Ethics

Introduction

'You are not strictly speaking a missionary'![1] Such was the attitude towards pioneer medical missionaries. Has this really changed, and if so, in what ways? Perhaps the answer is to be found in a deeper understanding of the theology of medical mission.

I was born 25 years too late to be a pioneer even in Nepal, and at least 25 years too early to enjoy the newest challenges of medical mission. I have not really been a jack-of-all-trades nor yet a master of any one, but I have been privileged to serve in Nepal for 30 years, a period which spans most of the major changes in medical mission in that country. This is the only medical justification for my standing here. I am also studying theology with the Open Theological College, but I am very conscious that even together these hardly qualify me for the privilege of giving the 2002 Rendle Short lecture. However, I thank you for the invitation and trust that with God's help, what I say may be currently relevant, thought provoking and personally challenging.

Medical mission or medical missions?

There are two current theological trends that relate to my subject. One is to speak of the theology of mission, and the other, to link history and theology. There is an increasing amount of scholarship related to mission theology generally, but a paucity of literature related to medical mission. Even the 1999 Medical Missions Summit did not consider this issue. As Wilkinson points out, it was because medical missions arrived late on the mission scene that they have largely been excluded from theological consideration and the literature related to them is mostly biographical.[2] But even he, in his 1989 Maxwell Lecture limited himself to recent medical missions. (with an 's'). My aim is broader - to discuss the Theology of Medical Mission (without an 's'). But because the subject is so vast, and so poorly documented, we can only touch on a few main points, and even those we will have to derive from historical developments and from the general theology of mission.

Traditionally medical work has been seen as a relatively recent add-on to mission,[3] presupposing that it was not part of the original mandate. In fact, Medical Missions as we know them did only come onto the scene in the 19th century, during the last of the classical eras of mission, but this is to ignore the broader dimension of medical mission that, I believe, has always been part of the ministry of God's people and the Christian church.

On the one hand, Wilkinson is right that 'medical mission does not require a separate and specific theology, because it is already provided in the theology of the mission of the Church.'[4] On the other hand, I feel it is a worthwhile exercise to look at the Biblical basis and then the historical development of mission and medical mission, supplementing our biased western perspective with brief reference to early missionary activity in the Eastern Churches, and the evolution of medical mission in Nepal in the last 50 years. This naturally reflects my own interest and experience, but also serves as a good illustration, for what has happened in Nepal has been a sort of recapitulation of the events in other countries, but within a much shorter time span.

Finally, within this backdrop, I want to pose the question as to whether we are today entering just a new phase of medical missions, or perhaps a radically new paradigm?

Biblical mission

As a basis for mission, the Great Commission alone is insufficient. Jesus did usher in a new age and this was a very significant paradigm shift, but what he came to do and what he commanded his disciples to go out and do in mission was in clear theological continuity with the Old Testament.

'The Bible does not encourage a purely naturalistic conception of sickness.'[5] Beginning from the Creation mandate, God's purposes were always holistic, and this is reflected in Hebrew vocabulary. 'Man' is nephesh, a 'living soul', encompassing body, mind, spirit, and will. Throughout the Old Testament God's desire for mankind was for them to experience shalom, a comprehensive state of physical and spiritual peace, welfare, health, and prosperity, translated in the Septuagint by the word 'hygiene', and for which the nearest equivalents in English are 'whole' or 'healthy'. 'The Hebrews laid special stress on physical wholeness',[6] and sympathetic understanding of depression and other psychological stresses are also found, especially in the Wisdom literature. There are examples of miraculous healing, even including some leprosy sufferers. Whether or not their disease was caused by M. Leprae is probably irrelevant in this context: the important principle is that God was showing his concern for those who were sick, and his power to deliver. Holiness and health were indissolubly linked, so that even if Neuberger was wrong to read a code of social hygiene into the Mosaic Law,[7] it still provided the Israelites with a framework for a healthy lifestyle. God used the Jews as an example and as a sign, for Old Testament mission was centripetal.

