A conversation with Julie-Rachel Elwood, missionary nurse/midwife
For the past 12 years, Julie-Rachel (JR) Elwood has been a missionary at Chitokoloki Mission Hospital, serving with the support of her home assembly (church) back in Northern Ireland. Sister JR is a fount of knowledge and bundle of energy, with a flair for organisation and ability to stretch well beyond her UK training as a nurse and midwife. Working with JR has been a pleasure for both of us and we are continually grateful for her skill and godly commitment. We sat down with JR to hear more about her life story and her experience of service at Chitokoloki and hope you enjoy hearing a summary too!
Can you tell us about your early life?
I was brought up in Northern Ireland, where my brother and I enjoyed a Christian upbringing. I’m still very close to my parents, who are hugely supportive of my work here in Zambia.
I don’t remember a time when I wasn’t aware that I was a sinner and that I needed to have God in my life. I became a Christian when I was about 6 years old. I had been at a meeting where the gospel was presented, and afterwards woke my parents up in their room, to tell them that I had trusted the Lord.
My home assembly (church) was at Cloughfern. There weren’t many young people in our assembly, and I was the youngest person there until I was 15 years old. It was quite a sheltered upbringing, and I missed out on some social, youth things, but it was a solid foundation to have. I grew up feeling encouraged and I value the fact that I had to come up to the level of teaching that older folk were receiving, rather than being talked down to. Our assembly maintained a number of homes kept for missionaries on furlough. I loved it when there were missionaries who came and stayed or ate at our house – I got all the stories!
Did you always want to be a nurse?
Growing up, I thought I would do medicine. I arranged work experience (while at school) in medical placements, and nursing was never something I discussed or considered. When I chatted to teachers at school, they thought that I would need some volunteering experience to be competitive for medicine.
I went to volunteer in a nursing home and loved the experience. I saw the role of a nurse for the first time and admired it. I felt like doctors seemed to often deal with people’s immediate problem – they would work through a busy clinic and address lots of complaints in turn. On the other hand, nurses often get to know their patients better as a person, and spend more time with them as individuals. I chose to study at Coleraine (Northern Ireland), where the nursing school had an international perspective.
How did you come to work at Chitokoloki?
If you are coming to work as a missionary, I think you need a strong ‘call’. If there were a get-out clause, I wouldn’t have stayed. For me, this call was in the form of lots of little things, confirmation upon confirmation. I always wanted to do something for the Lord, but had no set ideas. That had partly motivated my decision to do nursing. When it came time to choose my nursing elective, I considered Murchison Hospital in South Africa. But in the end, I sat down to read through the Echoes magazine (for mission supporters), and wrote down the names of those missionaries who were currently on furlough at home in Northern Ireland. This led me to Betty Magennis, who was (and is) working as a nurse/midwife at Dipalata Hospital in North-Western Province, Zambia. Through Betty, I ended up in Zambia on elective in 2002. It was my first time leaving Northern Ireland on my own, and my first time in a plane! I had a fabulous time at Dipalata and felt the Lord with me. It felt like the kind of work I wanted to spend my life on. I’d also heard of the McAdams [David McAdam is Chitokoloki’s missionary surgeon], so spent 2 days at Chitokoloki at the end of my elective.
After finishing my nursing training, and praying through my future, I came back to Dipalata in 2003 but it didn’t quite feel like the right place for me. I again came to Chit for a week’s experience and felt a strong sense of calling. At the time, there was a nurse called Sandy based here and I went out with her doing village work, teaching Bible stories and so on. As I spent more time at Chit, it seemed so obvious that there was a role for me here.
When I returned home, I told my parents my intentions, and while supportive, they told me to slow down a bit! I applied for a few jobs, and ended up getting a job in the theatre department at the Royal Victoria Hospital, Belfast. I was placed in the neurosurgery theatre. I enjoyed neurosurgery, although I wouldn’t have chosen to work in that area myself - it didn’t seem very relevant to a future in a mission hospital. However, the Lord knew what was best – when I was in a big neurosurgery case, the long length of time taken for each surgery would mean that the anaesthetists would have time to teach, and gave me extra skills that have been invaluable at Chit. Also, it was common in neurosurgery for our all-day case to be cancelled, and I would get to work in almost every other type of theatre, where I got a hugely varied experience.
