Showing posts with label global health. Show all posts
Showing posts with label global health. Show all posts

Friday, 31 August 2012

MC and Global Health--8

Home Coming

Back home in our garden in France
--and in member care--
 after travels in the Global Health domain.

Roads go ever ever on
Under cloud and under star,
Yet feet that wandering have gone
Turn at last to home afar.
Eyes that fire and sword have seen
And horror in the halls of stone
Look at last on meadows green
And trees and hills they long have known.
(JRR Tolkien, The Hobbit)
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In these entries we’ve explored some of the concepts, challenges, and practices of global health (GH) and GH's relevance for member care and mission. It is just a start for us and hopeuflly others will take GH further, sharing how GH is and can be actively part of mission and member care.
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Central to GH are the notions of equity and quality care for all. Our exploration has taken us to places all over the world via articles, web sites, short video docs, and analyses about issues and opportunities. We highlighted vulnerable populations, coordinated efforts, and further integrating both physical and mental health into the work of mission/aid. Health statistics, democratizing GH, and preventing sexual exploitation/abuse were also specifically addressed. Global mental health (GMH) was especially emphasized and  a crucial part of what we called mhM--mental health as/is misson.
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We advocate for a broader vision and a new phase for member care, in keeping with the challenges and opportunities facing humanity.
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We encourage maintaining the focus of the MC core while expanding the function of the MC corps (i.e. emphasizing wellbeing/effectiveness for mission/aid workers vs pursuing skills/involvement for  GH/GMH).
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Reflection and Discussion
Can we develop a consensually-derived global framework (agenda) for member care, even as there have been global frameworks within the health and mission domains?  
 
Could a Global Summit be set up to pursue this framework, including a diversity of people interacting before, during, and after such a Summit?
 
Here are some examples of frameworks/agendas to stimulate our thinking and inform our actions.
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Global Health
**A Framework Convention on Global Health: Health for All, Justice for All
Journal of the American Medical Association (16 May 2012)
**One Health Summit 2012: One Health, One Planet, One Future
Global Risk Forum (human, animal, environmental health, agriculture, food safety/security)
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Global Mission
**Missiometrics 2008: Reality Checks for Christian World Communions
International Bulletin of Mission Research (January 2008, see line 79 in summary chart; for 2012 statistics: click here)
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Member  Care
**An Agenda for Member Care in Frontier Missions
International Journal of Frontier Missions (July 1992)
**Global Treasures for a Global Field (resources and directions)
Member Care in India: Ministry Call to Home Call (MUT, 2012)
(initial version in Momentum May/June 2006, pp.49-52)

