Missionaries are on a journey that challenges every aspect of their lives. The Lord has promised to be with them, but can they count on senders to be with them in a caregiving way? Attrition among missionaries is sometimes preventable when appropriate, seamless, and comprehensive care makes a difference in the longevity and wellbeing of missionaries. Churches and mission agencies should therefore journey with the missionaries they support, for the good of the kingdom and the glory of God.1

Life happens! A couple finds out they are pregnant. First heartbeats are heard. Birth eventually comes as doctors and nurses are busy with the details of caring for the mother, child and, yes, the father at times. Children are taken for immunizations. While on vacation a child gets a deep cut in his hand from whittling with his knife. A rushed trip to the ER in an unfamiliar town gets help. As an adult you schedule your annual physical and discuss important health issues with your primary care doctor. An ambulance screams down the street carrying a patient to the ER. Families wait as the gentle hospice caregivers provide tender care for the patient and family, waiting for the expected end. Each of these life experiences is an example of health care. Medical care is attending to emergencies as well as helping individuals and families manage their lives in the best way possible.

These descriptions of health care are similar to the care mission teams need as they go through various stages of team life. Whether providers call it “missionary care” or “member care,” they need an approach that is both seamless (pre-, on-, and post-field care) and comprehensive (all aspects of missionary/team life). Frequently, churches and agencies responsible for missionary teams discover that the care they provide is similar to the care given in the ER. Yet, routine care providers need to know their limits and be willing to refer the missionary to someone else for additional care when needed. Moreover, they find themselves responding to emergencies because an immediate need arises that demands attention. The unfortunate reality of providing only this kind of care is that it places the caregiver (church or agency) and team in a reactionary relationship. A comprehensive and seamless approach to missionary care will place the interaction between the team and their supporters in a more positive framework. Their interaction will not be perceived as only addressing problems but will be seen as vital to the team’s health and ongoing success. This article will, therefore, deal only with routine care, not crisis or trauma care.

The Realities of Member Care

Interest in member care has been growing during the last two decades. It has emerged and developed in response to the circumstances in which missionaries find themselves in our changing world. Several realities are particularly important when considering member care in the context of mission teams.

The attrition rate among missionaries is unnecessarily high. Steve Sang-Cheol Moon states that “more and more missionaries are coming back home before the expected time, and more and more missions agencies are experiencing missionary attrition.”2 Moon goes on to list the major causes of attrition, including “problems with fellow missionaries, health problems, change of job, lack of call, weak home support, disagreements with sending agency, and poor cultural adaptation.”3 While some attrition is natural (retirement, family needs, completion of the job, etc.), Moon’s list makes us aware that some of the causes of attrition are preventable.

1. Team Conflict should be expected.

The Christian community has been forced to come to grips with the truth that Christians can and do hurt each other, and if conflict is common in the church we should not be surprised to find it in a mission context. We should not expect missionaries to rise above what is true in human community, even for Christians. The belief that conflict should not take place and the surprise when it happens may indicate that we, knowingly or subconsciously, hold missionaries to a higher standard. It is normal to have high hopes for them and their work, but it is also necessary for care providers to acknowledge their humanness.

The thought that Christians simply need to pray together and “all will be well” is naïve at best and biblically unfounded at worst. New Testament mission efforts were not very far along before conflict between missionaries erupted. The conflict involving Paul, John Mark, and Barnabas illustrates this (Acts 13:13; 15:36–41). Missionary activity in the New Testament shows us that reaching others involves God’s partnering with very flawed, broken humans. Through the study of New Testament churches, it is apparent that healthy communities result from spiritual teaching along with much difficult, intentional work.4 Even when missionaries are committed to following spiritual principles, working them out is the great challenge. One mission team I worked with was so broken they could not worship together. This did not make them any less Christian, but they needed help to work through the causes of the brokenness that had intruded into their lives. That essential work of addressing and resolving personal issues opened the door to renewed worship and praise.

