Forty-five years ago my father-in-law Dr. Jim Broomhall gave the Maxwell Memorial Lecture under the title 'Pioneering Today'.
He, his wife, four children and colleague had just been chased from a wild and remote slave kingdom in the Great Cold Mountains of eastern Asia. For four years this group of pioneer medics and pioneer kids had been the first westerners to survive without being shot or dismembered in this area the size of Wales, inhabited by a fierce minority group. The team had just succeeded in establishing this toe-hold before they, including my two year old wife Joy, managed, by a hair's breadth, to escape capture and imprisonment.
Last year a team including Joy and myself had the excitement of being involved in a community-needs assessment study in the land of her birth, carried out at the invitation of the government. Resulting from this a historic agreement was signed between a new medical agency, and the state government, for a long term community health programme.
I have recently come back from a seminar in Hong Kong, where a team of two nurses and one doctor were commissioned to take up residence in almost exactly the same mountain headquarters as my father-in-law had left forty-five years ago. And his original colleague is leaving in three weeks time, at the age of eighty, for what she hopes will be the first of several visits to teach English at the public health school just down the street from where she was interrogated in 1950.
* * *
At InterHealth, where we see members of over one hundred missions and aid agencies, I have the privilege of talking to medics involved in a vast spectrum of health options, undreamed of in the early pioneering days of medical missions.
HEALTH PRIORITIES
Here are some video shots of just a few of today's priorities:
MEGACITIES
The Problem:
WHO Press Release April 1996: WHO has warned that the growth of megacities will become the biggest threat to health in the 21st century. It then lists the enormously increased health dangers of crowded urban life-styles, as opposed to rural life-styles.
The Solution:
A range of medics to be involved in setting up new health programmes, developing existing projects, specialising in city-specific needs including drug abuse, HIV disease control and sanitation.
Needed: GPs, epidemiologists, front-line nurses, health educators, advisors to governments and NGOs. Needed also: counsellors, psychologists, psychiatrists and social workers.
MATERNAL HEALTH
The Problem:
Human Development Report UNDP 1994: Mothers in poor countries are 150 times more likely to die through complications of pregnancy than in developed countries. 99/100 pregnancy-related deaths occur in developing countries. In Bangladesh 8 in 10 women have maternal health problems.
Needed:
Doctors, nurses and midwives to become involved in community health programmes, epidemiologists to work with WHOs Safe Motherhood Initiative. Gynaecologists, midwives and GPs with a flare for implementing low-cost affordable solutions at first referral hospitals and primary health centres. Sister tutors and lecturers for medical schools and training institutes.
INFECTIOUS & PARASITIC DISEASES
The Problem:
In developng countries 17 million people die each year from infectious and parasitic diseases. World-wide there is a resurgence of cholera, dengue fever, meningitis, and schistosomiasis. Last month we had 7 positive cases of schistosomiasis in just 3 days of medicals - what does that have to say about the likely increase in sub-Saharan Africa?
Not just Africa:Latin American Press 1996: Quote: 'Dreaded diseases from humanity's past are returning to Latin America, and new ones are emerging, feeding on the continent's povery and deteriorating health systems.'
Needed:
Tropical diseases researchers to help develop new strategies and new drugs. Community health nurses, health trainers, medical logisticians. Epidemiologists to work alongside WHO's new unit of emerging and infectious diseases set up in October last year. Specialists in emerging or re-emerging killer diseases. Good straightforward medical generalists to care for sick people in rural mission hospitals and plan local control strategies.
SAFE WATER & SANITATION
The Problem:
UNDP again. Two billion people lack ,safe sanitation and one billion safe water. The gains of the last decade are leaking away as water tables deepen, vast influxes of displaced persons overwhelm existing systems and rainfall fails.
Needed:
Water engineers, public health doctors, medical anthropologists to interface between technologies and local beliefs, plus community health medics, trainers and animators.
HIV & AIDS
The Problem:
British Medical Journal May 1996. There are an estimated 1.75 million HIV infected adults in India. in four years India will have more HIV cases than any other country in the world.
The Solution:
HIV specialists in control, health education, counselling, terminal care. There are hundreds of openings, world-wide, for such ranges of health workers.
Organisations:
Mildmay Mission Hospital London, Action Aid, Macfarlane Burnett Centre in Australia, Emmanuel Hospital Association in India.
