It is autumn of 2002, and it is cold in Taipei. But down in the crowded subway system, there are intriguing new advertisements on the backlit glass ad boards. One shows a foreign child smiling shyly under a hot sun, and the text reads: "The purpose of medicine is to help life, to provide where something is lacking. Give life a chance, and it will find a way. Cleft palate and cleft lip can be treated. If you use love to give them what they lack, their smiles can be just as beautiful as yours."

On another backlit billboard is a picture of a father, obviously not from Taiwan, holding his baby who has just undergone surgery. The text reads: "Cleft lip and cleft palate surgery requires only one hour, but it can change someone's entire life. Vietnam, Cambodia, the Philippines, mainland China.... all are places where one can find the footprints of the Noordhoff Craniofacial Foundation surgical team. Through donations, every Taiwanese can change a child's life."

Of course, in busy urban life occasional advertisements are quickly forgotten. But the Noordhoff Craniofacial Foundation is also frequently mentioned in the media, so that people have a strongly ingrained respect for this organization, and funds continually pour in. The overseas work of the foundation is becoming even more intensive, and thus far more than 600 individuals have been helped.

As portrayed by Tibetan children, the work of the local Taiwan aid team takes on a more amusing air. (courtesy of IACT)

Doing a lot with a little

Here is a story that spread like wildfire over the Internet in 2002:

Taiwan has a medical assistance team stationed in the African nation of Bukina Faso. One of its members, 27-year-old Lien Chia-en, a doctor doing overseas service as a substitute for military service, discovered that many people in his host country, with its high unemployment, lacked adequate clothing. He also discovered the unrelated problem of local animals choking to death after eating plastic bags left around on the street. So, working with a local church group, he launched a "clothing for plastic bags" exchange program. He wrote to his friends online in Taiwan asking them to donate 40 boxes of second-hand clothing. His friends passed his email along to others, and eventually, with the Presbyterian Church in Taipei as the collection center, more than 60 boxes of clothing were mailed to Burkina Faso. Through the same channels, Lien raised NT$150,000 to dig new wells to improve the safety of drinking water for Burkina Faso residents, and a generous individual in Taiwan who heard about Lien's work then donated an additional NT$600,000.

As Lien's email rippled ever outward, more aid from Taiwan flowed to Burkina Faso. Via a volunteer in a remote land and the medium of the Internet, the kindness of people in Taiwan knew "zero time lag" with the people of Burkina Faso. When Lien returned to Taiwan for the Chinese New Year holiday, he said that though his term of service expires in June, he is considering signing on for another year to further share the kindness of Taiwan with new places.

It's a cold world, but many people have warm hearts.

Foreign medical assistance from Taiwan began with official aid to friendly countries, and in recent years has flourished as many private groups have joined in. According to a survey by the Department of Health, from 1995 to 2000 the government and nongovernmental organizations (NGOs) invested over US$100 million in medical and public-health assistance in 78 countries (see Table 1).

There are a number of internationally known organizations from Taiwan that directly send personnel abroad to provide free treatment, public health education, aid in the prevention of epidemic diseases, and disaster relief. These include the Noordhoff Craniofacial Foundation, the Taiwan Root Medical Peace Corps, the Tzu Chi International Medical Association (part of the Tzu Chi Foundation), the Taiwan International Medical Alliance (TIMA), and the International Action and Cooperation Team (IACT). In addition, many other groups better known at home than abroad-such as the National Tuberculosis Association, the Eden Social Welfare Foundation, Teng's Foundation (an antismoking group), and ROC Rotary clubs-all contribute to international technical cooperation in public health and provision of medical supplies. Moreover, some hospitals, religious organizations, and charitable groups in Taiwan have provided medical aid to specific target countries, sometimes long-term, sometimes on a one-off basis. But because they all keep a low profile and there are so many of them, it is impossible to provide an exhaustive list here.

More and more young doctors are choosing to work abroad in realization of the ideal "all men are brothers." Lien Chia-en, a doctor doing overseas service in lieu of military service, is working in Burkina Faso, where he is accepted as one of the gang by local kids. Some of the kids are wearing "exotic" clothes donated from Taiwan. (courtesy of Lien Chia-en)

Lives on the line

In principle, NGO medical aid providers from Taiwan do not take into account whether a country is a diplomatic partner of the ROC; they will help anyone who is in need, which is why their tracks cover so much of the world. But our story really begins back in the days when the government sent medical teams to assist allied countries.

