by Robert Wenninger, M.D.
The author discusses primary health care.
Every day around the globe tens of thousands of people make their way to mission and church hospitals seeking relief from a wide variety of maladies. They have been doing so for decades, often because they have no alternatives in the rural areas where most such hospitals are. Relief from sickness and suffering is a high priority for them and for us.
Nobody seems to know for sure how many mission and church hospitals there are, because no thorough study has been done, but by some estimates there are at least 2,000. How many people do they serve each year? Probably tens of millions.
These hospitals offer not only physical care but they also attempt to care for spiritual needs as well. Often they are a center, or sub-center, for church-related ministries. Hospital staffers regularly do evangelism, literature distribution, Bible study, and teaching to strengthen local churches and their leaders.
For a long time the activities of hospital-based mission health care programs have been taken for granted. Even though there have been occasional detractors who have questioned the validity of a fixed-base and expensive ministry as the proper domain of Christian missions, by and large the mission or church hospital has enjoyed the general support of its sponsoring agency. Perhaps for too long too much has been taken for granted. When was the last time, for instance, that you read an article about mission-based health care in a major mission periodical, especially an article that dealt with issues, strategies, and adjustments to changing times? Few have been written.
However, we can no longer afford to ignore pressing issues. We must face them because world conditions are changing and because African, Latin American, and Asian leaders are taking their proper roles. Mission agencies must openly evaluate their health care ministries, share facts about successes and failures, and develop and policies about their future intentions.
WHAT ABOUT PRIMARY HEALTH CARE?
Primary health care (PHC)—”a community-based health care approach using nonprofessionals and aimed at preventing many illnesses at the village level"—has been discussed. Many recurrent illnesses that overload hospitals are preventable with PHC education programs.
While the traditional mission hospital has enjoyed a long history and general acceptance, primary health care has encounted some resistance to being widely adopted. PHC is already accepted as an important health care approach by some governments, some of which have established nationwide PHC programs. Although they experience varying degrees of acceptance and success, these programs are in place now, sometimes before mission or church groups have decided whether or not to participate.
This emphasis on disease prevention is long overdue, but mission doctors resist PHC for some good reasons. With a shortage of nurses and supplies stretched to the limit, they fear that their already meager resources will be further strained to encompass PHC. They worry that PHC could undermine confidence in and commitment to their hospitals. Their uncertainty is rooted in the promotion of PHC as a less complex way for missions and churches to provide health care.
Mission agencies and mission doctors must understand that PHC is not a substitute for hospitals. PHC’s goals are preventive and community-based. Programs are run by non-doctors, usually nurse-supervisors and para-medical workers. PHC is a complementary program, entirely compatible with existing treatment-oriented care.
It is vital for the future of medical missions, however, that the criticisms of PHC be heard and that we try to bring some unity to the matter. We have genuine concerns for future roles and directions of mission health care programs, but we must disavow rivalries over different approaches. Polarization is a pitfall we cannot afford.
ADMINISTRATORS AND JOURNALISTS
Important as the debate over PHC and hospitals is, there is something more central to our future that we have to solve— ”the problem of isolation, which has many angles. For example, although health-care professionals take the lion’s share of hospital management, both hospital-based and community-based ministries would be invigorated by the empathetic counsel and expertise of mission or church administrators.
Perhaps administrators at times have felt isolated, because of perceived shortcomings in understanding the complexities of medical work. At other times, health-care leaders may have inadvertently made administrators feel unwelcome in the inner councils of health-care planning. To the extent to which this has happened, some degree of isolation of the hospital-based ministry probably has occurred.
To achieve greater dialogue between mission leaders and missionary doctors, both must be convinced that it will be best for both sides if they discuss future strategies and needed adjustments cooperatively. Even though administrators may feel unqualified, they must play a key role in planning, because of their administrative skills and because they often represent the medical work to the constituents at home.
Isolation also comes from a lack of interchange between church and mission groups, even within the same country. We do not generally gain the benefits from pooling information about our health-care ministries. While the world changes, our reporting has not kept pace. We simply don’t know what is going on in health-care ministries.
In some places, civil war rages around the mission hospital, creating MASH-like conditions. In others, refugees are a focus and a strain on facilities and resources. In some, deteriorating civil services force mission and church healthcare ministries to assume a larger role. Christians at home rarely hear about these developments. Mission agencies themselves do not talk together about them.
Missionary medicine needs a forum where we can discuss contemporary issues. We must discuss in print and widely circulate our findings. One reason, perhaps, for our lack of medical missionaries is a relative paucity of information about health-care ministries, when compared to church growth, people movements, unreached people, and tentmaking. Those emphases are important, of course, but where would a person find facts about mission- and church-based health care?
Health care workers do have a role in the future and we must say so openly. Uncertainty about the validity, role, and form of health care in the future is bound to cool off the flow of professional and para-medical volunteers. They are reluctant to join a "sunset" ministry that they fear might soon be disbanded.
Mission and church-based health care is undergoing unprecedented stress from personnel shortages, supply problems, growing work loads, and, in some cases, increasing government pressures. We must discuss these important matters and share our insights.
WHO WILL GO, OR STAY?
Asian, African, and Latin American church leaders want to include medical care in their programs, but most churches do not have either the people or the money to maintain hospital-based ministries. Although some hospitals have recruited local people, especially nurses, turning over the whole operation seems a long way off, especially if Christian distinctives are to be maintained. It would be much easier for the churches to carry on primary health care programs, which is one of the strengths of that approach.
Because government health services are declining on some countries, the need for mission- and church-based health services is still great and the opportunities many. We cannot afford the luxury of leisurely contemplation of the pros and cons. We can’t simply hope that things will turn out right.
Thinking about the tens of thousands who daily seek relief in our institutions is not mere sentimentality. These people really do hurt and they need us. Perhaps in the futureâ€”because of primary health careâ€”fewer of them will need hospital help, but there will always be some who will.
We can’t count on our past achievements to carry us through. In addition to caring for people, we must care enough about each other and our missionary medical programs to sit down together and plan for the future.
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