One of the Christian ministries I am grateful to God for is missionary work. People like myself came to Christ because missionaries brought the gospel to my nation. Leaving one’s own homeland and comfort zone to go, live, and serve among people of different race, culture, language and way of life or uncivilized is a huge sacrifice. The Lord Jesus who said ‘go’ (Matthew 28:19) also talked about the sacrifice missionaries make in leaving behind ‘homes, brothers, sisters, mothers, fathers, children and fields.’ (Mark 10:29,30)

What is a missionary?

The Oxford Dictionary defines a missionary as ‘A person sent on a religious mission, especially one sent to promote Christianity in a foreign country.’ An ambassador was interviewed on one TV station and the host asked him: ‘What is an ambassador?’ The ambassador who was full of sense of humour said jokingly: ‘An ambassador is a faithful citizen sent by his government to lie.’ I smiled and said what if a Christian missionary is asked the same question? Would he say, ‘A missionary is a faithful Christian sent by his God and Church to lie?’ No! Christian missionaries carry the good news of salvation to the perishing world! ‘How beautiful on the mountains are the feet of those who bring good news.’ (Isaiah 52:7)

The Apostle Paul spent three years in the province of Asia as a missionary among the Gentiles (Acts 20:31). What lessons can today’s missionaries learn from him? There are many but let’s go for the following seven from the narrative given in Acts 20:17-38.

1. Paul’s life among the Gentiles

‘You know how I lived the whole time I was with you, from the first day I came to the province of Asia. I serve the Lord with great humility…’ (Acts 20:18)

The first lesson is Paul’s life among the Gentiles. The secret behind Paul’s successful ministry among the Gentiles was his life of humility. From the first day he came to them, he put aside his high civilization and education, humbled himself, came down to their level, and treated and served them with respect, kindness and dignity.

2. Paul presented to the Gentiles the Lord Jesus as Saviour

‘I have not hesitated to preach anything that would be helpful to you... I have declared to both Jews and Greeks that they must turn to God in repentance and have faith in our Lord Jesus… I have not hesitated to proclaim to you the whole will of God.’ (Acts 20:20-21, 27)

Paul presented to the Gentiles:

• Repentance and faith in the Saviour Jesus Christ
• Anything helpful
• The whole will of God

Although Paul presented helpful knowledge to the Gentiles, it was the message of repentance, the cross, and salvation in Christ that was central in his ministry. ‘Before your very eyes Jesus Christ was clearly portrayed as crucified.’ (Galatians 3:1) That is the purpose for which missionaries are sent.

3. Paul paid a price

‘I served the Lord… with tears, severely tested by the plots of the Jews.’ (Acts 20:19)

In addition to the sacrifice of leaving home and comfort zone, another price missionaries pay is risking their very life. Threats, plots, prisons, hardships (see long list in 2 Corinthians 11) are synonymous with missionary work. But Paul’s slogan was: ‘None of these things move me; nor do I count my life dear to myself, so that I may finish my race with joy, and the ministry which I received from the Lord Jesus.’ (Acts 20:24 NKJV)

4. Paul the tent-maker

‘I have not coveted anyone’s silver or gold or clothing… these hands of mine have supplied my own needs and the needs of my companions.’ (Acts 20:33-34)

The missionary landscape is changing. Today, professional tent-makers who go to mission fields as teachers, economists, engineers, healthcare workers, farmers, etc are needed. The advantages of being a missionary tent-maker are:

• Tent-makers are welcomed everywhere even in restricted countries because their skills and services are needed.
• No one would be suspicious of them.
• They support their own ministry financially.

The two hands, spiritual and professional, need to both be functional when called to missionary work (1 Chronicles 12:2).

5. Paul’s time to leave came

‘Remember that for three years I never stopped warning each of you night and day with tears. Now I commit you to God and to the word of his grace.’ (Acts 20:31-32)

After three years of service in the Province of Asia, Paul’s time to leave came. A time comes when missionaries either retire and return home, transition to a new location God calls them to or are called home to heaven through physical death. Any of those three can happen. In Paul’s farewell speech (Acts 20:25-35) he:

• Reminded them of what he taught them
• Admonished them to keep watch over themselves and the flock
• Warned them about appearance of savage wolves that would devour the flock
• Committed them to God and his word of grace.

It is therefore important to develop leaders who will take over and carry the work forward after leaving.

6. Paul left them on their knees praying

‘When Paul had finished speaking, he knelt down with all of them and prayed.’ (Acts 20:36)

Ministry is started and established through prayer and kept, preserved, and continued through prayer. Paul learned from his Master, the Lord Jesus, who in his departure left his disciples on the mountain of prayer. (Matthew 28:16 & Luke 24:50-53)

7. Paul built a strong relationship with the people

‘They all wept as they embraced him and kissed him. What grieved them most was his statement that they would never see his face again. Then they accompanied him to the ship.’ (Acts 20:37-38)

In the three years Paul lived and served among the Gentiles, a strong bond of love was developed and built between him and the people. We see this in the time of his departure when emotions such as weeping, embrace, kiss, grief, accompaniment to the ship, and kneeling down to pray with him were all expressed to him by the people. This last point is a reflection of the first point. It is all because Paul from the first day he came to them treated them with respect, kindness and dignity.

Building strong and long-lasting relationships also help in building trust and paving the way for future missionaries coming to the community.

