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HEALTH MISSION TODAY: A Closer Look

FOUNTAIN, DANIEL E.

doi: 10.1097/01.CNJ.0000262271.57216.40
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Daniel E. Fountain, MD, MPH, is director of the global health training program at King College, Bristol, Tennessee. He and his nurse wife, Miriam, served as medical missionaries in the Democratic Republic of the Congo from 1961 until 1996 with the American Baptist of International Ministries in partnership with the Baptist community of Western Congo.

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Medical mission has a long and impressive history. During the past two centuries, Christian missionaries brought the first modern health care into many parts of the world, making it available to multitudes. Following the example of Jesus Christ, the missionaries provided care for the poor and the underserved. Their efforts cured millions of sick people and drew great numbers into the kingdom of God. They educated thousands of nurses and other health care workers in mission facilities. These medical missionary programs often served as models for government and other indigenous health services.

Much has changed in the last fifty years. In most countries, government health services have expanded rapidly, often better funded and equipped than most mission medical services. Governments established medical and nursing schools and began placing restrictions on missionary services and training programs. Mission health services faced escalating costs. At the same time growing churches in many areas began assuming responsibility for health care programs. Some countries expelled all foreign missionaries, forcing national control of health care facilities. North American and European Christians began to proclaim that the era of medical mission had ended.

Has the era of medical mission indeed ended? The answer is both yes and no. The old paradigm of medical mission is over. On the other hand, the challenges, opportunities and responsibilities facing Christian health ministries continue to grow. Furthermore, Christ's mandate to heal the sick has not changed. Today, obedience to this mandate requires a new paradigm for ministry and global health needs.

In the old paradigm, Christian doctors and nurses from North America and Europe established medical services in nations without Western-style medical care. The missionaries established hospitals and clinics on mission compounds, managing the programs themselves. Missionaries trained nurses and paramedical staff in curative care. These paternalistic medical missions depended heavily on foreign resources. Evangelical missionaries often used medical care as bait to draw people to Christ, reflecting Western culture's unbiblical dichotomy between the physical and the spiritual.

The term medical missions should now give way to Christian intercultural health ministries. The emphasis must shift from medical to health. The term missions, which implies sending and receiving, must become intercultural health ministries, to describe partnerships among Christian health professionals of different nations, cultures and subcultures within countries. The new paradigm operates through mutual learning, sharing of ideas and resources and working together toward common goals.

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Christian intercultural health ministries promote health in individuals and communities and seek to restore health to those who are ill. They educate competent health care workers to serve holistically in their communities. As Christians prayerfully form partnerships across nations and cultures, they yield control to the Holy Spirit. This approach requires a new set of interconnecting objectives. Christians model Jesus' character and purposes through high-quality curative care, health education, community health, holistic primary health care and seeking innovative approaches to health problems.

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High Quality Curative Care

Any health ministry must care for sick people, the urgent felt-need of all peoples. Care should correspond to the real needs of the people and must be appropriate to both the cultural and economic contexts. Good quality, culturally appropriate curative care requires cooperative international partnerships among Christians, mutually sharing resources and depending on God to work through his people.

Jesus healed people because they were sick. He sought to restore them to physical, emotional and spiritual wholeness—and restore them to their community. However, Jesus also healed people as a sign of his own identity and as a sign that the power of God was at work in the world.

Jesus' healing ministry raises important questions for Christian health professionals. As sick people are cured, do the results demonstrate the power of God at work in the world or simply the beneficial effects of medical science? Is Jesus Christ evident in what we do? In other words, does Christian health care differ from the competent health care offered by those who are not Christian?

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Training Paramedical Health Personnel

The vast majority of the poor people in the world will never see a physician or professional nurse. However, well-trained paramedical personnel can adequately care for more than ninety percent of illness episodes and refer the others to professional health care providers. Paramedical workers should be educated in formal programs on both diploma and auxiliary levels. Such education multiplies knowledge and skills, assuring sustained health programs and providing an opportunity to make disciples of Christ. The apostle Paul set this example when he instructed Timothy, “What you have heard from me through many witnesses entrust to faithful people who will be able to teach others as well” (2 Tim 2:2).

Every health professional should be an educator. Three to five diploma-level health workers and ten to twenty auxiliary workers can then serve with each health care professional, extending community health into urban or remote areas.

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Community Health

In community health people promote their own health. Health care professionals work with the people, serving as catalysts through building relationships with community leaders. Although health professionals know about the technical aspects of health and diseases, they know less about the cultural dynamics of health and illness. Health professionals and community leaders can work together to establish practical health initiatives.

Health care professionals need to develop cross-cultural communication skills, as well as understand how to introduce new ideas to a culture. They need to know their own culture, the culture of the community and the biblical world view, which serves as a foundation for health and a common ground for discussing principles and practices. Fluency in the local language helps. Change on the deeper levels of culture occurs slowly and requires building solid relationships and patient, ongoing dialogue. Community health, therefore, is something health professionals do with people.

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Primary Health Care

Primary health care (PHC) involves doingfor people, including disease prevention, health monitoring and health maintenance. For example, PHC interventions might include prenatal and pre-school clinics, immunization programs, health education and family planning services.

