2. Mission in tough places
Kat Wagner
BMS Mission Projects Coordinator
Welcome!
This session is looking at mission in tough places.

3. Most fragile Least evangelised Most marginalised Afghanistan
This session is going to focus on mission in Afghanistan, as it is one of the toughest places that BMS works.
Afghanistan can be classed as
- most marginalised (meaning that people live in very poor conditions),
- least evangelised (meaning that there are few followers of Christ),
- most fragile (meaning the country is at risk of failing because of weak institutions and government).
These are BMS’ 3 priority areas, and there are only 2 BMS countries which hit all three categories , the other one being… Guinea.
Part of my role at BMS is to relate to our partner in Afghanistan. So I am going to share from my experience of visiting Afghanistan, hearing from our mission workers there, and meeting local people.
In this session we’re going to highlight some of the challenges but also opportunities for mission in a place like this. My hope is that you can draw some linkages to the tough places which you are reaching into, and that you will be encouraged and inspired.

4. tough durable, strong, resilient resistant, unbreakable challenging
So what do we mean by ‘mission in tough places’?
The word ‘tough’ has various connotations:
In many ways, being ‘tough’ is a very positive attribute, describing something as durable, strong, resilient, firm, or determined.
But when we are seeking to bring change and transformation (which is what mission is about), these attributes can present us with barriers, of resistance, rigidity and a sense of being unbreakable.
And so ‘tough’ places can be difficult, challenging, hard, and a struggle.
I wonder what comes to your mind when you think about ‘tough places’ for mission?
What is on your heart when you contemplate those strongholds and places which are resistant to change?

5. Dependency on God Long-term commitment Sensitivity 99.85%
Religious context:
Q: Any guesses as to the religious make-up of Afghanistan?
99.85% of the population is Muslim (over 29 million people).
There are an estimated 14,500 Christians.
Operation World claims that there are 48,000 mosques but not a single church building.
BMS’ partner org in Af is overt in describing itself as “an international Christian organisation”, and one of its core values is ‘Dependency on God’. This has not hindered the org from working, and it has developed a good reputation of commitment to the people of Afghanistan, being the first NGO to be registered in the country, in 1966.
BMS has 3 mission families working in Afghanistan, many of them working in key leadership roles in our partner org.
So how is Christian faith practiced? Mission workers meet together for times of study and worship in their homes, being careful not to be meet too regularly in one place or time.
They do not seek to identify or specially associate with local believers, as this would increase the risks for those local believers. Team members believe 1 or 2 staff may be following Jesus.

6. Risk to personal security Loss and trauma Calling
City living comes with particular challenges, and most notable are the security risks. Kabul especially has seen a downturn in security over recent years and, as a result, all international members have been relocated out of Kabul to a different city for the next couple of years.
Security is taken very seriously, as the risks are so great. There are many suicide bombs and other attacks in Kabul and other cities. Mission workers have lived through the killings and kidnappings of friends and colleagues. Everyone knows someone who has been affected.
To mitigate this you are very selective in how you travel, varying your route and timing to get to work, checking in by text every time you leave or arrive.
Despite all of this, many mission workers who feel called to Afghanistan serve for many years, bringing their children, and loving the people.

7. If you can see the contours on the map, you’ll notice the central and eastern parts of the country are very mountainous. One section of our partner’s work is located here, in the Central Highlands region.
This area is one of the worst provinces for poverty in Afghanistan.
I’m going to give you a virtual tour of this remote part of Afghanistan.

8. The mountains are beautiful, massive…

9. …and go on for as far as the eye can see.

10. The quickest way to access this area is by air.
Currently the only way to do this is by UN Helicopter.
Helicopter travel is expensive though, and limited by the weather conditions

11. If you opt to drive, there are no tarmac roads in these mountainous areas, and a 4x4 is essential for navigating the steep and bumpy tracks.
Many of the villages where the work happens are in remote areas.
It’s extremely dry and dusty in the summer…

12. In winter time there is deep snowfall, temperatures of -20 degrees, and there is the risk of avalanches on some of the steep slopes.

13. Once the snow melts the roads can also be a challenge.

14. Most local people would walk or travel on a donkey.

15. Village life for many Afghan people is challenging.
Houses are a traditional wooden and mud construction. In the foreground of this photo you can see animal dung drying in the sun, which is the main fuel used for cooking and for heating in the winter.

