The Tzu Chi Free Clinic provides equal medical care to people of all skin colors who are without money, residence certificates, identity, or insurance...

A young Mexican woman entered the whitewashed one-floor building alone. She handed the receptionist at the registration counter her boyfriend's social security card and employee card.

The young woman had sneaked across the American border from Mexico four months before. For the past few weeks she had been experiencing persistent stomachaches. A friend suggested that she seek consultation at the Tzu Chi Free Clinic. Because she had illegally entered the country, she possessed no documents and could only bring her boyfriend's identification papers.

Tsai Hsiu-hsiu, the receptionist, checked the documents and told the girl that with her boyfriend's moderate pay, she was not eligible for free medical care. But the young lady said that because of the recession her boyfriend's part-time job opportunities had significantly decreased, and that they could barely make ends meet.

After further communication and confirmation, the Free Clinic decided to offer the lady free medical service. A volunteer guided her to the consultation room.

Rigid yet flexible control of screening process

The Tzu Chi Free Clinic is located in Alhambra, a city populated by many Chinese. The conveniently situated clinic is not far from downtown Los Angeles and is easily accessible by bus.

People of different races waited in front of the registration counter. Some stared at the TV screen; others quietly read magazines; more people gazed around themselves in a carefree manner.

The Free Clinic has operated on private donations since its establishment nine years ago, making it different from other free charity clinics, which are often subsidized by the US government. When the clinic was first opened, many patients found it unbelievable that the medical treatment was free of cost.

Those seeking medical treatment at the Free Clinic must show the receptionists their social security card, pay stubs, and bank statement or lease agreement to prove that they are unable to afford treatment elsewhere. Ho Pei-chen, who has volunteered at the free clinic for nine years, said the work of a receptionist is stressful because they have to carefully screen all applicants to prevent precious medical resources from being misused. However, sometimes their detailed questioning brings complaints. Some patients who are deemed ineligible yell and make threats at volunteers right on the spot.

Despite all these setbacks, Ho still patiently lets all applicants know that the Free Clinic is entirely funded by donations, and that everyone's love put together has made the operation of the clinic possible. Some people, after hearing her explanation, put pennies and small change into the donation box to show their support and appreciation.

The wall behind the registration counter is lined with shelves completely stuffed with patients' files. After nine years of operation, the number of patients' files has reached 10,600. Volunteer Wang Tzu-hsing was sorting files. She off-handedly took out file 302 and explained that this patient was a 65-year-old woman. Scanning through her file, Wang said that the patient had received an array of treatments such as herbal medicine, dental services, electrocardiogram, a blood test, X-rays, etc. Altogether, she had been to the clinic over 130 times.

Through the door to the left of the registration counter are consultation rooms for ophthalmology, Chinese herbal medicine and Western medicine, along with a treatment room and a little Buddhist prayer room. The dentistry room, laboratory, sterilization room and office are to the right of the counter. The little building encompasses multiple functions.

Although these low-income families without insurance can apply for medical assistance at other free clinics, many still choose Tzu Chi because Tzu Chi offers more services, longer office hours, shorter waiting times and flexible manpower. Moreover, at Tzu Chi, the homeless and low-income receive abundant love from volunteers.

Fruit as gifts

Mr. Liao was receiving naprapathy and acupuncture therapy. He and his wife immigrated to Los Angeles from Canton, China, eight years ago. He had sought medical treatment at the Tzu Chi Free Clinic until he found a job with a restaurant which also gave him medical insurance. Last year, a sudden stroke paralyzed his right side. Consequently, he lost his job and insurance. Then he remembered Tzu Chi. Although Liao had not visited the clinic in a long time, Dr. Hsu Ming-chang recognized Liao at first glance. Liao was surprised.

"Dr. Hsu is very nice." "Ms. Ho is very patient." "Nurse Mei-lan is also a wonderful lady." Liao and his wife greeted all the staff they met by name and with compliments.

Liao came for medical treatment twice a week. He said his children in Canton were worried when they heard he had had a stroke, but after learning that their father was receiving free treatment at Tzu Chi, they were more at ease.

The wall displayed many thank-you cards from patients. Sometimes patients bring homemade desserts or homegrown vegetables to thank the staff.

Dr. Yen Ching-yi, a specialist in Chinese medicine, has served at the free clinic for seven years. He comes every Friday morning. A devoted Christian, he has zealously participated in service-oriented clubs since his student days. Because he studied in Sao Paulo, Brazil, he can speak English, Portuguese, and Spanish. Many patients at the clinic are Mexican, and he can communicate fluently with them.

All the doctors at the Free Clinic are volunteers, and they come on a weekly or sometimes monthly schedule. Dr. Huang Chao-shuo, a recently retired oncologist, drives one hour from Irvine, Orange County, to the free clinic three times a week. Sometimes doctors must close down their own clinics to participate in overnight medical outreaches.

