Mastery And Mystery

Scott spoke to us at the annual Mental Health and Missions conference in Indiana last month. As health professionals we live in the tension between mastery and mystery, and he helps us live there with his story of grace.

Tending Scattered Wool

We seek competency and proficiency in many areas of our lives. That is good and proper stewardship of what God has graced us with in life. As caregivers, it behooves us to provide as excellent of care as we can.

We feel most comfortable discussing and pursuing mastery. Mystery, though, is another reality IMG_0785.JPGaltogether…

Its the mysteries in life that undo us.

Mysteries are the life circumstances in which we often feel stuck, confused, and undone. We cry out to God for relief and nothing seems to change. Even the Apostle Paul experienced God saying “no” to him when he cried out for help (see 2 Corinthians 12 for example).

Tolerance for Mystery
God seeks to grow us in our tolerance for mystery. As we grow in tolerance for mystery, we actually become more competent in our mastery. However,  we often, sometimes unknowingly, ignore and hide the broken places…

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Social concern by evangelicals in the 1800s

Once in a while it is good to remind ourselves that Bible believing Christians over the centuries have been in the forefront of social concern, demonstrating the character of Jesus by good works of compassion.  Things changed somewhere in the early 1900s, but especially before that the church was a model for many social programs.

In Glasgow, Scotland, Thomas Chalmers operated a church school in the early 1800s, with an aim of lifting up the lives of children who had no access to education. His church also took on responsibility “for raising and distributing poor relief in its parish.”*

“In a society without state social welfare provision, a large range of philanthropic effort was undertaken by churches and Christian organizations. Children were a particular focus of concern. Education was largely in the hands of the churches until the State began its own efforts in the 1870s. Anglican and Catholic orphanages were widely established. The London Congregational minister Andrew Reed (1787-1862) started three orphanages, a hospital for children with severe learning difficulties and a home for people with incurable illness. George Muller’s Ashley Down Orphanage supported some 2,000 children in Bristol in the 1880s. In the East End of London, Thomas Barnardo (1845-1905), who started a mission for young people, had by the time of his death rescued around 60,000 children. He pioneered approaches to fostering, operating a ‘no destitute child refused admission’ policy. In 1905 Barnardo’s children’s homes were caring for over 8,500 children, of whom 1,300 were disabled or suffering from serious illness.

“One of Britain’s most widely respected philanthropists and social reformers was Lord Shaftesbury (1801-85). He was strongly motivated by his evangelical social conscience, and steered legislation through Parliament to outlaw the employment of children in underground coal mines, to reduce the hours of children worked in mills, and to improve housing conditions and the care offered to people with mental illness. Evangelical social reformers and philanthopists in Britain helped ameliorate some of the worst social ills of the Industrial revolution; indeed the nineteenth century has been called ‘the Evangelical Century.’ However, other issues remained unaddressed, and the biggest social reform provisions such as universal pensions and unemployment pay had to wait until government intervention at the start of the new century.”

*See “Christianity: The Biography — 2000 Years of Global History” by Ian J Shaw (Zondervan 2016)

Traveling Wise in a Fast World

Here are some lessons that most of us would benefit from. The only problem is that we may not be able to divide our day into ‘thirds,’ and only work two of three. Medical ministry is pretty demanding. Or should we be thinking differently about healthcare ministry in a mission setting? How can we best communicate Jesus to our patients and staff?

Tending Scattered Wool

Several weeks ago I posted a link to a video that has garnered some good feedback in many circles. You can see the blog here with a link to the video in it.

One person commented on that video post wondering what it would look like to seek to live this type of pace while traveling internationally at jet speed. This is a great question.

Lessons on Itinerant Shepherding
Personal, on-site interaction is a core philosophy of my shepherding. I want to walk the IMG_7018streets of those I tend to – meet their community, sit in their living room (if they want that) – enter into the very fabric of their lives. We all long to be known. Long-term, particularized care leads to others being known, loved and that creates space for life change.

There are some hidden temptations that come with such a model. One of the greatest is…

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What should characterize public health done by Christians?

