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Thriving in Medical Missions
Today we're going to continue looking at how to encourage medical missionaries, and we're going to hear from another experienced physician who understands what this is all about. David Narita, his wife Lara, and their three children served with OMF International for 13 years in Northwest Cambodia. Currently they live in California where he facilitates OMF healthcare missions.   Red Strings When we first arrived in Cambodia, part of our settling in was learning the Khmer language and culture. I remember my instructor pointed out one day, “The red strings you see everywhere are a symbol for protection. Cambodians tie it on their wrists, bicycles, doors, everywhere like a good luck charm.” He made them sound like they were everywhere, but I hadn’t recalled seeing many of them. Yet as I walked out of class, I felt like I was in a different world. There were red strings everywhere.  There’s an idea I call the Red String Principle. If you name something, you’ll see it. All those red strings were there before; I just wasn’t looking for them. You can understand it. Now those strings had significance to me. And that new understanding allowed me to engage with their meaning. What do I think about those strings? What will I say if someone offers one to me? Ultimately naming something gives us a bit of control. Nothing I’m going to share with you is new. It’s always been there. But I hope by putting a name on it and drawing your attention to it, you’ll be able to see what’s happening, understand it and be able to engage those situations in a more thoughtful, godly way. Preach the Gospel Daily Two men went up into the church to pray, one a missionary and the other a really bad guy. The missionary, standing by himself, prayed: ‘God, I thank you that I am not like others, caught up in their worldliness and using their gifts for themselves. I value what you value; I mean I gave up my family, my career, my nice suburban life all for You.’ But the really bad guy, standing far off, would not even lift up his eyes to heaven but beat his breast saying, ‘God be merciful to me, a sinner!’ We exist because of God’s grace. None of us in any real sense is more righteous than the next in God’s eyes. We have all sinned and fallen short of God’s holy standard. John Stott wrote, “Nothing in history or in the universe cuts us down to size like the cross. All of us have inflated views of ourselves, especially in self-righteousness, until we have visited a place called Calvary. It is here, at the foot of the cross that we shrink to our true size.” (Stott, John R. W. The Message of the Galatians: John R.W. Stott. Leicester, England: Inter-Varsity Press, 1986. P. 179.) I am a proud and self-righteous person. I love to feel like I’m doing the right thing; doing better than those around me. I’m a great Pharisee. But this isn’t the way of Christ. Pride is a path that leads to bitterness and discontent, to emptiness and fruitlessness. Godliness with contentment comes from knowing that our works do not earn our salvation; that no one is better or more ahead than anyone else. Not super apostles, not missionaries, not really bad guys. We are all sustained by God’s grace through Christ. So before we go out to minister we come to the cross and preach the gospel to ourselves first. What will you do when you start feeling like a Pharisee? When your self-righteousness threatens to take away the grace God has given you? What will keep the grace of God before you day after day? Remember Christ’s Body We arrived in Cambodia very excited. But you know excitement is often just another word for stress – with a positive spin.  Naturally to bring order to that sense of chaos, we organized and categorized things in our minds. For example, we’d be asked where we stood on issues such as taking the time to learn the local language or use a translator, providing food/resources to people in need or protect a community’s sustainability, paying local pastors or encourage them to be bi-vocational. We accepted that there was a right way to do ministry and a wrong way. Lines were drawn. Those lines formed groups. Groups led to polarization. And polarization can lead to conflict. Maybe not outright hostility but a sense of separation and distance.  A veteran missionary reminded us that Christ unites while Satan divides. Recognize that our real battle isn’t with those around us. Not with your spouse, your children, the nationals, other groups, your leadership, your teammates. They’re typically not the ones out to get us. Remember there’s an enemy who would rather you give up and go home. He divides us when we judge our way of ministry is better than another’s, when we allow something small to consume us, when we grow bitter towards others. That’s our sinful nature controlling us. Satan divides but Christ unites. And uniting means valuing others as Christ does.  We’re not all supposed to be the same. We would never say, “Everyone needs to be a doctor.” What an un-fun world that would be! Neither does every Christian need to be just like me. I’m thankful for a colleague passionate about theological education as much as those feeding orphans. Both have equal and important callings from God. We’re very different members of His body doing very different things but serving the same Lord. Always be humble and gentle. Patiently put up with each other and love each other. Try your best to let God’s Spirit keep your hearts united. Do this by living at peace.  