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ss nucleus - spring 2006,  Radical discipleship in medicine

Radical discipleship in medicine

Peter Saunders outlines the example set for us by our Lord[1]

'Jesus has always many who love His heavenly kingdom, but few who bear His cross; many who desire consolation, but few who care for trial…All desire to be happy with Him; few wish to suffer anything for Him… Many revere His miracles; few approach the shame of the Cross. Many love Him as long as they encounter no hardship; many praise and bless Him as long as they receive some comfort from Him. But if Jesus hides Himself and leaves them for a while, they fall either into complaints or into deep dejection…

If a man gives all his wealth, it is nothing; if he does great penance, it is little; if he gains all knowledge, he is still far afield; if he has great virtue and much ardent devotion, he still lacks a great deal, and especially, the one thing that is most necessary. What is this one thing? That leaving all, he forsake himself, completely renounce himself, and give up all private affections. Then, when he has done all that he knows ought to be done, let him consider it as nothing, let him make little of what may be considered great; let him in all honesty call himself an unprofitable servant…

No one, however, is more wealthy than such a man; no one is more powerful, no one freer than he who knows how to leave all things and think of himself as the least of all.'

I first read this passage, titled, 'Of the fewness of those who love the cross of Christ', when I was a fourth year medical student. It comes from Thomas à Kempis' Imitation of Christ, and was written in 1427, a time characterised by general moral and ethical decline and widespread secularisation. Translated into 90 languages, it is the most popular book in western history outside the Bible.

I was deeply moved by it because I recognised that the person being described – the mercenary, fair weather Christian who loved miracles and God's heavenly Kingdom but actually wasn't willing to carry Jesus' cross – was me.

The nature of discipleship

The term 'radical discipleship' is a tautology, because Christian discipleship is radical by its very nature. Jesus is a radical King who calls us to follow him in his radical footsteps. 'Christian disciple' actually means 'follower of Jesus'. Acts 11:28 tells us that the disciples were first called Christians in Antioch, many years after Pentecost. Before that they were called disciples. So Christian and disciple are one and the same thing.

The gospel is not some kind of therapy to make our lives easier. Discipleship is costly. It involves suffering, persecution and hardship because it involves following in the footsteps of Jesus. Becoming a Christian does not insulate us from suffering. If anything it makes us targets.

Jesus pulled no punches with his disciples:

If anyone comes to me and does not hate his father and mother, his wife and children, his brothers and sisters - yes, even his own life - he cannot be my disciple. And anyone who does not carry his cross and follow me cannot be my disciple…Any of you who does not give up everything he has cannot be my disciple.[2]

If they persecuted me, they will persecute you also.[3]

John understood what it meant to follow Jesus:

This is how we know we are in him: Whoever claims to live in him must walk as Jesus did.[4]

We can be greatly blessed by God and not be his disciples; countless people were healed by Jesus, yet never became his disciples because they didn't repent and follow him.[5] We can be greatly used by God and not be his disciples[6] – Judas was. The parable of the houses on rock and sand makes it clear that those who build their houses on the rock are those who both hear God's word and obey it.[7] Scripture teaches us that many will think they are out but will actually be in, and vice versa.[8] We cannot have Jesus as Saviour without also having him as Lord – being a disciple means following in his footsteps.

Are we serious about following Jesus in this day and age, knowing that it will cost us, that there is suffering and hardship, a price to pay? Do we think Jesus is worth it? That depends on whether we really understand who he is and what he has done for us.

Jesus is God himself who came to this earth to be rejected, humiliated, abused, murdered and nailed to a cross in order to rescue us from the judgment we rightly deserve; he calls us to partner him in his work of redemption and then to spend all eternity with him.[9]

If we really understand what we have been saved from and to, we will also recognise that we have to respond to his call, and follow him like Peter:

Lord, to whom shall we go? You have the words of eternal life. We believe and know that you are the Holy One of God.[10]

In the words of one of the greatest hymns ever written:

When I survey the wondrous cross,
on which the Prince of Glory died,
my richest gain I count but loss,
and pour contempt on all my pride…
Love so amazing, so divine, demands my soul, my life, my all.

In 1956 four young American missionaries were mercilessly butchered by members of the Auca tribe they had gone to befriend in the jungles of Ecuador. Later their wives went back and won them for Christ. This year sees their story, End of the Spear, released in cinemas worldwide. Just before going to his death, one of the four, Jim Elliott, wrote:

He is no fool who gives what he cannot keep to gain what he cannot lose.

