This article was originally published in Missionalia , the journal of the Southern African Missiological Society . If you would like to see some other articles from Missionalia , have a look at the list of Missionalia articles on the Web
WESTERN MEDICINE - SECULARISED AND SECULARISING
A medical missiological problem
Gerard Jansen 1
This article explores the medical missiological aspects of secularisation since the introduction of Western medicine into the Two-Thirds World, with special reference to Africa. After surveying the history of secularisation in the West and the developing dialogue between medicine and religion, the author traces the Greek, Christian, Arab-Islamic, Renaissance and Enlightenment roots of Western medicine. Western medicine functioned as a secularising ferment in Africa by dethroning the traditional healer, replacing witchcraft causation with medical history and introducing modern hygiene. Over against this, African spirituality is communal and integrative in nature. It is the task of African Christian theology to develop a new ministry of curing and caring that embodies this spirituality.
The time is past when Western medicine was the much praised vehicle for the propagation of the gospel to foreign cultures. Now, in the final years of this century, we are less convinced of its efficacy than our forebears were in 1900. In any case, we have become averse to military metaphors as expressed in the bold statement at the International Student Missionary Conference in London, 1900: "Medical missionaries are the heavy artillery of the missionary army" (Walls 1982:290).
As we approach the closing years of our second Christian millennium, I aim to study medicine's involvement in the historical process of secu larisation. In a certain sense we have arrived, in this post-modern phase of our Western culture, at the final stage of the process of secularisation as far as North American-European civilisation is concerned. However, the Two- Thirds World is still exposed to the radiation hazards of what the First World generated.
Although the topic concerns a world-wide process, this article focuses mainly on the African continent, drawn from the author's experiences in South and East Africa. The Asian medical systems, rooted in the symbols and worldviews of the great Asian religions, are separate and distinct in nature and require a study which goes beyond the scope of this article.
THE HISTORICAL PROCESS OF SECULARISATION.
From the extensive missiological literature on secularisation two clusters of publications can be distinguished. 3 The first centres around the Jerusalem Conference of the International Missionary Council (IMC) in 1928. The second was inaugurated by Van Leeuwen's epoch-making book Christianity in World History (1964) on the eve of a cultural revolution in the Western world.
The prolific work of Lesslie Newbigin the ripe fruit of a long missionary career is a meritorious attempt to review the secularisation debate and to
present it as a challenge to Christians facing life in a pluralist society. At the time of the Jerusalem IMC Conference the world was experiencing the aftermath of the First World War and the old patterns of European culture were crumbling. The Jerusalem Conference was deeply aware of the crisis facing Christian civilisation. One of the main speakers at the conference, Rufus Jones (1928:284), regarded the "world-wide secular way of life and interpretation of the nature of things" as the greatest rival of Christianity. In a critical analysis of our secular civilisation he pointed to the emergence of science the world over. He concluded: "This situation of rivalry in a very acute degree confronts the Christian missionary in Japan, China and India, where the institutions of higher learning, both secular and Christian, have accepted the scientific method of explanation" (:305). In particular, the field of education was recognised as the channel through which this process of secularisation influenced the young intelligentsia of Asia and Africa.
Thirty-five years later this debate had shifted from the conference table to the ruins of western Christian culture in the turbulent 60s. Van Leeuwen (1964) sketched the revolutionary West in a historical panorama, devoting special attention to the scientific and technological revolution. In this compre hensive work he used the term "secularisation" in various senses, but pri marily in a positive sense, as a process of emancipation from religious constraints. This caused a fundamental disruption of the ontocratic pattern characteristic of most of the ancient "pagan" religions. Under the influence of Gogarten's work, Van Leeuwen viewed secularisation as a product of the gospel which the mission had proclaimed. In theological as well as socio logical literature a lack of consistency in the conceptualisation of this process has often confused the discussions. As a working definition for this article, it is preferable to describe the complex phenomenon of secularisation by using five key concepts, as identified by Larry Shiner (1967:52-57).
1) decline of religion
2) conformity with the world
3) desacralisation of the world
4) disengagement of society from religion
5) transposition of beliefs and patterns of behavior from the "religious" to the "secular" sphere.
