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  Asking the Right Questions  By Greg Seager Founder and CEO Christian Health Service Corps I am writing this post because I believe that most healthcare professionals wanting to serve in long-term missions are asking the wrong questions. And experience has shown me that asking the wrong questions can lead to unnecessary failure on the mission field. This post asks some of the questions that should be asked before selecting a mission organization through which to serve as a long-term medical missionary. I will concede these questions, I believe long-term medical missionaries should ask, maybe somewhat against the grain. I posed a list of questions in my book “When Healthcare Hurts” that seemed a bit sacrilegious at the time. However, I think they went on to shift the medical missions culture toward patient safety and showing greater respect for human dignity. The questions I share here may also be a stretch for some serving in, and leading, long-term mission organizations. It is my prayer this series of posts, and the book to follow, will have the same effect in long-term medical missions. I broke this list down into a few different categories of questions. First, what questions should a healthcare professional planning to serve in missions ask potential mission organizations? Second, what questions should a healthcare professional planning to serve in missions ask about being matched with a facility or health program? Third, what questions should a healthcare professional planning to serve in missions ask themselves to help them be successful on the field? This post will look specifically at the first category of questions. Subsequent posts will focus on categories two and three. Medical Missions is Different One thing that was always clear to me, was that sending a doctor, nurse or other healthcare professional to serve in a mission hospital, or even a community health program, looks very different than sending a pastor. I am convinced that most mission organizations today miss this very important point, and I believe this has contributed to much attrition in medical missions. If medical missionaries are lumped in with church planters, bible college teachers and bible translators it is hard to see if they have different issues driving them to leave the field. This has not been well studied but we can attest to this from observation and experience. I spend a great deal of time traveling to see medical missionaries serving across many different cultures. As a side note, I have interviewed hundreds of medical missionaries over the years, we have just started posting some of these interviews on a new YouTube channel medicalmissions.tv  For example, not long ago I interviewed a single female physician that left the field after only 2 years. She reported that because she was the lone single person on the mission station she ended up carrying a much greater load. Since she did not have a family to go home to and set boundaries around, she was expected to do more call and work longer hours. This eventually resulted in her departure from the field. I also spoke with a pediatrician that left the field after one year because he could not cope with the vast amount of child death he saw while serving in a rural African bush hospital, he lost 150 children in his first year. This is not your typical missionary set of problems. Medical professionals have many of the same challenges as other missionaries. Such as language acquisition, moving your family to another culture, working within the context of an Intercultural team, figuring out how to best educate children just to name a few. However, they also face the dilemma of daily life and death decisions. The classic reason missionaries leave the field, not getting along with other missionaries, still exists in medical missions but is far less traumatic than the many of the reasons medical missionaries come home. Many medical missionary challenges cause post-traumatic stress and life-long wounds. The Challenge of Our Internal Voice Medical missionaries must also manage an internal voice that asks the questions most non-healthcare professionals have never heard. The voice that asks questions we have all been forced to ask in our careers. If I would have done something different would that child have survived? Did I make a mistake? Is there something I should have learned before I came to the field that could have saved this child? How can I practice here, I never cared for a young mom with post-partum hemorrhage and no blood available? I never treated a child who is so malnourished they can’t stand walk or eat, where do I start? Experience has taught me that caring for a medical missionary should look more like caring for an aid worker in a disaster zone than a typical missionary. Mission organizations must understand this both conceptually and in member care practice. The above daily questions are inevitable in the first few years on the field as a medical missionary, and they add a huge amount of stress to already stressful life circumstances. These questions in combination with the immense volume of child and maternal death, being forced to work without needed medications, supplies, blood and equipment; oh and let’s not forget walking families through the death of child or loved one, often daily. These are just some of the unique challenges for medical missionaries. The Questions It is based on this understanding the list of questions below was created. Here are some questions to think about. In the book to follow I will to dig in to them in detail and explain the rationale for each. Does the organization recognize and understand the unique challenges of healthcare missions? Does the organization’s pre-field preparation include sections that are specific to healthcare missions? If so how much preparation is dedicated specifically to healthcare missions? Does the organization view healthcare as a ministry itself, or do they view it as a platform for evangelism? Does the organization view healthcare and healing ministries as part of the mission of the church? Is there spiritual and clinical mentorship available, promoted and or required? Does the organization have a missionary/member care program that focuses on and addresses the unique needs of healthcare professionals and their families? Does the organization ascribe to the International Global Connections in Member Care? What is the work schedule expected, and what are the leave and furlough policies? Are they structured to support healthcare professionals? Are visitors permitted in the first term of service? Is the organization familiar with World Health Organization (WHO) guidelines for clinical practice in resource-poor communities? Does the organization know about, and promote their missionaries learning, programs such as Integrated Management of Childhood Illness (IMCI), Integrated Management of Childhood Malnutrition (IMCM), Integrated Management of Pregnancy and Childbirth (IMCPC)? Will the organization provide logistical support for healthcare ministry work? I.E. Medical equipment, supplies, volunteer staff relief, grant requests made to support medical work etc.?