Lord, help us to learn from your servant Paul.

This commandment is not optional. It is a mandate for every Christian, in every time and place. One of the best illustrations I have heard so far about what it means to evangelize is a beggar telling another beggar where to find food. This illustration is interesting because it summarizes in a few words some aspects of our mission as Christians.

Each one of us was saved by God’s grace and not by our personal merits or qualities, as the Apostle Paul emphasized in his letter to the Ephesians: ’For it is by grace you have been saved, through faith—and this is not from yourselves, it is the gift of God, not by works, so that no one can boast.’ (Ephesians 2:8-9) In this sense, we can consider ourselves beggars, because we know our limitations and we know that we cannot do much, with impact for eternity, if we are separated from the vine, which is Christ. (cf. John 15:5)

On the other hand, if Christ is not the Lord and Master of our lives, we are poor; but poverty of spirit is an indispensable condition for entry into the Kingdom of God (cf. Matthew 5:3). It means recognizing our spiritual poverty and failure before the high standards of conduct that a holy and perfect God demands (Luke 18:13). Jesus sent a stern warning to the members of the church in Laodicea, who failed to recognize their true spiritual condition: ’You say, ‘I am rich; I have acquired wealth and do not need a thing.’ But you do not realize that you are wretched, pitiful, poor, blind and naked.’ (Revelation 3:17)

Our Mission

Our mission is to point to the Lord and Saviour Jesus Christ, the way, the truth and the life, who gives us access to eternal life with God (John 14:6). Jesus is the bread of life, who can satisfy our spiritual hunger and search for purpose in life (John 6:35). As Josh McDowell states in his book More Than a Carpenter, ’Christianity is not a religion; it’s not a system; it’s not an ethical idea; it’s not a psychological phenomenon. It’s a person. If you trust Christ, start watching your attitudes and actions because Jesus Christ is in the business of changing lives.’

In order to fulfill the mission of world evangelization we need to have a genuine love for other people, which is not something innate, but possible through the supernatural action of the Holy Spirit in our lives, who also enables us to do the works that Jesus did (John 14:12). Without this love and compassion for the lost, and without the presence and power of the Holy Spirit in our lives (Acts 1:8), we will not be very effective in this mission of going and making disciples of all nations.

There are many factors that hinder this calling:

• Lack of intimacy with God, little dedication to prayer, lack of time and availability are some of the most common.
• Having low self-esteem or considering ourselves somehow inferior to the person to whom we intend to share the gospel (because they are of a higher social status, more intelligent, or have greater abilities than us in some area.)
• Knowing that we are not perfect and thinking that we will therefore be bad representatives of the gospel cause.
• Thinking that we don’t have enough biblical and theological training to answer questions that we may be asked.
• Dealing badly with the indifference, rejection, and even some hostility that are relatively common when we proclaim the message of salvation in Jesus.

The truth is that there is no valid reason why we should not be more active and diligent in fulfilling this mission, because it was God who made the decision to hand over this task to mortal and imperfect human beings and not to his angels. Moreover, the Lord Jesus promises to accompany us in this noble mission, for he said, ’I am with you always, to the very end of the age.’ (Matthew 28:20)

Jorge Cruz MD PhD (Bioethics) is a vascular surgeon working in Portugal. He is a member of the national committee of the Portuguese Association of Christian Doctors and Nurses (AEMC).

‘What shall I do, Lord?’ I asked.
‘Get up,’ the Lord said, ‘and go into Damascus. There you will be told all that you have been assigned to do.’
My companions led me by the hand into Damascus because the brilliance of the light had blinded me. A man named Ananias came to see me. He was a devout observer of the law and highly respected by all the Jews living there. He stood beside me and said, ‘Brother Saul, receive your sight!’
And at that very moment, I was able to see him.
Then he said: ‘The God of our ancestors has chosen you to know his will and to see the Righteous One and to hear words from his mouth’.

Acts 22:10-14

Do you have an Ananias in your life? At times God brings people into our lives that bring about a transformation that lasts forever. These people we meet give us sight to look to Jesus, they point us to what God wants us to do, and teach us how to grow spiritually and draw closer to the Lord.

In my life, I have had several Ananias, one of whom was my pastor Rafi Shahverdyan.

I grew up in a strongly atheistic family, and I thought that religion and believing in God was for uneducated people. As a ‘smart’ and ‘clever’ person I would never think of such nonsense things. But the Lord opened my eyes to his grace after graduating from Medical University and I became a Christian.

However, I had a lot of confusion and conflicts in my mind. I was ultimately ‘blind’ and didn’t know what to do or where to go. It was then that I met Pastor Rafi who took care of me and gave me a vision of using my medical skills for the Kingdom of God.

Pastor Rafi (pictured centre) was a close friend of Dr Jany Haddad who once asked him if he knew anyone who could assist him during surgeries in Armenia. He organised a meeting with several medics from our church, and this was the first time that I was introduced to Dr Jany Haddad (pictured left).

This meeting was a life changing encounter. I was inspired by Dr Jany’s vision and with the encouragement of Pastor Rafi we started a group of Christian doctors (with only three doctors initially) which became the Armenian Christian Medical Association (ACMA). Within a year more than 50 people who had joined the association!

