Miracles of healing such as those reported in the Gospels – blind people seeing, the mute speaking, the deaf hearing, the lame walking (eg Matthew 15:30-31) – are regarded as supernatural manifestations of God’s power through his Son Jesus Christ and the apostles, during a special foundational era of the Christian church, and are not expected to occur in the present day.

The emphasis placed on the ministry of healing by more exuberant segments of Christianity, sometimes involving rather unusual practices, together with the lack of clinical confirmation of many alleged healings and miracles, has also contributed to the discrediting of this ecclesial ministry.

What Does the Bible Say?

There is no biblical basis for the belief, present in many churches, that the healing of the sick is a rare event and that the ministry of healing and deliverance is unjustified in contemporary society, which is more educated and informed, and has easier access to healthcare services.

Healing is part of God’s character. In Exodus 15:26 the Lord is called Rapha, the One who heals. In Psalm 103:3 we read: ‘who forgives all your iniquity, who heals all your diseases.’ Since his character is eternal and unchanging, this attribute remains present today, and was further enhanced after the coming of Christ and the descent of the Holy Spirit.

In the four Gospels we find reference to 41 healings (or moments of healing) performed by Jesus, which certainly represent only a fraction of those he carried out (cf John 21:25). At the beginning of his public ministry, in the synagogue of Nazareth, Jesus read from the book of Isaiah (61:1-2): ‘The Spirit of the Lord is upon me, because he has anointed me to preach good news to the poor. He has sent me to heal the broken-hearted, to proclaim freedom to the captives and recovery of sight to the blind, to set the oppressed free, to proclaim the year of the Lord’s favour.’ (Luke 4:18-19) These words were fully fulfilled in the life of Christ and represent a synthesis of the Lord’s mission (cf Luke 4:21; Acts 10:38).

For some theologians, Christ’s death on Calvary provides not only salvation for all who believe in him but also physical healing. In the messianic prophecy of Isaiah 53:5 we read that ‘by his wounds we are healed’. Indeed, the word “salvation” (sozo in Greek), in its original etymological sense, includes both the forgiveness of sins and the healing of diseases (cf Mark 2:9-11).

The Lord Jesus commissioned his disciples (Matthew 10:1), and later the seventy, to heal the sick and cast out demons (Luke 10:9), making it clear that ‘whoever believes in me will also do the works that I do; and greater works than these will he do, because I am going to the Father’ (John 14:12). After Pentecost, the ministry of healing and deliverance continued to be exercised by the apostles and the first believers, as we read in this account from the book of Acts: ‘They carried the sick out into the streets and laid them on beds and mats, so that at least Peter’s shadow might fall on some of them as he passed by. Crowds also gathered from the towns around Jerusalem, bringing the sick and those tormented by impure spirits, and all of them were healed’ (Acts 5:15-16). However, it was not only the apostles who performed healings and miracles in the name of Jesus. When the apostle Paul lost his sight on the road to Damascus, God called a believer from that city named Ananias to lay his hands on Paul so that he might see again and be filled with the Holy Spirit (Acts 9:17).

We should also reject the idea that illness is a cross that, as Christians, we must bear. Biblical texts that present a positive view of suffering associate it with persecution and tribulations related to the proclamation of the gospel, and not with illness (eg Romans 12:12).

It is true that in the first-century church there are recorded cases in which healing did not occur, such as Epaphroditus (Philippians 2:25-27), Timothy (1 Timothy 5:23), and Trophimus (2 Timothy 4:20). The apostle Paul himself refers to a ‘thorn in the flesh’ (2 Corinthians 12:7), which we do not know whether it was physical, mental, or spiritual in nature, although it is quite likely that he suffered from vision problems (cf Galatians 4:15; 6:11). Only in eternity will we have a full understanding of these matters (1 Corinthians 13:12), but one possible explanation for not experiencing the full manifestation of God’s power on this side of eternity, and for the many failures in prayers for healing, is that the prince of this world and the forces of evil remain active in opposition to the plans of the Lord and the Church. For this reason, we await with expectation the day when Satan and his angels will be destroyed and there will be no more death, disease or suffering (Revelation 12:9-10; 21:3-4).

Conclusion

The extraordinary scientific and technological advances of recent decades in the field of biomedicine have contributed to improved health and increased life expectancy worldwide. We should be grateful to God for this and value the dedicated work of healthcare professionals, many of whom are Christians.

Whenever we make use of healthcare services, we should not feel guilty, as if we were demonstrating a lack of faith, because high-quality healthcare – preferably delivered in a compassionate and humane manner – is a gift from God. However, we must not neglect the spiritual resources to which we have access as children of God, including healing from illness and health problems, whether physical or mental.

God heals today, as he has always healed throughout history, but this fundamental biblical doctrine lay dormant for centuries. In recent years, under the influence of the Pentecostal and charismatic movement, which is open to the supernatural work of the Holy Spirit and the exercise of spiritual gifts, it has been rediscovered by a growing number of Christians around the world, from all denominations.

Having myself experienced God’s healing power in my own life and in the lives of people I know well, I am fully convinced that the time has come for churches that call themselves Christian to fully fulfil their responsibility and mission to pray with confidence and expectation for the healing of the sick. Otherwise, they will not be faithful to the Lord’s mandate: ‘Go into all the world and preach the gospel to every creature. Whoever believes and is baptised will be saved, but whoever does not believe will be condemned. And these signs will accompany those who believe: in my name they will cast out demons; they will speak in new tongues; they will pick up serpents; and if they drink any deadly thing, it will not hurt them; they will lay hands on the sick, and they will recover.’ (Mark 16:16–18)

References

Brown, C. G. (2011). Global Pentecostal and Charismatic Healing. Oxford University Press.

Clark, R. (2015). Power to Heal: Keys to activating God’s Healing power in your life. Destiny Image.

Keener, C. S. (2021). Miracles Today: The supernatural work of God in the modern world. Baker Academic.

Johnson, B.; Clark, R. (2011). The Essential Guide to Healing: Equipping all Christians to pray for the sick. Chosen Books.

Raichur, A. (2023). Ministering Healing and Deliverance: Every believer can do this! All Peoples Church & World Outreach.

Trachsel, J.L. (2023). Moving in Miracles & Healing: A supernatural handbook. Destiny Image.

