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.

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.

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.

‘…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.

Summaries of many of the papers I’ve read have found their way into PRIME international emails, as many of them have been about topics that are core aspects of PRIME’s teaching and vision.

Examples include: the continuing issue of empathy maintenance in health professionals’ training, the problem of burnout, professionalism and how it should be taught, restoring virtue to health professional education, being patient centred, being agents for change, communication skills, compassion, the use of humanities (art, literature) in medical education, and the importance of role-modelling.

What all these publications explicitly or implicitly reveal is that the core values of compassion and respect for all individuals and a person-centred approach to health care provision, all have a positive impact on patient outcomes and health-care professional wellbeing. Gradually (but at an increasing rate), more and more publications are dealing with these issues and contributing to a growing weight of evidence that supports PRIME’s core values and approach (for example, Google Scholar currently lists over 137,000 publications on the benefits of compassion in healthcare).  
 
Should this surprise us? Of course not. It is simply the truth that Jesus demonstrated during his earthly ministry – caring for and healing the sick, getting alongside the bereaved, welcoming the marginalised, touching the untouchables, releasing people from oppression and sometimes even raising the dead. He was all about demonstrating the reality of God’s Kingdom values in the often messy, painful and broken lives of anyone whom he met, unafraid to speak truth to power in a way that ultimately led to his crucifixion, death and (surprise!) resurrection.

As his followers we feel the truthful, loving congruence of the things he did, and all over the world today similar things continue to happen in usually unrecorded and little-known ways and places where faithful believers follow his call to serve their neighbours.

We don’t need scientific evidence to know that these are self-evidently good things to do, but as the health-care professions work from a science base it is nevertheless good to have it. What we seek to do is increasingly ‘proven’ to be good for our patients, students and for ourselves, so there can be no rational objections to seeking to spread this kind of practice all over the world, as PRIME is seeking to do.
 
There are some similarities here, I’d suggest, with what Cosmologists call the ‘Anthropic Principle’ –  the values of the constants of nature that have a bearing upon the existence of human life.

‘Humanity’s very existence shows that the current structure of the universe and the values taken by the constants of nature permit life to exist. Indeed, it appears that many features of the universe that are necessary for the evolution and persistence of life are the results of unusual coincidences between different values of the constants of nature – quantities such as the mass of the electron, the strength of gravity, or the lifetime of the neutron. The significance of these coincidences is not understood. What is understood is that, if these quantities were even just slightly altered, then no form of complexity or life could exist in the universe’.

Now, we don’t need the Anthropic principle to believe in a Creator, but the sheer statistical improbability of such fine-tuning coming into being by chance is totally congruent with the existence of such a Being.
 
Similarly, we don’t need the evidence from medical education journals and publications to know that teaching and practising Christian values based whole person care is good for our patients, students and ourselves, but it is good to have it to reinforce our mission and vision, and to strengthen the appeal of our work to colleagues who may not be aware of it. The growing weight of evidence means it is an increasingly inescapable truth.
 

Huw Morgan is a retired GP and member of the PRIME management team. This article is reproduced by kind permission from the PRIME newsletter.

What is Conversion Therapy?

Most of these therapies should rightly be banned: the list includes aversion therapies, using drugs, enemas, electrical shock treatments and also brain surgery. All these were administered by the medical profession. Not only were they cruel, but there is no evidence that any of them worked. At a time when homosexuality was illegal, individuals were pressurised to have their orientation changed by such methods.

The deliberate untruth, which campaigners frequently tell us, is that, ‘People cannot change their orientation because they are born that way’. This is clearly untrue. No genetic evidence has ever demonstrated this, despite extensive genetic research. Neither is it supported by the study of identical twins. They overlook the fact that many homosexuals admit to being ‘fluid’ in their sexuality. Bisexuality is demonstrated whenever middle-aged adults suddenly declare they are gay, after being happily married for 20 years and having several adult children.

The deliberate confusion is that all these therapies were discontinued over 50 years ago! Nowadays homosexual activity is legal in many countries, along with gay marriage. In the West, only talking therapies are available to those who want help. These include professional counselling, pastoral care, prayer and support from family and friends. In Australia, LGBT pressure groups are now seeking to ban all of these.

