Keeping Faith in Faith-Based Organizations: A Practical Theology of Salvation Army Health Ministry

Foreword

If Dean Pallant’s book was only useful for Salvation Army leaders, it would still be a bold work, drawing on carefully documented global investigation in that remarkably wide array of institutions that are the fruit of radical movement born in London in 1865, now planted in 124 nations. This is far more—and far more relevant—than an inside discussion intelligible only to those comfortable with the nuances of Salvationist discourse. Pallant’s work is useful precisely because of its particularity, modeling for those in positions of influence of any faith-based organization a high order of reflection on practice using all the tools of mature reflection including theology inside and outside his own tradition, insights of social and medical scientists and a rich store of carefully observed work in the field. Finally, Pallant delivers the final stage of reflection—plainly written recommendations that can be acted on.

This book joins a still small but growing literature that many are surprised to find is still necessary in the twenty-first century, long past the time when social scientists expected religion and its institutions to be relevant for anyone other than historians to understand. But it turns out that religion matters because of its tools of theological reflection, its practices of institutional adaptation to hundreds of particular contexts, its capacity for moving coherently at global scale as an agent of change, its way of creating social spaces in which humans worship, think, care, and act as social bodies. Faith is of practical value when it is practiced and reflected on with integrity, as this book models.

Most would be satisfied with something less ambitious; perfectly happy with a handbook or catalog of best practices which are popular among those in a hurry to do good, raise money, or make problems go away. Pallant displays an inconvenient integrity that takes the whole religious phenomena seriously, including its theological and institutional roots. There is still a lot of hubris among the bio-medical elite, who believe too much in the efficacy of their pills and treatments designed to beat back death or disease. Pallant skips over the question of whether faith institutions can do useful things in the context of healthcare. In recent years it has been more common for governmental organizations at all levels to seek to plug in religious networks and institutions into their plans for responding to vast crises such as HIV/AIDS and a panoply of conditions ranging from suicide, hand-washing, immunizations, and obesity. It remains surprisingly common to hear of a researcher discovering that faith organizations are relevant to this or that community condition.

The Salvation Army has no need to argue for that with its many decades of living on the toughest streets in the world. The question Pallant wants us to struggle with is deceptively radical, shifting from a focus on disease to healthy people. By the way, what is a healthy person? Who is best qualified to engage the question, much less build a field of practice on the answer? It may be possible to develop best practices to immunize populations without knowing a great deal about their rich complexity and diversity. Recent decades of public health experience suggest that even the most straightforward technical interventions fail because it turns out that people and their many-faceted social relationships are not made up of autonomous rational decision-makers responding to simply economic motivations. Religions knew about healthy people long before medical sciences developed the technical means to accelerate physical health at large scale. Pallant models the fact that religious language and patterns of thought are better for talking about healthy humans than biomedical technologists, not because faith institutions are better run, but because they begin with a more complex idea of what a human is, how we are together—and what we can become.

Pallant goes boldly where nobody really wants to go, toward congregations as agents of health, healing and, of course, salvation in its richest, most vital sense. Anyone who has ever tried to lead, or even attend a real congregation for more than a month or two would wish that science would have a pill to immunize us from having to enter into their radically unpredictable realities. Everything bad or frustrating about them is true. Libraries are filled with texts about the problematic nature of congregations. But if we did not already have hundreds of thousands of the peculiar social entities that are endemic to communities all over the globe, we would have to invent them to fulfill the promise of healthy people. The move toward congregations honors the confluence of science that needs relationships in order to work. Pallant sets out a list: addictions, diabetes, disabilities, end-of-life care, eyes, HIV/AIDS, hypertension, infectious diseases, leprosy, maternal and child health, mental illness and nutrition. He will not let us have the instrumental power of faith-based organizations without paying attention to the movement that created them and continues to drive them into the future. Faith based movements are rooted in the places where faith is formed, nurtured and reimagined again and again—congregations.¹ Of course, congregations can be instrumentalized just as larger institutions are. But Pallant does not dumb them down into being tools of others’ strategies; rather they are relevant because they are alive to and generative of faith experience in the social body.

