Missionary Care

Dr. Ronald Koteskey

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Bill has been an effective and dedicated missionary for a decade, but now, in his mid-30s, his missionary service seems more like labor than a labor of love. He used to enjoy interacting with nationals and feel deep satisfaction in his friendships with them. Although he continues to spend time with them, he becomes annoyed at what he sees as their increasing demands.

From all appearances he is a successful missionary that others respect and even envy a bit; however, internally he is exhausted, feels isolated, and seems spiritually depleted.  Even talking with his supportive wife does little to help. Bill is suffering from what has recently come to be called compassion fatigue.

What is compassion fatigue?

An article in Family Practice Management published by the American Academy of Family Physicians defines compassion fatigue as “a deep physical, emotional, and spiritual exhaustion accompanied by acute emotional pain” http://www.aafp.org/fpm/2000/0400/p39.html.

Compassion fatigue is a combination of burnout and secondary trauma. In classical burnout missionaries cope by withdrawing and becoming less compassionate; however, missionaries with compassion fatigue continue to give fully to their work with nationals. They often feel like they are being pulled irresistibly down by a whirlpool, and they are powerless to stop. These people may be viewed as incredibly dedicated and successful missionaries by others, but they often do not feel that way about themselves.  Here are some of their major symptoms.

• Feelings of depression and hopelessness
• No feelings of accomplishment and joy
• Blaming and complaining about others
• Increasing irritability and anger
• Nightmares and other sleep problems
• Startled by unexpected sounds
• Personal and professional life not separate
• Intrusive frightening thoughts

Neither burnout nor secondary trauma are approved medical diagnoses, rather they are lay terms, as is “compassion fatigue. ”Compassion fatigue is also sometimes used to describe an organization characterized by high absenteeism, turnover, and interpersonal conflict, or to describe the decrease over time of a whole country’s donations to victims of disasters such as earthquakes or floods. Here it is used to describe individuals showing signs of burnout and secondary trauma.

What does the Bible say about compassion fatigue?

 The Bible never uses the term “compassion fatigue,” but Moses is a good example in that he continues for years until he finally breaks under it. Moses was not a missionary, but he was a Third Culture Kid who was leading a group of cross-cultural workers as they transitioned from one culture to another. At about the time of receiving the Ten Commandments, he shows tendencies toward compassion fatigue.

• Exodus 18.  Only a couple of months out of Egypt and before receiving the commandments, Moses’ father-in-law told him, “What you are doing is not good… you will only wear yourself out. The work is too heavy for you; you cannot handle it alone” (vs.  17-18). 
• Exodus 32.  A few weeks later as he was coming down Mt.  Sinai with the commandments, Moses became so angry with the people that he destroyed the tablets on which God had written them.
• Exodus 34 and Deuteronomy 9.  Moses went back up Mt.  Sinai and spent nearly six weeks prostrate before God interceding for the people, but neither eating bread nor drinking water. A plague on the people followed.
• Numbers 11.  On their way from Mt.  Sinai to Kadesh Barnea the people complained, so God sent fire on them. Moses again interceded and then told God, “I cannot carry all these people by myself; the burden is too heavy for me… put me to death right now—if I have found favor in your eyes—and do not let me face my own ruin” (vs.  14-15). 

One would think that Moses would change. However, 40 years later at Kadesh Barnea he was again leading the children of those he led at Mt.  Sinai. The people were again complaining. Moses and his brother interceded, and they left the tent following God’s directions. However, when Moses spoke to the people he struck the rock twice with his staff rather than speaking to it as God had told him. This disobedient outburst resulted in Moses not being allowed to lead the people into the promised land (Numbers 20).

Do I have compassion fatigue?

Of course, you can look at the major symptoms above to get a general idea. Fortunately, the best measure of compassion fatigue is available online free of charge at http://www. proqol. org/ProQol_Test. html. It is available in about a dozen languages and is called the ProQuol, Professional Quality of Live Scale. The English version comes in a self-scoring format which includes scales for both burnout and secondary trauma. This test has high internal reliability but no research on validity. When scoring the test, be sure to reverse the scores for the items indicated on the burnout scale. Your scores will tell you if you are low, average, or high on both burnout and secondary trauma.

What causes compassion fatigue?

The major causes of compassion fatigue are not having time to do what needs to be done while serving others who suffer from many sources of traumatic stress. Missionaries may find that their time is taken by trying to meet the demands of headquarters, committees, field directors, nationals, governmental red tape, families, etc. They are serving people who suffer from illness, violence, poverty, alcohol, corrupt government, etc. 
Missionaries try to get more time by eliminating things that would help them cope. They often engage in less and less of the following:

• Prayer, meditation, reading the Word
• Breaks through the day, and restful lunch (they read email, return phone calls, etc. )
• Time with friends, spouse, and children
• Exercise, sleep, and relaxed meals
• Hobbies and other outside interests

Everyone has exactly 24 hours in every day, and each person has to decide how he or she is going to use that time. Missionaries who spend all their time doing “God’s work” should remember that going beyond a certain point, the harder they work the less they accomplish. Coffee breaks were not given because employers cared for the workers, but because research showed that people who took them accomplished more than others who did not. During World War I Britain required people to work seven days a week, until research showed that people who worked six days a week (i. e.  enjoyed a Sabbath)and had a day of rest accomplished more than those who worked seven.

Things to do to get over compassion fatigue?

The logical place to begin is with what Moses’ father-in-law suggested. First, Jethro listed Moses’ roles: be the people’s representative before God, teach them the decrees and laws, show them how to live, show them their duties. Second, Jethro told Moses to select men who were capable, feared God, were trustworthy, and would not take dishonest gain. Then Moses was to appoint these men as officials in a hierarchy over groups of 10s, 50s, 100s, and 1000s (Exodus 18:19-23). In other words, delegate much of the work to others.

Later when Moses was complaining to God about the heavy load of carrying the people, God told Moses to choose 70 elders who were leaders and officials. Moses was to bring them to the Tent so that God could put the Spirit on them to help carry the burden of the people (Numbers 11:16-17). This was the same advice Jethro had suggested long before.

This is still great advice today, especially for people like Moses who seem to think that saving the world depends on them alone. All of us need others. Here are some further suggestions.

• Reaffirm your commitment to Christ, including daily time in the Word, meditation, and prayer as well as a weekly Sabbath (Matthew 22: 37).
• Reaffirm your commitment to others, including time for family, colleagues, and nationals (Matthew 22:39).
• Reaffirm your commitment to maintaining the temple of the Holy Spirit (your body), including eating right, getting daily rest, and exercising daily.
• Clarify your personal boundaries.
• Share your feelings with colleagues who can share theirs with you.
• Follow God’s call on your life even when it means saying “no” to good things.
• Develop a support system of people around you who listen well and care.

Things to stop doing to get over compassion fatigue?

In addition to doing the things mentioned above, one should

• Stop blaming others. People at headquarters, your field director, or your principal may act in ways that you disapprove of, but people are not responsible for how you react.
• Stop complaining. When you talk with other discontented people, it only makes you feel worse. You may have heard that misery loves company; it should be stated that “misery loves miserable company. ”Discontented people do not want others spreading cheer.
• Stop making big decisions. Do not decide to quit being a missionary, buy a luxury car, get a divorce, or any major life decision. You will be doubly sorry later.
• Stop looking for a quick fix, such as an affair, drugs, etc.