Category: Health

Racial Reconciliation

Tim Keller wrote “Generous Justice” in 2010. He speaks there about John Perkins’ strategy for rebuilding poor communities (Perkins has been a leader in community development and racial reconciliation for many years in the USA). I think the principle he articulates from John Perkins is so important for a vital, cross cultural, gospel-shaped ministry of healing.  Keller writes, “In both private charity and government agencies, many of the providers are of a different race than the care receivers. While Perkins insisted that leadership for development be based in poor communities, he also ‘invited outsiders [usually Anglo] to play a critical role in fostering indigenous leadership.’  He did this while many civil rights organizations ‘often radicalized and politicized the role of the outsider at the expense of people in poor communities.’

“These two factors — inviting outsiders to play a role along with insisting that the residents of poor communities be empowered to control their own destiny — meant that the leadership for the community development had to be multi-ethnic and interracial. It is always much easier for the leaders to be of one race — whether just indigenous members of the community or only professional helpers from outside the neighborhood.  But Perkins knew that the combination, if it could be made to work, was powerful. This was one of Perkins’s most important contributions and challenges.  What is best for the poor community — a non-paternalistic partnership of people from different races and social locations — was also one of the gifts that the gospel makes possible.”

Keller goes on to explain how the Bible provides ‘deep resources for racial rapprochement,’ since the depiction of creation cuts the nerve of racism — as all human beings are made of ‘one blood.’  “Why did God create only one human being?  So that no one can say to a fellow human being: My father was better than yours.” Racism has its roots in the pride and lust for power that arose from man’s sinful attempt to raise the tower of Babel (Genesis 11). And it has its healing in the cross of Christ, with the resultant outpouring of the Holy Spirit to break down the barriers that divide the nations (see the account of Pentecost in Acts 2).

So again we find that a gospel ministry to the brokenhearted is led by a team that is multi-racial and multi-cultural — by grace allowing the gifts of the body to be expressed — and showing the love of Christ to the world.

Sustainability

SustainabilityThere is much good talk and fine-sounding theory about sustainability and sustainable development these days.  When I first went to Ethiopia and did community health, I thought that my work should continue beyond my time, without outside financial input.  It was a noble-sounding idea; I didn’t want to create financial dependency but rather wanted to see long-term productive service or ministry.

I would like however to suggest that we might think more deeply about sustainability.  Not to throw away the concept, but to make it deeper, and root it more in the character of God and His kingdom.

Wikipedia defines sustainability this way: “In ecology, sustainability is how biological systems remain diverse and productive. Long-lived and healthy wetlands and forests are examples of sustainable biological systems. In more general terms, sustainability is the endurance of systems and processes.”

So first we need to recognize that sustainability is about the endurance of systems of processes.  For something to endure it has to have continuous input of resources; a plant for example needs sun, water and good soil.  Sustainability is not about my financial resources; it is rather a question about how the system/ministry/project/organization/church will continue to endure and produce fruit beyond my personal involvement.  My most important contribution may not be the money, but resources, skills, attitudes that are far less tangible than money.

The community health project that I did in southern Ethiopia in the late 80’s was not sustainable, i.e. it did not continue after I left. However the individuals that I was able to influence — that Jesus transformed — in the process of trying to do the project, they became the key to sustainability.  Today there are many effective community health efforts there, combining the Word of God with the good works of Jesus.  They are certainly not all from my wife and I!  But by His grace I was able to plant some seeds.  The Good farmer was able to grow up those seeds into a much stronger crop than I could ever have dreamed of.

In writing to Timothy, Paul wrote “But the goal of our instruction is love from a pure heart and a good conscience and a sincere faith.” (1 Tim 1:5).  Our aim is not just to sustain our work so that it might continue, but to that our work (and instruction) will grow up into a harvest of love.  This means that the heart matters, not just our acts.  To work along with the Holy Spirit and work in the Kingdom of God — the servant of the Lord must also attend to his or her conscience and keep the heart pure. This is only possible by the tremendous power of the gospel, not by finances.

