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The Training Of A Medical Missionary

( Originally Published 1913 )

" The first then, and incomparably the most important qualification for Medical Missionary Service is love; love that can be felt, that practises as well as preaches."—DR F. HOWARD TAYLOR, OF CHINA.

THE subject which is to claim our consideration in this chapter is one whose significance it is impossible to overstate or to estimate too highly. The preparation of the individual worker, who enters upon the service of Medical Missions, manifestly touches the whole of the enterprise. It bears a vital relation to the success or failure of the cause, and demands the most careful thinking that can be given to it. If there is defect here by so much is the entire work weakened. Equally on the other hand if the training of a Medical Missionary is what it should be, the gain resulting tends to the advance of the whole work.

How important this is, may be gathered from the way in which the question of training occupied a fore-most place in the deliberations of the Medical Missionary Conference at Edinburgh in 1910. At the first session of this important gathering, the following findings were unanimously adopted and sent to the Fifth Commission of the World Missionary Conference, who subsequently annexed, them to their Report :

" 1. That the Medical Missionary should be in definite charge of the spiritual work of the Medical Mission, and that this meeting heartily endorses the recommendations in the Report on Commission V. in regard to the spiritual preparation for such work.

" 2. That the professional preparation of Medical Missionaries should be as thorough as possible, and that no one who has not passed through the complete medical curriculum and obtained a diploma or degree in medicine from a recognised examining body should assume the title of Medical Missionary.

" 3. That seeing it is impossible for each denomination to have a Medical Missionary training institution of itself, such interdenominational institutions as exist, namely, taking them in their chronological order of foundation

(1) The Edinburgh Medical Missionary Society in Edinburgh ;

(2) The London Medical Missionary Association in London ;

(3) The American Medical Missionary College at Battle Creek, Michigan ;

(4) St Luke's College (Guild of St Luke), London ; and

(5) The Medical Missionary Institute for Germany

and Switzerland at Tubingen, Germany—should be encouraged in their work, and warmly commended to the sympathy and prayer of all interested in Medical Missions.

" 4. That every Medical Missionary should, before proceeding to the foreign field, have held, where possible, a resident post at a recognised hospital, and post-graduate study in special departments, and in particular eye and tropical diseases."

These recommendations cover a wide ground and reveal the strong feeling as to the preparation of Medical Missionaries which found voice at this Conference. Taken with the important section of the Report of the above Commission, dealing with the same matter, we have some of the ripest and soundest lines of guidance that can be offered in this connection. It will be our object in this chapter to discuss the subject under the two headings, Professional and Missionary ; but before proceeding to do so it may be well if we recall to our minds four essential points.

First of all, let us remember that the Medical Missionary is a member of the general missionary body. He is, it is true, a specialist in the ranks of missions, but he is none the less a bond fide representative of that noble army of workers whose primary and eternal purpose is the spread of the Gospel. Because it so happens that his particular work necessitates large differentiation in both his preparation and actual service, there is no reason, rather the reverse, for viewing him in any other light than that of a missionary. The missionary enterprise is not a series of disconnected units, it is one organic whole and has one predominant aim throbbing through every part. That aim is to obey the Saviour's last command and carry the message of His redeeming love to all mankind. And whatever prefix the missionary may have attached to his name, such a word is not, nor must ever be, more than an adjective of distinction.

Then in the second place it is necessary to keep the fact well in mind that the Medical Missionary is a missionary entrusted with a twofold piece of work. The aim may be, as we have already seen, one and indivisible, but the contribution that the Medical Missionary makes towards the accomplishment of that end runs along two perfectly distinct yet inseparably connected paths of service. As was defined at the London Conference on Medical Missions, which met in 1884, " a Medical Missionary is a legally qualified Medical Practitioner called of God and set apart for the twofold work of preaching the Gospel and healing the Sick." That is to say, neither of those capacities taken separately makes him a Medical Missionary, nor if they fail to exhibit between each other the closest harmony and collusion, can he assume that title. The very essence of the true conception of a Medical Missionary lies in this blending of two vocations into one two-sided ministry. Therein, as we saw in an earlier chapter, lies the very genius of Medical Missions, and it is of first importance that the stamp of this ideal should be impressed upon the Medical Missionary from the earliest days of his preparation.

In addition to these two essential preliminary considerations there is yet another of whose relevancy there can be no question ; we refer to the necessity of the Medical Missionary being one who is not lacking in general educational culture. Everything points to the significance of this element in his fitness for service. The prolonged and arduous professional training, the peculiarly exacting nature of the subsequent life work, the insistency with which it claims the best of brain and heart, all indicate how imperative it is that the Medical Missionary should be one who possesses a wide mental horizon, and whose capabilities are not meagre. No wealth of professional talent can adequately compensate for deficiency here. The life and work of a Medical Missionary is not a vocation whose educational preparedness is measured by the number of medical degrees that may have been obtained. Behind all that, there is an elemental need for a brain enriched and disciplined by a store of sound learning and general knowledge in which languages and science should have a liberal share.

