Tzu Chi, Taiwan’s largest Buddhist charity, provides medical care and other social services to better the wellbeing of the underprivileged at home and abroad.
One day in 1966, Dharma Master Cheng Yen went to a hospital in Hualien, eastern Taiwan to visit a friend. There she happened to see a pool of blood on the floor and was told that it was that of an aboriginal woman who had suffered a miscarriage, but was refused medical care as she was unable to pay a deposit for her treatment. Deeply saddened by that woman’s plight and sensing the importance of financial support in times of critical need, Cheng Yen thus established the Buddhist Compassion Relief Tzu Chi Foundation to help the poor.
Subsequently, Cheng Yen mobilized local doctors and nurses to provide the needy in Hualien and Taitung with free medical services. In 1972, she set up a clinic to offer free healthcare. Through these undertakings, she came to realize that sickness caused poverty and poverty caused sickness; both linked in a vicious cycle. She also learned that minor ailments often turned deadly because of delays in treatment, a situation that was particularly acute in some areas of the east coast of Taiwan, where medical resources were lacking at the time due to the area’s difficult transportation.
In 1979, Cheng Yen decided to build a hospital to improve access to medical care, especially for eastern Taiwan’s poor, and to upgrade the quality of healthcare in the region. After overcoming numerous difficulties related to acquiring land, raising funds and recruiting medical personnel, the first Buddhist Tzu Chi General Hospital was set up in Hualien City and began operating in 1986.
Over the last four decades, Tzu Chi has dedicated itself to the four major missions of charity, medicine, education and humanistic culture. The focus of these missions is offering material, psychological and educational assistance to those in need, in addition to protecting the environment and providing international disaster relief.
The organization also works to promote volunteerism to facilitate various social services as well as inspire compassion and benevolence in both aid donors and recipients. By actively working to improve society rather than only seeking personal, religious enlightenment, Tzu Chi members strive to practice “socially engaged Buddhism.”
Lin Chin-lon, chief executive officer (CEO) of the Medical Mission at the Tzu Chi Foundation, says pain from illness is the most intolerable of the various sufferings in life. A Tzu Chi principle, he adds, is that illness is the root of pain as well as of poverty, which is why the organization makes it part of its mission to offer quality medical care.
Lin notes that Tzu Chi’s health-care providers are guided by four Buddhist principles: kindness, compassion, joy and unselfish giving. “If doctors have a bodhisattva’s heart, giving compassion and love to all, they’ll strive to enhance their professional skills so as to take better care of patients and alleviate their pain,” he says.
“Medical care comes down to two aspects,” Lin says. “One is professional know-how concerning disease diagnosis and treatment. The other is the attitude towards treating patients. As for medical science, Tzu Chi may not be very different from other medical institutes, but its persistent pursuit of humanistic medicine—emphasizing patient-centered care, respecting life and establishing an emotional connection between physicians and their patients—is one of its distinguishing features.”
Holistic Healing
The philosophy of humanistic medicine, Lin further explains, is to provide holistic healing not only for a patient’s body, but also mind and soul via the application of multidisciplinary methods of diagnosis and treatment. Humanistic care seeks to facilitate recovery by connecting with patients through empathy, patience and compassion.
Tzu Chi provides free dental services as part of an event organized by the U.S.-based Remote Area Medical Volunteer Corps in in August 2009. (Courtesy of Tzu Chi Foundation)
Nowadays, however, to stay abreast of rapid technological advancements in the healthcare field, medical institutes must make hefty investments in facilities and thus largely are forced to give top priority to operational efficiency instead of patients’ needs, Lin says. That is why there are many complaints heard about hospitals in Taiwan such as asking patients to make repeated visits for various tests, as well as to learn of their test results.
To rectify this situation, Tzu Chi General Hospital endeavors to make the most convenient arrangements for patients possible, for instance by enabling them to get blood tests, X-rays, scans and electrocardiograms in the same morning and delivering their test results shortly thereafter. This kind of service, Lin adds, is especially desired by indigenous people living in the mountain villages of eastern Taiwan, as transportation difficulties make repeated visits onerous. Another example of working to fit patients’ needs is the effort spearheaded by the hospital’s branch located in Yuli Township, Hualien County to offer early-morning clinical services between 6 a.m. and 8 a.m., given that there are many farmers in the area that need to work their fields later in the morning.
In addition, Lin says for those who have limited mobility or are too ill to make a trip to the organization’s hospitals, Tzu Chi can send medical staff to patients’ homes. While making home visits, the doctors not only diagnose illness and prescribe medicine, but will even help clean up a patient’s living environment if need be.
Wu Yao-kuang, a doctor at the Division of Pulmonary Medicine at Tzu Chi General Hospital, Taipei Branch, says the thing that impressed him the most when he started working at Tzu Chi three years ago was the organization’s emphasis on humanistic medicine rather than cost efficiency, which was the highest priority for his former hospital and many others.
