What Kind of Dirt are You?
During medical training, you learn what it is like to be treated like dirt. Attending physicians treat the residents like dirt. Residents treat the interns like dirt. Interns treat fourth-year students as dirt, and the fourth-year students, nurses, ward clerks, cleaning ladies, and patients all treat third-year students as dirt. Medical students come to expect to be treated like dirt. Some of the same dynamics exist for nursing students and students in the allied professions.
But did you know that CCHF thinks of you as dirt too? For five years I attended CCHF board meetings and heard again and again that CCHF's goal is to plant and nourish the vision of health care among the poor. Now I'm no farmer, but the only time I ever did any planting, it was in dirt. And since CCHF focuses on health care students when it comes to planting the vision, CCHF must think of students as—well—dirt.
But maybe that's not so bad, because even God refers to us as dirt. Jesus told a parable about four kinds of dirt or soil (Luke 8:5-I5). In this parable he told what kinds of dirt don't bear fruit
and what kind of dirt does bear fruit. I believe the message of that parable relates directly to those of us in health care ministries.
The seed in the parable in Luke 8:5-15 represents the word of God. I used to think that the seed referred just to the story of salvation, relaying the message about the saving grace of Jesus Christ. But in the parable, the seed does not refer only to the message of salvation; it refers to the entire word of God. This includes Jesus’ call to serve among the poor. Matthew 25 says that we are to deal with the needs of the hungry, the thirsty, the poor, the naked, those in prison, and those who are sick as if those were the needs of Christ himself. When the word of God comes to us, it not only invites us to trust God for our salvation, it also calls us to show mercy to those around us. How do we respond to this seed?
The Hard Soil
Some of the seed fell on the path and it was trampled underfoot and the birds ate it. This hard soil represents those who have heard, but then the devil comes and takes away the word from their hearts so that they cannot believe and be saved (v. 12).
The hard soil is like asphalt. Have you ever seen seed grow when it falls on asphalt? It just sits there until the birds come and eat it. It never even gets started.
When we begin to talk about responding to the needs of the poor, I think that when the word of God falls among health professionals in this country, it mostly falls on asphalt. It never even gets started.
Most of us are exposed to the needs of the poor during our training. A lot of us spend all of our training working among the poor. Others train in suburban hospitals that have fewer poor patients. But we are all trained in hospitals with teaching services. Which patients are put on the teaching service? Those who come into the emergency room without a doctor, and of course those people are mostly poor.
Residents and students typically like to be on the teaching service because they have a lot more freedom and responsibility. This freedom, however, results in increased mistakes. That's how we deal with the poor—we use them to practice on, to make the mistakes that are a natural part of learning.
When most doctors finish their training, they figure, “Well, I‘ve done my stint for the poor. I’ve fulfilled my responsibility. Now it's time to move on to greener pastures where I can maximize the financial return on my skills.” That's the asphalt. Sadly, that doesn't just represent the non-Christians in our profession, it also represents many Christians.
You would think that training in health care would be designed to nurture compassion. But in fact, our training experience does the opposite. I know many students who enter medical or nursing school with at least some desire to use their skills to serve the poor, but during their training, their attitudes change. Why is that?
Our training, with its long work hours, makes us tired. Being treated like dirt by those around us makes us cynical. Since our training experience is with the poor, that cynicism often gets translated into our attitudes toward the poor.
When I was in residency, I was on call every third night. There were nights when I’d finally finish my work about 2:00 A.M. and get to bed. A half hour later, the beeper would go off, calling me to the emergency room. I'd go down to find an alcoholic vomiting blood, or an IV drug abuser who had skinpopped into his ulcerated legs, with with maggots crawling around. When I’d see one of these people, my heart would sink because I knew I wouldn't get any more sleep that night.
As these experiences happen over and over, we start to blame the poor. When l was in training, when you got an admission like that, the jargon was that you got “hit.” “We got a bad hit here for you.” It was like the person was deliberately trying to make your life miserable, trying to keep you from getting sleep. These experiences gradually permeate our attitudes toward the poor. If we’re not careful, we can begin our medical training with a real commitment to serve the poor and come out on the other end cynical and insensitive, without even realizing what has happened to us.
The Rocky Soil
Some seed fell on rocky soil. As soon as it grew up, it withered away because it had no moisture. The rocky soil represents those who receive the word with joy, but have no firm root. They believe for a while, but when they are tempted they fall away.
My first CCHF conference was in 1983. I was a fourth-year medical student. I ran into all kinds of medical students at that conference who were excited about serving the poor.