Faith-based organizations are the last thing from static—they are themselves a form of life. And they are more; they derive from religious movements that are nurtured with the ancient constantly new social tools of worship, ritual, songs, poems, scripture, and a constant flow of wisdom literature. The faith part of faith-based organizations is constantly renewed, not safely left in the past. The faith part will be the future, or the movement will disappear as mist in the sun (an image common in the scripture of the Jewish people). Thus the reflection of the role of faith-based health organizations leads inexorably toward the congregation, the discipline of thought called ecclesiology. What is the form and practice of faith operating at the base of faith? What science, techniques and practices relevant to health people should we hope to make normative there? Clarity about healthy people in relationship to each other and God lets us then imagine the more instrumental institutions we think of as higher: hospitals, clinics and the panoply of community health programs. Begin with an image of healthy people in healthy relationships; then imagine a movement of people carried forward on the Spirit of God to build the instruments God would hope for.

The Salvation Army has a particularly bold history on which to reflect—never fearing to be thought too odd or radical. Every faith is useful for imaging the future in a time when science offers us such extraordinarily useful tools. It is helpful to remember that every religion has been a movement bold in its place and times. Most can again move if they draw on their own deep wells of hope and then engage the offerings of science and government as partners to be engaged from strength.

We are in a hurry these days to hammer our best practices together, scale them up to national and global programs. Pallant suggests there is nothing quite so useful as a movement with the capacity to reflect clearly on its practices and then move in radical faith as far as God illuminates.

May it be.

Gary Gunderson

Memphis, Tennessee, USA

²

Preface

The Salvation Army will soon celebrate its 150th anniversary. Serving in 124 countries, it enjoys the affirmation of those its serves and those it partners with, whether churches, NGOs or governments. While we are grateful, we must always guard against pride, inflexibility, or a relevance that is veiled compromise.

As long as we have Salvation Army officers like Major Dean Pallant, we need not fear. His loyalty does not muzzle him from an honest assessment of how and why and when we did not keep faith with our theological roots and gospel motivation. But he is a realistic optimist. His own personal faith, study, and experience qualify him as one who deserves to be heard. He envisions a flexible, agile, ambitious Salvation Army movement, part of the wider Christian church, modeling a relevant, faithful, twenty-first century tension-building engagement in difficult situations resulting in an improvement in the health of the poorest people.

There is no sense of moaning about past failure or resting on our laurels or even presently committing to service that is mediocre at best. He speaks of a twenty-first century ministry of excellence and he calls The Salvation Army to a credible engagement with a view to making a difference. That difference will be the fruit of the work of effective, efficient, and resilient people who are clear on the raison d’etre of their movement. They understand that God in Jesus Christ offered a full salvation for the whole person, a relational salvation that effects change within a family, society, and even a nation. Transformation therefore need not be a pipe dream. Wholeness is the goal. When a Faith-Based Organization ministers out of a sound and practical theology, it is not only amazingly effective but it is blessed by God.

Though I have been challenged and encouraged by Dean’s fresh approach, I would hasten to add that this book is not a word in season for The Salvation Army alone. It is timely for any Faith-Based Organization. The time has come for us to stand because of our faith in order to serve with compassion and grace.

General Linda Bond

International Leader of The Salvation Army, London

Introduction

I have been privileged beyond measure in the past four years and this book is an attempt to share some of my many blessings with a wider audience. Two major events occurred in my life that changed my perspectives on many issues. First, my wife and I were appointed by The Salvation Army to review their health ministry around the world and develop an international vision and strategy. I have visited more than 40 countries in 4 years—what a privilege!

As we took up this appointment, I was studying for a doctorate in theology and ministry at King’s College London. Under the guidance of a brilliant and supportive supervisor, Dr Luke Bretherton, I was able to combine my Salvation Army research task with my doctoral thesis. This book is the fruit of these two tasks.

My perspective on the health of the poorest people has changed in the past four years. I have visited numerous slums, many overcrowded cities and scores of isolated rural villages. From the hundreds, if not thousands, of people I have met on my travels, one child stands out in my memory. It was a hot, dusty afternoon in Kolkatta—the massive Indian city once called Calcutta. Unusually, I had a couple of hours free. I left the relative tranquility of my hostel and walked down a crowded, busy street to buy a bottle of water. Immediately, a very young boy, less than five years old, ran alongside me as I picked my way through the crowds. He shouted Sweets, sweets! I walked on. I had no sweets on me. As I bought my bottle of water from a street trader, I noticed he was also selling sweets. I bought a handful. As I returned down the pavement the boy appeared again. Sweets? he cried. He touched my hand and I was struck by the softness of the skin. I put my hands into my pocket and, like a wild animal, he lunged, grabbed them and ran off. I was stunned. A child with such soft hands had already developed the skills and agility of a feral beast.

I should not have been surprised. The boy has probably lived on those tough streets since his birth. He developed the skills of survival. He had no choice. I never saw him again. Is he still alive?