Just inside the entrance of the offices of the International Cooperation and Development Fund (ICDF), located in the embassy area of Tienmu, a district of Taipei, the flags of Taiwan's diplomatic partners shimmer in a row. Many of the African countries represented here (who have changed from time to time as some have withdrawn recognition from the ROC and others have extended it) have been recipients of ICDF medical aid.

The ICDF is a foundation established by the Ministry of Foreign Affairs to offer technical assistance, investment, and loans to foreign countries. It is famous worldwide for its agricultural aid teams, but its overseas medical teams also have a long history. The first team of doctors, all from the armed forces, was sent in 1962 to help Libya improve its public and military medical systems, which means that ICDF medical aid to Africa dates back 40 years. Libya, Liberia, Guinea-Bissau, and the Central African Republic all benefited from medical aid in the past, and there are currently teams stationed in Burkina Faso, Chad, Sao Tome and Principe, and Malawi, all four of which have formal diplomatic ties with the ROC.

"The main reason that we have stationed medical teams mostly in friendly countries in Africa is because that is where the need is," explains Dr. Yang Tzu-pao, secretary-general of the ICDF. In the 1950s and 1960s, Taiwan eradicated diseases like smallpox and malaria at home, and many African states-with similar climatic, environmental, and hygienic conditions-felt that they could learn from Taiwan's experience. So the ROC Ministry of Defense sent medical teams to assist them. By the mid-1990s, given cutbacks and the shortage of military medical personnel in Taiwan, the ICDF switched over to recruiting personnel from civilian hospitals. In the last couple of years, young men working abroad in lieu of military service have also joined in.

The International Cooperation and Development Fund has been sending medical aid teams to allied African countries since the 1960s. Their work has always been well-regarded. The photo shows citizens of Chad lining up as they wait to be seen by an ICDF medical team stationed there. (courtesy of the ICDF)

Bringing in good water

The different medical teams have different duties, depending upon the needs of the host country. But most of these duties revolve around hospital work, serving remote areas, teaching medicine and medical technology, and public health guidance. Of course, medical aid also embraces donating medical supplies and equipment. One of the more unique programs, one started just recently in Sao Tome and Principe, involves instruction in acupuncture. Because traditional Chinese medicine (TCM) is gentle and relatively easy to learn, it could prove an effective means to help cope with the shortage of medical personnel in that country, while setting down roots for TCM in Africa in the process.

There are many medical aid teams from around the world stationed in Africa, but not many stick it out through political turmoil, whereas those from Taiwan often find themselves in the line of fire. Cheng Huai-cheng, a chief nurse formerly stationed in the Central African Republic, recalls that at the moment of the 1996 coup in that country, she was not with the rest of the medical team, and had to make a break for it on her own. She was robbed by rebel troops, and spent eight days trekking through mountains and swamps to avoid the fighting, until finally reaching the airport where she waited for UN peacekeepers to enter the country. There she came across personnel from the local ROC embassy and the medical and agricultural aid teams, who had scattered to safety and also found their way to the airport. Hugging one another and in tears, it seemed as if their previous encounters had been in a different lifetime. Later, wounded and injured persons flooded into the airport, where they were able to receive treatment thanks to the Taiwan medical aid team, the only one to remain in the country and keep working.

"Most people think of ICDF medical teams as only having a diplomatic purpose, and undervalue their humanitarian significance," says Yang Tzu-pao. Yang does confess, however, that diplomatic considerations are often given first priority, and the ROC has always responded to breaks in diplomatic relations by the withdrawal of aid missions. This means that aid teams find it hard to set down roots in recipient countries. In recent years the ICDF has devoted more attention to training local personnel who can carry on its work if it is forced to leave, and to strengthening local public health institutions.

Take for example the case of Papua New Guinea, a country with which Taiwan does not enjoy formal diplomatic ties. Epidemic diseases spread quickly there because it lacked a decent water supply system. In 1991, PNG asked for help from the Asian Development Bank, and the ICDF joined the ADB program as an equal financial partner to assist PNG to improve the water systems in two cities. They followed up this success with a similar project to assist Haiti to upgrade the water system in one city.