It's a tradition at conferences that on Saturday night people who are in ministries looking for staff can stand up and announce their openings, and people who are looking for jobs can stand up and tell what they're looking for. That night, there were several ministries looking for doctors, nurses, or social workers, but there weren’t any people there ready to move into those kinds of jobs—a lot of us were still students.
I thought, “Well, that's the way it is now, but look at all these students. Another three or four years down the road, this is going to be a totally different experience. We're going to have all kinds of people at CCHF conferences ready to go out and fill these slots in these ministries.”
But that hasn't happened. The same scene is repeated every year. On Saturday night, there are a lot of people in the audience who are excited. They have received the word with joy. But somehow, when they finally finish their training and it's time to go out, they have disappeared. If you talk with the ministries associated with CCHF, most of them will tell you the same story: they have more ministry opportunities than they have people to fill them.
I'm not saying that God calls everybody to work full-time in ministry among the poor. But it’s hard for me to look at the needs of the poor, to look at what the Scripture says about God's concern for the poor, and to believe that the Lord is not calling more people to fill these slots. Too often, the word is received with joy, but it falls on rocky ground.
In time of temptation, these people fall away. What are some of the temptations you’re going to face that could pull you away from the call you may feel to work among the poor?
FIRST, there are secular role models. When I was a fourth-year medical student, the chairman of medicine called me into his office. He was trying to get me to stay at the University of Illinois to do my residency. “What are you interested in doing?” he asked.
I told him.
“What? You want to live in North Lawndale and practice there? Why?“
And I told him why.
And he said, “If you really want to have an impact on the poor, the only way you'll ever do it is to stay in the university. He thought that if I was going to go to North Lawndale, I would get swallowed up and no one would ever hear from me again.
Don’t expect your secular role models to encourage you to work in a community setting to serve the poor. They‘re not going to do it. They don't understand it. They’re the asphalt. They don't understand God’s word and God's call for them to serve the poor.
SECOND, there are Christian role models. As you finish your training, you will suddenly become popular. So long as you're still in medical training, you may be dirt, but as you get closer to the end of your training, you'll start getting all kinds of mail from recruiters. The letters are all going to sound the same—“We‘ve got a beautiful place to live and a nice salary, a nice place to raise your kids...”
Most of this mail will come from secular sources, but, unfortunately, you’re going to get the same kind of temptation from Christians.
Last weekend I sat down with another doctor who is working among the poor in New York City and we went through some of the advertisements from a Christian newsletter for health care professionals:
Three board-certified, resident-trained Christian family practitioners seeking replacement for fourth partner in a growing, full-spectrum practice. Excellent staff, 80-bed hospital with Christian administrator. Community active and spiritually growing, beautiful North Michigan lake and recreation area, solid schools... Excellent salary guaranteed.
Why not serve the Lord and make a good salary at the same time?
Raise your children away from the hazards of large cities. Top notch hospitals, good call coverage. Exceptional evangelical churches in city listed by Newsweek as one of the top ten most desirable cities to live in the Unites States. Enjoy the security of a guaranteed start-up salary, plus excellent potential... Beautiful new facility and staff supplied. Ideally situated among the mountains.
One even advertised that you could do horseshoe pitching, biking, running, and play volleyball. If you want to do horseshoe pitching, don't come to Lawndale.
These Christian doctors are trying to recruit you with the same things secular doctors use—financial security, natural beauty, recreation, call schedule, practice security, a nice facility to work in, and a good family environment. Ministries that work full-time among the poor don‘t offer these things. If these are the things that are most important to you, our ministries can't compete. These are the temptations you’re going to face when you’re trying to determine if God is calling you to work full-time or even part—time among the poor. If these arc the things that determine where you decide to practice, I suspect you're going to miss God's will. Not that God calls everyone to work full-time among the poor, but God does call all of us to be involved with the needs of the poor.
ANOTHER TEMPTATION is paying off your educational debt. I have known a lot of people in CCHF who have come out of school and said, “I'm going to work a few years and pay off my debt. Then I'll work among the poor." It’s not a bad idea. But a lot of them start to make big dollars and their lifestyles change. By the time their medical school debt is paid off they’ve got a mortgage on a fancy home and big car payments.
There is a new federal loan repayment program, in addition to the revitalized National Health Service scholarship program. With the scholarship program, your education is financed by the government in exchange for four years of service after you complete your training. With the loan repayment program, if you practice at an approved site—and some of our Christian health centers qualify—the government will pay for most of your school loans. We no longer have the excuse that we have to make some money to pay off our debts before we can serve the poor. If you really want to work among the poor, there are Christian health centers where you can pay off your debt and work among the poor at the same time.
