Even the small island hamlets at the southern tip get a primary doctor once a month. Instead of a mainland hospital that takes a full half day to reach and return, a boat carrying doctors and a clinic crosses the sea. On the 23rd of last month, the ‘hospital ship’ (Gyeongnam 511) also dropped anchor off Nodo village in Sangju-myeon, Namhae County, for the first time in a month.

From early morning, news of the hospital ship visiting echoed through the village. “Hello, this is the block chief. They say the hospital ship will arrive at 2 p.m. Please bring your ID and come on time.” In Nodo, where 15 out of 20 residents are 65 or older, many elders forget even news they have just heard. So the block chief kept broadcasting the same reminder, worried anyone might miss the chance for care.

At 2 p.m., a small boat reached the village pier. Because the 162-ton hospital ship could not berth at Nodo’s shallow, narrow pier, the medical team came ashore by tender. Dividing up two large suitcases of medicines and bags with devices such as blood-pressure cuffs and glucometers, they walked up a slope with not a patch of shade toward the Nodo Cultural Center, where a clinic would be set up. That day, the apparent temperature in Namhae County topped 35 degrees Celsius.

As soon as the team opened their bags, the cultural center became a hospital. Residents took turns having their blood pressure and blood sugar checked, consulted on colds, skin conditions, and long-standing pain, and received needed medicines. “Thank you for coming all the way in this heat.” An elder, medicine in hand, greeted the sweat-soaked staff. When the little-over-an-hour session ended, the hospital turned back into an ordinary cultural center.

Like the ship that visited Nodo that day, five hospital ships make the rounds of island villages nationwide. South Gyeongsang, South Chungcheong, and Incheon each operate one, and South Jeolla operates two. Their catchment covers 257 islands and 34,066 residents. Having operated for over half a century, they are already an irreplaceable “hospital” for islanders, yet many off the islands do not even know they exist. We followed a day in the life of a hospital ship.

At 9 a.m. on the 24th of last month, Gyeongnam 511 cleared Tongyeong Port and set course for Naeji village on Sangdo in Saryang-myeon, Tongyeong. “Did you take seasickness pills in advance? Once we go out into the open sea, even our staff get seasick.” Park Kyung-suk, the administrative officer in charge of running the ship, said with a smile.

The care team that day numbered five. Administrative officer Park, staffers Kim Eun-nyeon and Ko Eun-mi who handle nursing, and public health doctors Go Won-gyu in internal medicine and Lee Hwi-un in Korean medicine boarded the ship.

Inside, the ship was a small general hospital. Along a narrow corridor stretched a waiting room and reception desk, and exam rooms for internal medicine, Korean medicine, and dentistry. On one side of the corridor was a “pharmacy,” with a notice reading ‘Prescriptions are not issued unless the patient comes in person.’ It was even equipped with an automatic packaging machine that fills blister slots with pills and seals them one dose at a time in printed bags showing how to take them.

On the ship, diagnosis, prescribing, and dispensing all happen in one place. In principle, the separation of prescribing and dispensing forbids this, but in areas without pharmacies, physicians or dentists are allowed to dispense by exception. Most islands visited by the ship have no pharmacy.

Before the ship reached shore, the day’s work had already begun. Gyeongnam 511 was scheduled to visit three communities that day: Naeji and Dabpo on Sangdo, and Meokbang on Hado. On a long table in the waiting room lay rosters of residents for the three villages. The staff reviewed who would be seen in each village and past prescriptions, and prepared the medicines and equipment to take ashore.

Among the 51 island villages Gyeongnam 511 visits, only two can be berthed by the ship itself. Meanwhile, of the 2,379 residents on the rolls, 1,333, or 56%, are 65 or older. Because it is hard to ferry elderly residents to the ship by tender, the team usually carries medicines and equipment into the village and sets up a temporary clinic. If they forget anything, they must ride the tender back to the ship, which can delay the schedule, so checking each resident’s medicines and exam equipment before disembarking is essential.

With this preparation repeated every month, the team has come to remember each person. They know who takes what, what last month’s blood pressure and blood sugar readings were, and even which pills someone has trouble swallowing. In this way, 2,379 residents across the islands of South Gyeongsang now have a ‘regular doctor’ who comes once a month.

At 10 a.m., the ship arrived off Naeji. The team loaded exam equipment and medicines onto the tender and crossed to the island. The Naeji senior center was already full of residents who had gathered after hearing the news.

