Not the way it’s supposed to be

“The veins of sin interlace with most of the rest of what’s wrong with our lives — through birth disorders, disease, accident and nuisance. Thousands of Third World children die daily from largely preventable diseases: out of laziness or complacency, certain grownups fail to prevent them. Thousands of First World children are born drug addicts: their mothers have hooked them in the womb. Some people with sexually transmitted diseases knowingly put their partners at terrible risk. It happens every day. Many accidents are, in retrospect, both accidental and predictable: somebody who needed to concentrate on his job in order to protect others (a pilot for example, or a lifeguard, or a ship’s captain) got drunk instead, or careless, or wholely preoccupied. Often, a number of such factors combine in some lethal and intricate way to bring havoc to human well-being.”

Cornelius Plantinga helps us look at sin and how it affects, and corrupts, the beauty and design of God’s creation. Most of us do not hear as much in our churches about sin as our grandparents did. It is at the root of much pain and suffering in this world. “Self-deception about our sin is a narcotic.” He wants to “renew our memory of the integrity of creation and sharpen our eye for the beauty of grace.”

In looking at root causes (and possible prevention) of diseases in Ethiopia in the 1980s I was struck that the causes were not just ignorance but sin. Nowdays in the West we classify intolerance as sin, but there is so much more lurking in the background which we tend to ignore: promiscuity, cheating, corruption, power-grabbing, pride, lying, dishonoring of others.  Ultimately this comes from the dishonoring of God who created and designed us.

I said to a colleague at the time, “My community program would work just fine if it weren’t for sin!”

That is largely true, and shows us our need for the forgiveness of sin found only at the cross of Christ. Community health is a good work, but community change is most effective when founded on love.

“Sin distorts our character, a central feature of our very humanity. Sin corrupts powerful human capacities — thought, emotion, speech, and act — so that they become centers of attack on others or of defection or neglect…. Sin, moreover, lies at the root of such big miseries as loneliness, restlessness, estrangement, shame and meaninglessness… In fact sin typically both causes and results from misery.”

“Sin is disruption of created harmony and then resistance to divine restoration of that harmony.”

“At the center of the Christian Bible, four Gospels describe the pains God has taken to defeat sin and its wages… Christians have always measured sin, in part, by the suffering needed to atone for it.  The ripping and writhing of a body on a cross, the bizarre metaphysical maneuver of using death to defeat death, the urgency of the summons to human beings to ally themselves with the events of Christ and with the person of those events, and then make that person the center of of their lives — those things tell us that the main human trouble is desperately difficult to fix, even for God, and that sin is the longest-running of human emergencies.”

So as we serve others with compassion, let us not ignore the longest-running of human emergencies.  Things are not the way they are supposed to be. Let’s make a full diagnosis of our human condition and receive God’s full remedy.

 

 

 

“…not merely a doctor”

“The doctor has so objectified himself that he never faces up to himself and his own life at all.”

“Somewhere in Pembrokshire a tombstone is said to bear the inscription, ‘John Jones, born a man, died a grocer.’ There are many whom I have had the privilege of meeting whose tombstone might well bear the grim epitath: ‘…. born a man, died a doctor’! The greatest danger which confronts the medical man is that he may become lost in his profession.”

D Martyn Lloyd Jones, in “Healing and the Scriptures.”

Dr. Martyn Lloyd Jones was a brilliant British physician and an outstanding preacher, and offers great medical wisdom and spiritual insight. This book was published in 1982 but still contains “a masterful view of the Christian physician’s calling, and of the dimensions of ministry to the whole man.” (Quote from J.I.Packer).

How often our identity is tied up with being medical professionals. Lloyd Jones challenges us to view success not merely as the accumulation of medical knowlege, reputatation and material wealth, but fruitfulness for Christ and His kingdom. The foundation of our identity must be in God, not ourselves; we are creatures made in the image of God and created for fellowship with God — all of which is only possible through the salvation obtained by Jesus at the cross.

Dr. Lloyd Jones says to us, “I beseech you not to allow the profession to make you forget yourself, that you are a man, and not merely a doctor.”  And to bring the vocabulary in the 21st century, we’d say, “you are a man or a woman, not merely a doctor!”

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.

Assessing the learning needs of medical mission workers

How does one assess the learning needs of healthcare missionaries or mission workers?  If you are looking to assess your own needs, here is an article that is a good place to start. How would you do it for an entire organization, or the entire enterprise of healthcare missions?

The Global Healthcare Workers Needs Assessment (GHWNA) Survey Report was completed in 2015 by Mark Strand and Amber Wood, under the sponsorship of MedSend and endorsed by the Christian Medical and Dental Association of the US. The aim was included in the title of the report: “That Healthcare Missionaries Might Flourish.”  The aim was to “investigate how to better equip healthcare missionaries for long-term service.” It builds on the PRISM survey which was more about the training, support and satifaction of healthcare missionaries with their role, with a view towards making needed changes in selection, preparation and equipping of these workers.