Jesus also indissolubly linked his preaching and healing, including the casting out of demons. 'He re-established the association between medicine and religion at a new and profound level.'[8] He proclaimed this as his ministry in the 'Nazareth Manifesto',[9] and worked it out as he 'went throughout Galilee, teaching in their synagogues, preaching the good news of the kingdom, and healing every disease and sickness among the people.'[10] It is probably irrelevant whether at least some of these illnesses are now medically curable conditions, for I believe it is a false dichotomy to totally separate God's working through supernatural miracles and his working through scientific medicine. Consider the experience of a Nepali Pastor. In the early days, when there were no medical facilities available, he saw many more cases of miraculous healing than he does now, when his ministry often involves him helping people reach their nearest health post or hospital. Similarly the question of whether Luke was the first medical missionary, or whether he deserted the practice of medicine to become an evangelist, should probably be dismissed as just one unhelpful example of the Evangelical-Liberal divide in mission. I believe that separating aspects of mission, like healing from evangelism - the spiritual from the material - is another false dichotomy based on the dualism of our Greek intellectual heritage.[11] Rather, 'the healing ministry is one of the clearest ways of (demonstrating God's love).'[12] Consider the practice of Nepali Christians who 'say grace' not only before their meals but also before they take their tablets. 'Suffering now should result in as much caring now as the threat of a lost eternity results in evangelism.'[13]

The three Greek words used for 'healing' in the New Testament overlap in meaning, and so do not separate physical and spiritual conditions, medical or miraculous means. The most commonly used is therapeuo, which originally meant to serve a superior, subsequently to care for one another, and hence to cure, usually by medical means. Interestingly, it is also used of the service or worship of a god.

While clearly the New Testament did add to mission the good news of eternal salvation accomplished in Christ, and a centrifugal thrust as missionaries were sent out into the community,[14] this redemptive mandate was never at the expense of the original creation one, for the church became the new sign of the kingdom. God's purposes for mankind had become clearer: they had not changed. He was still interested in their total well-being and not just their eternal souls. In consequence, the medical - or perhaps, more accurately - the healing dimension of mission, was there as the Early Church began to develop, and 'as with the ministry of Jesus… the witness of the early Christians comprised both word and action.'[15] In fact, if Palmer and Wilkinson are right, James 5 may be a pattern of the link between medicine and healing in the early church - appropriate medical treatment for that time alongside believing prayer.[16]

Paradigm shifts

It is important that we first understand the concept of paradigm shift and how it relates to medical mission. In his magnum opus, Transforming Mission, David Bosch explained how the world has been continually changing. Every few hundred years there has been a major change in the predominant world view, resulting in a paradigm shift in culture, which has then been reflected in church and mission motivation, methods, structures, and activities. For example, it was the scientific rationalism of the Enlightenment which led to the development of modern medicine and this, combined with the spiritual fervour of the Evangelical Revival, which took the benefits of modern medicine across the world, hence this last epoch is the one of Medical Missions. In former paradigms, medical mission assumed different forms. But we are now in the middle of a new paradigm shift, and may therefore expect that new forms of medical mission will evolve.

Jettisoning all elements of previous paradigms as the new one fully arrives, is an understandable tendency, accentuated by divorcing history from theology. It is however, essential that we retain the Biblical principles, albeit separating them clearly from contextual practices that are no longer relevant. It is also important that as we learn from our past mistakes, and accordingly change our behaviour, that we do not discard the good and enduring features of the earlier paradigms along with their bad ones. As an illustration, when medical work in the Third World moved into preventive medicine, there were times when the balance was lost and the value of curative centres overlooked until almost too late.[17]

Major paradigm shifts in mission

The patristic paradigm

The early Patristic Age brought little change from New Testament times, but gradually Greek philosophy infiltrated the church and left its mark on mission. With salvation regarded as deliverance from the world rather than for it, the church became increasingly important and mission began to revert to centripetal mode. The Western Church continued to experience miraculous healing but, as in Acts, little is recorded about medical work. On the other hand, 'the knowledge and practice of medicine and healing was a notable feature of (Nestorian) Christianity',[18] whose theological colleges gave missionary training to monks and physicians, among others, for their travel throughout Asia.