And then there is finally one further matter which requires careful consideration, and that is, the immense necessity for the Medical Missionary to be one whose physique and capacity for physical endurance are beyond reproach. He will have claims made upon his stook of bodily stamina and vital energy which will try the strongest. His duties will call not infrequently for a lavish expenditure of physical powers and demand such a concentration upon exhausting work, as is bound to mean a serious drain. If he starts well, if he commences with a goodsupply of constitutional vigour and wisely develops and conserves it, then the tasks which increasingly will fall to his lot will stand a high chance of being discharged satisfactorily. With a different constitution the case is often far other, and it is therefore of cardinal importance that physical robustness enters largely into the make-up of the prospective Medical Missionary.

Keeping in mind these points let us now revise the main aspects of the two divisions of his training.

I. The Professional Training

This may be considered under four sub-headings : (1) Pre-Graduate ; (2) Post-Graduate ; (3) Probationary ; (4) Furlough.

(1) Pre-Graduate.—There is no need to refer to this at any length for the obvious reason that the training before qualification is in no way different to that required of any student of medicine. The same time has to be spent, the same classes taken, and the same examinations passed. The Medical Missionary student must " walk the hospitals " just as any other medical student, and hold exactly the same appointments, e.g. surgical dresser, as is demanded from the one whose intention it is to practice in his own land. The only difference lies in the fact that, whereas the last-named will probably never be far outside the reach of whatever skilled help he needs in the course of his practice, the prospective Medical Missionary has to face a sphere of service in which he may have to depend wholly, or nearly so, upon his own resources. Consequently if in any way the work done by the two classes of students is to differ, then it should rather be in the direction of increased thoroughness on the part of the one who is to go abroad.

As to the question—Which of the possible medical qualifications should the Medical Missionary student work for ?—we would unhesitatingly advise that which confers a university degree. Not that the diplomas of other examining bodies are in any way to be regarded with disfavour, but rather that with the spread of modern education upon the Mission Field it is of importance that those missionaries engaged in scientific work should be graduates of a university and possess academic status. Moreover, speaking generally the knowledge required for most university medical degrees is in advance of that needed for the diplomas of other bodies, and that is all to the gain, for reasons stated already. There are however the Fellowship diplomas of the Royal College of Surgeons of England and of the Royal College of Surgeons of Edinburgh, which can in no way be regarded as inferior to university degrees, either in the severity of the examinations or in the prestige that they confer. Indeed the first named stands out as one of the most coveted surgical distinctions in the world. And if it is possible for any Medical Missionary student to work for one of these diplomas in addition to his degrees, he should not hesitate to do so.

Amongst other things the pre-graduate stage of the Medical Missionary should be conspicuous for earnest conscientious practical work. He will need all the clinical experience he can gather as well as all the book knowledge he can acquire. He should duly attend the practice of the special departments, and familiarise himself with all the technique of clinical investigations, pathological work, etc. Furthermore, he should early establish in the estimation of his teachers and in the opinion .of his fellow students a character for thoroughness and keenness. In a certain sense the credit of the calling he is taking up rests in his keeping, and however he may lack brilliancy—and that is by no means always an asset—he should never gain the reputation of being a " slacker."

The Medical Missionary student should endeavour to take as many of the hospital appointments open to students as he can make good use of. Whenever there are school examinations to be taken, scholarships or prizes to be competed for, he should try with a laudable emulation to obtain a good place in the list, not just for the sake of the immediate distinction such may bring to him, but pre-eminently because the work he will in this way have to do provides an excellent training for the sterner tests that will be his in later days. It is also of importance that the value of athletics should not be forgotten, both because of the need to maintain and improve a good physique and in the interests of the cultivation of true manliness.

Thus would we set a high ideal for the pre-graduate section of the Medical Missionary's professional training. The immense importance of laying a strong foundation for the strenuous life that is inseparable from this vocation can never be exaggerated. The best and only the best must be the goal always aimed at ; and the temptation to be satisfied with something less must be stedfastly resisted. From the beginning of his student days the injunction of the Great Apostle—" Thou therefore, my son, endure hardness as a good soldier of Jesus Christ "—should be the note ringing in his ears. And if at times the task seems long and its toils too wearying, the Medical Missionary student can surely claim and receive that grace and help which only His Lord can give.

