A new era in Roman healthcare

We take for granted that compassion is a natural response to the suffering of those who are ill. But compassion was not well-developed as a virtue in Roman culture.  Rome had not developed a culture of compassion; “mercy was discouraged, as it only helped those too weak to contribute to society.” Family members may come to one’s aid, and the wealthy could afford physicians, but “the common folk were often left to rely on folk healers and sellers of herbs, amulets and quack remedies.” *

“If a father decided that the family couldn’t afford another child, that child would be abandoned to the steps of a temple or in the public square. Female infants were exposed much more often than males.” These attitudes and practices are still with us today.  In India and China the practice of aborting female offspring is distressingly common.  In many parts of the world the handicapped are treated with disdain or neglect.

“The classic world possessed no religious or philosophical basis for the concept of the divine dignity of human persons, and without such support, the right to live was granted or withheld by family or society almost at a whim.”

What made the difference between attitudes then and now?  At least in many parts of the world today, human rights and dignity are considered absolutely fundamental (and they are!). Where then did these more ‘progressive’ beliefs come from?  The new ‘era’ in Roman healthcare came from the least likely place: from a new, small and persecuted culture which penetrated the classic Roman world: the culture of the Christians.

Despite a series of ten devastating persecutions, beginning with Nero in AD 64, Christians “carried on an active ministry of philanthropy which included the care of the sick. Far from the stereotype of shriveled ascetics who hated the body, early Christians valued the body and the medical arts necessary to heal it as good gifts from God.”

“James defines “religion that is pure and undefiled before God” in part as caring for ‘orphans and widows’ (James 1:27) — biblical shorthand for all those without protectors and in need. Christian theology thus birthed a personal and corporate charity which surpassing any previously known. Church leadership encouraged all Christians to visit the sick and help the poor, and each congregation also established an organized ministry of mercy.”

How different this is from our practices today!  How often we are concerned about ourselves without hearing the Lord’s commands to love God with all our heart and our neighbors as ourselves.

“A devastating epidemic began in 250 AD and spread across northern Africa to the Western Empire.  It lasted 15 to 20 years, and at one point in Rome 5,000 people died in one day. Beyond offering supplications to the gods for relief, public officials did nothing to prevent the spread of the disease, treat the sick, or bury the dead. This is not surprising, since the pagans believed that nothing effective could be done in a time of plague other than appeasing the gods.”  However in places like Carthage, north Africa, where the plague swept in with force, the Bishop Cyprian  “encouraged Christians to donate funds and volunteer their service for relief efforts, making no distinction between believers and pagans.”  They continued these organized emergency relief efforts for five years.

“The ministry of medical care in early Christianity began as a church-based diaconal, not a professional, ministry.  It was provided by unskilled, ordinary people with no medical training. Yet the church created in the first two centuries of its existence the only organization in the Roman world that systematically cared for its destitute sick.”

This is not a secret we want to keep from believers around the world today.  From Syria to Thailand, believers are caring for those who are marginalized and ill.  But sometimes I fear we forget our history, and we forget God’s command to love our neighbor.  Medical missions are a wonderful calling and ministry. But as we go about it we must not ‘overly professionalize’ ministry to those who are sick and brokenhearted. Unskilled believers ushered in a new era of healthcare in the Roman empire.  We have the opportunity to do the same among multiplied countries around the world, demonstrating goodness and grace of God, and the dignity of men and women created in His image.  This can be done only as professionals work together with non-medical professionals to care for the needs around them, especially those who are least able to help themselves.

Despite the cost, let’s help usher in a new era of healthcare around the world.

*Quotations are from “Christian History, Healthcare and Hospitals in the mission of the church,” Issue 101, pages 6-12

Too much to do? Time to re-examine our own assumptions!

Stress and burnout are recognized themes in medical missions.  One source of stress is the sheer magnitude of physical needs; one billion people in our world have no access to a trained health worker and healthcare workers often stand in the gap.

In the face of overwhelming need how do we maintain healthy margins?  Overextended, we lose our compassion, damage relationships, and often leave our fields of service early.  Yet, the pressure is there, since the patients show up, the children are literally dying, and there is often no alternative for those who are the most marginalized.  Wouldn’t Jesus have compassion on the sick and dying?

In the late 1980s I was in a similar situation in southern Ethiopia, where I was called to lead a small team to treat patients dying among the Mursi tribe; hundreds were dying around us from meningococcal meningitis.  While we had some effective antibiotics we couldn’t get ahead of the need – patients were dying faster than we could treat them.  In our case, the answer was not so difficult, as the Ethiopian ministry of health asked us to bring along their workers and meningitis vaccine; thus we were both able to save many who were ill, but also prevent new cases with vaccine.  Caring for the ill and prevention went hand in hand – with a team approach.

