At lunchtime in the social service office, one can hear the happy sounds of the Taiwanese folk song "Tiger Lady." Chun-hsia, Li-chiung, and Hsiu-Eh of the medical patrol team are busy preparing for the next day's patrol, happily rehearsing songs to be performed for children. In addition to medical work, the team also tries to close the distance between the hospital and the community.

At 7:00 the next morning, when most people are still asleep or having their breakfasts, the patrol team is already leaving the hospital. They must drive almost two hours to reach Luntien Community in Chohsi Township by 9:00. In order to use manpower more efficiently, the doctor is also the ambulance driver, the nurse is also pharmacist and hygiene teacher, and the social worker and volunteer do the registration work and lead children's activities. In order to use time more efficiently, everybody eats breakfast on the road and discusses the day's program and how to carry out the activities.

When they arrive, a lot of people are already standing in front of the school nurse's office, waiting for the free clinic. Students are sitting in their classrooms, waiting for these "big brothers and sisters" from far away. The patrol team quickly moves medicines and equipment from the ambulance into the temporary nursing station. The social worker and the volunteer clean up the area and register the anxious patients. Since the team already has a lot of experience in teamwork, they don't take very long to set things up. The doctor and nurse start to see the patients while the social worker and volunteer go to another area to lead the students in group activities.

Other Social Problems

Most of the patients in this aborigine community are old people and small children. This means that there is a predominance of chronic, degenerative and contagious diseases. Through translation by the local public health nurse, the older aborigine patients begin to describe their aches and pains. The same illnesses show different treatment results in the hospital and in the local community, due to the effects of lifestyle and environment. In such remote communities, the youngadults have mostly gone to the city for work. The older people not only have no one th take care of them, but they must also take care of the small children. Although the medical patrol team comes every week, there is still a high rate of high blood pressure and blood sugar, and sore backs and other aches and pains continue. Other than giving them suitable prescriptions and hygiene education, the medical team can do nothing about their living situation but offer them sympathy.

A group of small children plays happily at one side. A young mother carrying a feverish child waits for the doctor, chewing betel nut and talking with other mothers. The child has had a high fever for days and pus runs from one ear. Although he has already gotten many shots at other clinics, his condition has not improved. The result of the doctor's examination is that the child must go to the hospital immediately, or else his hearing will be damaged. The medical personnel suggest that the mother and child ride the ambulance back to the hospital. The social worker promises to help with the finances. However, the young mother unenthusiastically replies, "Who will take care of my other ten children?"

The free clinic is finally finished. Now the patrol team must go visit the homes of patients who cannot move. An old woman lives in a wooden hut at the edge of the community. She has a 40-year-old, mentally retarded son. The team, together with the local public health nurse, finally finds the old woman halfway up the mountain. She receives long-term care from Tzu Chi. The team had visited her over a year earlier. At that time, she sat on the ground by herself, surrounded by clothes donated by good people. Now, a year later, the old lady is still sitting there on the ground. The only difference is that there are even more clothes. Because she hasn't been able to move in a long time, her muscles have atrophied and her stomach and intestine functions have regressed. The team can only prescribe some medicine for her and ask the local public health nurse to take better care of her.

Teaching Hygiene to the Young

Elsewhere, schoolchildren sing "Tiger Lady" and become more familiar with the social worker and the volunteer. Then the children draw pictures of their community and their own homes. Under the direction of the team members, the children finish their picture of the community on a large sheet of paper. In their pictures of "My House," betel nuts, liquor bottles and cigarettes have been drawn in detail. From the pictures, the team members notice which families have factors that could affect the health of their members. Despite gaps in language, time and spaced, the medical team can grasp a part of the health situation in the community.

Afterwards, the nurse and the volunteer use demonstrations and skits to bring the students to another kind of learning environment. Through this interaction, the children learn about health and first aid. They also learn how to use this knowledge to take care of their community. When the activity is almost finished, the nurse and volunteer give them the week's homework assignment. At the beginning of next week's activity, the kids must report on all the things that happen in the community this week that have to do with health, such as who gets sick, who has a new baby, etc. Although the team members live in Hualien City, over a hundred kilometers away, they still clearly grasp the health conditions in the community.

Don't Count the Cost, Just Give

The above is a typical example of the work of the medical patrol team. I remember seven years ago, when I came from Taipei to Hualien, I didn't know much about Tzu Chi. I only came because of my enthusiasm to serve the communities in Eastern Taiwan. In high school, I admired Albert Schweitzer. In university, my service experiences in aborigine communities during summer and winter vacations naturally made me choose to serve in Hualien. In the last seven years, I've driven the patrol ambulance to all the aborigine tribes of Hualien. I often joke that if I don't want to be a doctor anymore, I can always be a tour guide.

There is a completely different work style between the bedside medical work in the hospital and medical service in the community. The authority that doctors have in the hospital can be a hindrance when working in the communities. In the hospital, patients treated by the medical staff usually make obvious progress, so the medical personnel can get a direct feeling of accomplishment. However, community workers must devote themselves wholeheartedly and must work as a team. Their goal is to take care of health and prevent disease, so the feedback is often unclear.

The spirit of community medical work is in participation, not in looking for immediate results. Since many medical personnel cannot get the feeling of satisfaction from community medical work that they do from hospital work, they prefer to stay at the hospital. On the first page of his work Community Health, American health education expert Lawrence Green wrote the following lines:

Coming together is a beginning,
Staying together is progress,
Working together is success,
Laughing together makes it all worthwhile.

It can be said that this is the best description of the spirit of community work.

Looking Forward to a Brighter Tomorrow

Medical work is the most direct way to enter a community. A free clinic provides the most welcome service in a community that has no other medical facilities. Therefore, the Tzu Chi Hospital medical patrol team provides the help that is most critically needed by the community. Other than answering the current needs, our greatest goal is to help the community be self-sufficient so that they can look after themselves. In remote aborigine communities, most families have alternate generations of old people and small children. We focus on the schoolchildren, training them to look after the community and to regularly report to us. Our colleagues laugh that this is a "Red Guard training program." Our goal is to let the people in the community have a feeling of participation. Making health concepts take root is a way to completely resolve the health problems of the community.

When beginn ing to carry out a community care plan , Tzu Chi Hospital first makes detailed observations and plans for the community, and then proposes the work content and schedule. They visit community and church leaders in order to get their support. They also seek cooperation by the local public health nurse and school so that the activity can be carried on smoothly. We clearly know that a free clinic can only provide a partial and temporary solution to the medical problems. The health problems of the old woman described above cannot be resolved simply by giving her medicine. The young mother of the feverish child reveals the importance of family planning and social care. Mixing health education concepts in lively songs, games and skits raises schoolchildren's interest and willingness to participate. We hope that by training the children, they will be able to shoulder some of the responsibility of taking care of the community. Combining the social service of Tzu Chi Hospital with the efforts of local nurses, teachers, students and churches can make tribal community work more effective.

Happiness Is Community Medical Service