Medical Preparation for Humanitarian Missions

“Doctor, this will be a very long war if for every division I have facing the enemy, I must count on a second division in hospital with malaria and a third division convalescing from this debilitating disease.” General Douglas MacArthur to Colonel Paul F. Russell, US Army malaria consultant, May 1943.

Just like soldiers going to war, people on humanitarian missions anywhere in the world can fail to accomplish their mission due to illness or injury. Whether missionaries seeking to advance the gospel of Christ, secular humanitarians trying to dig a well and build a school in a rural African village, or a combination of both, medical problems can inactivate the best intentioned and most capable teams. This article is intended to help people medically prepare themselves to go overseas on humanitarian missions. You can also watch the video.

Your baseline health

While in college I attended a lecture about living overseas doing humanitarian and missions work. The talk was fascinating but what changed my attitude was when the speaker said “to be most effective you must be in good physical condition. It does little good being an expert in your field or having the highest hopes when you physically are unable to perform.” That very day I took up running and in the 30 years since have never stopped. The basic three components of good physical health are adequate sleep (7-9 hours per night), good nutrition, and plenty of exercise. Meals should be high in fruits and vegetables, moderate in dairy, grains, and nuts, and low in meats and sweets. Exercise has three components: flexibility training six days per week, aerobic exercise at least three days per week, and resistance exercise at least two days per week, totaling at least 150 minutes of exercise per week. 10,000 steps per day is a common benchmark for walkers. Someone who is unfit at home will not become magically fit overseas; they are more likely to become even more unfit.

Living conditions will not be as comfortable on mission as they are at home. Water in developing countries is often contaminated, and ice is contaminated and scarce. Air conditioning is unheard of in much of the world, and the neediest countries are frequently the hottest. Showers, laundry, and good toilet facilities are usually harder to find in the developing world, Transportation may be lacking or dangerous, and garbage is often ubiquitous. Expect to walk farther and work harder on humanitarian trips than you do at home. Conditions that would be a minor annoyance back home can be harder to overcome. Overall, be in the best possible health before you go on mission.

Your pre-trip medical evaluation

Having practiced medicine for over two decades, I have evaluated many people preparing to travel overseas for business or pleasure. Such a visit is vital for medical preparation because it accomplishes a lot:

  1. Getting travelers up to date on their standard (US) required vaccinations.
  2. Giving travelers the vaccinations that are required for their destination, considering the conditions they are likely to face. For example, a person shopping in Tokyo for a week is not likely to need the vaccine against Japanese Encephalitis virus (JEV), but someone on a humanitarian mission for six weeks in rural Vietnam definitely needs it.
  3. Giving travelers the prophylactic medications, such as antimalarials and antidiarrheals, that are required.
  4. Refilling key prescriptions that travelers need to manage their baseline health problems, such as blood pressure or diabetes medications.
  5. Counseling the traveler on risks common to their destination, including identifying what they plan to do and figuring out how to minimize the health risks they face if they do it. This can range from teaching people about mosquito protection (bed nets, DEET and permethrin) to giving them information on local medical facilities in case they have trouble.
  6. Discussing what to bring on the trip.
  7. Discussing what to do on return from the trip, and when to come in again.

Visit your doctor at least four weeks before you leave for this evaluation. The Center for Disease Control and Prevention (CDC) provides useful information at their Traveler’s Health website. It is a good idea to visit the dentist before going since dental problems can be big and care may not be available. Patients with glasses may wish to get an updated prescription if they haven’t had one in the past year.

Insurance and Other Concerns

Most people going on humanitarian journeys will have medical insurance of some type, but you need to check the terms carefully. What benefits are available overseas? Is medical evacuation included? Do they require preapproval for visits, and is that possible at your destination? Will you need supplementary medical insurance? Trip interruption and cancelation insurance are also important. Such insurance can cost less than $10 per day.

The US State Department offers the Smart Traveler Enrollment Program (STEP). This free program allows US citizens and nationals to register their trip with the local embassy or consulate. The embassy will provide enrollees information about safety conditions in their destination countries, contact them in case of emergency, and provide a conduit for family and friends to get in touch if trouble strikes. Travelers who don’t mind the US government knowing about their trip may benefit.

The US Customs and Border Protection offers the Global Entry Program, in which pre-approved, low risk travelers get expedited clearance into the United States. The application process includes an online application, an interview, and a fee.

Your health packing list

Travelers on humanitarian trips must take the things that they need to stay healthy at home. These include:

  1. Enough prescription medications to last for the entire trip and two weeks afterward. These must be in their original containers and with original markings or they may be confiscated.
  2. One pair of glasses and one spare, or one pair of contact lenses and one spare pair of glasses.
  3. Other personal stuff such as extra batteries for a hearing aid, knee or ankle braces.
  4. Hand sanitizer, sunscreen and insect repellent.
  5. Ear plugs, since developing nations can be noisy, especially in vehicles.
  6. A pillow or neck pillow to improve sleep on planes and other vehicles and if you will be in primitive lodging.
  7. Eye covers (sleep masks) to improve sleep.
  8. Hygienic wipes to clean up when showers, or even water, are not available.
  9. Over the counter medicines – motion sickness, pain medications such as Tylenol and Motrin, decongestants, antacids, etc.
  10. If going on a medical missions trip, be sure to take personal protective equipment (PPE). This includes gloves and goggles in case you will be exposed to body fluids. For more serious risks of infection, such as responding to the current ebola outbreak, gowns and masks, or even face shields, are required. Gloves must be disposable, and everything else should at least be laundered daily after contact with patients. Adequate PPE may not be available at your destination.
  11. A basic first aid kit, including Bandaids for small wounds.
  12. Health documents such as copies of prescriptions, health insurance documents, and a contact card in case you are debilitated and colleagues need to reach the US Embassy or Consulate and someone back home.

Individual travelers will have other needs. Some may need a cane for walking, while others may need a back support to minimize their pain. Diabetics may need needles and syringes to self-treat their diabetes, and asthmatics may need inhalers. Again, people should take whatever they need to function at home, and a few other things tailored to the risks at their destination.

