Compassion That Knows No Bounds: The Tzu Chi Free Clinic in Batam, Indonesia

Early this March, Tzu Chi branches from Singapore, Malaysia, Indonesia, and Taiwan joined together for Tzu Chi's fourth free clinic on the Indonesian island of Batam. On each occasion so far, the number of local volunteers has grown, and patients and their families who have been helped in previous years have come forward on their own to lend a hand. At the clinic site, you can hear Mandarin Chinese, English, Indonesian, Malaysian, and Hokkien rising and falling. Compassion not only knows no national boundaries, it also breaks through religious barriers. The Tzu Chi experience is no longer simply a Taiwan experience, but has become a shared experience around the world.

Each Tzu Chi volunteer has specific responsibilities-(left to right) setting up a sink for the surgical theater, prepping for tooth extractions, sterilizing instruments, serving or preparing food-so that, in an orderly fashion, they build an instant hospital in a day. Even the eating times are staggered, so that there are always volunteers on duty.

Body and soul

Early on a March morning on Batam island, the sun is already intense, and even at 8:00 the air temperature is so hot that "the dog won't go out even if you beat it." Yet, when you enter the volunteer clinic that Tzu Chi has set up in the Batu Aji technical training center, there is an atmosphere of vitality and playfulness reminiscent of a summer camp.

Just inside the door, a volunteer in signature blue shirt and white pants approaches you to ask what type of doctor you wish to consult. If it is internal medicine, you can register in front of the assembly hall. For dentistry, surgery, or ophthalmology, you need to go over to the tent set up on the lawn, where you can check your name against the list and they will give you a number. There are unlimited drinks for waiting patients who are thirsty, and bread for those who are hungry.

Nearby, primary school students line up in a cafeteria to see the young dentist from Singapore. To maximize efficiency, volunteers separate out and make a list of those who need fillings or teeth pulled. Each child also receives a small backpack, which includes toothpaste, a toothbrush, and a rinsing cup, so that after the kids return home they can keep their teeth clean according to the dentist's instructions.

In charge of general medicine in the assembly hall is a Muslim woman doctor, wearing a beautiful tudong (Muslim headscarf), gently asking each patient where it hurts. Across a lawn from the assembly hall, in a space where the dentist has set up, little children, fearful of having their teeth pulled, eyes filling with tears, seem anxious to escape. The doctor from Singapore, speaking to them in Malaysian, 70-80% of which is similar to Indonesian, stays busy trying to keep them mollified. Next door to the dentist is the eye surgery room, where sophisticated equipment, flown in from Singapore only the day before, has been set up.

In the innermost chamber is the surgical theater, divided into three sections-hernia, cleft lip and palate, and tumors. While family members patiently wait under the tent outside, inside, where air conditioners (hastily set up only a couple of days before) clank away noisily, patients in various stages of surgery are laid out on ten provisional operating tables made up out of desks and chairs. Amazingly, their expressions do not show the least fear; on the contrary, they appear to be looking forward to treatment.

Each Tzu Chi volunteer has a specific responsibility, and everything is done in an orderly fashion. A group of Tzuchians mingles with the crowd, trying to put patients at ease. Suddenly the sound of song bursts out from the waiting area, and little children dance along with the music. Meanwhile, several volunteers spontaneously and inconspicuously detach themselves from the crowd, grab tongs and plastic bags, and begin picking up trash.

If you look beyond the fact that the facilities are jerry-rigged, the entire setup is like a duplicate of the Tzu Chi Hospital in Hualien, Taiwan. And as at Tzu Chi Hospital, here they take responsibility for treating not only bodily illnesses, but also the mental anguish of patients and their families.

Each Tzu Chi volunteer has specific responsibilities-(left to right) setting up a sink for the surgical theater, prepping for tooth extractions, sterilizing instruments, serving or preparing food-so that, in an orderly fashion, they build an instant hospital in a day. Even the eating times are staggered, so that there are always volunteers on duty.

