Louisville, USA - Dr. David Dageforde's life changed in a makeshift medical clinic in remote Ethiopia as he stared into the yellow, sunken eyes of a man with advanced liver disease.
The man's family had carried him three hours on a stretcher fashioned from tree limbs and a blanket. Dageforde's years in a lucrative cardiologist practice in Louisville had taught him that this man would die, 11 hours from the nearest hospital.
Amid the grieving family, a missionary began praying, talking of eternal life.
``Seeing their eyes, their faces, their look and understanding" revealed the awesome power of connecting healthcare with spirituality, Dageforde said.
It's a revelation that hundreds of thousands of other evangelical Christians have experienced, and it is changing America's foreign policy. Pressure from medical missionaries helped focus the Bush administration on AIDS in Africa and on genocide in Sudan. It is also one of the forces behind President Bush's faith-based initiative -- his effort to give religiously inspired groups more federal funds to provide services such as healthcare, education, and food to people in the Third World.
Dageforde, who founded an annual conference on medical missions that attracts thousands of doctors, nurses, and untrained volunteers, says that while spiritual revelations transformed his medical career, medicine is also changing the way missionaries convert souls.
``To give a Gospel message without caring for the people doesn't work," he said. ``Now, we try to care for the whole person -- physically, mentally, spiritually."
Drawing lessons from Jesus' life and from near-mythic role models like Dr. David Livingstone , medical missions are blossoming in popularity. Packing pills and syringes alongside their Bibles, an estimated 150,000 American Christians took medical mission trips last year of anywhere from a few days to several months, joining the approximately 2,000 medical professionals who are full-time missionaries.
More than 100 US-based organizations -- mainly nonprofits that are loosely affiliated with particular evangelical churches -- help supply or organize medical missions, according to the most recent Mission Handbook published by the Billy Graham Center at Wheaton College in Illinois. Countless churches sponsor their own trips, typically with volunteers paying their own way.
By presenting healing as the product of the word of Christ, the movement joins proselytizing and the practice of medicine to a degree that troubles some medical ethicists. Critics argue that offering basic medical treatments as the work of Christ is a manipulative way to gain new Christians.
But to those who serve in medical missions, the twin goals of physical and spiritual treatment are impossible to separate.
``Doctors treat, but God heals," said Dr. Sam Molind , a facial surgeon who has been on more than 100 short-term medical missions and now directs Global Health Outreach, a not-for-profit that organizes such trips.
``There is a marriage in the ministry of Christ between health wellness and accepting him as Lord and Savior," Molind continued. ``To me, that's an inseparable thing. Faith and medicine are related. There is a healing -- a health and a wellness -- that comes from your faith."
Though many groups eschew federal funds for fear of detracting from their religious goals, the world of medical missions is so intertwined that federal dollars are sometimes involved in missions even if the sponsor does not receive government money.
Medical suppliers and mission hospitals are among the largest recipients of federal aid among faith-based groups, so even if missionaries themselves do not get funding, they might at clinics outfitted by the US Agency for International Development.
The Bush administration's efforts to clear obstacles to faith-based groups receiving foreign-aid contracts have expanded the reach of medical missions, as the missionaries themselves have changed the image of the United States overseas.
The Rev. Franklin Graham , the president of Samaritan's Purse -- which received federal assistance for medical centers in Angola and Sudan -- estimated in a statement on his website last year that such hospitals bring ``thousands of people each year to salvation in Jesus Christ."
Said Graham: ``As God uses the medical ministry of Samaritan's Purse to ease pain and suffering, He also enables us to introduce multitudes to the Great Physician."
Inspiration for missionaries
When Dageforde saw a flier at his Southeast Christian Church in Louisville advertising a medical missionary trip to Ethiopia in 1994, he was interested in it as an adventure, on par with his scaling of Mount Rainier and Kilimanjaro.
But he returned with a renewed sense of purpose. He sold his Porsche 944 and bought a 1984 Chevy pickup. He resigned as managing partner of his heart practice and scaled back to part time, to allow more time for missionary work.
In addition to organizing the annual Global Missions Health Conference at his Louisville church, he's been on 17 mission trips -- to India, China, Gabon, Afghanistan, Guatemala, and five more times to Ethiopia. He often prays with his patients after administering treatment.
``It's easy to go to church on Sunday and be a good person during the week, but I saw the Gospel lived," Dageforde said.
