What is the most pressing need of the church today?  If Paul, observing false teachers within the church, experiencing persecution from outside of it and, all the while, desiring to be about the business of spreading the message of Christ to Gentiles, is able to write “First of all, then, I urge that prayers, intercessions, and thanksgivings be made for all people…”, then we need to take notice.  Mounce comments “It is not so much that prayer for all peoples is the first on the list but that it is the most important on this list.”[i] Jesus said, “My house shall be called a house of prayer” (Matt. 21:13) and yet we would be hard pressed to find many churches where the name fits.  The church needs desperately to recover the practice of corporate prayer. One the most basic level, prayer is an act of obedience before God.  When Paul urged Timothy to lead the Christians in Ephesus to pray, the Holy Spirit was speaking to us as well. More fundamentally, the Holy Spirit was speaking to those who are charged with the pastoral care of a church and calling to them to take a lead role in the prayer life of the church. This call is needed afresh. A survey conducted by Ellison Research found that just 9 percent of pastors under age 45 are very satisfied with their prayer life and, of the ministers between the ages of 45 and 59, only 13 percent say that they are.[ii]  The letter of 1 Timothy confronts us with the truth that a church’s ministries reflect the pastor, and so it is no surprise that a Lifeway study found that, when ranking the most important ministries in their churches, prayer received only 5 percent of the vote by those surveyed[iii] and we should not share in the surprise of an African church leader who, after visiting American churches commented: “I’m surprised by how little prayer I witnessed.”[iv] Much like Ephesus needed a Timothy to lead them, and much like Timothy needed a Paul to urge him to do so, our churches need pastors to lead them and our pastors seem to need older mentors to hold them accountable to doing so. Denominational leaders need to wake up to the true need in the church and call their ministers to action.

For what should the churches be called to pray for?  They need to pray for those within the church. Especially for unity within the local household of faith that is based upon a shared confession of the uniqueness of God and the penal substitutionary work of the one mediator between God and man, the man Christ Jesus. Jesus linked being “sanctified in the truth” to the ability of brothers and sisters in Christ to be a good witness before a watching world (John 17:19-23) and the church must recognize this need. They should also pray for those outside of our church, including our government.  On May 5, 2014, the Supreme Court affirmed that prayer before a legislative body is constitutional and it is permissible for that prayer to contain Christian faith-specific language and a 2012 Pew Research Center poll found that 65% of Americans believe political groups have gone too far trying to keep religion out of schools and government.[v] These facts indicate that churches have been given an opportunity to pray not only for, but in the presence of “all who are in high positions.” A privilege which Paul and Timothy did not have. 

How do we motivate pastors and lay members alike to embrace this call?  It must begin with a love of God and a love of man.  Undergirding this call to Timothy was the desire to honor God.  Paul, after having recounted the mercy shown to him in Jesus Christ, exclaims “To the King of the ages, immortal, invisible the only God, be honor and glory forever and ever. Amen” (1:17).  In a real way, the “then” of 2:1 could be linked to that proclamation:  “Our desires is that God may be honored (1:17), therefore (then) let us pray (2:1) for such prayers are good and pleasing in the sight of God our Savior (2:3).” Also undergirding this call was a desire to see men saved.  When we love God, we will love what He love and we will desire what He desires.  Paul makes it clear that God “desires all people to be saved and to come to the knowledge of the truth” (2:4).   This desire should be evidenced in every church that claims to love the Lord and it should be evidenced by their prayers. As D.A. Carson states,

If we follow Paul’s example, then, we will never overlook the monumental importance of praying for others.  Prayer will never descend to the level where it is nothing more than a retreat house in which we find strength for ourselves, whether through the celebration of praise or through a mystic communion with God or through the relief of casting our cares upon the Almighty.  Prayer may embrace all of these elements, and more; but if we learn to pray with Paul, we will learn to pray for others.[vi]

These points would have been readily affirmed by the students but none of them related the passage to their own context as medical students nor to that of the profession they are seeking to enter into. This is where the work of the Christian faculty of the school must begin. Much like Calvin’s likening of Prince Edward to Paul with numerous “Timothys” under his tutelage, so today’s Christian medical school faculty play a similar role.  They should take passages such as 1 Timothy 2:1-7 and point out that, although the hostel of God (the hospital) is not the house of God (the church), there are some similarities in the situation facing Christians in both.  

The church in Ephesus was established with the intention to honor God by following Christ but false teachers within had gained positions of influence and were making shipwrecks of individual’s faith and persecution from those in authority without threatened their welfare if they were to dare put their faith on display. In the same way, voices from within and outside of the healthcare system are pressuring Christians to steer clear of a faith-influenced practice of medicine.  “Doctors are in a position of power in relation to their patients…any attempt by doctors to impose their religious or political views would be an abuse of that power,” says Sheikh Muhammad Yusuf, a fellow of the Interfaith Alliance, which represents both doctors and patients.[vii]

Paul’s instruction to pray for those in authority because they had it within their power to make life easier for them has clear application here.  It should be the practice of every Christian physician to pray for hospital administrators, licensing bodies, and state legislatures which oversee the healthcare system, that they would allow for the freedom of expression and conscience when it comes to the faith of the physician. I have heard Christian professors, in their role as Paul, tell their class of Timothys tales of ignoring expected protocols in their dealings with patients and charging medical students to take a risk in doing the same when it comes to matters of faith. While the sentiment is appreciated and we must encourage our fellow Christians to “obey God rather than men,” one must wonder how much good could be accomplished if they were to follow Paul’s lead and instruct these students to begin, not in rebellion, but in praying that the hearts of those who create the rules would be changed and, as a consequence, the rules themselves.

The intended result of the prayers for those “in high positions” within the healthcare field is that there would be a freedom to engage with patients over matters of faith and to follow Paul’s charge to pray all kinds of prayers for all people without the fear of retribution. “Supplications, prayers, intercessions, and thanksgivings” would each easily find their place in the exam room and studies show that up to 70 percent of patients would be receptive to their doctors praying with them.  Despite this, those same studies show that as little as 10 percent of doctors actually do.[viii] Why is that? Physicians are told repeatedly that there are lines they cannot cross.  Resembling the false teachers within the church in Ephesus who were teaching doctrines which led the believers astray, one physician who identifies as a Christian warns, “Do not prescribe religion to non-religious patients; force a spiritual history if the patient is non-religious; coerce patients in any way to believe or practice; spiritually counsel patients; engage in any activity that is not patient-centered; or argue with patients over religious matters, even when they conflict with medical care and treatment.”[ix] No one would argue that one should “coerce” or “argue” with a patient but the use of such language gives the impression that is exactly what Christian physicians are being asked to do.  When a student is led to believe that the only alternatives are silence or coercion, then it is no wonder that many remain silent. 

            We desire the number of Christian physicians who are willing to share their faith to grow. With the increasing interest in spirituality and health, the resources available to help us in leading our students in this direction are more plentiful than they have ever been. 1 Tim 2:1-7, however, provides a much needed corrective to some of the most popular writings in this arena. For instance, many of the academic studies and popular treatments regarding faith and medicine focus on the so-called “power of prayer” in the exam room and its ability to change health outcomes.  The BBC produced a documentary which framed the topic in its most popular form by asking in its title “Does Prayer Work?: A Medical Perspective.”[x] Paul, however, frames it differently.  Certainly, the variety of prayers that Paul charges believers to pray “for all people” would include their healing and the hope would be that these prayers would “work” in that the people would, indeed, be healed.  But for Paul, that is not the end of the matter. Any physical healing is ultimately temporary in that physical death will come to all.  Paul reminds his readers that God is after the eternal healing that comes through someone coming to faith: He desires “all people to be saved.” A Christian doctor must remember the same and seek to ensure that their prayers are not perceived as simply a means to manipulate God into providing a quick fix for a medical problem, but, instead, are a genuine expression of faith in the One True God to whom all must turn for salvation and that they are prayed in the hope that the patient will, indeed, find this hope.

The alternative is to risk reducing our prayers to the level of incantations. As Howard L. Kay warns, 

To encourage religious practice and greater spirituality for its putative health benefits on the order of physical exercise, a low-fat diet, and relaxation training runs the risk of trivializing religion into little more than magic…If religion is practiced essentially for its therapeutic benefits, what happens to religious practice if scientists discover that some other psychotherapeutic technique, such as meditation or self-hypnosis, is more effective as a source of stress reduction, or if scientists identify the biochemical pathways by which prayer strengthens the body’s immune system and then develops a more potent pharmacological means of doing so? Might religion then become medically obsolete, similar to the early antidepressants?[xi]

Another issue that 1 Timothy 2:1-7 highlights is in regard to the question “to whom do we pray?” Even academics who claim the Christian faith include in their studies research on the health benefits of subscribing to non-Christian faiths. For example, Koenig, King and Carson’s monumental tome “Handbook of Religion and Health,” includes examinations of the health outcomes that faithful Jewish, Muslim, Hindu, and Buddhist adherents have experienced due to their own religious practice. Though such studies are not as numerous, the authors found that the results were similar to those of adherents of Christianity.[xii] The implication is that physicians need not concern themselves with the particular faith tradition of the patient for the results of their spiritual interventions will be the same regardless of the faith to which they subscribe. Paul disagrees. There is “but one God, there is also one mediator between God and humankind, Christ Jesus.” Christian doctors have to resist the urge to downplay the uniqueness of Christ in their efforts to avoid offending patients of other faiths as well as the administrators that they may fear are taking note of their actions. 

The fact of the uniqueness of Christ as the sole mediator between humankind and the one true God also begs the question as to which students/physicians should be encouraged to pray. This is no hypothetical question as Christian and non-Christian medical students alike take part in our medical mission trips.  If prayer is nothing more than a patient-centered therapeutic technique which brings about results no matter what faith the physician and/or patient subscribes to, then it would not matter who dispenses it.  If, on the other hand, it is a cry to the Father through the mediation of the Son by those whom He has saved, then only the redeemed can be truly called upon to engage in prayer with their patients. As a result, the manner in which we encourage our students in this exercise must be well thought out.  A generic call for all students to pray for all patients would, as Kay put it, “trivialize religion into little more than magic.”

Given the above, a way of paraphrasing 1 Timothy 2:1-7 for the context in which we work at the medical school might be something like this:

Christian medical students, first of all, I urge that supplications, prayers, intercessions, and thanksgivings be made for all of your patients, (and) for those who oversee the healthcare system you will one day be a part of. This includes those in the U.S. Department of Health and Human Services, the North Carolina Medical Board and the administrators who oversee the daily operations of the facilities within which you will one day work. Do this that you might practice medicine in all godliness and dignity. This is right and acceptable in the sight of God our Savior, who desires everyone to be saved and to come to the knowledge of the truth. For there is one God; there is also one mediator between God and humankind, Christ Jesus, himself human, who gave himself a ransom for all this was attested at the right time. For this I was appointed a herald and an apostle (I am telling the truth, I am not lying), a teacher of the Gentiles in faith and truth.

            I had opportunity to share these conclusions before a group of faculty and students who had gathered for a midweek morning worship service we hold on campus. The response was unanimous in its positive reception and calls for the message to be repeated in other venues.  One professor exclaimed, “This must be shared with others!” In order to accomplish this, I would propose that a teaching series be presented to our students through the auspices of the Christian Medical and Dental Association student group on campus.  It would cover the history of Christians in medicine and the challenges facing the practice of faith in the medical system today. The importance of prayer and of living out one’s faith in the context of their calling as medical professionals would be examined and we would talk about the uniqueness of Christ and the implications for how they approach patients from a variety of faiths. 

In addition, before our medical missions trips, we would gather together those whom we know to be Christians and discuss the importance of their praying and sharing their faith with their patients and how this can be a witness, not only to the patients, but to the non-Christian students who will be joining them on the trip. In the clinics, Christian faculty would model praying for the patients and would ask local pastors and missionaries to work closely with our students in an effort to ensure cultural sensitivity while modeling a boldness of faith. Upon our return, we would gather the students for a follow-up debriefing in which we would invite them to share of their experience to the CMDA group and to the student body as a whole.

  Locally, our department offers to conduct screening clinics at churches which they can leverage for evangelistic events.  Typically, we invite the student body as whole to join us and we have had large groups of students work in our screening clinics which were sponsored by groups like the Lion’s Club.  When a church asks to organize a clinic, I would propose that we meet with the pastor to inquire as to the church’s goals for the clinic. If the church is desirous for the event to be an outreach event, then we would limit the student participants to students of faith by issuing personal invitations to them. We would then conduct a pre-clinic teaching session much like what we would do before an international trip.  We would discuss the importance of praying with one’s patients with an eye to their embracing the Christian faith.   

Finally, I would propose that Christian faculty, students and student organizations should unite in prayer for those in places of influence in the healthcare system in the United States.  Those in “higher places” wield considerable influence over how medicine is practiced and whether or not physicians of faith can follow their conscience in the exam room.  In response, organizations like the Christian Medical and Dental Association have established Washington offices where they can speak to government officials regarding a variety of issues facing Christians in the field of healthcare. This is a commendable activity, but I would liken it to Paul’s instructions to Timothy on how to order the church in Ephesus when it was facing disruptions from within and without.  The instructions were necessary, but the first order of the day was to be prayer. Prayer that is lifted up for “peaceful, quiet lives, godly and dignified in every way.  This is good, and it is pleasing in the sight of God our Savior, who desires all people to be saved.”

[i] Mounce, 78.

[ii] “Survey: Pastors Dissatisfied With Personal Prayer Lives,” The Christian Post, accessed September 13, 2018, https://www.christianpost.com/news/survey-pastors-dissatisfied-with-personal-prayer-lives-13473/

[iii] “LifeWay study reveals pastors’ ministry priorities,” The Baptist Message, accessed September 13, 2018, http://baptistmessage.com/lifeway-study-reveals-pastors-ministry-priorities/

[iv] Jason Helopoulos, “Pastor, Include More Prayer in Your Church Service,” The Gospel Coalition, accessed September 13, 2018, https://www.thegospelcoalition.org/article/include-more-prayer-church-service/

[v] Michael Lipka, “South Carolina valedictorian reignites debate on prayer in school,” FactTank, Pew Research Center, June 13, 2013, https://www.pewresearch.org/fact-tank/2013/06/13/south-carolina-valedictorian-reignites-debate-on-prayer-in-school/

[vi] D.A. Carson. A Call to Spiritual Formation: Priorities from Paul and His Prayers (Grand Rapids: Baker Academic, 1992), 74-75.

[vii] “Doctors are told not to let their personal faith affect the advice they give to their patients,” The Scotsman, March 17, 2008, https://www.scotsman.com/lifestyle/doctors-are-told-not-to-let-their-personal-faith-affect-the-advice-they-give-to-their-patients-1-1159283.

[viii] Harold G. Koenig, Spirituality in Patient Care: Why, When, How and What, 3^rd ed., (West Conshohocken, PA: Templeton Press, 2013), 29.

[ix] Richard Sloan, Harold Koenig, Stuart Butler, Cynthia Cohen, and Christina Puchalski, “Is Prayer Good for Your Health? A Critique of the Scientific Research,” The Heritage Foundation, December 22, 2003, https://www.heritage.org/civil-society/report/prayer-good-your-health-critique-the-scientific-research.

[x] “Does Prayer Work?: A Medical Perspective,” BBC “Worldwide Ltd.; Films for the Humanities & Sciences (Firm); Films Media Group, (New York: Films Media Group, 2006).

[xi] Howard L. Kay, “Psychoneuroimmunology and Religion: Implications for Society and Culture,” in The Link Between Religion and Health: Psychoneuroimmunology and the Faith Factor, ed. Harold G. Koenig and Harvey Jay Cohen (New York: Oxford University Press, 2002), 283.

[xii] Harold G. Koenig, Dana E. King, and Verna Benner Carson, Handbook of Faith and Religion and Health (New York: Oxford University Press, 2012), 138-142, 453-456.

