When I arrived in Ethiopia in 1966

The Operating Room light was a remnant from someone's garage and hung on a rusting coat hanger from a sagging ceiling with beams that had almost been completely eaten away by the African termites of the neighborhood. In order to have the light in the area of the surgery, the four stools and table with the patient had to be moved.

When I reached for a sterile pack at 2 AM for an emergency surgery my hand came down on a large hairy pack-rat. He showed signs of wondering what he was being punished for.

To get from the clinic to the hospital I had to place my hands on my knees and wear protective head gear.  The previous doctor had been very short. The 105 beds of the hospital were only 12 inches off the floor so I had to say my prayers 105 times each time I made rounds.

The single World War II sterilizer blew up during my third month and my mentor doctor who had been there 20 years, with whom I had hoped to work with for five years, left after just 6 weeks. I still wonder what I might have said to scare him off.

The first drug order would not be filled because the hospital was said to be 9,500  U.S. dollars in debt.

The first five patients on the male ward had all been bitten by various wild animals: a lion, hyenia, leopard, snake and wild dog.

91 of my first 105 patients on the ward had conditions that I felt sure had never been described before.  When skin tests were given, the control, myself, was the only positive one. Pathology reports were never helpful.

The electric generator had Noah's fingerprints on it and seemed to have been constructed before the discovery of electricity. Its crank had a 3 foot radius. The challenge was to let go of the crank handle before you became the blade of a propeller.

The primary form of revenge was to burn your neighbor's thatched house down while they were sleeping at night so we always had about 20 severe burn patients in the hospital.

During my first days I ran into a bull while I was making rounds and had a chance to practice my gladiator maneuvers. The bull obviously thought that the new ward was still part of his grazing area.

Gourds hung from some of the nails on the walls.  These were filled with goat's blood. This was the vita-mine mixture recommended for speedy recovery by the witch doctors.

Kerosene lamps hung from the ceiling so the nurses could see where they were going for patient care at night.

A donkey with 4 kerosene tins on his back secured water for the hospital from 5 springs located in a nearby valley.

The autopsy room was a separate building located 15 feet behind the operating room. Whenever a patient died, this area was full of vigorously wailing relatives so that it was hard to concentrate on the work at hand, the saving of the life of another patient in a delicate balance between life and death.

The x-ray machine was a 15mA unit rescued from the jungles of the Philippine Islands after the second World War.

When I went to the clinic one day, 10 patients had soiled rags in their hands. They wanted me to count the number of human teeth and compare them to the holes in their own line up of remaining teeth. Then they wanted a "police letter" so that they could get financial remuneration for their losses. The teeth in the cloth usually outnumbered the vacancies in the mouth for missing teeth.

Thirty-two years later there are more than 750 churches among a tribe of about 5 million people.  The New Testament has been translated into the tribal tongue and most of the Old Testament as well. Solar powered tape recorders play the Bible, and New Testaments are read by those who now read.  The churches have sent out 120 missionaries from their group to other tribal groups in Ethiopia that did not have a clear presentation of the Gospel before. The president of the leading seminary in the country was one of my patients.  The present Chief Medical Officer and Chief of Surgery of the hospital was a student among 490 others who were trained in evangelism and as nurse practitioners to work in their own communities. During the time of the revolution many had patients who came to them even when there were no medicines just to have them pray and lay their hands on them.

What are the current trends in medical missions today?

First of all we see the disappearance of the career medical missionary.

30 missions organizations have 33 hospitals and clinics without a single doctor or nurse.

178 mission hospitals in Africa are all crying for more doctors.

50% of the present missionary force will reach retirement in the next ten years and there are very few replacements.

The gap between training and technology in the home countries and overseas is widening.

