By scrimping and sacrificing for a month, more than thirty residents from the island of Camiguin accumulated 150 pesos for transportation fees.

They took a boat from the island the day before, and then rode buses for a total of four hours before finally arriving at the Tzu Chi free clinic.

For these poor islanders, for whom basic subsistence is already a problem, seeking medical treatment at a hospital is an unaffordable luxury.

The ninth Tzu Chi free clinic visited Cagayan de Oro City, Philippines, from July 24 to 26, 1997. Each day before dawn, groups of sick residents and their families queued up in orderly fashion between wooden stake markers outside the walls of the Kwang Hwa Middle School. As the sun rose, tropical heat and humidity shrouded the people, drenching them in perspiration, but not dampening their single-minded determination to seek medical help and to obtain medical supplies.

As I walked towards the entrance of the free clinic, dressed in my Tzu Chi uniform, a young girl in her twenties rushed up to me. She asked if I had a ticket. This same question was encountered many times by all the members of the medical team. To all those who were impatient for their turns and who hoped to receive special preference, I gently replied that I didn't have a ticket, and if they wished to seek medical assistance, they should wait their turn in the queue.

Perhaps too many people were waiting and the girl had stood in line for a long time, for she anxiously asked me why I was allowed to enter the station. I pushed the iron gates open and entered silently, unable to give her a reply. In my heart, however, I deeply appreciated why these people would start lining up under the stars in the wee hours of the morning to seek medical attention.

Free Medical Consultation

After gaining independence from the United States in 1946, the Philippines continued to use the American system of public health care. Patients are required to foot the bills for medication and doctors' consultation fees. Government hospitals do provide free medical treatment, but patients are still required to pay for medicine, surgery, X-rays and other miscellaneous expenses.

However, this is an environment where the unemployment rate is 11.8%, the average annual income is US$1,200, and about 40.6% of the population struggle below the poverty line. For example, in Misamis Oriental, the majority of the residents eke out a living from fishing and agriculture. Their average annual income is between 20,000 and 50,000 pesos (US$1=30 pesos). Their daily subsistence is already extremely difficult, and should there be a sudden illness or accident, they simply cannot afford the additional expenses.

Hu Tzu-eng, a representative of Cagayan de Oro City, said there is a wide gap between the rich and the poor. About 85% of the city's 500,000 residents live in poverty. Although two public hospitals provide eighty districts with free medical services, people still have to pay for their own medicine, which is often in short supply. If they cannot afford to pay, they just do without it. Hu observed that this explains why there is such a need for the Tzu Chi free clinic.

No Available Treatment

Conrado Booc was a five-year-old boy who suffered a discoloration in his eyes, lips and fingers. His mother made a living from selling fish while his father was unemployed. They had no money to seek medical treatment for their son. When he was brought to the free clinic, his whole body had almost totally turned pale. He was immediately transferred to a local hospital for further treatment.

According to Sister Tzu Chien, head of the local Tzu Chi liaison office, the free clinics receive many patients who require further medical treatment and who have to be transferred to hospitals. Most of them come from remote mountain regions or distant villages, and it takes them two or three hours to get to the free clinic for treatment. Yet they are often fearful about being transferred to Manila for further treatment. Sister Tzu Chien sighed that they sometimes ask patients to call them to keep in touch, but some villagers have never even seen a telephone, let alone know how to use one.

Sister Segunda Aocdeio, a teacher at Kwang Hwa Middle School, has worked for thirteen years in the villages of western Visayas in Iloilo-hapi. She observed that during the monsoons, many of these villagers could only manage one meal a day, mainly bananas and sweet potatoes.

A dentist took an hour to extract the teeth of a patient. I was shocked by the extent of the tooth decay. Helen E. Daing, another Kwang Hwa School teacher who was assisting in the dental health unit, explained that the poor villagers cannot afford to buy toothbrushes or toothpaste. They often use guava twigs for toothbrushes and coarse salt for toothpaste. In their remote mountain villages, even salt is often unavailable. The lack of salt causes many people to suffer from thyroid inflammations.

Dentist Joselito Pascua added that the cost of dental treatment was far too high for the average villager. Furthermore, their knowledge of dental health was extremely inadequate. This underscores the importance of the Tzu Chi free clinic's on-the-spot dental health education for the villagers.

