by Daniel Fountain
Motivating people to change behavior is difficult. We hang tenaciously onto habits because they have deep roots in our cultural values and beliefs.
Motivating people to change behavior is difficult. We hang tenaciously onto habits because they have deep roots in our cultural values and beliefs.
Motivating behavior change is the primary goal of both discipleship and other forms of education, yet in spite of its importance and the training we have received, lasting changes seldom occur, especially in other cultures. Even in evangelism, millions of people come to faith in Christ, yet make few, if any, changes in their lifestyle. Some may continue to practice sorcery and others may even engage in genocide. It is likewise true in developmental education. Although many people accept a cognitive knowledge concerning health, agriculture or management, they continue to adhere to traditional practices.
Why are we so ineffective? It is largely because we do not address underlying beliefs and values that determine behavior, and thus we cannot help individuals reflect on the need to change. In this article I suggest a simple method—proven successful in the Congo—for helping people change health-related behavior.
In working with people on behavior change, be it social, moral or developmental, three stories are essential: (1) their story (what they have to tell us); (2) our story (what we want to tell them); and (3) God’s story (what they and we need to know).
These separate stories must intersect. To bring about changes in understanding and behavior, we must find links between the stories. This will result in the interchange of ideas and the transmission of knowledge, values and beliefs, leading to positive behavior change.
The starting point in this process is a careful study of the history, culture and behavior of the people with whom we are working. This prepares us for direct interaction on both a personal and a communal level. We begin by listening carefully to their story and then identifying certain aspects contained in it: (1) their strengths (what has worked or is working to benefit them); (2) their weaknesses (what is lacking in knowledge, understanding, skill or relationship); and (3) links (entry points for our story or God’s story which will help them reflect on their story).
WHY WE OFTEN FAIL
In the West, we make an unconscious assumption that we have the answers to the needs of those we are working with. In evangelism, it is the redemptive story of Jesus Christ. In discipleship, it is obedience to the laws and will of God as we understand them. In health, it is putting into practice the observed laws of hygiene, sanitation, nutrition and so forth. We assume behavior change or spiritual transformation will occur when we tell people either our story or God’s story. We proceed with one of the two without going through the essential process of intently listening to their story first. Often, we have failed to connect our story or God’s story with links or entry points into their story.
COMMUNITY HEALTH IN THE CONGO
Although what I recount here took place nearly forty years ago, the lessons I learned set the stage for catalyzing changes in health-related behavior that are used in many parts of Africa today.
During my first years as a medical missionary in the Democratic Republic of the Congo, I quickly became aware that disease prevention and health promotion were essential parts of my ministry. I joined with community and church leaders to discuss how to help individuals and communities improve their own health.
In October 1967, sixty community leaders gathered at one of our church centers. At the invitation of the head pastor, men and women came from a dozen villages around the area. I was there to teach them about intestinal parasites and the need for adequate latrines. We sat in a large circle and spent several hours in discussion.
Many described health problems they and their children experienced. Because I wanted to know what they believed to be the origin of these problems, I asked, “Where do these problems come from?” Their response was immediate: “You are the doctor. You tell us.”
I pursued the point: “Where do you think these problems come from?” The response was total silence. In no way were they going to tell me their belief system concerning the origin of illness. They feared I would either laugh at them or reject their beliefs. I had embarrassed them and had no idea how I was going to hear their story.
I prayed to God and tried again: “When a child in one of your villages becomes ill, what will the father and mother think about why the child is sick?” This indirect question allowed them to speak openly: “Doctor, some people in our villages believe the illness comes from the curse of an uncle.”
Now their story was beginning to come out. It took an hour to listen to the story of the curse, which included divination, reconciliation and healing. I was fascinated.
When they had outlined their story of etiology, diagnosis, treatment and prevention (charms, amulets, fetishes), I sat mystified. How could I explain latrines to people who believe illness comes from the curse of another person? Where was a link between their story and my scientific explanations?
THE FIRST LINK
I again prayed for guidance and the link came instantly. I thanked them for sharing their story and told them I was impressed by the wisdom of ancestors who had taught them that one person can make another person sick. I assured them my ancestors, with their scientific expertise, had discovered this same truth. They were astonished to hear a missionary affirming their belief system.
A person who relieves himself in the grass is leaving communicable parasite eggs or larva for someone else. The real enemy of health is not necessarily the uncle, but is whoever has no latrine or does not use one. My audience could now understand this part of my story. I had found the link because I had listened analytically to their story. When I asked how parasite transmission could be prevented, the reply was unanimous: latrines. In reality, they already knew about latrines because the Belgian colonial government had required them. However, the link between latrines and health had never been made.
I thought I was making progress until an elder suddenly said, “Latrines are for you white people but not for us. Our ancestors never had latrines.”
Two things concerned me about this statement: (1) he was fearful of doing something an ancestral spirit might disapprove of and (2) as far as this elder was concerned, latrines were an invention of white people. Africans had their system, and the authority of a white man was insufficient to make them change their time-honored system.
THE NEXT LINK: GOD’S STORY
A third time I prayed for wisdom. I then confronted them: “Who made your ancestors? God did. What did the God who made your ancestors say about latrines?”
Thinking I was joking, they burst into laughter. They were astonished when I read what God said about proper sanitation in Scripture. God said it is important because it protects us from our enemies (Deut. 23:12-14). A link from God’s story had been made. Because the Bible is regarded as God’s book in the Congo, this worked well. They saw that he was the ultimate authority for latrines.