Some key findings:

Healthcare missionary respondents had a mean age of 41 years. Years in cross-cultural service were 7.2 for those currently serving and 4.8 for those who had returned from the field. All were American missionaries, so we need to generalize with care.

85-90% of these healthcare missionaries reported that they were able to see lives transformed, meet spiritual needs, and share the gospel with those they served.

While there was a high degree of satisfaction with their roles in healthcare (93% and 84% of currently serving and returned missionaries, respectively), many (33 and 34%) reported a discrepancy between their roles and what they expected. Role inconsistency is a problem for medical missionaries.

Those currently serving spend less of their time on clinical work, and more on administration, church or mission agency responsibilities, and general organizational leadership, than post-field missionaries did when serving on the field.

In terms of needs assessment, healthcare workers serving overseas find themselves with many jobs for which they are unprepared. These cross-cultural healthcare workers rated professional development and leadership training as important as cross-cultural training in preparation for the field. Those serving on the field weigh public health equally to clinical skills in terms of training.

Leadership training needs reported by respondents in order of importance were: mentoring, strategic planning, and general leadership skills. However only 38% of all respondents had mentors, and only 18% of sending agencies assign mentors who are healthcare professionals themselves.

Of note, 18% of those serving and 20% of those previously serving were individuals at risk for burnout based on callousness, and 8% and 20% based on exhaustion.

Half of post-field respondents left the field for potentially preventable reasons, most often burnout, interpersonal conflict, or emotional exhaustion.

Learning needs for American medical missionaries might therefore include not only cross cultural preparation and clinical competence but leadership and management skills, burnout awareness and prevention, conflict management and emotional awareness. When possible there should be intentional mentoring which is delivered by healthcare professionals who understand the challenges of cross-cultural service.

How would you assess your learning needs in terms of service as a healthcare worker? Where would you agree or disagree with these survey findings?

 

Third culture leadership

William Dryness points out two parallel realities in our world: (1) the mobility of our times, and (2) the changing demographics of Christianity.  Not only are the majority of Christians no longer “Western,” but they are increasingly found in countries with young and growing populations, frequently among the poor, and exhibiting a vital evangelistic faith.

What are the implications for missions?  How must traditional mission organizations adapt to these new realities?

Based on the two realities (mobility as well as increasing impact of non-Western Christians) traditional missions will need to consider:

  • Missions must re-imagine ourselves as learning structures. This means that communication is not one way (from the West to the rest) but mutual sharing across cultural boundaries.
  • Dryness talks about “third culture leadership.”  Mission leadership should include prominently ‘bridge people’ who embody (ethnically and experientally) the diverse realities of our pluralistic world.
  • Facilitation of multiple forms of witness (where the grand strategy is under leadership of the Holy Spirit).
  • Longer term regional strategies, based on mutual exchanges and regional parterships.

I know that as a mission we are increasingly seeing the Lord develop “third culture leadership.” This is not a matter of Western vs. non-Western, but a mixture of gifts, ethnicities and cultures working together in leadership.

I have an Indian friend and brother trained in medicine in India, but also quite famliar with our Western ways, working in a Western mission agency.  In problem solving, he understood how we as Westerners want to go on a ‘straight line’ from problem to solution. Yet as an Asian, he is also quite comfortable ‘meandering around’ with a problem until a solution could be found.  Eventually, he said, either way would get us to a solution.  “When I do it as an Asia,” he added, “it may take me longer to get there, but I’ll have everyone with me when I arrive!”

So we need each other. There is no one right way and wrong way to tackle the serious problems we are facing in the world, whether we are considering impoverished medical care or impoverished friendships. We need cultural bridges, or third culture leadership.

How are the realities of mobility and increasing leadership from non-Western Christians impacting your efforts?

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.

Preparing for the field

What would I say to someone just preparing to leave to serve Christ in cross-cultural missions? Here are some of the things I hear myself saying to young people at SIM who are in orientation or training:

  • Prepare for a marathon, not a sprint. Missions is a learning experience which spans years, not just months.  We often go with high expectations of changing others but forget that also there are many ways we also need to grow and change.
  • Don’t shortchange language.  Take all the language that is possible.  I had an experienced mission doctor in Ethiopia tell me at the end of his career, “I thought I’d just be able to pick up the language by working; I was wrong. I am sure I lost a number of patients just because I didn’t understand all they were saying.” [As an internist of course I believe the history is the MOST important thing in the patient encounter!]
  • Don’t be surprised by the challenges of living cross-culturally. In our first term we experienced a home break-in; physical illness in ourselves and our children; delay in assignment; conflict with a fellow language school student who was later removed from the field; plus the adjustments to the sights, sounds and culture.  Would I trade it for something easier? No! Was it something I could have prepared for better?  Yes, by adjusting my expectations down just a little.  Medical folks like me tend to go for perfection.
  • Get cross-cultural training before you go.
  • Learn to love people more.  Ministry is all about relationships.  Look at how Jesus cared for those around him. He observed them, listened to them, befriended them, lived among them, cared for them, spoke God’s word to them.  People are the center of ministry, not projects and programs themselves.
  • Embrace your own gifts and callings, but also your own weaknesses.  God will use you as an individual with the strengths you have, but will also work through your weaknesses [which will be more obvious to you as you encounter the stresses and strains of cross-cultural living]. What an adventure!  Live in His grace, not by your own efforts.
  • Make friends, not only foreigners, but local people. You will treasure those friendships someday and they will treasure you. Find a mentor among colleagues but also among local people.
  • Stay close to Jesus and the Word of God. Don’t neglect Scripture, Sabbath, and a balance in life of ministry to self, family and others.  It’s amazing how often we can get busy with work [like we are trained to do] and neglect the inner life of the soul.  “Watch over your heart with all diligence, for from it flows the springs of life.”
  • Enjoy the journey. While it is not all bliss, it is deeply satisfying to be used by God to serve others with compassion and find joy even in little things.