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

In my many years of travelling to different countries and teaching with PRIME, I along with many other tutors frequently used a few simple questions in the ‘Whole Person Care’ and ‘Teaching to change Hearts’ courses that constituted some of the core PRIME material.

There is nothing new in this as a teaching technique, of course. It is generally regarded as having been initiated by Socrates some 400 years BC, and was certainly used extensively by Jesus as the Gospel accounts make clear. Asking the right questions opens avenues of awareness and insight that can be powerful stimulants of learning. One of our favourites was:

What are the characteristics of a healthcare professional
you would want to see if you were seeking help when unwell?

Wherever we were in the world, the answers usually described pretty much the same qualities. These included: compassion, availability, competence, a clear communicator, kindness, non-judgemental, a holistic approach, adequate time, a good listener, inspiring trust and hope.

Why should these vary so little between countries and cultures? It is surely that they describe the best of human qualities that should be the foundation of any personal and societal relationships. They are core human values that reveal the image of God in all people, no matter their racial, ethnic or religious backgrounds, and no matter whether they are aware of the Divine within them or not. Sometimes we might ask a further question in plenary after small-group feedback:

Who can you think of in history
who showed these characteristics as a healer?

Most groups would say ‘Jesus’, generally an acceptable role-model to atheists and prophet to our Muslim friends. Simple questions, not just helping healthcare professionals reflect on their values and practice, but potentially developing awareness of the Divine image in which they and their patients are made.

Another useful question under the general aim of resourcing oneself for compassion is:

What helps make you be more compassionate,
and what hinders your compassion?

Replies to this vary much more than to the questions above as they depend more on people’s circumstances and background cultures. However there are some themes which transcend culture, such as enjoying nature, exercise, listening to music, reading good literature and time with friends/family. Also in my experience it would be unusual for at least one person in the group not to say, ‘prayer’ or ‘meditation’, into which further enquiry as to what these look like to the individual citing them may
result in useful and illuminating discussion. So once again, the opening of channels of spiritual awareness
can be facilitated by questions about day-to-day practice and resilience.

Towards the end of the programme we generally had a question like: what are you going to do differently as a result of this course? It is important to get course participants to commit to changed attitudes and behaviour where these have been facilitated by the learning experience. Jesus always emphasised in his teaching (and of course in his behaviour) the need for practical outworking of his words and this question helps learners to focus and commit to particular courses of action.

It is an established tenet of higher education that questions may be more important than the answers
(because they can open the mind and heart to new perspectives and attitudes). Correctly framed, simple
questions can also raise peoples awareness of the Divine within themselves and others, and point to the one ultimate source of compassion in all the universe.

Do you have favourite PRIME questions?

Republished with permission from PRiME Partnerships in International Medical Education.

What is mental health?

The World Health Organization has defined mental health as a ‘state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’. Mental health is not just the absence of mental illness; it is associated with one’s well-being, capacity to love, work, relate to others, and find meaning in life.

Mental illnesses can interfere with thinking, perception of reality, and mood, differing from common emotions such as sadness or fear that anyone can experience in their life. They are often caused by a combination of biological, psychological, and social factors and can affect people of all ages, gender, and ethnicity, causing significant suffering to the patient, their family, and the community. Mental illnesses are highly prevalent worldwide, contributing to high rates of absenteeism and early retirement.

The most common mental illnesses globally include anxiety, depression, and those related to alcohol abuse and other dependencies. More severe mental illnesses, although less frequent, include schizophrenia, bipolar disorder, and eating disorders such as anorexia nervosa or bulimia, which may require psychiatric hospitalisation. However, a significant number of people with mental illnesses do not seek help from healthcare services, leading to undiagnosed and untreated cases.

What does the Bible say?

The Word of God acknowledges the influence of the mind on the body. For example, Proverbs 17:22 states, ‘A cheerful heart is good medicine, but a crushed spirit dries up the bones’ (NIV). King David wrote several Psalms expressing his moods, some of which reveal periods of depression (Psalms 22, 31, 42, 88). The prophet Jeremiah, who experienced the destruction of Jerusalem and the Temple by the Babylonians, also expressed emotional distress (Lamentations 3:1-2, 6-8, 17-18). However, diagnosing clinical depression in these cases lacks sufficient data, despite depression being one of the most common mental illnesses.

Mental illness, referred to in the Bible as ‘madness,’ was considered a consequence of the disobedience of the Jewish people to God’s will (Deuteronomy 28:28, 34). King David once pretended to be mad to save his life (1 Samuel 21:12-15), but the biblical character most associated with mental disturbance is King Saul. His emotional instability, insecurity, anxiety, anger outbursts, and phases of euphoria and depression resemble patients with bipolar disorder (eg, 1 Samuel 18 and onwards). However, it seems more appropriate to consider Saul’s behaviour as a result of character flaws and disobedience to God, primarily of a spiritual nature.

King Nebuchadnezzar of Babylon experienced a phase of madness, behaving like an animal—a rare mental illness known as boanthropy, where the patient believes he is a cow or an ox. In this case, his illness was considered a consequence of God’s punishment for his pride and arrogance, eventually leading to his recognition and praise of the true God (Daniel 4:29-37).

Scriptures also mention occasions when great men of God like Moses, Job, Elijah, and Jonah expressed a desire to die. Prophet Elijah faced profound discouragement and despair when threatened by the wicked Queen Jezebel after defeating and exterminating the prophets of Baal. Divine intervention, promoting rest, food, and hydration, remains a valid therapy in such situations (1 Kings 19:1-8).

Risk factors, protective factors, and warning signs

Several risk factors contribute to mental and behavioural disorders, such as easy access to drugs, alcohol, and gambling; isolation and alienation; exposure to violence, aggression, or trauma; work-related stress or life events (such as death of loved ones); bullying; peer rejection; unemployment; social inequalities (individuals with lower incomes and less education are more predisposed to mental illnesses); lack of social skills; child abuse or neglect; emotional immaturity and lack of control; chronic insomnia; interpersonal conflicts; economic insecurity; loneliness; pathological grief.

Protective factors include positive social interactions, social participation (especially in recreational, cultural, and sports activities), social tolerance, social support of family and friends, good self-esteem, the ability to cope with stress, autonomy, adaptability, mental health literacy, physical exercise and sports, positive parent-child interaction, cognitive stimulation from birth to old age, engaging in enjoyable activities, problem-solving skills, awareness of the meaning of life, knowing God and maintaining an intimate relationship with the Lord.