Healthy traveling

People going to places with poor toilet facilities often don’t drink enough clean water because they can’t find it, it is unappetizing (often warm), or they don’t want to use the toilet. This fact makes it even more important to be well hydrated (clear urine) before the trip. During the flight (or long drive), take off your shoes and stretch your feet and ankles. Stand and walk whenever you can, and sleep whenever you can, keeping a jacket or blanket nearby because planes can get cold. Keep medications, a change of clothes and raingear handy in case your luggage is lost.

Staying healthy on site

Drinking bottled water is important in all but the most developed countries, as is frequent hand washing, and using sunscreen and insect repellent. Missionary teams will likely be working with long term field workers and native staff and should take their cues from them. Non-faith based humanitarian teams should also have local support. I have seen troops in Iraq develop diarrheal disease from ice or even water on plates or soda cans so travelers must be careful. Motor vehicle accidents are the number one cause of death among travelers in the developing world and it is OK to ask local drivers to slow down.

Dietary suggestions are harder to give. The official recommendation is to eat only cooked foods and avoid salads or fresh vegetables. These recommendations are sound and can be followed by casual travelers but are harder in a missions context. Teams will often be invited into the homes of those they are working with and as such will be offered local food. As unappetizing as the food may look, it is probably the best that the host family has, and as such it would be a grave offense to reject it. There are no easy answers here, but eating small portions (never a bad plan) and staying with the food most thoroughly cooked is helpful. If you develop symptoms and make a return visit to your doctor after your trip, be sure to tell him about things like this.

Jet lag

The body operates on circadian rhythms which impact everything from hours of sleep to hormone levels. These rhythms are inherent and are influenced by light, drugs and other factors. Symptoms of jet lag include fatigue, slow mental processes, and poor sleep. Since most people don’t get enough sleep and have a baseline sleep deficit, they can minimize symptoms by getting as much sleep as possible before and during the trip. Once you are in the new time zone, stick as closely as possible to the new schedule, limiting yourself to no more than one nap of up to two hours duration per day.

Culture shock

When travelers first arrive in a new place they are often enamored by its newness. This “honeymoon” stage lasts up to a few weeks, by which time most casual travelers have returned home. Soon however, travelers who stay longer, as missionaries and humanitarian workers often do, start to dislike much of what they recently found so quaint, and they want to go home. Effectiveness plunges. Eventually they become acclimatized to the new culture just as they do to the new climate. Their function will improve and they will return to a new baseline. Culture shock happens when returning home as well.


Part of providing successful humanitarian aid is keeping team members safe. We have discussed medical issues and important threats such as motor vehicle accidents, but there are other things to keep in mind.

  1. Make copies of all travel documents, including passport, visa, plane tickets, and insurance. Keep a copy on the trip and leave a copy at home.
  2. Get good medical insurance, including evacuation insurance.
  3. Keep your passport and identification with you at all times.
  4. Avoid drawing attention to yourself, either with obnoxious behavior, ostentatious displays of wealth or immodest clothing. Avoid alcohol and drugs. You are there to serve others, not to display yourself.
  5. Do not walk or travel alone. Go in teams of at least two.
  6. Be sensitive to others and to the local culture.
  7. Do not identify yourself with issues likely to be controversial. Don’t wear obviously American or military clothing, or anything that may cause offense locally.
  8. Do not violate the trust or the security of the long term staff you are working with.

Team Leaders

It is your job to make sure that every member of your team is as ready as they can be. Consider an example from World War II:

“Good doctors are useless without good discipline. More than half the battle against disease is fought not by doctors, but by regimental officers. It is they who see that the daily dose of mepacrine is taken, that shorts are never worn, that shirts are put on and sleeves turned down before sunset… I therefore had surprise checks of whole units, every man being examined. If the overall result was less than 95% positive, I sacked the commanding officer. I only had to sack three; by then the rest had got my meaning.” General Slim, Burma Campaign, WW II (under General Slim, the malaria rate in troops decreased from 12/1000 per day to 1/1000 per day.

While team leaders in missionary and humanitarian endeavors do not have the same control over their teams as generals during war, the principles still apply. Leaders must do everything possible to help those working with them to succeed in whatever mission they face. The ultimate responsibility remains with the individual, but the leader has a vital role to play. Make sure that everyone knows what your team’s mission is, and that your team members have the right equipment and supplies to accomplish that mission.

Leaders should ensure that a first aid kit is available for the team. This should include larger quantities of medication and supplies than individuals are likely to bring.

  1. Over the counter (OTC) pain medications such as aspirin, acetaminophen and ibuprofen – at least 100 tablets of each
  2. OTC diarrhea medications such as Imodium.
  3. OTC motion sickness medications such as meclizine.
  4. Three and four inch elastic (ACE) wraps to wrap injured knees, ankles, wrists, and elbows. Be sure that someone knows how to use them.
  5. A large box of Band-Aids.
  6. Extra water bottles with water filter and purification tablets (if in a remote location).
  7. Large bottles of sunscreen and insect repellant.


It may seem that there is too much to do. It may seem like much of this preparation is not necessary. Both statements are false. First, humanitarian and missions work is vital, there are so many people with so much need that people who can should go. Second, every part of the preparation noted above must be done. To do otherwise is to compromise the effectiveness of each individual, and each team, in doing this important work.

For more information, please look at the section “Personal and Team Preparation for Humanitarian Response” under the Virtual Emergency Operations Center at

A Theology of Missions

18And Jesus came up and spoke to them, saying “All authority has been given to Me in heaven and on earth.  19“Go therefore and make disciples of all the nations, baptizing them in the name of the Father and the Son and the Holy Spirit,  20teaching them to observe all that I commanded you; and lo, I am with you always, even to the end of the age.”

This passage, so brief and so full of meaning and power to the followers of Jesus Christ, has changed the world.  The day that Jesus died, probably sometime in the spring of 30 AD, there were about 120 people who followed Him.  That night and the following Sabbath they cowered, despairing at the death of the One they loved so much, bewildered about what they were supposed to do next, and desperately hoping that the authorities were not going to murder them too.  When Sunday came and they found the tomb empty, these emotions mixed with a too-good-to-be-true excitement.  When they finally saw Him and realized that Jesus had really risen from the dead, the worries and questions dissolved into answers.  The One they loved had beaten death, their next task was whatever He directed, and they no longer cared what the authorities did.  If Jesus defeated death, those who loved Him would too.