The hellenistic paradigm

Constantine's conversion in the 4th century ushered in the Hellenistic paradigm, and in both eastern and western churches, as far afield as Rome and Japan, hospitals, orphanages and leprosaria began to be established and individual Christians exemplified Christ's love in caring for the victims of plagues. Then, as the western Roman Empire staggered towards its demise, the focus of medical scholarship moved eastwards into the Islamic world, strengthened by the preservation and translation of Greek medical treatises, often by Byzantine Christians.

The medieval RC paradigm

By the 10th century in the west, the medieval Roman Catholic paradigm had slipped into place, with the church now part of the establishment. Mission became as much the function of the state as of the church. Theology emphasised the atonement at the expense of the incarnation: the soul rather than the body. Medical practice was therefore discouraged and the healing ministry of the church degenerated into superstition and magic. These were the Dark Ages, but they were also the zenith of the monastic movement, and it was the monks who often set an example of Christian compassionate care for the poor, needy and sick. In the east, however, there were still examples of Christian physicians from Persia serving in the Chinese court of the Khans.

The protestant reformation paradigm

The 16th century Protestant Reformers did not initially make mission their priority, but when a new approach came, it was individualistic, in keeping with the new 'justification by faith' theology. Nevertheless, the intimate link between church and state persisted, a position that continued largely unchanged until the end of the colonial era, during which emerging national medical services in Africa and Asia were often staffed by expatriate Christian doctors, a role not always clearly distinguished from that of their mission colleagues.

The modern enlightenment paradigm

As the western world entered the Enlightenment era in the 18th century, the Modern Age of scientific rationalism began. Technological optimism, scientific medical advances and Christian triumphalism went hand in hand. The supernatural was discounted as superstition. On one side, the social gospel followed logically from secular humanism, and on the other, The Great Awakening and the Evangelical Revival led to the rediscovery of the Great Commission, and so the great century of missions started. The era of Medical Missions followed in its wake, beginning with a personalised curative approach, which took its inspiration from both the fundamentalists and the liberals, from a pre-millennial urgency to share the gospel before it was too late, and the love of Christ for all men, from a sense of awe, and an awakening of Christian conscience. It is 'a matter of historical fact, that the credit for introducing the benefits of western medical science to Africa and Asia belongs to the religious organisations of Europe and America.'[19]

Phases in medical missions

Apart from a few exceptions, perhaps more in the Eastern Churches in the early days, the medical dimension of mission up until the Modern period was fulfilled more through 'TLC' rather than any technical expertise. This was perhaps inevitable for at least two reasons:

With the exception of some outstanding contributions from the ancient east, and the Greece of Hippocrates time, up until the Enlightenment, medical practice throughout the world was traditional, religious, and superstitious. The priests were often the physicians. But with the upsurge of scholarship in the Renaissance, medicine was emancipated from religious philosophy, and became a science. The west suddenly had something worth sharing with the peoples of Africa, Asia or South America that the voyages of discovery had revealed to them beyond the boundaries of Christendom.

The influence of Cartesian dualism meant that mankind was regarded as a soul in need of saving and the body almost irrelevant, a philosophy that encouraged proclamation at the expense of any other dimensions of mission. Increasing western ethnocentricity desired to export superior technology, but within church and mission, it was the good news of eternal salvation that was prioritised. This was precisely why the earliest mission doctors were regarded as 'not strictly speaking missionaries'.

But as a trickle of doctors began to find their way to the mission fields of the world, they saw the overwhelming needs at first hand, and realised they had skills to contribute. They began to heal as well as to preach, and to campaign for something more to be done. An enormous paradigm change was about to occur, as the medical component of mission shifted from simple healing to scientific medicine, but also from a basically spiritual approach to a more secular one. The result was Medical Missions.