Difficulty with fellow missionaries is a primary contributor to missionary attrition. In his book, Cross-Cultural Conflict, Duane Elmer illustrates this point from his work with sixty North American mission executives. They all acknowledged that the missionaries’ greatest need stems from the breakdown of interpersonal relationships between one another.5 Another corroborating example comes from Ken Williams, former Bible translator and retired member care professional with Wycliffe Bible Translators. Williams states:

Many studies on missionary attrition have found poor relationships at or near the top of lists of reasons for leaving. Recently one large mission asked all their personnel what they needed help in most. The greatest need, reported by 78%, was help in relationships. This may be representative of missionaries in general—yet we do so little to train them how to thrive in their relationships.6

Positive interpersonal skills are needed and can be taught. Because teams are relational communities, the strength of personal relationships ebbs and flows, suggesting an ongoing need for giving attention to interpersonal skills among mission teams.7 The relationships between missionaries on a team are an easy target for Satan. If he can create conflict among a mission team, he can quickly diminish the effectiveness of their work and tarnish their example. After all, teams carry the gospel while they model the gospel as Christian community. By passing on tools for interpersonal health, care providers can help reduce attrition due to poor team relationships.

2. Training before leaving for the field can greatly enhance a team’s potential.

In his article summarizing the past five decades of member care, Kelly O’Donnell references Kevin Dyer as an early advocate for extensive pre-field training in the 1960s.8 Dyer acknowledges:

Merely bringing people together and sending them to the field wasn’t enough. They needed time for in-depth preparation and interpersonal bonding. They came from all kinds of sub-cultures and religious backgrounds and minor differences in personal taste that became magnified when living and working in the team situation.9

Additionally, the challenges of becoming a team are magnified within the context of cross-cultural living. The kind of member care Dyer proposes is a proactive preparation that will produce better results than simply bringing people together and hoping and praying that an effective team emerges.

My wife and I were part of a three-family team that came together on the field. We had only met one of the families before going to Kenya. Even though both of our families were supported by the same church we only had a few opportunities to interact with our teammates before they moved to Kenya, while we stayed behind to bond with the church. Later, we met the third family upon arriving in Kenya. Our team experience was a good one. Good things can occur when people are brought together without prior team building. However, our team experience would have been enhanced greatly by intentional team development.

3. Missionaries often fail to be self-reflective.

This lack of self-reflection is particularly true in our Western culture. Our culture is fast paced and self-absorbed. We hardly reflect on anything. Even though we may have the capacity for self-reflection, we also excel at self-deception. We tend to let things “ride” until they become unmanageable. Missionaries have some responsibilities to care for themselves and their fellow team members, but it is helpful to have a trusted third party provide an additional perspective. When this is done at regular intervals, rather than only when a team is at a breaking point, the team gains insight into themselves and those they work with. The end result of encouraging further self-reflection is that the individuals and the team have the potential to become more resilient.

4. Stress has a major impact on missionaries.

This is true whether one works on a team or not. However, cross-cultural stress certainly intensifies challenges, and this would especially be true for team relationships. Ken Williams contrasts the secular and biblical perspectives on the effects of stress. He asserts that the secular world primarily understands stress as a physical response, while the biblical view sees stress affecting the whole person (spiritually, emotionally, physically, mentally, and socially).10

Stressors are present in all aspects of missionary life. The list is long: physical, professional, financial, cultural, social, linguistic, political, educational, and spiritual.11 I would add: personal, relational, familial, and organizational. There is bound to be some overlap in these designations, yet adding to and being more specific about descriptions of stressors is helpful.

Investing in missionary care can address the preventable attrition among missionaries.

