volume 47 no. 2 summer 2016
TODAY’S
CHRISTIAN DOCTOR The Journal of the Christian Medical & Dental Associations
IN THIS ISSUE
Reaching the Unreached Preparing to serve in cross-cultural ministry
Changing the healthcare of an entire continent
Helping missionaries find spiritual renewal
TRANSFORMED Doctors, TRANSFORMING the World
45+ MINISTRIES. 1 MISSION. Changing Hearts in Healthcare.
We are a Christ-centered organization dedicated to motivating, educating and equipping you to be the hands of Jesus in your practice, your community and your world. We offer you discipleship, fellowship, mentoring, resources and missions opportunities to share the gospel and serve others. Become a member of CMDA today and join the thousands of Christian healthcare professionals who are changing hearts in healthcare. Our ministries include: ■ Campus & Community Ministries ■ Center for Medical Missions ■ Commission on Human Trafficking ■ Continuing Education for Missionaries ■ Dental Ministries ■ Fellowship of Christian Physician Assistants ■ Global Health Outreach
■ ■ ■ ■ ■ ■ ■
Global Health Relief Life & Health Resources Bookstore Medical Education International Pan-African Academy of Christian Surgeons Side By Side Women Physicians in Christ And many more...join today!
Christian Medical & Dental Associations • P.O. Box 7500 • Bristol, TN 37621 • 888-230-2637 • www.cmda.org
God’s Up To Something! David Stevens, MD, MA (Ethics) One of my children is now a healthcare missionary in a largely Muslim country where suicide bombers blow themselves up every few weeks. A few months ago, a man dressed up like a woman and set off his suicide vest at the entrance to the market where they shop. My daughter, son-in-law and two of our grandchildren are at considerable risk every day.
I firmly believe we won’t win the battle against radical Islam through drone strikes, bombing or even boots on the ground. Only salvation through the acceptance of the saving grace of Christ on the cross will change the hearts and minds of those so deluded by Satan that they will torture and murder in the name of their religion.
We surveyed the Your Call group a few years ago and learned that 25 percent felt called to established mission work, 50 percent felt God wanted them to go to the 10-40 Window to unreached people groups and 25 percent are not sure yet. God is up to something!
More and more mission hospitals have started post-graduate residency programs combined with intense discipleship to train national healthcare missionaries. Along with CMDA’s 11 surgery residencies through the Pan-African Academy of Christian Surgeons, there are now programs in family practice and med-peds. A mission hospital is Africa is working to start ophthalmology and OB/Gyn residencies. Most Muslim countries are impossible to access Graduates from these programs will have easier by traditional missionaries doing evangelism and access to areas that are hard to reach. God is up church planting. In the past, mission organizations to something! have sent people to share the gospel under the cover of doing business, teaching English as Of course, missionaries from the U.S. are only a second language or other disguises, but they part of the equation. A thriving Korean Christian are often found out and then thrown out of medical school is located in Ethiopia, and the country. Healthcare missionaries, though, other countries are also sending out healthcare are different. Their services are desperately missionaries. needed. Even if they are discovered, they are often still tolerated and allowed to stay. That is The work remaining to be done won’t be why I believe healthcare missions is the key to easy. The locations with nice climates, friendly completing the Great Commission! cultures and people with open hearts are already penetrated with the gospel. Great sacrifice, long It also may explain what God is doing, as we perseverance and real courage will be required are seeing a huge renaissance in healthcare more than ever. Some who go and serve will missions. At last year’s Global Missions Health not return. You and I should not be surprised Conference, more than 950 people made if we see a healthcare missionary or even their commitments to serve in long-term missions. entire family on TV dressed in orange suits with The conference itself has grown to around knives at their throats. 3,000 in attendance with 200 exhibitors and 150 workshops over a span of just two days. But remember, God did not promise ease or CMDA is now working to start similar mission safety. He promised His presence, the power conferences in Dallas, Texas and Southern of the Holy Spirit and His sustaining grace. As California. you read this issue of Today’s Christian Doctor which is focused on reaching the unreached, A number of years ago I started CMDA’s Your open your heart and mind. Commit yourself to Call program. It focuses on mentoring students praying and supporting those who serve. And if and residents (who are called to be healthcare God calls you, GO!
editorial
I’m not worried. In fact, I’m thrilled they are following God’s call, especially in a “difficultto-access” country. My wife Jody and I are praying for them faithfully and sleeping well at night, and we are able to do that because we gave those who are most precious to us into God’s hands a long time ago.
missionaries) during their long years of training. Its goal is to keep them on track to complete their call. More than 1,500 students and residents are in the program. The actual numbers aren’t available, but I would estimate that is equal to probably 30 to 40 percent of the total career healthcare missionaries now serving overseas. God is up to something!
Christian Medical & Dental Associations www.cmda.org 3
contents Today’s Christian Doctor
I VOLUME 47, NO. 2 I Summer 2016
The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.
5 Transformations STORY 12 COVER A Glimmer of Hope:
Disciples in Africa 26 Mforaking Africa
by Donald F. Thompson, MD, MPH&TM
CMDE Conference: 31 TAnheOasis in the Desert
Reaching the Unreached
Overcoming the barriers facing healthcare missions
reparing to Thrive 18 PAmong Dust and Thorns
by Will Couloir, DDS, with Elizabeth Couloir Planning to serve in crosscultural ministry
by Bruce C. Steffes, MD, MBA, MA
Changing the healthcare of an entire continent
by William Ardill, MD
CMDA helps missionaries find spiritual renewal
34 Classifieds
Return to Cuba: 22 AOpening Doors for Christ
by Robert J. Lerer, MD, FAAP
A physician shares Christ in the country he once fled
REGIONAL MINISTRIES
Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community
Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 Office: 503-522-1950 west@cmda.org
Midwest Region Allan J. Harmer, ThM 951 East 86th Street, Suite 200A Indianapolis, IN 46240 Office: 317-257-5885 cmdamw@cmda.org
Northeast Region Scott Boyles, MDiv P.O. Box 7500 Bristol, TN 37621 Office: 423-844-1092 scott.boyles@cmda.org
Southern Region William D. Gunnels, MDiv 106 Fern Dr. Covington, LA 70433 Office: 985-502-7490 south@cmda.org
Interested in getting involved? Contact your regional director today!
TODAY’S CHRISTIAN DOCTOR® EDITOR Mandi Mooney EDITORIAL COMMITTEE Gregg Albers, MD John Crouch, MD Autumn Dawn Galbreath, MD Curtis E. Harris, MD, JD Van Haywood, DMD Rebecca Klint-Townsend, MD Robert D. Orr, MD Debby Read, RN VP FOR COMMUNICATIONS Margie Shealy AD SALES Margie Shealy 423-844-1000 DESIGN Ahaa! Design + Production PRINTING Pulp
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Global Missions Health Conference November 10-12, 2016 Louisville, Kentucky Sponsored by CMDA
CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). TODAY’S CHRISTIAN DOCTOR®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Summer 2016, Volume XLVII, No. 2. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright© 2016, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tenn. Postmaster: Send address changes to: Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500. Undesignated Scripture references are taken from the Holy Bible, New International Version®, Copyright© 1973, 1978, 1984, Biblica. Used by permission of Zondervan. All rights reserved. Scripture references marked (KJV) are taken from the King James Version. Scripture references marked (MSG) are taken from The Message. Copyright© 1993, 1994, 1995, 1996, 2000, 2001, 2002. Used by permission of NavPress Publishing Group. Scripture references marked (NASB) are taken from the New American Standard Bible®, Copyright© 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977, 1995 by The Lockman Foundation. Used by permission. Scripture references marked (NIV 2011) are taken from the Holy Bible, New International Version®, NIV® Copyright© 1973, 1978, 1984, 2011 by Biblica, Inc.™ Used by permission. All rights reserved worldwide. Scripture references marked (NKJV) are taken from the New King James Version. Copyright© 1982 by Thomas Nelson, Inc. Used by permission. All rights reserved. Other versions are noted in the text. Christian Medical & Dental Associations P.O. Box 7500, Bristol, TN 37621 888-230-2637 main@cmda.org • www.cmda.org If you are interested in submitting articles to be considered for publication, visit www.cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.
You are invited to join CMDA at this year’s Global Missions Health Conference, the annual gathering point for healthcare professionals to network, share best practices and work together to advance missions. Enjoy a variety of speakers, a wide range of exhibiting organizations and some new special events this year. Continuing education will also be offered for a majority of the sessions. While you’re at the conference, be sure to visit the CMDA Zone in the lower level exhibit area. You can learn more about CMDA and get a closer look at our outreach ministries like Center for Medical Missions, Global Health Outreach, Medical Education International, Pan-African Academy of Christian Surgeons and more. The conference is hosted at Southeast Christian Church, and a number of the church’s members offer their homes as housing for students and residents to cut down on conference costs.
Christian Medical & Dental Associations www.cmda.org 5
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CMDA 2016 Member Awards The following awards were presented at this year’s National Convention. These articles are excerpted from the actual award citations which can be viewed at www.cmda.org/awards.
