Statement 5: Obey the rules

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I apologize for the delay in postings. Our family has made a big move of faith from Guatemala to rural Buies Creek, NC. I am working with Campbell University to develop a dept of medical missions and global health. Stay tuned.

Today we’ll take up again our journey through the 12 statements we have accumulated over the years and which Dr Peter Yorgin has put into its present form. We are all for building on these statements over time. Today we make the case for “Obeying the rules.”

We will obey all of the host country rules and laws, to the glory of God.

    • Obtaining permission to practice medicine (diagnose and treat illnesses of the body and mind)
    • No bribery –
    • No sneaking health materials into the country
    • Obtain malpractice insurance

In His word God makes it clear we are to obey the governing authorities. We would do well to recall what the situation was like in Paul’s time when he wrote the book of Roman’s under the inspiration of the Holy Spirit:

Let every person be subject to the governing authorities. For there is no authority except from God, and those that exist have been instituted by God. Roman’s 13:1

In my 11 years of serving in Guatemala I saw very few STMM groups whose healthcare professionals had obtained the necessary credentials to legally practice medicine in that country even though it was a fairly easy and straightforward process. To those who did take the necessary measures to be legal I applaud you. This is most easily done with an in country partner with whom you have developed a true partnership for the long term.

Further scriptural support of this mandate can be found in I Peter 2: 13 and following:

Be subject for the Lord’s sake to every human institution, whether it be to the emperor as supreme, or to governors as sent by him to punish those who do evil and to praise those who do good. For this is the will of God, that by doing good you should put to silence the ignorance of foolish people. Live as people who are free, not using your freedom as a cover-up for evil, but living as servants of God. Honor everyone. Love the brotherhood. Fear God. Honor the emperor.

We would confirm that this applies in cases where conforming to the governing authorities does not require us to act in contradiction to biblical principles.

One of the most significant roadblocks to “development” in not yet developed countries is corruption and what this does to the ability to develop trust and accountability not only between the public and the government but between outside agencies and local partners. We believe that bribery is unacceptable in any form for those involved in doing STMM’s. See this Best Practice article on bribery. One response you may hear is that “This is just the way things are done here, it’s part of the culture.” You may even be accused of trying to impose “western standards” on local partners. But these are not just western standards they are biblical standards which we can discover with careful exploration of God’s word together with our local partners.

I would like to believe that the majority of those doing STMM’s are aware that there are standards and guidelines for the use of medications in the field. I recall many groups trying to get through the airport with hockey bags stuffed full of medications collected and packaged (some not even packaged) to hand out during a week of clinic in some distant village. Many of these medications were near to or had passed their date of expiration and according to the law were not to be imported let alone given to patients in any setting. Yet these well meaning and zealous-to-do-good folks ignored these legal and ethical dilemma’s by simply ignoring them. There is a Best Practice paper which deals very nicely with this topic. Also it is fairly routine that groups will attempt to smuggle medical equipment of various kinds (maybe not CT scanners or X-ray machines) which if brought in by normal means would require the payment of a tax of some sort. I heard of one group bringing 500 pairs of glasses to Guatemala who were discovered and were required to pay a $2/pair tax! This can be avoided, usually, by again having a strong/long term partnership developed with a local ministry which can help avoid these problems.

Our final point would be that all who practice medicine in another country should obtain malpractice insurance.

Statement #5: Obey the rules

After an all too long break we are again starting up our Zeal With Knowledge blog post. Our family just made a change in location from Guatemala to a location just south of Raleigh/Durham, NC where I (mike) am working to develop a dept of medical missions and global health at a soon to open medical school at Campbell U. Stay tuned.

Today we turn out attention to statement # 5. Obey the rules with the following points:

We will obey all of the host country rules and laws, to the glory of God. (as long as it does not compromise our Christian witness)

  • Obtaining permission to practice
  • No bribery
  • No sneaking health materials into the country
  • Obtain malpractice insurance

The first of our points is clearly a biblical principle based on Romans 13:1-

1 Let every person be subject to the governing authorities. For there is no authority except from God, and those that exist have been instituted by God. Therefore whoever resists the authorities resists what God has appointed, and those who resist will incur judgment.

As painful as this may be to think about, considering the high levels of corruption in many places in greatest need, it is not a biblical mandate that we can just ignore. We would do well to remind ourselves of the situation Paul was living in when he wrote this letter. The Roman government of the time was not a model of democracy and equal rights and was going to become much more aggressive in its persecution of the followers of the “Way,” I have to wonder if this could be one factor for which we (resource rich folks who have a zeal to do good) we have not had a greater affect on bettering the health of those in underdeveloped countries. During my 11 years serving in Guatemala I almost never encountered visiting STMM’s team whose healthcare professionals had acquired permission to examine and treat ill people in clinics. There are some who visit and play by the rules but I heard of very few who did so. And the process is quite easy and can be managed by the local partner with whom one has developed a long term strategic partnership. Nearly all nations have standards by which they function regarding who will be given permission to practice medicine within their boarders. All who engage in STMM’s in other countries should obtain the necessary permission and follow the rules of the law.

Secondly we can see no good reason to tolerate bribery as a part of our Christian healthcare ministry outreach. This topic is dealt with very nicely in this “Best Practice paper. Some may claim that bribery is just a normal part of how things get done and that it’s just part of the culture. And you may even hear that we (westerners) shouldn’t try to impose our beliefs and values on other cultures. But bribery is not consistent with the honesty and accountability mandated by God’s word. When we hear these arguments our approach should be to point out that these are not “western” values but biblical values and then together with our local partners we can see by an examination of scriptures that it is not to be tolerated in our Christian efforts to bring health and healing to hurting people.

The third point today is that we should not be taking with us into other countries materials which are illegal. This included nearly or already expired medications. This is discussed in these Best Practices papers. Expired meds, Experimental meds, and Medication use. On top of the discussions related to medications we would also do well not to attempt to take into another country any equipment which may legally be subject to an importation tax. Again this goes back to our argument related to conforming to the rules of law which apply to each particular country. One group tried to important 500 pairs of used glasses into Guatemala and were found out and asked to pay a $2/pair import tax! If this group had done its due diligence with a local partner regarding the importation of such items this could have been avoided.

Finally we highly recommend obtaining malpratice insurance for work done in another country. Dr Peter Yorgin addresses this issue in this Best Practice paper.