The 'TLC' era - preachers & pioneers

The first 'medical' missionaries went out in the 18th century.[20] They were very few, and were missionaries who happened to be medically qualified - sent out to evangelise and care for their colleagues, and allowed to treat nationals only on sufferance.

Such men (and they were only men in those days) were our pioneers. Unable to ignore the desperate need all around them, they began to offer medical advice and treatment as part of their ministry. As time went on, they established small clinics, usually in their homes, and responded to requests to visit and treat both rich and poor alike. And they discovered that the stethoscope and scalpel opened doors that neither their sermons nor the colonial government could budge! It was, for example, Dr Thomas' work that led to Carey's first convert. Gradually they convinced their home boards that medical work was a vital part of mission, but it was a long and hard struggle, and over more than 100 years before a new generation could move on to the next phase.

Not because of reluctance to accept the healing dimension of mission, but for political reasons, the first phase of mission to Nepal took a similar form. By the 1930s, missionaries (including medics) working freely in India recognised the unmet needs of Nepalis, and developed a burden to help. They began to pray, to set up clinics along the borders of Nepal, and respond to the occasional invitation from some local officials to visit Nepal to treat members of their families.

The curative era - the hospital builders

The logical outcome of those early clinics was the building of hospitals, which soon began to spring up all over the Third World. They started as small general treatment centres, offering good but appropriate care to all, especially in the rural and remote areas that were not the priority of governments. A number became real centres of excellence, often surrounded by satellite clinics. Pioneer work in ophthalmology, midwifery, dentistry, and the care of amputees, leprosy and TB patients also began. While there were some notable early attempts at preventive medicine[21] and training,[22] this was, in the main, the great era of Curative care, lasting around 100 years, and deriving its motivation from the individualism of the age and the evangelistic concern of the church. It was the age of the medical generalist, the jack-of-all-trades, and it became also the Nursing Era.[23] It is interesting to reflect that the problem of evangelism versus social gospel, which arose during this period, is perhaps nowhere seen more clearly than in the issue of medical mission, and nowhere shown more clearly to be yet another false dichotomy. In those early days, although many doctors were undoubtedly overworked, there was less stress as we know it today, and in most areas, few political or religious constraints. There was little practical difficulty for the medical missionary to combine his medical service with evangelistic outreach. 'The mission hospital (became) one of the most effective means of presenting and spreading Christianity,'[24] and Sir Henry Holland spoke for all when he said, 'We always pray before we operate. To me, prayer, preaching and healing all go together.'[25]

Despite some further political constraints, this stage was also experienced in Nepal. It began in 1952 and lasted about 25 years, a period during which the missions [26] constructed small general hospitals and began to care for leprosy patients in particular. They provided subsidised treatment for the poor, and offered a level of care - particularly surgical and obstetric - unheard of elsewhere in those days before a government infrastructure was established. Some remote rural clinics were established and village girls trained to do nursing duties. They showed that good medicine is not primarily dependent on a big budget, and proved afresh 'that patients and families are not upset if we pray for them. Indeed they expect it and are grateful.'[27]

The community era - the PHC bandwagon

As medicine made further dramatic advances, and as governments in developing countries began to assume increasing responsibility for health services, a new paradigm of preventive medicine emerged. This was a global phenomenon, but one which had a significant effect on missions. It undoubtedly fulfilled a need that the pioneers had recognised but been largely unable to meet, but its utilitarianism did not always sit easily with the deep personal concern for individual patients which had been the characteristic of curative work, for 'individual medical care had a kind of theological sanction, and it was only later that this view was balanced by more emphasis on the community of which each individual was a part.'[28]

This Primary Health Care bandwagon had no brakes: community programmes, control projects, holistic, integrated multi-disciplinary and para-government health and development schemes followed one after the other. Doctors found themselves pulled in two directions, often without the appropriate backup of a hospital, as tertiary structures were sometimes neglected and became under-funded. It was the age of the public health doctor, while mission hospitals began to be caught in the inflationary spiral and found it hard to subsidise treatment for the poor. Some had to close: others chose to merge. Slowly it became an age of partnership and many started to wonder if the days of the mission hospital were numbered.

