A famous author and Poet Laureate in 1813, Robert Southey, planned to write a biography of John Wesley. He visited an old Methodist who, in his youth, had known the preacher well. He received a frosty welcome. The elderly saint couldn't understand how Southey, despite his writing skills, felt qualified to write the life story of a spiritual giant like Wesley. 'Sir,' he said, 'You have nothing to draw with and the well is deep.' [John 4:11]
Healthcare mission is both deeper and different from any other form of healthcare.
Christian mission is a deep well for it begins in God's own heart. His compassion, power, authority, wisdom and purpose flow together to form the spring that feeds this well. Like the Samaritan woman, we can let down our bucket to draw an unending supply of 'eternal life' and share it with others. [John 4:14] 'I have come that they may have life and have it to the full' [John 10:10]. We will want to know and to spread that life in all its fullness, beginning now and enduring for eternity.
Not only is it deep, but, coming from such a source, healthcare which is also mission will differ radically from healthcare arising from any other motivation.
Probably all of us agree to the idea of holism in healthcare. In a penetrating article, Tim Chester asks, 'What makes Christian development Christian?' He finds that a term like 'holistic ministry', which commendably 'affirms a concern for the whole person - physical, social, emotional and spiritual', is so commonly used by secular agencies that 'it no longer works as a definition of the distinctive nature of a Christian approach'. [The British Evangelical Review, Spring 2003] In a similar vein we should ask, 'What is it about Healthcare in Sub-Saharan Africa which will in the future be specifically Christian mission?'
I wish to note a few characteristics of such mission in the future
1. HEALTHCARE MISSION WILL BE WIDE
What is Mission?
John Stott defines mission as 'everything God sends His people into the world to do.' [John Stott, The Christian Mission in the Modern World] I like the emphasis on God as the author, His sending as the impetus, Christians as His agents, people of the whole world as the beneficiaries and the expectation to be up and doing as the challenge.
Another writer sees mission as 'God entering into our world to restore us and our environment to the glory that God intended.' [Ken Gnanakan, Kingdom Concerns, IVP]. Here is a broad sweep of ministry and a glorious goal, which fits the Lord's theme of 'eternal life'.
HIV
Fifteen years ago I joined Dr McLarty, a Christian consultant, on his ward round in the Tanzanian Government's principal teaching hospital in Dar es Salaam. Two young teachers accompanied us. McLarty told us that 20% of patients carried HIV. Today the percentage would be much higher of course. We reached a man suffering from infected scabies and I learnt that this disease, normally so treatable, becomes life threatening when AIDS undermines all resistance. The doctor looked at the two teachers and said, 'You are the people who have the answer to this problem, not us.' He said he treated the end-results; they could work at prevention.
Of course the consultant was right. Healthcare mission begins in the classroom. Ugandan President Museveni commanded that every class have a lesson on this subject at least once a week. His countrymen regard the ages of five to fifteen as 'the window of hope'. Now Uganda has experienced a significant drop in infection rate. But mission embraces so many other challenges as well - housing, nutrition, agriculture, water supplies, sanitation, care of orphans and, most of all, the teaching and compassionate care of Christians. For who can transform worldviews, values, beliefs and their resulting patterns of behaviour? And when all else fails, who has the answers to death and the future?
War
War traumatises people in many countries. Victims live in daily terror, mourn the loss of loved relatives or are ripped from their homes, families and society to seek refuge in huge camps where dignity dies and hope perishes. Someone has written, 'Never before have so many people fled from so many homes.' [Elie Wiesel, the Longing for Home, University of Notre Dame] She pleads for workers to extend hospitality, compassion, sensitive evangelism, advocacy, and empowerment.
Oil
Oil draws thousands into new living situations in Chad, Angola, Sudan and Nigeria. Western appetite for their product mounts as USA seeks alternatives to sources in the Middle East. Physical and mental health are last on the agendas of the developers. While we all welcome the doubling of GDP in a poor country like Chad, the churches groan over the problems of promiscuity and addiction which abound in the hastily erected and temporary camps forced to accommodate thousands of labourers. Do they need healthcare workers?
Ethnic Conflict & Nationalism
Ethnicity rips communities apart. In a multi-tribal situation in South Sudan, a large contingent of church leaders met recently for five days with local chiefs and tribal elders in what they called a 'Community Peace Workshop.' Archbishop Tutu chaired the Peace and Reconciliation Commission in South Africa. Churches in Rwanda cooperate with the government in efforts to reconcile murderers with the families of those they murdered so that they can live side-by-side again in their villages. When we ponder the consequences of such peace making, is this not, in some measure, healthcare mission? Do such efforts not need the Holy Spirit's power resting on those who have drunk deeply from the Lord's well of eternal life?
