Slate’s Brian Palmer is right: missionary medicine in Africa is largely unregulated, unstudied, and understaffed. I have seen with my own eyes—and performed with my own hands—clinical decisions that would rightly be considered malpractice in a developed setting because they required that procedures or medications used reserved for specialists be attempted in order to save a life (ask me sometime about the time I did hand surgery.)

What’s more, I did so in Jesus’ name, praying with and for patients whilst frequently consulting a chaplain to do some heavy-duty proselytization. Doing good for the sake of others doesn’t require that one believe in Jesus; there are plenty of organizations and individuals who are providing medical care without any spiritual strings attached. But neither does believing in Jesus necessarily inhibit people from doing good, as Palmer seems to suspect.

This, however, is not the end of the story, though it’s about all that Palmer bothers to talk about. The story of missionary medicine is more complicated— and expansive—than he realizes. One might think that a writer ostensibly dedicated to reason and scientific study might want to investigate the evidence that does exist—sparse as it may be—on the role of faith-based organizations and Christian missionaries within the medical systems of developing countries. Unfortunately, Palmer is content to fire off a few statistics about this bizarre tribe of missionaries and their backwards religious customs, then revel in horror at their unquantified habits of practice.

I have personally sat in meetings and seminars dedicated solely to exploring the ethical issues raised by practicing medicine in limited resources, using Biblical principles to sort out how to best care for patients in a way that is sustainable and merciful. I have listened to countless Christian medical professionals discuss the lengths that they go to in order to invest particularly in professional development for indigenous health practitioners. I have even been party to forums in secular professional meetings where the benefits and risks of an explicitly religious approach to medicine were openly debated. What’s more, these aren’t just my personal vignettes—they are an essential part of the numerous institutions that Christian missionaries train and serve in.

I certainly appreciate the historical nods that Palmer gives in his piece, acknowledging that criticism of missionary doctors goes back a long way. What he doesn’t mention, however, is the fact that the modern enterprises of community health and international development were not only founded on the precepts of missionary medicine, they continue to be shaped by the work of missionaries. Much of the evidence regarding community-based primary health care strategies comes from Christian projects. The Alma Ata Declaration—a WHO document that lays out the foundational principles for evidence-based primary care health systems—was based strongly on the work of Christian missionaries who helped to convene multiple conferences in the 1960’s and 70’s on international health. As Carl Taylor, who helped write the Declaration, stated:

“Coming out of the conference, the entire global health community, developed and developing, was energized to ramp up health care around the world. The tenets of serving the poor, service to the community as a whole, disease prevention, and the pivotal role of women in health, developed following [Christian medical conferences] and refined by Christian Medical Commission, were firmly built into the evolving framework of Primary Health Care.” from The Christian Community’s Contribution to the Evolution of Community-Based Primary Health Care (PDF)

Beyond the crucial role that Christian missionaries played in helping shift the WHO’s conception of health from the previously dominant compartmentalized, top-down model of care delivery to a more generous understanding of health as a function of human flourishing that must be secured as part of a social justice agenda, there are numerous initiatives within missionary organizations today to carry on this legacy. For example, both the ongoing Global Missions Health Conference and the recently launched Christian Journal of Global Health are dedicated to the exact sort of research, analysis, and quality improvement that Palmer thinks are missing from modern missionary medicine– which makes one wonder how hard he (or his editors) actually bothered to look into this subject. Most of the residencies dedicated to training indigenous physicians in Sub-Saharan Africa–whether surgeons or family doctors–are linked to one missionary organization or another. The “current emphasis of international health delivery” of education and training that he mentions? The Christian Medical and Dental Association even has a whole enterprise dedicated to it. A study to quantify who is working where and what they are doing that he hasn’t seen? It’s been out for 4 years! All of this is still bare-bones, but it’s disingenuous to suggest that medical missions is “a mystery,” as Palmer does.

Research and quality improvement are indeed lacking in Sub-Saharan Africa (although Palmer’s mention of PubMed is laughable because you can use PubMed to find all sorts of papers written by missionaries, they just don’t write “Christian Missions” in every title.) This is largely due to funding; most African countries have yet to devote the state funds necessary for ensuring basic healthcare provisions for their people, much less an ample funding source for research akin to the vast resources that NIH, charitable foundations, and pharmaceutical companies pour into investigation in the First World (and let’s not forget that in America we have to have big public campaigns to get our highly educated professionals to actually follow the evidence that has been amassed because said professionals are so bad at following it). Many missionaries—already working long hours with limited resources—still find the time and money to collect clinical data, report it to whatever entity is willing to crunch the numbers, and use the results to shape their practice.

