How Does Physical Health Impact a Missionary’s Decision to Leave the Field?

by Andrea Sears

There are many things about living on the mission field that can influence the physical health of missionaries and their families. When the body does not cooperate, even the most simple of tasks can become difficult. Sickness can necessitate trips to the home country for treatment, or even permanent relocation to an area where full recovery is possible.

We measured the frequency and strength of influence on the return decision for the following statements considered to be host-country-related factors:

  • I experienced significant health problems.
  • My spouse experienced significant health problems.
  • My child/children experienced significant health problems.
  • There was inadequate health care in my host country.
  • I had a lack of health insurance.
  • I felt that stress affected my health.
  • I felt that stress affected the health of others in my family.
  • I had limited access to clean water.
  • I felt that the climate/geography affected my health negatively.
  • I felt that pollution affected my health negatively.

When it comes to health matters, neither missionaries nor their sending churches and agencies are necessarily in control of how their bodies will respond to physical conditions, challenges, and illness. Country factors impacting health, such as climate and pollution, can hardly be changed. However, it is hoped that this data will be helpful for its descriptive value, as well as for the limited conclusions we can draw about preventable factors of attrition related to health. It may also suggest areas for deeper etiological research into the health of missionaries. 

 

Results
The table below summarizes the results for each question by providing: 

  1. The percentage of respondents who said that they experienced this factor on the mission field,
  2. The percentage of respondents who experienced the factor that said that this factor did (to some degree) affect their return decision, be it a slight, moderate, or strong effect, and
  3. The “strength index” of each factor, weighted for the size of the effect on their return decision. 

 

Discussion of Quantitative Results
It is noteworthy that more than half of missionaries reported having serious health problems. More than one-third reported serious health problems for their spouse. And one-third reported serious health problems for at least one child. These are very high rates of sickness for the periods of time being reported (the average tenure was approximately 8 1/2 years). In all three cases, over half of the respondents reported that this issue affected their decision to return to their home country, and to an overall moderate degree. It is hard to know how much overlap there is between the three categories, but clearly many families have multiple people experiencing significant health problems, which can compound the stress of dealing with them.

The most significant finding of this section (and indeed, one of the most significant in the survey) is the degree to which participants felt that stress affected both their health and the health of their families. More than two-thirds felt that stress affected their health, while half felt that stress affected the health of other family members. In both scenarios, this affected the return decision in 68-70% of cases, and to a relatively strong degree. These findings seem to indicate that the whole family experiences the stress of living on the mission field and is affected by it. Spouses and children are not immune. In addition, when stress is affecting the health of the whole family, the likelihood of attrition increases.

 

Qualitative Data
To survey the most frequent types of health problems experienced by missionaries, in addition to the quantitative scaled data, we collected open comments on the following question:

  • If applicable, please describe any serious health problems that you, your spouse, and/or your child/children experienced.

The collective suffering reported truly shows the sobering costs of the missions call, and the astonishing bravery and stamina of missionaries in facing them.

Many missionaries reported here on mental health issues that they and their families experienced. There is a subsequent section specifically pertaining to mental health, but at this point in the survey, respondents would not have known this, so some provided it here. The analysis of and commentary on mental-health-related data will be set aside until publishing of the relevant section, except for one very important observation: Missionaries reported mental health issues more than any physical health category, and this occurred without them being asked to include such issues specifically.

We must remember that these were self-reported “serious health problems.” We did not ask specifically about each possible health problem, nor define what constituted a serious health problem. 

 

Stress as a Contributing Factor
An important observation is the role that stress can play in many of these physical ailments, either giving disease a foothold or exacerbating a problem that would otherwise be less severe. In fact, 52 commenters specifically mentioned that they believed or were told that their physical health problems were caused by high stress: 

  • Some were diagnosed with cortisol regulation problems and adrenal fatigue, directly related to long-term stress exposure. 
  • Others developed disorders that are known or suspected to have stress as a contributing factor, such as migraines, gastric issues, high blood pressure, autoimmune disorders, insomnia, or mental health issues such as depression, anxiety, or PTSD. 
  • Still others had chronic health conditions that were potentially worsened by stress, such as asthma, diabetes, Crohn’s disease, or cancer. Stressed individuals are also more susceptible to viruses and infections, and take longer to recover from injuries and surgeries.

