Category: Community

Hope deferred makes the heart sick, but desire fulfilled is a tree of life. Proverbs 13:12.

My wife and I are part of a mission agency that has seeks to address not just our sin and alienation from God, but also the effects of sin in the communities we serve. When we went to the southern Ethiopia town of Arba Minch in the late 1980s we expected not to just be involved with the hospital and ministry of health, but also with the church and community health. I had a Masters in Public Health from Johns Hopkins and had trained as an epidemiologist at the Centers for Disease Control; I thought I must be pretty well prepared. But I was not adequately prepared for the challenges we faced; my preparation in fact was just beginning.

My hope for a bright and successful community health outreach to poor communities, spearheaded by Ethiopian churches, never materialized during our five year effort. We did many good things, taught Scripture, saw patients, advised when possible at the health department. But I was not prepared for the dual challenge of orienting the church outwards (to the community needs) and also for the entrenched cultural beliefs and misunderstandings about health. It was like my shiny new program was just stuck in the mud.

In retrospect, the churches was not ready for a full-blown embrace of their broken communities, since they were just surviving under communism themselves. And my brilliant ideas for change were great except I understood far too little of my Ethiopian brothers and sisters, and far too little of myself. In the final analysis, after we left the country, the believers did develop robust and full-orbed community programs which showed the love of God to neighbors. Perhaps we planted a few seeds of change.

Hope can be lost when expectations are dashed. Trust can be lost in the process as well, and that too was in poor supply towards the end of our Ethiopia experience — mostly because of my own frustrations.

So where did my expectations fall short? Where was my ‘hope deferred,’ making my heart sick? Here’s a list of some of my expectations, now with 35 years of hindsight:

  • “My program should work.”
  • “We will be fully supported by leadership (church and mission).”
  • “The believers will know and embrace what we want to change.”
  • “Since we’ve made the sacrifice to be here, God will work things out for us.”
  • “This will be fulfilling.”
  • “Opposition? How could any one want to oppose this good stuff?”

These expectations were not clearly formulated in my mind, so I didn’t realize that they were a kind of musical score I was singing off of. They provided a framework by which I saw the work. In the end the Lord set the work, the frame, and the score were all aside. My heart was sick, but over time the Lord enabled me to see some of my own folly, lay aside my perspective and seek His.

The Lord does not just send us around the world for the work we might do, but for the work He is doing in us. As we learn from Him and change from the inside, God Himself can use these very changes to work powerfully in the lives of those around us. And that is what happened. As we continued and even grew in His grace, He was working both in us and in our Ethiopian colleagues. In the end He taught us — through the same Ethiopian believers — wonderful lessons of patience, grace and prayer. And in His time he has begun to use them to transform the same communities.

So our own frustrations, conflicts and challenges can be a source of anger, burnout and brokenness for us. Or they can be a source of renewed hope and confidence, as we get back to the basics of God’s Word – and the work He wants to do in us, not only through us. He is accomplishing His work in history and uses us as medical and public health professionals. But it is His kingdom not ours. Not our program but His progress. Not even our timing but His.

So, how about you? Can’t find the joy in the calling He has placed you in? Watch where your hope is founded. Examine your expectations and suppositions. Ultimately He does His work of healing in His way, embracing communities but also working to change hearts. His work of grace, not ours.

How can Jubilee help us respond to COVID-19?

We are in the midst of one of the worst global pandemics of a century.  What does it have to do with healthcare and Christian mission?  There are many lessons we are learning.   But one clear message is that this pandemic is much more than the disease of COVID-19.  While preparations, PPE, and medical care are vital, we are also learning how to respond to many non-medical issues.  As a mission agency we are considering a multitude of threats which COVID-19 has revealed — from loss of livelihood, disruption of education, family breakdown, and loss of social cohesion.  Loss of freedom and bondage are especially evident among those with fewer resources.

A snapshot of this disruption is captured by quotes from local pastors during trainings over the last few months done by the Maternal and Newborn Community Health project of Kijabe Hospital, Kenya.

  • “The church is full of fear… We have noticed even the titles like Pastors and Reverend are of no value when we cannot place food on the table; we are forced to do any available job.  COVID-19 has reduced us to nothing.”
  • “Most marriages are separating, the wives are going upcountry or the village and husband is remaining in the slum.”
  • “.. we are anticipating a major social crisis in the next year in this region, especially teenage mothers.”
  • “..experiencing suicidal cases in this slum, something that was not common.”
  • “.. more domestic violence..”
  • “..parents are exposing their children to early sex, especially when they lack food, children are forced to prostitution to earn from long distance truck drivers..”
  • “..family assaults.”   
  • “..child abuse.”

On the positive side:

  • “We are revisiting how to prudently manage finance and resources we have.”
  • “We are sharing the little we have with the needy.”

Our healthcare workers are already working hard to care for those  ill with COVID-19, and in many cases don’t have time, energy or expertise to address these other foundational issues.  And what can be done about family dysfunction, lack of employment, anxiety and loss of hope?  What can be done by beyond our medical and public health responses?

The answer is that much can be done!  The good news of the gospel, centered on the death and resurrection of our Lord Jesus, impels us to enter into these sufferings and address all of life, not only the brokeness of our relationship to God but also the brokeness of our fellow human beings.

