Dr. Kenneth Gamble is the executive director of the Missionary Health Institute and a general health practitioner. Prior to his work with MHI, he served as a missionary doctor in South Africa and Zimbabwe. Dr. Gamble spoke with Salvationist.ca about health and wholeness.

If you had only three messages to offer your patients about their health, what would they be and why?
First of all, they shouldn't look to their physician to take charge of their health. I believe that patients are their own best health managers. In my clinic, we've redesigned our rooms and offices so that patients can see our computer screens and observe what we're entering into their data files. I constantly tell my patients that I'm not their boss but their consultant or advisor. If something I say doesn't make sense, I want them to ask me to clarify it.

Secondly, their intuition is usually well-informed. Generally, patients know how their bodies work and understand their bodies better than anybody. A patient once said to me, “You only have a one-dimensional view of me, but I have a three-dimensional view of myself.” She hit the nail right on the head. She not only feels what I can feel from the outside, but she feels it from the inside, too.

Thirdly, patients should be careful of where they find their health information. There is a plethora of advice on the Internet, and it's easy to be swayed by inaccurate sources.

How can better communication be fostered between patients and health professionals?
When I was working in Africa, I thought for the longest time that we knew what the people needed. The community health experts, who were evolving in their understanding, said, “Ask them what they need.”

Part of the problem in the beginning was that we didn't know how to ask them what they needed, and the people didn't know how to express their needs to us because they weren't used to being asked. But the longer we got to know the people, and the more our languages grew to match our ability to ask and their ability to answer, the greater we could effectively respond to their felt needs. Initially, we failed because we weren't connecting at the level of basic questioning. We're probably no different here in North America. We just have different environments through which those needs are expressed.

What are the most common ailments that you see in your patients? To what extent are these preventable?
In winter months, we frequently deal with infectious diseases and respiratory infections. More recently, diarrheal diseases have become extremely common and make up the bulk of what comes in on an urgent basis. Both respiratory and gastro-intestinal infections can be avoided if people follow preventive measures such as washing their hands regularly, utilizing proper coughing techniques and receiving flu shots.

Diabetes, heart disease, high blood pressure and osteoporosis are also on the rise, largely due to our sedentary lifestyles in North America. If there is a preventive measure that is undersold it is exercise. Recent studies show that in terms of all-cause mortalities, people who exercise on a regular basis experience more quality years of life and also live longer. Obesity has become an epidemic, and much of that is linked to our inactivity and quality of diet. A European study has shown that we can reduce the risk of diabetes by 70 percent with attention to both exercise and diet. Diabetes, unrecognized and poorly managed, can erode 13 quality years of life from individuals. It is one of the most significant diseases that can either be prevented or delayed.

In what way does our emotional and spiritual health affect our physical health?
This is an area that, from a scientific standpoint, has only recently been addressed. A colleague of mine who works at the University of Saskatoon conducted a study that formally explored the impact of faith on well-being. Despite a culture of skepticism where many health professionals are agnostic or atheistic in their orientation, many have accepted that her study clearly demonstrates that spirituality improves the quality of life.

What advice do you have for people to help them find balance in their body, mind and soul?
I tend not to be prescriptive in my approach with patients. My desire is to hear them first and try to understand where they are coming from. But as I listen to their stories, the discussion usually comes back to the basic principles of health. I was asked recently to give a lecture on health and wellness to some retiring missionaries, so I took the opportunity to search some medical literature to see what new things I could bring to the table. Throughout my research, I repeatedly saw the same foundational basics: diet, exercise and rest. By rest, I mean the various dimensions in which we find rest, such as sleep, but also spirituality.

As a medical practitioner, do you believe in miracles? Are there still instances where God heals today?
I have a theologian friend who said to me recently, “Man hides himself to be concealed. God hides himself to be revealed.” If I understand him correctly, I think he means that God's presence is often felt in our world in a hidden way. If I reflect on that in my practice, I realize that much of what we as humankind take credit for is only possible because of the hidden face of God. I think there is a dimension of his presence that is always with us, but which is hidden from us. We don't see it and we don't feel it in a way that we attribute to him, but that doesn't erase the fact that it's there. We don't recognize that we live in a miraculous world.

If we take a different definition of miracle in which God changes the order of the universe to express himself in a way not explained by natural means, then yes, I do believe in those miracles as well. I have seen them. When I think back to the patients I worked with in Africa, there were cases where I knew beyond any doubt that no more could be done, and yet there was a miraculous response that I can only attribute to divine intervention. I have seen it in the lives of my patients here in Canada, where they have no hope outside of a spiritual hope, and yet God has seen fit to bring healing.

I think there is also a dimension of the miraculous not only in physical healing, but also in the transformation of an individual. So, while they may not be cured and may die, there has definitely been a transformation of person. I would see that as being the greatest of all miracles, but perhaps also as the one that we can measure the least.

What do you think of two-tiered health care?
I think there are dimensions to a two-tiered health-care system that give us an infusion of energy that sometimes is lacking when we deny people the access to more choices. Having said that, I embrace with great enthusiasm the more socialized approach where health care is made available to all without compromise. I love the freedom and privilege of seeing patients without having to wonder whether or not they can afford it.

