Want to change the world? Invest in institutions

SIM’s first Asian medical missionary, Dr. Andrew Ng, served for years at Galmi hospital in Niger, and later provided leadership for SIM from Asia. He always had a youthful vision for how Jesus is shaping the world, and a special love for Jesus’ work in medical missions.  And while he just went home to be with his Lord, Andrew left me with many lessons. One of those lessons was about institutions. “Think about Mother Theresa,” he would say. He could see that she and her institution had a world-wide impact.

Here is how Wikipedia defines institution: “An institution is social structure in which people cooperate and which influences the behavior of people and the way they live. An institution has a purpose. Institutions are permanent, which means that they do not end when one person is gone. An institution has rules and can enforce rules of human behavior.”

Are you looking for lasting (even permanent) change? Try building up institutions! Hospitals of course are one type of institution. Let’s not just ‘do’ our medical ministry, but ‘leave’ hospitals where people love Jesus and continue to serve those broken in soul and body.  That means that part of our Christian effort is to invest in local people in order to build leadership and good governance, with a heart for this ongoing mission of Jesus!

Gordon Smith makes an excellent case for institutions in his Gospel Coalition article with this title:  Want to change the world? Invest in institutions.

But hospitals are not the only kind of health institutions. Hospitals and modern healthcare are important places to care for the brokenhearted. [The good Samaritan needed a place to care for the wounds of his new friend, and we have much in the 21st century to offer to relieve physical suffering.] But there are other kinds of institutions — some of which operate outside of bricks and mortar — social structures or organizations with governance and leadership that allows people to work together for good.  For example, an institution with a mission to:

  • do excellent hospice care
  • enable children to have access to clean water, sanitation, nutrition
  • build communities of individuals who will counter the poor health effects of local superstitions and beliefs that are tied to poor health
  • do good public health education
  • come alongside others (e.g. local government or community) in order to enhance response to disease outbreaks (epidemiology), promoting disease control or good local health systems
  • enable local churches to see the opportunites around them to be good neighbors by investing in critical needs such as handicapped ministries, HIV and AIDS ministries and the like
  • the list is almost endless

As Gordon Smith points out, we have a tendency to suspect anything with structure and authority. But rightly developed, institutions remain a key to healing our world.  Let’s not just plant churches, but institutions that flow out of the work of those churches. Thank you, Dr. Andrew.

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


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?

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


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.

Charleston, South Carolina

We all mourn the tragedy in Charleston, where the hatred of one white man for black people turned into murderous rage.  Eight African American Christians are dead.  As a nation we don’t know how to even think about such an evil act. We are humbled by the forgiving spirit of these families and friends.

Pundits are talking about gun control and the confederate flag, both of which are important discussions; however as Christians we are called to a heavenly perspective, and there are some things we should talk about.

This 21-year old man was hoping his rage would turn into a war. Yet there are no shots being fired back. He chose not just to kill African-Americans.  More significantly he chose to kill believers in Christ, those who knew the amazing grace of Christ, who gave Himself for our sins. Satan steals and kills and destroys; Jesus gives life and peace.  There is a world of difference.

The situation does call us all to healing.  There are significant issues surrounding race in American that we do not appreciate as the majority culture (i.e. Caucasian). What efforts are we making to really listen to our brothers and sisters in Christ who are black? Not just with our head but with our hearts.

Remember we talked about healing as shalom. That means wholeness in relationships. We need Christ’s shalom in this situation. This would only come by His grace, as we sit, weep, listen, converse, pray and plan together.  We must speak with one another then we can speak to the nation.

How grateful I am to see brothers and sisters of all races and colors join together in prayer in Charleston. We must not allow this to just be an isolated incident, because it is symptomatic of a deeper dis-ease, a dividing wall which Christ has broken down at His cross.  By His grace may this be the beginning of peace, not war.  The peace of shalom, expressed in words, prayer and action which live out the story of redemption, that Christ has conquered sin and death, and by the power of the forgiveness of the cross invites all to join in one body.

Remember in my last post, I said, “And nowadays we have not just two, but innumerable cultures in the church. Walls says, “Like the old Jerusalem Christians, Western Christians had long grown used to the idea that they were guardians of a ‘standard’ Christianity..” But the church is now very diverse, and in that diversity can more fully express the glory of God and the sweetness of His Son Jesus Christ, who brings us together yet allows us to express His grace separately.”

