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									The Face of Malaria



         Movie Link
                                          http://siteresources.worldbank.org/INTMALARIA/Images/feature-img-malaria




        Towards a Christian Response to Malaria


                                           Jeffrey Larson
                                         November 17, 2005



                                                                                                                     http://www.planet.nl/upload_mm/2/e/5/1986205283_1999996984_malaria.jpg
www.bprc.nl/BPRCE/ L4/ResearchPar.html
Surgeon-Major Ronald Ross August 16, 1897.

This day relenting God
   Hath placed within my hand
A wondrous thing, and God
   Be praised. At this command,
Seeking His secret deeds
   With tears and toiling breath,
I find thy cunning seeds,           www.cdc.gov/.../history/ ross_laboratory.jpg



   Oh million-murdering Death.
      History of the Disease
   Egypt
   Connection with Swamp
   Mal aria or ―bad air‖
   Meckel and Afanasiev         http://www.defence.gov.au/dpe/dhs/jhsa/ami/Image23.jpg




   Charles Louis Alphonse
    Laveran
   Ronald Ross


                             http://www.canalmuseum.com/photos/1905_fumigation_car.jpg
Life Cycle                 malaria_lifecy cle.exe




             www.cdc.gov
Life Cycle Continued




                 www.brown.edu/.../maleandfemalegametocytes.jpg
Classification of Plasmodium

   P. vivax
   P. ovale
   P. malaria
   P. falciparum


                    http://bepast.org/docs/photos/malaria/Malaria.jpg
Plasmodium vivax

              Benign tertian malaria
              Fevers every 48 hours
              Relapse
Plasmodium ovale

   Mild tertian malaria
   Quite rare
   Hard to Diagnose
Plasmodium malaria
   Quartan malaria,
   Paroxysms every 72 hours
   Large distribution
   Recrudescenses for up to 53 years
    Plasmodium falciparum
   Malignant tertian malaria
   50% of all malaria cases
   Large distribution
   Recrudescenses for up to 3
    years
   Merozoites can invade
    erythrocytes at any age
    Diagnosis
                                                                      Clinical manifestations
                                                                      Smears of peripheral
                                                                       blood
                                                                      Fluorescent dyes, DNA
                                                                       probes, PCR and reverse
                                                                       transcriptase PCR, and
                                                                       antigen dipstick
                                                                      Too expensive
http://www.ibms.org/images/images_science/malaria_rapid_test.jpg
          Pathogenesis

   Inflammatory response
       Too much tumor necrosis
        factor (TNF)
       Fever and chills
   Anemia
       Destruction of parasitized
        erythrocytes
       Complement mediated
        autoimmune hemolysis

                                     www.impact-malaria.com/.../ images/paroxysm.jpg
    Pathogenesis Continued
                                                     Prior to the first paroxysm…
                                                         Malaise
                                                         Muscle pain
                                                         Headache
                                                         Loss of appetite
                                                         Slight fever

www.developments.org.uk/ data/11/wv_killers.htm
Pathogenesis Continued
   Paroxysm begins
       Cold Stage
            Rapid increase of fever to 104˚F to 106˚F.
            Teeth chatter
            Nausea
            Vomiting
       Hot stage
            30 minutes to an hour later
            Intense headache
            Copious perspiration
             Mild delirium
                                               www.impact-malaria.com/.../ images/paroxysm.jpg
         
Pathogenesis Continued
           Cerebral malaria (Falciparum)
               Accounts for 80% of malaria related
                deaths.
               Peak incidence in 3 to 4 year old children
                in areas of low endemicity (Miller et al,
                1880).
               Progressive headache followed by coma,
                uncontrollable fever (above 108˚F),
                psychotic symptoms or convulsions and
                death within hours.
               ―Plugging‖ of capillaries leading to blood
                clots and cerebral anoxia
Pathogenesis Continued
   Pulmonary edema
   Algid malaria (rapid
    development of shock)
    due to septicemia
   Blackwater fever
       Systemic lysis of
        erythrocytes
       Fever
       Jaundice
        Persistent vomiting
                              www.impact-malaria.com/.../ malaria-paroxysm.jpg

    

