To mark its 35th anniversary, the DOH recently awarded outstanding contribution medals to several doctors and nurses. Dr. Chen is the youngest doctor to have received the medal, which was bestowed on him in recognition of his three years of meritorious service in Africa.

As the DOH's first representative to Africa, Dr. Chen was given the opportunity to realize his dream of "tending the nation." He has won the outstanding contribution medal in recognition of his meritorious service.

Healing the spirit, treating the sick

Dr. Chen--who is 40 and graying--stepped up to the podium with the medal on his chest and said, "To 'treat the sick, heal the spirit and tend the nation' has been my ambition since my student days. The DOH sent me as a representative to Africa to improve national and regional health care. I have thus been able to put this ideal into practice." Dr. Chen's eyes light up when he speaks of Africa.

In fact, Dr. Chen did not so much go to Africa as return to Africa.

When he was a medical student at National Taiwan University College of Medicine, he visited Africa as a donor's representative for World Vision's 30-Hour Famine. At the time, Mozambique was in the midst of a civil war and countless people had become refugees. The seeds of compassion that were planted in Chen Chih-cheng's heart prompted him more than a decade later to return Africa with his wife and children.

How much courage does it take to uproot one's family and leave one's homeland and its comforts for a strange and impoverished land? Why were Dr. Chen and his family willing to make this sacrifice?

Says Chen, "I saw Africa's need as well as my own responsibility." Hoping that his family would join him, he spent six months talking with his wife about it. Little by little, he allayed her concerns about Africa's lack of public security, health risks and poor educational infrastructure.

"Taiwan's younger generation must be willing to go abroad. Only then will they be able to see the world from a broader perspective. Africa is not such a scary place. In some ways, even, it's nicer than Taiwan," says Dr. Chen with a smile. At least in Malawi you're not likely to be taken in by phone scams.

With Chen Chih-cheng acting as a go-between, in February of last year a team of ROC volunteer dentists provided free dental exams to an orphanage in Malawi.

Going where the need is

Malawi has been Taiwan's diplomatic ally since 1966. With an annual per-capita national income of less than US$200, this southeastern African country is the eighth poorest in the world.

Because of a symbiotic relationship between poverty and disease, Malawi's health care system is unimaginably underdeveloped.

Malawi is three times bigger than Taiwan and has a population of 12 million people. With fewer than ten doctors in the various medical specialties, it has a life expectancy of 37.1 (2002) and an annual mortality rate of 2.32% (Taiwan's is 0.57%). The main causes of death are malaria, AIDS, TB, pneumonia, dysentery, anemia and malnutrition.

In 1997 Taiwan built a modern, 300-bed hospital in Mzuzu, the third largest city in northern Malawi. In November 2000, a Taiwanese medical team was sent to the hospital to help solve Malawi's medical problems. In July 2002, Taiwan's Ministry of Foreign Affairs (MOFA) officially commissioned Pingtung Christian Hospital (PCH), Dr. Chen Chih-cheng's employer, to run Taiwan's medical mission to Malawi. The mission currently has ten to 15 short- and long-term staff members.

In fact, PCH had run overseas medical aid programs for several years before the MOFA took the Malawi medical mission under its wing.

Since its foundation, PCH's guiding principle has been to go wherever there is a need.

Originally, PCH was mainly staffed by foreign doctors and run with charitable contributions from overseas, but in 1994 it was transformed into a wholly locally staffed and funded hospital. Motivated by the missionary spirit of its founders, the hospital now provides medical aid overseas. One of the main reasons the MOFA chose PCH to send a medical team to Malawi was that it was already running medical missions in Wapang on the Thai-Burmese border, Kyrgyzstan in Central Asia and Yangon in Burma.

Taiwan built a modern, 300-bed hospital in Mzuzu. But that was only the beginning: the main task was to get the Taiwanese medical mission up and running and to train local medical personnel.

Living in Africa

In October 2002, as he was about to leave for Africa, Dr. Chen recorded his feelings in his diary: "I can't say I'm not afraid. I feel a mixture of trepidation and excitement. I'm a fledgling medical diplomat. Like an eaglet learning to fly, the only way for me to learn is to spread my wings and go for it."

As the DOH's first representative to Africa, Dr. Chen has traveled to 18 countries in the past three years and forged ties with medical organizations in each of them. He describes himself as being much like a salesman who is always touting Taiwan's public health and medical care achievements and looking for opportunities to cooperate with African countries. Once, he had to take four separate flights over two days to get to a meeting in an African country and do the same again on the way back. By the time he got home he could barely move.