16. Bread is a staple food here, and most people in the villages grow wheat or other crops. During the summer and early autumn, there is palpable sense of urgency to bring in the harvest and prepare the fuel in order to survive the winter.
It is unusual to see any kind of mechanical agricultural machinery; most work is done by hand or with animals.
Because its so mountainous, many families will grow their crops on the steep hillsides. You wouldn’t notice that there were crops there, they are so sparse. But you see people working across the hillsides, bending down and picking each individual plant, as each was precious to them.

17. “I tell you, open your eyes and look at the fields
“I tell you, open your eyes and look at the fields! They are ripe for harvest.”
John 4: 35
Seeing this, I was reminded of Jesus’ words to his disciples, “I tell you, open your eyes and look at the fields! They are ripe for harvest.” (John 4: 35)
Each life is precious, loved by God, and God wants to draw each one to himself. Sometimes we need to open our eyes to see those people; sometimes we have to bend and work and put in the effort; but there are always people ready to respond to God.

18. You’ll often see a shepherd herding their flock of goats, sheep and cattle, and often small children are given this responsibility. Along the valleys, there are occasional stone enclosures, which the shepherds use to overnight their flock to protect them from attack by wolves which live in the mountains.

19. My sheep listen to my voice; I know them, and they follow me.
 John 10: 27
Again, I’m reminded of Jesus’ words: My sheep listen to my voice; I know them, and they follow me.  (John 10: 27)
We can take comfort that even though we don’t know all the sheep or all the people, Jesus, who is the good shepherd, does. He knows each one of us; and somehow we each have an innate ability to hear his voice. There are followers of Jesus in tough places like Afghanistan, following him like these sheep, in obedience and confidence. Let’s remember to pray for them, for their protection and their growth.

20. There is always a hospitable welcome
There is always a hospitable welcome. If you arrive during the middle of the day, they will roll out a matt and bring out teapots full of green tea, the traditional flat bread, and whatever has been cooked that day. Everyone dips their bread into the same main dish.

21. Most of these remote villages are peaceful and less affected by conflict. The place is actually called the ‘peace district’ because of this reputation.
However, in recent months, villages on the district border have become concerned about nearby armed opposition groups. The villagers are now starting to arm themselves and keep watch at night, to protect themselves.

22. Another trapping in these rural areas is the growing of poppies
Another trapping in these rural areas is the growing of poppies. This is illegal, but the income from the sale of the opium must be attractive enough to risk the repercussions. Each poppy head is individually scored with a knife to draw out the sap.
There are stories of the people who do this getting ill from the residue on their hands; once there was a cow which broke its way into the poppy field – it got so ill that the villagers were scared of the effects of the poppy and decided not to grow them any more.

23. Education and health facilities are provided by the government, but they are all funded with outside assistance. They are basic, under-resourced and sometimes poor quality.
Accessing quality healthcare can be very challenging, due to the difficulty in getting to a health centre especially in winter time, the lack of staff or drugs, and corruption among officials.

24. Corruption: Fatima’s story
Another challenge which affects everyone in Afghanistan is corruption. This is the story of Fatima, one of the friends of one of the team members here:
Fatima works at the District Hospital and is in charge of the distribution of supplements for treating malnutrition. This includes things like lentils and oil. However, the District Health Officer has been asking her for four lots of these supplements for his own family, and telling her to write it down as four patients.
Fatima has consistently refused to do this. So the District Health Officer has fired Fatima from her job and filled the role with someone else.
There is the opportunity to bring a corruption case against someone, but there is a penalty fee for losing a case, which would be unaffordable for Fatima. Fatima is not supported by her husband and has several children to provide for.
The Officer has threatened to put her on the ‘black list’ if she lodges a complaint, meaning that they would prevent her from gaining employment in any district health facility.
Fatima is by nature an activist for justice; she’s not afraid to share her thoughts in public meetings; she’s gone to an interview with a black eye (from her husband); and she’s courageous for standing up with her values against the ‘man in charge’.
Her dilemma is serious, and we can’t know what would be the repercussions for bringing a complaint. Amazingly, Fatima has decided to make a complaint against the doctor…

25. Challenges? Religious persecution
Ongoing conflict and risk to personal security
Practical difficulties/expense in accessing rural areas
Endemic corruption
Challenges of mission in tough places:
I wonder whether there are any parallels to your own situation?
The difficulties of openly explaining or practicing your faith, when there may be repercussions for yourself or other local believers
Where the risk to your life or property is very real, and it affects your day-to-day choices, and yet you feel called to serving God in that place.
The very practical difficulties (and the expense) of accessing the places where people are most in need.
The corruption in the very systems which people often rely on the most; the disappointment you feel when decisions are unfair; and the challenge to act in a way which is honest and yet frustratingly slow or expensive.

