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.

Epidemics can end in two ways – transmission is well controlled and new cases come down to zero, and the epidemic is history. The other is, the disease becomes an ongoing part of the infectious-disease landscape, or an endemic. The shift from pandemic to endemic entails a number of practical considerations for managing the epidemic and the way we live. But the shift is also psychological, as we will be deprived of the satisfaction that a clean pandemic end point would bring. Instead, societies will have to adapt to living alongside COVID-19 by making some deliberate choices about how to coexist.

Pandemics and endemics, in the past, have forced communities to move to newer ways of living and engaging in the world. Other major disruptions of life too have created new normal ways of engaging. Biblical stories are interesting examples. Adam and Eve had to build a new life in a new normal world outside Eden. Noah, Daniel and friends are examples of people who had to pick up the pieces and chart a new course, post flood and in captivity.

The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I, at somewhere between 20 and 40 million people. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Nationalism pervaded as people accepted government authority. This allowed the public health departments to easily step in and implement their restrictive measures.

The war also gave science greater importance as governments relied on scientists, now armed with the new germ theory and the development of antiseptic surgery, to design vaccines and reduce mortalities of disease and battle wounds. The medical and scientific communities developed new theories and applied them to prevention, diagnostics and treatment of the influenza patients. Similarly, the black death saw the origin of hospices and later the hospitals that we know of now.

Mental health

The current pandemic that we are going through, with all the devastation it has left, has been traumatic for most of us. The physical effects of the virus, with high mortality, morbidity and many families losing their loved ones is the most evident. The economic, and the broader social impacts, the job losses, the migrants who have lost their livelihood, the relational issues with increasing domestic violence etc have been in the news and some of us might have experienced them too. Education related challenges and their impact on the system, the children and parents, is yet another major issue. Cross cutting through all these are mental wellbeing related issues.

A recent Lancet article reviews this well. The COVID-19 pandemic has taken a toll on people’s mental health. Yet, the global extent of this impact remains unknown. The authors estimated a significant increase in the prevalence of both major depressive disorder (with an estimated additional 53·2 million cases worldwide—ie a 27·6% increase) and anxiety disorders (76·2 million additional cases—ie a 25·6% increase) since before the pandemic. Increased prevalence was seen among both males and females across the lifespan. These findings are all the more concerning because depressive and anxiety disorders were already leading causes of disability worldwide.

What is the new normal?

But at the same time, if you look around there have been many positive changes and trends emerging around us. The challenges that we as individuals, communities and humanity at large have faced, have been opportunities to engage in a new way. New Normal was a well-known term in business circles but has become the current buzz word. Most large organisations have ongoing research and strategy development teams looking at, sector by sector, what the new normal would look like. They engage in defining and understanding the new normal and coming up with strategies to limit the spread of disease at the same time mitigate impact on other sectors. Some of them have gone ahead and coined terms like ‘Next Normal’ or ‘Next Possible’ as buzz words, to drive a new direction for tomorrow.

A few trends are highlighted here. This is not a comprehensive list, but just a glimpse into the massive changes that are happening around us.

Faced with uncertainty and facing our mortality, the core issues of our life, existence and meaning, are in most people minds, though not publicly discussed. Questions like, if life is so uncertain and I do not have control of my life, how should I live, who am I, what am I in the world for, how can I find significance, have never been asked the way they are being asked this season.

Such questions are leading to many looking at job, career and work in diverse ways. Large numbers of people are leaving the formal work sector and are exploring more flexible ways of engaging. A Microsoft study discovered that 41% of workers worldwide are considering quitting their jobs described as the ‘Great Resignation’. The study shows that Gen Z is struggling more than other generations. Work life balance, being valued by managers, sense of belonging, a trusting and caring community at workplace, meaningful advancement of careers, flexibility and autonomy are what people are looking for. If this is not there, they are moving out to set up startups on their own.

For organisations and companies COVID-19 has brought on an even higher awareness that we cannot have healthy people on an unhealthy planet or workplace. So, companies are looking at climate change, healthy work environments recognising that if they do not address these, that they may not have a competitive advantage in the market.

With social and physical distancing becoming a norm, technology has become the driver of all engagements whether at personal, community, work or social levels. Digital systems and AI based algorithms helping in decision making and work has taken over many fields, including healthcare. Digital natives, children and young people find this easy, but digital immigrants, the seniors struggle with this.

