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.

 

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 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

[youtube http://www.youtube.com/watch?v=OO2Bp0LODrk&w=420&h=315]

This will be the last of my comments on the first video in this series. There are other themes we could discuss such as the comments made by the group from Buffalo New York who were at least willing to acknowledge that an ulterior motive for some of them in doing short term “missions” trips was to escape the cold during winter. This posting will address an especially important topic which manifests itself at the end of the video (@6:24 minutes). 

At this point in the interview with the team leader she is asked what her response would be to some in Honduras who would recommend to her that the team stay home and send money instead. The response is nothing if not astounding, reflecting a deep lack of knowledge on the part of the team as to the attitudes and thinking of those who live daily with the poverty the team is seemingly trying to address. After being asked how she would respond to this question the team leader states “Well I guess the truth of it is I haven’t thought about it a lot because I haven’t had any Honduran’s say that to me.”

One of the biggest challenges we face as outsiders who have zeal to do good for those who are living in poverty is finding where God is already working in that part of the world and then effectively plugging our zeal into the vision already given to the local Church. It is unfortunate in this video series we are not given the opportunity to hear from the Honduran believers that are working with this team. It would certainly have given us a more balanced insight into the workings of this team and how it is perceived by those the team does work with. But the comment I quote above would lead me to believe that the team has found someone in Honduras, likely a pastor in a local church, who they feel comfortable with and who welcomes the team and helps them do what they feel called to do during their brief stay. Most such contacts in underdeveloped countries function from a culture which is completely different when it comes to being frank and open about how they honestly view the work being done for their people. This could get into a lengthy discussion of Geert Hofstede‘s various cultural dimensions (Power distance, individualism vs collectivism, etc) but the reader can explore at a greater depth these important dimensions. Here I’ll just note that it is a huge challenge to find a local group of Christ followers who are willing to honestly tell a foreign group who wants to help their community, what they truly think about the work projects being contemplated.

It requires many long discussions over coffee or lunch or whatever method is most effective for building relationships of trust to come to a point where the local partner feels free enough to honestly express their opinions. I have worked in Central America for ten plus years and still find my local brothers and sisters in Christ find it difficult to say no to some crazy idea we gringo’s have come up with. We must constantly reinforce with them that we want to hear their honest opinions of how things are going in the work (which should be based on their own ideas of what is most needed and most effective) and to give us their opinions on how things might be done better. It is extremely difficult if not impossible to do this using the typical short term missions model employed by the majority of North American churches doing STM’s of all kinds. Doing this right requires the outsider to be an excellent listener, sensitive to cultural differences, patient and perseverant and willing to conform their efforts to the vision God has give to the local body of believers.