In the last act of His earthly ministry, Jesus gave His followers their final marching orders, the verses listed above.  Over the next 2000 years the Christians, as they came to be known, spread His story to every continent, every race, and every tongue.  The 120 followers of Jesus grew into 1.5 billion, 25% of the earth’s population, who call themselves Christians.  No man alive has been untouched by the influence of the Man from Galilee. 

Not everyone, however, thinks that this influence is a good thing.  Some say that all religions are equal and so trying to convert someone to another religion is arrogant and destabilizing.  Others say that missionaries are “bigoted cultural imperialists”1.  Many countries including Israel and the Muslim world, many Indian states, and other areas have laws prohibiting missionary work and some even have laws making conversion to another religion illegal2.  There are even professing Christians who believe that missionary work and even evangelism are unnecessary. 

A Theology of Missions

What then, is the truth?  Does God want His followers today to spread the story of Jesus to others or not? If we are to share the Good News, who should we share it with?  How are we to share it?  What are the key messages to convey?  To answer these questions we must have a framework of understanding missions, a “Theology of Missions”.  We will discover that God’s mission, and therefore our mission, is to bring the entire world, whosoever will, into right relationship with Him.  This mission is worldwide and for all time and eternity3. A good place to begin any discussion is by defining key terms.  In evangelical Christianity, “missions” means “the task of making disciples in all nations” and “mission” refers to everything the Church does to glorify God.  “Missio Dei”, a Latin term, refers to everything God has done and is doing to establish His perfect plan in the universe, and “missiology” is the formal study of “mission” 4.

Having defined our terms, the next step is to study the revealed Word of God, the Bible, to discover what God thinks and feels about missions.  Genesis 1:1 is the foundation.  God created the heavens and the earth and everything therein.  The rest of that pivotal chapter tells us that God created the physical universe, the earth, the plants and animals, and Man.  It also tells us that everything He created was good.  The Sovereign Lord of the Universe made everything so He owns it, He cares about it, and humans, the rulers of the earth made in His image, must take care of everything, and everyone, He has made.   Two chapters later we discover the problem, the rebellion of man and the subjugation of creation (Romans 8:20-22).  The rest of the Bible is a story of God’s work to redeem what He has made, Missio Dei, and our part in that, Mission. 

Genesis 12:1-3 describes the first part of God’s plan of redemption.  He selected one man to father a people who would reflect the goodness and glory of God to the whole earth.  Note that election is for mission and not for privilege; a minority is elected to bear the good news to the majority5. Romans 4:13 and Galatians 3:8 emphasize the universality of Abraham’s mission.  Over time Abraham’s descendents multiply into a mighty nation and move into their own land, Canaan.  But more than just Abraham’s people are there; a mixed multitude joined the Israelites (Exodus 12:38). Psalm 67 sings out in beautiful poetry that God’s concern is not only for the people of Israel but for the world.  Dozens of places in the Old Testament teach that Israel was chosen by God not because of its own goodness or for its own sake but to bless the entire world (Psalm 2, 33, 66, 72, 98, 117, Isaiah, Jeremiah, Ezekiel, Joel, Habakkuk, Micah, Jonah and Zephaniah).  The OT conclusion is clear:  God’s concern is that the entire world is brought back into right relationship with Him.   

The New Testament is even clearer.  God the Son, Jesus Christ, has come to earth in the climax of the Father’s plan for the redemption of His creation.  Matthew 9:35-38 shows Christ’s profound compassion for the lost.  Matthew 24:14 prophesies that the gospel will be proclaimed to the entire world before the end comes.  The Great Commission (and its corresponding passages in Mark 16:14-18, Luke 24:36-49 and John 20:19-23) is the passage cited above and is the clearest statement of the Lord’s compassion for the whole world.  Though the Reformers thought this command was limited to the original disciples, given Jesus’ call for unity in all ways in the body in John 17 6, there is little reason to limit it such.  Passages in Mark describe other facets of God’s heart in missions, including His suffering and the disciples’ difficulty in doing what He requires.  Luke emphasizes Jesus as the Sent One, preaching good news to the poor, proclaiming freedom to prisoners and sight to the blind, releasing the captives, and proclaiming the year of the Lord (4:18-19). John also focuses on Jesus, this time as the center of mission. 

Acts describes God’s work in spreading the gospel among not only the Jews but also among the Gentiles.  The whole book concerns the progression of the faith across boundaries of race, tongue, religion, and even political borders.  From the cornerstone verse in Acts 1:8 to the final judgment in Revelation 23:11-15, the gospel is spread to all mankind.

Looking at these passages, the next question is how does the nature of God relate to missions?  Simply stated, creation, morality, emotion, and spirituality are outgrowths of His nature.  If “real” is defined as “actually existing as created by God”, then God’s nature is the source from which all real things in the universe flow.  He is beautiful and so His Creation is beautiful.  He is intelligent and so we are intelligent.  He feels love, joy, anger and the full range of emotions so we feel the same.  He is spirit and body (in Christ) and so we are spirit and body.  Everything that He is is reflected, albeit imperfectly and warped by sin, in us.  Sin is, in the final analysis, a warping of the real things that God has made. 

The verses above tell us the God is dedicated to the redemption of His creation and the salvation of all of those who He has called.  In the Son, He showed His willingness to suffer and His patience with the frailty of men.  His nature also reveals the message.  He is rich and He wants to give salvation to the poor, He is free and He wants to proclaim release to the captives.  He is healthy and wants to proclaim healing for the sick.  God’s nature does not merely provide the motivation for missions, but also the message.

Mission theology also relates to other aspects of theology.  If the primary realms of systematic theology are the study of God, the study of man, and the study of the created order, then missions theology, describing the work of God, man and creation, ties them together.  Since mission is the work of the church, one can argue that “The greatest proof of the validity of theology is the success of the missionary movement”7. Several paradigms are included in missions theology8.

1.    Mission between the church and others

2.    Mission of evangelism and salvation

3.    Mission as theology

4.    Missio Dei

5.    Mission as a quest for justice on earth

6.    Mission as societal liberation

7.    Mission as inculturation vs. contextualization 

It is important to emphasize that mission theology must be practical.  In the past few decades, third world countries have been developing theologians and they insist on a practical gospel 9.

Mission theology has key themes.  The first and most important is Missio Dei.  God is working in the world to accomplish His goals.  He works through the church, but He also works through secular leaders and institutions.  Nature itself moves at the voice of its Creator.  In the broadest perspective, Missio Dei is what mission theology is all about.

