The crisis of our health-care system touches us every day. Employers, the working poor, the unemployed, parents of young children—all struggle with a system that costs too much yet does not truly prevent suffering.
Unfortunately, the debate over health-care reform has too often been dominated by concerns about money and privilege. People of faith have not yet succeeded in putting moral issues into the center of the debate. But churches have a wonderful opportunity to make their voices heard and their actions count.
Religious groups have long been at the center of efforts to heal the sick. According to medical historian Henry Sigerist, Christianity entered the world as a “religion of healing.” Churches and religious orders through the centuries have been known for founding hospitals and homes for the aged. Just as science has advanced, so has the effectiveness of religious organizations. In 1994, some of the most sophisticated medical centers in the world are owned by churches. Roughly 29 percent of all the hospital beds in the United States are owned by Catholic or Protestant groups. But more can be done.
Approximately 300,000 houses of worship can participate locally and directly in resolving the crisis in health care. The least we can do is be sure that everyone has access to basic medical services. But our concerns should go far beyond the question of who gets access to a system geared to curing disease. Health-care reform should focus on prevention, justice, and partnership.
Churches should first realize that preventing suffering has higher ethical priority than curing disease.
Prevention is a harder concept to communicate than curative medicine. Observ-ing a sophisticated operation to remove a tumor is far more dramatic than convincing a teenager not to smoke. But the ethical priority must be to avoid the cancer in the first place. Many urban hospitals routinely employ extraordinary medical technology to save the lives of underweight and premature infants. But it is far more compassionate to prevent such problems by seeing that every mother gets prenatal care and adequate nutrition.
Ten years ago the Carter Center conducted studies with experts in numerous health specialties to understand what would happen if our society would apply our current knowledge and technology to preventing disease. The findings revealed that more than two-thirds of all illness and years of life lost before age 65 were due to health problems that could be avoided by changing our own personal habits.
A recent study coauthored by Carter Center fellow William Foege in the Journal of the American Medical Association suggested that an even larger portion of health-related suffering is preventable. Officially, heart disease, cancer, cerebrovascular disease, accidents, and chronic pulmonary disease account for most of the 2.1 million people dying annually of the 10 leading causes of death. But what actually causes these deaths is tobacco (400,000 people), diet and sedentary lifestyle (300,000), alcohol (100,000), infections (90,000), toxic agents (60,000), and firearms (35,000), followed by sexual behavior, motor vehicles, and drug use. Churches, with their influence on how people behave, can have great impact in these areas.
Health-care reform also has to do with justice.
Roughly 29 percent of all the hospital beds in the United States are owned by Catholic or Protestant groups.
Matters of health are far too important to Christians to relegate them to others. Regardless of the outcome of health-care reform, people of faith will be drawn to visit the sick and the lonely, the hungry, and the hurt. More than one-third of the biblical stories of Jesus involve healing. Although most congregations have at least some activity in this area, few have matched the priorities of the Savior in spending time with the sick, counseling the troubled, or confronting problems that result in disease.
Staff at the Carter Center’s Interfaith Health Program have visited with hundreds of community leaders who have found practical ways to make a tangible difference in the hardest health problems our society faces. At a conference at the center earlier this year, 140 of these leaders from a variety of faiths and backgrounds came together to share what they knew about how to respond to the challenges of AIDS, mental health, hunger, violence, substance abuse, adolescent sexuality, and poverty. Everyone present was personally involved in doing something about the problem being discussed.
They had no easy words or quick fixes to share. But we found no problem that was not being confronted successfully by some church or religious group.
The debate over health-care reform has too often been dominated by concerns about money and privilege.
Health is too complex, and the issues too troubling, for any of us to do very well by ourselves. We found that the most successful ministries were done in collaboration, often across denominational boundaries. Churches that joined with other churches and religious organizations found they could do more in partnership than they could working separately.
Government is also a crucial partner in the work of health and healing. In our society, it is important that neither church nor state use the other to achieve dominance in certain areas of interest. However, collaboration in serving the poor and the sick is a practical necessity. Churches and welfare offices refer people back and forth; public health clinics and religious hospitals work closely together; church food banks use government food; and government programs for the elderly often use church buildings.
Unfortunately, many Americans do not believe a positive solution to the health-care crisis is possible. This is extraordinary given what we know about how much suffering is preventable. At no time in our history could we be as realistically optimistic about bringing health and wellness to our society. In this context, the most crucial contribution of faith groups is faith itself.
Our words have little meaning if not accompanied by actions. Our research has identified several gaps that people of faith must bridge if we are to reach the goals we seek:
■ We must confess to a gap between what we say we believe and what we actually do. Many congregations are recognizing the distance between their own ideals of service and social justice and the day-to-day activities of their congregations.
