I. Possibility Thinking

The past of medical missions. although full of troubles, was yet triumphant. The present is turbulent as the broadening spectrum of health care ministries moves from the doing and teaching phases into the enabling phase. The future promises to be most rewarding--if we have the courage to invest in the right choices now. Mission leaders have become adept at strategic planning, the reactive mode of most organizations. But what level of energy and skill is directed at strategic thinking, the proactive process which dares to envision where the group should be in ten or fifteen years? For example, we have noted that hospital/clinic-based curative medical care, by itself, does little to improve the level of health in a community. Denis Burkitt points out that providing curative care alone is like trying to use a bucket and mop to dry the floor without turning off the faucet which is overfilling the sink. What changes would come about in your organization if, as a result of strategic thinking, you decided collectively that within ten years 70% of your health care resources (personnel and money) would be allocated to the area of Primary Health Care (PHC) and the remaining 30% to institutional-based curative service? How about another challenge in the area of strategic thinking? If your organization has a health care ministry in the Two-Thirds World, would it be possible to target a certain geographic area for basic health care services by the year 2000? Can you picture this target area in the year 2000 with nearly all preventable diseases eliminated and with the health care program sustained mainly by the people in the area? If this could be accomplished, missions and churches would be successfully promoting physical health among people as part of their natural concern for whole persons. If Christians could make a significant contribution toward the realization of this goal through the appropriate inputs of skill and commitment, we would serve as models for the world to follow. Currently, the World Health Organization is promoting the campaign "Health for All by the Year 2000." This campaign is falling behind schedule, however, due to delays in the implementation of national PHC plans. Christians may be able to play key roles which will enable such lofty goals to be met.

II. Getting to Where We Want to Be

The principle aim of missions is to make disciples for Christ and to encourage the formation of local churches. Churches are established primarily to enable Christians to worship God and secondly to live the Christian life in community. The Gospel message is targeted for individuals and families, but affects the entire society. This is as it should be. As Dr. Nyerere puts it: "If the Church is interested in man as an individual, it must express this by its interest in the society of which those individuals are members." (Julius Nyerere 1974:148)

A practical way in which both missions and the churches could be instrumental in meeting genuine needs in their communities would be to include basic health/hygiene concepts in the curriculum of every seminary, Bible school, TEE course, secondary school and primary school. Teachers, pastors, and their spouses are natural community leaders. By devoting even 5% of the education time to health matters, the students and spouses would be encouraged to become both role models and promoters of health in their families and communities. How long can we afford to keep church leaders ignorant of the concepts of basic health behavior which would allow them to minister more effectively among people saddled with preventable health problems?

Great improvements in the level of health could be made if every mission or church school included the following subjects in the curriculum: (1) clean water supply, (2) breast feeding, (3) balanced nutrition, (4) hand washing, (5) human waste disposal, (6) oral rehydration solutions, (7) birth control, and (8) immunizations. Do these simple health concepts appear inconsequential? Imagine a world where 3% of the children no longer die from measles. . .or where newborns do not have to suffer painful muscle spasms and often death due to neonatal tetanus. . .or where the average child attending school in the Two-Thirds World does not have to miss 30 to 40 days per school year due to repeated bouts with sickness. Picture a world where 40% of the children in the poorer countries are not malnourished anymore.. .or where instead of less than 20%, every family has access to safe drinking water.

A great deal of progress toward this kind of a world could be made within one generation if the people who read this monograph implement the suggestion to make basic health and hygiene a part of the curriculum in every school and at every level.

For the church and mission to be involved in ministry to the physical body as well as the spiritual condition of people is perfectly consistent with the example of the earthly ministry of Jesus Christ. The "abundant life" Jesus came to bring includes both spiritual and physical well-being for the individual, and certainly freedom from preventable illness.

To have an impact upon the wholeness of people in community, mission leaders and personnel need to learn much more about people, their culture, and their thought patterns. Don Richardson has studied many cultures and found that each has a key which God has prepared so that the people there are able to hear and understand the message of the Gospel. (Don Richardson 1981) Without taking the time to unravel the myriad of reinforcing reasons why people behave the way they do, it may be next to impossible to enable them to effect permanent change in their values, attitudes, beliefs, and ultimately their health behavior.

William Komfield, an experienced missionary anthropologist, has suggested the following five guidelines for missions involved in cross-cultural situations:
1. Be culturally sensitive to the value orientations of the area where you are residing.
2. Learn the cultural clues that will enable you to become not only bilingual but, even more importantly, bicultural.
3. Seek to build genuine friendships with non-Christians as well as Christian nationals, thus avoiding the missionary ghetto complex, which has heretofore been so devastating to effective communication.
4. Study the history and culture of the people where you are working, thereby learning to identify positively with what they value from their past as well as their present.

