Kathryn Butler 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.
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?
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:
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?
Quotes from this helpful little book by Christopher Ash and Alistair Begg:
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:
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
New post ideas:
What topics would you like to hear more about?
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.
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”
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.
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
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.
CMDA CMDE Continuing education conferences every year in either Greece or Thailand.
What is your experience?
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:
Do you have other suggestions from your perspective? I’d love to hear from you.
You will hear many of our friends in SIM as they talk about the first year serving the Lord overseas. I love SIM! I love the Lord, for He is so gracious. Join us!
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.”
http://www.humansofnewyork.com/
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
Heal the brokenhearted 