To get at the heart of what Christian prayer truly is and what the implications are for the Christian physician, where should we begin? When asked to teach on the subject of prayer Martin Luther commented that any study should start with the Lord’s Prayer because it not only tells us how and for what to pray but, “since our Lord is the author of this prayer, it is without a doubt the most sublime, the loftiest, and the most excellent.  If he, the good and faithful Teacher, had known a better one, he would surely have taught us that too.”^[i]  In fact, in his “Personal Prayer Book” of 1522, Luther noted “I am convinced that when a Christian rightly prays the Lord’s Prayer at any time or uses any portion of it as he may desire, his praying is more than adequate.^[ii]

So, following Luther’s lead we will begin by looking at portions of the prayer. We find Jesus’ instructions recorded in Matthew 6:9-13:

⁹ “Pray then in this way:

Our Father in heaven,

hallowed be your name.

¹⁰ Your kingdom come.

Your will be done,

on earth as it is in heaven.

¹¹ Give us this day our daily bread.

¹² And forgive us our debts,

as we also have forgiven our debtors.

¹³ And do not bring us to the time of trial,

but rescue us from the evil one.  (NRSV)

We will begin by noting that the address “Our Father” demonstrates that prayer is, at its most fundamental level, a communication event with a personal God. As Andre van Oudtshoorn states “Prayer acts out the belief that God is more than a set of theological ideas, but is a person who esteems us enough to become open to us, to listen to our interpretations of reality and to respond to our prayers.”^[iii] The address further points to the fact that prayer is not only communication with a personal God who is open to our thoughts, but is the one true God with whom the pray-er shares a spiritually familial relationship. When Jesus led the disciples to pray, he did not call them to pray to the god of their choice or imaginations. “Father” was not a generic term for any being before whom they were in a subservient position. “Father” was a title full of rich meaning and which pointed to the God of Israel (Jn 5:18), the one true God (Jn 17:3) the only one through whom salvation is possible (Mt 7:21). Just as Jesus taught the woman of Samaria that “true worshippers will worship the Father (Jn 4:23), so “true” prayer would be that which is directed to the Father and him alone. 

For prayer to be true it must also be offered by those who stand in a positive familial relationship with the Father. The significance of this is made clear in the contrast that Isaiah presents between those who are in a positive relationship with the Father and those who are not. Isaiah describes those in a positive relationship as those whom recognize him as their salvation, strength and song; those who place their trust in him and count it joy to be the recipients of his grace; those who sing praises to his name and who tell others of his deeds in order that his name might be exalted (Jn 12:1-6). True prayer is offered to the one true God by those who know him and rejoice in him as Father.

These stood in contrast to those in Judah and Jerusalem who knew that God was the Father of their people but who did not respond to him as such. “Hear, O heavens, and give ear, O earth; for the LORD has spoken: ‘Children have I reared and brought up, but they have rebelled against me (Is 1:2)…they have forsaken the LORD they have despised the Holy One of Israel, they are utterly estranged” (vs. 4). These condemnations were not leveled against them because they failed to follow proper worship protocol. They offered multitudes of sacrifices (vs.11), entered into the temple courts (vs.12), burnt incense (vs.13) and observed appointed feasts (vs.14). Despite all of this, God declared “When you spread out your hands, I will hide my eyes from you; even though you make many prayers, I will not listen” (vs.15). These sentiments are echoed in Jesus’ teaching on prayer in Matthew 6:

⁵ “And whenever you pray, do not be like the hypocrites; for they love to stand and pray in the synagogues and at the street corners, so that they may be seen by others. Truly I tell you, they have received their reward. ⁶ But whenever you pray, go into your room and shut the door and pray to your Father who is in secret; and your Father who sees in secret will reward you. ⁷ “When you are praying, do not heap up empty phrases as the Gentiles do; for they think that they will be heard because of their many words. ⁸ Do not be like them, for your Father knows what you need before you ask him.

The hypocrites knew that the synagogue was the “house of God” but their prayers were said in the hopes that others would notice how spiritual they were, not that their Father would notice their love for him. Likewise, the Gentiles approached prayer as a way to manipulate God, not commune with their Father. These prayers are likened to “empty phrases” which will not be heard. Abraham Kuyper likens such prayers to the sound of an out of tune harp. God, the master craftsman, created our harps (our hearts) which could produce the beautiful music of prayer.  Sin, however, has put the strings out of tune to the point that they make only noise which renders the harp useless in its effect.  The fact that the strings can still be plucked at all points to the craftsman and the original work, but the music is unpleasant and unacceptable to his ears. Unless he repairs the harp (through regeneration), no real music (“true prayer”) can ever be played. ^[iv]

This is not to say that there are not examples in the Bible in God responds in mercy to those who do not rightly worship him.  1 Kings 21:25 declares that “there was none who sold himself to do what was evil in the sight of the LORD like Ahab.” Yet, when Ahab mourned and fasted after hearing of God’s judgment against him, God declared to the prophet Elijah, “Have you seen how Ahab has humbled himself before me?  Because he has humbled himself before me, I will not bring the disaster in his days; but in his son’s days I will bring disaster upon his house” (vs. 29). In cases such as these, it is best understood that God was not responding because he found Ahab’s appeals (assuming his “mourning” included appeals to God) acceptable, but merely that he desired to put his mercy on display. Calvin makes this point noting that this should cause true worshippers to pray all the more as they see that “even ungodly wailings sometimes do some good.”^[v]  

It is worth noting that, in the case of Ahab, though evil, he acknowledged through his mourning that the God of Israel was real, had a legitimate case against him, as well as possessing the power to bring about judgment. If Ahab had been crying out to another god, however, we cannot be sure that God would have been so merciful.  Prayer is a practice common to most religions and, so common is it, that it has been noted that “one might, without much ado, write a history of religion by writing a history of prayer.”^[vi] In the exam room, a Christian physician will encounter those who may be receptive to the offer of prayer but who will insist on the prayers being made to their own particular deity. Desiring to be a source of comfort by being present with them in their times of anxiety or grief, it will be tempting for the physician to join with them in their time of prayer. Even though their prayers may contain the same emotive elements as those of Ahab, they fail to acknowledge the LORD as the only one who has power to help them. Rather, they seek help from false gods which is considered idolatry, an affront to God^[vii] and even likened to the worship of demons.^[viii]   No Christian should feel comfortable engaging in such an activity.

There will be other times when the physician will be confronted with a patient who seems to be making an attempt at prayer and yet they, too, are uttering but “empty phrases.” Bonhoeffer gave an example of this when he recounted an incident which took place during a bombing raid on the concentration camp he was being held in.  ‘As we were all lying on the floor yesterday, someone muttered “O God, O God”- he is normally a frivolous sort of chap- but I couldn’t bring myself to offer him any Christian encouragement or comfort.  All I did was to glance at my watch and say: “It won’t last any more than ten minutes now”.’^[ix] Bonhoeffer had concluded that the man was not truly praying, he was merely reacting in fear with words  that had no more significance to him than if he had said “oh my goodness!” The only comfort that Bonhoeffer could offer him was the hope that the raid would soon be over.   

Reflecting on Bonhoeffer’s experience Philips says: 

I do not know why some people have relied on such examples to prove that there is ‘a spark of divinity’ in all men.  Fosdick, for instance, claims that in such prayers uttered in times of distress, though they are far from Christian prayers, one sees the urge to pray which is latent in all men…But what do these prayers amount to?  One would have to know more about each case before one could answer that question, but it is sufficient for my argument to show that unless prayers play a certain role in the person’s life after the crisis is over, they are not characteristic of the religious role of prayer in the life of the believer.  These prayers are far nearer superstition: kissing a rabbit’s foot or touching wood.^[x] 

The language of “Our Father” indicates that true prayer is far from a desperate act of superstition but has as its center a relationship between the pray-er and the God to whom the prayer is offered.  As Barth notes: “Prayer as a human act cannot be a gossiping, a series of phrases or mumblings…prayer must be an act of affection; it is more than a question of using the lips, for God asks the allegiance of our hearts.  If the heart is not in it, if it is only a form which carried out more or less correctly, what is it then?  Nothing! All prayers offered solely by the lips are not only superfluous, but they are displeasing to God; they are not only useless, but they are offensive to God.”^[xi]

This does not mean, however, that the opportunity to commune with them in their time of need is lost. Barth makes the intriguing argument that this is a chance for Christians to pray on their behalf and, in so doing, both commune with the world and join Jesus in his work of praying for them:        

But even while we are in the communion of the saints, in the ecclesia of those who are brought together by Jesus Christ, we are also in communion with those who do not yet pray, perhaps, but for whom Jesus Christ prays, since he prays for humankind as a whole.  It is the object of this intercession, and we ourselves enter into the communion with the whole of humanity.  When Christians pray, they are, so to speak, the substitutes for all those who do not pray; and in this sense they are in communion with them in the same manner as Jesus Christ has entered into solidarity with sinners, with a lost human race.^[xii]

Here Barth not only encourages us to lead others in prayer, but he also touches on the question as to why we should pray.

 In the Lord’s Prayer, Jesus instructed his disciples to pray that the Father would provide them with their “daily bread.” Immediately afterwards, however, Jesus tells them to not be anxious about what they should wear or eat for, “your heavenly Father knows that you need them all. But seek first the kingdom of God and his righteousness and all these things will be added to you” (Mt 6:32-34). Seeing that God knows what we need and is so desirous to provide these things to us, one would be forgiven for asking “Then why must we pray at all?”

Augustine wrestled with this and concluded that to ask that question is to misunderstand prayer. Prayers serve not to inform God of our needs but, instead to inform ourselves of our spiritual state.  They reveal to us the strength of our desires and prove to be demonstrations of our spiritual progress. In this way, prayers actually serve as a tool to admonish us when we are spiritually weak.  On the other hand, when we witness God’s answering of our prayers, we are spurred on to grow in our faith and pursue him all the more diligently.^[xiii] If Augustine is correct, then that would certainly inform the way in which a physician might approach prayer in the clinic. Diagnosis and treatment of the soul rather than the body would be the primary concern. A physician would find that their willingness, or lack thereof, to pray, as well as the content of the prayers themselves, as barometers of their own spiritual life and a part of their own spiritual development. They would also understand the prayers to be primarily a tool for the admonishment or encouragement of believing patients and for evangelism to the unconverted. This would seem to fit well with Paul’s concern in 1 Timothy 2:1-7 that prayers would be said in light of God’s desire that all would be saved. But is this all there is to it?

Aquinas agreed with Augustine that the purpose of our prayers was not to inform God of conditions or needs that he is unaware of. But he diverged from Augustine by positing a scenario in which God has already determined what will happen in this world as well as the means by which these things will happen. The events he refers to as “effects” and each effect has a “cause.” Aquinas argued that God has predetermined the effects and also what their causes shall be. Some effects are brought about by “natural causes.” Other effects will have as their cause the prayers of his people. Quoting Gregory, he says that we pray "that by asking, men may deserve to receive what Almighty God from eternity has disposed to give."^[xiv] Stanley Grenz echoes this understanding of prayer writing,

God wants to act in the world. But in certain areas God has decided not to act apart from prayer. Or, to restate the point positively, God has decided that the needed divine action will come only in response to prayer. In this sense, O Hallesby was surely correct when he wrote, ‘God has voluntarily made Himself dependent upon our prayers.’^[xv]

If they are correct, then that adds a touch of urgency to the prayers said within the clinics and the hospitals. If it is possible that God has determined that the effect of healing will come via the cause of the prayers of the faithful, then a Christian physician would be hard pressed to justify a lack of prayer in their daily practice. It is important to note that Aquinas does add that the act of prayer is not only about “causes” and “effects.” He writes that prayer is “moved by the will of charity” as we, first, seek to be united to God and, secondly, connected to those whom we pray.^[xvi] But is Aquinas right?

Eleanor Stump is not so sure. Responding to Aquinas’ argument, she writes, “Now surely, there can be no doubt that according to Christian doctrine, God wants men to pray and answers prayers; and consequently it is plain that God’s plan for the world includes human prayers as causes of certain effects.  The difficult lies in explaining how such a doctrine makes sense.  Why should prayers be included in God’s plan as causes of certain effects?”^[xvii]

Stump offers a solution of a different sort. She begins with the biblical notion that God loves humankind and desires to be loved in return. Corresponding to these desires, God is determined to experience something along the lines of a true friendship with humankind. This goal is made difficult by the fact that God is omniscient, omnipotent and perfectly good while people are not.  This difference between them opens up the possibility of two dangers.  The first is that the person will be so overcome by God’s superiority that they will dispense of any notion of having their own will and desires but will, instead, become but a slave seeking to replicate God’s personality. The second danger is that of becoming spoiled and self-indulgent because of their connections to the Almighty. Either way, true friendship would be difficult to come by.  The manner in which these dangers are avoided is through prayer.  When someone must ask for what they want, they are acknowledging that God is not an “interfering God” and will not impose upon them anything apart from their requests. In this way, they are protected from being overwhelmed by him and are free to be themselves. In addition, when there is no certainty that they will actually receive what they ask for, they are guarded against being spoiled. She comments, “God must work through the intermediary of prayer, rather than doing everything on his own initiative for man’s sake. Prayer acts as a kind of buffer between man and God.”^[xviii] If a physician were to embrace Stump’s scenario prayer in the exam room, while seeking for the healing of an ailment, would be concerned primarily with the relationship between the pray-er (and the pray-ee) and God. A physician might introduce the offer of prayer by encouraging the patient that God desires to befriend them and that prayer is a means by which such a friendship can be nurtured or begun.

Murray and Meyers also believe that prayer serves to guard believers from certain dangers.  Like Stump they argue that if all that we need and desire was provided for us apart from prayer we would take it all for granted.  In this case, rather than expressing gratitude to God for what we have, we would, instead, “degenerate into a pampered silence or, worse, contemptuous indifference.” ^[xix] By making God’s provision dependent upon our prayers, God insures that we recognize our dependence upon him and respond with the genuine gratitude he is due.  Murray and Meyers anticipate the question as to how this could possibly be fair for those who do not believe in God and, therefore, do not recognize the role that prayer plays in the provision of their daily needs. They respond that the provision that God makes for our daily needs serves differing ends for those who believe than those who do not. For those who do not believe, God could not possibly expect them to benefit in their understanding of him by his withholding goods from them. His provision for their needs, despite their lack of prayer, however, might be what leads them to faith.  Believers, on the other hand, must pray for their daily bread.  In this way, as they witness the dynamic of their prayers being directly answered by God, their faith is cultivated and grown.^[xx] There are certain similarities in the approach of Murray and Meyers with the others we have considered. The prayers of a physician for the healing of believing patient would have, as its primary goal, their encouragement in the faith. While it may seem that prayers for unbelievers are not necessary, it is implied that prayers would be commended in the hopes that they would see a correlation between their improved health and the prayers of their physician which would, in turn, lead to their coming to the faith.

Philip Clements-Jewery feels that arguments such as those of Murray, Meyers and Stump are not ultimately helpful in that they don’t adequately address questions such as “Why would God withhold a good from someone until they are prayed for by another?”  He answers that the solution is found in God’s desire for a universe that reflects the unity of the Godhead. So valuable to him is the unity between himself and humankind as well as the unity among the members of humankind, that he determined prayer to be great unifier. Prayer aims “at producing more fully personal human beings in communion with one another and with God. It is thus a prime instance of faith working through love.”^[xxi] In the clinic setting, then, prayer becomes an opportunity to become “one” with the patient as they engage in a spiritual journey to become unified to God.

While these are only a few of the many attempts to understand the purposes and motivations for prayer, there is an important common thread which runs through all of them. Each make the point that prayer is not only, or even primarily, motivated by the desire to receive things from God (or, from his perspective, to provide things to people).  Rather, the goal of prayer has ultimately to do with the formation and strengthening of relationships. Even though each of the theorems differ in the particulars, their overarching concerns accurately reflect what we find reflected within the Scriptures. Repeatedly in the Psalms, we find the prayers of the author followed by a response by God which results in a deepened relationship between the two.  A few examples are worth noting.  Psalm 3 presents David declaring “I cried aloud to the LORD, and he answered me from his holy hill. I lay down and slept; I woke again, for the LORD sustained me. I will not be afraid of many thousands of people” (3:4-6a). In Psalm 4 David says “the LORD hears when I call to him…you (God) have put more joy in my heart than they have when their grain and wine abound. In peace I will both lie down and sleep; for you alone, O LORD, make me to dwell in safety” (4:3b, 7-8). In Psalm 27:7-8, the Psalmist asks the LORD to hear his prayers and God responds with a relational request: “Hear, O LORD, when I cry aloud; be gracious to me and answer me! You have said, ‘Seek my face.’ My heart says to you, ‘Your face, LORD, do I seek.’” 

