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. 

   

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.

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? 

[youtube]http://www.youtube.com/watch?v=OO2Bp0LODrk[/youtube]

Here is the first of a six part series entitled “Evangelical Tourism” on youtube, produced by a now defunct company in Canada. Kurt Ver Beek, featured in the series, has granted permission for its use. It raises a plethora of questions and concerns regarding the use of short term teams for what many call “missions” endeavors. The group featured in this video is similar to ones I have encountered many times in Guatemala, where I have served on a full time basis since 2001. I have been a part of these types of groups in the past and when I watched this video the first time it made me cringe when I recalled what I had done as a representative of the Church on this earth. The first clip is not long but will serve to set the stage for a multi-layered discussion about many aspects of short term teams especially as it applies to those doing medical/dental outreaches. 

I am going to skip a discussion about the first thing that comes to my mind regarding these endeavors and which has to do with the question of “What is a missionary?” I would only state my opinion which is that one who goes to DO something for someone else you perceive as suffering and in need of relief is not being a missionary. It would be more appropriate to consider this a volunteer service project or something of like. 

That being said I would like to point out a real red flag that popped up right from the beginning. Hear is what the  team director said; “Most of these people are suffering and our hope is that we can offer some relief and relief that doesn’t cost anything.” 

Bryant Meyers, in his book “Walking With the Poor,” states “The world tends to view the poor as a group that is helpless, thus we give ourselves permission to play god in the lives of the poor. The poor become nameless, and this invites us to treat them as objects or our compassion, as a thing to which we can do what WE believe is best…… Whenever we reduce poor people from names to abstractions we add to their poverty and impoverish them ourselves. ” (page 57-58)

I don’t believe this team leader, nor the members on her team ever considered the possibility that they were viewing the Hondurans they went to serve as abstractions and that they were playing god in these peoples lives. And therein lies one of the most troubling aspects of short term service teams. (I can’t bring myself to call them missions teams and so will use something more appropriate) The vast majority of individuals who involve themselves (because God told them to do go of course) do so with a minimal understanding of what they are getting themselves into. Not knowing about poverty and its root causes is is a major roadblock to effective short term service teams. But the deeper concern is that those who go really cannot even answer the question posed by Meyers in WWTP; “Who are You? ….. we must begin where we are, ourselves. “Know thyself” is a useful reminder for any development worker. (in fact anyone involved in cross-cultural work) We must start with ourselves and a critical and honest assessment of who we are, what truly is the worldview we function from and how might we need to change it so that it conforms more closely with a genuinely Christian worldview. Every encounter we have in a different culture has an impact in that culture. Is that impact going to reflect a well informed worldview that demonstrates an understanding of the complexities of working cross-culturally by building long term relationships and not treating those you serve as abstractions or will those who are being served going to come away having experienced a worldview that is common to the Western mind. One that is rooted in a shallow understanding of poverty and why people are suffering in the world. One that is content with getting in and getting out quickly because it keeps us in our comfort zone? 

Next time we can begin to address the statement “and relief that doesn’t cost anything.”