Famine & Natural Disasters
We read a year ago, 'Some 14 million people in southern Africa face extreme food shortages' even though the 'climatic shock was not atypical for the region.' [African Affairs: Journal of the Royal African Society, Oct 2002] People sought to survive in risky ways - eating potentially poisonous plants, stealing crops, reducing meals to one a day, prostitution. Grandparents may care for ten or more children while child-headed households lack the skills (e.g. in agriculture) to survive. What is the call to future healthcare mission in such a deteriorating scenario?
Peter Saunders in his address to the Healthcare Mission Forum in 2001 said, 'Preaching the Gospel, healing the sick, and bringing justice are what healthcare mission means practically' and, in a breath-taking survey of human need, he listed no less than forty-two categories of skilled personnel required to accomplish it. Such mission will only become effective as we fix our eyes on the goal of all this activity - 'the glory that God intended'. Healthcare mission will continue to be wide and will grow wider.
2 HEALTHCARE MISSION WILL FOCUS ON THE CHURCH
The massive nature of Africa's healthcare needs can mislead us into an inefficient use of limited resources.
In an Interim Report of a review of AIM's manifold and practical healthcare mission, I read, 'Effective ministry was seen wherever the men and women recruited for health ministry are committed to AIM's priorities ...Conversely, where this commitment was not present in individual AIMers, their ministry was less effective.' [AIM Health Review 2002-4] My own experience confirms that healthcare workers, called to extend the kingdom of Christ, feel trapped when an abundance of professional activities leave them no time to share the Gospel.
Where should we concentrate? How can we prioritise? The New Testament key to the door of Christ's Kingdom is the church.
Does this mean that the discussions about the continuing role of mission hospitals, the importance of community health programmes, irrigation and agriculture and a host of other development schemes that impinge on the health of societies are irrelevant? Not at all. But, as we engage in them, we will focus on the establishing and the maturing of Christ's church. So I suggest we fix priorities for the future on:
a. Serving unchurched peoples
A small, poverty-stricken nation without a single church invited a team of healthcare missionaries into their hospitals. An experienced American surgeon, working amid great difficulties, established a reputation for skill, commitment and gentleness. His kindly professionalism undermined some of the strong anti-Christian prejudices that prevailed. Occasionally a patient would ask him to pray and, more rarely, for the 'Book' which they knew meant so much to him. Years after his departure, little groups now meet to worship in some of the homes. God used a scalpel to ease the pains of the sick and to open their hearts.
With so many calls upon our ministries of compassion, surely we should acknowledge the priority of serving those who have never heard the good news of Jesus nor drunk from His deep well. Although church growth continues apace in many areas of Sub-Saharan Africa, I am continually amazed by the number of unreached peoples. Many have never been noticed before; some have been evangelised in a previous era but have now lost the Gospel; and others are in danger of church demise as a result of rapid population turnover. This last arises from a combination of a high birth-rate (60% of Sub-Saharan Africans are under sixteen) and of a low average age of death (e.g. in Swaziland, men at 33 and women at 35[IFES], In Mozambique, 'A Yao man today is fortunate to live to thirty' [FEBA])
Our responsibility is to 'every tribe, in every nation, in each succeeding generation'
b. Training leaders
When Dr Carl Becker first arrived in the Congo forest, he learnt that the local people often called the tribal dentist to deal with rotting teeth. Using a chisel he tapped the tooth on both sides until it was loose enough for him to pick out with his fingers. Carl found that he could teach his illiterate African assistants to use dental forceps and relieve the agony of thousands. Years later, unrest forced all foreign workers to leave. By then he had trained a full team to run his hospital and huge leprosarium. [Dick Anderson, We Felt Like Grasshoppers]
Dr Becker is typical of many medical giants who have realised that the future of healthcare (and indeed of the church) rests with the national people.
The Gospel writers emphasise the Lord's training of disciples. Paul seldom travelled without at least one companion and often several, who were learning from their master all the time. The apostles fill their letters with counsel for leaders in the churches. Every article I read on the Christian response to AIDS emphasises the need to train pastors, school teachers, Bible school lecturers, community leaders and of course the whole range of healthcare professionals in management, care and prevention. Uganda's success in lowering the infection rate belongs to the teaching and example of such leaders.
