Friday, September 14, 2012

Healthy living, human nature and faith

Accident and emergency departments in the UK are experiencing a steep rise in alcohol related admissions. The majority of those are people over the age of 65; exceeding those in the 16 - 35 age range. This is a rather shocking revelation. Whilst the culture of drinking amongst younger people is known to be out of control, the same should be said for older people. Young people make an exhibition of themselves on the streets of cities and towns. Older people slump quietly at home in front of the television, drinking themselves senseless.

This is a particular cultural pattern of one country and may or may not be reflected in others, but it raises a universal question: How healthy are we really prepared to be? Because our health depends to such a high degree upon our behaviour, we recognise that self-discipline and personal habits will determine how healthy we are. This could as easily apply to smoking or diet or exercise.

There are some parallels with faith. Firstly, people need to believe that healthy living will make them healthy. This is not as ridiculous a statement as it might at first seem. We may have heard about genetic susceptibility to disease, and we may be sceptical about the impacts of behaviour change. We may put our faith in medications. Unless people can comprehend the facts about healthy living, then they will simply not accept the need for change. A sort of revelation is needed.

Secondly, few of us are good at self-discipline. It is notable that slimming clubs have adopted the language of faith. Weekly gatherings reveal sinners and saints. Confessions are made. Absolution is offered. People give it another try and hope they can do better. There is a conflict in human nature between reaching towards 'wholeness' and unleashing the chaos inherent in our desire laden bodies.

Thirdly, individuals struggle to make changes on their own. They need to be part of a movement, a community. Alcoholics who choose to fight their addiction join AA groups and recognise their need of continued support for the remainder of their lives. In this case, they look to divine inspiration to give them grace to live as recovering alcoholics.

There is much more to health than medicine. Medicine is required to combat sickness. Health is pursued by fallible people needing social support and depends to a high degree on habits and lifestyle patterns. The challenges may appear parallel to faith, or they may in fact be integral to what a healing salvation means. The church would do well to look more closely at what it means to be healthy and ask how this sits within the journey of faith.

Thursday, August 9, 2012

The placebo effect and faith

A well known study in the late 1950s examined the placebo effect on angina pain. Half the participants had a heart bypass operation. The other half went through the motions of the operation without receiving any intervention. Pain reduction in both groups was equal. This sort of result has been demonstrated countless times with both medicines and surgery.

The placebo effect has significant influence on physiological change as well as perception of well-being. The more seriously medical the treatment, the more impact. Injections have a stronger placebo effect than pills. Doctors who look the part induce a stronger placebo effect than the more casually dressed. Even the beliefs of the doctor influence the impact. If the doctor believes that the prescribed treatment will be effective, then this somehow communicates itself and the treatment is more effective.

Whilst the medical profession recognises this effect, it does not find it easy to deal with. The ethics of treating people with placebos are rightly uncertain. Evidence based medicine seeks to improve on the accompanying placebo effect and add efficacy. This is the test that new medicines have to pass. They have to perform better than the sugar pills offered in randomised controlled trials. However, this issue is about more than evidence based pharmacology and surgery. This also impacts the 'art' of healing. If so much depends on the interaction between patient and doctor, how much role play is involved in stimulating maximal effect of treatment?

If doctors find this phenomenon difficult, then priests tend to ignore it completely. For their role in healing, they claim a more divine effect. If prayers are said and hands laid on, if oil anoints in a dramatic act of healing, then any improvements can be attributed to the Holy Spirit. No need to consider the intricacies of the body's natural responses. Few priests would wish to ask whether their clothing, tone of voice or bodily movements improve the effect of their prayers on people.

The downside to maintaining a singularly divine attribution is that there remains a mis-match between religion and medicine. If the doctor recognises the placebo effect and the priest proclaims divine intervention, then there is little common ground to explore between science and faith. There may actually be a lot in common in terms of the practice of healing, but too much mutual suspicion to create a common language.

Perhaps there are those who have worked explicitly on this issue? For the sake of the integration of the church's ministry of healing with medicine, this might well be a profitable dialogue.

Tuesday, July 10, 2012

Empowering patients

I am currently reading Angela Coulter's book 'Engaging patients in healthcare'. It offers practical advice to patients and clinicians alike so that they can 'co-produce' good health outcomes. Co-production is a buzzword in public policy at the moment. It implies a greater degree of participation in the design and implementation of services by members of the public. The wider concepts of 'Public Value' and 'Social Value' take up this notion to improve the impact of a given service.

In the case of healthcare, co-production requires patients to take more initiative to address their health needs, and it encourages clinicians to work more sensitively and creatively with patients in order to nurture this initiative. Whether it is in the design of a course of treatment that takes into account personal preferences and circumstances, or in the adaptation of lifestyle for preventative purposes, co-production promises a higher degree of patient motivation and thus anticipates better health.

In so doing, co-production challenges the philosophy of 'the professional'. Clinicians, particularly physicians, have strong professional values and mindsets. The professional is a highly trained individual set within the context of a community of practice and subject to modes of acceptable behaviour and standards. He or she draws from a breadth of knowledge and experience to guide a person through the complexities of their situation. Physicians have traditionally required patients to accept their direction and to adhere to proposed treatments. Co-production shifts the nature of this interaction so that the physician is in a more responsive role. The autonomous patient requires the advice of the physician in order to decide upon a course of action.

