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ss nucleus - spring 2000,  The Challenge of the New Millenium

The Challenge of the New Millenium

Almost 2,000 years ago the ‘Great Physician’, Jesus Christ, sent out his disciples ‘to preach the kingdom of God and to heal the sick’(Lk 9:2). The historian who tells us this is Luke, probably the first Christian doctor, who accompanied the apostle Paul on his missionary journeys and wrote the books of Luke and Acts.

Christian doctors motivated by Jesus Christ’s teaching and example have been profoundly influential in shaping the history of medicine.

There have been many famous names including surgeon Ambroise Pare, Louis Pasteur (antiseptics), Joseph Lister (who applied Pasteur’s techniques to surgery), James Paget (‘Paget’s disease’), Thomas Barnado (Barnado’s Homes), Edward Jenner (discovered vaccinations), James Simpson (introduced chloroform), Thomas Sydenham (‘the English Hipprocrates’), the master clinician William Osler and missionary doctor David Livingstone.

But many others whose names are known only to their grateful patients have made substantial contributions in quiet corners beyond historians’ reach.

Christianity continues to shape healthcare today through the pioneering work of Christians in AIDS care and education, drug rehabilitation, child health, palliative care, relief of poverty and particularly service in the developing world. Christian initiatives in the last few decades in the United Kingdom alone include the hospice movement, ECHO (Equipment to Charity Hospitals Overseas), TALC (Teaching Aids at Low Cost), ACET (Aids Care Education and Training), Interhealth (Serving health needs of missionaries), MMA (Medical Missionary Association) and over 20 UK-based mission societies with medical work abroad.

Christian Medical Fellowship was founded in 1949 by Christian doctors in England who wanted to use their medical skills to serve a needy world. It has grown since to a membership of around 4,500 doctor and 1,000 student members throughout the UK and Ireland. Members represent all specialities and there are now over 60 similar national doctors’ organisations linked through the International Christian Medical and Dental Association (ICMDA).

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 the 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 Christian doctors today are called to carry the cross - to walk in the footsteps of Jesus Christ. As well as making it our first priority to preach the gospel to a dying world - in medicine this means two things. First, making ourselves available to serve the sick wherever God may call us and second, being willing to stand for Christian values in a profession which is increasingly jettisoning them. Both paths will involve difficulty and suffering - but both will be avenues of great blessing for a needy world - if we are willing to count the cost.

Sacrificial Service

Where are Christian doctors needed today? Essentially in every field of medicine at every level - but especially in the hard places.

The world’s population reached 6 billion in October last year but 2 billion still lack safe sanitation, 1 billion lack safe water and 1 billion live in severe poverty. And as water tables deepen, rainfall fails and mass migrations of displaced persons overwhelm existing systems, the gains of the last decades are leaking away.

Over 30 million people worldwide still suffer from blindness by WHO 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 30 million people are infected with HIV and the Indian epidemic looks set to eclipse that in sub-Saharan Africa. The AIDS needs alone of many African countries could exhaust their entire health budgets and there is not a city outside the west where a 2.5% HIV prevalence rate has not become 25% in 5 to 10 years.

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 impact of this currently treatable disease is equivalent to 20 fully laden jumbo jets falling out of the sky each day. Malaria still affects 105 countries world-wide with one third of the world’s population at risk - and now climate change is moving frontiers northwards in Europe and the former USSR endangering even more.

In developing countries 17 million people still die from infectious and parasitic diseases including five million childhood deaths from diseases that can be prevented by immunisation - along with the preventable mortality from gastro-enteritis and dehydration.

Maternal health remains a huge priority with 99/100 pregnancy related deaths occurring in developing countries.

With more wars being fought today than at any time in history - we can add the health needs of over 40 million refugees and the legacy of over 100 million unexploded landmines.

There are also the problems of 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 - and all of these are potentiated by the effects of debt in countries where health budgets have been slashed by 50% at the time when need and health problems are greatest.

There has been some encouraging progress with polio, smallpox and leprosy - and the life expectancy of people in the developing world is increasing - but overall there is an immense amount still 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 that is needed is the will to serve.