Ultimately, though, the goal is greater than just helping the missionary stay longer. Member care should seek to enhance and strengthen a missionary’s life in order that (s)he will not only endure but thrive and be resilient. Deborah Ford puts it this way:

A “thrival,” rather than a “survival” understanding of missionary care focuses not only on curative, but also preventative measures, seeking to reduce painful attrition through an emphasis on wholeness and effectiveness. The ultimate aim is to develop inner resources within the missionaries, as well as providing external resources to help them with their work.12

The price of failing to provide seamless and comprehensive care is great:

The cost of not doing member care is revealed when a worker “crashes and burns.” There is the human suffering of the worker, his/her family, and colleagues. Lower morale sets in when workers perceive they are only valued for their work, not for their person. There is lost credibility with the people of the host country and with donors back home. Huge amounts of money are expended in salary, start-up costs, training, and repatriation. The quiet cost of not doing member care is revealed when a worker limps along, joyless, powerless, and ineffective.13

Other costs include the resulting broken lives and loss to the kingdom. These costs are very significant. If we want to avoid them, then we need to be serious about providing care that is comprehensive and seamless. As Prins and Willemse acknowledge:

If we consider the time, energy, money, personnel and prayer invested in new missionaries before they go to the field, should we not invest just as much time, energy, money, personnel and prayer in helping them through their problems after they reach the field?14

Having been involved in missions as a missionary, a church mission committee member, and a trainer and care provider, I know how challenging it is to maintain a commitment to continuous care once a missionary team is in place.

An Example of Member Care

Teams must be able to do their work and also maintain meaningful relationships. What does that look like? O’Donnell describes the characteristics of a resilient team as follows:

• Coping ability
• Commitment
• Appreciation
• Communication
• Time together
• Understanding
• Structure
• Spiritual wellness15

These characteristics need to be the outcomes for any pre- and on-field care. Going forward I want to share some examples from personal experience that will help illustrate healthy practices related to comprehensive and seamless care.

Pre-Field Care

Caring for a mission team can be described as “spiritual formation.” Thomas Kimber, for example, cites two studies of teams on the field that underscore the relationship between a strong awareness of God and good team relationships all the way along the path to eventual reentry.16 One of the assessments the Halbert Institute for Missions (HIM)17 uses throughout the missionary life cycle includes a measure for how missionaries feel about their spiritual lives. Frequently, missionaries characterize their spiritual lives as either lacking or dry. Part of the reason for these feelings is because they give of themselves deeply, often neglecting their own spiritual wellbeing. Therefore, an overarching purpose of missionary care is giving attention to their spiritual lives.

At HIM, pre-field training focuses on topics such as:

• Relationship with God
• Practice of spiritual disciplines
• The theological core of missions
• Calling
• Getting to know the team (spiritual journeys and genograms)
• Diversity (personality profiles and spiritual gifts)
• Theological fit within the team and with the sending agency/church
• Fund raising
• Stress assessment (CSA)
• Conflict resolution
• Team covenant (descriptions of what it means for this team to live in Christian community)
• Trust/openness
• Team health assessment (PATH)
• Site specific training (may include a survey trip)
• Leadership and decision making (Dynamic Governance and Statement of Grace)
• Team, families, supporters weekend

These components give attention to a person’s walk with God and his or her relationship with the team. They also illustrate the value of diverse personality traits and spiritual gifts, measure the compatibility of theological perspectives, draw attention to areas of personal stress, examine how well the team is working together, provide a dynamic understanding of team leadership and decision making, and experience the realities of team interaction as they visit their future mission context. These topics and others are covered during five long weekends plus additional times with a team.

Team building should not be seen as a one-time experience, but as a continuing process that extends through the life of the team.18 HIM is blessed to be involved with Abilene Christian University and, therefore, have extended interaction with teams that are forming. The length of team training, then, can range from six months to two years. Some are students at ACU while others move to Abilene, Texas, to be trained. While the best training is certainly face-to-face, the challenges of costs and schedules have forced us to develop a flexible, hybrid model in which we train at ACU, travel to a team’s location, and do some training online. Utilizing longer, varied training periods and methods assists in developing cohesion and trust among team members.

