The “Fish” Model of Project-based Outreaches

A model for doing not only medical missions, but many forms of short-term projects (partnered with a long-term ministerial presence) looks a bit like a fish (or an ICHTHUS if you prefer). It is based somewhat on the model used for CPM (Church-Planting Multiplication). The same basic principle can be utilized.


Rapid Seed Sowing




This comes from my book “Principles and Practices of for Healthy Christian Medical Missions: Seeking the Church’s Role for Effective Community Outreach in the Philippines and Beyond”


A: The idea of a medical mission comes to one person or a small group, and there is the decision to attempt to move forward with the idea.

B. This is the team-building phase. Buy-in is developed within the community and with outside help. Partnerships are developed and plans are worked out.

C. Others are told about the mission. The community is invited and the outside team supporters are told and encouraged to pray and help in tangible ways. Eventually a maximum number of people are involved as the entire community (ideally) is involved or invited, and the outside team is sent off.

D. This describes those involved in the medical missions. This number is smaller because not everyone who is invited actually comes. In the Philippines approximately half to 2/3s of those invited actually come (at least in rural areas).

E. This describes those who respond to the Gospel based on assent. In some cultures, this assent is to the Gospel (expressed perhaps in saying the “sinner’s prayer,”) In some cultures, such as the Philippines, this sort of response may be made without any real conviction. As such it may not be the most useful guide for follow-up. However, it is important to keep records of all who attended and all who made this decision.

F. It is also useful to find a narrower filtering of those who come. This may be with a desire for Bible Study, or for home visitation. In the Philippines, for example, many will express an interest to “pray to receive Christ” as a way of expressing gratitude for the medical care provided. However, there is no such feeling of debt to agree to a Bible Study (for example) so it is often a better guide for community spiritual response.

G. After the medical mission, the hosts can do follow-up. They would probably start with Group F as priority, then to Group E, and finally Group D. However, in all likelihood those who actually act on their spoken decision will be smaller than the other groups. So for example, in the case of a Bible Study, one may have hundreds attend the medical mission, with dozens responding in faith, and perhaps 2 or 3 dozen desiring a Bible study. Of these, perhaps 10 or 15 actually respond. These can be put into 1 Bible study, or perhaps 2 growth groups, or maybe a handful of accountability groups.

H. It is from the core group G that growth will occur with multiplication of small groups, or development of house churches, or creation of a church, or whatever.

Medical Missions Reprise

Some things go away but don’t stay away. For the most part, my wife and I stopped doing medical missions back in 2010. From 2005-2009, we were with a group called Dakilang Pag-Ibig Diadem Ministries. During that time, we served about 30,000 patients in about 70 different sites. Then, in the first couple of years But of our present ministry (Bukal Life Care) we continued to do some medical missions– especially when tied to disaster response. I think the last medical mission that we organized and ran was in 2013… although we have helped with bits and pieces of some since then. I think it is a good ministry… but does have some potential pitfalls.

But just in the last month, we have been asked by three different groups advice regarding medical missions. That can be tough because there is such variety that can be involved in the methodology and long-term strategy. But since questions keep coming in, here are a few resources. Some are directly related to medical missions… and some a bit less so.

Article #1.  Healthy Medical Missions

Article #2.  Models for Church-Based Relief and Development

Article #3.  Changing Priorities and Practices

Article #4.  From Baguio to Baguionas

Book:  Principles and Practices for Healthy Medial Missions41l78twlool



Blessing to be a Blessing

I guess I have a temperament for being task-oriented. In missions, that shows itself in trying to squeeze the last bit of ministry out of the money, and being as efficient with ministry time as possible. In teaching, I like to pump out as much information as I can, and not do too much in class that could be labelled (by people such as myself) as “frivolous.”

But then I have to remind myself of things that I have learned– things I now know are true, even though they go against my temperament.