Pastor Rafi, who was not an ACMA member, was incredible in supporting the association from the very first meeting. He connected us to other doctors, advertised ACMA, prayed for ACMA missions and conferences, preached at ACMA annual conferences and meetings, and counselled ACMA members. One of his main messages to Christian doctors was to demonstrate the Father’s love to their patients, treating them with compassion in a way that other doctors cannot.

He healeth the broken in heart and bindeth up their wounds.

Psalm 147:3

Rafi was one of the few leaders who reminded ACMA members of the danger of burn out due to their medical workloads. He taught that the best place to go for the Holy Spirit’s refreshment was at the feet of Jesus Christ. I learned from him that inner healing is essential and that without inner harmony you cannot work efficiently and serve God.

During ACMA conferences, Rafi could spend several hours praying for every person there and listening to their stories and needs. His arms were always open to hug and comfort the broken ones.

In Armenia there is a national unforgiveness which is rooted in historical persecution with Turkey. As a grandchild of a genocide survivor, I too struggled with this. Pastor Rafi however, was a Christian that looked beyond nationalities. He looked at every nation with the eyes of the Lord and had a heart for them. He organised several reconciliation conferences inviting Turkish Christians, and he went to Turkey several times and sent several missionaries from his church to Turkey.

Pastor Rafi was trying to break the wall that had built up between these two nations since 1915, and was encouraging us as Armenians to forgive and love our neighbours. After one particular trip to Turkey he wrote a beautiful book, Armenian Wine and Turkish Bread – A Real-Life Journey of Reconciliation.

Because of Pastor Rafi, I started to look at the country of Turkey and its people with a different lens, and began to think about starting a Christian Medical group in Turkey. I shared my vision with Pastor Rafi who was delighted to hear of my plans and helped connect me to his Turkish contacts. This was the journey of starting a Christian medical group in Turkey.

Through Pastor Rafi, I was also introduced to Alice, an Iranian dentist, who is now leading a group of Iranian medics.

Pastor Rafi was a person with whom I could share my successes, difficulties and challenges and receive his godly advice and prayers. Our meetings always ended with gifts which were usually books that had either been written by him or had been a blessing to him.

The last book he gave us, in November 2022, was Wipe My Tears, a message of healing to comfort people who grieve. It was a collection of testimonies from people that he had met during his years of ministry. They were people who had experienced much brokenness but had also found healing and restoration in Christ. Their stories were a motivation to believers to help those who are grieving find comfort.

Pastor Rafi had a wonderful family. He was married to the lovely Janet and they had three beautiful daughters and five grandchildren. He was a beloved husband, father and grandfather and by just looking at his family you could already learn a lot.

I am very grateful to God for the Ananias and Loving Fathers I have met on my life’s journey. Because of them I am a completely different person.

Today my two spiritual Fathers are rejoicing in eternal life with our Lord. They leave us with beautiful memories and are a testimony of how to be a Loving Father to others before we join them there.

It is my prayer that everyone in ICMDA can be an ‘Ananias’ for someone and finds one for themselves. Amen.

Dr Kristina Alikhanyan is the ICMDA Regional Representative for Caucasus, Eurasia

Wikipedia defines partnership as ‘an arrangement where parties agree to cooperate to advance their mutual interests.’ In Christian ministry terms, this would mean advancing mutual ministry interests to advance God’s kingdom. In the above text, Peter and those with him signalled (called) their partners in the other boat to come and help them in pulling the net. There is always need for partnership in ministry.

Importance of Partnership

Partnership is important for three main reasons:

• To work towards a common vision
• To carry out joint activities
• To carry out an activity that may be extremely difficult for one organisation to carry out alone.

Mary T Lederleitner summed it up that ‘We partner and work with our brothers and sisters around the world for reasons far deeper than any specific ministry outcome or objective…’

Reasons for partnership

In building God’s Kingdom, the following form the basis and reasons why organisations partner in ministry.

1. God’s kingdom and the Great Commission are greater than one Church or organisation

This is a self-explanatory truth. God’s kingdom is the biggest Kingdom that needs to be built and established on earth. The ‘ends of the earth’ in the Great Commission cannot be reached by one church, organisation or ministry. No one organisation can be effective or can claim it can evangelise the whole world or meet all the vast and enormous ministry needs alone. As such, collaboration and partnership are needed.

2. Partnership brings the mutual joy of winning souls together

In the Luke 5 story, the Lord Jesus needed a partner, Peter. Peter on the other hand signalled for partners in the other boats to come and take part in pulling the net! It is a joy when our joint collaboration and partnership results in winning souls for Christ.

Luke and Mark mention three types of partners:

• Net directing partners: The Lord Jesus in Luke’s story is this type of partner. A discerning and visionary partner who could figure out and guides to where the net should be cast ‘for a catch’. This type of partner saves effort and time from being wasted. They, like the children of Issachar, know what to do in the right time, in the right place, in the right way (1 Chronicles 12:32).

• Net-casting and net-pulling partners: Peter casted the net and he signalled to his partners in the other boats to come and pull the net with him. Mark says ‘Jesus saw Simon and his brother Andrew casting a net…’ (Mark 1:16). Who are the net-casting and net-pulling partners? These are the evangelists who preach God’s word and pull the net in a pulpit call for sinners to receive Christ. We need these frontline evangelism partners!

