by Jonathan Hallsted
Since I’m not a doctor I would never presume to tell one what to do as he/she practices the art we call medicine. I have, however been a patient. I’ve also been a missionary. Therefore, I’m qualified to have an educated opinion regarding how a doctor should approach the care of individuals, not on a technical level, but rather on a human level, both in their nation of origin and on the foreign field.
I spent six years in Romania working with a local ministry that is addressing the healthcare crisis in that nation. My experience working in that local medical ministry in Romania provided me with plenty of material for reflection. I’ve watched others try (and sometimes persist in) things that were very ineffective, and I’ve made numerous mistakes myself. Many of the principles I share below will apply equally well to non-medical missions work.
A Brief History of Medical Missions
Over the last two centuries medical missions has encompassed everything from traveling doctors and/or nurses with very basic tools, to full-scale mission hospitals equipped with the latest technology. Both approaches have historically demanded long-term commitments from those engaged in the work. In contrast, short-term medical missions teams have become increasingly popular over the last few decades. These teams often include some doctors, a handful of nurses, and a larger group of well-intentioned individuals who come along to serve. These teams typically “ lit a location for one to two weeks, and often choose their locations based on the presence of a crisis or a natural disaster. They frequently carry all their equipment with them, including western pharmaceuticals.
While both long-term and short-term approaches can take many various forms, they tend to share some common characteristics:
Sharing the gospel
Communicating the gospel is what puts the “mission” in medical missions. For short-term teams, this is often performed during the waiting process, while established medical missions typically rely on relational, reputational, and community impact to help spread the gospel.
A heavy reliance on Western staff
An unfortunate characteristic that has been historically common in both long and short-term medical missions is a heavy reliance on Western staff. Regardless of the model, Western missionary doctors have frequently provided a bulk of the care.
A low occurrence of sustainable practices
While we should rejoice that both approaches tend to view the gospel as central to the mission, we should be disappointed at the fact that many of the historical approaches have been unsustainable in nature. The training of nationals and the long-term nature of some missionary doctors can help mitigate this problem, yet it remains a concern, especially if we intend to continue using medicine as a ministry tool. We must find ways for the work to carry-on.
Because of the higher capital costs required to launch long-term medical facilities, many organizations have shifted their full attention to short-term medical missions. This “bang for the buck” perspective appears to point to this model as the option offering the most impact in the shortest amount of time with the smallest amount of financial input. Personally, I’m not convinced, and my observations on the field often point to contrasting conclusions.
A Biblical Case for Medical Missions
In the Old Testament
In the Old Testament, the Lord demands that His people be concerned with the needs of others; namely orphans, widows, and foreigners. Psalm 103 begins with praising the Lord for his benefits; included in the list are both the forgiveness of sins and the healing of diseases. There are also cases in the Old Testament when suffering and/or the relief thereof was the gateway to spiritual repentance both for individuals and entire communities. We see this in the healing of King Hezekiah (2 Kings 20), and in the other Psalms that allude to or describe the physical benefits of the healing from the Lord, both metaphorically and literally.
Throughout the Old Testament we see numerous cases of healing at the hands of the prophets (this link gives more details). Someone once referred to the book of Leviticus as “the healthcare manual of the Bible.” In that book God gives direction as to the treatment of certain diseases and instructions related to basic healthy living.
In the New Testament
In the New Testament, Jesus frequently used the physical to open the door to the spiritual. In Matthew 8, when Jesus heals a man with leprosy, and in the chapters that follow where Jesus heals numerous others, He sometimes addressed the spiritual need of the person after healing, and at other times He heals them and lets them go. Perhaps the most popular case of Jesus addressing both the physical and the spiritual needs is when Jesus healed the paralytic man. The Pharisees doubted his ability to forgive sin, yet it was the physical healing that closed the case on the issue, at least for those who believed.
Jesus’ healing work served as confirmation of his ministry. John the Baptist sent his disciples to ask Jesus an important question, “Are you the one who was to come, or should we expect someone else?” Jesus’ response is quite amazing:
Go back and report to John what you hear and see. The blind receive sight, the lame walk, those who have leprosy are cured, the deaf hear, the dead are raised, and the good news is preached to the poor.– Matthew 11:4-5
It’s true that the eternal work of salvation is the most important part of any medical ministry. However, many of us need to become more comfortable with Jesus’ model, which was relational in nature. Natural opportunities arise to address the spiritual needs in individuals, and other times when it’s best to bless them, and let them be. Jesus was often willing to let people marinate in what God had done for them, sending them away without any spiritual fanfare. James addresses this in his short, power-packed letter, stating (in no uncertain terms) that any attempt to “bless” someone spiritually while failing to meet a clear physical need that the individual has serves as the very foundation for dead faith. He calls for faith and action to hold tight hands in our ministry work and lives. Personally, I find this to be the most challenging aspect.
The selected examples above provide a clear precedent for meeting health needs as we seek to meet deeper, and often un-realized, spiritual needs. Questions remain, however, as to the methods and principles we should employ.
Short-term or Long-term Medical Missions – Where Should Our Emphasis Be?
