Re-visiting Health care and Christian Response – 2013

I am quoting from an article in Christianity Today of 2009.

“The reasons Christians developed the world's first health care system—as opposed to simply medical practitioners—are as relevant today as they were 2,000 years ago. In Gary Ferngren's book Medicine and Health Care in Early Christianity, Ferngren says, "Christians of the first five centuries held views regarding the use of medicine and the healing of disease that did not differ appreciably from those that were widely taken for granted in the Graeco-Roman world." Medicine, as developed by the Greeks, was a naturalistic field. Doctors studied the body, made observations, and practiced their art without appeal to Greek divinities. So Christians had no reason to oppose its practice.
When an epidemic struck in the ancient world, pagan city officials offered gifts to the gods but nothing for their suffering citizens. Even in healthy times, those who had no one to care for them, or whose care placed too great a burden on the family, were left out to die. Christians found this intolerable, and they set about to take care of these people and others similarly afflicted. They did so because, Ferngren writes, "Early Christian philanthropy was informed by the theological concept of the imago Dei, that humans were created in the image of God."

This led not only to a belief in the responsibility to aid others and the inherent worth of every human being, but also to a belief in the sacredness of the body itself. “The idea of imago Dei also led to a redefinition of the idea of the poor. Christianity, in addition to seeing all people as "neighbors," developed a special consideration for the poor. As a result of these theological beliefs, Christians developed a robust system for caring for the poor, the ill, widows and orphans, and other members of society in need of care.

As early as A.D. 251, according to letters from the time, the church in Rome cared for 1,500 widows and those who were distressed. A hundred years later, Antioch supported 3,000 widows, virgins, sick, poor, and travelers. This care was organized by the church and delivered through deacons and volunteer societies. When the plague of Cyprian struck in 250 and lasted for years, this volunteer corps became the only organization in Roman cities that cared for the dying and buried the dead. And after the plague, with a staff of workers and an existing administrative structure, "Christian medical care became outwardly focused, now enlarged to include many who were victims of the plague."

Finally, when Emperor Constantine legalized Christianity, these services were formalized in a number of institutions, including the first hospitals. "The experience gained by the congregation-centered care of the sick over several centuries gave early Christians the ability to create rapidly in the late fourth century a network of efficiently functioning institutions that offered charitable medical care, first in monastic infirmaries and later in the hospital," Ferngren writes. (The Health Care Debate, Early Church Style; Rob Moll 8/26/2009; Christianity Today.)”

It is important to understand that, this is the legacy we are part of. But somewhere in the 700 ADs, with institutionalization being strengthened, the Christian heath care lost its “incarnational” focus. With the dawn of the enlightenment era, scientific reasoning and thinking, management revolution, drastic changes started to happen to Health Care institutions. What was seen as a Home of Hospitality became a professional run, with strict hierarchical structures, run and managed for efficiency and outcomes. The focus on Knowledge and systems and structures required for management of these “knowledge work force” changed the profile of institutions. Last few years of technology advancement, and commercialization of health care has muddied the context much more.

In the bargain, what was lost out was the incarnational, compassionate, care and focus on the poor and those in the margins of the society. Institutions became self serving, and the focus became, maintaining and sustaining well run institutions. Recognizing that we are losing the “compassionate care” efforts have been put in by many to realign ourselves to the older paradigms of care, through Whole person care systems, Health care communication systems, hospitality support systems etc. But these have not done much since these are being piggy backed on to already set in hard to change institutional systems.

It is in this context, we need to consider, if it is time to consider alternative models of health care, either within the current institutional models or outside of the same.

If healing and wholeness is our ultimate goal, if the poor and disfranchised are our focus, how do we re-engineer health care and health care institutions? Wholeness can happen only in the context of “Communities of caring” who share the pain of individuals, families and communities. If so how do we build such communities of caring?