• Net-preparing partners: Mark in his gospel also mentioned this type of partners. ‘He (Jesus) saw James son of Zebedee and his brother John in a boat, preparing their nets’ (Mark 1:19). Clearly, these are partners behind the scenes supporting evangelists financially and prayerfully. When evangelists travel to cast the net, we don’t normally know the people who gave the money for their air ticket, hotel accommodation, and their personal needs. Some people behind the scenes are ‘preparing’ the financial net and ‘interceding’ for them that the word they preach be anointed.

With all these three partners and others collaborating, God’s kingdom is built. I believe it was a great joy that day when the partners in the two boats joined hands in harvesting the fish.

3. Partnership brings greater blessing to the partners:

There is a blessing in partnership! We know from Luke’s story that the partners in the two boats were both blessed when they joined hands. ‘The two boats were both filled.’ This is a big lesson we all need to learn. God blesses and honours collaboration. God will bless individuals and ministries that are willing to partner and collaborate with other ministries. Their boats will also be filled.

4. Partnership is an acknowledgement of each other’s calling, giftings and ministry

Mother Teresa has said: ‘You can do what I cannot do. I can do what you cannot do. Together we can do great things.’ Why did Peter call his partners in the other boats? There were people in the other boats with gifts, skills and calling in pulling nets that he might not have. This is another good and strong reason to collaborate. There are organisations and brothers and sisters in the body of Christ with gifts, talents, capacity and calling we might not have.

5. Partnership reveals the truth about our hearts

Human beings have the selfish tendency to build their own kingdoms and ‘protectorates’ they do not want invaded by others. This makes people insecure and suspicious when it comes to building partnerships. Will they not become more dominant, influential, and known than us? Mark tells us how the flesh with its competitive and jealous nature came to surface among the disciples of the Lord Jesus Christ!

‘”Teacher,” said John, “we saw a man driving out demons in your name and we told him to stop, because he was not one of us.”’ (Mark 9:38). The Lord had to intervene and correct things. Partnership cannot live in one room with competition and jealousy. The right attitude in ministry should be:

• Cooperation not competition
• Complement rather than fighting for territories
• Having the big picture of God’s kingdom in perspective rather than individual myopic view

Let’s put our hands together and partner for God’s glory.

Alex Bolek is ICMDA Coordinator for Sub-Saharan Africa and Regional Secretary for East Africa  

These ideals are based on the biblical worldview: every person has been created in the image of God. Supremely, Christians affirm the dignity of every human life because God himself, in Christ, became flesh. Christ was incarnate from the moment of conception. God, the giver of life, demands that human life should be protected from conception to natural death. 

From the inception of the Christian Church at Pentecost, countless followers of Jesus Christ have lived out the biblical command to love God and love neighbour. Through history, Christians have challenged injustice and abuse, and provided care for the needy, often at great cost to themselves. This has had a beneficial and widespread impact on all areas of human life, including healthcare and philanthropy.

Jesus’ teaching that his followers were to love enemies and show mercy to all was revolutionary in his day. In pagan culture, compassion to the needy was often regarded as foolish. From the earliest centuries, Christians cared for the sick (whether they were believers or not), provided hospitals, looked after lepers, rescued abandoned infants, and resisted abortion. A major factor in the rapid growth of Christianity during the first three centuries (despite persecution) was the Christian ethic of protection of life and care for the needy. Believers risked their own lives to care for others during plagues. By contrast, the pagans often abandoned even their own families to flee to safety.

The early universities grew out of the communities of teachers and students based around Christian cathedrals. The conviction that the Creator God has called us to study his works as well as his words lay behind scientific endeavour and resulted in significant medical advances.

For centuries, the Church provided care for the sick, the poor and the elderly by means of the monastic system. In areas impacted by the Reformation, after many monasteries were closed down, there was a fresh upsurge in Christian provision of hospitals and dispensaries: one of the ethical results of the Evangelical Awakenings.

Thomas Sydenham (1624-1689) is remembered as the ‘The Father of English Medicine’. He was motivated by his Christian faith and urged everyone involved in the care of others to remember that we will all answer to God for how we have treated them. We are not to be proud of our abilities or knowledge, as it is all a gift of God’s grace and to be used for his glory and the benefit of others. However needy or pitiful the person we are caring for, they must be afforded dignity, because Christ’s incarnation has for ever ennobled the human nature that he, the eternal Son of God, took upon himself. All who care for others should be humble – all are likely in time to be dependent on the care of others.

Worldwide, Christian missionaries have led the way in providing medical clinics, blood banks, mental health programmes, and alcohol and drug rehabilitation schemes. Working in some of the toughest situations on earth has led to some major medical breakthroughs, such as the missionary Paul Brand’s pioneering treatment of leprosy.   

Christianity is the first truly global religion. Local believers across the world serve their fellow human beings in medical and dental care, as well as other vocations and ministries. Christians are often allowed access even to closed countries to minister to physical needs.

Because all people are made in God’s image, and because of God’s ‘common grace’, we find those who are not Christians also extending excellent medical and dental care to others. We are thankful for that and give God the glory. The gifts these colleagues possess, whether they acknowledge it or not, come from their Creator.

God has created us as whole people, body and soul. Jesus cared for both. Christians through history have done the same. The unique and glorious contribution Christians bring is that we, alone, have the message of hope in the face of death. Jesus Christ rose from the dead and triumphed over sin and death. He lives and reigns for ever in his glorified body.