       Renal failure
Immunity and Resistance
                                         High endemicity
                                             Maintain high levels of
                                              parasitemia
                                             Few symptoms of disease
                                             Premunition
                                                  ―resistance to reinfection of
                                                   superinfection, conferred by a
                                                   still-existing infection. The
                                                   parasite remains alive, but its
                                                   reproduction and other
                                                   activities are restrained by the
                                                   host response‖ (Roberts and
 www.who.int/ features/2003/04b/en/
                                                   Janvoy, 674).
                                             Resevoir
Immunity and Resistance
      Low endemicity
          Acute deadly disease
      Duffy blood groups - P. vivax.
      Sickle-cell anemia




                 http://www.wfu.edu/~shapiro/research/sick1.gif
Epidemiology - Control and
Treatment
   A comprehensive multifarious
    approach must be employed.
   Roberts and Janvoy suggest that 5
    main factors contribute to control:
       1)   Reservoir
       2)   Vector
       3)   New Hosts
       4)   Local climate
       5)   Habitat
                             http://history.amedd.army.mil/booksdocs/wwii/Malaria/figures/figure17.jpg
Reservoir

     Asymptomatic parasitemia
     Permanent reservoir




            http://www.calvarychapel.com/savinggrace/uganda/200305mayjune/child2.jpg
Vector
   Anopheles mosquito
       Abundance
       Blood-feeding
        behavior
       Survival
       Ability to support
        malaria parasite
                             WHO/TDR/Stammers




        development
                     New Hosts
                                                                                                                Increase in mobility
                                                                                                                 (Martens and Hall, 103).
                                                                                                                     Increased air travel
                                                                                                                     Population redistribution
                                                                                                                      from rural to urban areas
                                                                                                                     Civil conflict
                                                                                                                     Environmental
http://www-nlpir.nist.gov/projects/tv2003/active/topics/example.images/Airplane%20Taking%20off%20Small.gif
                                                                                                                      degradation
                                                                                                                High birth rates
Climate
   Changes in rainfall patterns
   El Niño and global warming




               http://www.osdpd.noaa.gov/PSB/EPS/SST/data/anomnight.current.gif
Habitat
   Increase in habitat
       Deforestation
       Irrigation systems.
   Increased building projects
       Dams
       Canals                             http://medent.usyd.edu.au/fact/fwslide3.jpg




       Highways
       Mining activities (Martens and Hall, 106).
       Control Strategy
   Problems vary enormously
    therefore control activities
    must be adapted accordingly
    if they are to succeed‖
    (Kondrachine and Trigg, 26).         http://stat.qwest.net/imgs/globe.gif




   Strong research base, strong
    international collaboration,
    and sustained government
    support (Nchinda, 402).
                                   http://www.dhss.mo.gov/Images/handshake.jpg
Control Strategy
   Several fronts
       Drug development
       Vaccine development
       Vector control.
   Integrated
    approaches must be
    pursued for effective
    and sustainable
    control (Beier, 520).
                              http://www.malariasite.com/Mal7.jpg
      Drug Development
                                                                     Quinine - used for more than three centuries.
                                                                      Until 1930’s only effective treatment. Cinchona
                                                                      tree. Intravenous quinine for severe malaria
                                                                     Atebrin- No longer used due to complications
                                                                      with undesirable side effects.
                                                                     Chloroquine - Between 20% and 30% of
                                                                      strains are highly resistant (Nchinda, 400).
                                                                     Proguanil - Proguanil is still used as a
                                                                      prophylactic in some countries.
                                                                     Malarone - Effect in malaria treatment. The
                                                                      drug is 95% effective in cases of otherwise
                                                                      drug resistant falciparum malaria. There are
                                                                      few side effects; yet, the drug is prohibitively
                                                                      expensive to be used on a wide scale.
                                                                     Maloprim, Fansidar, and Mefloquine -
                                                                      Widespread resistance.
                                                                     Halofantrin - Side effects
                                                                      Artemisinins - Currently prohibitively expensive
    http://home.att.net/~steinert/_borders/Copy_of_atabrine.jpg
                                                                  
