Tzu Chi's first free medical services started about twenty-four years ago. The clinic was on a street in Hualien City and depended on Tzu Chi volunteers and medical staff from Hualien Hospital and local clinics.

After Tzu Chi Hospital opened its doors in 1986, doctors, nurses and pharmacists from the hospital volunteered to treat the needy once a month at the Abode of Still Thoughts. They continued to do so until the Taiwanese national health plan was established in 1995.

With the expansion of Tzu Chi's international relief work around the globe, Tzu Chi members throughout the world have found that places afflicted by poverty or struck by disaster all lack adequate medical resources.

The Buddhist Tzu Chi Free Clinic in the United States was the first to break tradition and go out into local communities to treat the needy.

Tzu Chi branches in other parts of the world also have medical teams who bring free medical treatment to people in need.

Tzu Chi medical professionals have left their footprints in remote mountain areas in Taiwan, in poor Mexican villages, and even in countries devastated by war. Over time, these volunteers may forget the difficulties they encountered during their work in these places, but the memory of their work will remain in the heart of every patient.

Let's take a look at some of these footprints and enjoy some of the touching stories.

The Tzu Chi US Free Clinic

By Li Hsiao-wen
Translated by Lin Sen-shou

People tend to think that the United States is a rich country and that it has a good social safety net. Actually, in the San Gabriel Valley, where the free clinic is located, seventy-five percent of new immigrants have no medical insurance. Because they have neither income nor transportation and because they face a language barrier, San Gabriel Valley is a forgotten land in the field of medical services.

In order to provide timely, efficient medical services to low-income families, Tzu Chi estabished the free clinic on November 1, 1993, in the city of Alhambra. Besides providing dental and both Chinese and Western medical services, the free clinic also regularly holds bone marrow donation drives and gives disease prevention workshops, cancer examinations, flu shots, etc. Over the past five years, these services have benefited over forty thousand people.

In July 1995, the first "health fair" to provide medical care to low-income families was held in El Monte, California. In December of the same year, a medical team was sent to Pipila, a suburb of Tijuana, Mexico, to help local residents there. The US clinic has also helped in other areas abroad. In Peru, for example, flood victims have received free medical examinations, and medical supplies have been sent to Afghanistan, Senegal and other countries.

A complex process

How do free clinic personnel determine whether a certain place needs medical assistance? When the office receives a report from local Tzu Chi members in a certain area, administrators from the free clinic go to that area to evaluate the situation. They also collect relevant information from the Internet or from the government in order to get a full picture and reach an objective conclusion. Then, the implementation of medical assistance is planned.

"The destitute areas in San Bernardino County and the villages in Mexico where we regularly go to provide medical services are all remote places without good transportation to the outside world and without medical facilities," said Sister Tseng Tzu-hui, head of the clinic volunteer team. "In addition, some illegal immigrants have no medical insurance at all, and some have to rely on meager government pensions. They don't have money for expensive medical bills."

Once a location for free medical services has been decided upon, the people in charge start collecting information regarding the lifestyle of the local residents, the health conditions of the area, the types of diseases encountered there, and the availability of medical resources in the area. After that, they have to decide what sort of medicine and equipment the doctors should prepare. The whole process requires a great deal of time and energy.

"In countries like Mexico and Peru, the weather is very hot," observed Sister Tseng. "Because of poor sanitary conditions and a lack of basic understanding of good personal hygiene, many people have skin and digestive problems. Many children and adults also have bad teeth. It is important that we prepare the appropriate supplies so that we will have enough medicine for the kinds of diseases that patients in a particular area are likely to have."

After that, the free clinic has to apply to the local government or police for a permit to hold free medical services. "In the beginning they tended to push us around, because they saw us as a religious group and didn't understand us," said Sister He Pei-chen, deputy captain of the volunteer team. "But after a few contacts, they knew why we were there, and later it became easier for us to apply for the necessary permits."

Preparing medical equipment, arranging for transportation, setting up on location, and other related tasks… everything is done in a very orderly fashion. Success in this area is the result of constant meetings and communication.