However excellent the medical care we extend, we cannot ultimately prevent death, but believers can look forward to being raised, with glorified bodies, to love and serve God for ever in the new heavens and new earth. The certainty of our eternal security, and the passion to share this great hope with others, has motivated so many Christians to go to the hard places, at great personal risk, many at the cost of their own lives, to care for both the bodies and souls of our fellow human beings.

Sharon James studied history at Cambridge University, has an MDiv from Toronto Baptist Seminary, and a doctorate from the University of Wales. She is married to Bill, who is Principal of London Seminary. Sharon works as Social Policy Analyst for The Christian Institute, UK. She is the author of several books, including  Gender Ideology: What do Christians Need to Know? (Christian Focus, 2019); and How Christianity Transformed the World (Christian Focus, 2021). Her webinar on How Christianity transformed healthcare is available on the ICMDA YouTube channel.

In general, population health has improved with life expectancy rising from 45 to 70 years over the last 40 years, largely through better maternal and child health and a reduction in death from infectious diseases. However, as in other low- and middle-income countries, increased longevity and lifestyle changes are leading to an increase in non-communicable diseases (NCDs). More than 60 per cent of deaths are from NCDs with increasing numbers of people living with disability from long term conditions. According to our modelling, at any one time around 120,000 people in Nepal require palliative care.

This demographic shift in illness requires a fundamental change in the focus of healthcare from acute illness to integrated chronic disease management (CDM) – a particular challenge in such a low-income setting. In a recent survey of advanced chronic illness in rural areas, we estimated that around four per cent of the population are housebound with chronic illness, disability or age-related frailty. Despite government health posts in each village area, the majority of people in this group do not receive effective healthcare. They have difficulty getting to health posts due to rugged terrain and staff who provide care there lack training in CDM. Such people become invisible and marginalised. Families struggle to care for them and according to OXFAM, girls frequently drop out of school to become carers.

Addressing these issues requires a holistic and community development type approach which will transform primary care and empower communities. Healthcare workers need to be trained and healthcare facilities need to develop the systems and resources to deliver appropriate CDM. Families need to be given the support in caring for chronically sick and dying members. At the same time, it is imperative to enable children and young people to continue in school and not drop out because of caring duties. Otherwise, the cycle of poverty will continue.

These challenges resonate strongly with urgent global public health priorities for primary care led universal health coverage (UHC) and the recognition that caring for those with advanced illness and the dying is not possible without community mobilisation – a concept which has been promoted in the WHO Palliative Care Strategy and has been named ‘Compassionate Communities’.

Not only do the challenges resonate with global health, they also resonate with the principles of integral Christian mission. Colleagues in the Emmanuel Hospitals Association of India have demonstrated how community palliative care is transformational in the areas they work with effects beyond the care of the dying. In serving the marginalised with advanced illness in rural areas, palliative care teams embody the love of Christ and see communities transformed. One pastor remarked: ‘Palliative care is not a way enabling us to share the gospel, it is the gospel’.

In addressing these challenges, INF Nepal in partnership with Scottish Christian healthcare charity EMMS International have established a palliative care and chronic illness unit at Green Pastures Hospital and Rehabilitation Centre, which was dedicated in November 2020. The new Centre for Excellence, funded by EMMS International, will focus on clinical care, education and research, developing models of care which will enable integrated CDM for rural Nepal. This represents an expansion of EMMS International and INF Nepal’s palliative care work which has been gathering pace over the last eight years involving: needs assessment research, developing training resources, including translating the Palliative Care Toolkit into Nepali, training numerous health care professionals and also training church members in basic, compassionate caring skills.

EMMS International and INF Nepal’s next major project (‘Sunita’ – a girl’s name meaning ‘Justice’) will develop a model of community primary palliative care and compassionate communities for rural areas. Working with Nepali Christian development organisation HDCS, which runs the government Lamjung District Hospital and local Lamjung District health posts, we aim to develop a robust and appropriate health system for palliative care. We plan to work with community teams to train volunteers in caring, modelled on training church members in basic caring. We will work with school students promoting caring as compassionate action for all to be involved in, not just girls and work with schools to see how children involved in caring can be supported to continue their education.

The Sunita Project has the cross-cutting theme of empowering women and girls – #EveryGirlMatters – which is a key area of UKAid policy. If you would like to be involved in helping us develop this compassionate programme, please visit emms.org/everygirl.

Dan Munday is an Adviser in Palliative Care to International Nepal Fellowship and Honorary Senior Clinical Lecturer, Primary Palliative Care Research Group, University of Edinburgh. This is reprinted with kind permission from CMF Blogs.

In this short post, I reflect on some lessons from nations that seem to have done well, in supporting their church-run and other mission institutions. These reflections are based on stories I have heard from some of the founders of national hospital associations and trying to draw some principles from these stories.

This is in no way comprehensive and complete but is written in the hope that some of the issues raised might stimulate more questions and ongoing reflections within ICMDA and its member organisations. I have not given many references as we do not yet have data to prove all that is written. So, these might look anecdotal and nebulous, but I hope will be the start of asking further questions on these assumptions or observations.

Many southern continent nations have had large numbers of MHs started by international mission agencies (IMAs). Most of them started in late 19^th century or early 20^th century. This was during the large cross-cultural missionary movement of those decades.