Effective PHC programs include educating auxiliary and diploma-level personnel and making some cultural adaptations with the support of community leaders. Successful PHC programs require good organization and management, supervision and evaluation, and adequate funding.

Community health and primary health care complement one another, but they are not the same. Community health is not weighing and immunizing babies under the village mango tree. That is PHC. Community health is not a geographical term but rather a functional term. The community forms the base, and the people serve as principal actors. In PHC, the health service forms the base, and health care workers serve as the main actors. Primary health care seeks to prevent communicable diseases, whereas community health fosters sustained changes in health-related behavior.

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Caring for the Whole Person

The biomedical approach to health care separates physical care from psychological, social and spiritual care. Investing so heavily in technological physical care precludes caring for people as Jesus did. It does not reflect what the Bible, as well as scientific research, teaches about wholeness. Caring for the whole person requires a major paradigm shift from the biomedical compartmentalized view of human life to the biblical view of wholeness. Health professionals must learn new patterns of recording patient history, including asking about the patient's personal and social life, emotions, feelings, attitudes, faith and spiritual activities. We must also move away from the faith/science dichotomy, trying to squeeze the spiritual dimension of life into a psychological framework. Although psychology helps us understand emotions and behavior, only Jesus Christ can forgive sin, heal the spirit and provide the resources needed to heal the soul. We cannot discount that the Spirit of God and evil spiritual powers continue to actively intervene in the world today.

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Innovative Approaches

The explosive HIV epidemic continues to spread almost unchecked in spite of massive efforts in research, care and education. Educational efforts to deal with the root causes of risky behavior have in most cases failed. Compassionate care offers hope with spiritual, psychological and even physiological benefit, often resulting in remission of HIV disease even without specific anti-retroviral therapy.

Christian intercultural health ministries can help identify and control HIV, as well as other new infections and resurging infections such as tuberculosis and sexually transmitted diseases. Working in a close relationship with the community creates awareness of the social and cultural dynamics that spread such diseases. Furthermore, we are often able to teach health workers to diagnose, treat and control diseases. In some areas of the world, the network of radio and e-mail communications in Christian health agencies make us part of the early-warning system of an epidemic situation.

The world faces enormous, complex health needs with limited resources. Therefore, Christian health agencies and personnel must broadly and intentionally network with one another. Through increased international partnerships and cooperation, we learn from each other, strengthening all our ministries as we coordinate our approaches to global health needs.

As private sector agencies, Christian health ministries hold a great advantage. We have freedom to develop new approaches to health problems and new types of relationships with the community. Such innovations require research, evaluation, adequate communication with local leaders and a dependence upon God. Many Christian health programs have become models for secular programs, including government health services. Christian health programs and personnel can and do improve health and social conditions around the world.

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Looking to Jesus

In reviewing the challenges and opportunities for Christian health ministries, it becomes evident that Jesus himself was involved in all of the above. He compassionately cared for the whole person. He healed the sick, including those with infectious and sexually transmitted diseases. He multiplied his knowledge and skills through teaching others and partnered with all who were open to him. His immeasurable impact provided the foundation for health care today. We are the Body of Christ. Jesus continues his healing work in the world through us.

God has a plan for the health of the peoples of the world. Yet God works primarily through his people. We are his people. We can pray, therefore, along with the psalmist, “May God be gracious to us and bless us and make his face to shine upon us, that your way may be known upon earth, your saving [health] among all nations” (Ps 67:1–2).

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Who's Who?

The term paramedical personnel refers to formally-trained, polyvalent health personnel. In the Vanga Hospital in the Democratic Republic of Congo (formerly Zaire), the hospital trains paramedical personnel to staff outlying health centers. They diagnose and treat common diseases, do preventive care and much health promotion. Their role could be compared to that of a nurse practitioner or physician's assistant in North America. This decentralized approach to health care now exists throughout the Congo and is substantially improving the health of the people.

Diploma level education is a certificate offered for a formal course of study that may or may not be officially recognized by the government.

Auxiliary level personnel are the equivalent of hospital-trained nursing assistants.

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COMPASSION

BY KRISTENE DIGGINS

“[Jesus] had compassion for them” (Mt 9:36). I noticed myself pondering the word compassion as I sutured the wound on Edivaldo's hand. I, too, felt compassion for this man and desperately wanted to relieve his pain. Jesus must have felt compassion often in his ministry. He cared deeply about people's physical needs.

A subtle danger lurks in medical ministries—the potential to use medical, relief or development programs only as a vehicle to win souls to Christ. Humanitarian programs can become a mere means of enabling us to reach what we think is really important: souls. “Although the body is temporary, souls live forever.” There is coldness to this line of reasoning. It prevents us from loving flesh-and-bone people. It moves evangelism into a realm where physical suffering, as long as it is not our own, seems relatively unimportant.

Jesus did not heal people simply as a means to win souls. He hated the disease, deformity, suffering and death that sin brought into the world. So should we. Jesus healed and helped people because he loved them and had compassion for them. He wanted to relieve their suffering and pain.

Instead of viewing health ministries as a means to an end, the impact would be much different if we would view ministering to whole people as the end itself. Jesus will bring people to himself. We are called to love unconditionally all those he places in our path.

Copyright © 2004 InterVarsity Christian Fellowship