Some warning signs indicating compromised mental health include sleep-related problems, constant anxiety or tension, mood swings, irritability, withdrawal from people and activities, memory problems, lack of motivation and will, deep sadness and hopelessness, impulsivity, increased alcohol or drug consumption, reduced performance at work or studies.

There is a clear stigma associated with mental illness, which remains a taboo subject, even among Christians. Acknowledging a mental health issue and seeking help from a psychologist or psychiatrist often requires courage and determination, but it may be the only way to diagnose the problem correctly and initiate appropriate treatment for a quick and complete recovery.

How to develop mental health

There are several ways to develop mental health and prevent psychological suffering, including:

• Adopting a healthy lifestyle, including a varied diet low in carbohydrates, regular physical activity, good sleep habits, and avoiding the consumption of alcohol, and tobacco.
• Coping with stress by engaging in activities that bring pleasure and well-being.
• Cultivating positive social relationships by investing time in building healthy relationships and reducing exposure to social media.
• Maintaining a healthy balance between work and personal/family life.
• Developing all dimensions of human existence—physical, mental, social, and spiritual, the latter being related to the meaning of life.
• Seeking professional help when necessary, especially when warning signs are present.
• Forgiving those who have offended, harmed, or mistreated us is undoubtedly one of the most important aspects.

The medicine of forgiveness

Forgiving does not mean forgetting, tolerating, or excusing harmful or abusive behaviours. It is a conscious and voluntary decision, often challenging, resulting in acceptance, inner healing, and emotional liberation. Jesus said, ‘Do not judge, and you will not be judged. Do not condemn, and you will not be condemned. Forgive, and you will be forgiven’ (Luke 6:37). The Lord himself set a sublime example of forgiveness. When facing agonising and unimaginable suffering on the cross, he prayed, ‘Father, forgive them, for they do not know what they are doing’ (Luke 23:24).

Bishop Desmond Tutu (1931-2021), who chaired the Truth and Reconciliation Commission in South Africa, established to investigate human rights violations during the Apartheid era, wrote: ‘Until we can forgive the person who harmed us, that person will hold the keys to our happiness, that person will be our jailor. When we forgive, we take back control of our own fate and our feelings. We become our own liberator.’

Forgiveness does not erase the past, but it prevents negative experiences from poisoning our future. It reconciles us with the past and demonstrates trust in God regarding the future.

Perhaps the greatest motivation for us to forgive is our personal experience of having been forgiven by God and being aware of the need to receive forgiveness for the harm that we, consciously or unconsciously, have done to others (Matthew 6:12).

References

Beer, M. Dominic & Pocock, Nigel D. (Eds). Mad, Bad or Sad? A Christian approach to antisocial behaviour and mental disorders. Christian Medical Fellowship, London, 2006.

Nervous and Mental Diseases. In: Douglas, J. D. & Tenney, Merril C. Zondervan Illustrated Bible Dictionary. Zondervan, Michigan, 2011.

Toussaint, Loren L. & Worthington, Everett L. & Williams, David R. (Eds). Forgiveness and Health: Scientific Evidence and Theories Relating Forgiveness to Better Health. Springer: Dordrecht, The Netherlands, 2015.

Tutu, Desmond & Tuto, Mpho. The Book of Forgiveness. HarperOne: San Francisco, 2014.

Winter, Richard. When Life Goes Dark: Finding hope in the midst of depression. InterVarsity Press, Illinois, 2012.

On the one hand there are those who view it in a totally positive light and see it helping to improve the lives of millions of people as its applications (particularly perhaps medical ones) grow and make life easier and safer. On the other hand are those who see it as a clear and present danger to human existence, with the possibility of an ‘extinction event’ occurring in the not too distant future. An article in a recent edition of the British Medical Journal Global Health¹ helps to clarify the issues in non-technical language.    

The authors suggest there are three categories of   threat to human health and well-being from the misuse of AI. Firstly there is the threat to democracy, liberty and privacy. The enhanced ability to process vast amounts of data, develop targeting and mis-information and implement-enhanced systems of surveillance could lead to increased societal divisions and entrenchment of inequalities.

Secondly there are threats to peace and safety caused by the ability to develop and deploy lethal autonomous weapon systems (LAWS) that have enhanced lethal capacity together with dehumanisation of use of lethal force.

Thirdly there is the threat to human work and livelihoods as a result of large-scale replacement of work and employment through AI driven automation. The subsequent health outcomes from widespread unemployment are likely to be increasingly adverse for physical, mental and spiritual health worldwide.² 

We also face the existential threat of the emergence of self-improving Artificial General Intelligence (AGI). This could augment all the problems listed above, disrupt systems we depend on, use up resources we depend on and ultimately attack or subjugate humans.

Apparently the simplistic ‘couldn’t we just turn them off’ solution isn’t tenable – by the time they were an obvious threat we could be too dependent on the continued functioning of multiple networked AI and AGI systems to survive without them.

Another area for concern is how interaction with intelligent machines may affect the emotional development of children.³ Research by Kate Darling⁴ indicates that children who grow up interacting and playing with robotic pets are well aware that the robots are not alive, but they understand them as being ‘alive enough’ to be a companion or a friend. It seems many children develop a new category – or new way of thinking – about their robotic toys.

As one group of researchers wrote: “It may well be that a generational shift occurs wherein those children who grow up knowing and interacting with life-like robots will understand them in fundamentally different ways from previous generations.” ⁵ In other words, how might human relationships become distorted in the future if children increasingly learn about the meaning of love and intimacy from their interactions with machines?

So how do we respond to all this? It is good to remind ourselves that we are all created in God’s image, and that human creativity, imagination, the ability to do science and medicine and develop useful technology like AI all result from our God-given capacity. Unfortunately of course we are not perfect, so the freedom God has given us allows us to do harm as well as good. Our capacity for self-delusion and arrogant pride can also stop us seeing the potentially destructive consequences of what  we may create. 

We face the age-old dilemma of should we do or create something just because we can. History suggests that we almost always choose to do first and only consider the necessary ethical behavioural constraints later. It seems to me that with AGI there must be international monitoring and agreement about boundaries and precautions to limit and control the development of this technology which we are only beginning to grapple with. We need to lobby our elected representatives to press for the setting up of an international AI/AGI monitoring body. This is perhaps especially needed from those of us living in the UK, as our current Prime Minister wants to establish the UK as a key development hub for AI development and regulation.⁵

We can I think take some encouragement from the nuclear industry, where we have an immensely powerful technology that could be used for the destruction of mankind as well as for the (not without risk and problems) powering of electricity generating plants. Knowing the likely outcome, the nations of the world that have the capacity have managed by the grace of God not to use a nuclear bomb in war for the last 78 years. 