TUBERCULOSIS
The Problem:
WHO Press Release March 1996. TB deaths reach historic levels. More people died from TB in 1995 than any other year in history. One third of the world is infected with the bacillus. TB has been declared a global emergency.
The Solution:
Medics at all levels to join in vertical and horizontal control programmes. Under the Directly Observed Treatment Short Course Method (DOTS), for as little as $US 11 per person, TB can be cured if health workers supervise each treatment dose. But where are the medics who will pioneer strategies and implement DOTS treatment regimes? And the doctors and nurses able to set up health programmes with strong TB components? From New York city through Yemen to Zambia it is almost too late.
WAR & LANDMINE INJURIES
The Problem:
World Disasters Report. International Federation of Red Cross Societies 1995. There are more wars now, that at any time since 1945. Immediately after World War Two, there were four. In 1992 there were 53. Forty two million are either refugees in their own countries, or have fled outside their borders - that is one person out of every 125. There are at least 100 million unexploded land mines waiting to maim and to kill.
Needed:
A whole range of medics able to get involved in disaster relief: e.g. - front line curative care with MSF, water programmes with OXFAM, emergency and reconstructive surgery and physiotherapy in field hospitals with the Red Cross, vector control and public health programmes with Tear Fund Disaster Response Unit. Also needed are longer term community health workers to bridge the gap from disaster relief into long term development e.g., with the Salvation Army. 1 person in every 125 people is a refugee
MALARIA
The Problem:
When I researched Good Health Good Travel last year, malaria affected 105 countries and two billion people were at risk. Since January this year malaria has spread further. The latest country to be affected is Azerbaijian, with malaria now threatening the Russian Federation for the first time in a generation. latest studies of children in Gambia using the polymerase chain reaction have shown that 95% are infected. The same may go for much of central Africa.
Needed:
Community health workers, public health and vector control specialists, programme managers, researchers. WHO calculated last month that impregnated bednets could save 500,000 African children a year at a very low cost ... but where are the medics able to work along side partner agencies and churches in Africa and Asia to implement this?
OTHER HEALTH PRIORITIES
Each of us could name them in our own speciality: cataract surgery, diabetes, the problems and diseases of ageing populations, tobacco and alcohol -caused diseases, industrial and road accidents, pollution-induced illness, mental health. These are all prime areas of work for medical missionaries.
SUCCESSES TO ENCOURAGE US
1. Polio, smallpox, river blindness, guineaworm and leprosy. Going-going gone - Why? The intellectual brilliance, logistical dexterity and sheer slog of this generation of adventurous medics. Wanted: an even bigger crop of the same for even bigger problems straddling the millennium.
2. Fantastic, often sacrificial service by thousands of medics running mission hospitals and community health programmes, and ongoing heroic missionary surgeons.
Needed:
Even more long-term, short-term, any-term workers, as health infrastructures, especially in Africa, continue to decline.
SO WHAT DO WE DO ABOUT IT?
*URGENT OPENINGS
In this month's MMA magazine, Saving Health, there are 19 urgent openings for physiotherapists, 124 urgent jobs for doctors, and 136 for nurses and midwives. Needs in 72 countries are listed. The International Health Exchange has many more listings as do the personnel officers of missionary societies, and aid agencies such as Save the Children, Health Unlimited and VSO.
*SHORT-TERM OPENINGS
There are over 50 Christian organisations currently placing short-term workers overseas. Many missionary societies do this as well as many new mission agencies springing up at the rate of several per year.
Within just 25 years, Youth With A Mission has become the world's largest mission agency. An increasing number of churches are going in for 'direct sending', especially the new churches (house churches) forging their own links with overseas partners.
*AN OPEN WORLD
The following countries are open either to orthodox missionary work or 'creative strategy approaches'. Almost every country in Africa, almost every country in Asia, almost every country in Latin America, almost every country in the Middle East, almost every country of the former Soviet Union, and almost every province of Eastern Asia i.e., most of the world.
BUT history tells us that doors revolve and some may close again. The incredible openness now may not last.
*GROWING CHURCHES
Churches in the developing world welcome and need professional Christian colleagues to work in partnership with them. Why are we hanging around? The church is growing faster than at any time in history. So is Islam.