It would be inaccurate to portray this as an either/or situation. The doctor/patient relationship has always been complex, with power ebbing and flowing between. But this is a real tension that needs careful thought. In an era of increasing standards of education and more immediate forms of information supply, the patient is becoming far more knowledgable and demanding. It is not enough now to assume the dull obedience of the patient to the superior wisdom of the physician.

This all reminds me of changes that have been going on in the church over past years. People have formed their own views about theology and religious practice. They have in some cases set up their own independent churches to nurture their own faith experience. The professional recognition of clergy was challenged half a millennium ago and is now far from authoritative. In matters of faith, people are largely autonomous and self-supporting. This is a long way from the situation with clinicians, but the signs are there that people wish to exercise more choice and autonomy than they once did.

Angela Coulter has provided some helpful pointers to do this well. I commend the book to all.

Thursday, May 31, 2012

Parish churches offer health and healing

Having moved from place to place over the years, it is good sometimes to return to a town I once called home. I recently had the pleasure of walking through the doors of the parish church in which I was married, at which our children were baptised and which supported me as I explored my vocation to ordained ministry. It happened to be a very significant weekend for the parish. They were celebrating 20 years of their outreach ministry - a drop-in centre that reaches out to those whose lives are severely blighted by alcohol and substance abuse.

As I heard stories of how people had emerged from their addictions and had begun to get to grips with the underlying problems in their past, I was touched by the significance of this ministry. My friends from many years back had committed themselves and their church building to the most vulnerable members of society. As a result they witnessed the sort of healing amongst individuals who normally fall furthest through the net.

In particular, I was pleased to see that they were working with health authorities to address the physical symptoms of destructive lifestyles. Nurses from the local primary care trust are in church 4 days a week to address the health needs of clients, even as centre workers and volunteers are promoting growth in confidence and hope.

I have seen this sort of ministry also in the United States and in Canada. I am sure it goes on in many other parts of the Anglican Church. Parish churches are responding to needs and demands that are not easily addressed in formal health care settings. The level of trust, care and long term commitment creates a context where those with the deepest problems may discover hope for their lives. As those who carry the gospel of healing and salvation, church members bring the power of the Holy Spirit to awaken this hope and point others towards a life with meaning.

To the good people of St. Luke's Church, Bolton, UK, I salute you and pray for God's blessing on your ministry. May others be inspired by your example.


Tuesday, May 1, 2012

Person Centred Medicine

I met up with Professor John Cox recently. He was in Geneva to attend a conference on person centred medicine. John has a distinguished background in psychiatry in the UK, and is currently Professor of Mental Health at the University of Gloucestershire. He knows Geneva well since he was for a time Secretary General of the World Psychiatric Association. He has been involved in the movement for person centred medicine for many years and kindly introduced me to this line of thinking.

In reaction to medical reductionism, person centred medicine seeks to look at the wider picture of the person. This provides considerable space not only for the psychological and emotional, but also for the spiritual. It encourages physicians to take the time and energy to look at the deep rooted causes of illness and not simply to treat symptoms. The famous Genevan physician, Paul Tournier, is closely associated with this movement and made a major contribution to the understanding of the spiritual within the psychosocial approach to the person.

There is inevitably a tension running through the practice of medicine. The body, mind and spirit are complex systems with their own emergent properties. This is what makes each one of us unique. And being unique requires personalised approaches to the pursuit of health. Medical specialties focus on certain parts of the body in order to become more effective in treatments for the heart, the liver, the brain etc. But in the process, the systems thinking required to look at the whole becomes ever more complex. Can medical generalists still maintain the extent of knowledge required to look at the whole system of a single person? Perhaps this is where team work is required.

I would at this point refer to the pioneering work at Burrswood Hospital in the UK. This is a small Christian facility that has emerged from the healing ministry of Dorothy Kerrin. It has traversed the boundaries between spiritual, emotional and physical and offers a uniquely creative approach to the discipline of medicine. It utilises the skills of physicians, physiotherapists, counsellors and chaplains to allow patients to address their health from all angles. These work together and consult on the basis that most patients will need multiple interventions. For more information, take a look at their website:

However, with more complexity and greater attention to the person comes higher expenditure for the cost of skilled care. This is no easy tension to confront and may require fresh thinking about how people are supported in their pursuit of health. Perhaps you have some experience you can share? Do please offer comments.

Monday, April 23, 2012


Chronicity was the buzzword for last week's major global conference - the Geneva Health Forum. It is a term that encompasses the breadth of chronic health conditions, including the high profile non-communicable diseases (NCDs) such as heart disease, diabetes and cancer. This year's forum pulled together a wide range of participants from all over the world to consider how health systems can make a more substantial impact to stem the tide of chronicity facing those in both developing and developed countries.

40% of all mortalities are caused by NCDs. This should not surprise or shock us. After all, everyone has to die of something. If we are successful enough at keeping infectious diseases at bay, then it is likely to be an NCD that gets us in the end. We are not going to make any impression on the 100% mortality rate that we all face. However, many of these chronic diseases are affecting the young and middle aged. Two thirds of these cases could be prevented. One third can be treated.