Numerous other definitions contain components of this broad formulation. Items 1) and 3) are most relevant to the secularising effects of medicine. Sociologists such as Peter Berger and Thomas Luckmann included in their definition the liberation of society from the domination of religious institutions. An example of recent date is the nationalisation of mission hospitals in the post-colonial era.
Some authors introduced the concept of "secularism" as the negative side of secularisation. Holyoake coined this term in 1871, followed by a later study on its origin and nature in 1896. 4 Newbigin took secularism "to refer to a system of belief, or an attitude, which in principle denies the existence or the significance of realities other than those which can be measured by the methods of natural science" (1966:8). It is this shadow side of secularism which concerns the evolution of a reductionistic biomedicine.
MEDICINE AND RELIGION
Several approaches to this theme are possible, varying from the acceptance of an unbridgeable gap, as in a secular society, to the acceptance of a close relationship, presented as "religious medicine" in some non-western cultures.
Kenneth Zysk (1993) gave his study on the history and evolution of Indian medicine the name Religious Medicine. Shamanism is an example of this strong intertwinement between medicine and religion. As a ritual specialist, the shaman fulfils an essential role in a society steeped in religion. In a previous publication (Jansen 1973), describing the experiences of eleven years of medical mission work in the Transkei (1959-1970), this author addressed an African element. During that pioneering stage of missionary work, African religion, medicine and magic were found to be closely inter woven. One hears the suggestion that Western medicine started from its very onset as a medicina sacra 5 and that in the space of time it evolved into a full- blown secularised practice and profession. However, Western medicine never knew in its history a period of medicina sacra, comparable with "religious medicine."
Currently we live in a time of dialogue between Western medicine and religion. Several initiatives in the USA demonstrate the felt need to make overtures to each other. In 1980 the Institute on Human Values in Medicine of the Society for Health and Human Values published the report Medicine and Religion. Donald Shriver (1980:xv), the editor of this study, believed that the growing dialogue arises "from the intense concern within the medical profession itself for the ethical, philosophic, and religious dimensions of medi cine practice in our day."
The Park Ridge Center in Chicago, established in 1985, is an interdis ciplinary research institute that brings together representatives from religion, health care, and the humanities. The Center was founded in view of the perceived international need for the study of religious aspects of human well- being, with the focus on the links between medicine and religion. Under its auspices two useful publications have been edited. 6
In the dialogue between medicine and religion, basic questions must be raised. With reference to our discussion it is important to know if Western medicine, with its representatives (the medical profession), is a discussion partner that is totally secularised. We can only try to answer this question by approaching the problem from a historical perspective.
The roots of the Western medical tradition
It is impossible in this article to present an extensive account of the evolution of Western medicine from its ancient origin to the twentieth century. It is more helpful to expose the different historical roots from which Western medicine arose.
The history of Western medicine shows a remarkable hybridisation of distinct healing traditions and medical beliefs that influenced each other in the course of its development.
Greece
Greece as the cradle of European civilisation produced in the fifth century BCE two main streams of ancient medicine: the priestly Asclepian medicine versus the rational Hippocratic medical school, which was of younger date. Both were living in co-existence; an early example of medical pluralism! The Hippocratic school rejected the belief in the deistic or demoniac origin of disease, as taught by the Asclepian school. A paradigm shift had taken place with the emergence of the revolutionary view that the causes of illness are to be found in human beings themselves and their environment. The medical historian Vivian Nutton (1995:23) argued that "the authors of the Hippocratic Corpus all presume that bodily processes, health, and disease can be explained in the same way as other natural phenomena, and are independent of any arbitrary, supernatural interference." One can say that this new view on the etiology of disease inaugurated the secularisation of ancient religious medicine in Greece, to be understood as the emancipation of people from religious constraints. This development in Greek culture occurred beyond the sphere of Christian influence. Unlike Van Leeuwen, I believe that secular isation can also take place without being a "by-product of the gospel." The Christian medical tradition adopted much of the new professional ethos formulated in the Hippocratic Oath, but without citing the opening invocation of the four healing deities. 7 The cult of Asclepius the Greek god of healing was celebrated into the fourth century CE, coming to an end only when the Christian emperor Constantine demolished the last temple of Asclepius in Aegae, Cilicia, during his reign (312-337).