Another confirmation of my call to Chit came from a phone call from an individual who said, ‘the Lord has told me that you are going to be a missionary in Zambia… I’m going to teach the Lunda language and grammar to you.’ I had known how important language skills were, and in 2006 I got a work permit against expectations to work in Zambia, which again seemed to confirm I was on the right track.
On my previous visits to Zambia, I had been struck by how many of the medical challenges came in the form of obstetric emergencies, and I had a strong sense of wanting to also be trained as a midwife. The programme was competitive, with 600 applicants for 40 places, and I prayed that if God wanted me to get in, I would get an interview. I applied for midwifery training, then when I received an interview, I quit my job and came to Zambia again for another spell of volunteering. While I was out here, I heard that I’d been accepted for a place. I finished midwifery training in 2009, then things moved quickly; I received support from my local church elders and Echoes (mission service agency) to come permanently as a missionary nurse at Chitokoloki.
What is your understanding of your role as a missionary?
A missionary’s role is to share God’s love, and the message of salvation, it’s not just being an overseas worker. If I were working in a secular job, I would be curtailed by the priorities of my employer. In my situation, my number one focus can be sharing the gospel. When I was in Northern Ireland, I got in trouble once for handing out gospel literature at work. Here, there are opportunities for Christian witness in every aspect of life.
The hospital draws in many people, so the care needs to be good. This is a big part of my focus. Most of our staff won’t have a personal Christian faith, but they will encounter a strong ethos of good patient care, and many staff are impacted by the love and attention that they see being given to patients.
As time has gone on, my role has changed dramatically and I’ve now taken on more leadership responsibility. I’m not a naturally confident person, and I don’t like being in leadership. What I like best is giving one-to-one care, particularly with people who stay with us some time. You walk through those patients’ journeys with them, and have lots of meaningful interaction, including at a spiritual level. Over the years, I’ve become involved with lots of hospital activities, including management of club feet and cervical cancer screening. One of the reasons I enjoy cervical cancer screening is that it gives you an opportunity to invest your full concentration on that one person, offering them good clinical advice and also pointing them towards God.
What makes me feel stressed is when I feel like I don’t have time for people, and I’m dealing with so many people that it can feel a bit like a cattle market.
To a degree, being a missionary is being a free agent; ultimately our boss is God, not someone stuck in the healthcare hierarchy. I am accountable to God in how I use my time and energy, and I work out of a sense of duty, or responsibility, or emotion. This is actually a higher responsibility than working for a human boss. I work many more hours here, with more energy than I would have done in paid employment, because I have a clear sense of working for the Lord. There are always things that need done, and you want to do them. I think my missionary role enables me to be more flexible and efficient; I’m not tied to someone else’s framework or timescale.
What do you enjoy about life work in Zambia?
I relish interactions and relationships with the people I meet at hospital and beyond. Over the 12 years that I’ve been permanently based at Chitokoloki, I’ve made many Zambian friends who are now spread throughout the country. In Zambia, you are able to freely share the gospel, you’re not just whispering it. There is openness and freedom for religious discussion here; supermarkets will commonly play Christian music, and it is normal to talk about God. I count that as a special privilege, that I don’t think we have in the UK, where many people are anti-Christian. Zambia’s status as a ‘Christian nation’ does give some challenges; everyone will say they are a Christian, regardless of what their beliefs are, or whether they actually know Jesus personally and have a saving faith.
Work here feels meaningful and has eternal significance. I did a Tropical Medicine course in Liverpool and studied with a big group of people working in very similar situations to me, but with different motivations. Their motivations were in themselves good – eradicating poverty, hunger, etc, but it felt a bit empty. Eradicating poverty and hunger is an unachievable aim, but we can help people to eternity and also give practical help and encouragement to those who are suffering.