Most nations currently are facing or have already faced reduction in the numbers of such institutions, expect for a few well-run ones. These exceptions do well due to specific teams or support systems. But in the midst of such a global decline, there are signs that in some regions or nations, there is still life and energy. What are some of the reasons for such ongoing life and energy, what are some of those systems, processes and directions that make these locations different?

I want to look at six themes or directions that might have contributed to such a difference.

1. National Hospital Associations

Nations that have seem to do well are those who have been able to build and strengthen National Hospital Associations which are owned and led by national leaders.

We see such examples in South Asia and some African nations. In these nations, IMAs recognised the need of moving from focusing on running their institutions to playing a facilitatory role. Some IMAs even gave up their institutions to national organisations for a greater purpose of building and strengthening national hospital associations. There are stories of missionaries who gave up their positions and roles and travelled all over the nation to encourage mission institutions to come together and support the formation of National Hospital Associations and support the national ownership and running of such associations.

RW, a well settled CT surgeon in the most prestigious institution in the nation, gave up his position, travelled all over the nation where he was a missionary, to understand the context that was emerging in MHs. He met with the church leadership of that nation and challenged them to form a health care association that would run and manage the potentially closing MHs.

2. Christian Medical and Dental Associations

Many of these nations did not have a strong Christian Medical or Dental fellowship or organisation, at the time when hospital associations were formed. Where there were strong CMDAs or CMFs or where such groups were established alongside, and where the CMDAs or CMFs and hospital associations have held hands to support each other and grow together the MHs have done well. This was very evident again in South Asia and some other African nations.

FG, a professor of surgery and a missionary, took five years leave and travelled across the nation he had come to adopt as his own, challenging national young doctors to form a new CMDA for the nation.

3. Handing over control to health professionals

In many contexts and locations, the institutionalised church that did not have the know-how of running complex medical institutions, ended up managing these institutions not too well. But where the church and mission agencies gave control to trained healthcare and management professionals to run MHs, institutions seem to have done better. These people were those who can strategise and plan to take institutions forward.

4. Leadership development

Where proactive leadership development was a focus, national hospital associations have done well. Where senior and second line leadership has been built intentionally, there is still a cadre of leaders who provide leadership from the front. In some nations IMAs focused on this as their strategy of transition. Some nations like India were privileged to have IMAs who built Christian Medical colleges which played a major role in leadership development. In other nations national CMDAs or CMFs have proactively focused on leadership development, and built a cadre of trained professionals who are willing to take the leadership of institutions.

HS, a missionary family practitioner, in a MH, spent one year, traveling to all the medical schools and major towns and cities, meeting with young consultants and faculty, challenging them to move into MHs and take responsibility for these institutions. He gave up his position and role to focus on the bigger picture of the nation.  

5. Ongoing mentoring

Supporting and motivating these young leaders and journeying with them is key if these leaders must take institutions forward. Where ongoing mentoring support is provided to these leaders who have taken up responsibility and such systems and process have been set up, MHs seem to have done well.

6. Good governance

Studies have shown that in addition to HR, the other factors that influence MH sustainability are Governance and Hospital Management systems, (finance, material, human resources, quality statutory etc). David Stevens has addressed this well in his webinar. Those institutions that are doing well are those where such issues have been proactively addressed.  

The way forward

There will be many other issues like professional training and financial support. But one thing that stands out in all these contexts that are well doing are that there was a proactive and engaged leadership. COVID-19 had taught us that in locations where such leadership exists, institutions engage effectively.

How can we understand some of these issues better? What other factors are important? How can we start supporting MHs in nations where ICMDA has its presence?

Responses and reflections from the ICMDA family are invited.

Santhosh Mathew is ICMDA Head of Training and South Asia Regional Secretary

I was leading a discussion group for medical students when one of them asked these questions. At first, her line of reasoning seemed logical. If the most important question of our lives here on earth is the eternal destination of our soul, then why do medics spend their time healing bodies when those bodies only get ill again and eventually die? Why spend six years at medical school and countless years practising medicine if our bodies are destined to become nothing but dust when we depart this world? Surely, if we take our faith seriously, then we should all be evangelists and spend our energies on saving souls for heaven? Would this student be right to give up medicine and become an evangelist? Well not necessarily, if we understand what the Bible really says about ‘heaven’ and the life to come.

We often think of heaven as a place where God and Jesus live and where the non-material part of us, our soul or spirit, goes when we die. Many Christians believe that at the end of time, when Jesus returns, he will destroy the sin-infected material world and take the souls of the righteous to be with him in heaven. In this understanding, the purpose of the Christian life is to save as many souls as possible for this heavenly bliss, and the main question that the gospel answers is ‘how do I get to heaven when I die?’

But if we explore the Bible, we see that the idea of heaven as an escape route from earth is a reduction of the full gospel of Jesus Christ. It owes more to a Neoplatonic dualistic worldview,¹ in which evil matter and good spirit are in opposition to one another, than it does to the witness of the Christian Scriptures.

In his letter to the Ephesians, Paul doesn’t say that God’s will is to save souls for a spiritual heaven, but rather to ‘bring unity to all things in heaven and on earth under Christ’ (Ephesians 1:10). The Christian story begins in Genesis with the goodness of the created physical world and of human bodies (Genesis 1:31), and it ends not with the destruction of the earth and an escape into heaven, but with a renewed heaven and a renewed earth² (Revelation 21:1-5).

