A Different Way of Doing Medicine

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Medical / Health

I was only fourteen when I decided I was going to become a medical missionary. In my fourth year of medical school, when it was time to decide where to spend my elective term, I assumed I would be going to Africa – back then I thought all missionaries went to Africa.

But I was surprised to learn that female medical personnel were most needed in Muslim countries, where many women died because there were no women doctors to attend them.

So I ended up doing my medical elective term at the Pennell Memorial Hospital in Bannu, north-west Pakistan. It was in a compound with high fences and armed guards. Women were not allowed outside the compound alone, and we had to cover every part of our body including our head. I have pictures in my mind of old rusty beds, surgical gloves hanging out to dry after use, hot sweet tea and lots of kids with thin mums. Women would travel great distances to come to this hospital, some even on horseback from Afghanistan, to see the famous obstetrician Dr Ruth Coggan.

Stomping on Baby’s Bottles I started to think about holistic health and doing medicine in a different way, after I witnessed a nurse at Pennell Hospital stomping a baby’s bottle under her foot. Her strange action started making sense after I learned that bottle-feeding contributed to the malnutrition, infection, growth retardation – and even the death – of babies there.

Big multinational companies sold their milk formulas cheaply, and promoted bottlefeeding as the way of the West, until it became a common belief that good mothers bottle-fed rather than breast-fed. However, many poor village women watered down the formula to make it last longer, depriving their babies of the nutrition necessary for growth. Not only that, the lack of clean water and inability to sterilise bottles frequently led to infection and diarrhoea, then dehydration and death.

My brief time at Pennell Memorial Hospital taught me so much. I learnt the importance of preventative and community medicine. I learnt that even though curative hospital care was exhilarating and necessary, prevention is better than cure. I began to understand that people’s health is more than physical, and that it is bound to their poverty, education level, status, economic means, gender and religious beliefs. In short, I had begun to understand about holism.

I probably could not articulate it at the time, but it was there I first understood that being healthy is not as straightforward as I had previously thought. As I began to consider the type of medicine I wanted to be involved in, it was very clear that, even though I enjoyed hands-on healing, my future lay in primary health care, community medicine, teaching and training.

Theological study I reached another turning point in my Christian journey in Pakistan. While visiting Multan Christian Women’s Hospital I had the opportunity to go on an evangelistic ward round. The hospital evangelist would share the gospel with the captive audience of the patients’ friends and relatives, who stayed there to care for, wash and feed the patient. I thought it was great that the gospel was shared, but I was uncomfortable with the division: doctors dealt only with the physical, and evangelists dealt only with the spiritual. I didn’t want to restrict myself to being only a doctor; I wanted to share the message of Christ myself, and to teach from the Word of God. I realised two major things then: I did not want to do medicine full-time, and I was going to need more theological training than I’d previously thought.

So in 1990 I began full-time theological study, while also working part-time as a GP to help pay my bills. After I finished my theological training, I worked in churches and as an itinerant speaker, still juggling that with part-time GP work. During this time of doing two jobs I was able to reflect on the interaction of the physical, emotional and spiritual. I also did a counselling course which was based on an integrated understanding of the person. We are complex beings and being healthy is a complicated business. Our emotions, hidden or conscious, have a powerful effect on our wellbeing and our perception of the world, and the way we impact others.

Community development When I applied to become an Interserve Partner, I was willing to go where I was most needed. That turned out to be Central Asia, where the church had grown exponentially since the fall of the Soviet Union, but leaders were young in years and young in faith. I would be serving there as a General Practitioner training other GPs.

This role was a concern to me. Even though the GP training programme was vitally important (it was part of a reform of the whole health system from being very hospital based to one that is more primary health care based), it was not the grassroots, community-based medicine that I wanted to do.

My first year there was focused on learning Russian, but I also attended community development training. This was another significant turning point, as I caught the vision of impacting communities in a holistic and grassroots way, where they could be empowered not only to recognise their own problems, but also to solve them with local resources.

By the time my language learning ended, there was a breakthrough in my work situation: my organisation decided to start a community development department. It meant that I got the opportunity to work in a small team that, among other things, did health screening and trained village health workers. Working in the project team was quite a cross-cultural experience, with sometimes four languages needed for everyone to understand what we were going to do, or what we were thinking. I would say something in Russian, for example, then my Russianspeaking friend would translate it into the local language for my Korean colleague to understand, then she would say something in Korean to her husband, and he would then respond in English! It was a wonderful experience, but needed lots of patience.