But what is assuring is, we are not in this alone – there is a collective vulnerability of our world. The most macho leaders, the most high-tech scientific establishments, and the economic powers have all met their match in this lowly virus. It should make us humble — think about what we need to do differently; how we need to act and behave differently.

Adapting to the new normal

So how should we face and live in such a world? It was Darwin, who said, it is not the strongest of the species that survives, nor the most intelligent; it is the one most adaptable to change.

If we need to live as salt and light in this world, we need to cultivate some mindsets and lifestyles. Daniel and his friends in Babylon are a good case study to reflect on. Faced with a new normal they did a few things. They did not shy away from embracing the changes around them. They learnt the new language, immersed themselves in the new context and culture and lived lives of influence. They built their knowledge and expertise in new ways of engaging and excelled themselves in the spheres of engagement. They built their lives with a long-term perspective, Daniel serving three empires and four emperors over 70 years. But they held on to the core values and their faith as foundations. They supported each other, as they faced challenging contexts and situations.

A changing context of the world and new normal emerging around us, is a call for us to live such lives. Return and renew our commitment to the core foundations of our faith and values that should undergird our lives. At the same time, accept and embrace change and excel in new ways of engaging. We need to live our lives with a long-term life perspective – a long obedience in the same direction. Rooted in our relationship to God we need to build our dependence on the faith community that we are part of, to support and be supported in our journeys. Remember, God is still on the throne and in control. Such people and communities will continue to be salt and light in a world that is changing and losing its saltiness and light.

Mathew Santhosh Thomas is ICMDA Regional Secretary for South Asia

Published in Campus Link, UESI India bi-monthly magazine, Jan-Feb 2022, Volume 24, No.1. Home – Campus Link (campuslinklive.org), Republished with permission.

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.

The meaning of being literate has expanded to include other types of literacy like ‘computer literacy’. Johannes Gutenberg, the father of modern printing brought the greatest revolution to human civilisation. Some cultures have embraced reading and writing for centuries. Each year, hundreds and thousands of books are written and read in the Western world, a phenomenon rarely observed in other cultures. Availability of electronic books today has made carrying of books lighter and easier which is a further encouragement.

Factors affecting reading and writing

Many factors have invaded people’s reading and writing habit and worn it out. Top of the list is TV which has diverted people’s attention away from books. Today people prefer watching a TV program to reading a book. Cultural and family background is another factor that affects the way people relate to books. Political crisis in many countries also adversely affects reading and writing.

Why then is reading and writing important? There are many reasons.

The importance of writing

First, writing communicates to a wider audience. Ideas and thoughts printed in books and articles travel far and wide and benefit many people. Giving a lecture in a university hall, for instance, only reaches the student and academic community unless it is televised or put online.

Second, writing helps us leave a good legacy. I am reading President John F Kennedy’s book ‘Profiles in Courage’ written before I was born. Writing is one legacy that keeps people speaking after this life like Abel who ‘though he is dead, still speaks’ (Hebrews 11:4). The Psalmist talks of telling the ‘next generations’ (Psalm 78:3,4). The Lord told the Apostle John: ‘Write what you have seen, what is now and what will take place later’ (Revelation 1:19). God similarly told the prophet Jeremiah: ‘Take a scroll and write on it all the words I have spoken to you concerning Israel… from the time I began speaking to you till now.’ (Jeremiah 36:1,2). God wants all life experiences – past, present and future – written and left for future generations to benefit from!

Third, writing is important for record keeping and history’s sake. Written history and well-kept archives are important for researchers and history. Mordecai’s story for instance was discovered and became an important and integral part of the Bible all because it was written and kept (Esther 2:21-23).

Fourth, writing sharpens writing skills. Putting down something in writing where we know other people will be reading it makes us think twice about the content, language, grammar and information flow. This strengthens writing skills. ‘Wake up! Strengthen what remains and is about to die.’ (Revelation 3:2)

The importance of reading

Reading, on the other hand, has many advantages but I want to emphasise three.

First, reading widens our knowledge and world. A friend of books has a broader world and general knowledge than one who is far from books. People often seem to accumulate knowledge only of their field of study but that is myopic as life is bigger than that. The first century Athenians were known to be hungry for new knowledge of any subject (Acts 17:21). If they lived today, they would be searching all websites for information! Reading deepens understanding and insight (Job 34:34,35).