A FOURTH TEMPTATION is that “family comes first.” A lot of people, when they feel God's call to work among the poor, say, “I can't do that to my family.” But Jesus said: “Anyone who loves his father or mother more than me is not worthy of me; anyone who loves his son or daughter more than me is not worthy of me; and anyone who does not take his cross and follow me is not worthy of me. Whoever finds his life will lose it, and whoever loses his life for my sake will find it” (Matthew 10:37-39). God expects us to put his call and following him above our own family. That is a tough one, but it is still what God expects.
THERE IS THE TEMPTATION to reach the rich. It's scriptural that the gospel is for everyone and we are to go to all the corners of the world and preach the gospel. But let’s not deceive ourselves. We are all called to deal with the needs of the poor.
FINALLY, WE CAN BE TEMPTED to rationalize the call away. I hear several common objections to serving the poor.
- “My money is my own.” But Christ might have said that his life was his own. Then where would we have been?
- “The poor are undeserving." But are any of us really deserving? Yet Christ gave his life for the undeserved.
- “The poor may abuse my efforts." Christ knew that millions would trample his blood under foot, that many would make it an excuse for sinning more. Yet he gave his own blood.
When you decide where you are going to practice, expect to be tempted to rationalize that the poor are not deserving, that they will abuse you, and that they will not appreciate you. But be prepared to respond as Jesus did.
The Thorny Soil
Some seed falls on asphalt and doesn’t even germinate. Some falls on the rocky people get excited but nothing comes of it. Then some falls among the thorns. The thorns grow up with it and choke it out. These represent those who are choked with worries and the riches and pleasures of life. Those seeds bear no fruit to maturity.
When Jesus said some seed was “choked by life's worries,” I think he was talking about burnout. Of course, there are people who work full-time among the poor for a while, then God calls them someplace else. But there are also people who leave even though God isn’t calling them to another place. These people start to work among the poor, but the worries bear down on them until they burn out and lose their commitment. What are some of those worries?
One worry is staffing. If you have a commitment, but you don’t have enough people to join you in the work. it wears you down. It can discourage you.
Another worry is that you don’t know what you’re doing. When I finished my residency, I came to North Lawndale full of enthusiasm and confidence that I knew all I needed to know to start a clinic. Once we started, though, I realized that I had never been taught anything in medical school or residency about running a practice. We made lots of mistakes. it can be discouraging to realize that you are not prepared to do what you need to do.
Funding is a worry. I have yet to find a community health center that doesn't have some worry about funding. Since I am the executive director of our center with about 30 staff, I sometimes find myself worrying about the funding instead of just giving it over to God. I attracted a lot of these people away from other positions that would have been much more secure. When I am not being particularly trusting, I can start to feel responsible, to worry about the funding.
Patient volume is a worry. When we started the health center, I had the idea that all we had to do was hang out our shingle in a medically underserved area and people would just pour in the doors. It doesn’t happen. I haven’t seen it happen with any ministry. It takes time to build a reputation in the neighborhood.
Before we opened I got all these Christian people to volunteer—nurses, doctors, medical students. In the beginning, these people would show up and there wouldn't be any patients. That got to be embarrassing. They would say, “Where’s this big need you’re talking about? There aren’t any patients!“ During our first three months, we saw an average of 47 patients a week. It didn't take someone with an M.B.A. to figure out that if we didn’t increase our patient volume, we weren’t going to make it.
Worry about number of souls won. You always have some well-meaning churches supporting you who want to know how many souls you have brought to Jesus. We want to build relationships with people so we can introduce them to the Lord, but I don’t whip out the Four Spiritual Laws to every person that comes in with a sore throat. Some people will say, “Unless you are winning a lot of souls to the Lord, there is no reason for you to do what you’re doing.” I don’t think that is scriptural. I think we should be sharing our faith, but I believe that the Lord calls us to serve the needs of the poor even if some of those poor people don’t come to know the Lord.
Another worry is that if you work among the poor, your clinical skills may atrophy. This last week a dear friend of mine came because he is thinking of joining our practice. Alan is a cardiologist, as I am. He spent a couple of days with me at the hospital. One morning we got called up to the floor and there was a patient breathing about 60 times a minute, with a heart rate of about 200. It was clear that he was in danger of dying. I told Alan we would give him some Verapamil.
"Don‘t give him Verapamil,” Alan said.
“Give him some Adenosine. You push this stuff. It only lasts six seconds, so if you get in trouble it’s no problem.” I had never heard of that. “You do have Adenosine in your hospital, don’t you?” he asked. And I had to tell him we didn’t.