He could not keep his own life but he could not lose his life with Christ. Being a real disciple of Jesus Christ is costly – but worth it.

Luke 4 – a radical manifesto

So what is radical discipleship in medicine? What was Jesus the Great Physician's agenda? The first Christian doctor, Luke, tells us that Jesus, who

later sent his disciples to preach and heal,[11] first set out his manifesto in his home town, Nazareth:

The Spirit of the Lord is upon me, because he has anointed me to preach good news to the poor. He has sent me to proclaim freedom for the prisoners and recovery of sight for the blind, to release the oppressed, to proclaim the year of the Lord's favour.[12]

The Jews listening would have recognised this quote from Isaiah 61, which actually ends, 'And the day of vengeance of our God'.[13] Jesus didn't read these words but stopped mid-verse to illustrate that redemption and judgment were going to be separated in history. Judgment would be delayed in order to allow people to repent. The Jews didn't understand God's mercy in delaying judgment, his love or the scope of his plan.

The manifesto starts, 'The Spirit of the Lord is upon me, because he has anointed me'. Elsewhere Jesus says, 'As the Father has sent me, I am sending you... Receive the Holy Spirit'.[14]

The same Holy Spirit who anointed Christ and empowered the apostles was to be given to every believer. Many Christians fail to understand the power that has been given to them to resist temptation, to obey God and to serve others. The God who does all these things lives in them by his Spirit. The Christian life is still a fight – we still wage war against the flesh, the world and the devil – but we have living in us by his Spirit the very God who created the world, rescued his people from Egypt, empowered the prophets and raised Jesus from the dead!

The rest of the Nazareth manifesto reveals Jesus' four-fold ministry, which is to be our own model: preaching, healing, deliverance and justice.

Preaching

'To preach good news to the poor' is the first goal of the manifesto. Preaching the good news is the thing of first priority, as Jesus demonstrated when people begged him to stay and do more miracles and healing: 'I must preach the news of the Kingdom of God to the other towns also because that is why I was sent.'[15]

Jesus' priority was preaching the gospel and he instructed his disciples to do likewise - in Jerusalem, Judea and Samaria and to the ends of the earth.[16] Where are our local equivalents? Nottingham? Manchester? In whatever city you find yourself in, but right to the ends of the earth.

Smith Wigglesworth, a British preacher at the turn of the century, had quite an extraordinary healing ministry. Yet, near the close of his life, he said he would rather see one sinner saved than ten thousand healed. Jesus said that if a person gains the whole world and loses their own soul they gain nothing.[17] Better to lose part of your body than retain it and be thrown into Hell.[18] Jesus healed many people but he didn't come primarily to empty hospitals. He came to empty graveyards.

Take a penny for every Muslim and the trail would stretch from London all the way east to Anchorage in Alaska! Some years ago a group of CMF students on a Muslim evangelism training weekend heard testimony from a young British ex-Muslim who had suffered enormous persecution in this country for converting to Christ. One student decided: 'If this young man was willing to suffer in this way to become a believer then we should be prepared to suffer in this way to take the gospel to Muslims.' And now that young man and his doctor wife are developing world missionaries.

Preaching the gospel should be our first priority and the task is far from finished:

  • 1,200 million Muslims
  • 900 million atheists
  • 800 million Hindus
  • 500 million Chinese and tribal religions
  • 400 million Buddhists
  • 100 million Sikhs, Jews and cults

Unreached peoples are mainly in the 10:40 window – between 10 and 40 degrees north of the equator – making up much of Africa and Asia. But people from this window are present in British hospitals, medical schools and communities. God has brought the world to us and the universities of Europe are the gateway to every culture in the world. A Christian medical student in Britain probably has more access to more people from more countries than anyone in human history; access, resources and time.

What are we doing about it? We hear a lot about rights today but the most fundamental right of every human being is to hear about Jesus Christ. Can we deny our friends this right? Sharing faith in today's multi-faith world is complex and involves real skill to demonstrate that the gospel is true, relevant and reasonable – but that is not a barrier. It is rather an incentive to make the most of the opportunities we have. Your classmates will never be as accessible to the gospel as they are now. Make it your aim at medical school to know the gospel, know how to explain it in words people understand, and know how to answer the difficult questions that inevitably come up. Confident Christianity, Saline Solution and Answering Other Faiths are three CMF resources that can help you.

