Missionary Medicine in a Changing World

by Min Chul Kim

Medical doctors who respond to a missionary call are interested in more than just medicine. They have a clear and ultimate reason for joining a mission agency and going to the mission field: the salvation of all nations to the glory of God.

Medical doctors who respond to a missionary call are interested in more than just medicine. They have a clear and ultimate reason for joining a mission agency and going to the mission field: the salvation of all nations to the glory of God.

When medical doctors go into the mission field with mission agencies, they often struggle with an identity crisis. Am I a missionary or a medical worker?

Medical personnel were not regarded as missionaries until the late nineteenth or early twentieth century. The Lausanne Congress in 1974 firmly established a theology of mission based on two mandates in the Bible: the cultural mandate and the evangelistic mandate. Based on this biblical, holistic foundation, there was no doubt that a medical professional can also be a missionary.

So, why still the identity crisis? Missionary doctors are often told they are welcome anywhere. Yet, new missionary doctors are often troubled by the limited choices in places or types of ministries. This is true particularly when the applicant strongly believes in ministering to unreached people. Most mission agencies prefer to post missionary doctors at established hospitals. This preference is understandable. But should we simply follow the examples of the past?

THE EARLY MISSIONARY MEDICINE
In the early days of Protestant mission, during the colonial and early postcolonial eras, medical professionals were scarce on any mission field. Until African countries won their independence and established their own healthcare system and medical schools, they had to depend on the few foreign medical personnel.

Medicine frequently played a pivotal role in dismantling the prejudice that many indigenous people had against foreigners and the gospel. When Dr. H. N. Allen successfully treated the illness of the royal family of Korea, he also impacted the collective xenophobia of the Korean people, lifting the barrier to evangelism. In Africa, medicine provided the driving force for Christian missionaries to advance from the coast to the interior of the continent. The same phenomenon took place in China and India.

Medicine was not as specialized or sophisticated as it is today. Also, medical costs were relatively cheaper. Simpler medical institutions, such as leprosariums, were used to effectively win souls in the unreached people groups. As many of these groups came into contact with the gospel for the first time, there was often an explosion of evangelism.

In light of this, it is not surprising that many old missionary doctors are nostalgic for the golden age of medical mission. It is understandable that some retired missionary doctors occasionally criticize the doctors from younger generations for not devoting themselves to the mission hospitals. But this criticism may be based on a viewpoint that overlooks the rapidly changing environment on the mission field.

That changing environment includes such realities as the closing of the famous Lambarene hospital, founded by Albert Schweitzer. I have seen many neglected evangelical mission hospitals covered with dust in Africa. Rural mission hospitals are particularly susceptible to neglect and closure.

I don’t mean to imply that all mission hospitals will meet the same fate, or that they are good for nothing. Still, recent radical changes make it worthwhile to ask the question, “Whatever happened to missionary medicine?”

GLOBALIZATION AND MEDICAL MISSION
During the last two or three decades, the mission field has changed so rapidly that it may not be recognizable to former missionaries. Consider the current situation in Nigeria. Like all developing countries, it has the responsibility to establish its own healthcare system and to develop medical professionals. Currently Nigeria has twelve medical schools with teaching hospitals which employ specialized consultant doctors. The government is also funding the construction of new medical institutions. In addition to national governmental efforts, WHO, USAID, UNICEF and many NGOs also have been engaged in medical work supporting the indigenous medical system.

Like most countries, Nigeria now has its own equivalent of the FDA. Strict inspection of new medicine is required, even if medicine is to be used to help the poor. Therefore, it is getting harder and harder to bring in foreign medicine and medical supplies.

Many indigenous Nigerian doctors, who are already accustomed to the convenience of city life, are reluctant to serve in the underdeveloped parts of their country. The lack of educational opportunities for their children and the low salaries in mission hospitals also turn them away from rural areas. Additionally, the government now restricts the work of foreign-trained doctors. As a net result of these factors, nurse practitioners began to run clinics, providing primary medical care at low cost. Even though the number of indigenous medical personnel is increasing in Nigeria, fewer doctors are available for service in rural mission hospitals.