The second theme relates to what those people who are sent by God do.  The Lord certainly uses the world but He especially uses those He has called into His service.  The church is involved in many things, including worship, teaching, righteous living, social justice, and community activities and one theme of mission theology is “what do we do”.  The third theme is related to the second.  What is the central core of things that God’s people must do?  Churches participate in many good activities such as those above, but what are the most important things?

The fourth theme in mission theology is, “what am I as an individual Christian called to do?”  Ultimately each of us will stand alone before God and He will hold us accountable for our actions.  Mission theology leaves the theoretical and enters the practical when it forces me to discover God’s intent for my life and then say “Here am I, send me.”

Webster’s defines a motif as “a main theme or subject to be elaborated on or developed” or “a repeated figure in a design”.  Scripture provides the primary motifs in the messages that we share in the core of our mission.  They include10:

1.    The kingdom of God – the fully realized reign of God Almighty on the New Heaven and the New Earth.

2.    Jesus – God the Son who is the creator of all and the author and finisher of our faith.

3.    The Holy Spirit – God the Holy Spirit who indwells each of the chosen people, regenerating them towards perfection.

4.    The Church – the corporate body of all true believers, past, present and future.

5.    Shalom – peace, including spiritual salvation, physical healing and social justice.

6.    The Return of Christ – this age will one day pass away and Christ will return to inaugurate the new age.

Having considered Theology of Missions in some depth, the last question to address is how this should impact the lives of ordinary Christians as they serve their Lord.  The full-time Christian worker, whether missionary or church leader, will use mission theology to focus his ministry.  Understanding the relevant passages, combining them into a comprehensive understanding of God’s nature, grasping how missions theology is central to all other theology, and zeroing in on key themes and motifs will help Christian professionals bear more and better fruit in their ministries.  Layman should do the same, but will apply these truths less to the organized church than to the workaday world.


A Theology of Mission helps mankind to understand the Mission of God in all its complexity.  It makes us aware of God’s nature, His scope of concern, His key messages, and how we need to act as a result.  As a result, those whom the Lord has chosen will be in right relationship with Him forever.  Then missions as we know it will cease to exist and replaced with the ultimate goal of the church…worship11.

Jesus at the Feast of the Tabernacles

Modern Jews and Christians are far removed from the ancient Israelite culture. Our food supply in the developed world is relatively secure, while their food supply, and their survival, depended on each year’s harvest. “Feast” in rich modern nations usually means low food prices and “famine” means high food prices, whereas feast in ancient Israel meant life and famine meant death. Refrigeration and cheap transportation give us variety and reliability at the dinner table, while the lack of both made it frequently hard for the Hebrews to know where their next meal was coming from. In modern times we emphasize the role of technology in our prosperity and downplay the grace of God, while in ancient Israel they used existing technology wisely while recognizing that the hand of the Lord was the source of all things.

Is it any wonder that modern first-world Christians don’t understand how important the feasts were to the Hebrews in the Old Testament? Many Americans’ main worry surrounding the main cultural feasts, Thanksgiving and Christmas, is not putting on too much weight. Political and social leaders encourage people to enjoy family and friends, and maybe even thank others who grew the food, but say nothing about God.

To better understand the Bible we must have some understanding of the feasts that meant so much to the Israelites at the time.  

Significance of Feasts

Most ancient Israelites lived in farming villages and spent their days within a few miles of where they were born. Unlike today, when transportation is quick and communication instantaneous, transportation and communication in their world were at the same speed; that of the foot, the horse, and the ship. Travel was expensive and dangerous and people traveled little, except when going to Jerusalem twice per year for one of the feasts. There were two harvest times in ancient Israel, the spring (“Feast of Weeks”), when the winter grain was harvested, and the fall (“Feast of Tabernacles”), when the grapes and olives were brought in.

The Israelites loved their festivals. They got a break from their hard work and traveled with friends and loved ones over many miles of interesting landscapes. They met with people from the other tribes, sharing news, technological and cultural advances, and trade. When they arrived in Jerusalem they gazed at the beautiful city with its pools and palaces, and most of all saw the Temple. Most celebrants would never experience such gold, silver, silks and other finery as they saw in the City of Zion. The spread of food at the tables was spectacular, drawing the produce from every region and representing a variety of cuisine almost unimaginable to a remote villager. The religious ceremonies accompanying the feasts were impressive yet inspiring. Even more, singing with thousands of other Israelite voices, praying with their coreligionists, and sharing stories about the goodness of Jehovah was an experience they could never have anywhere else.  

Bringing all of the people together twice per year served many important functions for the government. The twelve tribes had spent more of their history divided than united (under David and Solomon only). By bringing the Hebrews together physically they were more united politically and religiously. The monarch in Jerusalem would gain legitimacy from the city, the Temple, the history, and the rituals. Thus he would find it easier to rule. It was this fear that led Jeroboam I to set up a separate religious system when he was king of the Northern Kingdom of Israel after the death of Solomon (1 Kings 12:26-33).  

The Feast of Tabernacles

God commanded His people to obey as well as to celebrate.  In Exodus 23:16 and Deuteronomy 16:13 He commanded Moses and the Hebrews to celebrate His provision for them at the end of the summer harvest.  The Feast of Tabernacles was the first feast celebrated after the Babylonian Exile (Ezra 3:2-4).  Celebrants lived in open topped tent-like structures as a reminder of the tents they lived in while wandering in the Sinai desert.  Each day of the feast, helpers would fill a golden flagon with water from the pool at Siloam.  The high priest would carry the flagon, leading a procession to the temple.  Three horn blasts were sounded and a choir would sing the “Hallel” (Psalms 113-118). On the last verse, each male would wave a branch, hold a citrus fruit and cry “Give thanks to the Lord”.  The daily drink offering of wine and the water would then be poured out to the Lord (pp 321-322).  Josephus wrote that Tabernacles was the most popular and one of the most significant of the major Jewish feasts (Kostenberger 108). 

Jesus fulfilled the symbolism

Despite the fact that the Jewish leaders in Judea wanted Him dead, Jesus had the Father’s work to do and He traveled secretly to Jerusalem.  The symbolic parallels between Jesus and the Feast of Tabernacles were great.  As Tabernacles was a celebration of the provision of God for His people, so Jesus is the ultimate provision of God for His people.  As the outpouring of water was one of the key rituals in the festival, so Jesus is the source of Living Water. On the final day, the greatest day of the feast, Jesus stood up and shouted that He was the source of the Spirit and that whoever believed in Him would outflow with rivers of Living Water (Kostenberger 109). 

