Due credit to missionaries – from the Lancet Global Health Blog

Lancet Global Health Blog

An overlooked WWI legacy: maternal and child health in sub-Saharan Africa

— from the Lancet Global Health Blog, November 2014

While medical missions provided 25-50% of maternal and child health care in sub-Saharan Africa throughout most of the 20th century, their legacy is often overlooked.

Often incorporating local knowledge and culture, missionaries provided family-centered health care at the grassroots level—bringing services to sub-Saharan Africa while they were also on the rise in England, writes Chris Simms, assistant professor in the School of Health Administration at Dalhousie University in Halifax.

The risks of academics dismissing missionaries as an embarrassment and ignoring their achievements, Simms says, are “that lessons-to-be-learned are neither identified, nor acted upon, and that past mistakes will be repeated.”

Simms says, “Indeed, studies suggest that, rather than being a source of embarrassment, medical missions have shown what can be achieved when health initiatives are planned and implemented as if ordinary people mattered.”

Click here for the entire blog.

"And who is my neighbor?"

Yesterday I was talking with a nursing teacher who is an expert in the care of women with childbirth injuries called fistulas. SIM has a hospital caring for these women in rural Niger, West Africa. She is considering ways to get involved helping train our national staff. The hospital treats any woman in need, regardless of their race, religion or creed. Someone made a comment that there is a widely held belief that Christian mission hospitals only treat Christians. Nothing could be farther from the truth!

During Jesus time a Jewish lawyer came to test him, asking “Teacher, what shall I do to inherit eternal life?” Luke 10:25-26. Jesus had him summarize the entire law of Moses by saying “You shall love the Lord your God with all your heart, and with all your soul, and with all your strength, and with all your mind; and your neighbor as  yourself.” Luke records the lawyer’s response: “But wishing to justify himself, he said to Jesus, ‘And who is my neighbor?'”

The answer is somewhat surprising, and gets to the heart of our motivation for cross-cultural mission work. Who is my neighbor? And how do I love my neighbor as myself? We must listen to the response of Jesus. He tells us the story that we now call the “Good Samaritan.”  See Luke 10:30-37

Tim Keller helps us to unpack Jesus’ lesson in his book, “Generous Justice — How God’s Grace Makes Us Just.” He says, “In other words, the law expert wanted to whittle down the command to make it more achievable, and to keep his works-righteousness approach to life intact. ‘Surely,’ he implied, ‘you don’t mean I have to love and meet the needs of everyone!'”

“In response, Jesus tells the story of the Good Samaritan. A Jewish man was riding through a mountainous, remote area where he was robbed, beaten, and left in the road ‘half dead’ (Luke 10:30). Along came first a priest and then a Levite, one of the temple workers who assisted the priests. These were both people who should have stopped to give aid, because the Jew was their brother in the faith. However, they ‘pass by on the other side,’ possibly because it would have been extremely dangerous to stop on a desolate road in a region infested with highwaymen.”

Keller continues, “Then a Samaritan came along the road. Samaritans and Jews were the bitterest of enemies. Samaritans were seen by Jews as racial ‘half-breeds’ and religious heretics, and so there was great animosity between them. Yet when the Samaritan saw the man in the road, he was moved with compassion. He braved the danger by stopping, giving him emergency medical aid, and then transporting him to an inn. He then paid the innkeeper and charged him to care for the man until he had fully recuperated. That would have been a substantial expense.”

“What was Jesus doing with this story? He was giving a radical answer to the question, ‘What does it mean to love your neighbor? What is the definition of love?’ Jesus answered that by depicting a man meeting material, physical, and economic needs through deeds. Caring for people’s material and economic needs is not an option for Jesus. He refused to allow the law expert to limit the implications of this command to love. He said it meant being sacrificially involved with the vulnerable, just as the Samaritan risked his life by stopping by the road.”

“But Jesus refuses to let us limit not only how we love, but who we love. It is typical for us to think of our neighbors as people of the same social class and means (cf Luke 14:12). We instinctively tend to limit for whom we exert ourselves. We do it for people like us, and for people whom we like. Jesus will have none of that. By depicting a Samaritan helping a Jew, Jesus could not have found a more forceful way to say that anyone at all in need — regardless of race, politics, class, and religion, is your neighbor. Not everyone is your brother or sister in the faith, but everyone is your neighbor.

Well said, Tim Keller. Thank you, Jesus. Friend, who is your neighbor?

"And who is my neighbor?"

Yesterday I was talking with a nursing teacher who is an expert in the care of women with childbirth injuries called fistulas. SIM has a hospital caring for these women in rural Niger, West Africa. She is considering ways to get involved helping train our national staff. The hospital treats any woman in need, regardless of their race, religion or creed. Someone made a comment that there is a widely held belief that Christian mission hospitals only treat Christians. Nothing could be farther from the truth!