The Christian tradition
The Christian tradition did not conceptualise its own medical doctrines, and the early church did not often reject secular medicine. In their well-docu mented article on "The early Christian tradition," Amundsen and Ferngren (1986:60) distinguished the elements of compassion and charity as constant features of Christianity since its beginning, subsequently leading to the establishment of hospitals in the fourth century. Those early hospitals offered more in the field of caring than of curing. It was in that activity of caring that Christian ministry was most clearly expressed. In the genuine tradition of Christian agape, special emphasis was placed on Christus medicus as healer, and in this spiritual climate the church became a statio medicinae, or in the words of Harnack: "das Lazarett der Menschheit" ("the hospital of humanity," quoted by Schipperges 1965:15). From the fifth century a number of priests and monks took up the practice of medicine, heralding the new era of monastic medicine, which came to an end in the time of the Reformation.
Arab-Islamic medicine
A third root, often not recognised, was the influence of Arab-Islamic medicine, which reached its pinnacle during the reign of Charlemagne. It is interesting to note that Nestorian refugees carried Greek medicine into Mesopotamia, with its center in Edessa, and then to Persia. The works of Hippocrates and Galen were translated into the Arabic language, a process that was dominated by Christians, such as the Bayt al-Hikma family, who possessed knowledge of Greek and Syriac and had prior experience of translation work. It was Galen's work which set the standard for Arab medicine in this era of translators (Conrad 1995:108). The Arabian school produced great physi cians, including Rhazes (ar-Razi), Avicenna (Ibn Sina) and Averroes (Ibn Rushd). Avicenna's opus magnum, the five-volume Canon of Medicine, was a standard work for six centuries. A series of medical works written between the tenth and fifteenth century, entitled Prophetic Medicine, were authored by orthodox pious scholars, who combined ancient Arabian medicine with the Greek tradition of scientific medicine (Rahman 1989:154). It is argued that even gifted Arabian doctors were doomed to be mere copyists of Greek medi cine because they were hamstrung by the Qur`an's prohibition of dissection.
The Renaissance
With the Renaissance, Western medicine entered a new era, characterised by a process of rationalisation (Hewa and Hetherington 1995:130-132). Max Weber conceived this process as the fruit of the Reformation, which liberated individuals from the past bondage of religious domination. Weber spoke of the "disenchantment of the world" as the ultimate fate of modern Western society. This process of rationalisation had its impact on virtually all aspects of society; not only medicine and science, but also arts and commerce. The publication of Andreas Vesalius' masterly work De Humani Corporis Fabrica ("On the fabric of the human body") in 1543 laid the foundation of modern anatomy by its analysis of the human body based on minute dissection. It was published in the same year as Copernicus's revolutionary work proposing a heliocentric universe, and it announced the Medical Renaissance which heralded the era of modern medicine. From that point, medical doctrine has undergone a series of paradigm shifts, including the scientific revolution of the seventeenth century, which led to the triumphs of modern medicine, as seen over the past 150 years.
The European Enlightenment
The processes of rationalisation and secularisation found optimal conditions for growth and expansion during the European epoch of the Enlightenment. This radical change in Western culture created a secular world, replacing the traditional religious world of the Middle Ages with secular values. Medical thought was deeply influenced during the Age of Enlightenment. The following changes, typical of the Enlightenment, can be distinguished (Cunningham and French 1990:3):
From the religious to the secular world;
From a real concern with the soul as medically active to the mathematical measurement of "virtue";
From the closed world of the doctor-patient relationship to ambitious schemes of rational social planning to eliminate disease once and for all.
The first change refers to the process of secularisation. The second points to the expansion of rationality in terms of predictability and calculability rather than metaphysical and mystical speculation. The last embodies a new em phasis on rational planning, which makes the claim of being able to eliminate disease. This element of planning determined the new agenda for inter national health care, and through it the World Health Organisation (WHO) thought to realise its slogan "Health for All by the Year 2000." The final pro duct of Enlightenment medicine was the biomedicine of the twentieth century, with its antimetaphysical and pragmatic orientation.
Postmodernism
In the last decade of our century modern medicine faces the postmodernist claim that the "grand theories" or "master narratives" of the past have lost all credibility. Modern medicine is quite a conservative monolith, and despite such modern critical theories, western medicine has not lost faith in its progress. As the medical historian Nelly Tsouyopoulos (1994:268) remindes: "The credibility of the great recits [narratives] is still very strong in medicine."