Turning the New Testament, we find the prayers that were lifted up by Paul, for example, consistently had at their center an expression of his concern and love for those about whom he prayed. A clear example is seen in his address to the church in Philippi: “I thank my God in all my remembrance of you, always in every prayer of mine for you all making my prayer with joy, because of your partnership in the gospel from the first day until now” (Phil 1:3-5). Similar expressions of love can be found in his greetings to the churches of Corinth, Ephesus, Colossae, and Thessalonica. In each instance his prayers are motivated by and are expressions of his love for the Christians he was addressing.  We not called to pray only for fellow believers, however.  As we have seen in 1 Timothy 2:1, Paul urges that prayers be made for all people. These prayers include prayers of “thanksgivings” on their behalf with the motivation that God “desires all to be saved” (2:4). We would conclude that “all people” would include the enemies that Jesus called us to pray for as well. The desire would be that they would cease to be enemies and become brothers or sisters. To pray for another is to invite them into a relationship for which you are thankful. A part of our bearing the image of the Triune God is the desire to live in community with others.  As such, an invitation from others to unite with them is generally responded to in a positive manner. Studies have shown that up to 81 percent of patients say that the relationship between them and their physician would show a significant improvement if the physician would engage them on a spiritual level. ^[xxii] This should not be any surprise as our praying for them is demonstration of the fact that we are willing to carry their burdens before the LORD. A consideration of our role as members of the priesthood of believers is helpful here.

[i]Martin Luther, “An Exposition of the Lord’s Prayer for Simple Laymen,” in Luther’s Works, Eds. Jaroslav Pelikan and Helmut T. Lehmann,  (St. Louis: Concordia Publishing and Philadelphia: Fortress Press, 1955–1986) 42:21.

[ii] Martin Luther, “Personal Prayer Book,” in  Luther’s Works, ed. Jaroslav Pelikan and Helmut T. Lehmann (St. Louis: Concordia Publishing and Philadelphia: Fortress Press, 1955–1986), 43:12. 

[iii] Andre van Oudtshoorn, “Prayer and Practical Theology,” International Journal of Practical Theology: Berlin 16:2 (2002): 291.

[iv] Abraham Kuyper, The Work of the Holy Spirit, trans. Henri De Vries (Chattanooga: AMG Publishers, 1995), 666.

[v] John Calvin, Institutes of the Christian Religion, ed. John T. McNeill, trans. Ford Lewis Battles (Philadelphia: The Westminster Press, 1960), 871.

[vi] Quoted in Friedrich Heiler, Prayer: A Study in the History and Psychology of Religion, ed. and trans. Samuel McComb (New York: Oxford University Press, 1932), xvi.

[vii] Ex 20:3-5; Lv 19:4; Is 45:20; 1 Jn 5:21

[viii] 1 Cor 10:19-20

[ix] Dewi Philips, The Concept of Prayer (London: Routledge and Kegan Paul, 1965), 116.

[x] Ibid.

[xi]Karl Barth, Prayer, 50^th Anniversary Edition, ed. Don E. Saliers, trans. Sara F. Terrien (Louisville: Westminster John Knox Press, 2002), 20.

[xii] Ibid., 23.

[xiii] Augustine, “Letter 130,” in  Nicene and Post-Nicene Fathers, First Series, Vol. 1, ed. Philip Schaff. (Peabody, MA: Hendrickson Publishers, 2004), 465.

[xiv] Thomas Aquinas, The Summa Theologica of St. Thomas Aquinas, trans. Fathers of the English Dominican Province. (Online Edition, New Advent CD-ROM Version 2.1), 2.2, q.83, a.2.

[xv] Stanley J. Grenz, Prayer: The Cry for the Kingdom, rev.ed. (Grand Rapids: Wm. B. Eerdmans Publishing Company, 1988), 51.

[xvi] Aquinas, 2.2, q. 83, a.1.

[xvii]Eleonore Stump, “Petitionary Prayer,’ American Philosophical Quarterly, Vol. 16, No. 2 (April 1979), 86. https://www.jstor.org/stable/20009745

[xviii] Stump, 90

[xix] Michael J. Murray and Kurt Meyers, “Ask and It Will Be Given to You,” Religious Studies  316.

[xx] Ibid., 318.

[xxi] Philip Clements-Jewery, Intercessory Prayer: Modern Theology, Biblical Teaching and Philosophical Thought (Aldershot, England: Routledge, 2005), 109.

[xxii] H. Koenig, Spirituality and Patient Care, 499, 501.

In the Old Testament, it was the responsibility of the priests to present the interests of the people before God (Ex 28:29).  When he would enter the Holy Place of the tabernacle, he would wear a breastpiece upon which were fastened stones that bore the names of the sons of Israel. The breastpiece was attached to the shoulders of the ephod which the priest wore and the stones were positioned over his heart.  This illustrated that he bore the burden of their sins and the weight of their needs upon his shoulders as He came before the LORD and that the people were constantly on his heart. As Exodus 28:29 declares, “So Aaron (the high priest) shall bear the names of the sons of Israel in the breastpiece of judgement on his heart, when he goes into the Holy Place, to bring them to regular remembrance before the LORD.”

Jesus, as the great high priest, has fulfilled the office of the high priest by entering into the holy places once for all (Heb 9:12), appearing before God on our behalf (Heb 9:24), bearing our sins upon himself (Heb 9:28) and now ever interceding for us before the LORD (Heb 7:25).  Christians, in turn, are now united with him as “a royal priesthood” (1 Pt 2:9) who are called to live disciplined lives that their prayers will be effective (1 Pt 4:7) as we, now, pray for others (see 1 Pt 2:12 and 3:18 in light 1 Tm 2:1-7). Just as Jesus always lives to make intercession (Heb 7:25), so should we now be praying always (1 Thes 5:16). Praying for others, then, is to make a declaration “I will carry your burden before the LORD as I hold you close to my heart.”

            When we pray, how should we pray? Returning to the address “Our Father in heaven,” we find that it indicates that the communication that is involved in prayer shares both similarities and differences with the type of communication we share among one another. On the one hand, the Father and his people relate to one another as persons and personhood implies the ability to communicate and interact. The person of the Father, however, is “in heaven.” We are unable to interact with him in the same manner that we might enter into discourse with someone who is sitting across the room from us. The incorporeal nature of God who is “spirit” (Jn 4:24) causes some to wonder if communication is possible at all.  If we cannot see God, how do we know that he is present and attentive? Baelz points out that, while prayer is best understood utilizing the analogy of a shared human relationship, the type of communication is much different.  As one who is omnipresent and omniscient, God does not need to be brought into a conversation, we do not need to gain his attention and, since he already knows what we are thinking, we do not actually even have to formulate our thoughts into words. He concludes that prayers do not actually require words at all as “talking is not the only way of ‘being with.’”^[i]  In Baelz we might hear echoes of St. Catherine of Siena who famously wrote that “charity is itself continual prayer” and “every exercise, whether performed in oneself or in one’s neighbor, with good-will, is prayer.”^[ii] While both would recognize the place for vocal prayers, they seem to be advocating the idea that prayer is ultimately anything one does for God. The problem is that when Jesus was asked by his disciples how to pray, he responded “When you pray, say…” (Lk 11:2) and then proceeded to give them a series of pronouncements and requests to vocalize.  This is typical of what we find throughout the Scriptures.  Prayer is consistently presented as communication through the use of words.  Admittedly, “vocalizing” a prayer does not require making intelligible sounds from our vocal chords. When Hannah prayed she is described as “speaking in heart; only her lips moved, and her voice was not heard” (1 Sm 1:13). Though no sound came from her mouth she was, nevertheless, “speaking.” 

While this type of silent prayer is acceptable to God, Aquinas provides us with three arguments for why vocalizing our prayers audibly can be helpful. First, hearing our voice can lead to the mind being more actively attentive to and our affections more greatly moved towards holy desires. Secondly, using our voice is a way of serving God with all that we have. In other words, not simply with our minds, but with our minds and our mouths. Third, what we vocalize tends to be an overflow of what is taking place in our heart.^[iii] We might wish to add a few additional arguments relevant for the clinical setting.  Fourth, praying out loud instructs and provides an example for other believers. It is not uncommon for individuals, especially in crisis, to be at a loss for what to pray. In these cases, the Christian physician has an opportunity to teach by example.  For this reason, one should always be ready to give a reason for their hope (1 Peter 3:15) and able to express that via prayer.   Fifth, using our voices lets those for whom we are praying know what it is that we are praying for and that we are, indeed, praying for them. It ought to the regular practice of physicians who offer to pray for a patient to pray in that moment and to pray out loud. Receiving the promise that prayers will be said on your behalf is nice, but hearing the prayer articulated in your presence is true encouragement.  Sixth, praying out loud can be a form of witness to those who do not believe. Through your prayers, you declare that there is a God who is relational, who hears when we make requests and in whom we trust to respond according to his lovingkindness.  In this way we honor God by pointing the patient to a hope that lies beyond them.

This may be overwhelming for those who are not used to praying in public.  In those instances, there is no shame in turning to written prayers for help. Puritan author Thomas Ridgely spoke of how the LORD sometimes calls on his people to make use of various means to bring answers to their prayers about.  Pointing to the examples of Moses being called to stretch out his rod over the sea and Hezekiah to take a lump of figs to place on a boil for healing, Ridgely concludes “we should not be adverse to pursuing means provided us by God to see our prayers for temporal things answered.”^[iv] In the same way, we should not be adverse to using the means provided to us by God to assist in saying the prayers themselves.  For example, Athanasius wrote to a friend named Marcellinus of how beneficial praying the Psalms can be.  He notes,

In the Psalter you learn about yourself.  You find depicted in it all the movements of your soul, all its changes, its ups and downs, its failures and recoveries.  Moreover, whatever your particular need or trouble, from this same book you can select a form of words to fit it, so that you do not merely hear and then pass on, but learn the way to remedy your ill.  Prohibitions of evildoing are plentiful in Scripture, but only the Psalter tells you how to obey these orders and refrain from sin. But the marvel with the Psalter is that, barring those prophecies about the Savior and some about the Gentiles, the reader takes all its words upon his lips as though they were his own, written for his special benefit, and takes them and recites them, not as though someone else were speaking or another person’s feelings being described, but as himself speaking of himself, offering the words to God as his own heart’s utterance, just as though he himself had made them up. When you would give thanks to God at your affliction’s end, sing Psalm 4, Psalm 75 and Psalm 116.  When you see the wicked wanting to ensnare you and you wish your prayer to reach God’s ears then wake up early and sing Psalm 5.^[v]

The praying of the Psalms with a patient can be of great comfort and an added benefit is that one can pray these words with the confidence that what is being prayed is acceptable to God.

A lack of confidence still may compel some to withhold the offer of prayer altogether and to justify themselves by arguing that their acts of charity are their manner of praying.  As has been noted, however, if we do not know the words to say, we have no Scriptural justification to believe that activity absent of words is accepted as prayer. As an example we might consider the act of fasting. Fasting is a means of declaring devotion to and dependence upon God. It can also be a means by which one mourns and repents before him. It is a way to approach the LORD when in great need. One would think that if there were a “prayer” that involved no words, fasting would qualify. Yet prayer and fasting are treated as two separate activities in the Old and New Testaments (Neh 1:4, Lk 5:33). 

This does not mean that there are not obvious differences in the type of communication with have with God and the type we have with one another.  Chief of these is that when we speak to God, we do not generally expect to hear God speak back. As Philips notes, in our communication there is not “the interplay of personal pronouns…in short, prayer is not a conversation.”^[vi] Though we do not expect to hear God respond in conversation, we are called to expect a response from him. That is the implicit message of the petitions of the Lord’s Prayer and the explicit message elsewhere. For example, in 1 John 5:14-15 we are told that ^“this is the boldness we have in him, that if we ask anything according to his will, he hears us. And if we know that he hears us in whatever we ask, we know that we have obtained the requests made of him.” Donald Bloesch comments “the essence of true prayer is heartfelt supplication, bringing before God one’s most innermost needs and requests in the confident expectation that God will hear and answer.”^[vii] Barth adds forcefully, “Let us approach the subject from the given fact that God answers.   God is not deaf, but listens; more than that, he acts.  God does not act in the same way whether we pray or not.  Prayer exerts an influence upon God’s action, even upon his existence.  That is what the word ‘answer’ means.” ^[viii]

For Luther, grasping these truths before praying was as important as the prayer itself. Luther argued in his 1519 sermon “On Rogationtide Prayer and Procession” that we could never approach God in confidence unless we first had a promise and pledge from Him and it would do us well to reflect on God’s promises to us and to remind Him of them.  God declares in Matthew 21:22, “Whatever you ask in prayer, you will receive, if you have faith,” and in Luke 11:9-13:

“And I tell you, ask and it will be given to you; seek, and you will find; knock and it will be opened to you.  For everyone who asks receives, and the one who seeks finds, and to the one who knocks it will be opened.  What father among you, if his son asks for a fish, will instead of a fish give him a serpent; or if he asks for an egg, will give him a scorpion?  If you then, who are evil, know how to give good gifts to your children, how much more will the heavenly Father give the Holy Spirit to those who ask him!” 

Luther encouraged his congregation, “We should cheerfully rely on these and similar promises and commands and pray with true confidence.”^[ix]

It is important to note Luther’s point that the confidence we have that our prayers will be answered comes not from a confidence that we are somehow deserving of his kindness. Rather the source of our confidence is the “promises and pledge” of God who will not go back on his word.  Moses recognized this when God declared that he would justly unleash his wrath upon the people of Israel after they had worshipped a golden calf that they had fashioned with their own hands.  Moses cried out to the LORD,

“O Lord, why does your wrath burn hot against your people, whom you brought out of the land of Egypt with great power and with a mighty hand? ¹² Why should the Egyptians say, ‘It was with evil intent that he brought them out to kill them in the mountains, and to consume them from the face of the earth’? Turn from your fierce wrath; change your mind and do not bring disaster on your people. ¹³ Remember Abraham, Isaac, and Israel, your servants, how you swore to them by your own self, saying to them, ‘I will multiply your descendants like the stars of heaven, and all this land that I have promised I will give to your descendants, and they shall inherit it forever.’ ”

The result of Moses’ prayer was that “the Lord changed his mind about the disaster that he planned to bring on his people.” What was it about Moses’ prayer that made it acceptable to God? First, Moses was concerned more for the honor of God’s name than he was for the safety of God’s people. This is illustrated by Moses’ concern that God’s unleashing of his wrath upon the Israelites would give the Egyptians an excuse to slander his name by accusing him of having evil intentions in bringing them out of Egypt. Secondly, Moses recognized that, while God owed the people of Israel nothing, he was the type of God who would be true to his promises to their ancestors: “Remember, how you swore by your own self.” Moses prayer was answered because it honored God above people. This brings us back to the Lord’s Prayer.  It is not without cause that Jesus had his disciples begin, not with their own needs, but with an expression of their desire for God’s honor to be upheld, his kingdom to come, and his will to be done. The way we can be confident that our prayers will be met is by prioritizing the honor of his name, the expansion and coming of his kingdom and the accomplishment of his will. In other words, “seek first the kingdom of God and his righteousness, and all these things will be added to you” (Mt 6:33).  Even the assurance that Jesus offered to the disciples that he would answer their prayers was grounded in his desire to glorify God: “Whatever you ask in my name, this I will do, that the Father may be glorified in the Son” (Jn 14:13). Jesus provides us with a model as he prayed in the Garden of Gethsemane, “My Father, if it be possible, let this cup pass from me; nevertheless, not as I will, but as you will” (Mt 26:39).