2016 Educator of the Year Award John E. Woods, MD
Dr. John Woods spent his childhood living with his missionary parents in Beijing, China during World War II. His father’s ministry introduced him to a life dedicated to service, outreach and healing. In 1949, he graduated from Asbury College in Wilmore, Kentucky, where he met and married his wife Janet. He received his medical degree from Western Reserve University in Cleveland, Ohio. Along with their young children, the couple spent two years in Panama where he completed an internship and residency before heading to Ecuador to serve as a healthcare missionary in a 16-bed hospital in the jungle. In 1960, they returned to the U.S. so he could seek further training in plastic surgery. In 1969, he joined the faculty at Mayo Medical School. For the next 24 years, Dr. Woods held many positions at Mayo, including professor of plastic surgery and vice chair of the department of surgery. He has been a visiting professor at a variety of schools here in the U.S. and across the world. He has also served as faculty at CMDA’s Continuing Medical and Dental Education conferences in Kenya and Malaysia, in addition to participating in a variety of short-term healthcare mission trips.
2016 Servant of Christ Award
Bill Rambo, MD, and Lydia Engelhardt, MD Dr. Bill Rambo was born and raised in India where his parents served as healthcare missionaries for more than 50 years. He attended medical school at the University of Pennsylvania and then completed a general surgery residency in Boston, Massachusetts with Harvard’s Fifth Surgical Service. After a research fellowship, he moved to Charleston, South Carolina to join the faculty at the Medical University of South Carolina in 1965. Bill’s first wife was a South Carolinian, and they had four wonderful children before she passed away. Lydia attend-
The Educator of the Year Award was presented to Dr. John E. Woods, who was unable to be in attendance.
6 Today’s Christian Doctor Summer 16
ed medical school at Georgetown University and then did her OB/Gyn residency in Charleston. It was during her third year of residency that she met Bill, who had been widowed the prior year. After completing her OB/Gyn training, Lydia served for three years with the National Health Service in rural South Carolina. After that time, she joined a private OB/Gyn practice. In 1999, Bill and Lydia made the decision to leave the practice of medicine in the U.S. behind, in order to begin doing what they describe as “long-term-short-term” healthcare mission work. With World Medical Mission, they’ve made 38 trips, serving in 17 different mission hospitals in 11 countries.
2016 President’s Heritage Award John Patrick, MB, BS, MRCP, MD
Dr. John Patrick received his Bachelor of Medicine, Bachelor of Surgery degree from the University of London & The Royal College of Physicians in 1963. That same year, he began practicing as a house physician and surgeon at St. George’s Hospital. After John and Sally were married in 1966, he spent three years as a clinical research fellow in cell physiology before becoming a research fellow in Jamaica working at the Tropical Metabolism Research Unit at the University of the West Indies. In 1980, they moved to Ottawa, Canada, where he began serving as an associate professor of clinical nutrition at the University of Ottawa. He continued to serve in that position for the next 22 years. In 1997, John was a founding member of Augustine College in Ottawa in response to the growing evidence that the modern university is toxic to the Christian faith. Nearly 20 years later, he still continues to teach courses at the college on the interaction between science, medicine and faith. After retiring in 2002, Dr. Patrick began lecturing throughout the world for both CMDA and the Christian Medical and Dental Society in Canada. He is one of CMDA’s most sought-after speakers, addressing both Christian and secular groups.
Dr. Bill Rambo (center) and his wife Dr. Lydia Engelhardt received the Servant of Christ Award from CMDA President Dr. James Hines (right).
Dr. John Patrick (right) and his wife Sally accepted the President’s Heritage Award from CMDA President Dr. James Hines (left).
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transformations
The Road Less Traveled by Grat Correll, MD There wasn’t even a road in this town! Flores was so remote that a doctor had never even visited before. The small houses dotting the outskirts of the community had no electricity or running water. And there wasn’t a road big enough for cars to travel on—just a path worn by years of foot travel. In preparation for our team bringing the first healthcare professionals to the area, a road had to be built that could accommodate the military transport bus ferrying us from civilization to this step back in time. This road brought other things to Flores, including its first exposure to the gospel. As far as our planning team knew, there were no Christians in this town. The gospel had penetrated the mountains above, but it had never worked its way into the valley below. Our team came to bring healing, both physical and spiritual, to this road-less town. I learned a lot about roads on that trip, including the physical ones we travel and the spiritual ones we carve into our lives. This was illustrated clearly to me by two alcoholics who came to our clinic by the same road, but left by different paths. Both come to Flores along the same dirt highway in the same condition—overwhelmed by life’s hardships and desperate for redemption from their lives of hopelessness. Both came on the same road, to the same clinic, and heard the same message about Christ. The first embraced it wholeheartedly, giddily
8 Today’s Christian Doctor Summer 16
dancing among the crowd of onlookers, proclaiming the wonderful salvation of God. The second rebuffed the message, turning instead to what little mercy he could find in his drink. He climbed aboard his motorcycle and drove away from the town. Around the first bend, he lost control of the bike, struck his head on a rock and died. If he had only known his mortality was so imminent, maybe he would have listened to the message differently. Both men came to Flores on the same road of mud and rocks, but they left along different paths spiritually. One headed toward a life of redemption and fulfillment, while the other met the end to his bitter life. The Scripture says “…strait is the gate, and narrow is the way, which leadeth unto life, and few there be that find it” (Matthew 7:14, KJV). I see the Christian experience as being one that leads us down the road less traveled. We all arrive at the cross by the same highway of sinfulness. Most continue on that same route. But some veer off the wellworn way to experience the road less traveled, and it makes all the difference. Grat Correll, MD, is a family physician practicing in Bristol, Tennessee. Through Global Health Outreach, he leads an annual healthcare mission team to South America along roads few others will ever travel.
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Event Calendar
For more information, visit www.cmda.org/events. New Medical Missionary Training July 14-17, 2016 Abingdon, Virginia www.cmda.org/training
Women Physicians in Christ Annual Conference September 22-25, 2016 Hilton Head, South Carolina www.cmda.org/wpc
Grace Prescriptions Seminar September 9-10, 2016 Charleston, South Carolina www.cmda.org/graceprescriptions
Marriage Enrichment Weekend September 23-25, 2016 Lexington, Kentucky www.cmda.org/marriage
CMDA 2016 Israel Tour September 18-26, 2016 Israel www.cmda.org/israel
Voice of Christian Doctor’s Media Training October 21-22, 2016 Bristol, Tennessee www.cmda.org/mediatraining
Oxford Graduate School
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Stress, conflicts, problems; they are present too frequently in our personal life, family life, and workplace. The doctoral program at Oxford Graduate School grounds the students in the fundamentals of conflict resolution and problem solving. The scholarly program inculcates a disciplined approach, enabling the student to use Christian beliefs to effect change locally and globally. The masters program uses Christian beliefs to train the student in Organizational Leadership or Family Life Education. Spending two weeks per year on campus allows the missionary, the dentist, or physician to prepare for a career change or continue current pursuits without interruption.