Across the sea

Batam Island, which in recent years has been endeavoring to develop tourism, is located about 20 kilometers southeast of Singapore, only an hour by boat. Dr. Latifah, participating in the clinic, notes that there are many small islands around Batam, and medical resources, inadequate to begin with, are also scattered. Given the great distance from Jakarta, the political and economic heart of Indonesia, local residents must travel far across the water for treatment. Often minor illnesses are ignored until they become major ones, and patients with serious problems deteriorate over time because they cannot afford the enormous costs of seeking treatment.

"Although there are Islamic medical groups who conduct periodic small clinics in these islands, most of those doctors are general practitioners," says Dr. Latifah. "For surgery, it is still necessary to have a large-scale clinic with a full complement of equipment."

In 2000, responding to the local shortage of medical resources, the Indonesian branch of Tzu Chi and the Indonesian Air Force agreed to cooperate in the holding of Tzu Chi's first free clinic on Batam Island. Two military flights were dispatched from Jakarta carrying medical supplies and staff, plus more than 100 volunteers from Singapore, the Philippines, Malaysia, and Taiwan. During the two-day clinic, more than 1500 local residents were treated. In cases where persons needing surgery could not get to the clinic because of the seriousness of their illness or the difficulty of transportation, Tzu Chi subsidized their transfer to hospitals in Singapore for treatment.

Following on the successful completion of this first effort, the Batam Island clinic has become a regular twice-a-year event. Operational control has been turned over to the Tzu Chi branch in nearby Singapore in order to save the enormous costs of long-range transportation. As the Singapore branch has grown increasingly robust these last two years, it has become able to handle all the expenses and organization of the clinic itself, with more and more Batam Island doctors and volunteers joining in all the time. As a result, branches in Jakarta, the Philippines, and Taiwan have steadily been able to reduce the commitment of resources to the island.

Each Tzu Chi volunteer has specific responsibilities-(left to right) setting up a sink for the surgical theater, prepping for tooth extractions, sterilizing instruments, serving or preparing food-so that, in an orderly fashion, they build an instant hospital in a day. Even the eating times are staggered, so that there are always volunteers on duty.

Instant hospital

Behind this two-day clinic were two months of non-stop preparatory work.

"Negotiating the loan of a clinic site and getting in touch with patients on offshore islands both require the assistance of the local government and public health agencies," says Qiu Jianyi, a Singaporean volunteer in charge of preparatory work for this clinic session. In order to improve efficiency, and ensure continuity and coordination with local health care operations, the health authorities on the offshore islands first did preliminary screenings of candidate cases for surgery and ophthalmology. The main factors weighed in screening were poverty and suitability for surgery at the clinic site.

Tzu Chi volunteers handled all the arrangements for transportation and accommodation for patients, and prepared the clinic site themselves. That is why volunteers from Singapore arrived in groups over the previous two days to do a whirlwind setup.

"Excellent! The kitchen is inside the clinic area," says one of the older women who is part of the team responsible for doing the cooking. Sticking their heads in for a look, they discover that except for a counter, the kitchen contains nothing at all. A volunteer explains that last time the clinic area was too small, and all the cooking had to be done somewhere else and the food brought to the clinic, which was pretty troublesome.

"Hey, come over here! I found a bunch of faucets we can use! This is just what we need!" says another volunteer with delight. Several older women, looking indescribably happy, start their hands and feet in perpetual motion, and in a short time the entire area has been completely cleaned, a gas stove has been set up, and vegetables have been washed and chopped. Before you know it, the aroma of fried rice-noodles begins to permeate the clinic site.

The space for the doctors to work in was initially as empty as the kitchen. But, with remarkable efficiency, in a single day Tzu Chi volunteers had set up a post-op recovery room, installed air conditioners, erected fluorescent lighting and surgical tables, and scoured an area the size of a football field, even cleaning the windows-twice! On the day the clinic opened, the volunteers got up at five or six a.m. and headed to the clinic area to do final preparations, then waited for the doctors of the Tzu Chi International Medical Association to do a final inspection. In two days, they had created a rudimentary but fully functioning hospital.