Beyond these concerns—which Palmer freely admits he might relinquish if secular physicians were carrying out the work—lies the question of faith. His willingness to admit that his discomfort about this issue won’t motivate him into an ideological crusade against health professionals who proselytize is certainly commendable. For a non-religious person steeped in a non-religious environment, it certainly seems apropos to be skeptical of missionaries who are open about their faith and wag a finger at those who would dare to use their position as a medical provider to share their beliefs with others. However, such an outlook is downright ignorant of non-Western conceptions of health and disease, which are far more open to spiritual causes of disease and more frank discussions of faith as it relates to health. In a world where cell phones and reverence for one’s ancestors are equally valuable and many people inquire of a witch doctor before seeking medical attention at a hospital, it is not at all unusual or inappropriate to practitioners to discuss their own religion and how it might offer a better perspective on the suffering and fear that their patients are facing. I don’t know if Palmer’s piece was vetted by any Africans, but it doesn’t seem to reflect any understanding of the holistic worldview that I have encountered among non-Western health professionals.

We do need to address the disquieting motivations that medical missionaries sometimes have for their work. Again, the white and wealthy cultural milieu finds animating spiritual convictions frightening for legitimate reasons and has ample historical basis for such fear (although the legacy of colonial missionaries is far more positive than most give credit for.) However, the dedication with which missionaries apply themselves to their work and the places that they choose to invest their labors are inseparable from the theological distinctives of evangelical Christianity. Just as the American Civil Rights Movement or the British anti-slavery movement cannot be understood without a deep appreciation for the religious teachings that shaped them, so missionary medicine is inseparable from the doctrines discerned from the Bible. Jesus’ ministry of preaching and healing are inseparable—the Gospels are full of incidents where He challenges, exhorts, encourages, or rebukes one who has been healed or a crowd around Him as a part of the healing. At the very heart of Christian doctrine is the understanding that as Christ’s suffering delivered us unto life, so our suffering as believers can produce similar fruit in others. Kent Brantly, Olivet Buck, and Jerry Umanos stand as excellent examples of such Passion-motivated compassion. Dr. Brantly survived his suffering for others, but Drs. Buck and Umanos did not—these theological convictions are what make Christian missionary medicine uniquely effective and continue to drive the disproportionate (but still insufficient) number of religiously based medical providers.

The deficiencies that Palmer notes in his piece are real, and mission work is desperately in need of the sort of resources we apply to Western medicine. However, both the spiritual aspects of Christian mission work and the rigor already applied to such medical endeavors are indispensable to the story of healthcare in Africa—even if if Palmer can’t be bothered to discuss them when he bemoans the lack of data plaguing health care abroad. Rather than casting aspersions and “standing aside,” those who love evidence-based practice ought to celebrate what has been done through missionaries, apply what they have to teach us, and follow them to places where just and equitable health systems are still being built.

Posted by Matthew Loftus

Matthew Loftus teaches and practices Family Medicine in Baltimore and East Africa. His work has been featured in Christianity Today, Comment, & First Things and he is a regular contributor for Christ and Pop Culture. You can learn more about his work and writing at www.MatthewAndMaggie.org

  • RobD

    I read Palmer’s article and appreciate his honesty. I found myself intuitively agreeing with him, but initially not exactly understanding why. As I thought about it a bit more, it struck me that my discomfort had little to do with medical missions. Instead, it had to do with the broader evangelical ideology that gives rise to the work of guys like Ken Brantley.

    I grew up in a mainline Christian home. When I was in my 20s, I began attending an evangelical Presbyterian church, which I’d found by accident (thinking that it was a mainline Presbyterian church). My faith grew. The church’s teaching provided the necessary “guts” to the somewhat inchoate profession of faith that I’d previously possessed. It was something that I needed at that time in my life. I’m deeply grateful for that church, its pastor, and its people. Nevertheless, I eventually ended up going back to the mainline church. I left evangelism because I just couldn’t seem to fit into its subculture or agree with its overarching epistemic idealism. Where I saw complexity, evangelicals saw simplicity; where I saw ambiguity, they saw only black and white; and where I saw a need for caution and analysis, they saw a need to plow ahead and not to look back. In short, evangelical action is deeply rooted in idealism and individual initiative, where the hero of the narrative is typically a lone individual who casts caution and doubt aside and plows ahead in pursuit of an idealistic vision, ever confident that God is running before him. In contrast, we non-evangelicals tend to ground our actions in pragmatism and institutional initiative. To evangelicals, Ken Brantley is a hero. To the rest of us, he’s something of a reckless idealist who took unwarranted risks to achieve a relatively marginal benefit.