How to prepare medical missionaries — part 2

Here were the resources suggested in our survey of current health workers in SIM. I’ve arranged them by topic: community health and health education; leadership and management; theology of work and mission; and tropical and international medical courses.

Community health and health education:

http://www.chenetwork.org/     Global CHE network – Community health education/evangelism

http://www.hifa2015.org/     Meeting the information needs of nurses and midwives – looks like quite a good site!

http://www.talcuk.org/shop.htm     Teaching aids at low cost at TALC, including “Where there is No Doctor”

http://www.thewhpca.org/resources/palliative-care-toolkit     Palliative care toolkit (example)

www.digitalhealthlibrary.net     Digital African Health Library, providing clinical decision support on mobile devices in Africa (includes DynaMed, Oxford Handbooks, medical calculators, etc. Only downloadable for those living in Africa.  Costs about US$45 per year.  Search app (IOS or android) “Digital African Health Library”

Leadership and management in healthcare missions:

www.TECHmd.org     Technical and equipment issues

http://managementhelp.org/     Excellent management library of resources and training ; check out their free “eMBA”! Can help in the areas of strategic planning, financial accountability, management of non-profit(mission) staff, etc.  Extensive library online; easy to use. Not a “Christian” library per se but very helpful for these kinds of questions.

http://www.cmf.org.uk/international/hsp/     Here is a pretty complete list of mission hospitals, agencies, national association, training programs and other resources!

https://cmda.org/bookstore/product/beyond-medicine     “Beyond Medicine: What Else you need to know to become a healthcare missionary.” Written by CMDA Director David Stevens.

Theology of work and mission

Connecting your work to God’s work: Every Good Endeavor by Tim Keller

How to alleviate poverty without hurting the poor: When Helping Hurts (Corbett); avoiding paternalism

What is the Mission of the Church?  DeYoung

Preach and heal” by Fielding. Very good at some points; somewhat anti-institutional.

Sharing our faith in practical ways as medical professionals; training designed for an international context; saline process

Tropical and international medical courses:

http://intermed.org.au/   Graduate diploma in International health and development in Australia

http://medicine.hsc.wvu.edu/tropmed/tropical-medicine-course/     West Virginia tropical medicine course

http://www.equipinternational.org/who-are-you     Equip courses for physicians and medical practitioners (and some non professionals too!)

http://www.lshtm.ac.uk/study/cpd/stmh.html     Diploma in tropical medicine and hygiene (3 months in London)

http://wrair-www.army.mil/OtherServices_TropicalMedicine.aspx     3- and 5-day “Operational Clinical Infectious Disease Courses” at Walter Reed Army Institute

http://www.inmed.us/     The mission of the Institute for International Medicine is to equip healthcare professionals and students with the unique skills to serve forgotten people.

Also highlighted by most:

CMDA CMDE Continuing education conferences every year in either Greece or Thailand.

What is your experience?

How to prepare medical missionaries

We polled about 100 of our SIM medical doctors, nurses and health professionals, asking them how they would prepare new medical workers for cross cultural mission.  Here are some of their responses:

  • Emphasize language learning; too many medical workers do not get adequate language — and it becomes a career weakness!
  • Prepare them for teamwork including multicultural team training
  • Help them build a good theological and missiological foundation for medical missions, including a robust biblical theology of suffering
  • Emphasize the importance of building healthy marriages and families (for the married ones) and healthy relationships for all
  • Burnout prevention; maintaining margins
  • Developing ministry vision
  • Help them articulate how medical missions is a calling (“real ministry”) and thus begin to form a new ‘identity’ as medical missionaries or healthcare workers
  • Explore with them options for ministry that may be beyond the usual preparation of medical professionals; for example simple ideas such as using home visits to minister to others physically and spiritually
  • Impart to them a vision for eventually becoming leaders in healthcare missions, and learning leadership together with local believers in the context of ‘doing’ mission

Do you have other suggestions from your perspective? I’d love to hear from you.