 

Environment as a Contributing Factor
Sometimes the physical environment in the host country was not conducive to maintaining the health of the missionaries and/or their family. This included primarily air pollution, but also natural substances that caused allergies or severe reactions. 

 

Mental and Physical “Grit”
Reading the stories of health trials reveals one type of high price paid by some missionaries for their commitment to the call. The mental and physical toughness of these missionaries is also apparent. Far from being “weak” or debilitated by their health struggles, they were more typically strong individuals who stubbornly persisted for some time despite them. 

Having a health emergency is frightening enough in one’s home country. Being in a place where you are not sure you can even get the medical care that you or your children need can cause an entirely different level of anxiety and uncertainty. One participant shared, “Frankly, any health issue seemed to be serious in an overseas context.” This is a sense of vulnerability that people in the home country cannot often understand.

It is truly impressive how much missionaries are willing to endure for the privilege of participating in the Great Commission. Sending agencies, churches, and friends back home should be aware of what missionaries may go through physically in order to provide the necessary emotional and practical support when health problems strike.

 

Lack of Support as a Contributing Factor
Even when faced with severe physical or emotional challenges, some said that they still would have stayed were it not for other barriers that came into play. For some, it was a lack of team support during health trials. Others even felt that team dynamics were actively creating stress in their lives that contributed to the health problems they experienced.

 

Conclusions
What can we learn from this data to help us better serve our missionaries? How can missionaries best protect themselves from health dangers on the mission field?

Physical health is important to all people everywhere. It enables us to have the energy and ability to follow our dreams and calling. When the body is working well, we don’t think about it. When it malfunctions, restoring it can quickly become the focus of our concern. Poor health can hobble our ministry as quickly as team conflict, family emergencies, or a loss of funding. 

We must not idolize physical health, for we know that our bodies are subject to decay and that God works through suffering as much as (or more than!) He does through health. But neither must we ignore it, naïvely missing its importance to our ability to serve. With this model of being good stewards of our missionaries’ health, but also recognizing that we are not in full control of it, we can do the following things to lower attrition:

  1. We can ensure that missionaries have adequate health insurance or a financial plan for the payment of health services. 
  2. We can train missionary candidates on physical health issues common to the area to which they are going, how to diagnose and treat them, and how to seek medical care when it is needed. 
  3. We can also train missionary candidates on the importance of stress management, and the effect that stress can have on their health. 
  4. We can practice good self-care as missionaries, being careful to steward our own health well. This includes pursuing healthy diet, exercise, and sleep habits; maintaining a healthy weight; and remembering to have regular times of rest.
  5. We can check-in about physical health when delivering missionary care. 
  6. We can provide mutual care and sensitivity to team members who are experiencing health challenges. 
  7. And finally, we can remember that even when all these things are done, there is still a spiritual war taking place in the unseen realm and physical problems may be a sign of spiritual attack. We must remember to avail ourselves of the spiritual armor of God, prayer, time in the Word, the laying on of hands, fellowship with other believers, and the power of the Holy Spirit.

And when sickness does come, we can remember that this too is forming us into Christ’s image. God still loves and cares for us even when He allows us to pass through difficult times, and these same trials can be used to glorify Him. 

 

For more detail and specific comments in the qualitative section, visit www.themissionsexperience.weebly.com/blog, or email andrea.d.sears@gmail.com to request the full pdf document of the results.

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Andrea Sears is co-founder of the ministry giveDIGNITY, which works in the marginalized community of La Carpio in San Jose, Costa Rica. The ministry focuses on Christ-centered community development initiatives in education, vocation, and violence prevention. Her family has been in Costa Rica for 11 years, and served as the Missionaries in Residence at John Brown University during the 2017-2018 year while on furlough.