Initially there were two doctors (myself and another) available to meet the villagers’ needs: we would see patients in the morning, then move on to teaching the local health workers how to prevent and treat common problems. However, I came to realise that I was undermining what we were trying to achieve in the project: as long as there was a doctor available, people wouldn’t bother to learn how to prevent the problems themselves. That is when I decided my main role would be to train and coordinate the work of our community development workers, rather than be directly involved in the community myself.

We had a few different ways of selecting communities and entering them. One involved doing health screening at schools and then presenting the findings to the parents at a public meeting. We then offered to help them, but made it clear that we offered training, not money. We began by training the people in identifying needs and problem solving. Our lessons covered many topics, such as physical health, income generation, agriculture, emotional issues and moral values like honesty and forgiveness.

Sometimes we were able to incorporate stories from the Bible in our teaching. One very powerful lesson on forgiveness was taught by using the story of the prodigal son, but adapting it to ‘the prodigal daughter-in-law’. This seems to be the relationship with the most strain here, the one between the wife and her husband’s mother. Wives go to live with their husband’s family, and the wife has to do the bidding of the family matriarch – her mother-in-law. Most women are not free from this until they become mothers-in-law themselves. We saw many people recognise the destructiveness of unforgiveness after this lesson, and many were willing to do the homework we set them, which was to forgive someone!

Most of the communities we worked with knew we were followers of Jesus, and through years of interaction they developed a more positive understanding of Christianity. We do this work not as a means to evangelise or plant churches, but because it is good in itself and demonstrates the love of Jesus to broken people. In many places around the world, however, the natural consequence of such holistic community development is that, over time, churches are planted.

TEE and discipleship A great number of local church leaders, when surveyed, said the biggest need in their church was for discipleship. The local church is great at evangelism and church planting, but after people turn to Jesus there are many obstacles that prevent them from growing in their faith. Many groups are started in small and isolated communities as people respond to the good news, but without local leadership they often go for months without receiving any biblical teaching.

Theological Education by Extension, or TEE for short, addresses this issue. Group members can study the Bible wherever they are. Books of self-study material become the tutor. Someone needs to know how to be a facilitator or group leader, but basically the group learns together, has home-study tasks and practical ministry assignments.

In my last term overseas I was asked to help develop a TEE programme for one of the Bible Colleges. A few of my former students were keen to work with me on this, as they realised that TEE was the best way to help the church grow, especially in remote areas. Mars, a gifted church planter, used to be a Muslim mullah until he encountered Jesus as he was saying his prayers. As Mars began small groups, he found he didn’t have the time or resources to follow them all up. Now, through TEE, the groups are provided with the resources they need to grow in Christ.

We have a big vision for our TEE groups: we want to use them to address the needs of the whole person. We plan not only to offer theological training in these groups, but also to pass on life-skills and knowledge in the areas of health, parenting, intensive gardening, income generation and so on. It is our hope that group members will become lights in the community which others are drawn to and want to learn from. This is still in process as change is slow.

When there is harmony between people and God (the spiritual dimension), among people (the social dimension), within the person (the emotional dimension) and between people and their environment (the physical dimension), we have holistic health. Illness is a breakdown of these relationships. As Christians we work to reveal the reconciliation that Jesus achieved through His death on the cross. He is Lord of all and has reconciled all things in heaven and earth to Himself (see Colossians 1:15-20). If He is Lord of all, He is Lord of every aspect of this world and of our lives. That’s holism.

Lyn Pearson is Interserve’s Regional Director for East Asia and South Pacific. She lives in Australia with her husband and two sons.

Why Go

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Other, Arab World

I am writing shortly after the news arrived about the death of Tom Little and nine others on a medical mission in Afghanistan. I knew Tom personally for years.

As a professional optometrist, Tom could have lived a gentle life in a safe, comfortable community. He didn’t. Instead, he and his wife chose to serve in a country perpetually at war. They did it because of Jesus.

When I was flying home after serving in the Middle East, I had a unique experience. I felt as if God’s Spirit was speaking to my heart about my own country. This kind of communication does not happen often to me, but it did that day. The words, spoken with authority and love and directness, said simply: “Your country is selfish. It is obsessed with its own security and wealth.”

That’s it. Nothing more followed.

For years, I have wondered about those words. What did God mean by telling me such a thing? To warn me to be careful about safety and comfort and money-making? To suggest that maybe these things could totally deceive a soul? Perhaps.

