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

How should we do justice?

I’ve mentioned Tim Keller’s “Generous Justice” before. Today I’d like to underline a practical and theological issue about “how.”  Keller tells us about Abraham Kuyper, a Dutch theologian and statesman who ‘remade the churches into voluntary institutions’ in Holland over a century ago.  According to Kuyper, the church was both and organism and an institution (See Kuyper’s work “Rooted and Grounded — the church as organism and institution.)  God has designed the church to be like a body (organic, rooted) and house (institutional, grounded on a foundation).  It needs solid outer shape but it must have inner life.  The church not only grows, but it is also built with structure.

Keller says that Kuyper distinguishes the congregation meeting under its leaders as the institutional church, and “all Christians, functioning in the world as individuals and through various agencies and voluntary organizations,” as the organic church (“Generous Justice,” page 145).

Keller continues, “As we have said, churches under their leaders should definitely carry out ministries of relief and some development among their own members and in their neighborhoods and cities, as the natural and crucial way to show the world God’s character, and to love the people they are evangelizing and discipling. But if we apply Kuyper’s view, then when we get to the more ambitious work of social reform and the addressing of social structure, believers should work through associations and organizations rather than through the local church.  While the institutional church should do relief inside and around its community, the ‘organic’ church should be doing development and social reform.”

He goes on to say that many of the churches that practice this sort of model of ministry (of the sort championed by John Perkins) form community development organizations, distinct from their congregations, to operate programs in their community. Otherwise the work of community renew and social justice can easily overwhelm the work of building up the church by evangelism and discipleship.

Mission organizations plant churches and disciple individuals and can be well suited to do ‘organic’ type ministries of justice and social transformation. However, mission organizations are specialized in seed sowing and building foundations, not in the ongoing work of the ministry — which must increasingly fit the local context with local leadership.  So just as we plant churches in various places, we have a vision to plant local mission organizations that can glorify Christ and address issues of justice and social needs.

Would you be happy to join with a view to this sort of gospel-centered mission to serve in the area of justice and social transformation?

Medical Missions, an assessment by a historian

Sent to Heal by Christoffer H Grundmann
Sent to Heal by Christoffer H Grundmann

Christoffer Grundmann writes, “Most nineteenth-century people, medics and theologians alike, paid little, if any attention to medical missions — even if they were addressing mission. And when they did, they almost always did so in very limited confines, leaving their discussions to circles of experts. This isolation made it even more difficult for any general discussion of the subject to be carried on. At the same time, this indicates that medical missions hardly – if ever – succeeded in formulating and communicating the rationale for their work in such a way that others could fully understand them. Thus their potential impact on theology, medicine, intercultural dialogue, and dialogue between science and religion was considerably hampered by this inability (on the part of most of them) to engage in adequate reflection on the subject. This might simply have been the cost of their enormous day-to-day demands of the work itself, which consumed their energies…

“From the outset, however, medical missionaries were compelled to validate their work in the face of the common assumption that only those who preached and taught the gospel explicitly were real ‘missionaries.’ It was not surprising then, that medical missionaries tended to defend their work somewhat apologetically.”

Without adequately reflecting on medical missions, how do we expect to engage the next generation in the amazing opportunities God has put before us to bring healing to the nations?  Our physical bodies were made by God and declared “good,” although distorted by sin from God’s original design.  We need plenty of people to adequately reflect on this subject.  That’s why I am writing this blog!  It is my intention to stimulate you to think about the needs of this world from God’s perspective, and get involved.  Physical and spiritual needs were all of concern to Jesus as he walked this earth.  The foundation of all healing is the work He did on the cross, bridging the divide between heaven and earth.  But his work is not done only by addressing the heart need of man; He is also a God who cares about physical suffering, justice, and manifold other mental, relational and spiritual needs.  Let’s not be so busy we cannot talk together and help one another accomplish what is good.

The Work of the New York Medical Missionary Society

I was recently at a meeting where the idea of a medical missions institute was proposed, in order to enable our healthcare missionaries to better flourish in their international settings.  In fact over 65 different agencies send out missionaries from America; if we add Canadians, Indians, Australians, Nigerians, British, South Africans, etc the number of mission agencies involved in cross cultural medicine is significant. I wonder if the time has come to begin to think again about how to better link hands together for the sake of Christ, showing the compassion of Christ to those who are suffering and speaking the words of Christ to bring salvation. The future for medical missions does certainly not depend on just American solutions.