Tuesday, 14 August 2012

MC and Global Health—7

Mental Health IS Mission
As early career psychologists, we headed into mission/aid work 25 years ago.
This 1987 photo is from a special farewell party in Los Angeles with friends.
We have grown deeply and broadly and so has the member care field!
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"The Christian mission requires that we meet basic human needs for education, food, water, medicine, justice, and peace. As is evident in the Apostle John’s assertion that Jesus was sent to “destroy the works of the devil” (I John 3: 8), our mission is to continue his earthly mission by undertaking the kind of organized research and enterprises that combat evil in all its forms—violence, injustice, poverty, environmental exploitation, drug trafficking, and disease… All of this is to the ultimate glory of our good and gracious Creator and Redeemer God." David Hesselgrave, describing the essence of Dr. Ralph Winter’s “kingdom mission.” Evangelical Missions Quarterly, (Volume 46, April 2010; p. 196).
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To “meet basic human needs” and to “combat evil in all its forms” also includes combating the causes and results of human suffering, such as mental ill-health and disease. In this regard, connecting and contributing to the global health domain (GH) is an important opportunity for the member care field even as it has been for parts of the mission/aid sector. Global mental health (GMH) is particularly relevant, as we have seen in these entries.
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Mental health (MH) fits solidly into the scope of “mission.”
It is not just a means to a “greater” spiritual end.
It is not just a bi-product of mission.
It is a core part of mission.
MH is mission (mhM).
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“The global burden of disease attributable to mental, neurological, and substance use disorders is expected to rise from 12.3% in 2000 to 14.7% in 2020 (1). This rise will be particularly sharp in developing countries. Research has documented the socioeconomic determinants of many disorders, the profound impact on the lives of those affected and their families, and the lack of appropriate care in developing countries. The enormous gap between mental health needs and the services in developing countries has been documented in international reports, culminating in the World Health Report 2001 (2). This evidence has increased the profile of international mental health, but action still remains limited. With every new public health challenge, mental health is once more relegated to the background. We argue that moral arguments are just as important as evidence to make the case for mental health intervention. At the center of these moral arguments is the need to reclaim the place of mental health at the heart of international public health.” (Beyond Evidence: The Moral Case for International Mental Health; Patel, Saraceno, Kleinman, American Journal of Psychiatry, 138:8, August 2006, pp. 1312-1315)
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Some Basic Applications
1. Further develop MH awareness/skills for:
**mission/aid workers
**member care workers
**health care workers
**the people and communities that are the focus of mission/aid and health care workers
(including vulnerable populations: the poor, those with minimal access to health resources, settings of conflict/calamity)
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Some resources:
**Mental Health First Aid (12 hour course)
(Links for Training in 15 Countries)
**Psychological First Aid: A Guide for Field Workers
(World Health Organisation, World Vision International, War Trauma Foundation)
**Community-Based Psychosocial Support: A Training Kit
(International Federation of Red Cross and Red Crescent Societies)
**Integrating Mental Health into Primary Care: A Global Perspective
(World Health Organisation and World Organisation of Family Doctors)
(Vikram Patel)
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2. Encourage mental health professionals and students to find relevant ways to connect and contribute to global MH.
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Some resources:
**A Resource Map for Connecting and Contributing (short article: July 2011)
**Finding Your Niches and Networks (short article: March 2012)
**A Resource Primer for Exploring the Domain (journal article: July 2012)
**GMH-Map website: A global map for a global movement
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Finally, and for some stats and real-life examples: Watch the short overview video about global mental health from the World Health Organisation’s “Mental Health Gap Action Programme.
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Reflection and Discussion
**Christian mission keeps the person and message of Christ central. Respond to this assertion in terms of the MH perspectives shared in this entry.
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**How could people in your settings including yourself further develop MH awareness and skills? How feasible is this?

Tuesday, 31 July 2012

MC and Global Health—6

Mental Health as Mission:
Go Broadly, Grow Deeply
In Tamil Nadu, India. April 2012
Is it time to seriously tweak our member care paradigms and skill sets?