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Loren Humphrey, MD, PhD Member CMDA Chairman, Board of Regents Oxford Graduate School Christian Medical & Dental Associations www.cmda.org 9
transformations
SEEN & HEARD VOICES OF CMDA
Voices of CMDA in Ministry “Thank you so much for opening up a slot of time within your full schedule. It was truly an eye-opening experience. I have always felt called to use dentistry as mission, and seeing your clinic allowed me to do so. Thank you for showing me what it looks like to be a part of such a community and how focused you are on the purpose of His will. You said multiple times throughout my visit that you want to ‘live life’ with the residents and workers there, pursuing dentistry second to His will. It was incredible to hear the vision you have for the clinic, but more importantly the people who are involved with it.” —A pre-dental undergraduate student who visited CMDA’s Dental Residency program “On behalf of all healthcare professionals, I sincerely thank CMDA for the work on protecting our right of conscience and request that you emphasize the need for prayer to ask God to come to our defense in this matter.” —A CMDA member “It was truly a privilege and an honor to spend the time with you and your team. I was humbled by the trip. I truly look forward to being a more effective witness for Christ in the marketplace.” —An attendee at CMDA’s Voice of Christian Doctor’s Media Training
Website Directory Members
Resources
Automatic Dues – cmda.org/autodues Join CMDA – joincmda.org Membership Renewal – cmda.org/membershiprenewal
Chapel & Prayer Ministries – cmda.org/chapel CMDA Bookstore – shopcmda.org Commission on Human Trafficking – cmda.org/humantrafficking Continuing Education – cmda.org/ce Ethics Hotline – cmda.org/hotline Events – cmda.org/events Life & Executive Coaching – cmda.org/coaching Marriage Enrichment – cmda.org/marriage Medical Malpractice – cmda.org/mmm Placement Services – cmda.org/placement Publications – cmda.org/publications Scholarships – cmda.org/scholarships Speaker’s Bureau – cmda.org/speakers Stewardship and Development – cmda.org/giving
Ministries Outreaches Campus & Community Ministries – cmda.org/ccm Dental Ministries – cmda.org/dentist Side By Side – cmda.org/sidebyside Specialty Sections – cmda.org/specialtysections Women Physicians in Christ – cmda.org/wpc
Missions Center for Medical Missions – cmda.org/cmm Commission for Advancing Medical Missions – cmda.org/camm Continuing Education for Missionaries – cmda.org/cmde Global Health Outreach – cmda.org/gho Global Health Relief – cmda.org/ghr Healthcare for the Poor – cmda.org/domestic Medical Education International – cmda.org/mei Pan-African Academy of Christian Surgeons – cmda.org/paacs 10 Today’s Christian Doctor Summer 16
Issues American Academy of Medical Ethics – ethicalhealthcare.org Ethics Statements – cmda.org/ethics Freedom2Care – freedom2care.org Washington Office – cmda.org/washington
Voices of CMDA in Missions “The 10/40 Window is tough to penetrate, but anything worth something costs something! We moved boulders, tilled soil and planted seeds.” —A team member on a GHO trip to the Middle East “We were having our first small group meeting after one of the Christian talks in at the retreat in Durres, Albania. The talk had been about how God affects your practice of medicine. The students were very open about whether they believed God existed and what they believed about ‘god.’ One student said she envied those who believed in God because they always had someone with them. Over the subsequent small group sessions throughout the weekend, the Albanian Christian group leader, I and others got a clear opportunity to share the gospel with the group.” —A team member on a MEI trip to Albania “My understanding of the Great Commission was deepened by seeing how the need is great, yet so few answer the call. I was reminded of the significance of these trips by the reception of those waiting for the clinic. I would not want them to be disappointed if we could not come there. It was truly humbling.” —A team member on a GHO trip to Honduras “Our small team has just returned…and all our expectations have been surpassed. The overwhelming gratitude for the Lord and His people in (the Middle East) cannot be described in words.” —A team member on a MEI trip to the Middle East “The working conditions stretched me beyond my comfort zone. I wasn’t prepared for the emotional drain. I absolutely needed to be faithful with my quiet time, because I felt a tremendous need to show the love of Jesus in such a dark place, and I knew I couldn’t do it on my own power. My greatest blessing was watching my (East African) brothers and sisters bonding, witnessing to the people.” —A team member on a GHO trip to East Africa “Our devotional times together were challenging and refreshing. It speaks well for the individual spiritual maturity of our team members. I think my greatest blessing was learning to know the team and sharing together on spiritual levels. I was refreshed and was given tools to add to my ministry resources.” —A team member on a GHO trip to Honduras “I have never considered myself ‘called’ to the mission field and felt fine with leaving even short excursions like this up to others—more experienced Christians or people who have more of a passion for helping others. Going on this trip required me to finally stop finding excuses and just say, ‘Yes.’ And it seemed like almost every day there was a new challenge or opportunity that required me to say, ‘Yes.’ God was right there with me and giving me confidence to do stuff I’d never done and wouldn’t dream of doing: get up close and personal with a team of total strangers, ask patients if I could pray with them and lay hands on them or play and sing with a whole church full of people. And it was fantastic!” —A team member on a GHO trip to Ecuador
??? HAVE YOU BEEN
TRANSFORMED? ARE YOU
TRANSFORMING OTHERS?
We want to hear from you Send your transformation story, letter or photos to communications@cmda.org or to P.O. Box 7500, Bristol, TN 37621. Please include an email address for us to contact you.
We want to hear your story It can be a simple comment about a CMDA ministry; it can be an account of your experiences on a missions trip; it can be a profile of a member who has had a huge impact upon you; it can be photos from a campus meeting; it can be statistics showing how your trip served the needy; it can truly be anything— we want to see how your work is making a difference.
We want to hear your ideas Do you have a great idea for Today’s Christian Doctor? Send your ideas to communications@cmda.org.
TRANSFORMATIONS SHOWCASING THE IMPACT OF CMDA ONE STORY AT A TIME
Christian Medical & Dental Associations www.cmda.org 11
cover story
A Glimmer of Hope: Reaching the Unreached by Donald F. Thompson, MD, MPH&TM
12 Today’s Christian Doctor Summer 16
T
he patient had been paralyzed four months earlier by a gunshot, leaving him unable to move or even talk. The young man’s wife had lovingly been providing complete care, hoping her husband would recover, but Dr. Judy knew there was no chance of improvement. The panic and fear of being a young widow in this culture was evident in her strained face, and she had been hoping beyond all hope Dr. Judy would be able to offer something for her to grasp. But Dr. Judy wasn’t able to provide even a glimmer of hope for the paralyzed young man. She couldn’t think of any comforting words that would have been appropriate in such dismal circumstances; besides, the translator struggled with anything more than basic English. Judy didn’t think the translator was even a believer in Jesus Christ, and she felt awkward and embarrassed at the thought of asking him to translate her generic prayer for a healing she knew would never come. Dr. Judy shed tears as she left the patient and slowly walked across the hot, dusty courtyard back to her dark examination room. As she walked, she watched the old tractor, with the paralyzed man lying in the dirty bed of the flat trailer, sputter out of the gate. What kind of life were they taking him back to? Her tears flowed as she thought of what lay ahead for both him and his wife. Not quite ready to go back to the clinic and face another patient, Dr. Judy slowed her walk, took out her bottle of water…and then completely fell apart.
ry of the Lord as the waters cover the sea” (Habakkuk 2:14, NIV 2011).
The Unreached
The patient Dr. Judy saw on her recent trip to Southeast Asia is only one person among the billions of people around the world who currently don’t know Christ. According to the Joshua Project, approximately 42 percent of the world’s population is unreached. They cannot call on the Lord, they cannot depend on the Lord and they cannot glorify the Lord because they do not believe in Him. The unreached are unreached due to a plethora of barriers. These barriers may be as obvious as geography, where rural, remote living may confine people far from any source of hearing the gospel. These barriers may be political. When war, political instability and corruption destroy a country’s infrastructure, standards of living and quality of life are degraded, leaving most people focusing on simply surviving. They may flee to refugee camps or turn to subsistence agriculture for their basic food needs. Other complex barriers keep many unreached. Socioeconomic barriers seem to persist for generations for many people, where the setting they are born into confines them, keeping them on the margins of society. They are not able to get an education and are unlikely to encounter anyone who cares about them.
Facing the Circumstances
Just like Dr. Judy’s patient and his wife, the people living in this area—which is the poorest province in one of the poorest countries in Southeast Asia—struggle just to make it through each day. No industrial or commercial work is available for skilled or unskilled laborers, and the literacy rate is appalling. In a province of more than 21,000 people, only 40 are literate to a third grade level. No, not 40 percent, 40 people—total. School teachers come from the country’s large cities, but most don’t stay more than a few weeks, due to the isolation. People groups in isolated locations like this are exactly those we seek to serve through Global Health Outreach’s short-term healthcare mission trips. But how do healthcare professionals, like Dr. Judy who are only able to stay in the area for days at a time maybe once or twice a year, make any sort of dent in the midst of the utter desolation and bleak circumstances these people face on a daily basis? Why should we put ourselves through the trouble, the anguish and the effort? What’s the point? The simple answer? Because God demands it: “For the earth will be filled with the knowledge of the glo-
The 10/40 Window
42% of the world’s population is unreached The hard-to-access 10/40 Window is the area occupying North Africa, the Middle East and most of Asia. This area includes the majority of the world’s Muslims, Hindus and Buddhists. Many of these countries are closed to Christianity and have high rates of persecution. A total of 4.5 billion people are within this area, and 63 percent of this area’s population is unreached. “It has always been my ambition to preach the gospel where Christ was not known…” (Romans 15:20, NIV 2011).
Christian Medical & Dental Associations www.cmda.org 13
Today’s unreached may be geographically close, living in cities, but with huge socioeconomic, cultural and worldview barriers. And these barriers are the most challenging. Local religious traditions may function only to oppress people, frightening them against any attempt to consider any other religion. Cultures may be collective, where a village leader decides what is best for everyone in the community. Anyone who goes against the collective decisions risks being ostracized from their family and the entire community. A collective culture, in an animist worldview setting where fear and power are the predominant characteristics, has many barriers to the change called for by the gospel of Jesus.
“I learned how important it is to share the gospel, not because of my own need, but because of the listener’s need.” —A participant on a GHO trip to Southeast Asia
And that doesn’t even begin to cover everything. In some cultures within the 10/40 Window, their religion has nothing to do with Jesus, and anyone who speaks against their god is persecuted or even killed. How do you convince people in Syria, Iraq and Nigeria to turn to Christ, when hundreds of believers have been killed by Islamic fundamentalists simply for professing Christ? For those who do want to believe, how can we begin to reach them in a language and context that
makes sense to them? A woman in Southeast Asia was carrying a gospel tract around with her, but when we asked about her understanding of spiritual issues, she exclaimed, “How can I understand? I can’t read!” For those fortunate enough to be able to read a Bible in their own language, how can they understand concepts like sacrifice, forgiveness and redemption unless someone preaches and teaches at their level, answering their questions in a meaningful way? Again, it begs the question, why should we bother when faced with such complex, extreme and even dangerous barriers? The answer—because God cares about each individual person. “Just so, I tell you, there will be more joy in heaven over one sinner who repents than over ninety-nine righteous persons who need no repentance” (Luke 15:7, ESV). And because God cares about them, so should we.
