During 35 years of practice as a cardiovascular and thoracic surgeon, I performed thousands of operations on the heart. After cardiac surgery, patients would often ask me how they could prevent future surgery. And even if they didn’t ask, I felt obligated to advise them anyway. I would talk to them about the importance of a healthy diet, appropriate weight, aerobic exercise, adequate rest, and stress reduction. Those who acted on my advice were generally blessed with years of comfortable living. Many of those who lacked the resolve to make the necessary lifestyle changes had to face the surgical knife again—often sooner rather than later.
Preventive measures are also essential for young adults who are preparing to serve missions. Today about 3 percent of missionaries have their missions shortened by either physical or mental health problems. Losing three out of 100 missionaries may not seem like very many. But to the individual and his or her family, having a mission cut short is significant.
For more than a year, I have served in a calling in which I observe the health problems missionaries encounter. Based on my experiences in this assignment, I would offer the following information to help young people who are preparing to become missionaries reduce the likelihood of developing these health problems.
Fortunately, many of the health problems that missionaries encounter are preventable with proper preparation. Elder David A. Bednar of the Quorum of the Twelve Apostles stated, “The single most important thing you can do to prepare for a call to serve is to become a missionary long before you go on a mission.”1
I recommend that health preparation begin at least two years in advance of the anticipated missionary service. Those who wait to prepare until the last minute or until after they have received the call to serve may not be ready and may even have their missions delayed.
Physical health preparation usually includes a routine office consultation with a medical doctor and a dentist. In some cases, mental health preparation may require evaluation by a mental health professional.
Regular (daily) exercise. A missionary must be able to walk an average of six miles (10 km) per day and ride a bicycle 12 miles (19 km) per day. Prospective missionaries who aren’t walking more than from the car to a class or a job will likely get sore feet and blisters when they reach the mission field. Those who are not used to riding a bicycle regularly will also become very “saddle sore” when a bike becomes their primary means of transportation. A missionary who is out of shape will be fatigued by missionary work, and a tired missionary is more open to discouragement and health concerns than a missionary who is physically fit.
Prospective missionaries can prepare for the rigors of missionary life by establishing a regular pattern of aerobic exercise—walking, running, or cycling for one hour every day. Those whose primary form of exercise is playing electronic games or text messaging will take at least four months to achieve the level of conditioning that will allow them to actually enjoy a workout.
Adequate sleep. Although sleep needs vary, young adults generally need to sleep seven to eight hours per day. Ideally, they should be in bed by 10:30 to midnight and out of bed by 6:30 to 8:00 a.m. Staying up until 2:00 or 3:00 a.m. and sleeping until 10:00 a.m. leaves a person feeling tired all the time and wanting to sleep until noon. Staying up all night to cram for examinations, playing video games most of the night, or working a graveyard shift can be detrimental because keeping late hours resets the body’s clock. Missionaries live a scheduled life. They are in bed by 10:30 p.m. and up by 6:30 a.m. every day. This schedule will be difficult unless prospective missionaries get into a similar routine well in advance of the call to service.
Healthy eating habits. Rather than living on sugar and fat, young people should learn to enjoy meals consisting of protein and fiber, such as lean meat, yogurt, vegetables, and fruit. Also, drinking more than 12 ounces of carbonated beverage per day is too much.
The Missionary Department requires that missionaries have a body mass index no higher than 37. This is actually on the border between obesity and morbid obesity. Prospective missionaries should strive to keep their weight in the normal range, thereby avoiding obesity-related health problems. Being markedly under normal weight can also have serious health consequences.
Meal preparation skills. Parents can help their sons and daughters learn how to prepare simple, healthy meals. I stress the word simple because missionaries often cook food on a hot plate or a single gas burner and may not have an oven. Every prospective missionary needs to know the basics of cooking and sanitary food handling. Since dishwashers are rarely found in missionary living quarters, it is also important to know how to clean up after meals with hot water and dish soap.
Personal hygiene. Personal cleanliness and good grooming habits are vital to missionary success. Favorable first impressions are lasting. Clean hands also help missionaries stay healthy and prevent the spread of communicable diseases.
Skin problems. Acne is a common teenage problem. Those with a severe acne problem should get help from a medical doctor well before entering the Missionary Training Center. Some acne medicines require monitoring over time and are not used in the mission field.
Dental health. Prevention is the key to good dental health. This means a habit of brushing teeth at least morning and night, daily use of dental floss, and consistent visits to your dentist. Any required dental repair should be finished before the missionary recommendation is submitted. Orthodontic treatment—which often takes two years or more—must be completed before arrival at the MTC.
Chronic health issues. Headaches are a common, difficult health problem that may worsen during missionary service and that can be difficult to evaluate and treat in the field. Occasional stomach and bowel problems may also become chronic during missionary service. Heart problems and breathing problems such as asthma should be thoroughly evaluated before missionaries begin service. With proper treatment, many health problems become controllable, making missionary service possible if treatment continues throughout the mission.
Bone and joint problems resulting from injury may require surgery. Orthopedic procedures, even arthroscopic operations, usually entail lengthy periods of rehabilitation. Prospective missionaries must obtain appropriate orthopedic care well in advance (four to six months) of entering missionary service. A young man or woman who arrives at the MTC on crutches two weeks after knee surgery will not be able to walk the distance required in the mission field.
Immunizations. Those preparing to serve missions should obtain all available routine vaccinations and booster injections at appropriate ages. Well before beginning their missionary service, they should also receive any special immunizations required for the particular country where they will serve.