But what about a hospital or clinic where the people come each day and yet the facility and staff are still overwhelmed?

One approach has been to assign numbers to non-emergency patients to limit those who can be seen on a given day.  Other barriers have been erected, such as raising fees – although this limits care to those who are most vulnerable and thus tends to defeat our purpose.  Outpatient clinic hours can be trimmed.  Specialty clinics can be opened only certain days.  All these efforts are ways of establishing boundaries and limits.  Some are needed; some are painful.

Yet, our hearts as medical providers are driven by compassion; we want to see as many as possible.  Compassion is from the Lord, and our instincts may be noble. But unexamined assumptions may contribute to our own burnout and long term lack of fruitfulness.

As medical healthcare workers and missionaries, do we recognize our own limits and vulnerabilities?  Or are we driven by a “Savior” complex where we must be the answer to everyone’s need?  Do we allow the needs to constitute our call, or does Jesus Christ shape the call?  If we are called and empowered by Him (as the true vine) then we (as his branches) can only produce eternal fruit as we allow Him to work through us.  Yes, this kind of ministry can be overwhelming, even impossible.  Are we connected to Him as the vine well enough that the life-giving grace of God gives us wisdom and strength?  Or have we subtly become “the vine” ourselves in the midst of the needs?

We do want to give our lives for others.  Good.  But our own wisdom and strength quickly fades and we must come to Christ and His word.  We might have the desire to “burn out for Jesus” but taken to the extreme we will damage our family and other relationships.  Exhaustion and callousness on a chronic basis are not the ‘living stream of water’ that Jesus promised would come from our hearts!

What is our ultimate purpose in medical missions?  It is to glorify Jesus Christ.  We become like a seed which falls into the ground; it must die and spring up with new life.  My hospital, my program, my health teaching – these are all means God uses to show His character through suffering and healing, to make disciples, to enable others to connect to the vine – ultimately serving others by God’s grace.

We must reflect on this ‘Me-first’ mentality.  Do we assume that these health ministries are about us and our ability?  That’s a prescription for the prosperity gospel!  Let’s not promote a false gospel based on our works rather than grace.

The ultimate purpose is to establish God’s reign, God’s kingdom on earth – or some small signpost of the kingdom in a broken and twisted world. We can make a real difference. However it is not by our trying hard enough, but by abiding in the Vine. We don’t want to plant our program; we want to plant the mission of Jesus.

Health is not just about the physical needs of those who come to us, but about their social, economic and relational needs. I fear that too often we apply a Western mindset [think separation of physical from spiritual/non-physical reality].  One way of creating more helpful margins is to actually involve local staff and others from churches and community in the care of those who come to us – enabling them to connect with our programs as whole people, not just disease conditions.

This takes building leadership for healthcare missions, not just adding medical practitioners.

Eventually this means we work with local doctors, community, nurses, churches, believers – to build healing communities. Only through teamwork can we begin to meet the overwhelming needs of those around us in a deeper way.  And yet in this way – as we die to our own ambitions – we are enabling others to see and to know and to serve the Lord Jesus Christ.  He is the King and Savior and healer and He is building His kingdom. We get the privilege to be a small part of His work. He is worthy!

Finding meaning as a Christian in mission

is a trauma and critical care surgeon who recently left clinical practice to homeschool her children. She teaches at Harvard Medical School, and has contributed to the literature on surgical critical care and medical education. She and her family live in the woods north of Boston.

This is her journey from medical mission mayhem to meaning.

Zeal without Burnout: Seven keys to a lifelong ministry of sustainable sacrifice

Quotes from this helpful little book by Christopher Ash and Alistair Begg:

  • “God so often allows his ministers to come to an end of themselves in order that they might begin to be more useful to his service.
  • And it is worth remembering that none of us thinks we are on the path to burnout until we are nearly burnt out; it is precisely those of us who are sure we are safe, who are most in danger. we need to heed Paul’s warning: so, if you think you are standing firm, be careful you don’t fall!
  • The problem is that we do not sacrifice alone. It may sound heroic, even romantic, to burn out for Jesus. The reality is that others are implicated in our crashes.
  • Perhaps the expression, “sustainable sacrifice” gets to the heart of the idea — the sort of self-giving that God enables us to go on giving day after day.
  • The trouble with being strong and healthy is that you and I begin to believe that we are something other than dust into which God has temporarily breathed the breath of life. Because I can walk, think, talk and act, I begin to believe that I am immortal — and that I will always be able to walk, think, talk and act. But I won’t.
  • Good sleep is a gracious gift of God.
  • The sleepless nights were caused by an addiction to adrenalin that was beginning to have a negative effect in other ways —
  • “We doctors in the treatment of nervous diseases, are compelled to provide periods of rest. Some of these periods are, I think, only Sundays in arrears.” Sir James Brown, The Times, 30 April 1991
  • God needs no day off. But I am not God, and I do.
  • Most people crack up because they try to do what God never intended them to do. They destroy themselves by sinful ambition, just as much as the drunkard and the drug addict. Ambition drives them on.
  • Some of us in a world of social media have a great many Facebook friends, but very few, if any, deep friendships.
  • Think about the kinds of things that drain you and the sorts of things that energize you. Try, so far as it lies in your power, to put in the diary sufficient of the things that energize you to keep you emotional, physical, intellectual, relational batteries topped up.
  • To neglect sleep, Sabbaths, friendships and inward renewal is not heroism but hubris. It is to claim that I am a level or two above normal members of the human race.
  • Gospel ministry is ministry in a messed up world. And there is grace in the disruption, for it humbles me. it shows me afresh my total dependence on God.
  • If joy is to motivate us to gospel work, then joy must be rooted in something outside the fruits of our work, something that cannot be touched by the vagaries and frustrations of this life under the sun.

Permission to mourn, anyone?

A friend shared this quote from a website called Humans of New York.  We often work in the midst of a mountain of death and suffering. Do we take time to mourn?

“Some of my colleagues tell me they can’t imagine working in pediatrics. Millions of years of evolution have conditioned us to respond to the cries of a child. We can’t bear to see a child in pain. And once we have children of our own, it makes the work even more difficult. We all handle it differently, but everyone cries at some point. Not in front of the patient, but everyone cries. Every few months we have a ceremony where we mourn all the children who have passed away. We have a slideshow. We make cards. We talk about them and remember them together. We acknowledge that we all feel the loss. And even though our grief is not as significant as the family’s, it’s not trivial either. And we must take time to acknowledge that. Or all of us will burn out.”

http://www.humansofnewyork.com/

An article in our county medicine publication (in the US) this month underscored the same need.  It was called “Physician Burnout: Don’t Let Fatigue Lead to Failure.”  To quote: “It wreaks havoc on your life and the lives of your patients. It can tear apart your family. It can end your career.  Physician stress and burnout affects some 45 percent of doctors in the United States.”  The article goes on to quote a Mike Drummond, MD who warns, “Here’s the unspoken tragedy: If you can’t be emotionally present for your patients beause of compassion fatigue, you can’t be there for your spouse, signifigant other, children or friends either. Everyone loses when you allow yourself to be tapped out at work. But physican stress is both preventable and treatable.”  How well do we build counseling and support for ourselves as caregivers into our ministries?  How can we intentionally identify folks who are safe to talk to about these things?  In looking to shift our culture as a mission to avoid burnout and enable us to fulfill our medical ministries with some joy and fruitfulness, we need to talk with one another about these things.  I’d love to hear from you.  Paul

The LORD, a God merciful and gracious

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Last week I wrote about a possible erosion of compassion in our healthcare service.   Those of us in healthcare as a profession can be inundated with the suffering in this world.  And beyond the physical aspects of suffering there is the question of meaning.  Even more painful than suffering is to suffer something that has not meaning.

Yet in the midst of the pain of suffering and the human condition, we find some hope and meaning in the Scriptures:

  • the pain of childbirth and the agony of death, which speak to us of the suffering of creation, are not random events, but are connected to the choices our first parents (Adam and Eve) made and the subsequent consequences which God made in Genesis 3:14-21
  • the consequences God put in place were not only curses but an amazing promise (that the seed of the woman would bruise Satan on the head – fatally).  Thus at some point the suffering will end and justice will be done
  • while suffering is often due to sin and rebellion it is not always due to personal sin (‘my sin’) but to our common lot as children of Adam and Eve
  • the good news is that redemption from sin is also not due to my personal goodness (‘my righteousness’) but to the righteousness of Jesus Christ, the second Adam
  • Jesus announced that suffering is a necessary part of His mission! See Mark 10:45
  • As followers of Jesus we are called to come alongside others in their suffering. Matthew 5:4-7
  • Thus the reason we serve others is not to be for money or our own reputation or influence. The character of God must be our motivation.  The LORD is merciful and gracious.   Yes he is strict with sin, not allowing it to be unpunished.  Yet by comparison His graciousness is overwhelming and extends so much farther than we can imagine (compare 3-4 generations to 1,000 generations)
  • We have every reason to serve others with compassion, and all the grace of our Lord Jesus Christ to actually do it!