<span lang="EN-US">, </span>絕大多數病患都已經擁有自己的病床</span><span style="color: #00b050; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">。</span><span lang="EN-US" style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;"><o:p></o:p></span></div>
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<span lang="EN-US" style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: normal; text-indent: 0px;"> </span><span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: normal; text-indent: 0px;">這次的外傷種類是「燒傷」<span lang="EN-US">, </span>和一般的燙傷不太一樣<span lang="EN-US">, </span>所有的傷灶都是深二度起跳<span lang="EN-US">, </span>大面積更是此種傷患常見情況<span lang="EN-US">, </span>又加上塵暴的性質容易伴隨嗆傷<span lang="EN-US">, </span>死亡率隨之攀升</span><span style="color: #00b050; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: normal; text-indent: 0px;">。</span><span lang="EN-US" style="color: red; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: normal; text-indent: 0px;">(</span><span style="color: red; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: normal; text-indent: 0px;">見<a href="https://www.facebook.com/BookyGirl/photos/pb.488542594562208.-2207520000.1436409972./1084826791600449">圖一</a><span lang="EN-US">&</span>二<span lang="EN-US">)</span></span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">圖一.燒燙傷患者面臨的危險</span></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuTdct8_MW9-z8zEg7H5RQYfroJpXvOtfGNFQDgwRx_DWxMf9ZpHqG9U_bg65ladaFiaiznzBo4SVc9j9_WTXeEa6XBMbGLm-X0mAuwt2EIM3NQXOH8Ey7YBdQ5qVufzxoRyrtABKEZEY/s1600/Modified+Baux+Score_0707%252715.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuTdct8_MW9-z8zEg7H5RQYfroJpXvOtfGNFQDgwRx_DWxMf9ZpHqG9U_bg65ladaFiaiznzBo4SVc9j9_WTXeEa6XBMbGLm-X0mAuwt2EIM3NQXOH8Ey7YBdQ5qVufzxoRyrtABKEZEY/s640/Modified+Baux+Score_0707%252715.jpg" width="632" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">圖二.大面積燒傷病人預後評估公式</span></td></tr>
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<b><span style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;"> </span><span style="color: blue;"><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"> 這些塵暴病患原本都應該直接送往加護病房照護<span lang="EN-US">, </span>但現實是大台北地區加護病床根本就不夠容納這麼多病患<span lang="EN-US">, </span>所有北部醫院都有規劃普通病房以最少人力達到加護病房密集照護的效果</span><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">。</span><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">北部各家醫院病房已經呈現過飽和被癱瘓狀態<span lang="EN-US">,</span></span></span><span lang="EN-US" style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;"> </span></b><span style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">除了各醫院的基層服務<span lang="EN-US">, </span>會因為大量傷患而<span lang="EN-US">"</span>當機<span lang="EN-US">",
</span>排擠其他重症病人外<span lang="EN-US">, </span>還含有幾項後續問題<span lang="EN-US">:</span></span><span lang="EN-US" style="font-family: "微軟正黑體",sans-serif; mso-no-proof: yes;"> </span><span lang="EN-US" style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;"><o:p></o:p></span></div>
<h3 style="background: white; line-height: 15pt; margin: 0cm 0cm 0.0001pt; text-align: left;">
<span style="color: red;"><strong><span lang="EN-US" style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">1. </span></strong><strong><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">植皮 大片燒傷病患有植皮面積不夠的危機</span></strong></span><span lang="EN-US" style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"><b><span style="color: red;"> </span></b><span style="color: #141823;"><o:p></o:p></span></span></h3>
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<span style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">換藥耗材和藥品這些是可持續生產供應的產品<span lang="EN-US">, </span>但是在後續最關鍵的<span lang="EN-US">"</span>植皮<span lang="EN-US">":
</span>大眾以為<strong><span lang="EN-US">"</span></strong><strong>南皮北送<span lang="EN-US">", </span>或是歐洲皮庫供應的屍皮<span lang="EN-US">, </span></strong>可以解決病人問題<span lang="EN-US">, </span>其實事實不全然如此<span lang="EN-US">, </span>這些都<strong>只能幫助患者撐過一段時間</strong><span lang="EN-US">, </span>但是<strong>要痊癒<span lang="EN-US">, </span>患者必須最終要<span lang="EN-US">"</span>植上自己的皮<span lang="EN-US">"</span></strong><span lang="EN-US">, </span>其他不屬於她自己身上的皮<span lang="EN-US">, </span>最後都會自體免疫反應而被溶解。</span><span style="color: blue; line-height: 15pt; text-indent: 23pt;"><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"><b>屍皮只是暫時的,大約<span lang="EN-US">10</span>幾天後會被免疫系統排斥而脫落,不過在這<span lang="EN-US">10</span>幾天有些淺<span lang="EN-US">2</span>度的傷口會自行癒合,因此燒傷面積大幅下降,活命的機會就會大增<a href="https://www.blogger.com/null" name="_Hlk424093961">。</a></b><span lang="EN-US">(</span>引用<span lang="EN-US">:</span></span><span lang="EN-US" style="font-family: 微軟正黑體, sans-serif;"> </span><span lang="EN-US"><b><span lang="EN-US" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; font-family: 微軟正黑體, sans-serif;"><span lang="EN-US"><a href="https://www.facebook.com/i.beauty.safe?fref=photo">美安診所</a></span></span></b></span><span style="font-family: 微軟正黑體, sans-serif;">臉書</span></span><span lang="EN-US" style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;"><span style="color: blue;">)</span></span></div>
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<span lang="EN-US" style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"><span style="color: blue;"><br /></span><span style="color: #00b050;"><o:p></o:p></span></span></div>
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<span style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">現在最大的問題是
這些燒傷已經超過<span lang="EN-US">60%</span>的病患<span lang="EN-US">, </span>恐怕最後皮都不夠植<span lang="EN-US">, </span>他自己身上健康可取皮區<span lang="EN-US">, </span>很明顯是不夠的<a href="https://www.blogger.com/null" name="_Hlk424092486"><span lang="EN-US">, </span></a>但是這些後續策略<span lang="EN-US">, </span>我們現階段連想都不敢想<span lang="EN-US">, </span><strong><span style="font-weight: normal;">就算植皮完成<span lang="EN-US">, </span>也很容易因為下列兩項因素而失敗<span lang="EN-US">, </span>而浪費原本植皮資源: </span></strong></span></div>
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<li><span style="color: blue;"><span style="font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;"><span lang="EN-US"><b>1) </b></span></span><span style="font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;"><b>感染</b><span lang="EN-US"><b>:</b> </span></span><strong style="font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;"><span style="font-weight: normal;">基本的皮膚保護屏障消失就是遭到感染的危險因子<span lang="EN-US">, </span>感染本身的菌株<span lang="EN-US">, </span>與造成的發炎</span></strong></span><strong style="color: blue; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;"><span style="font-weight: normal;">反</span></strong><strong style="color: blue; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;"><span style="font-weight: normal;">應<span lang="EN-US">, </span></span></strong><strong style="color: blue; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;"><span style="font-weight: normal;">都會使植皮死亡<span lang="EN-US">.</span></span></strong></li>
<li><b style="color: blue;"><span style="line-height: 15pt;"><span lang="EN-US" style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">2)</span></span><span style="line-height: 15pt;"><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">剪力<span lang="EN-US">: </span></span></span></b><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt;">復健過程中因為移動造成移位力道的關係<span lang="EN-US">, </span>致使以接貼合的植皮脫離原本位置<span lang="EN-US">, </span>這比較</span><span style="color: blue;">容易發生在關節等高度活動的地方</span><span lang="EN-US" style="color: blue;">.</span></li>
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<span style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">一個燒傷傷口的癒合到達陣到完全密合<span lang="EN-US">, </span>沒有植皮<span lang="EN-US">, </span>等於希望傷口周邊皮膚長過來癒合使傷口縮小<span lang="EN-US">, </span>這只有在小傷口才能發生<span lang="EN-US">, </span>大面積在沒有成功植入自己皮<span lang="EN-US">, </span>根本不可能達陣到完全癒合, </span><span style="background-color: transparent; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">而皮膚正是人體最大的器官<span lang="EN-US">, </span>包含感染防護屏障<span lang="EN-US">, </span>以及調節水分<span lang="EN-US">, </span>保護體溫<span lang="EN-US">, </span>大面積的燒傷病患<span lang="EN-US">, </span>很容易因為喪失以上功能<span lang="EN-US">, </span>使自己身體在照護全程承受生命危險</span><span style="background-color: transparent; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"><span style="color: #00b050;">。</span><b><span style="color: blue;">正因如此<span lang="EN-US">, </span>喪失皮膚本身就是接下來幾周併發症最根本原因<a href="https://www.blogger.com/null" name="_Hlk424094761">。</a></span></b></span><span lang="EN-US" style="background-color: transparent; color: red; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">(</span><span style="background-color: transparent; color: red; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">見圖三<span lang="EN-US">)</span></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjny5dnBKY-eYpfp1kOPU_paO8gXs5_HvARTDf_sq_ayFzgMLraSacYHWssllHM3pfgWoj4wWRv5fsfc_O-Amdlo9hyHbDB4Oe9-XiVLJugAGJiiPTcdALq5o406zeA9n48IjyPINLvWVU/s1600/%25E5%25A4%25A7%25E9%259D%25A2%25E7%25A9%258D%25E7%2587%2592%25E7%2587%2599%25E5%2582%25B7%25E7%2597%2585%25E4%25BA%25BA%25E4%25B8%2589%25E5%25A4%25A7%25E9%259B%25A3%25E9%2597%259C%25E8%25A6%2581%25E9%2581%258E_0707%252715.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="600" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjny5dnBKY-eYpfp1kOPU_paO8gXs5_HvARTDf_sq_ayFzgMLraSacYHWssllHM3pfgWoj4wWRv5fsfc_O-Amdlo9hyHbDB4Oe9-XiVLJugAGJiiPTcdALq5o406zeA9n48IjyPINLvWVU/s640/%25E5%25A4%25A7%25E9%259D%25A2%25E7%25A9%258D%25E7%2587%2592%25E7%2587%2599%25E5%2582%25B7%25E7%2597%2585%25E4%25BA%25BA%25E4%25B8%2589%25E5%25A4%25A7%25E9%259B%25A3%25E9%2597%259C%25E8%25A6%2581%25E9%2581%258E_0707%252715.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">圖三.大面積燒傷患者,有三大難關要過</span></td></tr>
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<strong><span lang="EN-US" style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;"><br /></span></strong></div>
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<span style="color: red;"><b><span lang="EN-US" style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">2. </span><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">呼吸系統的發炎反應及纖維化</span></b></span><span lang="EN-US" style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;"><o:p></o:p></span></div>
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<span style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-US; mso-bidi-font-family: Helvetica; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;"> 要注意這次是<span lang="EN-US">"</span>塵暴<span lang="EN-US">", </span>所以嗆傷病患比例甚高這些人死亡率極高<span lang="EN-US">, </span>一開始會肺泡發炎<span lang="EN-US">, </span>導致肺大量積水<span lang="EN-US">,
</span>一淹水是很麻煩的<span lang="EN-US">, </span>肺臟功能喪失後會不會搞到用葉克膜都不知道<span lang="EN-US">,
</span>結果真的有案例出現了<span lang="EN-US">, 7</span>月<span lang="EN-US">2</span>日聯合新聞已有報導<span lang="EN-US">184</span>傷者病危<span lang="EN-US">, </span>桃園有一名患者出現變化,已經裝上葉克膜。</span></div>
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<span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"> 這部分病人會不會好轉<span lang="EN-US">, </span>不是樂觀的<span lang="EN-US">, </span>就算度過肺炎與肺積水的危險期<span lang="EN-US">, </span>肺泡內皮細胞燒傷後就是纖維化<span lang="EN-US">, </span>這些都沒有換氣功能都是死腔<span lang="EN-US">, </span>病人長期的呼吸功能打折扣<span lang="EN-US">, </span>會需要更多的心肺復健<span lang="EN-US">, </span>負擔比一般人大很多</span><span style="color: #00b050; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">。</span><span lang="EN-US" style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"><o:p></o:p></span><span style="font-family: 微軟正黑體, sans-serif; font-size: 15.3333330154419px;"><span style="color: red;">(見圖四)</span></span><span style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-ansi-language: EN-US; mso-bidi-font-family: Helvetica; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW; mso-font-kerning: 1.0pt;"><br /></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4srHm78vRrHwVB30ylPPoMRxBDKTNnKj-Kktiti72KwArpZtDIkT2J5TgsJMCOiHtPFCDLF9wgkvXO4tIN6zEEeFLArt8TMNwjp-E0pJQMYNOnSrDED0OWV77B47pCSjWJalXGngWO5I/s1600/%25E7%2587%2592%25E7%2587%2599%25E5%2582%25B7%25E5%2590%2588%25E4%25BD%25B5%25E5%2590%25B8%25E5%2585%25A5%25E6%2580%25A7%25E5%2582%25B7%25E5%25AE%25B3_0707%252715.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4srHm78vRrHwVB30ylPPoMRxBDKTNnKj-Kktiti72KwArpZtDIkT2J5TgsJMCOiHtPFCDLF9wgkvXO4tIN6zEEeFLArt8TMNwjp-E0pJQMYNOnSrDED0OWV77B47pCSjWJalXGngWO5I/s640/%25E7%2587%2592%25E7%2587%2599%25E5%2582%25B7%25E5%2590%2588%25E4%25BD%25B5%25E5%2590%25B8%25E5%2585%25A5%25E6%2580%25A7%25E5%2582%25B7%25E5%25AE%25B3_0707%252715.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">圖四.燒燙傷合併吸入性傷害死亡率高</span></td></tr>
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<span style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;"> </span></div>
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<span style="font-family: 微軟正黑體, sans-serif; font-size: 15.3333330154419px;"><span style="color: red;"></span></span></div>
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<span style="color: red;"><b><span style="font-size: 12.8000001907349px; line-height: 15pt;"><span lang="EN-US" style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">3. </span></span><span style="font-size: 12.8000001907349px; line-height: 15pt;"><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;">心理層面 及後續社會適應 </span></span></b></span></div>
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<span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; text-indent: -15.3333330154419px;"> 要知道<span lang="EN-US">, "</span>久病無孝子<span lang="EN-US">"</span>的現象也會發生在這些年輕人身上<span lang="EN-US">, </span>意思就是<span lang="EN-US">, </span>親友及大眾的關心<span lang="EN-US">, </span>只會加油個一兩個月熱情就退去<span lang="EN-US">, </span>取而代之的<span lang="EN-US">, </span>他們接下來會被視為消耗醫療資源的族群</span><span style="color: #00b050; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; text-indent: -15.3333330154419px;">。</span></div>
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<span style="background-color: transparent; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; text-indent: -15.3333330154419px;"> 全部病患都有疤痕攣縮的關係使動作受限<span lang="EN-US">, </span>嗆傷病患呼吸道及肺泡纖維化都會造成大大心肺功能受損<span lang="EN-US">, </span>也會讓他們就業能力大減<span lang="EN-US">, </span>會降低這些人的工作機會<span lang="EN-US">, </span>這些層面<span lang="EN-US">, </span>在殘酷的社會現實底下怎麼支持他們<span lang="EN-US">, </span>也是大問題</span><span style="background-color: transparent; color: #00b050; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; text-indent: -15.3333330154419px;">。</span><span style="background-color: transparent; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; text-indent: -15.3333330154419px;">這是接下來精神科及職業醫學科的範疇<span lang="EN-US">, </span>這些<span lang="EN-US">20</span>歲上下的年輕人受到這種災難<span lang="EN-US">, </span>外觀完全變形<span lang="EN-US">, </span>心理必定受到嚴重傷害<span lang="EN-US">, </span>所以後續的心理建設是非常大的重點<span lang="EN-US">. </span>一個人正常參與社會的指標便是他的工作,在少子化的未來,他們更是我們十年後國家經濟的支柱<a href="https://www.blogger.com/null" name="_Hlk424096096">。</a></span><span lang="EN-US" style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: -11.5pt;"> </span></div>
