Christian Medical and Dental

of Christian Medicine & Dentistry Fellowship of Vol. 26 No. 1 February 2021 Australia ISSN 2209-9441

MORAL INJURY CONFERENCE CMDFA WEBINAR PRODUCED BY THE NSW STATE COMMITTEE – “What keeps me awake at night?” – Conversion Therapy Poverty: – Voluntary Assisted Dying It’s Not What – The Hospital Furnace You Think

Towards a theology integrating creation, providence and redemption in our daily Fire in the work, rest and family Belly 2021

1 • CMDFA LUKE’S JOURNAL • February 2021 www.cmdfa.org.au will take you... Deeper SMBC’s academic curriculum is founded on, and saturated in, the Bible – the inspired word of God. Study at SMBC will give you a deep and systematic understanding of the Bible, its theology and its application to all aspects of life. We offer academic rigour with flexibility – from undergraduate diplomas through to postgraduate research degrees – full-time and part-time. Further Cross-cultural mission is the very DNA of SMBC. With three missiologists on staff, weekly visiting missionaries, a missionary mentoring program, the SMBC Missions Conference, plus a broad range of missions units, SMBC excels in preparing its students for ministry across all kinds of cultural boundaries. Wider SMBC is interdenominational – lecturers, staff and students represent various denominational allegiances. There is mutual respect and understanding for differing viewpoints whilst holding to the heart of the gospel message. This, along with our international ‘flavour’ provides a diverse and healthy environment to study in. Closer It is a priority of SMBC that in addition to gaining a deep knowledge of the Bible, our students continue to grow in holiness with lives marked by prayer, love, humility and obedience to God. Time spent in the College community and being mentored by lecturers will help strengthen your Christian character and draw you closer into relationship with Jesus and his people.

“As a medical student, I was challenged to see theological education as akin to secular education. Prior to this I had felt it was only for those considering full-time vocational ministry. We study and train for years to work as a doctor, but we are called to be followers of Jesus 24/7. I had intended to do a short stint of theological study after completing medicine but, with work, family and continued lay ministry, this decision was delayed until this year. As I became a father and more involved in church, I realised that studying the Bible in depth has value for every facet of life. As a doctor it will shape and mould the way I approach my work, but more importantly it will equip me to understand and teach the Bible better. Ultimately, it will allow me to serve God effectively wherever he places me. After proclaiming I'd had enough of study forever, this year has been the LEARN MORE @ SMBC.EDU.AU most rewarding, enjoyable and life-changing study I have done. It's never too late!” SMBC student, Julian /SMBCOLLEGE 2 • CMDFA LUKE’S JOURNAL • April 2020

2 • CMDFA LUKE’S JOURNAL • February 2021

LJ 420 letter.indd 2 21-Apr-20 8:54:18 AM CONTENTS

4 EDITORIAL ‘Fire in the Belly’ 38 MORAL INJURY CONFERENCE: – Dr Catherine Hollier Moral Injury in Carers of Early Pregnancy – A/Prof Harvey Ward 5 Towards a theology integrating 4 creation, providence and 38 redemption in our daily work, rest 40 Art by Elle Chou (medical student) and family – A/Prof Alan Gijsbers

41 MORAL INJURY CONFERENCE: 9 Decision Making and the Will of God The Hospital Furnace – Dr Maria Haase – Dr Emily Ivarsson Srmo 41 9 12 Treatise on Health 42 MORAL INJURY CONFERENCE: – Prof Anthony Radford What keeps nurses awake at night? – Gabi Macaulay RN

19 Teamwork – Dr Monique Peris 46 MORAL INJURY CONFERENCE: The GP Landscape 19 21 Poverty: It’s Not What You Think – Dr Tony Rombola 42 – Ross Farley

48 HealthServe Australia: 24 Touched by Cancer, Touched by Connecting in Indonesia Love – Dr Shazza – Dr Michael Burke

24 26 MORAL INJURY CONFERENCE: 49 HealthServe Australia: Papua New 48 ‘What keeps me awake Guinea HealthCare Worker Manual at night?’ – Dr Ern Crocker – Dr Michael Burke

28 MORAL INJURY CONFERENCE: 50 HealthServe Australia: Definitions Lighting Paths, Healing Lives 26 – A/Prof Andrew Sloane – Dr Michael Burke 49 30 MORAL INJURY CONFERENCE: 52 What to Take on an Overseas ‘Nobody Expects the Spanish Medical Mission Trip Inquisition!’ – John Steenhof – Dr Maria Haase

35 MORAL INJURY CONFERENCE: 54 Medicine on YWAM Medical Ships 35 Conversion Therapy – Dr Thomas Chengxuan Lu 54 – Prof John Whitehall

56 Response to: 37 MORAL INJURY CONFERENCE: Issues Do we really save lives? Related to Voluntary Assisted Dying – A/Prof Alan Gijsbers 37 – Prof Natasha Michael 56

Themes for Until the Very End: Children of God Next Editions: Dying and Palliative Care copy due 30 Aug 2021 copy due 30 Apr 2021

3 • CMDFA LUKE’S JOURNAL • February 2021 Dr Catherine Hollier Catherine is a part-time GP in Newcastle, NSW. She is proud to have been involved with the high quality content of Luke’s Journal since 2016 and enjoys leading a team of enthusiastic volunteers in its publication. She is greatly pleased with the transition to digital format, allowing greater dispersion of its content to a wide and varied audience. EDITORIAL

Fire in the Belly

Wow! ‘Fire in the Belly’. Gijsbers’ “Towards a theology…” or from a are joined by the growing clamour desire to guide the younger generation, around gender dysphoria, conversion Impulsive? Idealistic? Irresponsible? e.g. Maria Haase’s “Decision-Making therapy and the idolisation of medical Or reasonable opinion? That is for you and the Will of God”. Others share from career in the hospital environment. to decide. many years of faithful work in the mission Recordings can be accessed online by field (see Anthony Radford’s “A Treatise contacting [email protected] Moving. Challenging. Passionate. in Health” and Ross Farley’s “Poverty Definitely. – it’s not what you think!”). There are There are also reports from long- pragmatic issues such as Monique Peris’ standing affiliates of CMDFA – With the digitalisation of Luke’s Journal “Teamwork” and personal stories like HealthServe Australia and ICDMA. It is and the extended reach of its readership, Shazza’s “Touched by Cancer. Touched timely to be reminded of our partnership there has been an increase in Fire in by Love.” around the globe with the common link the Belly articles – self-submitted and of healthcare in our Christian family, grounded in the passion of the author. We report summaries and presentations especially as COVID-19 unites the world The views expressed in these articles are from the recent NSW ‘Moral Injury and the church in so many ways. An those of the authors and not necessarily Conference’, which has become more invitation is extended to join with others those of the CMDFA or Luke’s Journal. As pertinent as the surrounding culture beyond our borders. Other mission focus such, these articles have less editorial presses ever more loudly against includes Thomas Lu’s “YWAM Medical input and should be read as passionate Christianity. The age-old topics of ships” and practicalities on “What to take expression rather than academic abortion and voluntary assisted dying with you on Mission Trips”. treatise. However, they will no doubt stimulate thought and robust debate as And finally, a response to a previous we seek to mature in Christ, and interact “[The articles] will Luke’s Journal article by Andrew Williams, meaningfully with the world. no doubt stimulate “Do We Really Save Lives?” which prompted Alan Gijsbers to write an Luke’s Journal is excited to publish what thought and robust alternative view. is likely to be the first of many issues debate as we seek to comprising only Fire in the Belly articles. We have a broad church in the CMDFA Authors have been inspired from all ages mature in Christ, and membership and it is with great joy that and many different backgrounds. Some interact meaningfully Luke’s Journal shares encouragement write from a theological perspective with the world.” and inspiration across the nation and integrating faith in daily work, e.g. Alan beyond.

4 • CMDFA LUKE’S JOURNAL • February 2021 A/Prof Alan Gijsbers Alan (MBBS FRACP FAChAM DTM&H PGDipEpi.) is a Specialist Physician in Addiction Medicine, Melbourne, and President of Christians in Science and Technology (ISCAST). He has a particular interest in a studying neuroscience and theology, the philosophy of the self, and spirituality, topics which underpin his approach to addiction care.

Towards a theology integrating creation, providence and redemption in our daily work, rest and family

“[God’s] creation is not an end, but Further, it seeks to integrate being and of human sin, God still cares for and a beginning – complete in itself as doing, and to integrate mission and provides for His creation. Even further, such, but still a beginning. It is not, evangelism. It seeks to integrate what God calls a people to Himself within therefore, an end in itself. Nor is it simply we do in church with what we do in our creation, and those people express conditioned by what might happen secular pluralist society. My overall aim His rule over the created earth. That is further between God and man on quite is to integrate faith and practice so that how God’s covenant develops. It came different presuppositions...the creation there is a broad two-way street of ideas through the call of Abram, through the of God took place for the sake of the and actions between the world we live in, patriarchs to Moses and to the children covenant and that itself it was the and the Word of God we live out of. of Israel. Israel was called to be a holy beginning of the covenant...” people, expressing God’s righteous rule in (K Barth, Church Dogmatics part IV Creation and Redemption the world. Israel was called to be a light the doctrine of reconciliation, p 131, Fundamentally, creation is the theatre in to the nations, so that all the families Continuum edition 2004). which God interacts with God’s people. of the earth would be blessed. This While in some ways God’s creating covenant was renewed in Christ through Integration work was completed on the sixth day, whom God has called a new people, the This paper seeks to move us as and God rested the seventh, in another church, to express God’s rule in creation. Christians to integrate a creation way God continues to work (John 5:17). Evidence of renewal can be seen in the theology with our redemption theology. God’s act of creating is the start of God’s way that the body expresses Kingdom Where they are separated, we tend to providence over the whole created values by the way it lives and loves. separate our Sundays from our Mondays, order. This providence, expressed our walk with God from our daily tasks. in God’s covenant of love towards This promise of the rule and reign of But our salvation impacts the whole creation, continues over the just and the God, as expressed in the theology of of our life. We cannot separate our unjust equally, even to today. Humans the Kingdom of God has been fulfilled salvation from what we do every day. disobeyed God in creation. Human sin and renewed in Christ who is also the As Barth indicates above, creation is the occurs within creation. Further, in spite promise of a further salvation for the stage on which God continues to express whole created order. Christ came and His covenant of love to His people. As well lived in this world showing God’s love as integrating our theologies, this paper “We cannot separate for the world by word and deed towards seeks to integrate our understanding of our salvation from what all, including the poor, the marginalised work (both paid and unpaid work) with and the oppressed. Christ lived as the leisure, to integrate work life with home we do every day.” obedient suffering servant who by His life, and to integrate work with worship. life demonstrated His worthiness of

5 • CMDFA LUKE’S JOURNAL • February 2021 being the true man and true son. By His but that is for another paper!) Nor is that concepts of righteousness and justice life He demonstrated practically how all, but it is also a theology of mission and became intertwined. God seeks out, loves and transforms the a theology of blessing the world! marginalised. He suffered His obedient God called Israel to be God’s holy people, death in the flesh and rose in a new and How can we bring creation, providence, who would live his way in the world, thus glorious body. Further, He formed His redemption and mission more closely showing the world the ways of God. God body, the church, on earth. He made a together? We integrate them first calls his people to live righteously. The covenant with His church that she might through the concept of holiness Torah contains within it what right living be a holy people living for God and and righteousness, and secondly by would be in an agrarian society living to spreading God’s blessing throughout the considering the nature of the Gospel. the glory of God. world. The church is called to proclaim a Kingdom in which all will become The word holy means ‘set apart’ and one under the headship of Christ. This “God ... is worshipped in God’s people are set apart to live an promise will one day be fulfilled when alternative righteous lifestyle under Christ comes again in glory to judge the our work, in our leisure, the command and covenant of God. living and the dead. He will then judge and in our relations.” Leviticus 19 shows how wide-ranging our deeds, done in our bodies, and bring and practical such holy living might us to glory. That glory will be that the New be. It involved caring for the poor by Jerusalem will come down from heaven the way the people harvested the to create a new heaven and a new earth Righteousness and holiness crops, it involved respecting elders in which God will dwell with His people Righteousness is not just an imputed and welcoming strangers and aliens. and so redeem the whole of creation. or an imparted quality (or more It involved respecting one’s neighbour, correctly, a forensic status conferred indeed to love one’s neighbour as God invites humankind to search out the on God’s people by the atoning oneself. It also included some curious hidden wisdom of God in creation and to death of Jesus Christ) – although it is rubrics like not boiling a kid in its mother’s wonder in awe at its power and beauty. gloriously that, and I bless God that milk, and not cutting the fringes of a God invites us to enjoy its goodness, to I can stand with my fellow believers man’s hair. This is not the only description be awestruck by its mystery and to be in that righteousness. However, more of ethical living in the first Testament but challenged to enter more fully into the fundamentally, righteousness expresses it is a provocative and comprehensive wisdom which created it all. We only an understanding that there are right list directed towards honouring God perceive this wisdom dimly; there is so ways of living and acting. Righteousness in every aspect of life. However, it is much in creation we still cannot fathom, is more than a forensic quality; it is more than ethical living because it is in spite of all we know. Further, God has fundamental to a right way of being living in response to the goodness and given humankind the responsibility to and doing things. Thus, a screwdriver providence of God, who is worshipped govern creation as stewards of creation, is used righteously when it is used to in our work, in our leisure, and in our and as such the more we know about drive in screws and a hammer is used relations. creation, the better we can fulfil our unrighteously when it is used to hammer mandate to govern it well. Theology in a screw. Secondarily, righteousness One of the mistakes the Pharisees made is about encountering God and God’s has developed a forensic quality in reading the first Testament was to Word. This we do when we look into the that legislation has come in defining think that a meticulous keeping of the book of nature, and discern God’s hand what constitutes righteousness and minutiae of God’s laws exhausted what in history, as well as reading the other unrighteousness within society. Thus the the Lord required from the people. The book, the book of Scripture. tithing of mint, dill, and cumin became more important than justice and mercy. Why do we work? By contrast, Christ called on a deeper To be fruitful, to multiply, to fill the earth, and richer righteousness and spelt that to subdue it and to have dominion over it. out in His teaching about the Kingdom of God, a kingdom of justice, mercy, and Do we always work? humility. Here humankind, even God’s No, God has ordained that we should rest people, and especially those who tried to on the Sabbath. be righteous by following the minutiae of God’s law, stands condemned because With these two simple statements, not they did not acknowledge that their lives only do we develop a theology of work and their work was unrighteous and that but also a theology of family (raising they needed divine mercy. a family IS work – and pleasure) and a theology of rest and leisure. (And lurking But those who bowed themselves before behind all this is a theology of pleasure, the Father and who confessed their sin,

6 • CMDFA LUKE’S JOURNAL • February 2021 found forgiveness and cleansing. They also found a new power through the Holy Spirit to live righteously, mercifully and with faith expressing God’s love in restored relationships. These restored relationships were expressed in their families, in their church, in their workplace, in society, and in the world.

Gospel and Kingdom When considering the nature of the Gospel, the Kingdom of God is a key theme. Accepting the Gospel is not only to accept Christ’s alien righteousness as one’s own, it is also to submit oneself to the Lordship of Christ and to become part of the Kingdom of God. The New Testament clearly describes a strong relationship between the Kingdom of God and the righteousness of God, because the Kingdom is a righteous kingdom. It also strongly implies that such righteous living is like a city on a hill, a light out from done. 1 Corinthians 3:10-15 gives us the Implications under a bushel. Such righteous living clearest picture of the testing at the end Work to honour God would be costly and those who live like time of what we have done. That which The Christian lives in the light of the this face persecution. is consistent with the Kingdom will last freedom of God’s forgiveness and – the gold, silver and precious stones – grace. We do not need to work to God’s Kingdom is a kingdom of love, of and that which is incompatible with the prove anything about ourselves. We a derivative love expressed in response Kingdom – the wood, the hay, and the are not workaholics using work for to the love of God. By its very essence stubble – will not survive. All we do, and self-actualisation or self-expression, or the Kingdom is relational. We are called especially the religious things we do, to avoid the insecurities of not doing to love God, love ourselves, love our will come under the judgment of Christ. anything. Our security comes from God neighbour, love the world, and love Hence what we do now – everything and we do not need to prove anything creation. Hence very deeply there is a we do now – is provisional awaiting the to anyone. God has accepted us, and relational dimension to all we do, in our verdict of the King. loves us. Consequently, we work for God work, in our leisure and in our rest. in gratitude for His love and care over us. Work then, is an expression of our love for Our prayer ‘Your kingdom come” is a very God. It is also a commitment to service, comprehensive prayer. It asks for God’s “We are called to for that is how the Master worked. Our Kingdom to come by supplying our daily righteous living and goals and ambitions then come under bread, by seeking to be forgiven and to the lordship of Christ and are directed by forgive, and by asking God to save us that righteous living is a Kingdom values and Kingdom aims. from temptation and to deliver us from witness to the Kingdom evil. of God in the world.” Work to be a blessing God’s covenant to Abraham was that This Kingdom is embodied in the Church of through him all the families of the earth Christ, for here we gather as God’s people, would be blessed. All God’s work of grace hear the word of God and seek to apply So, we are called to righteous living and towards humankind was directed to this that word in our lives in the community. that righteous living is a witness to the end of blessing, – to the honour of His Further, the church exists for the twin Kingdom of God in the world. As we act name. With the coming of the Kingdom purposes of glorifying God and serving the and speak, we present the Gospel of the of God, God’s blessing would be poured world, loving it as Christ loved it. Lord Jesus Christ in our daily work and out on humankind, on the poor in spirit, in all our relationships. As we live and those who mourn, those who are meek, We live in the in-between-time where the explain this, we integrate our worship, our those who hunger and thirst after Kingdom has come in Christ but it has work, our home life, and our public life, righteousness, those who are merciful, yet to come with Christ’s coming again. all done to be a blessing to the world in those who are peacemakers, those who When it comes, Christ will judge all that need of the Gospel. This is the theological are pure in heart and those who stand humankind (including ourselves) has environment in which we work. for righteousness (Matthew 5:1-16). These

7 • CMDFA LUKE’S JOURNAL • February 2021 blessed people will be a blessing to others. We express God’s blessing in the way we work and in the work we do.

Work as a proclamation of the Gospel The Gospel is expressed in many and varied ways. It is a proclamation of the Kingdom of God, it is the confrontation with evil, it is the story of Jesus Christ who came from God and who lived, died, and rose again to secure salvation for all creation. It is the story of divine love in the face of human indifference. It is the story of the indwelling power of Christ as the hope of glory. Christians live out and tell these stories in their daily work and in their relationships with their colleagues. There is no Sunday-Monday and without loving our neighbour, or our And how do you explain the Gospel? disconnection, there is no redemption enemy. This love then will be expressed We need to be prepared to explain theology separate from a creation in the church, the body of Christ to which our good works so that the glory for theology. We as Christians live as one. As we belong whether we like it or not. There them goes to the Father, and not to us. we live righteously, we set standards that is no room for isolated Christians, we When Paul gives potted summaries of will be a witness and a rebuke to others. express our faith and love communally. the Gospel, they vary greatly from an When we fail, we personally witness explanation of the righteousness of God, the grace and forgiveness inherent in to an explanation of who Jesus is, to a the Gospel. In all we do, we witness to comment like, “Christ in you the hope of the righteousness of God, and to God’s “We in our workplace glory” (Colossians 1:27). When Matthew, mercy. need that same Mark, Luke, and John tell the Gospel, they imaginative flexibility, tell stories of who Jesus is by what He Work as seeking after God’s wisdom did and what He taught. Jesus Himself God invites us to enjoy His creation. As and tell the story of proclaims the Kingdom of God and we grapple with it, we seek to come to Christ by telling His describes the nature of that Kingdom in grips with the order and chaos that is many and varied ways that stimulate the inherent in creation and we see more stories.” imagination. We in our workplace need deeply the divine design and divine that same imaginative flexibility, and tell mystery in creation. This is the basis of the story of Christ by telling His stories, the scientific enterprise, which is but one Not just what you do but how you do it like the Good Samaritan, the Prodigal of a number of ways of reflecting on the If our witness is in the world, it expresses Son, the Woman at the Well, and the story mystery of personal people like ourselves itself not just in what we do, but how we of Him Washing his Disciples’ feet. One of encountering the impersonal vastness do it. There is a loving humanity about my favourite phrases (which resonates of the order and disorder of the world in mature Christian expression, a human with my patients with addiction) is the which we live. And as we discover the connectedness that is often missing statement, “There is no fear in love for wisdom of creation we then understand from impersonal transactions. Elizabeth perfect love casts out fear” (1 John 4:18). and live less fearfully in the world God Kubler-Ross in her book On Death and There is a winsomeness about those has made. Dying observed that sometimes hospital words. chaplains would not engage with the Work in with God’s community humanity of the dying patient. High Conclusion If divine love is the basis of all there is – Church chaplains would hide behind Work-life balance is not simply about love that was there from the beginning in the sacraments, Low Church chaplains juggling different priorities but about the Trinity, a love that spilled over into the would hide behind the Scriptures. In integrating all we do in gratitude and created order, and a love that expressed neither case would there be a true to the glory of God. It is not something itself even more fully when that creation human engagement. It can happen in separate from our redemption but rebelled against its creator, and that was medical care – I have seen it happen in something that integrates our work with still more loved by being redeemed – psychiatry; it can happen in education; our salvation. We seek first the Kingdom then the redeemed express that love in it can happen, in fact, in any occupation, of God and His righteousness at home, at their work, paid and unpaid. Invariably even in theology. How refreshing when work in the church and at leisure, and we that is a relational thing – we cannot just your humanity is acknowledged in the will do that till He comes. love God without loving God’s people, transactions you encounter.

8 • CMDFA LUKE’S JOURNAL • February 2021 Dr Maria Haase Maria is a GP working part time in Private Practice. She and husband, David, relocated to Toowoomba, QLD in February 2019. She attends VISION on the Gold Coast to mentor students / lead workshops and thoroughly enjoys the wonderful fellowship with students.

