The Future of Mission Hospitals in Central Africa
Dr John Woodfield (Echoes of Service, April 2009)
John is a Colorectal and General Surgeon who has worked as a missionary doctor at Kalene Mission Hospital in Zambia since 2007. He and his wife Rachel, with their three children Katherine (11), Matthew (9) and Peter (5), are commended from Brethren assemblies in New Zealand.
Mission hospitals in Central sub-Saharan Africa are facing major problems. Unless decisions are made to address these issues, it is possible that within 20 years most mission hospitals will no longer function as hospitals. Many aspects of the spiritual work will continue, but the suffering of the local people will be greatly increased.
History of the Brethren mission movement in this area
Missionaries from the Brethren movement were pioneers in spreading the gospel from the west coast of Angola eastward across Zambia and South Congo (now Democratic Republic of Congo - DRC). They established a chain of churches, schools, health clinics and hospitals in a hostile environment. Many lives were lost to infectious diseases and there was significant spiritual opposition. That generation of Christians responded to the command to take the gospel to the heart of Africa, and communities were changed as the gospel of Jesus Christ was proclaimed. By the 1930s the area had over a hundred missionaries; churches in sending countries were praying and conscious of both progress and struggles. This area was fondly called by some the Beloved Strip.
What has contributed to the current crisis?
1) Changes in the focus of churches in sending countries
In 2009 the picture is very different. Spiritual fruit is evident, with probably 3,000-5,000 local assemblies existing in Central African countries. However, many young people know the right words without a true understanding of the gospel. Fear of witchcraft traps many, but they are also open to discussing the message of Jesus Christ. The need for evangelism and discipleship training is urgent, with 50% of the population under 15 years of age and average life expectancy less than 45 years.
We are very grateful to individuals and groups such as Echoes of Service, Medical Missionary News (MMN) and Brass Tacks, who pray and give practical support, but awareness of the needs overseas has diminished. Sending a missionary to Africa has become a clich, and the frequent news reports of problems in African countries promote Africa fatigue. While many older Christians are aware of Gods work in Central Africa, this is the case for only a few people aged less than 40. For the younger generation of Christians, the Beloved Strip is an unknown zone.
2) The impact of national problems on the delivery of health care
Prolonged civil wars in Angola and DRC have left many people destitute and without medical care or educational opportunities. There is little infrastructure or employment in rural areas. Angola is now peaceful, with opportunities for re-establishing medical outreach. Zambia has been politically stable since Independence, but rural areas have received less investment than cities. The number of children dying in the first year of life illustrates the lack of health care, and there are about 95 deaths per 1,000 births in Zambia, 130 in DRC and 185 in Angola. The actual figures may be worse in rural areas. Mission hospitals provide a lifeline to many people, especially in rural areas where nothing else is available. These services save many lives, alleviate much suffering and provide a powerful and effective demonstration of the love of God. Patients will often travel over 300 km (by bike or on foot) to receive help.
3) The struggling mission hospital
Although these hospitals are performing an essential function, they receive minimal support from governments and are all struggling to survive. In Zambia, Echoes of Service and MMN are making a big difference to our ability to stay open. However, the main problem is staffing.
The problems are seen in a review of the three countries.
Chavuma: Currently has no doctor.
Chitokoloki: Dr David McAdam is performing major surgery, with patients coming a significant distance for care, but is working alone.
Loloma: Did not have a doctor for a number of years. Currently has a doctor from DRC.
Kalene: I am performing major surgery, with patients coming a significant distance, but again am working alone. I have had to go to South Africa for health problems which may make it impossible for me to stay in Africa. A nursing school recently reopened.
Mambilima: No doctor for many years.
Ntambu: Was passed over to the government and has since been taken over by the Korean Catholic Church.
Other large clinics in Zambia with no doctor include Dipalata, Lukolwe and Lwela.
Democratic Republic of Congo
Kasaji: Dr Kayombo has worked alone for many years.
Katoka: No doctor.
Luanza: Taken over by the police during the civil war. A clinic has since been reopened.
Mitwaba: Destroyed during the civil war. Clinic reopened.
Mulongo: Has a doctor. They also have a programme for training junior doctors in Lubumbashi which is financed from Australia.
Pweto: Médecins Sans Frontières (Doctors Without Borders) were helping. Now functioning as a clinic.
Most of the remaining medical work was destroyed in the civil war. More recently, work has been re-established in Luena (see Angola article) and a clinic opened in Kavungo. Other clinics run in different areas.
