This past Saturday I was volunteered (by someone whose name will remain anonymous) for duty at our USCWM/WCUI foodbank. We receive just about to expire and some unsellable food from some local Trader Joes (thanks to TJ) stores and the food is divided into categories and then we each pass through to pick out food we would like to take home. This day I was accompanied by my daughter, Leah, who was to help me see what I needed to do so that I could actually be of some use. Also helping out as a “setup” person (they get to go through the line after the drivers and before all the rest) was Anne who is from Africa. She was there with her 2 lovely daughters and has been involved in this Saturday AM event for some time. I heard her accent and struck up a conversation as we were waiting for the drivers to arrive with the goods.

Enthusiastically she shared her story. Anne had grown up in a central African country and her was family was so poor that their poor neighbors considered her family as poor! But through the messages delivered by her pastor in their home church Anne began to hear God speaking through her pastors teaching and what she heard transformed her mind and her life. My immediate thought when she mentioned the name of her church (the name is too long for me to remember) was that it was probably a “prosperity” gospel church. Oh no Anne replied. What the pastor shared was not the prosperity gospel as most people understand it but a gospel of hope and encouragement that God did not intend that His people sit idly by suffering with poverty and ill health. No, He was a God of true prosperity but prosperity as understood in the concept of shalom. He wants His people to live lives that are full of His peace, the peace that passes all human understanding. This pastor taught that his congregants were responsible for their own well being and that their lives could be made better with their own efforts in tune with the work of the Holy Spirit active and alive in our lives! WOW I wanted to shout thanks be to God that He would allow me to hear such a story. But what has this to do with Zeal and Knowledge?

Let me take us back to the purpose of this blog. It is primarily intended to assist those with a passion/zeal for doing good to acquire a deepening knowledge base for how to match their zeal with sufficient knowledge so as to maximize our efforts for kingdom transformation. This story gets to the heart of this purpose. This story illustrates that there are indeed some excellent churches globally whose pastors are preaching and teaching sound messages that have enough impact to transform thinking and thus lives. There may be more sound messages such as this being preached globally than in the church in the west. So for those in the western church who are involved in global missions activities remember one of the principles we think is foundational to effective involvement cross-culturally is working through local churches who have leadership that is preaching and teaching the truth about the overwhelming good news that not only did Jesus die for our sins that we might have eternal life but that He also, along with the Father and Holy Spirit, desire to see His people living lives of shalom and not lives of poverty and dis-ease. We must acknowledge that God is working through His Church all over the world and if we involve ourselves and our churches in cross-cultural global ministry without being connected to such churches and leaders as Anne describes then we are not practicing zeal with knowledge and we are probably causing more harm than good.

 

I know I said I would start a series on a biblical understanding of health with my next posting but I wanted to explore the role of the church a bit further. I have been privileged to begin an exploration with my own local church as to what our “missions” strategy of the future will be. I used the Lausanne mantra as the foundation for our discussions: “The whole church, taking the whole gospel to the whole world.” Our second week discussion focused on the church (or Church) and we acknowledge that the true Church of God, His bride, those who are truly redeemed, is somewhat invisible. But that the local church, those who are meeting in buildings and calling themselves the church, can be seen quite readily still in the US though it is losing its power and influence. But as the local church we are still trying to figure out how we will go about working through other local churches globally.

Some years ago I (Mike) attended a fairly well known Christian conference (not in Louisville) and one of the main focuses was to be a discussion about working through the local church when doing “development” work. There was the normal level of excitement as the attendees became situated and the short time of sharing by the expert began. I think it safe to say that a good argument was made that the local church, no matter its level of maturity, is the means by which God has chosen to work in this world. The facilitator at our table did a good job of getting our table engaged in the discussion but something was missing. No one explained actually how they have been able to adhere to this policy in their own work globally. Most everyone agreed it was the right way to go about carrying out our individual and organizational calling but I wanted to hear how people were doing it effectively. No one came forward to give us such details. After the conference there was an attempt to put together a “best practices” working group to tackle this topic but it never went anywhere.

This blog is about sharing principles we have all learned so that our zeal to do good will be matched with an equal level of knowledge of how best to do it without mucking things up and leaving things worse off than before we started. So is working through the local church, when it exists, really a good strategy? Or is the local church just too messed up to even consider it as the main focus of our health development efforts?