A few years ago we did a 10-day mission trip to Palawan. It was a medical mission trip. We flew to Puerto Princesa (1), and then began a seven hour drive to Sicud (2). The next day we did a medical mission with close to a thousand patients. Then we traveled to Quezon and did a medical mission there as well (3). This one and the third were smaller medical mission sites but still handled several hundred patients each. But the day after, we take a day off and visited Tabon Caves, the local historical museum, and did some snorkeling. We then traveled back to Puerto Princesa (4), and we had another fun day snorkeling in Honda Bay. The next we preached in various local churches (I preached at Honda Bay Baptist Church… at little church for fishermen and their families… that meets on Sundays at 6:30am). The next day, we went to Concepcion barangay (5) (part of greater Puerto Princesa), and did our third medical mission. After that we returned to Puerto Princesa and flew home. palawan_map

Overall, I would consider this a successful trip. We worked effectively with local partners in Palawan (actually, this was a regionally driven short-term mission trip- I was actually the only foreigner in the group). I would like to think that the work done there was leveraged for greater work afterwards. To some extent I feel that this did occur… but I also know that some leadership changes in Palawan hampered that work as well. But one thing that made it successful was the balance of blessing and being blessed.

This was not “religious tourism.” We worked HARD, and sought to be a genuine blessing to the people in Palawan— partnering with the hosts in so doing. At the same time, we as team-members were not abused. We had fun activities, and good food, and time to socialize. We needed that as well. We need to “charge our batteries” for the rigors of the travel and the work. It also need to connect joy with serving. We may recall the hymn “There is joy in serving Jesus,” but when we work and work and work, without time for rest, recreation, and reflection, the joy can slip away. In more extreme cases, the team-members can come to believe that they are simply being used by the teamleader or the mobilizing organization.

For me, the positive experience helped me gain an appreciation for the medical mission ministry, and I eventually became a teamleader. However, I did have to remind myself more than once not to simply focus on “getting the job done.” I had to remember to ensure that the teammembers feel blessed in the experience so as to be effective channels of blessings for others.

Which Comes First

I have never cared for the assumption that the foundation for Christian Missions is the Great Commission. There are reasons for this, some of which I have talked of elsewhere. However, let’s take a fairly simple case as shown in two options:

1.  Great Commission is given priority over the Great Commandment. Behavior is given priority over the heart. So what is valued?

  • Preaching the Good News
  • Baptizing (drawing people into the unity of the church body)
  • Teaching/discipling

What happens if behavior is given priority over heart? Missions would not be easily differentiated from secular marketing. Good missions is effective missions, and effective missions is one that which brings positive results (converts/adherents).

2.  Great Commandment is given priority over the Great Commission.  If the Great Commandment is given priority over the Great Commission, then the heart is given priority over behavior. In this case then, the attitude and motivation of the Christian is to guide the behavior. We share the Gospel of Christ because we love the people we share with.

In this case, good missions is that which is motivated by love of God and love of Man. Missions must be done in good faith and good will to be considered good missions.

Let me give an example. For several years, my wife and I were part of a group that we helped found with others that did medical missions throughout the Philippines. Medical Missions is a great mission ministry from the standpoint of statistics. We were with the group from 2005 to 2009 and we treated around 30,000 people. Those who came had the gospel shared and over 50% responded. The Philippines takes seriously the idea of implied debt (“utang ng loob”) so many will respond as a way to please those who provide care.

If we are simply motivated by the Great Commission, we are simply focusing on getting as many to respond as quickly as possible and get them into the church. We are then not focused on proper medical care. We are not focused on providing what we promised. We can do “bait and switch,” deceptive marketing, and pressure tactics. But in so doing, although we might get more positive responses, we probably would be getting more negative responses as well. Unfortunately, negative responses can be poisonous in the community.

If our missions is motivated by love, then we are focused on providing good wholistic care, keeping promises, and demonstrating good will in the community. Might it get less measurable missional results? Probably… but it is likely to have more positive long-term results. People respond to divine love more over time than top-notch marketing.

I would suggest that the second case here is the correct one. While we tend to applaud big results… there is a certain “creepiness” (I swear, I can’t think of a better word) of Christian missions that seeks to be judged by numbers rather than love. Even if one desires to value “success metrics” one should take the time to view not only positive numbers, but negative numbers. When love is not the motivation, success of converts is likely to be balanced by those who have been driven away.

RA 8981. “Anti-Medical Mission” Law in the Philippines?

Provinces and regions of the Philippines
Provinces and regions of the Philippines (Photo credit: Wikipedia)

At the bottom of this post is an article about a new Philippine Law that is deemed to be anti-medical missions. I would recommend reading the article below to decide for yourself. I am NOT an expert on this law at all… nor plan to be, since I rarely do medical missions in the Philippines anymore. The law can be looked at a number of ways.

