HUALIEN, Taiwan — Here on Taiwan's rugged east coast, a good body is a hard thing to find. Or at least it used to be.
Now, one Buddhist group may have found the answer to the island's serious cadaver shortage.
For years, medical schools here were short on the dead bodies needed for research and training. The cadavers they did use were unwilling donors, often from mental institutions. One problem was cultural: Confucian tradition views a person's body as a precious gift from one's parents. The body should be buried whole and undamaged, the thinking goes.
But that began to change here in the mid-1990s, when a popular Buddhist group, Tzu Chi, began its "Silent Mentors" program.
Based in Taiwan, Tzu Chi is the world's largest Buddhist charity, with 10 million members and 2 million volunteers worldwide. In 1994, it began to appeal to its members to donate their bodies for medical research.
The call worked. Now, some 25,000 people have signed up. Hundreds have already passed away and had their bodies used for medical training.
Where once the student-cadaver ratio in some Taiwan anatomy classes was 100 to 1, now it's 15 to 1 or less, allowing for far better instruction.
"It's snowballed, it's getting really big — we can't stop it," Tseng Guo-fang, director of the medical simulation center at Tzu Chi's medical school.
Tseng says the key to the program's success is the promise to respect the silent mentor, and put the body to good use.
In most med schools, research cadavers are name-less pieces of flesh. But here, students get to know the donor's family. They learn about the donor's life. And sometimes they even meet the donor before he or she passes away.
"This way, family members know who is going to dissect their loved ones," said Tseng. "That establishes mutual appreciation and trust."
Huang Jian-yi, 54, is one relative. His father signed up as a Silent Mentor after a diagnosis of lung cancer. At first, some family members weren't sure about the program, said Huang. But now, they've all grown to appreciate it.
"What I most approve of is Tzu Chi's respect and reverence for the silent mentor," said Huang.
Ceremonies are held before and after the body is used. Both students and relatives of the silent mentor participate. After a body is used, it's carefully stitched back up and dressed. The students show their thanks to the silent mentor, and present flowers to relatives of the deceased. Then, in a solemn procession, they carry the bodies away in caskets to be cremated.
Such rituals not only make relatives feel better — they also help medical students.
In Taiwan, where folk beliefs still run strong, medical schools are rife with ghost stories. It's common to hear tales of students who joked over a cadaver, only to later come down with mysterious ailments. Others suffer from psychological problems.
(Warning: This video includes graphic images.)
Tseng himself says he felt "guilty" when cutting up cadavers as a medical student.
"It's not right to dissect someone who may not have been willing to donate their body for this purpose," said Tseng. "I wanted to say 'sorry' to the body, but there was no way to show my appreciation."
Taiwan medical students who practice on Silent Mentors can rest easier, because they know the person has willingly donated his or her body for instructional purposes. "Now, if students feel guilty, it's only because they haven't studied hard enough," said Tseng.
Josephine I-Hwei Chen is another Silent Mentor relative. Her father was a respected Tzu Chi elder. In 2003 he became the first "Silent Mentor" used for surgical simulation (previously, bodies were only embalmed and used for anatomy classes).
"We thought that he was a mountain, that we could always count on him," said Chen. "The last time we saw him he was smiling."
Embalmed cadavers aren't good for surgery practice, because the condition of the body is too different from a live body. For surgery simulation, Tzu Chi freezes cadavers instead.
In this case, Silent Mentors' bodies must be delivered to Tzu Chi within eight hours. They're promptly taken into one of the group's 32 freezer units and cooled to just below freezing. When needed, the bodies are thawed out over three or four days, then used for surgery practice.
So it went with Chen's father. Ten months after his death, his body was thawed. Relatives and medical students held a ceremony in the operating room before instruction. They gathered in a circle around the body and chanted Buddhist sutras.
Chen said the donation of Silent Mentors like her father was critical for training doctors with better skills. Otherwise, bodies are just buried or burned, wasting a precious medical resource, she said.
"In the future, we hope we can save more people," said Chen. "In this way, we can turn something useless into something useful."