One thing I do know is this — the cure to selfishness is serving. There is nothing like an old-fashioned, self-denying, pouring-out-your-life kind of giving. During their last week, Tom and the others trudged it out on horseback through deep snow drifts high in the mountains as they sought out remote villages. When they finally reached their destination, word quickly spread and, soon, hundreds came to receive medical care.

On the trip back, Tom said that everyone was exhausted. But it was a good exhaustion, the kind that comes when you know you have served God with your whole heart.

Not many of us have a friend who becomes a martyr. As soon as I heard the news about Tom it sobered me up. It put things in perspective. I stopped fretting over what colour to paint my balcony — it just did not seem that important anymore. It also created within me a desire to serve like Tom did —pouring out one’s life, knowing that it gives the greater satisfaction.

You may be asking, “Why should I go? Why should I leave a life of comfort and safety? Why should I leave an efficient, safe community with fine hospitals, schools and stores?”

Just ask Tom. In Afghanistan he was known to many everywhere simply as “Doctor Tom” — he served so much, teaching Afghans what a true Christian can be like.

Perhaps someone reading this will feel called to go and serve. You may end up giving away thirty years of your life and then die just as Tom did. If so, do not fear such a calling. I remember talking with Tom about the dangers. In reply, he told me of the time when God miraculously protected him from a bullet. He spoke nonchalantly and without fear, as if talking about the weather. He spoke like that because he knew: when we serve God with our whole hearts, our lives and our deaths are in God’s hands.

Just what do you want to live your life for anyway?

Security Risk

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Community Development

Paul Bendor Samuel, the Interserve International Director, looks at the changing face of suffering in mission.

I recently heard from a friend working with a mission in Africa. An Ethiopian missionary friend of his recently died from cerebral malaria. He and his wife had fled their work three times due to warfare and constant attacks, but always felt called to return.

It is humbling to see the sacrifice of people working with these young national mission movements. They ask us difficult questions: What is our view of risk? How do we assess it? How do we decide when to go, or not go; to stay or to leave?

Cross-cultural mission has always involved elevated risks. Here are a few:

Health and personal security: occasionally leading to death, generally the risks are greater for our national brothers and sisters.

Impact on our children: yes, children are resilient but they are vulnerable to emotional traumas at various stages of the mission life cycle.

Ministry cut short through forced exit: the destabilising effect of not knowing when you will be asked to leave, sometimes at such short notice there is no time for proper closure.

Professional deskilling: This is a particular risk in today’s fast moving world. Nor is there guarantee of getting suitable employment on return to the passport country.

Financial insecurity in older age: long term service will likely mean little savings and limited pension.

In recent years mission agencies have had to grapple with the realities of risk and suffering in a fresh way. At least two factors have brought this about.

Firstly, mission is being done in a context of increased hostility. For most of the twentieth century, western missions operated in a relatively protected context. Colonial governments provided security. Emerging nationalism was as yet not generally allied to religious ideology. The past twenty years have seen that change. The search for identity in a globalised world has fed the rise of fundamentalist expressions of Islam, Hinduism and Buddhism, matching the totalitarianism of communism. This change has come largely as a surprise to the Western mission movement, used to ministry from the privileged position of power.

This leads to the second reason why mission agencies are thinking about risk and suffering. Increased risk in mission come as a stark contrast to the prevailing church culture: ease, comfort and security. This culture is not simply a western church phenomenon. It dominates wherever the church is experiencing the affluence generated by capitalism. Present in many parts of the world, it is the dominant culture in the church in the West. Attitudes to life expectancy are a reflection of this. Today, life expectancy in richer nations is around 80 years. Long life is the expected norm in those countries that have provided most of the mission work force until recently. Long life is seen as our ‘right’.

Contrast this with those missionaries that left carrying their possessions in wooden boxes that could also double as coffins. Britains in the 18th and 19th centuries generally did not expect to live past the age of 40.

Our view of risk is so culturally conditioned. Many in the mission force from the global south do not come from cultures where ease, comfort and security are taken for granted. Does this in part help explain the bravery and boldness of some of our colleagues in the newer mission nations? Views of what constitutes ‘acceptable risk’ will be challenged in agencies like Interserve as we open ourselves up to partnership with those who come with very different cultural assumptions.

How, then, are we to hold together obedient, sacrificial discipleship with appropriate risk taking, recognising our cultural conditioning? For us in Interserve it means at least three things.

