International Medical Outreach


Written by Audrey Cheng, Peter Chu, Scarlett Liu, and Tina Tuan
Translated by H.B. Qin  

Volunteer giving

Tzu Chi International Medical Association’s healthcare professionals and volunteers hold a free clinic in the San Mateo neighborhood of Manta, Ecuador, on July 15, 2019. Photo/Peter Chu


Once upon a time, it was calm and tranquil in Canoa, a small coastal town in Manabi Province, Ecuador, where a tropical climate with minimal variation between seasons offered consistently warm temperatures. The town’s residents enjoyed picturesque views that seemed to be everlasting, with endless beaches and ocean, large trees in front of every house, and hammocks hanging wherever there was shade. 

The people would express their lethargy in the often humid heat by swinging in the hammocks; when thirsty, they would climb the trees to pick coconuts. The orchards growing on fertile soil always yielded bountiful harvests; gains from fishing were always ample, too. At the same time, continually visiting tourists brought business and profit to hotels and local produce shops. Gradually, the people forgot what sorrow was.

But then, a 7.8 magnitude earthquake on April 16, 2016, shattered their pleasant reverie and destroyed their homes. As they rolled from their hammocks to the ground in a panic, and before they knew it, even La Parroquia San Andrés, Canoa’s beloved Catholic church and a landmark in the town, collapsed to the ground in rubble amidst the people’s cries of horror. The sound of heartbreak seemed to emanate from its broken walls and ruins.

International Medical Outreach

Tzu Chi volunteers walking in Canoa
On April 29, 2016, Tzu Chi USA’s disaster relief team assesses damages in Canoa, one of the coastal cities hardest hit by the 7.8-magnitude earthquake that struck Ecuador on April 16. Photo/Tzu Chi USA National Headquarters
Disaster survey in Canoa, the hardest-hit area
Tzu Chi volunteers see countless collapsed and severely damaged houses during their disaster assessment following the 2016 earthquake in Ecuador. Photo/Tzu Chi USA National Headquarters

Rebuilding Homes Amid Ruins

As updates on the situation in Ecuador after the earthquake spread, Tzu Chi USA formed a nine-member disaster assessment team led by Tzu Chi volunteer Martin Kuo. The team traveled to five of Ecuador’s hardest-hit cities: Manta, Portoviejo, Pedernales, Canoa, and Jama.

During the assessment, Tzu Chi volunteers met Jenyffer Ruiz, who was born in Ecuador but had lived in the United States for over 20 years. While away from her homeland, she longed to return to help her people someday and finally did when she returned to Ecuador in 2015 to pursue what she felt would be a more fulfilling life.

Seeing Kuo leading the disaster assessment team, everyone traveling and working tirelessly, moved Ruiz. Thus, she joined the disaster assessment team, and since she is fluent in English and Spanish, she assisted as an interpreter, closely bonding with Tzu Chi during the mission that lasted over a month.

As an Ecuadorian, it’s my duty to help my country and fellow countrymen. But for Tzu Chi to come from afar to help us was so touching that words cannot describe it. Tzu Chi doesn’t owe us anything, but they took on the duty and came.

Accompanied by Ruiz and aiming to provide practical aid to disaster-stricken Ecuadorians, Tzu Chi volunteers proceeded with courage, determination, and creativity. Tzu Chi launched a Cash-For-Relief program during the earthquake relief mission in 2016 and a flooding relief mission in 2017. The initiative paid the survivors in several cities wages higher than the local average to participate in reconstruction, gathering people’s strength while motivating them to take action to overcome their pain. Hundreds of people joined the program. Tzu Chi, a foreign organization that had brought selfless help and support, warmed the disaster survivors’ hearts, inspiring their participation in recovery work while providing immediate assistance. 

On September 17, 2017,  Mexico, 2,400 miles from Ecuador, was hit by a massive earthquake that severely impacted several cities. Tzu Chi Taiwan invited Ruiz to participate in the Foundation’s disaster relief efforts there. Seeing that a team of doctors of different specialties was providing free medical care alongside Tzu Chi’s aid distributions, offering professional medical treatment to earthquake survivors in Mexico, Ruiz immediately thought of the post-earthquake healthcare needs in her homeland.

Ruiz took the initiative to talk to Kuo, saying, “You know the situation in Ecuador best, and an earthquake struck Ecuador before Mexico, so why did Tzu Chi offer free clinics in Mexico but not Ecuador? The people of Ecuador are also in great need!” Agreeing, Kuo and Ruiz approached William Keh, then-CEO of the Buddhist Tzu Chi Medical Foundation, to ask for help for Ecuador. Keh and Kuo then discussed the feasibility of a medical mission in Ecuador and the human resources required and began preparations for free clinics there.

Launching a Medical Mission in Ecuador

In January 2019, the Tzu Chi medical team traveled to Ecuador, answering the country’s call for free clinics. From January 10 to 16, the team held seven clinics whose services reached Canoa, Portoviejo, Santa Ana, and Guayaquil. With the U.S. team bringing medical resources and Ecuador providing additional human resources, the free clinics proceeded smoothly and served 3,842 patients.

When Martin Kuo first set foot on Ecuadorian soil with Tzu Chi’s medical team, he felt greatly relieved. “We first came here in 2016 after the earthquake and then after the floods. We realized that people really needed medical care, so I started coordinating with all the doctors and then made all the necessary arrangements. Today, free clinics finally came into being,” he recounted with gratitude for the outcome.