Decision Making and the Will of God

Much has been written on the will of Do we “put out a fleece”, or ask for a sign, This indicates an active process. Work God, both what it is and how we might or flip pages of Scripture until we find a must be done. Thinking is involved. discern it. Nevertheless, it remains a verse to support our own desires? Discomfort might be required! perennial topic, as we all have to grapple with this issue to find a comfortable Or do we use our God given intellect in Scripture has much to say on this subject. position for ourselves. Our understanding the light of application of correct Biblical is significantly influenced by our principles of hermeneutics, plus learn Romans 12:2 says, upbringing, denomination, worldview, from the wisdom of reputable scholars, “Do not conform to the pattern of discussions and most importantly, our prayerfully asking the Holy Spirit to guide this world, but be transformed by the knowledge of Scripture and the guidance us “in the truth”? (John 17) renewing of your mind. Then you will of the Holy Spirit. There is a perplexing be able to test and approve what array of ideas and many different Initially, clarification of definitions is God’s will is – his good, pleasing and stances taken on this subject. required. (I love definitions!) perfect will.” (NIV)

My goal in this article is to highlight Firstly, to define the word “decision”: Secondly, before looking in more detail differing views, summarise opinions, Decision [noun]: the act or process at the “decision-making” aspect, it is challenge concepts and encourage of deciding; determination, as of necessary to clarify the term “the will thoughtful consideration. Our views a question or doubt, by making a of God”. determine the impact on daily decision- judgment; the act of or need for making. Factored in is the challenge making up one’s mind; something What is “the will of God”? to continue to review previous beliefs, that is decided; resolution. How do we know this “will of God”? allowing room for change through (dictionary.com) How do we find it? growth and maturity. In this article, Most authors classify the will of God in to: I have posed more questions than given • The sovereign will of God answers as I would rather stimulate “God has planned • The moral will of God thought and encourage personal His course from • The personal will of God reflection than proffer a firm opinion. the beginning and The sovereign will of God. God has How do we make decisions? will accomplish His planned His course from the beginning How does God speak to us? and will accomplish His unalterable What is our concept of God’s guidance? unalterable purpose.” purpose. It is absolute and not Do we wait for a direct word from God? necessarily revealed to us.

9 • CMDFA LUKE’S JOURNAL • February 2021 I am God, and there is none like me, So, does God actually have a plan for my declaring the end from the beginning life? and from ancient times things not yet “……even as he chose us in him before done, saying, “My counsel shall stand, the foundation of the world, that and I will accomplish all my purpose.” we should be holy and blameless (Isaiah 46:9–10) before him. In love he predestined us for adoption to himself as sons The moral will of God. This is what is through Jesus Christ, according to revealed in The Holy Bible. The Scriptures the purpose of his will, to the praise of are a “Lamp to our feet and a light to our his glorious grace, with which he has path”, (Ps 119:105), providing some clear blessed us in the Beloved. In him we rules on how we are to live. It would be God-given wisdom is protective and have redemption through his blood, unwise to violate them. “But as for you, helpful for decision-making. Some the forgiveness of our trespasses, continue in what you have learned and people pray earnestly for help with according to the riches of his grace, have firmly believed, knowing from whom decisions but fail to follow the moral will which he lavished upon us, in all you learned it and how from childhood of God clearly written for us! If a decision wisdom and insight making known to you have been acquainted with the is outside of Scriptural injunction, then us the mystery of his will, according to sacred writings, which are able to make it is certain that this will be the wrong his purpose, which he set forth in Christ you wise for salvation through faith in decision. Our decisions must not violate as a plan for the fullness of time, to Christ Jesus. All Scripture is breathed out scriptural principles. unite all things in him, things in heaven by God and profitable for teaching, for and things on earth.” (Eph 1:4-10) reproof, for correction, and for training in The personal will of God. Does God have righteousness, that the man of God may a plan for my life? Firstly, yes! “Chosen in Him before the be complete, equipped for every good foundation of the world to be holy and work.” (2 Tim 3:14-16). Many have heard the popular statement blameless before him” sounds like a plan! “God has a wonderful plan for your life.” It seems like the big plan is “to unite all In some circumstances, there are It reads as though this plan is perfectly things in him, things in heaven and things specific directives. For example, on whom mapped out and has to be sought and on earth.” How that plan fleshes out in to marry - “Do not be unequally yoked daily life pales into insignificance in the with unbelievers. For what partnership light of eternity. has righteousness with lawlessness? Or “What if we what fellowship has light with darkness?” Does He have a specific plan for every (2 Cor 6:14). Similarly, Timothy and Titus concentrated more minute of our day? That is the conceptual give sound advice for living. In such on seeking God and challenge. Do we have a plan for circumstances, we can be clear on every minute of our days? That would what is a right and firm decision, without seeking first ‘the probably lead to anxiety, exhaustion and anxiety, as it is already spelled out for us. Kingdom of God’ than frustration. I wonder if we really need God Such commands are for us to obey. seeking the individual to micromanage us. Is it necessary to seek His guidance as to which coloured God has a will for man which is will of God?” shirt to wear each morning, or to ask His revealed in His law. It also reveals what help when choosing from a menu? We God desires from man. Ephesians 5 are free to be creative! I wonder if this is specifically directs our course for godly followed to “the dot”. This is commonly a misunderstanding of “spirituality” as living: “Therefore be imitators of God, as termed “the dot theory”. taught in some organisations and sectors beloved children. And walk in love, as of the church. That is to ponder. Christ loved us and gave himself up for Is a belief in a “personal will of God” us, a fragrant offering and sacrifice to a cultural question? Did previous Ephesians is basically a book on “how to”. God… Walk as children of light (for the generations or other cultures twist How to know, how to grow..… “to mature fruit of light is found in all that is good themselves in knots trying to determine manhood, to the measure of the stature and right and true), and try to discern if there is an individual, personalised of the fullness of Christ; so that we may what is pleasing to the Lord.” plan from God? Are we getting ourselves no longer be children, tossed to and fro distressed because of an incorrect by the waves and carried about by every After that, there is freedom to choose theological perspective? wind of doctrine. Rather, .....we are to grow according to wisdom (Proverbs is replete up in every way into him who is the head, with wisdom and commands us to beget What if we concentrated more on into Christ.” (Eph 4:13-15). To be grown wisdom), wise counsel and the desires of seeking God and seeking first “the up means accepting responsibility for our heart. Kingdom of God” than seeking the decisions and actions, not immobilised individual will of God? by uncertainty and insecurity.

10 • CMDFA LUKE’S JOURNAL • February 2021 Bob Goff in his book Everybody Always 3. Where there is no command, All of the above can seem very cognitive states, God gives us wisdom to choose. and prescriptive, lacking in joy and a “I’ve met a lot of people who are 4. When we have chosen what is sense of intimacy with God. So, as a waiting for God to give them a “plan” moral and wise, we must trust the contrast to the more prescriptive writing for their lives. They talk about this sovereign God to work all the details of Gary Friesen, whose tome on the topic “plan” like it is a treasure map God together for good. is huge, Dallas Willard encouragingly has folded up in His back pocket. Only writes: pirates have those. People who want a On a practical note, it is handy to have “The ideal for divine guidance is reason to delay often wait for plans.” some strategies to assist in making wise finally determined by who God is, and decisions. This checklist is helpful… who we are, and what a personal So, does God have an individual will for (The Decision-Making Process, relationship between ourselves each believer, fully mapped out (the thebalancecareers.com) and God should be like. Failure of dot theory), or is His primary will for us to competence in dealing with divine become mature followers of Christ and be 1. Define the problem, challenge, guidance has its deepest root in a His in eternity? Would He guide us along or opportunity. failure to understand, accept and the way allowing room for individuality but 2. Generate an array of possible grow into a conversational rela­ quicken our spirit to respond to kingdom solutions or responses. tionship with God: that sort of issues i.e. to lead us to fervently pray 3. Evaluate the benefits, or pros and relationship suited to friends who when an important event in the spiritual cons, associated with each option. are mature personalities in a shared realm is occurring, or lead us on the 4. Select a solution or response. enterprise, no matter how differ­ent path where a decision will determine the 5. Implement the option chosen. they may be in other aspects. next important step in our journey? This 6. Assess the impact of the decision is a challenging question. We humans and modify the course of action as It is within such a relationship that grapple with the cut-off point, the balance needed. our Lord surely intends us to have, between the mundane, where reason and and readily to recognise, His voice common sense are sufficient, but also the Also, take a look at the Black Dog speaking in our hearts as occasion understanding of supernatural intervention Institute’s Structured Problem Solving demands. I believe that He has made of a living, loving, relational God who is decision-making plan. ample provision for this in order there directing our paths during great to fulfill His mission as the Good need or uncertainty. Then, why does He • Don’t make narrative normative, Shepherd, which is to bring us life and seem to intervene sometimes and not i.e. in choosing a marriage partner, life more abundantly. The abundance others? Is there an actual cut-off point? I don’t ask for God to cause a specific of life comes in following Him, and doubt that we will know this side of eternity. person to come to a well and water “the sheep follow him; for they know your camels! Also, don’t count on a his voice” (John 10:4) So how are we to apply this fleece! to our lives? (Dallas Willard In Search of Guidance, Garry Friesen, in Decision Making and the • Beware of choosing verses to pp. 26-27) Will of God states: support your argument, especially “The Bible must be understood if this is outside of the moral will of I think that this is a most uplifting note according to the original intent of God, logic and advice from trusted on which to close. Ultimately, it is our the author when he wrote to the friends. relationship with our Father through original readers. In other words, it Christ and our response to His love by must be interpreted historically and • Seek wisdom and knowledge from obedience to Him, that allows us to grammatically as it was originally Scripture. delight and trust in His will. intended to be understood. To twist References: the original meaning of the text in an • Be prepared to challenge your views attempt to discover God’s individual in the light of further study, personal The Holy Bible (ESV unless stated) will for me is a misuse of Scripture and growth and reflection and alter your Garry Friesen with J. Robin Maxim Decision will prove to be misleading.” path if appropriate. A person can Making and the Will of God Multinomah Press1980 only make decisions based on the Dallas Willard In Search of Guidance Here are Friesen’s basic principles on best knowledge available at the HarperCollins 1993 knowing and doing the will of God: time and stage of growth. The Decision-Making Process. (thebalancecareers.com)

1. Where God commands, we must • Rejoice that God allows trust in Black Dog Institute Structured Problem Solving obey. the relationship with Him. We are Bob Goff Everybody Always Bob Goff Thomas 2. Where there is no command, developing an eternally-long Nelson Publishers 2018 God gives us freedom (and relationship with our Father. Godly Ravi Zacharias International Ministries responsibility) to choose. children can be trusted! https://www.rzim.org/resources/gods-will

11 • CMDFA LUKE’S JOURNAL • February 2021 Prof Anthony Radford Anthony has been a long-time member and was formerly national chairman of CMDFA and an international vice-president of ICMDA.

Treatise on Health

This article arises from Anthony’s extensive expertise around the globe to modify himself or itself continually, encompassing health work in many cultures. He proposes a new definition of the multifaceted concept of HEALTH and seeks a greater understanding of the inter- not only in order to function better in related environments that determine the health status of individuals and groups. the present but also to prepare for the future. Health like love and pain are difficult A potpourri of definitions of Health: to define but that makes them no less ...physical, intellectual and emotional real. Health comes from the Old English ...a condition or quality of the human performance which is acceptable to word hal or hale meaning ‘whole’. Health organism which expresses adequate the individual or to society. (Anglo-Saxon) is the condition of being functioning under given genetic and (Maddocks I & Maddocks D, 1978) safe, sound and whole. It is the same environmental conditions. (WHO, 1957) concept of health that is encapsulated ...wholeness – it is the complete in the Hebrew word, Shalom. This adds a ...that state of moral, mental and integration and perfect functioning special dimension in a religious context physical well-being which enables a of body and mind maintained to the question; ‘Would you prefer to be person to face any crisis in life with the throughout every phase of activity. cured’ or ‘made whole’ (Mark 2:8-12). The utmost grace and facility. (Maharishi Mahesh Yogi) People’s Charter of Health sets out health (Pericles, C5 BC) with a secular perspective as a ‘social, Whatever is eaten, unless there is rice, economic and political issue and above ...the state in which the individual is there is no life in the body. all a fundamental human right’. able to mobilise his or her resources – intellectual, emotional and physical – ...assured more by an orderly life and There are many definitions and for optimum daily living. Encyclopaedia wise behaviour at the table than by perceptions of health that have been of Educational Research, National those boxes with long, beautiful and proposed over the past 2500 years, Education Association, (USA) mysterious names in the shops of probably longer. Undoubtedly the most the apothecaries. well-known of these is that put forward by ...that quality resulting from the total (Francesco Redi, born 1926) the World Health Organisation (WHO) in functioning of the individual that 1946-7, namely, that empowers him to achieve a personally …a positive state of being able to do satisfying and socially useful self. the things they enjoy, and participate ‘Health is a state of complete mental, (E B Johns, source unknown) in meaningful social relationships. physical and social well-being, and (Baxter M 1991 in Labonte R. not merely the absence of disease ...not a state, but a potentiality – the International Perspectives on and infirmity’. ability of an individual or social group Healthy Communities.)

12 • CMDFA LUKE’S JOURNAL • February 2021 Figure 1: Chemical Health is the power to live a full adult The Environmental living life in contact with what I love Game We All Play Physical Personal – the earth and the wonder thereof – the sea, the sun – I want to be all that I am capable of becoming. Alterable Variables: Social Biological Spiritual (Katherine Mansfield quoted by Rene Dubois.)

Health designates a process of adaptation. It is not the result of Fixed Variables: AGE GENETIC PATTERN SEX instinct, but an autonomous yet culturally-shaped reaction to socially created reality. It designates an ability Outcome: Health or Illth? to adapt to changing environments, to growing up and to ageing, to hypertension or diabetes, or level of I would add that failure to take this into healing when damaged, to suffering rehabilitation of an injury, such as that account may fail to provide the template and peaceful expectation of death. following an amputation and, secondly, required for their best pathway of care. how well the individual or group relates Health embraces the future as, and to those conditions. I have developed a new definition therefore includes anguish and inner of health which identifies its major resources to live with it. Much less well known is the revised WHO components, and which can be (Ivan Illich, Medical Nemesis). definition put forward a decade later, considered from both an individual and which added the importance of and a group or community perspective Health as a normal condition of the environmental conditions in determining body does not mean absence of health status. The original WHO definition HEALTH is the level to which, as disturbance but rather an effective may have been based on that put individuals and groups, we can bodily reaction toward them which forward by the Greek philosopher adapt to and live in harmony with, continuously re-establishes the Pericles in the 5th century BC, but Pericles the inter-related spiritual, mental (or precarious equilibrium between specifically identifies that effective personal), social, physical, chemical different physiological functions. functioning with ease is an essential and biological environments, in (H.P. Drietzel). component of good health. which we live, work and recreate, without disease and without dis-ease. Health is the natural order of things WHO again revised its definition in (Radford 1979). and a positive attitude to which men 1998, at last recognising the importance [and women] are entitled if they of the ‘spiritual’ component which was This definition can be illustrated (Figure 1). govern their lives wisely. incorporated into the 1947 version. (Rene Dubos, 1959) This recognises that the patient or Various societies and cultures may have their community recognises a spiritual very different perspectives on what The original 1947 WHO definition was dimension to their lives irrespective of are the criteria for a healthy individual very restricted, and expresses a kind what their health professionals and the or community. This is illustrated in the of utopian wish, perhaps coming so society around them believes. And following table. soon after the Second World War. Table 1 As expressed, almost none of us ever HAWAIIAN WESTERN achieve such a state and therefore Love of the people for the land Primacy of the self: reproduction of profit the definition has very limited use. For Interdependence of people and nature Domination of humans over nature example, an amputee who has adjusted Protection of nature Exploitation of nature to his or her state can certainly be Sacredness of nature Instrumental view of nature ‘healthy’, even if they have a persisting Conservation of nature Endless consumption of natural resources disability or handicap. Similarly, a Respect for the inherent value of each Modification of nature by man for profit community can be said to be healthy living (and non-living) object with minimal but adequate material Use and sharing among people of all Individual ownership and individual benefit resources, such as some of the Pacific resources islands. ‘Ohana’ (extended family, the collective) Individual as central as central Two important dimensions in considering ‘Laulima’: cooperation among people; Competition: class against class, individual a definition of ‘health’ include, firstly, working together in harmony against individual the level of containment or control ‘Lokani’: unity Conflict, class antagonism of any pathological process such as Polygamy Monogamy

13 • CMDFA LUKE’S JOURNAL • February 2021 Source: E Ola Mau. The Native Hawaiian Health Needs Study, Hawaii: Alu Like Inc., 1985 In summary, the present western-based SICKNESS has been found to be a of which you have ‘all’ or ‘none’. It is a health delivery practices are predicated relative state [and like ‘health’] capable dynamic or changing state. You may on the values of secular-definition, of almost infinite interpretation by both be very healthy today, able to function specialisation, and individualism. This is potential patients and the medical well and with joy, but tomorrow often in opposition to many communities profession. (M. Cooper in M Perlman, you may develop pneumonia, or whose values are more holistic, familial, The Economics of Health and Medical exhibit tinea or schizophrenia, or feel and spiritually embraced (Look, M. et al. Care, 1974, p.105) depressed. The same may be true of Pacific & Health Dialog, 5(2): 296, 1998). your family, workplace or community. A DISEASE is a series of clinical An individual may be ‘healthy’ but The following photograph illustrates the appearances found in association their family, church, soccer team or social significance of conditions such as with special morbid anatomical, community may be quite ‘unwell’. head lice, which in some communities biochemical and physiological findings, of Papua New Guinea and of Australian but presents us with the dilemma of ‘at • Health relates both to individuals Aborigines is not necessarily regarded as what point in a continuously variable and to groups. And the level of health an illness. parameter do we leave normality exhibited by one person may well and pass to abnormality’? (H Dudley, affect the level of health of others, 1969) For example, when does blood either positively or negatively. pressure become high enough to be labelled hypertension? We all belong to several groups: family, office, football team, church or religion, Figure 2 is a summary. class, bingo club, village and city, even nation. Any of these groups may be The above is very much ‘a medical dysfunctional – ‘unhealthy’. Clearly, model’ of disease that does not if the family is functioning well, the address the issues of ‘social lesions’. individuals in it are much more likely to In its concentration on the political feel good about life and themselves, and determinants of health the People’s conversely, if the family is dysfunctional Charter for Health identifies ‘inequality, then that is more likely to alter the state Photo: A J Radford poverty, exploitation, violence and injustice’ of health of its individual members. as the root causes of ill health and death, During the 1990s there was a strong Illness and Disease especially for the poor and marginalised. movement which extended this concept There are also numerous definitions of to addressing the issue of ‘Healthy Cities’ illness and disease that are often as The International People’s Movement and later ‘Healthy Islands’. And if one imprecise as those of health. for Health believes that globalisation can have healthy cities, nations and and war are currently the major social islands you can have unhealthy ones, for An ILLNESS is a state of the determinants of ill health. For example, example, the social ill-health on Pitcairn organisation that fulfills the UNICEF identifies that over half a million Island, the unhealthy Nauru Islanders with requirements of an appropriate children deaths resulted from the their very high level of Type 2 diabetes, or reference group for admission to sanctions imposed on Iraq after the Gulf Scotland and its level of ischaemic heart the sick (and sometimes other, War in the 1990s. disease compared with other western e.g. criminal), role. It is not, per se, nations. sickness. (An appropriate reference HEALTH is not something one does or group is the social group most able, does not have. • Health is fundamentally about most willing or both, to underwrite the adaptation. Health status is the social cost of the sick role). (I Pilowsky, • Health is a level, that is, it is a state outcome of a number of stresses Adelaide). See also Maddocks & that may change from day to day or to which the human organism or Maddocks definition of health above. month by month. It is not something group is subject; from conception

Figure 2

“An illness” “A complaint” “A sickness” “A disease” when taken when recognised which if to others is ... by society as a labelled by legitimate excuse a doctor for avoiding becomes ... social obligations becomes ... Adapted from Charles Florey.

14 • CMDFA LUKE’S JOURNAL • February 2021 Figure 3 to consolation (death). How well we adapt to these stresses determines Overweight our level of health. This will depend in Smoking Stress? part on the level of stress and its rate Animal Fat of change and our capacity to adapt Hyper- Exercise tension to it.

• Health presupposes some level of harmony or contentment, expressed AGE FAMILY HISTORY (GENE POOL) SEX so well by Pericles in his definition quoted above. Health is not a matter of mere existence. CORONARY LIFE DISEASE • Health is essentially environmentally OR CARDIAC DEATH determined. There are at least six readily identifiable categories of environment – spiritual, mental (or such as high blood pressure and through which we weigh up the meaning personal), social, physical, chemical diabetes, levels of blood fats, and of our life – visible and invisible – past, and biological. These environments present and future.” are variously inter-related with • whether or not I exercise, smoke or each other in the expression of can successfully adapt to the level Most people believe in the power of any illness or disease state. Each of stress to which I am subjected, the spiritual world to influence in some of these six environments can be whether I have a family history of high way the state of health of individuals further subdivided into a number cholesterol, and certain gene patterns or groups. WHO now recognises that of component parts, which are also know to be associated with ill health. most, probably all, cultures have a set variously inter-related. See below. of spiritual beliefs held by a varying • all influence whether or not I have proportion of their populations. • Health relates to what we do – a coronary life disease or a cardiac living, working or in recreation. death. Spirit worlds may have both ‘good’ and ‘bad’ dimensions. For example, to • By comparison, ill health expresses These factors interacting may have more Christians the Holy Spirit empowers the itself in either disease or dis-ease. influence on my ‘heart health’ than the work of God for good and Satan with all his fact that I am a middle-aged male with spirits, seeks to throw chaos into the world. These six inter-related environments a family history of heart disease, even can almost all be changed, either by though all of the above factors are risk ‘Every Christian would agree that a man’s the action of an individual, or by society factors per se for heart disease. Figure 3 spiritual health is exactly equivalent to his or its groups e.g. by consensus, by illustrates this. love for God’ (C.S. Lewis, The Four Loves, committee or by law or lore. For example, Collins, 1960, p.8). by personal or group consensus or Let us look in more detail at these inter- committee decisions, or it may be related environments that determine our To the animist, there are also good and enshrined in legislation such as tobacco, health status. bad spirits – of fertility and the forest, food and road safety issues. The age, gardens, rivers and fields. It is believed sex and hereditary components of the The spiritual environment that Health exists when there is joyful biological environment, while discrete conforming to the will of God and variables, are virtually unalterable, and Figure 4 ‘binding’ Satan in the case of the former, all the other components impinge on and successfully placating or appeasing them in an interactive manner. those of the latter groups. Benevolent Spiritual The outcome of these interactions Malevolent Irrespective of their own belief system, determines whether we are health care workers working in a culture ‘healthy’ or ‘illthy’. or subculture different from their own, need to gain an understanding of the For example, D’Souza (2001) says that “spirituality is spiritual world of the communities in • what I eat, drink and breathe, the generator that sources the energy which they work, and the ways they within and enables a person to search believe it may influence their lives. • whether or not I am able to control for meaning through connections with any other disease variables the environment and in relationships. It Their beliefs may significantly associated with, say, heart conditions, represents ‘a dialogue within ourselves’ determine whether or not they will

15 • CMDFA LUKE’S JOURNAL • February 2021 seek care (e.g. abortion), comply with advice (e.g. control smoking or drinking), or undertake medication (e.g. immunisation) or surgery (e.g. Jehovah’s Witnesses).