During Jesus time a Jewish lawyer came to test him, asking “Teacher, what shall I do to inherit eternal life?” Luke 10:25-26. Jesus had him summarize the entire law of Moses by saying “You shall love the Lord your God with all your heart, and with all your soul, and with all your strength, and with all your mind; and your neighbor as  yourself.” Luke records the lawyer’s response: “But wishing to justify himself, he said to Jesus, ‘And who is my neighbor?'”

The answer is somewhat surprising, and gets to the heart of our motivation for cross-cultural mission work. Who is my neighbor? And how do I love my neighbor as myself? We must listen to the response of Jesus. He tells us the story that we now call the “Good Samaritan.”  See Luke 10:30-37

Tim Keller helps us to unpack Jesus’ lesson in his book, “Generous Justice — How God’s Grace Makes Us Just.” He says, “In other words, the law expert wanted to whittle down the command to make it more achievable, and to keep his works-righteousness approach to life intact. ‘Surely,’ he implied, ‘you don’t mean I have to love and meet the needs of everyone!'”

“In response, Jesus tells the story of the Good Samaritan. A Jewish man was riding through a mountainous, remote area where he was robbed, beaten, and left in the road ‘half dead’ (Luke 10:30). Along came first a priest and then a Levite, one of the temple workers who assisted the priests. These were both people who should have stopped to give aid, because the Jew was their brother in the faith. However, they ‘pass by on the other side,’ possibly because it would have been extremely dangerous to stop on a desolate road in a region infested with highwaymen.”

Keller continues, “Then a Samaritan came along the road. Samaritans and Jews were the bitterest of enemies. Samaritans were seen by Jews as racial ‘half-breeds’ and religious heretics, and so there was great animosity between them. Yet when the Samaritan saw the man in the road, he was moved with compassion. He braved the danger by stopping, giving him emergency medical aid, and then transporting him to an inn. He then paid the innkeeper and charged him to care for the man until he had fully recuperated. That would have been a substantial expense.”

“What was Jesus doing with this story? He was giving a radical answer to the question, ‘What does it mean to love your neighbor? What is the definition of love?’ Jesus answered that by depicting a man meeting material, physical, and economic needs through deeds. Caring for people’s material and economic needs is not an option for Jesus. He refused to allow the law expert to limit the implications of this command to love. He said it meant being sacrificially involved with the vulnerable, just as the Samaritan risked his life by stopping by the road.”

“But Jesus refuses to let us limit not only how we love, but who we love. It is typical for us to think of our neighbors as people of the same social class and means (cf Luke 14:12). We instinctively tend to limit for whom we exert ourselves. We do it for people like us, and for people whom we like. Jesus will have none of that. By depicting a Samaritan helping a Jew, Jesus could not have found a more forceful way to say that anyone at all in need — regardless of race, politics, class, and religion, is your neighbor. Not everyone is your brother or sister in the faith, but everyone is your neighbor.

Well said, Tim Keller. Thank you, Jesus. Friend, who is your neighbor?

So what do we mean by healing, anyway?

Perfect peace 2

As a young person in medical school, my view of health was confined to understanding disease processes, drugs and physical causes.  Health had to do with the body, and things of the spirit didn’t overlap the physical world. As a young believer in Jesus, I could see that He had dominion over both the physical world (witness His miracles) and the spiritual world.  But I still saw the world as two compartments – one material and one immaterial.

Enter a trip to Kenya.  Clare and I went for several months to Kijabe, a mission hospital in Kenya, after my third year in medical school.  This trip challenged my “two compartment” assumptions! Why did the poor suffer physical illness in ways that the rich did not? Why did they carry such a burden of illness? And why was it so difficult to make changes in lives by only addressing physical health? Why didn’t medicine work as neatly as it seemed to do back in America?

As we probe the root causes of illness, we must look deeper than microbes and microscope. I learned, coming back to the USA and finishing a master’s degree in public health at Hopkins, that one of the strongest predictors of the infant mortality of a nation is the educational level of the mothers. I went on to learn – in the classroom and in my experience – of so many connections between mind and body; these included cultural understandings that put the body at risk, and bodily illnesses that affect the soul. We are made as whole and connected beings – body, mind, spirit; God has also made us for community – and for Himself.

Gradually I came to understand that my (almost unconscious) view of the world as two compartments had to be challenged. Reality was much more complex and nuanced, with innumerable connections between all. Health is not just the absence of disease.  WHO’s definition is helpful: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Yet how do we attain to such a lofty condition? How should I understand what makes for health? Where shall I find it if I untie my boat from the moorings of my “two compartment” world?