In addition, the ICDF has gotten together with Yang Ming University in Taiwan to establish the International Health Program. It will offer scholarships to students from the developing world and assist in the training of medical personnel.

Young doctors from Taiwan's "International Action and Cooperation Team" are working in a Tibetan refugee area in southern India, teaching local children correct ideas about public health and sanitation. (courtesy of IACT)

Missionary spirit

There is a consensus among international medical aid groups about the basic principles of providing aid: do no harm to the local medical system, inculcate correct ideas about public health and hygiene, improve local public health and sanitation, assist in the construction of a more efficient medical system, do follow-up monitoring and guidance, and so on. Thanks to the experience accumulated by the ICDF and other aid groups, NGOs providing medical aid need no longer be limited to satisfying the ambition of some romantically minded individuals to do good deeds. For example, the cleft lip and cleft palate surgery program of the Noordhoff Craniofacial Foundation (NCF) in Vietnam, Cambodia, the Philippines, and elsewhere includes free consultations, technical instruction, equipment donation, post-surgery speech therapy, and so on, so that medical resources are applied in a systematic manner.

"While it only takes an hour to repair a cleft palate or cleft lip, the incidence of this problem among Asian people, at one per 500-600 births, can certainly not be handled by Taiwanese doctors sporadically going abroad to help," say NCF director Rebecca Wang. Full treatment requires an entire medical team, including a reconstructive surgeon, orthodontist, ENT (ear, nose, and throat) specialist, speech therapist, and psychologist, as well as a patient follow-up system. If effective aid is to be delivered, then people in the host country must be trained to take part in this system. Thus in recent years not only has the NCF taken its work overseas, it has also offered support for doctors in recipient countries to come to Chang Gung Memorial Hospital for training in craniofacial surgery.

M. Samuel Noordhoff, a doctor from the United States, had been in Taiwan for decades when he founded the NCF in 1990, and he began taking teams of Taiwan-trained craniofacial surgery experts to other countries in 1998. Whereas the most common formula adopted to explain overseas aid is "giving something back to international society," Rebecca Wang says that it would be more accurate to say that they are driven by "a missionary spirit," with their religious-based concern for others naturally knowing no national boundaries.

A project to ensure supplies of clean water in Papua New Guinea, in which the International Cooperation and Development Fund played a major role, sharply reduced the incidence of epidemic diseases. (courtesy of the ICDF)

The joy of giving

Religious-based concern for others is greatest when it does not distinguish among formal faiths, but embraces all. While the NCF has been doing its work in neighboring countries, Taiwan's world-famous charitable organization, the Tzu Chi Foundation, has spread across the globe, providing medical assistance in a spirit of respect for the host nations and utilizing medical resources in situ to help others help themselves.

The Tzu Chi Foundation was created as a result of the compassion felt by Dharma Master Cheng Yen for those suffering in the world. Its spirit is summed up in four terms: compassion, relief, joy, and release. It is a large reformist organization providing social assistance that combines spirituality, medicine, culture, and education. Tzu Chi members are spread around the world, and its medical system extends to virtually every corner of the planet. The Tzu Chi International Medical Association was founded under its auspices to provide free medical care and emergency relief.

"Tzu Chi branch organizations abroad are like those in Taiwan, and keep a continual eye on local needs, with the local Tzu Chi Medical Association handling all medically related duties," explains Wang Yun-ching of the Department of Religious Culture & Humanitarian Aid in Tzu Chi. Local people understand their situation best, and the main organization in Taiwan tries to interfere in overseas branch activities as little as possible. They only arrange assistance from neighboring countries to nations that have relatively few Tzu Chi personnel. For example, disaster relief and medical care in Indonesia are in part provided by personnel sent by Tzu Chi branches in Taiwan and the Philippines. In contrast, the enormous expenses of the two dialysis centers in Malaysia are covered entirely locally by donations from grateful patients and the money raised by local volunteers through small donations and recycling of waste.

Wang Yun-ching relates that most people have the mistaken idea that all Tzu Chi volunteers are Buddhists. In fact, those handling medical duties for Tzu Chi branch organizations around the world include persons of many different faiths. For instance, most volunteers in Indonesia are Muslims, most of those in Brazil are Catholic, and so on. No faith is excluded, and all those who contribute to providing medical resources through the Tzu Chi network are equally "Tzu Chi people."