There are international agencies actively monitoring the production and use of nuclear materials. Surely we urgently need the same for AI, to ensure we can reap the benefits of this technology whilst minimising the risks and harms. Unfortunately AGI may prove much harder to control than nuclear power, but it is a challenge that as God’s vice-regents on Earth we cannot afford not to meet. 

This post first appeared on the PRIME monthly international email. Reposted with permission.

Images – All images were created by PRIME’s PR & Communications Manager using AI with Vecstock.

References

1. https://gh.bmj.com/content/8/5/e010435
2. Religion as a social force in health: complexities and contradictions. BMJ 2023; 382 doi:      https://doi.org/10.1136/bmj-2023-076817  
3. https://www.johnwyatt.com/the-robot-revolution-is-comingbut-are-christians-ready/
4. http://gunkelweb.com/coms647/texts/darling_robot_rights.pdf
5. https://www.reuters.com/technology/uk-must-seize-opportunities-ai-remain-tech-capital-pm-sunak-2023-06-11/

Dr Huw Morgan is a retired GP Training Programme Director in Bristol, UK and a former PRIME Education Lead and Executive Member. This article is based on a previous personal blog post by Huw Morgan.

As one looks around and engages with people, one can see unhealthy preoccupations and callousness around health.

Physical Health

The first issue is an unhealthy preoccupation with physical health. The body is the temple of the spirit and should be taken care of. A healthy diet, reasonable exercise, and healthy habits are important, but there is a culture of preoccupation with the body as the center of life. This is evidenced by the increasing number of executive full-body checkups and full-body scans that people undergo on a regular basis, as well as a preoccupation with any minor changes that laboratory tests reveal. The average person may not realize that there is a huge industry that wants them as their trusted client.

There is also the health and nutritional supplement industry that promotes every new fad in town as the answer to all your health problems. Not to mention the increasing sales of the cosmetic industry and cosmetic medicine too. All of these contribute to an addictive preoccupation with physical health, to the extent that the body becomes an idol that one worships, and keeping the body healthy becomes the preoccupation around which their lives revolve. We should not forget that God is God, and our bodies are a temple of God that cannot replace God. Let us build our bodies to be that temple.

Emotional Health

The second preoccupation is with emotional health. Post-COVID, there is an epidemic of mental health challenges, and this needs to be understood. Many people are struggling with mental health issues, and it should not be taken lightly. Needed care and support should be provided.

At the same time, we should recognize that there is a bigger cultural change happening around us. Carl R. Trueman, in his excellent book “The Rise and Triumph of the Modern Self,” writes that the world and culture have moved from the era of idiotic man, political man, religious man, economic man, and now psychological man (and woman). In such a culture, emotions are the center of life. What we feel is who we believe we are. This is something one should be aware of. Our feelings are not who we are. Our identity and who we are go beyond what we feel, and being preoccupied with our feelings is unhealthy. We need to guard our hearts, which are the wellspring of life.

There is also a callous carelessness with which we engage our minds. We need to reflect on the health of our minds. We allow social media, Netflix, AI chat bots, and other information systems to influence our minds. Instead of engaging the mind with intellectually stimulating and life-building information and options, we fill the mind with garbage and junk.

False truths and manipulated information that the media puts out are what many people are occupied with. Garbage in, garbage out is true these days. The output from the average person becomes shallow and not intellectually sound or life-building. Our minds are meant to be transformed and renewed. For such transformation and renewal, we need to engage our minds with what is true, right, pure, and life-giving.

Relational Health

There is also callousness with which we consider community and our relational health. The community is primarily online and virtual in many circles. Even if it is otherwise, it is more about what I can get out of the community than how I can be a channel to build and encourage others.

As Foster says, ‘Superficiality is the curse of our age,’ and this is true for relationships too. We enjoy community and relationships but with boundaries that we set for ourselves. Vulnerability and openness are not part of our communities. We share only what we want to and keep those areas closed that might show us as weak. A true community is one of foot-washers, where we are willing to expose our dirty feet and allow them to be washed by each other. Let’s spur one another on and consider deeper engagement in our communities.

These preoccupations and callousness emerge from an area that we tend to neglect – the health of our soul. Nurturing and preserving the soul should be our priority. Proactively engaging in personal life disciplines that nurture the spirit is foundational for our physical, emotional, intellectual, and relational health. Growing in intimacy with God, who is the giver, protector, and preserver of our soul and spirit, is crucial.

Mathew Santhosh Thomas is ICMDA Regional Secretary for South Asia

Of the many challenges faced by foreign medical students, increased susceptibility to depression and anxiety disorders is the most prevalent (Ruzhenkova et al., 2020). Due to the high-demand and high-stress nature of studying medicine, medical students experience depression and anxiety disorders much more often compared to the general population. Given the added challenges that foreign medical students face being isolated outside their home country, these students are at an even higher risk of depression and anxiety disorders (Buzoianu et al., 2016; Machul et al., 2020). Personal stress, lack of support, language barriers, financial issues, different curriculum structure, and separation from loved ones are just some of the numerous risk factors foreign medical students must handle (Georgieva et al., 2017; Rashid et al., 2020). In addition, all of these issues contribute to the higher dropout rates and increased number of semesters required to complete a medical degree seen in foreign medical students, which only exacerbates the risk of depression and anxiety disorders even more (Huhn et al., 2015).

In a study by Henning et al. (2012) which focused on the quality of life of foreign and domestic medical students in New Zealand, researchers found that foreign medical students rated their social and environmental quality of life significantly lower than their domestic classmates. Notably, foreign medical students rated their level of satisfaction with their personal relationships and social support lower than domestic medical students. Foreign medical students also felt less safe and secure in the region they study in, had less opportunity for leisure activities, and had less access to information which would be helpful for their daily living, compared to domestic medical students.