Let us pray and trust the Lord to enable us to find and create practical bridges between the various cultures representing America, and thus show our unity in Christ in love. But this will take some sacrifice from us as “majority” culture, just as it took from the Jews when they found out that God did not deal exclusively through their culture. Please let us take the time to begin to hear, listen to one another, pray and speak to others of how Charleston might be a stepping stone not to war but to shalom.


The Ephesian Moment — one body, many parts

Health Ministries - Infant PutureMission medical workers want to see healing of the body, the child with malaria, the mother suffering with postpartum depression, the young man wounded in a fight. But there is another body we want to see healed, the body of Christ. In Acts chapter 15 we read, “And some men came down from Judea and began teaching the brethren, ‘Unless you are circumcised according to the custom of Moses, you cannot be saved.’ And when Paul and Barnabas had great dissension and debate with them, the brethren determined that Paul and Barnabas and certain others of them should go up to Jerusalem to the apostles and elders concerning this issue.” (Acts 15:1,2).  As Paul and others shared the good news concerning Christ with Gentile believers, a clash of cultures arose; the Jews argued that a true follower of Jesus must become Jewish, while Paul said ‘no.’

The Jerusalem council eventually settled the matter by a historic decision: God had been taking out a people for Himself from among the Gentiles, and it should not be man’s business to force them into a Jewish culture in order to follow Christ. (See Acts 15:13-29). The purpose was “in order that the rest of mankind may seek the Lord, and all the Gentiles who are called by My name.”

Just as there is a oneness and diversity in the human body, so there also should be both a oneness and a diversity of cultures in Christ’s body, the church. This has profound implications for medical mission work, as we want to be sure that Christ’s compassion is expressed in many cultures and many ways, not just through the dominant worldview and culture of Western medicine.  We want to see the ‘best of the West’ connecting with the best of the rest. Think of the cover of Time magazine this past year, where Dr. Jerry Brown, Liberian surgeon, trained in the joint mission program called Pan African Academy of Christian Surgeons, was honored.

Missiologist Andrew Walls says, “Traditionally, observant Jewish society and Hellenistic pagan society could be viewed as distinct entities, and the distinctiveness of each was marked at the meal table. Jews ate with Jews, Gentiles with Gentiles. The events reflected in Acts 15 produced two distinct Christian lifestyles corresponding to these ethnic and cultural divisions, the one for Jewish society and, the other for Hellenistic society. One might expect as a result that these would be two Christian communities, a Jewish church and a Gentile church. The Ephesian letter has not a dream of such an outcome: ‘In union with him [Christ] you too are being built together with all the others to a place where God lives through His Spirit. (Eph 2:22)’” The Cross Cultural Process in Christian History”

“Emphatically, there was to be only one Christian community. That community has become more diverse as it crossed the cultural frontier with the Hellenistic pagan world; and Christian obedience was tending to increase the diversity by developing parallel lifestyles that would penetrate and influence Jewish society on the one hand and pagan society on the other.  But the very diversity was part of the church’s unity. The church must be diverse because all humanity is diverse; it must be unified because Christ is one… The Ephesian letter is not about cultural homogeneity; cultural diversity had already been built into the church by the decision not to enforce the Torah.. Only together, not on our own, can we reach Christ’s full stature (Eph 4:13).”

And nowadays we have not just two, but innumerable cultures in the church. Walls says, “Like the old Jerusalem Christians, Western Christians had long grown used to the idea that they were guardians of a ‘standard’ Christianity..” But the church is now very diverse, and in that diversity can more fully express the glory of God and the sweetness of His Son Jesus Christ, who brings us together yet allows us to express His grace separately.

Good doctors and nurses don’t just treat the liver or heart; they are concerned for the effect of illness on the whole person. Good medical mission workers likewise are not just concerned for the effect of sin and injustice on one particular culture, but on the effect of sin on the whole. God is doing something beyond what we can ask or think, allowing His gracious gospel to transform the cultures of the world to express Christ in different ways yet in unity of Spirit. Medical missionaries — from various cultures — have background and training that is vital to the worldwide missionary task of the body of Christ.


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.