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How does Global Health (GH) relate to member care and vice versa? One key connecting point is through global mental health (GMH). We think that GMH will have an increasing role to play for member care and mission/aid. We like to think of it as “mental health as mission” (mhM).
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mhM embodies our joint efforts to serve humanity via the mental health sciences/disciplines. It is an important extension of our member care work, building upon the core MC focus of wellbeing/effectiveness for mission/aid workers in order to further equip/support workers who themselves are helping people in areas like domestic violence, depression, substance abuse, traumatic stress, etc. It can also involve our own direct services for people needing mental health and psychosocial support—so another important way for skilled MC workers to contribute beyond their usual roles.  
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mhM is quite a frontier too, especially since mental conditions are largely untreated among the poor, and there are lots of poor among Unreached People Groups of course. For example, currently it is estimated by the World Health Organisation that estimate of 450 million people suffer from mental, neurological, or substance abuse conditions (MNS)--with about 75% going untreated in low to middle income countries. Further, one in four humans will likely experience some type of serious MNS condition during their lifetime. The ripple effects of course are considerable especially when MNS conditions are not treated, affecting friends, family members, finances, communities, the economy, etc.
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Interview in India
Here are some more thoughts about mhM, weaving together global health and global mission realities. They are excerpted from our recent interview in the Chennai-based Christian Manager magazine (April-May 2012). Have a look at the entire interview (pages 23-28) as well as other articles in this issue on mission in India. This interview encourages us to consider the many opportunities to relevantly connect and contribute to mhM as we go broadly and grow deeply.
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"One of the global trends challenging missions is the issue of migration--people who are on the move. According to the Geneva-based International Organisation for Migration (IOM), there are around 300 million people who are in some form of significant international migration…The transition experience of migration incurs loss, grief and perhaps alienation [and many positive benefits!]. So the transition experience is not just something to focus on for mission workers and their families, but for other major blocks of humanity as well. I see all this as opportunities for missions.The world’s on the move and we should be too….The mission community can benefit from cutting edge resources such as the materials on the website of Families in Global Transitions (www.figt.org).”
“…the concept  of missions and who is a missionary needs to be revisited in the light of global realities...we can no longer talk only about traditional missionary work in an explicit evangelism and cross cultural contexts.  The utter need for crossing cultures and focusing on unreached people groups is still at the heart of mission. Yet the mission of God is much more than that. This also means going cross-sectorally in order to connect with human structures such as the global health community (e.g., World Health Organization and many NGOs), the United Nations Millennium Development Goals, [e.g., end hunger and poverty, provide universal education, improve child and maternal health, ensure environmental sustainability] and other organizations with an international, multi-sectoral, and faith-based reach—a good case in point is World Vision International. Clearly it is a call to bring both new and old gems out of our mission treasure chest, an ongoing process,  as envisioned by Christ in the Kingdom parables (Mt. 13:51,52).”
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Going Further
1. Have a look through our new and main website for Member Care Associates, Inc. (www.membercareassociates.org). This site, like all we do in MCA, is dedicated to encourage us as we intentionally cross sectors, disciplines, and cultures for good practice in light of global realities. You will find a lot of materials to help broaden our boundaries—thinking, relationships, activities—for mutual learning and effectiveness as learners-practitioners.
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2. Review the new article in the 16 May 2012 issue of the Journal of the American Medical Association, A Framework Convention on Global Health: Health for All Justice for All by Lawrence Gostin.  If you get a bit lost (in spite of how well-written it is) don’t fret, since there are probably several new terms, organisations, ideas, and issues that you will come across and which are all part of becoming more conversant with GH. Why read this article? One important reason is because GH realities needs to inform our thinking and work in MC in mission/aid.
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 Reflection and Discussion
**List a few items from the materials above (interview, web site, article) that are most relevant for your life and for your member care work in mission/aid. We really encourage people to review the materials with colleagues.