By the mid 1970s in Nepal, the government had made formal 5-year health service development plans. Government hospitals were being built and community medicine burst onto the scene. Suddenly the missions were co-operating with government in TB and Leprosy Control, running MCH clinics and feeling their way towards rural community health and development programmes. And they were struggling to raise the funds to keep open their own hospitals or support joint projects with HMG/N.

The training era - countdown to handover?

In most mission contexts, skills had always been imparted to co-workers informally, but as governments began to open more medical institutions, the need for trained staff became an urgent priority. In some countries this phase preceded the community one, but in others it was the new level of partnership with government that began to involve the medical missionary in more formal training, with a view to eventual hand-over. It was the age of the medical teacher, as those with increasing levels of specialisation were recruited to fulfil university requirements. Doctors began spending longer in professional training before volunteering, and fewer years actually serving overseas. Short-term assignments became popular, but some of these doctors experienced difficulty in adapting, and were, at times, unrealistic in their expectations. They gave valuable technical contributions, but a number lacked the vision and language ability to fulfil an equivalent role in evangelism and the church. Some of them were not, strictly speaking, missionaries at all!

Nepal has gone from zero medical training to more than 5 medical colleges in 5 decades, with a corresponding increase in nursing and paramedical courses, and mission personnel in all medical disciplines have been involved in this development. Mission visions for training schemes were sometimes ahead of their times. For example, the value of Anaesthetic Nurses was recognised many years ago by the missions, but has only recently been accepted by government. It is perhaps significant that those who earned their right to teach by first working alongside as conscientious colleagues, have perhaps made the greatest contribution, as their personal witness and example have complemented their role in medical education.

There is one further point to be noted with regard to the Enlightenment Paradigm and the Age of Medical Missions. While many medical missionaries have themselves been deeply spiritual men and women, they were also children of their own age. They enthusiastically replaced what they saw as 'primitive' superstition with modern scientific facts, but in so doing opened the way for a secular understanding of health and disease that left little place for holistic and spiritual dimensions,[29] an effect later compounded by the often enforced handing over of responsibility to non-Christian national colleagues. But, as this epoch neared its end, things had begun to change, as medical workers rediscovered that they had a 'duty to bring wholeness.'[30]

A new postmodern paradigm

We are now entering a new age. It may come as no surprise to hear that we are living in the midst of a major paradigm shift, which is affecting the whole of our lives - personal and professional. It may even come as a kind of relief - to help us understand why we are suffering so much stress! Our world has become a vastly different place from that in which Medical Missions were nurtured. Almost everything has been turned on its head, but in the midst of the changes there are also some exciting challenges.

In the west, Secularism, with its mechanistic view of the universe, and a Materialism that leaves God out of account, have proved unable to answer the deepest questions of life, and so a supernatural dimension is once again being sought. Christianity is erroneously regarded as tried and found wanting. Dualism is giving way to holism. Absolutism is virtually synonymous with intolerance, and the new Relativism is reflected in religious Pluralism, with Christianity just one among many options. Western superiority is an outdated myth. There is a new humility with regard to mistakes made by previous imperial powers, but combined with a lack of confidence to say anything definitive (even about the gospel) any longer. National boundaries keep changing and global communications have shrunk the world so that mission can no longer be defined geographically. As a result some have suggested a moratorium on missions.[31] Were they perhaps right? I submit that the answer is both 'yes' and 'no'!

A new paradigm for medical mission?

'In one sense the days of the traditional medical missionaries are over,'[32] but there are still parts of the old vision that remain to be fulfilled, and it is clearly right that we do not immediately jettison all the components of the older paradigm of Medical Missions. But it is also important that we take a fresh look at this new age and see what should be the form of medical mission for the 21st century.

A new phase for medical missions

A new phase commits us to completing the original vision, the old work, but in new ways.

