The Outlook had a chance to interview a few of those who attended this year’s meeting in Louisville – and, through their stories, to give Presbyterians a better understanding of the day-to-day realities in parts of Asia and Africa. Asked what Americans can do to support those who work in mission overseas, Beverley Booth, a doctor who works in Nepal, answered: “Learn more about the world.”
In 1998, Booth was forced to leave India – a place very near to her heart, where she had worked for 13 years – when Hindu fundamentalists withdrew missionary visas. She tried to get a business visa, but it was denied. As a physician, Booth had worked in India as a consultant to Christian health organizations, mostly community health and development organizations. “I thought I was where God wanted me to be,” she said.
When she had to leave, it was difficult to see what lay ahead, difficult at first to find enthusiasm for learning a new language and resettling in a new place. But she now lives in Katmandu, the capital of Nepal, a country of 23 million and “the only Hindu kingdom in the world.” She works for United Mission to Nepal, a large Christian development organization in its 49th year. And through her work – helping a large development organization identify and address the challenges of the future – she now sees how the work she did in India, all that she had to leave, is helping to shape what’s happening in another place.
Nepal is predominantly Hindu country that has never been colonized and was closed to foreigners until 1954, when United Mission was founded, with help from the Presbyterian church. While Christians then were permitted in the country, there were considerable restrictions. Even now, “we’re allowed in to do health work and education only,” Booth said. “Until 1990 it was illegal to be a Christian (in Nepal) and Nepali Christians who converted others were put in prison, for months to years. We have signed an agreement with the government not to proselytize.”
Because of the restrictions, the development organization with which Booth works has, through the years, largely been led by foreigners – because for a Nepali to be in charge of a Christian organization would not have been permitted. There is still considerable discrimination against Christians, who are now estimated to number about 700,000 in Nepal, about 3 percent of the country’s population.
While Nepali Christians were not permitted to start their own schools or other institutions, the influence of United Mission to Nepal is significant – its four hospitals provide about 20 percent of the hospital care in the country and their hydroelectric power plants about 20 percent of the electricity, Booth said.
This is, however, a time of tremendous change in Nepal. The revolution in 1990 resulted in the establishment of a parliamentary monarchy, a democracy “that’s very fragile,” Booth said. Since 1996, a growing Maoist insurgency has led to increasing unrest; last year, the struggle led to more than 5,000 deaths, Booth said. In June 2001, the king was assassinated by a member of his family, and in May 2002, the country’s parliament was disbanded.
Across Nepal, the Maoists are destroying the infrastructure – bridges, roads, the telecommunications network, “so the country is greatly deteriorating,” Booth said. In the rural areas, Maoists control about 70 percent of the territory, making safety an issue for hospitals run by United Mission and making it harder to staff those facilities in a time of decreasing funding from mainline Protestant denominations in the United States.
So this is, for United Mission to Nepal, a time of change – a recognition that Nepali nationals likely will be taking on increasing responsibility in the organization, while expatriates such as Booth provide mentoring for those people to learn the skills to run key facilities. That’s where her experience from India comes into play. There, Booth said, she worked mostly under Indian nationals, so she knows exactly how such a system works.
With expatriates in charge, “you can run things quite efficiently,” she said. But “if we have to leave, because the country deteriorates or the government throws us out, then it all leaves with us.” So Booth is helping to mentor and train Nepalis to run their own facilities – work she said is difficult, because the switch to a more decentralized approach also means that new priorities are being set and that some projects are being closed down. “It’s not a comfortable time, but it’s an exciting time,” she said.
And as teams have gone out from United Mission to the districts in Nepal, trying to make decisions about where to establish geographic bases and where to scale back, where it is safe to keep operating and where it is not, “they had phenomenal experiences of closeness to God and moments of revelation,” Booth said. “God was amazingly, amazingly present.”
Now, she can also see God’s hand in the path her own life has taken – even if she wasn’t always sure where things were leading at the time.
Until she went overseas, Booth’s background was in academic medicine. She originally went to India as a pediatric kidney specialist. One of the first things she did there was to set up a hemodialysis unit – an early lesson in flexibility. In the United States, “I’d have an architect on my right and an engineer on my left and I’d say, ‘I want three beds there,’” Booth said laughing. “In India, I’d have a plumber and me.” Over the years, she learned new ways of doing things.
Then she was kicked out of India and sent to Nepal. “Because I worked in India, which has already thrown missionaries out, I was sort of coming back to the future,” with exactly the expertise that was needed, Booth said – something she didn’t realize at first.
She has learned “you need to be able to be open and just let God use you.”
MICHAEL and NANCY HANINGER
He is an obstetrician-gynecologist, she a nurse-midwife. Unlike Beverley Booth, the Haningers are relatively new to overseas mission work. After raising their four children to adulthood, they left their jobs in the United States to become Presbyterian mission co-workers and started work in the Democratic Republic of the Congo about a year and a half ago.
