What did I learn about goals? Always include the goal to learn. Consider other goals as flexible, especially if this is a first trip. Be ready to rework your plans to fit what you find. Even missionaries who go yearly report they never return to exactly the same place they left.
No matter how reasonable your goals, you may spend days assessing where you fit in. If you find yourself in this position, watch, listen, and shadow others. Be ready to find and fill the gaps.
Remember your guest status. The local missionaries and staff at NCH were hospitable and encouraging. They organized our room and board, provided e-mail access, took us to local markets, and advised on safety and other practical matters. We had the opportunity to encourage them by bringing them hard-to-get items, celebrating with them, and recognizing their work.
How can you be a good guest? Ask in advance what personal gifts you might bring for the missionaries, such as (in our case) chocolate chips, chili mix, Kool-aid, or candied ginger. While on the field, ask about their day-to-day work and how you can help. Recognize their achievements. Take an interest in their interests. Listen.
Always remember that you are a guest on the mission field. Consider how you might feel if someone moved in next door for 2 weeks "to help" you with your work, particularly if that assistance involved using your car, computer, food, home, and time. This is the possible scenario created by short-term workers if we are oblivious to the ongoing work of resident missionaries and staff. While local missionaries may be gracious, our efforts could wreak havoc on theirs.
You also are a guest of the country that you visit. You are subject to local laws, customs, and dangers, so heed advice from those who live there. If told that women dress only in a particular way, conform. If they tell you not to go to town at night or not to wear jewelry, act accordingly. You have chosen to be part of a foreign and a mission culture. Honor both.
Be flexible. I found the proverb, "Blessed are the flexible for they shall not break," one of the first rules of missionary life. Significant differences between western and Nigerian perception of time and cultural norms tested our tensile strength. Heavy rains, power outages, and road disrepair created transportation and communication issues. Local workers were unfamiliar with donated, high-tech, equipment. Electricity was sporadic.
In addition to these daily adventures, locals asked us for anything and everything. I had come to NCH with the idea that I was there to improve local physical and spiritual health, but when I arrived I was asked for "bics" [pens], hand lotion, the scrubs I was wearing, information on how to come to America, money, photographs, and so on. The requests were pervasive and exhausting.
In this matter, Maranz's (2001) counsel was especially helpful. Work to see the constant requests not as obstacles, but as opportunities to develop Christian relationships with those you wish to serve. Many requests are actually indirect compliments. Friendly denial creates neither surprise nor offense among those asking. Maranz's suggestions—"appear to take the request seriously, fend off the request with a polite excuse as to why it will not be granted. And... [when possible joke about] it in a clever way" (p. 81)... gave me a culturally appropriate way to build relationships.
A request, especially for personal possessions, may be a compliment. Prepare in advance to give friendly, smiling responses such as, you "will give them your shirt when ‘it has a little brother’ [i.e., when you have another], ‘Not today,’ ‘If I give it to you, what will I have left?’" (Maranz, 2001, p. 81) or "This is not mine to give away" when true. I saw otherwise compassionate missionaries lose their tempers when they felt besieged by constant demands; the result was embarrassment and damaged relationships.
Recognize that time delays are not a sign of disrespect. Relax and move on. Observe what starts at the stated hour and what does not.
Learn. Deming's comment, "Learning is not compulsory... neither is survival," (as cited in Thinkexist.com, 1999–2006) could have been written about missionaries. Each thing I learned better prepared me for my next trip.
Through journal keeping, I recorded not only the facts of daily life on the field, but my met and unmet expectations, feelings, and reactions. I kept lists, and I tried to reflect daily. My son kept a journal, and as an artist he included numerous sketches.
My written narratives helped me explain NCH experiences to others. In rereading them I am reminded that Nigeria is a culture of personal relationships, so I should greet everyone, ask about their families, take small gifts, and be prepared to receive visitors in the evenings. I see that healthcare at NCH is reactive not proactive, as illustrated in not making the postoperative bed until the patient returns to the ward—perhaps because life there is more fragile. I find in my narratives that palliative surgery is effective in reducing cancer-related disfiguration, pain, and odor when curative therapies are a world away. I discover that healthcare at NCH is more like early 20th than early 21st century care—Nigerians more often die quickly from infectious diseases in their homes where the focus is comfort not cure. I note conversations from staff meetings that illustrate how Nigerian and western nurses often share similar concerns: schedules, pay, benefits, vacations, and education. I realize how happy and encouraging the Nigerian people are despite hardship.