Public health skills are powerful tools to promote flourishing of communities; they complement medical care of individuals.  Christians also want to promote human flourishing, since this demonstrates the goodness of God.  What will characterize public health done by Christians?

Some of the ancients were inclined to treat disease and plagues in terms of supernatural forces and magic, shamanism and religious practices. The Hebrews stressed regulation of personal and community hygiene, isolation of lepers and other ‘unclean conditions,’ and family and personal sexual purity; God gave to Moses commands related to a weekly day of rest, limits on slavery and oppression, sanitation and food regulations.  The children of Israel gave to the world the teaching concerning human dignity since all are made in the image of God.

Modern public health is a noble sphere of human endeavor, whether done by Christians, Muslims or Secular modernists. Good public health practice should be characterized not only by good science but love for humankind. Christians are especially motivated by the value of human beings, as well as God’s command to love the Lord our God with all our heart, and love our neighbor as ourselves. We glorify God by seeking His best for our fellow human beings.

At the same time, modern public health – Jenner and vaccination, Snow on cholera, germ theory, bacteriologic revolution, hospital reform, immunology, the development of epidemiology – has grown up as part of the modern scientific revolution and out of Enlightenment thinking.  It is often characterized by a ‘split’ of sacred and secular, and a peculiar perspective that things ‘scientific’ define reality whereas things of God are confined to personal and private belief. I believe this is an inadequate foundation for public health as it tends to relegate ethical and moral matters to a private and subjective world.

As Christians we have much we can learn from our public health teachers, and much to give in order to alleviate the suffering of this world.  But ultimately our motivation for doing public health is to demonstrate the character of Jesus Christ to the world; we cannot bring utopia to this world but we can point to a Savior who cares about men and women – body and spirit. He is the Savior who not only frees us from our sinful selves but also frees us for His purposes in a world which He has made and is in the process of re-creating.

As a Christian epidemiologist, I will use the techniques of case control studies, disease surveillance and risk identification just the same as anyone else. The tools are the same, whatever our faith orientation. Our desired outcome – disease prevention and health promotion – will be the same; public health professionals seek the best for others.  Christian public health is not just public health done by Christians; it becomes activities, programs, policy and advocacy informed by God’s Word – which commands us to ‘love justice, seek mercy, and walk humbly with.. God.” (Micah 6:8)

A Christian perspective on public health and human flourishing will be informed not only by material success, but also by an understanding of the darker forces we face, including suffering and death. It will seek to address these matters with courage and meaning. A Christian perspective on public health can deal with life well because of the hope God offers in His promises in both life and death. The cross of Jesus Christ has won the victory of sin, darkness and rebellion in order to usher in life here and eternally.

Ultimately health is not an achievement of man but a blessing of God. And He is working in the world to bless the world through His Son Jesus Christ, who gave His own life for the ultimate in public health – salvation from sin, rescue from darkness and oppression, and the freedom of a life of love and grace.

Why should public health be part of our Christian commitment to mission? Isn’t curative care enough?

There are a great many ways that public health skills are being used in preventive and community health programs around the world. Yet when we think of ‘medical missions’ over the last 200 years there has been a strong clinical (medical) approach.  Why should a preventive approach complement this strong medical component of medical missions?

If diseases all responded to a curative approach, there might not be a need for disease prevention. But in almost any category of “disease,” there is need for BOTH a curative and a  preventive approach.  This can be illustrated with just an example or two.

Neonatal tetanus must be dealt with by antitoxin and medication to avert death and respiratory paralysis, and yet it can be prevented by careful care of the umbilical cord at birth. In one animistic tribe in Ethiopia there was the belief that the umbilicus must be covered with dirt from the entrance of the house in order to control access to the spirits to the entrance of the body; clearly there was a need for both medical intervention for the sick but also for education – addressing not only the biology but also the fear of spirits which were part of the local worldview.

In Nepal there is a high maternal mortality rate because of lack of access to facilities with good midwifery and caesarian section capability. The problem cannot be addressed with clinical care alone, but there must be attention to community education, early detection of high risk pregnancies, and training of community based midwives.

