By Gregory E. Saunders ’85
It was just after the end of the Great War. My grandfather and grandmother, having recently completed their medical missionary course at the College of Medical Evangelists, set sail for India. It took them about three months to reach their duty station, and it was seven years before their first furlough back in Canada via England (Grandpa’s motherland). My dad, born in India, remembered that trip as a preschooler, being introduced to “home” that wasn’t really home.
Fast-forwarding to 1957, my dad, who had become a U.S. citizen during World War II (which enabled his being drafted into the U.S. military and getting his way paid through medical school at the College of Medical Evangelists), took his wife and two daughters to Pakistan by ship. This time the journey was measured in weeks. I was welcomed into the family the next year.
Our family was transferred to Gimbie Adventist Hospital in Ethiopia in 1961, which included a mid-term four-month trip to the U.S. to visit family (which I don’t remember). The age of jet travel had arrived, and the trips were then measured in days. It wasn’t until 1966 that I remembered visiting “home” that wasn’t home. We spent a year in California and then returned to Ethiopia, this time to Addis Ababa, where we spent another four years before our PR (permanent return) to the U.S. in 1971.
In 1994, my wife, Kathy, and I, with four kids in tow, landed in Nigeria, where we ultimately spent 10 years working at the SDA Hospital in Ile-Ife. In 2015, with the kids all launched (some off on their own international ventures), we returned to Africa, this time to the Adventist Health Centre in Lilongwe, Malawi, to help develop surgical services.
We are into the fourth generation of wearing the label “missionary,” with feelings varying from gratitude to embarrassment. We are grateful that we’ve been able to experience the joys (and frustrations) of being a part of a worldwide movement. Our lives have been enriched by exposure to different cultures, customs, cuisines, and languages. We have friends scattered on various continents that are like family if we drop in on them. It is also satisfying to look back and consider that we had a part in leaving a place a little better than we found it, whether in infrastructure development, quality of health care provided, or more importantly, in development of local manpower to sustain the mission for the future.
At the same time, it can be a bit embarrassing to be in the presence of a person who starts to gush about how they admire the great “sacrifice” we are making or how hard it must be to live in “primitive” conditions. Yes, we have been exposed to situations where electricity and clean (or any) water access were a bit more challenging to sustain. But, truth be told, in almost all of our experiences abroad, we have been better off than most of the people around us. By the accident of birth into a certain race, passport country, economic status, and education, we find that we have little reason to feel sorry for ourselves. We have much better options and possibilities than the majority of the world.
Most of our Adventist health care institutions in Africa were established in fairly rural areas. Some, like our hospital at Malamulo in the southern part of Malawi, have become large educational institutions, training nurses, lab technicians, and clinical officers (who provide much of the country’s primary care). Now there is a surgery residency program, which should graduate its first surgeon in the next year or so. Malamulo is a great place to learn, and the residents with whom I have interacted are knowledgeable and developing good skills. The interesting (and unfortunate) thing is that when they finish their training, Malamulo cannot afford to hire them unless there is a special financial provision from elsewhere. All but one of the specialist physicians at Malamulo are paid through Code 1 International Service Employee (ISE) budgets from the General Conference in Silver Spring, Maryland. Because the institution predominantly serves the rural poor, it cannot generate adequate revenue to pay the higher salaries that are expected by such professionals, even on the local scale (which is much less than they would make in the U.S. or Europe).
My ten years at Ile-Ife, Nigeria, were on a Code 1 budget. It’s not a way to get wealthy by U.S. standards, but I was assured of periodic travel back to the U.S. for family visits and for continuing education to maintain my professional certification. My children’s education was also subsidized. My African colleagues were not so fortunate. One of them had even trained in the U.S., but working under the local conditions as a national, he could not afford to maintain his specialty certification in the U.S. or send his kids to reputable schools. So ultimately, he left to work where the conditions were better, and I could not blame him.
Where I am now in Lilongwe, Malawi, I work under a Code 4 budget, which means I get all the benefits of a Code 1 budget, but the local institution has to support it. It makes me an expensive employee by local standards and also means that we have to cater to the more wealthy clientele. This, of course, calls into question what our mission really is. When we consider the first part of Jesus’ mission statement in Luke 4: “The Spirit of the Lord is upon me because He has anointed me to preach the gospel to the poor,” it’s a bit troubling that the poor of this city cannot afford to be seen at our facility. The cold hard facts are that if we brought the poor in and took care of them, we would soon have to close due to inability to pay salaries and buy supplies.
On the other side of the equation, though, are other “mission” considerations. First, we should not perpetuate a condition of dependency on outside help. At some point our institutions need to be sustainable on their own. It is also likely true that if we can offer high quality health care locally, such that the wealthy people will stop leaving the country to go to India or South Africa for their health care needs and will spend that money locally, it will be better for the local economy and help reduce poverty. In Asia, all of the Adventist health care facilities of which I know, apart from Nepal, are in more urban areas, and they don’t rely on Code 1 budgets (“missionaries from abroad”) anymore.
Secondly, we have many patients in our facility who are Asian (originating from India or Pakistan). They tend to be the wealthier merchant class in many African countries. Most are Muslim. Serving them through health care is one of the few ways that we can build bridges to confident and meaningful relationships, and that is definitely a worthy mission.
In addition, it makes sense to me that we should be developing places that can ultimately serve as training sites for treating the diseases of the affluent. The surgery residents at Malamulo will rarely get an opportunity to do a laparoscopic cholecystectomy because that disease entity is rare among the rural poor. It’s also difficult to justify the cost of laparoscopic procedures in that setting. But the affluent in the city have learned to eat the foods that bring on such diseases. Having a facility where the residents can round out their training with a different disease cluster would be beneficial. I dream of growing our institution to the point where that can happen.
The disparity remains troubling. While we cannot forget the poor without risking a loss of mission, to ignore the development of sustainable health systems will just perpetuate disparity. In the days of my grandfather and my father, it was just “the way things were” that the American or European missionary came in with the education, skills, and support to make the mission succeed. We have moved that paradigm toward self-reliance quite a bit in the pastoral and educational ministry, but it seems a bit more difficult in the healing ministry.
This is a challenge in balancing compassion with envisioning a future that is not forever dependent on help from abroad. Though I believe that international interaction will always be beneficial, I dream of a day when those of us who come from other countries are here to learn from and augment what our indigenous colleagues are doing. We will have achieved our mission well when our presence is no longer vital to its sustainability.