On-Field Care

Once a team is in place the real work, for them and for caregivers, begins. A question that must be asked is, “Who is best to provide the care?” The answer is multifaceted. The research of Högström and Gingrich articulates three sources of such care: friends and colleagues, in-house member care providers and pastoral workers from the sending church, and mental health workers external to the organization.19 Their research also illustrates that the missionaries, in regard to all three categories of care providers, preferred to have someone who has experience in missions themselves.20 One missionary was quoted as saying, “I think it is less important that one is a ‘professional’ counselor and more important that it is someone who has been where I have been and walked many of the same steps that I have walked.”21

An argument can be made for the value of care from third parties instead of the supporting church or organization. When team members are supported by various organizations or churches, which can give care to the team as a whole? Who among the supporters can be completely objective? A third party, especially if they have been involved in the training of a team, can probe deeply, yet the team members feel free to respond openly. When the third party has a relationship with the team and has previous mission experience his or her effectiveness and credibility increases.

HIM commits to providing regular team development (seamless care) for the teams we train. Sometimes care providers make onsite visits, while other times they make contact via Skype. These visits have several concerns: the missionary, the family, the team, and the work. Two months prior to an “official visit,” I write each missionary (husbands, wives, singles) and ask for their input about what issues need to be addressed. I make sure they understand that we may not be able to address all the issues. In one instance every person mentioned the same sensitive issue. None had been able to bring it up amongst themselves because of its sensitivity. During the visit the team felt comfortable enough to discuss the issue and did so in a beautiful way.

One month before making the visit the team takes two assessments: CernySmith Stress Assessment (CSA) and Periodic Assessment of Team Health (PATH). Overall, these help both the third party and the team members prepare for the visit.

The visit usually takes two weeks, which includes travel time. This allows us enough time to stay with each family unit and engage them in casual conversation. This time is very special and important as it expresses our interest in the missionaries themselves. During the time in each home we debrief the CSA.

The CSA is an assessment that measures stress by examining five domains: organizational, cultural, relational, behavioral, and personal.22 Each domain has various scales that are used to measure a person’s stress, including stress related to spirituality. While taking the CSA the missionaries have opportunity to write in their own words what they believe is causing the stress and the level of that stress (extreme, quite a bit, moderate, a little bit). I have given the CSA to a new team, and among them they listed over thirty items as sources of “extreme” stress. The power of this instrument is in its debriefing. Because of our past missions experience we were able to normalize the stress and coach them to find ways to mitigate it. This process not only encouraged them but also gave them hope.

Over a five-day period we usually spend four to five hours in the mornings doing team development. During the meeting times we begin with worship. Each household is given responsibility for one of the worship times. During these meetings we debrief PATH. This is an assessment that grew out of my Doctor of Ministry project thesis.23 PATH has seven domains: team commitment, diversity, communication skills, conflict resolution, leadership, decision-making, and trust/openness. Each of these domains has five Likert scale questions followed by two write-in questions. One write-in question asks the missionary to reflect on him- or herself and the other asks him or her to reflect on the team. PATH has proven to be very helpful in surfacing needed conversations about both the tasks of a team and maintenance issues (relationship issues) related to a team.

These two assessments, CSA and PATH, are given each time HIM makes an official visit. Value comes from seeing the progress of an individual or team over the years. Once I asked a team to look at their CSA from two years before and to compare those results with their lives presently. They were amazed to see the progress they had made in dealing with difficult stress issues. A team will always have things to talk through. PATH helps them raise those issues and maintain healthy relationships.

Often a team’s emails alert me to the fact that they want or need to talk about the work, perhaps regarding some decisions they are facing. We make sure we give time to hear these concerns. When questions arise as to how to move forward, the DRAWN process has been very helpful.24 DRAWN means: D for “desire/dream;” R for “reflect on resources and reality;” A for “attend to ABBA;” W for “weigh what you heard;” and N for “next steps.” This is a spiritual process for discernment using one’s reflection on deep desires and resources, listening to God, hearing and weighing what he says through everyone, and out of that process, along with prayer, deciding what is the next appropriate step.