Notice that Jesus’ imagery was not of a cup overflowing with good things as David’s was (Psalm 23:5). As beautiful a picture as this is, it is far too small. Instead Jesus’ word picture was of rivers of living water flowing out of Him. Even more amazing, Jesus promised that rivers of life would flow even out of those who believed in Him (John 7:38). The devoted Christian is not one who is needy and sucking in, barely surviving and always wanting more in a hostile world. Rather he is one who is overflowing with rivers of love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self-control (Galatians 5:22-23).

Role of water in the feast

Water played a great role in the feast, both in the ceremony of the outpouring noted above and also in the Old Testament background to the feast. In the parched land of Israel, especially at the end of a hot summer, the beginning of the rainy season in October was a welcome relief. Thus water itself was evidence of God’s gracious provision for the people and the promise of a good harvest the next year. Just as the first fruits of the harvest were given to the Lord in thanks for His care, so water was given to Him in gratitude for His goodness.  

Old Testament background to Jesus’ interaction with the Jews at the Feast.

Jesus presented Himself to the Jews as the source of the Living Water, the Spirit that God promised His people. The miracle noted in Exodus 17 in which God provided water from a rock provided the basis for the Feast of Booths and for the imagery of God providing His Spirit. Isaiah cited God’s free offer of mercy to him who thirsts (Isaiah 55:1), Ezekiel described the water of the Lord, referring to His Spirit, flowing out of the temple (Ezekiel 47:1-9), and Zechariah painted a similar picture (Zechariah 13:1). All of these form the background of Jesus’ interaction with the Jews at this feast.


The Bible is difficult to understand because it was written long ago to people far removed from our day to day experience. Nonetheless it is the Word of God and therefore Christians must study it; bringing our knowledge as closely to theirs as possible. When we do we discover that feasts were vital to public and religious lives of ancient Hebrews, and held tremendous imagery reflecting what God would do for His people. Jesus came, fulfilled the prophecy and clarified the imagery. He then offered rivers of Living Water to all those who believed in Him.


Carson, D. A. The Gospel according to John (Pillar New Testament Commentary). Grand Rapids: Wm. B. Eerdmans Publishing Co., 1990.

Kostenberger, Andreas J. Encountering John: The Gospel in Historical, Literary, and Theological Perspective. Grand Rapids: Baker, 1999.

A Sense of Time and Place

Several months ago I waited with my children at the school bus stop. It was a cool, sunny morning and a neighbor and her child walked towards us. She had a Middle Eastern accent and an olive complexion. Having learned some Arabic in Iraq I greeted her with “Sabah al khair” (“Good morning”) and she replied with “Sabah al noor.” Curious, I asked where she came from, expecting the answer to be an Arab country in the Middle East. She replied “Iran”, where the dominant language is Farsi, and I asked if she spoke Arabic as well as Farsi and English. She answered “no, but Farsi has adopted many Arabic words and phrases since they invaded us.” What strange words to American ears, “since they invaded us.” Her explanation was shockingly personal and immediate, as though it had happened to her, even though the invasion of which she spoke was in 636 AD, climaxing in the famous Battle of al-Qadisiyyah. I couldn’t imagine saying of the British “since they invaded us”, as though it happened to me personally, but the history rolled off her tongue as if it was a current event. I asked if that was the invasion that she was referring to and she said “yes”. The centuries that had passed had no bearing on her feelings about it.

In January 2003 I was stationed in Heidelberg, Germany and encountered a truck driver delivering a package to the community center at Patrick Henry Village. His name was von Manteuffel and during our conversation I asked if he was related to the famous German general from World War II, Hasso von Manteuffel. The truck driver sprang to attention, clicked his heels together and replied “Feld Marshal General von Manteuffel war mein grossvater (General Field Marshall von Manteuffel was my grandfather).” This ordinary man beamed with pride because of the exploits of his grandfather, as though he shared in them by virtue of their common blood. I later described this encounter to the US Army Europe (USAREUR) historian who explained it by saying “Americans have little sense of history and place; certainly nothing like we find in Europe. Heimat (home) is more than a place to Europeans; for them it is filled with meaning in a way that is hard for many of us to understand.”

Abraham Lincoln famously said “I don’t know who my grandfather was; I am much more concerned to know what his grandson will be.” Like most Americans, Lincoln was always looking forward and rarely looking back. It is difficult to imagine my neighbor at the bus stop or the truck driver in Heidelberg saying what Lincoln did because the distant past was as real to them as events yesterday. Their sense of time and place, and its effects on the present, were palpable. My neighbor and the truck driver would have been puzzled by Lincoln, but both would have perfectly understood Colonel Robert E. Lee’s refusal to fight for the Union against his native Virginia.

American policy makers have struggled for years with this mindset. More than one leader complained about the Serb determination to keep Kosovo; never understanding that it related, at least in part, to their crushing defeat under Prince Lazar against the Ottomans under Murad I in 1389. Some thought that this explanation was a ruse intended to cover up their real reason for waiting to keep the territory, such as money or power. It may have been, but only in part.

We encountered the same problem in Iraq. The Sunnis and the Shia have been bitter foes for millennia, since Imam Hussein was killed by the forces of Yazid at the Battle of Karbala (680 AD). Though there are current reasons for their animosity, ancient ones still matter. Events of which most Americans have never heard influence peoples’ thoughts and actions today. Many Turks remember and still rejoice in the Fall of Constantinople (1453) and Osama Bin Laden was motivated to terror, at least in part, in response to the Spanish Reconquista (1492).

Each individual attaches a different level of importance to their home and each perceives time a little differently. Some Americans have a powerful sense of the importance of their place and some Germans have little concept of Heimat. I have met people in the American South who, like my Persian friend, bristle at the Union forces who “invaded them” 150 years ago. On the other hand, many Americans hold no grudge against the Japanese, even though their atrocities happened much later. Culture, not necessarily nation, seems to be the key factor here. How each person views time and place seems to fall along a continuum; some value both highly, others not at all, and most people fall in between.

