THE TZU CHI MEDICAL RELIEF TEAM went straight from the airport to the RS Senopati Hospital near Yogyakarta, and they wasted no time once they arrived there. They worked with local Tzu Chi volunteers and hospital staff to set up an operating room. All pitched in to scrub the room, sterilize surgical instruments, and put in an air conditioning unit. Within an hour, the room was ready.

It was an old and sparsely equipped hospital. Many surgical instruments had to be sterilized in boiling water. Occasionally, the operating room would experience disruptions from such things as power outages and breakdowns of the air conditioner. Despite all the difficulties, the Tzu Chi medical team plowed ahead and finished one operation after another.

Traveling across town to the RS Jogyakarta Hospital, the Tzu Chi team walked into an operating room that was literally bare. The only visible equipment surrounded by the room's four walls was a surgical lamp--nothing else. Even the air conditioner was added only after the team had arrived. Luckily, the Tzu Chi Indonesia branch operated a free clinic in Jakarta. Local Tzu Chi members transported from the free clinic to the hospital in Yogyakarta--400 kilometers (250 mi) away--some of the much needed items: an operating table, an anesthesia machine, operating gowns, vacuum pumps, and medicine. A bare room was hence transformed into an orthopedic operating room, albeit one whose functioning was a little rudimentary.

A general shortage of everything was evident everywhere in the hospital. To read x-ray films, some physicians taped x-ray films on windows, and others simply held up x-rays against some background light. There was no footrest to hold up a patient's leg during an operation, so a physician held it up by hand. The hospital also lacked many surgical instruments, so the team instead bought the garden-variety versions of those instruments from regular hardware stores. Drills, pliers, and stainless pins were good examples of such substitution. Of course, those stand-ins were thoroughly sterilized before they were used on patients.

Back in Taiwan, each person who works in an operating room has a dedicated brush for cleaning and washing his hands. All instruments are cleaned and sterilized by a dedicated team of hospital staff members. Many other items are one-use only. Such ideal conditions for an operating room did not exist here at the disaster site in Indonesia. In fact, there was only one brush for the entire operating room and it was reserved for cleaning instruments. Therefore, the Tzu Chi team had to cleanse their hands by rubbing repeatedly and thoroughly in order to minimize the chances of infecting patients.

Xu Shu-hua (徐淑華), a surgical nurse at Hualien Tzu Chi Medical Center, used that sole brush to clean instruments that had been used in a prior operation. "It's really hard to clean the joint of this pair of scissors," she said. She carefully cleaned each instrument in turn. But she frowned and paused when she picked up a transparent plastic tube from a vacuum pump that was blood-stained on the inside. She was not sure how to remove the stains with a mere brush.

Suddenly, a strong odor pervaded the operating room. Anesthesia had relaxed all the muscles of the patient on the operating table. This resulted in the evacuation of his bowels, and hence the stench. "In Taiwan, all patients must fast before an operation, and they are artificially induced, for example with an enema, to empty their bowels the night before the scheduled surgery," said Wang Si-hui (王思惠), an anesthesia nurse on the Tzu Chi team. Since this kind of pre-op preparation was out of the question here after the disaster, the team just cleaned up the mess and moved on with the surgery.

The handbook for Tzu Chi medical delegation members contained an appendix on frequently used medical terms in the Indonesian language. With that, some body language, and the help of a volunteer interpreter when needed, Dr. Li Ji-yuan (李繼源), an anesthesiologist at the Taipei Tzu Chi Hospital, communicated directly with his patients in order to understand their reaction to the anesthetics that he administered.

"I said to a child patient, 'Tamgan ke atas--Raise your arms,' but the child did nothing," Dr. Li remembered. "So I raised both of my arms, and the little boy smiled and followed suit. I pointed at his wound and asked, 'Sakit? Sakit?--Does it hurt?' and he nodded. He even pointed at the exact location where it hurt. Sincere signs are the best way to melt away any communication obstacles.

Dr. Lin Kun-hui (林坤輝), an orthopedist at the Taipei Tzu Chi Hospital, cared for a woman with a broken spine. Due to the lack of necessary equipment, Dr. Lin could only fix the fractures in her limbs, but not her spine. Her prognosis was bleak: gradual paralysis of the lower body. It is heartbreaking just to imagine how dismal her future might be.

This trip gave Dr. Lin a chance to appreciate what he has in Taiwan. He vowed to take full advantage of Taiwan's advanced medical equipment and facilities to help more patients regain their quality of life in the future.