When Helen returned home after the first day of the free clinic, she was unable to sleep till 1 a.m. She kept thinking about the patients and about Tzu Chi until tears rolled down her face. "The patients have been extremely fortunate, and I am eternally grateful to Tzu Chi."

Collective Efforts

In planning for the clinic, Sister Tzu Chien, head of the local Tzu Chi liaison office, Lee Wei-sung, medical coordinator, Chai Wan-lei, volunteer team leader, and Dr Ker Sian-chi, a physician from the Chinese General Hospital in Manila, commuted to the site no less than ten times to ascertain the suitability of the location, organise work teams and ensure appropriate medical backup arrangements. The search for an appropriate location involved much hard work and was extremely time-consuming.

In the beginning, when the field task force identified the Kwang Hwa Middle School as a suitable venue, the Philippine Chinese Chamber of Commerce expressed apprehensions that the fact that it was a Roman Catholic school could pose problems. The Tzu Chi representatives, however, quickly made it clear that the cause of charity transcends religious differences.

Sister Yuen Shue-chen, principal of the Kwang Hwa School, explained that she was away when the Tzu Chi representatives first visited the school. On learning that Tzu Chi was planning to hold a free clinic for the poor at the school, the other nuns wanted to give their immediate consent for the use of the facilities. However, they decided to wait for Sister Yuen to return, unsure if she would actually agree to the plan. When she finally gave her permission, the elated sisters shouted for joy.

Sister Tzu Chien observed that in the past, the maximum number of patients treated was about 1,000. At this clinic, they treated more than 1,600 patients on the first day! The busiest day at the dispensary would normally be the first day, and just the preparatory work alone would have taken half a day. However, because the number of patients had almost doubled, the situation became unmanageable and extra help had to be called for.

Sister Tzu Chien deftly planned and managed the allocation of personnel to various units according to the demands of the work at various times throughout the day. In response to compliments on her ability, she humbly said that through years of involvement in free clinics, they had been able to learn from experience and continually improve themselves. Dr Wang Yin-wei, director of the family health department of Tzu Chi Hospital, who had been involved in many previous free clinic missions, said that about a fortnight before, volunteers had had to transport about180 cases of medical supplies to Cagayan de Oro. He commented that for the medical team to be able to commence their work immediately, the preparatory work of the support team was vital. Without it, the best and most able doctors would not have been able to function effectively.

Recognising the hard work and efforts of the support team, Sister Tzu Chien said that what touched her most was that all the members of the Tzu Chi Philippines liaison office had uncomplainingly, wholeheartedly and willingly sacrificed their time and efforts to the cause. She said the new Tzu Chi Philippines branch office, which would be officially established in August, would provide a central point for the coordination of Tzu Chi medical services and supplies and facilitate the organisation of free clinics in the future.

Realisation of Our Goals

During this mission, we treated a record total of 5,033 patients. Despite setting new records, Sister Tzu Chien said that if they had not made these sacrifices, they would never have known that so many people needed their help. "Up till now, we still feel that our efforts are inadequate. My only wish is to be able to do more and to do even better."

Ting Min Piow, chairman of the Philippine Chinese Chamber of Commerce, assisted greatly in the free clinic. During the three days of the clinic, he discovered that there were still so many poor people in his own country. Seeing those who had come too late to seek medical treatment, his eyebrows furrowed as he said, "My heart aches for them!"

As Chairman Ting bade farewell to the Tzu Chi team at the airport, he raised the same question asked so often by the locals at the end of every Tzu Chi free clinic: "When will you return?"

Regrettably, no one had an answer. There are 7,107 islands in the Philippines. How many people are living in remote regions without medical aid? How many more need medical attention but are unable to afford it?

Procopio's Predicament

By Weng Yu-ming
Translated by Low Siew Kiang, Singapore

Procopio A Galgo was one of those farmers who could not afford to pay for his medical bills. He had worked in a hotel for eleven years. If workers made any small mistake or felt ill, the manager would often use that as a pretext to direct them to halt their work. For workers receiving only daily wages, this meant no income. Driven by the difficulty of trying to eke out a living, the workers organised a strike in the hope of communicating a message to the hotel management. Unfortunately, this only led to their dismissal from their jobs.

