ANALYSE YOUR MOTIVES
'It made me want to go back home and become a good doctor so that I could come back here again.'

'It was quite simply the best part of my training.'

These quotations from recent elective reports sound incongruous in the context of a nation where one in four doctors and even more nurses leave the profession within four years of graduation, while many older healthcare professionals are looking to retire as soon as they reckon they have earned an adequate pension.

What is so special about an elective in a Christian mission hospital when healthcare in the UK is so full of disillusionment? Maybe it is that it makes sense when so much else in our post-modern society does not. Whatever your reasons for starting a career in the health professions, there is only one that can last. Intellectual challenge loses its appeal after qualifying unless it can be prolonged by post-graduate study and research. Money has a way of failing to satisfy. Helping other people becomes less attractive when so many of the public, the media and the authorities are constantly finding fault with what you or your colleagues do. Working long hours at a job you actually enjoy is counter-cultural. But realising that you are primarily appointed by your Creator, that you are ultimately accountable to Him and that He will make all that is done in His name count for eternity, does satisfy.

This may sound theoretical but on your elective you may discover that God has a heart for the poor - be they sick, hungry, cold, homeless, friendless, or defenceless. In fact, they are strategic in His plan to rescue the world. You may find yourself working with colleagues of other cultures who care about their patients and about you. You work and live with them, pray and study the Bible with them. They may experience more overt opposition to their faith than you do, but defend it by demonstrating a love of God that comes from the heart of the gospel. Back home you have seen secular society steadily erode the opportunities to express your Christian faith in your work by a stream of legislation. They, on the other hand, practise holistic healthcare and they live holistic lives, while you are being driven to a spiritual schizophrenia because it is increasingly difficult to be both a Christian and a healthcare professional at the same time here in the West.

LOOK AT THE BOOKS
The Christian Medical Fellowship and MMA HealthServe produce booklets on where to go (Elective Opportunities) for your elective and how to plan it (Preparing for your Elective Overseas). Start at least 18 months ahead if you want to explore the options and find a situation with which you feel at home. If you will be applying for grants you need to have your plans ready to present to the grant making trusts in time for them to make a decision before you go.

Most but not all of the opportunities are planned by applying to traditional mission societies. When you apply to the mission society it has to correspond with its partners overseas. Some societies will want to see you and for you to attend an orientation day. In asking a mission society to organise a place for your elective you may be asking to join a community of nationals and expatriates in a remote situation. Orientation will enable you to know how you can best fit in and be of help to your hosts, as well as further your own learning and experience.

In addition to books there are Elective Days held each year in Scotland, Leeds and London that explore some of the options and ideas with those who have been hosts and students themselves. Elective reports written by those who have gone before can be found on the CMF and MMA HealthServe websites and in their magazines. MMA HealthServe has other elective reports on file and may be able to send you a copy of one relating to the hospital to which you plan to go and may be able to put you in touch with its author.

There are various practical preparations that also need to be made such as the journey, visas, and health precautions. The journey from the destination airport may need planning. Most mission societies will have much experience of how you should get to the hospital. Use public transport rather than a private taxi if you can when you are travelling out of town, unless you know the driver. It is often best to travel with a colleague - there is safety in numbers. Travel by day, and remember road accidents are a more common cause of death than in the UK. Finding yourself in a strange culture and entering parts of it where there is much poverty can be a lonely experience. You will want to decide what to take with you for your own use and/or for those you will be leaving behind at the end of your elective.

You may write to those with whom you will be working and ask if there is something you can bring but be sure you know what to do about importing equipment and especially any medical drugs. You may decide to plan a project or you may find that the clinical workload and reading up about the conditions you see is likely to provide you with enough to do. You can ask about any reading you can do in advance relating to the healthcare problems, the culture and the languages used. Your medical school may have requirements about where you go and what you do. They and any grant giving body will probably want written reports on your return.

You need to find out what the entry requirements to the country are, what health regulations there are (e.g. which immunisations are needed, which antimalarials are needed (if any), and what precautions need to be taken to avoid HIV infection). You will need some kind of insurance against health problems and property theft or damage. Health insurance may include options for medical evacuation and safe blood transfusion. The Banner Group provides cover for members of mission societies and volunteers. (Banner House, Church Road, Copthorne, West Sussex RH10 3RA Tel: 01342 717917, Email: medical@bannergroup.com) In general it is best to travel light and keep a low profile but there will be certain items you need or want to take such as passport, tickets, money, camera etc, that are expensive to replace. Carry them on your person, hidden if possible.