The mental (or personal) environment

Figure 5

Mental Intellectual

Psychological religious beliefs, political legislation and example, of Cuba and the state of Kerala Emotional professional attitudes (and skills, for in India, both of whose populations are Others Self example, ability to perform a sterilisation very poor. However, both have high levels procedure), local customs and beliefs. of education and a political system This environment relates to how I which promotes equity of access to feel about myself and others – our Example 2. Whether or not an individual services such as health and education. relationships. Its components include smokes relates not only to availability Kerala, although one of the poorest the psychological and emotional states of tobacco products, but also to states of India has one of the highest which interact with each other, and with the consequences – cost, political standards of education and best set of our state of being: for example, the level constraints such as tax, advertising, laws health indicators – it is also the most of tiredness; or hormonal state – pre- regulating use in public places, wages, communist and holds the highest menstrual, pregnancy, menopause; efforts to influence our choice by health proportion of Christians! employment status; family harmony professionals, peer pressure, family and so on. And here we can identify the environment and so on. The physical environment potential influence of the biological and social environments on the mental one. The potential interaction of these Figure 7 first three ‘environments’ and their The social environment is perhaps relationship to health status is well Temperature the most important category when demonstrated in the perception of Physical Humidity considering health services and their ill-health of much of the developing effect on health status, both of groups world. Professor Ogunlesi of Nigeria Radiation and individuals. stated many believe that ill-health is

Figure 6 The effects of temperature: burns (water, steam, sun, frost, and electricity) and Professional radiation (cataracts, skin and other Educational cancers) are obvious. Interactive with Social Religious Economic the physical environment and many skin cancers is the genetic component of Professional Political the biological environment, comparing white and dark-skinned races and family genotypes. Less obvious are those influences resulting from high barometric Like other environments, the social related to a ‘disturbance of relationships pressure: the bends in divers and low environment has a very complex and between individuals or groups, or pressure: altitude sickness in mountain interactive set of component parts. between an individual or groups and the climbers. Adaptation has a major role in supernatural’. Increasingly in industrial the expression or otherwise in many of Example 1. Whether an individual or societies, we are recognising that these conditions (e.g. the story of frog community uses technologies for disturbances in relationships are a major and its response to water of different child spacing depends firstly on their factor in the incidence and prevalence temperatures) knowledge of methods and their of illness, both mental and physical capacity to access or purchase the (e.g. depression, RSI, PTSD). The chemical environment method of their choice. The availability The chemical environment includes what of the technologies relates not only Example 3. Poverty of itself is not an we eat, drink, inhale, and absorb through to knowledge and cost but also to absolute correlate with ill-health, for the skin. Fluids may contain elements

16 • CMDFA LUKE’S JOURNAL • February 2021 Each society has differing beliefs which Figure 8 may be positive or negative with respect Food to health. They may be related to Water Drugs: anthropological or sociological factors, Fat Medicinal & Absorbents Recreational which in turn may be derived from the Chemical Carbs dominant culture, one of its minority Air pollutants cultures, or from any of the subcultures Protein Vitamins within them (eg social behaviour of Minerals some bikie and age-specific groups. Perceptions of health and illness are a major issue when it comes to advocating positive for health, such as adequate but but also consists of our immunological beneficial behaviour change to an not excessive levels of fluoride, low levels state (due to gene patterns, individual (such as encouraging exercise of alcohol and iodine, or negative ones immunisation, previous disease and or wearing a crash helmet or seatbelt) including toxins such as arsenic, mercury, nutritional status), current medication and to minimise risk of a behaviour alcohol or lead. and to various pathophysiological (such as weanling diets). Perceptions conditions that we may have, such as are also important when encouraging Our food has many items such as water, diabetes or hypertension. a population to access health services vitamins, protein, fats and carbohydrates and adopting health behaviours likely to as well as essential elements such as These internal and external states improve or reduce health status. iodine and iron. A correct balance is interact with each other and with other essential for health, while deficiency environments. For example, if you have Time is an important factor in changing and excess can both cause disease, e.g. had designer influenza immunisation (a health behaviours in groups (e.g. Vitamin A. Similarly, our diet may contain chemical), you will probably be immune smoking, cost). The whole area of potential elements that can damage (internal environment) from this year’s consequences and benefits may be health e.g. high saturated fat or low fibre flu virus strain (external biological important. intake. environment). If you do not know about influenza vaccine or cannot afford it, Examples include criteria for seeking The biological environment has two or the government does not supply it or not seeking care, such as the age, major subgroups: the external and (education and economic and political gender or ethnic or social group of internal. components of the social environment), the health worker and their attitude to then your health is at risk, as is that traditional healers or complementary Figure 9 of the rest of the community, as the medicine or beliefs by individuals level of population (herd) immunity or groups regarding the capacity Microbiological and other will be reduced with low immunisation of the health service to manage a coverage, thereby increasing the risk of particular condition such as goitre or Biological disease and death to others, especially cataracts, or the value of alternative the very young, elderly people and those or complementary medicine. Smoking Age who are immuno-compromised. or not smoking, or the chewing of betel Gender nut or eating a particular food may be Heredity Let us look at the cultural aspect of forbidden by either a religion or group the Social Environment in a little more pressure, and societal norms may be Pathophysiological Equilibrium detail. formulated by legislation (e.g. vitamin-

The external environment includes organisms which may cause illness (such as viruses, bacteria and protozoa), the animals which can inflict injury (such as crocodiles and snakes) or transmit illness, such as mosquitoes and parasitised sheep, pork, prawns and fish.

The internal biological environment has three components, which we cannot change, namely, age, heredity (well, almost!) and gender (though some try),

17 • CMDFA LUKE’S JOURNAL • February 2021 enriched foodstuffs). For example, working in the area, tried to encourage among Adventist, Muslim, or Jewish the use of pawpaw as a weaning food groups, there is no incidence of pork- because of its high content of vitamins A related diseases such as Taenia solium and C. The mothers attending the clinics or trichinosis. In countries where there admonished their daughters, who were is a high level of education, this can used as interpreter nurse aides, ‘You be used to influence legislation aimed, i) good: such as breast feeding and know papaya causes scabies, maybe for example, at tobacco and iodine- care of the elderly. the other stories you are telling us are related diseases, fluoride in toothpaste ii) bad: such as rubbing dirt or dung equally stupid!’ and traffic injuries and use of helmets on the birth cord stump, or smoking or seatbelts as evidenced by the falling cigarettes. Thus, health is a multidimensional incidence of the prevalence of tobacco- iii) neither good nor bad: such as pre- concept which can be influenced both related diseases. Motor vehicle accidents chewing food for babies, the gypsy positively and negatively in the incidence and those with iodine deficiency have custom of placing an onion in a sock and prevalence of disease. The health been reduced. Varying eating patterns to treat fevers or wearing a copper worker, the community and politicians in one cultural group such as fat intake bangle to help arthritis. need to develop an understanding may result in marked differences in iv) both good and bad: for example, low of how the many components of disease such as in the gradient of and excess alcohol use. the environment can be changed to ischaemic heart disease incidence v) not known. improve the health and quality of life of among the Japanese in Japan, Hawaii individuals and groups. and California. Those that can be identified as ‘neither good nor bad’ may be so only while the Looking back through some old papers Such changes are not exclusively related wearer is not compromised. For example, I came across the following which a to the use or non-use of a particular the lucky charms or talismans that are student produced in a class exercise aetiological agent such as tobacco or common in many cultures and usually exploring definitions of health at a YWAM fatty foods, but may include changing worn around the neck may be harmless School of Primary Health Care in Perth the coverage of a preventive measure in themselves, but are not so if they delay in 2000. I think it is the most succinct such as exercise or immunisation. seeking care for significant conditions. description of health I have found. Change may also be the result of The charm needles or susuks of Malays “Health is the expression in body, mind, participation rates such as in screening are inserted subcutaneously into the face and spirit as God meant us to be.” for diabetes or hypertension followed and chest. They may or may not have a by the use of effective and acceptable spiritual significance. Copper and other References remedies such as hypertensives for types of bracelets to ward off arthritis D’Souza R (2000). Spirituality and religiosity – high blood pressure. Many of these also fall into this category. has it a place in psychiatric assessment and interventions may be multiple and management? Dept of Rural Health. Broken Hill, NSW. interactive, such as those which have The good can be used to affirm a cultural contributed to the decline in ischaemic trait that is good for health such as Hiebert, PG. Anthropological Insights for Missionaries. Baker: Grand Rapids. 1987. heart diseases and stroke incidence breastfeeding and used as a basis for Lingenfelter, SG & Mayers MK. Ministering rates in industrialised countries. changing those behaviours that are Cross-culturally. Baker: Grand Rapids. 1987. detrimental for health. We can observe Radford AJ & Harris RD (1986). Specific Cultural patterns which are positive for those behaviours whose value we don’t Strategies in Health Education. health can be used by health workers know until we can place them in another Hygie V:38-44. to encourage other healthy behaviours category. For ‘foreign’ health care such as breast-feeding, or ensure that workers, it is a good idea to establish Extended Biography: Emeritus Professor Anthony there are female health workers as a file of different health behaviours, to J Radford AM completed well as male in Muslim societies. Where which you can refer in developing new undergraduate training in Adelaide foreign health workers are used, such programs, and leave as a record so that in 1969 and postgraduate study at the Universities of Liverpool, preclusions for attendance may be the person who follows does not have to Edinburgh and Harvard. acceptable. Behaviours may also be bad start again from the beginning. He has undertaken health work in for health and need to be discouraged. 45 countries working with WHO, Some examples of such behaviours Failure to pass on acquired knowledge UNICEF, the World Bank, World Vision International and numerous would include female circumcision, may have undesirable health outcomes. NGOs in areas of Primary Health rubbing dirt on the birth cord stump, and In the Oro Province of Papua New Guinea, Care, especially in Maternal and the prohibition of certain nutritious foods people believe that the milky sap from Child Health. His also worked as a rural locum GP in remote and especially for women and children. the skin of the pawpaw (papaya) that isolated South Australia. He has two irritates the human skin is the cause autobiographies, namely Singsings, With respect to its health value, any of scabies. Without knowing about this Sutures and Sorcery and Have Stethoscope, Will Travel. particular behaviour or custom may be: local belief, foreign public health nurses He has been a long-time member and formerly national president of 18 • CMDFA LUKE’S JOURNAL • February 2021 CMDFA and an international vice- president of ICMDA. Dr Monique Peris Monique is a General Paediatric Advanced Trainee working in Melbourne, Victoria. She completed her medical training in NSW, joining the CMDFA community in her first year of medical school in 2007 through Transfusion camp.

Teamwork

“I am not looking forward to today.” If the whole body were an ear, where to ask yourself when reflecting on the “Why?” would the sense of smell be? But situation. “X is on today, you know what in fact God has placed the parts in they’re like.” the body, every one of them, just as Have you prayed? “Yeah, I was on with them last week. he wanted them to be. If they were The Bible is very clear about praying Nightmare. I thought about saying all one part, where would the body for our enemies. This isn’t excusing the something but what’s the point?” be? As it is, there are many parts, but behaviour, but bringing it and the person one body.” 2 Corinthians 12:14-20 before God and allowing Him to give you Have you ever been in a conversation His wisdom and strength for the situation. similar to this one? Most people can Just as tension between parents can relate to a situation where they have influence children, so dysfunction “You have heard that it was said, worked with a difficult person or team. between team leaders and senior ‘Love your neighbour and hate your In the strange and uncertain times of the clinicians affect junior medical staff. enemy.’ But I tell you, love your COVID-19 pandemic, unspoken tensions Just as we diagnose and manage the enemies and pray for those who are more likely to surface. illnesses of our patients, we need to persecute you, that you may be recognise and address the behaviours children of your Father in heaven. Just as illness stems from a part of the that may cause injury to our teams, He causes his sun to rise on the evil body not functioning properly, so medical and ultimately compromise the care of and the good, and sends rain on teams can become less functional if patients. the righteous and the unrighteous. there are issues within the team. If you love those who love you, what So, as Christians in our workplaces, what reward will you get? Are not even the “Even so, the body is not made up can we do? Here are a few questions tax collectors doing that? And if you of one part but of many. Now if the greet only your own people, what are foot should say, “Because I am not a you doing more than others? Do not hand, I do not belong to the body,” it “We need to recognise even pagans do that? Be perfect, would not for that reason stop being and address the therefore, as your heavenly Father is part of the body. And if the ear should perfect.” Matthew 5:43:48 say, “Because I am not an eye, I do behaviours that may not belong to the body,” it would not cause injury to our Working with a difficult team member for that reason stop being part of the can take its toll. Know that Christ came body. If the whole body were an eye, teams.” to set us free, which includes not feeling where would the sense of hearing be? oppressed or dominated in this life.

19 • CMDFA LUKE’S JOURNAL • February 2021 “Jesus returned to Galilee in the power of the Spirit, and news about him spread through the whole countryside. He was teaching in their synagogues, and everyone praised him.

He went to Nazareth, where he had been brought up, and on the Sabbath day he went into the synagogue, as was his custom. He stood up to read, and the scroll of the prophet Isaiah was handed to him. Unrolling it, he found the place where it is written:

“The Spirit of the Lord is on me, because he has anointed me to proclaim good news to the poor. He has sent me to proclaim freedom may become a vicious cycle that can junior. Depending on the personalities for the prisoners and recovery of sight ultimately infect a team and further involved, sometimes stating the obvious for the blind, to set the oppressed free, isolate the person or persons involved. If awkwardness is a good way to proclaim the year of the Lord’s this occurs it is often a sign that conflict of acknowledging that it exists. favour.” resolution needs to take place. One way to move forward is to consider a third Is there illness/burnout? Then he rolled up the scroll, gave party mediator - just as couples may Staffing shortages seem to be an it back to the attendant and sat seek out a marriage counsellor, a third ongoing pattern in medicine that will down. The eyes of everyone in the party may assist mediation in teams. continue if we don’t look after the synagogue were fastened on him. workforce we have. This starts with He began by saying to them, looking after each other. Sometimes “Today this scripture is fulfilled in we are so close to the problem, that your hearing.” Luke 4:14-20 “Continue to we can’t see the forest for the trees. Consider bringing in a third party such Remembering that Jesus is the ultimate acknowledge and as a financial adviser who can crunch Saviour, setting the oppressed free brings respect the expertise of the numbers and review the number of a heavenly perspective to the situation. each individual in the patients to be seen and the ideal staffing. Present these findings in a structured Is it one person or a culture? team.” way to your hospital review board or Cultural shifts can be as difficult as budget committee. You may want to managing one person. Often once battle encourage your staff to log the extra lines are drawn and sides are chosen it hours they are required to work so that can be difficult for a group to see what Is there a power differential? there is evidence of the need. Working started the divide in the first place. The In the work of medical training, there outside our means is ultimately not first point is to recognise that the team will be occasions where a person who sustainable, and compromises our ability has become dysfunctional. This may was previously the junior then becomes to care for ourselves and our patients. be evidenced by subtle indicators such the senior. This can cause contention as lateness to important meetings or amongst team members. Ultimately, As Christians, we all have a part to play increased sick days. At other times, it it is important for team members who in spreading the gospel and being the may become obvious through clear are now in the more junior position hands and feet of Jesus. We serve a disagreement in regards to patients to recognise that the responsibility of God who will not leave us or forsake us and differences in opinion regarding the patient or decision is now on that and for whom no challenge is too great, management. person’s shoulders. Also, it is important no situation too difficult, no person he for the person in the new senior role to cannot reach. External processing or “venting” is a way be sensitive to the power shift without of processing a situation with the aim of feeling guilty for what they have “May the God of hope fill you with all coming to a solution. It is a recognised achieved. It is helpful in moving forward joy and peace as you trust in him, so form of mental processing. The problem to continue to acknowledge and respect that you may overflow with hope by develops when the instances of venting the expertise of each individual in the the power of the Holy Spirit.” do not reach a solution endpoint. It then team, just as they would have as a Romans 15:13

20 • CMDFA LUKE’S JOURNAL • February 2021 Ross Farley Ross works for TEAR Australia as an educator and Bible teacher. He has decades of ministry experience with several organisations and churches. Ross has lectured in a number of theological colleges and training programs and is author of Strategy for Youth Leaders, Following Jesus and Leading People and Strategy for Youth Leaders for the 21st Century. He is co-author of Incite, Making a World of Difference. Ross is a graduate of the Brisbane School of Theology.

Poverty: It’s Not What You Think

People once believed the world was disadvantage them (10:7-10); needy, are probably involved; greed, lies and flat until someone explained, “It’s not plundered and groaning (Ps 12:5, 7) oppression lurk in the background. The what you think.” Many Australians think causes of poverty are spiritual and moral, they know what poverty is, but they Those who oppress the weak are not just economic. misunderstand it. The Bible, however, described as: arrogant and scheming points us in the right direction. (10:2), boastful and greedy (10:3), proud Perceptions of poverty in the 2 (10:4), liars (10:7). They think they are developed world Poverty in Psalms 10 and 12 invincible (10:6) and unaccountable (10:11, Our modern understanding of poverty In Psalm 12:5 David wrote, ‘“Because 13). They have no regard for God and emerged in the aftermath of World War II. the poor are plundered and the needy don’t believe that God will call them to Much of Europe had been destroyed but groan, I will now arise,” says the Lord. account. They think they are superior to had been rebuilt and was progressing. “I will protect them from those who malign others and entitled to behave this way. The idea developed that, what we did them.”’ Psalm 10 observes how powerful for Europe, we can do for the developing people trample the poor.1 These psalms There are many causes of poverty. world. Poverty became seen as not describe poverty and challenge common The Bible teaches that some are poor having enough stuff and the solution perceptions. They don’t focus on ‘stuff’. because they are foolish (Proverbs 22:26) as giving people ‘stuff’. However, this When Australians describe poverty, they or lazy (Proverbs 10:4). However, when ‘solution’ did not produce the same focus on what poor people don’t have. whole people groups live in poverty results as it had done in post-war Europe. These psalms focus on how the poor for generations, the issues in Psalm 10 The developing world saw significant are treated. The poor are powerless and improvements but many serious lose out to the more powerful. The poor problems still remained, and some are not poor in isolation but other people “When Australians countries received considerable aid contribute to their poverty, intentionally yet nevertheless got worse.3 or unintentionally. describe poverty, they focus on what poor A turning point came in the 1990s, when The poor are described as: hunted research conducted by the World Bank, (Ps 10:2, 9); victims of greedy schemes people don’t have. called Voices of the Poor, asked the (10:2, 3); lied about and threatened (10:7); These psalms focus poor themselves to define poverty. Over victimised and ambushed (10:8); helpless, on how the poor are 60,000 of the world’s poorest people were crushed, disempowered, afflicted and surveyed with surprising results. The World oppressed (10:9, 10, 12, 14, 17); trapped treated.” Bank found that “while the poor mention in relationships that don’t work or that having a lack of material things, they

21 • CMDFA LUKE’S JOURNAL • February 2021 tend to describe their condition far more or high-altitude mountains. As a result, in psychological and social terms. Poor they have less income, poorer nutrition people typically talk in terms of shame, and are more prone to disasters. The inferiority, powerlessness, humiliation, fear, city poor often have to squat illegally hopelessness, depression, social isolation on vacant land or under bridges and to and voicelessness.”4 live with the constant threat of eviction. All this leads to reduced physical The poor were less concerned about strength and mental capacity due to ‘stuff’ but were much more concerned poor health and hard labour. Physical with how they were treated. When the weakness becomes both a cause and poor were asked to describe poverty, result of poverty, leading to further they raised the same issues that David disempowerment. wrote about in Psalm 10. Poverty is not about ‘stuff’ but powerlessness. • The poverty of the poor is linked to the behaviour of the non-poor. What is poverty? Proverbs teaches that the poor can be There are two basic views:5 as superior: perhaps even as saviours, exploited, crushed (22:22); oppressed who save the poor with our ‘stuff’. This, (28:3); mocked (17:5); denied mercy Poverty as deficit: in turn, promotes materialism and (18:23); shunned and avoided (19:7). the Twentieth Century view. presents possessions as the solution to Psalm 10 and other scriptures teach that This view sees poverty as ‘stuff that’s life’s problems. It is an approach that the non-poor significantly contribute to missing’. The poor don’t have enough promotes unbiblical views of the poor, us the poverty of the poor. food or access to safe water, schools, and material things. health care, etc. Of course, this is true Many of the non-poor see themselves as far as it goes: the poor don’t have Poverty as disempowerment: the recent as superior and believe they are entitled these things and people need them. and ancient view6 to do what they like with the poor. Psalm However, this confuses the symptoms • The poor are disempowered. The poor 10 refers to the ‘arrogance’ and ‘pride’ with the disease. Measles comes with don’t have what they need because they of people like this. They have a sense of spots, but the spots are symptoms, not lose out to more powerful people and entitlement, believe they are anointed the disease itself. So, yes, the poor lack lack recourse to justice. to rule and have the right to do to others ‘stuff’ but that is a symptom. We need to what no one else must ever do to them. ask, ‘Why don’t the poor have the stuff The poor lack social power and are The poor are often oppressed by people they need?’ The answers to that question less able to resist unfair treatment by with vested interests in maintaining low will vary but they will include the sorts of politicians, police, the courts, landowners wages and other injustices. things David wrote about in Psalm 10 (see and businesses. They become easy above). Responses that don’t address prey for companies, who take their land Oppression evokes images of guns and those underlying causes are inadequate. for logging, mining or whatever, and armed militants, but it can also be the That is true in Australia. There are good they are less likely to receive proper work of accountants, lawyers, company reasons why some Australians are compensation or income. The poor boards and political rulers. Such people poor: family breakdown, death of the are often excluded from community use words and numbers rather than breadwinner, unemployment, etc. You decision-making and their voices are guns, but they can be just as destructive. can give people ‘stuff’ as a response, but not heard. unless the reasons behind the poverty • The instrument of disempowerment are addressed, those people will soon be The powerful live on the best land and is deceit. in the same position again. The same is the powerless try to survive on the least- There is an African tribe which believes also true in developing countries. productive lands like flood plains, deserts that God has given all the cattle in the world to them.7 They believe that cattle Furthermore, if we see poverty as the owned by other tribes must have been absence of ‘stuff’, and offer as a solution “Unless the reasons stolen at some point and that they are provision of what is missing, we reduce entitled to raid other tribes and steal the poor to being passive recipients. behind the poverty cattle because all cattle are rightfully This demeans and devalues the poor, are addressed, those theirs. They have a sense of entitlement who we then see not as being in the driven by a lie. This happens in the image of God but rather being defective people will soon be developed world as well as in Africa. and inadequate. Sadly, a view of the in the same position In the debate around the Iraq war, poor as being deficient can easily someone is reported to have said, “Why become their view of themselves. On again.” did God put our oil under their sand?” the flip side, we will then see ourselves Many in the West believe that they are