There are few, if any, pioneer situations left in the old sense, but some of the new challenges in the wake of AIDS, civil war, genocide, terrorism, floods, land-mines, drought and famine require as much, if not even more vision, initiative and professional adaptability as in the early days. In some places Refugee Medicine and Disaster Management have become the new face of Third World medicine, with Christians again frequently in the forefront.

Curative care will always be needed, but its ultimate responsibility must lie in the hands of national governments, for as Tom Hale says, 'We (missionaries) don't set policy; we set an example… of compassionate medical care.'[33] But, while much of what was initiated by medical missions has, I believe rightly, already been handed over, this does not necessarily mean an end to all mission contributions. Super-specialists, particularly as tent-makers[34] seconded to government institutions, are usually still welcome, although it is arguable that the promotion of general practice in these countries is more likely to offer greater help, in the long run, to both patients and the medical profession.

Many old diseases still remain to be controlled - Leprosy lingers, TB has returned with a vengeance, and there are some new nasties. AIDS is becoming possibly the biggest single major medical problem the world has ever faced.[35] MCH and Safe Motherhood objectives were sadly not achieved by AD 2000. Medicine still has a number of unsolved puzzles that need researching. In all these fields, partnership is often still welcomed. On the other hand, while many rural and urban areas remain underdeveloped, political unrest and militant anti-Christian attitudes in some lands are making community medicine increasingly difficult for expatriates.

Training also remains generally acceptable, and may well continue to be so for some time, for it is an on-going task, with new trainees each session, and new techniques being developed each year. To pass on one's knowledge and skill, especially when it is combined with a testimony of one's faith, is still part of medical mission no matter where the training is located, or even whether it is conveyed through books.

While there are new ideas and techniques that fit into the old forms, there are also two major changes discernible, both of which relate to the nationalisation of the work of Medical Missions. The first is the progressive hand-over to national medical professional colleagues, and the other, the increasing responsibility that national churches are assuming for various aspects of medical work. The former is an exciting sequel to the years of training invested, and the latter, an equally exciting outworking of the holistic theology of the younger churches.

It is also perhaps significant that towards the end of the 20th century, the effects of the Charismatic revival began to be felt on the mission field, with a move towards the restoration of the dimension of healing prayer.

In Nepal, missions are still involved in TB and Leprosy work, but have extended their rehabilitation activities to those with other disabilities than Leprosy. Hospital type treatment is now being taken to the districts in an extensive programme of camps. The problem of equipment maintenance has been addressed, as has quality control for Laboratory services. Drug and alcohol dependence programmes are running. Para-medical disciplines like Physiotherapy and Speech Therapy have been promoted and training courses initiated. The problem of AIDS has been considered. Professional training scholarship schemes are being promoted. National colleagues, some of whom are Christians, are increasingly assuming the leadership of programmes. Local communities and NGOs are being supported. The national church is also beginning to respond to the challenge of involvement in various kinds of medical ministry, and combining traditional evangelistic outreach with a service component.

Or a new paradigm for medical mission?

On the other hand, a new paradigm implies welcoming a completely new vision, as well as working out new ways of fulfilling it.

Medical mission is, and always has been, about fulfilling God's purposes for the whole 'man' in the whole world. God's purposes remain the same but his plans for their fulfilment may be changing. The history of mission combined with a Biblical theology provides us with some essential principles, which include:

• God's view of mankind as one whole - with no false division between the physical and spiritual,
• his holistic pattern for mission - with evangelism and medical service fully integrated,
• his equal compassion for individual patients and concern for communities, and
• the importance and value of prayer in and for healing.

Medical Missions worked by taking modern medicine alongside the gospel from one part of the world (the 'developed' western 'Christian' countries) to another (the 'underdeveloped' eastern or southern non-Christian ones) - essentially a geographical movement.