JAGGED FAULTLINE
These are the people above all - the poor, the powerless, and the marginalised - that need our love, care and service. The world has a jagged, blood-stained faultline running through it. It cuts between countries, between communities and between families, dividing the world into two opposites. The descendants of the rich man who already have an awful lot, and will probably soon have even more, and the descendants of Lazarus, his beggar, still sitting it out against the rich man's fence with its security cameras.
A line which separates off and disqualifies the unfortunate half who have drawn the short straw - who when ill have no access to heath care, who are powerless and dispossessed, who live under the tyranny of urban ' jungles, denuded and cropless mountain slopes and ex-savannahs, or who cower beneath inner-city Mafia kings or as the helpless victims of structural readjustment programmes and world debt. These are the people above all the poor, the powerless and the marginalised - that need our love, care and service.
In the last World Health Assembly (1995) the WHO Director General said, 'if we are serious about bridging the gaps in health we must win the battle against poverty. Past achievements and future prospects for health are threatened by the combined shocks of currency devaluations, structural adjustment programmes and economic transition.' Part of the solution is within grasp, within OUR grasp.
Needed:
A massive, strategized mobilising of Christian medical students and young, middle-aged and older doctors, nurses and other health workers. Some to fill gaps, but others to set up and lead new initiatives and gain the highground for God's Kingdom.
DANGERS
*MEDICAL SCROOGES
Somewhere armed with a powerful pair of dark glasses and thick earplugs, a group of doctors, nurses and medics are talking about the era of missionary work being over.
That we assume to be happening. What did happen in March of this year at an international conference in New Delhi is even more sinister: donor fatigue, cynical disregard and the draw of the dollar. At the World Conference of Obstetricians, delegates heard that in 1996, 100,000 Indian women will die in child birth.
The attending BMJ columnist continues in an article entitled, 'We know why they die,': 'What was so chilling was the lack of anger in the hall. As one speaker outlined an initiative he was involved in to train primary health workers, there was a steady exodus of expensively dressed lady obstetricians from the hall. Later that day the organisers shrewdly chose the smallest hall for the Safe Motherhood Initiative Seminar. Afterwards its chairs were taken to pack the largest hall for the session on in-vitro fertilisation.'
*THE TYRANNY OF THE CV
While doctors in developed countries worry about the fine-tuning of their CV's, preventable death and disability shadows the world. We need to think, plan and pray about out careers, yes, but above all we need to obey what God is telling us to do today, believing that he will construct a good retrospective CV for us. And if he doesn't are we really the losers?
*DOWN -PLAYING THE GREAT COMMISSION
Our primary aim is to serve God and work to His glory. If our work is exciting, professionally interesting and good for our career - that's a bonus - but must never supplant our prime purpose.
*THE CHALLENGE FOR THIS GENERATION
Without ignoring the fortunate half, our commission is to help provide health care for the needy half of the world, at an affordable and sustainable level.
Working from hospitals, working from communities, working in war zones, working in refugee camps, working for governments, for missionary societies, for churches, for NGO's and for the WHO. Working short-term, long-term, as frontline surgeons, ophthalmologists, physiotherapists, paramedics, in community rehabilitation and prosthetics, or as travelling consultants - in repairing landmine injuries and war wounds, in HIV care, counsel and control - in teaching in medical schools, universities, or remote health posts in the Amazon jungle - in running clinics for child prostitutes, migrant labourers and inner city junkies - in pioneering, then distributing vaccines against malaria, dengue fever and HIV.
In the Nazareth manifesto of Luke chapter 4, Jesus, after listing the incarnational mandate of drawing alongside all humanity's neediest subgroups, goes on to float one of Scripture's most triumphant promises - the Year of the Lord's Favour.
For me that is the most exciting thought of the year to date. Isn't that the era we are in now, the Year of the Lord's Favour? When God not only plans to show favour but does show favour, when his future promise, stored for generations, does become the day-plan?
And how is he doing it? - Partly through direct heaven-to-earth miracles, but mainly through person-to-person responses in a world probably more open and accessible than ever before. And is it the year of Our Favour? When out of grateful hearts for all God has done for us, we favour Him with the offer of our lives and skills.
This is an era with such incredible, multiple, need and such an astonishing menu of possible responses. Carpe diem cum spirto sancto, or in less pious language, 'Let's go for it and may God's Spirit be with us.'