First I hope we can all agree that yes the church is the earthly means by which the Lord has chosen to continue the spread of the good news which Jesus initiated with His ministry and which His disciples and then His Church carried on with various levels of success since then. DeYoung and Gilbert in their excellent work “What is the Mission of the Church” point out that the “keys of the kingdom of God-the authority of that kingdom, the right to act in its name-are given in this age, by the King, to the church! …. to this ragtag bunch of argumentative, self-centered, struggling-for-holiness but gloriously forgiven sinners.” In Ephesians 3:10 Paul explains that the mystery of the gospel was revealed so that “through the church the complicated, many sided wisdom of God in all its infinite variety and innumerable aspects might now be made known to the angelic rulers and authorities (principalities and powers) in the heavenly sphere.” DeYoung and Gilbert continue “The life of the kingdom of God-a life of poverty of spirit, meekness, mercy, purity and peace (shalom)-will be manifested to the world in the church…. and as the world sees and responds to that kingdom life, the church will not only manifest the kingdom, but also bear witness to it.”

Secondly, if we accept the first point as being true, then what are the strategies that we have found that work best to make this happen effectively? If you are working for a Christian college/university and want to give your students the best experience for learning how effective wholistic/integral transformational health development ministry can happen how do you partner with the local church where you are sending your students? If you are a local church in the west wanting to practice biblical principles in working in other cultures how do you partner with small indigenous churches in other parts of the world? How do large or even small Christian NGO’s make this work? These are some question we must answer:

  1. how does one go about finding a “healthy” local church with whom to work? or does it have to be defined as being healthy?
  2. should we focus on working through local church or pastor’s associations instead of just one single church? if you partner with a specific local church I can tell you that you will immediately lose the participation of many in the community because they belong to a different church which probably exists because of infighting among members who used to be friends.
  3. if we find a local church with whom to develop a relationship and hopefully a long term transformational project then what do we use as our guiding principles for developing that relationship/partnership? Can’t we just shake hands and say let’s go for it and let the Spirit lead?
  4. what if there is NO local church but you are instead seeking to reach an unreached people group? How do “work through the local church” in this scenario?
  5. how do you develop the partnership without creating unhealthy dependency? (or we could say unhealthy co-dependency – if you know what I mean)
  6. how do we help to strengthen the local church in whatever form it exists? should this be our highest priority?

When I talk to groups about development I do encourage working through the local church if possible. I use the illustration of a large Greek temple. The roof of the temple is the local community in which the church exists. The pillars that support the roof are what we like to focus on because that’s where we can show results: these are the pillars of justice, economy, healthcare, education, the environment, and we could throw in agriculture. But the huge foundation of it all is the local church! If we are developing programs, no matter how important, but are ignoring the local church and what we could be doing to strengthen local churches then we are not doing our best. Local pastors of poor rural and urban churches are thirsting for more knowledge as to how effectively shepherd their flocks.

I recently became aware of a wonderful effort by TearFund to address this issue. Check it out here. I am waiting to get approval to post to the Health for All Nations website a paper written by one of their country reps. More later. PLEASE GIVE FEEDBACK with methods you have seen which have worked with regards to this theme.

We have finally reached the final statement for what we believe are the minimum set of standards that lead to excellence in short term and long term health related missions activities. Or in other words adopting and implementing these standards will lead to sufficient knowledge to match the zeal many feel for doing good through health outreaches in the name of Christ.

Todays statement has to do with multiplication. Christ spent 3 years with a very select group of 12 disciples whom he knew he would have to count on to carry on the work after his death on the cross. Yes He was aware that this group and their future followers would be equipped with the Holy Spirit to help them on their journey but his presence in the flesh provided an unprecedented level of mentorship that the world will never witness again. Now I am not implying that we (this is written chiefly to westerners involved with inter-cultural health work) should view ourselves as the world’s answer to providing mentorship to those serving in developing nation settings. On the contrary I think we have just as much to learn from them as they from us. What is taught and learned varies. But I am saying that if we who are blessed with material resources are working with developing nation partners we should always do so with a mindset of doing what we can to multiply our efforts. Make every effort to work ourselves out of a job. Or work so that at some point in the future (not too distant) our services/assistance is no longer necessary. This will require strategies of multiplication. Some ideas include:

  • We need more laborers in the harvest field! How many Christian healthcare providers are there who have felt a calling to do healthcare missions activities in international locations that are very difficult and challenging? It is likely there are MANY. Been there, done that. This article is one that helped change my life: http://www.worldmag.com/1999/06/not_to_be_served/page1If many are called but few go then our efforts at multiplication will fall short. (2X2 equals a lot less than 20X20) 
  • Encourage the creation of Christian health professional groups.
  • Multiplicative training – encouraging indigenous Christian health professionals to be engaged in missions themselves.
  • Give a man a fish -> Teach a man to fish -> Enable/Encourage a man to teach others to fish – a major challenge in the work of multiplication is that knowledge is power and as such it is shared with others sparingly. Yes, even in the church. As we help educate/equip our global partners to be more effective in their own efforts at health related kingdom initiatives we must do all we can to assure that this knowledge is shared just as freely with those they work with and serve.

