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Missionary malpractice in Uganda? A reflection on ‘good intentions’

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In the routine stories of humanitarian activism gone wrong, we find ready reminders of the limits of good intentions. In each case—whether among governments or non-profits and religious institutions—we see how a heartfelt motivation to “do good” can easily serve as a blind spot on hearts and minds.

One of the latest examples involves Renee Bach, an American missionary who, at age 20, moved to Uganda and soon started a charity for malnourished children. Now, Bach is under fire for allegedly providing medical care under false premises and hurting children in the process.

What Bach had originally founded as a local hub for free hot meals soon evolved into a clinic of sorts. Bach herself referred to the center as a “hospital,” serving children with a range of complex conditions, from pneumonia to tuberculosis to stage 4 HIV. According to former volunteers at the center, Bach was performing blood transfusions, inserting IVs, and giving medical advice to patients with problems that went well beyond basic malnutrition.

One problem: Bach was a young, high-school graduate without medical training, and, for at least the first two years, the center did not employ any doctors.

According to NPR’s Nurith Aizenman, in its first five years, the center took in 940 “severely malnourished children” and 105 of them died, leading two Ugandan mothers to file a civil lawsuit against Bach, claiming she is responsible for the deaths of their children. Bach now claims the two children mentioned in the claim were never served under her care. Regardless, the suit has led to increased local resentment against Bach, now making it unsafe for her to live in Uganda. “I get death threats all the time,” Bach says.

The case is still being decided, and arguments for and against Bach’s charity continue to pop up across the web. Some have pointed out that the child mortality rate in Uganda is high to begin with, and Bach likely did little to help (or hurt) cases that were somewhat doomed from the start. Others, such as UNICEF’s Saul Guerrero, note that a 10-20% in-patient mortality rate is unusually high, even in Uganda. Further, he says, “malnourished children with extra complications are so fragile that unless a health provider knows exactly what he or she is doing, it’s actually safer to do nothing.”

As for Bach, she believes she was simply making the best of a difficult situation—providing access to food and nutrition to those who couldn’t find help elsewhere. “It wasn’t ideal,” she says. “But what do you do in a non-ideal situation?” According to Aizenman, however, several Ugandan pediatricians and global healthcare experts beg to differ, arguing that there are plenty of accessible and properly licensed clinics in the region. See here for more details of the case, as well as statements from the opposing lawyers.

But even amid the many concerns that have been raised outside of the civil lawsuit, which seem to have plenty of merit, it’s hard to not sympathize with Bach. It seems quite clear that she stayed in Uganda and founded the charity out of genuine concern and compassion for those in need. Surrounded by tragedy, she was trying to help, and probably did help many people.

But alas, as with other tales in this genre, the question still remains: How and why do these “good intentions” sometimes manifest in such reactionary and reckless action? And why do participants in such action often find it so hard to reconsider their strategy, given the results?

Aizenman points first to the cultural factor, namely, the increasing allure of Western volunteerism and the subtle self-gratification of White Messiah-ism. There’s now a magnetic draw to these things, and it’s not an environment that invites a lot of serious study, self-critique, or long-term reflection:

It helps to know that the place where Bach set up her operation — the city of Jinja — had already become a hub of American volunteerism by the time she arrived.

A sprawling city of tens of thousands of people on the shores of Lake Victoria, Jinja is surrounded by rural villages of considerable poverty. U.S. missionaries had set up a host of charities there. And soon American teens raised in mostly evangelical churches were streaming in to volunteer at them. Bach was one of these teens.

…”The American cultural narrative is that these countries are basket cases,” says Georgetown University’s Lawrence Gostin. “People think that they’re doing good. And they have no idea how much harm they can cause.”

That cultural narrative certainly doesn’t help, and it’s far too often reinforced by government policy and the hubris of economic planners, as outlined in Acton’s Poverty Cure series.

But perhaps what’s most notable, at least for Christians, is the role that divine calling seems to have played in Bach’s initial decision:

In an interview with NPR, Bach says it felt like a calling from God. “It was a very, very profound feeling and experience. It’s kind of hard to even describe in words,” she says. “Like there was something that I was supposed to do.”

At first Bach wasn’t sure what that was, beyond a sense that it should address some need that wasn’t already being met by existing charities….Bach says seeing a child in this state — impossibly thin arms, ribs poking out, sunken eyes — “was almost an out-of-body experience. And a sense of, ‘Oh my goodness, this isn’t right. This needs to stop.’ ”

She says she agreed to help the children. And before long she came to feel that this was God’s plan for her: turn the house into a center where malnourished children and their mothers could live while the youngsters recuperated — complete with free rations of the special foods they would need, the medicines doctors had prescribed and lessons for the mothers on nutrition … and the Bible.

Many will be quick to ridicule such a story, mocking Bach for giving way to petty sentimentalism in the guise of “a calling from God.” Yet it’s actually a strong example of how vocational clarity ought to work—at least, at the beginning: Bach noticed real human needs, recognized how she might match her personal gifts to meet those needs, sacrificed her own comfort for others, and proceeded to seek the voice of God to confirm the path.

More of us should begin with such a process, whether it leads us to become a missionary, start a business, work in a mundane 9-to-5, or become a stay-at-home parent. Unfortunately, this is where the “divine” part ends for many Christians.

We tend to take God’s message (the “what”) and proceed to ignore or distort His methods (the “how”). Then, when the negative results begin to roll in, we quickly fall back on that initial call—”but I was called,” “but there was a need”—failing to take responsibility for the real-world implications and whatever signals we’ve been heeding in the meantime.

In such cases, we should be keen to reflect more carefully on our decisions and discernment with humility, not necessarily calling it all “phony” or feeling excessive shame and guilt, but simply asking how we might better marry our faith and spiritual life with reason and the practical constraints of the world in which we live. Without continuous humility and self-denial—from beginning to the end—vocation simply isn’t vocation.

The way of the Christ follower is surely one of altruism, beginning (yes) with “good intentions.” But only when our love for others is rooted in active, humble, and ever-growing daily discernment—both with the Holy Spirit and an understanding of human relationships and human systems—can we hope to transcend the risks of our own impulses and designs.

Only when our love is pursued and enacted according to ways that are higher than our own ways, can we expect ends that are higher than our ends.

Image: Jinga, Uganda streetview (CC BY-SA 3.0)

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Joseph Sunde is an associate editor and writer for the Acton Institute. His work has appeared in venues such as The Federalist, First Things, The Christian Post, The Stream, Intellectual Takeout, Foundation for Economic Education, Patheos, LifeSiteNews, The City, Charisma News, The Green Room, Juicy Ecumenism, Ethika Politika, Made to Flourish, and the Center for Faith and Work. Joseph resides in Minneapolis, Minnesota with his wife and four children.

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