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<span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: -11.5pt;"> 政府要為這些受難的年輕人進行及早的重返社會及輔導就業的計畫,比照職業健康服務政策中復工及配工的概念, 要有積極政策輔導這些受難者,讓他們有需要時能從迎合未來職場需求的就業配套措施獲得足夠的資源<a href="https://www.blogger.com/null" name="_Hlk424092654">。</a>協助他們完成醫療程序後有正常參與社會的能力,要趁大眾熱情還在時提早做,不然熱情冷卻時,人性開始出現,到那時怎麼呼籲都來不及了。</span></div>
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<span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"><b><span style="color: red;">4. 醫療器材及人力的消耗戰<span lang="EN-US">, </span>現在才正開始</span></b></span><span lang="EN-US" style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;"><o:p></o:p></span></div>
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<span style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;"> 所幸就醫療資源的調度<span lang="EN-US">, </span>當下看現場反應藥品及紗布等這些都尚且足夠<span lang="EN-US">, </span>但是在上病房之後病患由於需要大量換藥及水分灌注<span lang="EN-US">, </span>耗材量非常大<strong><span lang="EN-US">, </span></strong>也有醫院回報特定的抗生素如<span lang="EN-US">Vancomycin</span>開始缺了。 <span lang="EN-US">(Vancomycin, </span>對付皮表菌如金黃色葡萄球菌感染常用的指標抗生素<span lang="EN-US">, </span>雖然在今日還尚有其他新一代較為昂貴的抗生素可以取代<span lang="EN-US">) </span>由於大量的病患都有為了及時降溫都有跳至漂漂河的因素<span lang="EN-US">, </span>為了對抗感染<span lang="EN-US">, </span>抗生素的角色非常重要<a href="https://www.blogger.com/null" name="_Hlk424096200">。</a><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"><a href="https://www.blogger.com/null" name="_Hlk424096200"> </a></span><span style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">現在人力問題上</span><span lang="EN-US" style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">除了各醫院徵召整外出走的醫美醫師回鍋</span><span lang="EN-US" style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">醫療團隊也整個重新規劃</span><span lang="EN-US" style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">據悉已經有不少醫院把泛外科系醫師都拉下來加入換藥團隊</span><span lang="EN-US" style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">不只是一般外科的人力而已</span><span lang="EN-US" style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">包含口腔外科</span><span lang="EN-US" style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">耳鼻喉科甚至泌尿科骨科</span><span lang="EN-US" style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">這段期間也會拉下內科醫師一起進行照護</span><span lang="EN-US" style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">除了上述呼吸系統外還有</span><strong style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;"><span style="font-weight: normal;">腎臟功能及感染情況的監控</span></strong><strong style="background-color: white; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;"><span lang="EN-US">,
</span></strong><span style="background-color: white;"><span style="color: blue;"><b><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">在外科系醫師顧不來的情況下<span lang="EN-US">, </span>這時會拉來內科醫師幫忙評估建議會比較有效率<span lang="EN-US">, </span>所以各家醫院內外科團隊針對這次事件的整併已經開始了</span><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">。</span></b></span></span></div>
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<strong><span lang="EN-US" style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;"> </span></strong><strong><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"><span style="color: blue;">至於各家的護理人力資源調度此時都用在刀口上<span lang="EN-US">, </span>所以此時若是再發生醫糾時<span lang="EN-US">, </span>責任怎麼歸屬呢<span lang="EN-US">? </span>後續的影響效力又是什麼呢<span lang="EN-US">? </span>好戲恐怕在後面幾週了<span lang="EN-US"> , </span>後續死亡率的攀升</span><span style="color: red;"><span lang="EN-US">(</span>見圖五</span><span lang="EN-US"><span style="color: red;">)</span><span style="color: blue;">, </span></span><span style="color: blue;">以及醫護的續航力<span lang="EN-US">, </span>是在考驗人性的</span></span></strong><span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"><span style="color: blue;">。</span></span></div>
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<span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;"> 這部分也會排擠到原本非塵爆相關的重症住院病患的可能</span><span lang="EN-US" style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">除了</span><span lang="EN-US" style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">ICU</span><span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">挪床問題</span><span lang="EN-US" style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">並拖延很多種重症如癌症病患或急症需開刀病患的治療計畫</span><span lang="EN-US" style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">究竟這些族群死亡率會不會提高</span><span lang="EN-US" style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">? </span><span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">這是隱藏版未爆彈</span><span lang="EN-US" style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">, </span><span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 11.5pt; line-height: 15pt; text-indent: 23pt;">希望都不要發生。</span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">圖五.燒傷患者死亡原因</span></td></tr>
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<span style="font-family: 微軟正黑體, sans-serif;"><span style="color: red;"><b>一些事情的檢討</b></span></span></div>
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<span style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">由於民眾原本就有沒事就擠急診的習慣<span lang="EN-US">, </span>一個急診頂多在非常緊急的過程中只能一時多容納<span lang="EN-US">20位</span>左右的病患<span lang="EN-US">, </span>現在急診最危險的時間過去了<span lang="EN-US">, </span>現在是內外科病房的排擠效應。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"><span style="color: #141823;">台灣非常怪異的醫療建設失衡現象</span><span lang="EN-US" style="color: #141823;">, </span><span style="color: #141823;">平常中小醫院就在總額預算排擠下失去分流功能</span><span lang="EN-US" style="color: #141823;">, </span><span style="color: #141823;">民眾也不愛去</span><span lang="EN-US" style="color: #141823;">,<span class="apple-converted-space"> </span></span><span style="color: blue;"><b>這實在大量傷患可不可以扮演分流病患及讓非重大傷患及輕症民眾提供另一個就醫選擇<span lang="EN-US">, </span>尚待檢驗了。</b></span><span lang="EN-US" style="color: #141823;"><o:p></o:p></span></span></div>
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<span class="fbunderline"><b><span lang="EN-US" style="color: #141823; font-family: "微軟正黑體",sans-serif; font-size: 11.5pt; mso-bidi-font-family: Helvetica;"> </span></b></span><span class="fbunderline"><b><span style="font-family: 微軟正黑體, sans-serif;"><span style="color: red;">現在真的要呼籲台灣民眾及醫療決策高層<span lang="EN-US">, </span>不要再獨厚醫學中心<span lang="EN-US">, </span>改善自己就醫習慣<span lang="EN-US">, </span>信任自己社區範圍的中小醫院及診所<span lang="EN-US">, </span>醫療高層也要規劃平時落實醫療轉診<span lang="EN-US">, </span>這種災難發生時的各種荒唐現象才能減至最低</span></span></b></span><span style="font-family: 微軟正黑體, sans-serif;"><b><span style="color: red;">。</span></b><span lang="EN-US" style="color: #141823; font-size: 11.5pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 微軟正黑體, sans-serif; font-size: 11.5pt;"><span style="color: #141823;">[感謝]</span></span></div>
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<span style="color: #141823; font-family: 微軟正黑體, sans-serif;"><span style="font-size: 15.3333330154419px;">1.</span></span><span style="background-color: transparent; color: #141823; font-family: 微軟正黑體, sans-serif; text-indent: -15.3333330154419px;"><span style="font-size: 15.3333330154419px;">圖一感謝</span></span><span style="background-color: transparent; color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 15.3333330154419px; text-indent: -15.3333330154419px;">劉育志、白映俞醫師臉書提供轉載。</span></div>
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<span style="color: #141823; font-family: 微軟正黑體, sans-serif; font-size: 15.3333330154419px; line-height: 15pt; text-indent: -11.5pt;">2.本文插圖感謝敏鷹保險經紀人股份有限公司的精美製作, 與專家學者們提供實證醫學背景資料。</span></div>
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Sliver Linings LOHAS (撥雲見日 樂活人生)http://www.blogger.com/profile/05560492105797220203noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-89951371556040807052015-07-05T06:22:00.002+08:002015-07-05T08:11:54.783+08:00嚴重燒傷住院傷患之診治建議<div dir="ltr" style="text-align: left;" trbidi="on">
◎文: 蔡宏斌 (台大創傷醫學部主治醫師)/ 圖:實習醫學生不點 (Tnoip)<br />
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衛福部在2015/7/02的專案會議中, 整合各界資源, 將醫療量能盤點、醫療處理、藥品及衛材供應、傷患風險評估、個案關懷及社福救助服務、諮詢專線與事件專區設置等都動員起來, 在嚴重燒傷住院傷患的診治方面也提供建議,讓醫病雙方可以有一個溝通的參考平台。<br />
<a class="_58cn" data-ft="{"tn":"*N","type":104}" href="https://www.facebook.com/hashtag/%E5%9A%B4%E9%87%8D%E7%87%92%E5%82%B7%E4%BD%8F%E9%99%A2%E5%82%B7%E6%82%A3%E4%B9%8B%E8%A8%BA%E6%B2%BB%E5%BB%BA%E8%AD%B0?source=feed_text"></a><br />
<span class="text_exposed_show"><b><span style="font-size: large;">《嚴重燒傷住院傷患之診治建議》</span></b><br /><span style="color: blue;"><b>一、 根據實證醫學及臨床專業判斷,對於嚴重病人應盡最大能量救治。<br /><br /> 二、 啟動家庭會議:醫療團隊(醫、護、心理師、社工)召開家庭會議,讓家屬及病人瞭解病程進展、治療計畫及預後。<br /><br /> 三、 共同醫療決策</b></span><b style="color: blue;">:</b><span style="color: blue;"><b>醫療團隊持續溝通,讓家屬及時瞭解病人病情變化,以利共同醫療決策。但是若病情已進展至死亡不可避免,為不讓病人受苦,建議採取一定時間醫療嘗試原則(Time-Limited Trial),必要時依法撤除維生醫療(包含高科技維生醫療) 。</b></span><br /> 對於我們第一線照顧工作者而言, 大面積燒傷的病程變化快速, 治療過程又會拖得很長, 這一次衛福部版的「嚴重燒傷住院傷患之診治建議」,可以給醫病雙方討論溝通的方向, 有利於共同醫療決策的進行, 請大家要多體諒, 在實際的照顧工作還是要尊重醫師的臨床裁量, 給第一線醫事同仁們繼續支持, 共同度過難關!<br /><br /><span aria-label="主題標籤" class="_58cl"><a class="_58cn" data-ft="{"tn":"*N","type":104}" href="https://www.facebook.com/hashtag/%E5%BB%B6%E4%BC%B8%E9%96%B1%E8%AE%80?source=feed_text"></a>[延伸閱讀]</span><br />1.衛福部因應八仙樂園粉塵爆炸事件專案小組第四次會議說明-2015/07/02<br /><span style="color: #0000ee;"><u><a href="http://www.mohw.gov.tw/CHT/Ministry/DM2_P.aspx?f_list_no=7&fod_list_no=5314&doc_no=49935">http://www.mohw.gov.tw/CHT/Ministry/DM2_P.aspx?f_list_no=7&fod_list_no=5314&doc_no=49935</a></u></span><br />2.陳志金:請不要再說「家屬決定拔管,放棄治療!」天下雜誌網路版-2015/07/04<br /><a href="http://www.cw.com.tw/article/article.action?id=5068945" rel="nofollow" target="_blank">http://www.cw.com.tw/article/article.action?id=5068945</a>#<br />3. </span>塵暴傷患對抗要命感染 家屬也能盡分力。中央社-2015/07/02<br />
<a href="http://n.yam.com/cna/healthy/20150702/20150702130566.html">http://n.yam.com/cna/healthy/20150702/20150702130566.html</a><br />
<span class="text_exposed_show"><br />-----附註------<br />路障(在本篇)泛指醫師<br /> 松鼠-心理師 鸚鵡-社工師 貓咪-護理師<br /> 除了本圖出現的以外,也感謝各界醫護人員及治療師對本次災害的協助。</span><br />
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Sliver Linings LOHAS (撥雲見日 樂活人生)http://www.blogger.com/profile/05560492105797220203noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-2419460132025684062015-04-11T21:03:00.000+08:002015-04-12T18:39:14.685+08:00醫療暴力有感-比較美國和台灣急診護理師的執業尊嚴與安全感!<div dir="ltr" style="text-align: left;" trbidi="on">
◎ 作者: Pantoprazole<br />
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目前自己在美國攻讀博士 ,我的指導教授 (簡稱老闆 )是系上很資深的教授 ,也是我們系上唯二還有持續在執業的教授 。她是資深的 part -time 急診護理 師,每隔兩周的周六會在急診室工作 12 小時 ,也因此我常有機會聽到她在急診工作時所發生的大小事情 。<br />
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今天在會議中與老闆討論完畢後 ,老闆跟我說了一件上周六所發生的事情 。 她上周六在急診工作時 ,照顧到一個氣喘發作的女病患 ,女病患自訴有氣喘病史 ,有在抽菸及吸食可卡因 (cocaine ,一種毒品 ,這位病患 是從鼻子吸食 ),進來急診時是呈現氣喘發作的狀態,我老闆 先緊急處裡症狀後安排了一堆檢查 ,包括胸腔 X光,肺功能吹氣試驗 ,以及尿液檢查等 。胸腔 X光顯示女病患有支氣管炎,但慶幸的是沒有肺炎徵狀 。而尿液檢查確實證女病患有在吸食可卡因 。<br />
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這位女病患在症狀緩解後 ,開始咆哮急診室的醫護人員,罵每個人都是廢物,罵 大家對她的服務都不夠好,甚至罵我老闆的一位同事是黑鬼。 這位女病患是白人 , 我老闆 也是白人 ,當天我老闆的同事及跟搭檔patient assistant (協助護理師的幫手 ,非護理人員 )中都有黑人 。我老闆直接嚴厲的開口阻止她行為 , 訓誡她不得對所有人無理 。後來女病患的男友進急診室,男友的態度更差,不斷幫他女友辱罵醫護人員 。<br />
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在男友一進來急診室後 ,我老闆馬上感受到暴力威脅程度上升 ,於是當著女病患及她男友的面前假裝說 : 我的 call 機響了 , 我得回護理站去查看是誰 call 我。 一回到護理站 ,我老闆直接按下藏在桌子面的安全鈕 ,並開始看手錶計時警察 (不是保全喔 , 是 hospital police officer ) 何時來到她身邊。60 秒以內六位警察衝到我老闆身邊 ,直接問 ”Dr.XX, 你需要我們為妳做甚麼嗎 ?” (警察們知道我老闆是教授,所以稱呼她為 Dr.XX)<br />
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我老闆帶著六位 警察重返女病患床邊 ,指示三位警察先將她男友架到醫院大門外面隔離開來,並看住男友 ,接著帶另外三位 警察到女病患床邊為她做出院準備 。 這三位 警察 的目是保護我老闆 ,在她跟女病患說明出院手續、處方籤內容、服 藥方式、及返家注意事項時 ,三位 警察保護我老闆不受此女病患的傷害 。<br />
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當然俗辣男友及女病患在看到六位 警察 時氣焰都消了一半 ,但就在我老闆說明完處方籤後 ,女病患又開 始大聲咆哮說自己沒那麼多錢 (病患要持處方籤到藥局拿藥付錢 ) ,我老闆嚴肅地說 “如果你可以把買菸及毒品的錢省下來 ,或許可以有足夠的錢治療支氣管炎 !! ”<br />
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在我老闆說明完後 ,所有警察仍呈戒備狀態 ,確認女病患完成出院手續及與男友離開醫院所屬範圍後 (不是離開醫院大門而已喔 ,而是要離開醫院所屬範圍 ,確實距離我不清楚 ),六位 警察才完成他們對我老闆的保護工作 。<br />
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在我老闆跟女病患說明完出院手續後 ,我老闆嚴厲地對這位女病患說,自己會去投訴她這個病人 --- 對,你沒看錯 ! 是我老闆這個護理師可以去投訴這位病人喔 ! <span style="color: red;">醫院的政策是病人可以投訴醫護人員 ,醫護人員也可以投訴病人 。對病人而言,被醫護人員投訴是嚴重的事 ,因為同一位病人如果被投訴超過三次 ,這位病人將不得再進入此醫院接受醫療服務 (就算你的保險有給付</span><span style="color: red;">,</span><span style="color: red;">你也不得再進入此醫院看病!)。</span><br />
當然我老闆有向女病人宣讀這項規定 ,並面露兇狠地表示自己一定會去投訴她 !! 聽到我老闆(資深護理師)在美國面對醫療暴力時的處理過程,我自己的感觸是很深的。<br />
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身為一位在台灣醫院走跳10 幾年的基層護理人員 (我待過急診及病 房) ,我面臨過不知道多少次大小的暴力威脅 ,有病房家屬發飆操三字經辱罵我們 ,有議員助理拍護站桌子大罵我們 ,有病人在病房直接踹我肚子 ,從來也沒有人可以保護我們 。<span style="color: blue;">就算我們按下隨身的警衛遙控鈕 ,醫院警衛也都是姍姍來遲 ,從來沒有甚麼 60 秒以內出現在醫護人員身邊的措施 。</span><br />
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<span style="color: black;"> 我</span>同事還曾在值病房的大夜班時遇到家屬發飆 摔護理站椅子 ,一個病房 有 46 位病人 ,大夜班時只有兩個護理人員 ,一個護理人員要照顧 23 位病人 。當那位家屬發飆時我同事及她的搭檔 ,真的當下是孤立無援 ! 我聽到都頭皮發麻 !! 在夜深人靜的病房 ,就算你被打死可能當下都沒有人知道 ! 當然後來警衛及夜班護理長有幫忙 ,但如果 那位盛怒的家屬當場要傷害我同事 及她搭檔,真的是誰也都阻止不了 。<br />
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<span style="color: blue;">看國外,想台灣。當我們還在吹噓健保是世界奇蹟時,有多少的醫護人員活在醫療暴力的威脅之下 ?</span> 醫療暴力 並非這幾年才出現, 媒體上可見到的醫療暴力 媒體上可見到的醫療暴力 都只是冰山一角, 不論急診, 病房或各式醫院單位,實際上被暴力威脅的醫護人員多不勝數,而台灣的官只想著如何讓護理執業門檻再降低,卻對提供一個安全的醫療執業環境都做不到!<br />
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<span style="color: blue;">貼警惕海報有何用? 家屬火上來誰會去看那海報 ? 設再多意外通報系統有何用? 當下沒辦法保護醫人員免於傷害的系統通報再多次也沒用 ! </span>多年過去也不見醫院長官對於統計出來的通報數據有任何實質上的反應 ,通報系統只流於應付評鑑 之用 ,更糟的是醫護人員在飽受驚嚇後,還要利用下班時間打那些通報的內容 (因為上班時絕沒有間完成通報內容,只 能利用下班時間打完 )!!<br />
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<span style="color: red;">培育一位醫護人員不容易,然而改善醫療執業環境的速度如牛步般緩慢,台灣要到甚麼時候才能做像美國一樣重視醫護人員的命 ? </span>謝謝大家聽我抱怨,也希望仍在台灣執業的護理人員自己多加小心,畢竟工作可 以再換,但命只有一條,共勉之!<br />
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[延伸閱讀]<br />
1.病人家屬分享心靈的悸動, 不捨跪在地上幫病人服務的急診白衣天使。醫勞盟臉書 2015/04/11<br />