(2) Post-Graduate.—The Medical Missionary has now become a fully qualified medical practitioner, and to that extent has completed the greater section of his professional training. He has come to the point at which his offer of service can appropriately be communicated to the Society with which he desires to become connected. Yet at the same time he has by no means qualified himself for instant service on the field. Indeed, if he go out at this stage it may be to court a great disaster to his career, and to learn in the wrong place and by bitter experience what he should have acquired in post-graduate training here at home. It is there-fore highly necessary that we should consider the most approved manner in which the Medical Missionary candidate can now proceed to add to his knowledge—experience.

There are two things that naturally suggest themselves as essential divisions in this post-graduate work : first, the experience that can be gained in general medical and surgical practice, and secondly, the special experience that is required, for one going abroad, in certain particular sections of scientific medicine.

As to the first of these we are persuaded that nothing is more valuable or more likely to give what is required than resident hospital appointments. In fact it is difficult to avoid the conclusion that the holding of at least one such post should be regarded as an indispensable part of the post-graduate training of the Medical Missionary. In no other way can he so well acquire that practice in clinical observation, and that intimacy with the treatment of medical and surgical diseases, which it is essential he should possess when called upon later to undertake the work of a hospital on the field. Furthermore, it is of supreme advantage to a young medical graduate to have the opportunity of working immediately under the eye of a master in the profession, and to have his natural weaknesses in diagnosis and practice pointed out and corrected. Then, too, whilst he is engaged in preparatory work for one of the higher examinations a resident appointment carries with it a high degree of intrinsic value.

One point should be emphasised, and that is that whatever other appointments may be held a surgical resident post should not be omitted. Surgery of necessity bulks very largely in the practice of almost every mission hospital, and we have known of one case at least where the failure to hold a surgical house appointment before going out placed the young Medical Missionary at a very grave disadvantage. At least six months should be devoted to the work of such a post.

In connection with this general part of his post-graduate training there is one caution which we would venture to give to the Medical Missionary candidate, and that is, not to allow his off-time to be disturbed by too many outside calls for meetings, etc. It is, alas, too easy for this to happen, and secretaries of Societies are too prone, as they hear of a prospective Medical Missionary, who perhaps can be introduced to churches as an outgoing volunteer, to press upon him the duty of fitting in such engagements. Yet, what-ever gain may be derived by the words that a Medical Missionary candidate may thus address, nothing can compensate for the distraction and diversion that such work involves to the proper claims of his resident post. An occasional meeting or Sunday service may do no harm, but a jealous guard should be kept against any-thing like an habitual invasion of the time he has at disposal during this period.

We come next to the second part of the post-graduate training, viz., that which gives special experience in certain particular branches of medicine. As to this, no hard and fast rule can be laid down, and each case must be dealt with upon its merits, with due regard to the field in view. But speaking generally, there are five branches of medical study from which the Medical Missionary candidate will do well to select subjects to which to devote from six to nine months of his time before proceeding abroad. These are : (1) tropical medicine, (2) eye diseases, (3) practical bacteriology, with in addition, in some cases, public health, (4) difficult midwifery, and (5) throat, nose and ear diseases.

The first-named of these can be studied at one or other of the special tropical schools now established, and for those going forth to fields like Africa, India, and and the greater part of China, a course of three months at such a school should be rigidly regarded as an essential. It would be well, also, if those taking the course were to obtain the diploma in tropical medicine, for which an examination has to be passed.

The study of eye diseases should be pursued at a special ophthalmic hospital, with which, in most cases, courses particularly designed for post-graduates will be found to-day. If the field in view be India, China, North Africa, Palestine, Persia or Arabia And certain other lands, it will well repay the Medical Missionary to obtain, if he can do so, a junior clinical assistant-ship under one of the ophthalmic surgeons. If that is impossible, then a clear three months should be devoted to regular attendance upon the practice of the ophthalmic hospital which has been selected. In any case, care should be taken to include one of the classes on the operative surgery of the eye which are arranged from time to time at most eye hospitals.

Practical bacteriology is increasingly important, and six weeks given to a laboratory class in this subject will be of great value. There is hardly a field where the technique and knowledge thus gained will not prove most useful. If beyond this it be possible to devote from three to six months in the study of public health, it may be very valuable in the case of those proceeding to fields like China, where sanitary reform is bound, ere long, to be a burning topic, and where the Medical Missionaries may be looked to for a lead in such matters. A course of lectures on hospital ad-ministration, as is usually held in connection with the D.P.H. course, will also be of real value in view of what Medical Missionaries have to do on the field in the administration of their own hospitals.

