Missionary Doctors Seek New Role.” This was the title of a report on the fifth International Convention on Missionary Medicine in the January 17, 1969, issue of CHRISTIANITY TODAY. What the report seems to be saying is that we have arrived at an era of medical progress in which there is no longer any need for the traditional inefficient “White Father” institutions whose adventures filled the pages of Sunday-school magazines for a hundred years. There might, however, still be work for a few specialists as teachers or short-termers for a week or two. We are told that “every doctor should be telling others the way to salvation,” and that “missionary doctors should not spend their time on difficult or hostile people, but should concentrate their efforts where chances are best for a payoff in church growth.”
Perhaps this brief news report does not fully reflect the sentiments of this august congress. Still, there are enough pronouncements of this type among our American brethren that some sort of reply seems in order. To the critics I address the following three questions:
- What is the nature of medical care in the world today?
- Are mission hospitals really backward and inefficient?
- Why are Christians doing medical work?
My own answers to these questions are based on eleven years’ experience at L’Hôpital le Bon Samaritain in Limbé, in the Republic of Haiti.
The Nature Of Medical Care Today
Medical progress world-wide is limited to certain geographic and economic groups; great hordes of people today are as desperately in need of even poor medical care as their forefathers. This can be seen even in the United States.
The first obvious fact is the concentration of doctors in cities. The medical situation in Haiti is perhaps an extreme example of what is taking place in most of the underdeveloped countries of the world, and even to a certain extent in the United States and Europe. There are probably 250 doctors, more or less, counting residents and public and private physicians, in all of Haiti, a land of perhaps four million citizens. Of these, about 200 doctors practice in the capital, Port-au-Prince, a city of about 500,000 people. The remaining fifty doctors are distributed among the larger cities and towns of the republic, such as Cap Haitien, Jacmel, Port-de-Paix, Gonaives, and Aux Cayes. The enormous peasant population of rural Haiti has precious little medical care of any kind for scattered government clinics, several missionary (both Protestant and Catholic) establishments, and a number of charlatans.
The reasons for this unequal distribution of doctors operate in most other countries of the world as well. Rural Haiti is poor; disease is rampant. Any doctor working for the Haitian peasant must content himself with a small salary and very hard work. This condition keeps away all but the most determined idealists. In addition there are the obstacles of living in a socially deprived area where diversions are few and illiteracy and ignorance are great, an area where the average physician would not care to raise his children. This is true for Haitians as well as for foreigners. Physicians are usually trained in cities. Often they and their wives come from urban families. Their tastes run to city society, and their aspirations for their children cannot be met in the setting of rural Haiti.
But the problems of obtaining medical care do not end in the cities. Even in the Haitian capital there is a large degree of financial selection. The physician’s economic needs are often quite high, and his principal source of income must of course be the collection of fees. In the sprawling tropical city of Port-au-Prince, the 200 physicians may in fact be serving only 25 per cent of the population with medical care approaching North American standards. Thus the ratio of doctors to population, instead of being the mathematical 1:2,500, which might be tolerable, is probably more like 1:10,000, because large numbers of people cannot afford to pay physicians’ fees or to buy the medicines prescribed. Mission groups operating in or near a metropolis often find it necessary to carry on some sort of medical program for the poor in the city.
I believe that an assessment of medical care in most of the underdeveloped countries of the world will reveal a similar situation. Even in the United States there is a continuing migration of skilled medical personnel into the cities, leaving rural areas and many small towns with inadequate medical care. This movement will probably continue, though attempts are being made to staff poor areas with temporary personnel (two-year residents in Haiti) or lesser-trained workers (such as doctor’s assistants and nurses). Who then will provide the medical care to these vast regions of the world where the average doctor’s tastes and demands cannot be met, and where the care of suffering humanity will have to be carried on at some sacrifice?
During the early days of freedom in Haiti, when King Henry Christophe was seeking teachers and professional help from the Abolitionists in England, James Stephen, the friend of Wilberforce, remarked that religious zeal and the desire for money were “the only two motives strong enough to keep any man or woman without necessity” six months in Haiti. The judgment is probably still valid. Since the financial situation will always be more attractive elsewhere, it will remain for Christians who perceive all men as made in the image of the living God and deserving of kind and loving care, to provide medical help for the vast underdeveloped areas of the world. I believe that the need for medical missionaries will be greater in the future than in the past.
Backward Mission Hospitals?