<a href="https://www.facebook.com/TMAL119/photos/a.118547204943363.20053.118446058286811/640939509370794/?type=1&theater%E5%8F%B0%E7%81%A3%E6%80%A5%E8%A8%BA%E5%AE%A4%E5%A0%B4%E6%99%AF%E4%B9%8B%E4%B8%80:%20%E8%B7%AA%E5%9C%B0%E6%9C%8D%E5%8B%99%E7%9A%84%E6%80%A5%E8%A8%BA%E8%AD%B7%E7%90%86%E5%B8%AB,%20%E5%80%BC%E5%BE%97%E5%A4%A7%E5%AE%B6%E5%B0%87%E5%BF%83%E6%AF%94%E5%BF%83,%20%E6%84%9F%E8%AC%9D%E4%B9%9F%E5%B0%8A%E9%87%8D%E5%A5%B9%E5%80%91%E7%9A%84%E4%BB%98%E5%87%BA!">https://www.facebook.com/TMAL119/photos/a.118547204943363.20053.118446058286811/640939509370794/?type=1&theater<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
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<tr><td class="tr-caption" style="text-align: center;">台灣急診室場景之一: 跪地服務的急診護理師, 值得大家將心比心, 感謝也尊重她們的付出!</td></tr>
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Sliver Linings LOHAS (撥雲見日 樂活人生)http://www.blogger.com/profile/05560492105797220203noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-21176282149735463582015-03-26T19:06:00.002+08:002015-03-26T19:34:40.093+08:00急診室生離死別的情景 讓我難過 要我堅強<b>急診室生離死別的情景 讓我難過 要我堅強</b><br />
<b><br /></b>
◎ 作者:林汶欣 / 急診室護理師<br />
<br />
今早夜班大交班就得知昨晚忙翻了...<br />
<br />
全院 ICU 爆滿!插管的重症病人只能轉院,<br />
但,有兩位轉不出去的,就得在急診室待轉。<br />
<br />
其中一位腦出血的媽媽,氣管內插著管子,<br />
女兒在她耳邊一邊哭一邊說話,<br />
雖然她佔著我急救車的位置,<br />
但我知道此時別打擾她的好,<br />
因為腦出血大片到已壓過中線,<br />
那就是代表等待死亡的意思...。<br />
<br />
我每當看到這樣的片子總是心中會喊著「天啊!」<br />
因為即使再努力也一樣,有些人註定回不了家。<br />
<br />
後來家屬忍痛簽了不實行心肺復甦的切結書。<br />
<br />
下班前去看病人,依舊插著管在重症區等待 ICU,<br />
看著她休克衰竭的生命徵象,<br />
交待學妹要注意突發狀況,<br />
小心病人在當班可能就會離開。<br />
<br />
預期性的死亡好無力,<br />
相對地,突發性的死亡好可怕。<br />
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中午,又送來了個狀況很糟的阿嬤,<br />
全身水腫器官衰竭喘呼呼的,<br />
雖然人現在還算清醒,<br />
醫生和家屬解釋了很多醫療方向。<br />
<br />
吃飯時我問了醫生:<br />
「我想做再多,阿嬤還是會走向毀滅性的結局對不對?」<br />
<br />
他回我:<br />
「對,但能不做嗎?」<br />
<br />
是啊,能不做嗎?<br />
我們每天救人,救好多一面之緣的人,<br />
但當遇到就是註定離開的,我還是會難過。<br />
<br />
所以活在當下好重要,<br />
這是我在急診室裡學到的真理,<br />
你可以生氣可以難過但別讓愛你的人傷心,<br />
可以做些不讓自己後悔卻也不會造成別人困擾的事。<br />
<br />
這很難,我懂。<br />
因為人本來就是互相牽引又牽掛的動物。Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-1468521563891777922.post-16958940451058445202015-01-26T14:11:00.001+08:002015-03-26T21:01:14.716+08:00持平看病歷中文化:醫病皆傷!<b>持平看病歷中文化:醫病皆傷!</b><br />
<br />
◎ 作者:邱淑媞/<span style="background-color: white; color: #333333; font-family: Verdana, Arial, PMingLiU, sans-serif; font-size: 18.3999996185303px; line-height: 24.4799995422363px;">國民健康署署長</span><br />
<br />
這陣子引起爭論不安的病歷中文化入法一事,我試著從政策分析的角度來看它。<br />
<br />
主張病歷中文化者,有兩大具體修法訴求:<br />
一、預計修正《醫療法》第六十七條第一項為:「醫療機構應以中文建立清晰、詳實、完整之病歷。」<br />
二、配合修正《醫療法》第七十一條;醫療機構應依其診治之病人要求,提供中文病歷複製本,必要時提供中文病歷摘要,不得無故拖延或拒絕;其所需費用,由病人負擔。<br />
<br />
現況: 目前並沒有禁止病歷使用中文,而是大家習慣使用英文。即使不入法,只要用中文是美事一樁,現況並不影響大家使用或推廣。尤其對於以提供給病人為目的的病歷摘要或健檢報告等,更應該使用中文(除了顯然難以翻譯的項目以外)。但全面中文化? 在現階段乃至於未來的幾年,恐怕確實工程耗大,可能性極低。主張者認為本來就該用母語,何況中文並不比英文不優美等等,這理由也沒錯,但問題並不在於哪種語文好或不好,而在於要全面翻轉,極其困難,得不償失。<br />
<br />
任何法令皆有其行政成本,所以,第一個就要問: 怎麼了? 有什麼問題? 問題有多大? 嗯,是為了讓病人(以及其他人?)看得懂病歷。這聽起來似乎是一件好事。<br />
<br />
前面提到,以提供給病人為目的的病歷摘要或健檢報告等,應該使用中文,這應是有共識的。但是,若整本病歷都要寫中文、都要讓病人看得懂,那就要問: 改用中文書寫,就能看得懂嗎? 甚至,有沒有副作用?<br />
<br />
對病人與其他人來說,病歷看不看得懂,或者進一步說,對病情不瞭解、懷疑醫方該做的事到底有沒有做,困難可能不在於書寫的語文,而在於醫療確實有其專業性;加強溝通,可能比用什麼語言寫更重要;加強溝通的方式包括直接對話、採用有實證的輔助溝通流程(例如5A's衛教模式)、或透過衛教教材(書面的、影音的)、透過活動、病友組織等等,這些可能都比直接看一本又厚又充滿專業名詞的病歷更有效。所以,就所提出的理由,中文化並未解決問題,而且有其他更有效的替代方法。那麼,應該把力氣用在加強這些有效的事,而非固執於使用哪種語言書寫,反而還剝奪了醫療團隊做有效的事的時間。<br />
<br />
其次,全面使用中文,是不是有副作用? 似乎是有的,第一線人員反映,對於病人或家屬不便讓彼此知道的訊息,使用中文似乎就赤裸裸的呈現了,會不會對病人隱私反而構成困擾?<br />
<br />
主張者會說,即使中文病歷不是萬能、而且有點副作用,也不表示就不能或不必全面推行吧? 這時,我們也需要考慮: 到底成本大不大、差異有多大。<br />
<br />
以法令要求全面中文化,第一個直接成本是,醫護人員從早到晚幾乎都在寫病歷,這樣全面性的改變,使他們要花很大力氣與時間去適應,會剝奪掉他們原本要用在病人身上診治病情與解說病情的時間 。臺灣在健保預算跟不上時代的情況下,醫事人力很難再擴充;在有限人力下,如果後者比前者重要,應該把時間花在後者,而非前者,否則對病人是得不償失。<br />
<br />
第二個直接成本是,病歷是病情與一切醫療活動的紀錄與資訊傳遞基礎,若無法一開始就大家都使用一致的中文用詞,將會亂成一團,同一件事有不同寫法,同樣寫法有不同意思,資訊紊亂、各自解讀,將會製造更多誤解,也等於製造了病人安全的地雷。與其如此,為何不讓醫療人員視實際情況決定使用英文或使用中文,英文的部份,在有需要給病人時,可再翻譯成中文,在有原文的前提下,即使譯得不一致,仍能從原文知道是在說什麼 (何況新世代會一般英語的已比長一輩多很多了,可能也不必翻譯了)。<br />
<br />
另外,還有間接成本,那就是中文化恐怕不利於醫療體系的國際接軌。本來大家用英文學、用英文寫、用英文交流,是很順暢的,現在硬要中文化,恐怕從教育就要開始用中文(否則用詞怎會一致)、並一路用中文。雖然其他使用母語寫病歷的國家未必醫療水準就不好,但他們與國際的交流確實有受影響(法國、韓國),而且,他們的體系是長久以來已適應那樣的狀況,而臺灣卻是在極其忙碌血汗提供服務之外,還要應付日新月異的變化、與國際保持同步,已屬不易,又突然高舉病人權益大旗,創造出一道語言隔閡,若講不出具體數據及事實,到底目前使用英文是對病人產生什麼明顯傷害、改成中文又將有什麼確切的效益,只是為中文化而中文化,搞到雞犬不寧,實在令人憂心、不解!<br />
<br />
再回到 “發生什麼事” 的第一個問題來看,以臺灣目前的醫病關係與健康問題,要提昇醫療品質、增進民眾健康,最迫切要做、也最有效的,一是落實預防醫學,二是增進醫病夥伴關係(這與寫不寫中文無關),三是充實醫衛人力,四是導入能獎勵品質的給付模式。中文化,講穿了就是出於對醫療的不信任,結果,不把力氣用在改善信任關係,反而採用攤牌的方式,加深雙方對立,迫使醫界把精力耗用在紙上紀錄、耗用在自我防護,這對於改善民眾健康,既不迫切、也不有效、又具高難度、不可行,甚至衍生更多撕裂、傷害,很明顯毫無優先性啊!<br />
<br />
-------- 新聞報導 --------<br />
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病歷中文化?邱淑媞:用詞不同易誤解</h1>
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〔中國時報/廖珮妤〕病歷中文化不只台北市長柯文哲認為暫不可行,就連國民健康署長邱淑媞今天都在臉書開罵,指病歷中文化是「醫病皆傷」。<br />
<br />
邱淑媞提到,目前並沒有禁止病歷使用中文,而是大家習慣使用英文。即使不入法,只要用中文是美事一樁,現況並不影響大家使用,尤其對於以提供給病人為目的的病歷摘要或健檢報告等,更應該使用中文,但病歷中若沒有統一中文用詞,同一件事有不同寫法,恐製造更多誤解,憂及病人安全。<br />
<br />
邱淑媞表示,醫護人員從早到晚幾乎都在寫病歷,這樣全面性的改變,使他們要花很大力氣與時間去適應,會剝奪他們原本要用在病人身上診治病情,與解說病情的時間 。<br />
<br />
邱淑媞認為,對病人與其他人來說,病歷看不看得懂,或者進一步說,對病情不了解、懷疑醫方該做的事到底有沒有做,困難可能不在於書寫的語文,而在於醫療確實有其專業性,加強溝通可能比用什麼語言寫更重要。<br />
<br />
<a href="http://www.chinatimes.com/realtimenews/20150118002037-260405">http://www.chinatimes.com/realtimenews/20150118002037-260405</a>Anonymousnoreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-35616458920975313912015-01-21T22:47:00.000+08:002015-01-21T22:47:06.638+08:00病歷書寫該用何種工作語言 是專業不是傲慢<a href="http://tmal119.blogspot.tw/search?updated-max=2015-01-17T11:32:00%2B08:00&max-results=7">病歷書寫該用何種工作語言 是專業不是傲慢</a><br />
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作者:張志華/醫勞盟理事長<br />
<br />
臨床的病歷書寫會主導教學和研究。如果病歷只能寫中文,學校就不會教英文了,那麼醫師要進修或做研究,就無法有效地和國際接軌。<br />
<br />
人體全身有好幾百塊骨頭,每一塊骨頭的名稱,我也只記得英文或拉丁文,要我重新背中文會要我的命(難道要我回去再唸七年中文的醫學教育?),而且國際會議或發表,沒有人會用中文,包括中國醫師,也得用英文和國際接軌。<br />
<br />
現行法規本來就允許「中、英、台語」夾雜書寫病歷,我的病歷也是。我們反對的是有心人士誤導立法委員們去推動修法強迫醫師「只能用中文」書寫病歷!<br />
<br />
另外,除了中文,我們也贊成視狀況用台語〔注音〕描述主訴〔可在旁加註英文〕。<br />
<br />
病歷書寫該用何種工作語言〔working language〕是專業問題,而且是攸關人命的專業,並不是醫師傲慢。因為,「病歷」是醫師的工作日誌,是醫療人員之間的溝通的管道,並不是醫病溝通的工具,更不應該便宜行事被拿作興訟之用。病人要了解病情,可以面對面跟醫師溝通,可以要求開立中文診斷書,也可以要求醫院提供中文病歷摘要。將病歷的首要用途用於「訴訟」而非「醫療」,是極度可惡的行為!<br />
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<br />Anonymousnoreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-83922504710182451962015-01-11T12:19:00.000+08:002015-01-11T12:28:32.213+08:00<b style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">[醫改會和民團,不要當破壞台灣醫療的罪人] </b><br />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;"> -- 我堅決反對病歷中文化 </span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">台大婦產科施景中醫師</span><br />
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<b>非關病人安全,無助減少醫糾,對病人瞭解自己病歷效果極有限,卻讓台灣醫界與世界脫節。</b></div>
<span style="background-color: white; color: #141823; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 15.5555562973022px; line-height: 23.0000019073486px;"><b>政府現在強推病歷中文化,民團醫改會還要政府訂時間表,到底在為了什麼鋪路?</b><br />************************************************************************************</span><br />
<b style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">病歷是記載醫師思辨、鑑別、治療的過程,是醫療人員溝通的工具。這部份的訓練源於原文的文獻,無法用中文取代。</b><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDegWfa2aovJOfbVQNfJFiopVjPq4y9Fv24dx5wv3cwrpouzqW4-3LeK9Nn5Cmyx50Nu0kEJJ1WxUPbXlC_VEbfTeZrWa4dEerKwleZHoQlA8DY9eEc65oWpbTfk_fz33GYgU6oJZFQA/s1600/Hippocrates.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDegWfa2aovJOfbVQNfJFiopVjPq4y9Fv24dx5wv3cwrpouzqW4-3LeK9Nn5Cmyx50Nu0kEJJ1WxUPbXlC_VEbfTeZrWa4dEerKwleZHoQlA8DY9eEc65oWpbTfk_fz33GYgU6oJZFQA/s1600/Hippocrates.jpg" height="640" width="490" /></a></div>
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><br /><span style="font-size: 15px; line-height: 21.5599994659424px;">( 圖來自http://uncyclopedia.wikia.com/wiki/Hippocrates)</span></span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">病人可以取得自己電子病歷,要中文化可以自己用google translation,一鍵完成。我反對將我們的工作語言,為民粹的原因,改成中文書寫。如果嚴格執行,醫療人員勢必看著中文的病歷,反過來猜說原來醫療人員想表達的原文是什麼,只會造成更多的書寫負擔與溝通錯誤機會。</span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">1. 我到過很多國家演講,實際並非如同如報紙所寫。其實多數國家並非用母語記載病歷,尤其病名藥名的記載,幾乎清一色以英文(原文)病名溝通。</span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">2. 英美各國確定用自己母語書寫病歷,醫療糾紛就比較少嗎? </span><br />
<br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;" />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">3. 中國大陸醫學中文化最徹底,只是長久下來,醫師看不懂原文的文獻。病歷記載一律用中文,醫療糾紛有比較少嗎? 中國還常常會有醫療人員被砍死的報導。</span><br />
<br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;" />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">4. 醫改會和民團,認為中文書寫病歷可讓病患瞭解自己就醫狀況。 只要中文就看得懂了嗎? 引一段科普文章,請醫改會和民團跟我說妳們看懂了嗎? </span><br />
<br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;" />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">http://scimonth.blogspot.tw/2013/05/blog-post_8948.html 2012年7月4號</span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">在一場全球矚目的實況轉播會議上,位於歐洲的大型強子對撞機(LHC)計劃底下的兩大實驗團隊── CMS與ATLAS,各自宣佈了在高能質子束對撞後的殘骸中,發現了疑似希格斯玻色子的跡象,其質量若依愛因斯坦著名的質能關係式(E = mc2)表達,約莫落在126 GeV/c2 能級附近。截至目前為止,訊號不曾消失掉且益發強烈,在可預見的將來這顆疑似希格斯玻色子極可能被宣布為一顆真正的希格斯粒子。若屬實,這無疑是粒子物理發展史上的一大勝利,標誌著人類對物質世界的瞭解又往前邁進了一大步。對高能物理學有興趣的讀者,在媒體鋪天蓋地的報導下,或許已經對於發現希格斯粒子在物理上的重要性了然於胸,知道它是標準模型的粒子家族當中尚未證實的最後一員,它的存在可解釋萬物質量之謎。 </span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">名詞註解:GeV/c2,為基本粒子的質量單位,GeV 代表10 億電子伏特,而c 代表光速。根據質能公式E=mc2,能量為質量乘以光速的平方,因此以電子伏特為單位的能量除以光速的平方,就是粒子的質量。 </span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">5. 現在有google translation。一個按鍵下去,英文已經可以自己翻成中文。(電子病歷讓病人自己就可中文化)。</span><br />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">但是醫改會和民團,妳們確定病人就可以看懂? 氯胺酮、麥角新鹼、氨甲喋呤 ....... (原來是Ketamine,Ergonovine, methotrexate),結果病人和醫生一起看不懂。 </span><br />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">GOT, GPT病人一看就懂,中文化變成麥胺草醋酸轉胺脢和麥胺丙酮酸轉胺脢。</span><br />
<br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;" />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">套句網友的話,從看得懂的英文,變成有看沒有懂的中文。</span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">6. 法院文書、政府公文,雖然是中文,我也常常看不懂。</span><br />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">債務給付不全、假處分、假扣押、阻卻違法.... 這些都與我的公民權利相關。</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoR_kVcxW75nANbmKn1qJQfnVjt8THDTvGBPA2CcPcBSpqfXY90mV9k55LWMboBgz9kne60riMfxKD6xEzuSRQXCgfQ9b6IuZHWAOkJ8c9Oj1Ipt7-UTWMECtxeECyCcPauDNaG__DnA/s1600/8BY4A.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoR_kVcxW75nANbmKn1qJQfnVjt8THDTvGBPA2CcPcBSpqfXY90mV9k55LWMboBgz9kne60riMfxKD6xEzuSRQXCgfQ9b6IuZHWAOkJ8c9Oj1Ipt7-UTWMECtxeECyCcPauDNaG__DnA/s1600/8BY4A.jpg" height="251" width="400" /></a></div>
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(來自網路,原作者歡迎轉載)</div>
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">照醫改會和民團說法,法院和政府是不是違反我的公民基本人權? 可以叫法院、政府一起改嗎? (反正看不懂就是寫的人的錯?) </span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">7. 我買的電腦硬碟標示,上面都是英文,嚴重違反我的消費者權利。</span><br />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">中文化後,工程師們可能要搖頭。</span><br />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">500G 要翻譯成 500千兆字節,Cache翻譯成高速緩存,RAM變成內存。 </span><br />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">醫改會和民團,看到這個,妳們會高興一點嗎? </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLEl2oGk9FKEx4c-PBjYjqhEJfrseCO8VEIweITLV2BJ5L8War2tci7fjKr-Z61GWmyOZaWBiJ9QcgWoZqOi-wx5m7oJ28drYejyLs6i8iXkA5FWYWSaiQucdr2kliikwIJij9asNk2w/s1600/079BEC46065C8A328133B34EC276DC7773EAF925_large.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLEl2oGk9FKEx4c-PBjYjqhEJfrseCO8VEIweITLV2BJ5L8War2tci7fjKr-Z61GWmyOZaWBiJ9QcgWoZqOi-wx5m7oJ28drYejyLs6i8iXkA5FWYWSaiQucdr2kliikwIJij9asNk2w/s1600/079BEC46065C8A328133B34EC276DC7773EAF925_large.jpg" height="320" width="320" /></a></div>
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">(圖片連結自Hitachi公司)</span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">醫改會和民團,請不要當破壞台灣醫療的罪人。</span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">請不要製造更多的問題、更多的糾紛。 </span><br />
<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">中國大陸徹底醫學中文化,教科書用中文,病歷書寫用中文。結果醫學與世界潮流脫節。原文期刊看不懂,不大會用英文發表醫學著作。邀請西方國家的人去演講,必須透過翻譯。 </span><br />
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<span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 15px; line-height: 21.5599994659424px;">除非確定要與世界脫節,不然沒有台灣醫生想走中國大陸的模式。 我們也不想用原文教科書學習,但進入臨床必須全部在重頭改過思考模式才能寫病歷。</span>Anonymoushttp://www.blogger.com/profile/13087521778357742794noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-21971433957577826882014-12-30T01:47:00.001+08:002015-01-01T08:29:19.994+08:00醫病五溝通, 向無效醫療說停<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="text-align: left;">◎台灣醫療改革基金會 辜智芬研究員</span></div>
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<b><span style="font-size: large;">我是否思考過生死問題? 我的人生期末考卷答得如何呢?</span></b></div>
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<span style="font-size: large;"><b>病人有緊急狀況時, 當醫師講的我聽不懂, 敢不敢跟他(她)說請再說一次, 講白話文嗎?</b></span></div>
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<b><span style="font-size: x-large;">醫病五溝通-首先講醫療實證</span></b></div>
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<b><br /><span style="font-size: x-large;">醫病五溝通-第二尊重病人意願</span></b></div>
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<b><span style="font-size: x-large;">醫病五溝通-第三要了解家屬意願</span></b></div>
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<b><span style="font-size: x-large;">醫病五溝通-第四要明白照護選項</span></b></div>
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<b><span style="font-size: x-large;">醫病五溝通-第五要尋找可用資源</span></b></div>
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<span style="font-size: x-large;">反躬自省, 在「捨得」與「捨不得」中要有全觀性的思考</span></div>
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Sliver Linings LOHAS (撥雲見日 樂活人生)http://www.blogger.com/profile/05560492105797220203noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-24573617633545812092014-12-21T19:34:00.000+08:002014-12-21T19:41:13.520+08:002014伊波拉特輯之一: 比防護衣更重要的事 醫療人員該知道的伊波拉病毒感染<div dir="ltr" style="text-align: left;" trbidi="on">
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</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">◎疾病管制署</span><span lang="EN-US"><span style="mso-spacerun: yes;"><span style="font-family: Calibri;">
</span></span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">蘇家彬醫師</span></div>