To conclude this discussion, let me summarise: Western medicine is the fruit of a centuries-long process of acculturation. Several civilisations around the Mediterranean Sea Hellenistic, Arabic, Jewish, Christian, Syrian influ enced each other in the realm of medicine. The Renaissance in European history became the dawn of modern science and medicine was integral to the scientific revolution. The breakaway of the medical tradition in the Middle Ages, when Galenic medicine was still the dominating doctrine, caused a new development, which meant that Western medicine drifted further from other healing systems that held humoral theories, as in Mexico, the Arab world and South East Asia. Finally, in this century, Western medicine has grown into a cosmopolitan medicine, integrated into the prevailing world system.
Western medicine as a secularising ferment in the world
Western medicine started penetrating non-Western cultures in the Vasco da Gama era of world history. In that time two main streams of foreign medical aid were operating: colonial (imperial) medicine as a governmental organi sation of medical care and missionary medicine, initiated by missionary societies and churches. Both propagated and practised the same cultural model of medicine, taught in medical schools of Europe and North America. However, the two types of health services diverged in the aims pursued, the motivation of their staff and the comprehensive approach of medical mission work. Often the medical missions sailed in convoy with the colonising powers, although there are numerous examples of pioneering work by medical mis sions independent from colonial policy and support. The medical missionary movement expanded in the second half of the nineteenth century when Western medicine gained momentum through a series of advances and discoveries. The introduction of Western medicine did not take place in a cultural vacuum, as if local populations had not thought of their own expla nations for illness and healing. The traditional religions and worldviews were the articulated answers to the basic questions of suffering and misfortune. In a recent study on leprosy among the Limba in Sierra Leone (Opala and Boillot 1996:3-19), an African anthropologist and a medical coordinator of a leprosy and tuberculosis programme emphasised the importance of worldview as a key to understanding patient attitudes and behaviour. Unfortunately in the past the significance of this understanding was often overlooked or not honoured by colonial and missionary medicine. It is questionable whether today's perception of worldview has been much deepened by medical anthropological studies. Rapid changes in traditional cultures obscure the primal vision to which the worldview of the people is related. Moreover, the pragmatic attitude of Western practitioners created an indifference to the indigenous ideas and beliefs of the people they were serving.
Is Western medicine indeed such a potent secularising force when it comes in contact with cultures and medical traditions foreign and distinct from those of the donor country? Neither missiologists nor anthropologists have at their disposal a measuring instrument for quantifying the process of secular isation in the fields of health and healing. We cannot simply count the number of secularised traits in health care and apply them as an index of secular isation, but the anthropological literature offers us some insight into this shift of worldview. A good example is Hammond-Tooke's research on the effects of urbanisation on the interpretation of misfortune among the ama-Xhosa of the Eastern Cape in South Africa (1970:38). He found a shift towards a more secular worldview among the townspeople of Grahamstown, when compared with the rural area. He calculated an increase from 7.3 to 37.6 percent in the proportion of non-mystical modes of explanation. 8
To complicate matters, secularisation coincides with the dynamic process of acculturation, which alters the foundations of traditional society. Confronted with the modern way of life, the whole pattern of traditional life is being trans formed. We can say that in the Two-Thirds World the secularising ferment dif fused mainly through the process of acculturation, this in contrast to the Western world, which generated its own secularising forces as an inward process spread over several centuries.
Desacralisation
Those changes which occurred in the pioneering stages of the confrontation between Western and traditional medicine can be described in terms of desacralisation, i.e. the shift from the realm of the sacral to the profane reality. Mircea Eliade (1958:xii) defined the adjective "sacral" as the opposite of profane. The crucial change brought about by this process of desacralisation is the dethronement of the healer as a ritual specialist. His or her vocation is to be a medium between the supernatural powers/spirits and the patient. In most African cultures this religious role is fulfilled by the diviner. His or her diagnostic work takes place in the supernatural sphere of the seance, as communication with the spirit world is essential in discerning the cause of misfortune. Ancestral beliefs provide explanations for sickness and mis fortune. In this spiritual contact the ancestors serve as agents who guarantee the authority of the sacred (Hammond-Tooke 1989:104). Western practice undermines, nolens volens, this authority by establishing another frame of reference in its diagnostic approach. Medical history and physical examination are, in Western eyes, the indispensable elements for clinical judgment. As previously mentioned, this new orientation was developed by the Hippocratic school of medicine, which introduced clinical observation of the patient at the bedside. This medical school on the Greek island Kos proclaimed that every kind of illness is subject to natural laws. African medicine, especially among the Nguni people, often departs from a dichotomy in its nosological 9 system. Conco (1979:59) speaks of the dualist theory of traditional African Bantu medicine. This theory distinguishes between natural and supernatural causa tion of diseases. To the latter category belong the African cultural diseases, in Zulu/Xhosa called ukufa kwabantu or simply isiXhosa. This is the territory of the traditional healers, to which a Western practitioner has no access.