There is a Hebrew word called shalom which can be translated completeness, soundness, welfare or peace. See Isaiah 26:3 quoted in the picture for example. The root word has to do with completion or fulfillment; it can also refer to contentment, friendship or a covenant of peace. Shalom can also translated health.  The Old Testament view of health includes more than a lack of disease, but restored relationship.  In contrast, our enlightenment view of health is based more on Greek thinking, which dicotomizes the physical and spiritual. We don’t tend to think that there is a connection between health and broken relationships. I believe shalom is a better conceptual model.

This concept surely helps us understand that God’s concern for health includes physical suffering but goes beyond it. In other posts we considered the destruction of Jerusalem. The sins of the leaders of the people were spelled out by Jeremiah, and contrasted below with God’s purposes for men and women.

“Woe to him who builds his house without righteousness and his upper rooms without justice, who uses his neighbor’s services without pay and does not give him his wages.” Jeremiah 22:13

Jeremiah contrasts the actions of the good king Josiah, saying, “‘He pled the cause of the afflicted and needy; then it was well.  Is not that what it means to know Me?’ declares the LORD?”  Jeremiah 22:16

This helps us begin to understand what true healing is about. It is not just about disease in isolation but people in relationship with one another. Where have you seen examples of such healing?

 

The wounded healer

Ethiopian villageWhen I arrived in Ethiopia in 1986 the country had been impoverished by communism, famine and long-standing poverty. I was trained in community health at Johns Hopkins School of Public Health and was ready to roll out a comprehensive community health program, working alongside the church. With hindsight now I can say that I was unsuccessful; all the wonderful principles and practices I had learned didn’t work in that context. It took a number of years to figure some of the reasons why. Along the way I discovered the secret of being a wounded healer.

What is a wounded healer?  Someone who does not provide all the answers. Someone who has been humbled by his own limitations. Someone who has discovered that his own cultural perspective has blinded him from seeing the people as God sees them. Someone who finally figures out that it is not all about ‘me’ (and my programs) but rather about Christ. Someone who recognizes that his own healing is still a work in progress.

Eventually this community and church was transformed. The seeds that were planted did grow, but after we were gone. But the healer had learned a vital life-lesson. As Christian servants we cannot divorce what God does through us from what God does in us.

Paul expressed a very similar idea when he said “Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and the God of all comfort, who comforts us in all our affliction,so that we may be able to comfort those who are in any affliction with the comfort with which we ourselves have been comforted by God.  For as we share abundantly in Christ’s sufferings, so through Christ we share abundantly in comfort too. If we are afflicted, it is for your comfort and salvation…” 2 Corinthians 1:4-5.

The healer must embrace his or her own wounded condition. As we ourselves admit our own loneliness, isolation and brokenness we are set to receive the comfort available to us through Christ. He can use this comfort to help others in their suffering. As healers we are on a journey of woundedness and comfort, which is our primary qualification to extend healing to others who are broken.

"Why have you stricken us so that we are beyond healing?"

angel_of_grief
As healers we must face the limits of healing.  Life and healing are a gift of God, and yet because of sin, He has set limits. Death itself is a limit to healing. We were created by God as the pinnacle of His creation, not designed to die.  Yet human rebellion against His authority caused Him to limit the extent of our lives, since He designed an eternity with joy, not rebellion.  He put into place the offer of new life through Jesus Christ. “So then as through one transgression there resulted condemnation to all men, even so through one act of righteousness there resulted justification of life to all men.” Romans 5:18.

So it is good to be humble with our ministry of healing. I have seen many examples of healing, some miraculous and many ordinary. The human body is extraordinarily designed for healing, and God does answer prayer. Yet healing is not the final frontier; eternity is. Healing is one of God’s many good blessings on earth, and the Lord Jesus spent considerable time healing the sick, blind and lame. Yet there are limits. Only in the new heavens and new earth will we be able to say, “He will wipe away every tear from their eyes; and there will no longer be any death; there will no longer be any mourning, or crying; or pain; the first things have passed away.” Revelation 21:4.

How about communities?  Can they be stricken beyond healing? This is not a popular concept, as we cherish our health, comfort and prosperity so highly. While my whole life has been committed to healing, I would be foolish to promote a false security in healing itself. In my last post I wrote about Jerusalem’s fall to Babylon in 586 B.C.; it was completely and utterly destroyed. Here is a description of their religious prophets: “they are prophesying to you a false vision, divination, futility and the deception of their own minds.” Jeremiah 14:14.

I want to do all I can to bring healing to the nations, and especially to those who are marginalized. Yet there are limits to the deception, violence and falsehood that any community can be founded on. I don’t want to be discouraged or overwhelmed by those limits. But it would be foolish to not recognize them, speak about them, and call men and women to turn back.