The half-truths they promote are that ‘talking therapies’ don’t work and are harmful, causing clients to become depressed and suicidal. Certainly, counselling treatments may well be unsuccessful and are always difficult to evaluate scientifically. You cannot do ‘double blind, controlled, cross-over trials’, as there is no possibility of finding a placebo for counselling.

As for causing harm, homosexuality itself runs a high risk of harm. It is strongly associated with mental illness, alcoholism, drug addictions and a greatly increased risk of catching STDs, which may have life-long, even fatal consequences. These are all good reasons for wanting to move away from homosexual behaviour and culture. Yes, counselling can also be stressful, which is true for treating any addictive behaviour.

Hear what Elton John had to say in his autobiography, ‘Me’. He admits he was addicted to drugs, alcohol, food and sex (pp225/6). He chose to undergo counselling therapy in a residential unit, but he walked out after six days. He said, ‘It was tough…I couldn’t sleep…I had panic attacks…mood swings…depression and anxiety…I felt ill…weak and lonely.’ (pp230/1)

A further deception that campaigners spread, repeating it like a mantra, is that homosexuality ‘is not an illness and therefore cannot be cured’. Both these terms are deliberately misleading. Bereavement, Post-Traumatic Stress Disorders and relational difficulties are not ‘illnesses’ that can be ‘cured’. They are, however, stressful conditions for which counselling is often effective in resolving. Such problems are ‘managed’ not cured and they commonly recur if therapeutic techniques are ignored or further aggravating events happen. Counselling rarely ‘cures’ anyone and the therapist may be as important as the therapy in achieving a good result.

Does counselling ever lead to change in a person’s sexual orientation? Yes, though not always or even often, but there is a growing number of people around the world, who now happily identity themselves as being ‘Ex-Gay’. If the identity of LGBT people is to be respected, then so should the identity of ex-gays – LGBTX. Success may depend on a younger age, high motivation and the degree of sexual fluidity.

Is such talking-therapy ethical? Yes. To ban such therapy would be seriously unethical, denying basic human rights – freedom of speech, freedom of conscience, freedom of religion, and freedom to choose your treatment – while condemning people to live a lifestyle they want to leave.

‘The overall aim of counselling is to provide an opportunity for the client to work towards living in a way he or she experiences as more satisfying and resourceful.’ BACP code of practice.

For counsellors to ban such therapy is a denial of their ‘raison d’être’, the very purpose of their existence. Yet many therapists are now prohibited from helping clients troubled by their sexual orientation. Whether there is a legal ban or not, they will be struck off their professional registers if they offer it.

It is the therapist’s task to stand where their client stands. It is not the therapist’s role to introduce his own agenda and values into the counselling relationship. Ironically, the transgender debate highlights the importance of counselling for those who wish to change their sexual identity. This campaign to ban talking therapies for those who are troubled by their sexual orientation and request counselling should be vigorously opposed.

Peter May is a retired general practitioner in Southampton, United Kingdom

‘Therefore, keep watch, because you do not know on what day your Lord will come. But understand this: If the owner of the house had known at what time of night the thief was coming, he would have kept watch and would not have let his house be broken into. So, you also must be ready, because the Son of Man will come at an hour when you do not expect him.’ (Matthew 24:42-44)

What is REALLY going on behind COVID-19? Is it the start of a New World Order, a CDC cover-up, a planned biological attack on the Western world, or one of the multiple other possible explanations being given? If you truly believe that one of these theories is 100% correct and you are willing to base your life on it, please read no further.

However, for those who aren’t sure, or who have friends who keep wanting them to consider alternative explanations, I hope this post helps.

Firstly, as a doctor I have seen the reaction that we are having as a society played out hundreds of times in individuals over the years. Consider a young woman just told she has breast cancer. She will go through some predictable responses and emotions:

• Denial – (‘The tests are wrong; we need to redo them. I want another opinion.’)
• Anger – (‘It’s not fair; why me? I have small children!’)
• Anxiety/Depression – (‘I’m so scared and worried’/‘What is the point of it all anyway?’)
• Bargaining – (‘I’ll clean up my diet and start exercising more.’)

