CHAPTER V.

MEDICAL WORK IN THE STATION DISTRICT.

Thus far of the force in its general aspect. When we turn to closer consideration of the medical and educational work we meet with a difficulty. Medical and educational work, as we have already pointed out, often, if not generally, have a definitely evangelistic character, but each, nevertheless, appears to be designed to meet a special need of the Church and people. There is a strong tendency in thought, and often in speech, to emphasise this special need and to make it a distinct, separate need. Herein lies a danger. Medical missions are sometimes urged upon our attention as though they were founded to meet a medical need of the people, as if it were the recognised and accepted duty of missionary societies and of missionaries to supplant the native medical practice by western scientific methods as certainly and fully as it is their recognised and accepted duty to supplant native religion by the faith of Christ. But that we for our part emphatically deny. The one may be a philanthropic duty; the other certainly is a religious duty. Consequently we deny that there is a medical need which it is the duty of missionaries to supply in the sense in which we affirm that there is a religious need which it is the duty of missionaries to supply. Medical missions are, and ought to be, evangelistic in their aim, mere handmaids[1] of evangelism. Similarly we deny a separate and distinct educational need which it is the duty of missionary societies to supply. The missionary societies ought not to take upon themselves the supply of every need. We think the Christian Church is misled when it allows the medical need of a country to be presented as a distinct need which it is the duty of missionaries to meet, and when it allows the ignorance of a country to be presented as a distinct need which it is the duty of missionaries to meet. From such a presentation educational missions become detached, medical missions become detached, each designed to meet a distinct and separate need of the people.

[Footnote 1: If any reader experiences a revulsion at this expression, he will know at once what we mean when we say that a distinction has been drawn between evangelistic, medical, and educational missions as though they were three co-equal and separate things. They are not co-equal and they ought not to be separate. Education does not necessarily reveal Christ, medical science does not necessarily reveal Christ, only as education and medicine assist the revelation of Christ are they proper subjects for Christian missionary enterprise, that is, only when they are clearly and unmistakably subordinate to an evangelistic purpose. Of course we do not undervalue medical and educational efficiency: efficiency should increase evangelistic power.]

One result of the sharp distinction which is drawn between medical and educational and evangelistic work is that in some countries there are distinct medical and educational associations which collect information about the state of medical and educational missions in the country, dealing with these missionary activities most prominently, if not wholly, from the point of view of medical and educational efficiency. These associations issue questionnaires and publish reports often more full, detailed, and carefully compiled than any evangelistic reports. Consequently it is peculiarly dangerous for a layman unacquainted with the working of these associations to trespass upon their preserves. These departmental surveys should be treated separately by experts. Nevertheless, since we are dealing with the work of the station in its area, and this work includes often medical and educational work, we cannot pass over it with no more than the general treatment which we have hitherto given. We need to know what is the medical and what the educational work carried on at the station, when these are viewed, as they are viewed, separately, as distinct expressions of missionary zeal.

Dealing first with medical missions we suppose that the question might be put in this form, What are the medical missionary resources available in the district in relation to the need which it is proposed to meet?

Here again there arises the difficulty that there is no common agreement as to the purpose of the medical work of the missionary societies. What are the doctors there for? What does the hospital exist to do? Who can tell? So diverse are the ideas of different men on this subject, so little thought out, that a man of unusual experience told us that he had met few missionary doctors who could answer the question: "On the basis of what facts ought the question of the establishment of a hospital to be decided?" Few could tell him whether in sending doctors the missionary societies ought to consider the duty of caring for the health of their missionaries first or last. Few could tell him whether the care of the health of the children in schools and institutions was the first duty, or the last, or any duty at all, of the medical missionary. Yet obviously, those two points if they were once admitted would influence largely the location of doctors and hospitals. Again, we hear it argued that missionary societies ought to establish medical schools, hospitals, and institutions of the finest possible type in order to show how the thing really ought to be done, to demonstrate the very best example of western medical work, and to train natives to a western efficiency. That would not only influence the location of doctors and hospitals, it would also affect the character of the buildings and would demand a special type of medical missionary. Or again, we hear it argued that medical missions are the point of the missionary sword; but if it is the point of the sword then it ought to be in front of the blade. That, too, would direct the location of the doctors and hospitals. It would also affect the character of the building unless the missionary sword is to become an immovable object, which having once cleft a rock remains fast in the breach until a God-sent hero, like King Arthur, appears to pull it out and set it to work again. We cannot state all the different aims. They are not simple and formulated; they are complex and confused. Very often the establishment of a medical mission turns upon no more thorough examination of the facts of the situation than the conviction of a capable missionary that there is need for medical work in his district, and that he must supply it if he can, and that he must persevere in appeals till he can supply it. When a man asks: "On the basis of what facts ought this or that to be done in the mission field?" he has got a long way into the complexity of the problem, and the need for survey, if a society is to act with wisdom, is already apparent to him. But most men in the past have acted simply, without much argument: they said, "Here is a need; I can supply it," and the societies were the feeders of such men. Naturally. So one hospital and a doctor was the point of a sword which in twenty years' time was stuck fast in the rock; and then the hospital was enlarged and became a medical school under the fervent direction of a doctor who was a natural teacher; and then it became an institution, and then part of a college. And in all this there may have been no definite policy, any more than there was any definite policy in the guidance of its twin brother, which, instead of changing its character, remained what it had always been, the point of a sword, only buried in a rock, competing feebly with a Government institution. When one writes of mixed motives, and mixed policies, and mixed methods, it is natural to use mixed metaphors.

