韓國三星醫院在MERS爆發中難辭其咎

SEOUL, South Korea — It is the jewel of South Korea’s medical service: a 1,900-bed hospital of steel and glass owned by the famous Samsung conglomerate. It also is where a 35-year-old man whose symptoms were misdiagnosed as pneumonia languished for three days in an overcrowded emergency room and hallway, where he coughed up sputum teeming with the Middle East respiratory syndrome virus and exposed dozens.

韓國首爾——這是韓國醫療服務領域的一顆明珠：一座鋼材和玻璃結構的醫院，擁有1900張牀位的，業主是著名的三星集團(Samsung)。也就是在這所醫院裏，一名35歲男子的症狀被誤診爲肺炎，在擁擠的急診室和走廊裏煎熬了三天。他咳出痰液中充滿了中東呼吸綜合徵（簡稱MERS）的病毒，許多人因此暴露於病毒之中。

Doctors of the renowned hospital, the Samsung Medical Center in Seoul, were the first to confirm the disease, known as MERS, in another patient a week earlier but failed to detect the connection between the two cases. Investigators now say the misdiagnosed patient, awaiting a vacant bed in a general ward upstairs, wheezed and expectorated in common areas with no oversight, turning into a MERS “superspreader.”

這家著名的醫院就是首爾的三星醫療中心(Samsung Medical Center)。早前一週，該院的醫生最先在另一位MERS患者身上確診了這種疾病，但他們未能發現兩起病例之間的聯繫。調查人員現在說，這名被誤診的患者在普通病房樓上等待空牀位時，沒有人監護，他呼吸急促，而且咳痰，成爲了MERS的“超級傳播者”。

The mistakes by the Samsung Medical Center are now the focus of much that has gone wrong to escalate South Korea’s MERS crisis, the worst outbreak beyond Saudi Arabia, where the disease first appeared in 2012. As of Tuesday, nearly half of all 162 confirmed MERS cases in South Korea have been traced to Samsung, historically regarded as the nation’s best hospital.

三星醫療中心犯的這個錯誤，現在成爲了韓國MERS危機的焦點。這是除沙特阿拉伯之外，該疾病疫情爆發最嚴重的一次，它最早是2012年在沙特出現的。截至本週二，韓國162個確診MERS病例中，有將近一半可以追溯到三星醫療中心。在大家眼中，它一貫都是全國最好的醫院。

Several hundred of its patients are under quarantine in the hospital or elsewhere, either because their infections have been confirmed or they are under observation for symptoms. Nearly 300 of its 3,900 medical and other staff members are under similar quarantine. Other hospitals have refused to accept patients from Samsung for fear of infection. By Sunday, it stopped taking new patients as it struggled to prevent the virus from further spreading beyond its gleaming compound.

該院的數百名患者正在這家醫院或其他地方接受隔離，要麼是已經確診感染，要麼是正在觀察症狀。該院3900名醫護及其他工作人員中，有將近300人也受到了類似的隔離。因爲擔心感染，其他醫院拒絕接收來自三星醫療中心的患者。爲了極力防止病毒進一步蔓延到這座光鮮的醫院之外，這座醫院到了週日已經不再接收新患者。

“We offer our deep apologies to all MERS patients and those quarantined because of our employees,” said Song Jae-hoon, the president of the medical center, bowing before television cameras.

“我們向所有MERS患者，以及因爲我院員工而受到隔離的人士，表達深深的歉意，”三星醫療中心院長宋在焄(Song Jae-hoon)說，並在電視鏡頭前鞠了一躬。

Up until now, Samsung’s reputation for quality had gone unchallenged. South Koreans looked no further than its list of patients: Lee Kun-hee, the country’s richest man and the chairman of the Samsung conglomerate, has been hospitalized there, holed up in a 20th-floor V.I.P. room, since his heart attack last year.

