Buddhist Compassion Relief Tzu Chi Foundation

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Jun 19th
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The Light in Southeast Taiwan That Never Dims

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At 4:30 a.m. the alarm goes off. Dr. Chang Yuh-Lin, superintendent of the Yuli Tzu Chi Hospital, wants to stay in bed and out of the cold. But he fights off the chill of winter and hurries to the emergency room, the first stop of his work every day.
Let us go back to the year 2003, when a new section of the hospital opened. Although the area of the hospital has been expanded, it was still very short of manpower. There was only one medical staff in the emergency room, with no security guard. Dr. Chang feared for the safety of his staff and remained in the hospital until 10:30 every night; then he came around four in the morning to accompany and comfort them.

Sleep late and wake early for the early morning clinic

After he arrived at the hospital, Dr. Chang discovered that farmers tended to postpone visits to the doctor because of all the chores they have to do. They were worried that, if it rained before they harvested their grain, it would waste their work of the whole season. There were also many students who could only visit the doctor before school.

So Yuli Tzu Chi Hospital started the early morning clinic in 2003. At first, it was only Dr. Chang who conducted the morning sessions from Monday through Friday all by himself; he was concerned that his colleagues might not be able to get up early. Later, Dr. Chang Feng-Gang, who had a habit of taking a swim in the morning, proposed that he take the clinic, which started at six every morning.

Dr. Chang said: “When I wake up to rain and cold mornings, I really want to stay in bed, thinking there might not be too many patients in this cold weather. But, when I arrive at the clinic, I still see a lot of patients coming despite the weather. One time, there was even a ninety-five-year-old grandmother who came all the way from Rui-Sui.”

It takes at least half an hour to drive from Rui-Sui to Yuli; both the grandmother and her family had to wake up even earlier. Dr. Chang thoughtfully offered a three-month prescription in order to reduce Grandmother's visits but the family courteously declined, saying that it is always the happiest day for her to visit the doctor.

The grandmother always dresses up very nicely on this day of the month because she is going to see the doctor. The family begged Dr. Chang not to take away the grandmother's joy; he realized that tending to a patient included both caring for the mental state as well as the physical symptoms. Sometimes, the mental aspect is more important than the physical one.

There are many elder people in this rural area who have chronic illnesses and problems with their joints. Therefore Dr. Chang promotes stretching routines and exercises. Dr. Chang says: “The engine of an old car needs to be started and warmed for a while before driving. In the same way, I asked the elderly people to warm up with stretching when they get up every morning. If they pull their muscles, strain their joints and contract infection, they will need to take medicine frequently, which might lead to the need for dialysis. That is why exercising is very important to maintain a healthy body.”

Some patients say that they have been exercising during their work on the farm all day, so why do they still need to exercise? Dr. Chang explains that, the more physical labor they do, the more stretching exercise they need. Knowing how difficult it is to exercise every day, Dr. Chang demonstrates a routine exercise with a colleague in the waiting area of the clinic in the morning and evening; this promotes the good habit of exercising to the public.

Twenty-four hours of brain surgery saves lives in small hospital

Operations are part of Dr. Chang's job description. As a brain surgeon, Dr. Chang often sleeps in a hospital bed at night to accommodate the unpredictable schedule of brain surgeries. He gets so exhausted that he falls asleep within three seconds of lying down in bed. By the time he is fast asleep, his phone rings with a request for surgery.

When he tends to a patient and asks about his condition, the patient replies: "my heart is very happy".
Dr. Chang: “I have not woken up to hear you say that your heart is happy. I am not happy.” After clarifying with the patient's family, Dr. Chang realized that he had had a palpitation.

Dr. Chang explained that medical staff should use language understandable to the patients, as well as learning to understand the language they use.
When patients say: "I feel a sense of suppression in my chest", they may have chest pain.
When they say: "I hear singing in the ear", they may have tinnitus, with a high risk of a stroke.
If they say: "my head is turning", they probably feel dizzy.
There is also the expression of "my ears are far", which may refer to hard of hearing.

Operating a 24-hour emergency clinic is exhausting for the medical staff. However, the patients can be effectively diagnosed and treated in a timely matter, especially when emergencies occur. Dr. Chang always says: "the speed of an ambulance cannot compete with the transformation of diseases."

It is essential that patients with brain damage are treated immediately. Several years ago, a little girl fell off a review stand when traveling to Rui-sui, Hualien with her parents. After she arrived at the Yuli hospital, she was diagnosed with internal bleeding in her head. Dr. Chang explained the condition to her parents and said that there was an immediate need for surgery.

However the father was doubtful: "are you capable of doing this kind of surgery in this hospital?" Dr. Chang explained that he himself was a brain surgeon and would never waste time by letting a patient stay in the hospital if he was not able to perform the surgery. The girl's mother was also in the medical profession; she understood the urgency of her daughter's condition and agreed to the surgery. The little girl soon recovered after a successful procedure.

Ting-wei, a college student living in Tai-mali, Taidong, fell off the roof of his parents' house when he was doing preventive measures for an incoming typhoon. His brain was severely damaged. His parents were going to send him to Hualien Tzu Chi Hospital; but, by the time they passed Chishang town, he was already unconscious and scarcely breathing. They took him immediately to Yuli hospital for surgery.

During the surgery, Chang found blood clots in Ting-wei's brain and the blood pressure was decreasing. Fortunately, the young man survived the surgery. When he was discharged, the hospital planned a celebration for his rebirth with a cake. His father was very grateful to have Yuli Tzu Chi hospital in a rural area in eastern Taiwan.