A group of ICMDA members and volunteer researchers have begun a research project to explore the current context of foreign medical students around the world. The purpose of our research project is to understand the challenges faced by foreign medical students in order to determine how to better support these students. ICMDA organizations are present in the majority of countries who send or receive foreign medical students. With ICMDA’s reach across so many regions, there is an incredible opportunity at hand to coordinate reaching out and supporting foreign medical students in the ways they need it most. Awareness and understanding of the challenges foreign medical students face is crucial to propelling change. By understanding the challenges they face, initiatives can be put in place to address these challenges. Such a coordinated support could help many students and young graduates who are finding this phase of life difficult.

Our research group has put together two questionnaires – one for foreign medical students and graduates, and another for ICMDA fieldworkers and ICMDA national leaders. The links to the questionnaires have been emailed to the appropriate groups and will be open for completion until mid-October of 2022. These questionnaires are available in seven different languages. They include questions specific to the target audience with the overarching goal of gathering information about the current context and challenges faced by foreign medical students. If you are a foreign medical student, foreign medical graduate, ICMDA fieldworker, or ICMDA national leader, we strongly encourage you to complete our questionnaire through the links below to help us in our research.

Links to Foreign Medical Students & Graduates Questionnaire (by language):

• English
• Spanish
• French
• Portuguese
• Russian
• Arabic
• Chinese (Simplified)

Links to ICMDA Fieldworkers & ICMDA National Leaders Questionnaire (by language):

• English
• Spanish
• French
• Portuguese
• Russian
• Arabic
• Chinese (Simplified)

Additionally, members of our research group are in the process of interviewing foreign medical students, foreign medical graduates, ICMDA fieldworkers, and ICMDA national leaders to listen to their personal experiences and wealth of knowledge on the subject. By speaking to these individuals, we are also learning about the current supports in place and which supports would be beneficial for students in specific regions. If yourself or someone you know is interested in being interviewed for this research project, please reach out to Dr Santhosh Mathew to get more information.

Our heart for this research project is that no foreign medical student would struggle alone. Studying medicine is an extremely difficult and demanding period of one’s life, and journeying through those years in a foreign country adds countless challenges. Please stay tuned for the publishing of our findings in the coming months. We pray that this research project would ultimately bring Christ glory and empower organizations to strengthen foreign medical students all over the world.

References:

• Buzoianu, A. D. et al. (2016) ‘Correlates of depression, anxiety and stress among foreign medical students studying general medicine in Romania.’, European Psychiatry, 33.
• Georgieva, L. et al. (2017) ‘Environment for the immigrant medical staff and foreign medical students in Bulgaria’, European Journal of Public Health, 27(suppl_3). doi: 10.1093/eurpub/ckx186.139.
• Henning, M. A. et al. (2012) ‘Quality of life: international and domestic students studying medicine in New Zealand.’ Perspectives on Medical Education, 1(3). doi: 10.1007/s40037-012-0019-y
• Huhn, D. et al. (2015) ‘International medical students – a survey of perceived challenges and established support services at medical faculties’, GMS Zeitschrift fur Medizinische Ausbildung, 32(1). doi: 10.3205/zma000951.
• Machul, M. et al. (2020) ‘Lifestyle practices, satisfaction with life and the level of perceived stress of polish and foreign medical students studying in poland’, International Journal of Environmental Research and Public Health, 17(12). doi: 10.3390/ijerph17124445.
• Organisation for Economic Co-operation and Development (OECD) (2021) Health at a Glance 2021: OECD Indicators, OECD Publishing, OECD iLibrary.
• Organisation for Economic Co-operation and Development (OECD) (2019) Recent Trends in International Migration of Doctors, Nurses and Medical Students, OECD Publishing, OECD iLibrary.
• Rashid, M. A. et al. (2020) ‘“Doctor, teacher, translator:” International medical students’ experiences of clinical teaching on an English language undergraduate medical course in China’, Education for Health: Change in Learning and Practice, 33(1). doi: 10.4103/efh.EfH_212_19.
• Ruzhenkova, V. V. et al. (2020) ‘Prevalence and dynamics of depression and anxiety in local and foreign medical students for a 6-year training period’, International Journal of Early Childhood Special Education, 12(1). doi: 10.9756/INT-JECSE/V12I1.201044.

This picture did not come from a vacuum but from watching the head of the surgical unit where I was posted. We looked up to him with awe. He was our role model—a UK trained Fellow of the Royal College of Surgeons (FRCS), who wore a three-piece suit in the heat and humidity of South India. He was a phenomenally skilled surgeon who stood an imposing six feet tall.

A Change of Mind

Immediately after my graduation, I started work at a mission hospital in rural India. I met many doctors there, one of whom stood out. He was a surgeon who would ride a bicycle to work, wearing the traditional attire of khadi jubba and mundu, without any train of people following him. Initially, I did not pay much attention to him. But when I realised he was highly skilled and had a double FRCS, my perspective changed.

In conversations with him I learned he did not see himself primarily as a doctor, but a follower of Jesus who happened to be a well-trained surgeon. For a young doctor who had been brainwashed over 6 years of training to believe your identity is married to your profession, this was a paradigm breaking perspective. He considered all he had earned and received for his hard work as given to him by God. 

In every conversation, he displayed gratitude for being chosen and being given the skills, the profession, and the platform to care for others. I had studied hard and earned a degree on my own, so I was not used to considering it as a gift I had been given. But for him it was a privilege to give back to God by caring for those in pain.

An understanding of the gospel and his personal relationship with Jesus had transformed him to recognise he had been given a privilege to be part of Jesus’s own ministry in the world.

His posture confronted the reasons I joined the hospital. I joined healthcare thinking God needed my service and I had much to offer to God and the many whom I thought needed my help. I was realising the life of Jesus can transform me inwardly and the way I live outwardly in the world.

Being a healthcare practitioner and a follower of Christ can change our hearts, our reason for being in healthcare, our career choices and the way we carry out our professional practice.

A Change of Heart

A few years down the line I began working in a mission hospital in India. Most of my time was spent taking care of many with critical illness that needed my urgent attention. I had the opportunity to spend a few days with christians who were faithfully proclaiming and living out the gospel in difficult contexts. I saw the church growing vibrantly among a community that, just under a decade ago, was addicted to alcohol and had a long history of violence. The gospel was breaking through in power, with wonders and miracles.

I heard stories of many missionaries and church members who had died of Malaria in the field. I also had the privilege of caring for a missionary who was on her deathbed due to Malaria. The oldest member in that church community was 45 years old—the life expectancy there was less than 50.

