| Ideals Sealed The Deals | ||||||||||||
| By the Tzu Chi Monthly History Compilation Project Team Translated by Tang Yau-yang Photos courtesy of Tzu Chi Hualien headquarters | ||||||||||||
Hualien Tzu Chi Hospital opened in 1986 to serve people on the relatively undeveloped eastern coast of Taiwan. The area was known for its insufficient medical care—far from major population centers, vulnerable to frequent earthquakes and typhoons, backward in academic research, and far behind in medical expertise. It is no wonder the new hospital had a tough time recruiting physicians, even as its impending grand opening loomed large. It was the first such institution that Tzu Chi established to provide quality medical care to the public, especially to the poor who could not afford treatment. A nursing school, a medical school, and five more hospitals have since been created by the foundation in pursuit of that goal.
The Hualien hospital that spawned this medical-care network turns 30 this year. This article looks back at the early days of that hospital’s history, when challenges and uncertainty abounded. The construction of Hualien Tzu Chi Hospital was completed in January 1986. The original plan was that it would take three years to complete, but through the combined efforts of many people, construction on the hospital was finished nine months ahead of schedule. The rapid pace of construction was not the result of overtime pay or other monetary costs. On the contrary, the project came in substantially under budget. The hospital was built for NT$570 million (US$19 million), well under the total projected budget of NT$800 million. The savings were possible for two reasons. One was the hard work of the construction committee who kept a watchful eye on every expenditure. The second was the goodwill and discounted prices provided by contractors and vendors. Master Cheng Yen, the founder of Tzu Chi, thanked everyone for contributing to the successful building of the hospital. All parties involved were aware that the construction money had been donated by many loving people, so they were mindful that every bit of it should be spent carefully. The early completion, however, added to the pressure of recruiting personnel. Recruiters faced a daunting challenge in getting medical professionals to come to Hualien to work and live. After all, Hualien was far from major population centers, vulnerable to frequent earthquakes, backward in academic research and medical expertise, and had living standards far below those in western Taiwan. In addition, the Tzu Chi hospital was new—no one knew what the future held in store. As a result, many young physicians passed on the opportunity to join the staff. In light of the difficulty in recruiting, many members of the steering committee for the opening of the new hospital suggested to Master Cheng Yen that the grand opening be postponed until the hospital was more fully staffed. But after careful contemplation, the Master decided otherwise. “With support from the public, we beat our own deadline for building the hospital. The earlier we open, the sooner we’ll be able to benefit people in eastern Taiwan. If we put off the opening, people might miss out on a cure or even a chance to live. We can’t let our supporters down in that way.” Therefore, despite the monumental obstacles in hiring, the Master decided to open the hospital without delay.
Critical initial support The hospital ran newspaper ads for resident physicians in early 1985, more than a year before the opening, but the three-day ads yielded just two applicants, both dentists. Steering committee members Yang Sze-Piao(楊思標), Tu Shih-mien (杜詩綿), and Tseng Wen-ping (曾文賓) believed that adequate staffing could only be assured by linking the new hospital with an established one. They felt that such a partnership would help entice skilled physicians to serve at the new hospital, and would also assure that it could maintain high medical standards. They unanimously recommended that the Hualien hospital partner with National Taiwan University Hospital (NTU Hospital). “As the oldest and largest hospital in Taiwan, NTU Hospital has dual missions: patient care and teaching,” said Yang, who was then the superintendent there. “It has an obligation to train medical care professionals for hospitals in Taiwan, big or small.” He explained another benefit of the inter-hospital collaboration: Physicians at NTU Hospital did not necessarily get to treat