1. Recognise and own the risks: Jesus warns his followers of setting out in discipleship without recognising the cost. As we recruit and select mission Partners, it is our responsibility to discuss the cost of cross-cultural mission. Selection and preparation must involve the church family and, where possible, the family of the person going. Orientation must involve reflection on the Partner’s theology of risk and suffering in the light of scriptural teaching.

2. Identify and reduce unnecessary risks: At times we bring problems on ourselves through our lack of planning or unwise behaviour. Those who join Interserve join a missional community with much collected wisdom. We cannot eliminate risk, nor should we attempt to do so. However, there is now a mass of understanding about how to reduce the kinds of risks mentioned at the beginning of this article. Much of this wisdom is what is now known as good ‘member care’. This should now include training in personal security, given the contexts in which most Partners work in Asia and the Arab World.

3. Reflect on the cost of taking the risks: When considering the questions of risk and suffering, we focus on the risks that occur because we go.

If we do not take the risks, on the other hand, there will be those who continue to live with a distorted view of Christ, prejudiced against the gospel because they have never seen or experienced the transforming love of Christ in action.

If we do not take the risks, there may be individuals, families and communities that never have the opportunity to become disciples of Jesus Christ.

If we do not take the risks, there will be those who continue to lack community development, employment, health care, discipleship, theological education and who will live in environments that continue to suffer degradation.

If we do not take the risks, there will be those who continue to live under unjust and oppressive structures with no one to advocate for them.

But the risks of not going are not simply borne by the peoples we have been called to serve. It is we who will suffer. We will miss out in joining God in His redemptive, reconciling and recreating mission. Our churches will miss out on the renewing work of the Spirit that occurs when we step out in faith and obedience in mission. By not taking the risks now, we will risk our life’s work perishing in fire of God’s judgement as we settle for security and comfort now. (1 Cor 3:12-15).

We recognise risk. We work to reduce risk. Yet the question remains:

Do we embrace the security risk, or has security become our greatest risk?

Where Christ is not known

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Other, Arab World

Taking part in God’s mission has always seemed to me to the most exciting adventure that there is – so when I was asked to write an article on the sacrifices we’ve made I initially missed the point. What sacrifices? Have we missed out on much that’s worthwhile? Any losses we’ve experienced have been massively compensated for by the joy of adventuring with God and seeing His Kingdom coming.

My adventure started the first time I read through the Bible as a new Christian teenager. I remember resonating with Paul’s desire: “It has always been my ambition to preach the gospel where Christ was not known, so that I would not be building on someone else’s foundation” then “those who were not told about him will see and those who have not heard will understand.” (Ro 15:20-21). And when it came to choose a country in which to serve, I deliberately chose the place that was the poorest and the most overtly hostile to the gospel: home to the world’s most wanted terrorist, reeling from civil war, site of attacks on US facilities and the place where nuns had been shot in the street – killed just for being Christians. Shortly before our first visit two colleagues narrowly escaped a bomb planted just outside their flat. They got up from breakfast and minutes later their kitchen wall was blown in.

Why go to such a place?

Paul would say… “How can they believe in the One of whom they have not heard?” “Christ’s love compels us.” “It has always been my ambition…”. For me, to disobey His leading in my life seemed less safe than walking in His protection. I set off (with my wife and one-year-old) as soon as I was qualified.

The strange thing about living in chaos is that you get used to it. Three months after we arrived, three missionaries were gunned down in the hospital that we’d been planning to work in the following week. Six months in, the war in Iraq started and foreigners in our country were advised to leave. Over the years there co-workers were kidnapped – some released, others not. Neighbours died in bizarre circumstances – the value of life seemed so low to the locals. Embassies sent out warnings of terrorist plots – “wars and rumours of wars”. We felt threatened occasionally, but had an enduring sense of peace.

In time, we moved from the relative ‘ease’ of the capital to a city of 400,000 with virtually no witness. We had a real sense of calling and were completely open about our faith. I shared the message of God’s love as much as I could. I prayed for the sick, went to the homes of Islamic missionaries and invited seekers into my home.

Some were fascinated. Nicodemus-esque, a local lawyer came to my home several times by night. He was one of the first to come to Christ and introduced me to several other young men that wanted to hear about God’s love. The last time I saw him he had led his family to the Lord and had a house church of about twenty individuals.

In the meantime, other neighbours complained to the Secret Police. Soon the Minister of Health and the Deputy Prime Minister were informed of our ‘activities’. They didn’t accuse us of breaking the law but told us it would be unsafe for us to stay there because we’d aroused local emotions. They said the Islamists would take matters into their own hands if the government wasn’t seen to act so they ordered us out of town.