The story of grace told in the Bible is of a loving God who does not give up on his creation or on humanity. Even though what God intended has been marred and twisted by human sin, God’s work in salvation history is not to destroy the creation he loves, but to redeem it. As Paul puts it, ‘the whole creation has been groaning’ as it waits to be ‘liberated from its bondage to decay and brought into the freedom and glory of the children of God’ (Romans 8:21-22). We too groan as we suffer the sicknesses, diseases and death that mark this fallen world. But God’s answer to this groaning is not an escape into an otherworldly paradise but to bring about the restoration of his creation, including our physical bodies. We see this clearly in the healing miracles that Jesus performed in his earthly ministry.

When Jesus first began to preach, his key message was: ‘Repent, for the kingdom of heaven has come near’ (Matthew 4:17). His message was not about escaping into another world but about the kingdom of heaven coming to this world. And the first signs of this kingdom were his healing miracles. Outcasts with leprosy were restored to health (Luke 5:12-16), a man so violent that he had to be constrained by chains was returned to his right mind (Luke 8:26-39), a dead girl was brought back to life and a man born blind could see for the first time (John 9:1-12). These were no counterfeit miracles of a confidence-trickster. These were miracles that required complete re-creation of a broken and fallen world. Only the re-creative power of heaven could re-wire a visual cortex that had never received neural input so that it could see again and bring cells that had ceased to function back to life. However, it was Jesus’ resurrection that really convinced the disciples that Jesus had not come to provide a spiritual escape into heaven but to bring the restoring power of heaven to earth.

When the disciples first encountered the risen Christ after his crucifixion, they assumed he was a ghost, a disembodied spirit (Luke 24:37). But Jesus encouraged them to touch him and even ate some fried fish to prove that he still had a body (Luke 24:36-43). When he ascended into heaven, he did not leave his body behind on the hillside, but took it with him (Acts 1:9-11). And when Jesus comes to earth again it will not be to take our souls to heaven but to resurrect us, body and soul (1 Corinthians 15:12-19) so that we can live in a renewed heaven and earth. This is why the earliest confessions of the Christian faith has always affirmed belief in ‘the resurrection of the body’.³

So when, as medics, we care for bodies, just as when an ecologist cares for the natural world, we are not wasting our time. Rather we are participating in God’s work of restoring his creation. Being a doctor is not a secular occupation while the really spiritual calling is to be a full-time evangelist. Of course, telling people the gospel is vitally important because they need to know about the forgiveness and new life that God offers through Jesus Christ. But caring for bodies is to participate in the hope of this new life just as much as evangelising.

When we care for bodies we proclaim the uniquely Christian hope that God is bringing his kingdom of heaven to heal and restore the earth, not to destroy it. The gospel is a lot bigger than just saving individual souls for heaven. The work of God, in and through Jesus Christ and his church, is to save whole human beings, whole cultures, and the whole of human history, for the glorious joy of his new creation.

¹Neoplatonic philosophy arose in the third and fourth centuries AD and taught a basic division between pure spirit and sinful matter. It influenced some sections of the early church to interpret Christian faith in a similar dualistic direction.

²The Greek for ‘new’ in Revelation 21:1 is ‘kainos’, which describes something that has been renewed or made new again, rather than something brand new.

³This statement is found in the Apostles’ Creed, one of the earliest statements of Christian belief which dates from at least the fourth century AD, although what it teaches goes right back to the writings of the early Church Fathers, the apostles and the Bible itself.

Dr James Paul is the director of the English branch of L’Abri Fellowship. Previously, he practised as a doctor in London, UK, specialising in hospice care for the terminally ill.

If you want to think more about heaven (and earth) Dr James Paul’s book What on Earth is Heaven? is published by IVP on 18 February 2021 and is available at IVPbooks.com and on Amazon. In it he explores what the Bible has to say about questions such as:

• What is heaven?
• Where is heaven?
• Why can’t science find heaven?
• What happens to us after we die?
• What does heaven have to do with our lives now on earth?

Dr Paul is also speaking at an ICMDA webinar on 4 March 2021, click here to register for this free event.

The 9th of November this year marked the 31st anniversary of the fall of the Berlin Wall. I can still remember watching in excited incredulity as the TV news showed pictures of jubilant Berliners hacking at the concrete structure with hammers and pick axes, and friends and family members from both sides joyfully embracing as the confused East German guards looked on in passive discomfort. It became one of the iconic moments of the 20th Century, ushering in what was (in hindsight over optimistically) called the ‘New World Order’. At least for a while, the old order of things seemed to be swept away, as Communism folded across Eastern Europe and many opportunities for peaceful new relationships opened up.

It was as a direct consequence of this momentous event that PRIME was born. Because the opening of Eastern Europe allowed travel to and from many formerly isolated countries with few restrictions, Romanian health care professionals were able to travel to the UK to participate in ‘Doctor’s Dilemmas’ courses run by those who would go on to become the founding fathers of PRIME. It was the Romanian colleagues asking ‘why don’t you come to Romania to run courses like this?’ that led to the PRIME mission of teaching holistic, compassionate, Christian values based health care in a way that is acceptable to those of all faiths and none, all over the world.