Taking the medical history of a patient presupposes that his/her illness is conceived as a process with a beginning, and a specific course with signs and symptoms, while an African traditional view, e.g. that of the Limba, regard it as a life event. By following this approach, Western medicine has a demys tifying effect on the doctor-patient relationship in the transcultural context of medical practice. According to the Western concept there is no place for belief in witchcraft as an explanatory model for sickness. Hammond-Tooke, in his aforementioned study, is of the opinion that among the Nguni the witch bears the theodetical blame for the misfortune concerned. If the ancestors are viewed as fundamentally good and protective, the question arises: how can they allow any misfortune to befall their descendants? The concept of witch craft localises the evil in certain individuals, driven by envy and malice with the aim to harm others.
Another Western concept that has a strong desacralising effect is the modern idea of hygiene. Mary Douglas (1969) analysed the concepts of pollution and taboo in a monograph entitled Purity and Danger. She sum marised two notable differences between contemporary Western ideas of dirt or defilement and those of pre-literate people: a) to the former, dirt avoidance is a matter of hygiene or aesthetics and is not related to their religion; b)The idea of dirt among Westerners is dominated by the knowledge of pathogenic organisms (Douglas 1969:35).
According to this anthropologist, the concept of the bacteriological trans mission of disease produced "... the most radical revolution in the history of medicine" (:35). This revolution was transferred to Africa and Asia by Western healthworkers in the battle against infectious diseases in the tropics. Health education in particular was the medium of transmitting this new message about the etiology of infections.
The severe loss of a sacralised life opened the way for an increased secu larisation in a detribalising society wherein "things fall apart." Such a rapid change evoked a countermovement in African Christianity. African Inde pendent Churches (AICs), split into more than four thousand denominations, formed such a countermovement, protesting against the modernisation and secularisation of health care. As Oosthuizen (1992) explained, in Southern Africa the religious role of the diviner has been replaced by the AIC prophet. In other words, a re-sacralisation of the healer is realised, inculturated in an African background. Some of these movements banned the use of Western medicine and designed their own ritual methods of healing.
The contemporary discourse in the Western world dealing with the steady growth of a secular society is usually not the primary concern of the less industrialised countries that are struggling to survive. Without doubt, secular isation is an irreversible process in our globalising world, but the American sociologist Rodney Stark foretold that "secularization will not usher in a post- religious era" (quoted by Newbigin 1989:213).
Nevertheless the secular society will put its stamp on the modern world system of which all nations, industrialised and agricultural, rich and poor, will be a part, to a greater or lesser extent. The increasing internationalisation of Western medicine and academic education has a powerful influence on all non-Western countries, heaping them together as one bloc in the "United Nations." Institutions like the World Bank and International Monetary Fund press the low-income countries in the direction of a global system with the traits of a secular society.
In a critical appraisal, Newbigin (1989) spoke of "the myth of the secular society." He defined myth as "an unproved collective belief that is accepted uncritically to justify a social institution" (1989:211). What we need, Newbigin argues, is the unmasking of the powers, calling for a new kind of enlighten ment. This unmasking requires "the opening up of the underlying assump tions of a secular society, the asking of the unasked questions, the probing of unrecognised presuppositions" (:220). This is a pretentious programme in a pluralist world, in which Christianity is no more than one permitted option.
If we really believe in the challenge of "mission in six continents," then we must be attentive to the authentic voices coming from other continents. We focus especially on the Christian communities in Africa, who express their faith without being direct heirs of the Enlightenment. Some of them form a countercurrent in the ocean of a secularised world.