Above all, plan to read the Bible! The 'Doctor's Life Support' book of daily readings is available from this office, and is a useful, and practical commentary on scripture and clinical practice, whatever your profession.

COUNT THE COST
You will want to know how much the elective is going to cost and plan how to find the money.

There will be other costs of comfort and convenience such as differences in culture, food, weather, travel, languages, housing, worship and company. You may find loneliness a problem but this may be a learning experience and a challenge to rely more on the Lord.

There will probably be some greater risks to be taken, especially in relation to health, travel (particularly on the roads) and property.

There are also the longer-term risks and costs of searching for God's calling on your life. All costs are budgeted against gains, be they financial, material, intellectual or spiritual. You could draw up a budget to show expected gains and losses for yourself, but there is another budget that shows expected gains and losses to the Kingdom of God. An elective is an opportunity to discover not so much whether you are good at self-sacrifice as what your gifts are and how you can best use them for the Kingdom. You are taking steps of faith that in human terms are calculated as risks or sacrifices but which can become (and under God will become) doorways to fulfilment. Not self-fulfilment but God's fulfilment for you. 'Well done good and faithful servant, enter into the joy of your Lord' is the greatest reward in life and in eternity.

MAKE SOME DECISIONS

• Where do you plan to go and with which sending/receiving organisation?
• What are your objectives both clinical and spiritual? (and remember you may also want to make some time for a holiday)
• Draw up a plan of action with dates
• Preparation
• Projected elective - all you plan to do while there
• Post elective

Where you go and with whom you go are likely to be inter-related decisions. You may go with a UK based sending agency and ask them to suggest where you go. Alternatively, you may choose a place such as the hospital where a health professional originally from your university or college works (and who may now be supported by your CU or church). An elective is an opportunity to get to know a mission organisation with whom you might return one day, with whom you feel comfortable and whom you feel able to support.

If you choose a host who does not have a UK office or representative such as a Christian hospital or a Christian mentor in a secular hospital overseas you will need to research more carefully the conditions to which you are going and whether the hosts are aware of the requirements of your training. A Christian health professional's first responsibility is to do the job with integrity. In this case the job is to further your professional training and experience. Without that objective any other witnessing is in danger of being hypocritical. But there is a balance to be found between furthering your own education and serving others. Many national health professionals will not have had the training opportunities we have had in this country and you may be able to help and encourage them as a humble and sensitive visitor from the UK. However, they have an educational advantage over you, having seen so much more gross pathology and in having had to be resourceful in the ways they manage patients with far more limited facilities than any UK trained professional. When you return home your elective will be judged by what you have learned while there and the maturity with which you use the experience.

Return to this country should not be so much the end of an elective as the beginning of the next stage in your contribution to global healthcare mission. Pressure of exams or jobs may make it easier just to write a report and put the experience on a back burner. Rather, keep in touch with those to whom you went or with the mission society that sent you. Receive a prayer letter and/or a magazine. Attend a conference. Keep the vision alive.

If you are thinking of returning to work in a developing country you have to decide how to prepare. Most traditional mission or church hospitals are district level institutions and the doctors in them are General Practitioners in the local sense. They are often the only doctors available to rural people. Their work includes outpatient type general practice and inpatient hospital work of all specialties as well as administration and community care. Likewise nurses in rural clinics will have to act as GPs - the extended role of the nurse can be massively extended in the mission field. The same is true for every profession - physiotherapists and occupational therapists will see rehabilitation problems they would never see in the West, and have to manage without the equipment or trained support staff that they would expect here. Situations like these develop your ability to think creatively about the care and treatment you can offer your patients.

It is important to think long term about your post-graduate training and experience if you plan to go overseas once you qualify. Courses in tropical medicine are always useful, whatever your profession. Those run in Liverpool and at the London School of Hygiene and Tropical Medicine are internationally regarded and count many with mission experience among their academic staff. Becoming too specialised is unlikely to make you of much use overseas - one needs to be a generalist rather than a specialist. Nevertheless, you will be of most use long-term if you can get a good few years experience and some appropriate qualifications under your belt. Training qualifications for nurses, midwives and therapists are always useful, and for doctors it is always worth completing all parts of your royal college membership or fellowship exams.

EXPECT TO CHANGE YOUR PLANS
You can do no more than prayerfully plan and prepare for the next step and the possible longer-term future. God alone knows his plan for you and this may involve many difficult lessons, or things of which you had never dreamed. We should be good practitioners to those who most need us or at least better than we would have been without God but we can never achieve either unless we walk with Jesus.