He, his wife, four children and colleague had just been chased from a wild and remote slave kingdom in the Great Cold Mountains of eastern Asia. For four years this group of pioneer medics and pioneer kids had been the first westerners to survive without being shot or dismembered in this area the size of Wales, inhabited by a fierce minority group. The team had just succeeded in establishing this toe-hold before they, including my two year old wife Joy, managed, by a hair's breadth, to escape capture and imprisonment.
Last year a team including Joy and myself had the excitement of being involved in a community-needs assessment study in the land of her birth, carried out at the invitation of the government. Resulting from this a historic agreement was signed between a new medical agency, and the state government, for a long term community health programme.
I have recently come back from a seminar in Hong Kong, where a team of two nurses and one doctor were commissioned to take up residence in almost exactly the same mountain headquarters as my father-in-law had left forty-five years ago. And his original colleague is leaving in three weeks time, at the age of eighty, for what she hopes will be the first of several visits to teach English at the public health school just down the street from where she was interrogated in 1950.
At InterHealth, where we see members of over one hundred missions and aid agencies, I have the privilege of talking to medics involved in a vast spectrum of health options, undreamed of in the early pioneering days of medical missions.
HEALTH PRIORITIES
Here are some video shots of just a few of today's priorities:
| WHO has warned that the growth of megacities will become the biggest threat to health in the 21st century |
The Problem:
WHO Press Release April 1996: WHO has warned that the growth of megacities will become the biggest threat to health in the 21st century. It then lists the enormously increased health dangers of crowded urban life-styles, as opposed to rural life-styles.
The Solution:
A range of medics to be involved in setting up new health programmes, developing existing projects, specialising in city-specific needs including drug abuse, HIV disease control and sanitation.
Needed: GPs, epidemiologists, front-line nurses, health educators, advisors to governments and NGOs. Needed also: counsellors, psychologists, psychiatrists and social workers.
| 99/100 pregnancy-related deaths occur in developing countries |
The Problem:
Human Development Report UNDP 1994: Mothers in poor countries are 150 times more likely to die through complications of pregnancy than in developed countries. 99/100 pregnancy-related deaths occur in developing countries. In Bangladesh 8 in 10 women have maternal health problems.
Needed:
Doctors, nurses and midwives to become involved in community health programmes, epidemiologists to work with WHOs Safe Motherhood Initiative. Gynaecologists, midwives and GPs with a flare for implementing low-cost affordable solutions at first referral hospitals and primary health centres. Sister tutors and lecturers for medical schools and training institutes.
| In developing countries 17 million people die each year from infectious and parasitic diseases |
The Problem:
In developng countries 17 million people die each year from infectious and parasitic diseases. World-wide there is a resurgence of cholera, dengue fever, meningitis, and schistosomiasis. Last month we had 7 positive cases of schistosomiasis in just 3 days of medicals - what does that have to say about the likely increase in sub-Saharan Africa?
Not just Africa:Latin American Press 1996: Quote: 'Dreaded diseases from humanity's past are returning to Latin America, and new ones are emerging, feeding on the continent's povery and deteriorating health systems.'
Needed:
Tropical diseases researchers to help develop new strategies and new drugs. Community health nurses, health trainers, medical logisticians. Epidemiologists to work alongside WHO's new unit of emerging and infectious diseases set up in October last year. Specialists in emerging or re-emerging killer diseases. Good straightforward medical generalists to care for sick people in rural mission hospitals and plan local control strategies.
| 2 billion people lack safe sanitation and 1 billion safe water |
The Problem:
UNDP again. Two billion people lack ,safe sanitation and one billion safe water. The gains of the last decade are leaking away as water tables deepen, vast influxes of displaced persons overwhelm existing systems and rainfall fails.
Needed:
Water engineers, public health doctors, medical anthropologists to interface between technologies and local beliefs, plus community health medics, trainers and animators.
HIV & AIDS
The Problem:
British Medical Journal May 1996. There are an estimated 1.75 million HIV infected adults in India. in four years India will have more HIV cases than any other country in the world.
The Solution:
HIV specialists in control, health education, counselling, terminal care. There are hundreds of openings, world-wide, for such ranges of health workers.
Organisations:
Mildmay Mission Hospital London, Action Aid, Macfarlane Burnett Centre in Australia, Emmanuel Hospital Association in India.
