On Suffering, Solidarity, and Sheep: Is There a Distinctive Christian Approach to (Global) Health?
C. Phifer Nicholson Jr., MD (c) and Theology, Medicine, and Culture Fellow, Duke University
In Global Health Means Listening, Raymond Downing reflects on nearly 30 years of experience as a medical missionary in East Africa. He asks, “Is there a distinctive Christian approach to global health, or do we simply draw from the myriad approaches already described, testing each piece for how well it reflects general Christian principles?”[1] Drawing from French philosopher and lay theologian Jacques Ellul, Downing contends that the three distinctive Christian contributions are to “be preserving salt, revealing light, and…sheep in the midst of wolves.”[2] Regarding this “vocation,” Downing again quotes Ellul,
It is essential that Christians should be very careful not to be ‘wolves’ in the spiritual sense -- that is, people who try to dominate others. Christians must…offer the daily sacrifice of their lives, which is united with the sacrifice of Jesus Christ.[3]
This posture prioritizes listening, centers the voices and priorities of communities being served, and commits to long-term solidarity and personal sacrifice in the pursuit of friendship and liberation. There is no room for “white saviors,” short-term self-focused “voluntourism,” or extractive research that primarily benefits those seeking academic promotion.
In this paper, I also ask: is there a distinctive Christian approach to (global) health? First, I trace the development of the modern secular global health movement from its roots in colonialism to the more modern conception of a technocratic enterprise that, on face value, seeks to improve health for all—yet has been critiqued as the latest iteration of Western domination. The traditionally “colonial” is exchanged for modern neoliberalism that assumes limitless growth, technocratic technique, and fails to critique extractive economic practices.[4] A focus will be paid to the power differential between Global North institutions and the Global South that is often the focus of research and interventions, as well as the “socialization for scarcity” that dominates global health discourse.[5] Second, I will explore the mixed legacy of the medical missionary movement that formed parallel to the development of the modern global health enterprise. Many medical missionaries fall into similar colonial trappings. Yet, others deeply challenged them – and the legacy of medical missions must be reckoned with given its continued impact on health care systems in LMICs.
After contextualizing global health and medical missions, I will draw from Downing, Ellul, and the concept of accompaniment—a form of “pragmatic solidarity” from Latin American Liberation Theology brought to bear on the practice of medicine by Paul Farmer—to articulate a distinctive Christian approach to (global) health. These conceptual frameworks will be brought into conversation with my experience as a student researcher at the Mother of Mercy-Gidel Hospital in Sudan, a Catholic mission hospital that is the sole referral center in a region characterized by years of civil conflict and poor health outcomes. This distinctively Christian approach is one that takes seriously the invitation to be salt, light, and sheep among wolves who accompany those at the margins in solidarity and friendship, building capacity and agency, and offering an alternative to the colonial, neoliberal logic of global health.
[1] Raymond Downing, Global Health Means Listening (Nairobi: Manqua Books, 2018), 139.
[2] Downing, 145.
[3] Jaques Ellul, The Presence of the Kingdom, 2nd ed. (Colorado Springs, CO: Helmers & Howard, 1989), 4–5.
[4] Martha Lincoln, “Global Health Is Dead; Long Live Global Health! Critiques of the Field and Its Future,” BMJ Global Health 6, no. 7 (2021), https://doi.org/10.1136/bmjgh-2021-006648; Paul Farmer, Fevers, Feuds, and Diamonds: Ebola and the Ravages of History (New York, NY: Farrar, Straus and Giroux, 2020); Eugene Richardson, Epidemic Illusions: On the Coloniality of Global Public Health, 1st ed. (Cambridge, MA: The MIT Press, 2020).
[5] Jeremy Greene et al., “Colonial Medicine and Its Legacies,” in Reimagining Global Health: An Introduction, 1st ed. (Los Angeles, CA: University of California Press, 2013), 33–73.
It is essential that Christians should be very careful not to be ‘wolves’ in the spiritual sense -- that is, people who try to dominate others. Christians must…offer the daily sacrifice of their lives, which is united with the sacrifice of Jesus Christ.[3]
This posture prioritizes listening, centers the voices and priorities of communities being served, and commits to long-term solidarity and personal sacrifice in the pursuit of friendship and liberation. There is no room for “white saviors,” short-term self-focused “voluntourism,” or extractive research that primarily benefits those seeking academic promotion.
In this paper, I also ask: is there a distinctive Christian approach to (global) health? First, I trace the development of the modern secular global health movement from its roots in colonialism to the more modern conception of a technocratic enterprise that, on face value, seeks to improve health for all—yet has been critiqued as the latest iteration of Western domination. The traditionally “colonial” is exchanged for modern neoliberalism that assumes limitless growth, technocratic technique, and fails to critique extractive economic practices.[4] A focus will be paid to the power differential between Global North institutions and the Global South that is often the focus of research and interventions, as well as the “socialization for scarcity” that dominates global health discourse.[5] Second, I will explore the mixed legacy of the medical missionary movement that formed parallel to the development of the modern global health enterprise. Many medical missionaries fall into similar colonial trappings. Yet, others deeply challenged them – and the legacy of medical missions must be reckoned with given its continued impact on health care systems in LMICs.
After contextualizing global health and medical missions, I will draw from Downing, Ellul, and the concept of accompaniment—a form of “pragmatic solidarity” from Latin American Liberation Theology brought to bear on the practice of medicine by Paul Farmer—to articulate a distinctive Christian approach to (global) health. These conceptual frameworks will be brought into conversation with my experience as a student researcher at the Mother of Mercy-Gidel Hospital in Sudan, a Catholic mission hospital that is the sole referral center in a region characterized by years of civil conflict and poor health outcomes. This distinctively Christian approach is one that takes seriously the invitation to be salt, light, and sheep among wolves who accompany those at the margins in solidarity and friendship, building capacity and agency, and offering an alternative to the colonial, neoliberal logic of global health.
[1] Raymond Downing, Global Health Means Listening (Nairobi: Manqua Books, 2018), 139.
[2] Downing, 145.
[3] Jaques Ellul, The Presence of the Kingdom, 2nd ed. (Colorado Springs, CO: Helmers & Howard, 1989), 4–5.
[4] Martha Lincoln, “Global Health Is Dead; Long Live Global Health! Critiques of the Field and Its Future,” BMJ Global Health 6, no. 7 (2021), https://doi.org/10.1136/bmjgh-2021-006648; Paul Farmer, Fevers, Feuds, and Diamonds: Ebola and the Ravages of History (New York, NY: Farrar, Straus and Giroux, 2020); Eugene Richardson, Epidemic Illusions: On the Coloniality of Global Public Health, 1st ed. (Cambridge, MA: The MIT Press, 2020).
[5] Jeremy Greene et al., “Colonial Medicine and Its Legacies,” in Reimagining Global Health: An Introduction, 1st ed. (Los Angeles, CA: University of California Press, 2013), 33–73.