Anything can happen

"Whenever we go into a local community or overseas, there are always unforeseen situations," said Sister Tseng. "Unless you are there yourself, you can't imagine the tension and the complexity of the task." For example, whenever doctors expect to treat Peruvian or Mexican patients, they place both English and Spanish instructions on their tables, and they also ask Spanish-speaking volunteers or medical people to assist them.

Sometimes, if there are not enough translators to go around, doctors ask translators to record instructions on tape. "After I pull out a tooth," dentist Fang Min-chih said, "I simply push the 'play' button and everything after that will be okay."

Dr. Hsu Ming-chang says that since some of his patients are illiterate, he asks his translator to draw pictures on a piece of paper so that they will know what they have to do.

When they go abroad, there are problems with local regulations, customs, transportation of equipment and medicine, and so forth. Sister Tseng remembers that once when they were going to Peru, they bought a lot of medicine from Europe which was shipped to the United States and from there to Peru. They thought they only needed the regular customs documents, but then the customs officers also wanted documentation on production and expiration dates, and information on the possible side effects of these medicines. So they ended up wasting a lot of time.

Still another time when they went to Mexico, customs officials refused to let them enter the country because they were taking in too much medicine!

Brushing flies away

San Bernardino County has 180,000 residents, about half of whom fall into the low-income category. About fifteen percent of these have no money at all. When ill, residents of Mexican heritage who live in the mountains resort to traditional methods to cure themselves.

When first attending the free clinic in San Bernardino, many illegal immigrants tend to use false names because they don't want to reveal their true identities. This creates a lot of problems for clinic personnel. After volunteers allay patients' fears by explaining to them the need for using their real names, the patients finally allow the doctors to see them. When they see the doctors with all that equipment, their eyes are full of expectation.

Many patients are quite fascinated with traditional Chinese medicine, especially acupuncture. They are not afraid of the long, thin needles used in acupuncture. One little girl even raised her arms, both full of needles, to "show off" to her friends.

Among the various medical departments, dentistry is the one the children fear the most. Many children who have their teeth checked for the first time are so nervous that they try to cover their mouths with their hands. The dentists then have to sing, laugh or make faces to calm them down. Eventually, the children relax and allow the doctors to examine their teeth.

While the doctors are busy treating patients, volunteers engage people in group activities and teach them about hygiene. "Because we only come once every two or three months, it's not easy to see results in such a short time," Sister Tseng said. "Also, the patients migrate quite often, and we can't really track them down. Still, these patients can learn something useful from the doctors and volunteers."

Watermelon and tea

Volunteers bring candy and stationery for the children. They also give watermelon or cold drinks in the summer or hot tea in the winter to the patients, so the patients can feel warm inside.

The happiness and gratitude of the recipients inspire the medical staff and volunteers to put their inner feelings into concrete action, perhaps donating medical equipment or generators so that more poor patients can receive better treatment in the future. Some residents also help as volunteers.

"Providing treatment in free medical clinics and seeing patients in my office at home are as different as day and night," remarked ENT specialist Tu Yu-ching. "Once when we were in Peru, we ran out of the emergency packs that we ordinarily gave to our patients. When I saw the disappointment in the eyes of this one patient, I felt so terrible that I gave him the only pen I had in my pocket. This might have been an insignificant act, but it gave him so much joy. It is precisely this giving of joy that motivates me to be a volunteer." Dr. Tu joined the team two years ago and has vowed to be a full-time volunteer in the future.

Airline discounts and government awards

Among the more than thirty free clinics currently operating in Southern California, only the Tzu Chi clinic provides both Chinese and Western medical treatment. The Tzu Chi clinic also has a larger number of doctors and volunteers than the other clinics.

Since its opening five years ago, the Tzu Chi free clinic has received praise and recognition from local residents and government departments. The city of Alhambra was the first to give the Tzu Chi free clinic an award for its good work. In January 1998, the clinic also received the Sterling Award from the San Gabriel Valley Medical Center Foundation. This was the first time this award had ever been presented to an Asian Buddhist organization.

