A young woman was brought to the health centre unconscious after her family had found her collapsed on her way to work. She failed to respond even when a lumbar puncture was undertaken without anaesthetic. All results from the tests which were available were normal.

As she was transferred from trolley to bed, there was a suggestion of some voluntary movement, raising the possibility of a functional cause. When the test results were explained to her family, they reported that they were not surprised. They thought that she had 'seen a ghost in the field'. By the next morning, she had recovered consciousness. No abnormalities could be found and she was discharged to her family's care.

Where 'Western medicine' falls short

Situations like this were not unusual in the health centre. Working in a Muslim country, where African traditional religion continues to have a strong influence, meant that patients often explained their sicknesses in spiritual terms.Yet it seemed that they did not expect the Christian doctors and nurses to be able to address these problems – and the truth was that our focus was primarily on the physical and biological abnormalities that our western aware of these spirits than they were, and were reluctant to discuss them with our patients.

Instead, the local people sought the help of the marabouts (Islamic teachers and healers) who claimed to be able to control or pacify these spirits.

I knew that the Bible had plenty to say about the involvement of spirits in causing sickness, mainly in the gospels where Jesus casts out many demons, with the result that their former hosts are healed. 1 But I had never seen or heard this applied to medical practice. I wanted to understand better the anxieties and beliefs of my African patients at the same time as studying scripture, so that I might be able to return and help set them free from their fears.

African Bible college for an African context

So after completing my postgraduate training in the UK, I went to the Nairobi Evangelical Graduate School of Theology in Kenya. This college provides masters and doctoral courses in theology, missiology, biblical studies and Christian education – primarily for African students, but I hoped that by living with and learning alongside them I would be able to grow in my understanding of their worldview.

The missiology course included modules on anthropology and theology and my teachers had research interests overlapping my concerns – one had studied the beliefs held by the Swahili people about the Djinn (Muslim word for spirits) and the other had investigated local understandings of sickness and death in northern Tanzania. (2) It was a fantastic experience and I learnt as much over lunch each day, chatting with my Kenyan and Nigerian housemates, as I did in the classroom.

Research in West Africa

In my final year, I carried out a research project as part of the programme. I spent a few weeks back in West Africa interviewing friends and contacts about their health beliefs, and found that they all gave God primacy in determining whether they would be sick and whether treatment would work. Although it was recognised that a sickness might have a natural cause, even then God must have permitted it. They actually thought most sicknesses were the result of the evil intentions of another being – either a person or a malevolent spirit, and believed that the marabouts were able both to cause and to treat sicknesses.

Their treatments are intended to placate the spirits and to attract blessings from God, and involve herbal washes and rubs, praying and reading the Qur'an, wearing jujus (charms), giving alms and making sacrifices. The marabouts use divination techniques to reveal both the cause of the sickness and what treatment they should give.

The Bible on sickness, health and healthcare

In one of my theology modules, I also had the opportunity to review what the Bible says about sickness, health and healthcare. I knew that there had been no death or sickness in the Garden of Eden and that this will also be the case in the new creation. 3 However, I was quite surprised by some of my other findings:

• Death arrives early in the Bible and this is followed by infertility, apparently sent by God (4)
• Sickness is not described until Exodus, when it is first seen in the plagues (5)
• God warns his people that sickness will increase if they do not obey him (6)
• The link between sin and sickness persists throughout the Bible – God often sends sickness as a judgment on his people. However, Jesus denies that this link is direct enough for us to claim that any one sickness is a punishment for a particular sin (7)

The Bible also attributes sickness to two other causes. Satan's role is seen in the prologue to the book of Job, (8) when he questions Job's righteousness and seeks God's permission to make him sick; and in the gospels, where, as we have seen, sickness is linked to demon possession. But sickness is also linked to God's glory. In the end, this is the underlying reason for Job's sickness, so that he might know God; Jesus gives this as the explanation for one man's blindness; and this is also why Paul finally accepts his 'thorn in the flesh'. (9)

The truth is that when I am sick, I think primarily of biological aetiology and possible medical treatments. I will, rarely, wonder if God will use this to teach me something, but I never consider whether my sin has anything to do with it, nor do I worry about evil spirits.Yet, for as long as I continue to divide the physical from the spiritual in this way, I fail to have a holistic view of sickness, and in the context in which I work, I am failing to address the needs and fears of my patients.

The challenge to provide holistic care

The story of the young woman illustrates this well. Having completed my research, I now know that she is considered to have a sickness caused by a Djinn (a Muslim spirit) who has fallen in love with her. He will attack any potential husband and may kill any children she conceives. He will make her collapse whenever he feels he is losing control of her. Her family will spend a lot of money trying to appease this spirit. However, they will not be hopeful of success, as this sickness is notoriously difficult to treat. (10)

This surely should be the real challenge for medical mission in the 21st century. The people around my health centre have been hard to reach with the gospel. They appreciate the healthcare we provide, but these days many other NGOs are also able to provide good healthcare. As Christian doctors and nurses, we have much more to offer them – not just medical care, but also freedom from the power of evil and the spirits they see around them, and freedom to know and worship God through the victory won by Jesus Christ. This freedom is an integral part of salvation – alongside the acceptance of the truth of the gospel message and a developing relationship with Jesus and his followers. (11) Furthermore, descriptions of the conversion experiences of Muslim-background believers show that most have some experience of the power of God to intervene into their lives, as well as having a Christian friend – whose lifestyle gradually won their sympathy and interest and who presented them with the truths of the gospel message. (12)

I have just returned to work at the health centre where this event occurred. How would I respond now? I still don't have many answers. Jesus' warning about what may happen to a man who has a demon cast out, but who does not fill his life by following him, (13) means that I cannot simply pray for my patient to be freed from evil powers and then walk away. However, I see this as an opportunity to begin to walk a long road with this family, and with local believers who have a greater understanding of the spiritual context than I do. So I would seek to understand what the patient and their family believe about the cause of their illness; I would pray that God would reveal himself in this situation; and I would offer to meet them again to talk further about Jesus, who he is and what he can do to bring them freedom. More generally, I intend to continue to strive to understand and respond to these issues, applying the Bible to the whole of my life – including my medical practice.

Note. A fuller discussion of the role of demon possession in mental illness can be found in Demons and Evil in a Christian Context, Roger Moss, Chapter 7; Mad, Bad or Sad? Beer MD and Pocock ND (Eds). London: Christian Medical Fellowship; 2006