Up until that point we had not felt threatened but that changed at 4am one morning, when an explosive device was thrown over our wall. I was shaken awake by two loud bangs and rushed into my children’s bedrooms to make sure they were still intact. My first thought was about the couple whose kitchen wall had been blown in 8 years ago. Thank God, the children (and the house) were fine. The devices were improvised bangers: all bark and no bite, designed to terror-ise.

Even then, I didn’t want to go. I wrestled with God about staying but instead He led me to the book of Acts where Paul repeatedly got kicked out of every town he went to. He’d move on – and God would use him in each new place. I complied. We packed up and relocated to the capital. And I’d still be there now if they’d let me stay. We lingered for 3 more months trying to get permission to start another project, but the government made it quite clear that we had to go.

I’m not a hero. Romans 15:20 isn’t everyone’s calling, but it is mine. God has used me to help start three house-churches but the main adventure that God has taken me on has been personal. Mission has been His tool to craft intimacy, dependence, faith, joy and excitement into me. To me these far outweigh anything I’ve sacrificed. The beatitudes are true: we really are blessed (“happy”) when we imitate Jesus, no matter what the sacrifice!

Snow and starvation

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Agriculture

One of my first impressions of Mongolia during a visit in 2002 was that it is a land of contrasts and extremes. I’ve now been living in the capital, Ulaanbaatar, for 16 months, and the contrasts still stand out. Extremes of poverty and wealth; modern city lifestyle and nomadic herders; space and congestion; and it goes on.

But the contrast that stands out and dominates is that of the weather, and this past year has been greater than normal in its extremes. Mongolia has a continental climate with warm to hot summers and very cold winters. The last winter, some say, was one of the coldest for 30 years, with temperatures dropping to -50°C in some places. It has also snowed more than normal resulting in the fiercest winter in living memory. The previous summer was fairly typical, but with less rain than normal. So this contrast of a dry, warm summer where grass and consequently hay production was poor, followed by a very cold and snowy winter led to what is called a ‘dzud’. This dzud has been very severe.

A friend, travelling in the countryside for a few weeks, stopped at a ger, the traditional Mongolian home. He writes:

“Outside the ger tied up to the truck there was a goat. We asked the herder about how he made it through the dzud. He still had a good size herd. He told us he had close to 1,000 animals but now he has only 200 – 800 of them died in the dzud. The goat that was tied up outside had been found buried up to its back in the snow. It was the only one from that group of his herd that lived.”

Stories like this are typical. Current estimates are that about 20% of the 40 million head of livestock in Mongolia have died. Many that have survived are weak and the spring new-borns didn’t have much of a chance. Many more will continue to die. As of mid-May, there were reports that over 32,700 families had lost at least half of their animals, with over 8,700 households left without any livestock at all.1 A contributing factor to the extent of the disaster has been a huge increase in the number of livestock to beyond what the land can sustain; the Mongolian pastures have been groaning.

But what does this mean? In a country where approximately one third of the population depend on herding for a living, this is devastating. For those who have lost a large majority, if not all of their herd, this means that they now have no form of income. The UN expects 20,000 people to move to provincial centres or the capital to look for work. Unemployment is already near 50% in some places. The price of meat has risen by 50%. Infant and maternal mortality has increased by 30-40%.2 The children of herders are suffering significant psychological effects, among many other knock-on effects.

Many are trying to help but there have been difficulties in such a vast land. JCS is one of many NGO’s playing a part in distributing aid supplies and also looking to the future trying to advise on animal and land management. All that JCS does is done through the local church, but the Mongolian church itself is poor. I went with a JCS dzud relief trip to a small town with a church with which JCS has connections. Aid was given out to 200 families who had lost all their livestock, yet this was only scratching the surface; just as the livestock try to scratch through the snow and ice to find some grass hidden below, so it seemed with our relief efforts.

Summer is now here. Temperatures have been in the high 30’s. It has rained. The grass is green. It can be easy to forget the groaning and desperation of the cold and snow of a few months ago; the contrast is stark. But for many the devastating effects will last for years to come.

Photo: A car buried in a snowdrift; desperate Mongolians await food handouts run by a Mongolian Christian group; a Mongolian ger during a blizzard; Bactrian camels coping with the winter as best they can; Mongolian herders receiving food and other supplies.

