Twelve years ago I met a recently qualified Indian doctor. God had called her to work in the poorest slums of Delhi. Because she obeyed God Kiran Martin’s famous programme now cares for 200,000 residents in over 30 slum colonies. There are thousands of other places needing programmes the same size, smaller or bigger than Kiran’s. There are thousands of doctors and other health care workers needed to start them: the needs are great but the workers are few. Many Christians will have an idea of being missionaries, but have no idea where they are needed or how they can go. A survey was recently made of 100 Christian medical students interested in overseas service. Only twelve completed training for their calling, two actually went, and one stayed long-term. This is not the way to win the world.
Why should we go?
Consider Jesus’ last words to his disciples in the Gospel of Matthew.
‘Then Jesus came to them and said, 'All authority in heaven and on earth has been given to me. Therefore go and make disciples of all nations, baptising them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have commanded you. And surely I am with you always, to the very end of the age' ’ (Mt 28:18-20).
Christ has called us, his co-heirs in the inheritance God has prepared for him (Rom 8:17), to go and win his inheritance. ‘Ask of me, and I will make the nations your inheritance, the ends of the earth your possession,’ God said to his Son (Ps 2:8). Jesus sends us to go into all the world, whether on our doorstep or in far-flung areas, to preach the gospel to all creation (Mk 16:15) and to demonstrate his compassion in practical ways; in healing the sick, binding up the broken-hearted (Is 61:1) and visiting those who are in prison. He will go with us and be with us always, as he has faithfully promised (Mt 28:20). All authority under heaven and earth has been given to Christ (Mt 28:18) to whom we are united; it is he who will win souls, heal and comfort people through us if we but follow him. Mother Teresa once said, ‘Christ has no body now on earth but yours; no hands but yours, no feet but yours. Yours are the eyes through which to look with Christ’s compassion, yours are the feet with which to go about doing good’. As we serve God in all these needy places, opportunities will arise to talk of him and our motives for service.
Every year the world has more nation states than before. We would be hard pressed to think of one country which a doctor would be forbidden to enter, and as medical people, we have two passports: our national one and our medical registration. We have skills and knowledge that people need, and above all, we have the one thing that is truly necessary; the gospel. Bringing medical skills to the needy is a wonderful way to open hearts to listen to the good news of life. Jesus healed people with the express aim of demonstrating the love and mercy of God.
What are the needs?
Listed below is an ‘A to Z’ of diffferent specialties with particular opportunities for service.
Addiction
Detox programmes are badly needed but there are very few doctors who are willing to slum it out where the addicts are dying, not even for a million dollars. God’s love flowing from Christian hearts is the only successful motivator.
Care of the elderly
Worldwide, families are starting to disintegrate and millions of older people are being confronted with a harsh future of dependency. The obvious answer is to have more children to look after you in your old age. What are we doing for the world’s ageing population, much of it so impoverished? This is a call to lateral and creative thinkers.
Community based health care
Here, the centre of gravity is the community, not the hospital or clinic. Its aim is to empower local people to prevent two-thirds of their health problems, treat most of the rest and refer the remainder to the nearest health centre. Carrying out that simple sentence is probably one of the biggest challenges facing doctors.
Entrepreneurs
We need entrepreneurs - those who can bring together needs and solutions by creative and lateral thinking, exploiting the internet, developing telemedicine, going in search of willing workers and by taking risks. The entrepreneurial skills of a Richard Branson or Bill Gates do not have to be restricted to manufacturing money for its own sake, but can beused to serve God and his people.
Family planning
This is helping communities to practise child spacing. Having just three children each, spaced about three years apart would slash under-five mortality and make life far more tolerable for all members of the family.
General practice
Networks of accredited family doctors (GPs) are being established in many countries. Many people have died because there were no well-trained, affordable GPs available, and families have been forced to turn to traditional medicines or expensive private doctors.
Health promoters
These people use every conceivable way to prevent illness, promote well-being and delay death. The best people are those who are part of the community themselves, but they have to be trained and programmes have to be managed. Doctors can participate, advise and train.
HIV medicine
This terrible epidemic affects nearly 40 million people, causing untold suffering as well as political destabilisation. The burden of AIDS is eating up the health budgets, and infected soldiers run amok in war-torn countries, raping defenceless women. The desperation that HIV is causing in some countries is so intense that almost all other health care is on hold.
Immunisation programmes
Implementers and managers are needed: locally, with national governments and with UNICEF. Millions of people die of preventable infectious diseases worldwide. Epidemiologists and researchers are needed to design and deliver new vaccines to combat these.
Infectious diseases
These are the biggest killers in the world. Just as we thought we were beating them, these illnesses are making a spectacular comeback. Practitioners and specialists are required to tackle emerging and re-emerging diseases: malaria, schistosomiasis, sleeping sickness, dengue fever and TB to name just a few.
