I apologize for the delay in postings. Our family has made a big move of faith from Guatemala to rural Buies Creek, NC. I am working with Campbell University to develop a dept of medical missions and global health. Stay tuned.

Today we’ll take up again our journey through the 12 statements we have accumulated over the years and which Dr Peter Yorgin has put into its present form. We are all for building on these statements over time. Today we make the case for “Obeying the rules.”

We will obey all of the host country rules and laws, to the glory of God.

    • Obtaining permission to practice medicine (diagnose and treat illnesses of the body and mind)
    • No bribery –
    • No sneaking health materials into the country
    • Obtain malpractice insurance

In His word God makes it clear we are to obey the governing authorities. We would do well to recall what the situation was like in Paul’s time when he wrote the book of Roman’s under the inspiration of the Holy Spirit:

Let every person be subject to the governing authorities. For there is no authority except from God, and those that exist have been instituted by God. Roman’s 13:1

In my 11 years of serving in Guatemala I saw very few STMM groups whose healthcare professionals had obtained the necessary credentials to legally practice medicine in that country even though it was a fairly easy and straightforward process. To those who did take the necessary measures to be legal I applaud you. This is most easily done with an in country partner with whom you have developed a true partnership for the long term.

Further scriptural support of this mandate can be found in I Peter 2: 13 and following:

Be subject for the Lord’s sake to every human institution, whether it be to the emperor as supreme, or to governors as sent by him to punish those who do evil and to praise those who do good. For this is the will of God, that by doing good you should put to silence the ignorance of foolish people. Live as people who are free, not using your freedom as a cover-up for evil, but living as servants of God. Honor everyone. Love the brotherhood. Fear God. Honor the emperor.

We would confirm that this applies in cases where conforming to the governing authorities does not require us to act in contradiction to biblical principles.

One of the most significant roadblocks to “development” in not yet developed countries is corruption and what this does to the ability to develop trust and accountability not only between the public and the government but between outside agencies and local partners. We believe that bribery is unacceptable in any form for those involved in doing STMM’s. See this Best Practice article on bribery. One response you may hear is that “This is just the way things are done here, it’s part of the culture.” You may even be accused of trying to impose “western standards” on local partners. But these are not just western standards they are biblical standards which we can discover with careful exploration of God’s word together with our local partners.

I would like to believe that the majority of those doing STMM’s are aware that there are standards and guidelines for the use of medications in the field. I recall many groups trying to get through the airport with hockey bags stuffed full of medications collected and packaged (some not even packaged) to hand out during a week of clinic in some distant village. Many of these medications were near to or had passed their date of expiration and according to the law were not to be imported let alone given to patients in any setting. Yet these well meaning and zealous-to-do-good folks ignored these legal and ethical dilemma’s by simply ignoring them. There is a Best Practice paper which deals very nicely with this topic. Also it is fairly routine that groups will attempt to smuggle medical equipment of various kinds (maybe not CT scanners or X-ray machines) which if brought in by normal means would require the payment of a tax of some sort. I heard of one group bringing 500 pairs of glasses to Guatemala who were discovered and were required to pay a $2/pair tax! This can be avoided, usually, by again having a strong/long term partnership developed with a local ministry which can help avoid these problems.

Our final point would be that all who practice medicine in another country should obtain malpractice insurance.

After an all too long break we are again starting up our Zeal With Knowledge blog post. Our family just made a change in location from Guatemala to a location just south of Raleigh/Durham, NC where I (mike) am working to develop a dept of medical missions and global health at a soon to open medical school at Campbell U. Stay tuned.

Today we turn out attention to statement # 5. Obey the rules with the following points:

We will obey all of the host country rules and laws, to the glory of God. (as long as it does not compromise our Christian witness)

  • Obtaining permission to practice
  • No bribery
  • No sneaking health materials into the country
  • Obtain malpractice insurance

The first of our points is clearly a biblical principle based on Romans 13:1-

1 Let every person be subject to the governing authorities. For there is no authority except from God, and those that exist have been instituted by God. Therefore whoever resists the authorities resists what God has appointed, and those who resist will incur judgment.