Following God’s Plan
In Malachi 1:11, the Lord says, “For from the rising of the sun even to its setting, My name will be great among the nations…” (NASB). If this Scripture is so, then God must have a plan for reaching the unreached, and that plan includes each one of us. “How, then, can they call on the one they have not believed in? And how can they believe in the one of whom they have not heard? And how can they hear without someone preaching to them? And how can anyone preach unless they are sent?” (Romans 10:14-15, NIV 2011). So how do we follow God’s plan? First, we need to prepare and learn. To reach the unreached, we need to be prepared to travel farther than ever before. It could mean traveling halfway around the world to unreached people groups with great physical and spiritual needs in places like Southeast Asia. But missions is a summons to the frontiers of hostility, not necessarily just geographic frontiers. These frontiers of hostility may be in your own backyard with immigrant populations that have moved to your city. These groups may be easier to reach because they are close by, but harder to reach
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because of cultural barriers they have erected to protect themselves within your city. To reach the unreached, we also need to be better prepared to actually reach them. We need to do our homework to understand the politics, the culture and the worldview of the people we are serving. We need to know the basics of their belief structure, if they even have a belief structure. While they may live in a Muslim or Buddhist culture, it’s possible they know absolutely nothing about the spiritual tenants of that faith. We also need to learn how to penetrate spiritual blindness with the truths of the gospel. Every believer should be able to defend their faith in a winsome, tactful fashion. You have plenty of chances to practice this at work, school and in your neighborhood, so take advantage of these opportunities.
“The opportunity to have a pastor’s conference as well as local evangelists at each clinic took extra time and effort, but what a blessing and opportunity to share the gospel on cultural levels.” —A participant on a GHO trip to Southeast Asia That hostility we mentioned earlier? We need to learn how to penetrate it with the love of Christ, since the unreached are the people most hostile to the gospel. Don’t be bashful and don’t walk away when you face the first bit of hostility or apathy. Remember Luke 14:23, “And the master said to the servant, ‘Go out to the highways and hedges and compel people to come in, that my house may be filled’” (ESV). Once you do the hard to work to prepare and earn the right to speak, then you simply need to speak, both literally and figuratively. You open doors by meeting physical, emotional and spiritual needs. One key to doing this is listening, and then listening some more. Four patients in Southeast Asia thanked me effusively for coming to their country to care for them. They said they could tell I cared because I listened to them and touched them, because their own doctors never listened beyond the first question and never examined them. What an easy door to open. And once that door is open, you can present the truth of the Scripture in a context that makes sense to your audience. This is where your preparation from above comes into play. Don’t forget to commit to the long haul, though. The work does not end when you board the plane to head home. Learn how to build disciples, and then learn how to build disciple makers who will continue following God’s plan long after you are gone.
For example, thousands of people in Southeast Asia accepted Christ when the gospel was explained to them by one of their countrymen, using their language and concepts they understood. Yet, their understanding was at a most basic level. How could they learn to follow Jesus, learn to evangelize others and learn to become multiplying disciple makers without being taught? Pastor Alexi is another example. He had been a follower of Jesus Christ for five years and had been pastoring his small church for three years. His wife became a believer only two years ago. He had 30 faithful attendees at his church on Sundays, yet he did not know how to study the Bible or even share its message. That is where short-term healthcare mission trips are so valuable. In difficult locations like Southeast Asia, it is exceedingly doubtful that doors would be open for us to enter the country simply to develop fruitful spiritual relationships and offer training to pastors like Alexi. Yet, when we bring a short-term healthcare mission team and offer compassionate, appropriate healthcare as a demonstration of the love and compassion of Christ, then we often see the doors for further ministry swing wide open. That’s why we use these short-term trips as a strategic platform, a platform by which to truly follow God’s plan and fulfill His mandate to “…make disciples of all nations…” (Matthew 28:19, NIV 2011). This requires a different ministry focus, long-range commitment and planning, as well as the favor of the Lord. Christian Medical & Dental Associations www.cmda.org 15
One of our recent teams sponsored a three-day discipleship training conference for 70 local pastors, in conjunction with the medical clinics. The number of attendees grew each day as they were taught how to study the Bible and make disciples. It was apparent from their testimonies that some of these committed followers would eventually be martyred for their faith. At the end of the conference, one pastor reported that the town’s religious leaders knew they were followers of Christ and what they were doing. However, because they had come with a medical team that provided tender, compassionate care to the people, they were allowed to meet without any problems.
asked, “Judy, how much time did you spend with that man and his wife?”
“I love the way GHO involves local pastors so that short-term missions has a long-term effect. I was stretched beyond my comfort zone in sharing the gospel with people. I also was so uncomfortable and miserable with the heat. It pushed my physical ability to the limit, requiring God’s provision and strength to make it.” —A participant on a GHO trip to Southeast Asia
Judy said, “But I didn’t say anything about God or Jesus or salvation. I pretty much didn’t say anything, because I couldn’t talk to them!”
The Glimmer of Hope Grows
As Dr. Judy tried to regain her composure, she bared her soul and her deep sense of helplessness for the paralyzed man and his wife to Dr. George and Dr. Panin, two others serving on the same team. Dr. George 16 Today’s Christian Doctor Summer 16
“About 45 minutes,” Judy replied cautiously. Dr. Panin continued, “Dr. Judy, this lady and all the family members who watched your every move saw a doctor who came all the way from the United States spend 45 minutes showing compassion to that man. They know he is in bad shape, yet you took your valuable time to minister to them. You earned the right to speak into their lives because you met them where they were and helped them with their urgent needs.”
“Ah, but you did,” Dr. Panin gently responded. “Your gentle examination and even the limited care that you could provide shouted to them that there is hope.” “How can that be?” Judy questioned. Dr. Panin said, “The door to their house is now wide open. We will find the pastor who works in this area, and he will visit them this afternoon. He will share that he learned of their needs from you, and he will offer to help with some of their needs—for food, for medical supplies, for bandages. He will build a trusting relation-
ship with them and will gently guide the conversation to spiritual areas when the Holy Spirit shows that it is the right time. You are enabling all of this to happen!”
“We shared the gospel with people who had never heard the name of Jesus. Even if they did not accept Him, a seed was planted and that is so encouraging.” —A participant on a GHO trip to Southeast Asia Even though she didn’t know it at the time, the hope Dr. Judy shared with this one single patient is only the beginning of opening doors to the unreached. In the last seven years, Global Health Outreach teams have served in this particular province in Southeast Asia three separate times. The first year, the team leader said, “I feel like a blindfolded soldier at war randomly spraying bullets into the woods, hoping to pick off some of the enemy.” Three years later, the team was back in the same rural province. The mission was more established by then, but they still faced many challenges and difficulties. On their third visit to this province, a local pastor gave an amazing report of how the Lord had used their previous efforts. The pastor offered many details, rattling off the names of this village and that village where there had previously been no church. “Brother, your team pushed big boulders and softened the soil. Now these villages have house churches. And some of the villages where you ministered that had house churches now have daughter churches!” The team leader sat back and quietly thanked the Lord. He knew how difficult, how crazy and how seemingly random those past trips were. But now God
had given him a glimpse of the other side of the tapestry. The picture was more beautiful than he had ever imagined. It’s a picture of hope that proves following God’s call and God’s plan to reach the unreached is more important than ever before. “And this gospel of the kingdom will be preached in the whole world as a testimony to all nations, and then the end will come” (Matthew 24:14, NIV 2011). Are you preparing to answer that call and follow God’s plan? Prepare now to join a Global Health Outreach team to an unreached location like Southeast Asia, the Pacific, the Middle East and others by visiting www.cmda.org/gho. Editor’s Note: All of the above examples are composites of actual people and incidents, but names and locations have been changed for safety and security purposes.
About The Author
DONALD F. THOMPSON, MD, MPH&TM, serves as the Director of Global Health Outreach, the short-term healthcare missions division of CMDA. Don attended the F. Edward Hébert School of Medicine in Bethesda, Maryland and subsequently trained and is a fellow in both family medicine and public health and general preventive medicine. He earned a master of public health and tropical medicine from Tulane University, as well as a master of arts in cross-cultural ministries from Dallas Theological Seminary. He has faculty appointments in family medicine and preventive medicine and biometrics, and he most recently worked at the George Mason University in Arlington, Virginia where he worked on medical and public health preparedness. Dr. Thompson has been a member of CMDA since medical school and has been on short-term trips to Afghanistan, Albania, Armenia, El Salvador, Egypt, Ethiopia, Honduras, Indonesia, Mexico, Moldova, Nepal, Nicaragua and Vietnam. He particularly enjoys working alongside national physicians and medical students, learning from them while meeting the physical, emotional and spiritual needs of patients. Christian Medical & Dental Associations www.cmda.org 17
Reaching the Unreached:
Preparing to Thrive Among Dust and Thorns by Will Couloir, DDS, with Elizabeth Couloir
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“Nothing will ever be the same again.”
even thinking about preparing to go to hard places for the glory of God.
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Effective cross-cultural ministry doesn’t happen overnight, so get started.
hat was something we heard repeatedly from overseas workers as we prepared to move to North Africa. It’s easier to see the truth in that now, as I sit writing this on a bed covered by a mosquito net and listening to the loudspeaker from my neighborhood mosque, all from within my house surrounded by sand and Muslims. Ten years ago my wife and I were living happily beside a golf course in the United States, with no kids and a pretty comfortable life. Today there are four us, we’re rather uncomfortable, we live every day in three different languages—and we love it. That’s just weird. Nothing will ever be the same again, and that’s not a bad thing.