Treating Patients Well
Wu says that in fact he does not believe in any particular religion, but approves of and follows Master Cheng Yen’s ideals, including her philosophy of medicine, which focuses on how to treat a patient well and be a compassionate doctor instead of one who seeks fame. The overall culture of the hospital, as well as the many devoted volunteers there, he says, motivate him to do his best to take care of patients.
Wu traveled with other Tzu Chi medical staff to Sichuan province, mainland China, to attend to victims of the deadly earthquake that struck the region on May 12, 2008. He admits he did not join the team voluntarily and expected he might have a few complaints after returning from the eight-day medical mission. However, after witnessing so many people volunteering their time and money to contribute to the relief work, he says he was very touched and felt grateful to have had the chance to help others.
The experience of providing volunteer medical services both at home and abroad, Wu adds, has led him to give more serious thought to his profession and the quality of patient care he provides. “Doctor-patient relationships can often be tense and full of mistrust,” he says. “But at Tzu Chi, we are working to develop caring relationships with patients and assure that they receive adequate physical, emotional and spiritual care based on assessments of their individual needs.”
Wang Ying-kuan, director of the Nursing Department at Tzu Chi General Hospital, Taipei Branch, started working for the organization’s Hualien headquarters in 1987. “Initially, it was a two-year work contract, but I stayed on and now I’ve been working for Tzu Chi for some 20 years,” she says. “Nursing is a service job and should be offered anywhere there is a need.”
Wang says she is not a religious person, though the rest of her family members are Buddhists. Master Cheng Yen’s words of wisdom, however, have inspired her a lot. She has learned to forge good relationships with patients and people in general, which, she says, help her to create good karma and become a stabilizing, harmonious force in society. “I’ve long sought to practice what Master Cheng Yen has taught us in my work and life,” she says. “I’ve found how useful these principles are in guiding me through many difficulties.”
Wang feels that she has benefited in other ways by working at Tzu Chi, saying her personality has changed as she is more tolerant of the different views and behavior of others now and smiles more often. She notes that she has not only learned more medical techniques, but also the philosophy of facing the different stages of life—birth, aging, illness and death—with an “ordinary,” serene mind.
On another front, Tzu Chi CEO Lin notes that volunteers are perhaps the most significant characteristic of Tzu Chi General Hospital. When Tzu Chi started serving patients in its Hualien facility, it initiated a volunteer system at the same time. “For medical staff, volunteers are their best partners, while for patients and their family, volunteers are reliable supporters,” he says. “It’s thanks to the active participation of volunteers and their enthusiasm that our hospitals can manage to offer proper care to our patients.”
For instance, around 200 volunteers currently work in Tzu Chi Hospital’s Hualien headquarters on a daily basis. The volunteers are asked to take training for a half year in basic nursing and psychology before starting and receive ongoing training during their service period.
Moreover, Tzu Chi operates community support programs to promote healthcare on a wider scale. Community care team members include doctors, nurses, pharmacists, dieticians, social workers and volunteers. Team members provide checkups, consultations, information services and disease screening in local activity centers or schools, as well as make home visits to elderly citizens living alone to check on their condition. They also offer nursing services to chronically ill patients just discharged from the hospital and give instruction in patient care techniques to their family members.
Tseng Mei-yu, a 55-year-old volunteer, has been serving at Tzu Chi General Hospital’s Taipei Branch since 1992. She applied for early retirement last year from her nursing job at Tri-Service General Hospital in Taipei in order to become a full-time volunteer. Apart from engaging in several community services, she has joined Tzu Chi’s medical missions to mainland China, Indonesia and Thailand to deliver volunteer medical services.
New Attitude
“After working as a hospital nurse for some 30 years, I was burned out at my job. I felt depressed and impatient when seeing many patients awaiting service and I became insensitive to their conditions,” Tseng recalls. “But after making contact with Tzu Chi and learning from Master Cheng Yen’s teachings, I changed my mindset and consequently my attitude toward service. I realized that those who came for medical services felt unwell. I didn’t want to ‘hurt’ them again with my apathy.”
Wang Ying-kuan, a nursing director at , Taipei Branch, attends to a patient. Wang says she has found the teachings of Tzu Chi’s Master Cheng Yen useful in guiding her through many difficulties. (Photo by Huang Chung-hsin)
Since then, Tseng says she has been able to be thoughtful of patients and consider their needs from their own viewpoint. Now she feels that the more charity work she does, the happier she becomes. “In the past, I compared myself to other people and cared about what I did and didn’t have,” she says. “It wasn’t until I joined Tzu Chi and started to give alms and other aid to the needy that I was able to get rid of greed. Now, I feel like my life couldn’t be more fulfilling and enjoyable!”
In addition to its headquarters in Hualien City, Tzu Chi General Hospital now has five other branches—in Yuli Township, Hualien County; Guanshan Township, Taitung County; Dalin Township, Chiayi County; Xindian City, Taipei County; and Tanzi Township, Taichung County—that form a medical service network across the island. Together the branches provide nearly 2,900 beds and employ more than 4,800 medical personnel.