There were women dying of childbirth every day, infants and children dying due to Malaria, TB and Kala Azar every other day. This was a church that was growing spiritually and flourishing but its members were dying of preventable illnesses.

I found this experience disturbing my heart and challenging my theology. From seeing the healthcare practice as taking care of those in need of critical care, I was being challenged to consider healthcare as ushering in the new heavens and the new earth.

I began to relate God’s desire for shalom to the work I was doing on the field: “No more shall there be in it an infant who lives but a few days, or an old man who does not fill out his days, for the young man shall die a hundred years old…” (Isaiah 65:20)

“Thus says the Lord of hosts: Old men and old women shall again sit in the streets of Jerusalem, each with staff in hand because of great age. And the streets of the city shall be full of boys and girls playing in its streets.” (Zechariah 8:4-5)

The relevance of these images in the midst of the busy curative work I was engaged in began to change my theological perspective and its influence on the practice of healthcare.

I saw the importance of being an intentional healing presence as opposed to merely being a curing presence. I began to see that a person who may not be cured can still be cared for by journeying with them. I started to see that if healing has to come to a community and shalom has to be ushered in, there is a need for the church and a caring community where such a journey can take place. There was a need for a “multi-disciplinary” group of people who can support each other in this journey to healing and wholeness.

A Change in Responding to Challenges

During this season a person with HIV infection was brought into our OPD. In those days, it was a challenging task to get him admitted and provide him with care in the hospital. It was the early days of the HIV epidemic when there was so much fear, shame and stigma. The challenge for such marginalized communities to get access to compassionate care created internal disturbances for few of us in the team. We ended up starting a program to care for them.

After a few years spent working with and caring for HIV infected drug users and sex workers, we learned that the existing institutional structures were not open or accessible for such communities. The care needed to come in makeshift contexts—at home and within the community itself. For institutionally trained professionals this was tough but there was no other way.

We learned that when God challenges you to respond to a need he has put into your heart, being available for people is more important than the ability or availability of structures or institutional frameworks. Evolving models have to emerge from the needs around you. For those who have no cure in sight, we cannot but look beyond the body. And people can be cared for and healed only in the context of family and community. Such care can only come from a caring community.

The gospel invites us to be available to those who need the presence, the power and the love of God through a community that cares. The lifestyle, power and mandate of the gospel transforms our hearts, challenges our perspectives and warrants a response in our life choices. This is true not only for healthcare professionals, but for anyone who wants to follow Jesus.

This post first appeared on The Gospel Coalition. Republished with permsission.

The recent announcement by the Australian government that increased freedoms would be available to citizens who were double vaccinated for COVID-19, or have exemption on medical grounds, has caused significant consternation in the Christian community. Issues of conscience and concerns about exclusion have been raised as reasons why such measures should not be introduced. This paper has been written to consider how Australian churches should respond.

WHY WE USE VACCINATIONS

There is no doubt that vaccination can be an effective public health strategy to curb the spread of infection. We each have a God‐given immune system that constantly protects us against infections. As we are exposed to a disease, our immune system naturally works to both defeat it and provide us with immunisation against a future attack.  However, diseases such as COVID-19 can be life-threatening or leave us with serious health problems. Prevention is always a safer option. Vaccination can help us avoid or reduce severity of future infection. Vaccines trigger our immune systems to respond and develop immunity to that disease, without having to actually experience it.

SAFETY AND EFFICACY

The COVID -19 virus is a new virus with new vaccines. Rare but serious adverse events associated with vaccine use have been reported: blood clots for the Astra Zeneca vaccine and cardiac problems with Pfizer. Early recommendations restricting the use of the Astra Zeneca vaccine were based on a risk-benefit calculation for the individual, a calculus which changed when the Delta variant of COVID-19 appeared. The Delta variant is highly transmissible, estimated to be 60% more transmissible than previous variants. In light of this new situation, COVID-19 vaccines are a safe and highly effective way to avoid serious illness, hospitalisation and death. The revision highlights one of the problems in this conversation – the constantly changing landscape as more is learnt about COVID-19 and its management, leading to changes in health advice, which can be seen as contradictory and confusing when in fact it is a commitment to keep up to date. This has led to some citizens being unsure of which authority to trust when it comes to health advice.

But we now have solid evidence of the impact of COVID vaccines from research involving millions of participants. Double vaccination has many proven benefits. It:

• Significantly reduces the risk of catching the virus
• Reduces the likelihood and severity of symptoms if you do catch it
• Makes hospitalisation 73% less likely
• Reduces the risk of developing Long COVID by 49%

However, while the rate of infection among those who are fully vaccinated is low, risk of infection still remains, especially with increasing age. Therefore it is important to know how vaccination impacts transmission of the virus. In fact, vaccinated people are much less likely to pass on the virus: double vaccination reduces the chance of onward virus transmission by 40-60%. The reason for reduced onward transmission is that there is significantly less virus detectable in vaccinated people.

In summary, vaccination protects not only yourself, but those around you.

The goal of community vaccination programs is to achieve herd immunity. Herd immunity works through achieving sufficient population immunity that the transmission chain of a disease is broken. This protects the community from infection. While research is ongoing, it is calculated that 70-90% vaccination will be required to achieve herd immunity.

WHY VACCINE PASSPORTS

In a liberal society, restrictions imposed by the state on an individual’s liberty are justified only to prevent harm to others (rather than harm to ourselves). Unvaccinated individuals present a risk to society by being more likely to get infected and thereby infect others, possibly overburdening the health system and preventing others from accessing care (as is currently a concern in NSW). In the attempt to achieve herd immunity, incentives and disincentives for vaccination against COVID-19 have been widely discussed. One idea that has been proposed is a system of vaccine passports, similar to those which have been introduced in many countries. The idea behind a vaccine passport is that you cannot justify restriction of a vaccinated person’s liberty as they do not pose sufficient harm to others.

VACCINE PASSPORTS AND CHRISTIAN GATHERINGS

For Christians a major concern raised by the introduction of vaccine passports is the question of whether double vaccination should be a requirement for attendance at a church meeting.

A duty to gather?

A biblical text frequently cited in connection with this discussion is the exhortation in Hebrews 10:24–25: “And let us consider how we may spur one another on towards love and good deeds, not giving up meeting together, as some are in the habit of doing, but encouraging one another—and all the more as you see the Day approaching.”

