I called LDS headquarters this week to ask a few questions and raise some concerns about health care for missionaries (or rather, about what I hope are two unusual and exceptional cases). In the process, I spoke at length with several people in two different departments dealing with LDS missions and medical issues. I've also spoken with several missionaries and former missionaries. On the basis of these conversations, I agree that the Church does strive diligently to ensure that missionaries are safe, healthy, and get the care they need. There is a real effort to make sure that excellent care is given, and many millions are spent toward that end. I am also impressed with the statistics showing that serving a mission is remarkably safe and much healthier than the lifestyles of typical young people. And I am confident that in most missions, most missionaries receive an outstanding level of appropriate health care. However, I am also convinced that there is
still room for improvement in the health care provided for missionaries in at least some missions. And frankly, after expressing some serious concerns, I feel that others did not fully grasp the potential seriousness of the situation (not the nurse I spoke to - she was great). Sure, I can understand why people there might not pay much attention to a complainer from Wisconsin. But one significant person eventually assured me that corrective action would be taken in one case that I raised, but as you may deduce from the details below, the disappointing result would only prove to be more fuel for my burning concern. There is a problem, perhaps a rare one but certainly a real one that needs to be addressed.
In posting my comments here, I do not mean to point fingers at any of the mission presidents and their wives in the Church. I hope that will be clear below.
By way of background, missionaries in need of non-emergency health care often are asked to call the mission president's wife to discuss the problem. She may have the missionary talk with a Church-sponsored doctor over the phone to see if further attention is needed, or she may make recommendations on her own. If the missionary is sent to a doctor, the Church covers all the costs. Many millions are spent to ensure that good care is provided. I can see that requiring pre-approval before seeing a doctor in non-emergency situations makes sense when all the costs are being covered by a third party.
A problem arises, though, when the mission president's wife does not accurately assess the situation. Even if we required them to have medical degrees, there are cases when a phone call is inadequate to understand the nature of an injury or illness. I respect them greatly for the work they do to watch after missionaries, but perhaps too much is being asked sometimes. In my opinion, the same problem applies to those missions where doctors hired by the Church are available by phone to approve (and screen) missionary requests to see a doctor. If a missionary feels that he or she needs to see a doctor, but the mission president's wife or a long-distance doctor says no, what recourse does a missionary without his own insurance have? Perhaps we need some kind of backup system - perhaps a copay system for unauthorized office visits or a health care advocate/ombudsman a missionary can turn to when he or she is not satisfied with a recommendation.
Two Troubling Cases: May These Be Unique!I know of two recent cases, hopefully two very exceptional cases, in two different missions, where missionaries correctly recognized that they needed to see a doctor but were told not to. More than one request was made, but they were all denied. In one case a frustrated member in a local missionary's area, worried about the missionary's sports injury from a preparation-day activity, gave up on the system after multiple requests for approval to see a physician and simply took the elder to a walk-in clinic at the expense of the member. The mission's screeners had believed the injury to be minor and would not authorize a visit to a physician, even after a couple of concerned local members called various parties to intervene for the elder. However, X-rays confirmed that the missionary's injury was more serious than the mission president's wife and a remote Church doctor had recognized, and confirmed that a higher level of care was needed. In fact, the missionary will require surgery (relatively minor, fortunately).
Now that a correct diagnosis has been obtained - apparently this required a physically present physician using x-rays - I am confident that the surgery will be covered by the Church and that the missionary will get the care that he should have been getting several weeks ago. While it would have been best to see a physician right after the injury, I am hopeful that most of the problem can still be corrected. Though hopeful and grateful now that care has been initiated, I am unsettled by this event. Perhaps more than just a little unsettled. Local members were right to be concerned and a local member was right to buck the system by "smuggling" the missionary into a clinic to get x-rays. Glad he felt he had enough cash to spare to do that on his own. (
Update: the Church's Missionary Medical Department wishes to reimburse the member for wisely taking the elder into the clinic, so that's good.)
In a second and more serious case, a missionary's repeated requests to see a doctor were allegedly denied by a well-meaning mission president's wife. She thought the pains in his side might be due to inadequate fluids and recommended drinking water or Gatorade. He had appendicitis. Fortunately, the missionary is OK now, but I understand that he was worried and unsatisfied with the recommendation from the mission mom. His health could have been protected better by making it easier to see a doctor.
My dear brothers and sisters in the Missionary Department, although these two cases may be bizarre outliers in a system that normally works well to protect the health of missionaries at reasonable cost, they do point to a potential weakness in the system that might depend too much on the judgment of a well-meaning mission mom who typically is not a medical professional, or on the judgment of a remote physician who may feel a responsibility to cut back on seemingly unneeded doctor visits to prevent wasting Church funds. Could we consider a safety valve for those cases when a missionary really feels that a doctor's attention is needed? I believe that health care for missionaries is remarkably good, but in at least a few cases it needs to be better.
I am also concerned that an unfair burden may be placed on mission presidents' wives. All the ones I have known have been exemplary people, loving, diligent, and dedicated to the well-being of their missionaries. But I haven't known any that were licensed nurses or physicians. Isn't there a dangerous liability issue hanging over mission moms? I don't know of any such lawsuits, but one medical disaster coupled with aggressive personal injury attorneys could create a huge nightmare for them and for the Church.
My final concern involves the ability of parents to know what's happening with their missionaries. I can understand that mission presidents want families to just get upbeat news and not details of miseries from colds or other minor illnesses. But I believe that parents should expect to know the details of the health of their missionaries,
if the missionaries want to share that. Unfortunately, many missionaries are told to stay positive and not discuss health problems. They may feel pressure to not talk about problems like pains in their side or a sports injury that isn't healing. Look, they are adults and should be able to share whatever information they wish about their health. And who knows, perhaps a little more openness here could help serve as a safety valve, for increased awareness will bring increased accountability and perhaps improved health care access. I'm sure mission presidents, Church doctors, and leaders in the Missionary Department don't want a flood of overly nervous parents calling in to second-guess the level of care that is being provided when someone isn't feeling well, but as long as there isn't a safety valve to deal with the exceptional cases like the two I've raised here, then maybe a few more calls from concerned members and parents will help.
For the record, my missionary son is not one of the two cases discussed above. His health has been fine, as far as I know. (Well, as far as I know - I mean, I haven't heard anything negative, so I assume . . . oh oh . . .) And my oldest son who served in Argentina reports that he felt the health care provided was excellent, and the role of the missionary president's wife there was a very helpful one. She was really looking out for the missionaries and made sure they got good care.
Now if there are possible flaws in the Church's healthcare system for missionaries, it will be just one more reminder of how fallible all humans are, even those who serve the Church. Just as Moses the great prophet needed advice from his father-in-law to get him improve his inadequate management of the House of Israel, it's possible that outside advice from ordinary members like you and me and the parents of missionaries might be needed in some department somewhere in Salt Lake City, like it or not.
If you respond to this post, please note that I am not looking for a forum to criticize Church leaders, to denounce the Church, or to post anonymous and highly questionable alleged horror stories of missionary maltreatment. We've had some nasty examples of that from deceptive anti-Mormons on this blog before. But I would especially appreciate suggestions on how we can better help our missionaries, how we might avoid the exceptional problems I have raised here, and how members and leaders can better care for and protect our missionaries. I would also appreciate comments on how we can deal with the issue of what missionaries do and don't share with folks back home. And if I'm overreacting and being unfair in this post, let me know.
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