Day Six: Aspects of mission work

The following is part of a series of posts about the Developing Health Course 2012 run by CMF.

I cycled today! 14 miles on my dad’s mountain bike. Excellent practice for a potential 26 mile cycle to Skegness on my next rotation. I decided that this exertion deserved a reward with a croissant, before the morning session began…

Caring for the carers

Not Supposed To Feel Like This book coverMary Hopper has lived and worked in Rhodesia/Zimbabwe and South Africa for many years, and also runs a counselling and trauma workshop for those working in resource poor settings.

Elijah was afraid and ran for his life. When he came to Beersheba in Judah, he left his servant there, while he himself went a day’s journey into the wilderness.

He came to a broom bush, sat down under it and prayed that he might die. “I have had enough, Lord,” he said. “Take my life”.
1 Kings 19 

Following this, God strengthened Elijah, takes him to a quiet place, given a word of encouragement: and then gives him another difficult job to do.

The passage from Kings is a word to those who have grown wearing in well doing. Also a word to those who think that this will never happen to them. Huge list of people who have shown stress in history: Jeremiah, David, Charles Spurgeon, Martin Luther


Both acute and chronic stress have physiological effects. Its a common problem in the field of world mission. 20% have taken anti-depressants since becoming missionaries.

46% of missionaries suffer psychological problems (mainly depression) – their home organisations only knew of about 7.5%.

What can cause stress and burnout in resource poor settings?

  • Frustration
  • Feelings of inadequacy
  • Busyness and tiredness
  • Conflict within teams
  • Cultural differences
  • Language barriers
  • Distance from local church – no fellowship
  • Sad spouse, stuck at home
  • Personal healthcare issues

Greenhouse effect: a plant in a greenhouse in the UK won’t grow out of control. Pop it into the Congo jungle, and it will grow out of control. Social conventions in the UK can reign back behaviours: drinking too much, driving, marriage problems. etc – without that control, it can worsen abroad.

Children especially can find returning home to the very civilised culture in the UK very difficult. No one at school will understand the freedom of running around barefoot under the sun. Studies show that children struggle with moves most, especially when they have to leave friends behind.

Single women can have problems: cultural expectations are often that must be prostitutes.

Further problems

  • Questioning the meaning of life
  • Loss of purpose
  • Loss of hope
  • Changes in beliefs
  • Doubts
  • Giving up faith
  • Anger
  • Feeling far from God

“I felt as if my life had ended; I just had to do things for other people; I couldn’t do enough for them.”

It is normal to feel low/disorientated when adjusting to a new culture. People who accept this is normal, and seek support, soon start to feel normal.

What is our theology of suffering and poverty?

When surrounded by dying and suffereing, how do you respond to “How can there be a God, if all this is happening?!”

When working in a relief programme and witnessing a lot of death, poverty and suffering, I found my spiritual beliefs gave me a lot of comfort, and helped me “lay it all to rest” in my head.

“Are you tired? Worn out? Burned out on religion? Come to me. Get away with me and you’ll recover your life. I’ll show you how to take a real rest. Walk with me and work with me—watch how I do it. Learn the unforced rhythms of grace. I won’t lay anything heavy or ill-fitting on you. Keep company with me and you’ll learn to live freely and lightly.”
Matthew 11:28-30

Helping yourself: Prevention

  • Take a day off every week.
  • The Sabbath principle
  • Don’t overwork – do a Bible study on when Jesus said “no”, or didn’t meet needs”
  • Do things you enjoy
  • Have an attitude of gratitude

Helping yourself: Responding when you feel low

  • Allow yourself to cry or scream if you want to.
  • Write about your feelings in a journal, letter, email, blog…
  • Ask people to pray for you and find a spiritual coach.
  • Do things you enjoy: have a bath, go for a walk.
  • Set SMART goals: specific, measurable, achievable, relevant, time-bound.
  • Use CBT websites, such as Living Life To The Full

Savour the culture!

Mary has learnt far more from the people culturally in her area than she’s ever taught them. Coming home can be difficult because we have changed. She is no longer English – she is Shonglish: Shona and English. You come back, and you bring both cultures with you. One story she told us was very revealing:

“When I first went to Rhodesia, I still liked men to allow me to walk through doors first. There was one paramedic who seemed very rude – sometimes he would push me out of the way! One day, I confronted him, ‘Why are you so rude?’.

He explained, ‘In this land, I am the man, I must be first through the door. If I am first through the door, it is me who will be shot, it is me who will be blown up by the landmine.’

This rather turned my theology of manners upside down!”