I’m going to start with something you probably already know—“unreached people” are unreached for a reason. People list all kinds of valid reasons for this being true: difficult-to-access areas, harsh living conditions, resistance to the gospel, religious persecution, the need to learn a new language(s) and culture in order to effectively communicate the gospel, etc. In extremely simple human language, it’s hard to get there, harder to stay there and even harder to see any fruit. But, as I said, that’s simple human language. The reality is God is moving powerfully in the darkest places of the world in our generation, and we as healthcare professionals are strategically gifted with the tools to access areas closed to traditional mission endeavors. The problem is that if you truly want to effectively “reach the unreached,” then your life is going to have to radically change, and if you don’t start preparing now, then you’re probably going to fail.
The best way to prepare to effectively minister crossculturally overseas is…wait for it….to begin ministering cross-culturally NOW, wherever you are. Brilliant, I know, but much easier said than done. Here’s the simple truth, if we don’t consistently step outside our comfort zone today in our own country, then there is no reason to expect we will suddenly be able to effectively do it tomorrow when we arrive in another country. God intends for you to take risks with your life. As a dental student, I assumed I would simply concentrate on school for four years and worry later about preparing to go overseas. I found this assumption powerfully challenged by men and women who recognized that “later” often never comes, and if it does, it is overpowered and entrenched by a mortgage and the American dream. On the other hand, God is always ready to transform us now, wherever we are. For us, that meant moving from our comfortable suburban apartment in Memphis, Tennessee to an inner city neighborhood where we were suddenly the minority. That was rather uncomfortable at first. Elizabeth had never been mistaken for a prostitute before, and a bounty hunter had never shown up at our door before with a gun. We moved in with a lot of trepidation and little cultural understanding. It didn’t take long to figure out though that our neighbors weren’t that different from us. We wanted similar things—purpose, significance, joy,
Elizabeth and I got married after our junior year in college. We had dated for some time, and both of us shared a deep (and mostly theoretical) passion for seeing the kingdom of God advance among what are commonly referred to as “unreached peoples.” Like most kids in their early 20s, we also had no real idea what that meant or what we were supposed to do next. I was pre-med in college and decided to become a dentist. Honestly, that was the extent of my planned preparation. Fortunately, it wasn’t even the beginning of how God was planning to prepare us for cross-cultural ministry in hard places. We want to be straight up honest with you from the start; we’re still new to this thing. After about seven years of preparation and planning, we finally left the states about two years ago. Since then we’ve had a baby, lived on two different continents, studied two new languages and had a lot of “learning experiences.” With that in mind, here’s what we would say to anyone Christian Medical & Dental Associations www.cmda.org 19
trained pastors, they were healthcare professionals, engineers and various laypeople who loved Jesus like crazy and were wasting their lives on Him.
health for their families, stability. The problem was that we often came from very different backgrounds and didn’t share a lot of common experiences. This was my first really consistent exposure to stepping out of a place where my white, uppermiddle class culture wasn’t dominant. I realized slowly that communicating on a deep level about significant things wasn’t really possible without first seeking to understand and empathize with the plight of my neighbor. This wasn’t simply showing up for a few hours to work in a bad part of town before heading home and feeling good about myself. Rather, it was a process of failing and trying again to open myself up and be vulnerable and love my neighbor as myself. It was invaluable to what we’re doing now, and it taught us we need to regularly take risks to make disciples and advance the kingdom of God. Maybe moving into the projects isn’t what God has for you, but maybe finding the nearest Syrian refugee and loving him like a brother is His plan for you.
Learn to feed yourself.
As we prayed about where God wanted us to go, we had the opportunity to spend time with missionaries in restricted countries in Central Asia and North Africa. There were no traditional church buildings; even if it had been possible to build one, it would have been counterproductive to identify yourself as such an easy target. We watched as small groups of believers gathered together in their houses to pray, worship and teach each other from the Word. Some of these people had been working for years in isolated areas under great spiritual oppression. These weren’t seminary 20 Today’s Christian Doctor Summer 16
As we talked to these people, one of our questions was, “Where do you go for encouragement and to be fed?” The response was simple—learn to feed yourself or you won’t survive. It was a radically simple approach that seemed to take Jesus at His word when He said, “All authority in heaven and on earth has been given to me. Therefore go and make disciples… And surely I am with you always, to the very end of the age” (Matthew 28:18-20, NIV 2011). If we go filled with the Holy Spirit and take the Word of God, then God can use us. However, missionaries do burn out, especially really bright, gifted, talented ones (like healthcare professionals) who think they can operate under their own strength and forget who is truly doing the work. If you want to last in difficult places, build STRONG spiritual disciplines in your life now that will sustain you in the valleys and hardships that are coming. It’s too late to do it when trouble comes. You’ve got to start today.
Radical obedience to Christ is not easy... It’s not comfort, not health, not wealth, and not prosperity in this world. Radical obedience to Christ risks losing all these things. But in the end, such risk finds its reward in Christ. And he is more than enough for us. —David Platt, Radical
If you intend to be part of planting churches in hard places, then you should strongly consider being part of a church community that models a similar type of discipleship and worship. (As a corollary, if your overseas medical plans don’t include disciple making, then your dream is probably too small.) In most difficult service areas, these are small, intimate house church-type gatherings. If you can’t find such a group, start one. In the healthcare world, it would be impossible to become a licensed physician without demonstrating adequate competence in your specialty. Surprisingly, few seem to apply this type of thinking to church planting and disciple making. Why would you expect to be successful
in a foreign culture and language at doing something you’ve never practiced in your own country and language? We reproduce what we are, not what we aspire to be later. So, step beyond what is comfortable and begin to learn how to produce in your home country what you hope to replicate in another culture.
Develop a theology of suffering and deepen your affections for Christ.
Before you go overseas, sit down with your family and ask yourselves some hard questions. What’s our ultimate goal in this, and how far are we willing to go to pursue it? It’s a question Elizabeth and I wrestled with as we tried to figure out how deeply we truly treasured Jesus. If it was God’s will, would we be willing to serve in a hard place that put our kids’ lives in danger? What if one of them died? Would our love for God sustain us, or would such loss crush us? What if we labored for years like Isaiah and no one listened to us and we died and were buried in unmarked graves? Are we doing this because we treasure Christ above all things and want to see Him made much of, or are we seeking our own glory? These aren’t easy questions, and being human means it’s hard to predict what our response would be in real life. But we can root ourselves in Scripture, study and wrestle and memorize, as we develop a theology of suffering. Prepare by deepening your affection for Christ and go because of an overflowing love for Him, not to be a hero. We, of course, gave ourselves too much credit…then the theoretical became real. I remember sitting next to my daughter during a few terrifying minutes where she struggled for breath but her lungs were too filled with fluid from pneumonia to find it. As I rushed her to the hospital, I prayed desperately for healing, and I found myself questioning the same God who I felt ready to die for a few weeks before. I felt anger, even betrayal. Then a strange thing happened. I was given this incredible supernatural peace. He brought to my mind His promises in Scripture and reminded me of His sufficiency in hardship. Later, we rejoiced when our daughter recovered, but we were grateful for the experience because it was as if God was teaching us that He would be enough regardless of the circumstance, that truly nothing could compare to the surpassing greatness of knowing and communing with the Maker of the Galaxies.
While Christians choose to spend their lives fulfilling the American dream instead of giving their lives to proclaiming the kingdom of God, literally billions in need of the gospel remain in the dark. —David Platt, Radical
We have a sovereign King who delights in using broken and weak people to be a part of incredible things. We hope you (and we) are weak and He is strong, otherwise it’s probably going to go poorly. We’ve been given incredible gifts as healthcare professionals, and just as in the Parable of the Talents, our Master will return and demand an accounting of what we’ve done with them to expand His kingdom. Today there are millions and millions of people who will die and spend eternity apart from God if no one tells them who He is. We have resources, opportunity and the gospel as our possessions, and we have the Spirit of God within us as our inheritance. The only question is what we will choose to do with the days we have left. We’re hoping you will pray desperately, go boldly and serve selflessly. If you do, you will look back at your life in years to come with joy and wonder. We hope we will be there with you. And if you do go, we can promise you,
“Nothing will ever be the same again.” About The Authors
WILL COULOIR, DDS, and his wife Elizabeth live and work in North Africa with their two kids. Their team is working to develop and implement health strategies that facilitate the sharing of the gospel and making disciples among unreached people groups. Christian Medical & Dental Associations www.cmda.org 21
A RETURN TO CUBA Opening Doors for Christ
Photo © 2014 Gareth Williams www.flickr.com/photos/gareth1953/
22 Today’s Christian Doctor Summer 16
by Robert J. Lerer, MD, FAAP
T
wenty years ago, God called me to return to Cuba, the country where I was raised by my parents before it was overtaken by a communist regime that vehemently opposed my belief in Christ and severely discriminated against people of faith. And yet, it was the country that desperately needed to hear about the love of Christ.