4) Difficulties attracting and retaining medical staff (doctors and nurses)
There are two groups to consider: African nationals and missionaries.
a) African nationals
In contrast to Asia, there is a shortage of doctors throughout Africa. University training in Zambia is excellent, but many doctors leave the country as pay and conditions are better overseas. There are many Zambian doctors in Botswana, South Africa and the UK and most of those who remain in the country are working in cities. A Zambian doctor will not move to a rural hospital unless he has a calling to serve his own people.
Changes in medical training have made it difficult to recruit doctors from other countries. Twenty-five years ago, medical training equipped doctors with a broad base of practical skills (including obstetrics, basic surgical and anaesthetic skills), which are essential if one is to work in a rural African hospital. Now, medical training is more theoretical and skills are developed in an area of special interest. There are very few younger doctors with the breadth of practical experience necessary to work comfortably in a rural African hospital.
5) How our attitudes influence those around us
Attracting and retaining staff is related to how well they fit in. This is helped when there is an environment of Christian grace and an attitude of love and service, which can make all the difference as to whether an interested person stays or not.
a) African workers
Historically many mission stations were based on a colonial model. Today, mission is about partnership, which in a hospital environment means working with qualified African staff as equals, and appreciating that they have the same aspirations for themselves and their families as we have.
b) Mission workers and the church environment
People interested in serving in Africa come from a range of backgrounds. There are a variety of Brethren churches in any country, and a number of evangelical Christians from other traditions are enquiring about helping at mission hospitals. Kalene has been greatly helped by mission workers from other traditions. Those who come need to work along with what has been established, and have a desire to both develop the hospital work and edify the body of Christ. We need to develop an environment where those whom God sends are welcomed and encouraged to return.
Is there anything that can be done to help?
I would like to introduce four ideas that could make a difference.
1) Upgrading a hospital for training mission doctors and nurses to work in rural Africa
It is no longer possible to receive the breadth of training in the West to enable one to work in rural Africa. The solution is to provide the practical training required in a rural African hospital. While this could be done by any experienced doctor working in one of these mission hospitals, there are also other advantages in developing a hospital that is focused on training.
At Kalene we have been making efforts to create an environment where a successful training programme can be established. This includes the establishment of reliable 24-hour electricity, developing the scope of what the hospital can manage, reopening the nursing school and trying to create a positive working environment. We have also been working with Zambian staff who can help with training. In 2008 we began training a general physician (who will unfortunately return to New Zealand), and in 2009 we have begun training a newly qualified doctor from DRC who will return to Mulongo Hospital. A system of placements for training Zambian medical students and Clinical Officers is also being established.
The greatest need continues to be attracting more qualified staff to help with both the training and the clinical workload.
2) Developing a support network with Christian doctors and nurses in overseas countries
There are many Christian doctors around the world who could help the hospitals in Central Africa in a number of ways. These would include visiting for four to six weeks, retiring early and spending some time in a mission hospital or helping to source medical equipment and supplies. If a network of Christians interested in medical work overseas could be established, then this would provide a mechanism for better communication of needs and could be a great help. World Medical Mission is an example of such a group (http://www.samaritanspurse.org/index.php/wmm/). Establishing groups in the UK, North America and Australasia would require a medical individual in each of these areas who understood the benefit of this work and would be prepared to coordinate the programme.
3) Forming meaningful links with Christian doctors in African countries
The solution to a lack of qualified staff is to attract more African staff to work in our hospitals. This is not as straightforward as one might imagine. One approach would be to work more closely with churches in the cities to encourage Christian doctors and medical students to become involved in mission hospitals linked with their churches. Another approach would be to work more closely with medical Christian fellowship groups. The key to success would be the willingness to work in partnership.
4) Selecting and sponsoring the training of individuals in rural areas who will return to work in mission hospitals
Identifying and helping to train individuals who come from the area of a rural hospital, and who are prepared to return and work for their own people, is one way to improve hospital staffing. Mulongo Hospital has attempted to train doctors in this way. This requires a long-term vision and commitment. It is a high-risk strategy, as once trainees are qualified there is no guarantee that promises made will be kept! Wisdom in selection and forming a good relationship with the individual and family involved would help to improve the odds of this strategy working.
The Brethren hospitals in Central Africa have done a remarkable job, caring for people and sharing the gospel. God has been faithful in providing resources and blessing these places for over 100 years. At this time of need, we have to consider our involvement and ensure that we are not ignoring the call of God to spread the gospel to the youth of Central Africa. Some ideas have been shared in this article. I would be very interested in hearing from anyone who would like to make further suggestions or who can help in any way.