Introduction

Over forty Christian practitioners engaged in nursing, medicine, mental health, hospital chaplaincy, special needs and palliative care in six countries in Africa, the Middle East and South-West Asia met under the auspices of under the auspices of Oxtrad and the Bishop of the Church of Pakistan Congregations in the Gulf to explore how such Christian ministries might be enhanced and co-ordinated.

Data and Analysis

Many false perceptions persist which are not borne out by the evidence. Data on maternal health, miscarriages, infant mortality, HIV, addiction and psychological and physical abuse is under-reported.

Noncommunicable diseases are responsible for the deaths of over 41 million people worldwide. This includes 15 million aged between 30 and 69. Over 85% of these premature deaths are in low-and middle-income countries.

Mental health conditions are significantly undiagnosed and undertreated in low-and middle-income countries.

These countries rank lower in health security, immunization status, maternal and infant mortality, life expectancy and numbers of medical schools, hospital beds and healthcare professionals.

Those societies with poor health indices are characterized by authoritarian political control, by religious extremism, by corruption in public life, by people who are kept poor and ill-educated and by low government health expenditure.

People who might be uncorrupt are threatened with loss of their job if they expose corrupt practices. Even the Church is often forced into silence and its felt need for self-preservation can determine their community's life which often lacks vision and leadership for anything beyond itself.

Opportunities

Many opportunities exist for Christian service and witness in health care. To release their members' talent, churches need to train Christian disciples with a strong work ethic committed to serve the communities beyond their own membership in the love and power of Christ. Such a goal requires leaders willing both to relinquish a culture of control and to enable people to develop their skills.

In many cases resources are concentrated in urban centres and not in remote rural areas and among the very poor. The distribution of aid and mission partnership from western churches and agencies often replicates the global tourist map. How might richly resourced centres of excellence support areas of the greatest need? New partnerships emerged to strengthen the work of medical mission in different parts of the world.

Priorities for action

Maternal and Neonatal Morbidity and Mortality

Community-based care of the mother, the unborn baby and family can be enhanced through the Parish Community Health Visitor programme. This will reduce the numbers of children with special needs and of women with mental health challenges.

Provision for children with special needs should avoid cutting them off from their families and social interaction. They may be disruptive to school classes. Integrating them with other children requires extra support by trained volunteers and integrated church events. Their gifts, as well as their limitations, should be recognized. Can churches support families of such children?

Volunteers can listen to and enable women with mental health issues, often associated with childbirth, early motherhood and stressful family situations to express their distress through art, drama and music therapy. Thus genuine friendships and spiritual awakening can emerge which make for healing and recovery of wholeness.

Palliative Care.

In the countries represented, there is no Palliative Care for most people and no incentive to provide it. It will be necessary to address the current culture of denial of talking about dying, and to introduce policies for care at the end of life. Palliative Care training will be needed for all involved in Health Care. Medication to manage symptoms need to be made available for use outside of the hospital environment.

The Church must raise these needs with medical authorities and arrange for the training of individuals to support families caring for dying people. Providing a service at home is cost effective, easier and quicker to get off the ground and involves the family and local community. A good place to start is to gather a team motivated to set up care as Jesus cares.

Chaplaincy and Pastoral Care in Christian hospitals and clinics can provide a bridge between medical specialists and patients and direct the voluntary personnel resources in the churches into the most fruitful channels.

Chaplains sometimes face a culture that does not welcome patient focused Christian ministry either through a focus on technological medicine which objectifies the patient, a religious or secular culture hostile to Christians, or an overregulated culture. Chaplains can argue for the human rights of the patient to have access to spiritual care and for respect for religious diversity. Chaplains need to engage with the personal well-being and spiritual needs of staff.

Staff can give pastoral care to each other through debriefing together after experiencing distressing cases. Teams need to meet regularly. Encouragement (a gift of the Spirit), thanks and an edible treat can develop resilience.

Some team leaders began their day with prayer with staff which members of other faith groups often attended. Nurses could pray with patients as long as they did not disturb their neighbours.

Christian staff have responsibility for the well-being of non-Christian colleagues. While they enjoy support of the Christian community, non-Christians have no such resource to deal with the hurts they see and feel.

Requests were made for developing chaplaincies and international networks for encouragement and to share information.

Governance. Governance failures are one reason why many Christian medical institutions in the region struggle to survive and may in time lead to their closure.

Governance is strengthened when conflicts of interest between what is best for patients and the private gain of politicians and medical professionals, are met by patients being willing to complain as groups, structures of accountability, and public commitment to honesty, integrity, leadership, objectivity, openness, and selflessness.

Medical and Nursing Education

Jesus' principles for training disciples is a pattern for training a new generation of health volunteers and professionals. He challenged his culture, called out and directed people, taught them to serve poor people especially, and saw gifts in them they had not recognized. "See one, do one and teach one" was his approach; he did not hide mistakes; he issued a rebuke privately and gave a second chance so that people could retain their self-respect.

People are made up of body, mind and spirit. These cannot be addressed separately. Modern health care practice and education stems from the division of knowledge into the Humanities which focus on communication, and Sciences which focus on supposedly objective evidence. Yet there is no such thing as an uninterpreted 'fact'. In "Jesus Christ are found all the treasures of wisdom and knowledge" (Col.2.3). Our practice should seek to restore health care knowledge back to the framework of the kingdom of God.

A priority is to equip Christian workers in rural areas with basic primary healthcare knowledge and skills to extend holistic care to their families and communities. This will involve training in disease prevention, health education, managing minor health problems and appropriate referrals.

At grassroots level to teach mothers need to be taught the basic requirements of hand washing, the need for clean water, and sanitary hygiene. This would significantly reduce the 88% of all disease which is borne through unsafe water. Good sanitation brings wellbeing to communities which is linked to physical, mental health and social welfare. Such messages must address both the very vulnerable and the people with power and influence in society.

In academic health care education 'blended learning' combines face-to-face lecture, seminar or tutorial, with digital resources accessed through the computer. Where internet access is stable an online learning environment can be established. Teaching and learning can be in real time or lessons can be recorded. Such a process is efficient, flexible, cost effective, student-centred and self-directed. It can also establish shared learning anywhere in the world.

In some societies Christian medical institutions must have national staff. Large scale middle class emigration combined with the nationalization of institutions has meant that no new middle class has been created to staff these institutions. More Christian doctors, nurses and other health carers need to be trained. Institutions in decline can become sites for new innovative models in health care for communities. Change is needed or these institutions will die. Nursing and midwifery are major needs in Pakistani health care development. A Christian Health and Social Care school could enhance the reputation and practice of all disciplines.

Biblical and Theological resources

Worship, prayer and reflection on the Book of Job undergirded our consultation. Prayer support teams can address the difficulties preventing suffering communities receiving the ministry of Jesus through teaching and healing.

In the mystery of suffering, complaining to God is not the same as cursing God and that the ministry of presence is more important than fine words. A fuller expression of the nature and purpose of suffering and maintaining hope is found in understanding the life and ministry of Jesus as the instrument and suffering of God himself in redeeming his creation. It is such involvement which the consultation sought to promote and to assist.