The risk of illness has long been a problem for missionaries who serve in less-developed areas of the world. But over the past three years, there has been a significant drop in missionary illness—the result of work done by the Medical Advisory Committee, a group who advises the Church Missionary Department and the mission presidents around the world. To learn how the health of missionaries is being safeguarded and improved, the Ensign talked with Dr. Quinton Harris, chairman of the committee and a former mission president himself.
Q. What has the work of the Medical Advisory Committee meant to the missionary effort of the Church?
A. In general, parents can now feel much more confident that a son or daughter called to serve in one of the less-developed countries of the world will be healthier while serving and will not return with a long-term illness. Missionaries, too, can feel that their health is much safer if they obey the rules they are being taught. And the decrease in missionary-days lost to illness means a more effective army of missionaries serving the Lord.
Q. Dr. Harris, what are your committee’s responsibilities?
A. In the beginning, we were dealing with some specific problems on a limited basis. But as the scope of health problems affecting the Church’s missionaries became apparent, we were given the charge to prevent missionary illness, to see that missionary illnesses are treated properly, and to minimize lost missionary time.
Q. What results have come from the committee’s work?
A. With consistent and continued emphasis on positive health practices, illness among missionaries has been reduced by an average of 75 percent in the past three years. That translates into a great reduction in time lost from missionary work and also a reduction in the cost of treatment. Convert baptisms have gone up more than 30 percent in areas the committee has visited; that could be due in part to improved health among the missionaries.
In one South American mission three years ago, the president was spending half his time dealing with health problems. The latest report from his mission shows only seven missionaries treated during the month and no time lost from missionary work.
Q. How did the Medical Advisory Committee come into being?
A. It grew out of the concern Church leaders had for individual missionaries whose health problems had come to their attention. They asked some of us who are now on the committee to investigate. As we did so, it became obvious that the problems were more widespread than we had suspected. An ad hoc committee was formed in March 1988 to formulate a plan to attack and help correct these problems. In 1990, this committee was made a standing committee of the Missionary Department.
Q. Who are the members of the committee, and what are their areas of expertise?
A. I am a specialist in internal medicine. We also have Dr. DeVon C. Hale, an internist with a subspecialty in infectious diseases; Dr. G. Homer Ellsworth, an obstetrician-gynecologist; Bruce H. Woolley, a professor of pharmacology and nutrition at Brigham Young University; Dr. Cecil Samuelson, senior vice president for medical affairs of Intermountain Health Care; James Goodrich, group manager of health services for the Church Welfare Services Department; and Joseph McPhie, director of operations for the Missionary Department, who is the coordinator of our committee.
Q. How does the committee function?
A. We’re a resource to the Missionary Department. We respond to assignments. These usually involve broad health problems and their solutions. If we handle specific cases, it’s by direction of the department.
Q. With missionaries in so many diverse areas of the world, how could the committee know what health problems most needed attention?
A. Initially, we drew on earlier studies and on personal experience. For example, Dr. Hale and Brother Goodrich had been involved in a 1981 study prompted by inquiries from a mission president. That study examined the health of missionaries in three neighboring countries. The study found that in one capital city, 15 percent of the missionaries were suffering from intestinal problems in any given week. In the second country, the figure was 35 percent, and in the third, 40 percent.
Brother Woolley had also surveyed fourteen thousand returned missionaries at BYU. He found that most of those who reported experiencing health problems in developing countries had brought those problems home with them.
After our committee was formed in 1988, we were invited to visit 110 of the Church’s missions in less-developed areas of the world to become acquainted with local doctors and evaluate medical facilities. We have now visited 88 of these missions. In doing so, we have also visited ministers of health in the national governments, health departments of the United States embassies, and Peace Corps representatives. We’ve studied health problems throughout the countries involved.