No doubt many of you have other ideas about how to multiply our efforts so please add them to this discussion. Shalom, mike and the Health for All Nations team. 

 

Greetings once again from the ZealWithKnowledge blog at the Health for All Nations. With this installment we address the issue of using strategies that identify the type of situation we will be encountering when working in another culture. In their best seller “When Helping Hurts,” Corbett and Fikkert rightfully highlight the importance of knowing what type of situation we are working within. Is it a relief effort, (post tsunami Indonesia or post-earthquake Haiti for example) a recovery effort (they actually use the term rehabilitation) or a development situation? This is important for several reasons. It will change the type of team member we ask to participate (an ER doc is going to be more useful than a radiologist) and there will be a difference in the type of meds we arrange to be made available. But the most important factor may be our strategy for how we do things. In a relief effort we are doing all we can to save as many as we can and we will likely find ourselves in positions of leadership that are more in line with just getting done what needs to get done. Whereas in a development situation our approach will be entirely different. So our Statement 8 reads:

We will differentiate between relief, recovery and development efforts

  • Disaster relief
    • Short-term
      • Providing free or minimal cost care
      • Caring for emergent medical needs
      • Those who are most capable of saving the most lives are in positions of leadership with the approval of local authorities.
  • Recovery phase:
    • Medium term
      • Begin shifting focus of leadership toward local trusted individuals/entities
      • ID those who were previously doing sustainable (or at least moving toward) development work and review with them there strategies. Give feedback and input when asked.
      • Assist those with no long term strategy for sustainability to ID means by which they can move in that direction.
      • Assess healthcare infrastructure (assets) and fill in the gaps where local means are not sufficient.
  • Development
    • Long-term
      • Building healthcare capacity
      • Education
      • Assist in implementing strategies likely to lead to self-sustainability – Encouraging Primary Care, maternal/child care and Community Health.

This is obviously not an exhaustive list of activities at each level but you get the picture. I think we are very good at the relief level and probably with the recovery phase, however when it comes to the more long term development phase we have a lot of trouble. This is where issues related to culture come into effect and we have not too well over the years along these lines. Western culture is more interested in short term results and giving glowing reports about #’s of people treated and lives saved. But when it comes to reports related to achievements in the long term we are much less patient. If done right long term reports on transformation will have much more to do with what our local partner is accomplishing for their own community rather than what we as outsiders are doing for them. As always we welcome feedback. Mike and the Health for All Nations team.

  • We will promote using STMM’s to support long term, locally administered and sustainable health related missions

    • We seek long-term relationships, not medical missions tourism.

    • We will be health educators whenever and wherever we can.

    • We will encourage and support community health evangelism/education

Here we would do well to begin our thinking based on the approach promoted in “When Helping Hurts.” Are we going to serve in a relief, recovery or development setting? One aspect of relieving physical suffering that we have gotten very good at is dealing with natural disasters where a short term “relief” approach is most effective. We are also pretty good at recovery efforts but what we struggle with is finding out how we are most useful in the development phase. It is similar, I would say, to the Churches efforts at spreading the good news and announcing the kingdom. We are great at evangelistic campaigns that look good on the surface (lots of folks raise their hands to indicate a desire to follow Christ) but which produce no long term change in the lives of the people not their culture. So long term health development efforts are similar to (and one could argue are the same) what should be happening in places where new churches have been planted. This is the long and arduous process of being in relation with new believers and carefully shepherding/discipling them into maturity in Christ. 

We feel strongly, as do others (MEI at CMDA for example), that building into our STMM’s a component of health education is important. How one interprets “health” will surely have a lot to do with what is taught. Our feeling is that health as a biblical concept has more to do with right relationships than with physical well-being. And a healthy community may have more to do with a healthy local church rather than a good healthcare system. In any case we believe it is useful to conform our educational efforts to the wishes of the local healthcare providers. Find out what it is they wish to learn about and build your teachings on this framework. This requires having a long term partner in that community who can network with the local churches and healthcare workers to ask what they feel they would benefit most from learning. 