Now, he's become a hero to many medical missionaries, alongside others who cast a larger-than-life aura. Their stories have become powerful religious allegories for those who seek to follow in their footsteps.
Don Richardson , who lived among indigenous peoples and now teaches classes for would-be missionaries, tells a story about a young tribesman and his ear.
A wild pig had opened a gash so deep that the ear was hanging by its lobe. Given the sparse supplies Richardson and his wife, Carol, had in what is now Papua, Indonesia, reattachment would be a challenge.
He also knew that, in keeping with Auyu tribal custom, he and his wife could be killed if they were believed to have contributed to the man's death.
``It might turn gangrenous and the poison would go to his brain and kill him," Richardson recalled. ``We had to be very careful."
Yet the man insisted that he'd rather die than lose his ear. So Richardson held a generator-powered lamp while Carol, a nurse, sewed the ear back on.
The operation worked -- and the Richardsons were on their way to converting another Christian. It was a pattern repeated countless times over the 13 years they lived among remote tribes. Richardson estimated that he and his wife saved, on average, the life of one person a day; receiving such care ``softened hearts," he said, and led whole villages to convert to Christianity.
Similarly dramatic stories of conversions made possible by seemingly miraculous medical care have drawn innumerable people of faith to mission work.
Beginning with Saint Paul of Tarsus, innumerable Christians have devoted themselves to answering Old and New Testament commands to spread the word of God.
But despite biblical stories of Jesus healing physical ailments, the concept of adding healthcare to missions is less than two centuries old. Before that, missionaries had neither the ability nor the desire to heal those they sought to convert, believing that their main focus should be on spiritual needs, said Arun W. Jones , who teaches mission history at Austin Presbyterian Theological Seminary.
Doctors first joined in missions in the early 19th century, primarily to care for the missionaries who were being exposed to unfamiliar diseases and conditions. By the mid-1800s, however, Livingstone and other pioneers were using improved medical treatments to break down barriers to conversion, presenting the message of Christ as part of their care.
``By end of the 19th century, you had a change in rhetoric," Jones said. ``There's a sense that Western medicine is not simply a new and helpful technology, but Western medicine is one of the signs of what Christianity can do."
With the support of mainline Protestant denominations that helped build mission hospitals, medical missions grew dramatically through the first half of the 20th century, creating what some called a ``golden age" for medical missionaries. By 1925, the World Missionary Atlas counted 1,157 missionary doctors from Europe and North America.
After World War II, as medical costs skyrocketed, mainline denominations dropped some of their support for medical missions. But the drop-off has been more than offset by the nonprofit groups and their legions of volunteers.
``We've basically won the argument: Faithful Christians are supposed to care about the whole person," said Ronald J. Sider , a professor of theology at Palmer Theological Seminary in Pennsylvania. ``Persons are not just souls, or not just complex material machines. They're some profound mix of spiritual and material. The only way to get the most effective transformation is to work at every aspect of the person."
Medical missionaries report stunning successes in making conversions. Dr. David Stevens , who spent 11 years as a missionary in Kenya, said his hospital converted 5,000 per year on average, while tending to people who had no other access to healthcare.
The hospital held chapel services every morning and suspended patient care during that time to emphasize religion. They prayed with patients and taught the Gospel. Most powerfully, Stevens said, the doctors served as living examples of the power of Christ's love.
``The message of our religious beliefs was magnified by the care we had for patients," said Stevens, executive director of the Christian Medical Association. ``Nothing speaks louder than sacrifice."
Such sacrifice can have a profound impact on the practitioners as well as the recipients of care. Susan Harris , a registered nurse who came to a missionary training course in Louisville to prepare for an upcoming mission to Afghanistan, said she expects to witness divinely directed ``healings," strengthening her own faith and helping spread the message of Christ.
``They'll see that God is real, that he heals people, and that's a huge open door," said Harris, 24, of Charlestown, Ind.
Missionary doctors generally insist that they never refuse treatment to anyone who is not receptive to their religious messages. Yet bringing medical care under the umbrella of religion inevitably raises questions of propriety -- particularly if the people being served have no other access to modern medicine, said Richard P. Sloan , a professor of behavioral medicine at Columbia University Medical Center.