I will not hide my bias; I’m strongly in favor of long-term medical mission approaches. By this, I’m referring to the practice of providing resources to empower indigenous medical providers in the foreign field to better meet the medical and the spiritual needs of their people. That might involve better training, mentoring, better equipment, or suitable facilities. In many cases it will involve all of the above.
Short-Term Medical Teams
There’s a place for short-term medical missions work. While I remain leery of it’s potential for long-term impact, I will point out some of the advantages and disadvantages.
The advantages of short-term teams
First, there’s the obvious benefit to those who serve on a short-term team. The eye-opening experiences one has can be life changing, often building a bond that lasts a lifetime. Most long-term missionary commitments made today began with a short-term visit somewhere.
Another potential advantage of short-term visits can be strategic training, when specialized medical personnel from the sending nation provide training for indigenous medical staff. The goal is to help improve their ability to meet some special specific local need; essentially it’s capacity building. By necessity, this approach prescribes smaller rather than larger, and specialized rather than generic teams and the emphasis is on education and training, rather than the actual treatment of patients by the visiting doctor(s). It’s a clear example of the give me a fish or teach me to fish concept. Training is never going to be as sexy as patient care, but it’s more effective and sustainable. It’s only unfortunate that this approach is not employed more often.
The disadvantages of short-term teams
A lack of time and relationship
The most significant constraint for short-term teams is time. Genuine needs are rarely addressed quickly. In addition, they often require the context of relationship and community. Both time and relationship are key ingredients for genuine medical and spiritual impact.
Physicians will admit (despite the rat-race many Western doctors find themselves in today) that time is a crucial factor in properly treating sickness. Time to listen to the patient, time to consider the problem, time to perform and evaluate tests, time to educate the patient, and time for follow up if necessary.
On the same token, pastors know that dealing with sicknesses of the heart require the same two ingredients: time and relationship. We’ve tried it the McSavior way and remain dissatisfied with the results, both at home and on the foreign field? Effective ministry takes time and relationship, and we’ve tried for too long to accomplish too much without these two key elements.
Sustainability is another issue we have to grapple with when we consider the effectiveness of short-term teams. Listed here are some questions that short-term teams often fail to answer, mainly because they are not even on their radar screen. Is it reasonable to expect care to continue under local providers after the short-term team has blitzed a community and left? Will care continue at the same level? Are the same tests and medications available locally after the team leaves? Have they prepared the local medical providers to properly follow up with the patients seen by the visiting team? What incentive do those in the local medical community have to follow up? What patient records have been created and who has control over them after the team leaves? These are difficult (and potentially discouraging) questions, but they must be asked if we are serious about the issue.
Some short-term medical teams work hand in hand with local doctors and nurses; many do not. Teams often arrive and call the shots while the local medical providers watch from the sidelines. Even worse, in many cases the local providers are never informed or even invited to participate.
This brings up another question, whether short-term teams bring honor to the local medical providers or not? Visiting teams (with all their bells and whistles) often make local medical experts look less competent. Will their local community view them as second rate after the super-hero doctors have gone home? Will patients still want to see their local doctors even if they don’t have the shiny tools, the laptops, the gas generator, the videos to watch in the waiting tent, and free medicine to give out? Short-term teams run the risk of making it harder for local doctors to carry on their long-term work by setting an expectation that’s far too high for them to live up to on an ongoing basis.
The high cost of short-term teams
Medical missions work requires money; that we know. The question is not “how can we do it cheaply?” but rather “how can we be effective and make the impact last?” Medical missions teams are the most cost-intensive type of short-term team, both in terms of getting people and equipment to the field, and in terms of lost income while away from work. In addition to this, the money spent on taking a team to the foreign mission field for a few weeks, could often help cover the cost of operations on the field for a local medical mission for a year or more. I’m not necessarily suggesting a “stay-and-give” model. That brings it’s own troubles, and money should never be the only criteria by which we judge usefulness, but if we are to be intentional about being good stewards, these are questions we ignore at our own peril.
With regard to short-term medical missions, I do find value in providers coming on mission in order to provide training and assistance. By helping local providers do what they do better, we’ll have a better shot at achieving long-term impact and sustainability, and in the process help elevate trust and respect between local medical providers and their local communities.Long-term Medical Missions
The mission hospital model of the past had many inherent problems. However, I’m not convinced that we should abandon the approach entirely.
Advantages of long-term medical missions
Potential for long-term impact
As discussed, medicine and ministry both require time and relationship. It’s foolish to assume that we can effectively meet these needs without investing in a long-term sustainable health presence.
The ability to address real needs
Short-term medical teams cannot provide the necessary on-going care for chronic issues. In contrast, the on-the-spot, temporary relief they provide may actually reduce symptoms while failing to address the real underlying medical issues. This can unintentionally inhibit local providers from discovering deeper health issues that require on-going patient contact. Only a long-term approach allows these needs to be addressed in an on-going fashion.