1.  It does “punish” foreigners for providing medical care in the Philippines. Ostensibly, it simply puts foreign-doctor medical missions, or the doctors themselves, under PRC (professional regulatory commission) control. However, the net effect is to set up fees, fines, and new criminal and civil penalties. In this sense, it sure seems to be harmful to the Philippines.

2.  On the other hand, most medical missions done in the Philippines are done through church groups or barangays and so don’t tend to follow Philippine Law anyway. Of course, theoretically, the added teeth of the new law might squelch medical missions. Typically, Philippine Laws are so poorly enforced that it is not clear whether there will be a real change in the landscape of medical care in the Philippines. Time will tell.

3.  From a third perspective, there are lots of doctors and nurses in the Philippines, and many of them are ready to help out their kababayan (fellow countrymen). We don’t do medical missions very often anymore. But I have been directly or indirectly involved with dozens of medical missions. Of them, only a few had any foreign doctors involved in it. All of them had a majority of the medical staff being Filipino citizens licensed to work in the Philippines. Medicine is also pretty available in the Philippines and a lot cheaper than in the US (for example), so shipping of medicine into the Philippines isn’t all that necessary. Financial support for medical missions is the major lacking in the Philippines (with the exception of some specialists, like facial reconstruction).

4.  From a fourth perspective, I have written before about the problems with medical missions. They typically have little long-term benefit for health. They may actually encourage a lack of health infrastructure in the Philippines. There are other problems as well. Having laws that promote solutions from within may not be such a bad idea.

Anyway, you can click below for an article on this topic.

New Article on Medical Missions

<div style=”margin-bottom:5px”> <strong> <a href=”; title=”Healthy medical missions article” target=”_blank”>Healthy medical missions article</a> </strong> from <strong><a href=”; target=”_blank”>Bob Munson</a></strong> </div>

Relevant Book: Healthy Christian Medical Missions

Presentation for Wholistic Ministry

I see that the transfer of my diagram to .odt to .pdf to slideshare got a bit “smudgey.” I will try to fix this in the future. However, for now, I think the paper still have value. It is based on a summarization of the literary review portion of my dissertation.

<div style=”width:477px” id=”__ss_11361853″> <strong style=”display:block;margin:12px 0 4px”><a href=”; title=”Visual Model for Christian Relief and Development” target=”_blank”>Visual Model for Christian Relief and Development</a></strong> <div style=”padding:5px 0 12px”> View more <a href=”; target=”_blank”>documents</a> from <a href=”; target=”_blank”>Bob Munson</a> </div> </div>

Medical Missions Events in the Philippines, Part V

This is the last section on Medical Mission Events. This is based on my dissertation. The focus of the dissertation was the use of medical mission events in the Philippines for long-term impact in a community by a local church. As such, the traditional medical mission is inadequate. Traditional medical missions typically have little long-term impact. Here are some

Medical Mission in Sagada, Mountain Province


1. Medical Missions needs a committed local presence. That commitment is to wholistic concern for the community. A church that simply “wants to grow” is not enough since the desire of itself can be simply selfish. A church that is concerned for the community and the people in the community needs to focus on reaching out to the community rather than trying to lure people in.

2.  Medical Missions events should do more than simply short-term medical care. There are a number of ways to do this:

-Provide health and hygiene training as part of the medical care.

-Use the mission as a catalyst for bringing together concerned entities within a community for long-term programs

-Provide training programs integrated into the medical mission or operating in parallel.

<Consider training such as provided by   or>

3.  Intentionally plan for long-term ministry. This plan should gradually transition the outside team from providing the majority of services to being technical support. This requires training for local leaders, and material transfer.

4.  Work with local authorities, not just religious groups. Utilize and partner with local health and social services.

5.  Recognize transformation and evangelism in terms of gradual change, not quick fixes. God may have taken only 6 days to make the world, but after all of this time He is still not done transforming it. Consider a dictum from Engineering. Engineers like to say (when asked to design something) “The design can be Quick, Cheap, or High Quality. You can choose any two of the three.” If it is quick and cheap, it will be low quality. If it is cheap and high quality, it will not be quick. If it is quick and high quality, it will not be cheap. Same with ministry. High quality ministry takes time. I, frankly, am not sure that throwing more money at it will allow one to reduce the time.