Secondly, reading facilitates and bridges cultural dialogue. The first contact I had with the English people and their culture was through English literature like ‘Oliver Twist’ and ‘Great Expectations’. Literature, books and movies facilitate dialogue and bridge cultures. People who are exposed to other cultures are open-minded and get along with people from other racial and cultural backgrounds better than those who are not.

Third, reading enables learning from others’ style of writing. For those who aspire to be writers, reading others’ writings sharpens writing skills. When reading a book, one can see how the writer attracts his reader’s interest to read and like what he is trying to communicate. Napoleon Hill says, ‘The leading writer must add to their own stock of knowledge by appropriating the thoughts and ideas of others through personal contacts and by reading.’ (Master Key to Riches, p118).

The importance of libraries

A society with writers and people who love books is characterised by the presence of public libraries.

Are libraries important? If so, do governments plan and prioritise them? Napoleon Hill writes, ‘The Public libraries offer a great array of organised knowledge on every subject. The successful person makes it their business and responsibility to read books and acquire important knowledge which comes from the experiences of others who have gone before.’ (Ibid, p114).

Eleanor Roosevelt equally shed light on the importance of libraries: ’There are so many places that have no libraries and that have no way of getting books. What the libraries mean to the nation is obvious to all of us. I do not think that many people know how many states have large areas, particularly rural areas, where we cannot get books.’ Eleanor is concerned about the availability of books in rural areas let alone in capital cities!

Though not everyone is a writer, my humble opinion is that all should be able to enjoy reading as a general hobby. People should appreciate books as custodians of organised knowledge. Charles Lamb said: ‘I feel more like saying The Grace before a good book than before meat.’

Alex Bolek is ICMDA Regional Secretary for East Africa

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

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.

John 13:1-20

Jesus is approaching the climax of his life. All his acts of service were about to be culminated and summated in his willing sacrifice on the cross. And it is all motivated by agape love – the love that gives.

‘Having loved his own who were in the world, he loved them to the end (telos)’. The ultimate example of self-sacrificial love is about to be demonstrated in the act of foot-washing now, and in the cross to come. This is a sacred moment. Jesus is spending his last hours with his chosen few, and yet the evil one is in the room too – in the heart of Judas Iscariot.

John’s emphasis is on Jesus’ total and unshakeable knowledge – both of himself and his being, his status, his calling, and of this moment – ‘the hour had come’.

There are four things that Jesus knows utterly and unshakeably in the core of his being.

1. The hour had come
2. The Father had given all things into his hand
3. He had come from God
4. He was going back to God.

They encompass where he has come from. In the bliss of the Holy Trinity; his supreme position in the cosmos as Lord of Lords; the significance of this hour – the crux point – the pivot for the whole of salvation history; and his ultimate destiny at the Father’s right hand.

This is what Jesus knows, and this is what gives him total security in who he is. With such power and status, we might expect him to defeat the devil who is in the room with him in an overwhelming burst of spiritual power and light. ‘I saw the evil one fall from heaven like a flash of lightning’. He might have blown Judas away in a moment with a blast of divine wrath.

Instead, he gets up from the table and stoops to the floor. And he washes his disciples’ feet.

Washing feet was the most menial, lowly and despised occupation reserved for the lowest of the low. The streets of Jerusalem were dirty and disgusting – there was filth, disease, urine and excrement in the highways. It doesn’t take much imagination to see why washing feet was a filthy and demeaning task. It was particularly unacceptable to a religious person because it led to ritual impurity, and the foot washer would have been barred from all religious activities.

Some high-minded Jews insisted that Jewish slaves should not be required to wash the feet of others. In essence, this job should be reserved for Gentile slaves – or alternatively for women and children who didn’t count. And of course, we can see that to be forced by others to take on this role – to be compelled by force to wash the stinking feet of others – is profoundly abusive, damaging, humiliating.

The Jewish literature records that when Rabbi Ishmael returned home from synagogue one day his mother wished to wash his feet. He refused on the ground that the task was too demeaning. Apparently, there is no recorded instance in either Jewish, Greek or Roman literature of a superior washing the feet of an inferior.

So, the shock of the disciples at Jesus’ action is understandable. How can their Lord and Master do such a thing? Has he lost his mind? Or does this mean that perhaps Jesus is not who he claims to be?

The critical point is that John juxtaposes Jesus’ total and unshakeable security in his self-knowledge with his action in humble and humiliating service. John’s deep psychological insight (and the inspiration of his words by the Spirit) is that it is precisely because of Jesus’ total security in his status that he is able to lower himself in this striking way.