A powerful reminder of God’s care for mankind in both dimensions is the Jewish feast of Jubilee.  The Jubilee was designed by God to restore land to families that had sold land due to poverty and economic hardship; it was a mechanism that protected extended families from a downward spiral of poverty.  Leviticus 25: 10-12 reads

10 Consecrate the fiftieth year and proclaim liberty throughout the land to all its inhabitants. It shall be a jubilee for you; each of you is to return to your family property and to your own clan. 11 The fiftieth year shall be a jubilee for you; do not sow and do not reap what grows of itself or harvest the untended vines. 12 For it is a jubilee and is to be holy for you; eat only what is taken directly from the fields.

Jubilee was one of the many provision God built into His law to counteract the effects of sin and greed, and protect His people — keeping family and livelihood together. It was meant to be an overflow of His grace; the very word “Jubilee” is also translated “liberty” or “freedom.” God’s goodness provided practical means of overcoming economic bondage and slavery.

Christopher Wright points to the Jubilee as “God’s Model of Restoration,” in The Mission of God. “What God required of Israel in God’s land reflects what in principle he desires for humanity on God’s earth — namely, broadly equitable distribution of the resources of the earth, especially land, and a curb on the tendency to accumulation with its inevitable oppression and alienation.” Jesus himself carries this Jubilee theme as he declares His own mission statement (based on Isaiah 61) in Luke 4:18-19, saying

18 “The Spirit of the Lord is on me,    because he has anointed me
    to proclaim good news to the poor.
He has sent me to proclaim freedom for the prisoners
    and recovery of sight for the blind,
to set the oppressed free,
19     to proclaim the year of the Lord’s favor.”[a]

Thus our mission to proclaim good news to the poor (by our words) is designed to accompany efforts to set the oppressed free by attending to issues of oppression, debt, and economic slavery. And since this kind of freedom is not possible by our own efforts, it should cause us even more to marvel at the grace of the Lord Jesus Christ, grateful for His cross — both in saving us from sin as well as restoring brokenhearted and oppressed people.

All this must humble us as we think of these African pastors and their dilemma. The Lord hears their cry both for the spiritual darkness which surrounds them as well as the social and systemic effects of sin — in the midst of the physical challenges of the COVID-19 pandemic. We join them in making the good news of Jesus known in their communities, confident that He has put His people there in order to speak His words and show His deeds of love to hurting communities. “Mission” is our call to follow Jesus as He redeems and restores broken communities.

“We all sat at the same table.”

 

When resources are scarce and medical professionals are few, one gets overwhelmed with the physical needs of patients needing care.  Emotional, spiritual and community care seem like a luxury.  Yet the challenge is how to make a long range impact in these communities.  Here is an example from the Hopkins Medicine journal which shows how one group of professionals brought patients and community to ‘the same table’ – and thus began to discuss deeper issues.

After trying to engage women in breast cancer screening through a local church, these medical professionals felt like failures; only two women signed up. Lesson 1. Short term outreach which does not involve the community from the start has limited long term impact.

Despite their disappointment, they asked for feedback from the church, and were invited to a monthly meeting. “Someone stood up and said, ‘Doc, no one wants to be a patient.'” Being a patient was perceived as a burden, and the outreach was thus an invitation to become a burden.  “It was a hard lesson,” the author concluded, “that picking up medical services and dropping into a neighborhood without taking into account the communities priorities, stuggles, or having trust — that’s a formula for failure.”  Lesson 2. Our best intentions may be perceived very differently than we intend, and we must be humble enough to receive feedback from the community’s perspective.  (Think about short term medical missions; how often do we proceed with our own agenda?)

The author and his colleagues modified their approach to emphasize “knowing the science, knowing the patient and knowing the community.”  They launched an organization called “Medicine for the Greater Good,” to engage the socioeconomic determinants of health. Through this organization they created community partnershps which included not only the patients at risk but churches, schools, City Hall and health department — all sitting at the same table.  “We discovered that somewhere along our long journey as doctors, we had come to viewhealth as synonymous with medicine: prescriptions, research, guidelines. But for the community, health was more than feeling well.  Health is jobs. Health is providing for one’s family. Health is going to church and going to the park. Health is a sense of purpose.”   Lesson 3. One of the biggest obstacles to long term community transformation is our own misunderstanding of health!

Read the results of their discussions and the fulfillment they began to find.  How do we translate these lessons into health ministry motivated by the love of God and the good news of salvation through Jesus?

  1. Link short term outreach to long term engagement with the community, not an approach driven by one-on-one patient care.  Love demands that we think from both perspectives.
  2. Spend time with the community, not just with the patients that come from the community. This means actually getting out to know community members in their own homes, neighborhoods, churches and places of worship. It means getting meaningful feedback about how we are perceived. Our best intentions may not communicate the love we intend to show.
  3. We must change our minds about health. Health is not just meeting physical needs – but transforming community.  Most of the determinants of health are matters which the good news of Jesus addresses  — such as anger, sexual immorality, greed, guilt and shame.  Our role as health providers is not only to provide relief where we can, but to journey with our patients and community as Jesus builds His kingdom in their midst.  Jesus provides forgiveness of sin and relief from of the shackles that often lead to poverty and ill health.   The good news of the gospel provides meaning even when suffering cannot be fully alleviated.  As Christian health providers let’s not just be caught up in our useful activities, but also learn to sit at that table with the communities in which we serve.