“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.

 

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

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.

 

 

 

Navigating a path to sustainable Chinese medical mission participation

Take a look at some the challenges that Chinese Christian doctors could face as they consider God’s call to missions. And this article doesn’t even begin to address the cross-cultural issues of Eastern and Western medical worldviews!

As you consider these hurdles, let’s not think ‘it can’t be done!’ Rather, let’s think that “God is the God of the impossible.”  How might God move us as Western mission workers to include and partner with missionaries from other cultures.  Not so much to use them for ‘our’ work but to bless them for the sake of the Kingdom of God.

At the same time let us use our resources not just to do ‘our’ work but to develop spiritual leadership for medical missions which is diverse — celebrating and demonstrating the Kingdom of Jesus.

Challenges?  Yes. Opportunities? Definitely.  Needed? Leadership. Why?  Because this reflects the character of God and reflects His glory.

Jesus taught us, “With God all things are possible.”  Matthew 19:26

 

Lessons learned from an Angolan church leader

I had the privilege of knowing a leader of the association of evangelicals in Angola about a decade ago.  He was willing to share honestly his perspective on church mission relationships. Unfortunately the lessons are are not unique to ministry in Angola.

He said, “Many times we give answers to problems of local churches without taking the time to find the questions. We come with prefabricated solutions.”

As people motivated by the gospel of Christ we can get too attached to the means without attention to the ends. When Jesus was asked “Who is my neighbor?” by the rich man seeking to justify himself, Jesus gave him the answer in story form. Jesus didn’t just supply an answer but took the time to address the real questions (e.g. ethnic and religious pride) behind the question.  We must communicate the Word of God not just by speaking (from our perspective) but by listening to the perspective of the ones we are serving (and then speaking).

He continued, “In building community we tend to see only social problems. But the basic problem of the world is spiritual, not social [our alienation from God]. We can’t transform hearts by only changing the environment.”

In the early days of missions our forefathers went to the rural areas and brought rural education. Literacy rates began improving.  But while rural education began to improve there was little effort to change the educational system by reaching business people or teachers in the cities.  In the end the church lacked trained people, people who could contextualize the gospel message for the local culture.  Core cultural assumptions were not touched and thus some ‘believers’ reverted to animism.  His own understanding as a young man was that if you fail in life, perhaps then you can become a pastor!

It is a beautiful thing to educate children. But if we tackle only education without discipling teachers we may have limited impact. We are not just in missions to change the environment (education, health care, justice issues) but to communicate the glory of God in Jesus Christ and His redemptive plan for men and women. This means transforming local leadership, by His grace, to continue to follow Christ and meet the social, spiritual and physical needs around them. As outsiders we must think about the whole picture not just our part.  As Jesus establishes His kingdom on earth He reaches whole people — bringing us out of bondage to sin and into new life, in order that we can be salt and light to others!

He also said, “The church is depending on missionaries for leadership and funds even to get recognition in the country.”

I believe that much progress has been made in this last decade or two by the Angolan believers, but how important it is that we ‘missionaries’ have a heart to develop and train local believers — allowing them to ‘increase’ while we ‘decrease.’ Not an easy job.  In fact it is impossible, given our own sinfulness. But, with God, all things are possible.  In fact Jesus has already promised, “I will build my church, and the gates (authority) of hell will not prevail against it.” Matthew 16:18

 

"Every Good Endeavor"

“Christians’ disengagement from popular culture usually carries over into dualism at work. “Dualism” is a term used to describe a separating wall between the sacred and the secular. it is a direct result of a thin view of sin, common grace, and God’s providential purposes.

“Dualism leads some to think that if their work is to please Christ, it must be done overtly in his name. They feel they have to write and perform art that explicitly mentions Jesus, or teach religious subjects in a Christian school; or that they must work in an organization in which all people are professing Christians. Or they must let everyone know that they lead Bible studies in the office in the morning before work hours. This kind of dualism comes both from a failure to see the panoramic scope of common grace and the subtle depths of human sin.  People with this view cannot see that work done by non-Christians always contains some degree of God’s common grace as well as the distortions of sin. And they cannot see that work done by Christians, even if it overtly names the name of Jesus, is also significantly distorted by sin.