Transitions are a major challenge for teams. Losing or adding team members are, therefore, good examples of the kinds of issues that require continuous on-field care. Sometimes members of a team leave the mission context and return home. When this happens it is important to help the team member “end well.” Leaving without closure can often hurt those leaving and those staying. Providing a time of remembering and blessing is critical. The whole team can reflect on their coming together, training, life together in the mission context, and how they have seen God at work. Time is also given for the ones leaving to bless those who stay and for those who remain to bless those who are leaving. Whether the leaving is a good one or has some hurt connected with it, reflection and blessing are always appropriate.

Welcoming new members into the team is a critical time for team development as well. The existing team needs to pause and repeat some of the things they did in their initial training such as personality profiles and sharing spiritual journeys. These two activities help the new and existing members become familiar with each other. The team should take PATH and the CSA and recommit to the Team Covenant. These activities will help integrate the new members and even allow them to participate with the team in some reflection about their life and work together.

Whatever the situation, on-field care needs to be flexible and individual as well as team focused. A mentor needs to communicate in word and action that the lives of the team members are important, not just their work. One of the important pieces of feedback that Högström and Gingrich received from missionaries was that feeling as if you had been heard was the most valued feature of member care.25 Time is required for individuals and teams to feel like they are heard. After the morning sessions, Eunice and I participate with the team in their normal routines. If the women have a class or accountability time, Eunice attends. If the men do the same, I attend. I enjoy going with the men to see what they have been doing; whether walking with them to a local church plant or meeting their friends. They need to know that we care about their lives and are not simply there to assess them as a team.

After each visit a summary is written and sent to supporting churches or organizations. In writing such a report care must be given to the tension between giving a meaningful summary and protecting confidentiality. A copy of the report is first sent to the missionaries to make sure they agree with what was written.

Post-Field Care

As difficult as going to a mission context is, the often forgotten challenge is returning home.26 I was better prepared to go to Kenya than I was for returning home. Kimber says returning missionaries face isolation, confusion, and not feeling “at home” in their home culture.27 Returning home is not a “team sport;” it is faced alone. Still, the team left behind can have an impact, if leaving is done well, as mentioned earlier.

Reentry debriefing is important for returning missionary families. Giving the CSA at this time is helpful because it will show what stressors or challenges they are facing. Debriefing the CSA should be part of a lengthy debrief about their life in missions. O’Donnell describes a debrief this way:

The purpose of a debriefing session is to help a worker review his/her experience on the job. This debriefing is more of a routine nature and is not intended to be used with crisis workers or those who go through a traumatic event. During routine debriefing, the worker is given the opportunity to express feelings, explore the high and low points of work, express concerns, put more closure on unresolved areas, and get a better perspective on the overall experience. The interviewer’s role is to listen and help clarify, being careful to make sure the worker addresses the relevant aspects of his/her work. Debriefing does not involve counseling or performance evaluation.28

During the time of reentry it is important for a missionary to be heard. Giving him or her time to talk at length shows that you value the individual as well as his or her service. Churches and the missionary’s extended family are part of the “team” that helps with repatriation. The welcoming community often does not understand why reentry is so difficult or how important a role they play.

Along with providing for the immediate practical needs of returned missionaries, it is helpful for churches to be aware of the deep emotional and spiritual challenges many missionaries struggle with upon arrival in their home country. The returning missionary who is received by a supportive and loving community of faith may reasonably expect to experience lower levels of reentry distress as well as a more healthful transition, being reestablished in a community of faith, giving to others through meaningful ministry, and deepening relationships and meaningful roles in his or her community.29

It may seem like a daunting task to care for missionaries in such a comprehensive way. Yet, several events beneficial to returning missionaries are sponsored by organizations dedicated to improving missionary care (Missions Resource Network, Mission Training International, and Oklahoma Christian University).30 Missionary caregivers can prepare the family and church for their roles in a missionary’s readjustment if they take advantage of such resources.