Every day more than ten medical professionals and administrative workers staff the clinic. In its nine years of operation, the free clinic has established a good referral system with 60 local charity organizations. Many alcoholics and drug addicts have been referred here for treatment by other organizations. For example, the Salvation Army has referred cases to do TB tests. Likewise, the free clinic refers critically ill patients to the county hospital or informs them where else they can get help.

After the September 11 terrorist attack, the recession and unemployment problems increased and many under-funded charity organizations were closed down. Even some local health bureau budgets were slashed and some services were curtailed. Consequently, the Tzu Chi Free Clinic has been receiving an increasing number of patients.

Broadening services

The clinic provides dental services such as teeth cleaning, fillings and extractions, and it even makes dentures for patients. Tailor-made dentures are costly. A person with no insurance has to pay US$200 for one false tooth. Moreover, since a missing tooth is not an urgent illness, most charity medical associations have no room in their budgets for dentures.

Ho Pei-chen said other organizations that offer denture services would only make partial dentures, and patients had to wait for half a year to receive them. But Tzu Chi makes full dentures for patients whose missing teeth severely impair their appearance or otherwise affect their health.

Every Tuesday afternoon the clinic holds dental screenings for patients in order to plan subsequent schedules for doctors and follow-up treatments. Mr. Wilson, a black person wearing a pair of thick eyeglasses, was waiting for the dentist. He told me he lost his job after he was sent to an alcoholic rehabilitation center. Consequently he became homeless and life went wrong.

His slowly moving lips revealed that all of his upper teeth and some lower teeth were missing. A homeless shelter referred him to the Tzu Chi clinic. He hoped that after the dentures improved his appearance, he could find a job and rejoin society.

The clinic provides herbal medicine, Western medicine and dentistry five days a week. It also regularly extends services to remote poor regions by holding mobile free clinics to raise public awareness of preventive medical care and to provide medical services to Tzu Chi care recipients. When disasters strike, the clinic mobilizes its members to participate in cross-border mobile free clinics. In the past nine years, this clinic, with over 400 volunteer doctors, nurses, pharmacists, assistants, and general volunteers, has served nearly 100,000 patients.

Once when volunteers were conducting a medical outreach at a city on the Mexican border, the temperature was as high as 110 degrees Fahrenheit (43 degrees Celsius). Nevertheless, many villagers who had heard of the free dental service walked barefoot for several kilometers to the site and then walked home for another two to three hours. Many of them, without money, cars, green cards, ID documents, insurance or subsidies, hadn't seen a dentist in over a decade. In the United States, a simple dental treatment can easily cost hundreds of dollars, as much as an immigrant's living expenses for one or two months. A root canal treatment costs US$500-800.

Dentist Chen Shun-man, director of the Tzu Chi Free Clinic dentistry program, said that dental equipment is cumbersome. In order to provide dental services on outreaches, the dentists invented and improvised portable dental equipment. Even so, when the air conditioners and lights were switched on, voltage problems frequently occurred. Moreover, the portable equipment needed to be assembled and its maneuverability certainly had flaws.

To cater to the needs of the dental department on medical outreaches, a Tzu Chi clinic van with two dental chairs was designed and inaugurated in 2000. This vehicle greatly extends the services of the Free Clinic. Dental treatments can be provided wherever the van goes.

In the past, Dr. Chen would take assistants from her own clinic to help on medical outreaches. But as the frequency of the medical missions increased, more assistants were needed. Last year, the clinic began training dental assistants. When Yang Wan-hun heard the news, she immediately enrolled in the training program. After 40 hours of professional training, she was among the first group to get a dental assistant certificate. Now whether in the Free Clinic or mobile clinic, she can be spotted working beside the dentists.

Bringing the mobile clinic to schools

The mobile clinic greatly enhances the mobility of the clinic's dental services. Be it Mexico, a three-hour drive from the Tzu Chi Free Clinic, or northern California, six hours away, the mobile clinic has been there. Since this May, the mobile clinic began serving poor primary school students.

On this day, the mobile clinic visited Kittridge Street Elementary School, a one-hour drive from the Free Clinic. As the van approached the school, we saw Mary, the school nurse, wearing a blue T-shirt and a pair of white trousers, standing at the entrance awaiting our arrival. She had mimicked the Tzu Chi blue-sky-and-white-cloud uniform to show her support for our philanthropic spirit.

The first time Mary heard about Tzu Chi, she requested that the mobile clinic come to her school to give children treatments. She did not seriously expect that her wish would be answered. Seeing the dental van slowly entering the campus, tears fell down her cheeks. She later donated US$500.

Froiya, a little girl with her hair braided in two pigtails, was drawing as she waited her turn. Born in Mexico, she came to America with her parents when she was still little. A volunteer took her up to the van when her name was called. Her mother held her younger daughter's hand and silently watched the treatment. American law stipulates that a schoolchild receiving dental treatment must be accompanied by at least one parent.