An excellent base on which to build is the Community Health Evangelism (CHE) program. It is a proven approach for using biblical health teachings to evangelize people be it in rural or urban settings. This is something we can encourage our local partners to learn and use in their communities. At the next level we can prepare programs that help address the most crucial needs in an individual community or region. Again it is the local partner through interactions with local healthcare providers who will be able to guide you in preparing the most useful health education program to carry out during your STMM. A lot can be taught even in a short one week trip. 

And finally a word about sustainability. This was a key component of the original description of Primary Health Care as expressed in the Alma Ata declaration. We absolutely must promote healthcare initiatives that are sustainable after we leave. This again is something that requires a strong local partner with whom we have a trusting relationship. One indicator of a true partnership of equals is if our local partner feels comfortable telling us an idea we have is dumb and won’t work! If you get to this point you are further along than most. But our partner will provide the kind of input we need to develop health and healthcare projects that are sustainable over the long term. 

   

Statement 6: No Double Standards. Today we want to affirm that when doing healthcare in an international setting it is essential not to compromise our standards. We should not accept any hint of a double standard in the work we do. What do we mean? 

    • Give medications in a health-care setting: (Promote preventive practices, attitudes and behavior before or at the time of giving medications) (one could argue that a church is a health-care setting or should be)

    • In-country local primary health care provider who knows the patient and the culture should prescribe the medications.

    • No experimental medications

    • No expired medications. I think we can all agree on this one. But when it comes to not yet expired medications there is some flexibility. For example there is the 

    • WHO GUIDELINE FOR DRUG DONATION:

After arrival in the recipient country all donated drugs should have a remaining shelf-life of at least one year.

Most are aware of the severe shortage of medications that most clinic’s/hospital’s in developing nations experience on a nearly day to day basis. Medications that are brought legally into another country will likely be used up very quickly and we believe flexibility in this WHO standard is appropriate so long as it is assured that the leftover medications are left with a licensed professional who is able to monitor the use and distribution of the medications.

 

  • Safe distribution of medications

    • Child-safe

    • Labeled

    • WHO essential medications

  • Purchase medications in country – this is obviously a hot button topic since so many are now using medications received from foundations and individuals who really want to do good for those suffering from a lack of access to affordable medications. But by bypassing the local system we allow for the perpetuation of a local system that is not meeting the need. Also by buying in country we can help stimulate the local economy. Local purchases would of course need to be made with reputable sources and assurances as to the quality would need to be made.

  • We support the Core Principles of the WHO guidelines on donated drugs:

    1. Maximum benefit to the recipient
    2. Respect for wishes and authority of the recipient
    3. No double standards in quality
    4. Effective communication between donor and recipient
  • No drugs should be donated that have been issued to patients and then returned to a pharmacy or elsewhere, or were given to health professionals as free samples.
  • Sit side by side with the local physician who is prescribing medications.

  • Make sure to obtain an adequate history with medication allergies, a good examination and any laboratory or imaging studies as needed

  • Give important information about the medication to the patient

    • Labeled in the local language – medication, dose, and prescription.

    • What the medication does and what to do if the medication does not work.

    • Discuss adverse effects of medications

    • Site for follow-up

    • Risks associated with overdose

  • We will obtain informed consent for any anything that we do for people including prescribed medications.
  • We will keep accurate and accessible medical records and make arrangements for their long-term local maintenance.
  • We will correctly utilize interpreters so that the people understand health information and what we are doing on their behalf and what they can do to stay healthy.

Statement 4 may be the most difficult aspect of cross-cultural healthcare ministry to get right. I have found in my 11 years serving in Guatemala that the clash of cultures is a major factor in failed “partnerships” since few take the time to carefully craft and care for their long term partnership/relationship with majority world hosts. And this despite the fact that is an abundance of reading available on how to really do Christian networking and partnership right. See the resources page @ the Health for All Nations. Also check out this document from the Best Practices site:

Here then is statement #4 regarding best practices in global health missions:

We will nurture relationships without fostering dependency.

  • People don’t care how much we know until they know how much we care!
  • We will share knowledge with the in-country health professions with whom we work in those areas where they have requested learning opportunities. And we likewise will seek to receive knowledge from them. (Capacity Building)
  • We will honor our hosts by using safe and effective local equipment and procedures whenever we can. (Appropriate Technology)
  • Point to the Biblical God and historical Jesus first, not our materialistic life-styles, Western model of medicine, United States, etc
  • No junk for Jesus

There is perhaps no more important statement in this entire series. It is rare indeed to find a team of healthcare professionals from a Western nation that truly understands how to create a unique and biblical culture within their partnership such that the leaders from the majority world side of the partnership feel as equals and that their opinions and ideas are given highest priority. This is not easy work and can be frustrating for both partners in the relationship. This is why it is critical to also put much emphasis on statement #3. There must be a dedicated champion on each side of the relationship is thoroughly trained in cross-cultural work and who is an excellent communicator. Can you think of other points that could be added to this list?? 

