Adventist Mission

I'm sitting in the dark. The generator has just wound to a halt. A kerosene lamp gives it's warm but not far-reaching light to an otherwise shadow filled room. Sarah has gone to N'Djamena to take our Danish medical student, Trine, to the airport for her return to Denmark. It's just me and the guys. I'm sitting at the table in front of the lamp. The cat is playing with my foot as if it was a dead rat. Israel is lying on the couch on the right and Paul is sitting on the couch to the left.

As with most conversations between guys the topic swiftly turns to...missions. What would you talk about? Gosh! Israel is a nurse from Puerto Rico recently graduated from Southern Adventist University. He is fluent in English and Spanish and already speaks French quite well after only two months. He has taken night shifts where he is the only nurse in the hospital and post-call still comes into help in surgery. He's what you might call a missionary stud.

Not to be left behind is Paul. A Nigerian trained at the Ile-Ife Adventist Hospital he has had the highest level of nursing training, speaks fluent English, Hausa and Yoruba and has also learned enough French to be very dangerous. Despite not being Adventist and having most of his classmates tell him not to come to some God-forsaken place like Tchad, he has dedicated a year of his life to help his Chadian brothers.

Both have fearlessly followed Sarah's lead and learned to ride horses the hard way...both having fallen off at full gallop, not much the worse for wear.

So, I’m talking about the good and bad of Adventist missions. I mention that one of the positive things is the fact that my school loans are being repaid in exchange for six years of service allowing me to head out immediately after residency. However, the weakness is that our church only does that for doctors and dentists, not for nurses, PTs, Physician's Assistants, midwifes, etc. Israel states that if he could have his loans from nursing school paid off he'd gladly spend at least four years in the mission field. How hard could that be? Does the General Conference have to do it or couldn't we just ask the local churches to remember they are part of a worldwide movement, the body of Christ, each one interdependent on each other, those who have been entrusted with resources using them to help those who have not?

When an Adventist wants to be a missionary the Church tells him we have a budget here and there and in that small place where no one has been in a long time. Where do you want to go? Instead of asking the person, where do you feel God is calling you? We say where do we have a budget for a missionary. Instead of asking, where do we need someone? We ask if you have any other financial obligations. Instead of feeling called to life work among a certain people un-reached by the news about God and who he is, we jump around from place with a budget to another place with a budget every six years never bothering to learn to communicate with the locals in their own language, "because I'm just going to leave anyway, why waste the effort?"

If someone does decide to accept a "call" to where there is a missionary budget there is no contact with any local churches for the spiritual support and encouragement that is so desperately needed when one is so far removed from everything familiar and comforting. That responsibility is left to some people at a high level of administration who may have never seen you and may not even really know your name, where you are, what the conditions are like, and for sure haven't ever visited "sur le terrain" (on site). This robs both the missionary and the members of the local church who then never have contact with the outside world leaving their world small and inward focused on their own needs easily forgetting those "far away."

Paul brings up the problem in Ile-Ife. He literally begs me if there is anything that can be done to bring in specialist physicians, especially surgeons. They desperately need a general surgeon or an orthopedist or a traumatologist as they see so many motor vehicle accidents with mass casualties needing surgical intervention. They also need a neurosurgeon for the same reason, lots of head trauma. If only someone could come and teach their physicians and help them take care of the overwhelming load. Since when does the Third World not really need our help anyway?

Somehow I think we have that idea...they have their own doctors, their own nurses, their own etc...let them suffer on their own. But since when are we called to ignore suffering? Most of their doctors are in the cities making the "big bucks" too. Who's willing to go out to the small villages and towns? So even in Nigeria, where things are a lot more developed than Tchad, Paul is pleading, "Come help us!"

What is the ratio of patients to doctors in the US? Is it better than 140,000 to one? Here in Béré, our hospital serves a population of 142,000 in our district plus the thousands who come to us from the outside districts. I’m the only physician. Does that seem normal to you? How can anyone say we don't need another doctor here at the Béré Adventist Hospital? But I can guarantee you the General Conference of SDAs will never allocate another physician budget here...in fact, they are cutting back the number of missionary budgets because people aren't giving to the missionary fund anymore. And why should they? Does anyone in the church even know the names of the missionaries that are out there much less where they are? Only a andful of close friends and family.

So, what can be done? Mass changes. We need to create either a mission focused church again (the reason for the church structure to begin with was to better organize outreach/mission activities...not maintain existing structures and institutions)...but that's not likely. The church is too weighed down with top-heavy administrative loads to change. So, I propose a separate, yet affiliated mission organization whose only task is to coordinate and arrange support--financial and spiritual.

For example, start with medical missions. As a physician, I could work two months out of the year in the US and make around $16-20,000 depending on where and how much I worked. Working for a locums company specializing in placement of physicians in temporary positions I would have travel, car and lodging taken care of for those two months. Air travel to and from Tchad would be $2000 (x2 for me and Sarah) = $4000. Say we live pretty frugally but want to travel some the third month to visit relatives and sponsoring churches so we spend $3000 for those three months. That leaves us with $7-11,000 (depending on original sum). Emergency evacuation through South Africa can be purchased for $2000/person/year leaving us with $3000. Local health insurance bought through the Central African Union (I don't know the actual price but I'll guess) $1000/person/year leaving us with $1000. We can easily live off the local salary of $500/month that we are receiving currently from the Union so that would be $4500/year (for 9 months in Tchad). Therefore, Sarah only needs to work as a nurse enough to make $3500. An easy task with traveling nurse in the US or if we took our month vacation in Denmark (at least a vacation for me...she'd take the two months in the US as vacation) she could work in Denmark or Norway and easily make $8-9,000. Essentially, we could be self supporting by working 2-3 months abroad and spending 9 months at home in Tchad. Any excess expenses we could ask our sponsoring churches to help us cover keeping them involved financially as well as morally and spiritually (they could also help out
with hospital needs, etc.)

This would free up medical personnel from all fields (nurses, PTs, Pas, RNPs, Midwives, OTs, lab techs, etc.) to become missionaries where they would feel called and where their was a need without depending on someone "higher up" to create a budget there. The main thing many of them, especially the young ones like Israel would need would be loan repayment. If that could be raised by the local churches and then paid off each year based on years served according to a contract established between the churches and the missionary, that would free up many promising missionaries to go where they feel called.

Does it seem normal that a whole country like Tchad has only two Adventist missionaries, my wife and I? We should have a whole team here to meet the overwhelming needs and to support and encourage each other. There are so many amazing things that I'm getting to experience professionally and spiritually that others should have the chance to share but our current system blocks that on anything more than a one year volunteer scale. How much more could we be experiencing if we were a team and not just a burned out overworked doctor-nurse team trying desperately to salvage what lives we can from the teeming masses of under-treated people so desperate to find healing that they'll come from miles and miles around to our pathetic hospital just because it's so much better than they can find where they are.

Am I just venting or does somebody out there hear me?!

James Appel
Medical Director
Béré Adventist Hospital
BP 52 Kélo
Tchad
00-235-645-5188