Article by Greg Seager, Founder and CEO of Christian Health Service Corp  Integrated Management of Childhood Illness (IMCI) is an integrated approach to child health care, which is needed because children that present for care in developing communities rarely do so with only one condition. There are frequently multiple issues when a child presents for care with malnutrition often being an underlying issue. When implemented, IMCI can and does reduce early childhood morbidity and mortality. It also improves growth and development among children under five years of age. IMCI is both preventive and curative and is implemented by families and communities as well as by health workers. The strategy includes three main components: • Improving case management skills of health-care staff • Improving overall health systems • Improving family and community health practices In the missions world, we often use Community Health Evangelism (CHE) as the community level of IMCI. The training portion of the IMCI strategy for health workers teaches appropriate case management skills for the identification management of sick children. IMCI works at the rural health outpost level, outpatient clinic level, and inpatient level, using a combined set of protocols and charting system that ensures appropriate integrated treatment of all major illnesses. It also strengthens the counseling abilities of caretakers and speeds up a referral to higher levels of care for severely ill children. In the home setting, it promotes improved care-seeking behaviors, improved nutrition, preventative care for children, and the correct implementation of prescribed care. In short, IMCI is a MUST LEARN set of protocols for those planning to provide care in developing countries. You can download a copy of the IMCI Chart Booklet and Protocols here You can acquire the entire IMCI training Program on our Clinical Resources Page. Similar articles can be found on the CHSC Blog www.MedicalMissions101.com and check our Youtube Channel www.MedicalMissions.TV   See some of the case management videos here:            

Responding to Victims of Human Trafficking within the Health Care Setting By Jeffrey J. Barrows, DO, MA (Ethics) Imagine you are staffing the urgent care clinic at your hospital when you encounter a 19-year-old foreign national woman brought in by a family member because of a possible fractured arm. Radiologic studies show a spiral fracture of the radius raising the suspicion of abuse as the etiology of the fracture. As you continue your evaluation of this patient, you begin to notice that she appears cautious and at times fearful of this family member. You’re not sure exactly what’s going on and initially consider domestic violence. However several things remind you of that lecture on human trafficking several months ago. You try to remember the various indicators of trafficking and what you are supposed to do if trafficking is suspected. You wonder if you should try to separate the family member from the patient and whether there is any danger to you and your staff. What if the family member refuses to leave? The more you think about it, the more you realize that you are not prepared to deal with the problem before you and find yourself feeling helpless and frustrated. As greater numbers of health care professionals become educated about the issue of human trafficking, they are increasingly recognizing patients who might qualify as trafficking victims, but usually within a setting lacking advanced preparation, thus experiencing this frustration and sense of helplessness.  The answer lies in the development of a response protocol designed specifically for possible human trafficking victims. All hospitals and large clinics should take the time and effort to develop their own response protocol for potential victims of trafficking just as they have already prepared protocols for victims of domestic violence, child abuse, and sexual assault. This will allow them to safely and effectively assist the human trafficking victims regularly coming into their facilities. Fortunately, there is a free toolkit online that describes in detail the steps necessary to develop a response protocol at: https://healtrafficking.org/linkagesresources/protocol-toolkit/ There are multiple factors that complicate our ability as health care professionals to assist these victims, including the issue of trauma bonding, associated criminal activity, and the real danger these victims and their families face. Safely navigating these hazards and difficulties requires advanced preparation and careful consultation with various experts in your location. These experts include those law enforcement officials in your city who focus on the crime of human trafficking, local child protective agencies that have a full understanding of child sex trafficking, and Homeland Security officials who understand and can assist foreign national victims of human trafficking. In addition, local non-profits that focus their efforts to assist victims of human trafficking are critical partners as you encounter the many varied nonmedical needs of these victims. Perhaps you can be the champion within your health care facility that initiates and facilitates the development of a specialized response protocol for victims of human trafficking, so that you and other health care professionals in your organization don’t experience frustration and helplessness as you encounter these victims, but instead experience the fulfillment that your encounter has truly made a difference in the lives of these suffering victims.