The question might be, then, asked “If ultimately our desire is that God’s will be done, then why mention our will at all?” Shouldn’t our prayers simply be “Thy will be done, Amen.”?  Certainly D.Z. Phillips is correct when he notes,

When deep religious believers pray for something, they are not so much asking God to bring this about, but in a way telling him of the strength of their desires. They realize that things may not go as they wish, but they are asking to be able to go on living whatever happens…

Is this not at the heart of every prayer that a patient in distress prays?  Phillips continues,

The meaning of the specific request is internally related to the expression of readiness to accept the will of God.  As I have suggested, the believer is asking that his desires will not destroy the spirit of God in him.  But why should the specific requests be mentioned at all?  The answer to this point, I think, is that since a man is concerned with hope and meaning in his life, it is the desires which he actually does have which he wants to bring to God.  After all, it is these desires and not any others which threaten to overwhelm him, and through which he must seek God.^[x]

            Here Phillips describes the tension that we all feel.  We have certain desires but are unsure that they are what are best for us. We recognize the tendency of our flesh to lead us to desire that which we should not and to avoid that which we should. We have seen too many lives shipwrecked upon the rocks of ill-guided wishes and so we strive to bring this spiritual battle before the LORD.  We submit our sincere wishes before him while acknowledging that he knows what is best for us better than we and so we strive to be able to genuinely declare “thine, not mine, be done.” It should not surprise us when this does not come easy. John Koenig points us to how Jesus “offered up prayers and supplications, with loud cries and tears, to him who was able to save him from death” in Hebrews 5:7-8 and observes that “These words suggest that Jesus had to strive with God on a number of occasions, not only to hear answers from on high but also to receive the power to live them out. It would be naïve to expect that our own conversations with God will be chiefly peaceful and pleasant.”^[xi]

            We are not Jesus, however, and so how can we be confident of victory in our strivings before the LORD? Our confidence lies not in our own strength but in the help of the Spirit of God. True prayer always includes the Spirit’s involvement. Bloesch argues, “True prayer is not taking place unless it is enlivened and directed by the Holy Spirit…It is not the mere saying of prayerful words but actually speaking with God in the power of the Spirit.”^[xii]

            Etienne Veto makes a compelling case that the only way that true Christian prayer is possible at all is by the working and leading of the Holy Spirit within us. Many assume that to pray “in the Spirit” is to be engaged in a unique event typically related to ecstatic utterances promoted by the more charismatic forms of Christian practice. Each New Testament text that addresses the practice, however, speaks not to unique prayer events, but about prayer in general in all its different forms as it is commended to all believers alike. Ephesians 6:18 calls on believers to pray “at all times in the Spirit, with all prayer and supplication” as a part of donning the armor of God. Jude 20 calls on believers to pray “in the Holy Spirit” in their battle to resist false teachers. Galatians 4:6 and Romans 8:15-26 describe the work of the Spirit in believers to assure them of their salvation and as one who intercedes for them when they do not know how to pray. In Luke 10:21 we even find Jesus exulting in the Holy Spirit.

            What do we conclude is meant by praying “in the Spirit”? Typically, to be “in the Spirit” means to be led or controlled by him (see Lk 2:27 and 4:1) or to be inspired to say or understand something (Mk 12:36). In other words, it indicates that the Holy Spirit is active in doing something within us. When it comes to prayer, the Spirit is doing at least four things. First, he is leading the pray-er to pray (Lk 10:21, Rom 8:14). Second, he instructs us as to whom we should pray while giving us access to him (Rom 8:15, Gal 4:6, Eph 2:18).  Third, he inspires us as to what should pray for (Rom 8:26) and, lastly, Veto argues that the above implicitly teaches that the Spirit even instructs us as to how we should pray.

            In light of all of this, Dirk G. van der Merwe’s statement that “(Prayer and divine involvement) are like the two sides of a coin- you can distinguish them but never separate them. The one implies the other,”^[xiii] seems fitting and the encouragement we derive from this can be invaluable. This promise of the help of the Spirit highlights, however, the fact that there are many times when God does not seem to answer our prayers. If we have the confidence that he is true to his promises and the knowledge that his Spirit is at work in us directing our prayers, how do we make sense of this?  This takes us back to the question as to why we must pray at all.  If prayers are primarily concerned with receiving earthly things, then we may legitimately wonder at the fact that prayers for physical healing often go unheeded.  If, on the other hand, prayer is fundamentally after something else, then perhaps the physical healing is but a shadow of the real work that God intends to do.

In his treatise, “On Prayer,” Origen wrestled with the question of how God’s providential ordering of events and the prayers of his people work together. In doing so, he asked the question we considered earlier: “If God has already chosen what will take place, why should we pray at all?” In Chapter 3, “Objections to Prayer,” Origen writes:

“Were anyone to pray for sunrise he would be thought a simpleton for entreating through prayer for the occurrence of what was to take place quite apart from his prayer: In like manner a man would be a fool to believe that his prayer was responsible for the occurrence of what was to take place in any case even had he never prayed.^[xiv]

Later in Chapter 11, “The Object of Prayer,” Origen makes some helpful observations concerning the ends for which prayers ought to be prayed:

            For material and physical things count as fleeting feeble shadow, in no way comparable to the saving holy gifts of the God of All. What comparison is there between material riches and the riches that are in every word and all wisdom? Who in his senses would compare health of flesh and bone with health of mind, strength of soul, and consistency of thought—things which, if kept in measure by God’s word, make bodily sufferings a paltry scratch, and even slighter if we can grasp it.^[xv]

I find that weighing these two considerations together is helpful in seeking to understand the issue of “unanswered” prayers and will apply them to the case of David’s pleas for protection and my wife’s request for healing.

In 1 Samuel 16:1-13, the LORD informs Samuel that he has rejected Saul as king over Israel and has, instead, chosen David to take the throne.  When Saul recognizes God’s favor is on David, he becomes jealous and desires for him to be killed.  Learning of Saul’s intentions, David flees from him and hides in the cave of Adullam (1 Sm 22:1-2). While in the cave, David pens Psalm 57 in which he pleads for God to be merciful to him.  In light of the LORD’s word to Samuel that David would be king, was David’s prayer the prayer of a “simpleton” and a “fool” who was lifting up an unnecessary prayer? Would everything that the LORD intended to happen have happened whether David prayed or not?  

My wife has an ailment that prevents her stomach from being able to digest food correctly.  No medicinal treatment has made any improvements and the many prayers that have been lifted up by church, family, and friends for her physical healing have not led to any physical improvements.  Have our prayers, then, been useless? Would there have been any difference whether we had prayed or not?

We would be tempted to say that, in either case, the prayers were to no effect. In David’s case, in order to stay true to the word he had given to Samuel, God would have had to have saved David from Saul’s hands with or without his prayers. In my wife’s case, it appears that God has not intended to heal her body, at least up to this point, no matter how many prayers we pray.

But is it possible that there are other even greater things that these prayers were designed to accomplish which, apart from them, would not have come to be? Again, the words of Origen: “material and physical things count as fleeting feeble shadow, in no way comparable to the saving holy gifts of the God of All…who in his senses would compare health of flesh and bone with health of mind, strength of soul, and consistency of thought?” The prayers that David prayed in the cave led him into a deeper relationship of trust with God and the Psalm which came as a result of those prayers has served to encourage God’s people throughout the ages. The prayers that have been lifted up on my wife’s behalf have served to strengthen the bonds of friendship, put familial love on display, and unite the church in a common concern for one of their own. If relationship in service to the glory of God is the primary point of prayer, then it can be said that their prayers have been answered in greater measure than they might have even suspected were possible.

Might someone argue this is a case of “bait and switch”? Jesus instructed in Matthew 7:7-11:

⁷ “Ask, and it will be given you; search, and you will find; knock, and the door will be opened for you. ⁸ For everyone who asks receives, and everyone who searches finds, and for everyone who knocks, the door will be opened. ⁹ Is there anyone among you who, if your child asks for bread, will give a stone? ¹⁰ Or if the child asks for a fish, will give a snake? ¹¹ If you then, who are evil, know how to give good gifts to your children, how much more will your Father in heaven give good things to those who ask him!

My wife and I have been praying for the “fish” of her healing, might we be excused for considering and the response “here are deepened relationships instead” as something of a “stone”? Before we answer in the affirmative, we must look again at some of the directions given to us regarding our prayers. For example, Jesus instructions from Matthew 6:25-34:

²⁵ “Therefore I tell you, do not worry about your life, what you will eat or what you will drink,or about your body, what you will wear. Is not life more than food, and the body more than clothing? ²⁶ Look at the birds of the air; they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they? ²⁷ And can any of you by worrying add a single hour to your span of life? ²⁸ And why do you worry about clothing? Consider the lilies of the field, how they grow; they neither toil nor spin, ²⁹ yet I tell you, even Solomon in all his glory was not clothed like one of these. ³⁰ But if God so clothes the grass of the field, which is alive today and tomorrow is thrown into the oven, will he not much more clothe you—you of little faith? ³¹ Therefore do not worry, saying, ‘What will we eat?’ or ‘What will we drink?’ or ‘What will we wear?’ ³² For it is the Gentiles who strive for all these things; and indeed your heavenly Father knows that you need all these things. ³³ But strive first for the kingdom of God and his righteousness, and all these things will be given to you as well.³⁴ “So do not worry about tomorrow, for tomorrow will bring worries of its own. Today’s trouble is enough for today.

On the one hand, Jesus tells us to pray for our “daily bread” but, on the other hand, he qualifies that by saying that we should not be anxious about things such as food but, rather, we should be focused on that which is “more than food,” namely, “the kingdom of God and his righteous.” This sets our priorities in prayer.  Recall that, in the Lord’s Prayer, the disciples are not called to ask for their daily bread until after they have already prayed “Hallowed by your name, your kingdom come, your will be done on earth as it is in heaven.” The message is clear: the disciples first priority is concerning things regarding God’s kingdom and all else is prayed in a manner that indicates “I desire this in as far as your provision of it serves to magnify your glory, expand your kingdom and accomplish your will.” James explains that the reason that we do not receive what we ask for is sometimes do to the fact that “you ask wrongly, to spend it on your passions” (Jas 4:2). God rejects prayers whose ends are the satisfaction of our own passions, but is receptive to prayers that will serve to glorify the Father (John 14:13). 

            But does that not only serve to beg the question? My wife’s prayers have consistently been, “Please heal me as a way of bringing glory to your name.”  Are not her priorities in order? On the one hand, no one, not even she, truly knows her own heart in the making of that request. Koenig remarks,

Our conscious desires are not always single-minded. The impediment is not so much a lack of faith as a request made in conflict with ourselves (Jas 1:7). Part of us, either the true or the false self, does not actually want what we are asking for; and God honors this duplicity by refusing to grant our petition until we can be taught what we truly desire by the Holy Spirit (Rom 8:26).^[xvi]

This may truly explain why some of our prayers are not answered, but if only prayers that are single-mindedly offered are answered, we must admit that it is a wonder than any prayers are ever answered at all.  Koenig later makes a point that proves to be eminently encouraging and which I would like to end on.

            The Scriptures point out a number of reasons that may lay behind God’s refusal to grant our prayers in the manner in which we pray them. Understanding our own selfishness and sinful natures, we might be expected, then, to be ready to have our prayers consistently denied or, at the least, to be ready to accept less than what we desire. Koenig argues that this is not the case by directing our attention to Ephesians 3:20-21. “Now to him who by the power at work within us is able to accomplish abundantly far more than all we can ask or imagine, to him be glory in the church and in Christ Jesus to all generations, forever and ever. Amen.” Koenig concludes,

This means that sometimes we might not get just what we consciously ask for because it is not good enough. Or, to put it another way, the no or wait that we receive from God turns out to be part of an immeasurably larger yes. Thus the same Paul who has previously experienced a negative answer to his prayers for personal healing (2 Cor. 12:9) can tell the Corinthians that “in (Christ) it is always Yes. For all the promises of God find their Yes in him. That is why we utter the Amen through him to the glory of God” (2 Cor. 1:19-20). And to the Romans Paul wrote, “(the God) who did not spare his own Son but gave him up for us all, will he not also graciously bestow upon us all things with him?” (8:32). Not some things, not just the things we ask for, but all things (see also 1 Cor. 3:21-23). To be in Christ is to live in a new creation (2 Cor. 5:17) where our petitions are being constantly reformed by the Spirit to help us receive fullness of life. With Christ pleasant things and fearsome things alike take on the quality of answers to prayer…Of course this does not happen easily with a steady and predictable unfolding of confidence on our part. Always we stand next to the father of the epileptic boy, crying, “Help my unbelief!” (Mark 9:24). But this prayer too is answered “far more abundantly than all that we ask or think.” There are experiential breakthroughs into the grandeur of God’s redemptive love; there are real advents of the kingdom.^[xvii]

When approaching prayer in the clinic, then, what must be kept in mind? First, prayers should only be considered “true” prayers when said by a Christian and offered to the Father. This means that a Christian physician should not join in a patient’s prayers to a false god, but should, instead, offer to pray on their behalf before the LORD. As they do so, they need to guard themselves from the tendency to approach prayer in a utilitarian manner in which the pray-er attempts to manipulate God to achieve their own earthly desires- typically, in this context, physical healing. Rather, they should see healing as secondary to the greater work of relationship development that God seeks to accomplish through our prayers. This would include a deepening of the relationship between the physician and patient, but would always have in view the enriching, in the case of Christians, or the beginning, in the case of unbelievers, of their relationship with God. When approaching God in prayer, the physician should be confident that their prayers will be heard because God will be true to his pledge and promises that he will hear and he will respond according to his will. The physician can also be confident because they know that their prayers are said with the help and direction of the Holy Spirit. Armed with this confidence, the physician should feel free to pray aloud with their patient knowing that such a prayer will communicate to them their genuine care and concern. Ultimately, all prayers are to be submitted to the will of the Father for Him to answer in a way that best brings glory to himself, expands his kingdom, and accomplishes his will.  When we approach him this way, we can rest assured that, even when our prayers are not answered in the way in which we might hope, God is at work doing even more than we ask or think.

[i] Baelz, 27-28.

[ii] Catherine of Siena, “Dialog,” 4.4.2, Christian Classics Ethereal Library https://www.ccel.org/ccel/catherine/dialog.iv.iv.ii.html.

[iii] Aquinas, 2.2, q.83, a.12.

[iv] Thomas Ridgely, Commentary on the Larger Catechism: Previously titled A Body of Divinity: Wherein the Doctrines of the Christian Religion are Explained and Defended, Being the Substance of Several Lectures on the Assembly's Larger Catechism, Vol. 2, (Alberta: Still Waters Revival Books, 1993), 589.

[v] Athanasius, Letter to Marcellinus, Theology and Ethics, https://www.theologyethics.com/2016/08/22/the-letter-of-athanasius-to-marcellinus-on-the-interpretation-of-the-psalms/

[vi] Philips, 43.

[vii] Bloesch, 67

[viii] Barth, 13.

[ix] Ibid., 88.

[x] Phillips 121-122

[xi] John Koenig, Rediscovering New Testament Prayer: Boldness and Blessing in the Name of Jesus (Harrisburg, PA: Morehouse Publishing, 1998), 19.

[xii] Bloesch, 38.

[xiii] Dirk G. Van der Merwe,”Prayer, the encounter and participation, the experience: A Pauline exhortation towards a spirituality of prayer”, Verbum et Ecclesia 39(1), a1768, 1. https://doi.org/10.4102/ve.v39i1.1768.

[xiv] Origen, On Prayer. (Grand Rapids: Christian Classics Ethereal Library, n.d.), 9.

[xv] Origen, 31.

[xvi] J. Koenig, 57.

[xvii] J. Koenig, 62.

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Jesus’ prayer is not the only passage that Paul echoes in his charge to Timothy. An important inter-text for 1 Timothy 2:1-7 is found in Solomon’s prayer for the dedication of the temple in 1 Kings 8:22-61. Recognizing that he was dwelling in a house made of cedar while the ark of the covenant was kept in a tent, Israel’s king David had determined to build a temple unto the Lord.  God told David that task, instead, would fall to his son Solomon (2 Samuel 7:1-17) because David had been a man of war but Solomon, who would reign as king after David’s death, would be a man of peace (1 Chronicles 22:6-10).  After David’s death, Solomon constructed the temple and, having gathered all the congregation of Israel before it, had the ark placed within the Holy Place by the priests.  When the priests emerged from the Holy Place, the glory of the LORD filled the temple in the form of a cloud (1 Kings 8:1-11). Solomon then prays a prayer of blessing to the Lord (1 Kings 8:12-21) followed by a prayer of dedication for the temple (1 Kings 8:22-61).

The prayer of dedication and its benediction can be outlined as follows:

1. Praise to God for his faithfulness (8:22-24).
2. Request for a continuation of David’s dynasty (8:25–26).
3. Request for God to hear his prayers and Israel’s prayers to respond in forgiveness (8:27–30).
4. Request for justice in the land (8:31–32).
5. Request for forgiveness and a restoration of His blessings upon the nation when they repent of their sinfulness (8:33–40).