22 • CMDFA LUKE’S JOURNAL • February 2021 entitled to take the resources of other I asked a group of project participants in countries if they can get away with it. Bangladesh how their lives had changed as a result of the project. They said very Psalm 10:7 suggests that lies are used little about ‘stuff’, even though they had as an instrument of oppression by much more ‘stuff’ than they did before,10 the proud. Ahab and Jezebel8 wanted but they listed off over 20 ways in which Naboth’s vineyard, so they lied about their lives had been empowered. Then Naboth. Naboth was tried and executed one man said: “We now have dignity”. under false accusations, and Ahab Their marred identity was being healed. took possession of his land. The legal system was used in combination with What can we do here? lies to make murder and stealing appear they were created. This is the deepest legitimate. Stealing someone’s land is and most profound expression of poverty. • Give. readily seen as unjust, but, if you first tell The poor come to believe that they are, lies to depict such a person as unworthy and were always meant to be, without • Advocate. In the Psalms, David of the land, you are much more likely value and without contribution.” calls on powerful people to treat to get away with it. Similarly, lies can the poor differently and we can be used to depict particular people as The poor have a marred identity and a speak up on behalf of the poor. subhuman in order to justify making distorted sense of who they are. They them slaves or to compel them to work don’t know they are created in the image • Pray. Psalms 10 and 12 are also for low wages in inhumane conditions. of God and precious in God’s sight. They prayers, where David calls on have believed lies about themselves God to protect the poor and Jesus was tried and executed on a and they need to know the truth. Poverty disempower those who oppress case based on lies. The Jewish leaders denies the love and justice of God and the them. Only God can save from constantly lied about Jesus. Jesus said, image of God in human beings. Poverty is evil, so we need to pray. “You belong to your father, the devil - he not just about ‘stuff’: these are moral and is a liar and the father of lies.” (John 8:44) spiritual issues. There is something satanic about people who use lies to take others down for their Responding to poverty References: own advantage. Poverty is not about stuff If poverty is disempowerment, the 1. D.C. Fleming The Old Testament Speaks. Volume 5. Psalms. Page18. but powerlessness. Behind that, there is solution is empowerment. The goal is for 2. Much of the information in Point 2 is taken oppression legitimated by lies. Behind the people to earn all they need through their from Bryant Myers, Walking with the Poor. lies are forces of evil. own efforts and not to be dependent on Pages 26-32. handouts. Little of that involves giving 3. See publications like When Helping Hurts, Dead Aid, and Toxic Charity. • The result is a marred identity. ‘stuff’. In TEAR Australia projects, a lot of 4. Steve Corbett and Brian Fikkert, When The idea of karma tells people that funds go to paying the local project staff Helping Hurts. Page 53. they deserve to be in their present to work with the poor in support, training 5. Bryant Myers outlines six views in pages condition because of their former lives. and empowerment. People get ‘stuff’ 113-132 but this is reduced to two due to time constraints. Aspects of five of the views If they had lived better lives they would but it is in the context of empowerment. presented by Myers are captured in the have been reincarnated into better For example, they might get goats but second view, disempowerment. circumstances. Many Asian poor believe that is in the context of goat-rearing 6. This is developed by Myers in pages 123-132. this for themselves and think they have training, aimed at setting such people 7. http://www.bluegecko.org/kenya/tribes/ maasai/livestock.htm Also Steve Bradbury no right to education, social services, just up in their own businesses. That changes discovered this on TEAR project visits. employment or decent living conditions. the way the poor think of themselves. 8. 1 Kings 21. In other contexts, white people tell blacks Empowerment heals the marred identity 9. Walking with the Poor. Page 127. that they are inferior, and often black of the poor. Just giving them ‘stuff’ 10. They had all established their own people believe that to be true. reinforces that they are deficient. businesses as well as received safe water, sanitation and food security as a result of that particular project.

In short, lies are used to disempower the Bibliography: poor and, after years and generations, “Empowerment heals Fleming, D.C. The Old Testament Speaks. the poor believe the lies. The poor no Volume 5. Psalms. Hong Kong: Living Books for the marred identity of All. longer believe that they are created the poor. Just giving Kidner, Derek. Psalms 1-72. London: Inter-Varsity in the image of God: their identity is Press, 1973 9 marred. Bryant Myers wrote, “A lifetime them ‘stuff’ reinforces Myers, Bryant L. Walking with the Poor. of suffering, deception, and exclusion is Principles and Practices of Transformational Development. New York: Orbis Books, 2011. internalised by the poor in a way that that they are Corbett, Steve and Fikkert, Brian. When Helping results in the poor no longer knowing who deficient.” Hurts. Chicago: Moody Publishers. 2009. they truly are or the purpose for which

23 • CMDFA LUKE’S JOURNAL • February 2021 Dr Shazza Dr Shazza is an RMO in Queensland

Touched by Cancer, Touched by Love

Dr Shazza is an RMO in Queensland. As a junior doctor who has faced their why we are facing the challenges we own health battles they have found the QHealth system very difficult terrain face but trust we must. This is a small to navigate. As such they left their employment, feeling very much alone and part of my story, written in 2019…. nothing more than an employee number. They have, however, found great solace in writing. This is one such piece. The Australian Bureau of Statistics recently revealed the number of times Dr Shazza has now moved to locuming, working when they’re well enough and someone craves a hug each day is undergoing treatment when required. Their experience as a patient has certainly thirteen. Additionally, the time a hug made them a much better doctor. lasts is three seconds. But interestingly the duration of a hug that can have The world of patient care and medicine my own personal journey as a patient. So medically healing properties lasts twenty has been forever changed. Ironically, how do we ‘survive’ in times of loneliness seconds. The lesson: hug long and hug every corner of the globe has been and isolation? As practitioners how do we often. ‘touched’ by a term now coined as navigate this foreign landscape? ‘touch starvation’. It goes against the I’ve always been a hugger. In fact, if grain of humanity. We are in essence On a personal level my faith has been ‘professional hugger’ was an occupation ‘herd creatures.’ From the moment we my rock. I hold fast to this promise: I’d be a strong candidate for the position. hurtle screaming into the world, skin- “’For I know the plans that I have for you’, to-skin contact is greatly encouraged. declares the Lord, ‘plans...and a future.’” Touch is a powerful anxiolytic. It Yet COVID-19 has taught us to isolate, (Jeremiah 29:11). We may not understand dissipates any worries, frustrations or to be ‘socially distant,’ to avoid hugging fears. It lets you know someone is there. or shaking hands. It is the complete It speaks volumes through silence. And antithesis of being human. As Health best of all, it doesn’t cost a damn thing. Professionals it is vital we realise the “The bureau of When words fail us, human touch can healing power of touch – even during a statistics recently prevail. pandemic. revealed the number of If a loved one is sick it’s sometimes hard As a junior doctor I have found the void times someone craves to know what to do... what to say... what of touch an incredible hindrance to the a hug each day is to ask... But from my experience, the level of patient care I can deliver. But as greatest thing you can do for a loved one a Metavivor* I have also experienced first thirteen.” is nothing at all. Simply put - just be. hand the impact COVID -19 has had on Be present. Be in the moment. Be there.

24 • CMDFA LUKE’S JOURNAL • February 2021 You don’t have to utter a single word. Time can be so fleeting. In the blink of an Instead a loving hug, the holding of eye and the snuffle of a snort, my friend their hand, simply touching their skin had come and gone. is enough. You are enough. I’d only just missed her. She had only just No present needed. left. And it was the best sleep I’d had in No trinkets wanted. a long time. I was rested, I was pain-free No flowers required. and my sleep was enveloped with the love of a dear friend sitting watchfully by Admittedly, everyone has their own my side. language of love. But if there were to ever be a universal currency, then hugging “How rude!” I exclaimed at the top of my would be like liquid gold. hoarse voice.

There is something safe about a hug. I’m “Why didn’t you wake me!?!” I insisted on not sure if it’s the warmth of the embrace, knowing. the pressure of the loving squeeze or simply the meeting of two heartbeats “What did she do?” I enquired, still that makes them so therapeutic. But dumbfounded by my Sleeping Beauty in that short space of time, suddenly Through the haze of illness I can recall moment. everything feels OK. several humbling moments where humanity was on its best display. One I was reassured that she wasn’t offended. When you’re exposed to continual moment I will always treasure was when She was the one who insisted I sleep. treatments, procedures and hospital a friend decided to visit. I’d already And she simply sat, held my hand and admissions you quickly realise how cancelled on her multiple times and I watched a great episode of Dr Phil and a “dehumanised” and “clinical” our was wracked with guilt to do it again. solid midday movie. healthcare system has become. You But I was feeling more curdled than a become known as the ‘blood pressure of bottle of milk left for over a month in the “What a champion!” I declared. And 190/110’, the ‘white cell count of 0.2’ and blazing sun. I was nauseated... vomiting... indeed, she was perhaps more than a the patient ‘awaiting 1g of Ceftriaxone’. and everything hurt... even breathing. champion. We attributed my epic sleep Sure, these numbers are important, but But how bad could it be? A simple visit directly to her silent presence that day. sometimes healthcare professionals get wouldn’t hurt? Suck it up Shazza and And it taught me so much about the so focussed on the numbers they never psych yourself… I decided to get a few power of just “being”. Just “being” with really see the actual patient in front of Zzzz’s in before a shower and her arrival. a loved one in their hour of pain, their them. It’s cold. It’s confronting and it could Upon waking, I noticed the sun had seconds of nausea and their breaths of all be improved through compassion and almost set. I heard the familiar screech overwhelming anxiety is the mark of a the power of human touch. of the overhead parrots as they made human who cares. their afternoon pilgrimage home. And I’m fortunate in that I have many friends I noticed an empty chair sitting right Human touch is a powerful healer. It sings who work in the system, and on the beside my bed. with warmth, talks through silence and whole I’ve been treated with love and smiles through frowns. It’s the antidote compassion. However, the greatest to loneliness and the treatment to illness. doctors and nurses I’ve come into It’s the leveller, the equaliser. When you’re contact with haven’t focussed on the “When you’re sick, “things” no longer matter, but people numbers but on the person. They don’t exposed to continual do. Without human touch, our lives would give me a yellow jar to pee in, they give be sadder, our pain would be deeper and me a warm blanket instead. They give treatments, procedures our souls a little emptier. me a comforting cuddle before reaching and hospital for the complexion-flattering purple admissions you Never underestimate your presence. It’s chemo gloves and apologise for actually something that can never be unfelt and it having to wear them. They show a side quickly realise how streams of liquid gold!! of humanity that has long been lost in ‘dehumanised’ and healthcare because of the demands *A Metavivor is someone with stage IV and pressures of the industry. And these ‘clinical’ our breast cancer who is still fighting but are the individuals who you remember healthcare system also surviving. We will never be cured because they managed to make your and every day we fight this disease we day a little brighter, your anxiety a little has become.” are Metavivors. quieter and your tears a little drier.

25 • CMDFA LUKE’S JOURNAL • February 2021 Dr Ern Crocker Ern is a recently retired Nuclear Medicine Physician. He is currently the NSW State Chair of CMDFA. He is the author of three books: Nine Minutes Past Midnight, When Oceans Roar and most recently, The Man in White.

‘What keeps Moral Injury Conference CMDFA WEBINAR PRODUCED me awake BY THE NSW STATE COMMITTEE at night?’

Never have healthcare workers been might happen. Many of our members on the challenges that face healthcare so pressed or challenged. Never have were deeply challenged at work, in the workers on a daily basis. Problems would they been required to dig deeper marketplace, and in their personal lives. be defined, and solutions proposed. into their faith or draw nearer to their There were medical board appearances, Heavenly Father for strength and legal challenges, and major family issues. Our purpose in providing this webinar courage. The COVID-19 pandemic, and We understood that our struggles were was: the introduction of legislation relating to ‘not against flesh and blood, but against issues such as voluntary assisted dying, the rulers, against the powers, against the 1. To define the issues that face gender dysphoria and abortion have world forces of this [present] darkness, healthcare workers. challenged us as never before. against the spiritual forces of wickedness 2. To raise an awareness of these in the heavenly (supernatural) places.’ issues in our members. In February 2020, the NSW State (Ephesians 6:12) 3. To provide practical means of Committee initiated a weekly prayer approaching these issues in a meeting on Zoom for members and Prompted by the discussion paper on Christian context. affiliates to address these issues. Our Moral Injury circulated by the Ethics 4. To raise up a body of people willing members began to share their personal Management team and following to intercede on behalf of and circumstances, sometimes specifically, discussions with Dr Andrew Sloane support fellow healthcare workers. sometimes not, and we were able to pray (Director of Research /lecturer in Old with and for them. We prayed for healing, Testament at Morling College), the NSW against burnout, for practice issues, and State Committee elected to run a webinar The webinar was presented on November for family and personal matters as well. dealing with issues associated with this 7, 2020. Transcripts and summaries of the We saw many of those prayers answered. subject. eight people who presented on the day Often people would contact Angela Wang follow. These include: (our National Prayer Convenor) or I after The webinar would deal with those issues the meeting asking for member’s contact that ‘keep us awake at night’. National Dr Andrew Sloane details, that they might pray with them experts would discuss concerns relating Director of Research/lecturer in Old and counsel them privately. to voluntary assisted dying, gender Testament & Christian Thought, Morling dysphoria, and abortion. Speakers College. It became apparent that even as would address pressures upon young Andrew introduced the concepts of God was moving, there was a counter doctors in training and upon first moral dilemmas, moral luck, moral spiritual movement against Christians. responders. Burnout, in particular, would residue and moral injury in pandemics We were naive not to anticipate that this be addressed. There would be discussion and everyday practice.

26 • CMDFA LUKE’S JOURNAL • February 2021 John Steenhof Dr Emily Ivarsson ‘The most significant issues’ Managing Director of Human Rights Law Senior Resident Medical Officer. The topics of moral trauma and moral Alliance. Royal Hospital for Women stress are perhaps the most significant ‘Nobody Expects the Spanish Inquisition!’ ‘The Hospital Furnace.’ issues that we have dealt with for Health Regulators, Codes of Conduct Issues facing interns and doctors-in- many years in terms of the welfare and Implications for moral injury to training and how to approach them. of our members and affiliates. On practitioners. behalf of the NSW State Committee, I Gabi Macaulay want to thank members of the Ethics Prof. John Whitehall President of the Nurses Christian Management team for their prompting Professor of Paediatrics and National Fellowship of Australia and encouragement to proceed with Chair CMDFA ‘What Keeps Nurses Awake at Night this webinar, and to thank all of the ‘Issues facing Australian healthcare – A Personal Experience.’ contributors for their time, their efforts workers in relation to gender dysphoria.’ Issues facing nursing staff and as a and their prayerful concern. Readers first responder. will be blessed and empowered as they Prof. Natasha Michael prayerfully consider each presentation. Director of Palliative Care, Cabrini Health Dr Tony Rombola Melbourne General Practitioner from Windsor ‘Current issues relating to legislation ‘Personal Reflections from General Videos of these talks are available to regarding Voluntary Assisted Dying.’ Practice’. members of CMDFA. If you are not a Clinical issues from General Practice member and would like more Assoc/Prof. Harvey Ward and how he has dealt with them. information please call the Assoc Professor Obstetrics and CMDFA Office on 02 9680 1233. Gynaecology UNSW ‘Moral Injury in Carers of Early Pregnancy.’

27 • CMDFA LUKE’S JOURNAL • February 2021 A/Prof Andrew Sloane Andrew is Associate Professor of Old Testament and Christian Thought and Director of Research at Morling College, where he has taught since 2002. He teaches in the areas of integration of faith and work, Old Testament, philosophy of religion, and bioethics. Andrew qualified in medicine and practiced briefly as a doctor before training as a Baptist pastor. His latest book is Vulnerability and Care: Christian Reflections on the Philosophy of Medicine (T&T Clark, 2016)

Moral Injury Conference CMDFA WEBINAR PRODUCED BY THE NSW STATE COMMITTEE

Definitions

Introduction child). It’s not their fault; it’s just terrible 1. It arises when one believes one knows The COVID-19 pandemic has thrown (moral) luck. They rightly feel bad the morally right thing to do (or avoid many complex moral dilemmas our (‘agent regret’), but we need to think doing), but one’s ability to do this way, requiring us to make hard and very carefully about the perceptions is constrained by internal and/or costly decisions. We face the prospect which may arise from that feeling. external factors. — or current experience — of moral Specifically, we need to distinguish dilemmas, bad moral luck, moral between wrongs and harms. We wrong 2. It comes in two phases. There is “initial distress, moral residue, and even moral someone when we (knowingly) treat distress” at the time of potential injury. I would like us to think about them in a way that fails to acknowledge action (or inaction); later, there is these things theologically. what is owed to them. We harm “reactive distress” or “moral residue” someone when we injure them (or that occurs in response to the initial Some helpful distinctions their psyche or their reputation) in episode of moral distress. Moral dilemma some way. In the above example, the As health professionals, we are pretty bus driver wronged no one, but they 3. It involves the compromising of one’s familiar with this category. Moral certainly harmed the child. It is entirely moral integrity or the violation of one’s dilemma is when we face a complex appropriate that they feel regret for the core values. situation in which it is either unclear harm they have done. But they should what we ought to do, or there are two not feel guilt for it. Regret needs to be Moral residue (or more) mutually exclusive options distinguished from guilt. Moral residue occurs when moral distress between which we must choose (e.g., is prolonged and has a longer-lasting who gets the ICU bed?). In such cases, if Moral distress impact on the affected person. we make a good decision (even if it’s not Moral distress is: ‘Ethical unease or the only ‘right’ decision), we should feel disquiet resulting from a situation where One paper describes it like this: neither guilt nor shame, even though we a clinician believes they have contributed may grieve the human cost. to avoidable patient or community harm “In situations of moral distress, one’s through their involvement in an action, moral values have been violated due to Bad moral luck inaction or decision that conflicts with constraints beyond one’s control. After This is hard to define, but easy enough their own values.’1 these morally distressing situations, to see. It’s where a bad thing happens the moral wound of having had to act outside of someone’s control, even if it is The origins of moral distress lie in nursing against one’s values remains. Moral the result of their action (e.g., a careful literature, which identifies the following residue is long-lasting and powerfully bus driver accidentally kills a careless associated elements: integrated into one’s thoughts and

28 • CMDFA LUKE’S JOURNAL • February 2021 views of the self. It is this aspect of moral correctly: is this an occasion when a multi-faceted response. Psychological, distress—the residue that remains— someone has been wronged, or harmed emotional, social and spiritual care can that can be damaging to the self and (or both)? It is important to acknowledge work together to help a person process one’s career, particularly when morally the psychological and emotional impact, and move through experiences of moral distressing episodes repeat over time.”2 and receive appropriate support and dilemma and distress. counselling — a second, and vital step. Moral injury Similarly, moral injury may be defined While psychological support and A video of this talk is available to as: “the profound psychological distress counselling are helpful, they do not members of CMDFA. If you are not a which results from actions, or the lack of address guilt and shame especially member and would like more them, which violate one’s moral or ethical well. That, I suspect, is because moral information please call the code.”4 distress and moral injury are real spiritual CMDFA Office on 02 9680 1233. phenomena as well as psychological/ It is worth noting that this category was existential experiences, and need an developed in response to the experience appropriately differentiated response. of combatants in the armed forces. Shay, Church communities ought to be places who coined the term, included a clear where spiritual support can be found, Footnotes institutional element: “Moral injury is and people pointed to the grace of God 1. Christine Sanderson et al., “Re-defining present when: in the gospel. moral distress: A systematic review and critical re-appraisal of the argument- based bioethics literature,” Clinical 1) there has been a betrayal of what’s While the gospel is the best ‘spiritual Ethics 14, no. 4 (2019): 195, https://doi. org/10.1177/1477750919886088 right [in the soldier’s eyes] therapy’ I know, we also need to be 2. Stephen M. Campbell, Connie M. Ulrich, and careful. While we might seek spiritual Christine Grady, “A Broader Understanding 2) by someone who holds legitimate care as a means of dealing with of Moral Distress,” American Journal of Bioethics 16 (2016): 2. authority distress, it is unlikely to ‘work’ if it is only a 3. E.G. Epstein and S. Delgado, “Understanding ‘therapeutic strategy’. However, we also and Addressing Moral Distress,” Online 3) in a high-stakes situation.”5 need to recognise the diverse riches of Journal of Issues in Nursing 15, no. 3 what spiritual care offers us, and discern (2010), https://doi.org/DOI: 10.3912/OJIN. Vol15No03Man01 Moreover, “Morally injurious events can what kind of response will be most 4. Victoria Williamson, Dominic Murphy, and include acts of perpetration, acts of appropriate for the case at hand. Neil Greenberg, “COVID-19 and experiences omission or experiences of betrayal from of moral injury in front-line key workers,” Occupational Medicine 70, no. 5 (2020): 317, leaders or trusted others. Unlike post- In cases of bad moral luck, people need https://doi.org/10.1093/occmed/kqaa052 traumatic stress disorder (PTSD), moral to be able to articulate their ‘agent 5. Shay, 2011, 183, cited in Joseph Wiinikka- injury is not a mental illness… Moral injury regret’, and lament the harms that Lydon, “Mapping Moral Injury: Comparing Discourses of Moral Harm,” Journal of is not limited by context or profession. have been done and their role in them. Medicine & Philosophy 44, no. 2 (2019): 179. For example, a recent review found that However, they also need to recognise 6. Williamson, Murphy, and Greenberg, exposure to moral injury was significantly that guilt is not appropriate. Lament “COVID-19 and experiences of moral injury in front-line key workers,” 317. associated with PTSD, depression and will also be helpful in cases of moral suicidal ideation across a range of distress, moral residue and moral References • Campbell, Stephen M., Connie M. Ulrich, and professions (e.g. teachers, military injury, but in these situations, there may Christine Grady. “A Broader Understanding personnel, journalists) and across a also be appropriate guilt for wrongs of Moral Distress.” American Journal of variety of countries (e.g. USA, Australia, committed or permitted. This guilt needs Bioethics 16 (2016): 2-9. • Epstein, E.G., and S. Delgado. “Understanding Israel).” to be confessed, and the forgiveness of and Addressing Moral Distress.” Online the gospel received (after appropriate Journal of Issues in Nursing 15, no. 3 (2010): Moral injury is always pertinent for remedial actions). Concurrently, they Manuscript 1. https://doi.org/DOI: 10.3912/ OJIN.Vol15No03Man01 Christian healthcare professionals, may need cleansing and transformation • Sanderson, Christine, Linda Sheahan, Slavica particularly in contexts where hard by the Spirit. Finally, institutional factors Kochovska, Tim Luckett, Deborah Parker, decisions are having to be made in need to be identified and, where Phyllis Butow, and Meera Agar. “Re-Defining Moral Distress: A Systematic Review and the context of overwhelming need and appropriate and possible, dealt with, to Critical Re-Appraisal of the Argument- allocation of finite health resources. avoid unnecessary repetition. Based Bioethics Literature.” Clinical Ethics 14, no. 4 (2019): 195-210. https://doi. org/10.1177/1477750919886088 Possible responses Conclusion • Wiinikka-Lydon, Joseph. “Mapping Moral The first step is to recognise the As health professionals, we will all Injury: Comparing Discourses of Moral Harm.” Journal of Medicine & Philosophy 44, importance of truth-telling. People need face situations that challenge our no. 2 (2019): 175-91. to acknowledge what they have done, moral compass. Various feelings and • Williamson, Victoria, Dominic Murphy, and or have witnessed, and the way it has perceptions may arise from the conflicts Neil Greenberg. “Covid-19 and Experiences of Moral Injury in Front-Line Key Workers.” affected them and others. They also and pressures associated with this, and it Occupational Medicine 70, no. 5 (2020): 317- need to interpret those experiences is important to recognise the benefits of 19. https://doi.org/10.1093/occmed/kqaa052

29 • CMDFA LUKE’S JOURNAL • February 2021 John Steenhof John is the managing director and principal lawyer at the Human Rights Law Alliance. HRLA is a not-for-profit law firm that was established in 2019 to specialise in matters of religious freedom, freedom of conscience and freedom of speech. John has represented various individuals and organisations involved in religious liberty cases throughout Australia.