After a careful check-up, dentist Chen decided to fill Froiya's cavities. When the little girl saw the serious expression on Dr. Chen's face, she knew that things didn't look good and became tense.

As I predicted, Froiya cried during the treatment. Her mother held her little hand tightly and told her in Spanish not to be scared. The cute little face gradually twisted in fear and then she raised both hands gesturing Chen to stop. Eventually she attempted to jump off the dental chair.

Seeing pearl-like tears sliding down her daughter's cheeks, the mother was very worried. Knowing the mother could not speak English, a translator explained to the mother how the little girl's cavities were being treated. Chen caressed Froiya's little belly and gently comforted her. Only then could the treatment continue.

The construction of the dental van was not easy and neither was applying to the government for licensing. Not only must the staff and equipment comply with the regulations of the California Department of Health and labor laws, but maintenance is costly as well. Therefore, few charity organizations are willing to devote much effort to providing dental services.

Likewise, getting permission for the mobile clinic to enter campuses is not easy either. Dentists' qualifications, nurses' training, and volunteer health checkups must all pass the tests, because staff from the Department of Health can survey the mobile clinic any time.

Yang Wan-wan remembered a two-day outreach to Mexico three years ago, before the mobile clinic had come into being. At that time, each dentist brought his or her own portable dental equipment and worked in a crude environment.

After long hours of work and transportation, most dental assistants fell asleep on the way back. In the dimly lit bus, Yang saw three dentists who were still enthusiastically discussing the flaws of this free clinic. The scene was deeply embedded in her mind and became the force that has motivated her to volunteer at the Free Clinic all these years. She feels it is a blessing to be able to help.

Such touching stories and mutual gratitude make the free clinic what it is today.

On the wall of the free clinic is a framed calligraphic work written by Master Cheng Yen for the inauguration of the Free Clinic. It says, "Great mercy even to strangers and great compassion for all." It implies that we must show care and concern even for people that we don't know and we must share compassionately in the unhappiness of others. Abiding by the Master's teaching, the only charity medical organization in the United States formed by a Chinese Buddhist group has been quietly providing services to the needy for nine years.

The Backbone of the Tzu Chi Free Clinic:
Debra Boudreaux

By Lee Wei-huang
Translated by Teresa Chang
Photograph by Yen Lin-chao
　

The Tzu Chi Free Clinic and Kaiser Hospital were getting ready to jointly launch a large-scale medical outreach to an agricultural community in Fresno, California. Debra Boudreaux (Tseng Tzu Hui) rose early in order to drive Ho Pei-jen and Chuang Fen-liao to Kaiser Hospital for a pre-outreach meeting, one of the many meetings she had to attend.

Debra hopes that every single Tzu Chi medical outreach can also inspire hospitals near the free clinics to participate, because there is a limit to what Tzu Chi's resources can do for the underserved. This joint medical outreach launched by Tzu Chi and Kaiser boosted the spirits of both.

The round trip to Kaiser Hospital took roughly six hours on Highway 99. Such a distance was nothing to Debra because she had just driven twelve hours by herself the previous night to a free clinic in Modesto, northern California, and then back to Los Angeles.

The day was hot, with the average temperature over 100 degrees Fahrenheit (39 degrees Celsius). As she drove, Debra seized the time to discuss the crisis management of the medical mission with Ho. In a free clinic conducted a few days before, an epileptic who had walked six kilometers to the clinic site under the glaring sun suddenly fainted and went into a seizure. Debra emphasized the importance of on-the-spot crisis management to protect patients and the clinic itself. In the United States, medical lawsuits arise all the time. Thus, even if one has the heart to do good deeds, one must act with wisdom.

Debra then asked Chuang whether the medicines to be used at the outreach in Tucson, Arizona, were ready or not. Throughout the ride, they discussed the manpower allocation of each outreach, and decided to donate surplus wheelchairs and diapers to the Salvation Army.

Debra has been with the Free Clinic ever since it was established nine years ago. She has persistently sought ways to broaden Tzu Chi's medical services and to bring the Tzu Chi medical mission into mainstream society.

After the 9/11 terrorist attacks, Debra saw the importance of emergency relief skills. Therefore she began inviting Tzu Chi volunteers to enroll in disaster relief classes held by the Red Cross.

Before the birth of the Free Clinic in 1993, Debra had volunteered in local hospitals for many years. With the opening of the Tzu Chi Free Clinic, she unhesitatingly shouldered the planning of volunteer training. Gradually she left her own career to become a full-time volunteer at the clinic. Although she often suffers from joint pain, she devotes a lot of energy and time to the clinic, and she is just as busy as she was when she was a career woman.

Throughout these nine years, almost all affairs of the Free Clinic--public relations, documentation, network building, researching and complying with related government regulations, finding suitable outreach sites, or allocating resources--have been coordinated by Debra. It is true that the establishment and operation of the free clinic depends on the efforts of everyone. But if one were to name the backbone of the free clinic, unmistakably it would be the senior volunteer--Debra Boudreaux.