Since the establishment of its first overseas branch in 1993, the Tzu Chi International Medical Association has set up shop in 11 countries. It is hard to estimate how many people have been treated, but the number is enormous. Side-by-side with consultations, Tzu Chi also implements community public health programs. The Kali Angke River plan, an ongoing Tzu Chi project in the Indonesian capital of Jakarta, is an example of community public health improvement that has gotten a lot of attention around the world.

The Taiwan Root Medical Peace Corps found large crowds waiting at each stop in their volunteer tour of Bolivia. TRMPC members came to realize that medical aid requires not just enthusiasm, but also endurance. (courtesy of the TRMPC)

Helping others help themselves

In January of 2002, there was serious flooding in Indonesia, and Jakarta was under water for a solid month. When the water finally receded at the end of February, the village of Kapuk Murua, located at "the black heart of Jakarta" where the Kali Angke River reaches the sea, was at each high tide steeped in seawater heavily polluted with garbage and human waste.

At first the Indonesian Tzu Chi branch just entered the area to provide medical care and basic necessities. But when the water finally receded for good in March, there was a serious threat of epidemics of dengue fever and dysentery. So they mobilized people for thousands of man-days to undertake several large-scale cleanups of both banks of the Kali Angke River, clearing away as much as nearly one million tons of garbage in a day.

But the local Tzu Chi branch concluded that provision of additional medical care and basic necessities could only be stopgap measures, and that the only way to get to the root of the problem would be to eliminate illegal construction along the river and create flood control mechanisms. Therefore, Tzu Chi sought cooperation from the Indonesian government and began the enormous task of taming the Kali Angke River.

Tzu Chi Indonesia has taken responsibility for rehousing the people from Kapuk Murua. They acquired land from the government land development bureau to create "Tzu Chi Cengkarang Village," and are constructing 1100 new housing units there (known in Tzu Chi parlance as "great love houses"), built entirely using funds raised locally. The Indonesian government is deciding what illegal buildings along the river to tear down and is in charge of engineering work on the river.

"Self-help, local resources" is the aim at Tzu Chi. They believe that medical aid is not simply coming to the help of someone in pain, but should also inspire local people to bring their own compassion and kindness into play, so that even more people will contribute.

The advantage of youth

The Noordhoff Craniofacial Foundation has its expertise in cranio-facial surgery, and Tzu Chi has the support of over ten million volunteers around the world. Two newcomer medical aid groups-the International Action and Cooperation Team (IACT) and the Taiwan International Medical Alliance (TIMA)-rely instead on youthful enthusiasm. Undaunted by the near impossibility of comparing with the outstanding accomplishments of their predecessors, they are serving people with academic medicine and medical matchmaking.

IACT was formed in December of 2001, and currently has nearly 60 members. Most are under-thirty professionals working in the fields of medicine, law, and accounting. IACT President Chen Hou-chuang says that the group was founded in response to the dramatic changes that have swept Taiwanese society in recent years.

"The shock of the 921 [September 21, 1999] earthquake on young people around 30 years of age is almost impossible to put into words," says Chen. People who had grown up with the economic and political miracles of the previous three decades learned trust and a belief that hard work would be rewarded, and thought only of moving ever higher and farther. But 921 caused many people to realize that amidst the seemingly endless demand for more that characterizes economic growth and democratic politics, there also remains a great deal of pain in this world. If in a wealthy country like Taiwan recovering from 921 is as difficult as it has been, they wondered, what must it be like in the developing world?

"The strengths of young people are their ability to learn and a driving curiosity to get to the bottom of things," says Chen. Before the founding of IACT, they sent several delegations to France to visit the Medicins sans Frontieres aid group, to study the attitudes needed for international medical assistance. They launched their effort in a spirit of "research," seeking to get to the root of problems of illness and public health in the developing world, in order to help train medical personnel in host countries and inculcate correct ideas about public health there.