Moral Injury ‘Nobody Conference Expects the Spanish Inquisition!’

Health Regulators, Codes of Conduct and implications for Moral Injury to Practitioners

This paper gives a brief overview Health practitioners are bound by the moral injury from the binding of their of recent developments in health codes of conduct and ever-increasing conscience. Doctors will face the regulation in Australia. It provides numbers policies that are released by profound psychological distress which a context for understanding the AHPRA and the Medical Board. results from the choice to speak what current interplay between health they believe or to violate their own moral regulators, codes of conduct and health Health practice regulators are and ethical code in assenting to things practitioners who are operating on the increasingly kerbing healthcare worker which are fundamentally inconsistent front line of medical practice, day in freedoms with regulation of far more than with their deepest held convictions about and day out all around Australia. just clinical care and professional ethics. truth, goodness and proper health care. In the standards that bind doctors, there A notable Monty Python comedic is an increasing creep of contestable This really is moral Injury – to force a routine from the 1970s television show ideological concepts about issues like person to call what they believe to be is centred on the surprise appearance cultural safety, colonisation and systemic true a lie and vice versa. There is a good of the Roman Catholic inquisitors racism. These standards for doctors are reason that in the book 1984, the Party into an otherwise ordinary domestic becoming increasingly politicised and mentally tortures Smith and breaks him conversation. When someone states, “I the risk is overreach into practitioners’ by forcing him to declare that, “2 + 2 = 5.” wasn’t expecting the Spanish Inquisition”, personal lives and the censorship of their Such a claim to control objective reality they appear in a cloud of smoke fundamental freedoms. causes fundamental stress and moral remarking, “Nobody expects the Spanish injury. Inquisition - our chief weapons are fear, As such, there is an increasing likelihood surprise, a ruthless efficiency and an that religious practitioners will risk That all sounds overly dramatic, doesn’t almost fanatical devotion to the Pope.” it? And indeed, we don’t live in 1984. But the seeds are there for this kind of moral In Australia, health regulators have “There is an increasing injury to practitioners to become a more extraordinary power to determine what likelihood that religious regular occurrence as doctors face a constitutes offences of “heresy” by medical modern version of the Spanish Inquisition. practitioners. In the case of doctors whose practitioners will risk political and religious convictions do not moral injury from Case study: Dr Jereth Kok align with the latest cultural ideology, Dr Jereth Kok is a Chinese-Australian these sins are not considered venial, but the binding of their resident of Victoria. Jereth is married with are considered mortal and worthy of the conscience.” two children. He has been practicing as most serious punishment. a general practitioner for over ten years

30 • CMDFA LUKE’S JOURNAL • February 2021 in a Melbourne family practice. Jereth has never been the subject of any clinical complaint about his practice.

Jereth is a devout Christian with strong conservative opinions. He likes to share them on social media. Many of his opinions relate to life, marriage, identity and sexuality. On Facebook and other social commentary internet sites he would regularly post his opinions and comments on both contentious and mundane religious and social issues.

In March 2018, an anonymous person (not a patient) complained to the Medical Board about one of Jereth’s Facebook posts that was allegedly in bad taste proposed to suspend Jereth from team, Jereth appealed the Medical following the 2017 Flinders Street terrorist practice using emergency powers. He Board’s decision to the Victorian Civil attack. had less than a week to prepare for and Administrative Appeals Tribunal. On a hearing before the Medical Board 28 February 2020, there was a hearing. The Medical Board failed to notify Jereth and less than two business days to On 27 March, the Tribunal published about the complaint (as required by law) prepare submissions on a complaint a decision rejecting that appeal.3 The but conducted an investigation without he had just received. Tribunal, consisting of a legal member his knowledge.1 Twelve months later, in and two doctors, decided that the Medical March 2019, the Medical Board formally The Medical Board provided Jereth with Board’s use of emergency powers was advised Jereth of the complaint and set a document of more than two thousand appropriate – Jereth must remain out four allegations with a requirement for pages containing his complete internet- suspended. him to explain. Jereth responded within a posting history. The Medical Board had month. scoured this in order to cherry-pick Jereth has been unable to work for around thirty posts from a ten-year eighteen months at the time of writing this Unknown to Jereth, in May 2019, a second period that it used to determine that it article, and remains unable to work as a anonymous person (again, not a patient) was in the public interest that he should doctor. He is at the mercy of the timing complained to the Medical Board that be suspended. of the Medical Board’s investigation and Jereth had made offensive internet posts. their stated intention to strike him off the Medical Register for good when the The Medical Board again failed to notify “That this law matter finally goes to trial. Jereth of this second complaint. The has made it onto Medical Board also failed to provide Jereth is a good doctor. He does his job Jereth with 3-monthly progress updates Australian law books is well. He treats his colleagues well. He of their investigation, as is required by concerning.” treats his patients well. That apparently law.2 doesn’t matter to the Medical Board. Solely on the basis of his internet posts, In late August 2019, on a Friday afternoon, Jereth appeared before the Medical this good doctor can’t join other doctors Jereth was hit with an avalanche of Board less than one week later on 22 on the front lines of the battle against a correspondence from the Medical Board. August 2019. To the extent possible, he had deadly disease in 2020. removed all of the identified posts from (a) Firstly, the Medical Board withdrew the internet and he undertook to maintain This happened not because Jereth did the three of their four original allegations. complete internet silence until the Medical wrong thing but because Jereth said the Board investigation was complete. The wrong thing – all this originating from an (b) Secondly, the Medical Board advised Medical Board was not satisfied and anonymous complaint. of the second complaint and provided suspended Jereth immediately pending him with a copy. a full investigation and trial. He lost his job Jereth’s case raises key concerns about less than a week after finding out that it freedom of speech and the power of (c) Thirdly, the Medical Board wrote Jereth was under threat. health regulators to threaten those to advise that before he was even freedoms using legal powers. All doctors aware of the complaint, the Medical On the advice of his medical defence are subject to the oversight of the Board had met and decided that it insurer, and represented by their legal Medical Board of Australia under the

31 • CMDFA LUKE’S JOURNAL • February 2021 Health Practitioner Regulation National “‘There is no doubt that Dr Kok… has engage with ideas but instead chose to Law. This law gives the Medical Board (a clear conservative leanings.’ And there attack Jereth’s career. The Medical Board bureaucratic and administrative body) you have it folks. What need we have decided to enthusiastically take up those exceptional power over doctors and of due process (or even to release complaints and to use the full extent of other health practitioners. It allows them the evidence)? ‘Thought Crime’ is a their powers to suspend Jereth. to take immediate action to suspend crime in the Peoples (sic) Republic of a doctor in a number of prescribed Victoria!” It is also clear that the COVID-19 circumstances. These circumstances are pandemic has not quarantined not carefully defined and in fact the laws “I would comment but not anymore.” this administrative urge towards were amended in 2018 to give the Medical Cancel Culture. The Tribunal in review Board wider powers to take action “Far to (sic) dangerous to comment. acknowledges that there is a public against doctors where it is “in the public Disgusting result.” interest for doctors to be able to practice, interest” to “uphold public confidence particularly “in the current health climate in the provision of services of medical “I’ve just committed a ThoughtCrime where it is readily foreseeable that practitioners.” (sic) by reading this.” health services may be stretched to their capacity”. It matters not that we are in a That this law has made it onto Australian world medical emergency not seen for law books is concerning. It is a great “More excellent a century and that Jereth has never had threat to fundamental freedoms to a clinical complaint. Jereth’s career is give far-reaching powers of censure to doctors like Jereth will cancelled. He cannot practice medicine. unaccountable administrative bodies. It be targeted for their He cannot contribute to the fight against is also extremely problematic for laws to views on life, marriage, the coronavirus, not because of any provide vague and imprecise grounds shortcoming of his practice, but because such as “the public interest” on which gender and sexuality of the risk that his opinions might bleed those powers can be exercised. rather than for real into his practice.

Oftentimes, the people administering tangible issues of Recent changes to social media these laws are members of a class of clinical practice.” policies and codes of conduct society that is uniform in socio-political AHPRA has recently updated its medical viewpoint and part of a privileged Code of Conduct and Social Media administrative class that is so isolated Jereth’s case is also a disturbing example Policy. Unfortunately, the changes from the “public” that they are least of how regulatory procedures can be impose progressive ideology on doctors, qualified to determine what is in weaponised to cancel people who nurses and carers. They also expand the accordance with the public interest. hold and express unfashionable ideas regulator’s powers to intrude into the and views. ‘Cancel Culture’ promotes personal lives of health professionals The biggest threat of these laws is to destroying someone’s livelihood because and police the expression of their social, freedom of speech. The Tribunal observed of what they say. Speech is not met with political and religious beliefs. that Jereth has “clear conservative speech. Speech is met with cancellation – leanings,” and he expressed his views boycotting, discipline and career threats. This is another step towards legislated strongly. The problematic posts related Cancel Culture targets the player and not Cancel Culture and forces doctors into to abortion, sexuality and transgender the ball. Generally, this is done through accepting and espousing contentious issues and there were also suggestions social media campaigns and public ideology for fear of losing their jobs. that his posts could be read as supporting backlash is supported by complicit media More excellent doctors like Jereth will be violence and racism. The Tribunal reporting to cancel a celebrity or an targeted for their views on life, marriage, considered that there is a risk that entertainer. gender and sexuality rather than for real Jereth’s convictions on these matters tangible issues of clinical practice. might bleed into his practice. The subtext Disturbingly, this modus operandi seems to be that there is a reverse onus appears to be making its way into law Changes to social media policy on conservative voices to positively prove and the rules that govern professions in AHPRA updated its Social Media Policy that their views will not adversely affect Australia. In Jereth’s case, the anonymous in 2019.4 The new Social Media Policy their medical practice. This has the effect complainer(s) could have engaged with intrudes into the personal beliefs of of silencing alternate points of view and Jereth’s ideas instead of complaining. practitioners. It includes examples that dissenting voices. They did not. The best way to respond to are clear impositions on their ability to bad ideas is with good ideas. This allows speak about their beliefs on the basis of Consider some of the comments made viewpoint diversity and prevents bad hypothetical “harm” to certain groups. by doctors when this story was published ideas from becoming orthodoxy simply in Australian Doctor news: because those who have other ideas The policy now includes a requirement are erased. The complainants did not stating:5

32 • CMDFA LUKE’S JOURNAL • February 2021 • Cultural awareness, safety and (e) Ideological terms: References to practitioner and patient beliefs – “systemic racism” and “colonialism” social and clinical have been included as matters that As a registered health practitioner, practitioners must be aware of and your views on clinical issues are allow for in practice. These are terms influential. Comments in social media that are infused with ideology and to that reflect or promote personal views which not all doctors would subscribe. about social and clinical issues might impact on someone’s sense of cultural (f) ATSI statements: A large section safety or could lead to a patient/ has been included concerning client feeling judged, intimidated or Aboriginal and Torres Strait Islander embarrassed. care and safety. Much of this section is political in nature. For example, • Example 1 it indicates that understanding the A health practitioner, who works in effects of colonisation will assist in a small town makes their religious providing medical care. This is asking views about sex before marriage and practitioners to be responsible for homosexuality public by tweeting: political and cultural issues that ‘Abstinence is the best way to avoid extend well beyond their profession. HIV. Not sure why we are investing public dollars into developing of public expression and their private (g) Bullying: A large section has vaccines. Just do what the Bible tells life. been included on bullying and us to do’. A patient sees this and now a requirement to report fellow feels concerned they cannot reveal (b) New section 2.2: A new section notes practitioners. Although no one wants their sexuality to the practitioner, that doctors must consider the effect bullying in the workplace, the section thereby compromising their health of their public comments outside of could capture reporting for political and safety. They make a notification work, including online. This shows that and religious views. about discrimination. AHPRA is explicit in its oversight of practitioners’ private lives and social Some overall implications of these The new policy shows the extent to media interaction. This is a significant changes include: which AHPRA will engage in viewpoint overreach. The regulator should discrimination in favour of socially concern itself with demonstrable (a) Regulators now limit health fashionable ideology. It disguises its harm through misconduct in practitioner’s personal freedoms: progressive left agenda to quash doctors’ professional practice. The distinction between practitioners’ religious and political expression behind a professional and private lives highly contestable assertion of potential (c) Cultural safety: The concept of have become blurred under the “harm”. ‘cultural awareness’ has been new Codes. They are an attack on changed to ‘cultural safety’. This freedom of speech, conscience, Changes to Code of Conduct implies that cultural sensitivity is a belief and political expression. It AHPRA has also just updated its Code of matter of harm and patient safety. is concerning and telling that the Conduct (https://www.medicalboard.gov. It suggests that a practitioner who Social Media Guidance says that a au/codes-guidelines-policies/code-of- does not take cultural differences doctor’s personal views about social conduct.aspx) for practitioners. The new into account in treatments may be and clinical issues, “might impact on Code mirrors the new Social Media Policy putting patients’ health at risk. someone’s sense of cultural safety or to extend the control of regulators over could lead to a patient/client feeling the personal lives of doctors and legislate (d) Conscientious objection: A new judged, intimidated or embarrassed.” contentious ideology. section requires practitioners to A doctor’s religious beliefs – a inform their patients when their fundamental aspect of their identity Significant changes to the Code include: personal opinions do not align with – are to be suppressed because the profession’s generally held views. of hypothetical embarrassment to (a) Social media guidelines: AHPRA’s This could be used maliciously, someone. social media guidelines have been if doctors are persecuted for specifically included as a standard conservative Christian views. Various (b) Vague terminology will be for practitioner behaviour online. amendments also reinforce that ideologically interpreted to shut Use of social media is now explicitly doctors do not have true freedom of down unpopular views: Codes of highlighted as coming under conscience anyway – they still need Conduct are increasingly being used the application of the Code. This to give referrals to patients against to shut down speech across a variety encroaches on practitioners’ freedom their conscience. of professions. It is a standard feature

33 • CMDFA LUKE’S JOURNAL • February 2021 of these codes to use vague and Summary Footnotes: broad language so that the regulator Overall, it is clear that health regulators 1 Health Practitioner Regulation Law (Victoria) Act 2009 (VIC), s 4; National Practitioner applying the codes has maximum in Australia have extraordinary power Regulation National Law (Queensland) discretion and freedom to move in in regulating the conduct of medical (QLD), s 161(1). 2 Health Practitioner Regulation Law (Victoria) applying them. practitioners. Unfortunately, Codes of Act 2009 (VIC), s 4; National Practitioner Conduct and Social Media policies Regulation National Law (Queensland) (c) This is the politicisation of science: are also being used as a means of (QLD), s 161(3). 3 www.austlii.edu.au – http://www. The medical profession is not a censoring practitioners’ fundamental austlii.edu.au/cgi-bin/viewdoc/ forum for regulators to bring culture freedoms. There are many potential legal au/cases/vic/VCAT/2020/405. wars. People’s physical health and implications for practitioners, as well as html?context=0;query=Kok;mask_ path=au/cases/vic/VCAT+au/legis/vic/ wellbeing should be paramount. A the potential for ongoing moral injury. consol_act+au/legis/vic/num_act+au/ health regulator should not be able legis/vic/hist_act+au/legis/vic/reprint_ act+au/legis/vic/anglican+au/legis/vic/ to dictate a medical practitioner’s The fact that real medical practitioners repealed_act+au/legis/vic/consol_reg+au/ politics. It is deeply concerning that are actually experiencing this reality legis/vic/consol_reg+au/legis/vic/ num_reg+au/legis/vic/reprint_reg+au/ the Code says practitioners must also highlights the need for change in legis/vic/repealed_reg+au/legis/vic/ acknowledge systemic racism – the way that doctors are regulated to bill+au/legis/vic/bill_em+au/other/ a concept promoted by cultural restore doctors’ fundamental freedoms VicBillsRR+au/other/vic_gazette+au/other/ VicOmbPRp+au/other/VicSARCAD+au/ Marxism. and to pull back the overreach in current other/rulings/vicsro/VICSROBF+au/other/ regulations that allow unwarranted rulings/vicsro/VICSRODT+au/other/ rulings/vicsro/VICSRODA+au/other/ (d) Health Professionals risk their jobs intrusion by the Medical Board. rulings/vicsro/VICSROFHOG+au/other/ for the personal views expressed rulings/vicsro/VICSROFID+au/other/ rulings/vicsro/VICSROGEN+au/other/ outside work. A doctor can lose rulings/vicsro/VICSROLT+au/other/rulings/ his job for posting something on vicsro/VICSROLTA+au/other/rulings/ social media that might not even be A video of this talk is available to vicsro/VICSROPT+au/other/rulings/vicsro/ VICSROPTA+au/other/rulings/vicsro/ connected to medicine at all. Dr Kok’s members of CMDFA. If you are not a VICSROSD+au/other/rulings/vicsro/ case is an example. member and would like more VICSROTAA information please call the 4 https://www.nursingmidwiferyboard.gov.au/ news/2019-11-11-social-media-guide.aspx A regulator should not be able to compel CMDFA Office on 02 9680 1233. 5 https://www.nursingmidwiferyboard.gov. the speech of a doctor. au/Codes-Guidelines-Statements/Codes- Guidelines/Social-media-guidance.aspx

www.cmdfa.org.au

Published by the Christian Medical and Dental Fellowship of Australia Inc. ABN 95 084 292 464 Please submit all contributions to: LUKE’S JOURNAL EDITORIAL TEAM Dr Catherine Hollier Ph: 02 4957 5242 Email: [email protected] Subscription and change of address details to the National Office listed below. CMDFA CHAIRMAN Prof John Whitehall Email: [email protected] CMDFA NATIONAL OFFICE Unit 35A / 9 Hoyle Avenue, Castle Hill NSW 2154 PO Box 877 Baulkham Hills NSW 1755 Ph: 02 9680 1233 Fax: 02 9634 2659 Email: [email protected] CMDFA NATIONAL MANAGER David Brown – Contact through the National Office CMDFA NATIONAL SECRETARY Dr James Yun Email: [email protected] ReGS (Recent Graduates & Students) Dr Ben Reardon Email: [email protected] Dr Mack Lee (students) Email: [email protected] CMDFA BRANCH SECRETARIES SOUTH AUSTRALIA (and NT): Dr Chrissy Lai Email: [email protected] WESTERN AUSTRALIA: Dr Bianca van der Nest Email: [email protected] VICTORIA (and TAS): Dr Aleisha Mak Email: [email protected]

34 • CMDFA LUKE’S JOURNAL • February 2021 Prof John Whitehall Professor John Whitehall has been interested in the growing phenomenon of gender confusion in children since 2016. He has authored articles in Quadrant Magazine (https://quadrant.org.au/writer/john- whitehall/) , submitted to enquiries and courts, criticising legislation mandating hormonal affirmation as an affront to human rights, particularly that of children to be free from experimentation.