He sticks in my memory and represents billions of people referenced in this academic work. I hope that in the midst of all the complex theory, detailed references and elaborate debate, the lives of individual people—such as the ‘sweet’ little boy in Kolkatta—will not be lost. These are real people, their plight is dire and the memory of that boy’s soft skin coupled with cat-like reflexes motivates me when I feel weary.

This book unashamedly promotes a faith-inspired vision of a better world. Despite the billions of dollars spent on improving the health of the poorest people, the evidence of improvement is patchy and unsustainable in the face of economic turbulence. New approaches are desperately needed—the old approaches are too costly, overly bureaucratic and ineffective. The resources of faith must be brought to the task. This book describes a way this can happen and uses current Salvation Army situations to show how.

I hope readers find it has application well beyond The Salvation Army. This is a tradition-specific piece of practical theology. It has to be. That was my task. However, the methodology and literature referenced in this book have application for other faith-based groups—hence the title, Keeping Faith In Faith-Based Organizations. The task is too big for The Salvation Army alone. All people of faith are needed, as are their faith resources.

I acknowledge all the encouragement, insights, and advice from many friends, colleagues and family in the writing of this book. First, I acknowledge my friend, fellow Salvationist, and practical theologian Dr Helen Cameron. Helen has been a consistent encouragement and I could not have completed this book—and the doctorate in theology resourcing my research—without Helen’s mentorship. Dr Brian Brock and Dr Stephen Plant examined my doctoral thesis. I acknowledge with sincere thanks their in-depth analysis and recommendations for improvement. I have included a number of their insights in this book.

Many unnamed but perceptive people around the world helped me appreciate the complexity and potential of Salvation Army health ministry. I am deeply grateful for each one. Two Salvation Army officers require special acknowledgement for their long-term contribution to my personal development. Commissioner (Dr) Paul du Plessis and Commissioner John Swinfen have shared many significant conversations with me over a period of more than 20 years. These two wise, gifted, and experienced Salvation Army leaders have given lifetimes of service in developing world countries. I am particularly grateful they were willing to comment on a draft of this book. I will continue to be grateful for their friendship and wisdom.

I acknowledge, with sincere thanks, the significant support provided by The Salvation Army for my doctoral studies and the completion of this book. I also thank my aunt, Alison Brown, a professional indexer, for her gift of this book’s index.

Finally, my wife Eirwen, and children, Laurence and Rachel, deserve special acknowledgment for their patience, support, and love throughout the hectic, crazy past few years. I love you all very much.

Dean Pallant

London, New Year’s Day, 2012

1. I have written about the strengths of congregations that pertain to the health of communities in my book Deeply Woven Roots (Fortress Press,

1997

).

2. Rev Dr Gary Gunderson is Director for the Interfaith Health Program, Rollins School of Public Health, Emory University, Atlanta and Senior Vice President of Health and Welfare Ministries for Methodist Healthcare, USA.

1

Identifying the Issues

Faith–Based Organizations (FBOs) are receiving attention in the global quest for better health for the world’s poorest people. Governments are increasingly partnering with FBOs to achieve domestic and foreign policy objectives. There is appreciation of the high levels of trust many of the poorest people have in FBOs—with 82 percent preferring FBOs to non-faith groups in a recent survey in sub-Saharan Africa.¹ The World Bank published research noting higher quality of service and lower prices from FBO health providers in Uganda.² The Bill and Melinda Gates Foundation funded research into the reach and effectiveness of FBOs, noting that between 30 and 70 percent of health institutions in Africa are in the hands of religious entities.³ This assessment of the impact of FBOs is widely accepted and quoted.⁴ A number of academic disciplines are currently engaging with the complex task of defining, mapping, and evaluating the contribution of FBOs to global health.⁵ Partnerships with faith-based groups are increasing but there is concern that enthusiasm for partnership has run ahead of the knowledge of the nature, scope, and scale of religious entities and religious response, not to mention their unique characteristics that may demand a specific strategy.

⁶

The definition and use of the term Faith-Based Organization is contested and controversial. The terms Religious Entities and Religious Assets have been proposed as alternatives.⁷ However, this book uses FBO given the priority this descriptor gives to matters of faith. Included within my definition of FBO is every group or organization that claims to operate from a faith-base beyond the worshipping community. Therefore, local congregations are not included within my definition of FBOs but I include a myriad of organizations who claim a faith-base including schools, hospitals, clinics, grassroots community development groups, advocacy organizations, national coordinating bodies, multi-national development agencies, etc. My priority is not to assess organizational capacity but, rather, the contribution of faith.