From Peace to Revolution
My family immigrated to Cuba from France in 1946 when I was a baby, just after the end of World War II. My parents, both dentists, sold all their belongings in Paris with dreams of a better life in America, and they ended up settling in Havana. The 1940s and 1950s were prosperous times. My dad was a successful dentist, well-liked by Cubans and popular with the large expatriate community in Havana. I was a typical teenager in the ‘50s, devoting my time to school, sports and socializing with friends. It was an idyllic existence. However, I knew from listening to adult conversations that there was a civil war in the eastern provinces, with violent guerrilla fighting between President Fulgencio Batista’s troops and rebels under the leadership of Fidel Castro. At night, I heard the sound of bombs detonating. During the day, I watched Batista’s police officers brutally beat university students for protesting civil right abuses. On New Year’s Eve 1958, Batista and his top leadership suddenly and unexpectedly left Cuba. A few days later, I joined hundreds of thousands of Cubans, who were hoping for peace, lining the streets of Havana to watch and cheer Fidel Castro’s military troops as they marched and rode atop captured tanks and trucks through the main streets. But peace did not come. During the next two years, I witnessed a radical transformation of my country and my people. Consolidation of power occurred with tremendous savagery. Former sympathizers of Batista, civil servants, soldiers and businessmen were sent to jail, and many were executed. Businesses and property were seized in the name of the state. Eventually, Fidel Castro declared that his aim was to turn Cuba into a communist country, aligned with the Soviet Union and true to Marxism and Leninism. The Cuban revolutionary Congress soon officially declared Cuba an atheist country. My parents, my Cuban-born brother and I fled Cuba two years after the triumph of the communist revolution, moving permanently to the United States to start a new life in a new land. Again.
All Roads Lead Back to Cuba
I was 15 years old when we fled to the U.S. in 1960, becoming penniless refugees. Five years later, I became
the first Cuban American refugee accepted to Johns Hopkins Medical School. Twenty years after graduating from medical school, I had a powerful born again experience during a weekend retreat with my wife Janis, a psychiatric nurse. I heard the still voice of God convicting me that I was not using my gifts in pediatric medicine to reach the lost outside my community, especially in the third world. In 1991, Janis and I started volunteering on short-term mission trips with Caring Partners International, a medical ministry based in Cincinnati, Ohio. Through them, we joined groups of healthcare professionals doing primary care in underserved regions of India and Mexico, and we also joined Christian medical faculty teams teaching in medical schools and hospitals in China, India and Nicaragua. Around that time, I joined CMDA and was particularly transformed after attending a weekend Saline Solution seminar which allowed me to become better equipped to present the gospel to colleagues and patients. In 1995, I felt God calling me to return to Cuba as a healthcare missionary. But serving the Lord in Cuba would be challenging. Everything about Cuba’s recent history made it clear I would encounter resistance, but the work would not be effective if we didn’t work with the government. However, before I could even think of returning to the country, I had to find it in my heart to forgive a government that had caused my family to uproot and face all the challenges inherent in immigrating to another country. On my own, I could not possibly succeed, but our great God is more than able. By faith, I trusted Him and began planning to return to Cuba. Christian Medical & Dental Associations www.cmda.org 23
Healthcare in Communism
When communism took over in 1959, Cuba had one of the best and advanced healthcare systems in Latin America. It had the third lowest infant mortality rate in Latin America, and there was one doctor for every 1,000 people. Each of the six main provinces had at least one university-affiliated hospital for advanced patient care and for teaching students and residents. Many physicians at that time received all or some of their education or completed post-graduate fellowships in the U.S. or Europe. After the revolution, private healthcare ceased to exist as all control and property reverted to the government. Healthcare professionals were put on salaries ranging only $25 to $30 per month. After 50 percent of the healthcare professionals left the island within three years, the government took even more measures to centralize healthcare. Yes, the healthcare system was free and was readily accessible to patients, but it faced frequent and chronic shortages of instrumentation, equipment, computers and medicines. Faculty and teachers in the medical schools who remained taught the same quality medicine in post-graduate training that was being taught prior to the revolution; however, without access to information about advances in medical care or new treatments, as well as funding after the fall of the Soviet Union, overall healthcare skills eroded as time passed. Buildings, equipment and hospital infrastructure continued to deteriorate, leaving most healthcare professionals working long hours with limited tools in challenging conditions.
Returning to Share Christ
Janis and I took our first trip to Cuba in 1996, where we met with the Minister of Public Health and received approval to set up faculty visits from medical schools in the U.S. We also coordinated a humanitarian program that allowed shipping containers filled with medical equipment and supplies to be donated from the U.S. Since then, I have taken 35 trips to teach at more than 20 hospitals, accompanied by teaching faculty teams from across the United States. Dr. Victor González, a prominent oncologist at a university hospital in Havana who was also a leader of the Western Cuba Baptist Convention, became host to our teams. He helps obtain necessary visas from Cuba and licenses from the U.S. government. Caring Partners has provided millions of dollars in medical aid to Cuban hospitals, and the Cuban government has long acknowledged that it is the number one provider of medical humanitarian help to Cuba from the U.S. The teachings we organize on these trips are extremely useful to their healthcare system, but what is even more valuable is the love of Christ we offer. For three decades following the communist revolution, religion was severely suppressed and Christians faced discrimination. All Christian schools and universities were shut down and church leaders left Cuba by the thousands. Demonstrating your faith by attending church or sharing Jesus was equated with a lack of support for the government and the Communist Party. During this time, openly Christian students were denied advancement in high school, admission to medical school and placement in residency. In spite of decades of suppression and discrimination, Christianity survived and thrived. And by the time I returned to Cuba in the mid1990s, the government had amended its constitution and softened its stance against religion, allowing for freedom of religious expression and forbidding discrimination against people of faith. Soon all churches of all denominations started growing exponentially. Nevertheless, the majority of the population remained unreached, including healthcare professionals. Through our teams, I have noticed, over time, the opening of once closed doors, enabling our faculty members in classrooms and volunteers in patient wards to share the gospel openly in all government hospitals. In 1997, while members of the team were making rounds with our colleagues
24 Today’s Christian Doctor Summer 16
and nurses, we visited with the bishop of the Methodist Church of Cuba who was hospitalized following a stroke. We asked him if we could pray for him, but one of the hospital administrators informed us it was against hospital rules. One bold Cuban nurse spoke up and asked what harm would come from a group of American Christian physicians and nurses praying for this man of God. The administrator consented, and several members of our team laid hands on the patient and prayed for healing, strength and restoration. No sooner had we finished than we heard three other patients and their loved ones, in adjoining beds in the room, asking us to come and pray for them, which we did. Today, there is more openness to the gospel and praying for patients among the Cuban healthcare professionals. Now, they often direct our ward prayer teams to the sickest patients so we might pray for them, and our Cuban colleagues frequently join us. It is not unusual for hundreds of people to attend our lectures. At other times, we teach in smaller classroom venues or churches where we give seminars open to professionals and the public on common diseases and how to manage them. This year, we handed out Bibles to every person attending our courses in the medical schools, something we have never done before and would not have been allowed to do even five years ago. When our team members deliver excellent scientific sessions in Cuban hospitals and medical schools, then take a few moments to share their faith and their motivation to volunteer in Cuba, Jesus is honored and glorified. And they also receive a powerful message that being a Christian physician, scientist or nurse is congruent with faith in God.
A New Era of Ministry
After more than 50 years of open hostility between the U.S. and Cuba, diplomatic relations were restored in 2015 and the American flag now flies over the U.S. Embassy in Cuba. As the two countries enter a new era of diplomacy, so too do we enter a new era of ministry. Our new partnership with CMDA brings new opportunities for teaching teams through Medical Education International (MEI). The first two MEI teams to visit
Cuba in the program’s history traveled there in November 2015. The first team was an autism team, and the conferences they hosted shared valuable information and techniques with more than 250 Cuban national healthcare professionals, as well as parents of children with developmental disabilities. The second team was a multi-disciplinary team, and they visited the busiest emergency room in Cuba, presented a variety of lectures on topics including oncology and surgery, hosted a pastor’s conference for local pastors in Cuba and more. In Cuba, you never know what obstacles, what spiritual warfare, what fiery darts might be hurled by Satan. Fortunately, all planned programs went off without any difficulties. There is no doubt our daily prayers for protection and effectiveness in teaching and sharing Jesus were crucial. Throughout all of the lectures and conferences, the members of the two teams were able to share their own personal testimonies and also spend time showing Christ’s love to patients in various hospitals around the country. MEI is planning more trips to Cuba as the country continues to grow more open to Christianity, and I invite you to join us. You can come and share your expertise and also be blessed by the wonderful people of Cuba as you introduce them to Christ. For more information about joining us in these efforts, please visit www.cmda.org/mei.
About The Author
ROBERT J. LERER, MD, FAAP, graduated valedictorian of his class from Birmingham-Southern College in 1966. He obtained his medical degree from Johns Hopkins Medical School, where he graduated third in his class. After completing three years of pediatric residency at Yale, including being chief resident of the neonatal intensive care unit, he joined Pediatric Associates of Fairfield in suburban Cincinnati, Ohio. Dr. Lerer is an Associate Professor of Pediatrics at the University of Cincinnati College of Medicine and at Cincinnati Children’s Hospital. He has been the Commissioner of Health of Butler County for 40 years, the longest serving health chief in the history of Ohio. He and his wife Janis, a missionary nurse, have four adult sons and daughters. Christian Medical & Dental Associations www.cmda.org 25
Making Disciples in Africa for Africa by Bruce C. Steffes, MD, MBA, MA
Five hundred million heathen have not yet been evangelized, so it is computed! Yet our great Missionary Societies have reached high water-mark, and if they have not already begun to retrench they are seriously thinking of doing so. Meanwhile, the heart of Asia, the heart of Africa, and well nigh the whole continent of South America, are untouched with the Gospel of Christ. C.T. Studd, the famous British cricketer turned missionary, made that statement more than 120 years ago, long before smartphones, internet and international flights. And yet, the statistics he quoted are worse now in 2016, despite the fact that parts of those great continents have been reached with the gospel to varying degrees. There remains hundreds of millions of souls on the continent of Africa who face physical suffering on this earth and an eternity without Christ. In fact, there are billions— 26 Today’s Christian Doctor Summer 16
not millions, but billions—of people around the world who are still untouched with the gospel.