Managers
Medics who can manage, together with their non medical administration colleagues, are absolutely essential. With more of these around, the efficiency of most hospitals and programmes in developing countries would be doubled overnight.
Medical journalists and broadcasters
The needs of communities must be brought powerfully and compassionately to the public and the power brokers’ attention.
Medical anthropologists
Socially sensitive doctors, or specialist anthropologists can help programmes get it right, so that we don’t dismay the local population by a chain of social blunders, or set up a programme totally out of synchronisation with the community’s needs.
Mental health specialists
More than one in four patients consulting doctors in the developing world need some form of psychiatric help. This is virgin territory in most countries (a bit like surgery 100 years ago).
Nutritionists
A huge number of people are malnourished, which reduces their resistance to disease; we need medics and other health workers specialising in nutrition to advise, practise, train and work alongside the community.
Obstetricians
Doctors who can perform tricky deliveries and caesareans are much needed: but also people who can set up training programmes for traditional birth attendants, start up referral units, maternity waiting houses, and implement everything in the WHO’s safe motherhood initiative. Many women have no antenatal care and there are few accessible referral centres for obstetric emergencies or premature births.
Orthopaedic surgeons
Millions of landmines litter four different continents. Surgeons working with those trained in prosthetics, orthotics and community rehab can deal with the terrifying carnage that results.
Paediatricians
Generalists with paediatric training or specialists for referral hospitals are both needed urgently. Half the population of the developing world comes into the paediatric age range.
Pharmacologists
Pharmacologically trained people are needed to design and implement rational drugs policies that are cheap and safe for use. We need life-saving medicines at community level that are clearly defined, properly used and always available.
Surgeons
These are needed not only in hospitals, but also for community surgery. Pioneering ways of doing simple operations in village homes for the millions too frightened, too poor or too distant to ever get to a hospital are vitally needed. Community surgery is a speciality waiting to happen.
TB control
One person in three has had a primary infection. Each year more people die than the year before. Most communities in developing countries are still waiting for effective programmes, rather than half-baked attempts which cure a few but spread drug resistance to many.
Water and Sanitation
Doctors with special knowledge or large doses of practical sense are needed to work with water and sanitation engineers, to help the vast numbers who still spend their daily energy carrying water or digging holes for defaecation. Poor sanitation leads to epidemics.
Whatever your interest, gift, speciality or generality - God can use you somewhere in the world.
Where could I go?
Here are some suggestions; all of them offer opportunities of bringing medicine and the gospel to those who need it.
Battlefields
There are over 50 wars within or between countries being fought at the present time. The Red Cross was born on a battlefield and is found near all of them today.
Churches and church-based clinics
Countless churches are longing to reach out with health care to the communities around them, but usually they have no doctor available, and no clue how to start.
The community
Places such as villages, city slums or financial centres all contain spiritually empty people. We need community based medical mission to the poor, the rich and the super-rich, customised to the exact needs of each group.
The corridors of power
The UN, national governments, the EC and the WHO are all bodies where decisions are made and strategies formed. These are also strategic locations for Christians to work and make a stand against corruption.
Disaster areas
The victims of floods and earthquakes always need medical help. We also need a planned medical response to the effects of global warming.
District Hospitals
Many are run down and non-functioning, but they are key to a country’s health system.
Eye and ear camps
Doctors take much-needed care for the visually and hearing impaired to the places where they live, rather than where the health workers live. This can change people’s lives.
Hospitals again
Small and struggling, referral, tertiary, mission, government hospitals all need people. The scope for doctors with all levels and types of training is limitless.
Medical schools and universities
Specialists and super-specialists are needed to train, research, teach research, set up new departments and form bridges with western institutions, and inspire the next generation.
Mercy ships, planes and trains
There are Christian-owned ministry ships needing doctors, and at least one plane and one train set up as surgical units.
Mobile clinics
Land Rovers, recycled ambulances and canoes are just some of the modes of transport needed to bring medical care to remote communities.
Nomadic peoples
They need health care too; this may mean becoming semi-nomadic yourself.
Primary health centres
Large and small centres all over the world need more people. They are often unstaffed, especially in mountainous or remote areas, hostile climates or in unstable zones where local people are reluctant to serve. Sometimes it means repairing the roof or rebuilding the centre before you start the clinic.
Prisons
Diseases including TB and STDs are rife here. Addiction and mental illness are endemic.
Psychiatric hospitals and community based rehabilitation centres
Most are still waiting to be set up.
Refugee camps and roadside clinics in war zones
These places are crying out for medical skills.
Schools
Hundreds of international schools need medical officers (this is ideal for part-timers).
Television and radio stations
Health soap operas are becoming one of the most powerful ways of changing unhealthy living patterns of whole communities. Christian doctors are needed to advise, write and participate and to start new programmes in new countries.