Everyone is multi-tasking

A raft capsized in October 2012. A patient was rushed to Yuli Tzu Chi hospital and diagnosed with swollen lungs, causing him to breathe heavily. His friend wanted to transfer him to Hualien Tzu Chi Hospital, but Dr. Chang worried that the patient might not survive, even with intubation, because the severe condition of the swollen lungs might cause hypoxia. Considering the risk too high, Dr. Chang treated the patient in the Yuli Hospital.

Five days later, the patient recovered and was discharged from the hospital, going back to Taipei. He was very glad and asked to take a picture with Dr. Chang; he expressed his intention to post his story online. He thanked the medical team of the hospital to help him recover in such a short period of time. Dr. Chang said: "to tell you the truth, with such a severe condition of swollen lungs, it is sometimes hard to save life, even in an environment with abundant resources."

A doctor from the emergency department of a large hospital in west Taiwan came to the hospital; he did not understand why Dr. Chang would treat the drowned patient who had severely swollen lungs. Dr. Chang replied, "since this is a small hospital, we must be able to multi-task. A brain surgeon like myself also needs to treat patients with lung infections, asthma, diabetes and swollen lungs. Both the doctors and the nurses are multi-functional."

Only listen to the Superintendent

If we speak of multi-functions, the hospital must run its emergency clinic, regular medical clinics, conduct surgical operations, tend to patients and carry out administration and meetings. It also shoulders the responsibility of organizing medical and charity missions. With the help of his staff, Dr. Chang frequently helps families in need to clean their homes and provides medical treatment there. Many patients accept treatment because they believe in him. One example is Grandfather A-Zhi, 90, who lives on his own.

Grandfather A-Zhi once tried to cure his swollen hand by applying herbal ingredients; it almost caused cellulitis. Dr. Chang visited him and persuaded him to accept treatment with clear and comforting words. Grandfather A-Zhi also had heart problems, so he needed to regularly visit the doctor. However, he sometimes missed his appointments intentionally – but the reason that he accepted treatment was because he trusted Dr. Chang.

As Grandfather's heart grew weaker and finally began to fail, it could only function weakly. He had heavy breathing and gasped for air and had to stay in the hospital. The nurse found him not wanting to eat; the relations between him and his son were poor, so he did not listen when his son asked him to eat. He closed his eyes when the nurses talked to him. Dr. Chang knew that using an esophageal nasogastric tube or forcing him to eat was not the way he would wish to be treated. With his failing heart, neither water nor an intravenous drip could be used. The only way was to persuade him to eat of his own free will.

One morning, Dr. Chang visited the old man when he was still asleep. Remembering that his son had mentioned that his father liked to have a warm towel on his face, Dr. Chang wet a towel with warm water; he applied it on Grandfather's face and gently rubbed his face for a while.

Dr. Chang then said to Grandfather: “It is morning now. Grandpa, let's eat something.” He reacted by opening his eyes, nodded at Dr. Chang and began to eat. Afterwards, the treatment went smoothly.

The Lighthouse of medical treatment is always shining

In general, ambulances that go to the Yuli Tzu Chi Hospital are traveling on Provincial Highway 9. To the south, it is the Dong-li Village in Fu-li Town (Hualien County). From the north, there are Sang-ming, the Yuli Fire department and Rui-sui. Further to the north is Fu-Yuan Village. On Provincial Highway 11 on the coast road, there are Cheng-gong (Tai-dong County) and Chang-bing Town. The official population of Yuli is 25,000. However, the actual number of people living there is only about 20,000. If you add people from nearby towns and villages, the total population of the area is less than 60,000.

“According to the regulations, a hospital with less than 100 beds does not need to have an emergency clinic. However, our mission is to protect lives, which is hard to accomplish without an emergency clinic. That is why we need to keep the emergency clinic operating,” emphasizes Dr. Chang. “Operating an emergency clinic is a big burden on our staff and the budget of the hospital. But, to carry out compassion of Master Cheng Yen, we must maintain it, despite the hardship.”

One might ask: with such a small population and geographic disadvantages, it must cost a lot of money to build a hospital in Yuli. To answer the question of why they keep going despite financial deficits, Dr. Chang replies: “because we need to respect lives. Whether it is immediate treatment or gradually warming the hearts of the patients, it is the hospital's mission to respect lives.”

Most people can sleep throughout the night until the next morning. During the past decade, Dr. Chang has been on call throughout the night until the next morning. Whether it is emergencies or a nurse not being able to give an injection, he is always the one being called. It is usual that he starts looking after the patients without having had breakfast in the morning. With all the tasks he has to do, he is working harder than doctors in residency.

“Operating the Yuli Tzu Chi Hospital is like running a grocery store with many tasks of different importance. It is easy to get lost during busy times. But, after working all night, I look out of the window, seeing the dawn rising over the village, it is really beautiful.
“Sometimes, looking at the landscape around me and up to the sky makes me understand that everyone has his or her role in life. A swallow doesn't need to envy a roc being able to fly high. Swallows can build their own homes. When your heart is filled with joy, ten years can feel like a day. Looking back, the highs and lows don't matter that much any more.” he said.

“Imagine our hospital as a lighthouse. If we turn it off or if we turn off the light of the Guan-shan Tzu Chi Hospital, the valley between Hualien and Taidong on Provincial Highway 9 would be dark. Therefore, the symbol of this light is very important. To keep the light strong and bright, we need energy and a giving heart from each of us.” Dr. Chang continuously protects this lighthouse on Provincial Highway 9; he understands the importance of Yuli Tzu Chi Hospital.

By Wu Wan-Lin in Yuli, Hualien on March 1, 2014
Translated by Kay Tsao