在此之前，三星醫院的口碑從未受到過挑戰。韓國人一看到該醫院的患者名單就信服了：韓國首富、三星企業集團會長李健熙(Lee Kun-hee)自去年心肌梗塞發作後，一直在該中心20樓的一個VIP病房裏接受治療。

Nobody was surprised when Samsung diagnosed the country’s first case of MERS on May 20, attributing the discovery to its medical skills.

當三星在5月20日診斷出該國首例MERS病例時，沒人覺得意外，還把病例的發現歸功於該院的醫療技術。

Calling Samsung a general hospital hardly explains its place in South Korea’s system.

說三星醫療中心是一家綜合性醫院，幾乎無法解釋它在韓國醫療系統中的位置。

In South Korea, when a parent gets sick, it is widely considered a filial duty for the children to mobilize all connections to secure a bed in Samsung or at a few other mega-hospitals, including one run by another family-controlled conglomerate, Hyundai, that they believe provide the best care.

在韓國，人們普遍認爲生病後，子女有義務動用一切關係在三星，或是其他幾家大型醫院弄到一張病牀。韓國其他幾家大醫院中的一家，是由另一個家族企業集團現代(Hyundai)經營的。人們認爲，這些醫院提供的醫護服務是最好的。

When that strategy fails, patients are often taken into the hospitals’ emergency rooms, where they can wait for days for a bed in a general ward to be available.

這一策略失敗後，患者常會被送到醫院的急診室。在那裏，他們可能要等好幾天，才能等到普通病房的一個牀位。

The Samsung hospital beds were usually filled, with 1,800 patients, with a long waiting list. Each day, 8,500 outpatients passed through.

三星醫院的病牀通常都是滿員狀態，住着1800名病人，還有很多人排隊等着，每天還需要接診8500名門診患者。

But it was not just the fame of Samsung that attracted patients. Medical service is so affordable under the country’s universal medical insurance system that “there is no threshold at hospitals,” said Kwon Jun-wook, a senior Heath Ministry official.

但吸引患者的，並不僅僅是三星的名氣。韓國保健福祉部的高級官員權俊旭（Kwon Jun-wook，音）表示，在韓國的全民醫療保險制度下，醫療服務的成本完全可以承受，以至於“去醫院根本沒有門檻”。

“Patients go to hospital as if they go shopping,” Mr. Kwon said, referring to the widespread practice of hospital hopping to get a second opinion or to get a referral to a mega-hospital, some of them with more than 2,000 beds.

“患者去醫院就像去購物一樣，”權俊旭說。他指的是人們爲了得到重新診斷，或是轉到大醫院，而到不同醫院就診的普遍做法。部分大醫院的病牀超過2000張。

Low medical fees also mean that hospitals must treat as many patients as possible to stay profitable. The big hospitals get more crowded as family members and private nurses they hired stay with patients, sleeping on cots between hospital beds. It is also important to social etiquette for South Koreans to visit hospitalized relatives, friends and colleagues, often with gifts like fruit boxes. Church members cluster around a patient’s bed, praying and singing.

醫療費用低也意味着，醫院爲了盈利，必須儘可能多地接診患者。大醫院更加擁擠，因爲家屬和他們僱來的私人護工會陪着患者，睡在病牀之間的行軍牀上。對韓國人來說，看望住院的親友和同事也是一項重要的社交禮儀。他們通常會帶着水果禮盒等物品。教會的成員還會圍在患者牀邊祈禱唱歌。

The overall scene, as Koreans like to say, looks like a “flea market.”

就像韓國人喜歡說的那樣，整個場面看着就像“跳蚤市場”一樣。

It is this overcrowded hospital condition that a World Health Organization mission said had made the otherwise modern South Korean hospitals particularly vulnerable to MERS. All those in the country who have the virus were infected in hospitals. Of them, 65 were relatives, friends or family-hired caretakers who contracted the disease while they were visiting or looking after hospitalized patients.