Several observations about these verses should be borne in mind as we consider their relevance to the present discussion:

• The situation being addressed in the letter to the Hebrews is not one in which the readers have found themselves temporarily prevented from holding large, face-to-face gatherings. Its challenge is not to believers who are conscientiously minimising health risks by complying with a public health order; it is to believers who are growing slack in their care for one another and shrinking back from publicly identifying with Christ and his people.
• The reference to “meeting together” in verse 25 is grammatically subordinate to the primary exhortation in verse 24: “And let us consider how we may spur one another on towards love and good deeds.” Its function within the sentence is to unpack what it will look like for the readers to obey the primary exhortation. It would be ironic in the extreme if we were to seize on the words about meeting together and use them as a justification for rushing back prematurely (and without vaccination) into face-to-face gatherings, without giving careful consideration to the “love and good deeds” we are meant to be spurring each other on toward.
• The kind of “meeting together” that the verse encourages as a vehicle for mutual encouragement does not necessarily require large, weekly, extended, indoor gatherings. There are other ways in which we can fulfil the purpose of the exhortation in this verse.¹

Nevertheless, it is true that face-to-face presence with other believers is basic to how the Christian life is normally to be lived, and Christians who are physically separated from one another will long to gather in person as soon as the circumstances that prevent it can be overcome. In our current context, this gives us as Christians a further motivation to embrace the opportunity of vaccination, if that will help to create the conditions under which such gatherings will be safe and legal.

Conscientious objections

For a small number of vaccine-hesitant Christians, the objection to vaccination is a conscientious one, arising from the fact that the process of developing some vaccines involved the use of cell lines derived from human fetuses electively aborted decades ago. The use of fetal cell lines in pharmaceutical research is certainly a matter that ought to be of concern for Christians. Nevertheless, there are good reasons why Christians who place a high value on all human life should support rather than oppose the use of the vaccines currently available for COVID-19, none of which contain fetal cell tissue or contribute in any direct way to the destruction of fetuses in our own time.² The conscience of those who remain unpersuaded by those arguments should be respected, but respecting a person’s conscience does not automatically confer on them a right to act in a way that endangers the health and safety of others.

Non-conscientious objections

Other Christians (and other members of the broader community) resist vaccination for a variety of other reasons, including anxiety about the vaccines’ extremely rare side-effects or scepticism about expert opinion, government policy or the motives of the pharmaceutical industry. Objections of this nature may be firmly held, but in most cases they are not of the sort that should rightly be described as matters of conscience.

Questions for Christian leaders and congregations

In the COVID-19 era, churches will be aiming to be inclusive, respectful of conscientious convictions, and safe for all those who attend. Given the current state of our knowledge about the vaccine and assuming levels of community transmission and hospitalisation that are within the capacity of our health system, it is reasonable to anticipate that there will soon be a time when opening our churches to those who are double vaccinated will be unproblematic. But what about those who are unable to be vaccinated for medical reasons, or the children in our church communities who are too young to be vaccinated? What about those who object to vaccination for conscientious reasons, or because they distrust the experts, the authorities or the pharmaceutical industry? And what about the frail and sick members of our church family, for whom infection still poses a serious risk even after vaccination?

BIBLICAL PRINCIPLES

What biblical principles apply as we seek to address questions such as these?

1. Love our neighbours (Mark 12:31): In the absence of any convincing argument to the contrary, accepting vaccination should be strongly encouraged as a way to reduce the duration and severity of the pandemic, lessening risk of illness and death, the stress of lockdowns and the strain on our healthcare system. It is an obvious and practical way in which Christians can obey God’s command for us to love our neighbours.
2. Obey our leaders (Romans 13:1): Our government has a legitimate, God-given responsibility to protect the safety of its citizens and safeguard the interests of the most vulnerable. It is not overstepping the boundaries of its mandate if it requires religious groups to install smoke detectors in their buildings, obtain WWCC clearances for their staff and volunteers, or observe public health regulations to restrict the spread of a pandemic. There are situations in which our duty as Christians to love God and seek the good of our neighbours may require us to stand in civil disobedience against an unjust law, but it would be a rare situation indeed in which conscience required us to disobey the public health measures put in place by a democratically elected government.
3. Respect the consciences of others (Romans 14): Those whose are genuinely convinced that it would be morally wrong for them to accept the vaccine should not be coerced into sinning against their conscience. But conscientious objection usually comes at a cost of some sort and the safety of the most vulnerable members of the church and the wider community should not be held hostage to the desire of others to do as they please, irrespective of government health orders or the risk to others.
4. Prioritise the weakest and most vulnerable (1 Corinthians 12:21–26): In both our duty to the wider public and our care for the congregation with whom we gather, we are to prioritise the needs of the weakest and most vulnerable. This is the case even when (and perhaps especially when) they do not have a loud voice of their own to broadcast their opinions and lobby for their rights.

A PATH FORWARD

Given our responsibility to love our neighbours and prioritise the interests of the most vulnerable, there are good and persuasive reasons for us to support and implement a system in which proof of vaccination (or medical exemption) is a standard requirement for attendance at large indoor gatherings such as church services. Because of the high levels of vaccination that would be required for herd immunity, the interconnectedness of the world’s populations and the likely emergence of new variants of concern, a requirement of this sort may continue to be necessary for some time into the future (along with other measures such as social distancing, mask wearing, and frequent handwashing).

But this should not mean that we exclude those who have not been vaccinated from the fellowship of the church or from the circle of our ministry. If a regime of vaccine passports is to be with us for some time into the future, then our energy should be expended not on fighting against it but on finding safe, inclusive and responsible ways to gather and minister within such a context. One obvious option would be to advocate for a system that permitted those who remain unvaccinated or incompletely vaccinated to produce evidence of being COVID-negative as a condition for church attendance. Another would be to continue and expand the range of online opportunities for Christian fellowship and online communication. And, as restrictions on outdoor gatherings continue to be relaxed into the future, another would be to take more of our gatherings, both small and large, into suitable outdoor spaces.

With care, creativity and a willingness to pursue the good of others ahead of our own convenience and advantage, it should be entirely possible for us to practise both our call to minister the gospel to all people and our responsibility to love our neighbours and care for the vulnerable, without requiring one of these commitments to trump the other.

Author: A/Prof Megan Best, 14 September 2021 (republished with permission.)