Ted Lankester, Director of Interhealth, recently pointed out our responsibility to help the needy half of the world: ‘working from hospitals and communities, in war zones and refugee camps, for governments, missionary societies and NGOs. Working short-term, long-term, as front-line surgeons, ophthalmologists, physiotherapists, paramedics, in community rehabilitation or as travelling consultants - in repairing landmine injuries and war wounds, in HIV counsel, care and control - in teaching in medical schools, universities, or remote health posts - in running clinics for child prostitutes, migrant labourers and inner city junkies - in distributing vaccines against malaria, dengue fever or HIV... what is called for is person-to-person responses in a world more open and accessible than ever’.[1]

There is need in the developed world too of course - but in general the diseases that kill most in the rich world are those of overconsumptive lifestyles: ischaemic heart disease, cerebrovascular disease and cancer - difficult to prevent and expensive to treat. In the face of such need abroad we need to have a strong call if we are to stay here rather than go to where the need is greatest.

Standing for Christian values

In the not-too-distant past there was a broad consensus about principles of medical ethics - formulated in such ethical codes as the Hippocratic Oath and the Declaration of Geneva. These codes are broadly consistent with the Bible but they are no longer adhered to.

We now live in a post-Christian society where the plurality of religious traditions, cultural backgrounds, world-views and ideologies makes any real consensus impossible. As a result a new secular ethic has been imposed - but one based on an atheistic view of the world. The Christian principle of the strong laying down their lives for the weak has been replaced by an evolutionary ethic whereby the weak are sacrificed for the sake of the strong. The situation has been potentiated by advancing technology and financial and resource constraints.

This change of ethical tack is no clearer than in the issue of abortion - abortion was illegal throughout the wold at the turn of the century, but with ‘sexual freedom’ has become the norm - to the extent that world abortion rates (50 million pa) now equal human deaths from all other causes. The acceptability of abortion has paved the way for embryo experimentation, genetic manipulation and prenatal search and destroy for abnormal foetuses.

Anxiety over world population has led to the one-child-family movement and campaigns for population control through coercive contraception and abortion policies - without addressing the real problem of western overconsumption of resources nor correcting the economic imbalances which lead people in developing countries to choose large families.

Pressure for euthanasia world-wide is mounting now that it is legally sanctioned in the Netherlands. Resource restrictions are increasingly being used as justification for non-treatment and triage decisions that discriminate against those deemed to have a lower quality of life. We face a century where doctors will increasingly be expected to participate in abortion and euthanasia as part of ‘good medical practice’. Just as abortion and post-coital contraception have become part of ‘the full range’ of gynaecological services- we now face the prospect that euthanasia could become part of ‘the full range’ of geriatric, psychiatric, neurosurgical or intensive care services. This will be fuelled by the growing pressure to harvest organs for transplant from patients deemed to have a low quality of life - unless xenotransplantation finds wider acceptance, with all its attendant risks.

All this is driven by an increasingly cost-driven health system, where priorities are determined by budgets and political agendas rather than by genuine need.

These trends exist ultimately because our society has abandoned Christian values. If there was no sexual immorality there would probably be no AIDS or abortion. If there was adequate sharing of resources then developing world debt and population pressure would not pose the problems they do. If we recognised the image of God in every human being there would not be the pressure to cull brain-damaged adults and abnormal foetuses. We would have no hesitation about putting the weakest first and making the time and money sacrifices necessary to maximise their welfare.

Sacrificial service and uncompromising moral standards are what following Christ in medicine means practically - in this century as in all others. As Christian medical students at the beginning of the new millennium you will need to know where you stand on all these issues and have the moral courage to stand there together whatever the cost may be to your reputations, careers or even lives. 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 (we must always be ready)- and whether our obedience to Jesus successfully changes the world’s course or not - we are still called to be faithful. We may not be able to meet the need, but we can still show how the need can be met. We may not be able to stop the moral decay - but we can still stand firm for godly principles. Most of all we need, like the first disciples to be preaching the gospel, because judgement is coming and ‘the time is short’ (2 Pet 3:11; Col 4:5). And if with Christ’s help we can stand together then history will testify that we faithfully followed those Christian doctors before us.

  1. Lankester, T. Colours of Dawn. Saving Health 1996; 35(2):3-7
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