TUBERCULOSIS
The Problem:
WHO Press Release March 1996. TB deaths reach historic levels. More people died from TB in 1995 than any other year in history. One third of the world is infected with the bacillus. TB has been declared a global emergency.
The Solution:
Medics at all levels to join in vertical and horizontal control programmes. Under the Directly Observed Treatment Short Course Method (DOTS), for as little as $US 11 per person, TB can be cured if health workers supervise each treatment dose. But where are the medics who will pioneer strategies and implement DOTS treatment regimes? And the doctors and nurses able to set up health programmes with strong TB components? From New York city through Yemen to Zambia it is almost too late.
WAR & LANDMINE INJURIES
The Problem:
World Disasters Report. International Federation of Red Cross Societies 1995. There are more wars now, that at any time since 1945. Immediately after World War Two, there were four. In 1992 there were 53. Forty two million are either refugees in their own countries, or have fled outside their borders - that is one person out of every 125. There are at least 100 million unexploded land mines waiting to maim and to kill.
Needed:
A whole range of medics able to get involved in disaster relief: e.g. - front line curative care with MSF, water programmes with OXFAM, emergency and reconstructive surgery and physiotherapy in field hospitals with the Red Cross, vector control and public health programmes with Tear Fund Disaster Response Unit. Also needed are longer term community health workers to bridge the gap from disaster relief into long term development e.g., with the Salvation Army. 1 person in every 125 people is a refugee
| . . .last year malaria affected 105 countries and 2 billion people were at risk |
The Problem:
When I researched Good Health Good Travel last year, malaria affected 105 countries and two billion people were at risk. Since January this year malaria has spread further. The latest country to be affected is Azerbaijian, with malaria now threatening the Russian Federation for the first time in a generation. latest studies of children in Gambia using the polymerase chain reaction have shown that 95% are infected. The same may go for much of central Africa.
Needed:
Community health workers, public health and vector control specialists, programme managers, researchers. WHO calculated last month that impregnated bednets could save 500,000 African children a year at a very low cost ... but where are the medics able to work along side partner agencies and churches in Africa and Asia to implement this?
OTHER HEALTH PRIORITIES
Each of us could name them in our own speciality: cataract surgery, diabetes, the problems and diseases of ageing populations, tobacco and alcohol -caused diseases, industrial and road accidents, pollution-induced illness, mental health. These are all prime areas of work for medical missionaries.
SUCCESSES TO ENCOURAGE US
1. Polio, smallpox, river blindness, guineaworm and leprosy. Going-going gone - Why? The intellectual brilliance, logistical dexterity and sheer slog of this generation of adventurous medics. Wanted: an even bigger crop of the same for even bigger problems straddling the millennium.
2. Fantastic, often sacrificial service by thousands of medics running mission hospitals and community health programmes, and ongoing heroic missionary surgeons.
Needed:
Even more long-term, short-term, any-term workers, as health infrastructures, especially in Africa, continue to decline.
SO WHAT DO WE DO ABOUT IT?
*URGENT OPENINGS
In this month's MMA magazine, Saving Health, there are 19 urgent openings for physiotherapists, 124 urgent jobs for doctors, and 136 for nurses and midwives. Needs in 72 countries are listed. The International Health Exchange has many more listings as do the personnel officers of missionary societies, and aid agencies such as Save the Children, Health Unlimited and VSO.
*SHORT-TERM OPENINGS
There are over 50 Christian organisations currently placing short-term workers overseas. Many missionary societies do this as well as many new mission agencies springing up at the rate of several per year.
Within just 25 years, Youth With A Mission has become the world's largest mission agency. An increasing number of churches are going in for 'direct sending', especially the new churches (house churches) forging their own links with overseas partners.
*AN OPEN WORLD
The following countries are open either to orthodox missionary work or 'creative strategy approaches'. Almost every country in Africa, almost every country in Asia, almost every country in Latin America, almost every country in the Middle East, almost every country of the former Soviet Union, and almost every province of Eastern Asia i.e., most of the world.
BUT history tells us that doors revolve and some may close again. The incredible openness now may not last.
| The church is growing faster than at any time in history. So is Islam. |
Churches in the developing world welcome and need professional Christian colleagues to work in partnership with them. Why are we hanging around? The church is growing faster than at any time in history. So is Islam.
