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Medical Missions - an old paradigm revisited

Mark Nelham, BSc, MD, MSC Mark, an SIM partner has been working in Mozambique, and wrote this article after running a discussion group at the ICMDA Congress in Durban in July 1998.
Jesus' teaching and practice Throughout history, the Church of Jesus Christ has been active providing health care services for the needy. Caring for people was clearly placed in our core values when in the Sermon on the Mount Jesus said: "Blessed are the merciful, for they will be shown mercy." (Mat 5:7). Jesus expanded on our responsibility to love our neighbour in the parables of the Good Samaritan (Luke 10:25-37) and the separation of the sheep and goats (Mat 25:31-46). Jesus not only taught the grace of caring for others but practised it.

History of mission based healthcare
Following the Reformation a new missions thrust began with William Carey's work in India. Medicine soon became an important expression of Christian compassion and a tool to open up many areas to the message of the gospel. The fact that acts of mercy are justifiable solely on the grounds that they are a demonstration of the grace of God has at times been confounded by the desire to link them to evangelism. Some have focused on the social gospel and others on the gospel with social action, but regardless, acts of Christian compassion have been strongly linked to missions.

A colonial model
In the past medical missions have tended to establish centres of excellence to care for the sick. From such hospitals we have modelled good medical care in the context of Christian love. We have trained nationals and developed community outreach programmes which to varying degrees have become community based. We have often had difficulty transferring these centres to national ownership and operation because of their high running costs.

Change of ownership and sustainability
Local churches are now a reality in many areas of the world where missions have been working. As local church leadership has matured , issues of national ownership and sustainability have grown. In seeking to transfer our projects to local leaders we should ask ourselves if it is really fair to saddle them with the obligations that go with those projects.

A Community initiative
Governmental and non-governmental agencies working in health services have both been major forces for care in developing countries. They seek to establish sustainable programmes based on indigenous ownership and participation. They look for the initiative to come from the community itself. Such approaches are useful but often ignore the sinfulness of man being based on humanism rather than the grace of God in Christ.

The church's initiative
Is there another way? I believe the question of 'initiative' is critical does it belong to the community or the expatriate? Is the initiative the government's, the community's, or the church's? There are unique opportunities for Christians to work with our national brothers and sisters in helping them develop their initiatives and build their capacity to meet the needs around them. We should not assume that our expatriate ideas will become their ideas. By now we should appreciate that we do not know best.

Furthermore, it is primarily the local church's responsibility to demonstrate the love of God in acts of compassion. "For we are God's workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do." (Eph 2:10)

An old paradigm revisited
To conclude, we cannot call this a new paradigm for we are really returning to our roots. The difference is in realising that the paradigm belongs to the local church. We should not presume to know what "God has prepared for them to do". Where we are foreigners we should not lead. The initiative must be theirs. We may be privileged to help them realise their goals. After all, this is what it means to serve.

Work yourself out of a job?
Who will continue to care for the people after we are gone? The answer being implemented in many countries, is to work side by side helping, encouraging, and training national health professionals and other care givers to accept the responsibility but these efforts are still limited. Can we change our approach and encourage national churches and evangelical organisations to take the initiative? Instead of relying on external missions and agencies, can we help nationals to take over their role as the church of Jesus Christ reaching out to the needy in their own countries?
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