Two rooms in the center became exam rooms for internal medicine and Korean medicine. The central kitchen-living area became registration and waiting. At the desk, staffer Kim checked people in by recognizing faces even before asking names. To “I saw you come in, so I registered you. You will see the Korean medicine doctor too, right?” came the reply, “Sure, I will get one acupuncture session before I go.”

At the same time in internal medicine, Dr. Go started a kind of ‘twenty questions to find the medicine.’ “You know that tomato ointment. I want to get one.” “Tomato ointment? Madam, what would that be?” After asking whether it was something to apply or to take, and what was bothering her, he finally found the answer: a drug in a package as red as a tomato.

Next door in Korean medicine, Lee, who is from Busan, narrowed the distance with elders by using dialect. To “Mother, what brings you today?” the elder pointed first to her knees and then her back. Her joke, “I only work just enough not to die,” set the room laughing.

The ship’s remit begins with tending to everyday ailments and managing chronic disease. It treats colds, skin conditions, and long-standing pain; checks blood pressure and blood sugar; and confirms whether hypertension and diabetes medicines are working. In effect, it performs the primary care role of a neighborhood clinic.

Such periodic checks sometimes catch something more serious. Recently in Deokdong village, an abnormal blood pressure reading led to a referral to a mainland hospitalan alarm that might not have surfaced without the visit. Kim smiled and said, “Since then, whenever the ship comes in, the elder tells us, ‘I lived because of you.’”

After a lively round of consultations, when the last resident left the exam room, the hospital turned back into a senior center. The ship will return to Naeji a month from now. In the meantime, if medicines run out or someone falls ill, islanders have two choices: fight the heat to reach a mainland hospital, or endure the pain.

There are two main routes from Naeji to the mainland. One goes to Yongampo in Goseong, a 20-minute boat ride. The other goes to Tongyeong: take the village bus to Geumpyeong Port on Saryangdo, board a boat to Gaochi Port in Tongyeong, then take a taxi into the city center.

Even the relatively close Yongampo route does not put you right at a hospital. From the harbor to Goseong-eup, where the hospitals are clustered, it is 25㎞, a 33-minute drive. Paradoxically, Samcheonpo in Sacheon on the opposite side is closer at 12㎞, a 21-minute drive. That is why residents mostly go to Samcheonpo when they have business on the mainland.

Cheon Dul-ja’s hospital is in Samcheonpo, too. She takes the 8:30 a.m. boat to Yongampo in Goseong and then a taxi to Samcheonpo. The cost is not small. “A round trip runs about 30,000 won just for taxis. Transport subsidy? There is no such thing.”

More pressing than money is time. Cheon finishes the hospital visit, stops by a pharmacy, does some shopping, and catches the 1 p.m. boat back to Naeji. Miss it, and every return option pushes the homecoming back by an hour. Even with everything hurried, at least half a day disappears.

It is no different in other island communities. In Nod, Namhae County, the story was similar. To reach a hospital, residents must take a ferry to Byeongnyeon Port. The boat crosses only six times a day. Getting off at the pier is not the end; they must call a taxi and ride 17㎞20 minutes one wayinto Namhae Town.

Even after arriving at a hospital, the race against time continues. If the line is long, they sometimes explain they came from an island and are allowed to go ahead. Getting an IV drip is often given up, even when ill. The consultation, buying medicines, even eating a meal, all have to match the timetable of the return boat.

Given this, islanders are grateful for the hospital ship simply coming once a month. Kim Seok-se of Dabpo said, “In weather like this, going to a mainland hospital by boat is hard. When the hospital ship comes and gives us medicines, how grateful that is.” Yet he does not wish for more frequent visits. “The ship has to go to other islands, too, right? Even if we would like it to come often, that would be too hard on those people, the staff.”

Over two days, island residents called the ship a “lifeline” and “our hospital,” cherishing it. Yet there was one thing even lifelong users did not know: under the current healthcare laws, nowhere is the hospital ship recognized as a “medical institution.”

A hospital ship has no address. On the 23rd of last month, the Nodo Cultural Center was the hospital; a day later, the Naeji senior center was. To open a medical institution, you must designate and report a location and meet facility standards at that site. A ship that moves every month meets neither condition. The Regional Health Act lists four types of regional public health institutions: health centers, public health medical centers, branch clinics, and health-living support centers. Hospital ships are not on that list.