Chronicity is something that requires a significant input of medical resources. The control of diabetes requires daily medication and regular check ups. Cancers and heart disease can be treated with ever more effective but expensive interventions. Where people are incapacitated for the long term, the burden of care is high. One calculation suggests that assuming current trends in both morbidity and treatment, the cost of health services in the United States will rise from its current unsustainable peak of 18% of GDP to an astronomical 40% by 2050. Clearly that is not going to happen. New approaches to the prevention and treatment of chronicity are essential.

This raises key questions. Chronic diseases are often related to lifestyles. The impact of proper exercise and diet regimes in prevention is by far and away the most significant. Yet people struggle to make the changes they need because of limits to personal self-discipline and the influence of social habits. Then there is the question of death. In countries with comprehensive health systems, the cost of care in the final 3 months can often exceed the sum total of all prior costs of care. The medical profession tries to meet our unrealistic expectations with huge inputs of treatment when there is little purpose in extending life. Death is too often perceived as a failure of care.

I have no doubt that the Church can offer a great deal to these conundrums; to promote prevention, to support the care of the chronically sick and to help find an appropriate setting and expectation for the end of life. These are dilemmas facing individuals, families and communities. Our healing vocation sits very squarely in this territory. We can help improve diets, help draw in more people to exercise opportunities and be present to care for those whose lives are blighted by long term chronicity.

Perhaps you have some ideas about this or experiences to share? Feel free to comment.


Wednesday, April 4, 2012

Life and Death

Holy week confronts us with the reality that some people have the power over life and death. Like Pontius Pilate they can be swayed one way or another. To take a life or to save a life? In the medical world, this is experienced most controversially in abortion. In some countries doctors are offered guidelines within which they are free to take the life of an unborn child. They use their professional judgement and ethical perspective to make this choice.

In another classic example, the state can exercise the power of execution. The life of a killer can be cut short as punishment for the crime. In Switzerland, there are two agencies that provide euthanasia services. The tools of self-destruction are provided to those whose will to live has expired. Though less directly involved, the choice is still negotiated with the agency. It's judgments influence who lives and who dies.

Beyond these very controversial examples are those regular decisions taken by doctors the world over. Do they let life slip away or do they intervene more aggressively to hold back the tide of death? Their professional and ethical training is designed to help them interpret the circumstances of an individual patient and to guide their actions for treatment or to assist a comfortable end.

This power over life and death remains in human hands, uncomfortable though that is. In many ways we now have more options and therefore more complex choices. Pilate recognised the political dangers of the dilemma before him and hoped for an alternative. Ultimately he was forced to choose: Jesus was hung on a cross. An eternal and divine injustice was committed. Choices cannot always be avoided.

Not many of us have to face dilemmas such as these, and even if we do, we have a natural instinct to save life rather than extinguish it. Yet death becomes us all. We see how profoundly people suffer in the fight to hold on to life until the bitter end and we realise that the power we have to intervene is not easily wielded. These choices haunt us even as they give many the hope of rescue.

There are no easy answers to these common dilemmas. The passion of Christ holds us this week in the grip of death. It is a story and a context we should embrace and from which we can draw spiritual strength for the times and choices that lie ahead.

Thursday, March 22, 2012

Maternal and new born health programme

I am currently working with colleagues from the Liverpool School of Tropical Medicine, the National Health Service in the North West of England and a technology consultancy company called Our Mobile Health. We are designing a comprehensive programme to address the very poor progress being made to achieve MDGs 4 and 5. Our focus is on 3 countries in Sub-Saharan Africa.

I have to say, the realities of trying to create something 'comprehensive' are mind-boggling. No wonder most people prefer to work on limited interventions to test their impact. But we believe that individual interventions are inadequate unless they form part of wider plan of service improvement.

In this programme we are going to draw from community mobilisation methodologies, mhealth tools, clinical training, health facility upgrades, and hopefully achieve the ultimate goal of establishing community based skilled birth attendants. A health financing solution will be important to make sure that health facilities do not continue to impose patient fees. That holds back many women from coming for their deliveries, particularly when the culture around them assumes that home is the best place to give birth.

Our programme will incorporate many of the features of AHN's work in the past couple of years. The partnership has a range of skills and capacities to bring to the programme. AHN is facilitating the involvement of Anglican agencies so that they can offer the best of their expertise.

Improvement in maternal and new born health services will not come easily or cheaply. It would be good to hear from others about their efforts in this field. Please add your comments below so we can build up a wider picture of what is going on amongst Anglicans in different parts of the world. We have much to learn from one another and an opportunity to work more closely together.


Thursday, March 8, 2012

Diocese of Texas takes the lead in breast health initiative

St. Luke's Episcopal Health Charities (SLEHC) in Houston is taking significant strides forward in its 'research informed grant making'. Established in 1997 by the Diocese of Texas, the agency is focused on evidenced based interventions in communities that are underserved by medical facilities. Its mapping and data collection systems are designed both to provide portals for access to health information and to identify data for public health interventions. In this it has become the lead agency within the metropolitan area of Houston, drawing together city, county and state authorities alongside foundations and other organisations concerned with public health.

SLEHC's most recent initiative was to focus on the distribution of breast health services. Its mapping tools identified areas in the city where women were most at risk of late diagnosis. The difference in survival rates can as high as 28 times between one community and another. Working with a range of breast health agencies and with the support of major foundations such as Avon, SLEHC has overseen the development of a breast health portal. This provides women with information on the range of services offered in their particular district. Partners in this project have used the mapping information to improve the distribution of mobile clinics and screening so that women in the poorest communities have ready access when they recognise a problem.

