[Collapsed Pediatric Care]②Four Hours by Express Bus for Chemotherapy: Seonghyun's Journey to Seoul for Treatment

No Pediatric Hematology-Oncology Specialists in Gangwon Province
Emergency Rooms Turn Away Patients
Most Doctors Concentrated in Seoul, Incheon, and Gyeonggi
Widening Regional Workforce Gap

Editor's NoteAlthough it is expected that, after a year and a half, resident doctors who left hospitals in protest against the increase in medical school admissions in February last year will resume their training, the situation in essential departments that handle critical and emergency patients remains precarious. In particular, in pediatrics, resident doctors are avoiding the field due to the low birth rate, an irrational reimbursement system, and increasing legal risks, while existing specialists are leaving. As disparities in medical services between regions widen, the system for treating sudden pediatric emergencies and severe pediatric diseases requiring specialized intensive care is also being shaken. There are fewer children being born, and even fewer doctors to care for them. Asia Economy will examine the current state of the pediatric medical system and directions for improvement in a six-part series.

Seonghyun (alias), who lives in Donghae, Gangwon Province, was diagnosed with acute lymphoblastic leukemia, a type of childhood cancer, in 2022 when he was in the third year of middle school. After noticing something wrong with his health, he visited a local clinic, where he was advised to get examined at a larger hospital. He went to Gangneung Asan Medical Center and was then transferred to Asan Medical Center in Seoul to begin treatment. This is because there are no doctors in Gangwon Province who can treat pediatric leukemia patients. For three years, he and his mother took an express bus from Donghae Intercity Bus Terminal to Dong Seoul Terminal in Seoul-a three-hour journey-then took a taxi across Cheonho Bridge to the pediatric ward at Asan Medical Center. After each round of chemotherapy, he would be discharged and then readmitted, and to receive chemotherapy injections four times a week, they rented a room 15 minutes from the hospital and stayed there for about two months.

Seonghyun (alias), a pediatric leukemia patient, and his mother, the guardian, are traveling after arriving at Dong Seoul Terminal in Seoul by express bus from Donghae Intercity Bus Terminal in Gangwon Province to receive outpatient treatment at Asan Medical Center in Seoul. Photo by Kang Jinhyung

Seonghyun (alias), a pediatric leukemia patient, and his mother, the guardian, are showing their bus tickets after arriving at Dong Seoul Terminal in Seoul by express bus from Donghae Intercity Bus Terminal in Gangwon-do to receive outpatient treatment at Asan Medical Center in Seoul. Photo by Kang Jinhyung

Traveling to Seoul for outpatient treatment was difficult, but an even greater problem arose in emergencies. After chemotherapy, when his white blood cell count was low, even a slight fever could be dangerous, requiring immediate hospital care. However, no emergency room in Gangwon Province would accept him, so he always had to go to Seoul. Seonghyun's mother recalled, "If a leukemia patient develops a fever and is not treated immediately, it can quickly worsen into a severe condition like sepsis. It was extremely unsettling that there was no emergency room near our home where we could go right away in an emergency," adding, "In urgent situations, even our neighbors would step in, driving us to Seoul in their own cars at night or dawn."

Each year, about 1,300 children under the age of 15 are diagnosed with cancer in Korea, with pediatric leukemia accounting for 40% of these cases. Chemotherapy takes two to three years, but the cure rate exceeds 90%, and the prognosis is generally good, so with proper treatment and management, children can grow up to be healthy adults. However, procedures such as hematopoietic stem cell transplantation and chemotherapy are by no means easier than adult cancer treatments. Typically, patients are hospitalized at the beginning of treatment and then receive outpatient chemotherapy, sometimes up to four times a week, depending on the treatment process. For patients living far from the hospital, who are already physically and emotionally exhausted, the time spent traveling often exceeds the time spent receiving treatment.

Kim Hyeri, a professor in the Department of Pediatric Hematology and Oncology at Asan Medical Center in Seoul, said on August 27, "Half of my current patients come from outside Seoul, and they have to spend a tremendous amount of time traveling for outpatient treatment," adding, "There was even a patient from North Gyeongsang Province who received outpatient chemotherapy every day because it was not feasible to stay near the hospital for several months."

Currently, there are only 69 pediatric hematology-oncology specialists working in hospitals nationwide. More than 60% of them are concentrated in Seoul, Incheon, and Gyeonggi Province, widening the gap between the capital region and other areas. There is not a single specialist in Gangwon Province, where Seonghyun lives, and only one each in North Chungcheong Province and Jeju Island. Professor Kim explained, "In the past, basic chemotherapy for pediatric cancer was administered locally, and patients were referred to Seoul hospitals only for surgery, radiation therapy, or multidisciplinary care. But now, there are simply not enough specialists who can treat pediatric cancer, so in regional areas, there is neither the staff to care for inpatients nor the capacity to provide on-call coverage, making it impossible to even begin treatment."

With so few medical staff continuing treatment, some hospitals face a precarious situation where if even one doctor takes medical leave, patient care could come to a halt. Even though there is ample skill to treat patients and a high probability that they will grow into healthy adults, the shortage of medical personnel raises serious concerns about disruptions in treatment.

For this reason, the government has designated pediatric cancer as an essential medical field where adequate medical services are not being provided, and since last year has been working to establish pediatric cancer hub hospitals in five regions nationwide, excluding Seoul. The plan involves forming dedicated teams within hospitals, including pediatric hematology-oncology specialists, inpatient hospitalists, contract physicians, and other pediatric specialists, or having pediatric hematology-oncology specialists from university hospitals (hub hospitals) work together with experienced pediatric cancer specialists at local hospitals and clinics, or having pediatric cancer specialists regularly visit university hospitals to support outpatient care.

However, there are concerns that these regional hub hospitals are merely a minimal safeguard, and that without practical benefits such as increased reimbursement rates, simply fostering hub hospitals will not be enough to ensure proper operation. Professor Kim said, "If we want patients to choose local hospitals closer to home over hospitals in Seoul, it will require a long-term, substantial investment in financial resources and personnel, as well as accumulated treatment experience," adding, "Just as you cannot reduce the number of firefighters because there are fewer fires, support should not be determined or discontinued based on short-term results."