      1) When God causes them to be defeated by their enemies (33-34).

      2) When God causes there to be no rain (35-36).

      3) When there is famine, pestilence, blight, mildew or plague (37-38).

      4) Plea for forgiveness and that the people may fear the Lord (39-40). 

1. Request for God to hear the prayers of foreigners who visit the temple that all the peoples of the earth may know God’s name and know the temple is called by His name ( 8:41–43).
2. Request for victory in times of war (8:44–45).
3. Request for the people of Israel to be brought back from captivity after they have repented in the cases in which their sins might lead God to give them over to their enemies (8:46–53).
4. Benediction

1) Praise for God’s faithfulness thus far and a plea for his continued faithfulness (8:54-57).

2) Request that the Lord would incline the people’s hearts to walk in his commandments, rules and statutes (8:58-59).

3) Expression of hope that all the peoples of the earth will know that God is the only true God (8:60).

4) Charge to the people to keep God’s statutes and commands (8:61).

            There are a number of ways in which these two texts demonstrate common themes and concerns. First, they concern the “house of the LORD” and its central place in the lives of God’s people as well as its function as a witness to the non-believing world. The mercy seat which covered the ark of the covenant held within the temple was the place where God’s presence dwelled (Leviticus 16:2).  In this way, though God cannot be contained within a house (1 Kings 8:27), the temple could be properly called “the house of the LORD” where He would dwell forever (1 Kings 8:13). The temple, then, stood as a representation of God’s presence in the midst of His people, the place where they, themselves, longed to dwell (Psalm 27:4), and as a testimony to the outside world to God’s presence, faithfulness and power (1 Kings 8:43). 

The apostle Paul, likewise, admitted that God did not live in temples made by man (Acts 17:25) and, yet, refers to the church in Ephesus as “the household of God” (1 Timothy 3:15). Jesus also had told his disciples that “where two or three are gathered in my name, there am I among them” (Matt. 18:20), and so the identification of the gathered congregation with the presence of God is a natural one.  So closely was the church to be associated with the presence of God, Paul refers to the church in Ephesus as the “body of Christ” (Eph. 1:22-23). Paul expected that this “household of God” would be, like the temple, a testimony to a fallen world.  God declared that Israel would be a “light to the nations, that my salvation may reach to the end of the earth” (Is. 49:6b), Paul mirrored this declaration in telling the church in Philippi that they should “shine as lights to the world” by being “blameless and innocent, children of God without blemish in the midst of a crooked and twisted generation” (Phil. 4:15).  Paul has this same concern for the church in Ephesus, that they live “peaceful and quiet” lives “godly and dignified in every way.” Implicit in this is his desire that they, too, would shine as lights into the darkness of Ephesus (1 Tim. 2:1-4).

Second, both Solomon and Paul express a recognition of the sinfulness of man, how it steers people from God and demands his justice. In his prayer, Solomon repeatedly anticipates future acts of rebellion on the part of the people of Israel and the resulting judgment of God (1 Kings 18:31, 33, 35, 39, 46-53). In response, he calls on them to have “true hearts” and to walk in God’s statutes and commandments (1 Kings 18:61). The charge to prayer that Paul issues in 1Timothy 2:1-7 arises from a similar concern. False teachers had arisen in their midst and, as a result, the church was in danger of being led astray from having “pure hearts” (1 Tim. 1:5) and Paul calls them to walk in “godliness and dignity” (1 Tim. 2:2).

Third, a confidence in the power of prayer is clear in both instances.  When the ark was placed in the temple, Solomon’s first act was to pray a prayer of dedication.  In that prayer he begins with thanksgiving and then moves to bold requests before the LORD for his continued faithfulness, his forgiveness, his sovereign power to be displayed over man and nature, for his influence on the hearts of the people, and for the salvation of others.  Paul, likewise, begins his charge to Timothy and, through him, the church, with prayer including a variety of approaches: supplications, intercessions and thanksgivings.  In both instances, these prayers were lifted up with a confidence that the LORD could move the hearts of people both within and outside of the household of faith.

Fourth, both passages include expressions of the desire that all people would be saved.  Solomon anticipated the arrival of foreigners who would come to pray towards the temple.  His call to the LORD was that he would hear their prayers “so that all the peoples of the earth may know your name and fear you, as do your people Israel” (1 Kings 18:43).  Solomon was also concerned that the people of Israel would live uprightly “so that all the peoples of the earth may know that the Lord is God; there is no other” (1 Kings 18:60).  Paul expresses this same concern.  Perhaps as a response to the false teachers who were apparently exclusive in their claims to God’s favor, Paul emphasizes that God “desires everyone to be saved and come to the knowledge of the truth” (1 Tim. 2:4).  Paul explains that it was for this reason that he was called to go beyond his kinsmen the Jews and to be a “teacher of the Gentiles (1 Tim. 2:7) and why he now called upon the church in Ephesus to live uprightly.   

Fifth, both affirm that there is only one God by whom all people can be saved. Solomon began his prayer by declaring “O LORD, God of Israel, there is no God like you, in heaven above or on earth beneath” (1 Kings 8:23). He concludes by stating “the LORD is God; there is no other” (1 Kings 8:60). Paul, likewise, makes it clear that “there is one God and one mediator between God and mankind, Christ Jesus” (1 Tim. 2:5).

Sixth, they both acknowledge that a payment must be made for the sins of mankind. The ark of the covenant that was placed in the temple had upon it the mercy seat (see Exodus 25:17-22).  Elwell notes that

the Hebrew word for which ‘mercy seat’ is the translation is technically best rendered as ‘propitiatory,’ a term denoting the removal of wrath by the offering of a gift. The significance of this designation is found in the ceremony performed on the Day of Atonement, held once a year, when blood was sprinkled on the mercy seat to make atonement for the sins of the people of Israel (Lv 16)…The propitiatory or mercy seat points forward to Jesus, who is termed by Paul (Rom 3:25) the ‘means of propitiation’ through faith in his blood for all who have sinned and fallen short of the glory of God. Here in Romans 3:25 the Greek term translated ‘propitiation’ is the same Greek word consistently used in the Septuagint and in Hebrews 9:5 to translate the Hebrew word for mercy seat in the OT.^[i]

Paul points to the need for the Ephesians to have Christ, “the” mercy seat, act on their behalf when he writes, “there is one mediator between God and humankind, Christ Jesus, himself human, who gave himself a ransom for all” (1 Tim. 2:5-6).

Seventh, they both call for a proper regard for the law and for an order by which the people of God should live. Solomon’s concern was that the people of Israel would “walk in all (God’s) ways” and “keep his commandments” (1 Kings 8:58). These were represented by the two tablets of the law that were kept within the ark and they, along with the other commands of the law (i.e. “the book of the covenant,” Ex. 24:7), were given to Israel that they might be a “priestly kingdom and holy nation” (Exodus 19:6). Paul expresses in 1 Tim. 1:8 that “we know that the law is good, if one uses it lawfully” and that he law calls to account the disobedient and those who hold to “whatever else is contrary to sound doctrine” (vs. 10).  He then calls those in the church to “hold faith and a good conscience” (vs. 19). It is in this light that his expressed hope that the church in Ephesus would “lead a quiet and peaceable life in all godliness and dignity” (1 Tim. 2:2) should be understood.  Paul will then go on to present an order for church life, including qualifications for church offices and instructions for the behavior of individuals and groups within the church, which will enable them to do just that. 

As a “Hebrew of Hebrews” and “as to the law, a Pharisee” (Phil. 3:5), Paul would have been intimately familiar with the story of Solomon’s dedication of the temple and one may be justified in believing that he reflected upon Solomon’s words as he considered the role of the Christian church as a witness to the fallen world around it.  Just as Solomon saw the “house of the LORD” as a testimony to the faithfulness and presence of God among his people and, thereby, a witness to the nations, so Paul saw the “household of God” as playing the same role.  The only difference being that Solomon’s temple was built of brick and mortar, the one in Ephesus built of believing Christians. 

Solomon, in his wisdom, foresaw the issues that the church in Ephesus faced. “There is no one who does not sin” he declared (1 Kings 8:46) and that sin often led people to stray from God making shipwrecks of their faith (a la 1 Tim. 1:19). He may not have anticipated the particular struggles facing the Ephesian church but his manner of addressing the challenges of his day was the same as those of Paul in his: prayer. 

During the years following the deaths of the apostles and despite their warnings, false teachings continued to arise within the church. One of the ways that heresies were addressed by those who were entrusted with leading the church was through the composition of rules of faith, creeds and confessions. It has been said that “creeds are signposts to heresies”[ii] and they served to contribute to the “good battle” that Paul had called Timothy to (1 Tim. 1:18). But it was not only in combatting false teachers that one might link Paul’s charge to Timothy to the use of these compositions.  They were also a “testimony and witness to the world.”[iii]  Christians were called to declare their belief in times of peace and times of persecution alike. Rules of faith, confessions and creeds were tools by which they did this.

            From the earliest days of the post-apostolic church, rules of faith echoed 1 Tim. 2:5-6 by containing affirmations of the uniqueness of God and of Christ who had come in the flesh for the salvation of man. Irenaeus composed a rule of faith (c. 190) in which he declared that the church believed in “one God, the Father Almighty, Maker of heaven, and earth, and the sea, and all things that are in them; and in one Christ Jesus, the son of God, who became incarnate for our salvation.”  Perhaps, one might be able to read echoes of 1 Timothy 2:4 when Irenaeus expressed that in Christ’s future return, Jesus would come “in the glory of the Father ‘to gather all things in one,’ and to raise up anew all flesh of the whole human race, in order that to Christ Jesus, our Lord, and God, and Savior, and King, according to the will of the invisible Father, “every knee should bow, of things in heaven, and things in earth, and things under the earth, and that every tongue should confess” to Him, and that He should execute judgment towards all.”[iv]

Later, the Interrogatory Creed of Hippolytus (c. 215), a forerunner to the Apostle’s Creed, affirmed God the Father as “all governing” and Christ Jesus as he who will come to “judge the living and the dead” but also adds a belief “in the holy Church.”[v]  The Nicene Creed (325) affirmed that Jesus was fully God, but it was The Definition of Chalcedon (451) which made sure that it was understood that he was also fully man.  Reflecting Paul’s description of Jesus as “himself human” (1 Tim. 2:5), the Definition describes Jesus as “perfect both in deity and also in human-ness; this selfsame one is also actually God and actually man” and “as far as his human-ness is concerned; thus like us in all respects, sin only excepted.”[vi]

            It is not until much later in the Augsburg Confession of 1530, written by Philip Melanchthon for Holy Roman Emperor Charles V, that a few more elements from 1 Timothy 2:1-7 appear.  After Martin Luther’s death in 1546, theological conflicts commonly arose among his followers and the Augsburg Confession was written for two reasons: “to establish the integrity of the Christian faith of the Protestants, and...to justify their corrections of abuses in the life of the Church.”[vii] The concerns contained within 1 Tim. 2:1-7, are echoed throughout.  First, the occasion is similar.  Paul was responding to theological conflicts within the church in Ephesus which weakened the faith of those within and diminished their witness to those outside.  In 1530, theological conflicts were now plaguing the Lutheran church. A unified system of belief needed to be put forth to secure peace within the church while placating those outside who may have seen the conflicts as evidence that their complaints against the Catholic church were on unstable grounds and that, perhaps, their voices needed to be silenced.  Secondly, like Paul’s charge to prayer, the Confession is directed at influencing “kings and all who are in high places” (1 Tim. 2:2). The Lutherans were being associated with radicals[viii] and so the threat of their being persecuted by the forces of local rulers aligned with Charles V was real. The Lutherans sought to live “peaceful and quiet lives” and this was an effort to obtain it.  Third, the confession emphasized the role of the church.   In Article V, it is asserted that the “office of ministry” was instituted by God so that the Holy Spirit might work faith, “when and where he pleases, in those who hear the Gospel.” In Article VI, good works are said to be done for God’s sake and not to earn merit before him.  This echoes the concept of Paul that the church’s desire to live peaceful and quiet lives is good and pleasing to God, not because he desires easy lives for those in the church, and not because these lives become ways for them to earn his good pleasure, but because he desires all people outside of the church to be saved. Fourth, in Article XXI, a rejection of prayers to the saints is directly linked to 1 Timothy 2:5 as it announces that Jesus “alone has promised to hear our prayers.”  In 1540, Melanchthon produced an altered version of the Augsburg Confession to appeal to Calvinists which John Calvin himself signed. 

Sixteen years after signing the Augsburg Confession, Calvin published his commentary on 1 Timothy and it was, like the Confession, directed towards one “in high places.”  Dedicated to “The Most Noble and Truly Christian Prince, Edward, Duke of Somerset”, Calvin begins his Commentaries on Timothy, Titus and Philemon with high praise for the prince. After noting that he has demonstrated heroism and piety by making “the restoration of religion…in the kingdom of Europe…(his) principle object”, Calvin notes how Paul’s relationship to Timothy might serve as a model for him to follow with the Timothy’s that are under his charge:

Now, since in order to restore the English Church, which, along with almost every other part of Christendom, had been miserably corrupted by the shocking wickedness of Popery, you employ your strenuous efforts under the direction of your King, and for that purpose have many Timothys under your charge, neither they nor you can direct your holy transactions in a more profitable manner than by taking the rule here laid down by Paul for your pattern. For there is nothing in them that is not highly applicable to our times, and hardly anything that is necessary in the building of the Church that may not likewise be drawn from them. I trust that my labour will, at least, afford some assistance; but I choose that this should be known by experience rather than that I should boast of it in words. If you, most noble Prince, shall approve of it, I shall have abundant reason for congratulating myself; and your remarkable kindness does not permit me to doubt that you will take in good part that service which I now perform.^[ix] 

Calvin’s commentary on 1 Timothy 2:1-7 echoes that of the critical exegesis above on a number of particular points but the differences in his approach are not negligible. What differentiates Calvin in particular is in what he chooses to emphasize in the passage. His historical context led Calvin to have two main concerns in mind: 1) the role of civil authorities in promoting religion, 2) the challenge that Catholicism posed for a correct understanding of the work of Christ.  

            As already noted, Calvin dedicated his commentary to Prince Edward who he credited with seeking to restore proper religion to England. Perhaps it is not surprising then that he spends a great deal of time in his exposition emphasizing the role that princes have in promoting proper religion and the respect due them by the populace. Since “God appointed magistrates and princes for the preservation of mankind, however much they fall short of the divine appointment,” we ought “not on that account cease to love what belongs to God, and to desire that it may remain in force.” For “that is the reason why believers, in whatever country they live, must not only obey the laws and the government of magistrates, but likewise in their prayers supplicate God for their salvation.”^[x] Calvin likens prayers for governments to produce peace to our prayers for the earth to produce fruit: “We must always hold by this principle, that magistrates were appointed by God for the protection of religion, as well as of the peace and decency of society, in exactly the same manner that the earth is appointed to produce food…so in those benefits of which we have already spoken, we ought to consider the ordinary means which he has appointed by his providence for bestowing them.”^[xi] The fruit of such prayers is that the governments will promote “godliness” through their promotion of religion and “decency” through their promotion of an ordered life.^[xii] Calvin adds that if we do not experience these fruits, we need to take a look at ourselves.  Seeing that God assigns rulers for these ends, if they do not come about it is likely because God is rendering the rulers useless because of our sins.  The first response to poor rule from the government, then, is personal confession by their subjects.