About PAACS
These statistics and the philosophy behind Studd’s comments are exactly what drive the mission of the Pan-African Academy of Christian Surgeons (PAACS). And it’s something we take extremely seriously as we seek to make a difference in the spiritual and physical health of an entire continent. As a commission of CMDA, our goal is to train African physicians to become surgeons in Africa for Africa, with the intent of serving their fellow Africans for a lifetime. With academic credentialing provided by Loma Linda University and recognized by both African colleges of Surgery, PAACS uses mission hospitals to give training in general surgery, orthopedics and pediatric surgery. Additionally, a one-year fellowship in head
and neck surgery recently joined the PAACS family in Cameroon. Through these residency programs, we strive to serve the poor of Africa, build capacity within the healthcare sector and help maintain the faith-based healthcare facilities that provide a significant percentage of the healthcare in Africa. To be accepted into the program, candidates must be African graduates of recognized medical schools, be less than 35 years of age, speak English fluently and have a valid medical license in both their home and training countries. Those who are admitted undergo training at one of several well-established evangelical mission hospitals in Africa, under the direction of experienced, board-certified surgeons.
Making Disciples on a Daily Basis In the years since Studd’s proclamation about the lost, much has been made of the concept of the 10/40 Window in order to increase awareness of the need to reach unreached peoples in those parts of the world. However, it has been overemphasized at times, creating somewhat of a false dichotomy. Christ died for the lost in all of the countries of the world, and much work remains in the countries outside of the 10/40 Window. This is especially clear considering that most missiologists consider 2 percent of the population becoming Christ followers as the “tipping point” at which the group is generally considered “reached” with the gospel. Clearly, by that definition, there remains a huge amount of work to be done even in a “reached” country. As Africa includes countries both inside and outside of the 10/40 Window, much remains to be done.
hospital paradigms, some of the faith-based hospitals are in countries which are partially or wholly considered to be non-Christian. For example, SIM Galmi Hospital is located in Niger, a country where the estimated percentage of Christians in the population is between 0.5 percent and 5 percent. Although Egypt has a long history of Christianity, it is now predominately Islamic and Christians make up approximately only 10 percent of the population (estimates range from 3 percent to 20 percent). Ethiopia has a similar history of Christian influence and overall is estimated to have 63 percent Christians. However, the southern regions of the country have an Islamic majority.
PAACS is a symbol of hope for Africa. When all of my hope was lost and gone, when all my dreams and visions for specialization were dead, there was PAACS to reawaken my hope by offering me a golden opportunity. Souls and lives are being saved because of PAACS. —A PAACS resident Some of this patient draw may be internal, as patients from non-Christian parts of our own countries of service may come to be healed physically and thereby be introduced to the gospel. Other hospitals draw patients from other nearby countries, as the proximity of the hospital to the border of a difficult country draws the unreached from those countries. One program director writes, “It is not uncommon to hear that a patient came to [a PAACS Hospital] because
In Matthew 28:19, Christ calls us to make disciples as we are going about the daily activities of our lives. By our very nature as healthcare missionaries, the care we give our patients is reaching the “least of these.” On a continent where the shortage of surgeons is huge and difficult to even quantify, the excellence of care we provide is a magnet that draws in believers and unbelievers from all strata of society. But it doesn’t stop there. Healthcare in Africa provides a unique opportunity to share the gospel as we deal with patients and their families who, as they face critical questions about their health or the health of their loved ones, almost invariably consider the spiritual and eternal implications of possible impending death.
Spreading the Word in Africa for Africa So what does this look like within the PAACS residency programs, most of which are located in countries considered to be “reached” but where large percentages of the inhabitants are still not followers of Christ? Additionally, in the most classic of mission Christian Medical & Dental Associations www.cmda.org 27
he was told in [the capital city of an Islamic country] that he would be treated fairly and with love at our hospital.” Because of this draw from other countries, even those hospitals in countries open to Christianity are able to have a large impact on unreached people groups. For example, Kijabe Hospital in Kenya has a special draw for people from the Horn of Africa, both those who are immigrants within Kenya and those who must cross the border to come for care. Tenwek Hospital in Kenya has long fostered a relationship with South Sudan. Mbingo Hospital in the Northwest province of Cameroon draws patients from Nigeria, the Central African Republic, Chad and the Islamic north of Cameroon. Soddo Christian Hospital in Southern Ethiopia has a draw area that includes Sudan and Eritrea. Bongolo Hospital in Gabon ministers to the local immigrant population of Muslims who come from as far away as Mauritania, Mali, Benin, Burkina Faso and Chad. Harpur Memorial Hospital in Egypt draws patients for charity care from Syria and Sudan.
Long-Term Impact Realizing that our North American missionaries will always be limited in their acceptance in certain cultures and countries, the most effective long-term efforts will be in the hands of those we train and who are salt and light in the world where they find themselves. We train residents who may serve in mission hospitals or district hospitals in extremely difficult areas. Phila28 Today’s Christian Doctor Summer 16
delphie Dembele, a graduate of the Bongolo program, is serving in Mali, a largely Islamic country. And three residents in training plan to return to their home country of Sudan to help with their country’s great need. This is true as well for other trainees who wish to return to their home countries of Liberia, Sierra Leone, Burundi, Democratic Republic of the Congo (DRC) and Malawi. That’s what makes PAACS so unique—our goal is for our residents to eventually return to their home countries with a vision to serve their own people and proclaim Christ among them. And that’s exactly what our graduates are doing throughout the continent of Africa. Elijah Mwaura from Kenya is serving at Chigoria Mission Hospital in Kenya, while Tony Mwenyemali from the DRC is the only surgeon at Maua Methodist Hospital in Kenya. Jean Claude Bataneni has served almost five years now in Nebobongo Hospital in Northeast DRC as the only surgeon in a primitive hospital. Jerry Brown is the only surgeon at ELWA Hospital and one of the few surgeons in all of Liberia. He played a vital role in the battle against Ebola in Liberia. Martin Salia, another PAACS graduate, died of Ebola virus while serving his beloved countrymen in Sierra Leone. Pediatric surgeon Aiah Lebbie serves as the only surgeon for children in the entire country of Sierra Leone. Elson Randrianantenaina, Heuric Rakotomalala and Roseline Razanamapionona serve with faith-based organizations in hard areas of Madagascar. Nesoah Ngoe served first in the far north of Cameroon and then relocated in response to the risk posed by the Boko Haram terrorist group.
I see people at work who could have had it all, but sacrificed many things for the sake of Christ and for His people. This humbles and challenges me… why not do it too, even for my own people. —A PAACS graduate Nationals like our residents and graduates can have this long-term impact not simply due to the medical training they receive through PAACS. Nationals can go to areas Western missionaries simply can’t access. They already know the language and the culture, so they don’t have to spend their time in language school or learning to connect with the local people. A great example of how our graduates are making a difference is Dr. Hubert Kakalo, the third graduate from the Bongolo program. Despite the dangers of war, Dr. Kakalo returned to his homeland of Congo with his wife and four children in 2005. Some of the remnants of the Nyankunde Hospital staff had regrouped in a nearby town and opened a clinic in a rented house. Dr. Kakalo joined them and began caring for injured patients and operating on them in one of the bedrooms. Less than a year later, he moved to another hospital, but when rebel forces threatened to attack that city, he was so fearful for his family that he fled to Kenya. In Kenya, he worked in various mission hospitals, but he longed to return to his hometown of Kisangani in Congo to establish the city’s first Christian surgical clinic. Using his own money, he returned to Congo, rented a private house, gathered some beds, collected a few surgical instruments and began treating patients in Jehovah Rapha Clinic.
Within a Yard of Hell
The migration of refugees from the Middle East has captured the headlines for months now, and the current situation in this area paints a bleak picture of what life is like for our graduates, our residents and the people we serve. However, as one missionary recently observed, “God’s great work will not be stymied. If we will not go and make disciples of them in their countries, He is fully capable of making sure that His chosen can come to us to hear the gospel of Jesus Christ.” As C.T. Studd once observed, “Some wish to live within the sound of Church or Chapel bell; I want to run a Rescue Shop within a yard of hell.” We have an obligation to share Christ’s love with the world, no matter the political situation, danger from terrorists or other fears. So that’s what we do each and every day through PAACS across the entire continent of Africa. We strive to take care of the ill as our Savior modeled and create African Christian physicians who are not afraid to “run a hospital within a yard of hell.”