6.  Medical missions should be done “right”. A major purpose for medical missions is to express love and goodwill in a community in a form that can be recognized and appreciated. Therefore doing things poorly, sabotages that purpose. Here are a few things I have seen (shockingly enough) done in medical missions… that obviously should not be done:

-Bringing too little medicine (or medical samples or random medical donations).

-Bringing expired medicines.

-Hard-sell evangelism. Filipinos will typically say what people want them to say (especially if given something). Missions is not about getting people to “say stuff.” It is about changing lives.

-Bait-and-switch tactics. Don’t offer more of what people want and then switch and more of what you want.

-Having inadequate medical personnel. Inadequate can be in number, training, and licensing.

-Failing to limit the number of patients.

<The last one seems strange to some people. Consider an evangelistic concert. If 50 people come, that is okay. If 500 come that is great. If 5000 come that is excellent.> But not so in medical missions. If you have medical personnel and medicines for 500 people, if 1000 people come, a large number of people will be unhappy… at you and who you represent. It is better to have a smaller group that is treated well, than a large number treated poorly.>

I am sorry if these 5 posts are a bit disjointed. The dissertation is much much longer with much much more information. Instead of boring people with that, I just wanted to hit a few points on medical missions. Summing things up:

  1.           Doing a good job is more important than doing a big job
  2.           Preparing for long-term ministry is more important than an impressive short-term event
  3.       Demonstrating goodwill and God’s love in a tangible way is more important than “wowwing” the crowd

These three points are true with nearly all ministries.

Relevant Book: Healthy Christian Medical Missions

Medical Mission Events in the Philippines, Part IV

Partnership is necessary, albeit unpleasant at times. Some churches often do not desire to work with local government because of mistrust. NGOs often feel the same way about churches. These feelings are, sadly, often justified. Creation of solid partnerships is done due to necessity, not because it is easy or enjoyable.

Theoretical Proposition Two.  In medical missions, it is not simply what one does, but why one does it. This is because motive affects action. Good motives lead to effective ministry, while unsound motives lead to failure. Good motives in medical missions should have at least three characteristics. First, the medical team should be centered on Christ. Medical mission teams should use Christ as their example for ministry, and should seek to have the same love He has for those in need. Second, the team should be focused on the wide variety of felt and actual needs of the community. Outsiders should make a genuine attempt to give relief to the community and provide a vehicle for long-term improvement. Third, the medical team should seek to empower the local body of believers to help effectively their own community.

Theoretical Proposition Three.  A clear understanding of the goal(s) of the medical mission should be part of the planning from the beginning.It could be argued that this is simply a corollary to the first two propositions; however, the importance of this finding justifies special attention. Interviewees disagreed considerably on some points, including the goal of medical missions and the appropriate follow-up.

With regards to goal, many interviewees focused on spiritual change, while others on the wholistic side. This difference relates to Ballard’s description of attitudes regarding Christian social ministry. He describes five of them. Interviewees tended to focus on ulterior motives or on wholism. Rather than supporting one attitude and attacking another, it seems reasonable simply to note the difference in goals, and promote dialogue between outsiders and hosts to ensure that they share the same goals. The same can be said in follow-up. Others saw the role of follow-up to be with the local church or community. Some saw it as, at least in part, in the hands of the outside NGO. A miscommunication or misunderstanding between parties as to their roles on a long-term basis can result in follow-up work not being accomplished.

The difference in attitudes between the different parties is important. Most interviewees noted the importance of members of the medical mission partnership to act with the right motives. Many also noted the importance of evaluating the success of the medical mission in both implementation as well as short-term and long-term results. Differences in parties will affect how things are done and how they are evaluated.

Theoretical Proposition Four. Doing medical mission events poorly is NOT better than doing nothing at all. Poor medical services may be worse than the services already available in the area. It can also lead to unwarranted mistrust of local medical services. Mission events with no long-term strategy and no skills transfer can lead to dependency in the community, and encourage local government and organizations not to improve local health care. Medical missions that are not built on a healthy partnership can be used by local government and individuals for political ends. Local churches may use medical mission events simply to try to lure members away from other churches.