    Pragmatists are reluctant to enter places like Liberia unless they can build institutions that will have a lasting effect. So, in that sense, evangelical medical missions fills an immediate need that would otherwise go unmet. Even so, the missionaries’ efforts will probably have few lasting long-term effects on institutional dysfunction that permits these outbreaks to arise in places like sub-Saharan Africa.

    Moreover, I suspect that we pragmatists see this evangelical idealism against a broader tableau. The work of medical missionaries illustrates the positive side of evangelicals’ individualistic idealism. But we’re also keenly aware of the negative side of it, such as in evangelicals’ penchant for engaging in the Culture Wars. So, the reckless idealism that leads Ken Brantley to take on the task of serving dying ebola victims in Africa is the same reckless idealism that leads other evangelicals to advocate for a society that would deny basic legal rights to LGBT people.

    Scott Lively and Ken Brantley are simply two sides of the same coin. Both act from the same reckless idealism–an idealism that knows no ambiguity, sees no complexity, and harbors no doubt. Their fruit only looks different because of the different venues in which they’ve chosen to act. And that’s why we non-evangelicals hesitate to heap too much praise on Brantley. After all, we ultimately know that praise of Brantley may give credence to the same ideology that sustains the ministries of Lively, Gary Bauer, and other Culture Warriors. We know in our hearts that, for evangelicals, the line is thin between serving ebola patients in Liberia and calling for the imprisonment of LGBT people in Uganda.

    I think that explains Palmer’s reluctance to laud Brantley too vigorously. And I think his instincts are probably right. A brief perusal of the internet suggests that those who are most angered by Palmer’s slight of Brantley are committed Culture Warriors. One doesn’t need to peruse too many of the Culture Warriors’ blogs to see that evangelicals themselves see little difference Brantley’s work and Lively’s work. Why then are evangelicals outraged when someone like Palmer hesitates to laud the former for fear of giving undue credence to the latter?

    • Rob,

      Thanks very much for your thoughtful comment. I certainly understand your reservations; I think your analysis would be very much worth considering if it were true about medical missions. Unfortunately, while it may reflect some missionaries and it’s probably more likely to be true of your average American Culture Warrior, it’s hardly what I’ve seen in my experiences in various evangelical mission organizations.

      You may certainly have seen a lot of black-and-white thinking in your evangelical experience. That’s certainly a common part of our discourse; however, as I stated in the OP, that was also a feature of abolitionist and Civil Rights movement (read any MLK sermon and tell me it’s not full of idealistic, black-and-white thinking!) It’s also an attitude easily found in just about any left-leaning or secular publication that takes itself seriously enough– Jacobin, The Prospect, Salon, The New Republic, etc. Furthermore, if you spend any time in the literature written by or for medical missionaries, there is an abundance of nuance, flexibility, and pragmatism (did you click on any of the links provided within the OP?)

      Moving on to the concept of your “individualistic idealism” lens. Here’s a column from the President of the Christian Medical & Dental Association, entitled “Kent Brantly Is Not A Hero.” (http://cmda.org/resources/publication/dr-kent-brantly-is-not-a-hero). I think that about sums it up. The vast majority of missionaries don’t see themselves as exceptional evangelical superheroes, they see themselves as fellow Christians who have callings different from most of their friends and family. They are part of a worldwide communion of saints and they are dependent on the prayers and support of Christians who work their 9-to-5 in the West to do their work (for more on these ideas, see my previous piece here: https://mereorthodoxy.com/radical-rhetoric-siege-warfare-christian-population-density/).

      You need only to click through a few articles on this blog (or, again, any of the links above) to see that there’s a sizable evangelical contingent dedicated to “institutional initiative.” Specifically within the realm of medical missions, there is a serious movement to focus on building up indigenous health systems leadership and strengthening the capacity of health care systems in poorer countries. This was my biggest beef with Palmer’s piece– this information is all over the internet, and even a brief reading of the literature within the field itself is all you need to see how many medical missionaries are working to help transform health care to be more sustainable and effective (and have already done so for decades.) Palmer apparently did not bother to engage with any of this literature whatsoever, much to his shame (and perhaps even more to his editors, who apparently didn’t ask him to do his background research.)

