Tuesday, February 5, 2013

What is a Mission Hospital?

- by Dr. Pradeep Ninan   (pjninan@gmail.com)

What is a Mission Hospital?

These days, it has become politically incorrect to ask such questions! The fashionable response these days is to say that a mission hospital is any hospital in which a Christian doctor works.  And, indeed, there is a lot of truth in that statement.

A Christian doctor can work in any place God has called him to. If he is in the centre of God’s will for his life, and accomplishing the mission that God has given him, he will be a God-ambassador, and a missionary in the sphere in which God has placed him.

Today, however, I am asking a different question. What happens when an entire hospital wants to be a mission hospital? Does God have a mission for a hospital?  Is there a God-mission in which an entire hospital can participate?

Over the years, it has been my privilege to work (for varying lengths of time) in about 10 such “mission hospitals” scattered over 5 states in North and North East India. In addition, I have visited, I think, at least another 10 mission hospitals scattered over North and South India.

You could say that mission hospitals have always held a fascination for me, especially as I have watched, studied and learnt from the way they function, and reflected about the purposes they accomplish in various parts of India.

Recently, I have been thinking again about the question, “What is a Mission Hospital?”  I have dusted off an old PowerPoint presentation I made in 2007, and re-written it as a blog post. I find that writing often helps me clarify and focus my own thoughts and opinions. This is a work in progress as I seek clarity and personal direction. Please feel free to comment and respond. As we discuss, perhaps, more clarity may emerge

I think this may be part of a series of mission-hospital related posts to come....let’s see how long the creative juices keep flowing!

All that is gold does not glitter,
Not all those who wander are lost;
The old that is strong does not wither,
Deep roots are not reached by the frost.
(Bilbo Baggins in The Lord Of The Rings by JRR Tolkien) 

What Is a Mission Hospital?

A hospital that claims to be a mission hospital is making a very powerful statement: It acknowledges that God has a plan for a region, and claims to be a part of God’s mission and to be collectively trying to accomplish God’s purposes in its region.

That is HUGE!

As I see it, God might have three purposes for a Mission Hospital. He would want it to:
1. Seek His Kingdom Mt 6:33
2. Serve the poor and marginalized Is 58:5-7, Is 1:17, James 2:1-9, 15-16, Job 34:19, Luke 3:11
3. Glorify His Name by running on the basis of principles put forward in His Word 1 Cor 10:31, Col 1:10, 1 Pet 4:10-11

Understanding God’s purposes is crucial if we are to fulfil them.

http://cowanglobal.files.wordpress.com/2012/06/alice-and-cheshire-cat.jpg"That depends a good deal on where you want to get to," said the Cat.

"I don’t much care where--" said Alice.

"Then it doesn’t matter which way you go," said the Cat.

"--so long as I get SOMEWHERE," Alice added as an explanation.

"Oh, you’re sure to do that," said the Cat, "if you only walk long enough."
(Alice's Adventures in Wonderland by Lewis Carroll, Chapter 6)

1.      A Mission Hospital must be Seeking God’s Kingdom. (“Thy Kingdom come, Thy Will be done on earth as it is in Heaven”)
This means that a mission hospital would not just be finding its vocation and purpose in treating the sick and working on the prevention of sickness. The focus of the hospital would be on seeking God’s kingdom.
The hospital would support and participate in the extension of God’s Kingdom, not just through evangelism, outreach and discipleship, but, equally importantly, through promoting Kingdom values like, for example, social justice and equality (across the sexes, castes, economic statuses). For example, a mission hospital would actively work against bonded labour and slavery, exploitation of the poor and the ‘lower castes’ and tribals and women. A mission hospital would speak up for those who do not have a voice. A mission hospital would get involved in these issues, because it has a higher definition of “Wholistic Health”.
Some mission hospitals may, additionally, also have a specialised role in a specific area. For example, a training institution seeking to be a mission hospital would seek to establish God’s kingdom by advocating in its spheres of influence (and passing on to its students) Christian values and paradigms of compassionate, ethical and competent care.