That does not make care provided on board illegal. The Medical Service Act allows care outside medical institutions when the state or a local government requests it as necessary for the public interest. Whether in the exam room on board or in a village hall, hospital-ship care relies on this exception. There is also a basis for operating the ship: a Ministry of Health and Welfare directive titled “Regulations on the Management and Operation of Hospital Ships and High-speed Evacuation Boats,” and local ordinances. There is a basis to treat and a basis to sail, but nowhere is it written what a hospital ship is.

The ship’s being outside the law is not because the history is short. South Gyeongsang’s first hospital ship, the ‘Seomdolbogi-ho,’ set sail in 1973. In 1978, five 120-ton hospital ships based out of Masan Port toured more than 640 islands nationwide that had no doctors.

Lacking legal status is not a simple problem. The Regional Health Act allows the state and provinces to subsidize up to half the operating costs of regional public health institutions. Because hospital ships are not on that list, they cannot receive this support. The money to run the ship and the people to crew it depend entirely on each local government’s means.

Questions such as how to keep medical records, how to link them with other institutions’ records, and whether a new health program includes hospital ships all require case-by-case judgments.

As a result, whenever an issue arose in operating the ships, an exception had to be created. In 2024, when a pharmacy opened near the Saryang-myeon branch clinic, Saryang-myeon was removed from the areas exempt from the separation of prescribing and dispensing. When operations in the Saryang-myeon area were suspended because the ship could no longer dispense, residents protested. The Ministry of Health and Welfare responded with the view that islands could be interpreted separately, and Saryang-myeon was again designated an exception area.

This kind of handling has occurred recently as well. Because a hospital ship is not a regional public health institution, it cannot use PHIS, the clinical information system used by health centers and branch clinics. As a result, the ship cannot check what medicines residents received from other providers, creating a risk of duplicate prescriptions. South Gyeongsang Province repeatedly asked the Ministry of Health and Welfare to allow PHIS on the ships, but until recently that had not led to actual use, because a hospital ship is not a regional public health institution under the law.

Recently, however, a blocked door opened. The Kyunghyang Shinmun has learned that the Ministry of Health and Welfare, after review by the Active Administration Committee, decided to allow hospital ships to use PHIS. The method, however, is again an exception: when a ship visits an island in County A today, it will be recognized that day as County A’s branch clinic; when it visits an island in County B, it will be recognized that day as County B’s branch clinic. A ministry official explained, “We took an active-administration step in the absence of an explicit legal basis defining hospital ships as medical institutions.”

While the government layered on exceptions, the National Assembly let a chance to fix the ships’ legal status pass by. In the 21st National Assembly, the so-called “three hospital-ship bills” to include hospital ships among regional public health institutions, National Health Insurance providers, and national health screening institutions were introduced but lapsed at the end of the term without review. In the 22nd Assembly, in June, People Power Party lawmaker Kim Tae-ho proposed an amendment to the Regional Health Act, and on the 16th of last month, lawmaker Kang Dae-sik of the same party again introduced the “three hospital-ship bills,” but it is unclear whether they will be handled.

Last year, the five hospital ships nationwide treated a de-duplicated headcount of 38,853, according to local government tallies. Based on data received via information requests to the four provinces and cities that operate the shipsSouth Gyeongsang, South Chungcheong, South Jeolla, and Incheontheir total operating cost last year was 4,585,510,000 won. Of that, 60.5%, or 2,773,720,000 won, was fuel. Unlike fishing boats or ferries, hospital ships did not receive duty-free fuel support. Local govrnments covered all operating costs. None of the four received a single won in national funding for operations.

Local governments have not failed to press the government and the National Assembly for improvements. South Gyeongsang Province petitioned nine times last year and twice this year for a legal basis, national funding, and duty-free fuel. South Jeolla made the same requests when Prime Minister Han Duck-soo visited in September and November 2024, and South Chungcheong did likewise at a Ministry of Health and Welfare meeting on May 12. Nothing changed.

Meanwhile, the Ministry of Health and Welfare this year called public health doctors “the last bulwark of local primary care,” and presented “rounding,” in which public doctors at health centers periodically cover 200 branch clinics without an assigned doctor, as a measure against care gaps. Hospital ships also carry those public doctors around the islands. It is the same rounding, yet on land it is a national “measure,” while at sea it is a local “project.”

Administrative officer Park explained the reality of a “hospital that is not a hospital.” “Because only four jurisdictionsSouth Gyeongsang, South Jeolla, South Chungcheong, and Incheonoperate hospital ships, many people do not even know they exist. For islanders, they uphold local healthcare to the point of being called lifelines, but in the current state, it would not be strange if they disappeared at any time.”