We think we understand what is happening in our world, but a look back in history shows that we are standing on the shoulders of giants.

I have been researching the history of SIM’s response to human needs since our inception in 1893, and so I’m attuned just now to history. I discovered Christoffer H Grundmann, who is a Professor of Religion and the Healing Arts at Valparaiso University, in Indiana.  In the Christian Journal for Global Health he quotes Gordon Dowkontt as writing in the Medical Missionary Record (1897), “To merely talk piously and tell suffering people of a future state, while neglecting to relieve their present needs, when in our power to do so, must be nauseating both to God and man, and certainly is a libel upon the Christianity Christ both taught and practiced, in which He combined care for the whole being of man, body and soul.” He was trying to correct a distortion of Scripture which emphasized the spiritual apart from the physical. The Scriptures shows that Christ cares for both; the root foundation for it all is His work on the cross.

In fact Rev. Roland Bingham, the founder of the Sudan Interior Mission (now SIM), warned against the dangers of a gospel which was so spiritual that it did not allow for God to use physical means (doctors, drugs, procedures, etc) for healing.

However even before the Sudan Interior Mission was founded in 1893 (by an amazing group of three men who went out to reach interior of Nigeria – another story), there were groups of men and women writing and preparing for medical missions!  And we think we are on the cutting edge!

In a Google search for Dr. Dowkontt’s article, I found a Wikipedia article entitled “American Medical Missionary College.”  I would like to include a few paragraphs describing the New York Missionary Society, founded in 1881. If you follow the link you can also read an online autobiography by Dr. Dowkontt in ‘external links.’ Dr. Dowkontt ‘pleads the cause of the specially educated medical missionary.‘  Note that during that era of colonialism and “Christendom,” the unreached of the world were often referred to by words which sound paternalistic (or downright racist) to our ears. I wonder if we could take the passion of this missionary society and work towards a future when East and West, North and South can work together to heal the brokenhearted of the world. Maybe a similar medical missionary society – or a network of them around the world – could be used by the Lord to work towards this end, out of the compassion of Christ.


“We have received a courteous letter from Dr. George D. Dowkontt, of this city, Medical Superintendent of the New York Medical Missionary “Home and Institute,” regarding the subject of “specially trained medical missionaries,” to which we referred in our issue of March 6. Dr. Dowkontt pleads the cause of the specially educated medical missionary. The great need of medical and surgical aid in heathen lands, and the great missionary value of such aid, are referred to, while the scarcity of men both willing and fitted to go is insisted upon. It was for these reasons that the Edinburgh Medical Missionary Society was founded in 1841, and the New York Medical Missionary Society in 1881. The peculiar need for the existence of the latter society, we are told, lies in the fact that medical missionaries must be particularly well educated medically, and American medical colleges are not good enough, and do not furnish sufficient training. Our correspondent adds:

” ‘Allow me to say, in conclusion, that there is great force in the suggestion you made, that we could well spare two thousand out of the four thousand physicians annually graduated in America; and this is forcibly shown in the fact that while in 1880 there was one doctor to 585 people in the United States, there was only one medical missionary to nearly ten millions of the heathen.

” ‘You observe that these could well be spared to go forth and disseminate the gospel. Would to God they were able and willing so to do, then we need not exist; but they must first possess this gospel in their own hearts and lives to be able to disseminate it, and they must further be actuated by the spirit of self-denial which characterized the Great Physician for body and soul, the Lord Jesus Christ, before they will be willing to do so.

” ‘Thank God for the noble men of our profession who have gone forth to heathen lands, as Scudder to India, Parker to China, Livingstone to Africa, and Post to Syria, but oh! for more such men who are willing rather to live to give, than to get.


An Upside down World. Distinguishing between home and mission field no longer makes sense. Christopher J.H. Wright

Chris Wright is the international director of the Langham Partnership.  He wrote “The Mission of God: Unlocking the Bible’s Grand Narrative (Intervarsity, 2006). This CT article highlights the changes in Global Christianity, where the “old peripheries are now the center.”  He speaks of our “blindness to the ways Western Christianity is infected by cultural idolatry.”  And that now, with the center of gravity no longer in the West, we have the opportunity to return to ‘normal’ Christianity, not dominated by one geographic locus or territorial center.  In this ‘normal’ mission we will be re-learning the multi-directional nature of mission in the Book of Acts; he points out that our preoccupation with concentric circles has obscured the more complex pattern of mission and movement in Acts.  “What held together these crisscrossing lines of missionary movement all over the international Mediterranean world?  Carefully tended relationships of trust.  He encourages us to recapture the relational, partnering, reciprocal style of missional interchange exhibited in the book of 3 John, where travelling church planters and teachers were to be welcomed in a manner worthy of God.