But to return to our point. It is not easy to say what some hospitals are there for. If we knew, we could at least formulate tables to set out the progress which they have made towards the object proposed. That would be reasonable survey as we have defined it. To collect all possible information concerning all the things which the doctor or hospital might do, or may be doing, unrelated to any end, is to collect a mass of information which we cannot use; and that we have declined to do. What course then can we pursue? We propose first to accept the notion that the medical mission is there to supply a medical need of the people, and to consider how far it does that; and then to look at the medical work at the station as definitely designed to assist the evangelisation of the people, as evangelistic in its purpose. We have, therefore, designed a double set of tables to serve these two purposes.

First, tables to show the medical work in relation to the presumed need of the district for western medicine.

Here, as before for evangelistic work, so now for medical, we have expressed the relation between the medical work and the district in terms both of area and population in order that each table may be a check upon the other. Thus:—

(i) In terms of area.

——————————————————————————————————
| |Number of| | | |
| |Qualified|Number of |Number of |Number of|Number of
| |Medicals.|Assistants.|Hospitals.| Nurses. |Dispens-
| | | | | |aries.
District.|Area.|————-|—————-|—————|————-|————-
| | M. | F. | M. | F. |For | For | M. | F. |
| | | | | |men |women| | |
————-|——-|——|——|——-|——-|——|——-|——|——|————-
| | | | | | | | | |
| | | | | | | | | |
| | | | | | | | | |
——————————————————————————————————
| | | | | | | | | |
_________|_____|____|____|_____|_____|____|_____|____|____|__________

(ii) In terms of population.

It will be observed that in this second table the items are not identical with those in the preceding table. In the place of hospitals we have beds; because in relation to the area the thing of importance is the number of the hospitals; but in relation to population the thing of importance is the number of beds available. Two hospitals in a single area are probably not in the same place and imply more widespread influence; but if each has twenty beds, in proportion to population it is of no importance whether the forty beds are in one place or two: forty in-patients fill the beds.

But in medical work, when we are considering the need of the district, another factor of importance often enters. The medicals of the mission are often not the only men meeting that need. There are often others, Government officials, or private practitioners, who, from the point of view of medical practice, are doing the same work. The medical need of a district where the missionary doctor is the only exponent of western medicine is not the same as that of the district where he is competing with Government or private doctors fully trained as he is. Consequently it is essential in order to understand the position that we should know what other, non-missionary, medical assistance is available, and we need the following table:—

——————————————————————————————————-
|Hospitals.|Qualified|Assistants.|Nurses.|Dispensaries.|Beds.
| |Practi- | | | |
tioners. | | | |
————|—————|————-|—————-|———-|——————-|—-
| | | | | |
Mission-| | | | | |
ary| ____ | ____ | ____ | ____ | ____ | ___
——————————————————————————————————
| | | | | |
Non- | | | | | |
Mission-| | | | | |
ary| ____ | ____ | ____ | ____ | ____ | ___
| | | | | |
——————————————————————————————————-

If any surveyor finds it difficult to fill in such a table, he must make an estimate, but he ought to realise that a table of the kind is a necessary part of any appeal for increased support; for support cannot be reasonably given to his work on the ground of this medical need unless these facts are known. Of course that does not mean that support ought to be given or withheld solely on the statistics so provided. There may be a thousand reasons for strengthening and enlarging work where this table would suggest less need; but no support should be given in ignorance of these facts.