Jeremiah did call for the people to turn back, but unsuccessfully. God said to him, “The people also to whom they are prophesying will be thrown out into the streets of Jerusalem because of the famine and the sword; and there will be no one to bury them –neither them, nor their wives, nor their sons, nor their daughters — for I will pour out their own wickedness on them.” Jeremiah 14:16

I’m sure it is not politically correct to talk about pouring out their own wickedness. But just a scalpel hurts before it heals, so it is with the words of the Lord. He invites us to life and healing in Christ, not a life of self-absorption and deceit.

Jeremiah continues:

“‘Let my eyes flow down with tears night and day, and let them not cease;

For the virgin daughter of my people has been crushed with a mighty blow,

With a sorely infected wound.

If I go out to the country, behold those slain with the sword!

Or if I enter the city, behold, disease of famine!

For both prophet and priest have gone roving about in the land that they do not know.'”

“Have you completely rejected Judah? Or have you loathed Zion?

Why have You stricken us so that we are beyond healing?

We waited for peace, but nothing good came; and for a time of healing, but behold, terror!”  Jeremiah 14:17-19

What about you and I today? We are not beyond healing. There is a balm in Gilead, as I explained in my last post. We are touched by suffering and death. Yet our stricken condition can lead us to the healing balm. Christ was stricken for us so that we do not have to be stricken beyond healing. Have you received that gift of healing?

"Why have you stricken us so that we are beyond healing?"

angel_of_grief
As healers we must face the limits of healing.  Life and healing are a gift of God, and yet because of sin, He has set limits. Death itself is a limit to healing. We were created by God as the pinnacle of His creation, not designed to die.  Yet human rebellion against His authority caused Him to limit the extent of our lives, since He designed an eternity with joy, not rebellion.  He put into place the offer of new life through Jesus Christ. “So then as through one transgression there resulted condemnation to all men, even so through one act of righteousness there resulted justification of life to all men.” Romans 5:18.

So it is good to be humble with our ministry of healing. I have seen many examples of healing, some miraculous and many ordinary. The human body is extraordinarily designed for healing, and God does answer prayer. Yet healing is not the final frontier; eternity is. Healing is one of God’s many good blessings on earth, and the Lord Jesus spent considerable time healing the sick, blind and lame. Yet there are limits. Only in the new heavens and new earth will we be able to say, “He will wipe away every tear from their eyes; and there will no longer be any death; there will no longer be any mourning, or crying; or pain; the first things have passed away.” Revelation 21:4.

How about communities?  Can they be stricken beyond healing? This is not a popular concept, as we cherish our health, comfort and prosperity so highly. While my whole life has been committed to healing, I would be foolish to promote a false security in healing itself. In my last post I wrote about Jerusalem’s fall to Babylon in 586 B.C.; it was completely and utterly destroyed. Here is a description of their religious prophets: “they are prophesying to you a false vision, divination, futility and the deception of their own minds.” Jeremiah 14:14.

I want to do all I can to bring healing to the nations, and especially to those who are marginalized. Yet there are limits to the deception, violence and falsehood that any community can be founded on. I don’t want to be discouraged or overwhelmed by those limits. But it would be foolish to not recognize them, speak about them, and call men and women to turn back.

Jeremiah did call for the people to turn back, but unsuccessfully. God said to him, “The people also to whom they are prophesying will be thrown out into the streets of Jerusalem because of the famine and the sword; and there will be no one to bury them –neither them, nor their wives, nor their sons, nor their daughters — for I will pour out their own wickedness on them.” Jeremiah 14:16

I’m sure it is not politically correct to talk about pouring out their own wickedness. But just a scalpel hurts before it heals, so it is with the words of the Lord. He invites us to life and healing in Christ, not a life of self-absorption and deceit.

Jeremiah continues:

“‘Let my eyes flow down with tears night and day, and let them not cease;

For the virgin daughter of my people has been crushed with a mighty blow,

With a sorely infected wound.

If I go out to the country, behold those slain with the sword!

Or if I enter the city, behold, disease of famine!

For both prophet and priest have gone roving about in the land that they do not know.'”

“Have you completely rejected Judah? Or have you loathed Zion?

Why have You stricken us so that we are beyond healing?

We waited for peace, but nothing good came; and for a time of healing, but behold, terror!”  Jeremiah 14:17-19

What about you and I today? We are not beyond healing. There is a balm in Gilead, as I explained in my last post. We are touched by suffering and death. Yet our stricken condition can lead us to the healing balm. Christ was stricken for us so that we do not have to be stricken beyond healing. Have you received that gift of healing?