Boundaries in Medical Missions - How to Prevent Burnout and Stay Emotionally Healthy Spiritually

For the next few months, we are going to look at encouraging medical missionaries. We want to look at it from several different angles and get a real picture of what we can do to fortify those serving on the field – and we’re going to start with the development of God-honoring boundaries. We are excited to have a guest blogger today, Jim Ritchie. Jim served 25 years in the U.S. Navy and was emergency medicine residency director, deployed twice to busy combat support roles in Afghanistan. In Afghanistan, he developed an interest in combat medicine ethics and the psychological aspects of trauma relating to physicians working in difficult and under-resourced environments. He later taught widely on the subject. Upon retiring as a captain from the Navy in 2013, he became a medical missionary and moved to Chogoria Mission Hospital in rural Kenya, helping to start a family medicine residency with faculty from four mission agencies. He continued to encounter psychological trauma in cross-cultural medical missionary practice and was heavily involved with the growth of the hospital chaplaincy program, with whom he shared the theology of illness, healing, and death. In 2021, Jim and his family moved from Kenya to Virginia, where he now serves as VP of Partner Strategies with MedSend. We hope you enjoy reading some of Jim’s wisdom today!

Boundaries Help Prevent Burnout

Burnout is epidemic in the healthcare professions in the West, in part due to a work ethic that prioritizes the needs of the patients and places great responsibility for outcomes on the medical team.  When members of the medical team go to the developing world, we encounter far greater need, far fewer medical workers, and far less control regarding outcomes.  Burnout seems inevitable. 

But when we embrace our God-given limitations and develop God-honoring boundaries, we can serve for full careers – staying healthy and with emotionally healthy families.

Mistaken expectations

We Christians can confuse ourselves by misunderstanding Scripture.  Some verses may seem to imply endless physical endurance: “They shall run, and not be weary.  They shall walk and not faint.” (Isaiah 40:31) or “I can do all things through Christ who strengthens me.”  (Philippians 4:13) But these verses are poetic metaphor and principle regarding hope in God and contentment, not a promise to be able to work without sleep.

Instead, God gave us limitations.  We must sleep.  We must take time to build and maintain relationships.  We are not in control of life and death.  We are not omnipotent.  Ignoring our God-given limitations can be sinful.  Embracing our God-given limitations can be worshipful.

Even Jesus, in His earthly life, embraced His limitations.  At times, Jesus sent the crowds away!  Sure, He worked hard, sometimes even through the night.  But at times, He stopped healing and went away, despite the disappointment of crowds of people.  And unless we think we are “Super Jesus,” able to work when He could not, we should do likewise.

A swamp has no borders and no destination.  No boundaries.  The swamp is stagnant and breeds disease.  A river has banks and a destination, and it is powerful and life-giving.  The river has boundaries. 

Setting Boundaries 

Sometimes we can be hesitant to adopt boundaries, thinking that we are distancing ourselves from our calling. But healthy boundaries aren’t like a huge, imposing stone wall with razor wire on top, keeping us away from the people we’re called to serve.  Also, healthy boundaries aren’t like a line in the sand, able to be crossed with no effort.  Instead, healthy boundaries are like a substantial green hedge with a gate.  And you are in control of the gate.  At times, the gate is open, and we are in full contact with other people.  And at times, we close the gate to rest, prepare, build relationships, and work on other responsibilities. 

In establishing healthy boundaries, it’s important to identify the driving idea.  Is your life dictated by the work that needs to be done and by others’ expectations of you?  If so, the overwhelming needs and unrealistic expectations will strongly tend to drive you to overwork and burnout.  Or, instead, is your life guided by a recognition of your God-given limitations and assurance of God’s love?  If so, you can establish your own guidelines for healthy living and working.  Make yourself available for work and social activities within those guidelines.

What are some reasonable boundaries for healthcare missionaries?  Most healthy boundaries reflect a sound theology of human limitations, which are then translated into specific practices.

Healthy Boundaries

One healthy boundary is a reasonable workweek.   

We have many responsibilities as healthcare missionaries: patient care, teaching, communicating with supporters, mission agency communication and admin, growing in relationship with our spouse and children (when applicable, of course) and with friends, growing in relationship with God, learning language and culture, resting for sustainability, building community, participating in special ministries, meeting licensure and immigrations requirements, and many more.  If we allow patient care to dominate our lives, we try to cram our many other responsibilities into remaining time and wind up with spiritual and relational anemia and failed duties.  Instead, we can decide to structure our weeks for fruitful medical practice and healthy lives. 

One pattern that has proven to be sustainable in several locations is a five-day workweek, with four clinical days and one day for other professional responsibilities mentioned above.  Allocate one day for community building or other ministries and one day for Sabbath.  This pattern may seem odd to Western healthcare missionaries, but, when adopted by the whole team, it has proven to be restorative and sustainable while providing healthy, vibrant missionaries on the field.

Another healthy boundary is a limited queue of patients. 

An unlimited queue of patients has become traditional in some settings.  But this pattern can lead to frustration, not only with the medical staff but also with patients.  Establishing limitations for the numbers of patients to be seen in a day is a simple acknowledgement of personal limitations and of other legitimate responsibilities. 

A friend in a surgical specialty found herself in a hospital with a tradition of unlimited clinic queues, and she suffered through that paradigm for a time, along with the tired clinic staff.  But then she required a limitation of 30 patients per clinic and assigned a nurse to be the “gatekeeper.”  There was some initial pushback, but shortly this pattern became normal in the eyes of the staff and there was a new enthusiasm for caring for the patients.  This sort of limitation usually should be associated with a triage plan, so the neediest patients are included in the numbers to be seen. 

The same idea can be put in place for ward rounds, limiting the time available.  It may not be possible to see every patient every day, and a stratagem for prioritizing the patients who are seen must be established.  But this boundary has proven to be life-renewing for many healthcare missionaries. 

The same idea can be put in place for meetings, regarding duration, number, attendance, and time of day.  Do you want to see life return to a tired missionary’s eyes?  Cancel a meeting!

Boundaries need boundaries. 

Boundaries can divide teams if some members insist on boundaries and other members resist them.  This can produce resentment and accusation and guilt.  This is lamentable, especially because God loves unity in His people.  The Bible emphasizes the need for unity, and our witness to our community can be closely tied to our team relations.  It’s very important to consider boundaries as a team dynamic.  As often as possible, the boundaries should be agreed-upon by the entire team, especially the leadership.  This promotes unity and a bearing -up of each other's burdens.

We have seen individual missionaries adopt so many boundaries that they do not integrate with their communities and do not become valued by the hospital leadership.  Even boundaries need boundaries. 

The development of God-honoring boundaries is a critical skill for healthcare missionaries.  Such boundaries honor our God-given limitations, honor our many responsibilities, and honor our important personal relationships. 

May God guide you in honoring Him in this way.