Med-Send, an organization founded in 1994 under the Christian Medical and Dental Society (CMDS), finds that only 20% of the doctors who were feeling the call of God to go as missionary doctors will still have that interest when their training is completed and their debts have been paid off.  This last requirement usually takes five to ten years. By then the fire is gone. The family and practice are well situated. The imagined work and call schedule in the mission hospital produces only panic. The fact that there were 272 mission hospitals in China in 1949 and 8000 missionaries in 1934 at the height of the missionary movement there is forgotten. On the good side, Med-Send has now sent out 80 young doctors and medical personnel to needy mission hospitals and ministries since its inception.

The second trend is the shortening of the medical missionary career from the former 30 to 40 years to less than four years.

There seems to be a loss of the same level of commitment. No desire for sacrifice is apparent. The vision of what can still be accomplished by the mission hospital in world evangelism, especially in the 10/40 window of opportunity is gone. In some ways the short term service and short term teams have killed long-term service.  The question may be asked, "If I can fulfill God's requirements for my life for world evangelism by a two week time commitment per year, why should I consider a life time commitment?"

One survey found that of 100 feeling the definite call of God to missions, only 12 completed training for this calling, two actually went and only one stayed.

Third is the actual closure of mission hospitals because of their expense, the lack of key medical staff, the difficulties in running a mission hospital and sometimes the lack of vision from mission leadership. At a time when there were 12,000 Americans earning good oil money in a certain near east country, 6 medical personnel could not be found for a mission hospital that had operated there for forty years.  The mission hospital was closed in spite of the pleadings of the government to keep it open.

Fourth is the fact that even though the need for the mission hospital is actually greater now than ever before to meet medical, surgical and spiritual needs, it is being proposed that this is not so.  Because of medical missions, Nepal has over one half million Christians today.  80% of the Christians in India related their conversion to a Mission Hospital experience. If you inscribe a circle with a 50 mile radius around each of the 272 mission hospitals in China, you find that these are the areas for revival today. As much as 90% of the medical needs of some countries are met by mission hospitals. When you think of the government hospital in a poor country giving their patients a list of items such as gloves, syringes, needles, medicines, and intravenous supplies to pick up from a local pharmacy, you know that the need for mission hospitals is not past. With the start of the Pan African College of Christian Surgeons  two years ago for the training of African Christian doctors in mission hospitals in Africa for the continuation of the mission hospital, you know the needs for training personnel is even greater than before.

The fifth trend has been a tendency to buy into the advertised myths of missionary medicine and theology such as "The lost are not really lost and therefore don't really need to be saved." They will say this inspite of the fact that Luke 16 tells us the story told by Jesus where the tormented of hell are even pleading for someone to tell their friends about the good news so that they can avoid hell.

The mission hospital has been painted as a "sunset ministry" even when we know that only one surgeon works in the African country of Malawi, a country of 8 million people, and the Chicago area has many more than one thousand surgeons.  When a Fellow of the American College of Surgeons visited Mozambique recently he doubled the number of ACS fellows in the country.

Loving and compassionate in-hospital care and the spread of the Good News is still the domain of the mission hospital where the Jesus video can be shown to a thousand people every day. We should not be stopped by the idea of hard work, a less than ideal location or a poor on call schedule.

Personal peace and affluence have become dominant values of our culture. Recently the Public Broadcasting System had a program on the terrible epidemic in the USA called "Affluenza" where we work so hard to keep up with "the Jones's" that we have almost no time for family and friends, husband and wife must both work, frugality is a thing of the past, recycling is insufficient and repairing items broken is a lost art. The audience was admonished to get their lives back into line with their life purpose and take up voluntary simplicity. To help doctors do this Dr.Richard Swensen has written a book called "Margins".

A.W. Tozer put it this way.

We see the world not as a battleground, but as a playground. We are not here to fight; we are here to frolic.  We are not in a foreign land; we are at home. We are not getting ready to live; we are already living. We don't realize that we are in a life and death struggle.

1) I said, "Think of how much I could give if I stayed." But God said "I own the cattle on a thousand hills.  You cannot serve two masters."

