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. 

   

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

With this posting I come to the third in the series delving into the vision360 video series entitled “Evangelical Tourism.” Again this week we don’t need to listen very long to find another important topic to address relating to the challenges faced in being zealous to do good but not having sufficient knowledge about how to do good without causing harm.

In the opening statement made by the team leader she explains how the team will be breaking up into various smaller groups and that one of the groups will be “building two homes FOR families.” Unfortunately we don’t know more about the details of how this gets done in this particular case but in my experience this often means that the team has folks volunteering to be involved in construction projects but who may have little if any experience doing this type of work. You can just imagine if someone were building a home in the US and a group was visiting from Guatemala and wanted to help with the construction. What would you, as the eventual homeowner, want them to be doing? If one of the visitors stated he/she had experience in construction you would still want an expert you trust to assess this individuals abilities before giving them the responsibility of working on your roof for instance. So why should it be any different in this case? If we are going to send our son’s and daughters (and in this case also a mom who was spending her first time away from her 18 month old baby) to work cross-culturally shouldn’t they be asked to be involved in something they are gifted and trained to do within the context of what the locals identify is a need they cannot fill themselves? Doing FOR the people something they can do for themselves only creates unhealthy dependency. (see Fikkert’s “When Helping Hurts” and Glenn Schwartz’s work “When Charity Destroys Dignity.”) But it sure makes us feel good. 

These same principles apply to health related missions activities as well. This group does have included in their agenda a time for doing a dental clinic. I’m not sure if they also plan on doing medically related work as well but many such teams do. If in country partnerships have been well developed then there should exist the knowledge, having been imparted to the visiting team by the local partner, as to what health related activities are most needed in the communities to be visited. What cannot be provided locally by local health care providers? And if there are significant deficits in healthcare provision why is that the case and what can the visiting team do to correct those deficiencies? The knowledge gained can then be used to implement the most useful strategy to bring about the changes necessary in country so that local capacity is developed and eventually the team no longer is needed to provide services that the locals should be providing for their own people. This will contribute to a much greater chance for sustainability in any project engaged in between resource rich groups and those who are not yet resource rich.