6 Good Things about a Cancerous Life Overseas

I have cancer.

The first time I said it out loud, I actually had to shout it into my phone. Like shout. As in, “I HAVE CANCER!!!!!” And since I am anti-exclamation points, let the fact that I just used, like, a bajillion, communicate how loudly I shouted it.

I shouted, “I have cancer,” because I was trying to tell my husband the news.

He is not hard of hearing.

He also was not in the vicinity when Dr. D called.

I was in my car. He was not in the car with me. He wasn’t in the city with me. He wasn’t in the state. He wasn’t on the continent.

See, I got cancer while my husband and I are living on opposite sides of the planet for a season. Don’t worry about us, we’re all good. Going on twenty years of a great marriage. But our twins graduated and sixteen years ago, when we moved to Somalia, I told my husband, “When they graduate, I’m going to spend at least their first semester of college in the US.”

So here we are, sixteen years later.

And apparently, God had a plan for my life. That plan included the superb timing of me getting cancer while living in a country that has the medical prowess to detect and treat it. #miracles

But, ahem, God? What about my husband? One big perk of marriage is having a companion for life’s junk. I don’t like that part of this plan, that part that has him in Djibouti and me in Minnesota, and there is a poor telephone and internet connection and so instead of beating around the bush with something like, “The doctor found papillary thyroid carcinoma,” or, “the test results aren’t exactly awesome,” or even, “They found cancer,” which would imply it was not exactly me, or mine, or inside my body, I had to shout, to be very clear and to make sure he got the message before the internet shut off, “I HAVE CANCER!!!!!” (again, those darn exclamation points).

Anyway. My point is that this international life is hard and beautiful and amazing and sometimes, it really really stinks. Sometimes it means periods of unwanted and un-chosen separation. It means money spent changing plane tickets at the last minute. It means feeling divided. It means lonely grief. Work and team and home on one side of the ocean. Sick wife or worried husband on the other side.

But there are good things, too, about a cancerous life overseas. #learninggratitude #perspective

There are incredible aspects of the life overseas that truly manifest, to my surprise to be honest, during times of pain, grief, confusion, and sorrow.

Here Community. I have had to learn to ask for help and to accept help when it is offered. Why is this so hard? It shouldn’t be. My ‘here’ community for now is in the US and it is a community I haven’t relied on in physically present ways in a long time. Now, they are bringing me meals and driving me around and dropping off bags of goodies and giving me cash gifts for massages or books(!). The generosity of intimate family and friends, as well as near-strangers is breath-taking.

There Community. We have the incredible privilege of a ‘there’ community, which right now means an internationally located one. Usually, these two communities are reversed. But for now, over there, people are caring for my husband while we are apart. They are bringing him meals and having him over for game nights, celebrating his birthday, and checking in on him. And they are sending messages to me of encouragement. Kindness, compassion, practical care. People abroad know that we are all abroad without our closest families or friends and they step up. Local people and other expats. They move in and hold our fear and grief and it is precious.

Surrounded. I have people praying for me literally all over the world. Which means at all times of the day and night, too. I have people from all manner of faith traditions praying for me. I find this so comforting. I feel it, I feel like the inside of a Twinkie, the creamy middle. I feel weak and squishy and like, if I weren’t surrounded, I’d spread out all over the place in a goopy mess. But the prayers of my Muslim and Christian and Jewish and no-faith people are holding me together, holding me in place. I got a prayer message from a dear Somali friend the other day and nearly cried. This is such a profound and unique gift.

Thankfulness. A lot of thankfulness has to do with perspective. I have so much to be thankful for. Hospitals with no wild animals wandering through them. A knowledgeable well-trained surgeon. Fully stocked pharmacies with medications that are not expired. The timing of this adventure. Clean drinking water. An abundance of nutritious food. Toilets that flush on the first try. Hot showers. Fifteen years in a developing-world country has radically changed my perspective.