A greater chance for sustainability
The goals of short-term teams often include maximizing patient visits. The needs often seem overwhelming, and the crowds un-ending. They report about seeing 100’s of patients in the course of an 18-hour mission clinic day. Not only is that unsustainable, but it’s also antithetical to the nature of good care (remember, time + relationship). If healthcare is to be incorporated into our mandate to share the gospel we must ensure that we can sustain what we start. This requires thinking, planning, strategizing, and pacing ourselves so that we have the human capital and financial capital to ensure we will be there for the people down the road. This type of planning is more likely to occur when one is committed to a place for a long period of time, and much less likely to occur when one is a visitor. Planning for on-going medical care will result in more sustainable practices.
Increases the reputation of Christ’s people in the area
One of the goals of medical missions is to demonstrate practically that God cares for all of our needs. Like Jesus, we can open the door to one’s heart and possibly effect eternal change. Yet, this approach will not be effective if we do not provide quality care. I’m not speaking only in terms of technology, but also (perhaps mostly) in patient care and interaction. I’m referring to things like compassion, love, patience, dedication, the ability (and willingness) to listen, showing dignity, and patient education. Through these practical displays of character, the reputation of Christ is exalted through his people, in and among the community. We can try to convince ourselves that those qualities can be communicated during a one-week traveling clinic, but it’s just not practical. Those qualities are demonstrated over time, necessitating a long-term presence and approach to medical ministry.
Disadvantages of long-term medical missions
There are some inherent disadvantages to providing long-term, on-going, and/or facility based medical missions care, the first being the higher start up cost. Long-term approaches do require more upfront time and money, and some needs go unmet during the development process. Yes, some people will go without care, while steps are taken to ensure many more receive care into the future. We have to decide if that’s a price we are willing to pay for long-term effectiveness.
The need for sustainability
The need for sustainability is both a tremendous blessing and a challenge. That’s why I’ve placed it on the advantages and the disadvantages list. As with the cost issues, the downside is related to both time and resources. Good intentions alone won’t create lasting results. Planning, time, structure and strategy are required to make a sustainable impact on a local level. Sadly, for many this price is too high, and so they opt for shortcuts.
The potential for mission drift
All organizations are susceptible to mission drift. Applied specifically to medical missions, mission drift could be described as the gradual dominance of non-crucial issues related to operations and providing medical services over the central issues of people and ministry. In long-term missions it often takes the form of supporting a system and structure to the point that ministry takes a back seat. In short-term missions it often happens when the trips and the need to keep donors engaged becomes more important than being effective in kingdom work.
Medical missions must keep the mission before the medicine. Perhaps we should consider altering our vocabulary, and start using the term Missional Medicine to help drive the point deeper into our minds and hearts.
Practical Steps for Effectiveness in sharing the Gospel through Medical Service
This article is an overview, rather than a complete evaluation of the issues discussed. Be that as it may, it would not be complete without some practical recommendations. I will be brief, because my simple recommendations carry with them not-so-simple elements of implementation, each one warranting articles of their own. These will reminisce of both the advantages and disadvantages listed above, and are by no means intended to be an exhaustive list.
- Focus on long-term solutions and lasting impact, not temporary relief. Consider how your work will impact the people 25-50 years after your work is done.
- Rely on local medical staff, and not imported or expatriate staff.
- Have all operations be fully supported by the local economy, eliminating dependency on Western nations.
- When using western funding – do so only for capital expansion, not operational costs (as listed above).
- Do not always offer everything for free. Address genuine needs that the local healthcare market is demanding, needs that at least some people in the community are willing to pay for, thereby covering some of the ministry expenses through fee-for-services.
- Bear in mind that most cultures are more naturally minded than we are in the West. We might more efficient if we are willing to be open to natural solutions, rather than always depending on our technology heavy methods imported from the West. This approach might be more effective and costs less.
- Focus on training and education, empowering local providers to increase their capacity, instead of providing services directly as outsiders.
- Short-term teams should focus on education and specialization rather than general primary medical care, meeting only those needs that no local provider can.
- When and if a short-term team approach is employed, work with local providers in tandem to better ensure continuity of care, and to help boost trust levels between the local provider and the patient base.
- Don’t be rushed to find solutions. Time and relationship will often reveal them.
- When visiting a region for the very first time, consider providing no care. Rather learn, observe, and listen so that your work in the end will be more effective. It’s difficult to stop or change directions once you’ve begun. A team that comes with a pre-prepared package will find it hard to alter that even when they discover that the situation is not what they expected.
- Never forget the two most important elements in effective ministry and medicine: time and relationship.
Olsen, Viggo, and Jeanette W. Lockerbie. Daktar Diplomat in Bangladesh. Chicago: Moody, 1973.
Schwartz, Glenn J. When Charity Destroys Dignity: Overcoming Unhealthy Dependency in the Christian Movement : a Compendium. Lancaster, PA: World Mission Associates, 2007
Reese, Robert. Roots & Remedies of the Dependency Syndrome in World Missions. Pasadena, CA: William Carey Library, 2010
Jon Hallsted, along with his family, served as missionaries to Romania. He currently oversees HealthBridge Global, the Christian medical missions ministry that he founded upon his return home.