Regarding the challenge of the Catholic Church, Calvin focuses on their promotion of prayers to the saints. He comments: 

First, the name is so hateful to them, that, if any one mentions Christ as Mediator, without taking notice of the saints, he instantly falls under a suspicion of heresy. But, because they do not venture to reject altogether what Paul teaches in this passage, they evade it by a foolish exposition, that he is called “one Mediator,” not “the only Mediator.” As if the Apostle had mentioned God as one out of a vast multitude of gods; for the two clauses are closely connected, that “there is one God and one Mediator;” and therefore they who make Christ one out of many mediators must apply the same interpretation in speaking of God. Would they rise to such a height of impudence, if they were not impelled by blind rage to crush the glory of Christ?^[xiii]….Some person will perhaps think, that it will, therefore, be easy for us to come to an agreement with the Papists, if they place below the only intercession of Christ, all that they ascribe to the saints. This is not the case; for the reason why they transfer to the saints the office of interceding is, that they imagine that otherwise we are destitute of an advocate. It is a common opinion among them, that we need intercessors, because in ourselves we are unworthy of appearing in the presence of God. By speaking in this manner, they deprive Christ of his honour. Besides, it is a shocking blasphemy, to ascribe to saints such excellence as would procure for us the favour of God: and all the prophets, and apostles, and martyrs, and even the angels themselves—are so far from making any pretension to this, that they too have need of the same intercession as ourselves.^[xiv]

When considering Calvin’s interpretations of the passage, it is helpful to understand his methodology.  Fortunately, he described it in his dedication of his commentary on Romans to a man named Simon Grynaeus.  In the dedication, he describes his methodology as a “lucid brevity” which is undertaken to “lay open the mind of the writer.” Calvin favored “plainness” over “the evil of tiring readers with prolixity.”^[xv] He believed that “it is an audacity, closely allied to a sacrilege, rashly to turn Scripture in any way we please, and to indulge our fancies as in sport” and bearing that in mind, “we may not be stimulated by any humour for novelty, nor impelled by any lust for defaming others, nor instigated by hatred, nor tickled by any ambition, but constrained by necessity alone, and by the motive of seeking to do good.”^[xvi]

Given these concerns, Calvin’s commentary on 1 Timothy 2:1-7 is wonderfully illustrative of how historical contexts shape one’s approach to the text. Calvin sought to be faithful to Paul’s thinking and labored to avoid any type of novelty in his approach.  Yet a number of his comments would be seen today as completely out of step especially by a reader in the United States.  For example, in his context, those who rule over the government were expected to promote religion.  It was not a question of “will they?” but of “which kind?” Calvin was thrilled that Edward was promoting a Protestant religion in the face of Catholic opposition which he saw as a real threat to the true church.  Commenting on 1 Timothy 1:7, Calvin likens the lack of understanding on the part of the Ephesian false teachers to the teachings regarding purgatory and the intercession of the saints by the Catholics of his own day. His understanding was that these are the teachings that will shipwreck true faith and which must be addressed not only by the church but by the government as well.  This sounds so foreign to our current historical context, particularly in places where the separation of church and State is a given.  In these contexts, to argue that the government has a place in the promotion of true Christian religion would be tantamount to treason.

 It seems that his own context limited Calvin’s ability to see what Paul was really striving for in this passage.  Paul did not expect Rome to promote the Christian religion but he did expect it to be used by God to provide a safe environment in which Christians could live.  This point of difference may not seem that profound until we take into consideration the ends for which Paul prayed. For Calvin, at least in his understanding of this passage, religion was to be promoted by the rule of government.  For Paul, religion was to be promoted by the lives of believers. No greater difference can be conceived.  If the spread of the faith is to come by the work of the government, then the peace that we are after is one of disconnecting from or suppressing the elements of society which do not line up with our systems of belief.  If the spread of the faith is to come by the work of the church, then our prayers for peace are ultimately prayers for the opening up of opportunities to connect to the world at large.  That being said, Calvin does us a favor that reminding us that prayers for the government are important and do bear real fruit for the advance of the kingdom.  It is not enough to simply pray for the avoidance of wars and the removal of corruption.  The church should actively pray for the salvation of those who rule over us for we know that, even if they cannot directly promote the Christian faith, the laws that they do promote will affect the way in which we are able to practice it. 

            Whether it be in dealing with the role of government or addressing doctrinal challenges, and whether or not we agree with his conclusions, Calvin’s approach is commendable in that it is pastoral. Modern commentaries often spend so much time questioning the text as to its veracity that, by the time one gets to the point where the interpreter is ready to posit their conclusions as to what the text itself means, one might be forgiven for wondering if they care anymore.  The manner in which every word is dissected for every conceivable nuanced meaning (see, for example, Craig S. Keener’s commentary on Acts) leaves the reader ready to accuse the author of “the evil of tiring readers with prolixity”! Calvin desired that his commentaries be read by pastors in order to be helpful to their congregants.  To that end, he pursued brevity with a view to application. Perhaps, that is why the readers of his commentaries, even while differing in their conclusions as to the meaning of a particular passage, still value them so.

            In his “Argument on the First Epistle to Timothy,” Calvin states “This Epistle appears to me to have been written more for the sake of others than for the sake of Timothy, and that opinion will receive the assent of those who shall carefully consider the whole matter. I do not, indeed, deny that Paul intended also to teach and admonish him; but my view of the Epistle is, that it contains many things which it would have been superfluous to write, if he had had to deal with Timothy alone.”^[xvii] Indeed, the letter to Timothy was composed with others in mind because it is, as 1 Thessalonians 2:13 says, “God’s word, which is also at work in you believers.”

Indeed, the word of God is living and active” (Hebrews 4:12), forming and transforming believers even today. Today’s political climate provides a rich context in which the Holy Spirit can use 1 Timothy 2:1-7 in new ways to form persons into the image of Christ and transform persons into better disciples. As an example, the 2017 headline in the Washington Post read, “Photo surfaces of evangelical pastors laying hands on Trump in the Oval Office.”[xviii]  Since that day, pictures of President Trump surrounded by ministers praying for him have become common as he has found himself embraced by a host of evangelical leaders.  Not every Christian is as enthused about Trump however, and he has been a lightning rod for criticism from those within the church as much as from without.  When the conversation turns to the question “What are we going to do in response to President Trump?”, 1 Timothy 2:2 provides the answer: pray.  For Paul, praying for “kings and all who are in high positions” was not about approving of their governance.  It was about asking the Lord to use them for the purposes of his kingdom. Could Trump be used to create an environment where Christians are able to pursue “peaceful and quiet” lives? Some say he already has.  Even when Trump has faced criticisms regarding past conduct, Franklin Graham, founder of Samaritan’s Purse, has been outspoken in his support of Trump stating "I never said he was the best example of the Christian faith. He defends the faith. And I appreciate that very much."[xix] Even if one is not convinced, the call still remains to pray.  Praying for someone that you do not care for is an act of humble service and one that we enter into with Christ.  As Karl Barth explains,

Even while we are in the communion of the saints, in the ecclesia of those who are brought together by Jesus Christ, we are also in communion with those who do not yet pray, perhaps, but for whom Jesus Christ prays, since he prays for humankind as a whole.  It is the object of this intercession, and we ourselves enter into the communion with the whole of humanity.  When Christians pray, they are, so to speak, the substitutes for all those who do not pray; and in this sense they are in communion with them in the same manner as Jesus Christ has entered into solidarity with sinners, with a lost human race.[xx]

Regarding the populace at large, studies have consistently shown that our nation is more divided now than it has ever been in recent history[xxi] and a deep distrust and dislike for the other has evidenced itself in confrontations both verbal and physical.  Christians may be tempted to jump into the fray but what does 1 Timothy call us to do?  Again, the answer is pray.  We are urged to pray for “all people.” These prayers include prayers for God to meet their needs (supplications), prayers that demonstrate genuine concern for their wellbeing (intercessions) as well as prayers of thanksgiving for them and the work that God is doing in their lives. If Christians today would follow this charge given to the believers in Ephesus, it would go far in diffusing some of the discord that marks our society today and would serve to make the church shine as a light of hope into this dark world. Jesus called on his disciples to “love your enemies, and pray for those who persecute you” (Matt. 5:44), surely that includes political enemies?

            When we look across the political, social and racial landscape that exists today, what do we see?  The Christian answer is not given in terms of political affiliation, social status or color of one’s skin. The Christian answer is “we see people whom God desires would be saved.” As has already been noted, when you love God, you love the things he loves and desire the things he desires.  The church has no option, then, in the face of all the division but to pray.  Pray for hearts which love God and, out of that love for God, love humankind wishing with him that they would turn to the only one who can save, the man Christ Jesus. 

^[i] Walter A. Elwell and Philip Wesley Comfort, “Ark of the Covenant.” In Tyndale Bible Dictionary. (Wheaton, IL: Tyndale House Publishers, 2001), 884.

[ii] John H. Leith, Creeds of the Churches (Louisville: John Knox Press, 1982), 9.

[iii] Ibid.

[iv] Ibid., 21.

[v] Ibid., 23.

[vi] Ibid., 35-36.

[vii] Ibid., 63.

[viii] Ibid.

^[ix] John Calvin, Commentaries on the Epistles to Timothy, Titus, and Philemon, trans. William Pringle (Bellingham, WA: Logos Bible Software, 2010), xi.

^[x] Ibid., 51.

^[xi] Ibid., 52–53.

^[xii] Ibid., 52.

^[xiii] Ibid., 58.

^[xiv] Ibid., 59.

^[xv] John Calvin, Commentary on the Epistle of Paul the Apostle to the Romans, trans. John Owen (Bellingham, WA: Logos Bible Software, 2010), xxiii–xxiv.

^[xvi] Ibid., xxvi–xxviii.

^[xvii] Calvin, Commentaries on the Epistles to Timothy, Titus, and Philemon, 13.

[xviii] Sarah Pulliam Bailey. “Photo surfaces of evangelical pastors laying hands on Trump in the Oval Office.” Washington Post, July 12, 2017.  https://www.washingtonpost.com/news/acts-of-faith/wp/2017/07/12/photo-surfaces-of-evangelical-pastors-laying-hands-on-trump-in-the-oval-office/?utm_term=.03b51323dccd

[xix] Justin Wise. “Franklin Graham: Trump defends the Christian faith.” The Hill, Nov. 25, 2018. https://thehill.com/blogs/blog-briefing-room/news/418180-franklin-graham-on-supporting-trump-he-defends-the-christian

[xx] Karl Barth, Prayer, 50^th Anniversary Edition, ed. Don E. Saliers, trans. Sara F. Terrien (Louisville: Westminster John Knox Press, 2002), 23.

[xxi] Steven Shepard. “Study: Americans more divided along party lines than ever,” Politico, Oct. 5, 2017, https://www.politico.com/story/2017/10/05/poll-americans-divided-party-lines-243466

It was 1874 when Andrew Taylor Still, MD developed the practice of Osteopathic medicine. Still was the son of a Methodist minister and physician and he pioneered the concept of "wellness" in the treatment of patients. Still’s concept of “wellness” did not end with treatment or cure of specific symptoms, but reflected the biblical concern for the whole person and is reflected in the tenet that “The body is a unit; the person is a unit of body, mind and spirit.” The Osteopathic philosophy is concerned with promoting the overall health and well-being of individuals, families and communities by recognizing, for example, that spirituality and religion have a role to play by supporting actions that enhance physical and mental health. It is this Osteopathic philosophy that undergirds the training of the students at Campbell University’s Medical School. 

The world that our students are graduating into, however, is much different than days of old. In many cases, the name “hostel of God” would be considered a misnomer and the concept of “wellness” has changed. Today hospitals around the globe, rather than being concerned with following Christ in his concern for “the least of these,” are involved in practicing abortions for parents who would prefer children of specific genders or who would like to be spared the “trouble” of raising a child with a developmental disability; performing sex reassignment surgeries on children as young as four; and performing euthanasia individuals with mental illness or cognitive disorders.  As a consequence, medical practice has gone from an expression of faith to an institution where political and cultural battles are fought.[iii] Those expressing religious concerns regarding the direction medicine is taking are now being told by others in the profession that, if they cannot leave their religion at the door, they need to get out of the practice of medicine altogether.[iv] As a consequence, leave their religion at the door is exactly what many doctors do. 

Despite this, there a renewed interest in the link between religion/spirituality and health. Campbell University now joins three-quarters of all U.S. medical schools which offer courses in spirituality and medicine. [v] We have utilized materials from academic centers such as the George Washington Institute for Spirituality and Health and have invited researcher, Harold Koenig, an associate professor of psychiatry and behavioral sciences at Duke University Medical Center, and author of a number of publications on the intersection of religion and health, to present lectures to our students. I have taken the opportunity to deliver lectures on “Taking a Spiritual History” and my message to our students is that, to care for the whole patient, one must tend to their spiritual health as well as their physical.

How do we go about doing this? 1 Timothy 2:1-7 gives us some direction.

1 Timothy 2:1-7

2 First of all, then, I urge that supplications, prayers, intercessions, and thanksgivings be made for everyone, 2 for kings and all who are in high positions, so that we may lead a quiet and peaceful life in all godliness and dignity. 3 This is right and is acceptable in the sight of God our Savior, 4 who desires everyone to be saved and to come to the knowledge of truth. 5 For there is one God; there is also one mediator between God and humankind, Christ Jesus, himself human, 6 who gave himself a ransom for all  - this was attested at the right time. 7 For this I was appointed a herald and an apostle (I am telling the truth, I am not lying), a teacher of the Gentiles in faith and truth. (NRSV)

            Paul’s first letter to Timothy was born out of an urgent desire to see false teachers who had cropped up in the fledgling church in Ephesus confronted and their teachings silenced.  Discord had been introduced into the house of God and it could not be allowed to remain.  With persecution bearing down upon Christians from outside of the church and teachers making shipwrecks of people’s faith from within the church, Paul must have wondered how much longer this congregation in Ephesus could survive. In response, Paul entrusts the Ephesian church to his faithful companion Timothy whom he charges with guiding and nurturing them with pastoral care.  To this end, Paul sends Timothy a letter with specific instructions regarding the proper order that must be instituted and maintained in the household of God. In 1 Timothy 2:1-7 we are exposed to the first set of instructions but we are also given insight into the core of Paul’s methodology and motivation. Paul’s first tact for combatting the false teachers is not public debate but public prayer.  Prayer will accomplish what other methodologies cannot.  And Paul’s first concern is not simply for correct doctrinal training to replace the false.  What motivates Paul is a love for God and, therefore, a desire for the things which He desires. God desires that all men might be saved and Paul recognizes that a church unified in their love for the truth and living out their faith in the public sphere can be a powerful witness to a lost world.

Historical and Literary Contexts

The question of Paul’s authorship of 1 Timothy has been raised by scholars who feel that several arguments point to it being pseudonymous: a) the testimony of the early church does not appear to be very strong; b) the polemical style seems much different than the style of the epistles which have been accepted as genuine (Romans, 1 and 2 Corinthians, Galatians, Philippians, 1 Thessalonians and Philemon); c) the situation of 1 Timothy is hard to place in what we know of Paul’s activities; d) the vocabulary used in 1 Timothy is differs substantially from the genuine epistle; and e) the church order presented seems like it belongs to the turn of the century or later.[vi]   Those who accept the letter as authentic counter that: a) until the 1800’s it seems that nobody questioned their authenticity including representatives of the early church such as Polycarp, Irenaeus, Tertullian and Eusebius who all recognized them as being authentic[vii]; b) the language utilized differs from other Pauline letters because the occasion was different and demanded different terminology; c) the organization of the church described in 1 Timothy is no different than what we see in Philippians and we know that Paul appointed elders from the beginning of his mission work (Acts 14:23).[viii]  As far as the timing of the writing is concerned, the letter presents an occasion when Paul left Timothy in Ephesus while he made a visit to Macedonia.  Though we cannot know exactly when this happened, we know of two occasions in which this exact scenario took place (Acts 20:1-3 and 2 Corinthians 1:16, 2:12-13, 7:5-6) and so it is easily within the realm of possibility.  Even if neither of these two occasions fits the timing of the writing of 1 Timothy, our knowledge of all of Paul’s activities is not exhaustive.[ix]         

The letter is written to Timothy, Paul’s younger mentee (1:2, 1:18). We are introduced to Timothy in Acts 16:1-3.  He was a disciple who was living in Lystra and his good reputation among the Christians led Paul to invite him to accompany him and Silas on their missionary endeavors. Timothy’s mother was Jewish but, because his father was Greek, Timothy would have been considered a Gentile. Paul, therefore, circumcised him in an attempt to prevent his presence from being a stumbling block to the Jews he was hoping to reach. This paid off as we read that, through their combined efforts, “churches were strengthened in the faith, and they increased in numbers daily” (Acts 16:5).  Timothy accompanied Paul and Silas on the remainder of Paul’s second missionary journey (Acts 15:36-18:22) and then accompanied Paul on his third missionary journey when he travelled to Ephesus.  Paul sent Timothy and a disciple named Erastus ahead to Macedonia to prepare for his own arrival there on his planned trip to visit Jerusalem (Acts 19:21-22).  Later, he was again sent ahead to prepare the way for Paul, this time to Troas (Acts 20:1-6).  The picture that is painted of Timothy is one of a highly trusted companion who helped manage Paul’s affairs and who, at times, served as an ambassador for Paul to carry on his work of strengthening and confronting congregations (cf. 1 Thess 3:1-6, 1 Cor 4:17; 16:10-11; Phil 2:19-24). 