Added to this is the fact that Nigerian mission hospital buildings are old. With little support from the government, they are struggling to pay employee salaries that have gone up while foreign assistance has dropped. Labor unions or local communities also prevent the reduction of mission hospital payrolls. The government neither provides free land for mission hospitals nor gives them any tax benefit.

In the past, the hospitals operated on the basis of bills being paid by rich patients which subsidized the costs for the poor. The government also helped finance the hospitals. Until 1983, the Nigerian government paid more than half of the salaries for doctors and nurses in the country. Today, this benefit has been largely reduced if not entirely withdrawn. Rich patients can go to a nearby city or a foreign country for better medical care. Poor patients have no option but to accept cheap, often inadequate, medical care.

In general, as the governmental standard for accrediting a medical institute gets upgraded in Nigeria, mission hospitals and nursing schools struggle to meet the standards. All of these factors have made it difficult to help poor patients. Medical missions may still be welcomed, but not for the same reason as they were during the colonial and early post-colonial eras.

Another dilemma is the skyrocketing cost of medical care, the Achilles heel of the Western medical system. According to the Christian Medical Commission of the WCC, today we have “better and better medicine for fewer and fewer people.” Even mission hospitals are not immune to this trend. Globalization has struck a severe blow to the medical field by accentuating the disparity between the poor and the rich nations—and between the poor and rich in a given nation. Even though globalization is not singularly responsible for this problem, international free trade can put at a disadvantage countries that are not yet ready to compete in the global market.

Almost fifty percent of the 120 million Nigerians are Christians today. Yet, according to Operation World, forty-five people groups in Nigeria have no church, and thirty-four have no believer at all. Although the percentage of Christians has increased remarkably, there are now more Nigerians who do not know Christ than there were a century ago. Additionally, Muslims have expanded their effort to evangelize Nigeria. Thirteen of Nigeria’s northern states already have introduced sharia law, which authorizes the repression and discrimination of Christians and other non-Muslims. During the last decade, more than ten thousand Nigerian Christians were killed, and several hundreds of church buildings burned.

Though evangelism is flourishing, the population growth results in the need for even more evangelism and church planting—all at a time when such a ministry is getting more difficult. Missionary medicine has played an important role in both healthcare and evangelism, but its future may not be so bright. Where did it go wrong? Let us consider some basic questions.

QUESTIONING MISSIONARY MEDICINE
What is the best medicine? It is often said that missionary medicine aims to provide the “best medicine.” But what is the best medicine? Medical professionals from developed countries are accustomed to thinking that the best medicine is provided at big hospitals, by specialized doctors using sophisticated equipment. This idea inadvertently promotes “better and better medicine for fewer and fewer people.”

In my own experience I have seen preventative medicine provide better results than curative medicine. I was helping Rwandan refugees in Goma, Congo, during the tribal war in 1994 where a cholera outbreak had already killed fifty thousand people. Whose efforts finally stopped the outbreak? Not the doctors. It was the engineers who solved the problem by constructing a water sanitation system. I saw that good healthcare in Africa requires medical personnel to be proactive, going out of the hospitals and taking preventative action to avoid medical disasters like AIDS, diarrheal diseases and malaria.

Despite the absence of well-equipped medical facilities, basic hygiene has allowed countries such as China, Sri Lanka and Costa Rica to achieve a health level and life expectancy comparable to that of more wealthy countries.

Distorted concepts of healthcare have been transplanted to the underdeveloped countries of Africa. Many Africans have abandoned a traditional, holistic understanding of healthcare that incorporates the wellbeing of the physical, social and spiritual aspects of human beings. As a result, community-initiated primary healthcare—which is cheaper and more cost effective—has been discouraged. Broadening the concept of health may give more ministry opportunities to the medical missionary.

What is missionary medicine? Can we naively reduce medical missions to the exportation of Western technology and technicians to other countries? This is what happens in some mission hospitals. Jesus may be lost in a hospital that was built in his name. Few missionary doctors support this concept.

However, is missionary medicine nothing more than bait that allows medical “fishers of men” to better catch their “fish”? This is a dangerous concept. It implies that when more non-Christians get sick, it’s better for the missionaries. The reality is that evangelical zeal must be coupled with real compassion for human suffering, whether people respond to Christ or not.