It is an example of the profound Christian doctrine of kenosis. The one who though he was in the very nature of God, did not count equality with God a thing to be grasped, but emptied himself (kenosis) – made himself nothing – and took the form of a servant. He humbled himself by becoming obedient to the point of death, even death on a cross (Philippians 2).

Jesus takes off his outer clothing (perhaps symbolic of stripping himself of outward security), takes up the servant towel and puts it around his waist. He willingly adopts the garment and appearance of the most menial house slave. He pours water into a basin, stoops down to the floor and starts the filthy task.

The doctrine of kenosis does not mean that Jesus exchanges the form of God for the form of a servant. It means that Jesus willingly and self-consciously lowers himself in order that the true nature of his deity is revealed unmistakably through human frailty and humble sacrifice. His status is not lost through the act of foot washing – it is powerfully revealed, unveiled, and made known.

Here’s a thought experiment. Imagine yourself incontinent, lying in faeces, urine and vomit, being gently and tenderly washed and cleaned by Christ himself. This is the true nature of God revealed in the face of Jesus Christ.

I think it is profoundly significant that Jesus washes the feet of Judas Iscariot too, the one indwelt by the evil one. He doesn’t just confine himself to nice people, to grateful people, to the chosen ones. He washes the feet of the unlovely, the hostile, the wicked, the abusive, the malevolent, the one dedicated to destroying him. He washes the feet of the evil one himself! What majestic and mysterious power. How can he do this? It comes from his total unshakeable security in who he is.

Having performed this dramatic and shocking action, Jesus then explains it. First, there is divine action, and then there is explanation.

Verse 12: Do you understand what I have done for you? You call me Teacher and Lord and you are right for so I am – If I then your Lord and Teacher have washed your feet, you also ought to wash one another’s feet. For I have given you an example that you also should do just as I have done to you. Truly, truly I say to you a servant is not greater than his master nor is a messenger greater than the one who sent him.

Jesus claims the title of Lord, the one who has total authority over his disciples, and Teacher, the one who instructs, guides and models.

‘You should do exactly what I have done to you’. But just as Christ’s loving and voluntary self-abasement is rooted in his security in his supreme status, so in the same way, we cannot take the lowest place unless we are rooted and founded in the knowledge and security of our own status.

To be forced by an external power to take on the role of the lowest of the low, the house slave, is damaging, abusive, destructive. But to voluntarily choose the lowest role, motivated by love and out of the security of knowing our real status, as dearly loved daughters and sons of the King, that is totally different. This is the profound dignity of Christ-like service.

So, Christ’s action is motivated by free agape love, ‘there is no compulsion in love’. It is not coerced, manipulated, even driven by a sense of duty, of ‘ought’. It is totally free and un-coerced.

And although it is not recorded in the passage, we know from elsewhere in the New Testament that Christ’s action was motivated by joy. ‘For the joy that was set before him, he endured the cross, and despised the shame.’ It was joy, bubbling, inexpressible, eternal joy that motivated Jesus to take on the role of the slave.

From the outside, the actions of Christ and the actions of the abused house slave may look indistinguishable. They are wearing the same clothes, grovelling on the floor, covered with filth, absorbed in back-breaking toil. But the house slave is driven by external force and necessity, she is conscious of her status as lowest of the low, bottom of the pile, human trash, and she is damaged, demeaned and further humiliated by the process.

The Christian servant is driven by agape love, compassion and joy is conscious of her or his supreme status as a loved and honoured princess or prince of the royal family, and is ennobled, upbuilt and fulfilled by the action, thrilled to be living out the life and love and presence of Jesus. From the outside, they are indistinguishable, but on the inside, the experience is totally different.

Jesus’s example and John’s description of it in his Gospel was a fuse which ignited an explosion of caring in the ancient world. It was profoundly formative as a model of Christian service and care for the sick, the infected and the dying. And if we have ears to hear it can ignite further explosions today.

John juxtaposes the story of Jesus washing the disciples’ feet with another foot washing – but this time it is Jesus whose feet are washed.

In John 12, John emphasises that this incident happens only a matter of days before Jesus is to be crucified at the time of the Passover – the time the sacrificial lamb was put to death.

Mary the one who has previously sat at Jesus’ feet now takes a litre of expensive perfume– a huge quantity equivalent to over 300 grams – stoops down to the feet of Jesus and anoints his feet (and probably other parts of his body) with the precious ointment. Such is the quantity of the perfume that the whole house is filled with the fragrance. And then in a shocking and intimate act, she releases her hair, stoops down to his feet and tenderly wipes them with her hair.