Well-qualified and experienced expatriates will continue to find a welcome for many years to come, but more and more as the trainers of trainers.
c. Trusting leaders
Indigenous means 'home grown' or 'begotten within'. Future effective healthcare in the churched areas of Africa will be conceived, developed and possessed by Africans. Visionaries from overseas would be wise to take the time to ensure that church leaders not only accept their visions but also adopt them so completely that they feel they gave birth themselves to the ministries that result.
A doctor friend of mine, whom I deeply respect, wished to set up a specialist centre for treating disabled children in the heart of a well-churched district of Sub-Saharan Africa. Knowing my concern to encourage African Christian leadership in all our ministries, he said, 'We will start it with foreign help; then, in perhaps twenty years, we will hand it over to African leadership.' I asked, 'Why not begin with African initiative, ownership and direction for this country has so many mature church leaders and able doctors?' He knew of no African Christians who shared his vision despite the fact that African Christians practised medicine in the capital city only an hour's drive away and others held high office in the Government health services. Was he right in going ahead? When he presented his plans to the church leaders they readily agreed to sanction the project in the name of the church. But did they really own it? If the missionary is forced to withdraw, will they continue to run it? Are they prepared for all the effort and sacrifices involved? Does this project fit their own priorities? Should he have taken time (perhaps a long time) to build up his relationship with African healthcare entrepreneurs first?
3. HEALTHCARE MISSION WILL RESPECT CULTURE
You will think of all sorts of cultural challenges facing healthcare missionaries; I will mention just four:
a Build relationships
Another surgeon graciously offered two years service to the Church of Uganda. Asked to enter a short programme of language and cultural orientation, he declined saying, 'I am only here for two years; my skills are urgently needed; I cannot afford the time.' The church valued his technical work but never knew him as a person.
In contrast an agriculturalist settled for two years in South Sudan. He told me, 'These people have survived for thousands of years. I will spend a year to get to know them and to learn their skills; and then, perhaps I may be able to impart something to them.' At the end of two years people were both listening to him and imitating his methods.
b Avoid misunderstandings
Tim Chester could have been writing about Africa when he said, 'A Christian NGO digs a well in an Indian village. The villagers have a strong sense of the spiritual world; they look to spirits for guidance, fertility and prosperity. The drilling team have strong technical skills. They do the right tests, drill in the right place and construct a good well. But what message is communicated? That salvation is found by western technology and lifestyle? Or do the villagers thank their spirit-gods for the provision of this water? Or do they fail to use the water because they believe the cause of sickness is bad karma rather than dirty water?' [Tim Chester ibid.]
Our medicine too is so technical that it separates us from people. Admission of a Turkana woman to our hospital in Kenya involved taking off most of her beads, although these were important for her sense of identity. She must also remove her skins, which tell the world if she is married or single. She submits to a scrub in a bath and then dons a simple white gown. For our convenience she climbs into a bed (although at night she would choose to sleep outside the ward in the sand). When she left hospital, she would go through a cleansing ceremony to rid her of contamination picked up in our foreign place.
Walking down to commence my antenatal clinic I picked my way through the clutch of women sitting in the precious shade of the hospital veranda with legs stretched out in front of them - their traditional pose. After many years a Christian Turkana told me that, if you step across the lower limbs of a pregnant woman, you convince her that you have cursed the child in her womb.
c Follow Jesus' example
Paul told a church, 'You know how we lived among you for your sake. You became imitators of us and of the Lord; in spite of severe suffering, you welcomed the message with the joy given by the Holy Spirit.' [1Thessalonians 1:5,6]
If we wish to so display Him to believers that they will want to imitate us and, in so doing, find that they are copying the Lord Himself; we must live very close both to Jesus and to them. 'Those who bear the Gospel do not stand in its way but appear rather as living introductions to the message.' [JH Bavinck, An Introduction to the Science of Missions]
d Learn culture
If we are to reveal Christ to unreached peoples we need to speak their language, understand their thinking, know something of their belief system. Throughout Sub-Saharan Africa a primal worldview prevails (even in Islamic areas). A sick African might ask, 'Who caused this; why and by what means?' He may think our talk of viruses and bacteria is secondary to the real aetiology, which has something to do with the spirit world. We trust in our medicine, while he looks to God's intervention (e.g. on one occasion a Christian doctor reached for a vial of antivenom to treat snakebite; but the non-Christian husband of the patient demanded, 'Pray first'). While the primal worldview is limited, it has more in common with the Biblical worldview than the secular worldview in which many of us trained. We will not agree with it, but can arrive at a sympathetic understanding, which both enlightens us ourselves and equips us to communicate effectively. [R.Staples, Western Medicine and the Primal World View, Int Bulletin of Missionary Research, April 1982]
Painfully I have learnt that everything I did proclaimed something about me - my clothes, home, holidays, use of vehicle, greetings (or lack of them), hospitality, even the way I walked around with my wife and taught my children. If only someone had prepared me before, I could have been more sensitive to the beliefs of those to whom I ministered and wiser in the ways I introduced changes.