A recent trend for hospitals worldwide is the effort to meet International Organization for Standardization (ISO) standards, under which the hospitals develop, implement and maintain a quality management system and continually work to make that system more effective. The Hualien headquarters of Tzu Chi General Hospital secured ISO 9002 certification in 2000 and ISO 9001 certification in 2001. The institution was accredited by the Taiwan Joint Commission on Hospital Accreditation as a medical center in 2002 and remains the only such an establishment in eastern Taiwan to date. Today, all of its branches have ISO 9001 certification.
CEO Lin acknowledges that a big operational challenge for his hospitals, especially the ones located in Hualien and Taitung, is the recruitment of medical workers, as many young doctors and nurses are unwilling to relocate to the area and serve in remote locations. To solve this problem, in 1994 Tzu Chi moved to establish a university in Hualien to cultivate the necessary talent and accomplish another important mission—promoting education.
Great Bodies
Besides imparting medical knowledge, Tzu Chi University emphasizes the concepts of evidence-based and humane medicine, as well as medical ethics pertinent to the decision-making rights of patients, the doctor-patient relationship and alternatives for terminally ill patients, among other things. According to Lin, the most significant program of all, however, is the university’s Great Body program, which relies on donated cadavers for training ranging from basic anatomy in the third year of medical school through to clinical surgery training in the sixth year. The goals of the Great Body program are to give students surgical experience on actual human bodies and enable resident physicians and surgical assistants to improve their surgical skills, helping them provide the best medical treatment for patients.
Master Cheng Yen began advocating Great Body donation in 1995. She once said, “Life is unpredictable and turns from helplessness to uselessness when one dies. We should make good use of the body to exemplify the meaning of life.” By October 2009, nearly 25,700 Taiwanese had signed up to donate their bodies post-mortem to the Great Body program. Medical students call these donated cadavers “silent mentors” who teach them with their bodies. They not only perform solemn memorial services designed to pay the utmost respect to the dead before the simulated surgeries begin, but unlike other medical schools, even visit donors’ families to learn about the deceased.
Several touching stories have since been passed down regarding the Great Body program, such as that of donor Li He-zhen. Before he passed away, Li once said to a group of medical students, “Doctors are medical Bodhisattvas. When you become a doctor, I’ll give you my body to practice on. You can make as many mistakes as you like on me, but never make a mistake on a patient.”
Meanwhile, Tzu Chi medical chief Lin Chin-lon says his hospitals have spared no effort to develop cures for deadly diseases and to promote the future development of medical services through conducting extensive academic research and utilizing high-tech equipment. Accordingly, Tzu Chi has established several research centers including the Cancer Prevention Center, Clinical Trial Center, Genetic Development Center, NeuroMedical Center and Stem Cells Center, among others.
In particular, the Stem Cells Center, which was set up in 1993 to help people with blood diseases, has grown to be the world’s seventh largest such institution. As of the end of September 2009, an estimated 327,627 people had registered as potential bone marrow donors. The center has thus far helped 2,000 patients find donors in 27 countries.
After several decades of technological development, Tzu Chi hospitals have cultivated a number of specialties including organ and bone marrow transplants, cardiology, thoracic surgery, stroke treatment, orthopedic surgery, minimally invasive spinal surgery, deep-brain stimulation for Parkinson’s Disease and high-tech health screenings.
Many international patients with unique diseases come to Hualien Tzu Chi Hospital for medical assistance, Lin adds. The hospital, for instance, has conducted a successful separation of conjoined twins from the Philippines, helped an Indonesian boy suffering from gigantiform cementoma by removing the tumors that covered his face, and helped siblings from Singapore with Hallervorden-Spatz syndrome, an inherited neurological movement disorder, to walk without assistance.
Furthermore, Tzu Chi moved to promote international outreach programs by establishing the Tzu Chi International Medical Association (TIMA) in 1996 to help people around the world gain access to medical care and offer immediate relief in the event of major disasters. TIMA, composed of 7,200 medical professionals and 3,700 volunteers worldwide, has set up chapters in 11 countries and served more than 3.2 million people.
Beginning with 30 members in Taiwan in 1966—mostly housewives and vegetable vendors who donated a few cents of their grocery money each day to help the poor—Tzu Chi has expanded over time to become an international humanitarian organization with 345 chapters in 47 countries and more than 178,000 volunteers.
“Master Cheng Yen’s teaching—when others are hurt, we feel the pain; when others suffer, we feel the sorrow—serves as our inspiration while practicing medicine,” Lin Chin-lon concludes. “From doctors and nurses to volunteers, we are dedicated to carrying out our medical mission of safeguarding life, health and love with gratitude and respect. Hopefully, our practices can set an example in Taiwan’s medical field and encourage more medical institutions to follow suit.”
Write to Kelly Her at kelly@mail.gio.gov.tw