In 1993 I visited four mission hospitals in Zimbabwe and Mozambique.
Sadly, they are all in very much the same chronic distress as hospitals
throughout the Third World: broken-down equipment, leaking roofs, staff
shortages, power outages, overcrowding, outdated and inappropriate medicines,
inadequate water and sewage systems, and endless lines of out-patients.
With enormous courage and commitment, the staff are performing feats
no less than miraculous under the circumstances. Working long hours, most
expatriates and nationals are doing the job of two or three persons.
All the hospitals have some degree of cooperation and support from the
government. Staff are paid from government grants and, in some cases, funds
for other budget items are provided. Two of the hospitals are training
nurses for the government.
Budgets of the four hospitals are funded, universally inadequately,
by government, church, patients, and donors. Hospitals pay the church a
fee for "administration", which exceeds the grant from the church, so the
church is, in effect, making money from institutions that are struggling
to survive financially.
With enormous courage
and commitment,
hospital staff are performing
feats
no less than miraculous.
Having visited dozens of hospitals in developing countries, I have become
aware that most of those that are doing well financially are treating only
those who can afford to pay enough to meet the institution's needs. This
raises questions of mission and purpose.
None of the four hospitals has a written statement of mission, vision,
or what they are about, and apparently there has been no opportunity for
discussion between church leaders and current staff regarding the function
of the hospitals within the total mission of the church. Some of the staff
feel the need for more supervision or at least "interest" on the part of
the church. If hospital administrative committees or boards exist, they
are made up mostly of hospital staff with little or no input from church
or community. Where church "medical committees" exist at the national level,
they are apparently not functioning.
There are one or two doctors at each hospital, but they should have
at least three for minimum functioning and more to meet government requirements.
At one hospital, the two doctors provided by the Methodist Church of Austria
will be leaving soon. At another, the doctors from Germany are provided
by a secular nongovernmental organization. Zimbabwe graduated 30 medical
doctors in 1992; 29 are reported to have left the country for higher paying
jobs.
While hospitals struggle to survive, the vast majority of the people
of southern Africa still have no access to any kind of medical care. Zimbabwe
has trained "village health workers" throughout the country, but most are
not functional due to lack of supervision and support. For the most part,
even when the know-how and the will are there, the resources are not.
The dire situation for mission/church hospital ministries is a global
phenomenon. A world conference is needed, bringing together thinkers and
doers from all continents and perspectives to discuss the plight of hospitals
and find solutions. This is a problem one church agency cannot solve alone.
It would be a discussion vital to all churches and mission boards.