Then we need tables to reveal, as far as such tables can reveal anything, the extent of the medical mission work done in the year.

——————————————————————————————————
District|Area|Popul-|Hospital |Dispensary,|Total|Propor- |Remarks
| |ation |Patients in|Patients in|Pat- |tion of |and
| | |Year |Year |ients|Patients |Conclu-
| | | | | |to Popul-|sions
| | | | | |ation |
——————————————————————————————————-
| | | | | | |
| | |M.|F.|Child|M.|F.|Child| | |
| | | | | | | | | | |
——————————————————————————————————-
| | | | | | | | | | |
________|____|______|__|__|_____|__|__|_____|_____|_________|________

Turning then from the medical need to be met, we proposed to inquire into the medical work as an evangelistic agency. This inquiry is hard to formulate; but we suggest that the three tables appended, taken in conjunction with the preceding, would throw certain light on this question, and would help towards a true understanding.

First, we inquire into the relative extent to which the medical workers make use of the assistance of evangelistic workers. This table would not reveal the evangelistic influence of the hospital. On the one hand, there is sometimes a tendency for the medical men and women to do medical work exclusively, and to leave all religious work to the evangelistic workers, and to give way to the temptation to imagine that if evangelistic workers read or preach in the waiting-room and visit the patients, the medicals can be satisfied that they have done their duty as medical missionaries. On the other hand, a medical who does his medical work in the Spirit, who speaks to and prays with his patients, exercises an evangelistic influence wider and deeper than that of many of the evangelistic workers directly so called, and in such a case the fact that the evangelistic workers are apparently lacking in the hospital does not at all show that the medical work is not a strong evangelistic force. But any danger of misguidance which might arise if this table stood alone must be counteracted by the other tables; for the three can be taken together. And when this allowance has been made the table is useful with the others, and lights one side of the question before us.

[Footnote 1: By "on staff" we mean regularly attached to, or regularly visiting.]

When we have seen the extent to which the medicals use the evangelistic workers in their institutions, we need to know the extent to which the medicals assist the evangelistic workers outside the institutions. We put this in the form of a table designed to reveal the extent to which the medicals assist in evangelistic tours, helping the evangelistic workers on tour, either by healing the sick on the spot, or by sending them to the hospitals, or by preaching, or in all these ways.

—————————————————————————————————- Number of |Number of |Number of |Number of |Number of |Remarks Evange- |Evangelistic|Medicals |Days spent by|Days spent|and listic |Workers |Assisting.|Evangelistic |by |Conclu- Tours. |Assisting. | |Workers. |Medicals. |sions. —————|——————|—————|——————-|—————|———- | | | | | | | | | | | | | | | —————————————————————————————————- | | | | | __________|____________|__________|_____________|__________|_______

Finally, we inquire how far the direct evangelistic influence of the hospitals and dispensaries can be traced. We might at first suppose that this could be done by asking the number of inquirers enrolled as a direct consequence of attendance at hospitals and dispensaries; but it is not surprising that patients are willing to enrol their names as inquirers simply to please the doctors or nurses, without any intention of pursuing the matter further when they leave the hospital; and consequently such a question by itself might be very misleading. We therefore add two further questions, the first, what number of communicants trace their conversion to their visits to hospitals or dispensaries, the second, what number of places have been opened to Christian teachers and preachers by the influence of doctors and patients. Some missionary doctors are much interested in this inquiry, and we all might well be interested in it. The answers would be a most important contribution to our study, and might go far to justify medical missions as an evangelistic agency.

+———————————————————————————-+——-+ Number of Inquirers Enrolled in the Year as a Direct | | Consequence of Attendance at Hospitals and Dispensaries.| | +———————————————————————————-+——-+ Proportion of Total Inquirers. | | +———————————————————————————-+——-+ Enrolled in the Year. | | +———————————————————————————-+——-+ Number of Communicants Derived from Attendance | | at Hospitals and Dispensaries in the Year. | | +———————————————————————————-+——-+ Proportion of Communicants Enrolled in the Year. | | +———————————————————————————-+——-+ Number of Places Opened to Christian Teachers through | | the Influence of Doctors or Patients in the Year. | | +———————————————————————————-+——-+ Proportion of Total Places Opened in the Year. | | +———————————————————————————-+——-+ Conclusions and Remarks. | | +———————————————————————————-+——-+