                                                                      for widespread use. Bill and Melinda Gates
Distribution system                                                  Foundation
Compliance is essential because sub-therapeutic dosages facilitate drug
resistance (Salako, 25).
     Vaccine development
   ―Currently prevention of the disease is
    dependent on avoiding contact with
    mosquitoes or on chemoprophylaxis‖
    (Miller et al, 1878).
   However, the emergence of drug-
    resistant parasites have rendered
    chemoprophylaxis less effective (Mehra
    et al, 955).
   Drug resistance has caused a dramatic
    rise in the cost for treating an
    uncomplicated case ($0.15-2.00).
   This increase necessitates the            www.uni-giessen.de


    development of malaria vaccines.
  Vaccine Development
                                                              Four basic types
                                                                 1) Pre-erythrocytic vaccines which
                                                                  prevent the sporozoites stage form
                                                                  entering or developing within liver
                                                                  cells.
                                                                 2) Asexual blood-stage vaccines
                                                                  which prevent the merozoite from
                                                                  entering or developing within red
                                                                  blood cells.
                                                                 3) Transmission-blocking vaccines
                                                                  which inhibit development of sexual
                                                                  stages within the mosquito.
                                                                 4) Vaccines based on cocktails of the
                                                                  previous three. Yet, development of
http://www.nature.com/news/2004/041011/images/inject.jpg          a vaccine is complicated due a
                                                                  number of factors.
        Vaccine Development
   Complications
       No relevant animal model for studying P. falciparum
       No potential to grow malaria parasites in a sufficient quantity (traditional)
            Live but weakened organisms
            Crude antigen preparations
       The parasite undergoes rapid antigenic variation (Miller et al, 1878-1879)
       95% of those affected by malaria could only afford cheap vaccines (The
        Heavy, 24)
       Pharmaceutical companies will not invest in a vaccine
       Intellectual property rights stifle the possibility of a generic vaccine
   Prospects
       Governments and foundations (Bill and Melinda Gates Foundation)
       More than a dozen potential vaccines that are in progress
       Novel adjuvants developed which enhance immune response to antigens
       Additional delivery systems such as salmonella (Engers and Mattock, 12)
     Vector control
“There are numerous examples of
how vector control measures like
indoor spraying of insecticides,
larval control, and environmental
management have helped control
or eradicate malaria” (520).

                                              http://www.psi.org/malaria/malaria/net_retreatment.jpg




          Genetic engineering (Nchinda, 402).
          DDT
          Synthetic pyethroid bed nets (Matteson, 310).
              Cost
              Risk trade-off
        Challenges of Control
                                                                      Western approach, cultural modalities,
                                                                       and treatment-seeking behavior
                                                                      Nchinda writes, ―African populations
                                                                       have traditional perceptions about
                                                                       disease causation and management.
                                                                       Some diseases are considered suitable
                                                                       for management by western medicine,
                                                                       while others are considered the
                                                                       exclusive domain of local traditional
                                                                       health practitioners‖ (400-401).
                                                                      Western medicine is often seen only a
                                                                       last resort.
                                                                      The formal system must become more
                                                                       accessible, acceptable and affordable
                                                                       to ordinary people. (Salako, 24).
http://www.itg.be/itg/Departments/Parasitology/Images/Malarb.jpg
                                                                      Education and Empowerment
       Burden of the Disease
   ―Despite 50 years of world experience in malaria
    control, more people are dying of malaria now than
    when such campaigns began‖ (Nabarro and Tayler,
    2067).
   Approximately 41% of the world’s population is at
    risk
   300 and 500 million clinical cases annually.
   Two million deaths each year are attributable to
    malaria (Martens and Hall, 103).
   Ninety percent of these deaths are in children less
    than 5 years of age (Nchinda, 398).
   ―Of the children who die before their fifth birthday,    http://www.ghs.org/images/Haiti_Mission_Trip_Teruel_with_Young_Girl.jpg

    98 percent are in the developing world‖ (152).
   2% of global disease and 9% of the disease burden
    in Africa (Salako, 24).
   Sub-Saharan risk to fatal malaria is 160 times greater
    then the rest of the world (Morrison, 105).
   One African child dies every 30 seconds (Fedunkiw,
    1046).
  Burden of Disease
                                                    Malaria kills just slightly less than
                                                     AIDS.
                                                    ―What makes the malaria deaths
                                                     particularly tragic is that malaria,
                                                     unlike AIDS, can be cured‖ (Robinson,
                                                     50).
                                                    ―The death rates from malaria are as
                                                     high as those from HIV…In many
                                                     ways, it’s a kind of silent Holocaust‖
                                                     (Robinson, 50).
                                                    ―There is hope for the future but any
                                                     impact the strategy will have on
                                                     malaria illness and death will depend
http://www.unicef.org/media/images/971148E.jpg       first and foremost on maintaining the
                                                     political will to combat the disease‖
                                                     (Kondrachine and Trigg, 27).
       The Problem of Healthcare Distributive Injustice:
       Nations have not beaten their swords into plowshares
       (Isaiah 2.4).