2.      A Mission Hospital must seek especially to serve the poor and marginalized. (“Let the oppressed go free”)

The priorities of a mission hospital would be radically different from the usual priorities in planning Health Care.

In a mission hospital, policy decisions would always be taken with the poor in mind. This is because God seems to have a preferential option for the poor.

The rich and poor would both be treated with dignity and get the same quality of care –the same amount of time in the OPD, same attention, respect, explanations, and reassurances. No patient would be sent away because of financial reasons. Treatment protocols would be poor friendly; diagnosis would be based on history and clinical examination, avoiding unnecessary investigations, and unnecessary and unnecessarily expensive drugs. Pharmacies would be poor friendly, stocking low cost, generic medicines rather than expensive brands. Specific strategies to help the poor may vary from hospital to hospital, but it would be clear to all looking on that the poor are the focus of the hospital.

Since there are so few serving the poor, a mission hospital would not be threatened by nursing homes, corporate hospitals and medical colleges. Its target population and priorities are very different!

3. A Mission Hospital would seek to glorify His Name by running on the basis of principles put forward in His Word. (“That in all things God may be glorified”)
 For example, the finances of a mission hospital would be clean and transparent. There would be ethical policies in place regarding, for example, cuts, bribes, referrals, private practice, etc
The hospital would work on the paradigm that Christian employees of the hospital are also equal members together of Christ’s body, the Church! All levels of staff would be encouraged, as fellow-children of the Father, and fellow-heirs of the promise, to share in the vision and participate in the mission of the hospital. Hospital policies would promote this equality among the staff. For example, all staff would be free to express opinions, communicate with the administration and have fellowship together with them. The hospital would function as a team, and not as a one-man show.

The hospital and staff would be actively involved with the local church. There would be a clear understanding that the hospital is only a part of God’s body, fulfilling only a part of God’s mission in a place.

The leadership of the hospital would be in the hands of servant-leaders who are genuinely fired-up with a passion for seeing God’s Kingdom come, and have a genuine care and concern for the ones under them. They would continuously ask their target population and staff members, “How may we serve you better?”

Wow! Does this sound really idealistic and unrealistic?! Is it possible to run such a hospital in this day and age?

Let me venture to speculate on ways in which hospitals that start off with noble intentions to be mission hospitals lose their way.

Mission hospitals lose their way
1.      When the emphasis shifts from seeking God’s purposes for the hospital to following man’s ideas. 
2.      When the hospital begins to imitate others, rationalising bad decisions saying, ‘Everybody does this!’, instead of finding God’s will, and leading the way.
3.      When the emphasis becomes survival and the hospital spends its energy reacting to the urgent needs that keep popping up. (‘We need to “somehow keep this hospital running”’)
4.      When the emphasis becomes “Healing” instead of “Seeking God’s Kingdom”
5.      When the emphasis shifts from serving the poor.
Let me suggest what might happen when a hospital begins to really seek to be a “Mission Hospital”

Matthew 6 : 33 (paraphrased for the mission hospital)
When a mission hospital seeks to fulfil God’s purpose for it, and begins to seek God’s Kingdom first, it will be flooded with poor patients in the OPDs. Wards will be full and staffed with committed people, and the community it serves will be transformed. Every resource it needs to serve God’s purposes will be added on.
Luke 6 :38 (paraphrased for the mission hospital)
As it gives to the poor, it will receive all that it needs: good measure, pressed down, shaken together and running over.

Let’s keep talking......

Monday, November 5, 2012



A reflection based on one of the beautiful devotional sharings that Dr. Arul Anketell led at the EMFI National Conference 2012 

The mystery of mysteries! The eternal God - creator of all that is - seen and unseen - becomes flesh, becomes one of us, takes on the form of a created being... forever forth!

The amazing and heart-wrenching enfleshment of our Lord Jesus is described in a 7 fold way by Paul in his letter to the Philippians (Phil 2.5 ff):

1.      He emptied himself Jesus did not hold on to the glory and honour that was rightfully due to Him. He refused to grasp that which was His - but let go of that out of love. Self 'dis-glorification'!