Mission in a groaning creation

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Other

Today, over 100 years after Edison’s seemingly forward-looking statement –“We will make electricity so cheap that only the rich will burn candles” – the promise of cheap, abundant electricity seems to hold true only for industrialized countries. Who could have anticipated that today more people have no light in their homes than the entire world population in Edison’s time?

There is a clear relationship between poverty and access to electricity. The more remote the community, the greater its poverty level, and the higher the costs for electrification and other development projects. Approximately 80% of Nepal’s 29.5 million people live in the rural areas, and about half of these live in such remote areas that neither a road nor the national electricity grid will reach them for decades to come. Nepal has no fossil fuel resources, so families in the remote areas use precious trees for firewood for cooking, room heating and light. Villagers – mainly the women and children – spend up to seven hours every other day gathering the needed wood. This dependence upon firewood, and especially the indoor cooking on open fireplaces, has a direct chronic impact on people’s health and is a major factor in the extremely low life expectancy for women and the high death rate of children under five. In some places families do not even name children under five, since child mortality is so high. Deforestation is alarming in these regions. The once picturesque, biodiverse forests and valleys are being stripped of their resources in unsustainable ways.

I have been working amongst these remote high altitude mountain communities since 1996, first with United Mission to Nepal and then, from 2001, as co-founder and director of a non governmental organisation, RIDS-Nepal (Rural Integrated Development Services), and as lecturer and researcher in renewable energy technologies at the Kathmandu University. The vision of RIDS Nepal is to improve, in partnership with individuals and communities, their living conditions and livelihood through long-term holistic community development.

In poverty-stricken mountain villages in Humla in northwestern Nepal, RIDS-Nepal is working on utilizing local renewable energy resources in more affordable, sustainable and appropriate ways. Over the past twelve years, four issues have again and again been identified by the local people as their most urgent needs for their holistic and sustainable development: latrines, smokeless stoves, basic indoor lighting and clean drinking water. This led RIDS-Nepal to develop a holistic community development (HCD) strategy named the “Family of 4”, which is implemented in close partnership with the whole village community.

The “Family of 4” HCD begins with the building of a pit latrine for each family. Next, each family purchases a (highly subsidised) smokeless metal stove for cooking and heating, specifically designed and developed to meet these villagers’ needs while consuming only about half the firewood of an open fire. The next step is a highly subsidised home electrification system for basic indoor lighting. The power is generated from local renewable energy sources, most often through solar energy or small scale hydro power plants. Finally, the commonly-owned village drinking water system is designed and built. Because the local people are involved in each step of the process, it creates in them a strong feeling of ownership, and a greater interest in keeping each project running.

It is crucial to understand that the local community is at the centre of any HCD project and that the contextualised technologies developed and applied are to serve and support their struggle for a better life. Therefore, any project has to be based on a thorough understanding of the local context and culture, and must include an understanding of the “invisible” causes of poverty, and the impact on the community of decades of deprivation. This approach demands time, compassion and dedication. These more “human” aspects of an HCD project are crucial factors that need to go alongside the technical aspects. In this way the people are recognized from the beginning as equal partners and not as receivers of imposed ideas. This time-intensive, often frustrating process is central to a HCD project.

As the “Family of 4” brought about positive change for families and their communities by addressing basic needs, other needs began to be identified by community members. RIDSNepal and the Kathmandu University, supported by the ISIS Foundation, worked together to create contextualised technologies to meet those needs through the “Family of 4 PLUS”, which has the following elements: increased food security (through greenhouses, solar driers and a nutrition programme), non-formal education (for mothers and out-of-school children), slow sand water filters (for indoor use), and solar water heaters (for improved personal hygiene and health). The greenhouse contributes to food security by extending the growing season from 3-4 months to up to 10 months per year; the solar drier provides a hygienic, effective method of preserving food whilst still keeping its nutritional value; and the solar parabolic cooker provides a wood-free cooking alternative. Approximately 65% of children under five in Humla are malnourished, so an intensive nutrition programme has been established, that uses only locally grown and available products.

Periodic surveys and evaluations are part of every long-term HCD programme, so that problems and needs can be identified, and adjustments made accordingly. Our aim is to partner with each village community for two generations (about 20 years), in order to bring about relevant, sustainable and holistic change.

It is our hope that as we listen to, live and work with the local people, over time our mutually identified solutions to their needs will “get under their skins” and become indigenous to their culture. This journey – somewhat like the 17-day trek through harsh Himalayan mountain ranges to reach Humla – is neither short nor easy, and there is no guarantee of success, but we believe the end result will be worth every steep hill we had to climb to achieve it.