To be sure, the way we handle finances is important!  When things go well and a project or system continues beyond my involvement, finances and resources will still be needed — and we should prepare leaders to take things to the next level (and it may mean we need to continue to put in finances!) Yet money should not be the root issue.  At the root is the character and promises of God, and the character and behavior of the leadership we have mentored or left in place.

Ultimately God is the one who produces the good fruit of righteousness and joy; we read in the previous verse that ‘the administration of God is by faith.” (1 Tim 1:4).

The good news is this. We are not just talking about a machine which we want to keep running. We are talking about something organic, productive, and multiplying fruit. Our aim should be on growth and transformation – whether we are putting in money or not. Our model needs to be less mechanical and more organic; “The kingdom of heaven is like yeast that a woman took and mixed into about sixty pounds of flour until it worked all through the dough.” (Matt 13:33)

The way we go about our health and development work makes all the difference.

Sometimes the thing we want to ‘produce’ can’t even be produced, and our efforts seem to die away.  But the way we go about it, even if our dreams seem to die, can yield fruit if we are working along with the Lord Jesus Christ, keeping to a good conscience and a pure heart by grace.  Don’t be overly discouraged if you don’t seem to have something ‘sustainable.’  Look deeper for seeds that you can plant in others’ lives that can grow up — even long after you may be gone.

Sometimes the thing we want to ‘produce’ can only be produced when led by local believers or the local community, and our job is to come alongside them (partner) and help prepare them for these leadership roles, as servants with a good conscience and hearts of love.

In the end the deepest things are not materials or economics, but love from a pure heart. And if you have not found out where to get these things, look to the good news of God in Jesus.

Where do you struggle with sustainability and might these simple ideas offer some hope?

New sustainable development goals

The online journal “Globalization and Health” has produced an article called “Health in the Sustainable Development Goals: Ready for a Paradigm shift?”  Current goals include reduction in infant and neonatal mortality and other important health markers. The newly suggested UN sustainable development goals would focus more on leadership development for intersectorial collaboration, prevention, and enhancing civic engagement (see abstract below and online article here).

It is an ongoing challenge (and paradigm shift) for us medical people to embrace the kind of leadership which will move us from a more strictly medical and scientific model to one which is more wholistic and involves relational, behavioral, emotional and spiritual aspects of health and healthcare.  It is an ambitious but important challenge.

Christian medical and healthcare mission efforts have provided a good proportion of health services in resource poor settings. While they don’t need to compete with government services, these mission efforts can complement and partner with them – and often do.  They can and should provide opportunities to explore and collaborate for the kinds of leadership we need to tackle the huge issues being addressed by these new sustainable development goals.  [I’m speaking of Christian missionary efforts which are developed over the long run with cultural sensitivity and local leadership.] For example, new and creative approaches to prevention, healthcare and leadership come out of these efforts; I have seen a number of instances where governments then have been able to scale up these smaller efforts. It’s a worthy challenge.

Abstract

The Millennium Development Goals (MDGs) galvanized attention, resources and accountability on a small number of health concerns of low- and middle-income countries with unprecedented results. The international community is presently developing a set of Sustainable Development Goals as the successor framework to the MDGs. This review examines the evidence base for the current health-related proposals in relation to disease burden and the technical and political feasibility of interventions to achieve the targets. In contrast to the MDGs, the proposed health agenda aspires to be universally applicable to all countries and is appropriately broad in encompassing both communicable and non-communicable diseases as well as emerging burdens from, among other things, road traffic accidents and pollution.

We argue that success in realizing the agenda requires a paradigm shift in the way we address global health to surmount five challenges: 1) ensuring leadership for intersectoral coherence and coordination on the structural (including social, economic, political and legal) drivers of health; 2) shifting the focus from treatment to prevention through locally-led, politically-smart approaches to a far broader agenda; 3) identifying effective means to tackle the commercial determinants of ill-health; 4) further integrating rights-based approaches; and 5) enhancing civic engagement and ensuring accountability. We are concerned that neither the international community nor the global health community truly appreciates the extent of the shift required to implement this health agenda which is a critical determinant of sustainable development.