“The opposite dualistic approach, however, is even more prevalent — and based on our experience, even more difficult to dismantle. In this approach, Christians think of themselves as Christians only within church activity. Their Christian life is what they do on Sundays and weeknights, when they engage in spiritual activities The rest of the week they have no ability to think circumspectly about the underlying values they are consuming and living out. In their life and work “out in the world,” they uncritically accept and reenact all of their culture’s underlying values and idolatries of self, surface appearances, technique, personal freedom, materialism, and other features of expressive individualism. While the first form of dualism fails to grasp the importance of what we have in common with the world, this form fails to grasp the importance of what is distinctive about the Christian worldview — namely, that the gospel reframes all things, not just religious things.

“The integration of faith and work is the opposite of dualism. We should be willing to be very engaged with the cultural and vocational worlds of non-Christians. Our thick view of sin will remind us that even explicitly Christian work and culture will always have some idolatrous discourse within it. Our thick view of common grace will remind us that even explicitly non-Christian work and culture will always have some witness to God’s truth in it. Because Christians are never as good as their right beliefs should make them, we will adopt a stance of critical enjoyment of human culture and its expressions in every field of work. We will learn to recognize the half-truths and resist the idols; and we will learn to recognize and celebrate the glimpses of justice, wisdom, truth, and beauty we find around us in all aspects of life. Ultimately, a grasp of the gospel and of biblical teaching on cultural engagement should lead Christians to be the most appreciative of the hand of God behind the work of our colleagues and neighbors.”

"Every Good Endeavor"

“Christians’ disengagement from popular culture usually carries over into dualism at work. “Dualism” is a term used to describe a separating wall between the sacred and the secular. it is a direct result of a thin view of sin, common grace, and God’s providential purposes.

“Dualism leads some to think that if their work is to please Christ, it must be done overtly in his name. They feel they have to write and perform art that explicitly mentions Jesus, or teach religious subjects in a Christian school; or that they must work in an organization in which all people are professing Christians. Or they must let everyone know that they lead Bible studies in the office in the morning before work hours. This kind of dualism comes both from a failure to see the panoramic scope of common grace and the subtle depths of human sin.  People with this view cannot see that work done by non-Christians always contains some degree of God’s common grace as well as the distortions of sin. And they cannot see that work done by Christians, even if it overtly names the name of Jesus, is also significantly distorted by sin.

“The opposite dualistic approach, however, is even more prevalent — and based on our experience, even more difficult to dismantle. In this approach, Christians think of themselves as Christians only within church activity. Their Christian life is what they do on Sundays and weeknights, when they engage in spiritual activities The rest of the week they have no ability to think circumspectly about the underlying values they are consuming and living out. In their life and work “out in the world,” they uncritically accept and reenact all of their culture’s underlying values and idolatries of self, surface appearances, technique, personal freedom, materialism, and other features of expressive individualism. While the first form of dualism fails to grasp the importance of what we have in common with the world, this form fails to grasp the importance of what is distinctive about the Christian worldview — namely, that the gospel reframes all things, not just religious things.

“The integration of faith and work is the opposite of dualism. We should be willing to be very engaged with the cultural and vocational worlds of non-Christians. Our thick view of sin will remind us that even explicitly Christian work and culture will always have some idolatrous discourse within it. Our thick view of common grace will remind us that even explicitly non-Christian work and culture will always have some witness to God’s truth in it. Because Christians are never as good as their right beliefs should make them, we will adopt a stance of critical enjoyment of human culture and its expressions in every field of work. We will learn to recognize the half-truths and resist the idols; and we will learn to recognize and celebrate the glimpses of justice, wisdom, truth, and beauty we find around us in all aspects of life. Ultimately, a grasp of the gospel and of biblical teaching on cultural engagement should lead Christians to be the most appreciative of the hand of God behind the work of our colleagues and neighbors.”