Good missionary medicine is often used as a bridge, especially with people hostile to the gospel. When my wife and I were working in Egbe hospital, Nigeria, we used to visit the nomadic Fulani people. The Fulani are devout Muslims. We once found a boy named Ibrahim, whose left lower eyelid was torn by a cow’s horn. Tears were rolling down his cheek constantly. We brought him to the hospital while an eye doctor was visiting. Ibrahim’s lachrymal duct was repaired and his tears stopped. Thereafter, twelve Fulani children from Ibrahim’s village began attending a Christian school. We also started a monthly weekend Bible camp at our house for the Fulani children. Their parents made the tough decision to allow their children to have a Christian education despite the pressure from their Muslim community.

Some may ask, “Is it enough to consider medical mission only as a bridge?” When Jesus healed the ten lepers, only one of them returned to thank him (Luke 17:12-17). Should we consider this healing ministry an evangelistic failure? Missionary medicine is rooted in the fact that Jesus healed with compassion, regardless of the evangelistic result. This idea is seen in the parable of the Good Samaritan who cared for the physical needs of the robbed and beaten man. Jesus simply said, “Go and do likewise” without calculating the spiritual outcome. As Jesus shows through the action of the Good Samaritan, missionary medicine needs to reach out to needy people with compassion, instead of simply waiting for them to come to hospitals. Missionary medicine should not be confined to the hospitals. The people in real need are those who cannot even come to hospitals on their own.

What does missionary medicine need in this rapidly changing world?Medicine needs to be contextualized just like theology. Therapeutic medicine cannot and should not be the only medicine for Africans. A variety of healthcare options should be offered. Outreach to villages where disease epidemics start is essential. Hygiene education, water sanitation, mosquito eradication, sex education and housing construction have all proven to be effective ways of improving the health in a community.

Primary healthcare may be tedious and unexciting. However, the goal of missionary medicine is to provide physical and spiritual care to needy people and communities. Programs such as Community Health Evangelism are combining healthcare education with evangelism. Even Bible studies can contribute in the fight against AIDS.

Condoms and safe sex education alone have proven ineffective in reducing the spread of AIDS. Antiviral medicines are not a cure for AIDS and they are not affordable for those who earn less than five hundred dollars a year. The only viable answer is to promote abstinence and marital fidelity, as has been proven in the case of Uganda’s successful ABC Program. Missionary doctors who recognize the seriousness of AIDS should motivate Africans to uphold biblical moral principles as a means of curtailing the spread of AIDS.

The wider we open our eyes, the more we realize that contextualization of missionary medicine is needed. Contextualization can guide the process of allocating limited resources effectively in a rapidly changing and increasingly needy world.

Just as the contextualization of theology raises many controversial issues, so too will medical contextualization. Consider the following example.

Many missionaries working with the Fulani have seen vaccinations given to cows instead of children. Cows are the most valuable possession to Fulanis. They make visits of condolence when a neighbor’s cow dies just as if a family member had died. My wife and I decided to vaccinate cows in hopes of building relationships with Fulanis. Yet we felt guilty that we were not vaccinating their children. Then we heard the reason for the Fulanis’ reluctance to vaccinate their children.

Fulanis believe vaccines may cause infertility. A well-known Muslim leader in Nigeria once argued on a BBC talk show that the poliomyelitis vaccination project was a conspiracy of the Western Christian countries to reduce the Muslim population.

Cow vaccination may provide a contact point with this people group that could lead to evangelistic opportunities. We hope that by vaccinating cows we may also remove their unfounded suspicion of vaccines for children.

LESSONS FROM MISSIONARY MEDICINE IN SOUTH KOREA
Korea’s economy rapidly rose from the ruins of the Korean War (1950-53). The national church also grew. Korea is now second only to the United States in the number of missionaries it sends.

During the last forty years, many changes have taken place in missionary medicine as well. Some mission hospitals that were started flourished for a short time and then faded away. But many remain and send out medical missionaries to other countries. There are several characteristics of those Korean mission hospitals which have continued to thrive.

1. Location. Location is critical. Nearly all mission hospitals that are still active and financially independent are located in big cities such as Seoul, Jeonju, Kwangju, Taegu and Busan. On the other hand, most medical institutes located in the countryside have downsized or closed. Urban hospitals can make rural outreaches, but not vice-versa.