Occasion

Paul and Timothy had come to Ephesus together but when Paul continued on to Macedonia he left Timothy there in order for Timothy to oversee the church. This oversight involved confronting false teachers who threatened to lead the Christians in Ephesus astray, and ensuring a proper church order was instituted and followed.  Since we do not know on which particular trip to Macedonia this letter was written, dating it is difficult.  Lea provides a helpful possible chronology for the letters of Paul and dates the writing of 1 Timothy somewhere between A.D. 63-66 which would be after Paul had been released from his first imprisonment.[x]

Form, Structure, Movement

1 Timothy is in the form of a letter and is typically described, along with 2 Timothy and Titus, as a “pastoral letter” because it was written to Timothy to help him in the discharge of his pastoral duties in Ephesus.   Dibelius and Conzelmann, who consider the letter pseudonymous, argue that it is a collection of church order materials put into the form of a letter attributed to Paul to ensure a wide audience and broad appeal.[xi] Gloer, who accepts the letter’s authenticity, argues that the letter shares the nature of a particular type of letter called the mandata prinicippiis.  This was a letter that contained orders given by a superior to a delegate who would enact the orders in their own sphere of influence.[xii] 1 Timothy contains elements which are personal in nature such as Paul’s instruction for Timothy to drink a little wine for his stomach ailments (5:23) but it is clear that Paul intended it to be read to the entire church from the letter’s closing statement “Grace be with you all” (6:21).  As a result, the letter does shift from personal to formal and back again on occasion indicating that it was intended to be a sort of guide for church order which Paul desired Timothy to share, at least in part, with the church.

The form of 1 Timothy follows the standard letter form of Paul’s day but Belleville notes that it is missing not only the standard thanksgiving section at the opening of the letter but, more strikingly, detailed travel plans and closing greetings at the end which both 2 Timothy and Titus contain.  Belleville explains that this “signals a troubling and pervasive state of affairs at Ephesus.”[xiii]

Towner (following the arguments of Johnson) argues that the theological perspective of 1 Timothy is shaped by the concept of “the good order from God” introduced in 1:4 (oikonomia theou).  The idea is that God divinely orders all of reality.  This would include the church, “the household of God” (oikos theou, 3:15), and the whole of the social and political world in which it finds itself.  The false teachers have created a disruption to this order in the church and Timothy is charged with admonishing the opponents and instructing the faithful in order that the church will see good order restored and it will, then, stand as a symbol of God’s ordering presence in the world.[xiv] Having greeted Timothy (1:1-2), Paul describes the challenge facing the church in Ephesus (1:3-11), relates his own call to ministry (1:12-17) and charges Timothy to his own ministerial call (1:18-20).  2:1-7 initiate the specific instructions that Timothy is to follow.

Outline of 1 Timothy 1:1-2:7

1. Opening Greeting- 1:1-3a
2. Body of the Letter 1:3-6:21
   1. The challenge in Ephesus 1:3-11
      1. False teaching including that regarding the law 1:3-7
      2. Proper use of the law in a fallen world 1:8-11
   2. Paul’s call to ministry 1:12-17
   3. Timothy’s charge to ministry in Ephesus 1:18-20
   4. The first response to the challenge- prayer with a view to gospel witness 2:1-7

Detailed Analysis

Vs. 1a “First of all, then..”

This connects 2:1-7 to what has come before.  Certainly, a link can be made to 1:3 and 1:18-20 (see Fee), but it seems better to see it as a natural outgrowth of all that has come before.  The prayers are said with the end of peaceful, quiet, godly, and dignified lives in view.  This is in contrast to what Paul has described in chapter one.  The situation that Timothy is facing is marked by speculations (vs. 4) and meaningless talk (vs. 6) by those who desire to be teachers while not understanding what they are saying (vs. 7) leading others to making shipwrecks of their faith (vs. 18) some of whom have had to be removed from the fellowship of the church (vs. 20). The broader context in which this is happening is a world in which lives the lawless and disobedient, the godless and sinful, the unholy and profane, those who kill their father and mother, murderers (vv. 8-11).  Paul recognizes that the fate that they deserve, he deserved as well and, yet, he received mercy (vv. 12-17) from the King of the ages (vs. 17).  Now Paul, has a young man named Timothy who has had prophecies made regarding him which has singled him out as a worthy companion and which will be of help to him as he fights a spiritual battle (vs. 18).  It is in light of all of this that Paul, therefore (“then”) charges Timothy to pray (cf. Eph 6:18) for earthly kings that peace may reign and others might receive mercy as he did.  Of all the work that Timothy will be called upon to do, prayers come “first of all.”  That they would come first in sequence and first in priority is not a surprise given the priority it is given elsewhere. In a situation that bears certain similarities to this one, Jeremiah writes a letter to elders, priests, prophets and all the (God’s) people who find themselves in a world whose system of belief is hostile to their own.  He calls on them to seek the welfare of the city by praying to the LORD on its behalf “for in its welfare you will find your welfare” (Jer 29:7).  Paul elsewhere calls for a similar priority be given to prayer when the situation is one of God’s people living in the midst of a world of conflict and conflicting viewpoints and the goal being one of peaceful interaction with others while standing for the truth (cf Col 4:2-6, Eph 6:18-20).

Vs. 1b  “I urge that supplications, prayers, intercessions, and thanksgivings be made for everyone,”

Mounce articulates the view of most commentators when he argues that Paul’s intention here is not to distinguish the various kinds of prayer but simply to make the point that “all prayers, of all types, should be for all people.”[xv] Gloer, argues that, while Paul does not intend to limit the types of prayers to these three (the term “prayer” being understood as a generic term while “supplications”, “intercessions” and “thanksgivings” being particular types of prayers), these three (at least) should be included in the prayers lifted up.[xvi] “Supplications” refers to asking God on behalf of others for a specific perceived need.  “Intercessions” refers to pleading on behalf of another in a way that demonstrates one’s concern for them in a time of need.  “Thanksgivings” are expressions of gratitude for the blessings bestowed upon someone.[xvii]

“for everyone, for kings and all who are in high positions, so that we may lead a quiet and peaceful life in all godliness and dignity. 3 This is right and is acceptable in the sight of God our Savior, 4 who desires everyone to be saved and to come to the knowledge of truth.”

Given the circumstances described in chapter one, one would expect that the prayers Paul commends would be primarily, if not solely, focused on those who were false teachers.  By praying either for their hearts to be changed or for their removal from their spheres of influence, this would usher in the peace and quiet for the church in Ephesus that Paul indicates would be a result of the prayers.  The prayers that Paul charges Timothy to lead the church in praying have a much broader scope however. Does this indicate that the troubles the church is facing are coming from all directions both within and without?  We know that Paul has sent Timothy to Ephesus at a time proximate to his being imprisoned while attempting to spread the faith, so this is a distinct possibility.  Viewing it in this manner, we might read Paul as saying, in essence, “Pray that everyone (troublemakers within and without the church) will just leave us alone that we might practice our faith in peace.”  This approach, however, does not seem likely.  First, Paul, far from expecting a life of comfort and ease for believers, expresses suffering as a means by which the power of God is put on full display and, as a result, life in Christ is spread to others (Eph 4:7-12). Secondly, earthly comfort does not appear to be one of Paul’s greater concerns.  In fact, compared to the glory believers will experience in the new heavens and new earth, today’s sufferings are but “light and momentary” and no cause for believers to lose heart.  Rather than praying for the suffering to cease, then, believers are encouraged to look beyond them to things unseen (2 Cor 4:16-18).  Debelius and Conzellman point to the perceived contrast between the author of 1 Timothy and Paul’s other writings to justify their rejection of Pauline authorship for 1 Timothy.  They state that, contrary to Paul, the author of the Pastorals “seeks to build the possibility of a life in this world…He wishes to become part of the world.”[xviii] If we assume Pauline authorship, what are we to make of this?  1 Thessalonians 4:11-12 may give us a clue as to what Paul has in mind here.  The same concern for believers living quiet lives is here linked to the result of their walking “properly before outsiders”.  His concern seems to be that the Gentiles, whom he longed to be saved (1 Thess 2:16), would see in the quiet lives of the Thessalonian believers the gospel on display. Since Paul’s concern in 1 Timothy 2:4 is for the salvation of others, seeing these as parallel passages would not be ungrounded.  Paul would be understood, then, to be saying “I am charging you to pray, not just for the trouble makers within the church in Ephesus, but also for community at large and those who rule over it as well. The goal of these prayers is that you would be free to live out your faith in a way that is untroubled by strife and conflict but, instead, as a living demonstration of the gospel.” “Godliness” refers to “the whole of the Christian life as the interplay between the knowledge of God and the observable conduct that emerges from that knowledge.”^[xix] And “dignity” refers to a “settled piety” which “results in moral earnestness, which affects both outward actions and inward intentions (and) wins the respect of others.”^[xx]

Paul’s emphasis that God desires that “everyone” would be saved may be a rebuke to those of 1:4 who were devoted to “endless genealogies” and, therefore, sought to limit the gospel’s reach to particular groups of peoples. God’s desire for everyone to be saved does not imply that all will be saved nor that God is powerless to accomplish what he wills. Arminians have used this text to argue against the Calvinist contention that God limits his will to save to only the elect. John Piper responds by pointing out that Calvinists and Arminians actually both agree on their basic approaches to 2:3-4. First acknowledging that neither Arminians nor Calvinists can accept the idea that there is a power in the universe greater than God which overrules what he wills, Piper writes:

The other possibility is that God wills not to save all, even though he is willing to save all, because there is something else that he wills more, which would be lost if he exerted his sovereign power to save all.  This is the solution that I as a Calvinist affirm along with Arminians.  In other words, both Calvinists and Arminians affirm two wills of God when they ponder deeply over 1 Timothy 2:3-4.  Both can say that God wills for all to be saved.  But then, when queried why all are not saved, both Calvinist and Arminian answer that God is committed to something even more valuable than saving all.

The difference between Calvinists and Arminians lies not in whether there are two wills in God, but in what they say this higher commitment is.  What does God will more than saving all?  The answer given by Arminians is that human self-determination and the possibility of a resulting love relationship with God are more valuable than saving all people by sovereign, efficacious grace.  The answer given by Calvinists is that the greater value is the manifestation of the full range of God’s glory in wrath and mercy (Romans 9:22-23) and the humbling of man so that he enjoys giving all credit to God for his salvation (1 Corinthians 1:29).[xxi]

Is their “being saved” and “coming to the knowledge of the truth” two ways of describing a singular event or do these describe two separate, albeit connected, events? It could be that this is simply two ways of describing a single salvation event with “the knowledge of the truth” emphasizing that faith is not anti-intellectual but involves an embracing of truth claims.[xxii]  In 2 Timothy 3:1-9, Paul describes those who had the appearance of godliness and yet who, despite all of their learning, never arrived “at a knowledge of the truth” (vs. 7).  Perhaps, what Paul has in mind, then, is that God desires that all people would avoid the fate of Hymenaeus and Alexander (1 Tim 1:19b-20) who had appeared to have embraced the faith and yet were led astray from a knowledge of the truth leading to the shipwreck of their faiths and the expulsion from the church.

5 For there is one God; there is also one mediator between God and humankind, Christ Jesus, himself human, 6 who gave himself a ransom for all  - this was attested at the right time.

            “For” connects vss. 5-6 to the call to prayer in vs. 1 and the contention of vss. 3-4 that God “our Savior” desires “all people” to be saved. Why would “our” Savior desire salvation for others? We might think of Peter’s response to Jesus when, after many of his disciples left him, he asked Peter “Do you want to go away as well?” Peter replied, “Lord to whom shall we go?” (John 6:67-68). In other words, since salvation can be found in no one else, who is there that we could possible turn to?  In the same vein, Paul makes the point that, if salvation is to be desired for others, there is no use in hoping they find it in any other source other than the one true God. There is only one God.  There is only one mediator between humankind and God.  Therefore, we pray for all people that they find God, the only hope that they have for salvation.  With vs. 5 echoing the Jewish affirmation on the uniqueness of God (Deut. 6:4), Mounce argues that verses 5-6 contain the strongest arguments that the Ephesian heresy was primarily Jewish.[xxiii] Arguing against the way that the affirmation was used by them in an exclusivistic way, Paul contends that “one God” means he is the one God for all the nations which are composed of a humanity that is in universal need of help which God has provided through the one mediator, the God-man  who identifies with them.[xxiv]

Most commentators connect this with Jesus’ statement in Mark 10:45, “For even the Son of man came not to be served but to serve, and to give his life as a ransom for many.” Towner notes that Paul has adapted 10:45 in numerous passages (Gal 1:4, 2:20; Eph 5:2; Titus 2:14). The importance of this passage for Paul lay in the presentation of Jesus’ death as a voluntary self-sacrifice as a representative and substitute.  Mounce argues that the placement of the phrase “This was attested at the right time” indicates that it is a comment on a creedal formula.^[xxv] Verses 5 and 6 may be the part of a creed, or the entire creed itself, which would have been known by the Ephesian church. “For,” connects the creed with the theme of the paragraph with Christ’s ransom being “for all” what Paul wants to emphasize.^[xxvi] If that is the case, we might read it as saying that Christ’s ransom for all people is the appropriate witness to the fact that the church should not exclude anyone from the offer of salvation. 

7 For this I was appointed a herald and an apostle (I am telling the truth, I am not lying), a teacher of the Gentiles in faith and truth.

“For this” is most naturally understood to be referring to Paul’s role as God’s instrument to lead people to a “knowledge of the truth” since the means by which he is to accomplish his appointment was by being a herald, apostle and teacher.  His target audience is composed of Gentiles which is proof in and of itself of the point that he has been making here.  Namely, that God’s desire that all (not simply Jews) be saved.   Paul is emphatic on this point and so exclaims “I am telling the truth, I am not lying.” 

Synthesis

There was an urgency to Paul’s insistence that Timothy remain in Ephesus and “wage the good fight” (1:18) against the false teachers who were active there.  And it is no wonder as their vain discussions were guilty of shipwrecking the faith of those in the church.  If it wasn’t enough that the world at large was hostile to the message of hope which resulted in a world that was full of disorder, inside the church similar conditions now reigned.  Paul had entrusted Timothy to be his representative to address issues in the churches on his behalf before and he has once again charged Timothy with the task of setting things aright.  But where should Timothy begin?  Paul has armed Timothy with a letter which gives him instructions for the household of faith.  “Teach and urge these things” Paul writes in 6:2.  What things? Instructions regarding the qualifications for elders (3:1-7) and deacons (3:8-11).  Instructions regarding relationships within the church (5:1-16), for the care and provision of elders (5:17-19), and for the relationships between servants and masters (6:1-2). Before Timothy is to address any of these things, however, Paul makes sure he understands what must come first: prayer.  Prayer is the main weapon in Timothy’s arsenal and, more than simply praying for the problem to go away, Paul leads Timothy in thinking through the broader implications.  It was not enough to pray that order within the church be restored.  That order had a higher purpose yet.  In Jesus’ high priestly prayer of John 17, Jesus prayed that the disciples would “all be one” in order that “the world may believe that you (the Father) have sent me” (John 17:21).  Paul now echoes Jesus’ desire.  The issues within the church must be addressed and unity of mind and action restored with the goal that a watching Gentile world would come to believe.

[i] Wesley J. Smith, “Religious and Pro-Life Conscience Unwelcome in Healthcare,” First Things, July 22, 2016, https://www.firstthings.com/web-exclusives/2016/07/religious-and-pro-life-conscience-unwelcome-in-healthcare.

[ii] “The Christian Origins of Hospitals,” Biblemesh, February 6, 2012, https://biblemesh.com/blog/the-christian-origins-of-hospitals.