26. Opportunities? Signs of the Kingdom Working alongside one another
Hospitality
Reputation
Opportunities of mission in tough places:
Signs of the Kingdom of God – courage in the face of injustice; people who are honest, persistent in seeking a fair outcome, hardworking, humble, forgiving
People working alongside one another, irrespective of differences in nationality or language or education or religion.
Hospitality, sharing the same bread – and what this says of welcome, openness, acceptance, generosity, unity, diversity and oneness
The opportunities which open up because of the respect and commitment which has been developed by faithful pray-ers and workers over the years.

27. Let’s pray…
And so let’s pray … about mission in tough places…

28. He will not judge by what he sees with his eyes, or decide by what he hears with his ears; but with righteousness he will judge the needy, with justice he will give decisions for the poor of the earth. Isaiah 11: 3b-4
Let’s remember that what we initially see with our eyes, or hear on the news, or even the fear that we feel … is not always the full picture. But we have the mind of Christ (1 Cor 2: 16), and so we can glimpse a God’s eye-view of this challenging world that we live in.
We may need to acknowledge some of our pre-conceived ideas, and clean the lens which blurs our vision.
Let’s ask for a fresh view of the tough places in which we find ourselves.

29. But let all who take refuge in you be glad; let them ever sing for joy
But let all who take refuge in you be glad; let them ever sing for joy. Spread your protection over them, that those who love your name may rejoice in you. Psalm 5: 11
We are reminded in Philippians 4: 4-7 to “rejoice in the Lord always” but also to bring our anxieties and requests to God in prayer. In places of insecurity, of risk, of challenge, we need His peace, to guard our hearts and minds.

30. I’m next going to share about one of the specific pieces of work that BMS is involved in…
Let’s take this to a more personal level…
Imagine … life as a woman in rural Afghanistan … life as pregnant woman in in rural Afghanistan
This is featured in BMS’ Harvest appeal this year, and here’s a very brief trailer…

31.
Watch Life’s First Cry (7 minute video) which explores the hidden struggle of mothers and babies in Afghanistan.
You can find more resources here:

32. Some stats…
Maternal Mortality Ratio (number of maternal deaths per 100,000 live births)
Global average
216 UK ?
Afghanistan
Let’s take a look at some statistics…
The Maternal Mortality Ratio is a global measure for maternal deaths.
These are 2015 figures.
The global average is 216 maternal deaths per 100,000 live births.

33. Some stats…
Maternal Mortality Ratio (number of maternal deaths per 100,000 live births)
Global average
216 UK 9
Afghanistan ?
UK 9
Lowest? 3. (Poland, Finland, Iceland, Greece) – all in Europe

34. Some stats…
Maternal Mortality Ratio (number of maternal deaths per 100,000 live births)
Global average
216 UK 9
Afghanistan
396
Afghanistan 396 (28th worst)
Highest? 1,360 (Sierra Leone). The 27 worst are all in Africa.
So Afghanistan has the worse MMR outside of Africa.
The Province where BMS works has the highest maternal death rate within the country.

35. Lack of infrastructure Inaccessible healthcare Lack of knowledge
Unsafe practices
Paternalistic society
Q: So why are so many women dying from childbirth in this part of Afghanistan?
Lack of investment in infrastructure: roads, health centres, schools, etc
It is difficult to get to a health centre
… so many women don’t get the usual medical support we’re used to here – antenatal care, advice on nutrition, ability to give birth with help from a trained midwife, access to emergency care if something goes wrong…
They have low levels of understanding of maternal health issues.
…Because of this, many unsafe traditional birth practices persevere and often lead to maternal deaths or death of the child.
Society is paternalistic and hierarchical, meaning that the mothers-in-law and husbands are responsible for making decisions about the care and treatment of pregnant woman, especially if problems arise.