L’Hôpital le Bon Samaritain, where I have been working for eleven years, has been largely supported by American Baptists. It now consists of a clinic, a maternity service, and a pediatric department. I have witnessed the acquiring of plumbing, electricity, a laboratory, X-rays, and even electro-cardiography. We have grown from 300 outpatients a month to 3,500, and from 5 inpatients to 90. We are training local Haitians to do laboratory work, provide nursing care, and maintain the necessary machinery, and I dare say that most such missionary establishments have a similar record. Nevertheless most North American visitors are obviously shocked by filth, lack of equipment, and primitive practices. I offer the following reasons for this state of affairs, while at the same time affirming that we are indeed making progress—slowly, perhaps, as it should be (“crash programs” have a stubborn habit of crashing):
- Cultural adaptation. In an underdeveloped society, the mission hospital will always be a compromise between Western scientific practices and the values and economic limitations of the society. Fundamental problems of running water, electricity, or refrigeration are not properly the problem of the modern American doctor or hospital administrator. But in a more primitive area the missionary doctor will have to concern himself with these basic necessities if he intends to operate a laboratory or an X-ray machine, or even to Store medicines. The American doctor is trained in institutions that have had several generations to work out the details of such problems as hospital administration, staff salaries, discipline, sterilization, and the maintenance of equipment. In establishing a hospital in an underdeveloped country he must attempt to bridge these gaps in a fairly short time, and at the same time create a new set of values among the people with whom he works. The result may stand in poor contrast to a new community hospital in California, but in its own context it may be an object of great human hope.
- Overloading. There are probably very few mission medical services that do not suffer from gross overloading of their facilities. The incessant mill of human necessity continues to grind out the same human equation: Overwhelming suffering and need, treated with meager funds and limited equipment, leads to overloading, rapid deterioration of existing apparatus, filth, bedbugs, and two children in one bed. Not many weeks ago I put a woman critically ill with pericarditis on the porch of the hospital, where she was covered by flies and wet by the rain. I will do this again many times in the future because it is simply true that medical treatment on our porch will be many times more effective than folk remedies in the Haitian countryside.
- Isolation and stagnation. Doctors working in a mission situation must face a certain amount of medical stagnation from isolation. It is also true that organ transplants and cardiac catheterization are not among our immediate needs in Limbe. The mission doctor hopes to achieve some wise harmony between Western medicine and the needs of the society to which he is called. For many physicians, periodic visits to the United States have proved helpful in keeping them up to date. The nearness of Haiti to the States has made it possible for us to carry on a teaching program in which senior medical students come here as an elective for six to twelve weeks, under private auspices or on occasion under a fellowship. Such a teaching program stimulates clinical discussion and helps us in our efforts to keep our institution up to date.
Why Are We Here?
Many seem to view the mission hospital as a lure for use in fishing for men. It may incidentally serve as such, but this theory of medical work must ultimately yield to the story of Jesus’ healing of the leper in Mark 1:40, after which he sternly forbade the man to tell anyone. Christians, like their Master, must be “moved with compassion.” Almost all medical works abroad started in this fashion. As James C. McGilvray describes the process:
The majority of Christian Medical Work began as an afterthought. An evangelist undertook his work in a particular area, but soon discovered that many of his neighbors were ill. He had a supply of medicines for himself and for his family, and began to distribute them as simple, unavoidable acts of charity. A generation later you came back to find a 50 bed hospital there and efforts being made to expand it to 200 beds [International Review of Missions, April, 1968, p. 213].
In Haiti, at this very moment, there are countless medical works in evolution, moving from the pastor’s back door to his yard to a small shack to a building to a clinic with a nurse to a “hospital” with a doctor. This movement is inevitable in those places where the Gospel brings a new dignity to man and a new dimension of compassion. In a very broad sense modern medicine itself is merely “organized compassion”—the attempt to treat our fellow men with the most efficient and efficacious methods.
A parenthetical word should be addressed to those who would step from the compassion of the mission hospital to the technological and statistical application of preventive medicine. I am constantly amazed by the apparent desire of many Americans to prevent illnesses in Haiti, but the obvious drive to treat them in the United States, as witnessed by the continuing expansion of medical facilities there. Were the same critics, along with their families, given the opportunity to live in the town of Limbe, there would be little question as to which they would find the most worthwhile—an anti-malaria campaign or the present hospital, poor as it may be!
In an increasingly secular world, cut adrift from traditional values of mutual respect and responsibility, there will be an increasing demand for those men and women who perceive the image of God in their fellow human beings and are willing to serve suffering humanity with the compassion that motivated their Lord. These cumulative acts of compassion will serve as a leaven within the society, pointing to the Source who “emptied himself, taking the form of a servant, being born in the likeness of men, and being found in human form … humbled himself and became obedient unto death, even death on a cross.” The world is crying for men and women who are so motivated and are willing to pay the cost.
William H. Hodges is a medical missionary in Limbe, Haiti, under the American Baptist Home Mission Society. He holds the A.B. (University of California at Los Angeles) an M.D. (University of Southern California).