■ We must close the gap between what is known in health fields and what is applied. For example, even though we can prevent or cure many mental illnesses, society’s stigma against people with mental illness often keeps them from getting the help they need. Churches can lead the way here.
■ We find a constant gap between the creation of successful programs and their replication in other settings. Effective models are rarely known outside certain groups’ circles of interest. We must help bridge this gap and encourage learning across the boundaries between faiths and professional specialties.
■ We must work at the gap between denominational traditions, races, and cultures. The hour of worship remains the most segregated hour of the week, which cripples our ability to understand the full range of what God would have us do in the world.
■ Finally, there is a gap between our current wants and our long-term needs. It is not enough to seek the health of our own circle of friends or even of those in our own time. We must, like the Native American elders, ask how an action will affect the seventh generation.
Is it realistic to imagine a movement of thousands of congregations reaching out to their neighborhoods as agents of wholeness and healing? We think so. There is hardly any congregation, any faith group, that does not look to serve God by alleviating suffering.
Such discussion of a national health movement is exciting, but it can obscure the demand for local commitment. Congregations should think of their own communities. They should make sure that every child is immunized against the basic diseases before the age of two; that every person has access to the rudiments of medical attention; that every pregnant woman receives prenatal care; that every elderly person is contacted each day, just to make sure he or she is okay; that every young person has a safe place to study.
None of this is expensive or complex, especially if we approach the tasks in collaboration with others who share our commitment to health.
President of the United States from 1977-1981, Jimmy Carter currently chairs the Carter Center in Atlanta, a non-profit organization promoting peace and human rights worldwide. The center launched its Interfaith Health Program in September 1992.
Changing Lives On Both Ends Of A Hypodermic
Numbers testify to the importance of Esperanza Health Center to the North Philadelphia Latino community it serves: 43 percent of families living below the poverty level; over 75 percent of children born out of wedlock; over 70 percent of adults lacking a high-school education. Most children here are behind in their immunizations, making childhood diseases more than just a nuisance. Most people think it impossible to die from measles. But in 1992, eight children from this community proved otherwise.
There are more disturbing numbers in this neighborhood. Located in one of the heaviest drug-trafficking areas on the East Coast, it has Philadelphia’s highest infant-mortality rate, three times the city’s average. Its suicide rate also ranks first.
However, thanks to Esperanza—the name is Spanish for hope—there are some good numbers, too. A host of doctors specializing in family medicine, internal medicine, pediatrics, and cardiology offer residents personal care integrated with nutrition education, Christian counseling, and social work. In response to the measles epidemic, Esperanza arranged for more than 40 students from the Medical College of Georgia in Atlanta to head north. For six weeks, the good old days when doctors made house calls returned. These young med students combed the neighborhood, delivering almost two thousand shots, 79 percent of them to children who were behind on their immunizations.
To Carolyn Klaus, Esperanza’s medical director, 400 was the most important number associated with that immunization effort. That was the number of people who either came to believe in Jesus Christ as Savior or said they wanted to know more about him.
The significance of this number is revealed in the first sentence of the ministry’s philosophy statement: “At Esperanza Health Center, we believe that fullest health comes through knowing Jesus Christ.”
That is why Esperanza does its best to coordinate its activities with the missions of local churches. Says Klaus, “Health care is perhaps only 20 percent medical. The other 80 percent has to do with jobs, housing, lifestyles, conflict resolution, meaning in life, forgiveness, and belonging to a caring community. What institution is better equipped to meet these needs than the church?”
Many of the community’s spiritual and physical needs, according to Klaus, can be addressed by laypersons, including people trained in the basic principles of preventive health care.
But, she says, prevention alone is not enough: “The area of need that grips me most every day is the area of mental health. One out of every three persons I see has a mental health problem sufficiently severe to interfere with his or her functioning or physical health. Many problems are very serious.”
Some of these problems—in particular, those that are spiritually rooted—can be handled by local I pastors. But, says Klaus, “The need for Christian counselors and social workers who are willing to serve the poor remains dire.”
While much remains to be done, much is being done, thanks to Esperanza. It expects some 100 students to participate in this summer’s child-immunization program. And it expects lives to be changed forever on both ends of the hypodermic needle.
—REPORTS BY RANDY FRAME.
Dying For Hope
Home of Hope sounds like the name of a place with a view to the future. In reality, this Grand Rapids-based ministry focuses on those who seem not to have much of a future. Indeed, people must be dying to get into Home of Hope, for it accepts only those in the last months of terminal illness, including people with AIDS, who have nowhere else to go and no one to look after their physical and emotional needs. Its 18-bed facility is always filled to capacity. Approximately 350 have come and gone in the last three years.