As painful as this may be to think about, considering the high levels of corruption in many places in greatest need, it is not a biblical mandate that we can just ignore. We would do well to remind ourselves of the situation Paul was living in when he wrote this letter. The Roman government of the time was not a model of democracy and equal rights and was going to become much more aggressive in its persecution of the followers of the “Way,” I have to wonder if this could be one factor for which we (resource rich folks who have a zeal to do good) we have not had a greater affect on bettering the health of those in underdeveloped countries. During my 11 years serving in Guatemala I almost never encountered visiting STMM’s team whose healthcare professionals had acquired permission to examine and treat ill people in clinics. There are some who visit and play by the rules but I heard of very few who did so. And the process is quite easy and can be managed by the local partner with whom one has developed a long term strategic partnership. Nearly all nations have standards by which they function regarding who will be given permission to practice medicine within their boarders. All who engage in STMM’s in other countries should obtain the necessary permission and follow the rules of the law.

Secondly we can see no good reason to tolerate bribery as a part of our Christian healthcare ministry outreach. This topic is dealt with very nicely in this “Best Practice paper. Some may claim that bribery is just a normal part of how things get done and that it’s just part of the culture. And you may even hear that we (westerners) shouldn’t try to impose our beliefs and values on other cultures. But bribery is not consistent with the honesty and accountability mandated by God’s word. When we hear these arguments our approach should be to point out that these are not “western” values but biblical values and then together with our local partners we can see by an examination of scriptures that it is not to be tolerated in our Christian efforts to bring health and healing to hurting people.

The third point today is that we should not be taking with us into other countries materials which are illegal. This included nearly or already expired medications. This is discussed in these Best Practices papers. Expired meds, Experimental meds, and Medication use. On top of the discussions related to medications we would also do well not to attempt to take into another country any equipment which may legally be subject to an importation tax. Again this goes back to our argument related to conforming to the rules of law which apply to each particular country. One group tried to important 500 pairs of used glasses into Guatemala and were found out and asked to pay a $2/pair import tax! If this group had done its due diligence with a local partner regarding the importation of such items this could have been avoided.

Finally we highly recommend obtaining malpratice insurance for work done in another country. Dr Peter Yorgin addresses this issue in this Best Practice paper.

At a recent regional “Best Practices” conference I attended and spoke at we were having a question and answer time to try and get the pulse of some of the attendees, to see how they were tracking with the ideas we were promoting. (effective partnership, systems thinking, we should be shooting for excellence and not just average) An older gentlemen raised his hand and stood to share his opinion. “I’ve been involved in this kind of work (short term medical missions I had to assume) for more than 40 years and most of what you say is all well and good but if we tried to do this before sending out teams we’d never get anyone to go.” (paraphrase of course) I tried to be as tactful as possible with my response which went something like this. “Maybe if that’s the case then shouldn’t we be asking ourselves should such groups or individuals go at all?” I had second thoughts after saying that but I believe it’s the truth. So we now come to point #2 in Dr Yorgin’s power point presentation which given in Tucson earlier this year. Please give us feedback and please inform anyone you think might be interested about this blog and about the Health for All Nations. 

Statement 2: Health missions team training

  • Christian healthcare professional short term team members should undergo training prior to engaging in international missions health care.
  • Paradigm shifts
    • Community health evangelism (CHE) instead of just focusing on doing clincs/curative care.
    • Mutual transformation/World view -> Beliefs -> Behavior (Behavior (taking into account that hosts tend to adopt the worldview of the goers so as not to displease their benefactors)
    • Integration of faith and vocation
    • Recognizing God as healer
    • Praying with patients
    • Dependency
    • Learning/Education rather than doing

Is it possible to be ignorantly zealous?

I receive a daily bible reading from eBible and along the right side of each posting are often some interesting articles. I found the following one particularly relevant to this blog: 

Source: 843 Acres | The Park Forum

Relevant Text: Isaiah 4:2-5:30

Advocacy | In the world of legal ethics, there is no zeal apart from knowledge. Lawyers are required to represent their clients “zealously” [1] and, therefore, they must have complete knowledge of the facts. If clients withhold relevant information – even bad or damaging facts – their lawyers cannot represent them zealously. Recall A Few Good Men. Downey told his lawyers that he was ordered to give a Code Red by Kendrick, but he failed to tell them that he himself never actually heard Kendrick give the order. When that information came out during cross-examination, his lawyers had to regroup because they knew that his having received the order second-hand was unfavorable to the case. They also knew, however, that they had to address it if they had any hope of winning.