Ebola needed both treatment units (highly intensive and technical) as well as community education and contact tracing – both a highly clinical approach to the individual as well as a highly preventive approach in the community.

Road traffic accidents must be treated with competent facilities and personnel, but to reduce the incidence of accidents also requires community and government initiative, safe roads, helmets, seat belts, and a shift in mindset away from fatalism.

Almost every condition requires both a clinical and non-clinical approach. Physicians and nurses are superb at what they do, but there is much that remains undone, either in prevention of illness and injury, or in follow up management of those with chronic conditions, infections and disabilities.

God’s covenant promise to Abraham was to bless all the nations of the earth through him and through his descendants. God showed his concern for justice and human flourishing as he gave to his descendants the commands, promises and laws which reflect the best of human flourishing. Jesus – the descendant of Abraham – continued to show God’s character by healing many and sending his disciples out preach good news and to heal many others. The compassion of Jesus has led many over the centuries to sacrifice their own comfort out of compassion for others.

Is God concerned with prevention of human suffering? Does He encourage us to promote health as well as cure disease?  Yes!  God’s Word stands in contrast to the thinking of behaviorists or other forms of fatalism – those who believe we can’t really change things.  We are not able to manipulate the universe but God does sovereignly control the world and works out all things according to His purposes and design.  He has demonstrated His promised blessing to Abraham and His children, and ultimately in the person of Jesus Christ.  This is a universe created and sustained by a Person – good, righteous and true — not an impersonal force.

A Christian can confidently work to show God’s care for human life. As followers of Jesus Christ we trust that the Lord of the universe can change things (He has authority and power) and that He (not we) ultimately works for the blessing of mankind. The salvation Jesus accomplished on the cross bridges the sin problem (our separation from God) and thus enables us, by His grace, to both love God and love our neighbor. That love extends not only to care but to the prevention of human misery.  That’s public health from a Christian point of view.

Why health is more than medical care

Why is health more than just medical care?  Here are some reasons:

  1. Medical care tends to address matters of the body but not of the spirit. As medical professionals we are trained to diagnose, treat and manage medical conditions. We seek to apply scientific evidence to our craft.  And yet health is something more than science, scopes and surgery.  The best doctors and nurses treat the person, not just the disease.  Illness is not just chemistry and biology; it includes the non-material aspects of existence, such as meaning, dignity and reconciliation.
  2. Health is an outcome of many complex factors, not just medicine. These include things like nurture, nutrition, good housing, healthy relationships.  The reduction in deaths from infectious diseases in the West, for example, was mostly due to non-medical factors, not antibiotics.  Again, the evidence is that the best correlation with worldwide infant mortality is the educational level of the mother. Those who want to improve health of populations must think beyond individual care to the social and enviornmental determinants of disease.  Health is more than just medical care.
  3. Ultimately health is not ‘controlled’ by any one discipline or profession. As health professionals we have a fairly narrow focus – to treat or manage conditions in individual patients.  But health — since is is more than the absence of disease but the well-being of people — results from more than our medical tools.  Smoking, gun violence, human traffiking, poverty, inadequate vitamin A in the soil, deforestation, natural disaster — all contribute to human suffering and poor health!
  4. Health is about dignity, not just treatment. While excellent medical treatment is essential, not all conditions are curable, and some remain fatal. Even when we can’t cure or treat, our work must sill say, “You are a person. You are made in the image of God!” Restoring dignity must be part our motivation.  We are not treating machines, but human beings. Too often in our bio-psycho-social disease model we think mostly about physical treatment.
  5. Ultimately, health is a blessing of God, who created the body and also gave it tremendous powers of healing.  The tagline at a mission hospital in Chiang Mai, Thailand reads, “We treat. Jesus heals.”  We have the privilege to serve in medicine in humble ways to alleviate suffering; but in the end it is our Lord and Creator who gets the glory.

I welcome hearing about your reasons for thinking beyond medical care to health.

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