臺灣北部地區越南女性新住民之就醫經驗與醫病關係

臺灣目前的跨國婚姻移民與日俱增，且除了中國大陸之外，以越南女性新住民為最大宗，這些因緣際會而嵌入臺灣社會的越南女性，因台越婚姻結構的影響，常來自弱勢家庭，入臺之後也常處於弱勢家庭，再加上語言的弱勢，跨國的衝擊常處於生活之間，而醫療是人們生活之必須，因此本研究認為越南女性新住民在臺灣的就醫經驗與醫病關係是值得探究的層面。本研究一方面從越南女性新住民及其家人在越南的醫療經驗，試圖瞭解她們在越南受到什麼樣的醫療文化影響，從其醫療環境、醫療資源及就醫習慣、概念之形成及侷限、就醫困難、就醫經驗與其他相關就醫層面予以分析探討。研究發現她們在原生國家的就醫資源經常不足，也常因為交通條件不足、時間成本高、醫療費用昂貴、醫病關係階層化與對醫療藥物的概念不足等而未形成就醫的習慣。而進入臺灣之後，在就醫交通與時間仍然存在一些生活問題，也出現了就醫資訊、陪同及中文能力與社會網絡、網路使用、經濟考量等弱勢問題，她們亦會習取臺灣的一些醫療文化、習慣，再加上原生國的習慣影響，她們在就醫層級及西藥的使用、忍耐病痛、複向求醫等各方面出現一些因應的方式，而其中也會因為她們臺灣家庭的經濟、型態之不同，而發展出醫療落差。本研究另一方面希求從臺灣醫師的觀點瞭解她們在臺灣的家庭、生活及就醫經驗，包括就醫陪同、決定權、醫療溝通實際情況、醫療衛生背景知識、對婦產科男醫師的性別避忌、疾病之嚴重程度、生育情況等，並深入探討她們與醫師在診療方面的溝通應對方式、就醫態度及配合度、醫療要求及糾紛、就醫負擔及選擇，以及醫師因應溝通不良之越南新住民時發展出來的治療策略，並進一步梳理其醫病關係及瞭解其醫療資源。為了使在臺灣的越南女性新住民能夠在醫療層面上獲得更公平全面的照護，本研究對政府機關提出相關之建議，包括：提升越南女性新住民之教育水準；協助其瞭解大眾交通使用及路線，有需要的輔導其瞭解交通法規及考照；施打水痘等相關疫苗及抽血檢驗登革熱等作為健康記錄，以利後續健康照護；以生活化的方式傳遞健保及衛教資訊；對於長期逛醫院的患者予以瞭解及協助；進行宣導使其瞭解通譯服務院所；加強醫護人員對新住民用藥習慣、原生國醫療文化等之瞭解；加強診間翻譯軟體應用及醫師資訊運用；對於教育機構及醫療單位宣導疫苗施打適用條件。另外對於醫療院所的建議為：可聘請及招募重要外籍配偶國家來源國之相關語言翻譯人員及志工，例如越南語、印尼語、泰語等提供就醫諮詢服務；改善院內交通、標示，設計對身心障礙人士或外籍人士友善的動線及環境；運用院內衛教環境，多語呈現，使新住民更瞭解自己的治療權益。

關鍵字

就醫經驗；醫病關係；醫病溝通；弱勢；就醫習慣；就醫困難

並列摘要

With Taiwan’s cross-border marriage immigration increasing day by day, together with mainland China immigrants, Vietnamese women have become one of the largest groups of Taiwanese new immigrants. Due to the influence of Taiwan-Vietnam marriage structure, these Vietnamese women often come from disadvantaged families in Vietnam and often stay in disadvantaged families after they come to Taiwan. Coupled with the disadvantage in language, the impacts of moving to a different country can be seen in every aspect of their lives. Since medical care is a crucial part of people’s everyday life, the medical experience of Vietnamese immigrant women in Taiwan and their medical relationship with doctors are worth studying. This study starts from analyzing how the medical culture in Vietnam affects the medical experiences of Vietnamese women and their families. The analysis includes the medical environment, medical resources, medical habits, the formation and limitations of medical concepts, medical difficulties and other related aspects. The study has found that the medical resources in their native countries are often inadequate, and they often do not form the habit of seeking medical care due to limited means of transportation, high time costs, high medical expenses, stratification of medical relationships, and limited understanding of medication. However, even more problems occur after they come to Taiwan, where they have difficulties in finding transportation, squeezing out time, receiving economic support, getting medical information, finding company, acquiring Mandarin skills, and accessing social networks and the internet. Besides these challenges, the new medical habits they form after they adapt to the medical culture in Taiwan, along with the influence of the medical habits they had formed in their native country, make them develop different ways of seeking medical treatment. In addition to the influence of these medical habits, medical gaps are also developed due to different economic conditions of their families in Taiwan. Besides analyzing from the perspective of Vietnamese immigrant women, this study also seeks to understand their families, everyday lives, and medical experience in Taiwan from the perspective of Taiwanese doctors. The medical experiences include company to hospitals, decision-making power, medical communication, medical and health background knowledge, gender avoidance for obstetrics and gynecology male physicians, severity of diseases, birth status, etc. This study also discusses their communication with doctors about their treatment, medical attitude and cooperation, medical requirements and disputes, medical burden and choice, and the development of treatment strategy that physicians come up with in response to the poor communication between them and Vietnamese new immigrants. This study also dives into studying the medical relationship between physicians and Vietnamese new immigrants and the medical resources these new immigrants have. In order to give Vietnamese immigrant women in Taiwan more access to fair and comprehensive medical care, this study proposes some recommendations to government agencies, including: improving the educational attainment of Vietnamese immigrant women, assisting them to learn about public transportation and routes, applying varicella vaccination and other related vaccines, giving blood tests for dengue fever to build health record for the benefit of follow-up health care, passing information about national health insurance and health education in a life-based way, strengthening the understanding of medical staff on the medication habits and the medical culture of new immigrants’ country of origin, increasing the application of translation software and physicians’ use of information technology, and informing medical and educational units of the medical needs of the children of immigrants. In addition, some recommendations for medical institutions are: hiring and recruiting language translators and volunteers from the countries where most foreign spouses come from, improving patient flow in hospitals, improving on giving patient instructions, and making the hospital a less intimidating environment for immigrants.