Medical Mission Makes Some House Calls

An Indian doctor sacrifices the prestigious cures of the rich for the preventive health education of the poor, and in so doing, confronts the profession with the need to change its traditional methods.

Jamkhed, india, a town of 6,000 people, isn’t the likeliest place for a revolution to start. But if medical doctor Raj Arole has his way, Christian missionary medicine around the world will never be the same because of what he and his coworkers have accomplished there.

A frequent consultant to the Population Council in New York and to the U.S. Agency for International Develoment in Washington, Dr. Arole found time to preach his new line of missionary health care to 400 participants at the Ninth International Convention on Missionary Medicine, sponsored by MAP International of Wheaton, Illinois.

Dr. Arole, who is in line to be ordained as a minister by the Church of North India, makes a strong pitch for changing the direction of missionary medicine for two reasons: the traditional hospital-centered curative approach responds to the needs of only the handful of people who, one way or another, can reach the hospital; primary health care, on the other hand, aims to keep people at grassroots level from getting seriously ill in the first place.

What this will mean for church-sponsored and independent medical missions is earth-shaking. Say “missionary medicine” and you think of U.S. doctors and nurses confronted with the overwhelming task of coping with an impossible caseload. Talk to mission agency executives and hospital administrators, and you hear about inflation and impossible costs. Talk to nationals, and you hear that missionary medical people can only treat those who can afford both transportation to the hospital and the cost of treatment once they get there. Most mission hospitals, however, provide charity care to those in real need who are unable to pay all or most of their bill.

Whatever way you look at this traditional standby of the U.S. missionary image, new directions are taking shape. Dr. Arole’s story clearly shows why.

He is the product of a traditional missionary hospital and medical college (Vellore), where he achieved what many U.S. Christians perceive to be what medical missions is all about: he became a firm believer in Jesus Christ and he did his basic medical degree studies. Again, Dr. Arole followed the usual pattern. He and his doctor wife went to a small village, Vadala (population 1,400), affiliated with the Church of North India, and started a small dispensary from scratch.

After five years, however, he was “converted” again, medically speaking. “We weren’t solving the problems,” he explained in an interview. “We were just scratching the surface. We decided to stop what we were doing and go to America to study the health problems of rural areas and what we could do about them.”

In west central India, the “problem” was what could be done to raise the average life expectancy from 35 or 40 years and to cut the abysmally high infant mortality rate of 200 per thousand live births. Dr. Arole found the answer in what is called “primary” health care—teaching people how to avoid common illnesses by attacking problems of sanitation, water supply, nutrition, prenatal care, and immunization.

Of course, along with Dr. Arole’s decision to abandon the traditional curative hospital approach came his commitment to responsible Christian witness in primary health care. He looked for a place where not only was there not a church, but a place where there were no Christians and where Western missionaries were not allowed. That is what led him to settle in Jamkhed.

The town’s political leaders and influential citizens were Hindus, except for a few Muslims. They knew the Aroles were Christians, but accepted the pair’s proposal for the beginning of a community-based primary health care program. They donated a place to live—a 60 X 30 three-sided storage shed with a cow dung floor—and a place to work—a former veterinary dispensary. Dr. Arole accepted, and recruited a team of nurses and paramedics, all Christians.

“The people in Jamkhed saw we were Christians and they knew we didn’t belong there,” Dr. Arole said. “But when they recognized we went to all this trouble, cheerfully, without complaining, they opened their hearts.”

The village’s preventive medicine program was launched when the people agreed to volunteer for a health committee and to back an educational approach. They had to grow food for a community kitchen, keep the well clean, and collect children for shots and keep records of their weights. Jamkhed’s accomplishments turned the local health scene around and sparked invitations to Dr. Arole from other villages.

He accepted only when there was a unanimous invitation from the village council. The religious issue always surfaced in the village discussions, as did such troublesome matters as immunization shots and family planning. Again, trust was required. On the matter of religious proselytism, Dr. Arole said, “We don’t go to a village just for numbers of converts. There is no direct preaching. But if because of the witness by our character someone changes his mind and wants to become a Christian, that is fine.” There are now 50 worshiping Christians in Jamkhed.

The response of Indian villagers to primary health care has startled the world-wide health community, to say nothing of the Indian government. Within four years, Dr. Arole’s teams of voluntary health educators and helpers covered 100,000 people in 70 villages. He is now one of 12 experts who formulate the country’s health policies. For two years he also has been an adviser to India’s planning committee for nutrition and primary health care.

Dr. Arole’s current assignment includes teaching in medical schools and leading government-sponsored community health training classes. The government has commissioned him to train 2,500 district health workers in his area encompassing 2.8 million people.

His philosophy is simple: bring basic health care to the doorsteps of the people. It has been estimated that Third World hospitals care for only 10 to 20 percent of the people with health care problems. That is one reason world health experts are pushing for establishing programs on the community level to meet basic needs and prevent disease and premature death.

To the leaders of the missionary health community, this doctor-preacher’s message is also simple: get your medical mission personnel to learn and teach community health care. But in India, at least, the government is more eager to take up the case of primary health care than the mission hospitals.

Dr. Arole is president of the Voluntary Health Association of India, which includes some 600 hospitals. He feels the mission-sponsored hospitals are fighting a losing battle, trying to salvage their traditional curative medical programs. They will lose because of escalating costs on the one hand and declining Western financial support on the other.

“They’re trying to be sophisticated, to get more patients. But they’re charging more and driving away the poor,” Dr. Arole said. “Such hospitals are a place for the middle and upper classes to get medical care. They’re image boosters for the local churches,” he charged.

The concept of primary health care for the poor does not fit such hospitals.

“We must reach people equally and at very low cost,” Dr. Arole said. “If a high-rise hospital is treating the rich, and children are dying of diarrhea in the neighborhood, that hospital should be closed,” he boldly affirmed.

His parting shot: “It is costing us in our program 25 cents per person per year to reach the poor.” Obviously, the issue of world health is not going to be settled by pennies and dollars. But Dr. Arole’s track record also has something to say for the value of his approach: average life expectancy in Jamkhed has risen to 50 and infant mortality has declined to 120 per thousand.

For Christians, it is also important to note that the church is growing in a Hindu culture. That may not impress the World Health Organization, which is calling for strong national commitment to primary health care, but it fits a definition of human development presented at the 1978 WHO conference: “Health encompasses the physical, mental, social, and spiritual well-being of the individual.”

Church and mission-sponsored hospitals have just begun to face the fact that they are at a crucial juncture. The road they take in the future may well determine not only the viability of their medical ministries, but also their opportunities for effective evangelism as well—to say nothing of their response to the world’s impoverished, malnourished, chronically ill millions.

Have something to add about this? See something we missed? Share your feedback here.