Conclusion

There are many reasons to be involved in the care of missionaries and teams. The greatest reason is that when we care in sustained, concrete ways, we model our missionary God. He sent many leaders and prophets with words that promised he would go ahead of them and be with them. Jesus sent out his apostles (and the church) with the promise that he would be with them. The church should take her call to be the body of Christ seriously and do the hard work of journeying with those who follow their Lord into mission contexts. We should count the cost and do member care well, like our Father and to his glory.

Sonny Guild served 10 years church planting in Kenya. After service in Kenya he preached for the Southwest Church of Christ in Tigard, Oregon, for 14 years. Most recently he taught missions at Abilene Christian University for 21 years. He also was the first director of the Halbert Institute for Missions and directed it for 10 years. He is now retired and teaches adjunct at ACU. He also gives time to his consulting business, Culture Concepts Consulting (http://cultureconceptsconsulting.com) where he provides access to his PATH assessment for teams. He and his wife, Eunice, live in Abilene, Texas, and have three sons, two daughters-in-law, and eight grandchildren.

Bibliography

Dyer, Kevin. “Crucial Factors in Building Good Teams.” Evangelical Missions Quarterly 22, no. 3 (1986): 254–58.

________. Team Building: Current Issues and New Alternatives. Addison-Wesley Series on Organization Development. New York: Addison-Wesley, 1995.

Elmer, Duane. Cross-Cultural Conflict: Building Relationships for Effective Ministry. Downers Grove, IL: InterVarsity Press, 1993.

Ford, Deborah. “P(r)ay as They Go? Re-examining the Role of the Local Church in Cross-Cultural Missionary Care.” Evangel 22, no. 1 (2004): 4–10.

Högström, K. Elisabet, and Heather Davediuk Gingrich. “Experiences and Utilization of Member Care in an International Missionary Sample.” Journal of Psychology and Christianity 33, no. 3 (2014): 240–53, http://www.thefreelibrary.com/Experiences+and+utilization+of+member+care+in+an+international…-a0385805842.

Kimber, Thomas R. “The Role of Spiritual Development in the Cross-Cultural Reentry Adjustment of Missionaries.” Journal of Psychology & Theology 40, no. 3 (2012): 211–19, http://www.thefreelibrary.com/The+role+of+spiritual+development+in+the+cross-cultural+reentry…-a0305103728.

Moon, Steve Sang-Cheol. “Missionary Attrition in Korea: Opinions of Agency Executives.” In Too Valuable to Lose: Exploring Causes and Cures of Missionary Attrition, edited by William D. Taylor, 129–42. Globalization of Mission Series. Pasadena, CA: William Carey Library, 1997.

O’Donnell, Kelly. “Building Resilient Teams: The CACTUS Kit.” In Doing Member Care Well: Perspectives and Practices from around the World, edited by Kelly O’Donnell, 391–98. Globalization of Mission Series. Pasadena, CA: William Carey Library, 2002.

________. “Global Member Care: Exploring and Celebrating Our History.” Member Care Associates. http://membercareassociates.org/wp-content/uploads/2012/07/ODonnell-Global-MC-History-for-India-MC-book-26-Janaury-2012-2.pdf.

O’Donnell, Kelly, and Michèle Lewis O’Donnell. “Running Well and Resting Well: Twelve Tools for Missionary Life.” In Doing Member Care Well: Perspectives and Practices from around the World, edited by Kelly O’Donnell, 309–22. Globalization of Mission Series. Pasadena, CA: William Carey Library, 2002.

Prins, Marina, and Braam Willemse. Member Care for Missionaries: A Practical Guide for Senders. Brackenfell, South Africa: Member Care South Africa, 2002.

Williams, Ken. All Stressed Up and Everywhere to Go! Solutions to De-Stressing Your Life and Recovering Your Sanity. Colorado Springs CO: Relationship Resources, 2010.

________. “Training Missionaries in How to Relate Well: Pay a Little Now or a Lot Later. In Enhancing Mission Vitality: Mental Health Professions Serving Global Mission, edited by John R. Powell and Joyce M. Browser, 245–52. Minneapolis, MN: Augsburg-Fortress, 1999.