世界衛生組織(World Health Organization)的一個專家組表示，這種過於擁擠的就醫環境，讓其他角度都頗爲現代的韓國醫院，在面對MERS時特別脆弱。韓國所有的MERS病毒攜帶者都是在醫院傳染的。其中65人是病人的親友，或是家人僱來的護工，在看望或照顧住院的病人時，感染了這種疾病。

“The Samsung Medical Center is a national hospital in the sense that there are no regional boundaries in medical service in the country and everyone wants treatment there,” said Kim Woo-joo, head of the Korean Society of Infectious Diseases. “The MERS outbreak was a stress test of our medical system, revealing its problems.”

“韓國的醫療服務沒有地域限制，從這一點來說，三星醫療中心是一家全國性的醫院，所有人都想去那裏治病，”大韓感染學會(Korean Society of Infectious Diseases)理事長金宇柱(Kim Woo-joo)說。“MERS的爆發是對我們醫療體系的一場壓力測試，暴露出了它存在的問題。”

At Samsung, the system began unraveling when the 35-year-old man, whom investigators called Patient No.14, arrived at its emergency room on May 27, a week after Samsung had discovered the first case.

在三星醫療中心，這套體系於5月27日，也就是三星診斷出首例病例的一週後開始崩潰。當時，被調查人員稱作第14號患者的35歲男子，來到了三星的急診室。

Patient No.14 had been infected by the first patient when both were in the same hospital south of Seoul in mid-May. But neither he nor Samsung doctors had any clue he was infected. Unlike the first case, he had no record of having visited the Middle East.

5月中旬，因爲與首例患者同處首爾南部的一家醫院，第14號患者被對方傳染。但這名患者和三星的醫生，均未發現任何顯示他已被傳染的跡象。不同於首例病例，他沒有去中東的經歷。

Samsung doctors diagnosed his case as pneumonia. But with no room in wards upstairs immediately available, he waited in the overcrowded emergency room for three days and sometimes loitered outside, investigators say.

三星的醫生對他的診斷是肺炎。但調查人員表示，因爲沒能立即在樓上的住院部找到病房，他在過度擁擠的急診室裏等了三天，有時候還在急診室外閒逛。

It was not until May 29, when the Korean Centers for Disease Control and Prevention told them about the man’s possible link to the first case, that the emergency room doctors were alarmed, according to Samsung officials. By then, the man had become the biggest “superspreader” in the outbreak, infecting people in South Korea’s best hospital.

韓國官員稱，直到5月29日，韓國疾病管理本部(Korean Centers for Disease Control and Prevention)告訴他們，這名男子可能與首例病例有關時，三星的醫生才警覺起來。那時，該男子已經成了此輪疫情中最大的“超級傳播者”，傳染了韓國最好的醫院裏的人員。

So far, a total of 162 MERS cases have been found in 13 hospitals, including 20 deaths. But before the disease was diagnosed, the patients also passed through 70 other hospitals, raising fears that they may have infected people there. In some train stations, the local authorities have used heat-detecting cameras to stop potential MERS carriers from entering their towns. More than 6,500 people are in quarantine or in self-isolation at home, many of them after visiting the Samsung hospital.

迄今爲止，韓國總共在13家醫院裏發現了162例MERS病例，包括20例死亡病例。但在被診斷出該疾病前，這些患者還出入過其他70家醫院。這讓人們擔心他們可能傳染了那裏的人。在一些火車站，當地政府爲了防止MERS攜帶者進入各自的城鎮而使用了溫度檢測攝像頭。超過6500人處於隔離或在家自行隔離狀態，他們中有很多人之前都去過三星醫院。

“What pains us the most is our failure to contain Patient No.14 at the Samsung hospital,” said Kwon Deok-cheol, a senior official at the government’s MERS response headquarters.

“最令我們痛苦的是，我們未能在三星醫院隔離第14號患者，”一位名叫權德喆(Kwon Deok-cheol)的高級官員在政府的MERS應對總部說。

Mr. Kwon said that the government planned to overhaul the country’s “hospital culture,” such as unrestrained visits. But critics also blamed a “Samsung-style management” for the crisis.

權德喆表示，政府打算改革韓國的“醫院文化”，如無限制探望。但批評人士認爲，“三星式的管理”也應爲此次危機負責。