This level of leadership and innovation in faith based health care is a major inspiration for others. It promotes the value of data collection and management, and shows how Anglican agencies can take the lead in responding to needs that show up as a result. To see how this was achieved, follow this link to a short video that tells the story: Check out the website on:


Health Systems Financing - what future for insurance

Oxfam recently issued a report criticising Ghana's National Health Insurance Scheme. The report's authors denounced it as inefficient, corrupt and inequitable. They question Ghana's statistics of around 60% membership and estimate that this could be as low as 18% of the population. They propose that the scheme be replaced by a tax funded health system free at the point of delivery.

Reports from colleagues in Ghana suggest a mixed picture. Clearly the scheme is far more successful in towns and cities where health facilities are located. The rural poor are not so easily covered. There have been problems with the administration of the scheme for those church hospitals that service claims. Some have had to wait 6 - 9 months for the scheme to recompense them for services rendered to the insured. This has caused acute cash flow difficulties. But otherwise, our Ghanaian colleagues seem fairly optimistic about the future potential of incorporating everyone into a scheme that combines personal contributions with tax revenues to ensure that health services are more widely available.

There is no doubt a healthy dose of idealism behind the Oxfam report. Many in the global health community feel instinctively drawn to a simple tax funded health system where everyone can get access to health care without the interference of financial systems. Health professionals are not generally drawn to medicine in order to get mixed up with market driven economic planning. Like priests, they simply want to be able to get on with their job of caring for people in need. But health is an expensive business. And even in the UK's National Health System, medics have to respond to concerns about cost and efficiency. Yet another wave of reforms faces them in order that expenditure on health might be controlled by new means.

As it happens, the issue of health systems financing was the theme of the World Health Report published by the WHO just before Christmas. It made reference to the Ghana health system as an example of the benefits of combining tax revenue, donor support and individual contribution into a membership scheme that has thus increased the resources available for health care. Most importantly, the report says, the Ghana scheme has offered financial protection to those who formerly paid user fees for their health care.

Rwanda has made the most progress with a national health insurance scheme in Sub-Saharan Africa. Other countries such as Kenya are at an earlier stage of rolling this out. It remains to be seen how many states in the poorest parts of the world can manage such large schemes successfully. Having lived in the UK and Switzerland I am aware of the strengths and weaknesses of insurance based health systems in comparison with tax based health systems. I do not subscribe to an ideal one way or another. The state surely has an innate responsibility to ensure that its citizens have access to health care. How it facilitates the infrastructure to both fund and deliver this care is a matter for trial and error. Statist or free-market ideologies do not offer idealised solutions.

AHN is supporting a market-based microinsurance project in Tanzania and India. But equally it supports colleagues in Ghana in their partnership with the state system. There is only one absolute: user fees for health services must be abolished one way or another. Everyone agrees with that. Unfortunately too many Anglican health services are delivered still under a regime of user fees. We must work hard together in these various contexts to protect people from financial risk in accessing health care, and at the same time improving what health care they can receive.


Brent Hospital prepares to celebrate its centenary

The Episcopal Church of the Philippines has long been committed to offering health services to the people it serves. It has a range of hospitals and health programmes that serve people irrespective of their creed. The Diocese of the Southern Philippines has supported Brent Hospital since its inception in 1914. Through this time the hospital has grown and developed its expertise and now is looking expectantly to celebrating its centenary in two years time. To help set the scene for this important moment, they have produced a video that reveals much of the character and values of the hospital. You can watch this video on YouTube on this link:

Here is yet another example of the belief within Anglican communities that providing health care remains a fundamental element of the mission of the Church. The integrated nature of prayer, teaching and healing seems natural in so many settings. We wish the diocese every blessing as they make further preparations to celebrate their valuable work.


Health and Equality

Does social inequality have inherent health impacts? If the gap between rich and poor is wider, does that mean the poor are going to experience distinct biological impacts that negatively impact their health? This question is a growing area of study. A British academic, Richard Wilkinson has built his career conducting studies that address the epidemiological differences of relative equality in different societies. Looking at the health patterns of the more equal societies of Nordic countries and Japan, Wilkinson makes a comparison with the health of populations in the United States and United Kingdom. He draws evidence to suggest that lower levels of oxytocin may be generated by lower neighborliness in a more competitive society. This combined with increased levels of cortisol generated by the resulting stress may increase susceptibility to ill health.

However, his thesis is questioned by some who give other factors greater precedence. For example, a higher murder rate in the US may be more associated with its gun culture than with inequality. They ask how higher divorce and suicide rates in more equal societies should be taken into account. There may be factors related to ethnic homogeneity. Do smaller countries with lower immigration rates manage the health and social cohesion of their populations more effectively than large countries with high diversity? Is the underlying issue a cultural one, drawing from the various pressures individuals experience in the more competitive consumer societies?

This is a serious area of study that should be of particular interest to Christian communities that seek to support the health and well being of their neighbors. However, the obvious challenge with this line of enquiry is its immediate relation to political philosophy. It swiftly becomes caught up in the age-old debate between capitalism and socialism. Nevertheless, if there is a significant health impact caused by inequality, then questions of public policy cannot be avoided. Public health practice suggests that society-wide structural changes are more effective than employing more doctors and nurses to address increased levels of ill health. Witness the example of tougher regulation on smoking.