Urban health centres
This is perhaps the key need of all. The groans of the urban poor are rarely met in practice by the compassionate face of a Christian doctor or the welcome of a friendly clinic. At least half a billion people attend these centres.
How do I know what to do?
The needs are so great and it’s all a bit bewildering; how do we find out where God is calling us? We must get to know God better to find out; he has a plan for each of us, he has prepared our service. We must be open to God’s voice as we read the Bible, pray and talk with our friends and church communities. God may speak to us through pictures of dying children in the news, through hearing other missionaries talk of their lives, through reading, daydreaming or more directly. We need to keep praying and trusting God to show us where to go and what to do. We must guard our call closely as it is easily trodden underfoot in the hectic pace of modern living and in the competition of the career ladder. We must learn to obey God and follow him whatever he asks.
Take opportunities to find out where the needs are and what the world is like. Read about, meet, and understand people from different countries, go on a mission elective, join a short-term project or exposure visit, take a creative holiday visiting the villages near the beach resort and see what medical and social problems are ripping through the local families. Join a mission society and pray for some of their missionaries regularly, write to them and find out what it is really like. Encourage people to pray for you as you think things through, and pray for them too.
How long should I go for?
You can go for anything from one week to 50 years. Medics used to go abroad for a long time and stay for years. Some situations still need this kind of service, but now the emphasis is more on empowering and training local people: to fill gaps, to start new programmes, to plan, work alongside and build the capacity of those already in the clinic or community, whether countryside or slum.
Long-termers are needed. For example, hundreds of vacancies exist in the mountains of western China. To work here, you must be in for the long haul: two years just learning Mandarin and building relationships with your Chinese partners, and only then getting into communities. Equally, short-termers are needed (eg a three to six month contract in disaster relief: straight in on day one).
Working in a mission hospital can last anything from six months to a lifetime. Centres of excellence or the corridors of power will occupy you for months or years. Sometimes visiting consultants and capacity builders can accomplish ten years of work in just a few weeks if skilled, focused and called by God.
When should I go?
If God has called you, you should go as soon as possible after you have the skills needed for what you’re sent to do. This may mean sacrificing your normal career structure... but God is in charge of your career!
The basic medical skills of GPs who have completed their vocational training are enough for many front-line situations, sometimes with a DRCOG or some additional obstetrics thrown in. A diploma in Tropical Medicine sometimes helps but is not always needed. For centres of excellence you may need to wait till you’re a specialist registrar or consultant. A year in biblical and cross-cultural training is helpful for the long-termer. But only delay for the shortest time necessary, as good resolutions and the cries of the impoverished are easily drowned by the lures of consultant posts or the security of General Practice. The good can be the enemy of the best.
Be prepared for opposition. Whether you are sane or stupid some people will probably oppose you. It may be your parents, friends or medical colleagues. This is part of the package - living beyond the comfort zone. Biblical and missionary heroes are pretty well divided between the sensible and the crazy. Some of those most used by God have broken the rules, jeopardised their careers and been idiots for the Kingdom. Others, probably most, have been missionaries through their normal, sensible careers. Both groups and all those in between, when really called by God, are equally valid. So it may be any country, any branch of medicine, any time, any length of time, any place. It might be the well worn path to the African mission hospital, or perhaps something never done before. We each need to be sure about what God is asking us to do. If we go beyond our brief and try to do everything we will get into burn-out, or worse, become cynics.
What is stopping you?
Do you have a call to remain right here where you are? If there is no pressing need for you here, there is a crying need for the gospel and for medical skills elsewhere. Christ died for the sick-looking paan-seller by the Hooghly Bridge in Calcutta, for the orphaned Tutsi child with HIV, for the mother dying of bilharzia in the African swamps, just as he died for you.
By the grace of God, eternal life has been given to you, but they do not know of the offer held out to them on the cross; their lives are short and chances are slipping away. God has given you the medical knowledge to use in his service for this very purpose; he himself has prepared the good works for you to do (ph 2:10). If you are afraid, know that the Lord of heaven and earth will go with you (Ex 33:14), and who is greater than God? (Rom 8:31)
It will be difficult, tiring and often thankless, but light and momentary troubles are storing up for you an eternal glory that far outweighs them all. (2 Cor 4:17). If you feel inadequate for such a task, it is God himself who makes you competent (2 Cor 3:5). It is the Spirit who convicts through your words and actions, not you yourself (Jn 16:8). If you don’t think you have the resources, God has them in abundance; he knows what you need and he will provide (Lk 12:29-31). Everything is possible for him who believes (Mk 9:23), since with God, nothing is impossible (Lk 1:37) and his word will accomplish his desire and achieve the purpose for which he sent it (Is 55:11). With such great assurances from one such as God, and such a task to do, we must all be missionaries, at home or abroad.