Throughout all this, there is a strong tendency for people to look for someone (or something) else to blame. Essentially what they are looking for is a sense of control and predictability – and it is totally okay to want this.

Think about how we have responded as a community to COVID-19. We have seen all the above reactions in ourselves and those around us: denial, anger, anxiety, and bargaining. And we are certainly seeing a lot of finger-pointing and looking for someone to blame. We do want to regain some sense of control, and that is understandable.

When people start blaming, however, there are a few problems:

• They are often picking out one or two things or people to focus their anger on, rather than acknowledging that there are many different contributing factors (some known and some unknown).
• They are so focused on finding a scapegoat that they fail to see all the good that has been done (and is being done). Their world becomes quite dark and hopeless. I am seeing a lot of this in my patients in recent weeks.

When people start looking to regain control, the theories I mentioned at the start can be very enticing. It gives a sense of relief to know that things are playing out as expected (even if not by the people that you wish were in control – at least someone is, and maybe we can stop them!)

So what happens when people start to believe that there is an organised plot to take over the world?

Even before COVID-19 there was research into this (it is not a new way that humans have used to cope with disasters and fear, but we are now seeing it intensified):

• They start to be able to ignore facts that contradict the story. Because they feel better by having a focus for their anger, they are willing to ignore logical inconsistencies. In fact, inconsistencies are often twisted into new ‘evidence’.
• They start to vilify people who believe differently to them, and rather than listening, they start to push their perspectives on others.
• In the short term, they feel a sense of relief and regain a sense of control. Along with this is a sense of feeling that they have special insider knowledge that they need to share with others so that they, too, can feel relief.
• Ironically, the long-term consequence is usually a sense of powerlessness and despair. I don’t believe we have seen this yet with COVID-19, but it is a very real danger in the coming years.

For now, none of us have the resources or capacity to investigate every theory that is out there. On the face of it, some seem downright ludicrous but many hold a germ of truth, which is what makes it tricky for even intelligent and educated people to discern.

My concern as a doctor and community member is that people are expending huge amounts of time and energy chasing after theories, discussing them and spreading them, and NOT focusing on the fact that we are in the middle of the worst medical crisis our generation has seen.

Let’s get our priorities straight.

When the dust settles and investigations are conducted in years to come, many of those questions will be answered. That will be the time to seek justice and call people to account. For the moment, we need to do what we know is important and helpful in reducing virus spread and unnecessary anxiety. So, on a very practical level:

• Check your own coping; are you drawn to theories because they give you a sense of control and predictability? Remember this is a temporary ‘fix’ only.
• Ask friends who forward you theories and plots to stop doing it; explain you find it unhelpful.
• Think twice before forwarding information that you cannot verify.
• Think twice before forwarding information that made you feel anxious when you read it.
• Consider turning off media and social media for a while; ask a friend to fill you in on anything essential (e.g. rule changes).

As Christians we know that, whatever happens, God is in control and knows the timing of everything including the return of Jesus. But we do not, so let’s not get caught up in predicting but rather ‘keep watch’ by faithfully obeying him in the present. That is how to ‘be ready’.

As individuals and communities there is still so much that we CAN do and control, so let’s focus on that!

Dr Tash Yates is a GP based in Gold Coast, Australia.

For centuries, compassion has been the motive and the practice of caring for the sick, not least in Christian monasteries where ‘infirmaries’ were established as long ago as 680 AD.  Today, although healthcare facilities are widespread and diverse, compassion provides a strong motivation for those who work within them.  And, in these days of COVID–19, such compassion has been poured out dramatically even in the face of high personal risk.

A formal research interest in compassion has a much shorter history.  Since the 1960s, it has grown substantially with a sharp increase in publications over the past ten years.  PubMed In August 2020 listed 12,915 scholarly references to this topic.