Acknowledgements: Thanks to David Starling, Kate Groom and Michael Jensen for their feedback.

Ethicentre is a new organisation which exists to provide reliable information about matters of Christian ethics within a Biblical framework. To sign up for the Ethicentre newsletter email: please send your name and preferred email address to [email protected].

1. This is true even in the case of the word episynagōgē that the writer uses here, which probably does imply a communal gathering of some sort for prayer and hearing God’s word. It is even more obviously true in the case of the wider range of daily interactions between believers that the writer speaks of elsewhere in the letter. 

2. For a discussion of reasons why Christians should accept the currently available vaccines, see Best M. Does acceptance of a COVID-19 vaccine represent endorsement of abortion?

Sadly, the ever-increasing specialism we see in the medical world furthers the concept of fixing the part, making it harder to see the whole, especially if we work in isolation rather than in a team. In this Covid era, where fortunately the need for and benefit of compassionate care has been emphasized both in the medical world and public media, our care and support for each other has become even more vital in underpinning our care of the patient.

This was expressed recently in Dame Claire Marx’s candid and refreshing resignation letter as Chair of the UK General Medical Council, which we reproduce here in part.

Dear Colleagues,

I wanted to write to you all to let you know that I am stepping down from the GMC, having recently been diagnosed with pancreatic cancer.

Since receiving this news, I’ve been reminded once again of the importance and power of kindness in everything we do as doctors.

Compassionate leadership has been a cause I’ve championed throughout my career, from my early days as a surgeon, to my position as Chair of the GMC. Now, as a patient, I’ve appreciated that kindness from my medical team and found its impact to be profound.

As doctors, the interactions we have with our patients are a crucial part of the medical care we provide. Our empathy and professionalism shape a patient’s experience almost as much as our diagnostic ability or surgical skills, and they shape our own experiences as clinicians.

As an orthopaedic surgeon, I was often in the fortunate position of being able to ‘fix’ my patients. Performing a hip replacement and knowing how much it would improve someone’s quality of life is immensely satisfying.

But receiving my diagnosis reinforced for me that neat outcomes aren’t the norm in most areas of medicine. Many doctors carry this weight, but kind words can soften the blow of bad news, and empathy and understanding undoubtedly ease the burden. There is no greater comfort than human connection.

The events of the last year and a half have meant many doctors have been dealing with unimaginably sad situations. Facing them has required great fortitude.

In those dark moments, it is the support of our colleagues that pulls us back up. Being able to laugh and cry together, to share our experiences and lean on one another provides the courage to keep going. In a profession that rises or falls on the strength of our teams, dignity and respect for each other is indispensable. So, in addition to compassion for our patients, we must show respect and kindness for colleagues.

Perhaps then, in areas of the world where medical citadels were once resistant to prioritising care and compassion, we will now find open doors that PRIME as an organisation is able to walk through. As well as sadness then, is this also a time of greater opportunity to bring God’s Kingdom into the medical world?

Dr Robert Sadler is Chair of PRIME Management Team. This article is republished from their website by kind permission.

‘…a state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude from positive and caring to negative and unconcerned. Burnout can occur when caregivers don’t get the help they need, or if they try to do more than they are able either physically or financially. Many caregivers also feel guilty if they spend time on themselves rather than on their ill or elderly loved ones. Caregivers who are “burned out” may experience fatigue, stress, anxiety, and depression.’

What causes caregiver burnout?

Caregivers often are so busy caring for others that they tend to neglect their own emotional, physical and spiritual health. The demands on a caregiver’s body, mind and emotions can easily seem overwhelming, leading to fatigue, hopelessness and ultimately burnout. They run into role confusion, unrealistic expectations, lack of control of the situation, unreasonable demands and dysfunctionality at individual level and work set up.

Life lays before us situations in which the lot falls on us to care for, and offer direction, for our colleagues. The healthcare provider often has the intellectual ability, skill and opportunity to provide care. Like David one leads well until those whom you lead and care for turn against you; forgetting that you are human, you have family, you have similar needs and wants, and you suffer similar issues to them.

This invites us to consider – what is the cost of care for our loved ones? What are the knock-on effects of taking care of a loved one? What are the symptoms of caregiver burnout? They are similar to the symptoms of stress and depression, and include:

• Irritability, withdrawal from friends, family and loved ones
• Loss of interest in activities one previously enjoyed
• Feeling weak, lost, irritable, hopeless and helpless
• Changes in appetite, weight and in sleep patterns
• Frequent illness
• Resentment and feelings of wanting to hurt oneself or those one cares for
• Exhaustion (emotional and physical) and irritability

The irony is when healthcare workers go through times of illness they face the adage of ‘physician heal thyself’. Their friends conspire knowingly and unknowingly like Job’s friends which can worsen the situation.

The ministry of encouragement stems from the realisation that we all need to be refreshed when our energies ebb. We need the support of others including from within our teams.

It is notable that in our ‘burnt out’ state there is still some potential to do good, to be generous, to care, to be grateful for the many blessings over our lives. In these we retain an optimistic view of life and do not give up. We become sources of refreshment for others whose reserves are depleted.

However, it is my proposition that in the meantime we must look out for our colleagues who need support. In the healthcare profession these are those who not only care for patients but also have next of kin who require even more care outside of the conventional setups, beyond the times, schedules and confines of clinical care.

That this has physical, emotional, psychological, financial, social strain on them is not in dispute. The management varies depending on the support systems in place. Whole person medicine demands that our team members who have had an incident are taken care of, as tenderly as the patients they themselves take care of, knowing that they are downcast, and heart broken.  The COVID-19 pandemic has additionally brought to the fore the import to give care for everyone within and beyond the confines of hospitals. Engaging the bio-physio-psycho-spiritual social and economic domains for our well being is paramount. It is incumbent on us not only to remember the wounded or sick but the caregiver as well. As in battle the soldiers require care and this has never been as urgent as it is now!

Some of the needs of the healthcare giver include having trusted friends, neighbours, co-workers, and colleagues to speak to about their experiences, feelings, frustrations and concerns. They receive help to understand their limits and to set reasonable goals and schedules both for providing care for others and for receiving physical, emotional and spiritual care for themselves.

Kizito Shisanya is a Consultant Surgeon and Lecturer at Kenyatta University, a PRIME Tutor and Advisory Chair for CMF Kenya. This article is reprinted with kind permission from the PRIME newsletter.