by Sharon E. Mumper
Back on furlough and feeling pretty much recovered from his bout with Hepatitis B, missionary Phil Smith (not his real name) doubted it was really necessary to have his blood tested for human immunodeficiency virus (HIV)—the virus that causes AIDS.
Back on furlough and feeling pretty much recovered from his bout with Hepatitis B, missionary Phil Smith (not his real name) doubted it was really necessary to have his blood tested for human immunodeficiency virus (HIV)—the virus that causes AIDS. But his mission doctor reasoned that if he had contracted Hepatitis B through treatment with unsterilized dental equipment, as Phil conjectured, then he might have picked up the AIDS virus as well. The disease is epidemic in the African city where Phil and his wife are stationed.
Seated in the doctor’s office a few days later, Phil was informed he had tested positive for the AIDS virus. After the initial shock came the questions. Would he contract the disease? Could he go back to Africa? Whom should he tell? What would people think? Most importantly, had he been handed a death sentence?
MISSIONARIES WITH THE AIDS VIRUS
No one knows how many missionaries have sat in Phil’s place, asking their mission doctors the same questions. Mission agencies are understandably reluctant to release statistics on missionaries who have tested HIV-positive. At least six missionaries are registered with the Johns Hopkins School of Public Health as having tested positive for AIDS. It may be assumed there are more. No missionaries are known to have actually contracted the disease.
Phil’s mission agency was unprepared for his questions. In fact, they had some of their own. How do they handle Phil now? Should he be allowed to return to the field? Should they change his ministry there? Should mission field leaders be informed? What about co-workers on the field? How about church leaders with whom he would be staying on his furlough speaking tour? If they were not informed, but found out later, could there be allegations, and worse, lawsuits? If he insists (as he eventually did) that no one be informed, do they respect his wishes in the matter?
DEVELOPING AN AIDS POLICY
Today, Phil’s organization is one of a relatively small, but growing, number of mission agencies international Christian organizations that have established policies for AIDS prevention, education, testing and handling of HIV-infected staff.
Some mission agencies have developed their policies with the help of a manual, AIDS and the International Organization: Policy Development Guidelines for Organizations with Overseas Staff. Published by MAP International, the manual was produced by a conference on AIDS held in Wheaton in 1987.
Euphemistically titled, "Contemporary Issues in Medical Missions," the conference topic was kept secret because of American evangelical antipathy to even discussing the subject. Now, to some extent, American attitudes toward AIDS have changed. Missions, at least, are able to discuss freely the ramifications of AIDS both for mission goals and personnel policy.
Health educators like Richard Crespo are impressed by the rational and caring attitude displayed by mission agencies in their discussion of AIDS. Crespo, who is the director of Health and Training for MAP International, initially feared mission agencies would respond in a reactionary way to the epidemic and to those it afflicted.
"Instead, mission agencies are taking a pro-active stance," he says. "We are not necessarily known for that in Christian circles. But unlike my experience with local churches, I have not found a single reactionary response in a mission agency. The mission agencies are taking the lead here."
Most missionaries are at low risk for contracting AIDS. IN fact, the mission agencies most concerned about developing AIDS personnel policies are those with medical ministries. Medical personnel involved in surgery, obstetrics, renal dialysis, dentistry and laboratory technology are more likely to be exposed to the AIDS virus. These are the people, the medical missionaries say, who must count the cost of serving Christ in areas where the disease is prevalent.
Nevertheless, those who follow proper medical procedures are unlikely to become infected.
AIDS INFECTION CAN BE PREVENTED
Preventing infection is one of the goals of new AIDS policies developed by mission agencies. Policies developed by organizations with medical ministries include protection of personnel in the health care setting, especially in the treatment of HIV-infected patients. Mission agencies with hospitals must make decisions regarding patient confidentiality, education, appropriate medical procedures and allocation of limited resources.
Medical agencies in particular may need to educate a broad constituency, from their own board of directors and staff to the national churches and institutions through whom they minister on the field. Mission policies must address the values to be communicated, the content of the message, the media to be used, the groups to be educated, and the goals and objectives of education.
A few international organizations like World Vision have produced booklets for distribution to field offices. What World Vision Staff Need to Know About AIDS describes AIDS and how it is spread, and outlines steps staff can take to keep from becoming infected. The booklet describes the organization’s attitude toward AIDS and AIDS victims and defines its goals in respect to the disease.
The booklet was distributed to some 50 field offices, which were asked to appoint committees to educate staff and project volunteers. The field office is also to make sure staff members and their families have access to safe injections and a pure blood supply.
PURE BLOOD: THE DILEMMA
Insuring a pure blood supply is a difficult task. One much-discussed option in areas where HIV blood testing is unavailable is the "walking blood bank," a pool of healthy blood donors who could be counted on to give blood in emergencies.
The concept is not without dangers. "Just because a person is a missionary doesn’t mean they don’t’ have the virus," warns Rufino L. Macagba, Jr., manager of World Vision’s International Health Program. "It is a delicate issue, because people would have to be tested regularly in order to ensure a pure blood supply."
The walking blood bank also presents a moral dilemma. Some mission leaders question the advisability of excluding national workers or local Christians from the program. Yet, as the number of people in the group expands, the danger of infiltration by the AIDS virus increases.
Some mission agencies now require missionaries who undergo elective surgery or who give birth to go to a hospital in a country where HIV blood testing is available. Others evacuate expatriate staff to the home country for major surgery or complex treatment.