A number of operating tables have been set up in the small surgical theater. Despite the crowded conditions, the doctors focus their complete attention on the tasks at hand.

Under the knife

During the clinic, the place that draws the greatest attention is the surgical theatre, where tables have been pushed together to form operating platforms. Although a specialist is on hand to give children a general anesthetic, for maximum safety adults only get a local anesthetic. Adult patients in for cleft lip or palate surgery have their eyes wide open-and full of hope-as they go under the knife. Although the operating room is crowded and noisy, the doctors are remarkably focused, taking no heed of the hustle and bustle surrounding them.

"Safety comes first. Although there has been a preliminary screening to decide which cases are suitable to come to the clinic for surgery, still the doctors do an in-person evaluation of the risks of surgery," says Dr. Fong Poh Him. Outside, just in case, two ambulances are waiting. If a severe emergency arises, the patient can be sent to a nearby hospital, which has more complete emergency-care facilities.

Despite the presence of this basic hospital, there is still a severe shortage of medical resources in Batam, as evidenced by the symptoms of the patients at the Tzu Chi clinic. For instance, fully half of those coming for cleft lip or palate surgery have reached adulthood without being treated. A group of young women have come all together, hoping the surgeons can give them the chance at youthful beauty that they missed out on when they were children.

About half of the hernia sufferers are also adults; some are in such serious condition they can barely walk. Meanwhile, the tumor section is replete with all kinds of bizarre conditions: One patient suffered a lip injury in a motorcycle accident two years ago, and it never properly healed; now there is a tumor the size of an egg on it. Another person has a fist-sized growth on her neck, while others have foot tumors so large they cannot walk.

"While local health authorities take responsibility for examination, follow-up observation, and treatment of tumors, Tzu Chi picks up the tab," says Fong Poh Him. Moreover, when cleft lip or palate surgery cannot be completed all at once, the patients will just have to wait until the next clinic to complete their procedure.

Even though this is just a temporary clinic, you can't cut corners on pre-surgical health check-ups. Underneath a temporary tent set up to provide some shade, Tzu Chi volunteers take patients' blood pressure while chatting and laughing to put them at ease.

He looks great!

Among the mothers in attendance, you can seek two markedly different expressions. On the one hand there are women like the mother of Kasjullah, a child from Duket Island who has just undergone cleft lip and palate surgery. She lovingly strokes him, and there is a smile on her face that just won't go away.

"He looks great," she says. Kasjullah, a happy child by nature, not only had cleft lip and palette, but also a severely deformed left eye. His appearance often frightened other kids, which naturally hurt him deeply. After surgery, his cleft was significantly repaired, and the shape of his eye was much improved. His mom hopes that as a result he will have a much brighter future.

Perhaps because of his mother's encouragement, Kasjullah did not cry either before or after the surgery. This courageous child says that when he grows up he wants to become a primary school teacher just like his father.

In contrast to the optimism of Kasjullah's mother is a woman in tears. She sits by the side of her child, who is in the post-op recovery room after hernia surgery. The anesthetic has not yet worn off, so he is still unconscious, which makes his mom so anxious that tears roll down her face and she can only burble inarticulately. Tzu Chi volunteers are continually at her side trying to calm her, but it is only when a doctor comes to her to explain what is happening that she finally relaxes a little.

Miracles occurred one after another on the operating tables, and miracles also occurred outside the clinic.

Lin Quanhua, an 83-year-old woman who lives on the offshore island of Selat Panjang, has returned for a special follow-up examination. Originally both her eyes were severely affected by cataracts. During the previous clinic she had had surgery on her right eye, after which, amazingly, even her left eye also had some of its vision restored. The doctor who performed the surgery is very curious to have another look at this case.

Lin's granddaughter, Huang Xinping, who has accompanied her grandmother for the boat trip to the clinic, says that because their family is poor, everyone who can work must work. After Lin regained vision, it was no longer necessary for Hsin-ping to stay home just to look after her, so the family now has an additional income.