⁸

Unlike much of the current research into FBOs working in the developing world, this book is not primarily seeking to determine how to improve the efficiency or effectiveness of the FBOs in terms of achieving global health objectives. I do not accept that FBOs should adopt objectives and policies set by politicians and government officials; nor simply determine program priorities according to the funding criteria of the world’s wealthiest people; nor embrace the business models of large commercial health providers. Although the actions of state and market inevitably impact FBOs, the direction and character of a Faith-Based Organization should by definition, be determined by matters of faith. Therefore, the theology of a Faith-Based Organization should be the primary influence on an FBO. If its faith does not drive an FBO, whose faith does?

The context: The experience of The Salvation Army

In October 2007, my wife and I were appointed International Health Services Coordinators for The Salvation Army. I have been a Salvation Army officer since my ordination and commissioning in 1993. My wife, Eirwen—a medical doctor and Salvation Army officer—and I received the appointment to International Headquarters tasked with developing an international vision and strategy for Salvation Army health ministry. It is not unusual in The Salvation Army for husband and wife to work together although we are the first couple to jointly hold this appointment.

The Salvation Army is a denomination of the Christian church working in more than 120 countries with many health programs. Globally this includes 29 general hospitals, 25 maternity hospitals, 19 other specialist hospitals, 56 specialist clinics, 135 health centers, 64 mobile clinics, and more than 15,000 local congregations (usually called corps) almost all of whom have a community service program.

⁹

Unlike most Christian denominations, The Salvation Army has a global governance structure with every unit and program ultimately accountable to one person—the General. During initial briefings, senior Salvation Army leaders expressed concern that many Salvation Army hospitals and clinics in economically developing countries were declining in their quality of service and were not financially sustainable. There was some internal disagreement on the way forward. For a number of years priority had been given to community-based rather than hospital-based health ministry. Community-based health care was more fundable, less risky, and perceived to be more effective and sustainable. In the past 25 years, The Salvation Army withdrew from almost all hospital-based health care in economically developed countries. Leaders responsible for the closures justified their actions on the grounds of increasing cost, the threat of lawsuits, and conflict with state grant makers and regulators over human life ethics. A number of influential western voices were recommending the closure of all Salvation Army hospitals around the world.

Salvationists in developing countries overwhelmingly disagreed with closure proposals. The arguments for improving institutional-based health ministry were justified on more than mere emotional attachment to institutions with a long and glorious past—although that driver should not be minimized. Salvationists expressed a desire to continue to serve poor and marginalized people through institutional, corps, and community-based health ministry by offering a continuous chain of care from home to hospital and back. Institutional-based health ministry was justified on the basis that hospitals and clinics give The Salvation Army credibility and provide a valuable space in the public square for ministry—particularly in Christian-minority settings where people of other faiths sometimes view Salvation Army corps and community-based initiatives with suspicion. An Indonesian Salvation Army officer, Major Yusak Tampai, explained this argument during my visit to Indonesia in January 2008. His presentation was a key moment in challenging my thinking on the role of hospitals and clinics in 21st-century health ministry.

In addition to concerns about the future of health institutions, several leaders in economically developed and developing contexts expressed unease at the increasing influence of secularist development thinking in Salvation Army health and development programs. Some leaders felt the communities’ capacity to solve their problems was being overestimated while health and development practitioners were sidelining theological resources.

The Salvation Army is not the only FBO facing this challenge. Stephen Plant identifies similar trends in other Christian agencies and suggests some are replacing Christian eschatology with a secular eschatology derived from non-religious, non-governmental organizations.¹⁰ Secular eschatology promotes hope, without any requirement for God and a belief in human progress with trust invested in concepts such as the capacity of science, the capacity of humanity, and human rights to secure a better world.

Plant notes how the seed of Christian hope of salvation grew into the bush of a belief in human progress¹¹ and suggests that, despite significant differences, it is possible to find commonality between secular development (defined as belief in progress) with the Christian eschatological hope. Plant does not hide the tensions between secular belief in progress and Christian development work and argues Christians need to tread a careful path between two heresies: On the one hand, Christians must resist those who advocate the eschewal of all political questions (such as development) as belonging to a fallen material world; on the other, they must resist the notion that human beings may work out their own salvation on earth. Christians, that is, have a proper penultimate interest in life before death, but their ultimate peace and fulfillment as human beings lies in the love of God.

¹²

In the framing of community health and development initiatives, Plant notes that