2.      Taking the form of a slave Man was meant to be free - but all around are people in chains. Jesus became a doulos - a bond-slave to set us free by his chains.

3.      Coming in the likeness of man This was no avatar - a form that can be cast off later for another form - our Lord Jesus has become permanently human! Jesus - God eternal becomes a flesh and blood man - and continues to be one while keeping His eternal divine nature as well! Oh glory!

4.      Found in appearance as a man People did not see anything special about Jesus. He had no special outward sign to him. Isaiah said he had no beauty to attract us to him. His enemies in the garden needed to sign of a kiss to figure out which of the men was Jesus!

5.      He humbled Himself True humility must lead to death. Jesus constantly lowered Himself out of love.
6.      He became obedient to death Jesus gave up all His self-rights and submitted Himself to His Father. Not my will but yours. This was costly obedience. Jesus became the first sacrifice who was both worthy and consenting in all ways.

7.      Even death on a cross The death Jesus suffered was the worst possible, the most shameful and painful way of dying. Only the wounds of God can speak to our wounds - and overcome the wicked mess we have made of things.

Our attitude, our actions, our lives should be the same as our wonderful Lord Jesus. As we serve among people broken by a host of issues - of which HIV is often a late symptom - our only real hope is in this Living Lord Jesus - who loved us enough that He came into this world to save sinners - of which I am the worst!

May our lives live out the incarnation! May people who are 'sin-positive' (100% of this planet - Rom 3.23) awake to the glorious hope of King Jesus! May we, our brothers and sisters and all those around us rejoice in this great hope and love!

p.s. a version of this appeared in the Jeevan Sahara Kendra prayer bulletin – please write to andisheba@yahoo.co.in if you would like to be added to the monthly JSK mailing list.

Saturday, November 3, 2012

Is the term ‘missionary’ helpful in our generation?

I attended the Graduate seminar ‘Pioneering Urban Missions’ led superbly by Dr Varghese Philip at the EMFI National Conference 2012 and thought I would share a few reflections after the interesting discussions that we had.

The focus of the seminar was to hear from a variety of people who had found themselves practicing medicine in the urban setting and for us as a group to open our minds to the possibilities of serving God in India, not just in the traditional ‘mission setting’ in remote rural areas but to be a blessing wherever God has placed us.

"Does God only care for those people in rural areas?"  The answer: "Of course not", but have we as a medical profession in the past concentrated more exclusively on rural areas, because the needs are so great, and perhaps become somewhat closed to the needs in urban areas? Have we in our own hearts, thought or decided that the rural areas were more important to God than the urban areas? I confess that at times, having a strong call to seeing access to health come to rural areas, I have been guilty of wondering why we as doctors were not all so concerned and rushing out to serve the poor in rural India... God has challenged me sharply on this!

Those speaking had a wealth of experience to share with us, from working in urban slums through church community development programs to working in their own private practices, and as they spoke it was amazing to see the influence they were having in seeing God’s Kingdom extended through being the hands and feet of Jesus.

It struck me afresh that God is working right now, in all areas and all sectors of society in India, and we will be called and placed exactly in the right position by God, ‘for such a time as this’. Some will be called to the huge medical needs in rural areas where health care access is woefully absent, but at the same time, some will be called to the urban areas. In urban areas there are vast pockets of material poverty and marginalisation, but at the same time imagine the influence and impact that ethical medical private or government practice in urban areas could bring as influencers of our cities, maybe people in high positions, visit for medical care and find something more, finding Jesus’ values in that place. What a light in the city that could have far-reaching effects for the nation of India

I qualified as a doctor 11 years ago [not sure if that classifies me into a young or middle aged doctor - perhaps depends on the reader?!], but as we delved into ‘missions issues’ in this seminar then it seemed to be that the new generation of doctors, either working now or coming up as students will bring with them a new wave of practicing medicine in a contemporary way for their own generation. New innovative ideas, understanding the differing cultural issues coming with a more modern and changing India, and it excited me to see God at work through different types of practice.