Healing

Part of Jesus' manifesto was 'recovery of sight for the blind' – the ophthalmologists get special mention. It's interesting that the reference to the blind does not come from Isaiah 61 but from Isaiah 35:5,6: 'Then will the eyes of the blind be opened and the ears of the deaf unstopped. Then will the lame leap like a dear, and the mute tongue shout for joy'. All these things happened in Jesus' and the apostles' ministries. There was a restoration of the whole body, as a sign of the gospel's authenticity and a demonstration of God's compassion. As Christians we maybe used by God to bring back sight to blind eyes and movement to broken limbs, either by supernatural means or by using the gifts of medicine that God has given equally graciously. Our concern should be to show the same concern for the whole person as a sign of the authenticity of the gospel, and to demonstrate God's compassion in mediating God's love.

Christian doctors are needed in every field of medicine at every level, but especially in the hard places. We should think first about the developing world. Over 30 million people worldwide still suffer from blindness by World Health Organisation definitions - and yet the major causes of cataracts (trachoma, river blindness and vitamin A deficiency) are all easily treatable or preventable with current technology. Another 40 million people are infected with HIV. The AIDS needs alone of many African countries could exhaust their entire health budgets; yet the disease can be prevented with the ABC strategy of Abstain, Be faithful and Condoms already in place in Uganda. Despite the fact that tuberculosis has been curable for a couple of pounds for over 50 years, we now have the world's worst TB epidemic ever, exacerbated by AIDS. The human impact of this treatable disease is equivalent to 20 fully laden jumbo jets falling out of the sky each day.

Malaria still affects 105 countries worldwide with one third of the world's population at risk; and now climate change is moving its frontiers northwards in Europe and the former USSR, endangering even more people. 17 million people still die from infectious and parasitic diseases including five million childhood deaths from diseases that can be prevented by immunisation. In addition, there is huge preventable mortality from gastroenteritis and dehydration. Maternal health also remains a priority with 99% of pregnancy related deaths occurring in developing countries.

More wars are being fought today than at any time in history, so we can add the health needs of over 40 million refugees and the legacy of more than 100 million unexploded landmines. Alcohol and smoking related diseases, the diseases of ageing populations, drug abuse and prostitution, psychiatric disorders, surgical problems, industrial and road accidents, and pollution-induced illness all potentiate the effects of debt in countries where health budgets have been slashed by 50 percent at a time when need and health problems are greatest.

My wife Kirsty and I had the privilege of working in Kenya with Africa Inland Mission. We were deeply moved by the burden of easily preventable and easily treatable disease that was destroying peoples' lives simply because there weren't enough health professionals available. I saw a woman weep with joy after I did a simple cleft lip repair on her three year old child. Another woman came to us after years of living with foul smelling urine leaking out of her vagina through a vesico-vaginal fistula she got as a complication of obstructed labour. She had been thrown out by her husband and rejected by her family and community. At home I have a photo of that same beautiful woman beaming with joy after I'd closed her fistula with a few stitches in a 20 minute operation. It was not difficult but we had to be there to do it.

There is an immense amount still to be done, and it is up to this generation to do it. In the western world we have all the money, skills and resources necessary. All we need is the will to serve. The real question is not, 'Am I called to go?' Instead we should ask, 'Am I called to stay?' Every Christian doctor cannot help but have concern for the needs of the developing world, regardless of the kind of commitment given – long or short term, short teaching trips, providing locums, training returning overseas doctors, or praying and giving generously.

As a student, I was advised to start living like a missionary. As a result, we have always had far more money than we needed, with lots to give away. Don't live beyond your means. Start to live like a missionary now.

In the face of such need abroad, we need to have a strong calling if we are to stay here. Think about the hard places in British medicine: the inner cities, drug addicts, ethnic minorities, crisis pregnancies, care of the elderly and palliative care. Care for those who will simply not be able to afford treatment in an increasingly privatised and market-driven NHS.