There, the Haningers were assigned to Tshikaji, a village of about 5,000 people eight miles from Kananga, a city of close to half a million people in the south-central part of the country. Michael works at Good Shepherd hospital, both in direct patient care and helping to train nurses, medical students and residents.
“My work in some respects would not be terribly different from that of a doctor in the United States,” Michael said – except, most of the time, he works with impoverished people with advanced diseases in a hospital with vastly inferior equipment and supplies. “A lot of the fancy stuff we do not have,” he said. “It’s like stepping back in time.”
And too often, “people do not come to the hospital until they are dying.” So things he might have done to help them if they’d come earlier are not an option anymore.
When people get sick in the Congo, Nancy said, often they go through a whole chain of seeking help before they consider the hospital. They might start with a mother-in-law or other family member “who’s known for having a talent for remedies,” then try the traditional village healer or a local health center. During that time, whatever money or resources they have usually are exhausted.
By the time a woman goes to the hospital, she’s often very sick. Michael saw one woman with a tumor so big she looked as though she was nine months’ pregnant. Once, when he was driving to a health center about an hour and a half from the hospital, he was stopped at a village where a woman had been lying on the ground in labor for two days. The baby was no longer in her uterus – it had burst through to her stomach and had died. Michael rushed the woman to the hospital to try to save her life.
In the Congo, one in 14 women die of pregnancy-related complications, more than die of AIDS, he said. “Women and children are vulnerable – a child there has only about a 50 to 60 percent chance of surviving to adulthood, with many succumbing before the third year of life. The typical scenario, Michael said, is that “mom gets pregnant again, mom can no longer breastfeed,” so malnutrition and other diseases kill the child.
Nancy Haninger works with young children at a malnutrition center, where those who receive treatment already are very seriously malnourished, so that without treatment, they will certainly die. She knows that, with a better understanding of nutrition and the need for water, with inexpensive treatment that could catch conditions such as diarrhea early, with more education and early intervention, some of this suffering could be prevented.
“In our country, for a child to die, it is something absolutely catastrophic and fortunately it is a rare event,” Nancy said. ‘There it is an everyday occurrence, whether they die at home, in a hut in a village or in a hospital.”
Some families “just say it’s God’s will,” Michael said.
Or many believe in sorcery, Nancy said, so if something bad happens, “it’s black magic.”
The Haningers also recognize that some of these deaths are preventable – if they’d only been treated earlier. In some cases, “all we need to do to save them is to give water, which is so simple for us,” Michael said. But water “is not readily available for them.” They have to go to the river to get it, and the water they haul back is water most Americans would never drink. Many Congolese parents don’t understand the importance of giving water to sick children – of keeping them from dehydrating. Every minute, six children die of diarrhea in Africa, of conditions “that would be preventable for a couple of cents,” Michael said.
Why did the Haningers go to Africa, leaving behind the comforts of American affluence? They had thought of it for years. “Those who are blessed by God, there is a reason for that. We are expected to use those gifts,” Michael said. His former minister put it this way: “How do you explain a calling? It’s when you run out of excuses.”
But faith is essential, Michael said. “There’s nothing glamorous about being a missionary. It is an emotionally and physically hard life. We are isolated. We are the only American people in our institution, the only white people. We are foreigners. We will never be a part of their culture, we are always outsiders . . . Your faith is necessary to sustain you.”
They are also struck, inevitably, by the contrasts between what they see there and what they’ve known in the United States.
The Haningers live in a place where people don’t choose to come on vacation. They do have running water, from the river, but “you don’t drink it,” Michael said. “The cockroaches are polite. You just have to not be worried about the fact that you have all manner of bugs living in your house.”
And Michael asks himself, daily, “How can there be such poverty? How can there be such suffering and injustice? How can there be such mal-distribution of the riches of the world? And there’s no great cry about this.”
Over the last five years, 5 million people have died in the Congo from the effects of the war, “and who cares?” he asked. “These things bother you. It’s difficult to see how they will change.”
Asked what message they have for American Presbyterians, Michael answered quickly, firmly, and straight from the Bible. “Sell everything you have and give it to the poor.”
Jesus said to love your neighbor as yourself. “As yourself,” Michael said. “We think we can continue to be grandiosely wealthy in this country and raise those people up to our level. It’s not possible. There is a limited amount of resources in the world.” If the resources are concentrated in a relatively few rich countries, “there will be poverty over there.”
By continuing to consume so extravagantly, far beyond what we need, “we are relegating these people to another form of slavery,” not caring about the deaths of their children, Michael said. “They are our brothers and sisters. We must do something.”