However, we were still a long way from a satisfactory conclusion. Another elder arose and said, “Doctor, it’s no use doing anything about this. We’ve always had worms.” I agreed and asked him why. He replied that it was God’s will.
Fatalism is the fundamental obstacle to making changes in most cultures. Good and evil, life and death, health and disease—all come from God. We are simply victims of what God sends us. If that is so, why should we try to improve our lives? Who can fight God?
I had found a link between my scientific story and their story; however, there was no link between the scientific story and the belief in fatalism. This is why most of our health education programs fail to bring about change. Everything is God’s fault: malnutrition, poor soil and all manner of diseases. We are simply passive recipients.
I prayed over this and God reminded me that he had written a book which dealt with this issue—Genesis. Their problem had nothing to do with knowledge about physical causes or scientific principles. Their fundamental problem was theological—a distorted concept of God. This was the real problem. It was time for God’s story.
I told them we must go back to the beginning and see what God’s will is for our lives. Is it for health or illness, life or death?
We worked our way through the six days of creation found in the first chapter of Genesis. They accepted that everything God made was totally good. We discussed the Garden of Eden. Did Adam and Eve get sick in the garden? No! Did they die there? No!
I asked if there were any hookworms, roundworms or mosquitoes in the garden. An animated discussion ensued. Finally, I reminded them that the Bible does not really talk about hookworm or mosquitoes. It does make clear, however, that God’s primary plan for us is that we be healthy.
“Then why do we get sick?,” they asked. We turned to the third chapter of Genesis.
We went through the story of the Fall, addressing the consequences of disobedience, namely sickness and death. I could see the truth penetrating their minds. “You mean sickness is our fault?,” they asked.
“Yes,” I replied. “Actions have consequences. We choose disorder, and disease and death are the consequences. We cannot blame God. They are our responsibility.”
GOD’S STORY: OBEDIENCE TO HIS LAWS
“What can we do about it?,” they asked. We began to discuss how God insists we obey his commandments and laws. In Deuteronomy 28 we are told that actions have consequences. We obey God and we benefit from it; we disobey God and bad consequences result.
Because of our sin, nature and human life have been fundamentally marred. A return to perfect health is not possible in this world.
However, God has made it clear that obedience to the established order and laws favors life and health. We find these laws not only in the Bible, but in laws discovered by science. By using the scientific method, we discover what God has built into creation. Therefore, when we present laws of health, nutrition or agriculture (even though not explicitly stated in the Bible), we are presenting the laws God has built into life. By doing this, we base the authority of our teaching not on ourselves, but on God.
The results of this long discussion were gratifying. Community leaders agreed to teach the people and to make sure every house had an adequate latrine. I told them that when all the dwellings in a community had satisfactory latrines—and when the community had established a committee to supervise cleanliness, sanitation and development—we would have a worm cure for the entire population. This was done and the health of the people improved.
The program has now spread to hundreds of villages across the Congo. Behavior has changed because theology has changed. So also has their philosophy—from fatalism to responsible initiative.
This experience helped me understand that scientific ideas can be useful in dialoging with people of other cultures. I also learned the importance of appealing to God and his Word as the ultimate authority. This has guided our health education through the years and has helped bring about behavioral changes in agricultural and community development.
Traditional worldviews in oral cultures often have fatalism at their core. Likewise are the worldviews of Islam, Hinduism, Buddhism and even secular humanism. Human responsibility plays no determining role in the course of human events. God, fate or chance decides everything.
Why do we so often fail to bring about change in these cultures? The problem is with us. Westerners interpret health problems as physical ailments; others understand them as spiritual issues. The same is true for agriculture and water sanitation. We understand the rain cycle, the water table and the idea of contaminant-free water. They do not understand these matters, but they do know who has given them their water. Since God has given them this water, they reason, it must be good for them. We tell them our story by conveying scientific knowledge about living, eating, drinking and planting. None of this, however, links with their spiritually-based story. If we do not find the links, nothing in their worldview will change.
A few years ago I was discussing malnutrition with twenty community leaders in Niger—most of them African folk Muslims. They believed malnutrition came from Allah.
The community health team from a nearby missions hospital had been telling them about protein for years. However, they still did not understand proteins, essential amino acids or how to find adequate sources of complete protein. Their problem was not a lack of knowledge, but rather a misunderstanding of God. This is where we began the transformational process.
I explained to them that, as a physician, I had studied the body and had seen how Allah had designed it to grow. I went into detail about how organs function and how certain foods help the body grow strong and healthy. The following Sunday, one of the Christian men in that discussion preached a message on “What God wants you to feed your children.”
Our scientific knowledge is of great value and people need to benefit from it. Yet health is more than just a scientific matter; it is a spiritual issue as well. If we learn to base our scientific education on the authority of the creator God—and link their understanding of the world with God’s word—fruitful behavior change will most likely occur.
These principles also apply to evangelism, discipleship and church planting. Before we present the gospel or show the Jesus film, we must listen to the story of the people. We must discern their understanding of life, discover redemptive analogies and finding links that can serve as entry points for the good news of Jesus Christ. We must also understand the community so that churches can use biblically-appropriate structures from their culture rather than from ours.
Together we can come to the truth which is found in God’s word and in creation. When we realize that our scientific story is God’s story, things happen. What happens when the three stories converge is that a dynamic interface between the cultures—theirs, ours and God’s—allows for biblically-based transformation to occur.
Daniel Fountain and his wife served for thirty-five years as medical missionaries in Congo/Kinshasa. Dan now holds workshops on global health missions at King College in Bristol, Tennessee.
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