When I arrived in Ethiopia in 1966, I found the OR table was an old metal examination table with only three legs the OR light hung on a rusting coat hanger from a sagging ceiling the sterilizer blew up during my third month...my mentor doctor with whom I had hoped to work with for five years left after just six weeks... the hospital was in debt the first five patients had all been bitten by wild animals..gourds hung on the walls were filled with goats' blood, witch- doctor-recommended for speedy recovery... a donkey with four kerosene tins secured water for the hospital from five springs in a nearby valley.

Thirty-two years later there are more than 700 churches among a tribe of about 5 million people ... they have sent out 120 missionaries to other tribal groups in Ethiopia. The president of the leading seminary in the country was one of my patients. The current CMO and Chief of Surgery of the hospital was a student among 490 others who were trained in evangelism and as nurse practitioners to work in their own communities. During the revolution many patients came to them even when there were no medicines just to have them pray and lay hands on them.

When you obey Him, He will do great things beyond what you could imagine.

Perhaps God planned for you to reach a tribe' and language group with the gospel through the gifts he gave you. But,instead you used them for yourself. Now over 100,000 people will be forever lost in the fires of hell.

Love always means sacrifice. Sacrifice always means death. 90% of the Christians in Cambodia lost their lives in the most recent upheavals there. It is estimated that today 17 believers will die as martyrs for the sake of Christ somewhere in the world. Death means death to selfishness. Death means conforming to Christ's image. My father's favourite verse was 'Except a grain of wheat fall into the ground and die it abides alone'.

In the book Of God and Men A W Tozer says 'We languish for men who feel themselves expendable in the warfare of the soul, who cannot be frightened by the threats of death because they have already died to the allurements of the world. Such men will be free from the compulsions that control weaker men. They will not be forced to do things by the squeeze of circumstances; their only compulsion will come from within - or from above.'

When God called me back to Africa more than ten years ago for ten more years of overseas service, I had ten good reasons for staying in my comfortable surgical practice in the USA.

1. 'Think of how much I could give if I stayed' I said. But God said ' I own the cattle on a thousand hills. You cannot have two masters.'
2. I said 'It is cruel to make my wife move.' But God said 'All these things shall be added unto you'.
3. I said ' But our home is so nice.' But God said ' There are many homes up here. I am your inheritance.'
4. I said 'Think of all the internationals in the USA'. But God said 'I am sending you'.
5. I asked ' How can I live in a communist country ? 'But God said 'I will go with you.'
6. Then I said ' No one will go with me because of AIDS, starvation, political unrest, persecution and suffering.'But God said 'There are windows in heaven'.
7. I said ' How can I find a suitable doctor to take over my practice? 'Guess what? God showed me the perfect person for the job within two weeks.
8. But I said ' What is wrong with where I am?' To which He replied 'This is your new assignment'.
9. But I said ' I don't want to beg instead of give'. God said 'I am your great reward. Is my hand short that it cannot save?'
10. I said 'I'm 55 going on 65. You need someone young and strong, without physical limitations.' But God said' I will do a new thing. Be strong and of a good courage. Fear not, nor be afraid of them. For the Lord thy God, He it is that doth go with thee. He will not fail thee nor forsake thee.'

IS IT SO BAD THAT:

• Your children may become missionaries? In God's mercy He blessed us with having both our children return to missionary service in Africa.
• You can have almost all three meals with your family every day? - even if you are the only mission doctor for a 105 bed hospital
• You can have your wife and children actively participate in the ministry as a family? Our daughter started making Sunday rounds on non-infectious cases when she was seven. She worked as a circulating nurse at the age of ten..Our son was fixing the evangelist's gospel recorders at the age of ten. By the time he was 14 he was overseeing hospital maintenance.
• Your children must attend home school? - where the Bible, memorisation, dedication to Christ, prayer, and The Ten Commandments can be joyfully followed
• Your family must enjoy wonderful exotic vacations together? - in Africa, Europe or the US because you have nine months off night call every three years

What are the trends in medical mission today ?

• The sad disappearance of the career medical missionary - only 20% of doctors who have felt the call of God to go as missionary doctors still have that interest when their training is completed and their debts paid off.
• The shortening of the medical missionary career - from the former 30-40 years to less than four years. In some ways the short term service and short teams have killed long term service . . . One survey found that of a hundred feeling the definite call of God to missions, only 12 completed training for this calling, only two actually went and one stayed.
• The actual closure of mission hospitals - because of their expense, the lack of key medical staff, the difficulties in running a mission hospital, and sometimes a lack of vision from mission leadership. At a time when there were 12,000 Americans earning good oil money in a certain near-east country, six medical personnel could not be found for a hospital mission that had worked there for 40 years. The mission hospital was closed despite the pleading of the government to keep it open.
• Even though the need for the mission hospital is actually greater now than ever before..it is sometimes proposed that this is not so. In Africa only one in twenty women needing a C-section for obstructed labour can get their operation. Only 15% of patients with hernias in Africa get the operation they need for their lifetime, even if their hernia is strangulated.When you think of the government hospital in a poor country giving their patients a list of items such as gloves, syringes, needles, medicines, and intravenous supplies to pick up from a local pharmacy, you know that the need for mission hospitals is not in the past.
• Because of medical missions, Nepal has over half a million Christians today. 80% of the Christians in India relate their conversion to a mission hospital experience. If you describe a circle with a 50 mile radius around each of the 272 mission hospitals in China, you find that these are the area of revival today. As much as 90% of the medical needs of some countries are met by mission hospitals.
• With the start of the Pan-African College of Christian Surgeons two years ago for the training of African Christian doctors in mission hospitals in Africa, the need for training personnel is even greater than before.
• The acceptance of certain myths of theology such as 'the lost are really lost.' This myth ignores the Luke 16 story told by Jesus, Himself, where the tormented of Hell are pleading for someone to tell their friends about the good news so that they can avoid the same eternal fate.
• Loving and compassionate in-hospital care coupled with the spread of the gospel is still the domain of the mission hospital where the 'Jesus video' can be shown to a thousand people every day. A W Tozer said 'We see the world not as a battleground, but as a playground. We are not here to fight; we are here to frolic.We are not in a foreign land, we are at home. We are not getting ready to live; we are already living. We don't realise that we are in a life and death struggle!'

Harold Adolph MD is an American surgeon who has worked overseas for 27 years. In retirement he and his wife travel the USA speaking and recruiting surgeons for world mission.