Is one attitude morally better than the other? No. However, depending on the situation, one attitude may be more useful than the other. Looking the future and not getting weighed down in the past has served America well. However, any American who wishes to stop a war or sell a car overseas must acknowledge that people in other cultures view the world with different eyes. While the basics, including physiological needs, security needs, esteem, love and belonging are consistent across the cultures, the specifics vary.

What should American Military Members, and Others Dealing with People from Other Cultures, Do?
1. Accept that not everyone sees the world as we do. In some cases others may be amenable to change, but in many cases not. In some cases we may need to change.
2. Study the history, language and culture of those we work with, and fight against.
3. Ask them why they do what they do.
4. Believe their answer, but take it with a dose of healthy skepticism.

Vincenzo Perugia stole the Mona Lisa from the Louvre Museum in Paris in August of 1911. When arrested in 1913 after trying to sell the painting to the curator of the Uffizi Gallery in Florence, Perugia was asked why he had stolen it. He replied that he had done it to reclaim an Italian national treasure that Napoleon had stolen. Though Napoleon did take hundreds of works of art during his Italian campaign (1796-7), the Mona Lisa was not one of them. King Francois had purchased the Mona Lisa from Da Vinci’s assistant Salai, who had inherited the piece after his master’s death. Though Italians hailed Perugia for his patriotism, the fact remains that he had tried to sell the painting. Even if he had a nationalistic motive, it wasn’t his only one.

American leaders at all levels must be aware of the different cultures they encounter and work to accomplish the goals of our nation without unduly offending our hosts. Though we may find these attitudes frustrating, on political and financial levels we must accept these differences of opinion and deal with them when accomplishing the mission. This is as fundamental to foreign policy as it is to commercial success. The United States will need a leaders with this knowledge and these skills to lead our nation in an increasingly complex and diverse world in the future.

Hellenization After Alexander – What was it, and Why Did it Matter?

When conquerors want to subdue a foe, they crush their armies. If they want to rule a conquered land, however, they must displace the culture of that land. Alexander the Great knew this, and as he wanted an empire that would outlive him, he needed to displace conquered cultures with his own. This was especially urgent to him due to the diversity of his empire, including Assyrians, Jews, Egyptians, Persians, Parthians, Armenians, and a host of others. Hellenism is Greek culture, and is the primary weapon, even more than his armies, that Alexander used to influence Middle Eastern and European history for millennia.

Some cultures assimilate foreign ideas easily, such as the Indian culture with its pervasive Hindu influence. Other cultures do not, such as that of Ancient Israel. Cities tend to adopt new cultures more quickly and easily than rural areas. This is partly because fewer people live in rural areas, technology and new ideas diffuse out there more slowly, and it is more cost effective to exercise influence in large populations than small. That is why politicians in a direct democracy spend more time in urban centers. If the US President was elected directly by popular vote rather than the electoral college, few contenders would ever show up in Iowa or New Hampshire.

Hellenism was urban, polytheistic, inclusive, and focused on the individual. Ancient Hebrew culture was rural, monotheistic, exclusive, and focused on the community. Hellenism was dualistic in its understanding of man and the universe. Ancient Hebrew Culture was unitary, believing in a united nature of man and God, even to the extent that Samuel speaks of Saul being afflicted by an “evil spirit from the Lord” (1 Samuel 16:14-15). No matter the conqueror, whether Nebuchadnezzar, Alexander, or Caesar, Palestine was known as a restive province due to the culture of its people.

Several individuals and groups followed closely after Alexander in their enthusiasm for Hellenization. Among the most fervent were Antiochus Epiphanes (216-164 BC), who desecrated the Jewish temple, Aristobulus II (reigned 66-63 BC), one of the last Hasmonean rulers, and the Sanhedrin, the ruling Jewish council, primarily comprised of Sadducees, who instigated the murder of Jesus. Many of these encouraged the spread of Hellenism for their own financial and political gain, although the inherent pluralism of Greek culture was conducive to Emperor worship and religious tolerance and therefore beneficial to those who wanted to maintain the status quo.

The Jews believed that they were punished by God for their failure to obey and follow the Law of Moses when Jerusalem fell to Nebuchadnezzar in 586 BC, and they were not about to make the same mistake twice. So when challenged with Hellenism, many Jews, among whom were the Hasidim (“pious ones”, later giving rise to the New Testament Pharisees), rejected it, sometimes violently. The armed rebellion of the Maccabees was rooted in opposition to Hellenistic paganism. Others accepted secular but not religious parts of Hellenism, while still others abandoned the Hebrew faith and became Greek in their religion and worldview.

In many ways, Western culture, with its Christian religious roots and its Greek systems of thought, is a direct outgrowth of the synthesis of Hebrew and Greek culture. Even today a German “gymnasium” is not just a place for sports and exercise but a secondary school with all kinds of learning and activities, similar to what it was in Ancient Greece. It is no exaggeration to say that the amalgam of Greek and Hebrew thought that arose in the Eastern Mediterranean in the centuries surrounding the birth of Christ made Western Civilization what it is. Europeans and Americans cannot understand their way of life and point of view without comprehending this union of Hebrew and Greek thought.

Preunderstandings and Presuppositions

In the Rodgers and Hammerstein musical the Sound of Music, 17 year old Rolf sings to his beloved 16 year old Liesl about her innocence as she makes the transition into adulthood. Rolf’s song, Sixteen Going on Seventeen, includes the line “your life, little girl, is an empty page, that men will want to write on.”

Though a charming sentiment, it is not really true. None of our lives are an empty page, ready to learn and experience anything that comes our way with complete accuracy and objectivity. We are each preconditioned by a host of factors to see and respond to life in a particular way.