2. Adaptation. Rural hospitals that have adapted to changing circumstances have remained viable. For instance, as the number of new leprosy infections dramatically decreased in Korea, Wilson’s Leprosy Center, which is located in a small seaside village, was transformed into a rehabilitation center which provides functional reconstructive surgery. This adaptive change, led by missionary Dr. Stanley Topple, allowed the institution to thrive.

3. Indigenous leadership. Indigenous people should assume the leadership of mission hospitals as they gain the ability to do so. When Dr. Stanley Topple left Korea for Kenya in the early 1980s, he left the rehabilitation center in Korean hands. The three-self principle (self-government, self-support and self-propagation), which became a driving force for church growth in Korea, was also successfully applied to Christian medical facilities.

4. Contextualization. Missionary medicine should be contextualized for the indigenous population. Dr. David J. Seel served in the Presbyterian Medical Center in Jeon Ju, Korea from 1954 until he retired in 1990. The PMC, commonly called the Jesus Hospital, started with relief work for war victims. It then moved to primary healthcare and later to a training center for Christian doctors and nurses. A considerable number of Korean doctors and nurses are now serving abroad as missionaries. Dr. Seel demonstrated how to contextualize missionary medicine and unchanging biblical values in a rapidly changing nation.

SUGGESTIONS FOR THE FUTURE OF MEDICAL MISSIONS
Missionary medicine must be grounded in the objective need of the people and on the objective goals of missions. To help the church maintain this grounding, I offer these seven suggestions.

1. It is imperative to review the goals of contemporary missions. The most pressing and strategic mission fields today are unreached people, cities, children and the AIDS crisis in Africa. Medical resources should be concentrated on these four fields.

2. Nostalgia must give way to a future-oriented attitude, as the medical and missional environment has changed dramatically. It would be counterproductive to give the bulk of medical resources for the maintenance of existing medical mission institutes.

3. Medical facilities in evangelized areas should be handed over to the indigenous church. Raising indigenous leaders and medical practitioners is extremely important.

4. We should strategically relocate medical resources for the evangelization of unreached people. This is an opportune time for medical missions, as many of the remaining mission fields are found in closed countries that restrict the ministries of full-time missionaries and evangelists.

5. We need to upgrade several competitive mission hospitals or institutes for the purpose of developing indigenous leaders. There is an abundance of Christian doctors and medical school students in Nigeria who do not know where they can be trained to do medical missions. These hospitals can also serve as a base camp for community outreach ministry.

6. Medical missions should focus on developing in areas underserved or neglected by the secular medical profession or government. This will relieve the financial burden of maintaining a general hospital and, at the same time, show the compassion of Jesus Christ, who healed the outcasts of the society—the disabled, the blind, the mad and the lepers. Today, AIDS is the new leprosy and should be a primary focus for medical missions work.

7. Finally, we must contextualize missionary medicine. Christian healthcare should be thought of holistically, contextually and as an integral part of the church’s mission. Medical missionaries should follow Paul’s example of cross-cultural flexibility so that “by all possible means [we] might save some. [We] do all this for the sake of the gospel” (1 Cor. 9:23).

References
Brown, Stanley G. 1985. Heralds of Health. London: CMF.

Ewert, D. Merrill, ed. 1990. A New Agenda for Medical Missions. Brunswick, Ga.: MAP International.

Seel, David J. 1979. Challenge and Crisis in Missionary Medicine. Pasadena, Calif.:William Carey Library.

_______. 2001. For Whom No Labor of Love Is Ever Lost. Franklin, Tenn.: Providence House Publishers.

Turaki, Yusufu. 1993. An Introduction to the History of SIM/ECWA in Nigeria 1893-1993. Jos, Nigeria: Challenge Press.

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Dr. Min Chul Kim, an Internist, and his wife, Dr. Keum Hee Choi, an Obstetrian and Gynecologist, served in Nigeria with SIM. At the moment, Kim is serving as director of the Jesus Hospital, a large mission hospital in Korea.

Copyright © 2005 Evangelism and Missions Information Service (EMIS). All rights reserved. Not to be reproduced or copied in any form without written permission from EMIS.

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