Christian theorists and activists offer the concept of justice to test public policy choices. Will a certain systemic change bring greater well-being or it will it bring greater harm? This is a good basis for theory, but it is hard to demonstrate relative impacts and hard to express any clear idea of what justice means between those of unequal standing. This debate will roll on, but as Christians we are determined to side with the poor. That is the overwhelming call of our faith and tradition.

At the sidelines of political process is a debate that emerges from psychosocial and biomedical studies of inequality. This is a matter of concern and should inform our thinking on public policy. However, it is not yet clear how the evidence will stack up. And even when that becomes clearer, it will require courage and creativity to find solutions that are best for the health of all.


Compassion, human rights and health care

The most common question put to me as I promote the work of Anglican health facilities is why the Church should still be involved in providing health services. Throughout the world the state and the private sector have come to varying accommodations to ensure that health care is available. People ask me why the Church should not now just get on with its core business - which presumably in their mind means prayer and moral guidance?

I wrote about this recently in a newsletter produced by the Africa Christian Health Associations Platform. I offer an extract as a taster, and hope you might follow this link to read edition english .pdf

Christian compassion dictates that the strong should help the weak and that the wealthy should subsidise the needs of the poor. We call this ‘charity’; a term which expresses the love we are commanded to have for our neighbours. It is a spiritual and practical corrective to the inevitable disparities that emerge in market societies, whether ancient or modern. In the idealised setting envisaged by the laws of the Pentateuch, the surplus of one person provides for the needs of another. The Jubilee principle dictates that no-one should become too dominant, and that no-one should be left in slavery and destitution.

This may have been applicable to the pre-modern rural setting where the transactional nature of this subsidy was personal, but what about this diverse and dynamic world of 7 billion neighbours we have now? Here there needs to be a more professional and universal system to ensure that resources are shared effectively. But does this then mean that interpersonal acts of compassion are no longer significant? Does it imply that government rather than local religious community should manage safety nets and redistribution systems? Or to conceive of the question in another way: Does the enlightenment notion of human rights supersede our religious vocation to express charity?

These quasi-political considerations have implications for Christian health mission. Can the ‘right to health’ be fulfilled to any extent by the ‘charitable’ sector, or is it by nature only government that can manage a comprehensive health system? In answering this question, Christian activists have to decide whether to focus on persuading governments to execute their task more effectively, or whether to expand their own services to those who are underserved by the public system.

Of course, the answer to these dilemmas is not going to lie at one of the polar extremes. If we discard the many outlets for compassionate care of our neighbours, we become less than the human persons into which God breathed loving existence. We are driven by divine commission to help those in need. On the other hand, if we think we can effectively transform the needs of society through some idealised divine kindness, we are blind to the limitations of our capacities. We are not yet in Heaven. We are still seeking the Kingdom. Laws and authorities will help direct societies to bring health and hope to all people, without prejudice or omission.

These are grounds for a positive partnership between Church and State. Working collaboratively, the energies of faith and the mandates of law can ensure a stronger human society, blessed by the underlying experience of compassionate love. Various alignments of responsibilities between Church and State can be adopted. Varying cultures can adapt the relationship as required. The goal of complementarity can be progressed to best effect.


Mary had a baby boy...

Some of us will celebrate Christmas in the snow. Others in the sun. Those facing water shortages may be praying for rain on our special day of holy celebration.  Under whatever circumstance we find ourselves in, we will once again hear the story of a teenage mother left to deliver her own baby one draughty evening in a stable. Trying to put my imagination into a situation 2000 years past, I wonder whether that was actually very far removed from what Mary was expecting. Certainly there were no other options than giving birth at home. And homes were places shared by all-comers, including animals.

Perhaps Mary would have called in the local birth attendant? Joseph may well have had an idea what was involved, but there were probably women who made it their business in rural communities to support women as they gave birth.

This is a situation familiar to many women even now. Qualified midwives and clinical facilities are in relatively short supply throughout the developing world. 'Traditional birth attendants' (TBAs) are the only support many women can find as they anticipate the joyous yet sometimes dangerous birth of their child. Naturally, the medical community wants to offer the highest level of support to women in pregnancy. The World Health Organization is campaigning for countries to marginalise TBAs and train more midwives. Many governments are actively discouraging these men and women from acting in their 'amateurish' fashion. But despite this, a high percentage of births are still overseen by TBAs.

In Ghana recently I was challenged by a compromise solution in the face of limited maternity services. The Diocese of Accra was running a project to improve the skills of TBAs. I went to the 'graduation' ceremony, where each TBA was offered a box of useful equipment following 9 days of training under supervision of staff from a hospital in the UK. Each graduating TBA was accompanied by one of their 'clients'. In fact, one of them reported attending a labour a couple of days before and finding the training for a difficult birth precisely relevant, leading to a positive outcome in the face of real danger.

A number of things took me by surprise. One was that there were some men who had come for training. It was said that most pregnant women prefer male TBAs, though the majority were women. The other surprise was that Ghanian women were deliberately choosing TBAs rather than maternity clinics. Local culture valued the opportunity to bury a placenta under a tree in order to gain blessings. The local hospital was required to treat the placenta as clinical waste. A difficult tension in the face of long held cultural practices.