“Perhaps what we most need to learn, since we so easily forget it, is that mission is and always has been God’s before it becomes ours…  This God-centered refocusing of mission turns inside-out our obsession with mission plans, agendas, goals, strategies and grand schemes…   We ask, ‘Where does God fit into the story of my life?’ when the real question is ‘Where does my little life fit into the great story of God’s mission?”

He ends with a call to us to go back to the Cross and relearn its comprehensive glory.  “It is vital that we see the Cross as central to every aspect of holistic, biblical mission—that is, of all we do in the name of the crucified and risen Jesus. It is a mistake, in my view, to think that while our evangelism must be centered on the Cross (as of course it has to be), our social engagement has some other theological foundation or justification.”

What is God doing in your part of the world as we move towards a model of missions which is not just ‘from the West to the rest?’ In SIM we embrace multi-cultural leadership, although we still have a way to travel on the journey towards the vision Chris Wright is helping us to see here. The cross of Christ speaks of servanthood and sacrifice. That’s the stuff that healing is made of.


Seeking the welfare of your captors

Bible Backgrounds Jeremiah

God removed His people from Jerusalem because of their sin, yet He wants them to seek the welfare of their captors, the fierce Babylonians. “Welfare” in the Lord’s command is the translation of the Hebrew word, “shalom.” Rather than retaliate in anger, or put their hopes on a swift return to Jerusalem (predicted by false prophets), God wants them to have peace. He directs them to settle down, seek the welfare of their new country, have families and become a blessing.  How different this is from the violence we see in the news today. Rather than taking lives, God’s intention is to give life. We as His people become channels of blessing to nations that do not yet know His goodness and grace.

Have you found a place where you can be a channel of blessing to others, even those who have done you wrong? This sort of assignment is too much for us, apart from the power available in the death of life of Christ.

Due credit to missionaries – from the Lancet Global Health Blog

Lancet Global Health Blog

An overlooked WWI legacy: maternal and child health in sub-Saharan Africa

— from the Lancet Global Health Blog, November 2014

While medical missions provided 25-50% of maternal and child health care in sub-Saharan Africa throughout most of the 20th century, their legacy is often overlooked.

Often incorporating local knowledge and culture, missionaries provided family-centered health care at the grassroots level—bringing services to sub-Saharan Africa while they were also on the rise in England, writes Chris Simms, assistant professor in the School of Health Administration at Dalhousie University in Halifax.

The risks of academics dismissing missionaries as an embarrassment and ignoring their achievements, Simms says, are “that lessons-to-be-learned are neither identified, nor acted upon, and that past mistakes will be repeated.”

Simms says, “Indeed, studies suggest that, rather than being a source of embarrassment, medical missions have shown what can be achieved when health initiatives are planned and implemented as if ordinary people mattered.”

Click here for the entire blog.

Is there no balm in Gilead? Is there no physician there?

Foundations of the burnt room, a house in the wall of the city of Jerusalem during David's time, destroyed in 586 BC by the Babylonians.
Foundations of the burnt room, a house in the wall of the city of Jerusalem during David’s time, destroyed in 586 BC by the Babylonians.
The sign at the site reads, "He burned the house of the Lord, the king's palace, and all the houses of Jerusalem.."
The sign at the site reads, “He burned the house of the Lord, the king’s palace, and all the houses of Jerusalem..”

Last month my wife and I had our first visit to Jerusalem.  We took these pictures at the site of the foundations of the wall of the original city of David, destroyed by the Babylonian army in 586 B.C.  The sign continues to read, “The floors of the houses were covered by a thick layer of ash. Beneath the heap of rubble in one room, Yigal Shiloh uncovered Babylonian and Israelite arrowheads and remnants of a charred piece of wooden furniture bearing a palmette design. The wood was imported to Syria, attesting to the high status of the residents of these houses.”

