Abraham Kuyper was a Dutch theologian, politician, journalist and statesman who lived during the end of the 19th and beginning of the 20th century. He was Prime Minister of Netherlands from 1901 to 1905. Kuyper was famous for his understanding that there was no aspect (sphere) of society that was outside the calling of the Church in which it is not too have an interest or influence. One of his most famous quotes was “There is not a square inch in the whole domain of our human existence over which Christ, who is sovereign over all, does not cry, mine!

If we believe this to be the case (and we do here at ZWK – Health for All Nations) then all we do on this earth as it relates to helping people live healthy lives (lives of shalom) is under the sovereignty of Christ. This would include all the resources being used in His name to conduct ministries of health and wholeness. If that is the case then we should do all we can to assure that we are practicing excellence in the stewardship of such resources. In the Christian health services dept this would require of us the best use of the hospital and clinics we have built around the world and would include the best use of the personnel and materials that God provides. (this is of course only a small fraction of what we believe the global Church is called to DO when it comes to health services) But is this what we are actually doing with these resources?

I would have to say that WE DON’T KNOW. We can’t answer this question because we may not be asking the right questions. But with this post I would like to simply focus on calling on the global Church to think more deeply and plan more abundantly to conduct research that critically analyzes what we are doing in the name of “medical missions” around the world and to make those findings known.

I wrote a piece regarding an article by Brian Palmer back in OCT which was based on his article in Slate. Here is what he said in part:

“There are a few legitimate reasons to question the missionary model, starting with the troubling lack of data in missionary medicine. When I write about medical issues, I usually spend hours scouring PubMed, a research publications database from the National Institutes of Health, for data to support my story. You can’t do that with missionary work, because few organizations produce the kind of rigorous, peer-reviewed data that is required in the age of evidence-based medicine. A few years ago in the Lancet, Samuel Loewenberg wrote that there is “no way to calculate the number of missionaries currently operating in Tanzania,” the country he was reporting on. How can we know if they’re effective, or how to improve the health care systems they participate in, if we don’t even know how many missionary doctors there are?”

This quote of course raises all sorts of questions and concerns but a major point that I believe we can all agree on is that there is a mountain of work being done in very difficult places (some where MSF won’t go I suspect) but for which we have no “Best Practices” or journal articles being produced! One of the most exciting ministries we at Health for All Nations are privileged to have birthed is the Christian Journal for Global Health. Two editions have been published (it is free and open access) with the 3rd nearly ready. (upcoming edition on global conflict) We believe momentum is being built up and we look forward to playing our role in claiming this SQUARE INCH of society (researching the Christian Global Health Movement) for Christ. If you are involved in such work and would like to submit an article please do so or if you are linked to this kind of work globally please advocate with your church or missions agency to invest in research that will help us ALL learn how to more effectively use our resources so that Christ is proclaimed among ALL peoples.

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.

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.