Too much to do? Time to re-examine our own assumptions!

Stress and burnout are recognized themes in medical missions.  One source of stress is the sheer magnitude of physical needs; one billion people in our world have no access to a trained health worker and healthcare workers often stand in the gap.

In the face of overwhelming need how do we maintain healthy margins?  Overextended, we lose our compassion, damage relationships, and often leave our fields of service early.  Yet, the pressure is there, since the patients show up, the children are literally dying, and there is often no alternative for those who are the most marginalized.  Wouldn’t Jesus have compassion on the sick and dying?

In the late 1980s I was in a similar situation in southern Ethiopia, where I was called to lead a small team to treat patients dying among the Mursi tribe; hundreds were dying around us from meningococcal meningitis.  While we had some effective antibiotics we couldn’t get ahead of the need – patients were dying faster than we could treat them.  In our case, the answer was not so difficult, as the Ethiopian ministry of health asked us to bring along their workers and meningitis vaccine; thus we were both able to save many who were ill, but also prevent new cases with vaccine.  Caring for the ill and prevention went hand in hand – with a team approach.

But what about a hospital or clinic where the people come each day and yet the facility and staff are still overwhelmed?

One approach has been to assign numbers to non-emergency patients to limit those who can be seen on a given day.  Other barriers have been erected, such as raising fees – although this limits care to those who are most vulnerable and thus tends to defeat our purpose.  Outpatient clinic hours can be trimmed.  Specialty clinics can be opened only certain days.  All these efforts are ways of establishing boundaries and limits.  Some are needed; some are painful.

Yet, our hearts as medical providers are driven by compassion; we want to see as many as possible.  Compassion is from the Lord, and our instincts may be noble. But unexamined assumptions may contribute to our own burnout and long term lack of fruitfulness.

As medical healthcare workers and missionaries, do we recognize our own limits and vulnerabilities?  Or are we driven by a “Savior” complex where we must be the answer to everyone’s need?  Do we allow the needs to constitute our call, or does Jesus Christ shape the call?  If we are called and empowered by Him (as the true vine) then we (as his branches) can only produce eternal fruit as we allow Him to work through us.  Yes, this kind of ministry can be overwhelming, even impossible.  Are we connected to Him as the vine well enough that the life-giving grace of God gives us wisdom and strength?  Or have we subtly become “the vine” ourselves in the midst of the needs?

We do want to give our lives for others.  Good.  But our own wisdom and strength quickly fades and we must come to Christ and His word.  We might have the desire to “burn out for Jesus” but taken to the extreme we will damage our family and other relationships.  Exhaustion and callousness on a chronic basis are not the ‘living stream of water’ that Jesus promised would come from our hearts!

What is our ultimate purpose in medical missions?  It is to glorify Jesus Christ.  We become like a seed which falls into the ground; it must die and spring up with new life.  My hospital, my program, my health teaching – these are all means God uses to show His character through suffering and healing, to make disciples, to enable others to connect to the vine – ultimately serving others by God’s grace.

We must reflect on this ‘Me-first’ mentality.  Do we assume that these health ministries are about us and our ability?  That’s a prescription for the prosperity gospel!  Let’s not promote a false gospel based on our works rather than grace.

The ultimate purpose is to establish God’s reign, God’s kingdom on earth – or some small signpost of the kingdom in a broken and twisted world. We can make a real difference. However it is not by our trying hard enough, but by abiding in the Vine. We don’t want to plant our program; we want to plant the mission of Jesus.

Health is not just about the physical needs of those who come to us, but about their social, economic and relational needs. I fear that too often we apply a Western mindset [think separation of physical from spiritual/non-physical reality].  One way of creating more helpful margins is to actually involve local staff and others from churches and community in the care of those who come to us – enabling them to connect with our programs as whole people, not just disease conditions.

This takes building leadership for healthcare missions, not just adding medical practitioners.

Eventually this means we work with local doctors, community, nurses, churches, believers – to build healing communities. Only through teamwork can we begin to meet the overwhelming needs of those around us in a deeper way.  And yet in this way – as we die to our own ambitions – we are enabling others to see and to know and to serve the Lord Jesus Christ.  He is the King and Savior and healer and He is building His kingdom. We get the privilege to be a small part of His work. He is worthy!