Alan wasn‘t trying to show me up. He was trying to be helpful. But that discouraged me because I knew that what I had feared was in fact happening. I am in a situation where there is no other cardiologist. I don’t get fed. I sometimes get so busy trying to run the clinic and keep it afloat that I don’t read like supposed to. There is no continuing education at our hospital. I am not as good a cardiologist as I could have been if stayed in the university setting. And that is a worry. In fact, if Alan doesn't come, I’m going to ask him to come once week a year for some short-term mission work and educate me!
Another worry is relocation difficulties. Yesterday one of our administrators was driving me to the airport. Her mother-in-law was visiting her for the first time since she had moved into Lawndale. Her mother-in-law is a nice Southern Baptist lady from North Carolina. She'd been watching a couple of little African-American children running around the neighborhood and they were saying a few things that were not exactly what she wanted her 1-year-old grandchild to hear. She had told her daughter-in-law with all seriousness, “You are not raising my grandchild in this community.“ That kind of pressure is a worry if you are going to relocate to a community of need.
There’s the worry of lack of appreciation. As health providers we are often so arrogant that we expect everyone we help to be grateful. That doesn‘t happen. In fact, maybe we even get a malpractice suit. You say, “How could you sue me? Here I am, a nice Christian guy. I could be working anywhere. Here I come and work among you poor people, and you turn around and sue me!”
If we’re going to work among the poor, we need to be prepared to face these worries so that they don't become thorns that choke us and drive us away from serving among the poor.
The Good Soil
Some seed fell on good soil and produced a crop 100 times as much as was sown. This represents those who hear the word in a honest and good heart, hold it fast, and bear fruit with perseverance.
Notice those three keys. CCHF is full of people with honest and good hearts who have heard the word. The next thing is to hold it fast. If God is calling you to work among the poor, you have to hold it fast. Go to CCHF events, do rotations at preceptor sites where you can be exposed to other Christians working among the poor, maybe go overseas to see what it‘s like to work in a mission hospital. But through it all you have to hold the word of God fast, because the devil is trying to take it away from you.
Finally, we are to bear fruit with perseverance. Somewhere we’ve gotten the idea that since we bear fruit by our own efforts, all we have to do is show up and start our practice among the poor, and that's all it takes. That's not true. Jesus says we must persevere.
As a cardiologist I like to do treadmill tests. You can tell a lot about a person’s perseverance from a treadmill. There are several types of people who come for a treadmill. There are the little old ladies who come hobbling along with their canes. I tell them to not even bother getting on the treadmill—I tell them to take the cane and hit the doctor who ordered the test over the head with it! If God hasn't called you to full-time work among the poor, don’t try to do it anyway.
Then there are some people who are afraid to try. Before I give a treadmill test, the patient has to sign a consent form. Some read the form that says they may drop over dead during the test if they have a myocardial infarction and say “Forget it.” These are like Christians who hear the call but think about all the bad things that could happen. “I might get broken into. Something might happen to my wife. Something might happen to my kids. I might go into bankruptcy.”
Then there are some who do get on the treadmill, but don't come prepared. I love it when these ladies come to do the treadmill—and they're wearing high heels. Some of us hear the call, we're willing, but we don't bother to prepare ourselves, so when it's time to go into practice among the poor, we’re not read isolate ourselves in our middle-class white environment, we don't bother to get any experience living among the poor, we don’t go to church among the poor. Suddenly we show up and think we're going to be effective. It doesn‘t work that way.
Then there are those who give up with a little bit of discomfort. They start walking, but as soon as they break into a little sweat they say “That's enough." A guy may be 35, breathing 16 times a minute, on the first stage of the treadmill, and he wants to quit. That‘s not perseverance.
But I love the people who persevere on the treadmill. These little old ladies start, they look ahead, they hold on. When they start sweating I say, “Do you want to stop?" and they say no and keep going. If you go far enough on a treadmill, you develop lacticacidosis and your blood pressure drops. Those are the people I love, the people I have to take off the treadmill because their blood pressure is dropping from lacticacidosis.
The Lord needs people with perseverance. Not people who think they can bear fruit in their own power, but people who are willing to give themselves to the Lord and to the poor, people who are going to go out and do whatever it takes to allow him to produce a bountiful harvest.
Art Jones, MD, is the medical director at Lawndale Christian Health Center on the west side of Chicago. He has lived in Lawndaie with his family for the past 11 years. This article is adapted from a presentation at the CCHF national conference on October 19, 1991.