Procopio sadly recounted that that was how he lost his job. After that, he wanted to work as a construction labourer since the wages were higher, but the site supervisor said that at the age of fifty-three, he was too old for the job. He subsequently tried to apply for many other jobs, but without success. Finally, he rented a piece of land to plant some crops. However, due to ill health, backaches and liver problems, the two crop harvests each year could barely sustain him and his wife. At times, he had to borrow money from his two married daughters to supplement his income.

Having been unemployed for four or five years, Procopio recently applied for financial assistance from a non-government agency. As a precondition, he had to undergo an X-ray and a medical examination, all at his own expense. This cost him six hundred pesos and he had to wait two weeks for approval. The reply would normally have taken a couple of months, but he was acquainted with someone in the agency. Procopio was quite upset by the inefficiency of government administration, but could do nothing about it.

Beginning from this month, Procopio can receive one thousand pesos per month for living expenses, but this payment is only available for eight months. Procopio says that he still needs to find a job.

Two or three years ago, he used the severance payment of 29,000 pesos he had received from the hotel, along with some 6,000 pesos from his daughter, to build a house. The landlord recently claimed that the residents do not own the land and that their houses would have to be demolished by 23 June.

Procopio remains puzzled: "Why didn't they inform us before we built the houses?" Eventually, with the help of the government, the forty families who had built their homes on the piece of land were temporarily relocated to a school in the west city district. Recently, as a result of a petition by the school teachers and students, all residents were notified to vacate the premises in two months. It has been learnt that the government has plans to buy a piece of land about seven kilometres away for the construction of public housing, which they could move into in the future. Procopio lamented that he did not understand why these unfortunate events should befall him.

Having heard that the Tzu Chi free clinic in Cagayan de Oro City was distributing free medicine, he made sure to come early to join the queue. At noon, after receiving treatment from the Tzu Chi free clinic and whilst waiting to receive his medication, Procopio browsed curiously through Tzu Chi brochures. He was, however, most pleased with the medical supplies he received from the clinic and the fact that for the next couple of months he will not have to worry about his medical expenses.

A Meaningful Trip

By Joyce Low, Singapore

"Thank you, Tzu Chi Medical Team" was a thanksgiving song performed by primary one students of the Kong Hua School at Cagayan de Oro, Philippines, where I spent my one-week annual leave. My heart was deeply touched by the sweet little girl who sang the song. She was accompanied by smart little boys and girls dancing on the stage and five young students holding posters with both the English and Chinese words of the song. This amazing thanksgiving performance was orchestrated by Sister Teresa Yen, principal of the Kong Hua School, for the 155-member Tzu Chi team, which included thirty-five medical doctors and ten nurses, twenty-two volunteers from the Tzu Chi head office in Taiwan, and volunteers from the Tzu Chi office in Manila. I was the only Singaporean. The school auditorium was used as a clinic, three classrooms were turned into surgical rooms and an operating theatre, and the canteen served as a pharmacy.

In this free medical service mission, I believe I met the most devoted, compassionate doctors that I have ever seen in my life. The Tzu Chi surgeons from Manila schedule five days every three months to provide free surgical services to the needy in areas identified jointly with the Tzu Chi liaison office in Manila. They do an excellent job of planning and operating, as well as counseling the patients. They also believe in giving the needy the best services and the best medicines. Although I was not a medical professional, I was proud to be part of the mission team. Daily, from 8 a.m. to 8 p.m., I was among the twenty volunteers working in the pharmacy division, which took care of packing, checking and issuing prescribed medicines to patients. At night, I slept at 12.30. Before 6.30 in the morning, I helped our Tzu Chi reporters from the Taipei office to translate (from English to Chinese) their various interviews at the Philippines Health Department, hospitals and a foreign medical mission. During lunch breaks, I loved to go to the surgical division to observe operations. In many hospitals, this may be the most awful area to be in. However during this mission, the surgical rooms (actually classrooms) were filled with the most positive energy. Doctors, surgeons and patients (including children) were filled with gratitude and calmness, which was very unusual in any surgical room or operating theater. I did not hear any screaming or crying,even though many patients were young children.