Living on a Prayer

The

tragic face of the SARS epidemic in Taiwan doesn't belong to a patient or a politician, or even to a doctor or a nurse. Instead, the most vivid expression of this outbreak's impact can be found on an eight-year-old girl, Tang Chia-ru, who wears her hair in pigtails and, when given the choice, prefers noodles to rice. Last Friday, she stood behind her father fidgeting with her face mask and staring at the swarm of photographers who surrounded her and at the smiling face of her mother who looked down from a picture frame hanging in a Taipei funeral parlor. Her mother was nurse Chen Ching-chiu, who died in the line of duty at the age of 48 and has become a touchstone for Taiwan's heartbreak and frustration at the government's inability to curb the spread of the virus.

"She is a hero to all of us," says longtime friend, Wu Feng-ying, who worked alongside Chen at Taipei Municipal Hoping Hospital, where Chen contracted the virus. Bowing to public sentiment, Taipei Mayor Ma Ying-jeou has decreed that Chen's name be added to the list on the Martyrs' Shrine.

Taiwan, however, needs fewer martyrs and more heroes. Last Monday, the island was shaken by news that nearly 150 frightened doctors and nurses in Taipei and in the southern city of Kao-hsiung had resigned, at a time when they are needed most. On Friday, the World Health Organization (WHO) removed Hong Kong and Guangdong from its infamous travel-advisory list, confident that these former hot zones had contained the disease. But in Taiwan, the epidemic shows little sign of letting up as the number of SARS cases on the island rose in seven days from 308 to 548 and the death toll surged beyond 60.

Adding to these woes is the knowledge that Taiwan's health-care system is itself partially to blame for the crisis: an astonishing 94% of the island's SARS victims have become infected inside hospitals. The hottest zone of all seems to be Hoping Hospital, where to date 120 people have been infected and 20 have died, including four staff members. Last week, Cloudy Wang, a 33-year-old nurse at Hoping, refused to return to work, together with 22 of her colleagues. She says her experience at Hoping left her "shattered" and killed her faith in hospital administrators. "The hospital," she claims, "had no policy on how to deal with SARS."

The outbreak at Hoping was finally disclosed on April 22, only after President Chen Shui-bian received a tip-off from a friend working at another hospital. But nurse Wang told TIME she first saw patients with SARS-like symptoms at Hoping on April 9. Interviews with eight nurses who were working at Hoping at that time show just how poorly the hospital handled the outbreak. Wang recalls treating two patients with SARS-like symptoms when "all we had for protection were face masks ... I felt like a lamb waiting to be slaughtered."

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Equally troubling, Wang and another nurse, Lo Wen-ling, 27, claim that a more senior nurse in their intestinal-disease ward instructed them to list suspected SARS patients as suffering from "pneumonia." They say they were also ordered not to tell the patients' families that the true diagnosis was believed to be SARS. If contacted by the media, adds Lo, she was ordered to say that "there were no SARS patients in Hoping." These instructions, claims Wang, were said to have come from "high up"—meaning upper management.

Wu Feng-ying, nurses' supervisor in Hoping's chronic-disease ward, says she saw no evidence of a deliberate cover-up. In her view, the real problem was that "in the early days, the criteria for diagnosing SARS were unclear." Indeed, Wu now suspects her friend and colleague nurse Chen Ching-chiu contracted SARS while trying to resuscitate a patient who was only later discovered to have had the disease.

Attending the memorial service of nurse Chen on Friday, Hoping's superintendent Wu Kang-wen denied playing any part in a cover-up, adding that "the truth will come out when the investigators' findings are released." In the meantime, the hospital has been fined $75,000 for its failure to report SARS cases earlier, and it remains closed. As for nurse Wang, she claims to feel no guilt about leaving her post. "Yes, we have a duty of care to our patients. But built into that duty there is a precondition that our safety needs are being met."

The government has taken a less sympathetic line, threatening to revoke the licenses of doctors and nurses who refuse to return to the front—an approach that has done little to calm fears among hospital workers. Although only a small percentage have walked out, those that remain have ample reason to be scared, says Tseng Jean-lie, chairman of the National Union of Nurses Association. "In some of the hospitals, medical staff are supplied with only two masks a week," says Tseng. "They should be getting a new one every four hours. It's not good enough." Not good enough for Taiwanese, or for the American Centers for Disease Control and Prevention (CDC), apparently. The CDC announced on Thursday that a staffer named Chesley Richards, one of nine Americans in Taiwan assisting authorities with the epidemic, had developed SARS-like symptoms and would be flown home immediately—bucking WHO recommendations that suspected SARS patients not be moved around, for fear of increasing the risk of transmission.

Health officials in Taipei insist they are now doing everything by the book. They claim that effective infection-control measures currently in place in hospitals mean that the load of new cases will soon decrease. Most of last week's reported spike, says Taiwan's Center for Disease Control chief Su Yi-jen, were the result of a backlog of 545 patients that had not been processed—meaning the victims were infected before new safety standards were introduced. "We're at the stage when we're about to come down," he says.

Taiwan's hospital administrators may have learned their lesson—that SARS is not a disease that responds to complacence or concealment. The trouble is, there can be a heavy financial price to pay for honesty. "Administrators don't want to admit they have SARS patients because it will mean a dramatic drop in patients coming to their hospital," says Michael Tai, head of the department of social medicine at the Chungshan Medical University in Tai-chung, "and that means they will lose money." Still, "other hospitals won't dare to buck the system now," says epidemiologist Ho Mei-shang, who has been tasked by the President to bring hospitals into line. "They are getting the message."

It's too late, though, for eight-year-old Chia-ru. Her father, Tang Se-hu, says she is still trying to comprehend the loss of her mother and misses the trips she used to make to the hospital where, he says, "her mom was always working." He adds, "she knows her mom helped care for people and saved lives." When she's older she will no doubt wish that someone had taken more care with her mother's life.