What does the destruction of Jerusalem in 586 BC have to do with healing the brokenhearted?  God had pleaded with His people through the prophet Jeremiah decades earlier: “Amend your ways and your deeds, and I will let you dwell in this place.  Do not trust in deceptive words, saying ‘This is the temple of the Lord, the temple of the Lord, the temple of the Lord.’ For if you truly amend your ways and your deeds, if you truly practice justice between a man and his neighbor, if you do not oppress the alien, the orphan, or the widow, and do not shed innocent blood in this place, nor walk after other gods to your own ruin, then I will let you dwell in this place, in the land that I gave to your fathers forever and ever.” (Jeremiah 7:4-7).

God cares for the brokenhearted and He wants His people to do the same. He commanded them to practice justice, care for the orphan and widow, and treat foreigners fairly.  Because this is God’s heartbeat, their obedient faith was far more important than God’s keeping the city and temple intact.  Jeremiah weeps over and over again for the choices they make to serve their own appetites and gods, rather than follow God’s ways. In 596 BC the warnings had gone on long enough; the entire city was destroyed and the people either killed or deported to Babylon.

Today God still cares for the brokenhearted; as Christ’s followers justice for the weak, care of the marginalized and fairness to foreigners are not an option, but express Christ’s heart for the nations.  All of us must be involved, not just those of us in medicine and healing professions. But Christians in medicine have a unique opportunity to bring words and works of healing to the brokenhearted. How are you involved? How might you engage with God’s heart this way in 2015?

Here’s a warning for us.  The people of God refuse to listen to Jeremiah.  He said (Jeremiah 8:11) “they heal the brokenness of the daughter of My people superficially, saying ‘Peace, peace,’ but there is no peace.”  The leaders of that day promised peace but the healing was superficial.  There was no inner change.  Real peace and real healing go hand in hand, and man cannot manufacture them; they are a gift from God.  Am I willing for God to break my heart for others in distress, or will I cling to superficial words of peace and superficial healing? My challenge is that I am committed to bring healing to the brokenhearted, but in order to do that my own broken heart must be healed.

When Jeremiah himself understands that His people will continue in their rebellion, he says, “Harvest is past, summer is ended, and we are not saved.” (Jeremiah 8:20).  In other words, Babylon will definitely come (as they later did in fact).  He laments, “Is there no balm in Gilead? Is there no physician there?”  In fact Gilead was a town east of the Jordan river known for its healing balm and arts.  But there would be no final healing for a nation that will not receive God’s medicine. God will not heal superficially.

Many of us are engaged in some way in Christian mission or medicine.  Do we heal with superficial words and actions, or are we attempting to bring deep healing to the wounds of the nations?  As we align with God’s purposes in Christ, harvest is not past, summer is not ended.  There is a balm in Gilead, found in the sweet person of Christ, and available for healing of the nations. First however, we must allow Him to apply the healing balm to our own broken souls. How about yours?

So where did hospitals come from anyway?

Many of us have some sort of notion that hospitals are just a natural part of the community; the idea of a hospital must be handed down to us from classical times.  But we we would be wrong.  They were nurtured in an unexpected place.

Among the ancient and pagan Romans, compassion was not well developed.  “Mercy was discouraged, as it only helped those too weak to contribute to society.  In the cramped, unsanitary warrens of the typical Roman city, under the miserable cycle of plagues and famines, the sick found no public institutions dedicated to their care and little in the way of sympathy or help.”  [“A new era in Roman healthcare” Gary Ferngren]

Ferngren goes on to explain while one of Rome’s greatest prides was its cities, they also provided fertile breeding grounds for disease, especially for migrants from the countryside.  No clinics or hospitals existed to provide healing or basic nursing care. Physicians were for the wealthy. In a world of gods who were not known for compassion, the Roman culture did not encourage a felt responsibility to care for the sick and marginalized.

Despite persecution, by the second century Christian churches had sprung up in most of the major cities, and their charity included care for the sick.  By the fourth century bishops in the eastern half of the empire began to establish Christian welfare institutions for the sick and poor, called xenodocheia.  Christian History magazine issue 101, “Healthcare and Hospitals in the mission of the church” details how this ancient movement flourished and eventually birthed the concept of the hospital.

An unexpected place!  Much of the impetus behind hospital ministry, especially to the poor and marginalized, comes from the faith of early Christians.  Is this  a surprise to you?  What can we learn now from their faith and example?  Reply below!