Eph 4:2-3 CEV When you feel that judgment and division say, “Satan, I’m not going to let you win!” Pray that God will give you a heart of genuine love and respect for others, allowing others to follow God as He’s called them, and be a unifying force for His kingdom. Look for the good in others, the ways they are reflecting God. Focus on that and thank God for them. When the lines seem to grow deeper between fellow believers, how can you love them as Christ does? When you’re tired and hot, people are pushing all the wrong buttons and you feel like you should just go home, what will you say to yourself to help you live at peace? Know Yourself It took me a while to realize this, but there are two kinds of people in this world – journey people and destination people. In simplest terms, it takes journey people two weeks to drive across the country. They see, they experience, they make new friends, they laugh and cry. Destination people: 38 hours and 23 minutes without traffic. In medicine, journey people want diabetics to take ownership of their disease. To work hard at diet and exercise. To care for their feet and find a new normal. Destination people: Medicine, A1c down, done. Are the most important characteristics in your church planting keeping it simple, sustainable and nationally-led or do you primarily picture a community of local believers? Journey and destination. Another way of saying this is to ask if you’re values-driven or vision-driven. Do you see the values embraced in the process as your motivation or is it the end result - what you hope to achieve – that you picture in your head? As you work with and lead others, this could be a huge source of unity or disagreement. Seek to understand the other person’s motivation; what makes the other person tick. Someone who is vision-driven will become incredibly frustrated by the seeming lack of focus of a values-driven person. And a values-driven missionary may feel a vision-driven colleague is a little too pragmatic, maybe to the point of compromise. I’m not saying one is better than the other, but if we can recognize our differences, we can all work together better. People hold pretty strongly to their positions because I believe it’s where they get their significance. It’s what makes them feel successful and worthy. Do you gain your significance by being a certain kind of person – upholding those values.  Or is it about accomplishing something – seeing a vision fulfilled? Am I here on the field in obedience? To become more like Jesus? To meet needs? You need to understand yourself, who you are and what you need in order to survive on their field. Why are you going to the mission field and what will give you the significance to keep you there? Do you have a vision for what you will do, what will happen? Are there core values you desire to live out? Maintain Perspective A lot of us look to Abraham’s life as an example of missions. Called by God, blessed to be a blessing, promised fruitfulness like the stars. We came to see our lives as that journey toward Canaan – a journey through school, more school, residency, years paying off debt. Abraham arrived in the hills, built an altar to God, pitched his tent. And I believed that perhaps like Abraham in that moment, when I arrived on the field everything would come together. I’d be able to use all those years of experience and the gifts God gave me fully in an incredible satisfying way. Getting to the mission field was a dream years in the making come true. But the biblical text continues: “Now there was a famine in the land.” What? Famine in the land of your calling? And sometimes there isn’t even time to settling in. Famine just overtakes you.  It looks like misunderstandings with your team members or your leadership. Stressors come from changing not only job roles and locale but also from culture and financial status, tensions come with our kids, our spouses – even from within ourselves.  A lot of this is normal – reactions to changes and loss. But realize that the enemy sows this; he delights in it. “Did God say...” The questions come. Was this what you signed up for? Will it get easier? Will it get better? Famine feeds our doubts, our disappointments, our insecurities. Several years ago I was sitting in an ICU in Thailand. You know what that’s like - the sounds and smells are the same all around the world. But I wasn’t there as a doctor but as a friend, sitting at the bedside of our fellow missionaries’ 17 year old son. Weeks earlier, he developed diabetic ketoacidosis. We were able to evacuate him from rural Cambodia into Thailand. And in the intervening time we prayed like we had never prayed before. People literally around the world, hundreds of people, lifted up countless prayers and fasted for this young man. We believed God would heal him. We had faith. We put our trust in God. We assured ourselves that He would do it. But in the end, this young man died. And it sent shockwaves through our team. God, they’re missionaries. They’ve given up everything to serve you. They’re faithful. We prayed so much, we prayed with such faith. What do we believe? What does God promise us? What has He told us and what do we assume? Do we think we’re special, that God will take care of us? How will we respond when famine comes in the very place God has called you? Remember that God is with us - in the famine, in the conflicts, disappointment and suffering. The incredible truth in Christianity is that He walks with us.  “Lo, I am with you always…” Like Peter walking on water, we keep afloat as we keep our eyes on Him. What assumptions are you making about God and how He works? What do you think will happen in life, ministry? Where is your hope? When doubts overwhelm and you feel like you’re about to drown, what will help you to fix your eyes on Christ? Seek Your Own Transformation In Christian circles, we like to emphasize servanthood. But I think that mindset creates a sense work, ideas and resources flowing from the servant to the served.  As a result, we think missions is for those we are serving. A better way to think about the whole endeavor of mission is “mutuality.” It’s a give and take – like a marriage, a partnership, any healthy relationship. In this way we can see missions as for both those we are serving and also for me and my family. Missions is an ideal opportunity for us to grow in our faith.  When we first started with OMF, a quote of Hudson Taylor’s struck me. “Unless there is an element of risk in our exploits for God, there is no need for faith” I wanted greater faith so what does “risk” look like? For me, getting to the mission field was a checklist of doing. College – check, med school – check, residency – check. Find someone who is both willing to marry me and go on the mission field – check. Pay off debt, gain work experience, find an organization, find a field to join, raise support… but who did I become in that process? How was it making me more like Christ? My checklist life became more challenging when we reached raising support or partnership development. We contacted people, we told them what we were going to do and then our organization tracked the progress of our support. Looking back I believe this is an unhelpful model. Why? It can reinforce the belief that what we do leads to God’s blessing; that we are in control. That success is defined by checking a box. It’s a works-based way of thinking. And unfortunately a way of thinking that we can carry over into the field. I think a picture of a sower is better. We are not in control of our crops; we’re not driving the ship. But we are in control of who we are, our attitudes as we spread seed. We sow and allow God to bring fruitfulness. It moves from a mindset of what I do to who I am. Don’t get me wrong – doing is important. But doing without becoming – without understanding this need to depend on God, seeing Him as the one who provides – leads to spiritual dryness and burnout. This is a vital realization for a successful ministry – we are not determining spiritual outcomes of fruitfulness. It is only God who can bring understanding and growth. “Unless there is an element of risk in our exploits for God, there is no need for faith.” If everything you do is within your control (or you think it’s in your control) where is there room to exercise faith and see God at work in your life? It’s only in the stretching, the moving beyond what we can accomplish on our own that we’ll see God. Be intentional – plan God into your lives. Acknowledge that you’re not in control but that God is. Embrace the uncontrollable, the things that you can’t check off or put in a box, because that uncertainty binds us together with God. It is the birthplace of faith. Where can I relinquish control and leave room for God to work in my life? How can I be intentional in seeking my own transformation through missions?
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Advanced Practice Providers Bridging Gaps Overseas
Advanced practice providers (APPs), such as nurse anesthetists, nurse midwives, nurse practitioners, and physicians assistants, have and can continue to bridge gaps by increasing access and quality of health care in cost effective ways especially in underserved communities in low and middle income countries (LMICs). Interviews with APPs and other healthcare professionals, personal experience living and working as an APP in LMICs, and literature reviews reveal similar results: utilizing APPs provides cost-effective health care access, improves morbidity and mortality outcomes, and enhances patient satisfaction without compromising the quality of care given in underserved areas. Challenges to APPs in LMICs include lack of access and standardization of higher education programs, role and title variability, physician resistance, limited research, and inconsistent legislation and licensing restrictions. When these challenges are overcome, APPs improve health care access in difficult to reach locations, exhibit adaptability and flexibility in challenging circumstances, and fill in the gaps of physician shortages particularly in primary care and rural locations. APPs are a vital, but underused role in health care. Enhancing APP training programs, defining roles and titles, educating health care providers and legislature writers, and promoting research in LMICs can improve the availability and implementation of APPs in LMIC and thus bridge gaps in global heath care. This presentation will provide personal perspectives from APPs who have worked around the World as well as present research that addresses advantages, challenges, and the necessity of APPs worldwide in bridging healthcare gaps.