all types of patients. Through joint efforts with the Tzu Chi hospital, they would have opportunities to treat diseases that were more prevalent in eastern Taiwan. This experience would be tremendously beneficial to the cultivation of these doctors. In August 1985, Tu was the deputy superintendent of NTU Hospital. He invited department heads and Lin Kuo-sin (林國信), the new superintendent of NTU Hospital, to visit Hualien Tzu Chi Hospital. Tu wanted to acquaint the visitors with the founding ideals of the Hualien hospital. He believed that with increased understanding, they would be more willing to recommend good doctors to work there. Tu also asked the administration of NTU Hospital to help recruit residents for the Hualien hospital. Tu retired from NTU Hospital in May 1986, after 44 years of service. He and his wife, Chang Yao-chen (張瑤珍), left Taipei and moved into their dormitory apartment in Hualien on July 19, 1986. Four weeks later, Tu took up his new post as the first superintendent of Hualien Tzu Chi Hospital. Though retired from NTU Hospital, Tu continued to hold an appointment there as a clinical professor, and he saw nasopharynx cancer patients there every Monday. After he had finished his morning clinic, he would visit various hospital departments in the afternoon. Many of the department heads had been Tu’s students. He talked to them about Hualien Tzu Chi Hospital’s collaboration plan with NTU Hospital and how they might be able to lend a hand. On the strength of Tu’s tireless work and with approval from the Ministry of Education, Hualien Tzu Chi Hospital signed a three-year collaboration agreement with NTU Hospital in July 1986, just in time for the opening of the new hospital. The early going In a show of support, many heavy-weight professor-physicians at NTU Hospital opened special clinics or conducted monthly teaching sessions at the new hospital when it first opened. Among these were Lien Wen-pin (連文彬), Wang Teh-hong (王德宏), Chen Kai-mo (陳楷模), Liu Chen-hui (劉禎輝), and Lee Tzu-yao (李鎡堯). They did not charge the hospital anything for their services, not even traveling costs. What is more, they brought costly instruments to Hualien so they could operate on patients. Professor Chen Kai-mo, head of surgery at NTU Hospital at the time, had three decades of rich experience as a surgeon. He was on the team that had separated conjoined twins Zhong-ren (忠仁) and Zhong-yi (忠義), joined at the ischial bones, in September 1979. The operation had received a lot of attention. Chen was a strict teacher. He was nicknamed “Thunder God” for his loud voice, and he didn’t mince words. However, he was very kind at heart. His mother was a pious Buddhist. She repeatedly asked him to help the Tzu Chi hospital as much as he could, so as an obedient and respectful son he did as he was told. When he visited Tzu Chi, he saw how Master Cheng Yen selflessly devoted herself to aiding the needy and building the hospital to help save lives. Moved, he decided to help the new hospital establish its surgery department. In accordance with a medical collaboration agreement between Taiwan and Saudi Arabia, NTU Hospital started sending physicians in cardiology and surgery to Saudi Arabia in 1979. According to the agreement, if hospital physicians volunteered to work in that country for two years after their residency, they would be promoted to attending physicians upon their return to Taiwan. That arrangement attracted many young physicians to travel to Saudi Arabia. To likewise attract physicians to serve in Hualien Tzu Chi Hospital, Chen replicated the Saudi Arabia incentive: After serving two years at the Hualien hospital, an NTU Hospital physician could return to his or her old post in Taipei and be immediately promoted to attending physician. “On the one hand, working in eastern Taiwan expands the horizons of resident physicians from NTU Hospital. On the other hand, having the service of high-caliber physicians ensures that Hualien Tzu Chi Hospital can provide quality medical service to its patients,” Chen said of the incentive program. “Unconditionally allowing these physicians to return to NTU Hospital is the best guarantee that I can give them.” Chen had always advocated the ideal that doctoring is a union of the art of medicine and the spirit of compassion. He believed that by serving in Hualien, NTU Hospital physicians could learn more about compassion. “The religious spirit of Master Cheng Yen is the best education.”