In the discussion time, different people were bringing up issues that I felt were relevant to us all as doctors in India today. I will just paraphrase a couple of the main issues discussed here: 

“Did working in private practice in an urban area mean we were less devoted to God or not seen as ‘extreme’ a christian as someone who has served on the rural mission field sacrificially for the past 40 years?” 
“Can you be a ‘missionary’ outside of a mission hospital setting?”

These were genuine concerns of those in the room, some poeple felt guilty that they were not able to serve in rural areas, and how refreshing to hear the honesty of those asking and answering the questions.

As I personally reflected on these important points I began thinking about the term ‘missionary’ and whether this is still a helpful term in our generation?” Perhaps I am making a controversial point here, but somehow I felt that using the term ‘missionary’, as well as having great meaning behind it, can potentially generate some negative connotations to the listener. If you are not a follower of Jesus, does ‘missionary’ generate unwelcome thoughts that the missionary doctor is here to forcibly convert or impose views onto them rather than genuinely deliver compassionate health care? Does the word ‘missionary’ strike fear into some of the hearts of those christian doctors who are not called to work in remote rural areas and therefore feel somehow that they have failed for God?

So as I summarise, the challenge for us all is to to simply be the ‘hands and feet of Jesus’, wherever He has placed us to be. Let us have flexible, creative minds to be open to how God can use each one of us, whether in rural or urban areas, and lets shine a light into every sector of society. Rather than being known as a ‘missionary’...  perhaps we could simply be known as doctors in India who love the Lord and want to see the gospel demonstrated through our actions, with integrity, love and compassion to all we meet.  

Dr Mary Cusack - paediatrics

Wednesday, October 31, 2012

7 Aspects of Jesus’ Healing

From the Seminar:  Faith, Science and Healing - facilitated by Dr. Jaison TM and Dr. Arul Anketell.

The EMFI Biennial National Conference was a rich time of learning and challenge for the 500+ who gathered at the Joe Beach Resort near Mahaballipuram.   We are starting a series of reflections from the conference with this post - and hope that many will contribute.

Here is a snippet from a rich seminar for graduates led by Dr. Jaison TM.  The two hours just slipped away!

7 Aspects of Jesus’ Healing

  1. Motivated by Love (2 Cor 5.14)
Jesus was moved with compassion.  The love of Christ compels us.  We see that Jesus did all that He did out of love - He left heaven and emptied himself of all but love!  We need to see this in our lives too.

  1. Eye to Eye Contact (Mark 10.21)
Jesus looked at him…  Jesus is us – how much we need to look at those we are working with.  How often our practices find us looking at papers and reports rather than the patient.

  1. Attentive Listening (Job 21.2,  Luke 8.18)
Job tells his friends to listen carefully to his words.  The needs of the suffering need to be heard and paid attention too.  Jesus did this.  The woman with the issue of blood told him everything.

  1. Wise Words (Luke 4.22)
Jesus spoke words that changed the destinies of those who were being healed by Him.

  1. Comforting Touch
Mark 1.41  Jesus was filled with compassion and reached out his hand and touched the man suffering from Hansen’s disease.

Mark 1.13  When meeting Peter’s Mother-in-law who was suffering from fever, Jesus went to her bed, took her hand, and helped her up.

How important it is for us to touch those we are healing.

  1. Prayerful Life (Luke 4.42, Luke 6.12)
Jesus was known to withdraw to lonely places to pray.   Praying for the patient precedes praying with the patient.  How much we need to follow the example of our Lord

  1. Serving Feet  (Luke 22.27, Mark 10.45)
The master came to be one of us.  Instead of lording it over us, he stripped himself and served.  All through Christ’s life we see this.  How different from so many of our health-care settings today where the doctor has the highest position and everyone else is subservient.