Our Christmas story reminds us that Jesus emerged into the same uncertain conditions as so many babies in rural communities. Mary was fortunate not to suffer complications and was able to devote herself to Jesus' upbringing. A holy mystery shone into their lives that night as they encountered some strange and varied visitors to this place of blood, amniotic fluid and breast milk. This is the heart of our religious experience; that God emerged in this messy and unscripted manner.

Wherever a woman gives birth, whether supported by more or less skilled attendants, we are reminded of the first cry of Emmanuel into our world. This is where it happened. This is the setting we should support and honour.

A blessed Christmas to all


Archbishop’s video message for World AIDS Day 2010

In his message for 2010 World AIDS Day, the Archbishop of Canterbury celebrates the good news that can be found in examples of local responses to HIV and the impact of global action reflected in the latest statistics. Having witnessed at first hand the work being done at a local level with his visits this year to the Mildmay Hospital in Uganda and the Arunima Hospice in India, Dr Williams said:

“People are learning how to live with HIV, they’re learning about its transmission. They’re learning to see it as something they can understand, and therefore something they can make sense of, and live with positively.”

Dr Williams also praises those living with HIV who have dedicated their lives to helping others – working to overcome the fear and stigma and demonstrating how, with access to treatment, people can live well with HIV. The Archbishop also reminds us that although there may be much to celebrate this year, there is still a good deal of work to be done to protect the very vulnerable, and in particular, women and children:

“They’re still particularly vulnerable in contexts where the understanding of the transmission of HIV is still developing. And so long as that vulnerability is there, we mustn’t relax our own vigilance, our own understanding and care for the situation.”

Finally he urges us to remain focused on this issue, despite the temptation to let it fall from our priorities during this time of global financial upheaval, saying:

“…as we give thanks for what’s been achieved, it’s all the more important that we renew our commitment, that we don’t let this slip down the list of our priorities, that we remember that the future of millions of the world's children lies in our hands in cooperating with those who help and serve them who enable them to grow up and be citizens, human beings, people who truly live.”

According to UNAIDS' 2010 Global Report, at the end of 2009 there were an estimated 33.3 million people living with HIV, 2.6 million were newly infected and 1.8 million died from AIDS-related causes. The estimated figures for new infections and deaths are nearly 20% lower than those estimated in 1999. However, rates of infection outpace access to treatment by 2 to 1. 10 million people are still waiting for treatment. UNAIDS notes that, while the number of children born with HIV has decreased by 24% over the past five years, 370,000 children were newly infected in 2009 due to lack of services to prevent mother-to-child transmission. While the number of new HIV infections is being stabilised or reversed in at least 56 countries, commitment and momentum must be maintained to ensure universal access to HIV prevention, treatment, care and support.

UNAIDS 2010 Global Report is available at:
To watch the message, visit


A Time to Heal

If you happen to suffer a severe burn in one part of Switzerland the medics will recommend you ring someone from a specialist range of healers. A simple phone conversation will suffice. Medical staff will of course treat you first, but to aid the healing process they have learnt over many years that people respond to this cadre of healers and recover more quickly. Perhaps they think the local trust placed in these healers creates a positive placebo effect?

In my parish ministry in Switzerland I noticed that church members seemed to visit healers and alternative therapists with regularity. They would come back with tales of recovery and increased hope for cure. I would offer the ministry of anointing myself once a month at a regular Eucharist. This was quite a public display of healing prayer open to all as they approached the altar to receive bread and wine. Sometimes there would be tears. A few would come every time this was offered. Some would come to that service especially to benefit from this blessing. I never felt as if I had a particular gift. I was just faithfully offering a traditional ministration of the Church and trusting in the power of the Spirit to work within people as they received God's blessing. I cannot offer you any tales of remarkable recovery. But I sensed that this was a positive benefit to many as they grappled with God in the midst of distressing illnesses and circumstances.

The more prominent practice of healing is full of strange tales and mesmerizing personalities. Stadiums are sometimes filled by people keen to receive a touch from internationally renowned American preachers who advertise their presence with posters of discarded walking sticks. At the other end of the scale, local clergy or lay people can gain widespread reputations on a one to one level. Their healing touch seems to have profound impact.

The Church of England has been reflecting on this ministry for some years now. It produced a widely respected report, 'A Time to Heal'. It contains a number of wise and creative proposals to help support and encourage the healing ministry. Healing experiences are many and varied. They come from those healers under the authority of the Church and from those whose beliefs are diametrically different to our Trinitarian faith. To weave our way through this mysterious and uncertain territory we need to combine enthusiasm to offer people the grace of God with humility not to assume we know all the answers as faith impacts the health of the body and mind. Christ the healer works in many and varied ways, not least through the evidence-based searchings of science. AHN is committed to bring a holistic approach that melds health and healing in a single concept supported by people of science and the ministry of faith.

I recommend 'A Time to Heal' as a well-rounded resource to help promote a common purpose and framework of thinking in our pursuit of a holistic health mission in the Anglican Communion.