The first full-time doctor Born in Tainan, southern Taiwan, Chen Ing-ho (陳英和) was an outstanding student at the NTU medical school. He made his teacher, orthopedic surgeon Professor Liu Tang-Kue (劉堂桂), very proud. Since childhood, Chen had loved to take things apart and put them back together. While a resident at NTU Hospital, he innovated and improved many surgical techniques. In his fourth year of residency, he devised an instrument for femoral neck fracture surgery that shortened the surgery time, reduced a patient’s pain, and decreased the amount of time medical workers were exposed to X-rays. In 1986, when Chen was the chief surgical resident at NTU Hospital, surgery chief Chen Kai-mo informed him of Hualien Tzu Chi Hospital’s urgent need for specialists. The hospital’s grand opening was fast approaching. Chen Ing-ho had visited Hualien for the first time just two years before. During the visit, he rafted down the Xiuguluan River. The natural beauty and serenity of that rural region, which reminded him of his own hometown, was a fond memory to him. Therefore, the idea of serving in Hualien did not immediately turn him off as it had done to many of his fellow physicians. Yet, though deeply attracted to the natural simplicity that was abundant in Hualien, Chen was not immediately convinced that he should move there. Living in an out-of-the-way place was just a small inconvenience for him, but what really weighed on his mind was that he might lose touch with mainstream research, so vibrant and readily accessible to him in Taipei. Both his former teacher Liu Tang-Kue and surgery chief Chen Kai-mo were strong supporters of the collaboration plan between the Tzu Chi hospital and NTU Hospital. Among the three surgeons who were asked to consider serving at the new hospital, Chen Ing-ho was the only one who was unmarried. Since relocating an entire family entailed more work, he became the best candidate for working in that distant outpost. Chen felt the urgency and pressure on him to make the move. He pondered. As a Christian, he knew that the new Tzu Chi hospital, operated by a Buddhist organization, would be run not for profit but to provide the best medical care for patients. As a doctor, he had a duty to use his expertise to serve patients. Now the new hospital had an urgent need. He was more inclined to help out than not. Besides, the professors had promised him that he could go back to NTU Hospital after just two years. He was on the verge of saying yes. One day in early 1986, Chen met Master Cheng Yen in a hallway in NTU Hospital, their first meeting. The Master had come to the hospital for a meeting on the collaboration between the two hospitals. Looking at the Master—frail yet determined and working hard to advance medical care in eastern Taiwan—Chen felt a sense of mission bubbling up inside. He took a few quick steps to catch up with her. “Master, I’ll go work for Tzu Chi,” he said. Less than two months later, in March 1986, he reported to work at the Tzu Chi hospital, where finishing touches were being added to the new buildings. Chen became the first full-time, in-house physician at the hospital.
Whatever your religion When Chen reported for work at the hospital, he asked the Master, “I’m a Christian. Am I fit to serve in a Buddhist hospital?” “That you’re Christian doesn’t concern me in the least,” the Master replied without any hesitation. “But I’d be concerned if your Christian faith was not deeply rooted in your heart. A true religion never deviates from love, and no work is more important to a medical worker than giving love to patients. You’ll give your patients unconditional love if you have a deep religious faith.” Those words removed any doubts Chen might possibly have had for serving at the hospital. Now he was all set to dedicate his undivided attention to his work at his new post. There seemed to be a thousand things to do to properly set up a new orthopedic practice at a new hospital. Chen carefully attended to all those tasks. He was even personally involved in planning the layout of the clinics and the selection and purchase of equipment and instruments. He knew that the funds for the establishment of the hospital had come from many donors, so he made each purchase decision very carefully. One day just before the hospital opened, the Master was checking things out in the hospital when she heard the rapid breaths of someone running up the stairs. It was Chen, carrying a large pair of shears. “Dr. Chen, I know you’re very busy every day. How can you have the time to trim plants?” the Master asked. Chen explained that he was not doing yard work. Instead, he had just bought the shears at a hardware store to be used to cut materials for treating orthopedic conditions. These materials were generally very hard. “The shears typically used to cut these hard things crack easily, so they often have a very short life span,” he explained. “What’s more, they’re expensive—more than 30,000 NT dollars [US$1,000] a pair at a medical supply store. These shears I found at a hardware store will do the job just as well, but at a tenth of the cost. They’re more durable too.” The Master was impressed by Chen’s thoughtfulness