My writing gave me the opportunity to learn from countless, less profound practicalities. The employee parking lot doesn't take much room—99% bicycles. A ceiling fan and breeze-capturing screened windows in the operating room keep the surgical team from sweating onto the sterile field (Figure 3). A cat in the supply room keeps the rats away. Never discontinue an intravenous infusion until the bag is empty because the patient paid for it and wants her money's worth. You can clean almost everything with almost nothing. Write your name on the pair of rubber gloves issued to you, and keep up with them; the next pair may have to come from the U.S. Bibles make great gifts at road blocks. An injection is thought more powerful than any pill. Nurses can keep the patient from falling out of bed if they move his mattress onto the floor. Take care to plug your gadgets into AC adapters with a surge protector and not the local DC outlet.
I planned time in my day to document my experiences. Practice discovery before, during, and after your trip. Begin a journal during preparation. Write (or draw) about why you are going, your actions to get ready, and what you find when you arrive in the field.
If you have computer access you might keep a blog or send e-mail reports to review later. Whether you choose to record experiences orally or in writing, remember that when you first experience something you will see it in a unique way that you may not notice the next time. Take lots of pictures, and write enough so you can later accurately label photos. Important details you thought you would never forget fade quickly, and the only memory may be what you recorded. Having a document to reread later affords time to digest experiences and weave them into a meaningful narrative. An example of the power of even brief notes to capture dramatic experiences is seen in Mancini's (2006) log of her Tsunami relief work.
When we returned home we were bursting with enthusiasm to involve others in the work of NCH and thereby extend mission work. "I wish I could find 200 doctors to bring over," commented my son. We looked for ways to continue our mission work by sharing our experiences.
Involve others. Involving others before we left made it easier to share after we returned. Prior to the trip, I asked church members for donations of Nigerian-requested, unused, prescription eye glasses and pocket calendars, and then I put a brightly wrapped collection box in my church's entry way. In 2 weeks, I received 100 pairs of glasses and almost as many calendars. Those donations have continued without my prompting!
During preparation, my acquaintances, colleagues, and friends asked how they could help. I was ready with a short wish list from resident missionaries: adhesive tape, children's chewable vitamins, Super Glue(r), bandages, sutures, or money I could use to purchase these items.
In Nigeria, I learned that local widows needed money annually to rent farmland and that the NCH mission had a distribution system in place. Funds were needed. The cost to help one widow for a year—the U.S. price of one extra large pizza. When I reported this to my church they began annually sending money for Nigerian widows.
I have had ongoing opportunities to recruit others for short-term missions. I've shared my experiences at mission conferences and served as a guest lecturer on global health issues in community health undergraduate nursing classes. Invariably students and others want to know how to go themselves.
After returning, I was invited to join the U.S. advisory and fund-raising board for NCH. Through that position I am better able to let others know about needs. Recently I set up an online Facebook.com group to discuss the work with interested health professions students from Christian colleges.
Let your enthusiasm show when you tell others about mission efforts. Your excitement—if not full knowledge—about the mission encourages others to participate. Have an informed answer when others ask how they can help, and remember that working with a church or nonprofit allows the opportunity for tax-deductible gifts and provides oversight of donations.
Say thank-you. After returning, I contacted every person and organization that donated to let them know specifically how their gifts helped. I shared first-hand stories about those whose lives were changed. My hope was that everyone involved would understand the value of their continuing efforts. I sent back copies of photos to the Nigerians who let me take and share photographs of them.
I cannot be the final judge of whether I accomplished much or little in Nigeria, but I take comfort in Jesus' words long ago: "She did what she could" (Mark 14:8). I remain confident that God uses both my successes and mistakes to achieve his purposes in the world.
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