Today we want to highlight a great resource from our annual conference - the audio version of the breakout sessions that are offered each year. These breakout sessions are FREE to members of MedicalMissions.com, and we hope you take advantage of going back and re-listening to your favorite sessions or catching some of the sessions that you missed. The highlighted session for today deals with resilience. Drawing principles from psychological research and Christian scriptures, this workshop will explore factors of resilience for those working in high risk, high stress cross-cultural work. Listeners will discover what enhances resilience and what contributes to decreased coping. The workshop will introduce practical resources for responding to stress and trauma with resilience, grace, and perseverance. We hope you enjoy this session! https://www.medicalmissions.com/events/gmhc-2018/sessions/how-medical-missionaries-can-be-resilient-in-the-midst-of-trauma-and-stress-2  

Today we are going to feature another story submitted to MedicalMissions.com. The story today is the powerful and real experience of working with refugee families. We hope you will find this story inspiring and that it might prompt you to share some of your own stories! During the horrific mid-20th century, my Omi along with her family was forced from her home in Europe. She was put into a Nazi boarding school in Germany but later escaped to Canada. However, my great-grandfather was sent to a “work camp” for his faith and was not seen again. While reflecting and reading about the inhumane situations created by the current conflicts in the Middle East I could only think of my Omi, and the worse sufferings that these current refugees were experiencing as they fled their homes. I knew I needed to act. Click HERE to read the rest of the story   

During the course of the past week, we have witnessed true devastation in the Bahamas due to the destruction of Hurricane Dorian. With sustained wind speeds of 185 miles per hour, Dorian is one of the worst storms in history. At least 43 people have been killed, but officials are warning that hundreds more are still missing. The United Nations believes at least 70,000 people are homeless on Grand Bahama and the Abaco Islands. All of this devastation is why Samaritan's Purse jumped into immediate action: "Samaritan's Purse has airlifted our Emergency Field Hospital and a medical team to the Bahamas, at the request of the World Health Organization and the Bahamas government. The 40-bed mobile facility can receive up to 100 patients daily and features an operating room with capacity for 10 surgeries per day, as well as an obstetrics ward with delivery room" (Hurricane Dorian Relief, samaritanspurse.org). Prior to deploying the Field Hospital, Samaritan's Purse had already sent 30 tons of emergency items and over a dozen disaster relief team specialists.  Many of you are wondering how you can be involved as a health care provider. Samaritan's Purse trains people just like you for times such as this. If you are interested in becoming part of their disaster relief team, learn more about their Disaster Assistance Response Teams.  You can also donate to the work that Samaritan's Purse is doing: Donate to Hurricane Dorian Relief Here at MedicalMissions.com, we always want you to have the resources you need to engage in wherever you feel that God is calling you. You might want to check out this breakout session, which was led by Dr. Elliott Tenpenny of Samaritan's Purse on The Biblical Call to Emergency Response.  If you are a nurse, this is a helpful article outlining ways for you to actively engage in relief efforts: Nurse Volunteers Kelly Sites, of Samaritan's Purse, also presented a breakout session about Nursing in Disaster Response Efforts Laura Smelter, Director of Training at Christian Health Service Corps presented a breakout session on Responding Well: Knowing and Applying International Principles and Standards in Disaster and Refugee Response We hope that this email will be a reminder to you of the gifts that God has given you and the many ways that you can use them. Our partner, Samaritan's Purse will be presenting their work at this year's GMHC, so we do hope to see you in November! GMHC 2019 Register Here