1000 sandals

Currently the IACT has three action plans in progress, one in the African nation of Chad, one in Nepal, and one in a Tibetan refugee area in southern India. Because they have limited funds and experience, they have opted to take their first steps in cooperation with international medical aid projects. For example, the ROC Ministry of Foreign Affairs provides financial support for their participation in the AIDS research plan in Chad, where they are working with the French branch of CARE.

In the Chad project the IACT discovered that truck drivers passing through Chad, which is a crossroads nation in north-central Africa, relieve their boredom by patronizing roadside prostitutes, and AIDS thus spreads along the highway. The IACT has been working with Chadian health education groups to go along the highway and advise truck drivers in the use of condoms in order to block the further spread of the disease.

Research in a Tibetan refugee area in southern India has also proved highly instructive. In visiting the area, IACT members found that the Tibetans, accustomed to living in a cool, dry climate at high altitudes, still maintained some of their previous customs even after moving to southern India, and these created a higher incidence of transmission of disease. For example, after washing their clothes, Tibetans just lay them on the grass to dry. But in the hot climate of southern India, this makes it easy for ground-dwelling parasites to get into the clothing, so the IACT advised people to change the way they dry clothes.

Likewise, Tibetans normally go barefoot when weather permits, so those is southern India often did not wear shoes at all. "We gave them 1000 pairs of sandals that we bought locally," says Chen Hou-chaung. By getting to the root of epidemic diseases in the refugee areas, they could attack the problem at the core, rather than wasting medical resources in treating symptoms.

Another miracle

The TIMA, also founded in 2001, defines itself as a medical matchmaker. Huang Song-lih, a professor at the Institute of Environmental Health Sciences at National Yang Ming University, says that many developing countries have Western medical teams stationed on their soil, but these groups are often short of resources. Taiwan is wealthy, and most TIMA members are high-income medical professionals with wide contacts, so TIMA feels that it is a more efficient division of labor to assist frontline providers to get the resources they need rather than going out in person.

Currently, TIMA is providing computers and software for a hospital serving refugees along the Thai-Burmese border. The computers were sent over early this year, and soon computer engineers from Taiwan will go to the hospitals to teach people how to use the new systems. In addition, the TIMA has introduced an American group doing antismoking work in Cambodia called ADRA to Taiwan's Teng's Foundation, which has been doing similar work to great effect for many years in Taiwan; Teng's Foundation will assist ADRA in the design of antismoking materials.

As more highly skilled professionals like Huang Song-lih participate in medical aid, it can be increasingly combined with scholarship and research. The Taiwan Root Medical Peace Corps (TRMPC), which has done volunteer medical care on more than 100 occasions home and abroad (including in Asia, Africa, and the Americas), offers an example of this synergy.

"Although the pattern in international medical aid is to offer long-term aid at fixed locations, the TRMPC will at least for the near future continue its approach of not adopting any fixed location, but of doing volunteer care deep in those areas that local medical systems do not reach," says TRMPC President Liu Chi-chun. Like explorers on the Discovery Channel, the TRMPC's tramping through the developing world has yielded some valuable academic discoveries. For example, in Africa they noticed local people using wild plant leaves in place of quinine to treat malaria. Liu entered into cooperation with the graduate institute of biopharmacology at Taipei Medical University to study this plant. "If we succeed, then residents can just get their medicine from their locality, and no longer will face the problem of only being able to take quinine in limited amounts because it is so expensive on the international market," says Liu Chi-chun, adding that the arduous task of going to remote places to offer medical aid can be made much more rewarding and interesting if combined with academic research.

The TRMPC was founded by doctors who are also romantic adventurers at heart, the Noordhoff Craniofacial Foundation is a manifestation of the missionary spirit, the ICDF fulfills Taiwan's responsibilities to the international community, the Tzu Chi International Medical Association extols the spirit of interfaith cooperation and self-help, IACT and TIMA are based on a rethinking of their world by young people.... But whatever their conscious motivations, perhaps their charitable instincts draw on an even longer tradition, one that has run through the blood of their fathers and brothers for centuries and millennia and is summed in the aphorism: "All men are brothers."

When one's brother is in trouble, no matter how far away, can there be any reason not to go and help? International medical aid is steadily expanding in Taiwan, but still this is just the beginning. Just like the miracles Taiwan has constructed in its economy and democratic political system, a new miracle of medical assistance is now being created.

Source: Department of Health