Sabbath living

It is good to try to live out a Sabbath principle, even if we can’t necessarily have a set day each week.

God has called us to be a living sacrifice, so there will be times where we do have to work very hard, at the same time there are periods where he takes us behind still waters, times to get up on the mountain out of the crowds.

God has also called us to be members of a body – teamwork is an integral part of sharing a workload, jointly serving.

Managing teams across cultures

Joyce Banda Malawi PresidentStanding barefoot in the sun for 20 minutes made me feel ready to sleep in the sun, but before that, we had Jane Bates heading up our final session for the weekend.

Cultural intelligence is a valuable skill, since our personal cultural situation so affecst the way we think, live and relate to one another. Jane shared some of the insight she has to this as a half Indian woman, raised in the UK by an English mother, and currently working in Malawi.

A simple model of different culture: our Prime Minister is the leader of our country, in Malawi, the President Joyce Banda is called the Mother of the Nation.

  • How do people greet each other?
  • How do people behave when they disagree with each other?
  • How do people behave when they disagree with you?
  • Do people publicly question/teach one another?
“A fish only discovers its need for water when it is no longer in it.”

We all have our own culture, but we may not recognise it until we are out of it.

Going beneath the surface

There are different layers of culture: “tip of the iceberg” culture is anything you can perceive with your five senses. Such as clothing, temperature, geography, smells. But its the deeper things that will affect your relationships more:

  • opinions, viewpoints & attitudes
  • philosophies & values
  • convictions
  • rules about relationships
  • attitudes to time
  • how the individual fits into society
  • role of the family
  • different role expectations
  • fear of losing face
  • attitudes to money & corruption

Case studies

What is your response, and what cultural issues may you need to consider?

You are part of a team of a team about to set out for a community visit and are waiting for team members to arrive. The last member of the team is over an hour late and gives no excuse on arrival.

  • “Initially I found this very frustrating, but as time passed, I settled into their culture and became more late myself. Important meetings, I would tell them an hour earlier than I actually wanted them there.”

As team leader your office manager is one week overdue in submitting a report for donor funds. The donors are hassling you for the report.

  • “Frustration”
  • Cultural clash from donor expectation

The hospital you work at has run out of oral liquid morphine. Last week your staff went to the pharmacy to get distilled water, and you contacted the pharmacy warning them of this impending shortage.

  • Frustration, understanding of problems with electricity.
  • Increase your stocks – create buffers.
  • Perhaps the pharmacist is not aware of pain being caused.

Overseas donors question why you have failed to extend the contacts of one of your staff members who they found ‘warm and personable’ on their recent visit.

  • Everyone can have several different faces.
  • Discussing problems, differences in living and working with people rather than seeing them on a visit.
  • Important to have knowledge local labour laws and local contracts.

A visiting foreign doctor in the department of which you are head has one month left on his contract. He disappears and emails a week later saying that he has “decided to get some experience in accident and emergency before he leaves”.

  • Considering his own advancement over his responsibilities. 
  • Need to look at the contract.
  • “?He is avoiding anyone losing face: if he came to me to ask for more experience, and I couldn’t provide it, then I’d be losing face”.

Your team refuse to go into the field unless you provide money a cold drink and a daily allowance.

  • Assess the normal amounts and behaviour.
  • Definitely provide a drink.
  • Bargain 

Patient on the ward is the wife of one of your staff team. She has tested positive for HIV but only you are aware of this result.

You get back from two weeks leave to find that only two home visits have been done instead of the usual 8-10.

You are planning to do an HIV awareness campaign in a local community. Your staff workers return from their day’s visit saying they failed to do the activity as religious leaders “refused permission”.

Your staff team are regularly seeing and treating relatives of staff with general health issues regularly during time for your palliative care clinic.

Within your team, rumours have reached you (from a senior team member) that another staff member is having a sexual relationship with one of her immediate juniors. The junior staff member is about to come up for his appraisal.

Keys for managing a team:

Lead by example

Teach forward planning


Transparent process of recruitment and selection

Train those starting work

Fixing salaraies and offering incentives

Seek opportunities for professional development

Team building get togethers

2 thoughts on “Day Six: Aspects of mission work

  1. Thanks for this post Chris, I have booked marked it so I can remind myself of these principles. Not feeling low yet though thankfully, the sunshine is doing me good. Keep up the good work it’s a great blog, Lo x

    1. I’m so excited being on this course, its amazing – and Amanda came and found me today. You’ll be unsurprised to hear I hadn’t learnt her name yet.

      I’m gonna try pretty hard to come visit you guys – Kat has said if you manage a year without having Jo stolen then I’m allowed to come…

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