When it opened in 1990, Home of Hope represented the fulfillment of a vision for Paul Van Oss. In the early 1970s, as part of his work with World Vision, he visited a Home for the Dying run by Mother Teresa in Calcutta, India. “I sensed the presence of Christ—in the care, compassion, and love extended there—in a very dramatic way,” he recalls. “I felt I had been put in touch with a little bit of heaven.” He adds, “This kind of ministry offers the church a chance to get beyond peripheral theological differences and work together. It is evangelical ecumenism at its best.”
The medical care offered at Home of Hope makes no pretense of curing. Rather, it is intended to relieve such symptoms as pain and nausea. Home of Hope eases the burden of its patients by creating aesthetically pleasing surroundings, good-tasting meals, and, perhaps most important, an environment where people feel at home, free to talk about anything from their childhood memories to their present fears. As one person put it, this is a place “where people live while they are dying.”
Despite the pleasant appearance, Home of Hope might seem at first glance a depressing place. Upon closer inspection, however, it becomes clear that Home of Hope has the future in mind after all. As the booklet for patients published by the ministry affirms, “The last word belongs to God.… God raised Jesus Christ from the grave and in this resurrection miracle all the terrors of death were overcome.” Despite the pervasive presence of death, Van Oss’s ministry points not to suffering and disease but to a future overwhelmed by the hope of eternal life.
A Road To Happy Endings
The staff of Columbia Road Health Services in Washington, D.C., like to view each of their patients not as statistics, but as stories. Behind each visit—and each need—is a story, one that physicians and other staff take time to learn. Tom, for example, was a 53-year-old man forced into a city shelter because of an apartment fire. Years of hypertension left him with kidney damage. After visiting Columbia Road Health Services, he received the lab tests and medications he needed. Connie, an elderly woman from El Salvador, came to the clinic because she had lost 30 pounds in just a few months. She discovered there she had diabetes. Oral medication took care of the problem for a while; the medical staff at Columbia Road eventually taught her how to administer her own insulin shots.
In 1994, this ministry, begun in 1979 by Washington, D.C.’s Church of the Savior, will encounter some 15,000 stories, many of them depressing.
But the story of Columbia Road itself is an uplifting one. The ministry is dedicated to serving those who cannot gain access to the mainstream health-care system. For some, the system is too confusing or impersonal. For others, it is unaffordable. Columbia Road answers the need with a staff that includes four medical doctors, eight medical assistants, two nurses, three social workers, and three counselors.
The story of Janelle Goetcheus, medical director at Columbia Road, is also inspiring. Back in the mid-1970s, she was preparing to go to Pakistan to serve as a medical missionary. That all changed after she visited some friends in Washington who showed her an inner-city housing project, complete with falling ceilings and hallways littered with dead rats. “I knew there were health needs overseas,” she recalls, “but I had never heard anybody talk about health needs in the inner city.”
Instead of going to Pakistan, she and her family came from rural Indiana to the nation’s capital. (She still pronounces it “Warshington.”) There she launched the health clinic that grew into Columbia Road Health Services.
There is nothing like proximity to centers of political power to reveal the limitations of government. “The structure of the welfare system,” Goetcheus observes, “is harmful to the family unit. Sometimes people have to separate in order to survive.”
Her top concerns are for the city’s children, whose housing and educational opportunities seem to be getting worse instead of better. Her other main interest is young black men who are hardened by a prison system that has virtually no concept of rehabilitation.
Goetcheus, now 53, and her husband raised a family in the city on an income more typically associated with a schoolteacher than a physician. There were times, she says, when her children resented the lifestyle their parents chose for them, but today they regard the experience as a gift.
For her part, Goetcheus is sustained for the long haul by actively participating in a strong community of faith. The medical work is important, but it is not of ultimate importance. She spends an hour in prayer each day. Every Thursday afternoon, the medical office is closed for worship. Four times a year it closes while the staff goes on retreat.
It is a sense of obedience and devotion to Christ that motivates Columbia Road to make sure as many as possible of those 15,000 yearly stories have happy endings. And those happy endings are made more possible as people hear and experience the message that God loves them, no matter how sordid their stories might be.
Paul Brand is a world-renowned hand surgeon and leprosy specialist. Now in semiretirement, he serves as clinical professor emeritus, Department of Orthopedics, at the University of Washington and consults for the World Health Organization. His years of pioneering work among leprosy patients earned him many awards and honors.