Deliverance

He has sent me to proclaim freedom for the prisoners.[19]

Who are these prisoners? It is striking that just after this passage we read of Jesus' encounters with evil spirits; people were held captive by demons, captured by Satan, enslaved to do his will.[20] It is a reminder that we also are locked in spiritual battle: the Devil is real and just as active today as he was then. His power base is false belief, and his most effective lie – prominent in the West – is that he doesn't exist at all. Here he works through selling seductive but self-destructive ideas that thrive on fear and create dependency. He suggests ways to lift our mood and get a buzz, numb our existential angst, gain pleasure and escape pain. Instead of filling the aching hole in our lives with God, he suggests God-substitutes: drugs, alcohol, sex, pornography, food, material possessions, computer games, illicit relationships, work, career, ambition, sport and music. He encourages the consumption of things that in many cases may be good and legitimate in themselves, but which ultimately will distract and enslave us if we put them in God's place.

The sort of overt deliverance we see in the life of Jesus – when demons are cast out and people miraculously delivered – is relatively rare nowadays. Far more people go to Hell today because of addiction to seemingly harmless God-substitutes than through overt Devil-worship, but the effects are the same. Work, career, alcohol, food, drugs, sex or a prized possession or relationship takes over, distracts and absorbs, usurping God's place in people's lives. Many in the West suffer and die today because they become slaves to self-destructive lifestyles of one kind or another from which they need deliverance. As Christian doctors, we are called to be co-workers with Jesus in their deliverance.

Many Christians don't really believe in the Devil; others fear him. But remember that the Devil is simply a dog on a leash. He can only do what God allows him to do. His judgment and ultimate destruction is assured. He had to ask God's permission to afflict Job and sift Peter.[21] We need not be afraid of him but he is a powerful adversary. As doctors, if we simply aim to heal without addressing the addictive sin and bondage to self destructive lifestyles that so often lie behind diseases, then we are not fully walking in Jesus' footsteps.

We don't have to cast out demons to offer deliverance. We need simply to recognise that it is truth that sets people free and that our most powerful weapon to counter the Devil is the word of God, which is God's truth. We must counter the self-destructive, flawed idea that salvation can be found in anything other than God himself.

Justice

The rest of Jesus' manifesto has to do with issues of justice: 'to release the oppressed and to proclaim the year of the Lord's favour'.[22] The Bible is clear that God's people are also to speak and stand for justice. We see this throughout Scripture and particularly in the Old Testament. We are called to be a voice for the voiceless,[23] to fight injustice,[24] to show mercy and compassion,[25] and to bring in the year of the Lord's favour.[26]

Most commentators believe that the year of the Lord's favour referred to in Luke 4 and Isaiah 61 is the Jubilee year in which debts were forgiven, slaves released and property returned to its original owners, as described in Leviticus 25. Only last year, U2's Bono quoted this passage at the US national prayer breakfast, which President Bush attended. His main point was that addressing developing world debt, which has such profound effects on health, was not an issue of charity but an issue of justice.

Dom Header Camara of Recife, who lived as a bishop among the poorest of the poor during the post 1953 Brazilian dictatorship, said: 'When I served the poor they called me a saint, when I asked why they were poor, they called me a communist'. Camara was a thoroughly modern bishop, extremely well educated and capable of understanding the structural reasons for the deep poverty of so many of his fellow Brazilians. He challenged the obscene wealth of the rich and the embarrassing linkage of the Church with the powerful men in his country. Like the prophets of old and the Lord himself, he was a pain in the butt!

Radical discipleship in medicine involves bringing justice and speaking out against the institutional evils that threaten the health and lives of vulnerable people. It involves being their advocates and empowering them to seek changes in their communities to improve the health of themselves and their children.

Who are those who are marginalised today? Who has no voice?

The poor

The world's population reached six billion at the end of the 20th century. Two billion still lack safe sanitation, one billion don't have safe water and a further billion live in severe poverty. This is an issue of justice.

The September 11 and July 7 terrorist attacks were a great tragedy with over 3,000 deaths in two days. Terrorism is a terrible thing; however, in our rightful remembering of those who died, let's not forget that every day 110,000 people in the developing world die, 40,000 of them children, largely from preventable diseases. Poverty and injustice kill far more people than terrorism: if we fight terrorism without addressing poverty and injustice – especially that which we have created, exacerbated or failed to rectify ourselves – then history and indeed God himself will be asking some very serious questions of us and our generation.