How does one understand wholeness? What need to be done to facilitate healing and wholeness? How does this translate into systems and processes which institutions can adapt and institutionalize? These questions need to be clarified and thought through, before embarking on re-engineering or repositioning.

Wholeness has to be understood as the biblical understanding of “SHALOM” – the wholistic sense of fullness. Healing has to be understood and whole person healing and not curing alone. Healing and wholeness has to be seen in the context of the individual in his or her relationships to the family and community.

This broader understanding will definitely lead to looking beyond “clinical services” but community health, development, empowerment and transformation. For this paper, we will not dwell much of the community development and transformation, which itself could be another full discussion.

Institutional re-engineering - Re-engineering our institutions is one way to achieve wholeness as outcome. The goal should be to facilitate systems in institutions, in such a way that patients who come into contact with our institutions are provided with a support which can facilitate wholesome life change.   

Creating communities of caring within institutions itself, by creating care teams in each ward and unit, instead of working in professional silos of Medical, Nursing Allied health etc could be a start of this process. Instead of the current model of Medical, Nursing and Allied health teams working independent of each other, but each care area being defined, and developing cross functional care teams committed to setting up holistic care systems for that area of care would be a way forward. This will require teams which are long term posted to one area of care and teams working together to plan and develop systems. Leadership of these team may need to be nurses who are better at caring than doctors, and doctors could be a member of the team like any other group of professional.

Institutions also will need to create family friendly infrastructure and care systems where family members are seen as part of the care team.  These family members will need to be trained and supported and proactively invited to be part of the care team. This should be planned as patients come in to the institution and systems should be developed to take this up as a core activity of care provision. But this will also lead to physical structures being remodeled where more members of family can be part of the care team.

The local church communities also should be invited to be partners on the care system development, if wholeness is the ultimate outcome. Volunteers from churches and other sister institutions who can provide the spiritual input by listening, counseling and prying have to be proactively built in as part of the care team.

Institution “Plus” models – These are important if we need recapture the original ethos and purpose of Christian Health care. A continuum care system with home, community and institutional care working as a well oiled care continuum is another way of relooking at health care.

Primary, Secondary, and if required Tertiary care and Health promotion systems all being made available within the geographic area through partnering and net working but developing a well coordinated  referral system are steps towards this. Primary care provision could be through trained community volunteers supervised by professional staff from institution. Primary care also should have Home and domiciliary care as part of the system, in addition to health promotion, Health Education and disease prevention programs. 
Secondary care could be through Christian hospitals which will function as the hub for other programs too. Identifying tertiary care referral systems also is important.

These could lead to establishment of well-run disease management systems where comprehensive care is provided at all points of need for the individual and the family.

Proactive identifying of marginalized groups and developing such care continuum for these communities or groups have to be part of this model. Identifying health care subsidy options have to be an integral part of the planning process if the poor and marginalized have to be recipients of care.

Institution “Less” models – Building on the above Model, systems of care also can be developed where care focus is shifted back to community and home with training and building of alternative health care manpower. Home nurses, Nurse practioners and other health care providers could provide most of the required care at homes and institutions can be the hubs around which these care programs run. Institutions will continue to play a pivotal role for crises care and capacity building for the newly developed health care teams.

“No” Institution models – at least in some locations, we could do away with running institutions – leave institutional care to the state and Christian health care professionals focus on developing community and home based care systems and partner with Government and other providers for developing a continuum of care.

Can these models be revenue generating too, so that these are sustainable?  Can a broader net work of institutions and organizations be built together as consortium in identified locations to develop such models of care?  These will be questions which need to be considered as look further at exploring this.

But if this is to happen there are some pre-requisites.

We need to have the broader vision of Healing and Wholeness clear. This broader vision has to be seen in light of the Kingdom of God vision. This has to become a shared vision, one which is shared with the family, community, church, and other stake holders.

Will we have the ability to dream beyond today’s paradigms of care and have the courage to step out and try some of these?