Medical missions is hard.  One could say that, if it isn’t hard, it isn’t medical missions.  As Christians, we are indisputably called to walk into the dark places of God’s creation and proclaim his glory and his love.  Our hands get dirty, and our hearts get beat up. A few months ago, at my hospital in Burundi, things were especially difficult.  Electricity was out.  The hematology machine was broken, as was the x-ray.  I had a slew of patients who didn’t necessarily seem incurable at their arrival, but despite all our efforts, they continued to worsen.  That's a particular challenge, since it feels like their being in the hospital is associated with them getting worse, instead of better.  With death, instead of life.  Every day I did rounds with a very green group of Burundian medical students, who had never been this entwined with caring for people this sick before. How do we bring hope?  For that matter, where is the hope?  How do I encourage my students to endure?  How do I beat off my own cynicism?  To avoid a premature resolution of this tension, let me be clear:  We believe in the free, eternal grace of God through Jesus.  We believe in eternal life, and we work to integrate evangelism into all that we do at our hospital.  However, neither my head nor my heart accepts that this annuls the awfulness of a young person dying of a preventable disease.  No one knows this better than Jesus, weeping at the tomb of his friend. Over the last several years, I have discussed these questions many times, with students or with visiting doctors, and each time I'm of course talking to myself as well.  There are as many answers as there are challenges, but I’ll share three things that have been an encouragement to me. First, if I want to be here when I can help, I also have to be here when I can't.  Every time my patient unexpectedly dies, or the test comes back positive for the non-treatable possibility, or my last therapeutic option just isn't working, part of me wants to abandon ship, to run away from all that I can't do.  I know that won't help my patients, but I guess I want to pretend that such situations don't exist, at least not in such a common and stark form. We can't know ahead of time whom we can help.  Sometimes we can make a great medical impact.  Other times, we can't.  The two are inextricably linked.  Part of what we love in medical missions is the chance to dramatically alter someone's life for the better.  Yet there is another side to that coin, because the magnitude and frequency of the tragedies go up, in a seemingly proportional manner.  This must be endured, but not just endured.  We have a calling here as well, for this is another place where we have to learn to trust God and find some way to bless and comfort these patients with the blessings and comfort that God has given us (2 Cor 1:3-4). Second, as Paul writes: Fight the good fight (1 Tim 6:12).  It feels like a fight.  It is a fight.  But it's a good fight.  So, let's keep fighting it. Third, though outwardly we are wasting away, inwardly we are being renewed day by day (2 Cor 4:16).  This is just as incredibly true for me as it is for my patients.  For though we are missionaries with a message to proclaim, part of our target audience is ourselves.  Part of where the kingdom needs to come is inside our own hearts.  So this hard road is God’s road of sanctification for us.  Thus, the doctor is the patient, and we all alike need the hope of the gospel that proclaims that suffering will be redeemed, that all things will be made new, and that our God is the God who, out of death, brings resurrection and eternal life.

"Am I 'called' to missions?" "How do I know if I'm called to missions and how can I be sure?" Every Christian considering serving in missions in any capacity has asked those questions, but what are the answers? In this session we will back up and ask a more basic question - "What do we mean by a "call?" The answer lies in comparing out ideas of "calling" with the Bible's teaching about how and why God guides his people. We’re taking some time to highlight some of the great resources that are available here at MedicalMissions.com. Today we wanted to point you to a breakout session from last year’s Global Missions Health Conference. This topic is always a popular one – Finding God’s Call for Your Life. In fact, it drives all that we do here at MedicalMissions.com! We hope you enjoy taking some time to listen to this session – you can also find these resources on the MedicalMissions.com Podcast. https://www.medicalmissions.com/resources/11519/gods-guidance-and-the-missionary-call