What do you feel will be the biggest health concerns in the next 20 years? What factors are contributing to this?
There's no question that the trend line is toward greater challenges with obesity-related illnesses. It isn't just diabetes; diabetes is the trunk of the tree that leads to high blood pressure, heart disease, kidney disease, strokes. As mentioned earlier, as a society we have become increasingly sedentary and this is going to have consequences. Our self-focus has become the driving force of our society, and we're now reaping the fruit of that.

What role does faith play in your professional life?
I read a sermon by Jonathan Edwards recently where he talks about the goals that we have in our life. He says that the supreme goal is that we live to bring glory to God. He says that life brings us into situations where there are many subordinate goals. And these are healthy as long as our subordinate goals don't become our chief goal. So, if I had the opportunity to express my ideal, I think my faith keeps me from seeing medicine as my ultimate goal, but rather a subordinate goal to that which is greater.

How will the predicted doctor shortages affect the most vulnerable in our society? What solutions do you feel should be explored?
The more our communities disintegrate, the more that marginalization will be felt. As soon as you have the disenfranchised divorced from society, with no sense that they are part of something bigger than themselves, then the services are going to fall away as well. There won't be the capacity within the system to meet their needs. It will be like it was for us in Africa: How do they express what they need? What language do they use to express that need? What motivates them to seek help? Do they feel welcome in the presence of the help that is available? How do they interpret the help that they receive? I think it's a very complex issue.

As you prepare missionaries for overseas service, what health advice do you offer them?
When I started working at the Missionary Health Institute, most mission organizations were very paternalistic. They had some kind of belief that they controlled health by enforcing these big medical examinations and providing forms to fill out. After a number of years, I realized that these forms merely helped determine whether potential missionaries were fit to go or not. They had absolutely no impact on the expression of care and didn't connect at all with the missionaries' well-being. If there's a change that I've tried to bring about in the mindset of mission directors, it's that they're not the guardians but the facilitators of care. It's the missionaries, the ones to whom it matters most, who are most able to embrace the responsibility to care for their own well-being. That's what I seek to promote, with all of the same core philosophical underpinnings that I already mentioned for my patients here.

What are the significant health concerns and illnesses worldwide? Should we be concerned about the spread of serious illness?
We have to be concerned, but we don't have to panic or worry. We need to find a balance between being swept along with the current of anxiety and being informed about the issues. Some of the great changes in health over the years have not come from physicians, but from agricultural workers and sanitation engineers.

There are basic principles that these international diseases bring to the foreground, and I think we, as Christians, have a responsibility to incorporate that into our ministry opportunities. Am I believer in preventive medicine? Yes. Do I think that diarrheal diseases are the biggest silent killer overseas? There's no doubt about it. But once again, it's a community response that's needed. There are so many levels to every issue, and physicians are often the least equipped to respond to them. Sanitation engineers and the people bringing clean water supplies can do more for the health of a nation.

HIV is clearly a global concern. Will it affect us? Yes. But we are self-centred. What happens overseas doesn't bother us unless it affects us directly. Even with a disease like polio, we can get complacent, but it just takes one airplane to bring polio back into our communities. If it comes back after an incubation period and we let our guard down, it's going to affect us again.

What role can Canadian Christians play in promoting the advancement of health care in the developing world?
As Christians, we have to move away from the mindset of living and doing things only for ourselves. We have to understand that God has called us into community. God has not given us wealth to put in big barns to store up our treasures here on earth. We have a global responsibility.

Christ was asked, “Who is my neighbour?” The Good Samaritan is an interesting story, and one that still resonates. In a global world, that neighbour might be thousands of kilometres away. How do we express that care? We might not be able to support them in person, but we can assist. We have missionaries overseas who lack support now because of our current economic crisis, but we still haven't suffered here to the point that we are going without food or struggling to clothe our bodies. And yet we're worried and caught in this vortex of anxiety that our world is collapsing. We can be better informed and broaden our knowledge about world issues.

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Intentional Care For Those With a Mission

Since 1936, the Missionary Health Institute (also known as International Health Management) has built an international reputation by providing quality health-care services to missionaries called to serve around the world. MHI is the only interdisciplinary outpatient expatriate health-care facility of its kind in North America and serves missionaries from over 150 countries.

Under the leadership of Dr. Kenneth Gamble, executive director, and Dr. Duncan Westwood, clinical director of expatriate care and development, the institute has become an important partner to a worldwide network of organizations.

The Salvation Army in Canada and Bermuda utilizes the services of MHI for all its reinforcement personnel serving in overseas appointments. “We rely heavily on the expert support offered by MHI,” says Major Sharon Giles, director of overseas personnel, THQ. “Whether it's conducting medical and psychological assessments, arranging for applicable vaccines or providing medical advice, MHI provides the necessary care and attention needed by those officer and lay personnel currently serving, or those who are about to serve, in other countries.”

In addition to reinforcement personnel, MHI assists with the assessment of candidates wishing to enter training to become Salvation Army officers. “We have a thorough application process for all of our officer candidates,” says Major Beverly Ivany, candidates secretary, THQ. “Dr. Westwood assists the Army in identifying those candidates best prepared to participate in the demanding program offered through our College for Officer Training.”