   Industrialized nations spend 5.3% of GNP on the
    military and only .3% GNP on overseas development
    assistance (Tan et. al., 8).
   $1.3 billion dollars each year is required for prevention
    and treatment
   Less than $23 million [2003] has been awarded by the
    Fund for Malaria (Tan et. al., 8).
   Global military spending totaled $1 trillion in 1990
    alone (Tan et. al., 8).
   Ten-percent of all health research funding is used to
    address ninety-percent of the world’s burden of disease
    (Delisle et. al, 2).
   ―Pneumonia, diarrheal diseases, tuberculosis and
    malaria, when combined, have been estimated to
    account for more than 20% of the disease burden in
    the world (mostly in developing countries), yet they
    receive less than 1% of the total public and private
    funds which are devoted to health research‖ (Delisle et.
    al, 3).                                                     http://www.cog21.org/site/cog_archives/ac_bcc/AC%20Bible%20Correspondence%20Course/Pictures/Sword%20into%20plowshare.jpg



   Malaria research receives approximately $42 per fatal
    case, while HIV/AIDS receives $3,270 and asthma
    $789 (Nchinda, 401).
          Healthcare Distributive
          Injustice


                                 http://www.syrrx.com/images/H_mainimg_static.jpg



   Of 1393 new chemical entities marketed over this time period [25 years] only 16
    were for tropical diseases and tuberculosis‖ (Tan et al, 7).
   ―World’s pharmaceutical companies would rather develop a drug against baldness
    than invest in a drug against the scourge of sleeping sickness‖ (Vesely, 39).
   Sub-Saharan Africa accounts for only 1% of the world’s drug sales, while North
    America, Japan and Western Europe account for over 80%.
   Francois Grois, a spokesman for the Franco-German Aventis pharmaceutical
    company laments, ―Unfortunately we have a financial commitment to our
    shareholders‖ (Vesely, 39).
   Dr. James Orbinski, president of Doctors Without Borders, finds this attitude
    unacceptable.
       ―The poor countries have no consumer power, so the market has failed them.‖
        Furthermore states that he is tired of the logic that says, ―He who can’t pay,
        dies‖ (Vesely, 39).
        The Need for a Distributive Ethic

   Tan et al write that
    healthcare distribution ―must
    ultimately include the ethical
    responsibility to redress
    gross inequalities. Adequate
    attention to the systemic
    forces underlying these
    infections thus necessitates
    correspondingly systemic
    solutions‖ (Tan et al, 9).       http://photos1.blogger.com/blogger/4332/1214/1600/malaria%20patient%20recovering.jpg
    Conceptions of
    Distributive Justice
   To each according to his merit or desert.
   To each according to his societal contribution.
   To each according to the open market.
   To each according to his basic needs.
   Similar treatment for similar cases.




                http://www.who.int/multimedia/ethiopiaweb/MALARIA/WHO-208696.jpg
To each according to his merit or desert

   Advantages are allocated in accordance
    with the energy expended and results
    achieved.
   ―Commitment to desert is revealed as
    the retrospective aspect of our
    commitment to free choice‖ (Sher, 10).
To each according to his societal contribution

   Moral primacy is given to: public
    interest, the common good, the welfare
    of the community, or the greatest good
    for the greatest number
   Distributive questions are determined
    democratically by utilitarian standards.
To each according to the open market

   Consumer free-choice is tantamount.
   An individual has the right to select
    personal values, determine how they
    are realized, and dispose of them how
    one chooses (Outka, 20).
To each according to his basic needs
   Basic needs are assumed to be given
    rather than acquired
   Inequalities in need reflect human
    finitude and not merit or desert.
   The ethic is concerned with ―those
    generic endowments which people
    share; the characteristics of a person
    qua human existent‖ (Outka, 22).
Similar treatment for similar cases
   The accepted treatment standards are
    applied impartially and universally.
   Treatment standards are determined
    democratically.
   ―There should be no obstacles:
    financial, racial, sexual, or geographical
    to initial access to the system as a
    whole‖ (Daniels, 175).
Healthcare Distributive Ethics,
Public or Private?
   Postmodernity
       Ethical medicine is
        understood as nothing more
        than furthering the ends of
        life as defined by the
        individual.
       Individuals are free to make
        any medical decision because
        it is a private decision.
   Autonomy
       Informed consent
        Privacy
                                  http://photos1.blogger.com/img/125/922/640/Postmodern%20Lyotard%20Condition.jpg