Each Tzu Chi volunteer has specific responsibilities-(left to right) setting up a sink for the surgical theater, prepping for tooth extractions, sterilizing instruments, serving or preparing food-so that, in an orderly fashion, they build an instant hospital in a day. Even the eating times are staggered, so that there are always volunteers on duty.

Stand up together

To allow patients who live on offshore islands to return home the second day, as much of the surgery as possible was done on the first day. Surgery proceeded nonstop from dusk to dawn, 12 straight hours, with doctors only grabbing a little rest at meal times.

In the dentistry section, six dentists pulled teeth continuously for two days, becoming so exhausted that they couldn't stop their arms from trembling. Volunteers collected all the pulled teeth for return to Singapore, where they would be studied as part of research into the relationship between the diet of Batamese and tooth decay.

Internal medicine, which drew the most patients, was handled by local doctors, who are most familiar with medical conditions around Batam, while all pharmaceuticals were provided free of charge by local health authorities. Dr. Latifah says that the main health problem for adults on Batam is high blood pressure, mainly because local people have the custom of eating animal viscera. The most common complaint for children is respiratory infections. This is because local residents have not yet learned to pay close attention to public health norms. People spit wherever they want, while the houses let in little sunlight and have poor ventilation, so children are much more likely to get infected and it is correspondingly difficult to cure them.

"The only way to get at the root of the problem is to inculcate correct public health concepts when people come to the clinic," says Dr. Latifah.

During this fourth clinic of Tzu Chi's held on Batam, altogether 901 patients were helped by the combined efforts of more than 150 Tzu Chi volunteers and 61 doctors from the medical association, as well as 9 local doctors and 52 local volunteers. In addition, more than a dozen volunteers from other Chinese Buddhist organizations also joined in or helped in transporting patients from offshore islands. Since 2000, more than 3700 people have benefited from the free clinics on Batam.

"You often see people who have been helped before, or their family members, coming to the clinic to ask if we need a hand. Tzu Chi has one person specially responsible for making a list of local volunteers to 'take shifts' in future clinics," says David Liu, director of the Singapore branch of Tzu Chi. Only by drawing together local resources and passing along the Tzu Chi experience can the people of Batam stand on their own.

Singapore volunteer Li Jianqun, who has been a Tzu Chi member for eight years, says that many people might think it foolish to use your vacation time to do volunteer work abroad, for which you even have to pay 100 Singapore dollars (about US$60) in travel expenses. But by participating in charitable activities, he has a chance to see people treat one another with sincerity, and to learn a sense of gratitude in his own life. No matter how much you give, the returns are always greater.

Li says that in Indonesia, where anti-Chinese sentiment is intense, the fact that Tzu Chi often lends a hand is gradually changing local attitudes toward Chinese. Now, if you go out wearing the "blue sky and white clouds" volunteer uniform of Tzu Chi, people will always greet you with a smile. Moreover, Tzu Chi activities carry no religious overtones, so that people of all different faiths are happy to participate.

At the opening ceremony for the Batam clinic, the sound of Muslim prayers rises like a beautiful song from heaven. Under the bright sunlight, Tzu Chi volunteers stay busy, and as they work their dark blue shirts becoming soaked with sweat; when the clothes dry, the salt marks left behind look like white lotus flowers that have just bloomed.

A designated vehicle brings residents of offshore islands from the dock to the clinic. Arriving patients look happy as they look forward to this chance to be treated.

Each Tzu Chi volunteer has specific responsibilities-(left to right) setting up a sink for the surgical theater, prepping for tooth extractions, sterilizing instruments, serving or preparing food-so that, in an orderly fashion, they build an instant hospital in a day. Even the eating times are staggered, so that there are always volunteers on duty.

A child who has just completed surgery for cleft lip and palate lies in his mother's embrace. Before mother and child go home, Tzu Chi volunteers will instruct them in what to look out for during post-operative care.

Children from Batam Island have few chances to see the dentist, so, despite the fact that this girl has already received an anesthetic, she cannot hide her trepidation.