African churches will increasingly shoulder the responsibility for mission in years to come. They too are realising that possession of a black skin, although helpful, does not guarantee understanding of another tribal culture. Some of the rapidly developing churches of Nigeria have adopted a policy that, 'Discipleship without missionary training is incomplete'. If that is true for their disciples, how much more for all foreign healthcare workers in cross-cultural situations?
4. HEALTHCARE MISSION WILL BE COSTLY
We will find the costs of future healthcare mission high. And, as biblical Christians, we will learn to rejoice in paying the price.
a Mission will be costly in skills
God uses hard-won skills in unexpected ways. Sheila lived with her husband in a desert outside the district centre. Medical authorities gave her no official recognition as a nurse. Even so, sick people quickly discovered her skills and called day and night. When they needed more than her meagre clinic could provide, she drove them to the district hospital where she became their advocate with reluctant staff. If they could not afford the treatment prescribed, she often bought medicines for them in the pharmacy. Once, convinced that the doctor had wrongly diagnosed typhoid in a desperately sick pastor, she seized the opportunity of asking a specialist who had flown in with students from the teaching hospital three hundred miles away to lay a hand on the pastor's abdomen. 'His appendix has ruptured and he will die in hours without surgery,' said the specialist; and he added, 'I'm afraid this hospital has no surgeon capable of performing this laparotomy.' Sheila persuaded the hospital authorities to release the patient into her hands and her husband drove him to another hospital 150 miles away where his life was saved. Over the years God had developed in Sheila abilities in diagnosis and in relating to people, which He could use in His own way to save lives. But she had expected a hands-on nursing ministry when she first obeyed God's call.
Jane lives in Chad on the edge of the Sahara. She too is a nurse. The church with whom she works has a vigorous training programme and has placed workers in clinics throughout their districts. While less highly qualified than Jane, they expect Jane to submit to their leadership. Her assignment is far from straightforward. How should she react when she knows they make mistakes? What should she do when they assign her to tasks way below the level of her training and experience? She has quietly followed their instructions while seeking chances to use her skills more effectively. Meanwhile she has used her position to form friendships in the community, which give abundant opportunity to witness to the love of Jesus.
In contrast Gillian felt strongly called to nurse children suffering from AIDS. She thought she had made this clear before she left for Africa, but the church leaders said, 'Sorry, but we need you in one of our general clinics.' A fellow missionary advised, 'Submit to them, do as they wish and, when you have won their trust in a year or two, tell them again how God is leading you and they will heed you.' But sadly Gillian gave up and came home.
We have spent years obtaining our qualifications and experience before going to Africa and have developed a mindset that demands that we use all this. But the Lord may want us to lay our skills on his altar too, allowing Him to use them (or not) as He sees fit.
b Healthcare mission will be costly in money
Healthcare has always called for financial resources. Speaking about this to a small group of retired businessmen one asked me, 'Can Africans not support their own people and programmes?' Another enquired, 'Why does so much aid money go into the wrong pockets?' They are sensible questions that we should not ignore.
A church leader sent me a photograph of a new church, walls built in concrete blocks and roof of corrugated iron. He told me the Christians spent £2000 on it. Could we possibly find another £1000 to finish it? In our own church in Scotland we are legally required to provide a toilet for disabled people and so are seizing the opportunity to make some small structural improvements at the back of our building - at a cost of £46,000.