and mindfulness. His mindfulness did not stop there. A kind of surgical tweezers used in microsurgery had very fine tips, so they broke easily. They were costly as well. Chen went to some stores that specialized in precision tools, and he found tweezers used in repairing watches and clocks. They were even more serviceable than the surgical tweezers and were again a lot cheaper. It was with such care and mindfulness that Chen went about setting up the orthopedics department. Three months later the job was completed. When the hospital opened on August 17, 1986, the services of the orthopedics department went online with it. Grand opening The brand-new Tzu Chi hospital stood tall and proud amidst the green landscape of Hualien, a miracle in any sense of the word given the abundant difficulties and obstacles that had been surmounted to bring it into being. The opening of the hospital was a great encouragement to its supporters, as it meant that people in that area would be able to receive better medical care. However, the opening of the hospital also meant lots of worries and sleepless nights for those who were responsible for keeping hospital services open and available to patients—something that would be very hard to deliver if there was not enough medical staff. “We were very short on physicians,” Tseng Wen-ping, then deputy superintendent of the Hualien hospital, recalled of those early days. “We only had about ten physicians in all. They included Chen Ing-ho, a handful of residents, and the four department heads of internal medicine, surgery, Ob/Gyn, and pediatrics.” Tseng and Superintendent Tu sent all their resident doctors to train at NTU Hospital, and NTU Hospital sent 14 residents and 7 interns to support Hualien Tzu Chi Hospital. With such a limited number of physicians, the new hospital began its service. The staff was short-handed and resources were few, but lots of work still had to be done. From setting up an orthopedics department to treating patients day in and day out, Chen Ing-ho was gradually transformed from a newcomer in an exploration-and-adaptation mode to a physician happily devoted to his work. Being Christian did not make him a square peg in a round hole in this Buddhist hospital. Quite to the contrary, the not-for-profit nature of the hospital made working there straightforward for him: He needed to concern himself only with patient care and nothing else. At the same time, he saw how Tzu Chi volunteers helped deliver an additional layer of care to patients and their families at the hospital. It was a good environment in which to work. With no baggage from the past to contend with, the Tzu Chi hospital supported all reasonable requests that its staff made. Chen had thus been able to carry out his ideals and do the work he wanted to do. He felt a great sense of fulfillment. So after his two-year commitment to serve at the hospital ended, he decided to stay instead of going back to Taipei. In August of that year, the Ministry of Health and Welfare granted the hospital the status of a quasi-regional hospital. That same month, doctors Hann-Chorng Kuo ( 郭漢崇, urology), Chien Sou-hsin (簡守信, plastic surgery), Huang Lu-chin (黃呂津, internal medicine), Wang Ying-wei (王英偉, family medicine), Tsai Bo-wen (蔡伯文, cardiac surgery), Chao Shen-feng (趙盛豐, cardiac surgery), Chang Tso-wen (張佐文, neurology), Tang Tze-wan (鄧子雲, radiology), Lin Mei-hwey (林美慧, pediatrics), Hsieh Yan-huai (謝沿淮, orthopedics), and Lee Jen-jyh (李仁智, pulmonary medicine) joined Hualien Tzu Chi Hospital. All of them came from NTU Hospital, except for Lee Jen-jyh, who came from a tuberculosis treatment center. These doctors were already attending physicians or would soon have been promoted to that rank if they had stayed at NTU Hospital. Yang Gee-gwo (楊治國, chest medicine), then studying in the United States, returned and joined them in Hualien the following year. The infusion of about a dozen young physicians made waves in eastern Taiwan. The unprecedented influx of talent immediately catapulted the ranks of full-time physicians at the hospital from 12 to over 20. Why Hualien? Lee Jen-jyh had been working at the hospital part-time, offering a clinic one day a week, ever since the hospital opened. He was therefore keenly aware that there was a dearth of internal medicine specialists, which made it difficult for the hospital to provide optimal patient care. Lee wanted to help alleviate that situation. “To me, this job is not a stepping stone to some other better job elsewhere. I’m here to put down roots and work hard with everyone else for the hospital.” Dr. Hann-Chorng Kuo had led the treatment of urinary dysfunctions at NTU Hospital for five years when he and his cohort of transplants from Taipei joined Hualien Tzu Chi Hospital. His rich clinical experience had made him one of a few leading experts in Taiwan in treating patients with voiding dysfunctions. He had not only held a special clinic at NTU Hospital but had also lectured and conducted research projects at the NTU medical school. He had also previously worked part-time at the Hualien hospital before he formally joined. Three months after the hospital opened, Dr. Yao-Jen Chang (張耀仁) invited