    

       Confidentiality
      Shortcomings of private ethics
   ―The goal of keeping quality of life, resource allocation, and
    other relevant value choices completely at the private level is
    ill-suited to the contemporary health care environment‖
    (Dresser, 21).
   ―The sum total of much of our ethical thinking about individuals
    has given us an unethical health system. Alas, no modern
    nation can build a health care system one individual at a time‖
    (Lamm, 14).
   The sum total of private ethical decisions creates a public ethic.
   ―Individual decisions, in short, sooner or later create a culture.
    We must decide in what kind of culture we want to live‖
    (Callahan, 28).
   There is no such thing as a private moral decision. ―My private
    moral life and the kind of person I have chosen to be makes a
    great difference to my neighbor’s life no less than my own‖
    (Callahan, 31).
     Shortcomings of private ethics
   ―When autonomy is the answer, the question is largely limited
    to asking whether the person decided freely. Autonomy
    counsels us not to ask if the decision was wise, or even good
    in the short run for the person making it. For many decisions,
    that is sound counsel. But not for all decisions, and certainly
    not for the sum of all decisions‖ (Murray, 32).

   Need common vision of what distributive ethic should be
    employed.

   ―If there is no common picture of what biomedicine can do to
    foster a good life- if the very question of what constitutes
    such a life has been banished in the name of pluralism- then
    that life will be pushed about in ways it is helpless to control,
    a frail ship that has lost its direction on a stormy confused
    sea‖ (Callahan, 31).
Gilbert Meilaender, 14
   Insofar as the search for consensus and the related fear of
    language that includes substantive moral claims about who we
    are or how we ought to live has driven bioethics to the
    purportedly neutral public language of rights, it is well on its
    way to losing its critical edge and even becoming boring.
    Endless affirmations of our autonomous right to die with dignity,
    but no help in understanding what that might mean of the
    significance of a human being’s death. Continued affirmation of
    the necessity of beneficence, but little help in discerning the
    best interests of a living human being. Rigorous commitment to
    justice, but relatively little help in understanding how human
    beings are harmed or wronged. We can say little about
    ourselves except that we have the right freely to determine the
    meaning of our living and dying. What threatens to come upon
    us without our choice-illness, suffering, infertility, a child, death-
    can have no human meaning or significance. This may seem to
    enlarge our freedom, but it diminishes the being who bears that
    freedom
     How do we get out of this
     mess?
   What is the task that we are
    avoiding? Religion.
   Religion is the source of
    meaning for human lives.
   Each form of religion is not
    commensurate in the society
    it will produce.
   Relativistic pluralistic religion
    is no more constructive as          http://admission.owu.edu/images/religion.jpg




    relativistic pluralistic ethics.
    What religion is then needed?
                         The Need for Christianity
                                                                               The particularity of the gospel of Jesus Christ is
                                                                                fundamental to comprehensive systemic change.
                                                                               Jesus Christ is the norma normans for humanity.
                                                                                He defines what it is to be human. He is God
                                                                                made man. His resurrection is paradigmatic of
                                                                                restoring health and wholeness. Healthcare
                                                                                merely images his ministry of healing body, soul
                                                                                and mind.
                                                                               Jesus has given us the example of self-sacrifice
                                                                                needed to establish healthcare distributive justice.
                                                                               The Holy Spirit empowers ideology to become
                                                                                praxis. The Holy Spirit’s activity is cardinal to
                                                                                systemic distributive justice. Actions flow from
                                                                                character, and character from the heart, mind and
                                                                                soul. The Holy Spirit must change the heart, mind
                                                                                and soul in order for the actions of healthcare
http://people.lulu.com/storage/users/296/42296/images/23756/cross%20light.jpg
                                                                                distributive justice to be fully manifest.
Political Theology of the Church
   Christians are held in dialectical tension between the ―already‖ and the
    ―not yet‖. Analogously, there is a similar dialectical tension between
    ―proclaiming the ideal and working in a setting that falls short of that
    ideal‖ (Cook, 60).

   ―not yet‖
        Transformative integration
        Common Grace
        Realist expectation

   ―already‖
        Transformative antithesis
        Redemption
        Idealist expectation                 http://www.townofhobgood.com/Country%20Church%20before%20moving.jpg




   While they are dialectically opposed, they are not mutually exclusive.