Alex Zahnd is a partner with Interserve Switzerland. For more information on any of the projects, go to www.rids-nepal.org

Aibeks Testimony

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Media, Arab World

About eight years ago, I noticed my mother watching a Christian programme on television. It was in Russian, my mother’s second language.

When I asked how much she understood, she admitted, “only about 30%.” And I realised that this was what it was like for most people across our nation: they hear but do not understand, as they don’t have any opportunity to listen to the Gospel in their own language.

That is when God impressed on me the great need for Christian programming in our national language. Initially, however, I received very little support for this vision, and it took some years of fervent prayer before God started opening doors. But I never doubted that God was in this, and He put people beside me to encourage and support me when I really needed it.

The breakthrough came in 2004, when I was given the opportunity to attend a Christian summer school for training in TV and video production. On completion of my training I was given responsibility for producing and directing a 30-episode Christian television drama: this project marked the start of our studio.

Our country is one of the poorest in the world, and our government, police force, and education and health care systems are riddled by corruption. Our people are bombarded with lies and deception from every direction, and, in desperation, many of them start to seek help from God.

But if they never hear the truth about God they will believe whatever was taught to them in the past, mainly Islam mixed with elements of Shamanism.

Christian television is such an effective way to teach our people the truth about God. They are able to watch in the privacy of their own home, and make the decision to receive Christ without the often negative influence of their extended family and community.

But there is a price to be paid for those who acknowledge their new faith publicly: they are viewed as traitors to their own culture, and are despised, ostracised, and often physically attacked. Persecution comes mostly from their relatives and close friends.

One young man, for example, was thrown out of his home after he became a believer. His father told him that he could only return home if he renounced Jesus, and studied the Koran. This young man refused; he said he could not throw away something that he knew to be true.

As followers of Christ in this country we strongly believe that God will send revival to our land and so, with God’s help, we are trying to do whatever is possible. We are praying that one day we will have our own TV channel, as we believe that God can and wants to use television to reach the people of this nation and influence them for His kingdom.

A New Hope Through Television

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Media, Arab World

We have been working in Central Asia for eight years, in a Muslimmajority country overwhelmed by major economic and political crises. In our time here, one of our biggest encouragements has been witnessing a national believer’s dream – that of broadcasting Christian television in the local language – grow from a vision into reality.

After Aibek* watched his mother struggling to understand a Russian language Christian TV programme, he realised that the great majority of his people had no access to the Gospel in their own heart language. And God gave him a vision for using television to reach people for Christ. However, when Aibek shared it with Christian leaders in the city, many of them told him that while it was a good vision, it would never happen: no one could or would help, and most actively discouraged him. But when Aibek shared the vision with us, God put it on our hearts to not only affirm and encourage him, but to work alongside him in bringing it to pass.

That was almost seven years ago. And although it has not been an easy road for Aibek, he stuck to the dream God gave him and now heads up a television studio which produces local Christian programming. These programmes are broadcast twice a week in several strongly Muslim regions in our country; it costs about $200 USD to air each slot, which is covered mainly by donations from local, indigenous churches. Each programme is based around a theme (e.g. forgiveness, family, testimonies of changed lives, alcoholism and other social issues), and contains a mix of teaching, testimony and music.

The vision of the studio is to eventually broadcast all over our country. This seems a long way off at the moment, but we have seen our Father open doors that we never thought would open. The fact that the programmes are being transmitted to some of the more remote, strongly Muslim areas shows that our Father’s hand is on the project. He is using this ministry to touch people who otherwise would never have the opportunity to hear the Gospel, and to bring hope and life to places where there is so little hope and so little to live for.

That Aibek is able to continue broadcasting with current restrictive religious laws is a testimony in itself. The director of the TV channel in one of the regions was strongly pressured to stop, but he told the Muslim community and officials that the programmes were good, and he would continue to show them as long as the studio continued to pay!

Television is particularly effective in reaching remote villages. Recently we received a letter from a mountain village in the south. These people have little contact outside of their village but do have television! Six of them had become believers through watching our shows: they have never met any other believers, and have no Bibles, but they meet with each other to share, and pray to the Father who has given them hope.

There are many stories like this, told through letters and phone calls, from people whose lives have been changed and transformed through the programmes. They include high ranking officials who contact usin secret, wanting to learn more but fearful for their positions, and even for their lives and families if they were to openly ask.