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><strong><span style="font-size: large;">前言</span></strong></span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在過去說起伊波拉病毒,大多數人的印象可能還停留在電影”危機總動員”那隨空氣傳播的致命疾病。其實自從</span><span lang="EN-US"><span style="font-family: Calibri;">1976</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年首度在中非薩伊北部伊波拉河附近發生首次疫情以來,此病毒在非洲地區已造成了二十次以上的群突發感染,但一直沒有廣泛引起大眾的注意。</span><span lang="EN-US"><span style="font-family: Calibri;">2014</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年開始於西非獅子山、賴比瑞亞以及幾內亞三國的疫情,已造成了上萬名個案感染,其病患數與死亡數是史上之最。國際間因此陸續投入了許多的資源協助控制疫情。但在美國與西班牙接連發生醫療人員照顧病患而遭到感染的事件後,喚起了在台灣的大家對於</span><span lang="EN-US"><span style="font-family: Calibri;">SARS</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">疫情的記憶。網路上開始討論防護裝備等級是否足夠,擔心發生院內感染,也對相關的疫情防治措施有許多疑問。身為醫療專業人員,針對致死率高的新興傳染病絕不可掉以輕心。唯有透過對疾病正確的認識,依據現有的科學證據,針對各種可能出現的情境,做好相對應的應變計畫,才能為可能來臨的疫情做好準備。</span></div>
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">伊波拉病毒屬於絲狀病毒科(</span><span lang="EN-US"><span style="font-family: Calibri;">Filoviridae</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),為未分節單股</span><span lang="EN-US"><span style="font-family: Calibri;">RNA</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">病毒,具有外套膜。本病毒可再細分為五種,本次於西非大流行的為</span><span lang="EN-US"><span style="font-family: Calibri;">Zaire</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">型。根據過去的研究顯示,果蝠被推測是可能的病毒天然宿主,其他靈長類野生動物也可能受到感染。在疫情初期,病毒可能是透過接觸受感染果蝠或野生動物直接傳染給人。感染者回到社區後,主要透過接觸感染而在人群之間傳播,造成疫情爆發。病患或其屍體之血液、嘔吐物等體液均含有病毒,黏膜或破損的皮膚直接接觸體液或被體液污染的環境,就有可能感染。此病毒雖然為接觸傳染,但僅需要少量的病毒即可感染人體,再加上感染者體液內病毒量極高,使得疾病傳播風險大大增加。</span><span lang="EN-US"><o:p></o:p></span><br />
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">伊波拉病毒感染至發病的潛伏期為</span><span lang="EN-US"><span style="font-family: Calibri;">2</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至</span><span lang="EN-US"><span style="font-family: Calibri;">21</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">天,本次西非疫情平均約為</span><span lang="EN-US"><span style="font-family: Calibri;">9</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">到</span><span lang="EN-US"><span style="font-family: Calibri;">11</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">天。病人於出現症狀後才具有傳染力,且其傳染力隨病患病程進展而增加。疾病初期病患將突然出現發燒、畏寒、倦怠等非特異性不適症狀,其他可能出現的初期症狀包括頭痛、咽喉痛、肌肉痛、噁心、嘔吐、腹瀉、腹痛等。數天之後,由於凝血功能受影響,可能開始出現出血相關症狀,如牙齦出血、皮膚淤青、腸胃道出血等。後期重症者常伴有肝臟受損、腎衰竭、中樞神經損傷及休克等併發症,個案死亡率可高達九成,在這次西非疫情中,致死率推估為七成左右。伊波拉病毒感染的診斷方式可分為核酸檢測、血清抗體檢測、免疫化學染色</span><span lang="EN-US"><span style="font-family: Calibri;">(Immuno-histochemistry)</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">等方式。檢體則以血液為主,咽喉拭子也可用於病原體的檢測,但其敏感度較低,主要於無法採檢血液的情況時使用。此外針對出現病變的皮膚及器官切片亦可檢驗出病毒。另外需要注意的是,由於發病後三天內,血液中病毒量可能低於儀器可檢驗的範圍,造成偽陰性的結果,故如血液檢體為發病後三日內所採檢,就算檢驗結果為陰性,應視病患病情在發病滿三日後再次採檢送驗,以排除感染。</span><br />
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 目前對於伊波拉病毒感染,尚無有效的抗病毒藥物或疫苗可供治療與預防。根據資料顯示,研發當中的抗病毒藥物或疫苗共計有十幾種,世界各國正在加速臨床試驗的進行。目前在病患治療上還是以良好的支持性療法為主,包括體液及電解質平衡、維持血壓及氧氣狀況、補充血液和凝血因子、併發性感染的治療等。部分病患可在良好的治療後恢復健康。</span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="font-size: large;"><strong>美國與西班牙院內感染事件帶來的改變</strong></span></span></div>
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在疫情爆發時,包括照護病患的親屬、醫療人員與殯葬人員,如果無任何防護措施而接觸病患血液、體液或屍體,被感染的危險性最高。由於目前缺乏有效的藥物與疫苗,落實感染管制措施以預防感染是控制疫情的重要方式。世界衛生組織與美國疾病控制中心於疫情初期,建議所有醫療人員必須配戴眼罩或面罩、口罩、隔離衣</span><span lang="EN-US"><span style="font-family: Calibri;">(Gown)</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">與手套等防護裝備。</span><br />
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 理論上這樣的配備已足以防護以接觸感染為主的伊波拉病毒,但在美國與西班牙陸續發生醫護人員配戴個人防護裝備照顧病患仍罹病的事件後,經過檢討,目前各國建議採取更嚴格的標準,我國也跟進採取類似的規範。其重點除了加入更多的防護裝備,包括雙層手套、連身式防護衣、長筒鞋套、</span><span lang="EN-US"><span style="font-family: Calibri;">N95</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">口罩、全罩型面罩、防水圍裙等來避免醫護人員可能的皮膚暴露之外,更重要的是強調所有相關人員必須接受嚴格與多次的訓練,以及在穿脫隔離衣的過程中,必須有一位經過訓練的觀察者全程協助監督,以確保整個過程均遵照事先規劃的規範進行。除此之外,個人防護裝備只是整體感染管制措施的一部份而已,包括如何早期篩檢出疑似個案、動線分流、人員管制、環境清消等等,都是醫療機構針對伊波拉病毒感染管制計畫中不可或缺的環節。因應最新疫情發展變化,相關文件將可能隨時修正。每間醫療機構應針對各自機構的屬性、設備、資源、病患組成、醫療人力等因素,參考官方指引與科學研究結果,設計出一套可行的感染管制措施並定期演練。</span><span lang="EN-US"><o:p></o:p></span><br />
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<span style="font-family: 新細明體;"><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖片</span><span lang="EN-US"><span style="font-family: Calibri;">1 </span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">:因應伊波拉病毒感染醫療照護工作人員個人防護裝備建議</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibdNW_nAxrLh04TN_oiNnQgNaszLJQwxIon_pYM-jTlNAjCM4lIgxkS_BwBMh7IxyS4tsiEaXOfNfdUiHstvh4EeDyE5zIwIxTuIYMfmMRQxFWU330yJ6a_IAOVlbk4S6BJv2WvrlFAs0/s1600/%E5%9C%96%E7%89%871.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibdNW_nAxrLh04TN_oiNnQgNaszLJQwxIon_pYM-jTlNAjCM4lIgxkS_BwBMh7IxyS4tsiEaXOfNfdUiHstvh4EeDyE5zIwIxTuIYMfmMRQxFWU330yJ6a_IAOVlbk4S6BJv2WvrlFAs0/s1600/%E5%9C%96%E7%89%871.png" height="640" width="347" /></a></div>
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<span style="font-family: 新細明體;"><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖片</span><span lang="EN-US"><span style="font-family: Calibri;">2</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">:新舊個人防護裝備比較</span><br />
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<strong><span style="font-size: large;"><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"></span></span></strong><br />
<strong><span style="font-size: large;"><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">疾管署針對醫療體系的整備作為</span><span lang="EN-US"><o:p></o:p></span></span></strong><br />
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">世界衛生組織於</span><span lang="EN-US"><span style="font-family: Calibri;">2014</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span><span lang="EN-US"><span style="font-family: Calibri;">8</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span><span lang="EN-US"><span style="font-family: Calibri;">8</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日宣布西非伊波拉病毒感染疫情為國際關注公共衛生緊急事件後,疾管署隨即召集各區傳染病防治醫療網指揮官,成立「伊波拉病毒感染緊急應變小組」。並確立以「出境衛教、入境檢疫、國內整備</span><span lang="EN-US"><span style="font-family: Calibri;">/</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">演練、國際合作」四大主軸為之疫情因應作為。我國針對此次疫情的初步風險評估顯示,因我國與西非疫情發生國交流有限,雖仍可能有境外移入個案的風險,但造成國內流行的可能性甚低。在醫療體系的整備方面,首先在全球資訊網(</span><span lang="EN-US"><span style="font-family: Calibri;"><a href="http://www.cdc.gov.tw/">www.cdc.gov.tw</a></span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)設置伊波拉病毒感染專區,制訂相關指引、核心教材等供醫療相關工作人員參考,並主動發佈致醫界通函,提醒相關疫情以及更新相關注意事項(訂閱網址</span><span lang="EN-US"><span style="font-family: Calibri;"><a href="http://www.cdc.gov.tw/subscribe.aspx">http://www.cdc.gov.tw/subscribe.aspx</a></span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。其次,疾管署已要求區域級以上醫院之感染管制委員會,將伊波拉病毒感染防治列為重點加強辦理,除了張貼宣導海報外,並依相關個案通報與處置的規定,制訂該院流程,並辦理相關教育訓練與個人防護裝備的穿脫訓練,主要目的是為了保障醫護人員的健康與病人的安全。另外疾管署也將進行</span><span style="font-family: Calibri;">
<span lang="EN-US">”</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鄧肯來了</span><span lang="EN-US"><span style="font-family: Calibri;">” </span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">無預警演習,以模擬病患至急診求診的方式,測試各醫院與公衛機關的實際應變措施以及流程運作情形,瞭解可能發生的問題並協助解決。最後,關於防疫物資的儲備方面,疾管署已採購兩萬套的防水隔離衣、頭套、面罩、長統鞋套等裝備,以備</span>不時之需<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。至於</span><span lang="EN-US"><span style="font-family: Calibri;">N95</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">口罩、外科口罩、全身式防護衣等防護裝備,在例行的醫院院感查核中,已有規定各醫院必須的安全儲備量,中央與地方衛生機關也都有相對充足的儲備物資。其相關資訊已上網公告供大眾查閱(</span><span lang="EN-US"><span style="font-family: Calibri;"><a href="https://mis.cdc.gov.tw/">https://mis.cdc.gov.tw/</a></span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。目前儲備量至少可供疫情發生一個月內使用。</span><span lang="EN-US"><o:p></o:p></span><br />
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">我國在</span><span lang="EN-US"><span style="font-family: Calibri;">SARS</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">之後,為了提升新興傳染病的整體應變能力,建立了傳染病防治醫療網,將全國劃分為六個醫療網區,以區域聯防為運作策略,並於每個網區聘任指揮官、副指揮官各一人,做為溝通橋樑,協助辦理傳染病防治相關事項。各網區內指定一家網區應變醫院,作為必要時收治病患的場所。目前針對各應變醫院,已完成負壓隔離病房檢視、個人防護裝備儲備、收治病患時相關動線流程演練等工作。依據目前的規劃,伊波拉病毒感染的疑似個案採檢與確定個案照護,將以收治於網區應變醫院為原則。故其他醫院可將重點放在急診與門診疑似病患的處置與轉送流程為主。</span><span lang="EN-US"><o:p></o:p></span><br />
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="font-size: large;"><strong>醫療人員該如何保護自己</strong></span></span><span lang="EN-US"><o:p></o:p></span><br />
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">身在台灣的我們,雖然看似距離疫情發生地非常的遙遠,但在現今空中交通發達的情況下,世界上任一角落的疾病皆有可能在一天之內進入國境,故良好的準備仍有其必要。針對伊波拉病毒等新興傳染病的應變與整備,醫療機構中管理階層與感染管制單位有責任設計出因地制宜的防疫計畫,估計醫護人力、硬體設備與個人防護裝備的數量與品質是否足以應付防疫所需。進行風險評估,預估各環節可能不足之處,適時加強。同時落實辦理教育訓練,讓每位第一線的醫護人員都有機會參與實際演練。</span><span lang="EN-US"><o:p></o:p></span><br />
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">醫療人員平時在執行工作時,就應該落實良好的標準防護措施,包括確實執行手部衛生、呼吸道衛生與咳嗽規範、接觸病患體液時戴手套等。因為您永遠不知道,您所照顧的病患是否有任何傳染性疾病。雖然依照規劃,伊波拉病毒感染確定個案將以收治於應變醫院為原則,但實際上病患可能出現於任何地方,故診治個案時一定要先詢問旅遊史、職業史、接觸史、群聚史等資訊,以期早期篩檢出疑似個案。如果您在基層診所執業,請您花半小時的時間瀏覽一下相關資訊,想一想,如果在看診時遇到西非回國的發燒個案,要如何處理?可行的作法包括先請病患戴上口罩,依照原先設計好的動線,隔離於院內獨立房間,並撥</span><span lang="EN-US"><span style="font-family: Calibri;">1922</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">防疫專線請求協助轉送個案,事後再進行清潔消毒的工作。如果您是在醫院工作,則請盡量多參加相關的教育訓練,向院內感染管制單位提出意見與討論,以設計出合適的疑似病患動線與通報流程,穿戴好適當的防護裝備後再進行後續診療,以避免可能的院內感染。事前積極參與相關演練,等到真正遇到疑似病患,方可保障自己與同事的安全。</span><br />
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 美國疾病管制與預防中心提出,醫護人員的安全的五大支柱包括了</span><span lang="EN-US"><span style="font-family: Calibri;">1. </span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">機構領導者必須負起責任</span><span lang="EN-US"><span style="font-family: Calibri;">2.</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">必須有專責人員規劃並執行相關措施</span><span lang="EN-US"><span style="font-family: Calibri;">3.</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">必須有清楚及標準化可執行的步驟</span><span lang="EN-US"><span style="font-family: Calibri;">4.</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">相關醫療人員必須接受足夠的訓練</span><span lang="EN-US"><span style="font-family: Calibri;">5.</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">任何措施必須有嚴密監督,確保所有流程正確執行。他山之石,可以攻錯。其他國家的經驗,值得我們借鏡。</span><span lang="EN-US"><o:p></o:p></span><br />
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伊波拉病毒感染是一種高死亡率且傳染性高的嚴重疾病。針對此次西非伊波拉病毒大規模感染之疫情,我國初步風險評估顯示,雖可能有境外移入個案的風險,但造成國內流行的可能性低。在美國與西班牙陸續發生醫療人員院內感染的事件後,個人防護裝備與感染管制措施的建議均有所修正。醫療人員處於防疫的第一線,感染病毒的可能性較一般民眾為高,更應該對此疾病有更多的瞭解,落實感染管制措施以避免感染。疾管署已在全球資訊網(<a href="http://www.cdc.gov.tw/">www.cdc.gov.tw</a>)建置伊波拉病毒感染專區,提供感染管制、檢疫及防疫相關指引、教材、FAQ等資料。如有任何疑問,歡迎隨時瀏覽查閱,或撥打免付費防疫專線1922專線諮詢。<br />
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<span style="font-family: 新細明體;"><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">姓名:蘇家彬</span></span></div>
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<span style="font-family: 新細明體;"><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">現職:衛生福利部疾病管制署 </span><span lang="EN-US"><span style="mso-tab-count: 1;"><span style="font-family: Calibri;"> </span></span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">防疫醫師</span></span></div>
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">經歷:林口長庚紀念醫院內科部 </span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">住院醫師</span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> </span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">林口長庚紀念醫院內科部感染醫學科 </span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 主治醫師</span><span lang="EN-US"><o:p></o:p></span><br />
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Sliver Linings LOHAS (撥雲見日 樂活人生)http://www.blogger.com/profile/05560492105797220203noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-10758263211362294352014-12-21T19:17:00.000+08:002014-12-23T04:18:51.145+08:002014伊波拉特輯之三: 經歷高雄伊波拉烏龍事件的心情點滴<div dir="ltr" style="text-align: left;" trbidi="on">
◎高雄榮總內科部感染科 周稚偵醫師<br />
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<strong><span style="font-size: large;">防疫視同作戰-高榮上百人迅速動員</span></strong><br />
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<span style="font-size: large; font-weight: bold;"> </span>到宣布陰性後的四個小時,終於意識到這段短短的時間自己的壓力有多大,大哭了一場,還好是陰性。<br />
防疫視同作戰,還真不是口號。隨便一個決定如果錯誤,就是一場大災難的開始。雖然事情的因由來的奇怪,但是我想我們整個團隊,特別是我,得到了非常寶貴的經驗。<br />
從一開始決定是否要啓動機制,接下來自啓動的那一刻起,之後一切從急診到隔離病房的流程和動線,醫護人員的出動、調度、配置,警衛、中控室、檢驗人員、清潔人員的配合,與衛生和中央單位的聯繫,一連串大概有上百個人開始嚴陣以待。<br />
身為第一線的醫療人員,從接到急診電話的那一刻起,根本無暇緊張,不斷打電話連絡,不斷開始想著之前演練過的流程,這個時候哪個單位應該要在做什麼,人應該在哪裡,我應該要去哪裡待命。到了隔離病房之後,要調動床位,要準備防護裝備,除了自己著裝還要協助其他人員著裝。幫忙清潔北北(伯伯)著裝的時候更是焦慮萬分。除了仰仗他們平時的教育訓練和演習,事實上在當下如何正確保護他們不受污染無形中成為我們的責任。</div>
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<strong><span style="font-size: large;">舒緩病人焦慮, 問他蝙蝠肉好不好吃?</span></strong><br />
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病人到病房之後,和護理人員著裝進去採檢問病史,不到十分鐘我已經開始頭暈氣促、滿身大汗,每問一句話都要先緩緩,吸口氣再開始。要做咽喉採檢的時候,病人嘴巴還沒張開就看起來快吐的樣子,那時候也無暇感覺害怕,只想著要怎麼讓他不吐然後又快速的做完採檢,結果還是失敗。<br />
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在裡面的時候,我想病人一定很害怕吧,還刻意多跟他瞎扯兩句,試圖減低他的焦慮。問他蝙蝠肉好不好吃,問他蝙蝠要怎麼處理,問他去那邊做什麼,他回答的煞有介事。直到脫除裝備,洗完澡,回護理站討論討論,結果我突然決定不了晚上該去哪裡,結果在辦公室窩了一夜,夜難成眠。<br />
躺在會議室的沙發上,我想著在非洲的那些NGO和醫護人員們,經歷的是比這困難十倍的環境耶。他們沒有這麼完善的裝備,非洲的天氣悶熱也沒有空調,病人量很多,可能還語言不通,又充滿著恐懼。有很多醫師都是從其他國家去支援的,到底他們是抱著怎麼樣的心情和心理準備?結果支援醫師回到她的家鄉,明明沒有症狀卻被隔離,要是我也會非常生氣吧。</div>
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<span style="font-size: large;"><strong>平常</strong></span><strong><span style="font-size: large;">扎實的演練 團隊通過考驗</span></strong><span style="font-size: large;"></span><br />
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> </span><br />
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 隔天一早再瞭解一下狀況,覺得陽性可能性真的很低,就回家了。回家路上走路短短三分鐘,可能是我的心理作用吧,覺得為什麼早餐店老闆不像以前那樣熱情招呼我了?為什麼管理員北北</span><span lang="EN-US" style="text-align: justify;"><span style="font-family: Calibri;">(</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">伯伯</span><span lang="EN-US" style="text-align: justify;"><span style="font-family: Calibri;">)</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">也不跟我說早安辛苦了?為什麼我覺得我好像做了什麼錯事一樣,之前看到的那些對於支援醫師回到自己國家之後正常出門走動的批評,在我腦裡一直浮現。在結果出來之前,他們也是這樣看我嗎?結果出來了是個虛驚,但我所經歷的這一切卻紮紮實實。</span><br />
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 我真的覺得我們整個團隊很棒!多虧了之前從</span><span lang="EN-US" style="text-align: justify;"><span style="font-family: Calibri;">H7N9</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">一路到</span><span lang="EN-US" style="text-align: justify;"><span style="font-family: Calibri;">Ebola</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的演練,整個流程的核心重點都做到了。從急診、護理、感管、內科部、各個支援單位,當然還有科裡的老師,特別是兩個主任,對於第一線的人員給了很大的幫助。在裡面處理病人的時候想到有任何狀況都有外面人員的幫忙和支援,我並不孤單,這點給我很大心理上的支持。</span><br />
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<span style="font-size: large;"><strong>分享穿脫防護裝備的三大重點</strong></span><br />
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<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 而這次在穿脫防護裝備的幾個重點,雖然做的並不完美但也大致順暢。一些心得與大家分享</span><span lang="EN-US" style="text-align: justify;"><span style="font-family: Calibri;">:</span></span><br />