AFRICAN SPIRITUALITY VS SECULARISED MEDICINE
So far non-Western voices have not spoken or intervened in this debate. In this context, the contribution from non-Western countries must not be missed. African Christian communities in particular distinguish themselves in respect of the ministry of healing by manifesting an authentic African spirituality. Volume Two in the series "African Pastoral Studies" entitled The Church and Healing. Echoes from Africa (Lartey, Nwachuku and Kasonga 1994) deserves special attention. Most of the contributing authors are lecturers at African uni versities and were all born in Africa. "Healing is central to any understanding of African Christianity," we read on the book's cover. The direct relationship between healing and Christianity is virtually absent in the modern Western world, as a result of the overpowering influences of secularisation. Despite the strong impact of colonisation and Christianisation, traditional African spirituality has survived. African spirituality is not a dogma or credo, but in the words of Ghanaian theologian Emmanuel Lartey, "spirituality is seen as vitality, liveliness, health and wholeness" (Lartey et al. 1994:47). We must understand these key words in the African text and context, without secular ising them in a Western sense.
Jean Masamba ma Mpolo, who teaches at a Protestant theological faculty in Kinshasa, identifies three basic elements of African spirituality: 1) Life is sacred because it comes from God the Creator. It must therefore be preserved and respected as God's gift. In Western countries this principle is often monopolised by the pro-life movements or secularised in quality-of-life measurements; 2) African spirituality is also expressed in the relationship between illness, misfortune and sin. Here sin is not taken in the biblical meaning but associated with violation against taboos and disrespect of the ancestors. Illness and misfortune have to do with personal or group trans gressions. For the African, healing is seeking liberation from life-negating forces and it can be achieved by repentance, confession and reconciliation;
3) The role of spirits and ancestors in African life is part of African spirituality. According to African cosmology, the universe is populated by spirits other than God and human beings. In such a concept, no clear distinction is made between spiritual and physical, body and mind, profane and sacred. Western secularisation has sharpened this distinction, resulting in a mechanistic world view. African spirituality does not have a dialogical character, but presents itself as an expression of the African soul (in Lartey et al. 1994:18-27).
Another contributor, Andrew Olu Igenoza (Nigeria), wrote on the notion of wholeness in African experience. The search for wholeness is currently in vogue in the Western world since the New Age movement made it a favored topic. It also functions as a key notion for counterbalancing reductionist medi cine. The author makes a critical comment on the WHO's definition of health, in which he misses a spiritual dimension (Lartey et al. 1994:126). He calls for a comprehensive Christian ministry of healing that recognises the spiritual, religious, medical and socio-ethical dimensions of sickness.
Let me summarise the fundamental tones of these African voices: The church in Africa is called to develop an authentic African Christian theology which is integrative, pastoral and therapeutic. What is also striking in this African approach is that healing is a corporate or community affair, in contrast to the largely individualistic way of treating patients in the Western world. A sharing and caring community is needed to practise such a ministry in daily life.
FROM THE PAST TO THE NEAR FUTURE
For the most part, this article has presented a retrospective view of an evolving medicine in a transforming Western culture. These transformations have a global character, and the Two-Thirds World is drawn into the vortex of this globalisation.
Most developing countries are eager to take advantage of Western science and technology. They are usually uninterested in, and ignorant of, the historical background of global culture. They do not enquire "into the roots of the tree on which these fruits have grown" (Newbigin 1966:25).
Mission and medicine are in transformation, as are we, as planetarians, with them. Living in this seculum, we suffer from the tension between the blessings of a secularised medicine and the shadows of a de-spiritualised culture. We must heed the warning of Mogadal and Bergh (Lartey et al. 1994:275) in their article on the "Challenges, issues and trends in health care and the church's mission":
And western health professionals, even Christians, are influenced by their own secularized culture in their general view of health and disease. By overemphasizing the physical and not taking the spiritual aspects seriously enough they may in fact contribute to a secularization of health care in the country where they serve. And this may not have been what they intended.