Today, 'everyone agrees that … 'mission' is no longer 'the West reaching out to the rest''[36]. Such an approach is infeasible, as partnership replaces paternalism, and the post- Christian west looks east for more holistic systems of alternative medicine, which seem to offer more personalised and spiritual approaches to healing. Diseases like AIDS, which know no geographical boundaries, threaten mankind in general, and the medical profession in particular. There is no apologetic for the new ethical dilemmas raised by the issues of abortion, euthanasia, gender and now genetics because the traditional Christian ethic of medicine has been eroded. As Tim Naish pointed out 'there is (however) a closer relation between mission and ethics than is generally acknowledged within the church or by scholars of either subject.'[37] I therefore submit that the new paradigm may possibly prove to be an Prophetic Paradigm, and the medical missionaries of the 21st century, the ones who, wherever they is, raise a prophetic voice.

The Old Testament prophets were men who spoke out the truth about God to a people who did not want to hear it. Their authority was derived only from God. They addressed issues of injustice, inequality, corruption, immorality, and idolatry at both personal and society levels. And they were ignored or eliminated.

Stanley Browne said something very similar. 'Christian doctors should be able to exert a determinative influence at strategic points and at strategic moments, so that God's eternal purposes may be forwarded in a very real way.'[38] Within a medical context, malpractice needs to be exposed, gender and age discrimination abolished, expensive treatments fairly distributed, and standards maintained in research and its documentation. The rights of patients, including the very young and the very old, need to be upheld. God's opinion of homosexuality needs to be proclaimed. And, perhaps we should not ask whether it is ethically right to witness during a consultation, but whether it is spiritually wrong for the committed Christian not to do so when prompted by the Lord?

Missions in Nepal have always maintained Christian standards within their own projects, but today there is a new opportunity to speak out against some injustices in society and any wrongs in medical practice. Explosion of the private sector and growth in numbers of the medical, nursing and paramedic staff in general over the last decade, together with increasingly liberal attitudes and lax behaviour among the younger generation, has precipitated the medical profession into debate with government over ethical issues. An abortion bill has recently been tabled and in response, the Nepal Christian Hospitals Association has drafted its own principles of action, and a statement to the government on behalf of its member hospitals.

Cconclusion

Rendle Short himself was never 'strictly speaking' a medical missionary, but he was a man who proclaimed God's word and influenced the practice of medicine in many lands. His style of writing, and even some ideas, may strike us now as dated and even a little paternalistic, but this was precisely because he was speaking in and for his own - modern - generation. If he were here with us today, he would be one of the first to speak out in new - post-modern - terms and challenge us to meet the needs of 21st century global medicine.

The new medical missionaries may therefore be any men or women of God - with a profoundly Biblical faith and a deep compassion that all of mankind might know God's full purposes. Not only will they will be closely in touch with God, but they will have learnt the language of communication with a post-modern world.

These new medical missionaries may be 'called' from (almost) anywhere in the world to work (almost) anywhere in the world. 'The West is now itself a 'mission field,'[39] and Keith Sanders has reminded us that, 'the same Christian attitudes to health care (should) be applied to the West as well as (in) more distant lands.'[40]

These new medical missionaries will be those who share their faith while they serve the people. Their professional and personal lives will be beyond reproach, and they will be openly known as Christians. They will speak into contemporary issues with a word from God, declaring God's judgement on those who reject his mandate for mankind, and proclaiming God's shalom for all who suffer in any way. They will speak the truth in love, and without fear. And they will suffer for it.

These new medical missionaries may be community or hospital based: doctors, nurses or paramedics: generalists or specialists: physicians or surgeons. They may be clinicians, teachers, technologists, researchers, managers, writers, or even theologians. One thing only is certain - they will be pioneers!

Such a new paradigm of medical mission implies that 'whatever the geographical location or professional nature of our service, we are all in this business of commending the Gospel by our life and work - and also word. In a very real sense, we are (all) being called to assume a prophetic role.'[41]

The original pioneers of medical mission were willing to do something no-one had ever done before. Are we? Or are we content to remain 'strictly speaking not missionaries at all'?