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">一</span><span lang="EN-US" style="text-align: justify;"><span style="font-family: Calibri;">.</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">是手套,與防護衣之間哪層在外哪層在內要確實穿戴,除了利於之後脫除的順</span><span style="text-align: justify;">序,手套也可固定住防護衣的袖口,才不會發生袖口上移暴露手臂的情形。</span><br />
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">二</span><span lang="EN-US" style="text-align: justify;"><span style="font-family: Calibri;">.</span> </span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">是鞋子,穿拖鞋、跟鞋或是勃肯鞋都有風險,一來腳背皮膚暴露面積大,再來是脫防護衣時非常容易掉。據我們的經驗,穿類似護士鞋的包鞋是比較安全的。</span><br />
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">三</span><span lang="EN-US" style="text-align: justify;"><span style="font-family: Calibri;">.</span> </span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">這次穿脫隔離衣的另一個重點是同儕檢視系統</span><span lang="EN-US" style="text-align: justify;"><span style="font-family: Calibri;">(buddy system)</span></span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,由著裝者和未著裝的同伴共同檢查穿戴的完備度和脫除時的程序,這個制度的好處不僅因爲多一個人幫忙盯著著裝而讓防護更安全,也可減輕著裝探視病人的醫護人員心裡的壓力。特別是在脫除裝備時,聽著同伴沉穩清晰的說著一個個指令,心就不會慌,動作不會亂,污染的機率也就更低了。</span><br />
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</span><span style="font-size: large;"><strong>請給第一線防疫人員溫暖的支持</strong></span><br />
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這一次的虛驚,媒體熱度很快就退散了,可能也很快就沒有人在意,但是真正的事件隨時都會來,持續的演練和心態上的警戒才是更為重要。防疫這件事,只有更好,沒有最好。<br />
也請大家對防疫人員給予支持和信心。有越多人對防疫有著正確的心態和認知,防疫工作一定能更完善!</div>
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<span style="font-size: large;"><strong>《作者小檔案》</strong></span><br />
周稚偵醫師<br />
學歷:成功大學醫學系 醫學士<br />
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現職:高雄榮民總醫院感染科 主治醫師<br />
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經歷:成功大學附設醫院內科部 住院醫師<br />
高雄榮民總醫院感染科 總醫師</div>
Sliver Linings LOHAS (撥雲見日 樂活人生)http://www.blogger.com/profile/05560492105797220203noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-44714264470057900622014-12-21T01:33:00.000+08:002014-12-21T19:43:23.009+08:002014伊波拉特輯之二: 聽到遙遠而微弱的求救聲, 您回應了嗎?<div dir="ltr" style="text-align: left;" trbidi="on">
◎疾病管制署 Anita Chan醫師<br />
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<span style="font-size: large;"><strong>抗波, 從基本做起</strong></span><br />
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</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;"> </span></span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">為了因應遙遠的西非</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">3</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">國疫情,台灣的各大醫院也開始準備動員伊波拉相關的防護,</span></span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">除了特定的六家醫院為了收治疑似和確定病患做準備,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">醫院急診和門診也被要求針對病人,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">落實旅遊史的詢問和針對疫區回來的發燒嘔吐腹瀉病患,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">要提高警覺,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">適當隔離,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">以保護醫療院所的感染控制安全。</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">12</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">月</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">4</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">日,假裝自己從奈及利亞回來的年輕病人,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">因為號稱他在奈及利亞吃過蝙蝠肉,在高雄演了一場斥資不菲的鬧劇,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">扎扎實實地給第一線的工作人員,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">既無奈又不得不準備的一堂課。伊波拉疫情雖然很遠,台灣與西非各國的交流雖不及中國等國家頻繁,但不怕一萬只怕萬一。</span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">疾管署每年都有傳染病防治網的醫院演訓個人防護衣</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">(personal
protective equipment</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">,</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> PPE)</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">穿脫和動線訓練,兩三年來的假想戲碼就是伊波拉。今年因為國外有疫情,各國針對</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">PPE</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">在</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">10</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">月底前有許多次修正,防疫醫師和感控組護理人員,特別針對最新版本,南下到傳染病防治中心,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">協助穿脫</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">PPE</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">的訓練課程。我們採用的是小組教學,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">一個老師,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">要幫忙</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">4</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">個學生完成穿脫</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">PPE</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">訓練,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">早上有重點教學講授,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">並實務演練,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">確定每位學員穿脫無誤</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">; </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">午餐後,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">穿上</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">PPE</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">到隔離病房,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">練習嘔吐物汙染地面的清除,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">以及檢體外送套袋訓練</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">; </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">做完兩個應用題之後,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">用螢光染劑髒污雙手和外層防水圍裙,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">經過實際穿脫,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">用紫外線燈確定汙染狀況並檢討。</span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我的組的學員其實剛好都是平時在做結核病的同仁,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">所以,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我們很有默契地,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">在早上多練習一次穿脫,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">下午,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">姊妹們的動作很快,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我們做完應用題後,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">脫得很熟練, 螢光染色的試驗都通過。</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我跟學員講,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">你們很棒,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">按照步驟好好脫,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">都沒有汙染到自己</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">! </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">這樣,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">萬一以後要照顧疑似</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">Ebola</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">的病人,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">應該更有信心了吧!</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">4</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">個歐巴桑級的資深護理師點點頭,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">很開心地合照。</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><br />
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<span style="font-size: large;"><strong>台灣專家, 願意到西非疫情調查</strong></span><br />
<span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;"><br /></span></span>
<span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;"> 回到教室,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">其他組的組員,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">還在練習,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">沒有回到教室,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">所以我們就閒聊了起來</span></span><span lang="EN-US" style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;">; </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我跟她們說,獅子山疫情好像短期下不來,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">獅子山本來就很缺醫師,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">醫師寧可到南非去,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">也不願意留在國內, 少數留在國內的醫師,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">最近犧牲了太多,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">導致幾十萬人口才分得到一個醫師</span></span><span lang="EN-US" style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;">; </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">此外,獅子山也需要很多不同領域的人手,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">比如協助做流行病學調查,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">確保病患的接觸者都被找到並且提供體溫監測及衛生指導,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">教育接觸者知道有症狀應該要做的事情,如何保護自己和家人的安全等等。</span></span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">所以最近有個機會,</span></span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我也跟不少同事一樣,丟申請書給國際流行病學調查班</span></span><span lang="EN-US" style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;">[Training Programs in Epidemiology and Public Health
Interventions Network (TEPHINET)]</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">希望有機會讓我們也去幫幫忙,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">就算是發揮專長,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">幫忙做疫情的整理,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">分擔一點工作,</span></span><span style="background-color: transparent; color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt; text-align: left;"> </span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">也好。</span></span></div>
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<span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">同仁用不可思議地眼神看著我,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">「</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">老師,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">你們是抱著必死的決心,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">做這個決定的嗎</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">? </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">為什麼要這樣</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">?</span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">」</span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我說,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">「</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">我只不過是去協助流行病學和疫情調查,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">更何況,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我們今天不是在訓練,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">正確的穿脫防護衣,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">再加上正確的知識,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">你就可以避免汙染自己和別人,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">不是嗎</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">? </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">你們剛剛不是說有信心</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">?</span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">」</span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">同仁真心地替我擔心,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">沉默,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">是一種關心,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">我感受得到。</span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">一個同仁很直接地說</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">: </span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">「</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">那老師,你要帶我們的防護衣和口罩去喔,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">你怎麼知道,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">他們給你用的,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">夠不夠保護你,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">你要多帶起套去。</span><span style="color: #141823; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">」</span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我當然回答,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">不要擔心啦</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">! </span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">我會保護我自己的。</span></span><br />
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圖一: 台灣疾管署防疫醫師在西非參與流行病學和疫情調查<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqE4r9zIys6nwI9HtSk8Xklk7SykYb8aj0RzHe7v_A3VMrUHpcvbu2s6IlIsHxKM3ElI6CcyFJeaIoGSelzXk3_bybXskRr-x53Zd7OM7r7sFH9GyVBUgHcfR-Ddf0oBzIkK98OeqE4d8/s1600/%E4%BC%8A%E6%B3%A2%E6%8B%89%E5%9C%B0%E5%9C%96_1220'14.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqE4r9zIys6nwI9HtSk8Xklk7SykYb8aj0RzHe7v_A3VMrUHpcvbu2s6IlIsHxKM3ElI6CcyFJeaIoGSelzXk3_bybXskRr-x53Zd7OM7r7sFH9GyVBUgHcfR-Ddf0oBzIkK98OeqE4d8/s1600/%E4%BC%8A%E6%B3%A2%E6%8B%89%E5%9C%B0%E5%9C%96_1220'14.jpg" height="314" width="640" /></a></div>
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<span style="font-family: 新細明體; font-size: xx-small;"><span style="color: #141823; font-size: xx-small; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><strong>2014時代雜誌風雲人物-勇敢的抗波英雄們</strong></span></span><br />
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<span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">每日在台灣和全世界,面對不知明風險,仍堅守崗位的醫護公衛人員,不論有沒有致命的傳染病,他們都兢兢業業地備戰者。她們現在卻在擔心我</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">! <o:p></o:p></span><br />
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<span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">時代雜誌</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">2014</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">年的風雲人物,是投入伊波拉戰爭的醫護人員。望著台南窗外的天空,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">想著那些跟西非三國,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">非親非故的醫護人員,投身在第一線作戰,前仆後繼,其實心裡面既感傷又感激。自己很幸運,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">這麼好命,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我們生在一個國家,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">女生可以讀書,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">可以當醫生,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我沒有被逼著要到另外一個國家去行醫,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我對公衛有興趣,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">所以我可以堅持在工作岡位上,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">領著還可以的薪水,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">過著想要的生活。</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"><br /><br /><o:p></o:p></span></div>