In 2016, a formal definition of compassion in healthcare was derived from a systematic literature review by Perez-Bret, Altisent and Rocafort.  They proposed compassion to mean ‘the sensitivity shown in order to understand another person’s suffering, combined with a willingness to help and to promote the wellbeing of that person, in order to find a solution to their situation.’  Thus, compassion’s two defining components are of an empathic understanding of suffering coupled with targeted, practical response to bring relief.

Not surprisingly, many scientific references endorse the benefits to patients of being treated compassionately.  A systematic review in 2013 highlighted the improvement of patient satisfaction and adherence, a reduction in their anxiety and distress, better diagnostic and clinical outcomes, and an increase in the ability of patients to improve their own health.  Less well known is that acting with compassion also brings benefits to healthcare professionals: better immune functioning; increased satisfaction with their relationships; protection against professional stress, abuse, and suicide attempts; and the least risk of burnout.

However, offering compassionate care can come at a cost.  Nearly 19,500 learned papers show overwhelming evidence that healthcare professionals are at greater risk than the general population of suffering significant mental health issues, including burnout.  

A useful tool to consider in this context is the ‘Stress Curve’ based on the research of two psychologists Yerks and Dodson in 1908.  Plotting ‘Performance’ against ‘Pressure’ shows that as pressure increases, performance improves to an optimum point, beyond which increasing pressure causes performance to deteriorate, and if unchecked, leads to ‘Burnout’.

Burnout is a word used loosely in common parlance, but we must be precise in our use of terminology.  In 2019, the WHO officially recognised burnout, defining it as ‘A syndrome resulting from chronic workplace stress that has not been successfully managed’.

Being aware of the causes and symptoms of burnout is important.  The former is to enable doctors to avoid precipitating behaviours, and the latter, to enable early recognition of the possible onset of burnout – not just in ourselves but in colleagues.

Doctors then need to consider what internal coping strategies they may have developed.  Peer support or ‘looking out for each other’ is frequently identified as of particular significance.  Identifying external sources of support is another vital part of our assessment, especially sign-posting people to individuals in their local work setting who have been given specific pastoral responsibility for staff and trainees.

The underlying principle is summed up in St Paul’s words of exhortation to the Galatians: ‘Carry one another’s burdens and so fulfil the law of Christ.’ (Galatians 6:2)

Dr Andy Mott is a retired UK GP with thirty years’ clinical experience, and former GP Sub Dean of the Brighton and Sussex Medical School.

Dr Richard Vincent is Emeritus Professor of Cardiology at the Brighton and Sussex Medical School, of which he was co-founder and Associate Dean.

PRIME

To explore burnout and compassion as experienced in the healthcare workplace, the UK Christian charity PRIME – Partnerships in International Medical Education – has been presenting a series of seminars called Compassion without Burnout on which this blog post is based.

Noting the pressurised work of medical staff as they deliver care with both scientific rigour and personal compassion, we designed the seminar programme for their encouragement and support based on small-group discussions.  In these, we review the benefits and challenges of providing compassionate healthcare, the causes and signs of burnout, and the ways in which burnout in the workplace can be minimised. 

We use a PowerPoint presentation to give information but emphasise sharing and listening as we explore the work-related challenges of the group.  To this end we provide a safe space for reflection and grounded discussions that allow the sharing of honest comments about participants’ experiences.  So far, the reception of our seminars has been strongly positive, and, not uncommonly, participants wish to pursue these themes further.

If the subject of Compassion without Burnout is of continuing interest, please see our webinar recorded with the ICMDA on 26 July 2020.  For more information about this programme, or more generally about the work of PRIME,  please click here or email us.

‘Trust in the Lord with all your heart and lean not on your own understanding; in all your ways submit to him, and he will make your paths straight.’ (Proverbs 3:5-6)

As I sit down to write this, my mind goes back to the welcome ceremony during my first year of medical school back in Bukavu in the eastern part of the Democratic Republic of the Congo (DRC).  About 600 first year students were packed in the hot auditorium.  ‘Ladies and gentlemen, welcome to medical school,’ the dean said.  ‘Congratulations for making it here out of the 1,200 applicants.  We felt it was you to whom we could give the chance to graduate from this prestigious institution.  We hope that one out of every ten of you will graduate after six years.  So, your job is to prove to us that you have what it takes to graduate as doctors from this institution.’  Seated at the back, I felt my head begin to spin.  Is it that difficult to become a doctor?  The question was tortuous.  Fast forward one year and of those seated in the auditorium, only 230 entered the second year.  A hundred and twenty-three reached the third year, and 53 entered the fourth year.  I leave the rest to your imagination.  The pressure had just begun.  