‘Things’ can block you from the Lord. People here in Zambia look to God – they know they can’t do things themselves. In the West, people don’t feel the need for God, and forget that without God, we have nothing.
What is challenging about life and work in Chitokoloki?
I would like to hand on some of my responsibilities, but often we don’t have the right people to take on roles. The majority of expatriate healthcare staff we get visiting us will not stay long, or will not return often. Many of my Zambian colleagues haven’t wanted to stay long at Chitokoloki either. Here, we are really in the bush and people leave to better their opportunities in life. Those who come from elsewhere usually want to return to town living.
As time goes on, I find it harder to go back to the UK. It is my ‘home’, but I no longer fit in, except with those who have had similar experiences. Life has moved on for my UK family and friends, and I particularly found this difficult while stuck in the UK during lockdown; there was a strong sense of ‘being in the wrong place’. When I go back to my home church, people have changed, or died, and circumstances have moved on. Zambia feels more like home. There is a sense of family here, where the missionary and hospital community feel like my brothers and sisters; their children are like my nieces and nephews.
One thing I like about living in such close community is that there is no fake-ness. People know your good and bad sides, when you’re having a bad day, and you can be yourself. You can’t ‘put on’ a certain personality, whereas in the UK it could feel like you were playing a character. Here, it is a fishbowl, which is challenging but also creates more natural relationships. I’ve build relationships with many generations of families – you care for someone’s son, deliver their grandchild. If we lose a child at hospital, for example, it is sad, but families remember, recognise and appreciate the efforts you make despite bad outcomes.
What local cultural issues do you find difficult?
Health/healthcare beliefs in the local community are a challenge to us. Pretty much everyone will go to ‘traditional doctors’ before coming to hospital. That will take a long time to change, and Christian educators probably have a bigger role than us in changing this situation.
Our role is to always tell the truth. If we tell the truth to someone with end-stage cancer, the hospital’s honesty will be demonstrated in what happens – contrasting with false claims from local healers.
I remember treating a young lady with breast cancer, who delayed and delayed coming to hospital, because the traditional healers told her, ‘if you leave us, you will die.’ When she did eventually give up and come to hospital, it was too late and there was nothing we could do to change her outlook. People here don’t understand biology, or pathology, and it will take better educational standards to change that.
I also find it hard to see certain social norms which aren’t good. It is hard to see women staying in abusive environments, because if they leave, they lose their children. Promiscuity is widely accepted, and women are often placed in submissive situations.
People without a sympathy for the Christian faith might argue that using healthcare provision as a platform for proselytising and evangelism is an abuse of your position of power and trust. How would you answer their concern?
What I’d say is that people do have a choice. They have a choice over whether they come here, or elsewhere, and they have a choice of whether they listen or not to our Christian perspective. There are lots of nearby government healthcare facilities, but people often bypass them to come here, because they know that at this mission hospital they will be treated with respect and that we will do our best for them. People travel long distances from big cities, including the capital, to get their care here.
If you don’t want to hear the gospel, you don’t need to listen to it. I’d also say that the care we give is identical for all patients – it’s the best care we can give, regardless of your beliefs. I try to give 100% to every patient, and the decisions we make are based not on money, or consideration of posterity, they are focused on what matters for delivering best patient care.
For me, this is an important part of our witness. It’s not money that makes the difference here, it is the Christian ethos and reliance on God. For most people, the healthcare we offer is their only chance. Many are offered referral elsewhere, and very few want to go; this is their end point. Of course, we don’t offer some services. Abortion is never an option and contraceptives are only available on a limited basis. Some of these services are available elsewhere in government facilities and people are welcome to travel there.
What are your hopes for the future?
I hope that more Christians decide to make cross-cultural mission work their primary focus in life; we have many short-term volunteers but few people dedicate their whole life to a work like this. I think there is a need for more people to do mission work without having another ‘vocation’; often missionaries can get caught up in their role rather than their overall goal. For me, I am in Zambia for the duration, unless I get a clear sense that God is calling me elsewhere.
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