What, then, is the task of health workers as they face a world system infiltrated by secular humanism and entering the information age? At the Tübingen Consultation of 1964, Lesslie Newbigin (1965:9) raised the ques tion, while discussing the secularisation of modern medicine, as to whether we must replace the traditional religious medicine which has been discredited by another form of religious medicine (Christian medicine). Together with Van Leeuwen his categorical answer was a wholehearted "no", because "the tower of Babel has no top and it is not the business of the Church to fill that gap" (quoted by Newbigin 1965:9). As Christians our task is down at the base of the tower.
As we have seen, the early church accepted secular medicine as a healing method and profiled itself by practising the ministry of caring for the sick, even in times of pestilence. It is encouraging to observe how today some African church-run hospitals, having learnt from their foreign mission's past, participate in this Christian ministry of healing and formulate their own mission statements 10 as a guide for their staff. Apart from that, it is timely to introduce a broader terminology: the Christian ministry of curing and caring. This is a more adequate term in the era of AIDS and the increasing prevalence of chronic diseases. The healing church must first and foremost be a caring church.
In the ministry of curing and caring, counselling and pastoral care are the two indispensable elements which received insufficient attention in the past of medical missions. The Great Commission of Matthew 28 was the compass by which missionaries went out to people abroad. "Making disciples" was the manifesto followed in the pioneering stage of planting churches and building hospitals. It is only John's Gospel that mentions in its last chapter Jesus' special commission to Peter as prospective leader of the early church. In the words of Köstenberger (1995:449), who studied the missiological dimensions of the Fourth Gospel: "The shepherd appoints an under-shepherd." Jesus replies to Peter's triple profession of love with a triple investiture: the three commandments, feed my lambs, look after my sheep and feed my sheep, represent the "tricolor" of pastoral care. In the person of Peter, this task is committed to the whole caring church. The care embraces the new and old generations (lamb and sheep), it renders special attention to those in need, and it provides (living) bread for the health of nations. This Johannine appendix to the Great Commission will be a touchstone for good health care in a new millennium.
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2 To mention the contribution of two missiologists to this debate: In his opening address to the Tübingen Consultation I, Lesslie Newbigin (1965) pointed firstly "to the group of problems which arise from the impact on medical missions of the world-wide process of secularization." David Bosch (1967) remarked in his address The aim of medical missions that "the rapid advance of secularization in Asia and Africa was to a certain extent a result of medical missions." Among the publications of Christian doctors I found the article of Arden Almquist (1967:1-11) an asset to the discussion. The Dutch doctor J.B.Ridderbos (1971:3-7) gives a clear analysis of the impact of the process of secularisation on the evolution of medical science.
3 In the aftermath of the Jerusalem Conference, the International Review of Missions published three articles on secularisation in the years 1929 and 1930, written by William Paton, Emil Brunner and Hendrik Kraemer respectively. In the 1960s Paul van Buren shook the theological world with his revolutionary book The secular meaning of the gospel (1963) and Harvey Cox with his bestseller The secular city (1965). In his inaugural lecture (Amsterdam 1965), Johannes Verkuyl discussed the task of the missiology in an era of secularisation and secularism.
4 In his book, The principles of secularism, G.J.Holyoake (1871) defined secularism as "the study of promoting human welfare by material means measuring welfare by the utilitarian rule, and making the service of others a duty of life" (:11). There has been a clear shift in the meaning of this term in the second half of the twentieth century.
5 The Dutch theologian C. Aalders (s.a.) called his monograph on the ministry of healing Terug naar de medicina sacra (Eng. Back to the medicina sacra).
6 The first publication in this series was Caring and Curing. Health and Medicine in Western religious traditions (Numbers & Amundsen 1986). The second was entitled: Healing and Restoring. Health and Medicine in the World's Religious Traditions (Sullivan 1989).
7 The translated text of the preamble of the original temple oath runs as follows: "I swear by Apollo the physician, by Aesculapius, Hygeia and Panacea, and I take to witness all the gods, all the goddesses to keep according to my ability and my judgment the following Oath..." (in Robin and McCauley 1995:1423).
8 Cases explained by non-mystical causes were categorised as old age, sickness, murder, accidents and over-exertion.
9 Nosology is the branch of medical science dealing with the classification of diseases .
10 An example is Chogoria Hospital, run by the Presbyterian Church of East Africa (Kenya), which formulated the following mission statement: "To witness to the Lord Jesus Christ by participating in the ministry of healing, addressing the need of the whole person to the glory of God", in the Annual Report 1994, p.27.
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