Recently Dr Mona Masood, a psychiatrist from Philadelphia, started the free National Psychiatrist-Run Hotline to offer doctors on the frontline Emotional PPE (EPPE).  She first presented the idea in a Facebook forum.  The response was immediate.  Psychiatrists started to contact her saying, ‘Please let me be a part of this. I want to volunteer.’  Dr Masood said, ‘In most cases, we have a lot of emotion on both sides.  There are a lot of tears, a lot of relief.  “If not me, then who?” they say.’

This enthusiasm to help fellow physicians is understandable.  Physicians have been facing mental health challenges since before the pandemic and doctors have long struggled with stigma while seeking psychological help.  They tend to chase perfection and have high expectations of themselves, their patients, colleagues and family.  These expectations don’t stop at medical school; they only get worse afterwards.

It is said that in medicine – whether academic, clinical or research – you need to keep up just to stay in the game.  Physicians are known to talk about medical stuff during social outings, even on dates.  It is not uncommon to see a group of surgeons bragging about how long it takes them to perform a particular procedure, that it was an open surgery, or that it was a minimal access one, or that they now perform remote surgeries thanks to the da Vinci system.  The pressure to keep up never ends.  By the time one is familiar with one procedure, another must be mastered.  This pressure can set people up for mental distress. 

Studies show that nearly 30 per cent of medical students and residents in the US have experienced depression.  A serious study that compared data from 2003 to 2008 for suicides among the general population and physicians showed that physicians who died by suicide were less likely to have consulted mental health experts, less likely to have been diagnosed with mental health problems, and less likely to have antidepressants in their system at the time of death.  Another recent study done in China suggests that the COVID-19 pandemic could exacerbate these trends.  Out of 1,257 healthcare workers interviewed in Wuhan in January and February this year, a significant number reported symptoms of depression, anxiety, insomnia and distress.  This was especially true for women, nurses and all frontline healthcare workers directly engaged in diagnosing, treating or caring for patients with suspected or confirmed cases of COVID-19.

What makes it worse is that this inner distress is never expressed.  Doctors often feel they can’t share their fears even with family members, largely because of societal pressure to act the part of a hero on the frontlines of what is being framed as a war.  Heroes are not supposed to complain or show vulnerability.  You don’t want to look like a coward.  Even for those not directly on the frontline there is no escaping the pressure.  As a friend of mine said, ‘I feel guilty that I am not on the frontline like my colleagues. I feel like my medical training is wasted. I should be out there helping people.’

Could it be even worse for Christian doctors?

Faith is the first casualty in our busy profession.  ‘We expect more from God.  He promised not to leave us nor forsake us after we gave our lives to Jesus,’ doctors say.  But it is Christian doctors who give very little time to God.  We hear people say, ‘I don’t have time to go to church or even read my Bible.  I’ll try and do that when I finish my residency.’  Then comes marriage and starting a family, and before you know it, faith is out the window.  It is not uncommon to see alcohol taking over or the pursuit of money leaving little time for faith related matters.  Soon, they are more in the world than in Jesus.

The world is a depleting place.  But I don’t for a moment think God agonises over what is happening in the world saying, ‘Oh no!  What is going on?’  Jesus said, ‘I have told you these things, so that in me you may have peace.  In this world you will have trouble.  But take heart!  I have overcome the world.’ (John 16:33).  In Four Screenplays, William Goldman sums up the fruit of the world: ‘Life is pain, highness.  Anyone who says differently is selling something.’  This is the difference between what God gives and what the world offers.  The Bible is not trying to sell us anything. 