Q. What are the most common illnesses missionaries face in less-developed areas?
A. Intestinal disorders are the number-one problem. Respiratory illnesses are the second most common, and skin infections and other dermatological problems are the third. After these, a host of miscellaneous illnesses shows up. Some cases of illness may be relatively mild, but they can become more serious or cause lasting damage if they are not treated properly.
Q. Are these illnesses a threat only to missionaries from developed areas?
A. No. In our studies, we have discovered that many missionaries who are natives of the countries involved are actually sicker than missionaries from more developed areas. But the natives have grown used to feeling as they do, so they report illness less often. Some of them are never completely well.
Q. Why are illnesses like intestinal disorders so persistent in these countries?
A. It’s difficult to escape exposure to them. Often, local practices or the conditions under which missionaries live contribute to the difficulty. The earlier study by Dr. Hale and Brother Goodrich found, for instance, that diarrhea was less frequent in areas where hot water was available for dishwashing and personal hygiene. The problem was also reduced in places where missionaries had flush toilets and refrigerators. The study showed an increase in illness where missionaries ate food from street vendors, or where there were high numbers of insects or rodents in their apartments.
Sanitation problems are getting worse in some countries that have always been considered comparatively clean. Their economies have been so weakened over the past few years that their governments cannot build or repair culinary water and sewer facilities fast enough to keep up with growing populations.
Q. Are treatments readily available to clear up the illnesses that missionaries get?
A. Yes, when the illness is properly diagnosed and the proper treatment is given. But in our tours, we have sometimes found some excellent practices and facilities and some inept practices and inadequate facilities. In a few places, we found that doctors had misdiagnosed illnesses. One laboratory had none of the equipment to perform the tests for which it had been issuing reports.
Sometimes, hospitals are in dire straits, too. Some high-technology equipment exists, but much of it is in disrepair.
In addition, we found that in some Third World countries the approach to treatment is different. One missionary had received many different prescriptions from one doctor for an illness. He had one prescription for headache, one for fever, one for pain, one for nausea, and others—all drugs to treat the symptoms, but no drug to kill the bug.
In some areas, doctors may never completely treat an illness because they realize that the conditions are the same and the missionary is likely to get it again. For example, doctors may only partially treat illness resulting from intestinal parasites; they get rid of the current symptoms and hope that a person’s resistance will take over. We don’t feel that that’s satisfactory for our missionaries. We want to eradicate the illness. In our studies, we found that even though many diseases are preventable, missionaries were often coming home sick.
Q. What can be done to make sure that missionary illnesses are properly treated?
A. Our committee members identify well-trained doctors and evaluate health facilities so we can best use them. Because of his background, Dr. Samuelson can evaluate hospital facilities. With his extensive laboratory experience, Dr. Hale checks to see whether equipment is up-to-date. Bruce Woolley can evaluate the pharmacies and the drugs used.
We have taken pains to introduce mission presidents to the doctors and facilities we recommend. We have also gone into detail with mission presidents on medications, preventive measures, and treatments that should be used. We continue to support and have reinforced the need for the use of gamma globulin every three months in less-developed countries as a protection against hepatitis. In some areas, it’s important to take preventive measures against malaria.
Lady missionaries have special needs, and we recognize that. Some problems are quite sensitive for them to discuss, but they may worry that they will be damaged for life—perhaps unable to have children, for example. Dr. Ellsworth says that reassurance can be important in these cases. When we go into a mission to visit, Dr. Ellsworth usually spends an hour or two talking with the mission president’s wife about how to handle the sisters’ problems.
Q. How can missionaries keep from getting sick?
A. We put a lot of emphasis on prevention. We teach principles of water purification, food preparation and handling, and personal hygiene. In connection with personal hygiene, for example, we teach how to prevent insect bites, how to eliminate rats and pests, and so on.
All missionaries are encouraged to boil the water they drink. Where that’s not possible, soda pop can be an alternative. In an experiment, Dr. Hale injected soda pop with several pathogens; he found that after three or four hours the drink was safe. He tells us that missionaries could consider pop safe if it has been bottled for more than twenty-four hours, but that they should avoid ordering fountain drinks or putting contaminated ice in their drinks.