5. Avail yourself of the opportunity to receive some definite training in anthropology if you have not already done so. (William J. Komfield 1973:204)

In addition to skills in anthropology which help to understand people of another culture, missions need adult educators who can help us to communicate effectively with those people. Adult or non-formal educators can facilitate a level of learning which will motivate positive changes in behavior. Such skills should be developed among present mission personnel and new recruits alike.

How can missionaries acquire these skills? Here is a suggestion: "If you wish to develop highly effective rather than average persons, you should identify those whom you want others to be like, examine what they do and why they do it, and relate to them the persons to be trained." (David Komfield 1985) This idea should have particular relevance to mission executives as they assign new missionaries to the field.

Missionaries need to remember the principle of II Timothy 2:2, teaching reliable men who will in turn teach others. It is through training or investing in the lives of nationals that leadership in PHC programs should emerge. The challenge for us Westerners as we enter a 'new' culture is to recognize that the people themselves are the greatest resource in the community. Can we learn to resist doing things for people, but instead enable others to make good decisions about their own health and development?

Ill. Suggestions Concerning PHC

Those in mission leadership positions and all health care missionaries should have a thorough working knowledge of PHC principles and practices. A good place to start is by participating in a MAP International workshop which is held for one week every six months.

Every mission agency should have a written policy statement concerning its health care ministry. This should include purpose, guidelines, objectives, goals, the biblical basis for each, and the interrelationship of the health care ministry to other ministries of the church. The booklet, "New Directions and Opportunities for Christian Health Care Ministries," available at no cost through MAP International, would be an excellent starting point.

Each mission involved in health work should have a coordinator of health and/or physical ministries. This person should oversee the entire health care effort of the mission and ensure understanding and cooperation between all members of the team. Each missionary, whether a health care professional or not, should realize that he is part of the health team. Basic health concepts, and the ability to effectively share them, should be part of every missionary's repertoire of skills. (In advocating this concept, I realize that the historical relationship between "missionaries" and "doctors" described in Chapter 1 has come full circle. Instead of the doctor being sent out to do medicine but not mission work, or later the doctor being accepted as a valued member of the mission team, now each missionary needs to be considered a part of the health care team!)

The greatest stumbling block to the implementation of PHC in urban areas appears to be the existing medical establishment. In the cities, curative medicine has been most widely practiced and is highly organized. Also, in the cities the concept of "community" is weak, due to the high mobility of many urban dwellers and the decreased social cohesiveness of many urban family units. Hopefully, through dialogue, discussion, and experience, successful methods of establishing PHC programs in urban communities will emerge. Missionary physicians and the leaders of mission hospitals need to become active proponents of PHC.

We can utilize our existing status and reputation as Christian physicians to play an important advocacy role on behalf of the team approach to comprehensive health care, emphasizing the strategic but complementary roles played by hospitals/clinics and the various components of community-based health care programs. (Howard G. Searle 1982)

IV. Final Challenge

As the church and mission evaluate their roles in the world, it is well for them to remember that the early disciples were mandated to heal (Matthew 10:1) as well as to teach, preach, baptize and make disciples. (Matthew 28:18-20) Christian medical missions is part of the response to this mandate, and the future is full of opportunity.

I see the greatest challenge for the Church today in ministry lying in the field of health and wholeness and a ministry of caring for its own and those to whom it has opportunity to minister. Nowhere in society is there a foundation, a base, a philosophy, a theology so strong and so geared to develop around issues of health than in the Church. (Ronald Ropp 1984)

The church and mission have ministered to millions through medicine in the past. But many of our medical ministries are heavily slanted toward curative services, with concomitantly high budgets. In some instances, those very poor whom we intended to serve can no longer come for care. With the development of PHC principles, and the lessons learned from the initial PHC projects, comes the possibility of addressing the health problems of the Two-Thirds World in a workable, affordable and equitable manner. Not only can the basic health needs of the poor be met, but in a manner that promotes self-esteem, self-reliance and church growth.

The challenge of promoting health for all is far too vital to be left to doctors and nurses alone. Many people with a wide variety of skills need to become more active members of the mission health care team if we are to be successful. Many members of the team--but only one Head, the Lord Jesus Christ, who showed us how to touch people at their place of need and assist them in becoming whole.

May God enable each one of us to be enablers on his behalf to the peoples of the world.

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