"Medicine and mission have gone together in the mind of the Christian public for at least 100 years ... in terms of "mission" the role of medical work seems rather ambiguous." He suggests five questions that need to be answered.

Is medical work mission or an adjuvant to it?
In an historical survey of medical mission he identifies three motives for medical mission and describes the continuing controversy over them a way into preaching - "a bait for the Gospel" an end in itself - compassionate caring as a good thing an expression of the Spirit of the Master - a vague statement that those who have lost confidence in the Gospel might see as a replacement for it.

He concludes "To heal the body does not enhance a human's standing before God on the day of judgement. ....We need to be concerned for the whole person but to treat disease and not to tackle sin is not Christian work. We must not delude ourselves nor the Christian public into believing that it is.. If we are to run medical work, it must be seen as in itself philanthropic, and maybe a way into proclamation of Christ, but no more".

Can Christian medical personnel engage in mission within the structures which currently exist?
Three problems are identified in what is perceived to be traditional hospital based medical mission.

• the pressure of medical work displaces spiritual work
• the failure of hospital work to meet health and spiritual needs
• the ethics of preaching to a captive audience

A community based primary health care approach facilitated by health professionals who live in the community could be seen as a solution to these problems.

He concludes "My contention is that whilst some structures may be conducive to good spiritual work, most structures are not . We need to be ruthless in examining our motives and methods ... is living on a mission compound appropriate to our spiritual work? ... do we need to consider shedding our light further than our own walls?

Are medical institutions useful in the propagation of the Gospel?
In the past they have been useful in breaking down barriers and have provided an opportunity for proclaiming Christ although he questions whether they have been effective in helping men and women to come to Christ. Now and especially in Muslim situations they may be seen as "inducements to apostasy" and may be counter- productive to preaching the Gospel.

Is Church money spent supporting medical institutions well spent, or is it an unnecessary burden?
Problems identified are:

• Hospitals place a burden of cost on the National Church once they have been handed over which has not had to be borne by the Western church.
• They may duplicate Government services or even subsidise a corrupt and inefficient service which may be improved if they were not there.

He concludes that Christian money should be spent on services that would not be given by other agencies such as leprosy and terminal AIDS care.

What should be the role of cross cultural workers in medical work?
The traditional medical mission role may have gone but other roles are emerging. There are many secular situations where Christian health care professionals can contribute to the health care needs of the community while relating normally to it and joining a local church. Christian organisations can provide aid and development work where ever they are welcomed. Training posts in mission and church related hospitals with the aim of "working themselves out of a job" have a place provided they do not become a cheap way of providing a service at the expense of keeping the national out of employment.

Editor's Comments
(The author is thanked for raising important issues that affect both those who cannot access health care of their own choice and those who give up career prospects to provide it for them. Readers views will be welcome and will be printed space permitting).

• The Christian church has been active and leading the way in health care throughout its history. The ethical problem seen as 'using medicine to make converts' is partly one of perception in our own culture. Many other cultures welcome prayer along with health care.
• Any Christian who has found peace with God through Christ will want to share that good news with others but integrity demands that a visitor does not abuse the welcome of his or her host. He or she must be convinced of the value of the medical work, given in the name of Christ, in its own right. If other suitable health care is available it may be time for the mission partners to pass on to other areas of service.
• The debate between primary and secondary care is one of trying to achieve the right balance. Primary health care, a 'bottom up approach' and community ownership and participation are excellent developments but still need provision for referral. Health care strategy should be determined by health care needs.

Summary of author's reply

• Hospital based Primary Care is in the Primary Care world by and large discarded now; since the focus usually remains on the hospital and not the community.
• ...if mission is fulfilling the great commission "to make disciples" then we need to examine where medicine fits into this. Just healing the body is not making disciples...this is the raison d'être of my paper...are we deluding ourselves in calling compassionate care mission or not? ...in many cases it comes with a good package of other things and aids these other things well...in many other cases the institution is pouring money and personnel in and doing nothing except medical care, in which case the Christian public who give the money are deceived.