Moral Injury Conference

Conversion Therapy

In August, legislation was enacted in The current Victorian Change or (my words) sexual behaviour is not a sign Queensland and the ACT that is of grave Suppression (Conversion) Practices of ‘broken-ness’ (theirs) thus negating concern to all Christians in Australia. Prohibition Bill 20203 which is likely to be the Gospel of forgiveness. Second, it will The legislation promises gaol sentences enacted in February 2021, is even more criminalise (literally put you in gaol) if for those who act upon the Biblical punitive in its attempts to eradicate you help by extending fellowship or by injunction of Romans 12, to not ‘copy the so-called ‘conversion therapy’ and the counselling anyone seeking to be liberated behaviour and customs of this world’ but prospect of relief from unwanted sexual from besetting sexual behaviour. Thus, instead ‘let God transform you into a new behaviour. If enacted, the definition of the twin bases of the Gospel, salvation person by changing the way you think’ ‘conversion therapy’ is so broad it will from sin through Christ and sanctification (Romans 12:2a NLT). By contrast, the become a criminal act for anyone, in by the Spirit, are to be abolished by Gospel promises forgiveness for human any way, to offer counselling to anyone parliamentary decree. weakness, but also help in overcoming burdened by unwanted sexual pre- unwanted behaviour. occupation, even if that help is freely The argument underlying the so-called sought by a knowledgeable adult. anti-Conversion Therapy laws is that The Queensland ‘Health Legislation sexual behaviour and identity cannot Amendment Act 2020’1 and the ACT In my opinion – and I repeat that this is and should not be restrained: that such ‘Sexuality and Gender Identity Conversion my opinion – this and pending similar restraint is cruel, depressing, unnatural Practices Bill 2020’2 are based on the legislation in other States constitutes the and impossible, promoting self-harm premise that attempts to restrain sexual most serious threat against the Good and suicide, and, therefore attempts behaviour and identity are misplaced: News we have ever faced in Australia. First, for change should be punished and That people indulging in behaviours its underlying principle is that ‘unusual’ abolished. Although the stated reason they do not want should be assured to legislate in this area is to protect they are not ‘broken’, and that attempts a population that is deemed to be to ‘convert’ them towards heterosexual “...[The Bill] intends, vulnerable or marginalised, I don’t think restraint and gender identity congruent forcibly, to install the that is its primary aim. I think it intends, with chromosomes are bound to fail and forcibly, to install the ideology of gender increase suffering in the process. The ideology of gender fluidity over society and to silence contrary Acts assume that sexual behaviour is fluidity over society opinion. immutable. To the contrary, the Gospel teaches that behavioural change is and to silence contrary To persuade for the necessity of banishing possible for those who seek it, especially opinion.” so-called Conversion Therapy, its with help from Above. proponents evoke the spectre of past

35 • CMDFA LUKE’S JOURNAL • February 2021 attempts to ‘convert’ homosexuality person who is arguing he or she is of the A video of this talk is available to to heterosexuality by administration of opposite sex, anywhere such ‘conversion members of CMDFA. If you are not a electric shock or other forms of what therapy’ is performed... in the home by member and would like more can fairly be described as torture, sex parents or grandparents, in schools by information please call the hormones, castration and even lobotomy.3 teachers, in churches by counsellors, CMDFA Office on 02 9680 1233. It should be needless to emphasise such in offices by doctors. Escape will be coercive, aversive interventions are no impossible: attempts to flee states with References and footnotes: longer practiced in Australia. Indeed, those laws and seek counselling elsewhere 1. Queensland ‘Health Legislation Amendment it was interesting that proponents for for a confused child will be a criminal Act 20201’ (Part 5 Amendment of Public Health Act 2005 [28 ch5B]) https://www. outlawing so-called Conversion Therapy act. Free speech will be curtailed. It may legislation.qld.gov.au/view/pdf/asmade/ in Queensland could cite no evidence for soon become a criminal act in Victoria to act-2020-031 its occurrence in that state, despite several ‘induce’ someone to seek change, putting 2. ACT ‘Sexuality and Gender Identity Conversion Practices Bill 2020’ (A2020- invitations to do so in the Parliamentary into law the ability of proponents for the 49) https://www.legislation.act.gov.au/ enquiry. Nevertheless, proponents for ideology of gender fluidity to ban ‘public View/a/2020-49/current/PDF/2020-49.PDF criminalisation argue that modern, broadcasts’ of a contrary point of view. 3. Victorian Change or Suppression (Conversion) Practices Prohibition Bill freely sought, psychotherapy, Christian 2020 https://www.legislation.vic.gov.au/ fellowship and counselling are the modern Australia has never seen such bills/change-or-suppression-conversion- practices-prohibition-bill-2020?fbclid=IwAR1 equivalent of the Medieval spectre and, determination to eradicate the promise tEqDsh0y0mKxXLDwwNidwWO24r3cUPZPHZut therefore, demand prohibition. of John 8:36 that ‘if the Son sets you free, jdmkOUWUnqaZ4oIZ5PHA you will be free indeed’. Moral injury will 4. The Bill declares equivalence between these medieval practices and ‘increased anxiety According to the current ideology be sustained by anyone feeling bound to and depression’ claimed by a few who of gender fluidity, sexual orientation, promote that promise. have undergone counselling, especially in expression and identity is immutable. Well, churches. A survey by the Melbourne-based Coalition against unsafe school education almost immutable. Fluidity of expression Practical things that may be undertaken www.freetochange.org is publishing a and identity is alleged to be normal to preserve religious freedom include report on 78 replies of positive help from counselling, as opposed to the one from and worthy of chemical and surgical joining in urgent calls to prayer as various La Trobe university which the Qld, ACT and support as long as its movement does bills come before Parliament; and signing Victorian claims to be the scientific basis for their legislation (with 15 replies). not revert ‘back’ towards congruence petitions being circulated through various 5? Kenny, Diana: Jul 16, 2020. NAPP (National with chromosomes. In other words, bodies, including the CMDFA. People Association of Practising Psychiatrists) administration of cross-sex hormones should certainly contact their local Children and young people seeking and with their inherent chemical castration member, preferably with an (even short) obtaining treatment for gender dysphoria in Australia: Trends by state over time (2014- and alteration of the structure of the brain, handwritten letter rather than an email, 2019) https://napp.org.au/wp-content/ and surgical attempts to create ersatz expressing concerns about the Bill. uploads/2020/07/GD-Trends-in-Australia_ Update-to-2019-13-7-20.pdf genitalia of the opposite sex, involving not only castration but also dismemberment, are now justified as long as they lead away from the chromosomes. Castrations and lobotomies are now in vogue. The irony should be compelling.

The extent of moral injury can only be imagined. Hundreds of Australian children and adolescents are, every year, entering the pathway of trans-gendering (see table, right).4

Since the Family Court abrogated its gatekeeping role in November 2019, we don’t really know how many children are attending clinics, and receiving hormones, etc. Certainly, ‘hundreds’ are presenting each year throughout Australia. With enactment of recent legislation, it will now be a criminal act to delay, seek to avoid or to offer an alternative form of therapy for gender confusion. ACT and pending Victorian laws threaten anyone who does not promote trans gendering for a young

36 • CMDFA LUKE’S JOURNAL • February 2021 Prof Natasha Michael Natasha is Director of Palliative Care at Cabrini Health in Melbourne.

Moral Injury Conference

Issues Related to Voluntary Assisted Dying

Our Christian faith, along with our still providing ongoing care for those who of the moral distress that occurs when palliative care tradition, embodies seek VAD. healthcare professionals find themselves a moral tradition of fundamental in situations where they feel they cannot convictions about what it means to The rights-based approach pursued by provide what they consider to be die well. legislation neglects the relational nature excellent care. of conscience, as well as the impact that The Voluntary Assisted Dying (VAD) violating one’s conscience has on the However, a message of hope remains legislation has posed both professional care that one provides. Likewise, the VAD the antidote to legislation. To engender and practical challenges. It asks if our legislation has neglected to recognise hope is to hold in front of a person the moral tradition should be reaffirmed, and prioritise the relational nature of reality of the love of God for each person, or modified to adapt to the new ethical decision-making in healthcare. It along with His mercy. To know that we caregiving realities of legislative and also ignores the negative consequences are loved fills us with hope, and knowing patient demand, along with physician that we are loved by another is the start compliance. More importantly, we as of love. Thus, despite our increasing a community need to ask if this moral “[The VAD legislation] demands to partake in the arena of tradition can be modified at all without policy and political debate, our true compromising our fundamental ethic of ignores the negative vocation must remain at the bedside care. consequences of the of the patient; to face their laments and hear their pleas, even those for a This presentation will explore some moral distress that hastened death. of the realities faced by practitioners occurs when healthcare in the current climate. The moral vision of palliative care and medicine professionals find articulates that we provide patients with themselves in control over the quality of life they can situations where experience in their dying. However, this scope of patient control does not extend they feel they cannot A video of this talk is available to to a decision to terminate life by medical provide what they members of CMDFA. If you are not a assistance, or suicide. We will explore member and would like more how practitioners experience conflict consider to be excellent information please call the of conscience in implementing the care.” CMDFA Office on 02 9680 1233. principle of non-abandonment, whilst

37 • CMDFA LUKE’S JOURNAL • February 2021 A/Prof Harvey Ward Harvey is a busy OBGYN on the Coffs Coast, active in his local church as a musician and apologist. He is a CMDFA NSW committee member and is training as a Saline Process trainer. He is happily married to Kathy and has 3 married children. He is passionate about teaching and making birthdays. His dreams of being a rock star are fading, but he has recorded 2 albums, published poetry and is writing a book.

Moral Injury Conference Moral Injury in Carers of Early Pregnancy

There are few examples more vexing for is right and wrong in a specific situation. callous choice to destroy this pregnancy the Christian Health practitioner (CHP) It is deeply held and guides decision because of her unwanted gender. This confronted with a request or situation making. Convictions are mostly, but not couple may terminate the pregnancy that conflicts with their convictions, always, formed by faith and reliance on anyway if they can’t get a test but you than abortion. revealed Divine instruction. For example feel that complying with their demand the conviction, “first, do no harm” for a test may make you an accomplice. With advancing gestation, there is (primum non nocere) is threatened if They ask you to do the test anyway. Can increasing desperation in the mother you are instructed by a soldier to pull a you refuse a test where you know the who wishes to terminate her pregnancy trigger to kill another human. Your refusal outcome may make you complicit in an and it is increasingly difficult for the to obey may result in your own execution. abortion? Doctor or Nurse/Midwife to object to Similarly, the law may allow for a participate. The law to terminate a procedure that your convictions prohibit, Moral injury: While legal, their request pregnancy for any reason up to 22 weeks but there may be significant cost to is unethical and gender discriminatory. has been passed in NSW and other stand by these convictions. Indeed, many In India, this is illegal but in Australia, States in Australia.1 The law has included a Christian martyr has faced the lions abortion for any reason is allowed in a conscience clause to allow those to for such. How can we approach these some states up to term. abstain from involvement electively in clashes of conscience as CHPs in early some states.2 obstetric practise? Principle being violated: thou shalt not murder4 – intentionally take innocent While the term “moral injury” was Consider Scenario 1 human life. No one would argue against originally coined regarding returning You are a busy GP and a couple come to the innocence, humanity or vitality of this military personnel from conflict see you and open the consultation with fetus. zones3, the same term can apply to the news they are pregnant. They have some degree for CHP managing early two girls and ask if they can do a NIPT Threat: potential loss of relationship with pregnancy. When a person’s conviction test to check the gender because they patients and their community. Possible is compromised, moral injury may be do not want another girl and will abort if complaint to HCCC / AHPRA, possible suffered. The difference between a they find out this fetus is female. departmental discipline. Personal conviction and a mere opinion is that hypocrisy if you compromise. the latter may change without much Moral challenge: By all accounts, this consequence while the former is a line is a healthy 8-week pregnancy, there Primary: be prepared for these one draws in the sand of the soul and is are no risk factors other than the fetus scenarios. Establish the principle and guided by faith, and a certitude of what being female. You are affronted with the always be ready with an answer for

38 • CMDFA LUKE’S JOURNAL • February 2021 the hope you have within you, given with gentleness and respect.5 You may divulge the root of your convictions if asked but it should not be forced without request from the parents. Role play with colleagues to practise what and how to approach this question. Pray daily for your practise and patients, that you would be ready for these events.

Secondary: at the time. Politely let them know of your conviction to protect and nurture innocent life from conception to natural death. Let them know that diagnostic tests merely reveal what is reality, is diagnostic for gender, and violates no principle of your conviction. Let them know what they do with the result is their decision and you would be orders. Your personal convictions are protection strategies to prevent it delighted to assist them in any way to being violated. happening again. Pray for such a time preserve the pregnancy but you would as this (Esther 4:14). not be comfortable referring to another Principle violated: Thou shalt not practitioner for the intent to destroy it. murder – take innocent life. Even while Secondary: establish the facts of You may let them know that there is a recognising the wrong done in the the pregnancy: alive, in utero, any NSW hotline for further advice which is conception, should the innocent life pay other medical issues to be addressed. on public notice. Also ensure that you will for the sins of the parent/s? Determine to inform senior or manager offer any ongoing physical, mental and about moral convictions and note the social care should complications arising Threat: loss of job, career, references, law supports conscientious objection from a termination occur (if they proceed future employment, complaints, to participating in abortion.2 Inform a with one), and that you would be there demotion, discipline and deregistration. sympathetic support person of your for them if they change their minds. Disrupted personal working relationships, situation maintaining confidentiality. fear, ridicule and anger. Ask for wisdom and prayer. Tertiary: reflect on the interaction. Pray for the couple in your quiet times, speak Tertiary: debrief: with colleagues, write to friends, confidantes about the injury down details of conflicts, pray for the you have experienced and revisit your “The law may allow for woman, her baby and those around her. convictions reading the Word of God a procedure that your Resolve to advocate for the unborn, crisis and authors who have pioneered these convictions prohibit, pregnancies, and practically help with difficult paths. (CMDFA resources library). volunteering, supporting financially or but there may be materially a local crisis pregnancy clinic Scenario 2 significant cost to stand or support group. A 17 year-old young woman finds out she was date raped and is 14 weeks pregnant by these convictions.” Scenario 3 and has been admitted for a termination A 30-year-old woman with a previous of pregnancy. She is scared but has abnormal pregnancy resulting in a signed the forms to have it done. You Primary: Recognise the objective value stillbirth with lethal multiple congenital come on duty as a nurse and she seems of life in the womb. If this was a wanted abnormalities, is pregnant again and at ambivalent to having the procedure. baby, the value of the fetus would be the 20 weeks scan there are signs that You escalate your concerns but the radically different and the approach to this abnormality is representing. She asks doctor and senior nurse on shift insist the mother would be entirely supportive. you as the doctor to stop the pregnancy you oversee her taking the abortifacient Prepare beforehand with colleagues before viability and let them grieve. The the pharmacy has dispensed. Your and role play. Recognise the injury done husband is heartbroken but does not manager suggests your ongoing to a woman violated. Set up alternative wish to terminate and would rather let employment depends on compliance options for the woman exploring the nature take its course. with departmental policy. requirements for a pregnancy, support, protection from and prosecution for the Moral injury: you feel coerced to Moral injury: patient is questioning, assailant, delivery of the baby, adoption participate in fetocide. You grieve at the superiors deny and coerce you to follow options, post-partum care and ongoing couple conflict.

39 • CMDFA LUKE’S JOURNAL • February 2021 Principle violated: taking of innocent discuss the course of action with another 2. Do not withhold nutrition or life, peacemaking mandate as a CHP. specialist. Inform the couple of potential hydration unless impossible to ongoing conflict, offer referral for conflict support. Consequences: estrangement from resolution. mother, loss of trust, family disruption, 3. Provide symptomatic relief as far demotion or career destruction, risk of Tertiary: Consider future scenarios with as is medically and psychologically complaint to AHPRA/HCCC. RANZCOG lethal conditions and ask what can be possible. Develop protocols such as position on mother’s primacy in opinions done to ease a life shortened by major those developed by Dame Cicely and decisions about her pregnancy may structural defects and metabolic errors Saunders for palliative care. result in complaints/dismissal. of metabolism. In early obstetric practice, they have Primary response: prepare for Principles: the 3 simple rules served me well, thus far. scenarios by careful thought before A pastor from the Hebrides at a 1983 CMF crisis. Prayerful study on valuing human student’s conference in Perth, Scotland References: life in all ages and forms. Pledge to once gave us three rules to conduct life- 1. Abortion Law reform Act 2019 no 11 protect all innocent life with dignity affirming practice in medicine. They have NSW Parliament even if unsustainable in the near future. never failed me yet. 2. Abortion Law Reform Act 2019 Section 9 Consider providing practical support and NSW Parliament resource development for women to offer 1. Do not take active steps to shorten 3. Koenig H (2020) Journal of religion and Health 59 (2323-2340) Identifying moral viable alternatives to abortion. Inform life – This is premeditated murder. injury in Health care Professionals – the senior staff of your position on pregnancy Nature may be allowed to take its Moral Injury Symptom Scale – HP management of lethal malformations. course. This is unless the ongoing 4. Exodus 20:13 Write out what you would say, read up pregnancy will result with predictable 5. 1 Peter 3.5 on advice given by professionals, ask certainty in the untimely death of colleagues how they would react. them both (ectopic, Eisenmenger’s A video of this talk is available to syndrome, renal failure?). members of CMDFA. If you are not a Secondary response: present your Withholding futile treatment in good member and would like more personal conviction and acknowledge faith that the intervention has little information please call the the legal right of the woman to pursue to no chance of extending life is not CMDFA Office on 02 9680 1233. termination. Offer the opportunity to intentional killing.

Art by Elle Chou (medical student)

40 • CMDFA LUKE’S JOURNAL • February 2021 Dr Emily Ivarsson SRMO Emily is married to Aron. They live in the Eastern Suburbs of Sydney and attend Vine Church in Surry Hills. Emily works at The Royal Hospital for Women and is about to start specialty training in Obstetrics and Gynaecology.

Moral Injury Conference The Hospital Furnace Where you can gain a career and lose your soul

The hospital environment offers Losing sight of yourself life? And why are you anxious about immense opportunity to be a part of 1. Defined by work clothing? Consider the lilies of the the work that Jesus is doing in the 2. Purposed by work field, how they grow: they neither toil world. We are in the privileged position nor spin, yet I tell you, even Solomon of walking alongside people in their Losing sight of all reality in all his glory was not arrayed like most vulnerable moments, with the “Do not lay up for yourselves treasures one of these. But if God so clothes opportunity of showing them care and on earth, where moth and rust destroy the grass of the field, which today is compassion with the love of Christ. At and where thieves break in and steal, alive and tomorrow is thrown into the the same time, the hospital environment but lay up for yourselves treasures in oven, will he not much more clothe can be a gruelling space for our faith. heaven, where neither moth nor rust you, O you of little faith? Therefore, do There are constant stresses and destroys and where thieves do not not be anxious, saying, ‘What shall we temptations that seek to pull us away break in and steal. For where your eat?’ or ‘What shall we drink?’ or ‘What from trusting in the true God and turn to treasure is, there your heart will be shall we wear?’’ For the gentiles seek all kinds of idols. also. The eye is the lamp of the body. after these things, and your heavenly So, if your eye is healthy, your whole Father knows that you need them In my talk, I will cover some of the body will be full of light, but if your eye all. But seek first the kingdom of God challenges that I have experienced and is bad, your whole body will be full and His righteousness and all these have witnessed other Christian doctors- of darkness. If then the light in you is things will be added to you. Therefore, in-training struggle with. I will talk about darkness, how great is the darkness? do not be anxious about tomorrow, how our working environment can lead No one can serve two masters, for for tomorrow will be anxious for us to lose sight of God and as a result either he will hate the one and love itself. Sufficient for the day is its own lose sight of who we are. When we have the other, or he will be devoted to trouble.” Matthew 6:19-34 lost sight of these things, we end up the one and despise the other. You losing touch with reality. I want to show cannot serve God and money. Surviving the furnace how Jesus speaks directly into this in His 1. Take the time that you need to Sermon on the Mount – He knew that this Therefore, I tell you, do not be anxious see God would be our struggle. about your life, what you will eat or 2. Have good accountability what you will drink, nor about your 3. Always be ready to quit. Finally, I hope to offer some solutions body, what you will put on. Is not life and encouragements as to how we can more than food, and the body more survive and even thrive in this furnace. than clothing? Look at the birds of the air, they neither sow nor reap A video of this talk is available to Losing sight of God nor gather into barns, and yet your members of CMDFA. If you are not a 1. An environment that does not heavenly Father feeds them. Are member and would like more acknowledge the existence or you not of more value than they? information please call the sovereignty of God And which of you by being anxious CMDFA Office on 02 9680 1233. 2. A career that does not allow much else can add a single hour to his span of

41 • CMDFA LUKE’S JOURNAL • February 2021 Gabi Macaulay RN Gabi Macaulay (RN, BA Science App Nursing, Grad Dip Midwifery, Grad Dip Theology, M Ministry) is a Lab Clinical Educator and works in Emergency as an RN. Gabi has also gone on several YWAM medical short term trips to PNG and more recently trained and worked in International Disaster Medical relief. She has taught locally and overseas at various conferences. She serves on the Nurses Christian Fellowship Board. Her passion is caring holistically for her patients and teaching this to the younger generation.

Moral Injury Conference

What keeps nurses awake at night? A personal perspective

As a career, nursing has allowed me into reliant on complex monitors, complicated powerless, frustrated or sad. Unlike PTSD, the most privileged of places humanity machines and abundant resources. Moral Injury is not classified as a mental can offer: illness. This in itself is a relief for healthcare • I have been present with the rich I am also comfortable in primary health workers today. undergoing overwhelming medical care settings in remote regions where procedures, there is no currency, electricity or politics. The term moral injury and its related • stayed with the poor in their time of expressions; complexity, ambiguity, fear, I have also been a first responder, landing distress, residue, courage and resilience2, • been a buffer when health news dealt on an island that had only hours earlier came from a military background where a harsh blow, been literally flattened by a hurricane1 people had been given instructions to • sat with distraught parents, (category 5), which hovered for three follow, yet had little or no say in the matter • lingered as a teen realised a whole days and nights to completely destroy or its consequences. new vocabulary involving scarves, hair the buildings, infrastructure and killed loss and sore gums, over 1500 people. I delivered medical Although soldiers have an extraordinary • and helped gather the chaos of a split assistance to those affected in the capacity to follow orders regardless second car crash into some form of immediate aftermath. of the outcomes, at times nurses are repair turning terror and fear back sometimes caught having to follow orders towards life, love and hope. Am I burnt out? Fatigued? Or edging into they are very uncomfortable with, and • I have sat with those after a weather Post Traumatic Stress Disorder? Nope. yet are expected to resurface with clear disaster attempting to make conscience and voiceless memories on some kind of sense of the national Clinically, I am doing well, but I do have the next shift. devastation enveloping them while memories and thoughts that wander recognising quietly that there is no back and challenge me – well, at a deep A range of factors can contribute to moral sense to be made. moral level. injury in nursing, which include: • I have delighted in hearing the first • poor communication, breath of a newborn, ‘Moral Injury’ has been defined as • lack of input into clinical decisions, • and gently stroked the hand of profound psychological distress that • disagreements with physicians about someone else while listening to results from action or lack thereof, which patient care, unsafe staffing levels their last. violates a person’s moral or ethical • inappropriate use of resources. code1. Essentially, one’s core morals or I am comfortable in acute trauma, ICU and core values have been injured or even When nurses find themselves in emergency departments, which are highly violated leaving a residual feeling of being situations where they feel they cannot

42 • CMDFA LUKE’S JOURNAL • February 2021 live up to their own values, or where their With the mother’s permission, I examined to the hope and expectation of a full and teams are not meeting high standards the babe with the little equipment I had long life filled with laughter, friends and of care they may experience negative - my hands, head and heart. He was mudfights. feelings such as guilt, shame, being small for gestational age, had soft yet voiceless and devalued.3 deep fontanelles, a reasonable heart I had moments to decide my role and rate, low blood sugar level, and shallow responsibility. I was also acutely aware Moral injury from a first responder’s respirations - irregular and at times that I had a younger health professional perspective takes on further layers of laboured. with me who I would need to debrief and complexities. Some of these include: help come to some level of resolution in • initial jetlag, He did not respond to my picking him up this unexpected situation. • unknown international medical team, or follow movements with his dear little • instant frontline speed, eyes. I smiled and asked the mother if I also had limited time as we were • continuous 12-hour shifts, she had consumed marijuana during expected to return to the team shortly • unknown cultural etiquette, her pregnancy and she proudly claimed and knew of the long hike and tidal • language barriers, new routines, she had had a lot of it. My heart sank, but barriers to get there. • overwhelming trauma, my face smiled toward her as I snuggled • the possibility of no initial electricity him into my neck flicking away the Given the presenting facts, so many or clean sanitation, memories of my own son at this age and questions crowd in: • and an exhausted population my heightened protective nature during • Should I give the newborn standard swimming in crisis. this time. injections, or will this be seen as precipitating his probable dire Let me take you to an island outcome? – not too far away and not too “I ... asked the mother • How will the mother see this long ago intervention? What right do I have to I was present as a primary health if she had consumed inflict pain on this flaccid babe? care worker and educator. During a marijuana during her • Is it worth it anyway? visit to a remote village I was asked pregnancy and she • What resources that this baby should to see a mother with a 3-day old have access to are even remotely baby for a check-up. Working in this proudly claimed she available? capacity brings its own series of had had a lot of it.” • Why are we so voiceless? barriers: walking ten times further • Am I enough? than you were initially led to believe, being aware of security and feeling The babe was quiet, yet I was captured So, after a silent internal explosion of responsible for venturing with another by his eyes which seemed to be looking emotion and helplessness I decide team member, carrying a heavy but not seeing. Mother had not named to forego the injection and spend my backpack of equipment, heat and the baby (which can be common due remaining time alongside the mother humidity, and difficult-to-traverse to high death rates) and my clinical red teaching her to latch properly, watch for terrain. Nevertheless, we were led to a flags were wilting my heart as I tried to effective swallowing, stroking his dear dirty run-down hut, off the ground with decide what my part was here. little feet, encouraging eye contact and a broken ladder to the open entry. It bonding with him. was barely waterproof and clad with With absolutely no health resources in or bedsheets carelessly strung around. near this remote village, a mother who We mimed out the importance of healthy Inside I saw a young woman who seemed to be waiting for the inevitable foods and better hydration for her and in appeared shy and vulnerable. to happen to her boy, and my clinical what seemed the blink of an eye, I knew expectation that the baby had a poor my time was at an end. Her friend who had guided us to the prognosis, I asked if I could watch her hut walked past the mother and feed. Both mother and baby were quite Walking back to the village, I talked at showed us the newborn baby lying disinterested in each other, and the length to my younger team member, supine, flaccid and quiet. I noticed the mechanical act took only a few moments knowing that her spirit would take a few mother did not move toward either the to leave a devastating impression on me. sessions to unpack the injustices of our babe or us. world. Playing this scenario out in my With the use of broken language skills home city would have this bundle of I lay awake that night – and many and my poor acting, we established innocence, prodded with needles for thereafter - wondering about my actions, that the babe was three moons (three blood gases, placed in a warm and or lack of them; days old) and last su-su (breastfeed) soft humidicrib, examined by leading • The impact on the mother and baby was when the shadow was on that far experts, monitored day and night then and if I had given them the best scrub path (let’s assume 5 hours ago). fearfully and wonderfully brought back opportunity possible.