36. Knowledge Behaviour Practices
BMS has been supporting a project to address these issues with the aim of improving the life chances for pregnant women and their babies.
The project is called BLiSS: Birth and Life Saving Skills.
BLiSS provides village-based lessons on how to stay healthy in pregnancy, during delivery and in the first few weeks after the birth.
They are a series of courses, held for groups of women, and separately with groups of men. They use picture books, demonstration dolls, and dramatized scenarios. Every participant gets a picture book and Birth Kit which contains things like a plastic mat, sterilized knife, and gloves.
As peoples knowledge improves, we hope to see people changing their behaviour and developing healthy maternal health practices.
This will look like more women having their deliveries assisted by skilled health personnel, increased screening for high risk pregnancies, breastfeeding in the first hour, and being able to perform life-saving first aid.

37. QUIZ
What would you do?

38. Set the scene: you live in this village in Afghanistan
Set the scene: you live in this village in Afghanistan. A woman has gone into labour and you have to help them deliver the baby safely. In Afghan society, it’s generally up to the men to make the decisions – so the safety of this woman and unborn child is in their hands. Here goes…

39. Your wife’s water has broken. What do you do?
Drive to the hospital
Call an ambulance
Deliver the baby yourself with some help from the neighbours

40. Your wife’s water has broken. What do you do?
Drive to the hospital
Call an ambulance
Deliver the baby yourself with some help from the neighbours
That’s right. You’re too far away from the nearest clinic – and hours from the nearest hospital! There aren’t any ambulances, and you don’t have a car. Good thing you’ve attended the birthing course.

41. It’s going to have to be a home birth then… where is your wife going to deliver your baby?
a. Anywhere in the house on a plastic sheet
b. Downstairs in your house
c. Outside your house

42. It’s going to have to be a home birth then… where is your wife going to deliver your baby?
a. Anywhere in the house on a plastic sheet
b. Downstairs in your house
c. Outside your house
It can get as cold as -20 outside, and downstairs is where the animals sleep. Women often give birth in the dirtiest room (on cow dung floor), because giving birth is dirty. But when the newborn baby is in contact with the floor, it can pick up Tetanus.
Instead, your wife should give birth on a clean plastic sheet (thankfully, you learnt this in your pre-natal classes, and you were also given the sheet).

43. Things are going pear-shaped
Things are going pear-shaped. Your wife has been in labour for two days and the baby still hasn’t arrived. You need extra help. What do you do?
Google it
Borrow a car from someone in the village to drive to the nearest hospital
Ask the traditional birth attendant to help

44. Things are going pear-shaped
Things are going pear-shaped. Your wife has been in labour for two days and the baby still hasn’t arrived. You need extra help. What do you do?
Google it
Borrow a car from someone in the village to drive to the nearest hospital
Ask the traditional birth attendant to help
One of the traditional practices is to push down on the stomach during labour to push the baby out. Sometimes a man does this from behind, to add more strength to the pushing.
But you know its time to get to a hospital. You need a trained medical professional to help you. You definitely don’t have WiFi or 4G to Google, and if your wife needs surgical intervention, no-one in your village will be able to help.
Thankfully, you’ve been saving money every month since you did the training, and so you have enough money to hire a car from someone in the village, or to pay someone to take you to the closest hospital.

45. You’ve got the help you needed (phew), and your baby boy has been born
You’ve got the help you needed (phew), and your baby boy has been born! It’s time to cut the umbilical cord. What do you use?
A razor
A sharp stone
A pair of scissors

46. You’ve got the help you needed (phew), and your baby boy has been born
You’ve got the help you needed (phew), and your baby boy has been born! It’s time to cut the umbilical cord. What do you use?
A razor
A sharp stone
A pair of scissors
It’s traditional to use a sharp stone over an old person’s shoe (for long life) to cut the umbilical cord, but this can cause infection. You might not have any scissors, and if you do, they’ve probably been used for other things first.
A clean razor blade is the best option – it gives a clean cut and won’t result in infection.

47. The placenta isn’t coming out. What do you do?
‘Shock’ the mother by shooting a gun near her
Open the door to entice the placenta to drop
Gently massage the lower womb and encourage the baby to breastfeed

48. The placenta isn’t coming out. What do you do?
‘Shock’ the mother by shooting a gun near her
Open the door to entice the placenta to drop
Gently massage the lower womb and encourage the baby to breastfeed
Some women believe that the milk in the first three days (collustrum) is not good, so they feed butter to the newborn instead. But breastfeeding can help the baby and the mother. If the placenta is still not delivered, take your wife to the nearest clinic as soon as possible.

