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North Chungcheong Province receive medical checkups from visiting doctors. (provided by Yeongdong County Public Health Center)

“I’m pregnant with twins, and they’re at 21 weeks now. I pushed myself too hard while we were moving a few days ago. I’m worried there might be something wrong with the twins,” said a pregnant woman surnamed Jung, 33, with worry in her voice. Jung, who was lying in bed for an ultrasound examination, had visited the “mobile maternity care vehicle” in front of the Uiryeong County Clinic in South Gyeongsang Province on May 2.

As the obstetrician, Dr. Kim Yang-gyun, listened to the patient, he was checking the status of the fetuses on the screen. “Here’s one of your babies, and here’s the other. Both of them are growing big and strong. You don’t need to worry - you can go about your everyday activities,” Kim said, reassuring Jung.

There’s no maternity hospital in Uiryeong County, where Jung lives. To run a maternity hospital with a delivery room in the shopping district, there have to be at least 250 pregnant women who can use the facility - but there are just over 150 pregnant women in the entire county. That’s why Jung is planning to deliver her baby in the city of Jinju, about 40km away, but until then, she plans to have her regular biweekly checkups at the mobile maternity care center.

The mobile maternity care vehicle is a service that regularly sends a large customized vehicle equipped with medical equipment and staffed by obstetricians to care for pregnant women in four counties in South Gyeongsang Province that don’t have a single maternity hospital - Uiryeong, Goseong, Sancheong and Hamyang. The service was launched in 2008, and similar mobile maternity care vehicle are also being operated in Yeongyang and Bonghwa Counties in North Gyeongsang Province, Jeongseon and Goseong Counties in Gangwon Province and Danyang County in North Chungcheong Province, while North Jeolla Province is looking into the idea as well.

South Gyeongsang Province spent 531 million won (US$473,000) (including 200 million won of funds from the central government) to operate the mobile maternity care vehicle last year, and this year it plans to spend 605 million won (US$540,000) on the project (200 million won from the central government). As of the end of 2015, 888 pregnant women were registered in the four counties, and last year a total of 2,182 people made use of the mobile maternity care vehicle. This year’s total is expected to far exceed last year‘s, with a total of 511 people having taken advantage of the service as of March.

In contrast with a big city like Seoul, which has several general hospitals and maternity hospitals in neighborhood office buildings, there are numerous parts of South Korea without a maternity hospital. As of the end of last year, a total of 34 cities and counties were designated as “challenging regions for childbirth” - defined as a region in which less than 30% of mothers deliver babies within 60 minutes of their homes and in which at least 30% of fertile women cannot reach a medical facility capable of delivering children within 60 minutes. Of these 34 regions, 33 are counties, the majority of which are made up of farming towns and fishing villages.

Blind spots in medical access have appeared all around the country because the central government doesn’t pay attention to what it can‘t see and because the private sector doesn’t invest when there’s little money to be made. In order to pick up the slack, local governments are devising various programs that are tailor-made to their own circumstances. They are looking for ways to implement comprehensive medical welfare “from the cradle to the grave,” covering the whole life cycle from birth to death. Such programs and efforts are rapidly spreading to local governments nearby.

On the afternoon of May 1, 11 children between three and four years old were working up a sweat as they frolicked inside a public health center in the Jeongneung neighborhood of Seoul’s Seongbuk District. Seongbuk District opened South Korea’s first children’s public health center on Feb. 28 because many of the residents are working parents with young children.

The children’s public health center provides health care for pregnant women and newborns, health and recreational programs customized to different stages of development and groups for people raising children. At the health center, children learn about healthy food and lifestyle habits while parents learn how to use their bodies to play and communicate with their children. In April alone, more than 1,400 people visited the public health center, and the center’s website (cafe.daum.net/sbchildhealth) is getting close to a thousand members.

“It’s hard for grown-ups to fix their lifestyles, but children improve before your very eyes. We’re using education about nutrition and sports that’s tailored to children so that clinics can handle medical care and public health centers can provide an atmosphere in which kids can grow up to be healthy,” said Lee Mi-seon, a public servant in Seongbuk District. The district is planning to open a second children’s public health center in the Seokgwang neighborhood this year.　

Elderly people in Yeongdong County

On the afternoon of Apr. 26, more than 30 elderly people in Wondang Village, Yangsan Township, Yeongdong County, North Chungcheong Province were sitting together in an elderly community center, waiting for someone. When a team of young people in white gowns with their hands full of bags entered the center, the elderly people’s faces began to glow. They had been waiting for medical professionals from the “elderly community center visiting doctors” program.

“Those doctors make me even happier than a soap opera or seeing a daughter get hitched. For old folks battling a spectrum of medical conditions, a physician is their best friend,” said Lee So-yeon, a 68-year-old woman. For ailing elderly residents of rural towns with poor transportation, getting to the nearest public health center, clinic or hospital is a major undertaking.

In Yeongdong County, a large percentage of the population is elderly (the opposite of Seongbuk District in Seoul), and the county has been operating the elderly community center doctors program since 2015. Every second and fourth Wednesday, 31 medical professionals visit elderly community centers in townships that have little access to medical care. The teams of 31 include 20 male medical students working in public health in lieu of their mandatory military service (11 practicing internal medicine and 9 practicing traditional Asian medicine) and 11 government officials in public health and nursing. Last year, they examined 13,734 people, 197 of whom got an early diagnosis for serious diseases such as stomach cancer. As of March, 3,277 people had been treated this year. With the elderly community center doctors program becoming more popular, the number of elderly community centers in the program increased from 44 in 2015 to 55 last year and then to 66 this year.

“It’s very important to have enough emergency rooms, maternity hospitals and medical facilities to treat chronic diseases around the country. This isn’t something that should be a matter of money. When it comes to addressing the blind spots in medical welfare, it‘s not easy to determine whether the central government or local governments are more responsible,” said Yu Ji-hyeon, chair of the Korean Health and Medical Workers’ Union.

“First of all, the central government needs to revise the health care delivery system, which is divided into first, second and third tiers, to keep demand for medical care from concentrating in Seoul and other major cities. Based on this, local governments need to have public hospitals and healthcare centers that can serve as local hubs, and they need to invest in and take care of those medical facilities to turn them into places that locals want to visit,” Yu added.

By Choi Sang-won and Oh Yoon-joo, South Gyeongsang and Cheongju correspondents, and Nam Eun-joo, staff reporter

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