As a result of Dr. Chen's tireless travels, Taiwan has launched medical aid programs in numerous African countries. For example, a Taiwanese team has effectively reduced the incidence of malaria in Sao Tome and Principe by spraying homes and buildings throughout the country. In Malawi Dr. Chen's Rainbow Clinic has developed a Fingerprint Identification System (FPIS) for AIDS patients.

Thanks to Dr. Chen's efforts, Taiwan has established medical missions beyond Malawi in Chad, Burkina Faso and Sao Tome and Principe.

It is also worth noting that Malawi's president has appointed Dr. Chen a member of his nation's medical delegation and that he has represented Malawi at World Health Organization conferences more than a dozen times.

Says Dr. Chen, "One of my responsibilities is to help Taiwan join the WHO as soon as possible. So far, Taiwan has been denied entry and has only been able to sit in the public gallery and listen to everyone else discuss issues that concern us." According to Dr. Chen, if Taiwan is to understand the rules of the game, it has to enter the inner sanctum and hear what is being discussed; only then will it be able to coordinate with its allies to find the best times for them to speak on its behalf.

The Fingerprint Identification System developed by Taiwanese doctors was presented at an international AIDS conference co-hosted by Malawi and the Taiwanese medical mission.

Rainbow Clinic

During his three years in Malawi, Dr. Chen did a great deal of grassroots work as a medical diplomat and humanitarian. He arranged internships in Taiwan for hospital staff from Mzuzu, set up a blood bank, organized blood donation drives, trained midwives, provided mobile health care to remote areas, founded the Rainbow Clinic for AIDS patients, introduced the FPIS for the clinic, and did much else besides.

The AIDS pandemic represents a huge, lurking threat to Africa.

Dr. Chen explains that Malawi has an HIV prevalence rate of 16-20%. To combat the disease, the Taiwan medical mission runs the Rainbow Clinic in cooperation with UNICEF and provides free AIDS drugs to impoverished patients, more than 3000 of whom visit the clinic on a regular basis.

To manage the distribution and administration of AIDS drugs more effectively, Dr. Chen and Dr. Yu Kwang-leung, head of the medical mission, jointly developed the FPIS. Until recently, the lack of a national ID card in Malawi made it impossible to identify which patients had already received AIDS drugs and to monitor treatment progress. The FPIS has solved this problem.

Midwife training aims to reduce Malawi's maternal and neonatal mortality rates.

Dr. Chen points out that Malawi has the highest maternal and infant mortality rates in the world. The neonatal mortality rate is 12.4%, and a quarter of the survivors do not live past age five.

Moreover, there are only two obstetrics and gynecology physicians and few qualified midwives in Malawi. To increase maternal and neonatal survival rates, Dr. Chen worked very hard to train midwives. In addition to providing basic public health education, he used diagrams to teach them how to identify twins, transverse lies and other difficult labor cases that required urgent referral to a clinic. He also provided midwives with bicycles and obstetric equipment.

"By saving a mother, we save a family. By saving a family, we give hope to the whole nation." One of Dr. Chen's most important tasks is to train midwives and provide them with equipment and facilities. Midwives are pictured here with the former mayor of Mzuzu (center).

Saving mothers

Dr. Chen is justly proud of the success of the first group of 25 midwives he trained. He reports that by June of last year, they had carried out 607 prenatal exams, delivered 404 babies and referred 14 cases to clinics. All expectant mothers and fetuses in their care were alive and well, a fact the medical community considers near miraculous.

Last year the medical mission began to help midwives set up delivery rooms in remote villages to prevent women from giving birth on the ground outdoors, as is the traditional practice. Says Dr. Chen, "By saving a mother, we save a family. By saving a family, we give hope to the whole nation."

As difficult as it may be to imagine, in Malawi people have no concept of giving blood. Hospitals don't have blood banks for emergency needs and many patients die because there is no blood for transfusions.

Dr. Chen recalls one particularly tough battle with death after a Taiwanese businessman contracted malaria. Tragically, the infection affected his brain, requiring an emergency blood transfusion that could not be performed because there were no blood banks in Malawi. Dr. Chen immediately mobilized colleagues and relatives to give blood, but despite their efforts the patient could not be saved.

To prevent a similar tragedy from ever happening again, Dr. Chen organized blood donation drives throughout the country, publicized the idea that giving blood saves lives, and imported blood screening equipment. Says Dr. Chen, "Achieving a safe blood supply is an enormous challenge in a country where one person in seven is infected with HIV."

Doing unto others...

Bit by bit, Dr. Chen's efforts have benefited people in Africa and indirectly strengthened Taiwan's ties of friendship with its allies.