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Our Story in the Story of the World
Today we're going to continue with our theme of encouraging medical missionaries. We hope that this series of guest blog posts is encouraging you and bolstering your faith as you strive to live out the Gospel in whatever context you are in. Our guest contributor for today is Mike. Mike serves as Director of Personnel and Training at Interserve USA. A theologian by training, he previously served twenty years at a global seminary teaching Old Testament. He is passionate about helping followers of Christ engage their workplace vocation with the good news of the transformation of all things. He is married to a pediatrician and has three adult children. We know you are going to be challenged and encouraged by Mike's words! The Bible's Story The Bible tells a story, a very big story. Yes, it is comprised of lots of little stories (many of us know them from Sunday School), and it is replete with all sorts of places, people and behaviors that are utterly foreign to us. But standing behind all those smaller “stories” is one, capacious, overarching narrative. Have we really grasped what this means not just for interpretation of the Bible, but for the way we live our lives? The way we are involved in missional healthcare? How our lives “matter” in the grand scheme of things, even boldly asking how our life matters in the story of the whole world? Theologian Lesslie Newbigin famously writes of his encounter with a learned friend in Asia who said to him: I can’t understand why you...present the Bible to us in [my country] as a book of religion. It is not a book of religion—and anyway we have plenty of books on religion [here in my country]. We don’t need any more! I find your Bible a unique interpretation of universal history, the history of the whole creation and the history of the human race. And therefore a unique interpretation of the human person as a responsible actor in history. That is unique. There is nothing else in the whole religious literature of the world to put alongside it. I remember the first time I read that quote. I put down the book in my hands and sat speechless. I realized that I had unwittingly done just what Newbigin’s friend had accused these emissaries to Asia of doing —the Bible to me was just a book of religion, and to read it meant to derive “religion” from it. Its message was wholly other-worldly, and served to prepare my “soul” for a different place. Humanity's Story But the story of the whole world? And humanity’s role in the story of the world, a story that involved healing, and flourishing, and justice and mercy? I realized, to my shame, that I didn’t really care about the world. I would never have admitted that, because I did have compassion for the suffering (at least I thought I did). I was a pre-med student for a reason, to become a medical missionary to serve the poor. I felt sorry for them. But of greatest import? I was just supposed to get my soul, and as many souls around me as I could, ready to die. But this world, if I really thought about it? Not much use for it. The grand story of the world, and God’s intention for justice, mercy and life in this, his good, created world, was lost on me. Newbigin awakened me to another way of perceiving the world and my work in the world. He awakened me to a way of reading the Bible that drew my perception of my work in the world as not just something to pass time to get to the really important stuff, but actually to join in a large story, God’s story, of restoration of the whole universe. Could the Bible really be that simple? Just one sprawling story? Yes, I discovered; there is a narrative backbone to the whole of the Bible. God created a world that turned away from his intention of integrity and flourishing, and in Jesus Christ, God came himself, not by proxy, to reverse the tide. And that great tidal reversal continues today, through the restoration of things we can actually see and feel and hear. Restored things often unravel again, for sure. But the very work of restoration demonstrates that restoration is the ultimate goal of the world. The bitesize pieces of restoration nourishment we now engage are crumbs from a great and final restoration feast we await. Admittedly, the Bible narrates this great story through diverse literary genres, languages that are unknown to most people who sit down to read the Bible, nations, peoples, cities whose names we stumble over if we have the misfortune of being called on to read from the Old Testament in public. Its capacious quality—the scope of the story, from beginning to end, creation to consummation—is not only a quality that draws us to the Bible but hinders our ability to insert ourselves at any moment in its pages. We are too quickly lost. So backing up, just for a moment, and asking the big question about God’s big story can be really helpful, even for the day-to-day seeming tedium of our lives and work in healthcare. The story of the Bible in its most basic scheme is like the greatest stories known to humankind. An idyllic scene, shattered by tragedy—in the case of the Bible’s story, the revolt of the beloved in the face of the Lover—and a long and gradual rebuilding and even surpassing of that first scene through a drama of the self-giving of the Lover. Restoration in the Story But the drama involves more than just an ethereal “relationship.” The drama includes the restoration of the whole scene, the whole theater if you will, in which this drama is being enacted. Restoration is the key, the restoration of “all things.” See Colossians 1:16-20, and take a look at the “all things.” This is one of those instances where there is no hidden meaning in the Greek of “all.” All means all. “All things have been created through him and for him. He is before all things, and in him all things hold together...For God was pleased to have all his fullness dwell in him, and through him to reconcile to himself all things, whether things on earth or things in heaven, by making peace through his blood, shed on the cross.” (NIV) With this overarching view of the narrative, small steps in the drama of our daily life can take on a larger import than simply what we see immediately before us. Honestly, what is before us is often enough to process! But what if we could shift our perspective, even just a bit, to see even a small interaction—with a worried patient, a grieving family, an obstreperous administrator, an obstructive government official—as a little dialogue or action in a greater drama of restoration? Might that re-shape the way we go through a moment-by-moment unfolding of our day? Through Jesus Christ, restoration—reconciliation—has come to this hurting and chaotic world. Yes, the unraveling—the lingering effects of rebellion and wayward stubbornness—continues. But against the backdrop of the great drama of Scripture, of God himself coming in Jesus Christ to bring all things back to him, we push against that unraveling. We become his agents. Our work in missional healthcare, from this perspective, isn’t just an add-on, or a platform to do some other work. It’s part of the core story. Done in the name of Jesus, it becomes part of God’s great drama of cosmic restoration: it is the smile of God on a saddened world. That’s a perspective adjustment worth thinking about.