A network of partnerships to fight diseases

These past few weeks I have been engaged in meetings which seek to promote the significance of various large scale diseases. The Stop TB Partnership held a consultation with civil society at the World Health Organization at the end of September. We heard from a range of practitioners that this historically rampant disease is ravaging many parts of the world, especially Southern Africa. Those weakened by HIV are particularly prone.

The Minister of Health for South Africa confirmed the seriousness of the situation at an interfaith conference on religion and health care hosted by the Archbishop of Cape Town in early October. He offered the statistic that his country bears 17% of the entire world's TB cases. At any one time throughout the world there are 9 million suffering from TB. 2 million die each year. Increasing numbers of these cases involve strains that are drug resistant; a situation exacerbated as sufferers do not maintain their treatment after an initial flourish of improvement.

This week I met with Mark Lodge of the International Network for Cancer Treatment and Research at his base in Oxford, UK,. He is looking for wider partnerships to address the growth in cancer prevalence in the developing world. The days have now passed when cancer can be considered a disease of the developed world. 60% of cases now arise from middle and low income countries, with 5 million deaths a year.

Later that same day I met with Ruth Wooldridge, a founder member of AHN who works with the Worldwide Palliative Care Alliance. She and her husband Mike, a respected BBC documentary maker and journalist, have made a film about some of the cancer services and palliative care facilities in Kenya. It demonstrates how much can be done with limited resources. Ruth has written a handbook which gives practical advice about running a simple palliative care programme in the most basic circumstances.

Along with HIV, malaria, maternal and child health, respiratory and diarrheal diseases, TB and cancer deserve wider interest and support. Quoting competing mortality rates might seem crass, but this helps to convey a wider picture of the overall burden of disease. The global health community can only manage to give attention to a limited number of so-called vertical diseases at any one time. Anglicans who seek to promote health and provide clinical services face the diversity of disease at grass roots level. We have to manage as broad a range of services as possible; a challenging task when resources are few and clinical specialists are absent.

The opportunity to improve our capacity to meet this challenge lies in networking with those who are active in their specialist fields. I suspect many of the skills and a considerable amount of knowledge lies within our own network. Shared with one another, these capabilities can have a widespread impact. Along with partners in other networks and agencies we have the chance to build health systems that can roll back such a high burden of disease. The work goes on...

AHN: a brief exposé of current activities

The challenge for AHN is to connect people with similar interests so that collaborative venture can add value to Anglican health ministries. Modern technology makes that possible, and we are about to launch into the next stage of web design to try to make that effective amongst our existing 250 members and those many more who will join us in due course. In the meantime, here is a snapshot of what conversations and projects are taking place:

  • The Tanzania health microinsurance project is due to launch at the beginning of October. The AHN marketing team is set to promote the policy in 21 parishes of the Diocese of Dar es Salaam with a target of recruiting 20,000 members by the end of the month. An immense amount of work is going on in the background to make this unique approach work successfully. 
  • I will be speaking at a conference on Religion and Public Health at the University of Stellenbosch in South Africa. Archbishop Thabo will be present along with a range of religious leaders from around the region.
  • Our colleagues in the Province of Central America are in the process of contacting Anglicans throughout the continent to draw their interest in AHN, in particular with the backing of Elizabeth Barahona and her able translation support for our Spanish version website.
  • The Harpur Community Health Centre in Sadat City, Egypt is preparing for its official opening on 1st December.
  • An October meeting is set in the Church of England to plan a major national conference on health and healing
  • Discussions are taking place with various donors and microinsurance agencies to allow us to invest in our capacity to pilot health microinsurance more widely.
  • I am attending a WHO consultation with civil society on combatting TB
  • Conversations on the health challenges faced by indigenous communities are beginning to emerge between Anglicans in Canada, Australia, New Zealand and the United States.
  • AHN is involved in the planning of a major international faith-based health conference for November 2011
  • Discussions are underway in relation to developing a public health curriculum to train Anglican health practitioners.
  • Whilst all this is going on, I am constantly gathering information about Anglican health programmes from around the communion; a community health project in Mozambique, the opening of a hospital in Myanmar, the development of nursing schools in DR Congo and Nigeria, the renewal of hospitals in the Church of North India, the struggle with flood damage in hospitals in Pakistan, the development of primary care projects throughout Africa - and so much more.

It is timely then that we shall gather some of our founding participants to review the strategic direction of AHN at the end of October. As well as look at how we can design our information systems so that we can more effectively engage people in collaboration with each other, we shall consider the most pressing needs and opportunities which are currently presenting themselves.

Meanwhile, please feel free to express your interest in these and other projects so that we can begin to build this collaborative momentum in order that we may offer God's healing ministry more bountifully.


Africa and Oslo

As our African bishops gathered for their conference in the rather luxurious hotel complex in Entebbe at the end of August, their good health was made a priority. Mengo Hospital provided a 24 hour clinic to ensure that all routine and emergency health issues were dealt with effectively. I know this because I had to make use of it myself. With a growing fever, I was grateful to Dr. Kalibbala Sendi for swift action to ensure that any danger from a possible malarial attack was offset by a heavy dose of the latest combined therapy drugs.