Following the precedent set by the Alhambra clinic, other American Tzu Chi offices have developed free clinics in their localities. For instance, the Tzu Chi New York liaison office has joined forces with Elmhurst Hospital to provide a mobile medical vehicle to give free medical examinations to poor and uninsured elderly. The liaison offices in Texas and Northern California offer free flu injections to children and the elderly. The Hawaiian office, which is also planning to set up a free clinic, already provides some regular free medical services, and has also sent a team to American Samoa to serve some seven hundred patients there.

Currently, the Alhambra free clinic has only limited funding, but there are plans to diversify the services offered. The clinic hopes to eventually have a twenty-four-hour outpatient department, cooperate with other hospitals, offer Pap smears and mammography, serve the increasing number of cancer patients by providing care for the terminally ill, and set up a small children's rehabilitation center.

In April 1998, the Tzu Chi International Medical Missions Association planning committee held its first meeting in Hawaii. It also set up a data bank of doctors in Taiwan, the United States, Vietnam and the Philippines, who are willing to contribute their skills for free clinics or international disaster relief missions. Thus, available human resources can be fully utilized, and the experiences gained can be passed on to new members on the medical teams.

Other Free Clinics Abroad

By Li Wei-huang
Translated by Lin Sen-shou

Can there be anything more valuable than spending a few hours to relieve a patient from years of suffering or even change his life? Inspired by the free clinics in the Philippines, Tzu Chi members in countries such as Brazil, Indonesia, Vietnam and Malaysia started to express their love for the people in their localities by reaching out through medical service. Once people have a chance to recover their health, they can find jobs and improve their lives. In the clinics, patient after patient comes filled with hope for a new life.

Overcome with joy, an old woman from the mountains kept embracing and kissing the doctor. "I never realized that my husband did not need to be blind for the rest of his life."

Medical consultations, surgery and injections are free in Philippine public hospitals, but patients do have to pay for their medicine, which imposes a tremendous hardship on the poor. Since 1995, Tzu Chi members in the Philippines have been dispensing free medicine to local residents. They have also been going into the mountains and to remote islands to hold free clinics.

In Brazil, which is called the "immigrants' paradise," the difference between medical care in the cities and in the villages reflects the gap between rich and poor. People can see doctors free of charge, but they can't afford the expensive medicine. They also need to wait for days to see a doctor. If they need to have an electrocardiogram, they may have to wait as long as three months before they can get one.

In March 1995, Tzu Chi members in Brazil held a free clinic in a school that they had long been supporting financially. In March of the following year, they also arranged for a medical team to provide free medical examinations once every month.

In Indonesia, tuberculosis is considered a disease of the rich. However, many poor people also have TB. Because they can't afford to pay for the medicine, they may simply keep coughing up blood until they die.

Working with the Serang County bureau of public health, local Tzu Chi members became aware that there was not enough money in the government budget to provide medical services to the poor. Therefore, in March 1997, Tzu Chi members joined the bureau's medical staff to hold free medical clinics in various villages in the county.

In Vietnam, one seventy-year-old man came with a Band-Aid covering a large hole below his left eye. There was also a girl whose left eye and four limbs were covered with tumors. Her lips were cracked and she didn't have much hair. Her condition was due to aftereffects of the Vietnam War.

Vietnam does not have any national health plan, and with an average income of about US$50, a sick person can only wait for a disease to take his life. In January 1998, Tzu Chi members in that country extended their work to include assisting local people with medical services.

If it is something simple like the flu, villagers follow grandma's advice and gather herbs from the mountains. If the illness is more serious, villagers will carry the sick person to the nearest road to be transported by car from there. But what if something goes wrong on the way? One villager said somberly, "It's a matter of luck."

Months of drought reduced the public income from taxes, forcing Sabah State in Malaysia to cut back on its medical budget. Therefore, in July 1998, the government invited local Tzu Chi members to provide free medical services to residents in inland areas. It was the largest free medical mission Malaysia had ever seen.