1. Genetics – A man who is color blind can never experience certain colors. Though the colors exist he is unable to see them, and so a traffic light that is in fact red may be forever perceived by this man as gray. The same is true of hearing problems and other medical disorders such as limb agenesis.
2. Sex – Men and women experience the world differently because of their anatomical, biochemical and socio-behavioral makeup. When a woman alone meets a strange man her first thought is often of fear and a desire for security. When a man alone meets the same strange man he may barely notice him.
3. Race – Blacks, whites, Hispanics, Indians, Asians, and all other races treat each other and are treated by each other differently in different areas of the world and at different times in history. A Chinese man in America in the 1800s may have been considered stupid but the same man in America today may be considered smart. He may have considered himself superior as a man from the “Middle Kingdom” to the “white barbarians”.
4. Culture – Civilizations with a basis in Christianity, scientific progress and the rule of law have a very different set of assumptions than those with a basis in Islam, Hinduism, Buddhism or Judaism, and those in which there is little technological progress and power is the only law. Early nineteenth century Hindus saw sati, the practice of immolating a widow on the pyre of her dead husband, as a valid and even constructive practice. The British, who controlled most of India in the eighteenth and nineteenth centuries, saw it as evil. The difference was their culture.
5. Experiences – In the Sound of Music, Liesl lived in a secure wealthy home with six siblings and a famous father, but without her mother, who had died several years before. She never woke up hungry in the morning, went to a factory or farm to work 12 hours and earn a few schillings, and then trudged home again to a cold, dark room. Educational and cultural experiences and the willingness to learn from them are also important.
6. Language – Each language has characteristics which influence how people who use that language speak and even think. German is a harsh sounding language which loads up verbs at the end of sentences and takes a lot of words to express a thought. The Gideon’s German translation of the New Testament, for example, has 338 pages and the English New Testament translation of the New Testament has 220 pages (1).

It should be clear that as Liesl was not actually an empty page, neither are we. Each of us sees reality in a way which is shaped and colored by the factors above, almost as glasses shape and color what we see. If because of struggles and suffering our individual glasses are dark like sunglasses, we may see reality as dark and foreboding. If because of wealth and ease they are rosy we may see reality as warm and safe. When we encounter a new thing, such as a passage in the Bible, we understand the new thing in light of what we have seen before. This is called preunderstanding.

Preunderstanding affects our ability to understand anything we encounter because it limits the possibilities we are willing to consider. Consider a cherished American phrase in the Declaration of Independence, “all men are created equal”. What could this mean?

1. All men are created equal to each other, but women and children are not.
2. All men and women are created equal to each other, but children are not.
3. All human beings are created equal to all other human beings.
4. Whoever is created equal, they are all equal in physical and mental abilities.
5. Whoever is created equal, they are all equal in outcomes, including wealth, health, and whatever else the observer would like to measure.
6. Whoever is created equal, they are all equal in value before their Creator.
7. Whoever is created equal, they are all equal in value before the writers of the Declaration, who were representing the government.
8. Whoever is created equal, they are all equal in value before the people of the United States.

If Person A’s preunderstanding makes him or her value men over others, he or she may preferentially choose number one. If Person B has an atheistic preunderstanding, he or she will exclude number six out of hand. Just as our preunderstanding limits how we interpret the Declaration of Independence, it will also limit how we understand the Bible.

Preunderstanding can be good and bad; helpful and unhelpful. As a physician, I must have a great deal of biomedical preunderstanding if I hope to diagnose and treat my patients. We test preunderstandings to see if they are adequate and appropriate in various ways.

1. We compare them to facts. Sometimes our preunderstandings are simply wrong. Alchemists for centuries thought that earth, air, fire and water could make gold.
2. We evaluate them against other parts of Scripture. The wise men clearly did not show up at the manger on the same night as the shepherds, and deceased people do not become angels.
3. We expose them to other ideas and people with other preunderstandings, through education, travel and interaction with others, and evaluate them in the light of God’s word and His Spirit.

Preunderstandings can never be completely eliminated because just as we do not notice our glasses when wearing them, we also can never see all of the factors influencing how we understand reality. Education, a wide variety of experiences, and a willingness to experience and learn from other cultures can help us minimize our harmful preunderstandings. Simply being aware of how we see the world and being humble enough to admit that in some areas we may be wrong will help us overcome errors in our preunderstanding.

Presuppositions are assumptions that we bring into the thing we are trying to understand (2). They are usually conscious, as opposed to preunderstandings which are often subconscious. A Bible critic who presupposes that miracles cannot exist must necessarily interpret the miracles in the Bible as something else. Evangelicals typically presuppose that the Bible is the inspired Word of God, is a trustworthy guide to the work of God in human history, and is unified yet diverse (3).

As an American, my preunderstandings are those common to my culture. I tend to emphasize freedom and individual action over authority and communal action. It is difficult to understand how a man can be saved with his entire household (Acts 16:31-33) unless each member individually accepts Christ. It is really difficult to understand how the sin of Adam and Eve somehow condemns all of their descendents an sinful nature. Perhaps people from a more communal culture can understand that better. The American culture is also one that values progress, activity and accomplishment, and I am deeply affected by these values as well. A former pastor of mine, Mike, was traveling in Kenya with a missions group from our El Paso church. When meeting the hosting Kenyan pastor and his lay leaders, Mike introduced each man and told their occupation. The Kenyans were unimpressed. What they really wanted to know was how many children each man had. What a difference in culture!

1. The New Testament, Gideon’s International
2. Presupposition, Webster’s New World Dictionary, 2nd collegiate edition, 1984, Simon and Schuster, New York NY, 1984
3. Duvall JS, Hays JD, Grasping God’s Word, Zondervan 2nd ed, Grand Rapids MI, 2005, p95

Hermeneutics – The Art and Science of Bible Interpretation

Hermeneutics, defined as the science of interpretation, is important in every field of endeavor (1). People working in law, philosophy and religion use hermeneutical techniques to interpret communication, whether written, oral or otherwise, but so do friends arranging a party, and even lovers proclaiming their everlasting devotion. Biblical hermeneutics applies the art and science of hermeneutics to gathering meaning in the Bible.

When a book is written and subsequently read, information and emotion are transferred from author to reader, and both have an important role in the process. Things become more complex when the reader is not the reader that the author was writing for, as is the case with the Bible. The role of the author is to assemble his ideas in a coherent fashion and then decide how best to communicate those ideas to his intended audience. He may use different languages, different genres (narrative, poetry, law, prophecy, wisdom, letters, and apocalyptic), different words, and different stories to illustrate his points (2). The author then puts pen to paper (or fingers to keyboard) to write his work.

Authors always write for specific audiences just as actors always play for specific audiences. The audience usually shares the author’s language, culture, geography and period in history. Communication with such an audience, while difficult in the best of circumstances, is far easier than communication with audiences that do not share these characteristics with the author. The role of the original readers of the text is to understand the meaning that the author put into the text when he wrote it for them.