So even though we have encountered a lot of very vocal and vigorous opposition, we continue to be encouraged by the testimonies we receive, telling us of God’s salvation, changed lives, restored families, and how God’s word, through television, is bringing hope in the hard places.

* Not his real name

When The Walls Came Down

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Theology / Church

The story of the church in one of the most repressive Central Asia countries, by Gulzoda, one of the first local believers.

1991 was a year of confusion and panic for people in my country. The largest nation in the world, the Soviet Union, was dividing and no one was sure what the end result would be. I had grown up believing in the Soviet system and was ready to give my life for it even as a local Central Asian. That is how my classmates and I had been taught. Then, one day, we saw everything we thought we were living for collapse around us. All systems of society, banks, schools, government, healthcare, and even transport came to a halt. When all of these systems stopped another work began.

With the government preoccupied people were able to come in and out of the country without problems. Just as our perception of the Soviet Union was crushed our view of the religion of our ancestors also began to wither. When I first learned that the Soviet Union had dissolved I began to look into Islam as a new source of hope and belief. In this religion I couldn’t find answers to my questions. Right away Russian Christians came down to us and began sharing the Good News. At this time I had just entered the university and a woman came to the university where her cousin worked and began preaching in classes with up to 200 students. About 5 or 6 of us students became believers after hearing her share for just a few minutes. In the brief conversation with the woman from Moscow I received all the answers I needed and walked away with a changed heart.

For the next several years many foreigners came and helped to grow the seeds that had been planted. The presence of foreigners also brought jobs, training and education for many. We had a time of rapid growth and saw believers raised up in many cities around the country. We were taught what “church” is and how we are to live as a body. Since we had no background in the Christian life we learned how to understand scripture and teach it to others. At one point I was leading 11 small groups in one week.

These years were not free of persecution as all of us who joined were attacked by family and society. Many of us also lost our jobs. As the new government began to form the number of restrictions also increased. These restrictions also applied to the foreigners, 80% of whom, after more than 10 years of open doors, were forced to leave. This was a difficult time as we saw many close friends and mentors leave as well as losing jobs and support for countless people.

All was not lost. After this the church began to grow increasingly underground. Since there were only allowed to be two official places of worship in each city these were inevitably used by the majority religion. Networks formed between cities and groups that helped connect the small pockets of believers around the country. An increase in unity has also taken place as denominational differences mattered less. People stepped up into leadership roles that had long been held by foreigners. Though it is still a struggle, leaders are being developed to multiply home groups, in essence seeing each person as a potential leader of a new group.

Challenges still persist in our very controlled environment. Like all developing countries unemployment is very high and a pastor who can live on the giving of his group is virtually non-existent. For believers, particularly in smaller cities, it is very hard to find work. Many educated leaders are leaving to go to other countries to find work because they can’t provide for their families here. Almost all pastors need to have a second job to help cover expenses which takes them away from full-time mission work.

Persecution continues to grow, making some stronger and others fearful. One fellow leader lost his job three times when his bosses found out about his faith. By the third time the police told him that if they caught him again they would plant drugs on him and he would go to jail for the rest of his life. Every week we hear about homes being raided and large fines or even jail time given to those present. In order to protect ourselves, times, locations and days of meetings are regularly changed. Unfortunately for some it became so bad they were forced to leave the country.

The need for outside support is still very strong. A new small group of foreigners has recently arrived bringing business models and ideas for income generating activities. This is helpful because instead of just giving salaries we are developing businesses that will remain even if foreigners leave and which also help to support the leaders of the churches. Since it has become very difficult to get training and education in the country many mission workers are now working and offering training in neighboring countries which we can travel to for short periods of time. This helps meet an important need in spiritual maturity as resources and information are very limited here.

As we look to the future of the church here we see lots of potential. Still young, less than 20 years old, with a country which looks increasingly outwards for help, there are many ways for the larger body to serve a group of believers making up less than 1% of the population. Finding ways to invest in the leaders both financially and educationally is crucial for multiplication. They need encouragement from the larger body to remind them that they are not alone. I have had the opportunity, along with many others, to travel to neighbouring countries to bring the good news. This type of effort has been very effective as our cultures and languages are very similar. In order to continue this and other efforts we need more and more people around us. Just as Paul wrote to the Corinthians, “this service that you perform is not only supplying the needs of God’s people but is also overflowing in many expressions of thanks to God, (2 Cor. 9:12)”.

A Body of Many Parts

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Theology / Church