It is a strange and wonderful scene of extravagant sacrifice and intimate tenderness; it is a sensual and scandalous act. Respectable Jewish women did not let down their hair in male company – this was something for the intimacy and privacy of the bedroom.

Mary is demonstrating her love and concern for Christ by this act which encompasses humility and self-abasement, tenderness, and extravagant willing sacrifice for the person of Christ. Interestingly, this episode comes before the example of foot-washing in John 13. Mary does not need to be taught about foot-washing – she does it instinctively and generously.

The reaction of Judas is that of the sensible, pragmatic, evidence-based moralist. The ointment was worth nearly a year’s wages for a peasant worker. Thousands of pounds. But Jesus understands her heart and defends her. The meaning of his words is uncertain, but I suspect that Jesus saw that she was, in reality, anointing his body for burial. Commentators have pointed out that because of the intense fragrance and quantity of the perfume, the smell would still have been present when Jesus was crucified six days later. In other words, as Jesus hung on the cross, he was smelling the fragrance of Mary’s sacrificial act, the fragrance of sacrificial and costly love.

The whole house was filled with the fragrance of sacrificial and costly love.

Christian carers have frequently been called to self-sacrificial love, at the cost of abandoning family, comforts, marriage, sleep, health, sacrificial giving, even sacrificing their own lives to care for others. So, both Christian medicine and Christian nursing may call us to pay a very high price.

Notice that Mary’s sacrifice was entirely voluntary and uncompelled. It was a spontaneous act of astonishing generosity. It was motivated by love for Christ.

So, what is the most precious, the most costly closed container in our lives, in our heart? Are we prepared to sacrifice it out of generous and costly love for Christ? Our natural tendency is to grasp, to hold on to the things which are most precious. But the way of fruitfulness is to voluntarily open our hand and release those precious things we hold so tightly.

‘Unless a grain of wheat falls into the ground, it remains alone – but if it dies, it brings forth much fruit.’

As the twentieth-century martyr, Jim Elliott said, ‘He is no fool who gives what he cannot keep to gain what he cannot lose.’

I am very conscious that much of this is theory, and that I continue to struggle to live in the reality of this example. But I know in the core of my being that it is the way of fruitfulness and the way of joy. I am sure that Mary did not begrudge the sacrifice of that perfume. I am sure her eyes were filled with tears of love and joy. This is what the perfume was for, to anoint the body of her Lord for death, and to fill the house with the fragrance of love.

By John Wyatt, Emeritus Professor of Neonatal Paediatrics at UCL and Senior Researcher at the Faraday Institute for Science and Religion, University of Cambridge.

Reposted with permission from CMF Blogs.

Listen to John talking further on this topic on a recent 1st incision podcast from CMF UK.

Catch up with stories of Christian doctors and nurses responding to COVID-19 in our voices from the frontline podcast miniseries

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Epidemic infections were a source of terror in the ancient world. They would sweep into the cities of the Roman Empire, causing devastation. The Plague of Cyprian was a pandemic that afflicted the Roman Empire from about AD 249 to 262. From 250 to 262, at the height of the outbreak, 5,000 people a day were said to be dying in the city of Rome itself.

Pontius of Carthage wrote a first-hand description:

‘Afterwards, there broke out a dreadful plague, and excessive destruction of a hateful disease invaded every house in succession of the trembling populace, carrying off day by day with abrupt attack numberless people, every one from his own house. All were shuddering, fleeing, shunning the contagion, impiously exposing their own friends, as if with the exclusion of the person who was sure to die of the plague, one could exclude death itself also. There lay about the meanwhile, over the whole city, no longer bodies, but the carcasses of many, and, by the contemplation of a lot which in their turn would be theirs, demanded the pity of the passers-by for themselves. No one regarded anything besides his cruel gains. No one trembled at the remembrance of a similar event. No one did to another what he himself wished to experience….’

Strikingly no first-hand accounts of the clinical symptoms and signs of plague have been recorded from the Hippocratic physicians at the time. Although the clinical descriptions of many other diseases were recorded with great detail, it has been remarked that the contemporary medical descriptions of plague seem vague and impressionistic.

Why was this? Almost certainly because at the first sign of plague, the Hippocratic physicians would have deserted the towns and fled to the safety of the countryside! When plague threatened Rome, the great physician Galen moved swiftly to a country estate in Asia Minor where he stayed until the danger had receded.