There are also a number of simple, inexpensive steps local members can take that will help prevent the spread of illness. In some areas, in an effort to economize, members may reuse plastic sacrament cups, without washing them, until they wear out. It seems to them a squandering of resources to throw the cups away. But the cups should at least be properly washed between each use. In one large city, we found that the water in the baptismal font was unsafe for human consumption. Pouring a cup of liquid bleach in the water and allowing it to stand for the proper amount of time resolved the problem.
Q. Can everything that is needed to treat and prevent illness be done where missionaries are serving?
A. The Church is sending vitamins to some missions to supplement the missionaries’ meager diets. The missions are also being sent drugs to help treat major illnesses, because the necessary medications are not available in some countries.
On the other hand, some medicines aren’t readily available in developed countries because certain illnesses are not commonly seen there. Where these diseases are common, it is easier to treat them in the field, where the most effective medicines can be bought. The prescribed treatments available in the United States for intestinal parasites aren’t nearly as effective as those in some other countries, and they have greater side effects. Because of our committee’s recommendations, many missionaries are now treated for parasites every six months, as well as immediately before returning home.
Q. The Church has tens of thousands of missionaries in the field; how can the needed information about prevention and treatment of disease be given to all of them?
A. We have the opportunity to teach both mission presidents and missionaries in large groups. We have been invited to speak at the annual seminar for new mission presidents at the Missionary Training Center in Provo. Members of our committee meet with missionaries at the MTC each week. And we attend mission presidents’ seminars outside the United States when we’re invited by the Missionary Executive Committee, which includes members of the Quorum of the Twelve. We have now been to seminars for missions covering most of the less-developed countries of the world, and we have given follow-up training to more than seventy mission presidents. Some of the best work we do is through one-on-one visits with mission presidents.
Q. Are these the only ways you have to teach about proper health care?
A. No, we now have some valuable educational materials to help. We have a videotape, available in English and Spanish, that teaches basics of disease prevention; where it’s appropriate, each mission has a copy to be used in zone conferences. It’s a very effective tool.
We also have recently revised the Mission President’s Health Guide and the Missionary Health Manual. One of the most important things missionaries can do is to follow the guidelines they learn from this book.
In addition, the Church has called some retired physicians as missionaries, and they have been placed in strategic spots where they can do great good. They are proselyting missionaries, but they are also serving as health medical advisers to mission presidents. We are training them specially for this role in the MTC. They serve in cities where there is more than one mission headquartered. That way, they can be of help to more than one mission. We also have twenty-two nurses in the mission fields.
Dr. Richard Hardy, in Santiago, Chile, has been having a regular weekly sick-call for missionaries in addition to his proselyting work. Sister Marian Durtschi, who worked for twenty-seven years as a physician’s assistant in Idaho, is on her second mission now, in Guatemala City. Her time, as far as her health work is concerned, is shared between two missions, with the blessing of both presidents. Her report for one of the summer months showed only eight missionary-days lost. She wrote a note that said: “I think that’s a near-miracle.”
Q. How are local members affected by efforts to improve the health of missionaries?
A. We’re focusing not only on missionary health; we’re also teaching the missionaries to show the members how to prepare their food and how to prevent illness. Where the missionaries take the time to do it, we’re getting some excellent results.
We have also had the opportunity, in one gathering, to teach basic principles of disease prevention to sixty-two stake presidents. We have had the opportunity to meet with local priesthood and Relief Society leaders in other areas as well. We hope that native missionaries will share the knowledge they have gained about disease prevention with their families and friends when they go home. It’s intended that the work we do with missionaries spills over into the lives of others. When our committee was formed, President Gordon B. Hinckley stressed that it’s important for Church members everywhere to improve their health.