The third installment in our series of 12, today centers on advanced planning.

We will engage in advanced planning for a short-term medical mission trips

  • Determine what people want done
  • Identify Assets
  • Identify Needs
  • Engage six groups
    • People
    • Partner
    • Churches
    • Local Health Professionals
    • Government
    • Other Christian groups and para-church organizations

There are certainly several points for discussion in this list. Of course well developed partnerships are the foundation for doing advanced planning. It is only through mutual partnerships that we can agree on a common End for which we are working together with preference being given to the locally identified Ends and not the Ends the visiting team members want to see themselves accomplish FOR their local partner. This is a point that cannot be emphasized enough. I have recently been reading “The Power of Positive Deviance” by Pascale and Sternin (Jerry and Monique) and find it a fascinating read. Their work clearly demonstrates how long term change in poor communities happens most effectively. It is through people becoming aware of others in their own community who are more than simply surviving the daily rigors of living in a resource poor community and who are actually doing rather well in spite of the difficult conditions. But the key then is that they can either accept the methods of these positive deviants or reject them. But the decision is theirs. Our (folks from resource rich countries) approach has always been to come to communities with what we believe are the solutions to their health problems and all they need do is accept our methods and treatments and all will be well. So for advanced planning (and there is nothing unbiblical about planning) we must be involved in deep and true partnerships in which all are equal partners and where we pursuing mutually decided upon Ends giving preference to local ideas and methods.

There are many other points to be made with Statement #3 and we would love to hear them and get a good discussion going online. mike

Sorry for the delay in postings. Our family is preparing to transition back to the US after 11 years of service in Guatemala. I also teach an online PHC class at Hope International U as part of their ID degree so I’ve gotten behind a few things.

Several of us from the Health for All Nations just attended and some spoke at the recent Best Practices in Global Health Missions conference in San Antonio. This was coordinated by Greg and Candi Seager and hosted by their church, Community Bible Church, or as it is better known, CBC. We had a wonderful time talking about many of things that get all of us fired up about health related missions. What I would like to do today, we may go back to the video series later, is begin posting the 12 points that Dr Yorgin so skillfully summarized in his best practices power point presentation in Tucson this past January. The first (lets just call them best practices principles) is:

›We embrace the 7 Standards as outlined by the Standards of Excellence in Short term missions.
1.God-Centeredness
2.Empowering Partnerships
3.Mutual Design
4.Comprehensive Administration
5.Qualified Leadership
6.Appropriate Training
7.Thorough Follow-Up
You can check these out in greater detail @: http://www.soe.org/explore/the-7-standards/
Are we all in agreement that these standards should be at the heart of our health related missions efforts? Please spread the word about this blog and the Health for All Nations.

Let’s renew our journey with our friends from AIM and the third video in the 360Vision series. Here our attention takes a bit of a turn toward what is actually a couple of topics of importance. There is a bit of mis-translation in the video. Around :48 seconds in they are interviewing Dr Iris Tejeda about the situation regarding the employment status of newly graduated medical students. They ask why so many are unemployed and she states because there is no money (the government doesn’t have enough funding to pay them) while the subtitles say because there are no openings. Which is obviously not the case. 

How appropriate then is it that short term medical teams come to a location such as the one in this video series and PROVIDE medical services when there is a 50% unemployment rate among recent medical school graduates? Rather than traveling to a country like Honduras and spending $50,000 to do so for a week, wouldn’t it make more sense that any such groups should have long term relationships built up with, first and foremost, the local healthcare system in the towns and villages where they will be serving? And at the same time long term relationships with the in-country professional schools that are educating the future healthcare providers in the host country? Wouldn’t it make sense that we should make every effort to coordinate our short term visits with all such entities? And that would include the ministry of health and any licensing entity that exists. Is this going to be challenging and difficult and probably not just a little frustrating? Yes of course. But is it not the approach that is going to give the kind of depth of knowledge we need to made long term lasting change for the health of the people we seek to serve? What do you all think?

There are other points to be made but I’d love to see some discussion about what I’ve written above. Can we justify bringing in STMM’s and taking away potential work and income from the 50% of local doctors that are out of work? How should it be done if we are thinking of matching our zeal with the knowledge of how to STMM’s with excellence and with a truly long term impact?