   The Church must witness to the Kingdom of God though creating an
    alternative community that embodies and proclaims Jesus’ ideal while
    concurrently seeking to transform this world into Kingdom likeness
    through political advocacy and cultural engagement.
        Church Response to Healthcare
        Distributive Injustice
                                                       What does this political theology of engagement
                                                        compel the Church to be in response to healthcare
                                                        distributive injustice?
                                                       What does it entail in a Christian response to malaria?
                                                       ―There must be two elements in any move towards
                                                        shalom. There must be the proclamation and
                                                        description of the ideal of shalom and just health.
                                                        But that ideal must be matched by a realistic strategy
                                                        for dealing with the issues of justice and health as
                                                        they actually face our world and us in the twenty first
                                                        century‖ (Cook, 60).
                                                       The Church must then articulate and embody a
                                                        theological description of the ideal of shalom and just
                                                        health.
http://www.dltk-kids.com/world/images/munity2.gif      The Church must wrestle with realistic strategies for
                                                        dealing with issues of justice and health as they face
                                                        our world.
                                                       The Church will not be faithful to its calling of cultural
                                                        engagement if either component is neglected.
    Critique of Conceptions of
    Distributive Justice
   To each according to his merit or desert.
   To each according to his societal contribution.
   To each according to the open market.
   To each according to his basic needs.
   Similar treatment for similar cases.




                http://www.who.int/multimedia/ethiopiaweb/MALARIA/WHO-208696.jpg
Individual Christian Response
   Conscientisation.
   The Holy Spirit will work in us to feel the desires of
    His heart through every medium which a human can
    epistemologically experience. The Spirit works
    through cultivation of the heart, mind, soul and
    strength. With respect to malaria this cultivation may
    include increased:

       Solidarity
       Education
       Purpose
       Deed
                              http://playback.trufun.com/images/oralleebrown03small.jpg
      Theological Qualification and
      Foundation
   We do not serve others simply as
    humanitarian philanthropists.
   We serve because in so doing we serve
    Christ, his body, and those he loves.
   Matthew 25.37-40 the righteous ask, ―Lord,
    when did we see you hungry and feed you, or
    thirsty and give you drink? And when did we
    see you a stranger and welcome you, or
    naked and clothe you? And when did we see
    you sick or in prison and visit you?' And the
    King will answer them, 'Truly, I say to you, as
    you did it to one of the least of these my
    brothers, you did it to me.‖                      www.impact-malaria.com/.../ images/paroxysm2.jpg



   Jesus explains in Matthew 25.35-36, 'For I
    was hungry and you gave me food, I was
    thirsty and you gave me drink, I was a
    stranger and you welcomed me, I was naked
    and you clothed me, I was sick and you
    visited me, I was in prison and you came to
    me.'‖
    Theological Qualification and
    Foundation
   We are not only called to love others as we love ourselves, but
    we are called to love others as Christ loved us.
   How did Christ love us? He died.
   We are called to die to ourselves so that we and others might
    live. We do not affect salvation, but Christ graciously chooses
    to use us and our will as his instrument.




                          http://uashome.alaska.edu/~jndfg20/website/cross.jpg
       Local Church Response
The following list is not exhaustive, and it is
    an invitation for more creative thinking to
    follow these suggestions:
1) Set up child sponsorships from regions
    endemic with malaria.
2) Form sister church’s in endemic regions
    and set up pen pal relationships.
3) Sacrificially give to a number of Christian
    organizations that are already helping
    with the disease.
4) Send out missionaries to malarial regions.
5) Encourage medicine as a good opportunity
    for Christian service and vocation.           www.ssndmankato.org/ open%20hands.JPG
Local Church Response
                                            6) Establish clinics through organizations such as
                                                the Jericho Road Foundation (Kilner et al 233).
                                            7) Lobby government to make policy that is
                                                guided by the principles of the Kingdom of
                                                God. For example, there should be licensure
                                                controls to avoid comparatively excessive
                                                concentrations of physicians in regions of
                                                affluence, and a period of time in an
                                                underserved area as a requirement for
                                                licensing (Outka, 26). Furthermore, churches
                                                could lobby for debt relief, and reformed trade
                                                policy etc.
                                            8) Facilitate incentive subsidies to physicians,
                                                hospitals, and medical centers to provide
                                                services in regions of poverty.
                                            9) Develop Christian insurance agencies such as
http://www.afghan-web.com/gallery/hug.jpg



