牡丹鄉衛生所醫護人員的工作世界

The Everyday Work of Health Professionals in a Mountain Indigenous Township in Southern Taiwan

盧敬文(Lu, Ching Wen)

指導教授 ： 劉紹華 ； 林文蘭

國立清華大學/人文社會學院/社會學研究所/碩士(2016年)

摘要

本研究考察山地醫護人員的工作世界，描繪他們實作衛生政策時遭遇的困難和評估政策成效的機制，並在此基礎上探討：山地鄉衛生所醫護人員工作的特殊性為何？衛生所的IDS巡迴醫療如何運作，對醫護人員與醫病互動關係產生什麼影響？山地鄉原住民的健康問題與相關防制政策，又如何影響醫護人員的工作策略？

我分別在2014年八月至2015年一月，以及2015年八月下旬，兩次至臺灣南部恆春半島的牡丹鄉衛生所進行田野工作，利用參與觀察、訪談和文本分析等方法，跟隨山地醫護人員的行程，理解醫療和公共衛生工作的過程。

本研究發現山地醫護人員必須因應山地鄉的環境、設備和地理條件，調整其工作策略。此外，依靠IDS經費的巡迴醫療，規律地在部落居民的日常生活世界中辦理，改變了醫病關係。但過於強調量化形式績效的檳榔防制政策，忽略醫護人員第一線實作的問題，無法貼近居民生活經驗；不同衛生單位負責的防制措施間缺乏整合，也導致防制工作經驗無法延續。

本研究透過描繪山地醫護人員的工作世界，指出醫療服務的實作深受山地鄉地理環境、族群文化慣習和衛生政策變化的影響。藉由實作上的問題和評核機制的缺失，反思衛生政策的問題，理解山地醫護人員的貢獻與處境，可作為未來偏遠地區醫療改革的參考。

關鍵字

山地鄉衛生所 ； 醫護人員 ； 在地醫療實作 ； 巡迴醫療 ； 檳榔防制

並列摘要

Although the government designed several rural health policies for solving the severe health disparities among indigenous and non-indigenous people in Taiwan, the fact that inequality of the health condition and the disparities in allocation of healthcare resources still remain in mountain indigenous townships after years. This study suggests another way to understand the causes of the health issues through the local perspectives.

This study investigates the everyday work of health professionals in mountainous area and tries to ask several questions as following: What is the specificity of their work in mountainous area? How does the mobile medical services operate? What is the impact of mobile medical services on doctor-patient relations? Finally, how do health issues and related policies influence the way of their work?

During August 2014—January 2015 and August 2015, the researcher had conducted fieldwork at the health center in Mudan township in Hengchun peninsula in southern Taiwan by means of participant observation, interview and text analysis, following the everyday course of the health professionals, and recording the details about their works.

This study finds, firstly, that the rural health professionals may adjust their strategies of work to the different environment, geographic context and facilities. Besides, the doctor-patient relations in the tribes have been altered since the mobile medical services funded by IDS operated in the same lifeworld as the habitants living in. Thirdly, the betel quid prevention policy, focusing on quantitative outcome overwhelmingly, results in disregarding the difficulties of practices and the life experiences of habitants; and it is the policies without integration that cause the inconsistency of the working experiences of front-line health professionals.

All in all, this study concludes that the local practices of medicine in Mudan township have been deeply influenced by the natural and social context; on the other hand, this study also reconsiders the problems within health policies, and understands the health professionals’ contributions objectively; in the future, hope to contribute to the rural healthcare reform, by revealing the difficulties of practice and the shortcomings of quantitative way of assessing policy impact.

並列關鍵字

health center in mountainous area ； health professionals ； local practice of medicine ； mobile medical services ； prevention of betel quid chewing

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