“Don’t touch her!”

I looked from my alarmed coteacher to the third grade student whose workbook I was leaning over. Giant red welts paraded up her arms. With the benefit of hindsight and two years of medical education, the words “fungal infection” now spring to my mind. But the question remains now, as then—why?

Students in Taiwan prepare for class

The humid Taiwanese climate that fostered Amy’s* infection was only a small catalyst in a long chain of events that threatened her health. Amy was a member of the Atayal tribe, one of the 13 indigenous groups that had inhabited the island long before it became a crossroads for East Asian political struggles, but that now represent less than 2% of the island’s population. During the Japanese occupation of the island in the early twentieth century, her tribe had been forced to relocate from its strongholds in the mountains to the flat, open areas along the coast, where any rebellious tendencies would be easier for the government to control. Later, after the Chinese Communist Party (CCP) takeover of mainland China caused the Kuo Min Tang (KMT) to flee to Taiwan with millions of its members, Chiang Kai-Shek instituted martial law that promoted Chinese nationalism by expressly forbidding the practice of local customs and speech in local tongues, further weakening the fabric of Atayal communities. By the time I met Amy, in the same coastal village that her ancestors had been forcibly driven to so many years before, martial law was a receding memory, but so were the Atayal language and culture. Students had to be taught their own heritage in school, because so much of it had been lost among the broader community. Cynical though it may sound, the government’s new willingness to fund such educational programs was again a matter of political expediency: the Democratic Progressive Party (DPP) had risen to power on a platform promoting Taiwanese independence, and as such, it sought to distinguish Taiwan’s culture from that of the mainland. Promotional materials traditional costumes served that purpose well, while providing the added benefit of attracting the interest—and money—of tourists.

Sadly, beyond dancing, the adults in Amy’s rural village suffered from limited employment prospects. Many had relocated to the cities in search of jobs, leaving their children behind to be raised by family members. Among those who remained, alcoholism and family violence were growing problems. One of my students would disappear for days at a time because he routinely ran away from home to avoid his stepfather’s beatings. Another was throttled publicly by his father over a small misunderstanding. My classroom was once thrown into commotion when an ambulance arrived in the village to transport a parent suffering from acute alcohol poisoning to a hospital an hour away. I sensed that the problems of violence and alcohol abuse were well-known in the community, but rarely openly discussed. They seemed intractable, and too often outsiders would use the information to justify prejudice against indigenous people. At one point, I witnessed an ethnic Chinese coworker yell at her misbehaving indigenous students that they would never amount to anything because their tribe was full of layabouts and drunks.

In Amy’s case, her parents had responded to the strain on their family by divorcing and moving away, abandoning her and her younger sister to the care of neighbors. Although Amy was only eight years old, she acted as her sister’s guardian. I learned none of this from Amy herself—it was a fact of life for her, and she did not consider it newsworthy enough to share.

Taiwanese students enjoying outdoors activities.

So it was that when the array of red welts began creeping up her arms, Amy found herself without access to medical care. Given the remoteness of her village, a doctor visited only once each week. Amy was not old enough to drive herself to the clinic, and she did not have enough money to pay even the small copay that would have been asked of her under Taiwan’s nationalized health care system. My co-teacher and I offered to take her to see the doctor ourselves, but embarrassed by the attention, she demurred. It was only a skin infection, after all.

A skin infection—and a small culmination of a century of history. The structural violence that has been visited upon her small, rural tribe by the forces of global politics is clear enough. But having seen it play out upon the bodies of children whose futures continue to be compromised still leaves me struggling with the question: why? How do we tolerate senseless suffering, and the waste of human potential that occurs when that suffering distracts students from their educations?

I turned to a career in medicine and public health in hopes of finding some small part of a solution. But learning the names of the fungi that may have infected Amy’s skin, and the anti-fungal medications that could have been used to treat her, has been more frustrating than satisfying. The tools we need to combat the small injustices of health inequity have long existed—what we lack is the social commitment to use them where they are needed. Such indifference is an implicit ratification of the broad injustices of our global history. We are long past due in making amends.

*My students all chose English names to go by in class, but I have changed Amy’s chosen name to further protect her privacy.