I think we should be making the same argument in the realm of healthcare missions done in the name of Christ. I would say this would especially apply to those doing short term medical missions, where it is very easy to let our zeal get the best of us. No surgeon worthy of his/her calling would enter a surgical suite to perform a complicated procedure without a thorough knowledge of the individual and her/his case. Shouldn’t the same apply to putting ourselves into cross-cultural situations that are often very complex and full of potential pitfalls? We should be as well informed as possible when agreeing to take part in a short term medical mission endeavor. What is the culture like that we are going to serve within and what are the factors that have led to this place being selected and at this time? 

Worship | Similarly, when it comes to worshipping God, there is no zeal apart from knowledge. Yes, zeal for God is essential [2], but our passion for Him is weak and vulnerable when it is not based on knowledge. As Isaiah prophesied, the Israelites worshipped with zeal, but they were exiled because their zeal lacked knowledge: “They have lyre and harp, tambourine and flute and wine at their feasts, but they do not regard the deeds of the Lord, or see the work of his hands. Therefore my people go into exile for lack of knowledge” [3]. Our zeal must be based on that same knowledge – the deeds of the Lord and the work of His hands. Today, we find that knowledge in the Word. The Bible is a wellspring for spiritual thirst. Not only is it a living power for the soul, it is also a double-edged sword for cross-examination. Even Jesus himself frequently settled important issues – divorce and remarriage, the Sabbath, worship and praise, the resurrection, eternal life – by referencing the Scriptures [4]. The Bible itself, however, is powerless as mere paper. We must open its pages and read it in order for its meaning and power to be unleashed with zeal in our lives.

Prayer | Lord, Raise our affections in accordance with truth. Cultivate our spiritual appetites daily by laying us in the way of allurement that is found in your Word. Let us long for the education of our minds and never let us think that studying your Word is bland. Instead, quicken our hearts throughout our lifetimes to long to unlock the riches of truth found in the Bible. Amen. [5]

And I would add simply “Lord, let us match our zeal to do good with a knowledge that is equal.” 
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I have been encouraged to economize the length of these postings so today I hope to keep it to only a couple of paragraphs. I know you all are very busy people. 

Today we come to the halfway point in video #2 (minutes 4:10). The example of Dr Nestor Salivarrias. The producers have moved to a completely different part of Honduras from where the AIM had been working. Dr Nestor is a pediatrician who has been working in this clinic in Olancho for 22 years. He has stopped hosting STMM’s saying they are too costly and have little to no long term positive effect on the health of the people. He instead utilizes Honduran doctors and if any foreigners come to work in this area they are specialists and not primary health professionals. But a comment was made that Dr Salivarrias felt the medical “brigades” (we call them jornadas in Guatemala) were helpful at first in raising awareness and “spreading the word” about his clinic.

This is a comment that I have heard my associate (the medical director of Salud que Transforma in Guatemala) Dr Erick Estrada make several times recently. I am always concerned that he gives in to the temptation of hosting STMM’s at the cost of losing our long view approach to our community health/development initiatives. But it seems one of the most valuable aspects in his mind, and it seems in the mind of Dr Salivarrias, of STMM’s is that it can, in a helpful way, raise awareness of a locally run and administered health initiative. Can we consider this then a “BEST PRACTICE” principle for STMM’s? Short term medical mission teams can be effectively used to raise awareness of locally initiated and administered healthcare initiatives. What would this require to be successful? Does anyone have some positive examples of this working in other places around the world? What other positive aspects do we find in the model used by Dr S?

Well here we are. The first posting for what we hope will become a valuable tool for Gods kingdom on this beautiful, dusty, wonder-filled, dirty, and often confusing world. There is so much knowledge and wisdom out there that is not being shared and we hope this will be a space for sharing and accumulating such knowledge. The only cost will be the time necessary to write postings and opinions. As we ID most relevant topics we can then rally a team around the theme to form working groups which will research the topic, write up a best practice paper which will be shared and which again will be open for further discussion. Many of the topics will cover areas of ministry that will be ever changing and so we should understand that once a best practice paper is published it may require modifying in the future. I have developed some categories and tags which I’m sure will be expanded in the future.