49. Congratulations!
You’ve safely delivered your baby. Wasn’t as easy as you thought, was it?!

50. Achievements and changes
2,600 women and men trained
Achievements and changes
So far… (3 years)
Over 1700 women and almost 900 men trained.

51. 90% receiving antenatal care
We are now seeing 90% of pregnant women attending at least one antenatal appointment; this used to be 20% before the course.

52. 53% men are saving money
A critical action for men is to save money for their wives to access maternal health care. This has increased from a barely existent 2% up to 53%.

53. 20% births attended by medical professionals
Before the course, only 5% of births were assisted by a skilled health professional – this is now 20%.

54. 97% mothers now breastfeed in the first hour
Before the course about half of new mothers would breastfeed their newborns in the first hour; this practice is now up to 97%.

55. Experiencing the benefits
“Thank you for these lessons – my husband was so nice to me, and my youngest daughter is happy, quiet, healthy and growing so well!”
Changes in maternal health practices
There is a stark reduction in harmful traditional practices, and corresponding uptake in healthy practices such as home-based first aid and seeking professional help.
Let’s hear some testimonials…
“For the first two pregnancies, I gave birth on dirty rags. I didn’t take my children for vaccines because there weren’t any. I have a one year-old daughter now; she was born after the course. It was quite a different experience: I used the Birth Kit, it was really clean. This pregnancy felt so much better. My husband was very good: he told me to rest and didn’t let me carry heavy things, he made sure I ate well and he brought me fruit. Thank you for these lessons – my husband was so nice to me, and my youngest daughter is happy, quiet, healthy and growing so well!”

56. Grandmother’s advice
“My daughter said, ‘Mother, how did you learn all these things?’ . I said I studied them in my village. These were very good lessons. I still remember them. Before, we were blind, but now we see.”
“Two weeks ago, my daughter went into labour in a different village. The clinic was closed because of Eid, so she called me. I took the lessons and the Birth Kit and helped with the delivery. I used the plastic sheet, the gauze, gloves. I didn’t put any pressure on the abdomen. My son-in-law was going to help the delivery by putting pressure, but I said, ‘No!’. I made sure she nursed the baby and gave the colostrum which is energy and good for the baby. My daughter was complaining about the after-birth pains and I told her she needs to keep nursing the baby. My daughter said, ‘Mother, how did you learn all these things?’ I said I studied them in my village. These were very good lessons. I still remember them. Before, we were blind, but now we see.”

57. Importance of involving men
“I took from my salary to save up money for the birth of my baby in case I needed to take my wife to the clinic. I made sure my wife didn’t pick up heavy loads. I tried to keep her happy during her pregnancy.”
Gender: importance of involving men
It is also clear that educating men in maternal health is important for creating positive changes for women’s lives in the areas of pregnancy, birth and childcare.
I was very interested in the course because this had to do with my own family. I didn’t know that it was important that a pregnant woman should not carry heavy loads. I have one child, a girl: she’s three months old. I took from my salary to save up money for the birth of my baby in case I needed to take my wife to the clinic. I made sure my wife didn’t pick up heavy loads. I tried to keep her happy during her pregnancy. My wife gave birth at the clinic. My neighbour’s wife was also pregnant, and he asked me to get a car for him because it was time for her to deliver. So I got on a motorbike to the next village, rented a car and brought it here. My neighbour told me, “Please take care of my house”, so for a day and a night I was responsible for his house, two small children and the animals.

58.
Featuring a beautiful poem by Lucy Berry, this short reflection video is perfect to show your church when you take up your offering for Life's First Cry

59. Meeting practical needs Partnership
Summary
Mission work in tough places is often very practical, meeting peoples basic needs, sometimes in life or death situations
It often involves working alongside people from different Church traditions, or other faiths. Partnership is important, as collective effort can achieve so much more than trying to work on your own.
In these situations, Scripture often comes to life in new ways, and we see more of God’s heart for his creation.
The importance of prayer … for preparing the ground, for giving us new perspective, and for helping people to persevere in the face of all the challenges
New perspectives
Prayer

60. Thank you!