[iii] Wesley J. Smith, “The ‘Medical Conscience’ Civil Rights Movement,” First Things, March 30, 2018,  https://www.firstthings.com/web-exclusives/2018/03/the-medical-conscience-civil-rights-movement

[iv] See for example The American College of Obstetricians and Gynecologists’ “Limits of Conscientious Refusal in Reproductive Medicine” at  https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/The-Limits-of-Conscientious-Refusal-in-Reproductive-Medicine.

[v]Manoj Jain “Should doctors pray with their patients? Despite skeptics, medical schools addressing spirituality,” The Washington Post, November 21, 2008, https://journaltimes.com/lifestyles/faith-and-values/religion/should-doctors-pray-with-their-patients-despite-skeptics-medical-schools/article_5a81059e-5da9-5774-9883-253bc28c974b.html.

[vi] Martin Dibelius and Hans Conzelmann. The Pastoral Epistles, ed. Helmet Koester, trans. Philip Buttolph and Adela Yarbro (Philadelphia: Fortress Press, 1972), 1-4.

[vii] Philip H. Towner. The Letters to Timothy and Titus (Grand Rapids: William B. Eerdmans Publishing Company, 2006), 10.

[viii] W. Hulitt Gloer. 1 & 2 Timothy-Titus (Macon, Georgia: Smyth & Helwys, 2010), 7.

[ix] Ibid., 4.

[x] Thomas D. Lea and Hayne P. Griffin, Jr. 1, 2 Timothy, Titus (Nashville: Broadman Press, 1992), 40-41.

[xi] Dibelius and Conzelmann, 5-7.

[xii] Gloer, 12.

[xiii] Linda L. Belleville, Jon C. Laansma, and J. Ramsey Michaels. Cornerstone Biblical Commentary: 1-2 Timothy, Titus and Hebrews (Carol Stream, Illinois: Tyndale House Publishers, 2009), 15.

[xiv] Towner, 68-70.

[xv] William D. Mounce. Pastoral Epistles (Nashville: Thomas Nelson Publishers, 2000), 79.

[xvi] Gloer, 137.

[xvii] Richard C. Blight. An Exegetical Summary of 1 Timothy (Dallas: SIL, 2009), 91.

[xviii] Debelius and Conzellman, 39.

^[xix] Blight, 99.

^[xx] Ibid.

[xxi] John Piper. The Pleasures of God (Sisters, Oregon: Multnomah Publishers, 2000), 333.

[xxii] Gordon D. Fee. 1 and 2 Timothy, Titus (Grand Rapids: Baker Books, 1988), 63.

[xxiii] Mounce, 85.

[xxiv] Fee, 65.

^[xxv] Mounce, 91.

^[xxvi] Mounce, 87.

Stanley Hauerwas and William H. Willimon

It was of particular interest to me as our department has not only been taking students to Haiti to offer free medical clinics, but also has a vision for developing residency programs at local hospitals which will, in turn, give birth to the creation of self-sustaining church-run healthcare clinics which will send out village healthcare workers who will reach further out into unreached areas where our students will one day go.

The following is a combination of handwritten notes and excerpts from handouts.

The meeting began with the pronouncement that we must learn from what has worked in other countries and one thing that we do KNOW is that PARTNERSHIPS work.  

The objectives of the conference were listed as thus:

Enhance the care of children and mothers in Haiti by...

•  Improving our capabilities
• Increase awareness
• Learn from other countries
• Develop effective partnerships
• Provide for ongoing collaboration

Zulfiquar A. Bhutta, MD, PhD the president of the International Pediatrics Society began by discussing the inequality of healthcare that exists among global populations.  He noted, however, that many countries have seen gains in health outcomes in spite of these inequalities.  For example, "two-thirds of the countries that have made strong progress in reducing the under-five mortality rate have shown worsening inequalities since 1990."

Despite this fact we have seen child (under 5 yrs.) mortality drop from 12.7 million in 1990 to 5.9 million in 2015.   That is great progress, BUT that still leaves us with 6 million deaths and we need to ask the question:  "What were the major blindspots that had hindered them but which they addressed to see positive results?"

He quoted UNICEF's Anthony Lake who noted:  "Disaggregate the data and we find that our statistical national successes are masking moral and practical failures.  People who are left behind simply because they live in rural communities or urban slums, in conflict zones, as part of indigenous groups, with disabilities or because they are girls."  

He argued that the indicators that we should focus on are birth and prenatal - not "under 5."  Also, something that has not been adequately addressed is that many of the high number of stillbirths reported (that have tended to be clustered in Africa and Southern Asia) were actually children who had died during childbirth.  In fact, the risk of mortality peaks around childbirth and the first day of a child's life is a critical window of risk:  

• Most direct obstetric maternal deaths.
• Around half of stillbirths (1.2 million)
• Around a third of all newborns die on their day of birth

He added that 1/5 of children with stunting were born small and so addressing this issue would mean we should start with the mother during the pregnancy and then follow-up after the child is born.  

Quote:  The road to inaction is paved with research reports.

We need to address the "Know-Do" Gap.  We are aware of the problem.  So?  We need to focus on reducing the gap and we do that by innovation- NOT "technology"- BUT a new way of thinking- even if it is very low cost.

Challenge #1- Financial Barriers.  Many mothers do not get prenatal care and give birth at home because of financial considerations.  In India they tried a "Safe Motherhood Scheme" where the government offered a small cash incentive for mothers to go to a birthing facility rather than giving birth at home.  As a result many mothers did choose to go to the facility and there was a dramatic drop in stillbirths.

Challenge #2- Human Resources.  There is a huge "brain drain" in developing countries with their physicians concentrated in urban centers or leaving the country altogether.  In Pakistan, they sought to combat this by training "Lady Community Health Workers" who promoted good health practices and engaged in some primary care and prevention, visiting mothers in their homes and addressing household practices.  They found that simple interventions (such as teaching them how to better treat the severing of umbilical chords and the cleaning afterwards) were saving lives.  They received a monthly salary amounting to about $50-$60.  They sought to get other women to volunteer to be trained to help.  The results were amazing with a 20% drop in new born deaths just through this program.  They saw the use of birthing facilities go up and the drop of newborn deaths increased to 29% and a 25% drop in maternal deaths.   Afghanistan has the highest infant mortality rate in the world and the introduction of community midwives reduced it dramatically.

After Dr. Bhutta's presentation, Kimberly Bunker, MSN APRN FNP-BC, gave a presentation on community care prevention packets.  

Care packages are divided up into various categories:

• Antenatal
  • Screening, nutrition, immunization
  • Antenatal case management
• Peripartum and Birth
• Postpartum-Mother
  • Interventions
  • Case management
• Postpartum- Newborn
  • Interventions
  • Case Management
• Infant and Children (under 5 years of age)
  • Interventions
  • Case Management

These packages are given at several levels - Village health care workers (50-60%) > Rural Health Centers (35-40%)> District General Hospital/Sub District Hospitals> University Hospitals (5-10%).

The results have been amazing with an estimated 2.3 million deaths averted (mother and child numbers combined) through the giving of packages at the community level; 700,000 deaths averted at the primary health center level; and 900,000 deaths averted at the hospital level.   

Her message was that "Successful implementation of community care interventions are essential if we are to fast-track improvements!"

We then had breakout sessions.  The one I attended dealt with the standardization of treatments and coordination of the various groups providing them.

 The vision is for there to be a central location where care packages- consistening of medications for commonly treated ailments- could be put together and picked up at the lowest price possible.  There would exist a collaboration between the organizations working in Haiti who would share what work they are doing and where, and what medicines they are actually using and which are needed.  They would agree on which methods of treatment would best address the most common ailments and standardized packets of these medicines would be put together. By having everyone work together to accomplish this, it would reduce costs for everyone- both in the cost of transporting medicines into the country (we would not longer have to do this- it would already be there in a warehouse) and the cost of the medicines themselves.  The communication between the various groups would also help to reduce overlap in the areas we are reaching and the potential for abuse by the locals who may attend a series of clinics, stockpile medicines and either misuse them or sell them for profit.  

Next came Parmi Suchdev, MD, PhD from Emory University who discussed "Malnutrition and Stunting:  Opportunities for Action in Haiti."  

He presented a graphic which showed the causes of under 5 mortality worldwide:  HIV/AIDS 3%, Measles 4%, Malaria 8%, Diarrhea 17%, Acute respiratory infections 19%, Other 12 %, Perinatal deaths 37%, Malnutrition 53%.

He then defined Malnutrition:

Malnutrition= "bad nutrition" -  "a state in which the physical function of an individual is impaired to the point where he or she can no longer maintain adequate bodily performance process such as growth, pregnancy, lactation, physical work and resisting and recovering from disease"- WFP.

Haiti statistics:

• Worldwide, malnutrition is responsible for ~50% of under-5 deaths
• Diarrhea is a leading cause of malnutrition in children under-5
• Malnutrition is also a major cause of morbidity (e.g., iron deficiency anemia is a leading cause of years lived with disability in children and adolescents) and plays a key role in child neurodevelopment.
• Haiti Stunting Moderate-Severe 2008-12 was 21.9% (DR was 9.8%); Wasting 5.1% (DR was 2.2%)

Three principle constituents:  Protein-energy malnutrition (PEM), Deficiency in micronutrients, and Overweight/obesity.

Assessment of malnutrition:

• PEM or growth
  • Define by anthropometric measurements (height/length, weight, mid-upper arm circumference)
    • Wasting (reflects shortage of food)= weight-for-height<-2 z-score
      • Marasmus & Kwashiorkor are types of severe PEM
      • Mid-upper arm circumference (MUAC) can be used in community settings to rapidly identify children with PEM who need treatment.
    • Stunting (reflects chronic deficiency of food or presence of infections)= height-for-age<-2 z-score
    • Plot measurements using software by WHO (www.who.int/childgrowth/software) or CDC (www.cdc.gov/epiinfo)
• Micronutrient deficiencies
  • Clinical signs late to manifest, so require laboratory detection; "hidden hunger"
  • Most common deficiencies: iron, zinc, vitamin A, iodine, vitamin D, folate (often occur together in same population)

Evidence-based interventions

The Causes of malnutrition include on an individual level- dietary intake; infection/inflammation; and age, sex, genetics.  On a community level- food security; maternal and child care practices; and environment, healthcare services.  On a societal level- social status, employment, education; poverty; political ideology, war, natural disasters.

• Nutrition-specific interventions:
  • treatment of severe malnutrition: WHO 10-step approach and ready-to-use therapeutic foods (RUTF)
  • dietary diversification and breastfeeding promotion
  • supplementation, fortification
  • prevention and management of infection
• Nutrition-sensitive interventions:
  
  • agricultural and food security, eduction of girls and social status of women, improve healthcare system and environment.

The best thing that mothers could do is breastfeed their children.  In Haiti, only 40% of infants are breastfed which has led to a high level of anemia and stunting.  

"Plumpy Nut" cookie recipe from partners in development good suplement.

ww.spring-nutrition.org

Next Nadene Brunk, CNM, MSN and Vavita Leblanc, MPH, CM, discussed the issue of "Unattended Births"

The number 1 reason that women do not go to health clinics:  mistreatment by clinic staff.  "It is not the facility, what matters is the person with the right tools."

72-90% of the time traditional birth attendants deliver babies.

In the United States, the maternal mortality rate was at about 850 per 100,000 births in 1900.  We did not see a dramatic drop in these numbers until the introduction of "granny midwives" in 1930.  By 1950 we were down to about 100 per 100,000 and they only dropped from there in the years following.

"Midwives for Haiti" is training women to fulfill this role.

Next came Julie Jacobs, MD who covered "Pediatric Pneumonia and Diarrhea."  

Haiti Statistics

• Worldwide: Pneumonia remains the leading cause of childhood mortality
• Worldwide: 20% of the deaths in children ages 1 to 5 are from pneumonia and diarrheal diseases.  Most pneumonia deaths are preventable.
• Under five death rate in Haiti from acutre respiratory infections is 16 per 1,000 live births.  The Caribbean range is 0-3.  
• In Haiti, the percentage of all children under five deaths from acute respiratory infections is 23%.  One of the highest percentages in the world. UNICEF.
• Percentage of children under 5 with symptoms of pneumonia taken to a health care provider in Haiti 2012 was 38% (2006 was 31).  Regional average was 75%.  UNICEF

Diagnosing Pneumonia in Children

• Appropriate management depends on an accurate assessment of severity.
• Assessment of a majority of children in developing countries are based on clinical signs alone.
• The literature suggests that trained frontline health workers in LMIC countries should be able to identify young infants and children needing antibiotics.
• Best Diagnostic apporach- including for non-medical works- in the absence of x-ray:
  • Chest "indrawing": The inward movement of the lower chest wall when the child breathes in, and is a sign of respiratory distress.  This was a reliable sign whereby children aged 0-4 years with cough could be intensive antiobiotic tretament and supportive care for severe pneumonia. 
  • Respiratory Rate:  This rate is a reliable basis for prescribing antibiotics at home for non-severe pneumonia.  Among children with cough it is diagnostic if:
    • Children 2-11 months have a respiratory rate of more than 50 breaths per minute.
    • Children 1-4 years of age have a rate of 40 breaths per minute
    • A large study indicated that he best threshold for predicting pneumonia in infants age under 2 months was 60 breaths per minute

Diarrhea

Haiti Statistics

• Diarrheal disease is the second leading cause of death in children under 5 years old.  It is both preventable and treatable.
• Diarrhea is a leading cause of malnutrition in children under five years old.
• Diarrheal diseases account for 1 in 9 child deaths worldwide, making diarrhea the second leading cause of death among children under 5.  
• In Haiti, the precentage of under five deaths due to diarrhea in 2015 was 10%.  The DR was 3%.

Prevention

Handwashing; Latrines; Clean water; Rotavirus vaccine in the future; Role of community (only) worming.

One issue that came up was in regards to de-worming.  Most groups take with them medicines to deal with worms in children without checking to see whether the presence of worms is an issue in the first place.  An attendee said that they had done testing in Guatemala of 2,000 fecal samples and had found no evidence of worms at all.  

Community Grid Facilities Levels of Care

The public health sector is composed of 4 levels of care- tertiary hospitals, secondary hospitals, primary health care centers, rural health posts called dispensaries.  Dispensaries offer consultations and dispense medicines, while the primary health care centers also offer pharmacy services, consultations but they may or may not have beds for hospitalization for minor illnesses.  Secondary hospitals, the main departmental hospitals, offer hospitalization services, dispensing of medications, emergency services and limited surgery capabilities.  Public tertiary level hospitals based only in the capital Port-au-Prince, offer all services listed under secondary level care facilities with the addition of surgical and specialty medical services not available elsewhere in Haiti.  The public health sector is complemented by private clincs and hospitals, and by non-profit clinics, primary health care centers and hospitals as well as mixed health centers, dispensaries and hospitals. 

Level                               Characteristics                            Capabilities

Pre-Development            No health care facilities;              basic pharmacy                                                   basic primary care with staff                                                                                   and basic pharmacy capability

1                                    Primary Care- ambulatory             Limited Lab Support                                           illnesses with more complex          No imaging                                                       pharmacy and increased staff        Prenatal care; no                                               capability and skill                         midwife or skilled                                                                                                   attendant; no                                                                                                         deliveries                                                                                                               Blood pressure                                                                                                       monitoring                                                                                                             Pharmacy- may have                                                                                             IV capability

2                                    Secondary Care- basically              OB: Midwife                                                     a "birthing center" along                 Delivery care                                                   with emergency pediatric               including eclampsia                                           care.                                             and some hemorrhage                                                                                           complications                                                                                                         PEDS: IV antiobotics                                                                                             and hydrations.

3                                     Tertiary care- specialty                OB: Complicated                                                referral care                                 deliveries                                                                                                               C-section                                                                                                               Blood transfusion                                                                                                   ICU Care                                                                                                               PEDS:  PICU Care,                                                                                                   NICU Care, Pediatrics                                                                                           Surgery    

 The Display Tables included the following groups:

• Biomeds Without Borders  
• Midwives for Haiti
• HaitiOne
• Four Corners Medical Software
• Port Lafito Shipping
• Because International  ("the shoe that grows")
• Bethesda Referral and Teaching Hospital
• Edu-Pack
• Vereb, Hitt and Associates
• Hospital Sisters Mission Outreach
• MedSurplus Alliance
• NAAHP
• Haiti First Responders
• Haiti Vision Ministry
• Days for Girls