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<span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我們其實一直都聽到遙遠而微弱的求救聲,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">不是只有伊波拉,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">我還聽到蠢動的結核病,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">愛滋病,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">數以萬計填不飽肚子的孤兒的聲音。</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">真希望我們的回應,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">被接納,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">聽到。伊波拉不是一個不能被控制的疾病,人類知道方法的,只不過脆弱的公共衛生基礎建設和已經殘破的醫療,需要被建立和扶持,那絕對不只是獅子山的事情而已。伊波拉不只是西非小國的戰爭</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">, </span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">是全球人類的戰爭。</span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"><o:p></o:p></span></span><br />
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<span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;"> 西非的疫情早在</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">2013</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">年底,幾內亞南部一個叫</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">Meliandou</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">村莊的兩歲孩童,死於出血熱,就透露了伊波拉跳躍到西非的跡象,但是那時候還不清楚這孩子是第一個病人。隨著幾內亞的病人越來越多,擴散到鄰國賴比瑞亞,還有獅子山,三個貧窮又歷經內戰的國家,原本就是醫療人力不足,公共衛生建設基礎薄弱,沒有辦法像長期有伊波拉病毒肆虐的中非或者經濟力道強勁的南非和奈及利亞,面對這突如其來的出血熱攻擊,雖然不是空氣傳染</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> (</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">如結核病</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">/</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">水痘</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">/</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">麻疹</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">)</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">,</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">也不是飛沫呼吸傳染</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> (SARS/</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">流感</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">)</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">,病毒本身再生率</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> (R value)</span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">不高,但致死率非常高,快速傳播的死亡陰影,醫護人員不是倒下就是逃離醫療現場,民眾得不到完整的訊息,對政府的不信任,種下了為期超過一年苦戰的種子。</span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"><o:p></o:p></span></span><br />
<span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><br /></span></span></div>
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<span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;"> 一些長期在西非耕耘的國際醫療組織,不斷地呼救,尤其是無國界醫師「</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">Médecins Sans Frontières/Doctors Without Borders (MSF)</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">」,聯合國世界衛生組織,在</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">2014</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">年</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">3</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">月確認這起疫情是</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">Ebola</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">所致。</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">但一開始評估,認為問題不影響全世界。</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">2014</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">年病毒隨著</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">7</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">月</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">20</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">日,賴比瑞亞發病後飛到首都</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">Lagos</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">的旅客,帶進奈及利亞,終於讓全世界的大國都擔憂了起來,因為奈及利亞可是有非常多航班飛出去其他國家的非洲第一大經濟體。大家對奈及利亞的經濟,</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">2014</span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">年已經超越了南非,成為非洲第一大經濟體,世界排名則是第二十六,可能跟我一樣不熟悉,但國際強權可是熟悉得很。於是世界衛生組織開始承認這是一個</span><span style="color: #141823; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">「可能</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">危及世界的疫情</span><span style="color: #141823; font-size: 11.5pt; mso-bidi-font-family: Helvetica;">」,增援西非阻斷疫情是非常急迫且需要各國援助的</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">。奈及利亞不但有世界衛生組織和美國</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">CDC</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">的駐點代表處,也有很扎實地,十一月才訪台過的流行病學調查班組織,一切就按部就班地控制了下來。一個不預期的病人,由於隱匿自己姊姊死於伊波拉,帶來奈及利亞首都</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">Lagos </span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">九名被他傳染的醫護人員,其中</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">4</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">名死亡的悲劇;又因為另一名與他接觸被傳染的病人逃到鄰近油港</span></span><span style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> <span lang="EN-US">Port Harcourt</span></span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">,造成照顧他的醫師在</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">8</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">月</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">23</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">日死亡。奈及利亞</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">CDC</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">動員自己的流行病學調查班,兩波疫情上千名的接觸者追蹤,</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">Lagos</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">做到</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">100%</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">,</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">Port Harcourt</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">做到</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">99</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">。</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">8%</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">。</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">19</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">個確診個案,</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">9</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">個死亡</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> (40%</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">致死率</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">)</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">,衍生出的接觸者,每個接觸者都被要求在自己家量體溫,等待</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">21</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">天可傳染期的結束。經過</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">42</span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">天的努力,奈及利亞脫離疫區。</span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"><o:p></o:p></span></span><br />
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<span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;"> 塞內加爾在</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">8</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">月</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">29</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">日報告了第一例個案,是一名隱匿了接觸史的學生,雖然塞內加爾</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">8</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">月</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">21</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">日關閉自己和幾內亞的邊境,這名學生,還是穿過邊界進入塞內加爾尋求醫療照顧,他的</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">70</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">多名接觸者被認出來,並且完整地追蹤</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">21</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">天,塞內加爾也在</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">42</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">天後從疫區除名。馬利則是由鄰國幾內亞</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">2</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">歲的女童,於</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">10</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">月</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">20</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">日拉開伊波拉的序幕,因為母親過世,外婆到幾內亞南部參加女兒的喪禮,並於喪禮後長途跋涉將孫女兒帶回馬利;馬利的第二波疫情是一名幾內亞人,</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">10</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">月</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">17</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">日開始有相關症狀,</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"> 10</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">月</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">25</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">日抵達馬利的巴斯德中心接受診治,這名回教教士接觸的醫護人員,以及參加葬禮而發病的其他親友,目前共有</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">7</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">名個案確診,馬利目前相關發病最後一案是</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">11</span><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;"><span style="font-family: 新細明體;">月</span></span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;">22</span><span style="font-family: 新細明體;"><span style="color: #141823; font-size: 11.5pt; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-hansi-font-family: Helvetica;">日,故仍然在觀察接觸者中等待著。</span><span lang="EN-US" style="color: #141823; font-family: "Helvetica",sans-serif; font-size: 11.5pt;"><o:p></o:p></span></span></div>
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Sliver Linings LOHAS (撥雲見日 樂活人生)http://www.blogger.com/profile/05560492105797220203noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-92183267603394825422014-12-18T21:00:00.000+08:002014-12-22T08:10:52.274+08:00【醫周影視】醫者找回初心, 翻轉體制舊習 ~ 醫手遮天 (Hippocrates)與臨床隨行(Clinical Shadowing)聯合簽書特映會<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="color: blue; font-size: x-large;">醫勞盟出版新書 籲民眾正視台灣醫療問題</span></div>
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◎記者陳思佳/台北報導<br />
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醫勞盟長期致力於改善台灣醫療制度,維護台灣醫療品質。近日,醫勞盟組織28名一線醫療人員,共同出版了《臨床隨行,走出白色巨塔陰影》一書。本(12)月18日晚,醫勞盟在真善美劇院舉辦了新書發表會暨簽名書會。會後,醫勞盟聯合佳映娛樂,推動舉行了電影《醫手遮天》的首場特映會。</div>
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《臨床隨行,走出白色巨塔陰影》的內容記錄了醫療現場的點滴,以及台灣醫療的種種病徵,也提出了可能的對策。醫勞盟出版此書,意在讓台灣民眾意識到台灣醫療存在的問題,並對此進行自我檢視與反思。作為醫勞盟代表和聯合作者,醫師蔡宏斌和葉庭瑜出席了發表會,與關心台灣醫療改革的民眾進行了交流。</div>
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蔡宏斌指出,目前台灣醫療存在諸多問題,如民眾對自身保健能力過於缺乏自信,連背上長一顆青春痘也要掛急診。在本書中,他探討了政府面對災難應如何為社會提供照護、病歷中文化的爭議等問題。他表示,醫勞盟出版新書,希望民眾能藉此正視當下台灣醫療的困境。</div>
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《簽書會與粉絲互動集錦》</div>
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《醫手遮天》是坎城影展的閉幕影片,將於12月26日在真善美劇院、喜滿客京華影城及<span style="text-align: left;">萬代福影城</span>上映。影片講述了立志從醫的班傑明對抗法國不合理醫療制度的故事:班傑明到父親工作的醫院實習,由於經驗不足導致了病人死亡。為了保護班傑明,父親動用職權掩蓋了真相,這讓班傑明意識到,醫生對他人生命所負擔的責任,遠超過「醫德」兩字所能負載。在內外壓力雙重擠壓之下,他決定豁出去挑戰現有的醫療體制,勇敢找回夢想的初衷。</div>
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《電影特映會上與台灣女醫師協會、公醫時代、醫勞小組、康健雜誌代表喜相逢》</div>
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《醫手遮天電影導演小檔案》<br />
導演|多瑪斯.黎提 Thomas Lilti<br />
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1976年5月30日生於法國,子承父業,取得了醫科文憑。然而,對電影製作 的熱愛讓他最終還是選擇了創作電影劇本和導演的工作。他的第二部長片《醫手遮天》有部份自傳,是他對醫學研究的獻禮。<br />
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就讀醫學院期間開始拍攝短片,2008年推出首部劇情長片《Les yeux bandes》於影壇初試啼聲。《醫手遮天》是導演的第二部劇情長片,將自己於醫界打滾的第一手見聞搬上大銀幕,勇敢揭露白色巨塔不為人知的秘辛。<br />
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《醫手遮天電影上映訊息》<br />
坎城影展 國際影評人週 閉幕片《再一次初戀》法國性格小生領銜主演<br />
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分級:保護級 片長:102分鐘<br />
類型:劇情片 出品國:法國\法語發音(2014)<br />
上映日期:2014.12.26<br />
上映戲院:台北真善美劇院、台北喜滿客京華影城、台中萬代福影城</div>
Sliver Linings LOHAS (撥雲見日 樂活人生)http://www.blogger.com/profile/05560492105797220203noreply@blogger.com0真善美戲院25.0430251 121.5073522999999825.0394286 121.50230979999998 25.0466216 121.51239479999998tag:blogger.com,1999:blog-1468521563891777922.post-46305071919161597412014-11-22T23:39:00.000+08:002014-11-23T07:52:50.264+08:00他是我學習的典範,別人卻稱他「終結者」<h3>
他是我學習的典範,別人卻稱他「終結者」</h3>
◎ 作者:張志華醫師/新光醫院急診科<br />
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講個故事給大家聽,我二十多年前當實習醫師的時候,有一個很有愛心的學長,經常為癌症末期、痛不欲生的病人施打嗎啡止痛。<br />
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那時根本也沒有什麼安寧緩和條例,有些病人打了嗎啡,難免就會血壓掉,甚至呼吸也漸漸終止,就走了〔往生了〕。<br />
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結果,雖然學長照顧的癌末病人,都能很安祥地走完人生最後最痛苦的一段路,病人的家屬對學長也都萬分感激,可是,醫院裡卻有不少同事,都認為學長是在「加工」讓病人死亡,給他取了個外號叫「terminator」〔終結者〕。<br />
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現在,安寧緩和條例通過了,重症末期病人的權益才被重視,我們做急重症或腫瘤科的醫護們,個個都成了 terminator。回想起當初學長在病房裡,握住家屬的手說「他走了,不再痛苦了」的那個畫面,再看看這兩天選舉新聞的炒作,真的很感慨。<br />
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切記,醫者,有三種角色:(一)治病,(二)安慰,(三)減輕疼痛。<br />
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延伸閱讀:誣指台大活摘器官 醫界呼籲罷免理事長蘇清泉<br />
<a href="http://news.ltn.com.tw/news/politics/breakingnews/1162961">http://news.ltn.com.tw/news/politics/breakingnews/1162961</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-5249043894416534812014-11-21T21:38:00.003+08:002014-11-23T07:46:17.877+08:00換心,要怎麼求菩薩?那是一命換一命啊!<h3>
換心,要怎麼求菩薩?那是一命換一命啊!</h3>
◎ 作者:Pi-Chi Lin<br />
<a href="https://www.facebook.com/pichi.lin.9/posts/10203648293860563">https://www.facebook.com/pichi.lin.9/posts/10203648293860563</a><br />
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我想 ~ 即便是醫護人員,應該也很少實際接觸過所謂 "器官移植" 兩方的病患跟家屬,<br />
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今天,不談嚴肅的專業問題,就跟大家分享一個故事 ~ 之前在某醫學中心 CCU 時,有一位 17 歲的高職女孩,因為急性心肌炎導致嚴重的心臟衰竭,經過長時間的救治,終於成功拔掉呼吸器,但因為心臟功能無法恢復,所以她身上裝著葉克膜,等待一個換心的機會。<br />
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就這樣,她每天躺在加護病房,看著她身上的機器、看著來來去去的醫護人員,用微弱的聲音問我們什麼時候可以換心?<br />
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有一天,我問她媽媽、那位篤信佛教的媽媽,有沒有去請求菩薩幫忙?她媽媽一聽,眼淚馬上掉下來,她問我 ~ 我要怎麼去求菩薩?那是一命換一命耶!我怎麼說的出口!她的話像一把大搥重重的搥了我!<br />
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沒錯!能有機會接受器官移植,代表另一個原本健康生命突然的隕落、一個原本開心快樂的家庭墜入了地獄,那就是一命換一命!而那個女孩就這樣等呀等,一直沒有等到心臟,最終還是離開了...........<br />
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我不想再去回想那數次,硬著頭皮、武裝好自己的情緒,跟傷心欲絕的家屬詢問 ~ 你要不要讓你的親人捐出他們的器官時的場景,那真的好傷人!<br />
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器官捐贈對大多數人來說或許只是個從電視、報紙、網路上偶然看到的名詞,但對經歷這些事情的雙方,尤其是捐贈器官的一方,卻是永遠不願意再回想起的痛!<br />
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不要因為選舉,污辱了強忍著錐心之痛仍勇敢捐出器官的家屬!<br />
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不要因為選舉,污辱了飽受內心煎熬仍拼了命想要活下去的病患!<br />
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不要因為選舉,污辱了吃力不討好仍一心想要多救幾位病人的醫護人員!<br />
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你們不配!完全不配!<br />
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請馬上澄清,正式道歉!<br />
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延伸閱讀:誣指台大活摘器官 醫界呼籲罷免理事長蘇清泉<br />