In light of how successful the experience has been in Africa, the DOH is planning to promote a similar project in the South Pacific. Mackay Memorial Hospital, Wan-Fang Hospital, Kaohsiung Medical University Chung-Ho Memorial Hospital, and Changhua Christian Hospital all plan to join the effort to pursue "medical diplomacy" among the South Pacific island nations that are diplomatic allies of Taiwan.

Dr. Chen's foreign aid mission has been remarkably successful, but his concern that he would be out of touch with his medical specialty for too long and that his children's Chinese language education would suffer made him decide to pass the baton once his three-year contract was over. He has been succeeded by Dr. Lu Tao-yang, of Pingtung Hospital, as the DOH's second representative to Africa.

For three years, more than a thousand days, Dr. Chen, his wife and children lived a life of isolation and great material deprivation in Malawi.

Dr. Chen has nothing but compassion and understanding for impoverished Malawi and harbors no resentment. When he speaks of the lack of public order, the ever-present thieves and the fact that so many people carry guns to protect themselves, his voice betrays deep sympathy for the local people.

"They live in great poverty," says Dr. Chen. To the locals, a roadside stall with a few simple items represents a wholesale store and a bicycle an ambulance. The day after the Chen family moved into their home, a thief broke into it. They were burglarized three times in all. Despite the fact that everyone urged Dr. Chen to buy a gun and told him that he could scare off potential thieves by firing it into the air, and that he was often unable to sleep at night because of incessant gunfire, he refused to buy a firearm. He had come all the way to Africa to "save people, not to kill them."

While he was traveling around Africa, Dr. Chen relied on security guards and five dogs (two of whom died of poisoning) to protect his wife, children and home. Other than that, he put his trust in God to bless and protect them.

Also a father

Neither material deprivation nor lack of security made Chen Chih-cheng seriously question his decision to take his family to Africa. But when his youngest son suffered two agonizing malaria attacks, he felt guilty as a father and was plagued by doubts. Had he brought his wife and children to this distant land to endure this? Was the sacrifice worth it?

In Africa, more than 3000 people die of malaria every day. In Malawi, the infection is as widespread as the common cold. Says Dr. Chen, "Although as a pediatrician I was capable of treating my children, I was worried about the potential sequelae of cerebral malaria."

Although Dr. Chen had his doubts before going to Africa, now that he looks back on the three years he spent there, he feels very positive about the experience. "In Africa I rediscovered much that we've lost in Taiwan," says Dr. Chen. As examples, he cites the relationship between doctor and patient and the respect accorded to doctors. In Taiwan, the status of doctors is declining by the day, but in Africa doctors are respected and rewarded beyond measure. Many patients curtsy when they speak or shake hands with doctors. Dr. Chen was deeply moved by such signs of respect.

Dr. Chen thinks that other than this, the three years they spent in Africa were a very valuable experience for his children. His five- and seven-year-old went to an international school run by an American church. In addition to schoolmates from Malawi, they came into contact with kids from all over the world and developed a genuine international perspective. In Africa, life is simpler and less cluttered with material enticements. The children got used to living without TV and electronic toys and learned not to want to accumulate stuff.

Sowing seeds in Africa

Since Dr. Chen completed his mission and returned to PCH he has continued to expand the hospital's overseas aid work. He thinks a great deal about all the unfinished work there is in Africa.

Says Dr. Chen, "The biggest difference between foreign medical aid and agricultural development aid is that the former helps people directly and is therefore the most deeply felt." According to him, that is why the work must continue. If diplomatic relations were cut and Taiwan stopped giving medical aid, it would be a huge blow to sick people in Africa.

Since returning to Taiwan, Dr. Chen seems to have left his heart back in Africa. He constantly thinks of Malawi's manifold needs and is making every effort to provide logistical support to the country. He hopes to raise funds to buy a bus with diagnostic, X-ray and surgical capabilities, which will be employed as a mobile hospital and TB prevention vehicle. He also plans to give midwives bicycles with attached flatbed carts to be used as ambulances to transport women in labor. And he hopes to raise the money to buy small gifts to be distributed to promote blood donation. "The Taipei Blood Center has already pledged a blood donor bus," says Dr. Chen, with obvious excitement.

PCH has plowed and sowed good seeds in Malawi, but it has yet to gather the harvest. Much work remains to be done. As the DOH's first representative to Africa, Dr. Chen believes that diplomacy aims to forge friendship and establish good relations between nations and to enable them to live and work together; but "medical diplomacy" enables us to save lives and show humanitarian concern for our friends. We must not give up this worthiest of missions, he says.

"Long ago, foreign missionaries came to contribute to Taiwan. It is now time for us to give back. We must go where there is need." Dr. Chen says that he may still go back to Africa at any time.