Yes, some Africans are wealthy and I know of Christians among them who are extremely generous. But on the whole they are poor - many in the depths of poverty. Aware of the discrepancy between their living standards and ours, they read that Dives should be committed to helping Lazarus. Jesus reminds us of the importance of correct attitudes to money in many encounters [e.g. the rich ruler, Zacchaeus, the poor widow] and parables [e.g. the shrewd manager, talents, the great banquet] and tells us His own mandate 'to preach good news to the poor' [Luke 4:18]
It is also true to say that money has been miss-spent. We need to follow Paul's example of using his collections for the poor in Jerusalem as opportunities to teach about motivation to generosity, regularity in giving, integrity in handling money, transparency in reporting. One of his great aims was to foster relationships and especially to deepen love between Jews and Gentiles through sacrificial giving. My wife and I attempted a seminar on these lines and an evangelist asked, 'When a guest comes to my home and the only money I have to buy food is the church collection which I have not yet handed on to the treasurer, what should I do?' Should he use the money for his friend or disobey a fundamental law of Christian hospitality? Have you ever faced that quandary? If he misuses that money, will you still contribute to the church collection?
I believe we can help by making clear what we will provide for and where we insist the church finds her own way of raising funds.
Much of the financial support for healthcare in Africa has in the past been channelled through missionaries. Increasingly the workers will be African Christians and support from the Western church is already diminishing as a consequence. In many poverty-riven areas healthcare mission will suffer if we fail to take on this responsibility. I think our chief hindrance is a lack in our theology of hope. 'When you give a banquet, invite the poor, the crippled, the lame, the blind, and you will be blessed. Although they cannot repay you, you will be repaid at the resurrection of the righteous.' [Luke 14:13,14]
c Healthcare mission will be costly in security
Our joy knew no bounds when, after a few years, our team in South Sudan numbered thirty-six. They were building clinics, training village healthcare workers sinking wells, advising farmers, establishing schools and starting little churches. Suddenly war swept through the area and they had to leave. Some eventually returned, only to be chased out once more and to see the destruction of all the work they had built up. The door remained firmly closed, but an opportunity for service developed a thousand miles to the north and off they went for a while until further persecution drove them right out of the country.
With the rise of militant fundamentalism, the situation is more dangerous now. I know of several instances where authorities have recognised that workers, who have built up friendships over many years, pose a threat to the prevailing religion and must be silenced - usually by expulsion. In February, a hospital employee in Yemen murdered several American doctors. It seems that one of the doctors had so lovingly and effectively treated the employee's wife that he feared lest she influence his wife to become a Christian. He applied for a job in the hospital and awaited his opportunity.
In his Annual Statistical Table on Global Mission, drawn up in mid 2001 (i.e. before the tragedy of 9/11), David Barrett lists numbers of martyrs as follows:
What does this say to workers called to healthcare mission in Sub-Saharan areas where fanaticism is increasing? Do we avoid them or engage with the risks?
When negotiating remote roads in many a country today, wise travellers make up their minds as to how they will respond to highway robbery. In most African cities workers will decide in advance how they will deal with the violent burglar in the home or the mugger on the street. Agency executives will learn how to react to the terrorist gunman who faces their workers.
Grieving over the suffering of a new believer, an African leader of a visionary healthcare programme said, 'If we are not ready to support and die with a Muslim convert, we should not talk about sharing the Gospel with Muslims with a view to asking them to make a commitment to Jesus Christ.'
Have we grown too comfortable? Have we lost sight of the Lord's promised rewards? We quote Matthew 5:13,14 about being 'salt' and 'light' but our brothers and sisters in northern Nigeria could remind us that these verses follow immediately on two beatitudes which stress the blessedness of experiencing persecution and command us, 'Rejoice and be glad because great is your reward in heaven.' Paul says, 'God has put us apostles on display at the end of the procession, like men condemned to die in the arena.' [1 Corinthians 4: 9 - in place of 'apostles' read, 'future healthcare missionaries'] Will our theology develop until we can sincerely agree with him, 'to live is Christ and to die is gain'? [Phil1lipians2: 1] When constructing St Paul's Cathedral, Christopher Wren asked three workmen, 'What are you doing?' The first replied, 'I am laying bricks'; the second, 'I am erecting a wall.' The third, with a smile on his face and a song on his lips, said, 'I am building a cathedral'. While we give ourselves to effective healthcare at present, let us always see our mission as establishing God's glorious Kingdom. One day we will see the whole edifice completed and hear, 'Well done, good and faithful servant. Come and share your master's happiness!' [Matthew 25:23] We will look over our shoulders thinking He is addressing someone else, and then realise to our astonishment He is speaking to us.
We will marvel at His deep well of grace and at the vessels He has used to pass it on
A full length version of this address is available on-line at the Global Connections Website