<a href="http://news.ltn.com.tw/news/politics/breakingnews/1162961">http://news.ltn.com.tw/news/politics/breakingnews/1162961</a>Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-1468521563891777922.post-53545230746337731772014-11-21T06:48:00.000+08:002014-11-26T05:30:08.909+08:00駁斥強摘器官的不實指控, 別讓遺愛人間的天使落淚!<div dir="ltr" style="text-align: left;" trbidi="on">
◎陳志金/ 急重症醫師<br />
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首先,這一個指控是在刻意誤導民眾相信:「柯P是為了要取得器官,加工讓捐贈者死亡,而且欺騙檢察官與家屬」。<br />
事實當然不是這樣!<br />
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1. 首先這些都是「臨床上腦死」或「無治癒希望」的病人,而且家屬的意願是想要發揮大愛,讓自己的親人可以遺愛人間的案例。並沒有強迫家屬捐贈或是讓病人死亡後,再說服其捐贈的問題。這個其實是在經過詳細的溝通之後,家屬瞭解到病人已「臨床上腦死」或「無治癒希望」,而做出捐贈的決定。而柯P的團隊只是在處理「死亡」的過程,有一點不一樣的做法而已,並非是「為了器官而把病人害死」!捐贈病人的死亡,是必然的結果,只是時間點的問題而已。<br />
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2. 報導提到的藥物pentolamine, heparin, mannitol是為了保護病人死亡後的腎臟所使用的藥物,並非加速病人死亡的藥物!這一點稍為對移植有認識的醫師,應該都知道(當然不是每位被稱為醫師的人都知道)。<br />
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3. 再來,柯P的論文也提到,在病人死亡後,要等檢察官來相驗這段時間,可能是比較長的(大家應該也都能體諒檢察官無法隨傳隨到吧?)。那麼,腎臟的缺氧時間會過久,也會造成能用的機率減少或者移植在受贈者身上能「有好的結果」的機率減少(這樣對於受贈者來說,也是有較高的風險。因為,他其實也是冒了手術的風險,但卻獲得一顆狀況不太佳的腎臟)。於是,柯P的團隊就想到在「心跳停止」之後,使用ECMO來「保護腎臟」,大大的提高了「心跳停止之後的腎臟」移植成效!而其結果也受國際期刊的審查專家認可!這樣做有什麼問題嗎?<br />
報導中提到的主動脈內的氣球,是阻止血流往心臟沒錯(目的是為了讓ECMO的循環有效的維持在腹腔/下半身),但這並不是在害病人,因為病人的心跳早就已經停止了啊!這是柯P的團隊,為了要完成病人與家屬的心願,要幫忙更多的病人,花了多少個不眠不休的夜裡所想出來的啊!如果這個行為是違反倫理,甚至是犯罪的,國際的知名期刊有可能會刊登嗎?同時,怎麼會有人把自己的『犯罪證據』拿去公諸於世、高調發表?更何況是一群行醫多年、德高望重的台大醫師呢?<br />
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4. 一般器官捐贈,要先進行「腦死判定」這個比較嚴謹的途徑透過腦死判定,確認腦幹已無功能,就可以進行器官捐贈,這是符合法律的。這樣也可讓病人在比較好的心跳血壓與氧氣之下,進行移植,器官的狀態也比較好,能夠因而受惠的受贈者也比較多。注意,這可是在病人「還有心跳血壓」之下去摘取器官的!(如果有心想要誤導民眾,說柯P是為了摘器官而把病人害死的人,應該會覺得這樣做更不可思議吧?其實,這就一般民眾不瞭解移植,可能會產生的誤解,但是,如果說是醫師不瞭解呢?那可能是某些單位的繼續教育沒做好吧?)其實,醫學上早就認定,腦死的病人是絕對不會存活的!因此,站在幫助病人可以完成遺願,以及可以挽救其他生命的前提之下,是允許一個「腦死」但「還有心跳」的「所謂活人」的器官被摘除的!<br />
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5. 當時柯P他們面對的問題是,有些病人的病況,無法承受「腦死判定」的嚴苛過程,因為無法執行「腦死判定」,而取而代之的是以「臨床上腦死」來認定(昏迷指數三分,曈孔對光無反射,無自發性呼吸,抽痰無咳嗽反射等等)。<br />
同時也考量到,如果是維持呼吸器讓病人自然死亡,病人和家屬都要承受較長時間的折騰(這並不是像連續劇演的那樣,可以等待奇蹟,讓病人好起來的!),醫療團隊會去和家屬討論器官捐贈,就是已認定「病人的死亡是必然的事」,只是醫師要不要再去延長死亡的時間而已。第3點也提到了,在病人自然死亡後,往往要等檢察官來相驗這段時間會比較長,而直接影嚮腎臟移植的成功率。<br />
所以,當時的團隊,為了以上種種的考量,在檢察官到達後,做了「撤除呼吸器」這個舉動,而且病人也在很短的時間內心跳停止(這點證明醫療團隊的評估沒錯,病人是不會活,而只是靠呼吸器在延長死亡!)這樣就能縮短等待檢察官的時間,而且ECMO團隊也在一旁準備好了,可以立即裝上!(如果等待心跳自然停止,再啟動ECMO團隊,那就得要多花時間了!記住,移植是分秒必爭的)<br />
「讓無治癒希望的病人,自然死亡」這件事,在當時,雖有共識,卻還沒有法律的保護!(大家就不必問為何立法委員立法會這麼慢了吧?)對於無治癒希望的病人給予撤除維生系統,是符合倫理的做法,但是,我們的法律卻遲至2012年底才修法通過(其實在2011年就修了一次,但是實務上根本不可行)。那修法之前是怎麼做的呢?大部分醫師都是採取「消極不做為」的方法,就是讓家屬「辦理自動出院」,把病人帶回去,由家屬「自己拔管」,醫師就可以逃避可能要面對的法律問題。<br />
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所以,柯P的團隊在當時,選擇了大膽的積極的做為,完成了多起的移植,成果獲得國際的認同,也挽救了數個家庭,同時協助另外一些家庭完成他們的親人遺愛人間的心願!這個本來是美事一樁,但是,誰也沒有想到,在他要選台北市長時,會變成是對手打壓的手段!<br />
柯P當時可以選擇消極的「不做為」,等到2012年法律通過了再來做,那麼,這樣不只讓台灣的移植醫學和ECMO落後12年,而且還辜負了想要捐贈器官的病人與其家屬的一片好意,同時也對不起當時許多等待的受贈者。<br />
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我們想想,到底要不要為了一場選舉,埋沒自己的良心?讓這個世界人人變成「守法的冷漠」?尤其是身為醫者的前輩們、所謂的醫界領導們,能不能夠找回當一個醫師該有的良知?給晚輩們當一個學習的典範?還是再繼續打壓台灣的醫學,讓移植醫學再倒退個十年?<br />
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【後記】<br />
1. 曾御慈醫師是柯P的學生,她的死亡,柯P無法挽救,柯P和曾醫師的父母一樣難過,但是卻能為這個學生著想,讓父母對她的愛可以化成對幾個家庭的大愛!這是令人敬佩的!無奈,竟然還有人為了選舉,在消費曾醫師,實在令人氣憤!<br />
2. 這些指控,不只傷害醫療團隊,也傷害了捐贈者家屬,是要他們背負"讓家人無辜受死"的指控嗎?未來,醫療人員要如何勸募器官呢?難道要被民眾罵說"你們又要強摘人家的器官嗎”?<br />
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【延伸閱讀】<br />
1.專業醫師談無心跳器官捐贈-2014/11/21 自由時報<br />
http://news.ltn.com.tw/news/opinion/breakingnews/1163620<br />
2.台大醫療團隊成員陳益祥駁立委「強摘說」-2014/11/21 東森新聞<br />
http://youtu.be/Y-zs1CADLz8<br />
3.藍委揭露柯文哲涉爭議醫療手段-2014/11/20 聯合晚報<br />
<a href="http://udn.com/NEWS/NATIONAL/NATS5/9078676.shtml">http://udn.com/NEWS/NATIONAL/NATS5/9078676.shtml</a><br />
4.這是醫療專業或政治鬥爭?2014/11/20蘋果日報<br />
<a href="http://www.appledaily.com.tw/realtimenews/article/new/20141120/509964/">http://www.appledaily.com.tw/realtimenews/article/new/20141120/509964/</a><br />
5.增加器官來源/無心跳器捐 衛署擬推動-2008/01/28 自由時報<br />
<a href="http://m.ltn.com.tw/news/life/paper/185553">http://m.ltn.com.tw/news/life/paper/185553</a><br />
6.專家:避免道德爭議, 配套應周延-2008/01/28 自由時報<br />
<a href="http://m.ltn.com.tw/news/life/paper/185554">http://m.ltn.com.tw/news/life/paper/185554</a><br />
7.小檔案:無心跳與腦死器捐差別-2008/01/28 自由時報<br />
<a href="http://m.ltn.com.tw/news/life/paper/185555">http://m.ltn.com.tw/news/life/paper/185555</a><br />
8.御守天使慈悲濟世 - 財團法人器官捐贈移植登錄中心 -2013年12月<br />
<a href="http://www.torsc.org.tw/concern/concern_content.jsp?sno=133" style="-webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; display: inline; font-size-adjust: none; font-stretch: normal; font: 12pt/18px Tahoma; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px;" title="財團法人器官捐贈移植登錄中心 Taiwan Organ Registry and Sharing Center">http://www.torsc.org.tw/concern/concern_content.jsp?sno=133</a><br />
9.憶曾御慈---一位永恆的福爾摩沙天使 -2013/06/18 林衡哲部落格<br />
<a href="http://linhenjer.blogspot.tw/2013/06/blog-post.html">http://linhenjer.blogspot.tw/2013/06/blog-post.html</a><br />
10.法定腦死判定流程圖-摘自「好命到終老」-2014年1月<br />
->搜尋google關鍵字: 好命到終老, 腦死判定流程<br />
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Sliver Linings LOHAS (撥雲見日 樂活人生)http://www.blogger.com/profile/05560492105797220203noreply@blogger.com11tag:blogger.com,1999:blog-1468521563891777922.post-21189658720862311382014-09-24T17:28:00.002+08:002014-09-24T17:30:15.382+08:00食安問題反映了台灣人只要「便宜又大碗」的心態<span class="Apple-style-span" style="font-size: 19px; font-weight: bold;"><b>食安問題反映了台灣人只要「便宜又大碗」的心態</b></span><br />
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<span class="Apple-tab-span" style="white-space: pre;"><span class="Apple-style-span" style="white-space: normal;">◎ 作者:黃冠維 物理治療師</span></span><br />
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<span class="Apple-tab-span" style="white-space: pre;"> </span>民以食為天,這個吃的問題左右著我們的生活大計。台灣食安問題層出不窮,雖早已不是新聞,但人是健忘的,過一段時間便會忘記,不斷的重複上演。同時這次的食安卻也顯露出許多問題,民眾的貪小便宜跟薪資問題,同時也顯露出民眾對於政府的公信力已經失去信心,以及將台灣人的奧氣展現無遺。<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinbjpGj8LWnrYP5nBCg6m_tcrT_UyNZD1v1UNrtvpqJdoRynY2AkMkrrqMx7m5RPenpnRIIlzlcOV5U0fpMADR7h09vw6WfwMZwqQ2mo2LZRv9k1F2XtYogu42BX3x-BzT8LVufGbwWqg/s1600/179.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinbjpGj8LWnrYP5nBCg6m_tcrT_UyNZD1v1UNrtvpqJdoRynY2AkMkrrqMx7m5RPenpnRIIlzlcOV5U0fpMADR7h09vw6WfwMZwqQ2mo2LZRv9k1F2XtYogu42BX3x-BzT8LVufGbwWqg/s1600/179.jpg" height="171" width="320" /></a><span class="Apple-tab-span" style="white-space: pre;"> </span>食安的問題真的只是食安嗎,其實換個角度來看,餿水油這個產出物品,是因為什麼而產生,而又為了甚麼再度被不肖利益商人回收製成食用油,這都是必須一層層考量。台灣的媒體雖然不是相當理想,會對於某件事情過度的去報導,而忘記了我們生活周邊更重要的新聞,甚至是只關注同一件焦點,這是媒體該去改善的,但政府機關的反應措施跟台灣人本身更該反省。<br />
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<span class="Apple-tab-span" style="white-space: pre;"> </span>物價過高,但薪資依舊無法成長,這不能只怪一個問題─景氣,而是要思考著台灣是否被過度內耗,只求選票跟無意義的爭吵,卻忽略了我們自己的未來跟競爭力?社會長久以來非藍即綠,我們的上一輩希望我們努力讀書,乖乖地聽話,對於不聽話不乖巧的人便貼上了標籤,師長認為該是如此,便將這樣的觀念繼續灌輸給下一輩;過去的教學法是填鴨,如今的教學法雖然已經擺脫填鴨字眼,但請仔細想想,真的擺脫了嗎?有達到所謂的適才任教,還是只是換個角度的填鴨?<br />
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<span class="Apple-tab-span" style="white-space: pre;"> </span>老闆們習慣員工付出,卻忘了員工跟獲利是相對的,為了壓低成本,不斷地使用責任兩字,忘了讓員工有好的生產力。當員工的成本被壓低,那薪資便也是影響因素,薪資雖然是反映一個人的工作跟自己所擁有的賺錢才能,不論是高薪或是低薪,最重要的目的,便是求一頓溫飽,填飽了肚子才能繼續生活下去,生活也不只是為了填飽,更必須要有安全跟歸屬感,這三項因素實實在在的影響著我們。一天的打拼為了是三餐溫飽,多年的打拼是為了自己能有個家,建立歸屬跟安全。但薪資低下,那該如何讓自己有個歸屬感,便先從吃下手,能有以低價買入最大的量,這就是不二選擇,這卻也是台灣人的奧氣,認為只要便宜大碗,那就是所謂的賺錢法則。<br />
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<span class="Apple-tab-span" style="white-space: pre;"> </span>而政府只願意看到自己的選票,深怕失去政權,民主是少數服從多數,卻忘了多數也必須尊重且傾聽少數的觀點,民主不是服從,是取得平和點,但多少人真的做到?為了簡單的一餐,必然會錙銖必較,卻忘了背後付出的成本,便宜的餐點必然會去質疑他們的原料,但往往受限於薪資,就暫時忘卻了質疑,先求有再求好,這就是台灣人普遍奧氣的因素之一,當有錢了,便拿出霸氣,認為該揮霍更好的,但對於尊重他人或是專業度的觀點就不同。台灣人可以為了撿便宜就讓媒體報導成小確幸,這真的是小確幸嗎?多少成本換來的客人就值多少錢。成本,這就是這次食安的問題,成本可以說是最主軸的因素,政府要樽節支出,讓民眾認為政府廉潔,壓低成本來做許多事情,但這些事情的效益有多大?只看到現在,卻沒有看到長遠,老闆要壓低成本,便將員工的薪資壓低,員工的工作變多,老闆認為是應該,卻忘了員工有產能老闆才有資金,健保為了壓低成本,忘了尊重各專科醫師意見,不斷的強調管控,名為管控實為踐踏專業。<br />
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<span class="Apple-tab-span" style="white-space: pre;"> </span>台灣人的奧氣在此次的食安事件中一展無遺,更讓台灣人自己蒙塵上一層不可抹去的陰影,卻只會怪罪販售的廠商,卻忘了仔細地想想,發生一件食安,為何有些廠商沒有出問題,那政府官員拋出更多荒謬的言論時,我們只能罵,當真的要求採取行動時,卻又說這是政府的事情?Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-84286303581841402432014-09-04T21:44:00.000+08:002014-09-04T21:52:46.525+08:00真正凌遲病人的是設計不良的健保政策<h3>
真正凌遲病人的是設計不良的健保政策</h3>
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作者:黃亮維 醫師<br />
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因為跟同僚討論到病人轉診的問題,讓我有感而發。來說個故事吧。那是一年前在加護病房的事情。<br />
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中午會客時間,病人的姐姐蹙著眉:“醫師,我們想要轉診到○○醫學中心。在這裡都治療兩個禮拜了,感覺病情沒什麼起色。”<br />
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病人是一位慢性酒精中毒的壯年男子。可以想見:嗜酒如命的人,自我照顧能力一定不會好到哪裡去。對他的第一印象是兩個星期前在普通病房,他才剛因為肺炎住院,呼吸有些費力,卻還不到非得插管不可的程度。他就像我們印象中典型的酒醉病人,一口爛牙,衣衫不整,講話有時像在說夢話,顛三倒四的。<br />
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主治醫師一開始就跟他的父親把狀況說得十分嚴重:說病情變化可能十分迅速,可能會插管進加護病房云云;後來果然發生了,倒不是我們烏鴉嘴,而是酗酒病人的免疫系統本來就脆弱。痰液培養結果也正是好發在酗酒病人身上的凶猛細菌-克氏肺炎桿菌 (Klebsiella pneumoniae)。病人的右肺爛了一大片,差點就成了膿胸。加護病房林主任眼看抗生素效果有限,便親自披掛,為病人進行支氣管鏡洗痰術,從發炎的肺中吸出大量髒、臭、濃濃的痰液。<br />
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我們暗地裡說林主任真是“舉枷”(台語,意指大費周章)-如此用心,且不論對病情幫助有多大,問題是家屬真的能理會嗎?果不其然,治療兩個星期後病人的姐姐就站在我面前,說出了以上的話。那天林主任剛好不在。<br />
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我在心中搖搖頭,感嘆健保讓民眾享受便利,予取予求,卻壓根沒有花資源在教育民眾,幫助他們弄清自己想求什麼,預期能求到什麼,以及如何正確地求。如此一來,只好由我來做這件絲毫沒有實質報酬、吃力不討好的事了。為何說吃力不討好?因為在當下順水推舟,把病人轉走是最簡單又皆大歡喜的,反正若不轉走,他一定會超長住院,讓醫院虧損。而把病人留在手上繼續治療,還得花時間解釋,一一回答家屬的質疑,弄不好甚至會出法律糾紛。所以我開門見山地說:<br />
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“可以阿,我不會擋你們,我會全力配合。畢竟把一個病情複雜的病人轉走,還省得麻煩。”<br />
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家屬閉上了嘴,不再說話。<br />
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“但是我希望你們聽完我解釋,因為我是真的站在你們的角度替你想,才會花時間說下面這些話。<br />
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如果是我的家屬,我不會現在把他轉走。<br />
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為什麼呢?我希望你們了解:您弟弟的肺炎相當嚴重,康復的速度本來就是要以週來計算,也就是至少要治療四到六星期。現在才兩個星期,才走了一半而已哪!還戴著呼吸器是很合理的。”<br />
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我接著跟他們解釋我們如何用體溫以及呼吸器的設定來評估病人好轉的狀況,向他們說明:這個病最嚴重的情況就是膿胸,得開刀;而若真需要開刀,醫學中心能做的,我們都能做(我們有胸外王牌柯主任!),轉過去不僅舟車勞頓,而且也沒什麼額外好處。<br />
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最後再補一句:“醫學中心很大是沒錯,可是你到哪裡找像我們林主任這麼『骨力』的醫師,還三天兩頭就幫你做支氣管鏡去洗痰,為的只是希望你弟弟快點好?”<br />
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護理長在一旁也搭腔:“不可能!找不到的!”<br />
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病人姐姐跟父親沉吟半晌,然後姐姐說:“那…我們不轉了。醫師謝謝你,解釋很清楚。”<br />
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在這個故事裡,醫病溝通的癥結點很簡單,就是病家一開始不了解這個疾病正常的治療期,所以有錯誤的期待,導致徬徨而尋求轉院。後來病人經過幾個星期的治療後,順利脫離呼吸器,轉出加護病房,得到皆大歡喜的結局。有意思的是,這裡最難的並非解釋病情,也不是治療,而是“下定決心去解釋病情,並且有擔當、有風骨地把病人留下來治療,避免給病家和醫學中心添無謂的麻煩”。畢竟,在健保制度下預期這個病人就是會帶來虧損,哪個醫師情願把燙手山芋留在手上?把自願當人球的病患送走,豈不是求之不得?<br />
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無怪乎醫勞盟張志華理事長對葉金川前署長喊話說:「真正凌遲病人的不是醫護人員,而是設計不良的健保政策。」凌遲二字,用來比擬勞民傷財的不當轉院,實在傳神。<br />
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不過我就快要下鄉,還是來學魯夫成為海賊王好了,病房裡這些煞費心神的事情,暫時交給別人去傷腦筋囉!Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-65825387250708369212014-06-03T21:31:00.000+08:002014-06-03T21:31:03.318+08:00台灣政府放任醫師超時工作,罔顧病人安全!促成美國對住院醫師的工時設限的主要原因,是因兩位急診的住院醫師〔PGY-1和PGY-2〕因超時過勞工作而開給病人〔Libby Zion〕不該用的藥,導致病人不幸因此死亡。<br />
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病人Libby Zion是大學新生,因不適就醫,剛送入急診時就出現"strange jerking motions",這是"serotonin syndrome"的初期表現,因她原來就服用抗憂鬱劑phenelzine,而過勞的PGY住院醫師,卻因同時照顧40個病人太過勞累,錯誤開立了不能在這類病人使用的meperidine給病人注射,結果導致病情加重,Libby變得躁動並高燒到42.2度C,最後心臟停止而死亡。<br />
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Libby Zion(右)因醫師過勞而導致死亡,她父親(左)促使美國政府立法保障醫師工時。</div>
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值班醫師的過勞問題,其實在台灣存在已久。從衛福部102年試評鑑的資料中,我們發現有某家醫院的整形外科的醫師,每周必須工作150小時,這麼誇張的工時,已經是一般勞工每月的總工時了,而台灣政府及人民竟然可以容忍如此過勞的醫師為病人開刀,您不覺得恐怖嗎?<br />
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Libby Zion的父親為一名律師,除了悲憤之外,也對Libby Zion的死因進行調查,質疑用藥不當及醫師過勞。經過一番複雜的調查程序,參酌紐約州醫事審議委員會的意見,努力促使美國政府推動一連串的立法,後來終於誕生了Libby Zion法案。法案的精神是確保病人在足夠的醫護人力下受到治療,不只增加了主治醫師對年輕醫師的監督、也限制了住院醫師的工時每週不能超過80小時。<br />
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而台灣呢?我們還要繼續放任醫師每周工作150小時嗎?台灣的病人安全不重要嗎?醫師過勞難道不是醫療糾紛泛濫的原因之一嗎?我們是否也該認真考慮訂立台灣版的Libby Zion法案,以健全醫療品質並保障病患的就醫安全呢?<br />
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延伸閱讀:<br />
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Libby Zion Law:<br />
<a href="http://en.wikipedia.org/wiki/Libby_Zion_Law">http://en.wikipedia.org/wiki/Libby_Zion_Law</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-29000126015029325822014-05-26T19:57:00.000+08:002014-05-26T20:02:06.357+08:00如果沒有健保,一樣要救到底嗎?<h3>
<b><span style="color: #073763;">如果沒有健保,一樣要救到底嗎?</span></b></h3>
文:<a href="http://www.facebook.com/jack119" target="_blank">張志華</a>/新光醫院急診科醫師、醫勞盟理事長<br />
圖:<a href="http://www.facebook.com/emergencygirl" style="text-align: center;" target="_blank">急診女醫師其實</a><br />
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某日,急診送來了一位80幾歲癌症末期的病人,老先生到院時嚴重休克,檢查發現敗血症及多重器官衰竭,必須使用氧氣罩及大量升壓劑才能勉強維持生命徵象。老人家是清醒的,但嚴重失智,又沒有家屬陪伴,身邊只有一個外傭。<br />
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於是,我打電話給病人兒子告病危,希望他能來醫院一趟,跟醫療團隊討論有關癌末病人DNR(放棄急救)事宜。無奈對方竟然說沒空前來,還說如果有事,要我們叫外傭轉告他就可以了。電話中,對方其實最在乎的是住加護病房是不是用健保的,急救藥物和器材是不是用健保的,外傭有沒有將阿伯的健保卡帶在身上...。掛電話前,家屬態度很堅定地說:「只要是用健保的,該插管就插管,該電擊就電擊,我們要救到底!」<br />
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圖:健保實施前、實施後。(由「<a href="http://www.facebook.com/emergencygirl" target="_blank">急診女醫師其實</a>」提供)</div>
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沒多久,病人身上插滿了管路,接上許多機器,被送去加護病房去了。從進急診到住加護病房,陪伴病人的就只是個國台語都聽不太懂的外傭。<br />
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我當下真的很想問家屬:「如果沒有健保,你們一樣要救到底嗎?」<br />
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科技日新月異,然而,人類終究無法面對自然的「生、老、病、死」,對醫療抱持著過多的期待,台大柯文哲醫師甚至感嘆地說:「高科技反而讓人不得好死。」如果只求「活著」,那麼現今的醫療科技的確可以延長基本的呼吸、心跳等生命徵象。但,如果短期內死亡屬無法避免的事實(如癌末病人),這樣身上插滿管子靠儀器維生算不算真正的活著呢?而這些只是延續病人痛苦的治療,完全由全民健保給付,不少家屬也因為有健保的給付,選擇將病人「丟」給醫院照顧,逃避自己該面對病人善終的責任。<br />
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秋天到了,樹葉就會掉落,這是自然現象。人,也一樣,生命如果已經走到盡頭,該慎重思考的是要如何善終。每個人都有自主權,而病人的自主權也是醫學倫理重要的一環,我們應當在自己還有能力做理性判斷的時候,多與家人討論,盡早規劃應如何善終,不要等到意外發生了才來打算,以免讓自己和家人陷入無助、痛苦的深淵。Unknownnoreply@blogger.com10tag:blogger.com,1999:blog-1468521563891777922.post-5845001011889465822014-02-13T22:11:00.002+08:002014-04-09T22:11:15.818+08:00身為魚肉的悲哀:論國考調漲三倍一事身為魚肉的悲哀:論國考調漲三倍一事<br />
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作者:eric lin <br />
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考選部自民國101年起,悄悄試辦醫學生畢業前臨床技能測驗項目(OSCE),單以通過率達九成以上,就逕自評估成效良好,次年起便成為第二階段筆試的門檻。作為影響數千人權益的考試變革,未曾廣徵醫學生的意見,卻任由高層「搓湯圓」,誇稱保障醫療品質云云,便強行實施。對於醫政界高層的威權作風,我們早已司空見慣;然而今次,僅僅一只非正式公告,便要將考試規費自去年的2000元狂漲至6000元,是可忍也,孰不可忍也。<br />