Systemic poverty often plagues the places where global health professionals serve. Grappling with this crushing reality can be overwhelming. Community health education is one tool that can help improve the well-being and dignity of those who suffer from the effects of poverty. The need for community health education in developing countries cannot be overstated. In many communities, the prevalence of problems such as pediatric/infant mortality, maternal mortality, and HIV/AIDS is alarmingly high. Health education interventions are effective in addressing many of the causes of child mortality. For example, studies show that better breastfeeding practices alone could save 800,000 lives per year. Dohn and Dohn’s article, “Short-Term Medical Teams: What They Do Well . . . and Not So Well” addresses this issue. They describe health education as one of those areas that medical groups do “not so well.” This is primarily because short-term volunteers often provide such education through translators and with inadequate cultural and worldview understanding. Consequently, it is unwise for use as outsiders to train local people without first learning their culture and developing relationships. The outcome will probably not be very positive. One model that has proven an effective short-term health education model is CHE (Community Health Evangelism). Primarily because it sees and understands poverty from an asset based approach instead of a needs based approach. See the global CHE Networks What is CHE?  Seeing Poverty in a Different Light Cross-cultural health education is challenging because we are faced with what many in the development world refer to as the “god-complex dilemma.” Jai Sarma presented these ideas at a workshop I attended many years ago. Jai was a longtime community development practitioner who serves as the head of Transformational Development at World Vision International. From his own heritage in India, he shared how westerners are often seen from the perspective of the poor. Our subconscious and subliminal attitudes can also drastically affect our interactions with the poor. He shared that poverty is to a large extent a manifestation of a marred identity and self-worth. Without adequate understanding, volunteers from developed countries leading health education classes in developing countries can further mar the identity of those they seek to serve. We need to train local people with extreme caution, sensitivity, and humility. We should learn as much about the culture, worldview, and life circumstances as possible. Another development practitioner also talks much about this idea of poverty being a manifestation of a marred identity; his name is Dr. Jayakumar Christian. In his book, God of the Empty-Handed: Poverty, Power and the Kingdom of God, Dr. Christian discusses the forces that keep the poor trapped in poverty. This includes a poverty of being (a broken sense of identity), a poverty of relationships (societal relationships working to maintain their entrapment rather than empowering them), and a poverty of purpose (a lack of vision for the future and lack of a powerful sense of vocation). He advocates for a holistic response to the powerless of the poor and for building their sense of self through reconnecting with their God-given identity. How Do We Support Human Dignity? We all know the Bible has a lot to say about serving the poor, but how do we serve the poor in a way that supports human dignity? I believe this starts with intentional study of poverty, its roots, worldview and beliefs. The challenge is that in our efforts to meet human need we often reinforce and support the limiting beliefs of poverty. Chief of which is that the poor are victims of circumstance, instead of being created in the image of God, and stewards of His resources. The goal of healthcare missionaries is not just to meet tangible, physical needs. It is also to minister in ways that enhances human dignity. It is about inspiring growth in people and helping them build on their God given capacity. Many years ago, when I was serving with Mercy Ships, I was part of a leadership initiative to rewrite all the organizations core documents related to programs. I look back on this now as one of my greatest learning experiences in missions. The idea was to create a foundation for our work that truly supported human dignity. We reviewed a lot of the literature on poverty and decided to use Bryant Myers book, Walking with the Poor: Principles and Practices of Transformational Development as our blue print. This book along with Dr. Christian’s book noted above have had a significant impact on shaping my understanding of poverty. As such, these books also helped me lay the foundation of CHSC missions philosophy. Which is a philosophy that holds to an asset based (not needs based) approach. We believe strongly that both relief and development begin with the same starting point, building on, and supporting local capacity.

Understanding the statistical foundations of epidemiology can lead to a better knowledge of research and implementation of new practices. This interactive session will look at issues that stem from the emphasis on positive “p-value” and the need for confidence intervals. Also reviewed will be some of the statistical fundamentals in epidemiology, including but not limited to: sensitivity, specificity, odds, risk, and bias.

