WOODO, South Korea — Jeoung Byeong-deok remembered how a grateful old woman waited on the pier so she could wave goodbye when his ship pulled away from the island.
“It’s the kind of thing that makes you feel proud that you are doing something good,” he said.
Mr. Jeoung, 57, is the captain of the 128-ton Jeonnam 511, one of five government-run hospital ships in South Korea that bring free medical services to hundreds of islands scattered off the country’s south and west coasts.
The ships have been in operation for decades, but their necessity has increased in recent years. The islands — like the rest of rural South Korea — have seen their populations decline rapidly as the country deals with the fallout of a demographic crisis.
There are no doctors on the islands. The older residents, most in their 60s and older, are cut off from the mainland, separated from the nearest hospitals by miles of choppy waters. The only regular medical services arrive with the hospital ships, which visit the islands once a month or once every three months.
“The ship brings a lifeline with it,” said Park Ok-hee, a 63-year-old resident of Woodo, a 155-acre island off the south coast. “It’s not easy, especially for the old people, to travel to the mainland to see a doctor.”
On a bright summer day, Mr. Jeoung steered Jeonnam 511 to Woodo, one of the 77 islands off the south coast that his crew of 14, including five doctors and nurses, cover. After a loudspeaker on the island announced the ship’s approach, islanders shuffled toward the village hall.
The wharf on Woodo was too small for Jeonnam 511, so the doctors and nurses transferred to a small boat to reach their patients ashore. They lugged their medical gear and supply bags up a gentle pine hill to the village hall, where 27 residents, all in their 60s and older, were seated on the floor, waiting to receive medical care.
“Most of their ailments, like back pain and arthritic fingers, have to do with a lifetime of hard labor, picking cockles and oysters off the tidal flats,” said Kim Gwang-jin, 25, a doctor on Jeonnam 511.
How to supply medical help for older citizens has become a growing concern, as governments grapple with rapidly aging societies in East Asian countries, and also beyond the region.
Aging in Asia
As people live longer and fewer babies are born in East Asia, countries in the region are grappling with the consequences of a demographic time bomb.
Goheung County, which includes Woodo, had 95,960 people in 2001, 20 percent of them 65 or older. Now, it only has 62,442, with 43 percent of them 65 or older. South Jeolla Province, which includes Goheung, has 2,019 islands. Of them, 296 were inhabited by people in 2015. Two dozen of these have since become uninhabited after one or two aging couples died.
Woodo has a population of 100, down from 152 recorded in 2001. But residents say they feel more isolated than other islands of similar size.
Twice a day on Woodo, the sea parts for a few hours during low tide, revealing a submerged, mile-long concrete road barely wide enough for a car. Villagers who have business on the mainland must rush out and return before the water rises again.
The natural phenomenon made Woodo “neither an island nor mainland,” as residents like to say. So the South Korean government never bothered to build a bridge or run a ferry service to Woodo.
There is no post office, police station or bank. The only school, which had as many as 100 students in the 1970s, closed in 2021 because, like many other rural schools in South Korea, there were no longer any school-age children on the island.
“The mud is all we got to support our life,” said Jeong Seong-soon, 75, who used the money she made catching octopuses and cockles from the tidal flats to raise four children on the island. But because of overfishing and pollution, she said, “the sea is not giving as much as it used to.”
For Jeong Gyeong-shim, 86, the island’s oldest resident, Woodo has been home since she married an illiterate fisherman here 64 years ago. The husband died a few years ago, and moving around has become harder for Ms. Jeong since she hurt her back collecting bamboo shoots last year.
She has since spent her days sitting alone in her low-slung tiled-roof house with a blue gate, watching TV, gazing at the sea down the hill or listening to early-morning monsoon rains. During a recent visit, there was no other sign of life in the house other than a stray cat peeking through the gate.
Ms. Jeong spoke proudly of her two sons, one daughter and eight grandchildren, who all live in cities or study abroad. But her voice choked with tears when she talked about another daughter, who died by suicide several years ago.
“She would be 66 now and would come to see me if she were still alive,” Ms. Jeong said. “My sons ask me to come and live with them in cities. But what am I going to do in a city where I don’t know anyone? I am not going to be a burden on my sons.”
For Ms. Jeong and other aging islanders, the hospital ship is one of the few connections they have to the outside world, one of the signs that they have not been forgotten. During the doctors’ visit, the patients lay on mattresses with their backs or knees spiked with acupuncture needles that they hope will relieve their pain.
Some of the islands are so isolated that they don’t even have a place for medical staff to gather their patients, much less a shop where they can buy goods like snacks and sundries. At Hyojado, an islet off the west coast, the crew from another hospital ship, Chungnam 501, set up at a villager’s home.
Pairs of rubber shoes crowded outside the house as villagers gathered inside to see the doctors. On another island, Chungnam 501 used a boat to fetch patients and bring them on board. The ship has modest dentist’s office and other mini-clinics and also offers heat therapy and acupuncture, treatments that older patients tend to favor.
The doctors are mostly young men who work on hospital ships in lieu of mandatory military service. They greet their patients as if they were their own grandparents.
Life on a hospital ship, they say, can be hard but rewarding. The crew, hopping from one obscure island to the next, spends as much time sailing as it does seeing patients.
“When the sea gets rough, you see the water out the window at one moment and the sky the next,” said Park Joon-ho, 36, who runs lab tests on blood samples on Jeonnam 511. “In this job, you get used to seasickness.”
“But people are really friendly,” said the internist Shin Hyeon-woo, 25, “because they know we have come a long way for them.”
Although the medical service is free, with the government covering the cost, the patients insist on expressing their gratitude by bringing food to doctors and nurses. Fish, abalone, mussels, garlic, lettuce and pepper.
“The noodle soup our chef cooks with those huge clams the villagers give us is like nothing I had tried before,” said Bae Sang-won, 26, a dentist.
Hospital ships cannot perform serious surgery, but doctors try to identify ailments that require visits to mainland hospitals. They provide prescription drugs and small bags of household medical supplies. Over the years, their contents have changed as the population has aged.
Few families look for cough syrup for children anymore, while there is a high demand for denture cleaner, eye drops and patches for pain relief.
“You can’t find any children on these islands any more,” said Lee Sook-yeon, 51, a nurse who has worked on Jeonnam 511 for 16 years. “You meet an old villager on an island, but when you go there again three months later, he is gone.”
Kim Nam-seok, at 62 one of the youngest residents of Woodo, said the island offered “no hope” for young people, who can earn more working in urban construction sites than fishing and digging for clams as their ancestors had for centuries.
“All we got left here are those who will die tomorrow,” he said, sardonically.
Sitting at home alone, Park Sang-son, 85, a fifth-generation islander on Woodo, wondered whether he would be the last of his family to live here. When his wife of 52 years died six years ago, he had to hire a boat to take her to a mainland port miles away, the nearest point where the ambulance would come.