``Who could object to medical professionals taking time out of their practices to go to impoverished areas around the world to deliver free care?" Sloan said. ``But if the delivery of medical care is contingent on some kind of manipulative or coercive religious communication, that's another story. When you're talking about people with no other sources of medical care, who are desperately ill, this kind of thing can be outright manipulative."
With cures, a lesson
Yet far from separating the medical from the spiritual, many missionary groups strive to intertwine the two to the point that they are indivisible.
At Medical Ambassadors International, one of the leading groups in medical missions, missionaries are trained in a strategy called ``Community Health Evangelism," which aims to fully integrate healthcare with Scriptures.
Missionaries learn to present malaria, for instance, first in medical terms -- what causes the disease, how it's spread by mosquitoes, and how cyclical symptoms make some people wrongly believe they are cured. Missionaries administer vaccines and treatments and also teach a scriptural parallel from the Bible's First Epistle of Peter: ``Your enemy, the devil, prowls around like a roaring lion looking for someone to devour. Resist him, standing firm in the faith."
Clean water is presented as Christ's ``living water," from the Gospel of John. Missionaries also quote biblical passages to impress the importance of clean latrines and basic agriculture. The aim is changing the behavior that causes disease, not just treating diseases, thus providing a path to healthy living as well as salvation, said Henri Haber , the group's director of mission advancement.
``We don't ask people to convert. We ask them to follow Jesus," he said.
Perhaps nowhere is the approach more evident than with HIV/AIDS. Some church groups used to shy away from AIDS patients, in large part because of the behaviors associated with the disease.
But Dr. Florence Muindi , a veteran missionary who has worked extensively in Kenya, Ethiopia, and Sudan, said she has detected ``a major shift" by religious organizations in recent years. As AIDS has exploded across Africa, missionary doctors have responded as if they have a ``special obligation," since they perceive so many sufferers to be in need of both medical help and spiritual assistance.
``The church is the custodian of the true solution to AIDS," Muindi said, referring to the behavioral changes that can stop the disease's spread. ``If there's anything positive about the pandemic, it's the way people are more receptive to the Gospel when they have a terminal illness. The church has the mandate to deal with such things, and they have the message to bring about a change in behavior that is lasting."
Spreading the Gospel is a task medical missionaries approach with a sense of urgency; many evangelicals believe Christ represents the only path to salvation and see healthcare as a way to reach more hearts. David Sills , a professor at Southern Baptist Theological Seminary who has traveled on missions in Ecuador, said the knowledge that so many people have yet to be reached serves as his daily inspiration.
``Fifty thousand people die every day never having been exposed to Christ," Sills said. ``What motivates me and gets me up every day is that if we don't reach these people, they're going to hell for all eternity."
Medical missions are spreading at the same time that evangelicals have grown more aggressive in seeking to convert Muslims and combat the influence of Islam, a trend that has quickened in the years since the Sept. 11, 2001, terrorist attacks. Islam, like Christianity, puts an emphasis on proselytizing, and many areas where Christian missions are active have significant Muslim presences.
Richardson counsels missionaries-in-training to learn enough about Islam to persuade Muslims to convert. ``I see world history as culminating in a to-the-finish-line test of wills between the two leading religions: Christianity and Islam," he said.
Not all missionaries judge their effectiveness by the numbers. Some veteran medical missionaries say the days of sudden cures bringing instant conversions are largely over, since so much of the world now at least knows of modern medicine even if so many lack access to it.
John Verburg , a Laramie, Wyo., resident who has led more than three dozen mission trips and has been on short-term trips for 30 years, recalled a visit he made to Honduras in August. The team of 12 -- including a doctor, two dentists, and a nurse -- saw nearly 900 people in eight days.
They treated burn wounds and rotten teeth and even high blood pressure, yet they did not convert anyone. But as his team was leaving, he saw a group of children drawing pictures of the nativity scene, and of Jesus walking on water. The children probably didn't grasp the spiritual messages, but the next team of missionaries in the area will have something to build on, he said.
``In terms of healthcare, we're not making a permanent difference," Verburg said. ``Where we make a difference -- eternally, I think -- is by coming down, everybody knows that we came down as Christians.
``I don't see the instantaneous, quid-pro-quo kind of thing with conversions," he continued. ``But I do believe, since we go as Christians, and we come being known as Christians, what we do is interpreted for the glory of the kingdom for many, many years after we leave."