Gone are the days when European doctors went out to join fellow senior staff in a remote but well-equipped and well organised mission hospital. Most nursing staff and many of the doctors are now locally trained, and a European may arrive to head a team of locals with little knowledge of the local set-up and no experience of it.
Sense of alienation
It may come as a surprise to find that in strictly missionary terms, there is no need for the doctor at all! African churches are more alive, more spiritually aware, and have many more faithful members than those at home. Furthermore, the institution is now in the control of a local organisation, and has its own hierarchy, often more traditional and immovable than its parent European body. That organisation may have lost its vision, and be wracked by internal division, social scandals, and, most commonly, frank embezzlement. No wonder the doctor just gets on with medical work, only too happy to get out of the longwinded committee meetings --at which little is decided and less resolved.
The European may find himself or herself working alongside a local practitioner with more experience, and indeed more expertise. This colleague does not struggle with the local language. The doctor may be surprised to find his or her standing locally is not as high as expected and that recommendations and medical orders are not universally accepted. Frequently, the apparently good ideas meet with an overtly positive response but nothing changes, because the local staff are too embarrassed or too polite to argue their case openly. A ,sense of alienation develops.
The European remnant in a hospital may stick together socially in an enclave, often regaling each other with stories of the locals' incompetence or ignorance. The tendency for superior racist thinking to encroach is then great, and this further alienate, the European doctor, who anyway often has a living standard far above those around (simply in terms of books, furniture, cooking facilities, video/TV/computer etc). An outsider who questions how much impact the medical missionary has is met with bemused silence.
Radical rethink
It may well be that the role of medical mission must be radically rethought. Where a national government fails to provide medical services, a mission can step in to fulfil this function but this needs great sensitivity and tact, and a deep knowledge of local tensions, needs and politics. The mission should probably co-operate rather than compete with government in providing medical input. Yet whenever a mission begins to work with official national agencies, it seems that financial support from Europe flies out the window. Support is based on individuals, and one person on his or her own can generate a lot of valuable backing.
A major need in Africa is not for doctors and other health professionals but for administrators. The singularly vital role of the administrator is too frequently downplayed by mission societies; yet even in a small hospital many thousands of pounds pass through the system. What a temptation for a local, however well-meaning, who sees his lifetime earnings pass before his eyes (on paper at least) in a month! How tempting to use these funds to help out a distressed relative in genuine financial difficulties! How easy to forget this misdemeanour when it is never noticed because no audit is kept! How readily money disappears into personal projects ...
Not only is the European manager unaffected by these peculiarly African temptations, but he or she has administrative skills gained from working in a well-ordered society unlike the chaotic African melee, is computer literate, has a good knowledge of accounts, etc. However, most importantly she has contacts in Europe and hopefully knows how to write appropriate proposals to donor agencies for obtaining funds. These are highly developed skills that doctors neither have, nor have time to acquire.
Who is the true mission doctor?
In all this, the position of the doctor working in the government institution (usually for a pittance owing to drastic devaluation of the local currency) has been overlooked. He or she has very little control over the work situation, over colleagues, and over disposal of the resources available. Yet he or she is in the real world, battling to provide a good medical standard when many colleagues have disappeared after 10am because the demands of private practice supervene. The poorest of the poor patients is someone for whom Christ died, created in the image of God Himself, and the doctor refuses to allow them to be shunted around by officious, or uncaring hospital clerks.
The doctor covers for colleagues who have vanished on their night on-call, does not get pushed around or compromised by the big-shot politician, may even have to dirty hands in the muddy waters of local politics for the benefit of those with no voice, and is willing to treat the patient with HIV who is shunned by the rest of the staff.
This doctor is the true mission doctor of 1999 ... yet how many mission societies recognise or support such a person?
Michael Cotton is a consultant surgeon in Bulawayo
Sense of alienation
It may come as a surprise to find that in strictly missionary terms, there is no need for the doctor at all! African churches are more alive, more spiritually aware, and have many more faithful members than those at home. Furthermore, the institution is now in the control of a local organisation, and has its own hierarchy, often more traditional and immovable than its parent European body. That organisation may have lost its vision, and be wracked by internal division, social scandals, and, most commonly, frank embezzlement. No wonder the doctor just gets on with medical work, only too happy to get out of the longwinded committee meetings --at which little is decided and less resolved.
The European may find himself or herself working alongside a local practitioner with more experience, and indeed more expertise. This colleague does not struggle with the local language. The doctor may be surprised to find his or her standing locally is not as high as expected and that recommendations and medical orders are not universally accepted. Frequently, the apparently good ideas meet with an overtly positive response but nothing changes, because the local staff are too embarrassed or too polite to argue their case openly. A ,sense of alienation develops.
The European remnant in a hospital may stick together socially in an enclave, often regaling each other with stories of the locals' incompetence or ignorance. The tendency for superior racist thinking to encroach is then great, and this further alienate, the European doctor, who anyway often has a living standard far above those around (simply in terms of books, furniture, cooking facilities, video/TV/computer etc). An outsider who questions how much impact the medical missionary has is met with bemused silence.
Radical rethink
It may well be that the role of medical mission must be radically rethought. Where a national government fails to provide medical services, a mission can step in to fulfil this function but this needs great sensitivity and tact, and a deep knowledge of local tensions, needs and politics. The mission should probably co-operate rather than compete with government in providing medical input. Yet whenever a mission begins to work with official national agencies, it seems that financial support from Europe flies out the window. Support is based on individuals, and one person on his or her own can generate a lot of valuable backing.
A major need in Africa is not for doctors and other health professionals but for administrators. The singularly vital role of the administrator is too frequently downplayed by mission societies; yet even in a small hospital many thousands of pounds pass through the system. What a temptation for a local, however well-meaning, who sees his lifetime earnings pass before his eyes (on paper at least) in a month! How tempting to use these funds to help out a distressed relative in genuine financial difficulties! How easy to forget this misdemeanour when it is never noticed because no audit is kept! How readily money disappears into personal projects ...
Not only is the European manager unaffected by these peculiarly African temptations, but he or she has administrative skills gained from working in a well-ordered society unlike the chaotic African melee, is computer literate, has a good knowledge of accounts, etc. However, most importantly she has contacts in Europe and hopefully knows how to write appropriate proposals to donor agencies for obtaining funds. These are highly developed skills that doctors neither have, nor have time to acquire.
Who is the true mission doctor?
In all this, the position of the doctor working in the government institution (usually for a pittance owing to drastic devaluation of the local currency) has been overlooked. He or she has very little control over the work situation, over colleagues, and over disposal of the resources available. Yet he or she is in the real world, battling to provide a good medical standard when many colleagues have disappeared after 10am because the demands of private practice supervene. The poorest of the poor patients is someone for whom Christ died, created in the image of God Himself, and the doctor refuses to allow them to be shunted around by officious, or uncaring hospital clerks.
The doctor covers for colleagues who have vanished on their night on-call, does not get pushed around or compromised by the big-shot politician, may even have to dirty hands in the muddy waters of local politics for the benefit of those with no voice, and is willing to treat the patient with HIV who is shunned by the rest of the staff.
This doctor is the true mission doctor of 1999 ... yet how many mission societies recognise or support such a person?
Michael Cotton is a consultant surgeon in Bulawayo