Revisiting 5 Themes of Ill Health Amongst Global Workers

As we serve the Lord in this complex task of missions, here are some of our vulnerabilities. This site is not directed exculsively to medical workers, but I see a lot of these same issues in medical missions. Thanks, Scott, for helping us see ourselves. This should cause us to stop, examine priorities and assumptions, and get back to basics. Whose mission is this anyway, ours or our Lord’s?

Tending Scattered Wool

A couple of years ago I posted five entries on five themes I saw consistently amongst global workers that cause or lead to ill health and ineffectiveness. Some of these entries are the most read on this sight. Below is the list of the five topics, the first two being the most repeatedly viewed:

  1. Spiritual Anemia
  2. Total Exhaustion
  3. Relationships in Crisis
  4. Identity attached to Role and Responsibility
  5. Lack of Permission for Personal Development and Care

Based on the first two being the most viewed, we may be a spiritually thin, tired bunch.

I am going to revisit these themes with some reflections and resources on what I have learned and observed over the past couple of years.

The Interesting Observation of these Same Themes Amongst Member Care Providers
I have increasingly been investing more time in training, coaching, mentoring, and advising other member care providers. What I have quickly observed is that these…

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“…not merely a doctor”

“The doctor has so objectified himself that he never faces up to himself and his own life at all.”

“Somewhere in Pembrokshire a tombstone is said to bear the inscription, ‘John Jones, born a man, died a grocer.’ There are many whom I have had the privilege of meeting whose tombstone might well bear the grim epitath: ‘…. born a man, died a doctor’! The greatest danger which confronts the medical man is that he may become lost in his profession.”

D Martyn Lloyd Jones, in “Healing and the Scriptures.”

Dr. Martyn Lloyd Jones was a brilliant British physician and an outstanding preacher, and offers great medical wisdom and spiritual insight. This book was published in 1982 but still contains “a masterful view of the Christian physician’s calling, and of the dimensions of ministry to the whole man.” (Quote from J.I.Packer).

How often our identity is tied up with being medical professionals. Lloyd Jones challenges us to view success not merely as the accumulation of medical knowlege, reputatation and material wealth, but fruitfulness for Christ and His kingdom. The foundation of our identity must be in God, not ourselves; we are creatures made in the image of God and created for fellowship with God — all of which is only possible through the salvation obtained by Jesus at the cross.

Dr. Lloyd Jones says to us, “I beseech you not to allow the profession to make you forget yourself, that you are a man, and not merely a doctor.”  And to bring the vocabulary in the 21st century, we’d say, “you are a man or a woman, not merely a doctor!”

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

 

Life-risking courage in the cause of love

This audio podcast by John Piper helps us address the question of loving others. How do I love to the fullest measure?  How do I ensure that my good deeds are not selfish ambition disguised as love?

He says, “If you abandon your quest to be satisfied in God to the fullest measure, you will not be able to love people to the fullest measure.”

Our love for others should be an overflow of the joy and satisfaction we have with our Savior, the Lord Jesus Christ.  The danger is that otherwise it can become manipulative, looking for some kind of return from our good works (e.g. glory, fame, recognition).

“Loving people means seeking to expand your joy in God by including them in it, whatever the cost, even if it costs you your life.”

Jesus’ love for the world (John 3:16) cost Him his life; love is cut from the cloth of sacrifice.

This is helpful to me as a medical doctor who seeks to serve others out of love; this is not about my own reputation or identity.  One blogger put it this way:  “For instance, I do good deeds, because by doing them , I feel better and good inside. So, technically, it’s for myself. I am proud and pleasant of myself for doing them. But, today, some of my classmates said that it’s worthless doing good deeds, because you don’t get anything good from doing them.”

Finding our satisfaction and joy in Christ enables us to love others.  God is glorified and magnified as we serve other and seek to include them in the joy we have found in Christ. So we do good deeds not for ourselves but as an overflow of our satisfaction with Jesus.

 

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.