About The Author
BRUCE C. STEFFES, MD, MBA, MA, FACS, FWACS, FCS(ECSA), FICS, is the Chief Medical Officer of PAACS, having served as the Executive Director from 2006 to 2014. He has been a member of CMDA since 1974 and is also a member of CMDA’s Continuing Medical and Dental Education Commission. He graduated from the University of Michigan, studied surgery at the University of Florida, received an MBA from Duke University and then received an MA in biblical ministries from Baptist Bible College. He is also certified in tropical medicine by the American Society of Tropical Medicine and Hygiene. Dr. Steffes is a fellow of the American College of Surgeons, the West African College of Surgeons, the College of Surgery of East Central and Southern Africa and the International College of Surgeons. He received the 2015 CMDA Educator of the Year Award. He and his wife are the authors of Medical Missions: Get Ready, Get Set, GO! and Your Mission: Get Ready, Get Set, GO!, both available through the CMDA Bookstore. Christian Medical & Dental Associations www.cmda.org 29
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hat a journey! Each one of us was in desperate need of a refreshing break from the daily grind of serving overseas as long-term missionaries. We had flown from our home in Nigeria to Lagos, before catching another flight to Nairobi, Kenya. After leaving the airport, our group of national and missionary doctors and nurses next drove up the mountains to the colonial-era Brackenhurst Conference Center. When we pulled into the long, spiraling driveway leading to the conference center, we knew we were in for a special time. The view was amazing. The sky was a clear deep blue bordered at the horizon by rolling green tea bush farms demarcated by deep brown dirt trails and white stone cottages. Yes, we were exhausted after our travels, but we were also excited to have finally arrived. Each meal in the enormous cathedral ceilinged dining room was a big homecoming as we greeted and hugged friends we had not seen since the last conference. Their stories were like our own, tales of commitment and sacrifice marked by emotional and physical scars. The plenary sessions each day were resounding choruses of
praise and worship with music from broken and joyful hearts alike, as well as biblical teaching that encouraged, challenged and stirred us. Like the disciples on the mountain with Jesus, we wanted to settle in and stay a while longer, basking in the encouraging fellowship, drinking in the rich teaching and resting in the quiet solitude of this mountain retreat. For hundreds of long-term missionaries serving in difficult countries across the world, CMDA’s annual Continuing Medical and Dental Education (CMDE) Conference is a port in the storm, an oasis in the desert, a light in the darkness. It certainly was for me during my 24year career as a healthcare missionary in Liberia and Nigeria.
What is the CMDE Conference?
CMDA has a variety of ministries providing resources for students, residents and healthcare professionals in the United States, but one of its most significant activities is running this two-week conference for healthcare
The CMDE Conference: An Oasis in the Desert
by William Ardill, MD
Christian Medical & Dental Associations www.cmda.org 31
missionaries to help them fulfill their continuing education requirements for their U.S. medical licenses. The conference location alternates between Kenya (now Greece) for the African-based missionaries and Thailand for the Asian-based missionaries. Several hundred physicians, dentists, nurses and other healthcare professionals from all over the continent who work in a wide variety of facilities and ministries come together. In fact, it is the world’s largest gathering of healthcare professionals serving overseas, and it also includes national physicians. It’s not easy to describe just how much CMDE has come to mean me as I serve long-term in Asia. The challenges in my assignment are not insignificant— spiritual darkness, poverty, tropical heat, small numbers of like-minded people in country, etc., and plenty of joys and opportunities to grow as well! But knowing every two years we will come together at CMDE to be refreshed academically with state-of-the-art medical education, to have fellowship with a like-minded peer group and to benefit from informal mentoring with those more experienced than myself has enabled me to keep pressing on through the mountains and valleys! During the two weeks, more than 180 continuing education credit hours are offered. At their own expense, more than 100 volunteer faculty members travel from North America and Europe to give lectures in their specialties, while other healthcare missionaries present topics related to working in resource poor settings. They also bring updates on the latest research, practices, technologies, treatments and medications in modern Western medicine. At the conferences I attended, I learned about the solar battery-powered hearing aid, how to run a crisis pregnancy ministry, how to make a formaldehyde fridge to sterilize instruments that could not be steam sterilized, the miracle of granulated sugar/honey dressings for healing open wounds and countless other tricks and ideas. The faculty members are amazing encouragers, willing to chat, pray and simply listen to our stories. And what about our areas of service while we’re gone? Even more volunteer healthcare professionals travel to our various hospitals and clinics around the world to staff them during our absence. Perhaps even more important than the continuing education, the CMDE Conference seeks to encourage the attendees spiritually and emotionally. A pastor or well-known 32 Today’s Christian Doctor Summer 16
Christian speaker also gives a daily spiritual challenge. I was richly blessed by the profound, biblical teaching of men like John Stott, Alan Farmer, Brennan Manning and Stan Key. There are also opportunities to meet with these servants of God for advice and counseling. Morning prayer groups are times of friendship, bonding and interceding for each other before the throne of God. Plus, children’s services and programs are provided, while volunteers also facilitate a separate spouses’ program. For many of us, the most significant benefit of the conference is the networking and encouragement of being with several hundred healthcare professionals in similar circumstances who face incredible hardships and overwhelming medical and spiritual challenges, as well as emotional struggles of loneliness, stress, anxiety and burnout. Some missionaries are new to the mission field while others have spent their careers in cross-cultural ministry. All come for refreshment, renewal and healing. The fellowship with like-minded healthcare missionaries is incredibly encouraging, and we enjoy learning about what God is doing through our colleagues all over the world.
Finding Spiritual Refreshment
I started going to the conference at Brackenhurst in Kenya when I first went to Liberia in 1986 and continued to attend every two years when I was in Africa. I went to each conference facing different challenges. One year I went to Kenya with the fresh emotional and psychological wounds of the Liberian civil war and evacuating from ELWA Hospital. Another year I was recovering from the physical and emotional wounds of being shot during an armed robbery at our compound in Jos, Nigeria. Later in my missionary career, I went to the conference struggling with discouragement and disappointment in my ministry. The conference had a huge
came alongside me during these retreats, helping hold up my arms, like Aaron and Hur helping Moses, as we served the wounded in the battle for the souls of the lost in Africa. We can get CE other ways, but the fellowship is a huge part of it. [This] ministry is really, really important! This conference is different. In the U.S., you can never grasp what you see here—the global effect of God’s kingdom all in one room. Our weekly worship time is five people, and to hear 695 people singing people was so wonderful. impact on me every time, refreshing me through the amazing music, spiritual messages and encouragement of seeing friends from previous meetings in similar circumstances. Each time I was refreshed and recharged to return to service in the “trenches.” For one reason or another, my wife Dorothy had never been able to attend the conference during the 24 years we served in Africa. We were determined she would go with me our last year in Nigeria in 2012. We made arrangements for our children and her work so she could join me at the conference. I had great fun introducing Dorothy to my friends from all over the continent with whom I had this wonderful and unusual intermittent relationship. Dorothy attended the special program for non-medical spouses and enjoyed sharing her experiences living in Africa and being married to a missionary physician. Fellowship with other wives in similar circumstances allowed her to encourage others and be refreshed herself. The weekend in the middle of the conference gave us a fun, refreshing break from the intensity of the demanding meeting schedule to be “tourists.” We went on a walking mini-safari in a Nairobi game park and saw hippos, giraffes, zebras, wildebeests, antelope, duiker deer and monkeys. Dorothy enjoyed shopping at the Masai market in Nairobi and getting a tour of the tea plantation. Since returning to the U.S., I have had the privilege of returning to the conference as a U.S.-based surgeon to give lectures. Because of the trouble some African physicians had acquiring visas for Kenya, the increasing political instability in many African countries and the desire of some missionary physicians to bring their families, CMDA changed the venue from Kenya to Greece in 2014. This conference had a record breaking number of attendees and was held in a beautiful resort hotel north of Athens.
I will always be grateful to both the CMDE Commission and the many faculty and fellow missionaries who
But I’m only one out of hundreds, even thousands, of missionaries who have been blessed by this conference since 1978. It is of immeasurable value to healthcare missionaries in so many ways—professionally, physically, emotionally, psychologically and spiritually. The CMDE Conference is a far-reaching ministry that has a great impact on reaching the unreached, far beyond what we can even begin to imagine. To get a glimpse of its incredible blessing and how it is making a difference, I encourage you to read the testimonies spread throughout this article from others about how thankful they are for this ministry and how treasured and cherished this conference is to them. And I also encourage you to join us and get involved. For more information, visit www.cmda.org/cmde.
About The Author
WILLIAM ARDILL, MD, was raised in Nigeria by missionary parents. He attended Ursinus College and then George Washington University School of Medicine. He completed a residency in general surgery in 1985 at Baylor University in Dallas, Texas. Following God’s call to serve as a healthcare missionary, in 1986 Bill went to ELWA Hospital in Monrovia, Liberia with SIM. In 1987, Dorothy Hostetter came to serve in the laboratory for the summer. They were married in March 1988 and served together at ELWA until they were evacuated in 1990 because of the country’s civil war. They returned to West Africa in 1992 to Evangel Hospital in Nigeria where they served for 20 years. They have three daughters and a son and live in San Diego, California. Bill is on staff at the Veterans Hospital and Dorothy teaches at a local elementary school. Christian Medical & Dental Associations www.cmda.org 33
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