A course of difficult midwifery particularly applies to lady Medical Missionaries, and should, in their case, be deemed essential. On the part also of men medicals, a study of the subject for those going to certain fields, e.g. China, may be esteemed as very important. The practice of one or other of the lying-in hospitals affords scope in this direction, and from one to three months given to this study may prove later on to have been time amply repaid. In a similar way experience in clinical and operative gynecology at some hospital for women may mean to the Medical Missionary candidate, man or woman, considerable gain.

Finally a study of throat, nose and ear diseases at some special hospital devoted to that class of affections is of real value, and this can often be worked in with the class of practical bacteriology and attendance at an eye hospital. As in the case of the last-named if it be possible to obtain a post of junior clinical assistant, it will be well to do so inasmuch as this confers the privilege of conducting many of the minor operations and becoming proficient in the technique of the methods of examination. Generally speaking three months will prove sufficient for this section of post-graduate training.

There are of course, beyond the foregoing, other branches of medical practice, e.g. skin diseases, which may with great advantage claim a share in the time at disposal. And it may be that in the place of some of those we have specially drawn attention to, such other work should be included. But, however that may be, enough will have been said, we think, to make it apparent that there is ample to occupy the time and energy of the Medical Missionary candidate ere he sails for his destination.

On the other hand he should not undertake more than he can adequately deal with at any given time, nor allow his time to be frittered away with running from one hospital to another. Rather should he, in the first place, carefully think over his available time, and then by consultation with Medical Missionaries from the field, and others best qualified to give advice, map out a schedule of the work that seems most necessary and that can be properly carried through. Having done so he should as determinedly give himself to the study of the subjects selected as he did previously to the work of his hospital appointments. The result, by God's help, will then be all that could be desired, and the Medical Missionary will finally terminate his post-graduate training and sail for the field, feeling that he has equipped himself professionally, as far as it has been possible for him so to do, for the great purpose to which he has consecrated his life.

(3) Probationary.—Not much need be said under this heading ; but it is necessary to emphasise that the Medical Missionary, during the two years of his probation on the field, and whilst he is pursuing his language studies, should not be severed from contact with medical work. It is, of course, of highest importance that the primary claim of this period should be language study, and that with such in view he should not be placed in charge of medical stations, or where he will perforce have to respond to the call for medical help. On the other hand, the young Medical Missionary, if he sees no medical work, will get " rusty," and hence he should be placed at some principal medical station where there is at least one senior Medical Missionary whose work he can watch, from whose experience he can learn, and under whose guidance he can familiarise himself with the diseases of the people, and the most successful modes of treatment. Too often, by being denied such an advantage, have Medical Missionaries suffered in their professional work, and though it may mean delay in opening up fresh medical stations, the new Medical Missionary should be carefully shielded during his probationary period and given the opportunity to add the coping stone to his professional preparation.

There is also this further point upon which emphasis should be laid, viz.—the great importance of the young Medical Missionary learning, during this period, to understand native customs, and to grasp the native point of view. How essential all this is to successful work, none but Medical Missionaries of experience can adequately realise. But the fact of its immense importance enhances the value of this probationary period of training.

(4) Furlough.—What has been said already concerning the extent and variety of a Medical Missionary's professional training will, we think, make it easy to understand that it is necessary for the periods of furlough to be utilised, in part, for the acquisition of fresh knowledge. Medical science is forever advancing, and nothing is easier than for medical men who are immersed in busy practices in this country to become very quickly out of touch with new discoveries in modern medicine and surgery. How much more, then, is it almost a certainty that those who are working as Medical Missionaries on the Foreign Field will remain unaware of, and their practice unaffected by, these advances ! They have small time even for perusing medical journals, and working, as so many of them are, for long periods in isolated places, it is next to impossible for them to do other than get into arrears, so to speak, with their medical knowledge.

Herein then lies the obvious need that part of the furlough of a Medical Missionary should be given up to refreshing his acquaintance with medical science. He should be given time free to attend the practice of some hospital, and to take, if necessary, one or other special course of study which his experience on the field shows. to be of particular importance. Moreover, not only should a sufficiency of time be granted for this purpose, but the Medical Missionary should be afforded all the guidance that can be given by the Medical members of the Home Committee, and where such is required, financial assistance should be rendered. It should in no way be regarded that time and money spent in this direction are an expenditure which is of less value than that given to deputation work, great as is the importance of the latter. Rather should it be held that for the Medical Missionary to fully avail himself of every opportunity that is open to him of establishing an up-to-date contact with modern medicine is to make a direct and vital contribution to the efficiency of the great work with which he is entrusted on the field. Facilties are not lacking to-day in all the main centres in the Home land whereby Medical Missionaries can obtain the exact courses which they require, and it is to be hoped that in a far larger measure than hitherto, this part of their post-graduate training will take a recognised place in their periods of furlough.

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