There are numerous biblical accounts of troubles or crises that occur right when Jesus is present.  Reread those passages to see what set the crisis in motion.  In Matthew 14:28-33 we see Peter sinking in the waves.  Just moments before, he had walked on water but then he stopped focusing on Jesus and looked instead at the extreme weather.  He feared and started to go under.  Then Jesus got hold of him and rebuked him for having ‘little faith’.  I know Peter is not the only one.  In times of crisis, stress or fear, we take our eyes away from Jesus and so our ability to think straight is impaired.  You’re driving in traffic and someone cuts you off.  The words that come out of your mouth are not reflective of who you are in Christ (to put it mildly).  As Prof Steve Reid would say, ‘How many of you will still be calm or Christian at 3 am when a drunk in ER swears at you while you stitch his wounds?’  In a crisis, the line between ‘sane’ and ‘insane’ gets blurred.  Some of us don’t even need a crisis to act crazy.  Focusing on Jesus, who has overcome the world, is what transforms the situation.

What is the lesson from crises like COVID-19?

My Mandarin is very limited.  I had to confirm the following with Dr Samundra Rana, our RR for South Asia.  In Mandarin, the word ‘crisis’ is written using two symbols:  危机.  These two symbols stand for two words: danger (危) and opportunity (机).  Maybe we can draw inspiration from this Mandarin word to ask ourselves each time we face a crisis: Is this crisis dangerous?  And what is the opportunity it brings into my life and into the lives of the affected?

So, what is the danger?

As we practise medicine, we need to keep in mind what John Wyatt said about our ethical dilemma: ‘The medical profession has always been associated with risk to healthcare workers.  COVID-19 just reminded us of the risk of our job as well as our vulnerability as professionals.’  But there is no room for worry.  As the Bible verse I quoted right at the beginning says, we need to learn to trust God and not rely on our own understanding.  And yet most of us remember Jesus’ words only when we face danger and crisis: ‘Can any one of you by worrying add a single hour to your life?’ (Matthew 6:27)

What about the opportunities?

A crisis like COVID-19 is an unprecedented opportunity to make leaders.  Prof Nancy Koehn from Harvard Business School says, ‘I have studied courageous crisis leaders for two decades, and through this work, I know that real leaders are not born; the ability to help others triumph over adversity is not written into their genetic code.  They are, instead, made.  They are forged in crisis’.’  Crises are opportunities for leaders to either rise to the occasion or fall into obscurity.  As David Foster Wallace said, we need ‘real leaders to help us overcome the limitations of our own individual laziness and selfishness and weakness and fear and get us to do better, harder things than we can get ourselves to do on our own’.  Read the Bible for examples of crises where ordinary people emerged as leaders and others who disappeared.  

So where do we start? 

Many people are now calling on God saying, ‘Where are you when we need you the most?’.  And Jesus responds, ‘Right here with you’.  His promise is to never leave nor forsake us.  And we constitute his Church – not the building but the hope for the nations.  We are the only Jesus some in the world will ever see, the only Bible some will ever read.  The Bible says, ‘You show that you are a letter from Christ, the result of our ministry, written not with ink but with the Spirit of the living God, not on tablets of stone but on tablets of human hearts’. (2 Corinthians 3:3)  Can we be like Jesus, open to a desperate and burning world?  As you open yourselves to the burn, remember you are not alone.  Jesus is right there with you. 

Firstly, pray.  The Bible exhorts us, ‘Rejoice always, pray continually, give thanks in all circumstances; for this is God’s will for you in Christ Jesus.’ (Thessalonians 5:16-18)  Once a man was asked, ‘What did you gain by praying regularly to God?’  He replied, ‘Nothing. . . but let me tell you what I lost: anger, ego, greed, depression, insecurity, and fear of death.’  Sometimes, the answer to our prayers is not gaining but losing – which is ultimately the gain.  I paraphrase Archbishop William Temple: When I pray, things happen and people say, it is just coincidence.  Well, I don’t know.  But what I do know is when I stop praying, those coincidences stop happening.