**Try to make a case (list a few reasons) for mhM being a distraction for MC and then in contrast for it being a duty of MC. Is MHM an obstacle or an opportunity--what do you think?

Thursday, 19 July 2012

MC and Global Health--5

Health for All:
Taking a Tour of Global Health

Note, image above: Cover of brochure from the Geneva-based NGO Forum for Health, a coaliton of 25+ organisations dedicated to making health for all a reality.  One of its many contributions is through the Mental Health and Psychosocial Working Group.
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Let’s take a fascinating tour of GH via Global Health TV. Below you will find seven short video reports on a variety of global health issues/organisations in a variety of coutries/settings. 
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 The video reports are useful to those of us in member care for at least three reasons:
1. They help us stay informed about important global (health) issues and innovations (e.g., health disparities).
2. Some of the resources mentioned can inform and equip our member care work (e.g., psychological first aid).
3.We can also learn from the types of approaches to heath that are being developed (e.g., e-health). 
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We start in Geneva at the 64th World Health Assembly (2011). “The term "global health diplomacy" aims to capture the system and the method for reaching compromise and consensus in matters pertaining to health in the crowded global arena. Global Health TV reports from the World Health Assembly.”
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Next we head to San Francisco, California. “Global Health Sciences at the University of California, San Francisco (UCSF) strive to address the poverty, health disparities and the scourge of chronic diseases and pandemics in developing nations’ communities.” One of their projects is featured, in Tanzania.
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Off now to Massachusetts General Hospital (MGH) Center for Global Health (CGH) highlighting their work in Uganda, South Africa, and Haiti. “In 2006 the CGH was established to build upon MGH's long and distinguished history of international work and humanitarian assistance.”
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Kenya and Asia are the sites in this video about the World Bank Institute's Health System Practice (WBIHS). WBIHS forms partnerships for “capacity building products including structured learning through courses, knowledge exchange, peer-to-peer problem solving, coalition building and partnerships to scale-up impact.”
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Addressing Global Mental Health Needs (Humanitarian/Settings) Moving now into the realm of humanitarian emergencies, Inka Weissbecker addresses mental health needs in such settings, most of which are not understood or neglected. She is with the International Medical Corps. Note: here are links to some of the resources she mentions: Psychological First Aid: Guide for Field Workers, IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings.
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This video takes us to Columbia University in the USA and one of their programs they support in Nigeria, the New Creation Empowerment Centre. “The International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University's Mailman School of Public Health supports high-quality, HIV-related activities around the world. ICAP works with host countries and other organizations, principally in sub-Saharan Africa, to build capacity for family-focused HIV/AIDS prevention, care, and treatment programs.”
Our final destination takes us to Afghanistan to look at how the internet and telecommunications are increasing access to quality health care. The focus is on the work of the Aga Khan Development Network.
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Going Further
**Review the new article in the 16 May 2012 issue of the Journal of the American Medical Association, A Framework Convention on Global Health: Health for All Justice for All by Lawrence Gostin.  If you get a bit lost (in spite of how well-written it is) don’t fret, since there are probably several new terms, organisations, ideas, and issues that you will come across and which are all part of becoming more conversant with GH. Why read this article? Because GH needs to inform our thinking and work in MC.
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**See also the historic Alma-Ata Declaration (1978, three pages), on primary health care/health for all.
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Reflection and Discussion
**Which of the GH videos interested you the most?
**What are some resources and ideas that you can use for your work in member care?

