Missionary Burnout: How to Set Boundaries

For the next few months, we are going to look at encouraging medical missionaries. We want to look at it from several different angles and get a real picture of what we can do to fortify those serving on the field, and we're going to start with the development of God-honoring boundaries. We are excited to have a guest blogger today, Jim Ritchie. Jim served 25 years in the U.S. Navy and was emergency medicine residency director, deployed twice to busy combat support roles in Afghanistan. Upon retiring as a captain from the Navy in 2013, he became a medical missionary and moved to Chogoria Mission Hospital in rural Kenya. In 2021, Jim and his family moved from Kenya to Virginia, where he now serves as VP of Partner Strategies with MedSend.

Missionary Burnout Is Epidemic and Preventable

Missionary burnout is epidemic in the healthcare professions, in part due to a work ethic that prioritizes the needs of patients and places great responsibility for outcomes on the medical team. When members of the medical team go to the developing world, we encounter far greater need, far fewer medical workers, and far less control regarding outcomes. Ministry burnout seems inevitable.

But when we embrace our God-given limitations and develop God-honoring boundaries, we can serve for full careers, staying healthy and with emotionally healthy families.

Mistaken Expectations

We Christians can confuse ourselves by misunderstanding Scripture. Some verses may seem to imply endless physical endurance: "[T]hey shall run and not be weary; they shall walk and not faint," (Isaiah 40:31) or "I can do all things through [Christ] who strengthens me," (Philippians 4:13). But these verses are poetic metaphor and principle regarding hope in God and contentment, not a promise to be able to work without sleep.

Instead, God gave us limitations. We must sleep. We must take time to build and maintain relationships. We are not in control of life and death. Ignoring our God-given limitations can be sinful. Embracing our God-given limitations can be worshipful.

Even Jesus, in His earthly life, embraced His limitations. At times, Jesus sent the crowds away. Sure, He worked hard, sometimes even through the night. But at times, He stopped healing and went away, despite the disappointment of crowds of people. Unless we think we are "Super Jesus," able to work when He could not, we should do likewise.

A swamp has no borders and no destination. No boundaries. The swamp is stagnant and breeds disease. A river has banks and a destination, and it is powerful and life-giving. The river has boundaries.

Setting Boundaries to Prevent Ministry Burnout

Sometimes we can be hesitant to adopt boundaries, thinking that we are distancing ourselves from our calling. But healthy boundaries aren't like a huge, imposing stone wall with razor wire on top. Instead, healthy boundaries are like a substantial green hedge with a gate, and you are in control of the gate. At times, the gate is open, and we are in full contact with other people. At times, we close the gate to rest, prepare, build relationships, and work on other responsibilities.

In establishing healthy boundaries, it's important to identify the driving idea. Is your life dictated by the work that needs to be done and by others' expectations of you? If so, the overwhelming needs will strongly tend to drive you toward what is burnout in practice: overwork, depletion, and eventual departure from the field. Or, instead, is your life guided by a recognition of your God-given limitations and assurance of God's love? If so, you can establish guidelines for healthy living and working. Resilience and the prevention of burnout address this tension directly and are worth working through before or during field service.

Healthy Boundaries in Practice

A reasonable workweek. Healthcare missionaries carry many responsibilities: patient care, teaching, communicating with supporters, building relationships with spouse and children, growing in relationship with God, learning language and culture, resting for sustainability, and more. If we allow patient care to dominate our lives, we wind up with spiritual and relational anemia and failed duties.

One pattern that has proven sustainable is a five-day workweek, with four clinical days and one day for other professional responsibilities. Allocate one day for community building or other ministries and one day for Sabbath. When adopted by the whole team, this pattern has proven restorative and sustainable.

A limited queue of patients. An unlimited queue can lead to frustration for both medical staff and patients. A friend in a surgical specialty required a limitation of 30 patients per clinic and assigned a nurse as the gatekeeper. There was some initial pushback, but shortly this pattern became normal, and there was a new enthusiasm for caring for patients. This boundary usually should be associated with a triage plan so the neediest patients are prioritized.

The same idea can be applied to ward rounds, meetings, and other recurring demands on a missionary's time. Missionary burnout accelerates when no structure exists to protect time, energy, and relationships.

Boundaries Need Boundaries

Boundaries can divide teams if some members insist on them and others resist. This can produce resentment, accusation, and guilt—lamentable, especially because God loves unity in His people. It's very important to consider boundaries as a team dynamic. As often as possible, boundaries should be agreed upon by the entire team, especially leadership.

We have also seen individual missionaries adopt so many boundaries that they do not integrate with their communities and do not become valued by hospital leadership. Even boundaries need boundaries.

The development of God-honoring boundaries is a critical skill for healthcare missionaries. Such boundaries honor our God-given limitations, our many responsibilities, and our important personal relationships.

May God guide you in honoring Him in this way.