JAGGED FAULTLINE
These are the people above all - the poor, the powerless, and the marginalised - that need our love, care and service. The world has a jagged, blood-stained faultline running through it. It cuts between countries, between communities and between families, dividing the world into two opposites. The descendants of the rich man who already have an awful lot, and will probably soon have even more, and the descendants of Lazarus, his beggar, still sitting it out against the rich man's fence with its security cameras.
A line which separates off and disqualifies the unfortunate half who have drawn the short straw - who when ill have no access to heath care, who are powerless and dispossessed, who live under the tyranny of urban ' jungles, denuded and cropless mountain slopes and ex-savannahs, or who cower beneath inner-city Mafia kings or as the helpless victims of structural readjustment programmes and world debt. These are the people above all the poor, the powerless and the marginalised - that need our love, care and service.
In the last World Health Assembly (1995) the WHO Director General said, 'if we are serious about bridging the gaps in health we must win the battle against poverty. Past achievements and future prospects for health are threatened by the combined shocks of currency devaluations, structural adjustment programmes and economic transition.' Part of the solution is within grasp, within OUR grasp.
| These are the people above all - the poor, the powerless and the marginalised - that need our love, care and service |
A massive, strategized mobilising of Christian medical students and young, middle-aged and older doctors, nurses and other health workers. Some to fill gaps, but others to set up and lead new initiatives and gain the highground for God's Kingdom.
DANGERS
*MEDICAL SCROOGES
Somewhere armed with a powerful pair of dark glasses and thick earplugs, a group of doctors, nurses and medics are talking about the era of missionary work being over.
That we assume to be happening. What did happen in March of this year at an international conference in New Delhi is even more sinister: donor fatigue, cynical disregard and the draw of the dollar. At the World Conference of Obstetricians, delegates heard that in 1996, 100,000 Indian women will die in child birth.
The attending BMJ columnist continues in an article entitled, 'We know why they die,': 'What was so chilling was the lack of anger in the hall. As one speaker outlined an initiative he was involved in to train primary health workers, there was a steady exodus of expensively dressed lady obstetricians from the hall. Later that day the organisers shrewdly chose the smallest hall for the Safe Motherhood Initiative Seminar. Afterwards its chairs were taken to pack the largest hall for the session on in-vitro fertilisation.'
*THE TYRANNY OF THE CV
While doctors in developed countries worry about the fine-tuning of their CV's, preventable death and disability shadows the world. We need to think, plan and pray about out careers, yes, but above all we need to obey what God is telling us to do today, believing that he will construct a good retrospective CV for us. And if he doesn't are we really the losers?
*DOWN -PLAYING THE GREAT COMMISSION
Our primary aim is to serve God and work to His glory. If our work is exciting, professionally interesting and good for our career - that's a bonus - but must never supplant our prime purpose.
*THE CHALLENGE FOR THIS GENERATION
Without ignoring the fortunate half, our commission is to help provide health care for the needy half of the world, at an affordable and sustainable level.
Working from hospitals, working from communities, working in war zones, working in refugee camps, working for governments, for missionary societies, for churches, for NGO's and for the WHO. Working short-term, long-term, as frontline surgeons, ophthalmologists, physiotherapists, paramedics, in community rehabilitation and prosthetics, or as travelling consultants - in repairing landmine injuries and war wounds, in HIV care, counsel and control - in teaching in medical schools, universities, or remote health posts in the Amazon jungle - in running clinics for child prostitutes, migrant labourers and inner city junkies - in pioneering, then distributing vaccines against malaria, dengue fever and HIV.
In the Nazareth manifesto of Luke chapter 4, Jesus, after listing the incarnational mandate of drawing alongside all humanity's neediest subgroups, goes on to float one of Scripture's most triumphant promises - the Year of the Lord's Favour.
For me that is the most exciting thought of the year to date. Isn't that the era we are in now, the Year of the Lord's Favour? When God not only plans to show favour but does show favour, when his future promise, stored for generations, does become the day-plan?
And how is he doing it? - Partly through direct heaven-to-earth miracles, but mainly through person-to-person responses in a world probably more open and accessible than ever before. And is it the year of Our Favour? When out of grateful hearts for all God has done for us, we favour Him with the offer of our lives and skills.
This is an era with such incredible, multiple, need and such an astonishing menu of possible responses. Carpe diem cum spirto sancto, or in less pious language, 'Let's go for it and may God's Spirit be with us.'
