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The Future of the Christian Hospital

A Report on the Healthcare Mission Forum November 2002
It had taken the best part of a year to pull together the programme for this year’s Healthcare Mission Forum – the main reason being that it was on a subject of such significance to the present and future of Christian healthcare mission that we wanted to get the widest range of speakers with a significant contribution to make in the field, together with major leaders in mission.

Christian hospitals have been at the centre of health care mission, and indeed, mission in general for some 150 years. In fact, this history goes back even longer if we look to the early church’s practise of opening their own homes, and in later times, monasteries and other Christian communities devoted to the medical and nursing care of the sick and dying. Yet, in the twenty first century we are seeing a crisis facing these institutions. Many are struggling to find the finances to keep running, most face a struggle in recruiting, training and retaining staff, and many are caught between the needs of the local community, and the priorities of the local church, denomination and/or mission agency.

So it was that on a cold November day, some fifty-six delegates, plus staff and speakers, all turned up at Partnership House in London. There was an air of excitement about the room as the event started.

A New Paradigm for the Christian Hospital
Dr Vinod Shah and Dr Verghese Phillip of the Emmanuel Hospital Association India started the programme with an incisive look at the situation in India, and proposed a new model for the governance, funding, role and vision of hospitals run by churches and missions.

Although the model of change they presented was worked out in an Indian context, where there are many church run hospitals across the country, and a large Christian medical network, the essential changes apply across nations and cultures. At its core, their argument was that hospitals need to change their fundamental model of working. Christian hospitals need to be focused on developing local/national leadership rather than flying in expertise from the West, or just focussing on training. They need to move the governance of Christian hospitals away from church or mission society leadership and towards a professional leadership to encourage visionaries and innovators. There needs to be a shift to a focus on the impact that the hospital makes on society rather than a focus on delivering services (e.g. from ‘does our hospital serve the poor?’ to ‘has there been a change in the burden of disease on the poor as a result of our work?’).

Other changes needed included a move away from the independent, unconnected hospital ploughing its own furrow, to the Christian hospital as part of a wider network of similar hospitals and bodies. A shift from a ‘programme orientation’ to a ‘Kingdom’ approach of transforming the surrounding culture (e.g. not just delivering a service for those with HIV/AIDS, but challenging and transforming the prejudice and stigmatisation of those with the virus in the surrounding society). Christian hospitals need to be prepared to act as catalysts for change and innovation rather than seeking to do everything themselves, and need to engage more fully with the local community, allowing community ownership of the work and vision of the hospital.

They then shared some examples of how EHA has sought to change how its hospitals are run in line with this fresh vision (see Paul East’s article in Edition 7 of HealthServe).

A copy of the overheads used in this presentation is available on request from the MMA HealthServe office.

Change in practice - Nepal
Beverly Booth and David Rodgers of UMN then looked at the impact that the different Christian, historical and geo-political environments of India and Nepal had on the way in which Christian hospitals functioned in the two countries, and at one example of how this worked out in practice. India and Nepal, though close neighbours share a different history, one being both colonised and thoroughly evangelised, the other only opening its doors to the outside world fifty or so years ago. As a consequence, though India has a strong network of Christian health professionals and hospitals, and institutions to support them, Nepal’s Christian community is small, has few health professionals and little theology of healthcare mission, and so all Christian hospitals tend to be run in partnership with secular authorities, ex-patriot mission staff and non-Christian national staff. This creates tensions, although it also creates positive opportunities.

However, the costs of maintaining the services, especially in remote areas mean that many hospitals have a fragile existence, and David shared how he had been involved in closing down one such hospital at Amp Pipal. Although the local community had subsequently taken on the task of continuing to run the hospital, the reality was that political, economic and geographical factors had made it impossible to find staff and resources to effectively run a hospital in this remote region.


The African Perspective

After some lively discussions before and during lunch, we reconvened to hear two cameos of African hospitals from Bridget Hathaway of Murgwanza hospital in Tanzania and Ian Spillman of Kisiizi hospital, Uganda.

Both presentations looked at how the challenges of supporting and developing national staff, finding appropriate funding and income generation, and responding to changing patterns in mission support from the West, along with the new challenges of AIDS, the changing attitudes of the Western church towards mission and globalisation, had all affected the work of these hospitals.

Views from Nepal and Israel
Rod MacRorie then looked at the comparative strengths and weaknesses of Christian hospitals versus government hospitals in Nepal
Finally, Derek Thomson spoke eloquently of the struggles and triumphs faced by EMMS Nazareth hospital in Israel. Being an openly Christian hospital, with Muslim and Jewish patients and staff (as well as local Christians) in an area on the edge of the ongoing conflict of the Palestinian uprising, presents a unique set of challenges. In many ways Nazareth is a modern, first world town, so its struggles are quite different, but no less real than those faced by the other hospitals presented at the forum - for more information, see www.nazhosp.com

Some Conclusions?

It was an exciting and stimulating day for all those present, and there were almost too many ideas and questions to address in one day. However, some key points for ongoing and future discussion and action were raised.


In summary, the main themes to emerge were:
  • Paradigm Shifts are needed in the way we approach the running of Christian Hospitals – these shifts include:
    • From equipping & training to leadership development
    • From tight church control and governance of hospitals to governance by professional, Christian bodies
    • From delivering a service to making an impact on the community and society
    • From working in isolation to building networks and partnerships with other hospitals and like-minded bodies.
    • From programme orientation to an orientation to change culture
    • From ‘do-it-yourself ’ to ‘making it happen’
    • From exclusiveness to social engagement
  • On-going partnerships between mission agencies, churches, Christian hospitals, governments, and secular development and other global bodies
  • Training and Education - developing the next generation of national Christian health professionals and leaders.
  • Sustainability - if this is not achievable, what are the alternatives? Can any hospital, even in the West be truly self-sustaining?
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