The advantages of immunization overwhelmingly exceed the minuscule risks of receiving vaccines. Immunization renders an individual resistant to disease for varying time periods. Maintaining immunity may require a booster injection.
All people have moments of sadness, anxiety, and discouragement. This is normal, especially at times of loss and grief. However, any emotional difficulty that interferes with normal daily functioning needs to be dealt with before missionary service begins.
Any unresolved sins can affect both the mental and physical health of individuals. These should be resolved through full repentance as potential missionaries meet with their bishops before receiving a call. But once this is done, there still may be other conditions needing treatment.
Mood disorders. Those who suffer from chronic or recurring feelings of depression, sadness, anxiety, or fear should be evaluated by a doctor or mental health counselor. Mood swings, especially when they involve temper and anger, should also be evaluated. Treatment, including counseling or medication or both, often reduces or relieves mood disorders, making missionary service possible.
Abnormal thought patterns. Excessive worry and guilt can seriously impair a missionary’s ability to serve. Perfectionism, which is a consuming need to be perfect, can also become a crippling mental health issue. Recurring painful thoughts and repetitive behaviors such as excessive hand washing are signs of obsessive-compulsive thought disorder. Counseling with a doctor or mental health professional can often effectively treat these abnormal thought patterns.
Learning disorders. Because the ability to learn and teach is the essence of missionary work, learning problems such as attention deficit disorder (ADD) can impair missionary success. However, evaluation and treatment of learning disorders may improve learning ability considerably. Some learning disorders may not be compatible with missionary life. Parents and prospective missionaries should prayerfully counsel with their bishop and professionals on the viability of serving a full-time proselyting mission.
Eating disorders. Because people can use food to comfort themselves and relieve feelings of depression or anxiety, eating can become an addiction leading to obesity. On the other hand, social pressure to be lean or even underweight can lead to anorexia nervosa or bulimia, both of which create serious health risks. These disorders will not resolve themselves during a mission. Because they are so difficult to treat, they may not be compatible with missionary service.
Homesickness. While mild homesickness is a normal part of the mission experience, leaving parents and siblings can cause anxiety so intense that it interferes with the ability to sleep or eat. Rapid weight loss is common among missionaries with severe separation anxiety. To prevent these problems, prospective missionaries should become comfortable being away from home. Extended camping trips or living in a dormitory at school can reveal any tendency for severe separation anxiety. Those who do have problems functioning when they are away from home should seek treatment from a doctor or mental health professional.
Social skills. Missionary work involves meeting and conversing with people of all ages and speaking before groups. Prospective missionaries should become comfortable talking to older people. They should practice being respectful and courteous, using proper table manners, and observing other social courtesies. Missionaries are also required to approach strangers and strike up a conversation. Therefore, prospective missionaries should learn to be comfortable in initiating contact and conversing with people outside their normal circle of family and friends. They should also be aware of cultural differences in the world.
Employment. Missionary work is just that, work. There is nothing easy about missionary work, so young people should develop the ability to work reliably. A regular job teaches such habits as getting to work on time, not missing work unnecessarily, doing assigned tasks well, looking for more work when the assigned task is completed, and not going home early. A job also helps young people understand the value of money. Where possible, prospective missionaries should plan to pay as much of the cost of the mission as possible, rather than depending on parents or donations from others. Helping pay for their own missions will help prospective missionaries learn to live within the stringent missionary allowance.
During the course of preparing to serve, prospective missionaries may discover serious physical or emotional issues. Prospective missionaries and their parents should be completely candid in disclosing all health issues and medications on the missionary recommendation application.
Unfortunately, some health problems can present insurmountable obstacles to serving full-time proselytizing missions. The First Presidency has stated: “There are worthy individuals who desire to serve but do not qualify for the physical, mental, or emotional challenges of a mission. We ask stake presidents and bishops to express love and appreciation to these individuals and to honorably excuse them from full-time missionary labors.”2 In such cases, service missions can be a great blessing, allowing individuals to live at home and receive appropriate medical care while growing and maturing in the service of the Lord. Parents, bishops, and stake presidents can help in encouraging and arranging appropriate opportunities.
Opportunities for service missions can also be found at the Church Web site www.lds.org. Select “Other Resources,” then “Mission and Service Opportunities.” Continuing higher education or technical training to allow better coping with chronic impairment is also an admirable alternative.
When prospective missionaries prepare themselves well in advance of submitting their recommendation applications, they can identify and resolve health problems, improve their physical strength, and be better mentally and emotionally prepared to withstand the rigorous life required of missionaries. They will then be much more likely to complete a successful mission free of significant health problems.
Unfortunately, some missionaries unpredictably become ill or injured while serving. More than 50 health-care professionals are serving as full-time missionaries throughout the world, with 200 additional volunteers serving at Church headquarters—all in support of missionary health. Speaking for this small army of health-care professionals, we will be there to help any missionary who becomes ill or injured. And we pray every day that our missionaries will remain healthy and safe from harm as they serve the Lord and His children.
Most Ensign articles can be used for family home evening discussions, personal reflection, or teaching the gospel in a variety of settings.
Create an obstacle course and time family members as they perform tasks from several of the sections in the article: for example, physical health preparation—go up and down stairs; healthy eating—peel a carrot; personal hygiene—tie a necktie; dental health—brush their teeth; and so on. Using the article, discuss how to prepare for a future mission. Have each person make a goal of one area to work on.
As a family, choose recipes for five simple, well-balanced meals. Learn how to prepare each meal, and discuss proper cleanup. Assign each older family member a meal to prepare during the coming week. Create a file of these and other simple recipes.