Theoretical Proposition Five.  Medical Missions need to be planned based on solid prior research, which must not only attempt to see “how” to do the medical mission, but first “if” the mission should be done at all. Some sites do not want a medical mission, and many sites that want this type of ministry do not need one. There is no such thing as a one-size-fits-all medical mission. Ones done without research may appear to be effective in the short-term, but there is no reason to expect their effectiveness as a long-term strategy for wholistic ministry to the community.

Theoretical Proposition Six.  A medical mission must always be thought of as a part of a broader, and cyclic, ministry. In some cases the medical mission team needs to plan periodically visits as a form of medical relief. In cases, skills transfer needs to happen so the community can continue on in a cycle of self-development. In other cases, the outside organization may need to change its strategy over time. For example, it may transition from medical care, to training, to capital equipment transfer. Regardless of the case, if the long-term strategy does not occur, continued transformation within the community should not be anticipated. Related to the above, a medical mission event should not be thought of as a single event. Rather it should be thought of as part of a longer-term strategy for ministry. While there may be times where one might choose to do a medical mission event with only short-term relief in mind (such as after a disaster), this should not be the norm.

Theoretical Proposition Seven. Medical mission events are not really about medical, dental, surgical, or eye care, or any of a myriad of services that can be provided. Rather, medical mission events should be about providing health, in the broadest sense. Perhaps a definition of wholistic health such as that developed by Lifewind would be appropriate. In the Community Health Evangelism model (CHE), good health is defined in terms of four good relationships: with oneself, others, God, and the environment. Another possibility would be to look toward wholistic growth as a model of good health. This model looks to Luke 2:52 for its inspiration. The verse states, “And Jesus grew in wisdom and stature, and in favor with God and men.” Thus, good health is defined as growth mentally, physically, spiritually, and socially. Regardless of the model, one’s definition of health should go beyond physical and curative health.

Theoretical Proposition Eight. An unhealthy tendency to cut corners on medical missions always exists. Some interviewees made this point indirectly. However, it was observed directly in a number cases by the difference between how interviewees say medical missions should be done and how they actually do medical missions. This study did not investigate this disconnection between theory and practice. It could be hypothesized that lack of resources or over-commitment (keeping too busy doing many medical mission events) results in missions being done differently from the recommendation of the interviewees. Since this research studied the beliefs of the interviewees more than their actions, for now the tendency to diverge from the recommended form is noted with caution.

Theoretical Proposition Nine.  Training should take on a lead role in all medical mission events. Team members must be trained before the mission as well as while they are on-the-job. The community must be trained, gaining skills previously absent. Training requires the transfer of material resources to ensure that the training can be applied.

Training should not be defined narrowly. Rather, it should be based on the needs of the community, including health and hygiene education. It could include spiritual discipleship, too. It may also include community development and livelihood aspects. The possibilities are vast. Again, the needs and desires of the community must be primary.

Theoretical Proposition Ten.  The local church must take on a role in the long-term ministry in the community. In those situations where a viable, self-sustaining body of believers does not exist, development of a local church should be a planned, intentional, outcome of the strategy utilizing the medical mission event. Where a church already exists, it should be empowered to minister effectively in the community. The reasons for this are simple. First, the local church has long-term presence that outsiders do not have. Second, the local church is able to provide the spiritual ministry lacking in other entities in the community.

Sometimes, more than one local church exists in the community. Since partnership is important in the ministry work, it is desirable to create a cooperative, rather than competitive, relationship among these churches. Medical missions should not be used as a method to draw people away from one body of believers into another.

Theoretical Proposition Eleven.  Evaluation and monitoring are necessary. They should be accomplished to make changes in an individual event or in the next cycle of work. Also, they should be done to make improvements on a long-term basis. Evaluation and monitoring should be carried out intentionally, honestly, and incorporating metrics. Not doing them can lead to failure to learn or to take advantage of new opportunities that arise.

Theoretical Proposition Twelve.  Medical missions and the broader long-term ministry in a community are spiritual work. The ministry is God’s, not people’s. This dimension of the work must be remembered in all of the research, evaluation, goal-setting, strategizing, and training involved in the activity. However, the spiritual dimension must never be used as an excuse to ignore the more mundane (or mechanistic) components of preparation and implementation. In fact, proper planning and strategizing should freely and fully incorporate prayer, meditation, seeking God’s will, and other activities that are often considered as more spiritual. These different activities should be considered complementary and synergistic.

Relevant Book: Healthy Christian Medical Missions