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五天籌錢 規則請自己查<br />
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筆者於2/7(星期五),忽然於非正式網路社團收到學校「公文」,要求於五個工作天內籌出六千元整,以及一堆文件資料,複雜的手續,毫不考慮實習醫生平日工作的繁忙,也未說明此考試變革之影響。到頭來,還是筆者自行上網搜尋。同學間譁然,疑問和不滿紛至沓來,有關單位仍顢頇的拒絕回應。<br />
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互踢皮球 成本漫天喊價<br />
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根據筆者了解,漲價案由考選部、衛生福利部、教育部及各醫學院校訂定,獨缺學生,心態可議。所謂反映成本云云,也僅是一方之詞。根據規費法第十條:「業務主管機關應依下列原則,訂定或調整收費基準,並檢附成本資料,洽商該級政府規費主管機關同意,並送該級民意機關備查後公告之。」試問有關單位,成本如何計算?錢都花在哪裡?卑微的醫學生有權利知悉嗎?考選部和台灣醫學教育學會,互說對方拿錢,今年三倍,明年要不要五倍?如此不對等的交易,攫竊自時薪十幾塊錢的我們,身為德術兼備的高層們,不曾稍感不安嗎?<br />
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倒行逆施 挾民意以自重<br />
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究竟技測成效如何,筆者不予置評。然自入醫學院以降,便上承大老「醫療品質」的緊箍咒,下受民眾「既得利益者」的睥睨,稍有意見,便動輒得咎,此次漲價事件亦然。對於少數民眾不悅勿考的言論,我們投與悲憫的同情;但考選部「醫學生有實習津貼,報名費不算高」的回應,何不食肉糜的口吻,令人哭笑不得。收入不到貧窮線者,被視為坐糜廩粟;荷包滿滿的高層,卻誇誇其談的嚷賠錢,價值觀的混亂,實令筆者大惑不解。<br />
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(作者為台大醫學系七年級學生)醫周刊http://www.blogger.com/profile/00037161558472297523noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-45372279232364636122014-02-06T22:30:00.003+08:002014-02-06T22:32:44.566+08:00原本昨天是二寶的生日<span style="font-size: large;">原本昨天是二寶的生日</span><br />
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<span style="font-size: large;">作者:Nicole Chen</span><br />
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<span style="font-size: large;">原本昨天是迎接二寶的開心日子,</span><br />
<span style="font-size: large;">如果上禮拜沒有大出血的話。</span><br />
<span style="font-size: large;">_</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">單純的想把小孩快點生一生的想法,</span><br />
<span style="font-size: large;">讓我決定在朔哥5個月的時候懷上二寶,</span><br />
<span style="font-size: large;">就在20周左右的產檢,醫生告知前置胎盤的狀況,</span><br />
<span style="font-size: large;">我一頭霧水,隨意google了一下,發現好像是一個蠻特殊的狀況,</span><br />
<span style="font-size: large;">在醫生的一再告誡下我,請假了幾周休息,</span><br />
<span style="font-size: large;">過了幾周發現沒動靜,心癢的回公司上班,</span><br />
<span style="font-size: large;">沒幾天就因為持續出血而住院安胎,這下可輕忽不得了,</span><br />
<span style="font-size: large;">我開始清楚的意識到,這是一條生命,開不得玩笑。</span><br />
<span style="font-size: large;"><a name='more'></a></span><span style="font-size: large;">_</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">就在上周六凌晨,睡覺睡到一半突然大量出血,</span><br />
<span style="font-size: large;">那種出血量,是我感覺到無法控制的湧出,</span><br />
<span style="font-size: large;">我躺在床上不敢移動,深怕流血更多會傷到二寶,</span><br />
<span style="font-size: large;">睡在我身旁的朔哥因為開燈而被吵醒了,我好怕他像平常一樣朝我抱過來要找我玩,</span><br />
<span style="font-size: large;">他坐起來,反常的沒有吵鬧,靜靜的坐著,看著我。</span><br />
<span style="font-size: large;">像是意識到今天有不尋常的事情發生一樣。</span><br />
<span style="font-size: large;">_</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">救護車很快就來了,醫護人員上來的時候其實我已經沒氣力了,</span><br />
<span style="font-size: large;">也不知道他們是怎麼把我搬上救護車的。</span><br />
<span style="font-size: large;">當我再醒來的時候,已經是躺在救護車上了,</span><br />
<span style="font-size: large;">覺得手腳發麻、沒有知覺、動不了、好冷。</span><br />
<span style="font-size: large;">_</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">我發現自己不清醒一段時間,也許下一秒昏過去還不知道會不會醒過來,</span><br />
<span style="font-size: large;">當時,我心中已經默默做了最壞的準備了,也許我不再醒過來了......</span><br />
<span style="font-size: large;">如果我只能再撐一分鐘,或者我只能在講三句話,那我要說什麼?</span><br />
<span style="font-size: large;">就在當時我感覺到我的肚子在動,二寶還在!還有胎動!</span><br />
<span style="font-size: large;">_</span><br />
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<span style="font-size: large;">"要救小孩"</span><br />
<span style="font-size: large;">這是我有印象和先生說的唯一的一句話。</span><br />
<span style="font-size: large;">_</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">之後我就沒意識了,再睜開眼睛的時候,已經在加護病房。</span><br />
<span style="font-size: large;">我看到姊姊和先生來看我,沒有抱朔哥進來,</span><br />
<span style="font-size: large;">(我當下還不知道這是加護病房的規定)</span><br />
<span style="font-size: large;">不知道早上朔哥這麼早起,現在怎麼樣?</span><br />
<span style="font-size: large;">不知道肚子裡的二寶有沒有保住,狀況如何?</span><br />
<span style="font-size: large;">_</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">心裡只覺得滿滿的歉疚,當下插著呼吸器,只能流眼淚。</span><br />
<span style="font-size: large;">爸爸媽媽來看我,他們牽著我的手誇我勇敢,我也流眼淚。</span><br />
<span style="font-size: large;">_</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">如果要說我這次有多勇敢,其實我一點也不堅強,</span><br />
<span style="font-size: large;">遇到了,沒辦法,其實我什麼事情也沒能幫上,</span><br />
<span style="font-size: large;">堅強勇敢的,是身邊摯親的家人朋友。</span><br />
<span style="font-size: large;">_</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">著急的在手術房外等我的爸爸媽媽和先生;</span><br />
<span style="font-size: large;">我的主治醫生率領救我的性命的馬偕專業醫療團隊;</span><br />
<span style="font-size: large;">懷孕以來,一路替我打點大小事的楊醫生,超級善良到極點;</span><br />
<span style="font-size: large;">最重要的是特地從美國回來,比我自己更要緊我的生命的姊姊。</span><br />
<span style="font-size: large;">_</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">如果沒有你們,我應該沒辦法再醒過來了,</span><br />
<span style="font-size: large;">經過這次的事情,我要記得更要把握當下,</span><br />
<span style="font-size: large;">孝順父母、快樂生活,這些都不能等,誰也不知道下一秒鐘會怎樣。</span><br />
<span style="font-size: large;">_</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">這陣子接收到很多親朋好友的關心,</span><br />
<span style="font-size: large;">才知道原來身邊這麼多關心自己的人,</span><br />
<span style="font-size: large;">我真的超級幸運,有這麼好的家人跟朋友!</span><br />
<span style="font-size: large;">即使插管+抽痰超通苦、輸血輸到全身過敏起紅疹、手臂因針孔而瘀青累累、脖子插了靜脈導管超痛</span><br />
<span style="font-size: large;">還有最揪心的是對二寶滿滿的愧疚。</span><br />
<span style="font-size: large;">_</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">身體的不舒服都會緩解,迎接我的是未來開心的生活,</span><br />
<span style="font-size: large;">謝謝大家的關心,也請大家繼續祝福二寶,希望他早日出院!</span><br />
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<span style="font-size: large;"></span>醫周刊http://www.blogger.com/profile/00037161558472297523noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-20909681487442455022014-01-19T18:06:00.002+08:002014-01-19T18:06:48.277+08:00換藥門診實習手記-「給別人幸福前,要讓自己先幸福」 換藥門診實習手記-「給別人幸福前,要讓自己先幸福」 <br />
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作者姓名:胡永信<br />
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外傷,是大部分人都曾經有過的經驗,像是被刀割傷、被熱水燙傷,或是摔車擦傷等……。疼痛,則在這些經驗中留下不好的回憶,而且不只是在受傷的當下,還有在傷口復原的過程。在外科換藥門診,我們接觸帶著形形色色傷口的病人,也第一線面對病人因為疼痛而產生的壞心情。<br />
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<strong>換藥門診的衝突</strong><br />
有些「惜皮」(台語,意指怕痛)的年輕人,帶著一身車禍後的擦傷來到換藥門診,每次我們都要像打仗一般戰戰競競地,首先是撕3M透氣膠布、拆下覆蓋傷口的紗布,但這些紗布往往會被乾掉的傷口滲液沾黏住;若是強硬地扯下紗布,可能就會撕下一層肉芽組織,讓傷口立刻鮮血淋淋,而病人此時肯定會痛到口無遮攔。因此,我們要先以生理食鹽水淋濕紗布,再拿濕棉棒配合、輕柔地將紗布從傷口剝離,然後用優碘或較不具刺激性的生理食鹽水消毒、清洗傷口,最後蓋上一層帶抗生素的油膏布(Sufucin,有不會沾著傷口新生肉芽的特性),有時候還會再抹上一層新黴素(neomycin)軟膏,不僅可滅菌、預防感染,也避免紗布沾著傷口,以減少下次換藥的疼痛。這個換藥過程不僅耗時,也考驗著醫護人員的耐心與容忍度。因為我們不只是面對病人的負面情緒,有時身旁的親屬為了表達對病人的關切,還可能會不明究理地責難換藥人員。<br />
<br />王伯伯是換藥門診的常客,他的屁股腰薦部有一個併發慢性骨髓炎的傷口。由於藥石罔效,傷口長期不能復原,他只能一周三次地來換藥、濕敷傷口,以避免傷口感染惡化。在他進門診前,護理師提醒我要格外小心,原來是王伯伯因為早就習慣過去某位資深護理師的換藥方法,認為只有這樣換藥才是正確的,於是只要別人的換藥方式一有不同,他就會嫌東嫌西,甚至是口不擇言地酸人,曾有一位新進護理師幫他換藥,還被他罵到哭呢!王伯伯一進門就開始上下打量著我,一旁的護理師立刻打預防針地說:「今天由我們的醫師親自幫你換藥喔!」第一次讓我換藥,王伯伯似乎是先試個水溫,只有抱怨覆蓋傷口的紗布太少:「起碼要五塊紗布、傷口才不會滲濕我的褲子啦!」我二話不說地立刻將紗布補上。<br />
<br />然而,第二次的換藥我就沒這麼好過了。王伯伯從進門到離開就一直不停口地大聲嚷道:「你上次黏的是什麼膠布啊!我才走過醫院前的ㄧ條街,紗布就鬆脫了!」<br />
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我心想:「傷口下緣貼著屁股溝,又覆蓋這麼厚的紗布,雖然我已經在紗布邊緣牢牢貼了井字,但其實只要他雙腿的動作一大,紗布下緣就會鬆脫。」<br />
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他繼續說:「照你這樣換藥,病人都跑去別家醫院了!像上次那個排在我前面的燙傷病人,今天就沒來!」、「我說的話你懂不懂,你要改進啦!」王伯伯縱情地開罵,而我則默默地照著他的一指一點換藥,直到他滿意為止。<br />
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走出門診後,他還得理不饒人地對其他病人大聲說道:「吼,阿裡面換藥的不知道在搞什麼鬼,連個膠布也貼不牢,被這個菜鳥換藥的人,算他倒楣啦!」雖然我不斷告訴自己不要和他一般見識,隨他怎麼說我都不回嘴,但他的字字句句都像刀一般刺著我,而我只能在心中留下無聲的抗議。<br />
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<strong>醫病同理心</strong><br />
<br />有位醫師描述自己某次為病人拔胸管的經驗。在她將固定胸管的層層3M膠布撕下時,病人哀聲叫痛,怒罵:「妳輕一點!」病人的兒子在一旁也附和道:「小力一點,我爸的皮很薄!」醫師語氣平和地回覆:「撕膠布時,真的很痛,我能理解,所以我會輕輕地撕。」然後又更小力地慢慢撕下膠布。不過,病人仍不停地叫痛,而憂心的兒子竟控訴道:「不是妳的爸爸,所以才不知道要輕一點!」<br />
<br />醫師於是停下動作,溫和地再對兒子說:「那我們一起來幫阿伯,我來扭開胸管引線,你來撕膠布;兩個一起來,動作比較快,可以縮短伯伯的不適。」憤怒的兒子看在醫師態度誠懇的份上,只好加入工作、照著醫師的方法慢慢地撕下膠布。但病人並不知道在身後撕膠布的人已經換成自己的兒子,於是繼續叫罵。此時,兒子不敢繼續唱和父親,只是默默地撕著膠布。醫師感嘆,當執行醫療行為,而無法完全避免疼痛時,儘管我們表達再多的同理心,有時仍然難以獲得病人和家屬的認同,假使醫療腳色互換一下,也許可以讓雙方了解彼此的難處。<br />
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<strong>切膚之愛</strong><br />
20世紀初,在西方傳教士將醫療技術帶來台灣的年代,彰化伸港鄉的一個貧農小孩,因為膝蓋傷口照護不好,感染延伸至大腿,造成大片糜爛。在他性命危急之時,求助於台灣彰化基督教醫院創建人蘭大衛醫師。經過清創手術和三個月的療養後,總算救回小孩的一條命,但是他的腿部大片傷口卻癒合不良,而且還有併發骨髓炎的風險。皮膚移植在當時的醫療水準還不是常見的手術,蘭醫師從文獻上讀到移植補皮的理論後、考慮一試,但男孩的家人中卻沒有合適的捐贈者。蘭醫師的妻子連瑪玉女士,自告奮勇提出自己作為捐贈者的想法,於是經過和小孩與家人的溝通,他們進行了無前例可循的皮膚異體移植手術。<br />
<br />在全身麻醉下,蘭夫人捐出四片皮膚,補在小孩清創後的傷口上。不過因為免疫排斥,移植的皮膚終究沒有存活,四天後形成血餅樣物質、脫落。經過一番討論和研究,蘭醫師改變方法,一個月後取小孩自身另一腿的皮膚,細片撒播在傷口上,小片皮膚成功地長起來,再經過四個月後第二次植皮,小孩的傷口在照護下逐漸癒合。<br />
<br />為了救一位素不相識的病人,竟有人願意捐出自己的皮膚,這樣捨己為人的情懷,蘭夫人自述是因為耶穌基督釘十字架的大愛,讓她感動而領悟。不過,看在一般人的眼裡,這是種超越常理、不凡的愛;在後世醫者的眼中,更是種視病猶親的精神典範。<br />
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<strong>讓自己先幸福</strong><br />
<br />在病患意識抬頭的現代,醫療行為逐漸被商業化,變成顧客病人的意見都是對的,而醫護人員倒是成了服務生,只能對病人的要求唯唯諾諾,以免遭到客訴後,還要寫報告。但是,醫療的本質畢竟不是服務業,它還有相關專業的道德操守,不能隨便讓病人予取予求。像是換藥,一個看似簡單的醫療行為,不僅是建立在無菌觀念的基礎上,有些醫護人員還會在換藥中多付出耐心與關懷,這個才是金錢無法計量的價值。如果我們只把換藥看作是健保給付40點的服務,而病人也斤斤計較要多蓋一層紗布、多擦一點藥膏,或是多貼一條膠布,如此才能值回票價,那麼醫療行為將失去那單純為別人好、人類最珍貴的同理心與無私的付出。若是一味地強調成本或是顧客至上,恐怕「切膚之愛」的精神永遠是個傳說奇談。而且,在這好興訟的年代,更遑論有人會冒險、願意在夜闌人靜的時分待命開急診刀、接生,或是不眠不休地站在手術檯前,做著高風險、時間長,卻有機會能救命的開顱手術。<br />
<br />曾有位老師對她成為醫師的學生說:「在給別人幸福前,一定一定要先讓自己幸福。」醫護人員也是人,需要病人與家屬的尊重和同理心。雖然醫療專業讓我們有更多的機會去幫助其他人、為別人帶來幸福,但我們也得先讓自己幸福。不僅要注意自己的身體健康、保持愉快心情,更重要的是從醫病互信的關係中,獲得正向的回饋,哪怕只是一聲感謝,也能成為支持我們走下去的力量。<br />
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作者部落格:<a href="http://yong-sinhu.blogspot.tw/">http://yong-sinhu.blogspot.tw</a><br />
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參考資料:<br />1. 維多莉陳的醫師觀察日記<a href="https://www.facebook.com/VictoriaChen.diary?fref=ts">https://www.facebook.com/VictoriaChen.diary?fref=ts</a><br />2. 彰化基督教醫院院史文物館<a href="http://www2.cch.org.tw/history/profile.aspx?oid=5">http://www2.cch.org.tw/history/profile.aspx?oid=5</a><br />註:為顧全病人隱私權,文中人物與故事情節皆經修飾,如有雷同,純屬巧合。<br />
<br />醫周刊http://www.blogger.com/profile/00037161558472297523noreply@blogger.com0tag:blogger.com,1999:blog-1468521563891777922.post-54034046374757383762013-12-25T07:30:00.000+08:002013-12-25T07:30:00.190+08:00我差點失去了妹妹<div class="separator" style="clear: both; text-align: center;">
<img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2Zj38C_hcL8WVw8ZzQK4sGd3bZiPvUDPUbVu3hJnYAdiz8waDq4QTGczWN_xEFWYz_GzEivMHb0B_3mwdxhEaOdM6SJNbO19G9YJ5ujRou9YDdsPQM0bspP22z9nNY-YuRPRB2Quql9Y/s1600/%E6%88%91%E5%B7%AE%E9%BB%9E%E5%A4%B1%E5%8E%BB%E4%BA%86%E5%A6%B9%E5%A6%B9.jpg" height="345" width="400" /></div>
<span style="font-size: large;"> </span><br />
<span style="-webkit-text-stroke-width: 0px; background-color: white; color: #333333; display: inline !important; float: none; font-family: "lucida grande", tahoma, verdana, arial, sans-serif; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-size: large;">我差點失去我的妹妹</span></span><br />
<span style="-webkit-text-stroke-width: 0px; background-color: white; color: #333333; display: inline !important; float: none; font-family: "lucida grande", tahoma, verdana, arial, sans-serif; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"></span><span style="font-size: large;"> </span><br />
<span style="-webkit-text-stroke-width: 0px; background-color: white; color: #333333; display: inline !important; float: none; font-family: "lucida grande", tahoma, verdana, arial, sans-serif; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="font-size: large;">作者:婦產科小醫師</span></span><br />
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<span style="font-size: large;">這天晚上,我兒子搞得很晚才哄睡,我也總覺得有些雜音翻來覆去睡不好。好不容易睡去,凌晨五點多爸爸突然開門進我的房間,驚慌的拿著電話說:妹夫說妹妹大出血,現在正在叫救護車。</span><br />
<span style="font-size: large;">我瞬間驚醒,雖然以前已經很習慣半夜被吵醒處理急症,但仍是驚魂未定,匆匆把在哭泣的孩子交給我媽,跟著爸爸飆車到急診。</span><br />
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<a name='more'></a><span style="font-size: large;">到醫院的路上,反覆思索吵醒主治醫師的時機。</span><br />
<span style="font-size: large;">打電話給妹夫,電話那端在救護車上,我隨口問了一句:妹妹還清醒嗎? 妹夫的回答竟是:他好像不太醒...<br /><br />很不妙。<br /><br />到達醫院急診,馬上衝到婦產科診療室打電話給可靠的Fellow學妹,幸好他今天值班。<br /><br />這時有台救護車到了,果然是妹妹,我看見妹夫在車窗無助的背影,還有妹妹的大孩子也隨行。</span><br />
<span style="font-size: large;">我告訴報到處的小姐:我曾是這裡的住院醫師,那是我妹妹,他前置胎盤,懷孕35週大出血休克。</span><br />
<span style="font-size: large;">妹妹被擔架下車,毫無血色,帶著氧氣罩吊著點滴,她微睜開眼睛說:救救我的孩子...</span><br />
<span style="font-size: large;">我心裡想這是哪門子的連續劇台詞,你給我堅強起來。<br /><br />我立刻打電話給我的老師--我妹妹的主治醫師,聽到老師的聲音像打了一劑定心針。</span><br />
<span style="font-size: large;">救護車的報告血壓只有60/30mmHg,急診量到了100...因此妹妹被送上產房。</span><br />
<span style="font-size: large;">產房的大伙兒都是熟識的學姐,他們一箭步齊手幫忙。一掀開被單,妹妹的衣服全被血浸濡,我們只得把衣物剪開丟棄,床上一攤血塊。</span><br />
<span style="font-size: large;">幸好超音波下,寶寶仍有心跳,只是心跳很急速,我們必須把握時間。</span><br />
<span style="font-size: large;">這時妹妹再度陷入休克。<br /><br />不能等了,開刀房同意讓我們上去,血沒抽什麼都沒做,硬是推上去開刀房。<br /><br />感激開刀房的學姐是熟悉的臉孔,大家不計疲累的幫忙。要來幾袋幾袋的血,麻醉科打上點滴及靜脈導管,插管麻醉,都在幾分鐘內完成。<br /><br />我的老師趕到,看到他我的心穩定了一大半。<br /><br />好熟悉的畫面,開刀房綠色的包布,我的老師及護士,刀床,大出血的病人。我的老師從以前到現在救過的產婦無以計數,只是場景依舊,在一旁幫忙的不是我,那流血的產婦是我妹妹。<br /><br />一劃開肚子,我們都看見了子宮上異常的大血管,那代表著下方有侵入子宮的胎盤。老師切開胎盤,孩子的頭看見了,拉出來的孩子爭氣的動好幾下,哭了,我鬆了第一口氣。時鐘顯示約六點鐘。胎盤拿出來後是另一個流血的開始,老師不停的縫合,切掉一小部分子宮,再將他們縫起來,再接著不停縫合。漫長手術接近尾聲時,桶子裡的血有1,700cc...這種手術是時間與技術的挑戰,誰也不敢說,我們可以救的回病人。一部分要靠病人的造化,上天的安排。<br /><br />妹妹終於停止流血,血壓也漸漸穩定。最後在下午兩點多轉入加護病房。因為失血過多,以及氣管較腫,呼吸管不能拿掉。<br /><br />妹妹的婆婆後來敘述,他去清理家裡,床墊都是血,滲到房間地板,客廳,血一路延伸到四個樓層樓梯。她邊清理邊哭,心想這不可能沒有兩三公升。</span><br />
<span style="font-size: large;"><br />妹夫真的受驚嚇了,我的老師說:我回台灣這趟值得了。</span><br />
<span style="font-size: large;">妹妹真得很堅強,輸著血,全身的血幾乎換過一輪了。<br /><br />轉入加護病房後,妹妹用顫抖的手寫字跟我們溝通。</span><br />
<span style="font-size: large;">第一句話就是寫:"朔"</span><br />
<span style="font-size: large;">那是她大孩子的名字,第二個問新生兒。</span><br />
<span style="font-size: large;">第三句話說:"我會不會死"</span><br />
<span style="font-size: large;">"不要怪我"</span><br />
<span style="font-size: large;">"小孩太輕,媽媽會不會生氣"</span><br />
<span style="font-size: large;">"幫我照顧小孩"<br /><br />最神奇的是...</span><br />
<span style="font-size: large;">"我見到外公了"</span><br />
<span style="font-size: large;">我們的外公早在我國中時就離開人世了。</span><br />
<span style="font-size: large;">我問她外公說了什麼...</span><br />
<span style="font-size: large;">"他叫我回來"<br /><br />我差點失去了妹妹。</span><br />
<span style="font-size: large;">身為醫護人員,我自己在工作時,很難時時感受到使命。遇到急症病人,有時甚至會累的生氣。但這次我要再次跟醫療團隊說,你們救了我妹妹,救了兩條生命。千言萬語,說不盡感謝。<br /><br />謝謝我的娘家:馬偕醫院婦產科,我的恩師,急診,產房,開刀房,外科加護病房,病房,你們的幫忙...只能用簡短的這篇文章,跟親朋好友們敘述者兩天發生的事,謝謝你們的關心及祝福。<br /><br />妹妹近日已經回家休養。寶寶很棒,每天奶量都有增加,他們都在努力中。</span>醫周刊http://www.blogger.com/profile/00037161558472297523noreply@blogger.com0