Disaster victims

2005 will be remembered for its disasters: the Indian Ocean tsunami, the Darfur crisis, the Kashmir earthquake. The majority of those affected were the world's poor. Justice is not just about 'not oppressing people'. It's also about our sins of omission – the good we ought to have done that we did not do. CMF doctors raised £100,000 for the Indian Ocean tsunami and the Kashmir earthquake last year: 500 members gave on average £200 each, a very small amount for rich doctors. Yet this relatively small offering paid for tents and survival kits for thousands of people, two communications centres, and equipment for two hospitals to deal with thousands of patients.

The unborn

50 million children, 180,000 in the UK, are killed every year from abortion; that's more than the total number of people killed in the entire Second World War. Speaking out for them is one of the loneliest roads a human being can ever walk. But it is an issue of justice.

asylum seekers and refugees. The Bible has a special place for the refugee and the needs of these groups in the UK are profound.

The elderly and mentally ill

These groups will be most at risk if the UK law on euthanasia changes.

Jesus was poor; Jesus was once an unborn child; Jesus was a refugee in Africa when his family fled from Herod. Christian doctors have a responsibility to speak out and fight the corner of the marginalised, the disempowered and those without a voice: the poor, elderly or confused person; those with head injuries, dementia or strokes; people suffering from chronic or psychiatric illnesses; the terminally ill, children, unborn children and even human embryos. Mordecai's words to Esther, urging her to speak out when her own people were under threat, are just as relevant to us today:

If you remain silent at this time, relief and deliverance…will arise from another place, but you and your father's family will perish. And who knows but that you have come to royal position for such a time as this?[27]

Preaching, healing, deliverance and justice

Jesus' priorities were first preaching, then healing, deliverance and justice. That's what radical discipleship in medicine is for followers of Jesus.

Throughout history Christians have made enormous contributions to the science and practice of medicine. Christians have consistently raised the social status of the weak, sick and handicapped and sought to love and care for them to the utmost of their abilities. Christians have been pioneers in hospital building and staffing, in research and ethics, in promoting increased standards of care, and in immunology, public health and preventative medicine. They have carried medicine across the globe and improved the quality of life of countless millions of people.

We should rejoice in the achievements of Christian doctors in the past, but the past is only of value to us if it motivates us to similar acts of service in our lifetimes. The health needs of this new millennium are greater than at any other time in human history. How will the next generation look back on us? How will history judge us? Like the earliest disciples, today's Christian doctors are called to radical discipleship: to carry the cross, to walk in the footsteps of Jesus Christ, and to make ourselves available to serve the sick wherever God may call us.

The Bible indicates that the time before Christ's return will be a time of great suffering. Whether the end of the world is imminent or not – and we must always be ready – and whether or not our obedience to Jesus successfully changes the world's course, we are still called to be faithful and urgent because 'the time is short'.

It's easy to feel overwhelmed, but don't be. Stanley Browne was known as Mr Leprosy because of his contribution to the treatment of that disease in the Belgian Congo. One of his favourite sayings was, 'You can't meet the need but you can show how the need can be met'.

A man was walking along a sizzling beach covered with thousands of dried out, dying starfish. One by one, he was throwing them back into the water. An inactive bystander asked him what difference he was really making. In response, he just picked up yet another starfish and declared, 'For this starfish it makes all the difference in the world'. That is the attitude we should have. Don't be overawed by the need. Just be determined to play your part in God's service, showing his love to people one by one and trusting the future to him. Think globally but act locally. Let's be radical disciples in medicine in this generation.

References
  1. Abridged from the conference address at the CMF National Students' Conference, 10-12 February 2006. Full address available on CD from pubs@cmf.org.uk
  2. Lk 14:26,27,33
  3. Jn 15:20
  4. 1 Jn 2:6
  5. Mt 11:20-24
  6. Mt 7:21-23
  7. Mt 7:24-27
  8. Mt 7:21-23; 25:31-46
  9. Phil 2:5-7
  10. Jn 6:68,69
  11. Lk 9:1,2
  12. Lk 4:18,19
  13. Is 61:1,2
  14. Jn 20:21,22
  15. Lk 4:42,43
  16. Acts 1:8; Mt 28:19,20
  17. Mt 16:26
  18. Mt 5:29,30
  19. Lk 4:18
  20. Lk 4:31-37
  21. Jb 1:6-12, 2:1-6; Lk 22:31,32
  22. Lk 4:18,19
  23. Pr 31:8,9
  24. Is 58:6-10
  25. Zc 7:9,10
  26. Is 61:1,2
  27. Est 4:14
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