                                                the Christian Brotherhood that would provide
                                                for Christians who are infected with malaria
                                                (Kilner et. al. 240-244).
       Global Church Response
   We are unaware of our own body. When we neglect the body we neglect
    ourselves and we stultify Christ’s witness. (1 Cor. 12)
   The body is a unit, though it is made up of many parts; and though all its
    parts are many, they form one body. So it is with Christ. For we were all
    baptized by one Spirit into one body—whether Jews or Greeks, slave or free—
    and we were all given the one Spirit to drink
   We are all baptized into one Spirit.
   Revelation 7.9 says, ―After this I looked and there before me was a great
    multitude that no one could count, from every nation, tribe, people and
    language, standing before the throne and in front of the Lamb.‖
   The kingdom of heaven will be a vibrant kaleidoscope of nations that God has
    created diverse yet unified in Christ. Our individuality is consummated in
    diversity.
   The beauty of God’s creating each person unique is fulfilled when it is
    juxtaposed to the unique nature of God creating a diverse panoply of
    community, color, and culture. The kingdom of heaven will be diverse and
    unified; we should seek to transform society into the image of, and witness to
    the Kingdom of God.
                                         Global Church Response
                                                                                Now the body is not made up of one
                                                                                 part but of many. If the foot should
                                                                                 say, "Because I am not a hand, I do
                                                                                 not belong to the body," it would not
                                                                                 for that reason cease to be part of the
                                                                                 body. And if the ear should say,
                                                                                 "Because I am not an eye, I do not
                                                                                 belong to the body," it would not for
                                                                                 that reason cease to be part of the
                                                                                 body. If the whole body were an eye,
                                                                                 where would the sense of hearing be?
                                                                                 If the whole body were an ear, where      http://216.241.45.248/Images/blogger/eye-big.jpg

                                                                                 would the sense of smell be? But in
http://upload.wikimedia.org/wikipedia/commons/thumb/b/b8/Ear.jpg/180px-Ear.jpg
                                                                                 fact God has arranged the parts in the
                                                                                 body, every one of them, just as he
                                                                                 wanted them to be. If they were all
                                                                                 one part, where would the body be?
                                                                                 As it is, there are many parts, but one
                                                                                 body.
       Global Church Response

   It is good that we are not all created alike. As God is
    infinite, finite persons can not fully image His character.
    We see more of God through the full spectrum of
    peoples who were created in his image, and are indwelt
    by the Holy Spirit.
   We compartmentalize God when we only allow
    ourselves to see Him through the lens of our particular
    culture, gender, and socioeconomic class.
   Furthermore, Christ ministry is handed over to the
    Church, not individual Christians. All of the gifts are not
    manifest in any one Christian or any one parish church.
    All of the gifts are manifest in the global Church.
    Consequently, parish churches should become more
    unified in order to have the full complement of spiritual     http://www.williamstownbaptist.com/img/diversity.jpg


    gifts available for the service of the Kingdom.
          Global Church Response
   The eye cannot say to the hand, "I don't need you!" And the head cannot
    say to the feet, "I don't need you!" On the contrary, those parts of the
    body that seem to be weaker are indispensable, and the parts that we
    think are less honorable we treat with special honor. And the parts that are
    unpresentable are treated with special modesty, while our presentable
    parts need no special treatment. But God has combined the members of
    the body and has given greater honor to the parts that lacked it, so that
    there should be no division in the body, but that its parts should have
    equal concern for each other. If one part suffers, every part suffers with it;
    if one part is honored, every part rejoices with it.




                            http://copies.anglicansonline.org/churchtimes/000303/pics/girl.jpg
          Global Church Response




                                 http://www.econ.ucdavis.edu/faculty/fzfeens/photo_6/10_Girls%20at%20the%20well.JPG



   When one part of the body suffers, the entire body suffers.
   Division in the body causes disease, and disease in the body causes division.
   physical disease is not disconnected from spiritual disease.
   Therefore, neglecting the physical disease of the Third world will result in spiritual disease
    for the Global Church.
   Christ came to heal those who knew they were sick, not those who thought they were
    healthy. Perhaps the Western Church is less healthy than they believe, and need to drink
    deeply from the well of the Third World Church – the well of living water. The well of
    suffering, death, and resurrection.
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