As it happened I had met Dr. Sendi the week before while I was visiting his hospital. Mengo was the first hospital in East Africa, opened in 1897 in Kampala. It has grown over the years to cover many specialities and remains one of the key referral hospitals in Uganda. It sits just below the Cathedral in Namirembe, close to the provincial offices. The Church of Uganda has an extensive commitment to health care. It employs somewhere between 25-30% of the entire health workforce of the country. To give me a broader insight into the range of settings in which health services are provided I had also visited the Azur Christian Health Centre in Hoima, which serves a more rural community. Bishop Nathan and his staff have been committed over many years to see this clinic emerge into a level 4 health centre, and recognize the importance of further development in the future. The needs are increasing all the time, especially with an average fertility rate of 7.2.

My own rather modest health concerns were not quite resolved at the conference clinic. From Entebbe I headed off to Oslo to a meeting to plan a major international conference on faith-based health care due in November 2011. We were there at the invitation of the director of a Church of Norway hospital. By the end of the first day's meeting, I found myself hanging from a drip in that same hospital while tests were conducted. No major problems emerged, but it was the first night I ever spent in a hospital.

I am familiar with the health risks of travelling. But I do hope that this will not emerge as a pattern. To receive treatment from every hospital I visit in the future will prove a testing vocation. I certainly hope this was a one-off. But It nevertheless reinforced in my experience the comfort that our health facilities offer throughout the world to people facing the fear and pain of disease. Providing the skills and reassurances of good health care systems allows the Church to serve people at their moments of deepest need.

Thanks to those who cared for me this time round. And a blessing to all of you who do this sort of thing day after day, week after week.


Visiting the Diocese of South Kerala

Just north of Trivandrum in Kerala, India there is a rural health training centre that serves many of the poorest fishing villages nearby. I arrived there one afternoon recently to visit the facilities and was surprised to find  myself clambering over building materials. Already a facility with 100 beds and a range of departments, this quasi-hospital is about to double in size. The medical staff are overrun with demand and are working hard to meet ever increasing expectations for quality of care.

Such is the vision and energy of the Diocese of South Kerala, that millions of rupees are being invested to upgrade and expand facilities to serve this rising demand. The formula is simple. This rural health training centre provides a standard of care and response to patients that put local government facilities to shame. They do this at a fraction of the price of the more sophisticated private hospitals that compete for business amongst the wealthy.

I asked our colleague, Dr. Bennet Abraham, how expansive were his ambitions? There are 3 diocesan hospitals, including Karakonam with its renowned medical college. It seemed to me that the Diocese was providing health services pitched at just the right point to serve the majority of the poor and rising middle class. In terms of impact, the sky was the limit.

How far should the Church go in fulfilling such a role in its surrounding community? My mind goes back to my visit to St. Luke's Houston, the largest health system in that part of Texas with its world class hospitals and community care projects. Anglicans in this network are not out there simply to fill temporary gaps in service provision. They believe that what they do arises from Christian vocation and is of unique value in their societies at large. In their prayers they see a God who cares for the world outside the Church. They see body and spirit intertwined. They follow the call of Christ the healer.

Our colleagues in different parts of the Anglican Communion face us all with a challenge: the care of the sick and the promotion of wellness is God's business and ours. As it stands, for those who have the vision, there is no ceiling on their ambitions. The sky's the limit...


Full time coordinator of the network

On 1st July I started my new role as full time coordinator of the network. 16 years in parish ministry has given me a perspective of the Church’s mission from the frontline. I bring that experience with me to help deepen the ministry of health and healing within the wider communion.

As I do, I am encouraged by signs both within the Church and beyond it to see a wave of momentum in this area. At the interface between faith and health Christian individuals and institutions are pioneering new approaches to bring holistic care. Others are responding to overwhelming need to bring health care to underserved communities. Alliances are forming, conferences called, studies undertaken. Far from retreating from its traditional role as health service provider, the Church in its many guises is tentatively taking steps forward to renew this role.

At the same time there exists a crisis of confidence in the willingness of wealthy nations to subsidise the health care services of the poorer ones. The most visible sign of this emerges from global donors for HIV/AIDS, Malaria and TB. Ambitions are being questioned. Funding is beginning to ‘flatline’ in some places. It may even be reduced in due course. In the past decade there was a good deal of expectation that funding of up to $20billion per year could yield significant gains to defeat the big diseases and build health systems. No one knows quite how these ambitions might need to be re-evaluated as finance comes under greater pressure.

Churches engaged with donors and strategists through this past decade and made their case for publicly funded support. Some signs of encouragement emerged, with partnerships and funding regimes agreed. This has brought a good deal more confidence amongst Church health providers that they play a significant role within health systems, and that their work can add great value to future national health plans. However, they have now to face a period of uncertainty in which faith-based health care providers may have to adapt their plans.

What we are learning as the Church is that faith and health are intimately tied together, and that the example of our forebears and of Jesus himself leads us to recommit ourselves to bringing greater health and wholeness. Whilst there is still suspicion and resistance, nevertheless our role as health service providers is gaining greater significance in the mind of the health community. We do not know how these next steps will play out in the context of the financial crisis, so we will need to be flexible.

I am about to visit Dr. Bennet Abraham of the Church of South India. He is our pioneer in testing the new health microinsurance model from his 650 bed teaching hospital in Kerala. As we learn from him and so many other innovators around the Anglican Communion, I hope this network can begin to make sense of the prevailing trends around us. In the process of mutual learning, we will need to see our work evolve so that it can release fresh hope and health from the communities we serve.


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