him to operate at the new hospital on a patient with bladder stones. At the time, Kuo was just thinking about making some extra money by moonlighting at the remote hospital, where he gradually worked more and more frequently. One day Chang took Kuo to see Master Cheng Yen, who shared with Kuo her ideals that had brought the Hualien hospital into being. Now, despite all the hurdles, the hospital had been built and was open, but it was having a hard time attracting physicians to work there full-time. Without enough doctors, the illnesses and sufferings of area residents could not be adequately relieved. Therefore, the ultimate goal of the hospital remained elusive. Speaking of this, the Master choked up with emotion and tears welled up in her eyes. Seeing the Master like that, Kuo silently told himself: “Though feeble and frail, she has enough perseverance and courage to bring a big hospital into being, and all she thinks about is how to relieve the suffering of the needy. Compared to her, we young physicians—also full of altruistic ideals and ambitions—seem to be doing nothing more than empty talk. Shouldn’t we give her a hand? Shouldn’t we work with her and create a miracle together?” He had no answers to his own questions. An attending physician and lecturer, Kuo was then single-mindedly focused on his goal of becoming a full professor at the NTU medical school. Uprooting himself from the capital city and relocating to serve in remote locales seemed a worthwhile and altruistic pursuit for the future, when he had passed middle age. But to do so now, at his age? He had a dream of his own to chase yet. So Kuo continued doing what he had been doing at the Hualien hospital: performing surgery there when such help was needed. After doing so for some time, he noticed a troubling sign: Some of his Hualien patients could have been healed without surgery if they had been treated sooner, and some should have had surgery long before he operated on them. However, that window of opportunity for early diagnosis and intervention had often been lost because there was a lack of local specialists. As a physician, he felt he had a duty to improve that situation, so he decided to open a urology clinic for patients in eastern Taiwan. He began working one day a week at the Hualien hospital, commuting back and forth between Taipei and Hualien.
Not alone One day, some NTU Hospital doctors who had previously served in Saudi Arabia had a gathering. Tsai Bo-wen, who had decided to work at Hualien Tzu Chi Hospital full-time, asked, “Anyone want to go with me?” That question could not have found a more receptive audience. These doctors had all treated patients at the Hualien hospital on a part-time basis, and in the course of doing that, they, like Kuo, had also noticed that by the time they saw their Hualien patients, they were often very sick. People there procrastinated in seeking medical attention not because they wanted to but because they had no access to specialists locally and could not afford to travel to western Taiwan to be treated by specialists. These doctors all had seen how desperately eastern Taiwan needed people—physicians just like themselves—to elevate the quality of local medical care. The need for their service was unmistakably there. Also clear was their desire to serve that need and to discharge their duty as physicians. Therefore, they decided to leave NTU Hospital and join Hualien Tzu Chi Hospital together. Kuo was preparing to study in the United States around that time, but he decided to give that up and relocate to Hualien to serve patients in eastern Taiwan. His decision surprised even himself. “It wasn’t that the Master had any magical power to sway my decision,” Kuo said, reflecting on the decision that he and his colleagues had taken. “Rather, it was the Master’s sincerity and the love of Tzu Chi volunteers that moved me.” So, in one fell swoop a dozen or so specialists set foot in Hualien. They took their families there too. “Rather than vying for wealth and status in Taipei, we chose to cultivate the medical field in Hualien on a long-term basis,” Kuo remarked. “Taipei could do without a physician like me, but in Hualien I could do a lot.”
● In August 1988, at a gathering in the lobby of their new hospital to commemorate its second anniversary, these doctors took turns sharing their thoughts about their group relocation and their decision to join the hospital. When Kuo took the stage, he said that when he had made up his mind to come to Hualien, his chief at NTU Hospital, who knew him well, said to him, “No way will you stay there for long—you’ll be back.” Many others asked him how long he would work in Hualien, three years or five. “I always answered that I’d serve at the hospital till 2018.” Thirty-five years old when he joined, he would reach retirement age 30 years later in 2018. “I’ll sign a long-term contract with Tzu Chi Hospital. I don’t want the Master to ever be worried again about not being able to find doctors to work at Tzu Chi.” Another doctor who had joined, Chien Sou-hsin, also spoke up: “Tzu Chi will be my home. I’ll be here until my last days.” |
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