43 • CMDFA LUKE’S JOURNAL • February 2021 • Could someone else have done better My value, contribution and identity has internal dialogue. I tell many younger and was my decision best practice in been doubted, challenged and nearly mentees that they are strategically this circumstance? discarded by moral injury. Yet my spirit positioned, well equipped, armed and • Did my voice count for anything? is fiercer, more bountiful and strangely ready for the interactions God has for • Was I enough? strong. them. I have remarkable confidence in them. No detail of life has taken God by Fast forward a few months and In the Scriptures I have been able to surprise. It is my turn to take my own to another island far far away! reclaim my value, contribution and medicine. I arrived 33 hours later somewhat identity and realise that, bold as it might jetlagged as a first responder to a new seem, maybe I was born for a time such It takes, frankly, a mountain of effort to field hospital a few days after a hurricane as this (Esther 4:14). believe that I was wonderfully made to has destroyed this and many other do each recorded day, to walk out His surrounding islands. plans and purposes to do good works, “I do know that the with prayer as an active tool and am not Working straight away in the ED brought fruits of the Spirit do alone in the journey. However that looks. new faces, new routines, long hours and although grateful, also a stressed and not include the fear, BUT GOD positioned me there and it was endless line of casualties. inadequacies, anguish, better than me not being there.

One of note was a young 6-year-old guilt or shame.” BUT GOD provided me with a scope of boy who arrived with his mother and practice that helped. presented with a cough, fever and obvious signs of severe pneumonia. Although stringing along Scriptures of BUT GOD brought voice to the situation Again, his dark innocent eyes of trust and convenience to fit my apparent spiritual by bringing my presence. faith in us captured my heart. The little need may not be the best theological man deteriorated very suddenly into an practice at times it sure as heck works BUT GOD knew that my hug and arrest situation with us working on him for me in these situations. My emotional connection was more important than for well over an hour. The early stage of headspace seems to perhaps outshine my shortfall of full medical knowledge. an emergency field hospital is not set up the need for true historical context: for intubation of a child and we watched BUT GOD used my voice to still the waters. this little chap slip from our hands into “Gabi, eternity. As a team we are well versed Psalm 139:14 – You were fearfully and BUT GOD calmed my thoughts before with death and dying. However, the wonderfully made, I slept. inability to have had everything that Psalm 139:16 – Every day of my life may have made the ultimate difference was recorded in your book. Every Perhaps my perspective is not the was devastating, especially as we moment was laid out before a single ultimate answer. God’s perspective is listened to the howling of his mother one of them had passed. greater than mine and my part was alongside us as she realised what was Jeremiah 29:11 – For I know the plans I small, but enough. It is sometimes easier happening. have for you, declares the Lord. Plans to listen to the voice that criticises my to prosper you and not to harm you. capacity than the voice that created my That night – and many others thereafter Plans to give you a hope and a future. capacity. – I lay in bed and saw his gorgeous little Ephesians 2:10 – For you are God’s dark eyes and heard his mother’s primal handiwork created in Christ Jesus The topic of moral injury is certainly recourse at God. to do the good works which He has breaking new ground in academic circles • We were not enough. prepared in advance for you to do. and rightly so. Healthcare has a high • We did not have more. 1 Peter 5:7 – Cast all your cares on fallout rate, high burnout, and tragically, • Circumstance drowned us. I am not Him for He cares for you. high suicide record. It is imperative we enough. Matthew 28:20 – And surely, I am with identify moral injury and teach a broader • I failed. you always until the end of the age.” understanding to our colleagues. • It is all broken. So, all in all, I do know that the fruits of the Ways to move forward BUT GOD… Spirit do not include the fear, inadequacies, 1. Create conversation So how are we as Christian nurses able anguish, guilt or shame I carry back from As multi-disciplinary health care teams to turn up to the next shift? Somewhere in these events. I cannot unsee some things we can lead the way in education on my heart I need to evolve a capacity to and I cannot unsmell others. Moral Injury. Many healthcare workers exist, survive and lead a way through this. have not heard of the term and are often I expect myself to be present for patients, Christ’s resurrection however allows relieved once they have. On an informal colleagues and myself. me to bring the BUT GOD back into my level asking “How is your moral compass

44 • CMDFA LUKE’S JOURNAL • February 2021 holding up?” or “What’s keeping you A noticeboard with webinars, articles, So what keeps me awake at strong?” is a start. Using a pre/post information, chaplains and help lines night on deployment? huddle shift where nursing leaders can may be helpful. • The sounds of my favourite worship explain the term and introduce the value songs, of mental well-being may create a fuller • The reading of my friends’ work environment. “Small acts of kindness encouraging emails, • Reading my kid’s silly texts, In-service training, speakers, remain a remarkable • My husband’s kind and faithful proud conferences and a safe platform to be way to show words heard are more formal approaches. • My reading of The Psalms and Hot (immediate) and cold (delayed) compassion.” Scriptures, believing that... debriefs, together with conferences and • Maybe, just Maybe, I was born for such speakers can also address the topic. a time as this... 3. Leadership Placing value on healthcare worker’s By expressing a genuine care and References morals should become normal concern for your team members, others 1. Williamson,V, Murphy,D and Greenberg,N conversation. will follow the cultural shift in the work 2020, “COVID-19 and experiences of Moral atmosphere. Small acts of kindness Injury in Frontline Key workers’ Occupational Medicine”, viewed 18 April 2020 https:// 2. Resources remain a remarkable way to show academic.oup.com/occmed/article/ Let the people you lead be aware of compassion. We must value each other doi/10.1093/occmed/kqaa052/5814939 your intentional interest for their well- and realise the impact this has on others. 2. Lachman,V.D 2016. “Moral Resilience: Managing and Preventing Moral Distress and being and the resources available to Moral Residue.” MEDSURG Nursing march- them. Allocated times of debriefing in a 4. Appreciation April 2016 Vol 25/No2 p121-4. confidential environment as a regular Open appreciation and public thanks 3. Duhig,S. 2020. Are your Nurses experiencing occurrence may diffuse lingering doubts continue to keep morale up in stressful Moral Injury? www.relias.com/blog/are- your-nurses-experiencing-moral-injury and normalise the process. times and can quieten the voices that cause doubt and conflict.

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About Luke’s Journal Subscription of Luke’s Journal is given Web content editor: Peter Shirley to members of CMDFA. It is also offered lukesjournalcmdfa.com This Journal is published by the to libraries and hospitals at the price Graphic design: Ivan Smith, Lilydale, Vic. Christian Medical and Dental Fellowship of $55 per issue including postage Stock photos: www.dreamstime.com of Australia Inc. (CMDFA). The views within Australia. Enquiries and notice of expressed in the articles are those of change or address should be directed Luke’s Journal Back Issues the authors and not necessarily those to the national office. of the CMDFA. Articles are reviewed Back issues can be by the editors and members of the accessed electronically at About CMDFA editorial committee. Material published lukesjournalcmdfa.com or on the in the Journal is subject to copyright. Membership of CMDFA is open to issuu app at www.issuu.com Requests for permission to reproduce graduates and students of medicine Please email the national office for any part thereof for purposes other and dentistry. Information about a photocopy version. This is free for than private study should be directed activities of CMDFA can be obtained financial members of the CMDFA or at to the editors. Additional copies for from the website at www.cmdfa.org. a cost of $20 for non-members. passing on to interested colleagues au or from Branch Secretaries. Further Payment details can be requested can be obtained from the national information and application details are from the office at [email protected] office or Branch Secretaries. available through the national office. or 02 9680 1233.

45 • CMDFA LUKE’S JOURNAL • February 2021 Dr Tony Rombola Dr Antonio Rombola (MBBS, DipRACOG, FAICD) is a general practitioner working in Windsor NSW. He has been practicing as a GP for over 30 years. Tony is also an adjunct Senior Clinical Lecturer with the University of Notre Dame, Sydney Medical School and a GP supervisor in the GP Registrar training programme.

Moral Injury Conference

The GP Landscape

General Practice is challenging more in bureaucracy and administration. Moreover, the current COVID-19 and complex. Its very nature is The rest of the medical landscape pandemic has significantly impacted unpredictable, with a broad cross- is also overloaded, with delayed or General Practice, adding further section of medical, surgical, social, blocked access from long waiting times, demands on already-limited resources. psychological, and other issues likely increased financial constraints, and The immensity and uncertainty of the on any given day. high out-of-pocket expenses. There is problem is resulting in rapidly escalating a higher burden of chronic diseases, mental health symptoms, both in The environment is often chaotic, an increasingly ageing population, the community and among health with frequent distractions and and a rise in psychological issues professionals. interruptions. There are pressures such as anxiety and depression. It is of varying degrees of urgency from not surprising that patients rely more Such an overview could make general patients, hospitals, colleagues, aged and more on their GPs to manage practice appear quite unappealing, care facilities, and others. The business their complex needs. With that greater with good reason for many sleepless side of general practice requires complexity, more time, resources, and nights. Despite this, with 30 years of attention to government regulations, expertise are required at the primary general practice behind me, I still find administration, Medicare compliance, care level. the opportunities to treat, minister, accreditation, accounting, payroll and and interact with patients immensely human resources. Increasing reliance on rewarding and challenging. computer technology demands ongoing “Patients rely more and maintenance, with the unpredictability As I ponder the things that have of potential outages. Then there are the more on their GPs to disrupted my sleep over the years, I practitioner’s own considerations - issues manage their complex realise that they fall into three broad at home related to their own health, categories: People, God, and Self. their partner, their family, and other needs. With that personal agendas. Yet, the pressure to greater complexity, Patient/clinical issues (People) see patients is constant, due to both the The sheer volume and breadth of work in patient’s clinical needs and the financial more time, resources, general practice can be daunting. The GP pressure to keep the practice running. and expertise are always has a background fear of missing required at the primary something, misdiagnosing or delaying Our medical system has squeezed diagnosis, and potentially harming a practice income through restricted care level.” patient by omission or by treatment. Medicare funding while demanding ever There are complex and difficult patient

46 • CMDFA LUKE’S JOURNAL • February 2021 presentations or complaints and music. Bring your day to God and lay sometimes unexpected outcomes. your worries on Him. Dealing with death and dying seems to get harder, especially with long-term “Come to me, all you who are weary patients. There is a pressure to deal with and burdened, and I will give you issues within set timeframes, sometimes rest.” Luke 11:28-29 dictated by external factors beyond the practitioner’s control. Recognise and acknowledge that God is in control. Intentionally seek Christian issues (God) fellowship, stay planted in one It is a constant challenge to follow a church, and attend regularly. Seek Christ-centred approach and to maintain encouragement from other Christians. a faithful witness. The pressures are amplified by the multiple interactions “Be transformed by the renewing of “Let us consider how we may spur each day with patients, staff, colleagues, your mind. Then you will be able to one another on.” Hebrews 10:24 and others. As Christians, we aspire test and approve what God’s will is … to treat patients as Christ would treat Do not think of yourself more highly 4. Community connection: Daily them, which can translate into setting than you ought, but rather think clinical work can be very isolating, ourselves higher standards of care than of yourself with sober judgment.” even in group practices. Therefore, might ordinarily be expected. Being Romans 12:2-3 be intentional in building your key human, we cannot possibly achieve this relationships: with your partner, your consistently and so we may experience Keep a lookout for harmful habits. family, and your friends. We all need internal conflict. Long work hours and Regularly monitor and review your a few trusted people in our support other commitments also affect the time behaviours and intervene early. network, so foster and strengthen your available for prayer, reflection, interacting Keep stock of your mental health. inner circle. Connecting in meaningful with other Christians, and attending ways can ease stress, lessen the church. 2. Physical well-being: Take breaks weight of your burdens, widen your at work, make time for lunch and interests, and provide accountability. Personal issues (Self) to connect with others, regardless Urgent problems may also arise at home. of your workload. Schedule regular 5. Connect with a GP: It’s important to Unpredictable illnesses may affect the leave. Recognise your particular see a regular GP and be a patient. practitioner and their family. Raising personal signs which suggest you Schedule regular check-ups. Review children brings numerous demands need time off. Be intentional about your mental and physical well-being and commitments. Houses need eating a balanced diet, sleeping and do not delay seeking help. maintenance and cars need servicing adequately, and exercising. Practice If you feel isolated, overwhelmed, or repairs. Work pressures impact social strategies to wind down after a day’s depressed, or anxious, talk to your GP, activities. It is sometimes a struggle to get work, especially if there have been a counsellor, or a psychologist. This away on a holiday and to relax. Balancing unresolved or difficult issues. must be done in a professional setting home life with work commitments is a during a scheduled appointment, never-ending challenge and can cause 3. Spiritual well-being: Pursue and and not ‘on the fly’ in a corridor or perpetuate tensions. maintain a spiritual perspective. Pray, consultation or a social setting. read scripture, and listen to worship My Response In summary, take care of yourself My response to these issues can be psychologically, physically, and distilled into five core areas: “As Christians, we spiritually. Stay connected to God and his people. Have your own doctor and seek 1. Psychological well-being: It is so aspire to treat patients professional help if needed. Be deliberate important to be intentional about as Christ would treat in setting up the best environment for your mindset, and to challenge you to thrive - both professionally and your thinking. It is easy to fall for them, which can personally. the “imposter syndrome” and feel translate into setting inadequate, leading to a lack of confidence in your judgement. Of ourselves higher A video of this talk is available to equal importance is to be aware standards of care than members of CMDFA. If you are not a of the opposing trap of being might ordinarily be member and would like more overconfident. God wants us to information please call the appraise ourselves fairly and expected.” CMDFA Office on 02 9680 1233. appropriately.

47 • CMDFA LUKE’S JOURNAL • February 2021 Dr Michael Burke Michael is Executive Officer of HealthServe Australia E: [email protected] www.healthserve.org.au

HealthServe Australia Bringing health, hope and wholeness

Photo: HSA in PNG

One of the beauties of HealthServe Editor’s Note: Australia is the way it links with other Living in the digital age makes our world both larger and smaller. Social media program partners, empowering their allows us to immerse ourselves in communities with ideas similar to our own, ministries. On our Indonesian tour we often unaware of differing points-of-view. On the other hand, technology can also connected with two such organisations. interrupt this inward lens, drawing our attention to different people and issues all The first was Torch for Life. We were over the world. encouraged by meeting with their representatives, Dr Jenny, Dr Enny and In this edition we are privileged to hear from a team engaging ‘beyond the bubble’. Elia. Torch for Life equips local community members to be a key health resource at HealthServe Australia (HSA) is a Christian health and development agency times of disaster, such as earthquakes that builds sustainable health programs globally. It aims to build a community’s and tsunamis. capacity for meeting its own health needs, through partnership. Here are some reflections from a February 2020 trip to Java (before COVID halted so many In Bali, we met our partners in the ministry mission journeys), an update regarding the PNG Healthcare Workers Manual, and Gerasa Bali. This organisation works as an invitation... a bridge of peace for local vulnerable people, especially women, children and those with blood borne viruses. Connecting in Indonesia model (Partnerships in International Medical Education) - https://www.prime- Perhaps HealthServe Australia is a Dear Luke’s Journal, international.org/theprimenetwork.htm group you would like to connect with. The pandemic had barely taken off when Together with our Indonesian partners, They partner in primary, secondary and four enthusiastic leaders left Australia’s Dr Ronald and Dr Teguh, we explored tertiary healthcare settings to deliver east coast for culturally-rich Yogyakarta. various models of whole person care. We holistic, evidence-based, community Lawrence, Maddie, Jean and Michael set the stage for medical consultation and individually-focussed health care were met by friends from the Indonesian with a framework that asks: ‘What are the programs. HealthServe Australia is Christian Medical Fellowship. Dr Maria physical, emotional, cultural and spiritual registered with the Australian Charities Widagdo (Dean of the Faculty of Medicine needs of the presenting patient … and of and Not for Profits Commission at Duta Wacana Christian University) the doctor?’ (ACNC) and the Australian Council for extended a warm welcome and we International Development (ACFID). immediately felt at home. We specifically examined the evidence Join with us and increase your vision, behind different strategies and the aims and values. HealthServe Australia’s vision is motivating practical aspects of making it work. Hot and grounding. It seeks global health, topics included adverse childhood events, Note: HSA runs a scholarship program transformed by accessible, compassionate stress, burnout and self-care. Over thirty for students and recent graduates with and high-quality health care for all. health professionals were in attendance. an interest in these visions and aims, The program was so successful that via the HeartStart program https://www. The focus of this project was teaching a subsequent visit, on the theme of healthserve.org.au/programs-of-health- whole person Medicine using the PRIME palliative care, is scheduled for 2021. serve-australia/156-heartstart-project

48 • CMDFA LUKE’S JOURNAL • February 2021 Dr Michael Burke Michael is Executive Officer of HealthServe Australia E: [email protected] www.healthserve.org.au

Bringing health, hope and wholeness

Papua New Guinea HealthCare Worker Manual Photo: HSA in PNG

Papua New Guinea is our northern Union PNG, Christian Health Services While Dr Smith mostly wrote earlier and nearest neighbour. Australian PNG, PNG National Department of Health editions, this third edition has a Christians partner with Papua New and AusVoc Educational Publishing. We comprehensive range of PNG writers. Guinean Christians in many healthcare acknowledge the generous support of The manual has two parts – a first part ventures to bring health, hope and Australian Aid. HealthServe Australia that addresses issues of prevention and wholeness to local communities. played a leading role in collaboration health communication and a second HealthServe Australia, with the support with Dr John Oakley part addressing treatment and health of many CMDFA friends, has partnered (HSA and CMDFA) management issues. The 2020 printing of in the third edition of the Papua New as senior editor fifteen thousand copies of the complete Guinea (PNG) HealthCare Worker and Gerri two volumes of the manual has been a manuals. Koelma (HSA) in significant milestone. Unfortunately, Cliff monitoring and was not able to see its final publication, Our first CMDFA national executive evaluation. passing in 2015. officer, Dr Clifford Smith OAM, and his wife Judy, served the people of Papua HealthServe Australia aims to promote New Guinea for many years. Cliff also wholeness for all partners – physically, was the initial executive officer for emotionally, and spiritually. Our HealthServe Australia. Cliff and Judy programs seek to bridge the health gaps valued health, service, equipping, in diverse communities so that those we compassion and wholeness. serve can embrace their potential in life. Together in partnership with PNG health workers, they created a Thank you to CMDFA people who have unique resource for healthcare generously responded to bring health, workers in rural and remote hope and wholeness. PNG – a textbook of unparalleled utility. Cliff and Judy oversaw Please visit our website to learn of further the first two editions, the second opportunities to engage in a wide range printed in 1996. After this, a of programs and partnerships: newer, more up-to-date third www.healthserve.org.au version was needed. Cliff handed over the task to an able team of Left: Judy Smith with new partners including HSA, Baptist the third edition books.

49 • CMDFA LUKE’S JOURNAL • February 2021 Dr Michael Burke Michael is Executive Officer of HealthServe Australia E: [email protected] www.healthserve.org.au

Bringing health, hope and wholeness

Lighting Paths, Healing Dr Editha distributing roofing materials Lives to Typhoon Yolanda survivors

Congratulations to Dr Editha well as different population groups. The Dignity and Right to Health Award is an and the other nominees on their initiative of International Christian Medical and excellent work. Read on to learn Dr Editha Miguel, an infectious Dental Association (ICMDA). The award provides more about Dr Editha and the disease specialist, graduated from recognition, support and publicity for the most work she and Agape Rural Health the University of the Philippines. outstanding role models and champions acting Program are doing in Palawan, She demonstrates visionary to address health and development issues, Philippines. and innovative leadership in including the HIV global epidemic. addressing the health needs of the Palawan Province in the western communities of Palawan. She has It is an international award acknowledging Philippines is an archipelago - felt drawn to serving the poor since the contributions of Christian doctors, dentists, an expanse of water with many she was a medical student. In 1986, nurses and other health workers. scattered islands. The province is Dr Editha and others established composed of the long and narrow the Agape Rural Health Program The award is an important symbol for ensuring Palawan Island, plus roughly 1,780 (ARP) in Palawan - that voices from diverse communities and islands and islets. Many recognise http://agaperuralprogram.org/ countries are acknowledged and championed. Palawan as the most beautiful By granting this award ICMDA aims to model, island in the Philippines, and one of ARP seeks to improve the health mobilise and encourage creative and the most beautiful in the world. conditions of rural communities sustainable initiatives that enhance the dignity through holistic health and human rights of all people, each made The Philippines has made development projects. As executive in the image of God. https://icmda.net/get- significant investments and director of the first province-wide involved/awards/drhaward/ advances in health in recent years. health program in the Philippines, Rapid economic growth and strong Dr Editha oversaw the training of 2020 Nominees: country capacity have contributed thousands of community leaders • National Torch of Love Foundation – to Filipinos living longer and more and village health workers. She Suluh Kasih Bangsa (SKB), Disaster Relief, healthily. Despite substantial sees the training as a way of Indonesia progress in improving people’s “empowering the local people by • Dr David Mills, Kompian Hospital, Rural lives and health in the Philippines, putting their health care in their Medicine Program, Papua New Guinea achievements have not been own hands.” Starting from just • (WINNER) Dr Editha C. Miguel, FPCP, Agape uniform and challenges remain. one province, Agape Rural Health Rural Health Program, Philippines Deep inequities persist between Program now serves five provinces regions, between rich and poor, as in the Philippines.