Long term mission in Uganda: Helping Heal Widespread Addiction In its urban populations, Uganda has one of the highest per capita rates of drug and alcohol addiction in the entire sub-Saharan region. Since it is difficult to determine the prevalence of addiction in far-flung rural areas, there are only estimates about how high the country's actual rate may be.   Adding to the problem is some societal beliefs in Uganda and other places. Some people do not consider alcohol consumption to be a problem or a disorder that requires treatment. People who are suffering from alcohol addiction may be unlikely to seek treatment because they do not believe that their alcohol use is a problem that needs correction. They may also fear facing the cultural stigmas associated with addiction and with seeking help.  If you are an addiction treatment expert who is considering becoming involved in treatment missions, Uganda is a country that may need your help.   Uganda’s Problems with Addiction   Unlike addiction treatment in First World countries such as the United States, the treatment resources in Third World countries are limited. Fortunately, there are several rehabilitation volunteer programs that allow professionals to go abroad to treat drug and alcohol addiction. The need for education that will help people understand addiction and move beyond limiting beliefs about addiction treatment is paramount.   According to Uganda’s Ministry of Health, alcoholism is one of the top causes of psychiatric problems in Uganda. It also contributes to the poverty rate because substance abuse may make it difficult for sufferers to work or maintain employment. Even if they can manage employment, they may spend a substantial amount of their earnings on alcohol instead of essentials.   Along with the erroneous belief that alcoholism is a curable health problem, there are not sufficient resources to treat people with addictions in Uganda. Unfortunately, Uganda’s cultural beliefs sometimes conflict with other beliefs about addiction, creating shame and stigmas that further alienate addicted people and prevent them from seeking help.   Since there is a lack in public education in the country and the Ugandan government does not regulate substances such as alcohol, stronger actions are needed. A study about alcoholism in Uganda reported that 55 percent of respondents did not seek treatment for their alcoholism because they did not think it was a treatable problem. Other respondents refused treatment out of shame or for other reasons.     The Effects of War and Poverty on Addiction   Poverty and addiction are pressing social issues in many countries, including Uganda. In addition to poverty, the nation faces widespread social and economic issues, including unemployment and illiteracy.   Uganda is still dealing with the fallout from war and invasion by the Lord’s Resistance Army (LRA). The LRA subjected the people of the region to rampant, indiscriminate violence and oppression. Murder, rape, enslavement, and forced military service for children in the area was common.   Without adequate resources to cope with the unspeakable things that happened to them, some people have sought to handle their trauma in any way possible, including using alcohol to numb their pain. The war left people mutilated, traumatized, and orphaned. Although Uganda is making some inroads to recovery, much still needs to be done to address the war’s devastating effects on the people of the country.   Since there is a lack of public knowledge about addiction, education is essential to encourage addicted individuals to seek treatment. People have not considered alcohol consumption to be a treatable problem in Uganda. Not enough attention has focused on the devastating impact alcohol may have on specific communities, such as pregnant women.   Volunteers talk with people in communities and schools to educate them about addiction and make them aware of options that are available to them. The ability to communicate key information in an easy-to-understand and creative way is an asset.        The Value of Volunteering in Uganda   If you are seeking a picturesque country with a host of geological wonders, Uganda is your place. Within its borders, the country contains broad savannas, dense forests, and majestic mountain ranges. The country is one of the few places where people can see the endangered gorilla. Visiting Uganda gives people the chance to see these majestic creatures up close in their natural habitat.   By nature, Ugandans are warm and welcoming people who go out of their way to make visitors feel at home. Hospitality is cultural. Activities to enjoy in Uganda include hiking and bungee jumping. The cuisine is also delicious and there are many restaurants to enjoy excellent local fare.    The Importance of Sharing Your Skills with Those in Need   You have training and skills that can help educate and assist people who are struggling with alcohol and drug addictions. Joining a mission may help you share your talents and compassion with people who may need information and treatment.   Consider contributing to the important work of healing the devastating addiction problems in other countries. If you are looking for a way to make a difference and use your education, training, and experience, helping fight addiction in Uganda may be a good option for you.

In the United States, the Centers for Disease Control and Prevention (CDC) recommends that children and adolescents get at least one hour of physical activity each day. It shouldn’t be breaking news that children need exercise. In fact, we are all aware that increased exercise for kids will promote healthy development, prevent chronic disease, and decrease problems such as obesity. Helping kids enjoy being active will set them up to become stronger and healthier teens and adults. Childhood obesity has become a serious epidemic over the last decade, and there are many contributing factors; however, one of the biggest causes is that kids have become more sedentary over the past 10 years or so. In other words, they’re spending a lot more time sitting than they used to. Kids are spending several hours every day in front of a screen (TVs, smartphones, tablets, and other devices). For most kids, there is far too much screen time and not enough physical activity, which can lead to the greater problem of childhood obesity. Check out this guide provided by Maryville University that includes a list of resources and articles about activities and exercises for children in grades K-12 with the goal of promoting a healthier and more active lifestyle.