      Anyway, thanks again for engaging. I hope you’ll reconsider some of your opinions in light of more information.

      • RobD

        I agree that medical missions may, in certain respects, be more pragmatic in its approach to other evangelical initiatives. After all, when boots hit the ground, nothing conforms perfectly to idealism or pragmatism. Even so, evangelical initiatives rely heavily on epistemic idealism. If medical missions is moving away from this rubric toward a more pragmatic, institution-focused approach, then that’s a good thing.

        But my point was to focus on Palmer’s reluctance to praise the work of medical missionaries, as someone who spent some time in the evangelical movement. You seem to chastise Palmer for failing to look at medical missions in isolation and to evaluate it separately from evangelicals’ broader social agenda. I’m just not sure that that’s a reasonable request. In fact, aside from you, Palmer’s evangelical critics have been quick to identify medical missions as a direct product of the evangelical worldview and its social idealism. So, if Palmer’s evangelical critics are right on that point, then we certainly have to evaluate Brantley’s work along side that of Scott Lively, Gary Bauer, et al. After all, their work is just as much a direct product of the evangelical worldview and its social idealism as is Brantley’s. It’s not that Palmer is so tribal in his thinking that he simply can’t bear to admit that an evangelical did something good for humanity, as Ross Douthat and others suggest. To the contrary, he realizes that this idealism presents a double-edged sword: The same idealism that leads Brantley to travel to Liberia to heal the sick is the same idealism that motivates Scott Lively to travel to Uganda to promote persecution of LGBT people. And for that reason he hesitates to endorse it wholeheartedly.

        Sure, Palmer could have done more to get some of the details about medical missions right. But that wasn’t his point. In fact, I suspect that he’d have the same misgivings even if had more information regarding the work of medical missions. After all, Palmer’s reservations don’t spring from anything directly related to Brantley’s work; rather, they spring from his knowledge of the darker side of evangelicals’ social idealism.

        Cultural elites tend to be fairly committed to a pragmatic form of social libertarianism. When it comes to things like permitting same-sex couples to enjoy the right of civil marriage, we are typically confident that our libertarianism offers something better and more humane than the anachronistic social idealism that evangelicals promote. Even so, pragmatic social libertarianism doesn’t seem to motivate people to serve the sick and dying in Liberia in the same way that evangelical social idealism does. And that should give us pragmatic social libertarians pause. It certainly doesn’t convince me that he evangelical social program is right. But it does lead me to be a bit more introspective about my own values and to recognize the need to do a bit of reevaluation. Why is it that we rarely travel anywhere where we can’t collect Starwood points?

        • RobD,
          I’m certainly glad that you are willing to consider the disadvantages of libertarian pragmatism (James Poulos’ Pink Police State essays at The Federalist may also be helpful in this regard.) However, I have a few more quibbles with what you say:

          I have no problem evaluating medical missionaries within the general schema of evangelicalism– I thought Ross Douthat’s column was spot-on in this regard. Us followers of Jesus are a mixed bag (see below), both individually and corporately.

          You’re really stuck on this “epistemic idealism” thing, which to me seems pretty ubiquitous to social movements (as is, y’know, the existence of double-edged swords– for every Harriet Tubman there’s a John Brown.) Furthermore, while Scott Lively is certainly popular enough, I think you can make the argument there is a far sturdier theological backing to Brantley’s efforts than Lively’s, at least based on what I’ve read (and fwiw, I had never heard of Lively until you mentioned him.)

          In the end, both evangelical idealism and libertarian pragmatism are going to be at war with the worst tendencies of human nature– but they’ll also be used by these tendencies for ill. Honest assessment of both, as you point towards, is crucial– which, again, is why Palmer’s lack of research is so disappointing.

          • RobD

            I’ve read Poulos’s essays. Many of his observations are astute, but I’m not sure that his thesis paints a complete picture or offers a reasonable prescription for moving forward.

            Yes, I am stuck on the idealism thing because I don’t find it to be all that helpful. This is precisely the point that James Davison Hunter makes in the first half of his book, To Change the World. Like it or not, pragmatism is what moves the dial at elite levels, not idealism.