It is strikingly appropriate that the falling of a wall should have led to the birth of PRIME, because the PRIME vision is all about the removing of the walls and barriers that we as health care professionals perhaps unconsciously raise inside ourselves, seeing patients, juniors, students, different categories of health professionals as ‘others’ and somehow different from ourselves, so not worthy of the same consideration and respect. This problem of ‘othering’ is of course a deep-seated tendency in all human beings and what leads to the inappropriate building of walls in the first place. PRIME’s message, following the example and teaching of Jesus, is that there is no ‘other’ – we all bear the image of God our creator and He loves us unconditionally, no matter what walls we may try to build to separate us from Him and other human beings. It is this wall destroying message that PRIME seeks to impart to all health professionals, hopefully leading by deed as well as word.

It was the imagination and determination of the people in East Germany, (the overcoming of the walls inside themselves that said this couldn’t happen, in which Christian churches with their non-violent demonstrations and prayer played no small part), that led to the ultimate fall of the actual concrete wall that contained them, and enabled them to gain their freedom. So, we as health professionals today can play our part in overcoming the barriers that separate us from ‘others’ by showing that all people are the same in God’s sight by how we treat them. Who knows what more concrete walls may fall around our divided world if we all play our part in this way?

Huw Morgan is a retired GP, Training Programme Director and Medical Missionary, and PRIME Management Team member.  PRIME, a close partner of ICMDA, is an international network of professional healthcare educators, committed to integrating rigorous science and compassionate care for the whole person. This article first appeared in the PRIME newsletter and is republished here by kind permission of PRIME.

In recognition of her committed service, the Dr Shane Sam Mathew Memorial ICMDA Medical Missionary Award for 2020 was given to Dr Camy Thomas at the South Asia Regional Online Conference.

Dr Camy Thomas, is a graduate of Christian Dental College (CMC) Ludhiana, from the batch of 2007. She is the daughter of Mr Thomas Jose, a retired Bank manager and Mrs Cathy Thomas, a school teacher and has a younger sister, Candy Catherine Thomas who is doing her masters in English Literature. Camy was raised in New Delhi and did her schooling in Carmel Convent School.

Camy’s faith was informed in her Catholic upbringing and molded deeply in EU, UESI meetings at college. As a child, she was drawn to Jesus, the beauty in the Word, the truth in many hymns and the stories of many a saint. Mother Theresa was one of her earliest inspirations, along with some priests and nuns who lived lives of service to the poorest and neediest. The focus of the church on the suffering and less privileged and the introduction to the poverty of rural India by the stories told to her by many families of domestic helps left a lasting impression on her. She found herself drawn to the medical profession and envisioned working in the neediest areas.

In her first year of College, she was introduced to Christians from many denominations and was inspired by some of her classmates, seniors and professors who invested in her spiritual formation. It was in one of the Discipleship Training Camps of EU that the fullness of the crucified and resurrected Christ first dawned on her as she came to an understanding of the amazing grace of forgiveness and mercy in the everlasting love of God for man. The scores of missionary doctors and mission workers who shared their lives and stories at the EU meetings continued to shape her longing to use the skills she was acquiring where the need was most. She found herself being drawn to Odisha and Africa specifically.

The desire to work in rural India was fulfilled when she was posted by her college in Uttaraula, UP and then for her rural obligation in Christian Hospital Bissamcuttack in South Odisha. She came back to Delhi rather grudgingly, to work in private practice for a month where she was able to pick up important skills that God in His wisdom knew would help her run a practice independently. She then took a break from dentistry and found an opportunity to work with Emmanuel Hospital Association in Kashmir in the aftermath of the 2014 Kashmir floods in Anantnag as an Advocacy Coordinator for the Disabled in Disasters. From 2015–2018 she worked in an Urban poor clinic in central Delhi where she was able to serve people from all strata of society. This experience sharpened her clinical and relational skills.

In 2017, Dr Prerit Thomas Jacob’s (Missionary surgeon at Khariar, Odisha) and Dr Shane Sam Mathew’s (Missionary Dentist at Ganta, Liberia) passing to the eternal home while in their mission places, put things in perspective for Camy. One was a senior she was greatly inspired by and the other a junior who she fondly adored.

A quote from the life of Corrie Ten boom helped her focus on Christ. “There are no ‘ifs’ in God’s world. And no places that are safer than other places. The centre of His will is our only safety – let us pray that we may always know it!” It took a moment of deep surrendering of her will to God’s will and a re-establishing of God as head of her life when the doors to serve in the Highlands of Papua New Guinea (in Oceania, far away from Africa!) in Kompiam District Hospital, Enga Province were opened through the visionary-missionaries: Dr Abi M Thomas (Principal, CDC), Dr Varghese Philip (Mission Aviation Fellowship), Dr Sheena Li (Samaritan’s Purse) and Dr David Mills (Kompiam, PNG) .They shared with her the need for dental services and for establishing the second International Mission outreach of a Christian Dental College after Liberia.

Camy is learning to see through Christ’s eyes and serve as Christ did when she is not overcome with herself on some days. To witness God’s redemption story, in Christ through the moving of the Holy Spirit especially in unreached and unheard parts of the world, fills her with humble awe and gratitude for God’s immense love even as the world groans in brokenness in the now.

Follow God’s example, therefore, as dearly loved children and walk in the way of love,
just as Christ loved us and gave himself up for us as a fragrant offering and sacrifice to God.
Ephesians 5:1-2

For more information about the Shane Memorial Medical Missionary Award, visit icmda.net/smmmaward