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.

Why I am blogging

As a medical missionary who has served on 3 continents, I want to blog about medical missions in order to encourage others in the task.  Please sign up and also respond to posts.  My aim is to make this as interactive as possible.

Here are some thoughts I had two years ago when I started blogging.  They are still true today.

Why I need to write the blog Heal the Brokenhearted

  1. To clarify my own thinking
  2. To view my priorities in writing
  3. To share some life long lessons in medical missions
  4. To encourage honesty and transparency in those involved in medical mission work
  5. To enable those in churches to see opportunities and obstacles
  6. To glorify the Lord for the many ways he has answered prayer
  7. To highlight a unique view of medical missions that tries to bring some balance to the debates within and encouragement to those involved

New post ideas:

  • Important priorities in mentoring medical missionaries
  • Suggested courses etc available
  • Review some of the helpful leadership books, aiming for leadership development for medical missions
  • Talk about short term missions and how churches might be involved
  • Member care from churches
  • Prefield screening and how churches can work together with agencies
  • Character issues, e.g. “Leading with a Limp” talks about character as the primary thing the Lord does in shaping our lives as leaders
  • Say hello and honor some of our old friends
  • Share specific experiences on the mission field
  • Talk about the work of support raising
  • Why mission agencies and not just going it alone
  • Health tracking/surveillance in SIM  – eg sick days, years of life of those dying in missions, stories of lives healed or saved
  • Blending the old and new missions thinking, link to CMDA and CMF and ICMDA

What topics would you like to hear more about?

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:     Global CHE network – Community health education/evangelism     Meeting the information needs of nurses and midwives – looks like quite a good site!     Teaching aids at low cost at TALC, including “Where there is No Doctor”     Palliative care toolkit (example)     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:     Technical and equipment issues     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.     Here is a pretty complete list of mission hospitals, agencies, national association, training programs and other resources!     “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:   Graduate diploma in International health and development in Australia     West Virginia tropical medicine course     Equip courses for physicians and medical practitioners (and some non professionals too!)     Diploma in tropical medicine and hygiene (3 months in London)     3- and 5-day “Operational Clinical Infectious Disease Courses” at Walter Reed Army Institute     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.

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.”

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