Lessons after eight years as medical missionaries in Africa

Here is an email from an American doctor couple who have been serving in Africa for the past eight years. They gave me permission to share their insights after a retreat designed specifically for medical missionaries. They are learning priceless lessons in the crucible of ministry. The Lord uses the blessings and challenges of healthcare mission work to shape us into His image.

Dear Paul, What an amazing gift these past few months have been.  We started our season here in Michigan at a place called Alongside – two weeks of intense counseling, debrief, learning, and digging into our deep feelings – which was hard but very, very good.  We discussed a myriad of things: Working out of rest vs resting because you have no more to give.  Understanding that to take a sabbath is an act of faith and trust that God has control over everything in this world, including the things that don’t get accomplished when you are resting. Struggling with the temptation to believe that our identity is in our service, not in the finished work of Christ, especially in the face of immediate, overwhelming, and ongoing need. The origins of our values and how these values play into our moral belief system.  Taking the time to consider if our values and morals have true Biblical origins, or are they more a reflection of our cultural upbringing, and have they been mutated by outside influences.  For example, if I value excellence, has it been mutated into perfectionism, or do I overvalue efficiency at the cost of relationships?  There is one particularly problematic belief that was driven into us during residency: “I am responsible for my patient’s outcome.”  The implication is that I SHOULD be able to control what happens to the patients under my care.  That if only I did enough, they would recover, and that I am ultimately responsible for any bad outcome.  But that is a cultural perversion of the Biblical reality.  Do I have responsibility? Yes, BUT to have full responsibility, you have to have ultimate authority. And in patients’ lives, DIVINITY is required for authority.  During this session, I was able to go from “I am responsible for my patient’s outcome” and move toward “I am responsible to do the best that I can with the tools God has given me in this moment, and the outcome belongs to the Lord.” Conflict resolution across cultures. Moral injury / moral distress / moral injury disorder:  Moral injury occurs when someone commits, is party to, or fails to prevent an act or event that violates one’s own deeply held moral values.  It is fundamentally tied to guilt and shame, and like any other injury or toxic exposure, it requires time for rest and restoration.  While there’s a lot to discuss on the topic, suffice it to say that during our last year on the field, I got to the point that I was unable to metabolize the moral injuries as fast as they were happening. Trauma and resilience / the nervous system / and one of my favorite quotes, “trauma constipates our brain.”  Stewarding body and mind in cumulative stressful environments, loss and lament, setting boundaries, and team mutual support. Our leaning on God amidst suffering is a witness for durable hope to encounter God’s glory. This is only done by the empowerment of the Holy Spirit. This is how our suffering transforms us.  Remembering that there is something going on in the grand scheme of things, in the big Story, that I am not privy to, that’s rough to swallow sometimes. (also, I think part of that might be a quote from a famous person, so maybe those words are not my original thought…)  There’s a lot more to discuss about what God does in suffering, and that’s just too much for one bullet point (plus this section is already getting long, kudos for making it this far!). Give me a call or we can grab coffee so we can chat and I can ask YOU questions. 😉 Because what a topic. Meanwhile, I remember reading Suffering and the Heart of God by Dianne Langberg, and wrote “read this every or every other year, so good” so those are my thoughts. We also had group therapy every day and individual counseling in the afternoons, all while the kids had an age-appropriate version of the same content. It was hard, and it was good. We are thankful. – Signed

• God’s work of transforming the world through the gospel of Jesus Christ begins with transforming us. Disciples (i.e., we) do not go to the field fully formed. To make disciples, we ourselves must continue to be discipled. (Also see my book Healthcare and the Mission of God.”)
• Many healthcare missionaries enter the field on conversion-story narratives (“I saw suffering, and God called me, so I went.”). But long-term faithfulness requires formation stories (“I was suffering, I learned to discern limits, and I stayed present.”)
• My service to others is important to God, but my service cannot form the core of my identity. Our identity, rather, rests in God’s work in me and through me. My most important job is to be faithful to Christ. This is also true for my team.
• While we, as medical professionals, have an important role in healthcare, medicine is only one sphere of life among many that God ordains for the sake of human health and flourishing. Others include the family and community, the church, the state, the market, and the scientific community. Christian must learn to partner across these spheres.

Which of these reflections resonates with your experience? How is God shaping you?