In the Hippocratic work ‘The Art’ the goal of the physician was defined as ‘to do away with the sufferings of the sick, to lessen the violence of their diseases, and to refuse to treat those who are overmastered by their diseases, realizing that in such cases medicine is powerless.’ To treat those who were dying was likely to bring the reputation of the profession into disrepute and damage faith in the healing skill of the physician.

So it is remarkable that it was a Christian bishop Cyprian, who provided the most accurate and detailed clinical description of ancient plague: ‘These are adduced as proof of faith: that, as the strength of the body is dissolved, the bowels dissipate in a flow; that a fire that begins in the inmost depths burns up into wounds in the throat; that the intestines are shaken with continuous vomiting; that the eyes are set on fire from the force of the blood; that the infection of the deadly putrefaction cuts off the feet or other extremities of some; and that as weakness prevails through the failures and losses of the bodies, the gait is crippled or the hearing is blocked, or the vision is blinded…’

Cyprian’s account suggests that the third-century plague he witnessed may have been a highly infectious and lethal haemorrhagic viral infection similar to Ebola virus, although there is continuing controversy about the nature of these ancient epidemics.

What is clear is that there were scenes of horror – the streets filled with the bleeding bodies of the dying, and there were desperate attempts from the population to save themselves whatever the consequences for others. Here is another witness account from Dionysius in Alexandria ‘At the first onset of the disease, the pagans pushed the sufferers away and fled from their dearest, throwing them into the roads before they were dead and treated unburied corpses as dirt, hoping thereby to avert the spread and contagion of the fatal disease; but do what they might, they found it difficult to escape…’

Yet in many of those cities of the Roman Empire there was a small body of believers, often shunned and despised as ‘atheists’ (because there were no idols in their homes and assembly places) or ‘Galileans’. How will they respond in this time of horror and distress? Will they too head for the countryside in order to save their own lives?

Dionysius’s account continues, ‘…Most of our Christian brothers and sisters showed unbounded love and loyalty, never sparing themselves and thinking only of one another. Heedless of danger, they took charge of the sick, attending to their every need and ministering to them in Christ, and with them departed this life serenely happy; for they were infected by others with the disease, drawing on themselves the sickness of their neighbours and cheerfully accepting their pains. Many, in nursing and curing others, transferred their death to themselves and died in their stead…’

Following the example of Christ, the Christian believers provided compassionate nursing care for their pagan neighbours – bringing them into their houses, washing wounds, cleaning up the blood and diarrhoea, providing water, food and basic medicines, ‘ministering to them in Christ’, even though they knew that they were exposing themselves to extreme risk.

The ancient world had never seen anything like this. Rodney Stark, a social historian, has undertaken a detailed analysis concluding that the actions of the Christians at time of plague were one of the most important factors in the explosive growth of the Christian church in this period.

When I read these accounts, I feel unworthy to be called by the same title as a Christian carer. How little I have experienced the cost of Christ-like caring compared with my sisters and brothers of the third century.

But over the succeeding centuries, Christian carers have behaved in the same way during the tragic history of epidemics from the Cyprian plague in 250 right up to the Ebola epidemic in 2014 and into the present. Many of the nurses and doctors in Sierra Leone who sacrificed their lives to care for Ebola victims were Christian believers. They knew that the protective equipment was substandard and that despite their best efforts, they could not completely protect themselves. And yet they kept on caring, just like their ancient sisters and brothers who ministered to the sick in Christ.

And I have no doubt that over the next weeks and months, stories of heroic self-sacrifice will emerge. Of course, it is not only Christian believers in our modern world who practice sacrificial care for strangers. We must celebrate the caring actions of everybody, whatever their creed or motivation. And of course, as professional carers, we must be wise about taking protective measures, so that we can continue to care whenever possible, rather than becoming a victim. But we should not forget the noble history of Christianity in a time of plague, remembering the words of Jesus just as those early Christians did, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me’ Matthew 25:40.

By John Wyatt, Emeritus Professor of Neonatal Paediatrics at UCL and Senior Researcher at the Faraday Institute for Science and Religion, University of Cambridge.

Reposted with permission from CMF Blogs.

Further reading

Rodney Stark, The rise of Christianity, HarperCollins

Join with CMF at 19:00 (7 pm UTC) each day to pray for frontline workers, our nation and the world as we deal with the COVID-19 pandemic at #COVID1900Prayer