With an inferior medical environment and dilapidated equipment, Dr. Tien Ya-ko went to cope with the dramatic increase in illness of the Yami people and saved many lives. This is something previously serving doctors could not even dream of.

Orchid Island is located about 49 nautical miles east of the city of Taitung. With education relatively late and travel inconvenient, much traditional culture and thinking is preserved. It's a great place for anthropologists, but for doctors these may be an obstacle.

Dr. Tien Ya-ko, himself a Bunung aborigine, discovered in the course of growing up and study that aborigines had problems of cultural adaptation, and he decided to devote efforts to these people. After passing the entrance exam to Taipei Medical College, he learned from a Yami friend that their medical environment was poor, and also that, because the government did not understand local culture, they enforced many "civilizing" projects that didn't work. The most famous case was building them concrete homes. Today, the Yami people still prefer to live in their well-insulated traditional homes, and the concrete buildings serve as warehouses or animal stalls.

Despite preparing for Orchid Island by reading many reports on the Yami people, he found he was not welcome when he arrived in July, 1987. But he was not angry. He set about studying local customs and attitudes to modern medicine. After that, he employed methods they could accept, and gradually improved their medical outlook.

"The deep Yami belief in evil spirits is the main obstacle to their acceptance of modern medicine," says Tien Ya-ko. The Yami people believe there are many souls. That of the head cannot depart before death, but souls of other parts of the body can leave at will. The Yami believe that illness is caused by an invasion by an evil spirit. To restore health, it is necessary to dispel the evil spirit. The best method is to starve him out, explains Tien Ya-ko. But in fact Yami only starved themselves to death or weakened their resistance to illness.

In the past, Yami spiritual doctors used herbs to cure slight illnesses. But for the Yamis, whose hygiene, weather, nutrition, and clothing are all poor, the illness rate is quite high. These problems can't be handled with traditional methods.

In the past few years, some Yamis have picked up the habit of visiting the doctor when they are sick, but then there's the problem of money. The main food of the Yamis are yams, fish, and wild vegetables. These come directly from nature, and there is little cash-generating activity. Most consumers who go to Orchid Island are tourists, but Orchid Island's tourist industry is not in the hands of the Yamis. Thus they can only rely on help from Taiwan or selling local handicrafts to tourists.

There are few doctors willing to serve in Orchid Island's rough conditions. Aside from himself and Dr. Liao Ching-yuan, who went to Orchid Island in 1982, doctors sent there still have their hearts on Taiwan, and don't spend much effort on the island.

Though Dr. Tien thinks the title of a Schweitzer too high, he has devoted much to the Yamis. He personally reconstructed abandoned rural township offices as a dorm just 20 meters from the clinic. His door is always open.

But the Yami people's traditional views are deeply rooted. Few will see the doctor on their own initiative. Tien understands this and has begun to go to each village to "capture" the ill, and bring them back to the clinic. "After I cured some people in a few days a couple of times, they began to have confidence in me," he says. He also cultivated the view that getting a shot or an X-ray is a way to dispel evil spirits. In his recent trip around the island to do chest X-rays, many Yamis lined up.

Tien makes sweeps of the island after a typhoon to see if anyone has been injured. If there's a motorcycle down on the side of the road, he asks around nearby villages to see if there's been an accident. He's always on the lookout for any opportunity to give medical attention. And thanks to his efforts, Yamis now pay only NT$50 (two US dollars) per visit.

The results? This year there were 7,000-plus visits, more than double his first year and almost four times the amount before he came.

The toughest nut to crack is transportation. Orchid Island's landing strip is closed at night, when it rains, or when there's artillery practice. At least half of every day they are cut off. If there is an emergency, nothing can be done. Tien wants to build a modern hospital in Orchid Island to let the Yami enjoy the same health resources as people in Taiwan. But this involves budgeting, personnel, and policy.

What Tien can do on his own he has done. As for the rest, he says, "Yami people live in the most beautiful place, but live with fear of illness and death. I hope they can be like everyone else and enjoy health and rights. Health is an obligatory goal."

[Picture Caption]

Tien Ya-ko could be called the "Schweitzer of Orchid Island."

Modernity has been a major shock to the Yami people.

Many Yami people still live in the "semiunderground" traditional homes.

Living in a poor environment causes the rate of illness among the Yami people to be high.

Looking a bit dishevelled and wearing the same old army khakis makes Tien look even more approachable.

The attitude of the Yami people toward medical treatment has been greatly improved; the photo shows a test of blood pressure.

Medical teams establish health stations in villages to make things easier on the people and to raise effectiveness of care.

Orchid Island's only medical institution--the Orchid Island Health Service--needs to be upgraded to a fully staffed small-scale hospital.

Tien Ya-ko believes the Yami people have the right to enjoy the same medical facilities as others.

Many Yami people still live in the "semiunderground" traditional homes.

Modernity has been a major shock to the Yami people.

Living in a poor environment causes the rate of illness among the Yami people to be high.

Looking a bit dishevelled and wearing the same old army khakis makes Tien look even more approachable.

The attitude of the Yami people toward medical treatment has been greatly improved; the photo shows a test of blood pressure.

Medical teams establish health stations in villages to make things easier on the people and to raise effectiveness of care.

Orchid Island's only medical institution--the Orchid Island Health Service--needs to be upgraded to a fully staffed small-scale hospital.

Tien Ya-ko believes the Yami people have the right to enjoy the same medical facilities as others.