I said, "Its cruel to make my wife move." But God said, "All these things shall be added unto you."

I said, "But our home is so nice." But God said "There are many homes in heaven. I am your inheritance."

I said, "Think of all the internationals in the USA." But God said, "I am sending you."

I said, "How can I live in a communist country?" But God said, "I will go with you," and He helped me study the theology of suffering.

But I said, "No one will go with me because of AIDS, starvation, political unrest, persecution, and suffering."  But God said, "There are windows in heaven."

I said, "How can I find a suitable doctor to take over my practice?" Guess what? God showed me the perfect person for the job within two weeks.

I said "What is wrong with where I am?" But God said, "This is your new assignment."

I said, "I don't want to beg instead of give." God said, "I am your great reward.  Is my hand short that it cannot save?"

I said, "I'm 55 going on 65. You need someone young and strong without physical limitations." But God said " I will do a New Thing." "Be strong and of a good courage. Fear not, nor be afraid of them. For the Lord thy God, He it is that doth go with thee. He will not fail thee nor forsake thee."

The greatest deterrents to medical missions today are:

The desire for equity for retirement and "affluenza"

The absence of prayer, and holiness

Resulting in a loss of vision

A willingness to be a servant

An emphasis on the Lordship of Christ

A confidence in the Sovereignty of God

A love of God's word, and

Zeal in evangelism

Is it so bad that you can have all three meals with your family almost every day even if you are the only mission doctor for a 105 bed hospital?

Is it so bad that you can have your wife and children actively participate in the ministry as a family? Our daughter started making Sunday rounds on the non-infectious case when she was seven.  She worked as a circulating nurse at the age of ten. She first assisted at the age of 13. Our son was fixing the evangelist's gospel recorders at the age of 10. By the time he was 14 he was overseeing the hospital maintenance and engaging in public health out-clinics with a jet injector inoculating 100's of babies with his sister.

Is is so bad that your children can attend home school where the Bible, Scripture memorization, dedication to Christ, prayer and the 10 commandments can be joyfully followed?

Is it so bad that your family must enjoy wonderful exotic vacations together in Africa, Europe or the US National Parks because you have 9 months off of night call every 3 years?

There is no call

1) To be interested

2) To good intentions

3) To almost persuaded

To partial priority and to lukewarmness

Perhaps God planned for you to reach a tribe and language group with the gospel with the gifts He gave you.  But instead you used them for yourself. Now over 100,000 people will be forever lost in the fires of hell.

Love always means sacrifice. Sacrifice always means death. 90% of the Christians in Cambodia lost their lives in the country's most recent upheavals. It is estimated that today 17 will die as martyrs for the sake of Christ somewhere in the world. Death means death to selfishness. Death means conformity to Christ's image. My father's favorite verse was, " Except a grain of wheat fall into the ground and die it abides alone."

For us today, missions demands a work of faith by God in each of our hearts so that

We will hear the voice of God to us amid the clamor of other voices

We will obey the voice of God however contrary to human reason

We will go on with God's work in the face of every opposition and discouragement

We will realize that God's work done in God's way secures God's reward

There are still 5 good reasons to go into career missionary service:

The story of Noah and the coming judgment

The story of Ezekiel and the responsibility of the servant

The story of Jonah and the overwhelming advantage of obedience

The story of Nehemiah and God's empowering and enabling, and

The story of Paul and the future prize because the prize is worth the price

We can count on the faithfulness of God to provide (Psalm 78:19), to protect (Isaiah 50:2), to direct (Numbers 23:19), and to do the impossible (Genesis 18:14).

In the book Of God and Men A.W.Tozer says,

We languish for men who feel themselves expendable in the warfare of the soul, who cannot be frightened by the threats of death because they have already died to the allurements of the world. Such men will be free from the compulsion that control weaker men. They will not be forced to do things by the squeeze of circumstances, their only compulsion will come from within...or from above.