Identification. I don’t know what it is like to be a refugee or to see my country decimated by war. I don’t know what it is like to watch my children go hungry or to bury a loved one who left too young. But every bit of pain, when it is not ignored but faced, thins out the dividing lines of race, religion, wealth, politics. Like the Grinch, our hearts can grow three sizes in one day, if we choose empathy. When we make space for our own pain, space opens up, almost magically, to hold the pain of others, too.

Joy. I’m not going to say look at the poor, they’re so happy. But I will say that people who have suffered, and that always includes poor people, can develop reservoirs of joy that the healthy, strong, and powerful will never know. It is a ferocious and subversive joy that refuses to be smothered by loss or pain and because of where we live and who we choose to love, I have seen this with my own eyes. I can draw strength from that example.

What are ways that living abroad while going through trials has brought unique blessing into your life and home?

What Frames My World

I sit here in the night time silence and remember.

The air hung swollen that day, pregnant with rains ready to be delivered.  The dry blowing out with fits and bluster begrudgingly making way for the wet to come.

I watched the winds blow the first real cloud cover we had seen in months onto our evening horizon.

That evening I wrote a story in pixels to send to “Grandmother” and “Grandfather” in America. (I bet my parents never guessed they’d have QUITE so many grand babies!)  I must say I have raised camera happy children a world away.  They are anything but shy of the lens.  And a few of them are maestros behind it as well!

We sat in the fading light huddled together with bursts of giggles over silly shots and dramatic poses.  I managed to sneak in a few “keepers” too.

All at once my crutches went walking away without me, held hostage by my then almost four year olds.  ”Eh” I call out, “ITA- ita silu de, ita be arfa wa gobadu ana.”

Everyone dissolves into laughter as I tell my preschoolers:  “You, if you take my crutches, you will have to pick me up and carry me. ”  I think they strongly considered my response a challenge.  I can only hop so far on one leg.  {But oh how they have carried me these years in their prayers.  Now feisty first graders, they carry me still.  I am humbled to tears by a love so big it reaches across continents and oceans.}

I watched them turn the crutches I lean on into picture frames for my lens.  I snapped away arresting time, freezing moments in place.  I didn’t want the light to leave.  I held it captive with my shutter and refused its departure.

Could the very thing the enemy meant to disable and destroy become that which frames the greatest release of God’s glory in our lives?

Some of you know my broader story.  Born too early with multiple birth defects, 23 surgeries by age 13; standing on one leg, 2 crutches and an eternity of grace.

I have watched God turn the things meant to take me out into that which He has used to bring me in. Again and again and again.  Into slums in India, leper colonies that refused any other witness.  Into hostile trash dumps in Africa and onto national stages in Central Asia.  Most of all, deeper into His heart.  I am certain the enemy is regretting his efforts because every single one of them has backfired– his current attempts included.

Do I think it is God’s perfect plan for me to have one leg?  Absolutely, categorically not.  Do I know God is a good Papa who works ALL things together for my good?  I stake my very life on it.

The limitations, challenges and obstacles that could disable me, when submitted to Jesus, become the very things that frame the greatest displays of His goodness in and through my life.

Impossibilities are His greatest invitations. Miracles can’t exist without them. {And how we are trusting for a miracle now, a miracle as big as our growing family from all over the world.  We are radically trusting for each and every one of our children in South Sudan to be fully sponsored so we can keep our doors flung wide… }

Let me ask you my friends: what crutches, what challenges are you holding onto that God is waiting to turn into a picture frame for His beauty to be revealed in your life?

All He needs is your YES.  He really will do the rest.

Michele Perry: Artist, Author, Executive Coach & Founder of Iris Ministries work in South Sudan
blog: From the Unpaved Road | twitter: @micheleperry | work: Iris South Sudan | USA: Create 61, Edge Creative Consulting, LLC