When Dan Fountain arrived at a bush hospital in Zaire in 1961, his skills as a surgeon were put to immediate and constant use, fulfilling a calling to medical missions he had felt when only six years old. Yet after a few months, he realized the people he was curing often got sick again with the same preventable problems. He recalls performing abdominal surgery on a three-year-old boy to remove an intestinal block caused by worms. The boy recovered quickly and went home in ten days, a “triumph of surgery and prayer,” Fountain says; but the boy was back at the hospital only four months later with the same malady.
What was needed, Fountain saw, were changes in the basic health practices of the people in the area, and a reshaping of his own role, from that of provider of curative treatment to one of teacher and trainer promoting preventive care. By the end of his 25-year stint in Zaire, Fountain had developed a model program of community-based health care that integrates hospital treatment, outpatient care, and health education.
Fountain’s change of practice and approach illustrates the sweeping changes taking place today in all of medical missions. A more holistic approach to health—one that encompasses the social, cultural, and spiritual, as well as the physical dimensions of life—is clearly the direction most medical missions are headed, albeit slowly, says Merrill Ewert, editor of A New Agenda for Medical Missions. Ewert describes the change as a “paradigm shift,” a new perspective that “sees health as something that people can grow for themselves.”
“No one says we should close down the hospitals. Curative care is still in need,” Ewert says. “Community-based health development just means working on a different end of the problem.”
The new health-care agenda calls for closer collaboration with churches, says Ewert, an associate professor of educational ministries at Wheaton College and a former community-development worker in Africa. And it requires new, sometimes ego-threatening, roles for missionary medical professionals.
Fortress Hospitals
The idea of doctors and nurses serving on the mission field reaches back no further than the 1800s. But medical missions grew quickly into the next century, as they often opened the door for further missionary work. Though the number of medical doctors serving in mission hospitals leveled off after the 1920s (there were about 1,100 in 1925, and about 1,000 in 1979), the importance of missionary hospitals continued to increase. By the seventies, Christian missions provided a significant portion of the health care in many Third World nations (frequently 30 to 40 percent overall, and sometimes the only service in certain areas).
As mission hospitals grew in importance, however, they also grew into “fortresses,” says Dr. Maybell Arole, who, with her husband, developed a comprehensive rural-health project in Jamkhed, India.
“In these fortress hospitals we have our own culture, often imported from the West,” Arole said recently, speaking to more than 800 health professionals gathered for the Twelfth International Conference on Missionary Medicine (ICMM). The triennial conference, sponsored by MAP International, serves as a global information exchange on health-care issues. “From time to time we put down the drawbridge and allow the poor to trickle in,” Arole said. “Sometimes, in the name of community health, we go out, but quickly return to the security and comfort within the walls.”
The trend to break down those walls began almost 30 years ago. Reformers like Fountain began to call for change, while other pressures started to build. The new governments of former colonies moved to nationalize many institutions. Denominations and mission boards began to turn facilities over to local church bodies, which lacked the resources and experience to direct them. And costs to operate hospitals skyrocketed, regardless of who ran them.
The need for new approaches became obvious, but change has been slow. Paternalistic approaches to medical missions are deeply ingrained, observers say. And the medical profession itself has created additional obstacles. “We have mysticized medicine,” says Arole, by hoarding medical knowledge in the hands of a few.
“I was trained to practice medicine in an institutional setting,” Fountain says. “That’s the way Western medicine works.” And Western institutionalized medicine is what many Third World people desire, equating it with better, more modern care, he says.
Sense Of Ownership
Relinquishing control of projects is difficult for Westerners because it often means standing by while disagreeable decisions are made, says Christian Aponte, director of MAP-Ecuador. For example, in a housing project near Quito, when a local committee took over control of a clinic last year, one of its first actions was to fire one of the two doctors there. Though the doctor was competent, the committee was affirming its control, Aponte says. And in return, the community developed a strong sense of ownership and support for the clinic.
In spite of such problems, control of health care seems to be shifting to national leaders. Ewert, who has attended several ICMM conferences, noted an increase in the number of speakers and conferees from the “Two-Thirds World.” “We haven’t gone as far as we need to,” he said. “But literally, the faces of medical missions are changing.”
By Ken Sidey in St. Simons Island, Georgia.
AIDS: An Unavoidable Risk
“To talk about medical missions through the end of this century is to talk about AIDS,” says Richard Goodgame, a Southern Baptist missionary physician who confronted the deadly disease for eight years in Uganda. In central Africa, the global region with the highest concentration of cases in the world, estimates of the total number of AIDS cases have been continually revised upward and now approach 3 to 4 million by the year 2000, according to World Health Organization (WHO) studies.
Worldwide, the number could reach 5 to 6 million. New reports indicate the epidemic is expanding to new parts of the world. “Anywhere venereal disease is found,” Goodgame warns, AIDS will appear.
Recent WHO figures show 63,842 AIDS cases reported (as of May I) in Africa; 153,720 in the Americas; 644 in Asia; 33,896 in Europe; and 1,976 in Oceania. Experts caution that AIDS figures from developing countries are often underreported.
For medical missionaries, encouraging news is indeed hard to find. Reuse of needles, inadequate testing of blood supplies, and lack of protective equipment not only spread the AIDS virus among patients, but also put health-care workers at risk. Responding to the advice of an expert to “double glove” when treating patients, one missionary doctor exclaimed in exasperation that he and his entire staff were allotted only two pairs of surgical gloves per week.
To date, ten cases of missionaries contracting AIDS have been reported.