Following Jesus in Health Care
Jesus told His disciples to ‘follow me’ – following Jesus in healthcare means not only going to where He went (in the cities, towns and villages) and meeting the people that He met (Luke 4.18-19) but also following Him in how He served.   As we see how Jesus cured people may we too be used as His hands and feet to bring healing, restoration and shalom!

Thursday, July 19, 2012

Inactivity kills as many as smoking!

Its official.  Inactivity kills.  A recent article in the Lancet estimates that inactivity now causes the same mortality world-wide as smoking does!

That's 5.3 million deaths per year attributable to the lack of exercise.  5.3 million people dying every year because we are not getting enough exercise.

Is this something that is just plaguing the West?  Hardly. 

India has an estimated 40.9 million cases of diabetes.  We host a mind boggling 118 million cases of hypertension (if all the hypertensives in India formed a country it would be the 11th largest in the world - right after Japan's 127 million).  An estimated 8-10 percent of our above 30 years urban population has coronary heart disease already!  (All figures from Prabhakaran and Singh 2011).  

In the same series, the Lancet calls for physicians to include 'exercise' as one of the vital signs (Khan et al. 2012).  Exercise can no more be seen as a pleasant diversion.  It is clear that it is vital for our health.

In India we are seeing a sea-change in our country's disease profile - and a lot has to do with what we call 'progress.' The WHO now estimates that 53% of deaths in India are now from non-communicable diseases (WHO 2011). One of the key reasons for this increasing burden of disease is our increasingly sedentary lifestyles - combined with the stresses that our ever more aspirational life-styles.  

The tripling of our average per capita income from Rs. 19,040 in 2003 to Rs. 53,331 in 2010 (World Bank 2010) has not resulted in an immediate improvement in urban health outcomes.  In fact, we can argue that   aspirational issues of ‘modernity’ may be contributing to our national epidemic of suicides.  We have seen national rates of suicides increasing from 7.9 to 10.3 per lakh in the last 2 decades (Vijaykumar 2007).  A leading study estimated 187,000 people die of suicide in India each year – with the largest number among youth.  Most sobering of all – a 15 year old male in south India has a 3.5% chance of dying of suicide over a 65 year period (Patel et al. 2012). 

So what are we to do?

Well, we can start by being healthy in body and mind ourselves.  There is no use for death health-care practitioners.  The age old saw of prevention being better that cure is never more true for us today.

Get up and walk.  20 minutes every morning.  Get to bed on time.  Pray.  Spend time with the Lord.  Eat moderately and at the right times.  Model a balanced life of work, worship and leisure.  If we are not able to do this, how can we advise others to so?

The Bible tells us that 'your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own!' (1 Cor. 6.19). Our bodies are very important in God's sight. Paul tells us that "We know the body, however, is not meant for sexual immorality but for the Lord, and the Lord for the body." (1 Cor. 6.13). What an amazing statement - Jesus Christ is 'for the body!'  Doesn't that liberate us to serve Him through our health-care?  Through our work in restoring and repairing His creation - as well as making sure that these bodies do not fall ill in the first place?

Let us not fall into a platonic trap of seeing only the 'spiritual' as important.  The Christian message that we believe is that Christ is Lord of all. We worship Him not only when we sing songs - but when we have a brisk walk and are good stewards of the beautiful bodies He has graciously given us.  We worship Him when we set our minds on things above - and do not allow ourselves to be conformed by the things of this world, but rather are transformed by the renewing of our minds (Rom 12.2).

And we have a task as guardians and promoters of our health in our nation to share these truths with those around us. Can we see a new generation of doctors who step out of being body-mechanics to addressing life-style issues.  A new set of interactions with our patients and neighbours and church-members where we see the Shalom of the Kingdom lived out in every area of our lives - and reap the benefits of health rather than distruction?

Inactivity kills as many as smoking!  The campaign against smoking has world-wide reaped rich dividends in lives saved (though there is still work to be done of course).  Lets get moving!

Sunday, July 3, 2011

Missionary doctors in the Himalaya

Challenging words from a missionary doctor couple who have been an inspiration to many of us!