Medical experts recommend that those who travel in AIDS-infested regions take kits with sterile disposable needles and syringes for use in case of medical emergency, to avoid treatment with syringes that may not have been properly sterilized. They suggest heavy-duty rubber gloves be included for use in assisting accident victims who suffer cuts. Some mission agencies now provide such kits to international staff who travel extensively.
Because of the high rate of injury in the frequent auto accidents in the developing world, doctors recommend the use of seat belts. In the event of injury, they counsel against accepting untested blood even if as little as only one unit is needed.
THE KNOTTY PERSONNEL ISSUES
Personnel considerations form the heart of mission policies. Agencies must struggle with the issues of mandatory HIV testing, confidentiality, protection and education of missionaries and national staff, and handling HIV-infected staff.
On a practical level, they must consult their health insurance providers to make sure coverage is adequate. Mission leaders should monitor the prevalence of HIV infection in geographical areas of their ministry and reevaluate precautionary measures when it seems appropriate.
They need to keep abreast of changing visa and residency restrictions in countries frightened by the threat of AIDS or angry abut negative publicity. An increasing number of countries require blood tests for residence permits. Some, especially Middle Eastern countries, require tests for travelers staying even only a few days. Many countries require the immediate deportation of anyone found to carry the AIDS virus.
But the knottiest issues with which missions must contend relate to the rights and responsibilities of infected staff.
Initially, those putting together policy guidelines for mission agencies anticipated strong reaction to the issue of mandatory testing of missionaries. Mission agencies that have established mandatory testing policies, however, have not seen the kind of reaction this stirs in the non-missions world.
Crespo believes this is because the missions community has a greater sense of moral commitment to its members, and because missionaries have less to hide than those who fear testing in the general US population.
Generally, agencies that require mandatory testing do so only for people in higher-risk medical occupations. Most agencies with such policies provide for a base-line test of such personnel and then periodic retest, varying from annually to every time missionaries return home on furlough.
An important issue for those who provide testing of medical missionary personnel is whether to test national staff as well. This policy may have far-reaching implications for the relationship of the mission agency with not only its medical staff and the national church, but even local governments.
WHO NEEDS TO KNOW?
One of the more sensitive personnel issues is confidentiality. Mission agencies developing AIDS policies must balance the individual’s right of privacy with the mission’s responsibility to protect its members and society at large. The key question is who really needs to know?
Everyone agrees the spouses of the HIV-infected missionary should be informed. Individual mission agencies must decide for themselves who else needs to know. This may or may not include the infected person’s field director, co-workers, the mission medical director, the mission executive officer, and local healthy authorities if required by law.
Before some agencies test missionaries they require them to sign a statement agreeing to a list of individuals who will be informed in the event of a confirmed positive HIV test.
Most misunderstandings can be prevented by proper orientation, especially in the missionary candidate stage. Some agencies are providing AIDS education and mission policy orientation, both for current missionaries and candidates, says Crespo.
Missionaries should be informed as to the extent of the danger of HIV infection in the area in which they will serve. They need to know how to prevent infection, and what to do if they become infected. They must understand mission policy regarding AIDS, and be willing to accept rules governing testing and privacy limitations.
WHEN THE TEST IS POSITIVE
Agencies should develop policies for providing aid to missionaries who test positive for the AIDS virus. This should include test repeats in order to determine the possibility of a false positive result.
The missionary should be informed by a sensitive, well-qualified staff member who can answer questions about the medical facts of AIDS and mission policy. Access to test results should be restricted in accordance with mission policy. Test results should never be p laced in easily-accessible files.
Agencies should provide both personal and family counseling to help the missionary cope with the stress of the discovery of infection and its probably outcome.
Crespo believes mission agencies tend to undervalue psychological counseling as a whole and to underestimate the need for such counseling for people who are HIV-infected.
"Where mission agencies have had missionaries infected, the need for psychological help has been greater than anticipated," he says. "Missionaries have done very well, and then had days of depression, then denial, then coping. It is an unending cycle."
Mission agencies have much to learn yet about dealing with HIV-infected personnel. To some extent a fearful secrecy, cloaked in the desire to protect the confidentiality of the victim, still surrounds the issue of missionary infection. Agencies may not yet be at the place where they can openly share data and coping methods or develop support systems for helping affected missionaries.
NOT WITHOUT RISK
What impact could publicity about missionary HIV infection have on recruitment of new missionaries? So far, mission agencies report fear of contracting AIDS is not a factor among young people with whom recruiters discuss career missions involvement. Although some short-term career missionaries have cancelled assignments in higher-risk areas, overall impact has been negligible.
Southern Baptist missionary physician David Sorely believes fear of AIDS could cause missionaries to retreat from personal evangelism into mass media in order to limit personal contact with potential AIDS carriers. So far, mission agencies with extensive works in the most affected areas report no negative impact on the kinds of ministries their missionaries will enter.
In spite of the AIDS threat, no one is suggesting missionaries withdraw from a sick and helpless population.
"This is a tremendous opportunity for mission agencies to minister to people in need," says Crespo. "Christians who are brave enough to reach out and touch these needy people with a word of hope and spiritual renewal are a powerful witness to Christ."
Undoubtedly, more missionaries will be found to be infected by the AIDS virus. Mission agencies, especially those with missionaries in high-risk occupations or in heavily-affected areas, can and should provide education and other preventative help, and in the case of HIV-infected missionaries, every possible resource.
The Great Commission has never been without risk. Perhaps now more than ever Christians may shine like a light in a dark world.
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