The journey to this milestone was long and challenging. The dental equipment was difficult to transport due to its size, weight, and the delicacy of precise elements and tools. Despite that, Dr. Shirley Chen, a Tzu Chi International Medical Association (TIMA) dentist from Tzu Chi USA National Headquarters, led the team and supervised the transport of the equipment across the ocean to Ecuador. 

Meanwhile, Jenyffer Ruiz was responsible for recruiting local dentists and dental students to join the clinics. “Twelve doctors from the U.S. came to work with the local doctors we recruited to provide services to local communities,” she recounted.

I see this as a great opportunity to use my dental skills and services to help those in need.

In addition to dental treatment, the free clinics also spared no effort in promoting oral hygiene education among the local population. Dr. Chen saw that many children had cavities: “Education on oral hygiene of deciduous teeth is critical. We tried to bring knowledge in this field to the people.” This opinion was in line with Dr. Tungping Cheung’s thinking. “Prevention is more important than treatment, and our long-term assistance to local health care should focus on healthcare education,” he explained. 

The team’s consensus was that if Tzu Chi could popularize healthcare knowledge and encourage the adoption of a healthy lifestyle, Ecuadorians could become increasingly free from pain and suffering, which is also the ultimate goal of Tzu Chi’s international medical missions.

Bringing Heavenly Dew to a Parched Healthcare Desert

A team of Tzu Chi volunteers went to Canoa in 2017 to start a long-term charity program involving the reconstruction of La Parroquia San Andrés, the Catholic church of the order of Hermanas Franciscanas Misioneras de Maria Auxiliadora (Franciscan Missionary Sisters of Mary Help of Christians), which was a cherished gathering point in town. Two years later, on July 13, 2019, La Parroquia San Andrés was already bustling with joyful activity before dawn, as the community had gathered there for a significant event – a reopening ceremony. Tzu Chi had fulfilled its promise to rebuild the church and also offered a second free clinic service as part of the special occasion, benefiting Canoa residents with medical care yet again.

TIMA doctors and volunteers from the United States and other places, together with local doctors and volunteers, organized this large-scale free clinic event that lasted two consecutive days, July 13 and 14. After the free clinic in Canoa, the team went to the city of Manta and served the residents of the San Mateo neighborhood on July 15 and 16. 

There is only one pharmacy and hospital in San Mateo, which only treats minor illnesses. Due to the many people seeking care, patients often fail to get an appointment when they try to register. Those suffering from colds resort to buying medication at their discretion. In the case of major issues, they must take a bus to the big city to seek medical treatment, where the charge is $20 for each visit. More complicated health problems can only be addressed in bigger cities even farther away, while the quickest wait for a referral can take two to three months. Essentially, limited access to proper and timely medical care is another disaster here.

Understandably, over 500 people from San Mateo, which has a population of only 5,500, had already lined up before 7:00 AM to wait for Tzu Chi’s free clinic to begin. In this small community, where just having enough to eat can be difficult, most residents are hard-working fishers with meager incomes. The free clinic services provided by Tzu Chi were like a refreshing dew from heaven in a healthcare desert.

Oriental Medicine That Saves Lives

The free clinic in San Mateo aimed to treat local people without medical insurance to relieve their physical ailments. Residents who had worked hard for too many years without access to medical care wanted to take advantage of this opportunity.

Domingo Quagga, a 69-year-old fisherman, had been fishing for 50 years until he became ill and quit. During his fishing career, Quagga supported his family of four with a meager average income of $5 a day. Moreover, there were times when there was no gain, as the family’s livelihood depended on the weather. “My meager income is only enough to buy rice, and fish is the constant dish on the dinner table,” Quagga bemoaned.

The now-retired fisherman suffered from chronic illnesses. Due to long hours of soaking his hands in cold seawater and carrying heavy gear and catches on his shoulders, Quagga had endured physical pain for years. When he heard that Tzu Chi was to provide free acupuncture, a Traditional Chinese Medicine (TCM) treatment from the East, he hoped that a single needle would be effective and improve his ailments. And the TCM treatment did help, indeed.

My knee has been in pain for years, so the Chinese medicine practitioner stuck a needle in my knee, and the pain was relieved right away.

The TCM doctor who treated him was also warmed and touched when seeing Domingo Quagga’s smile as his pain subsided. The San Mateo free clinic reached a successful conclusion with the cooperation of a team of about 60 Tzu Chi volunteers and hundreds of local Ecuadorian volunteers. A total of 5,410 patients benefited from the four-day free clinic event.

During the free clinics in Ecuador in 2019, William Keh called on local healthcare professionals to establish a TIMA chapter, encouraging them to care for the local population’s health and share medical knowledge with the public. As for the people who had benefited and received medical attention, some clasped the hands of Tzu Chi volunteers with tears in their eyes, repeatedly thanking them for their care and company along the way.

Ecuadorians had witnessed and felt Tzu Chi’s love, which motivated many to join Tzu Chi’s activities as community volunteers in their cities of residence. They supported rebuilding efforts after disasters and helped ease their fellows’ suffering with caring hearts. When returning to Ecuador next time, Tzu Chi hopes to see more beautiful fruits of kindness from sowing the seeds of good deeds through free clinics, with everyone spreading care and compassion together.

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