Lack of money and long distances are the two major hurdles that villagers in mountains and remote areas face when they need to see a doctor. Even if a free clinic is held in their area, some patients still have to borrow money and travel for two or three hours to the site. Others travel over forty miles through the night so that they can arrive early to register. About thirty patients from Camiguin in the Philippines saved every penny they could in order to make a four-hour journey by boat and bus to a free clinic.

An elementary school teacher in Candemulyo village in Tempak, Indonesia, said, "One of my students contracted an ear disease when he was five years old. Now he is in fifth grade but he has never seen a doctor."

A ninety-year-old man living in the mountains said, "This is the first time I have ever seen a doctor." Someone else exclaimed, "I can hardly believe how wonderful this is!"

What makes doctors who first had to be begged to volunteer for a medical mission feel that free clinics are their obligation?

To treat an illness you need a doctor. But when you hold a free clinic, you need much more: you need medical staff who have love and patience.

Dr. Lu Hsiu-chuan, associate director of Chung Jen Hospital in the Philippines and a supporter of the Tzu Chi Philippine free clinics, said, "When Tzu Chi first started providing free medical services, it was not easy to find doctors who were willing to participate. We all had to beg doctors to join us. But after a few times, the whole way we went about holding the clinics attracted many doctors and they are now quite willing to volunteer for us. It proves the high quality of our free clinics."

Some medical professionals come at the invitation of the local bureau of public health; others come on their own initiative. Most of them join because the free medical clinics have created a kind of "competition to do good." During the first free clinic held in Vietnam, team members who had jokingly called themselves "a motley crew" became a tightly knit group, held together by the common bond of wanting to show "great kindness to strangers and great compassion to all."

Doctors often have to travel over ten hours to reach the clinic site. Once they get there, they cannot simply put on their white coats, pick up their stethoscopes and start examining patients right away. The doctors on the Tzu Chi team in Vietnam do not hesitate to roll up their sleeves and help volunteers to clean up the classrooms. Members of the Philippine medical team know how to magically transform a school's meeting rooms into operating rooms and classrooms into recovery rooms.

So what makes these professionals willing to participate in the free clinics, where their workload is four times greater than in the hospital? Besides understanding the meaning of life as "giving without seeking anything in return," the loving encouragement from Tzu Chi's volunteers may also be one reason.

All the details before and after the free clinics depend on the volunteers.

Naturally, the volunteers are very busy too. Because the free clinics are held in remote areas, volunteers have to identify appropriate sites, find electricity, water and transportation, and arrange everything so that the doctors can concentrate on their work. For instance, when Tzu Chi in Malaysia was preparing to hold a free clinic in the state of Sabah, volunteers went to the location twice and held eight planning meetings before the local government understood and agreed to Tzu Chi's concepts of "directness, priority and respect."

During a clinic, volunteers help patients fill out their registration forms, maintain order, dispense medicine and explain to patients how to use it, clean up any vomit, take care of crying children and promote good hygiene. Since volunteers have to look after all sorts of things, they gain lots and lots of new experiences along the way.

Free clinics work best if they can utilize local resources. The Philippine Chinese Merchants Association, for example, not only can help find an appropriate location for a clinic, but they can also assist in getting the word out to villagers through radio broadcasts. The school that lends the site might assign teachers and students to clean and prepare the place, while the local government can provide transportation for villagers or level bumpy roads with gravel.

"Tzu Chi's free clinics are large operations and the doctors are skillful," said Dr. Lu Wei-ting, who participates in free clinics in the Philippines four or five times a year. "The clinics take a large variety and a sufficient amount of medicine and they have volunteers to complement the work of the doctors. These are things other free clinics cannot easily match."

As far as we know, plans for free clinics in the Philippines and Brazil for 1999 have already been made and Tzu Chi members in Brazil are actively searching for a suitable place to set up a free medical center.

Though greatly affected by the Asian economic crisis, Tzu Chi members in Indonesia still went ahead and cared for fishermen on remote islands in the Indian Ocean last August.