Second, take time to recharge.  The lack of sleep will be paid for whether you want to or not.  We will realise thatwe are only human; it is only a matter of time before our body announces its weakness to us.  Even our Lord took rest during the work of creation, so who are we to believe that life revolves around us?  As the saying goes, ‘If you knew how quickly your boss will replace you if you die, you will pay more attention to your family’.  Let wealth not be your focus.  My mentor, the late Prof Sam Fehrsen, once told me, ‘In medicine one can be guaranteed a job, a stable life, maybe a good wife or roof over your head.  But being rich is not part of the package.  If you see a rich doctor, you must know that somewhere, somehow, somebody is paying the price.  Whether it is your family, your health, your patients or your values the price has to be paid.’  As Jan Kunene said, ‘Our theology of health will shape our theology of healing’.  Understanding the role of God in the healing process will take away some pressure from us healthcare workers.  Remember the famous words of the sixteenth-century French surgeon Ambroise Paré: ‘I dressed the wound, but God healed it.’  

Third, spend time reading the Word.‘It is written: “Man shall not live on bread alone, but by every word that come from the mouth of God.”’ (Matthew 4:4)  Very often we read the Bible as part of our routine, our daily devotion or just in church.  And if the pastor has not touched a particular subject in a year or his/her theology is focusing only on one aspect of the Bible, we slack off.  I encourage you to read 2 Corinthians 4:1-20.  In the chapters leading up to this passage, Paul reflects on his ministry, the fragrance of Christ, his sincerity and a reliance on the Holy Spirit.  In this passage, Paul continues to share his own personal philosophy of ministry in the face of troubles, difficulties, unbelief and struggle.  Know that it is possible for God’s servants to ‘lose heart’ or ‘to be utterly spiritless, to be worn out, exhausted’ as is often seen in our profession.  However, Paul recovered from the hurt and discouragement due to the sincerity of his motive.  He was doing what God called him to do and knew that he had this ministry through God’s mercy!

What about those not on the frontline?

A friend said to me, ‘I just can’t justify to myself how I feel about being a doctor but not being able to use my skills where they are needed.’  As Desmond T Doss said in the movie Hacksaw Ridge, ‘I don’t know how I’m going to live with myself if I don’t stay true to what I believe’.  The answer to this is to get involved.  Look around you.  We are all either infected or affected – such are the challenges that COVID-19 presents to us.  ‘I don’t want to be a burden to others,’ some people say.  But this is not a biblical thought.  What COVID-19 has showed us is that we are interdependent.  In the early church ‘. . .there were no needy persons. . .’ because people looked after each other. (Acts 4:34)

Being involved requires that we be ‘others focused’.  We can all do all or some of the following:

• Mobilise resources or raise funds for the homeless or people who can’t afford to buy food.
• Gather useful information and share with friends (medical and non-medical).
• Contact people whom you have not spoken to in a while.  Check on them even if they are in another town or country.  Now that you have a bit of time on your hands ask how they are doing.   
• Check on colleagues, especially those on the frontline.  Don’t assume they are okay.  Your call may be the only thing that separates them from suicide.  
• Start thinking about how things can change from the way you have always done them.  Maybe learn a new skill or take that online class you have been procrastinating about.
• How about reading a book that has been collecting dust by your bed, or even write one?
• Reflect on how ready you are for a future should something worse happen – this may be needed.
• Work on your house more than the car which is rusting in the parking lot. 
• As St Francis of Assisi said, ‘Preach the gospel at all times.  When necessary, use words.’
• Add value to people’s lives through your money or time.  After all, we are the hands and feet of our Lord.
• Spread words of encouragement and hope, not of fear.
• Avoid conspiracy theories; they don’t help anyone or any cause.
• Don’t forget to sing praises to the Lord throughout the crisis. 
• Choose to be joyful in the crisis.  As Habakkuk 3:18 says about rejoicing in the storm, focus on praising him, confess your feelings, ask the Holy Spirit to help and sing. 

Remember this wisdom, ‘No candle loses its flame by lighting other candles’.  We are the light and the salt of the world.  Let us show the way and preserve the world, as our Lord requires us to do.

Dr Augustin Lutakwa is AEO for the Sub-Saharan African region of ICMDA.