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.
The table below summarizes the results for each question by providing:
- The percentage of respondents who said that they experienced this factor on the mission field,
- 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
- 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.
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.
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:
- We can ensure that missionaries have adequate health insurance or a financial plan for the payment of health services.
- 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.
- We can also train missionary candidates on the importance of stress management, and the effect that stress can have on their health.
- 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.
- We can check-in about physical health when delivering missionary care.
- We can provide mutual care and sensitivity to team members who are experiencing health challenges.
- 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.
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.