Monday, 25 June 2012

MC and Global Health—4

World Health Assembly, Post Conference:
Protection from Sexual Exploitation and Abuse (PSEA)
13 June 2012, after the IASC event on PSEA at the UN in Geneva.
“It was powerful, relevant, disturbing, and sicko.”
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The only thing needed for evil to prosper is for good people to do nothing...
or to do some ‘thing’ and then to move on.
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Life continues after the many conferences that we all attend. The post-conference challenge is to get back into ones usual work and to implement all of the commitments and plans that one makes while gathered together. This post-conference challenge is true for us after having attended parts of the remarkable 65th World Health Assembly (WHA) held at the UN in Geneva.
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Not surprisingly, we were back at the UN in early June. We attended a three-hour event sponsored by the Inter-Agency Standing Committee (IASC, a major coordinator for humanitarian assistance). The topic was the Protection from Sexual Exploitation and Abuse (PSEA), emphasizing the IASC member organizations’ efforts to deal with this reality (SEA) in their operations. Many thanks to the ISAC for all their hard work to organize this event! We were warned that it would likely be disturbing, and judging by the looks on our faces after the event (as in the photo above--hard to really smile), the warning was accurate!
The event featured the screening of the movie, The Whistleblower. This movie is “based on the experiences of Kathryn Bolkovac, a Nebraska cop who served as a peacekeeper in post-war Bosnia and outed the U.N. for covering up a sex scandal.” Bolkovac, played by Rachel Weisz, “finds herself confronting a 'dangerous reality of corruption, cover-up and intrigue amid a world of private contractors and multinational diplomatic double-talk'. A fictionalised account inspired by actual events, the movie deals with issues both real and abhorrent: human trafficking, violence against women and cross-border organised crime. United Nations peacekeepers and staff are portrayed as turning a blindeye to, or worse, actually being complicit in these crimes.”  The Whistleblower premiered in September 2010 at the Toronto International Film Festival. Click here for the movie trailer.
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What Happened?
The IASC event was moderated by Arafat Jamal, Chief, IASC Secretariat, with some very sobering and informative opening remarks by Mr. William Lacey Swing, the Director General of the International Organisation for Migration (who oversaw the UN peacekeeping effort in the Democratic Republic of the Congo from 2003-2007 when major sexual scandals were surfacing that nearly crippled the UN’s operations there).
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Four panelists actively involved in the humanitarian sector responded to the movie. In addition, Madeleine Rees contributed many helpful insights, the former human rights lawyer in Bosnia who was played in the movie by Vanessa Redgrave.  They all poignantly discussed issues raised in the film as well as current initiatives to strengthen PSEA, especially organizational, leadership and individual responsibility. Participants also contributed through the engaging time of discussion. The panelists:
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Ms. Beris Gwynne, Director World Vision Geneva, Leader for Global Accountability 
Ms. Marie Elseroad, International Medical Corps, Co-Chair of the IASC Task Force on PSEA
Mr. Ngonlardje-Kabra Mbaidjol, UNHCR Director Ethics
Ms. Lauren Landis, Director WFP Geneva, WFP Senior Focal Point on PSEA
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Some key comments and some take-aways (from movie and presenters):
If we don’t do PSEA well then it will negatively affect all that we do.
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 In addition to the negative impact on victims, SEA seriously demoralizes staff, undermines our humanitarian strategies, and dishonors our organizations.
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 PSEA in differnt forms exists in places where there are peacekeepers (e.g., food for sex and human traafficking).   It  is not just in the more publicized places (West Africa, DRC, Bosia). The protectors become the predators.
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We need to mobilize more courageous leadership on this issue.
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We need role models who are beyond reproach.
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A major challenge is confronting the organizational architecture of impunity.
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We need safe places for honest conversations.
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Our organization is dealing with this issue---top-down, bottom-up, and end to end.
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 There are no exceptions, no excuses, and high behavioral expectations for our staff.
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 Staff need to understand that it is “cool” to be “good.”
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 We need sustained commitment for PSEA and to maintain momentum in the face of so many other humanitarian and organizational demands.
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Unless you go public, the darkness will never see the light of day.
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To date, there has been no prosecutions of the people involved in the events depicted in this movie.
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 End of movie comment by Kathryn Bolkovac:
I would do it again [whistleblow to protect vulnerable people in spite of grave risks/consequences]. Yes, without a doubt.
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Updates on PSEA in the UN and Related Personnel
1. The Senior IASC Focal Points.
At their December 2011 IASC Principals meeting, IOM agreed to facilitate an initiative to provide new momentum to addressing the issue of PSEA within IASC organizations. Under the leadership of the IOM Director-General, each IASC organization has nominated senior PSEA Focal Points which met to discuss progress in addressing PSEA within their respective organizations.
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2. The IASC Task Force on PSEA
The IASC Task Force is the venue for collaboration among all IASC members (UN, NGO, IOM and International Federation of the Red Cross/Red Crescent) with objectives to strengthen leadership, support field offices and assist agencies in incorporating PSEA based strategies.  The objectives of the IASC Task Force are:
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 Some Applications for Mission/Aid and Member Care
1. Don’t think that this stuff cannot happen in mission/aid —that is, having to deal with all types of corruption such as SEA, and including confronting leaders, organizational culture, and unethical and illegal practices, as well as whistleblowers (leaders, staff ,and external folks) committed to the core values of an organization experiencing the consequences of such confrontation.
2. One example, similar to this movie, more on the extreme end of the corruption and confrontation continuum, is the movie All God’s Children (2008). "Through the eyes of three families, All God’s Children tells the personal story of the first boarding school for children of missionaries to be investigated for abuse at the hands of the parents’ missionary colleagues [in Mamou, Guinea, run by the Christian and Missionary Alliance]. The survivors and parents share their journey of seeking justice, redemption and healing. Through the eyes of three families…Cut off from their families for 9 months out of the year and without any reliable means of communication, the children quietly suffered emotional, spiritual, physical and/or sexual abuse at the hands of the all-missionary staff. It took the children decades to acknowledge the effects the abuses had on their lives. When they finally dared to break the silence and speak out, the Church denied all allegations and refused to help. But through years of persistent activism the survivors and their parents finally compelled the Christian and Missionary Alliance to conduct an investigation and acknowledge the abuses. The healing could begin. The investigation of the Mamou Alliance Academy was the first of its kind but has since inspired investigations at other schools of many different denominations” (description from the website). Click here to watch the movie trailer; Click here to watch the movie (free online).
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3. We cannot help but think of the current and protracted case regarding the international NCI fraud, characterized by the abuse of trust, stealing millions of dollars, cover ups and wrongful dismissals by major organizations, attempted impunity, and large scale apathy to do anything about it in the international church and mission community (CMC), primarily the Evangelical CMC. Sadly, these types of experiences are more prevalent than acknowledged and are NOT simply on the extreme end of the corruption and confrontation continuum. For more information visit the PETRA People website, the PETRA People weblog, and the PETRA People petition site (Shine the Light—Together).
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More Info and Resources
2. Keeping Children Safe Coalition provides free online resources and training materials (Toolkit) for organizations working with children as well as the children of staff (the video enactments in the Toolkit are especially helpful).
3. MCA Resource Update on Member Character (July 2012) including the link to quotes related to character and organizational health from the book Transparency: How Leaders Create a Culture of Candor.
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Reflection and Discussion
**Describe a few applications for MC as a field, for your organization, and for yourself, based on the items/commentary above.