50 • CMDFA LUKE’S JOURNAL • February 2021 Dr Editha has a passion for strengthening programs in reproductive health, domestic violence prevention and HIV care. She and her friends from Campus Crusade for Christ train teachers to teach a twelve month course on character development called ‘Life at the CrossRoads’. She believes Dr Editha giving a health lecture that young people, especially women, at the Urban Poor project when appropriately equipped can learn to make wise decisions when faced with life’s challenges. She encourages The ARP Mission: Christian women to be ready to become To love and serve the poor by being agents of change, empowering people leaders when God calls them to that through holistic development. role, such as in the case of Deborah in the Bible. Objectives: 1. To train individuals and educate poor and needy communities towards self- Dr Editha and her team provide essential reliance. health services for communities 2. To develop community projects resulting in improved quality of life. with difficulty accessing care due to 3. To provide compassionate health services to address urgent needs. geographic isolation. The health of these communities has always been a concern 4. To develop social marketing tools and strategies to promote the programme. as seventy percent of these communities 5. To provide continuing staff training and development. and municipalities have had little or no 6. To ensure sustainability and functionality of programme processes. access to any healthcare services over the years since Dr Editha’s graduation. Dr Strategies: Editha envisions that physical health and A. Training social and community development are best approached concurrently within one B. Community Development program, rather than as separate entities. C. Social Marketing/Programme Information Dissemination D. Compassion Dr Editha believes that unless health workers understand health in a holistic context, taking physical, social and Dr Editha exemplifies a life that “does “Looking back, I can see God’s hand moral/ spiritual needs into account, any justice, loves kindness and walks orchestrating everything for me,” she says. health intervention will at most have only humbly with God.” (Micah 6:8). She is a a superficial impact. great believer in the ‘multiplication’ of Dr Editha lives her life consistent with workers - “Training a few so that they her motto of ‘Lighting Paths, Healing ARP believes that progress and too can train others. That has become Lives!’. When asked about her ultimate development is a team effort involving my guiding principle in life.” She says goal, she says, “We seek to bring lasting all levels of society - from the grassroots her strategy is inspired by 2 Timothy transformation by beginning with inner to the top socio-political level - in 2:2, where Paul tells Timothy to ‘entrust transformation in the lives of the people implementing any program. With this in the truth to faithful men who will teach as they invite Jesus Christ to be the Lord mind, it has a focus on building strong others’. In the same way, she “chose to of their lives and their dreams. relationships with various stakeholders, be involved in programs or jobs that from both government and private allow me to train others so I can have a Only one life it will soon be passed, sectors. greater impact.” only what’s done for Christ will last.”

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51 • CMDFA LUKE’S JOURNAL • February 2021 Dr Maria Haase Maria is a GP working part time in Private Practice. She and husband, David, relocated to Toowoomba, QLD in February 2019. She has made annual short-term visits to Myanmar since 2006 to work in an orphanage and to hone her clinical skills. (COVID-19 prevented this year’s trip.)

What to Take on an Overseas Medical Mission Trip

I have been involved with overseas my cake of soap on the nogging of the It is often amusing as children line up for visits to a certain country since 2006: unlined wall to return the next morning their turn, knowing the ropes from staring visiting the same orphanage, watching to find gnaw marks all around the edges. through the open windows to observe children grow up, performing health Hence one very clean mouse gut! the proceedings. By mid-afternoon, it checks on the children, staff, affiliated is the adult session. I try to tailor the church members and, time permitting, It takes thirty minutes to set up on the examination to adult specific mode but checking other local orphanage first day. I have a small kit of essential they insist on the same examination children. equipment that I haven’t changed at all. as the children, thinking that I am Spare batteries are always required as neglecting care if I do not examine I am also the team doctor, so I can be occasionally children sneak in before their ears, etc! busy after hours, behind the scenes lockdown and leave the auriscope on all keeping the team well and functioning. night! I have a medical check sheet to What I have come to learn is that One team member down with illness complete for each child’s examination, medication should not be high-powered or injury has a flow on impact on the with children requiring tests, follow up for a local clinic situation. Simple performance of our whole crew whose or hospital referrals marked in red pen analgesics, antibiotics, gut medications, duties include running a holiday and placed aside for discussion with the asthma medications and topical creams programme and teaching varying skills leaders. are the most common requirements. as well as having fun. Before we leave, In some cultures folk feel ripped off if information is required on any medical Interpreters are essential and a good one not given medications. Small plastic problems so that I can pack my supplies. is worth their weight in gold. In 2019, some bags with a few tablets authenticate A compact but comprehensive supply children who spoke a different dialect the consultation. Local knowledge is of medications is essential for the team. had just arrived and two interpreters essential to know what is appropriate. Gastroenteritis episodes are common were required to relay information. This Teaching sessions are essential at with the change in water and diet. increased the time needed for each the end of every day, to ensure that examination. medications are being used correctly, I have learned much over the years and as an opportunity to upgrade skills. about cross-cultural work and the If the locals cannot understand a spoken complexities of packing my kit. In the “Medication should not direction, it is important to write it down, early years, I worked in a thatched hut be high-powered for a as often accents cause difficulty. Body with no running water, but more recently language helps so much. Acting out in a concrete building, still with no local clinic situation.” scenarios provides information and running water. Two years ago, I once left comic relief.

52 • CMDFA LUKE’S JOURNAL • February 2021 It is becoming increasingly difficult name as that would be dangerous for of the very important facts. Different rules to bring medications into developing the local doctor. This was a military do apply. These are parallel universes! countries, so taking money and sourcing dictatorship! World views are different, experiences are locally (mindful of the country of origin of different, values are different. medications) is sometimes easier. Taking Also, I could not guarantee storage a local to help with purchasing can be between 4-24 degrees for the Another important lesson is to listen helpful as prices can soar for foreigners. medications as the room was in a hut, in to the locals and learn what works for them. New team members often want My first day’s question is, ‘What have to impose their cultural values instead you run out of and what are your “World views are of adjusting to local values and seeking most urgent needs?” Then a trip to the different, experiences their wisdom. Saying that, sharing skills pharmacy that afternoon with a big list and empowering the tired local workers is most helpful. Betadine, ear drops, optic are different, values are creates wonderful memories. preparations and simple meds such as different.” paracetamol can often be purchased So, if you are a first timer, wondering how much more cheaply locally compared to pack, read about the culture, try to with purchasing in Oz. stinking hot conditions, where we worked determine the needs if at all possible and at temperatures between a cool 34C up ask for help from others who have walked One great frustration occurred five to 43C. I had to wipe the mouse urine before you. Learn each time you travel years ago when a Pharmaceutical off the stored medication bottles and and, most importantly, don’t forget your company’s charitable arm, under the retrieve the mouse nest from behind the mouse trap! guidance of their legal team introduced plastic storage drawers, so no, clean documentation requirements for conditions are certainly not guaranteed. procurement of medications. Suddenly, I suggested the lawyers accompany one had to supply the name of the local us to realise that their world was vastly medical recipient for the transported different from the one to which I was to medications. No, I could not supply a work in. Different rules apply. This is one

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Instructions for contributors Members of CMDFA are invited to submit articles or letters to the editors for publication in Luke’s Journal. Articles may CMDFA or may not be on the advertised theme. Writers may wish to discuss their potential contribution with the editors or their state editorial representative before submitting. Member News

You can find an article style guide and template and Let Luke’s Journal know what’s happening more information on getting involved at in your lives – including births and https://lukesjournalcmdfa.com/get-involved/ marriages. Some whose spouses have Articles, letters, book reviews and lengthy news items should passed would be interested in meeting be submitted (preferably in electronic form) to the editors with a covering letter requesting their consideration for with others in similar situations for support. publication. Photos supplied should be high resolution Contact [email protected] JPEGs (minimum 500K). with information, dates and photos Advertisements and short news items should be submitted (high res JPEGs) as appropriate. directly to the editor: [email protected]

53 • CMDFA LUKE’S JOURNAL • February 2021 Dr Thomas Chengxuan Lu Thomas is a general practice registrar in Sydney and a conjoint lecturer at UNSW. He has a keen interest in the intersection of medicine and faith.

Medicine on YWAM Medical Ships

L-R back row: Soufian (Dentist, Belgium), Thomas Lu, Hannah (PGY2, Germany), Shun (ED Attending, Singapore), Maggie and Kapi (Med II, PNG). Front row: Susana (Dentist, Australia), Rochelle and Ebony (Med II, Australia).

“The thief comes only to steal and kill My journey accumulation of overtime and the and destroy; I have come that they may I stumbled upon YWAM-MS during the frequent godless banter which seemed have life and have it to the full.” end of internship. As a medical student, fundamental to modern-day medical John 10:10, NIV I had always wrestled with what it teams. This inspired me to explore meant to live faithfully in the ever- medical missions overseas. Having seen This was declared proudly to all patients consuming world of medicine. My the YWAM stall at a previous CMDFA waiting in the sweltering sun at the conclusion was to be a dependent and meeting, I signed up for an outreach trip beginning of our primary care clinic. Here loving worker, who displayed a life of during annual leave. we were, Christians and non-Christians integrity and grace, with conversations intermingled on the shores of our close seasoned with salt and truth. This Outreach medicine neighbour, Papua New Guinea (PNG), rendered meaning and provided dignity There were many challenges in providing care in the name of Jesus. to my vocation as a servant of Christ in practising medicine in PNG. Each day the medical field. we would commute from the ship to our Background of YWAM target location. Some of these commutes Youth With A Mission (YWAM) Medical However, reality felt incongruous to were long and bumpy, featuring a mix Ships – Australia and PNG (YWAM – this with 6pm admissions, the gradual of worn rugged jeeps, wooden stalls on MS) are a Christian organisation with the back of old pick-up trucks, and even headquarters in Townsville. Using a a medium-sized dinghy to navigate converted cruise ship, YWAM-MS runs volatile waves. All the equipment, approximately ten to twelve outreaches to “In 2019, over 30,000 medicines and vaccinations were carried the rural and remote regions of PNG each vaccinations were in multiple heavy, large backpacks. year. The ship houses up to 130 temporary administered, and and longer-term volunteers from across The focus of each outreach is the the world who come from a diverse range 40,000 patients provision of primary care, in alignment of backgrounds and faith systems. 84% of reviewed in the primary with the national priorities of the country. the PNG population live in these areas and Interventions are cost-effective with the for them, such outreaches may be their care outreach clinics.” goal of providing the greatest quality only access to primary care. of adjusted life years (QALY). There is

54 • CMDFA LUKE’S JOURNAL • February 2021 a strong focus on providing childhood provincial and district health authority, page). Although their motivations and immunisations, and on family planning. is highly valued. In fact, part of YWAM- goals are similar, there is a richness MS’s funding is locally derived from PNG of cultural diversity in worship and Tropical diseases like malaria, corporates.2 With each outreach, there relationship to God. Many of the tuberculosis and yaws are prevalent in is holistic engagement with the local volunteers have not subscribed to the country,1 and occasionally, patients community. There is a commitment faith. Many have a deep sense of become significantly unwell. Allied health to education, for example, programs personal responsibility that aims to professionals are highly valued as there which aim to reduce gender violence. share from what they have benefitted are many musculoskeletal presentations, Infrastructure is also supported when from in Australia. Others have a strong secondary to people having hard lives possible, such as water pumps and sense of attachment to PNG. Within working the fields. The dental clinic water tanks repairs. All of this is built this environment there is much space can see well over forty patients a day. upon a solid relationship with the local for interaction, and for the building of In 2019, over 30,000 vaccinations were community. relationships through discussion of administered, and 40,000 patients culture and faith. reviewed in the primary care outreach Faith and remote medicine clinics.2 Although challenging at times, PNG offers Final thoughts the opportunity to practice medicine YWAM-MS continues to provide a Medicine in PNG was a cultural shock. steeped in faith. By tradition, YWAM continued presence of Christ’s love Apart from the significant language clinics always begin with a reminder and mercy in PNG through healthcare, barriers in history and examination, that Christ has provided life to the full. education and relationship development. more specialised investigations and The overwhelming Christian heritage in Participating in outreach has never felt sub-specialist support were unavailable. PNG makes spiritual acts such as prayer like a short-term endeavour, but rather This made presentations beyond the prevalent in consultations. For many a contribution to a long and successful most basic of issues difficult to tackle. patients with more complex and chronic partnership. For me, it was a reminder Although more specialised services ailments, unable to access treatment to cherish the deeply-valued resources are available in Port Moresby, there are due to resource limitations, a reliance on in Australia, whilst contributing to a significant barriers to access due to God is the only solution. These settings presence which I very strongly feel will the rural and remote locations that the have only reminded me of the natural make a difference in the world. YWAM- medical outreach services. decay of life, and to put our hope MS is always looking for keen doctors, ultimately in the eternal life provided by dentists and allied health professionals Holistic development and Christ. to join its team. partnership The medical work is accompanied Fellowship and evangelism by a strong emphasis on partnership Within the ship environment, there exists References: with local health providers. Papua New an amalgam of cultures and people. 1. Alkan M. [ISRAELI VOLUNTEERS ON THE YWAM Guinean healthcare workers regularly Christians from across the world, and SHIP, PAPUA NEW GUINEA, 2018]. Harefuah. participate in the outreach trips. Their from all different denominations come 2019;158(5):309-12 input on outreach priorities, based on to serve on YWAM (See picture previous 2. YWAM Medical Ships. 2019 - Annual Report.

Make a bequest to CMDFA CMDFA relies so much on the generosity of our members to promote, grow and share the Fellowship of Christ through our profession. After taking care of your family and loved ones, consider what a difference you can make to the future of your profession by leaving a bequest to CMDFA. A bequest is a lasting legacy that links the achievement of one generation to the well-being of the Help the next next. It will help CMDFA fulfil its ministry to the healthcare profession. generation of A bequest to CMDFA can be made in a number of ways: Doctors and • A stated percentage of your estate after your family has been provided for. Dentists share • The residue of your estate after debts, charges and other bequests have been deducted. the love of • A specific sum of money, or shares, or property. • Life insurance, with CMDFA as a beneficiary. Christ... So please prayerfully consider whether you can help the future work of CMDFA through a bequest. If you would like help or more information, please contact our National Manager: David Brown Tel: 02 9680 1233 • Mob: 0414 340 848 • Email: david @cmdfa.org.au

55 • CMDFA LUKE’S JOURNAL • February 2021 A/Prof Alan Gijsbers Alan (MBBS FRACP FAChAM DTM&H PGDipEpi.) is a Specialist Physician in Addiction Medicine, Melbourne, and President of Christians in Science and Technology (ISCAST). He has a particular interest in a studying neuroscience and theology, the philosophy of the self, and spirituality, topics which underpin his approach to addiction care.

Response to: Do we really save lives?

Andrew Williams’s story, “Do We Really Some adverse consequences followed In the meantime, I found a niche in the Save Lives?” (Luke’s Journal 2020, Vol 25 upon our return to Australia. First, Christian Medical and Dental Fellowship, No 2), brought back difficult memories I stopped being part of the church where we explored what it meant of a very similar conversation I had with preaching roster. Whereas before I had a for us to be Christians in the secular my vicar in the late 1980’s-early 90’s, role as a missionary sharing my faith in a environment where God had placed us. but with a very different outcome. different culture, now that I had returned, I found a further niche with the Institute I became one of God’s frozen people for the Study of Christianity in an Age My wife and I had just come back with in the pews – reduced to listening to of Science and Technology (ISCAST) our three children from a five-and- sermons, usually from trainees who were – an organisation of Christians in the a-half-year missionary stint at the novices at the art. There was little call in sciences – where we explored what it Christian Medical College and Hospital, our church for the sort of reflection I was meant to study God’s two books, the Vellore, South India. There our home on doing. They preached the simple Gospel Book of Nature, through science, and the the college campus had been a centre of God’s love, our sin, Christ’s atoning Book of the Word of God, Scripture. These for fellowship and Bible study, where work and our need to repent, become a explorations were enormously fruitful, medical students explored their vocation Christian and therefore receive life. Our enriching my reflections and my clinical as Christian doctors training for their lives had been saved, and that was that. practice, encouraging people without role, mostly in mission hospitals around There was little exploration on growing faith to come to faith, and encouraging the country. Our theme had been David in discipleship, growing into community, those with faith to have that faith Livingstone’s famous statement, “When and living as God’s people in the secular strengthened. God sent his Son into the world, he sent community. We were saved, that’s a medical missionary.” The conversation all that mattered. In retrospect, this is In my vocation as a Christian doctor, with our vicar centred on his vision to probably a caricature, but that is what I newly learnt the depth and breadth of encourage suitable candidates into it felt like at the time. Gospel proclamation. The Gospel is not the ordained ministry. I recall the event just for unbelievers, but also for believers. vividly. We were at the beach and As evangelicals (Gospel people), we I remember a strong sense of being “The Gospel feed on the Gospel for ongoing spiritual called to become a theologically- nourishment, eating Christ’s flesh and sensitive medical practitioner, seeking is not just for drinking his blood (John 6:53-58) as we to integrate Christian faith and clinical unbelievers, but reflect on how his atoning work impacts practice, bridging the Sunday/Monday also for believers.” all our relationships - in our families, in disconnect and seeking to incarnate the the church, and in the secular world. Christian Gospel into my daily work. Further, I learnt that the Gospel of God’s

56 • CMDFA LUKE’S JOURNAL • February 2021 love is not just preached from a pulpit, Taylor3 described the modern moral dentists to live for Christ. We encounter but is expressed in word and deed. Jesus dilemma (which in fact is ancient also) a lot of patients in our practices who embodied God’s love by his commitment of why should I do good, and how do I would have little contact with Christians to the poor, the outcast, the marginalised, get the power to do good? The Christian if they did not see us. It is one of those the sick, the dying, and even the dead. answer is that the love of Christ constrains unhelpful dichotomies to say that doctors Further, God’s love is not just embodied us and the power of the Holy Spirit is there save physical lives whereas clergy save in word and deed, but also proclaimed to develop in us the virtues of the fruit of spiritual lives. Most Christian doctors communally in the way the community the Spirit, empowering us to flourish as subscribe to the bio-psycho-social- of faith embodies the love of God in their we become more and more like the spiritual model of clinical care and the daily relationships. The church, in all its Christ we serve. Saline program empowers Christian diversity, embodies the love of God, and doctors to explore the spiritual dimension invites others into that community. of the clinical consultation in a sensitive “We need good clergy, and appropriate way. There is a lot of My neuroscientific reflections in addiction but the secular world literature on the value of spirituality in led me to see that the Gospel is not just medical care.4 a statement for intellectual assent, but also needs Christians a reflection of God’s loving passion for called by God to So then, what do I make of Andrew humans, who are more than just thinking Willams’ journey to the ordained beings. We are first emotional beings shine for him in their ministry? He felt he could do more being and our passions drive our thinking and vocations.” a clergyman than being a doctor, as behaviour. I explored this in my paper, did his mentor. I hope his education Neuroscience, Addiction and the Gospel has been broad enough to still be able (2008).1 I have the privilege of mentoring HMOs to speak into the everyday world of his and registrars in a secular space. parishioners. Helmut Thielicke describes My clinical practice in addiction medicine I commented to one, not a believer, that docetism in the pulpit - when the Word caused me to reflect deeply on how if I had my time over again, I would like to does not become flesh and stays within to address damaged relationships; explore psycho-spirituality in more detail. an ecclesiastical enclave. There is a great relationships with ourselves, other He commented, “Don’t you do that now?” need for Christians to be salt and light people, our higher power, and the Indeed. I was able to give a grand round in the secular world, and we can do that lived environment. Humans are not at the Royal Melbourne Hospital, a secular as medical missionaries to that world - isolates whose ideas need correction hospital, on spirituality in clinical practice. encouraged, prayed for and supported by or else they will not be saved, instead I explored meaning, purpose, love, and clergy aware of these broader issues. We we are embodied people, living in empowerment, as well as passion, and need good clergy, but the secular world community, in a physical environment. I told the audience two formative stories also needs Christians called by God to God has entrusted us as stewards of which shaped my outlook - the story of shine for him in their vocations. We are not this environment, and one day we will the Prodigal Son, and the story of the all hands or ears or whatever, and each be accountable to him for the way in Good Samaritan. I discovered again that of us cannot say to the other we have which we have discharged the creation day how attractive the gospel is to those no need of you (1 Cor 12:4-25). However, mandate that he has given us. Our sin is who are thirsty. On another occasion there are other calls than the call to the not just individual disobedience which I spoke to hospital chaplains about cloth, and I encourage medical students needs repentance, but also our corporate addiction and spirituality and explored to follow in the footsteps of the Great responsibility to care for the earth – for with them the skills of the Master Clinician Physician and his disciples, like David ourselves and for future generations. For as he sat with the much-married, now Livingstone, and so many in Australia a reflection on how the Atonement affects living-in-sin, woman of Samaria, gently through the CMDFA, and around the my clinical practice of addiction medicine peeling off the layers of defence until world through the ICMDA. see my paper Addiction and Atonement he had told her everything she had References: (2020).2 ever done. But that was healing, not 1. Gijsbers AJ Neuroscience, Addiction and the Gospel, talk at New College NSW, 2008. condemning! I follow Jesus as he skilfully https://www.iscast.org/node/229., also Trying to integrate my Christian faith addressed this lady’s deep thirst for God, as a written paper https://www.iscast. org/journal/opinion/gijsbers_a_2011-11_ into the secular world has caused me and how she found that through him, in neuroscience_addiction_and_the_gospel to become bilingual. So, when I talk spirit and in truth, she could have direct 2. Gijsbers AJ Addiction and Atonement: an with people of little or no Christian access to the Father. Easter reflection from the ISCAST President. 2020. http://iscast.org/node/768 faith, I explore with them the meaning 3. Taylor C. The secular Age. Belknap Press of and purpose of their lives and what The Christian Medical and Dental Harvard University Press, 2007:695ff. 4. Gijsbers AJ. Review of Hostility to hospitality: relationships they have. When I talk in Fellowship as a member organisation spirituality and professional socialization a Christian context, the language is the of the International Christian Medical within medicine. Balboni in MJ, Balboni TA; Oxford 2019. In Christian Journal for Global fundamental Christian virtues of faith, and Dental Association sees itself as Health. https://journal.cjgh.org/index.php/ hope and love. Further, in ethics, Charles empowering Christian doctors and cjgh/article/view/299

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LJ 420 letter.indd 58 21-Apr-20 8:54:26 AM LUKE’S JOURNAL NEEDS YOU!

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59 • CMDFA LUKE’S JOURNAL • February 2021 APPLY A CHRISTIAN PERSPECTIVE TO YOUR LIFE AT WORK

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