            Again, I take issue with your faulting of Palmer. He was writing a brief piece for Slate aimed at making a specific point to a specific audience. It’s not at all clear to me that any additional research would have contributed to the point he was trying to make. If you were aware of Lively, perhaps you would have appreciated the point that Palmer was trying to make.

          • Steve Knudsen

            great conversation. I think we should thank Palmer for starting it

          • I’m not sure we’re getting anywhere. You still haven’t convinced me on the idealism thing (citing Hunter in these parts is not exactly a substitute for an argument.) Palmer misrepresented both the state & history of medical missions and failed to consider the perspective of Africans (just read the ARHAP report he linked to and note the statistics he chooses to cite!) Both of those are at the very least crimes against good journalism, especially when he complains in the piece that there’s isn’t a lot of information and then doesn’t bother to look for it. Your obsession with Lively’s anti-GLBT prejudice (which isn’t mentioned or alluded to at all in the piece) doesn’t seem to be doing you any favors.

            And if both Palmer and you are so darn committed to pragmatism, wouldn’t exploring the evidence around medical missions and building primary health care systems (as well as the motivations behind all those idealists carrying them out) be even more important?

          • Robert

            I think I’m with Loftus on this. Palmer advances an argument based on his self-admitted ignorance. Saying “we just don’t know” several times is hardly a compelling reason to believe that he knows enough about his subject to convince us of his position. Frankly I’m surprised his article made it into print. Loftus is much more convincing that the information Palmer laments as absent is actually there for the finding. As I read Palmer’s article, I found myself wondering, “What solution is he actually suggesting?” By the end of the article the answer was obvious: none.

            Does Palmer really care about the suffering poor in developing countries around the world? Does he prefer that medical missionaries should just pack up and go home and leave millions with no health care services at all? What are the alternatives? If he really is so unsettled about persons of faith being involved in providing healthcare to the poor in the midst of desperate circumstances, I wish that Palmer instead would have written a piece about the need for secular forces and resources to join and strengthen the work already established and ongoing that is being sacrificially undertaken by medical missionaries and their supporting organizations. There is enough need to keep us all engaged.

          • RobD

            I think we’re talking past each other here.

            Palmer’s main point–and perhaps his only point–is to explore his personal discomfort with the prevalence of medical missions in sub-Saharan Africa. Your critiques fail to address that point, and instead focus on secondary or tertiary issues. Even if Palmer conceded that your critiques have merit (and I suspect that he would), I don’t think that would do anything to assuage his discomfort. After all, his discomfort with medical missions lies with the commingling of religious proselytizing with the provision of medical care. From the perspective of a secularist (Palmer) or a mainline Protestant (me), it can look like evangelicals are taking advantage of shortages in medical care to avail themselves of opportunities to spread their particular flavor of Christianity. That would still be the case notwithstanding your critiques.

            Yes, I took Palmer’s analysis a step further, given that I probably have more contact with evangelical Christianity than Palmer has. Building off of Hunter’s work and Christian Smith’s work, I hypothesized that evangelicals are largely blind to this criticism because their actions tend to flow from an epistemic idealism, as opposed to a more pragmatic approach.

            Even so, why should that bother people like Palmer and me? To Palmer’s audience, that’s pretty obvious: Evangelical Christianity isn’t exactly viewed as a force for good among the cognitive elite. I mention Lively’s missionary work in Uganda because that’s what most likely pops into the mind of most Slate readers when they hear about evangelicals doing work in Africa (although people probably couldn’t name Lively or AFA by name). Palmer doesn’t have to mention it because his readers can connect the dots. Moreover, various evangelical voices have connected those same dots. For example, Denny Burk, a leading Southern Baptist scholar, compared the suffering of medical missionaries to the social marginalization that American evangelicals are facing because of their opposition to gay rights. I recognize that a few figures don’t speak for the whole evangelical movement. And it’s probably not fair that, at this moment in time, evangelicals aren’t known for much besides their political opposition to gay rights. But that’s our present reality.

            I agree that there’s a much more nuanced story to be told regarding evangelical social engagement, including medical missions. So, in that sense, I think you’re onto something. But your defensive, hyper-critical reaction to Palmer’s piece isn’t likely to win you any converts outside of those already committed to the evangelical program. Then again, maybe I misread your intentions.

            Peace in Christ.

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