When the reader is not from the intended audience, such as modern day interpreters striving to understand and apply the Bible, communication is more challenging. Intended audiences of Bible books intuitively understood the background, setting, assumptions and authorship of the texts and could apply the message directly to their lives. Modern interpreters must discover the background, setting, assumptions and authorship and how the intended readers understood the passage (exegesis) (3). Only then can they understand the meaning in their context and finally apply the passage to their lives (3).

Further, all readers bring their own set of experiences, beliefs, preferences and assumptions about reality to any work that they read (2). In postmodern thought, it is not authors but readers who actually determine the meaning. On one hand, this is ridiculous. No judge writing a criminal verdict or bank sending out an account statement would agree that it is the reader who determines the meaning of what they have written. On the other hand, reader biases inevitably lead them to see things in a way that the author never intended, and miss things that the author intended to be clear. Readers must be aware of these things, the glasses through which they see reality, and be careful. All participants are important in conveying God’s message in the Bible. However, modern readers of Scripture are neither authors nor intended audiences, and we must therefore take special note to avoid the pitfalls of interpreters.

Four major challenges exist for a third party striving to understand a Biblical book (2). First, the Biblical languages of Greek, Hebrew and Aramaic are far different than almost all modern languages. Even Modern Greek (13M speakers), Hebrew (9M), and Aramaic (400K), spoken by less than 0.5% of the world’s population today, are significantly different from their forebears. Since languages never translate exactly into one another, meaning is inevitably changed and the author’s original meaning becomes more difficult to find. Second, the geography of the Middle East, Egypt and Southeastern Europe, the setting of the Bible, is vastly different from that of Northern Europe, Central and East Asia, the Americas, and the rest of the world. It is difficult to understand many of the events in Bible history without understanding the geography. Third, ancient Near Eastern culture is vastly different than cultures today, even modern Near Eastern ones. Webster defines culture as “the ideas, customs, skills, arts, etc. of a given people in a given period (4).” Culture involves religion, food, and everything large and small that characterizes a unique people. Much of culture is unnoticed by its natives; just as fish do not notice the water they swim in. Therefore, it is very hard to know, much less adapt to, a culture foreign to a person’s native one. Such adaptation, or at least knowledge, is important to understanding how the original audience understood a passage. Fourth, life from 2000 BC to 100 AD was vastly different than it is today, so time is a great separator of modern man from the original Biblical audience.

Geography is the easiest to overcome. The physical layout of the Bible lands and even their climate has changed little since Jesus’ time. It is not difficult to travel to most of the places that our predecessors walked. Culture is the hardest to overcome. Veteran missionaries born in the West who have spent decades in modern foreign cultures still cannot be totally a part of them (5). They can adopt the dress, the language, the food, the housing, the mannerisms, and even many of the attitudes of their new culture, and yet remain just a little bit outside (5). How much less can any of us become part of a culture that no longer exists? The best that we can do is to come close. Usually that is good enough.

Time is a very great distance between the modern day and the Biblical day which can never be fully overcome. Human nature and the natural world have stayed basically the same and yet the technologies of our lives and many of our ways of thinking have changed dramatically since Solomon wrote “there is nothing new under the sun.” The ancients held a largely cyclical view of life while moderns hold a more linear view. The ancients believed that religion and society were inseparable while most Westerners sharply divide the spiritual and the secular. Americans in general really believe that all men are created equal; a statement which would have been ludicrous to the most progressive Sumerian. Most of our assumptions about life are unquestioned, just as our forefathers’ were, and therefore color our observations without us even knowing it.

Another way in which time separates us from our forebears in the Bible could be known as “chronological chauvinism.” Later generations in the developed world generally think that they have better understanding of almost everything than previous generations did. As a young teen I was visiting a park in Bakersfield, California with my grandmother and she showed me a 19th century locomotive. As I mentally compared the old fashioned looking engine with mental visions of jet airplanes and spaceships, I asked her why earlier generations weren’t smart enough to figure out the wonderful things that we had. Taken aback, she scolded “Don’t ever let me hear you say that again! Why do the young always think that they are better than the old?”

In the same way, modern man believes that ideas of the divine right of kings, arranged marriages, inequalities between persons in society, and many other ancient ideas are not just incorrect but shameful. We judge not only the wisdom of our ancestors but also their morality. As such, we listen little and learn less. Our forebears had many things wrong with their worldview, but so do we. I am confident that people studying us 100 years from now will be dismayed by what they perceive as our ignorance and wickedness, and others later will think the same of them.

Time, and all of the attitudes surrounding it, does indeed pose a major obstacle to our understanding the word of God.

Many in history, such as the famous Alexandrian bishop Origen, have emphasized the allegorical over the historical sense of Scripture. They may give a passing nod to the historical meaning of a passage but then construct an allegorical meaning which they consider to be the true one. Often, the true historical context and significance is ignored and interpretations become fanciful. Allegory is present in the Bible but the plain historical sense of what was written is usually the better guide to truth.

In conclusion, hermeneutics refers to deriving meaning from content, such as speech or literature. Biblical hermeneutics deals with correctly interpreting the Bible. It is harder than it seems, with culture, geography, time, and language forming high barriers to understanding, much less applying the Bible to the modern day. It is not subjective; the Biblical authors put meaning into their words just as authors today do (2 Peter 1:21). Despite the fact that perfect interpretation is impossible (in everything, not just Christianity), mankind can understand God’s intent through Scriptures, and interpreting the Bible is one of the highest callings anyone can undertake. The Bible reveals the person of God, the highest and most wonderful person that man can conceive.


1. Hermeneutics, Webster’s New World Dictionary, 2nd collegiate edition, Simon and Schuster, New York NY, 1984
2. Klein WW, Blomberg CL, Hubbard RL, Introduction to Biblical Interpretation, Thomas Nelson, Nashville TN, 2004, pp 3-21
3. Fee GD, Stuart D, How to Read the Bible for all it’s Worth, Zondervan, Grand Rapids MI, 2003, p 23
4. Culture, Webster’s New World Dictionary, 2nd collegiate edition, 1984, Simon and Schuster, New York NY, 1984
5. Reyburn WD, Identification in the Missionary Task, Perspectives in the World Christian Movement, 4th ed, Winter RW, Hawthorne SC (Editors), William Carey Library, Pasadena CA, 2009, pp 470-476