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Breaking the Debt Barrier for Medical Missionaries

I became a doctor with a heart for the poor,” said Martha Carlough, M.D., who wanted to set off for the mission field as soon as the ink dried on her diploma. But like most medical school graduates, she was saddled with student debt—in her case, $65,000.

Mission agencies insist that candidates be debt-free. But since Carlough chose to follow her heart and work at a migrant farm worker clinic—and thus earned only $30,000 a year—she’d be delayed from going to the mission field for years. Unless somebody paid her debt.

Enter David Topazian, a TEAM missionary and retired oral and maxillofacial surgeon on Yale University’s medical school faculty. In 1994 he and Daniel Fountain, M.D., founded Project MedSend . The next year, MedSend made Carlough its first grant recipient.

The deal: Project MedSend would partner with a mission agency—in Carlough’s case, InterServe—and take over her monthly student loan payments for as long as she remained on the field. Project MedSend grants add years of service to a missionary’s career—years during which people would die without medical care and without the chance to hear the gospel.

Since Carlough, MedSend has given grants to 150 other physicians, nurses, dentists, physician assistants and other health professionals, each of whom serves under the authority of one of 45 mission boards which now collaborate with MedSend. These medical missionaries are called to serve in more than 55 countries, many of which are “creative access,” restrictive of missionary activity.

Half the world’s people has no access to healthcare, yet dozens of church and mission hospitals have closed in India and Africa, in part because of a lack of medical professionals to staff them. Diseases once thought to be virtually eradicated, such as tuberculosis, are on the rise. AIDS has killed 20 million people, and experts note that the worst of its death toll has yet to come.

There’s a staggering need on the mission field for doctors with Carlough’s heart. But Topazian knew that unfortunately, many medical students who plan to use their degrees as missionary doctors get caught up after graduation in repaying their loans, set up well-paying practices, and enjoy comfortable lifestyles. Many also rack up credit-card debt. The result: They never make it to the field.

Topazian, who has served as president of the Christian Medical and Dental Associations (CMDA), said that the association’s missionary members took note of a crisis on the mission field—the dearth of caregivers. “We started receiving reports from missionaries on the field who were overworked, who were due for furlough, and couldn’t come home on home assignment because there was no one to replace them,” Topazian said. “From an anecdotal point of view, the increasing costs of health education, and the need to pay that off before going to the mission field, was having an impact on the available pool of replacements.” Ralph Winter of the US Center for World Mission has called educational debt the single largest factor hindering missionaries from going to the field.

The association asked Topazian to look into the issue. He surveyed mission boards with health ministries, hospitals or health development ministries. From the 33 who answered the survey, “We found out that it was a real problem because those mission boards had 49 physicians who were partly through the candidate process but had been told to go to work off their debt and then return,” Topazian said. “And meanwhile, there were 30 clinics and hospitals represented in that group of missions that had no health professional in charge. They were empty and closed.”

Topazian and some CMDA members asked those same mission boards to tell them what type of organization could best help relieve what he terms the “increasing educational debt barrier” for those wanting to be missionaries. What he and the others learned at the meeting laid the groundwork for Project MedSend.

First, MedSend isn’t a sending agency—it partners with Christian ministries that send medical professionals. After a ministry pays MedSend a one-time participation fee, MedSend looks at the candidate’s qualifications and financial situation. MedSend assumes the debts for as long as they’re on the field. The average grant is $30,000, but grants for MDs can be more than $100,000. Most donors are Christian doctors.

Topazian said that with the exception of two families who left the mission field for family health reasons, no one has left to pursue a more lucrative career once MedSend repaid their loans. “We’re picking people who have an open-ended calling to a career on the mission field, and they just stay,” he said.

Carlough, who also has a master’s degree in public health, has delivered a thousand babies in Nepal, a country with a staggering maternal death rate. She also works as a Nepalese government care consultant to community health programs in which she teaches doctors and community health workers about improving women’s health and reducing maternal mortality.

Without MedSend, however, she would be still working to pay off her loan, which won’t be repaid until 2004. With MedSend, by 2004 she will have spent nine years serving Nepal’s people in the name of Christ.

“The biggest way God has been able to use me is through teaching and training community health workers to make changes in their own communities,” she said. “I wouldn’t have had the opportunity to go had it not been for MedSend.”

June 21, 2002