“Sometimes I have
difficulty walking up small mountains”
Health assessments as
part of a “Day of Grace” health, wellness, stress and spirituality seminar for
Lutheran Pastors in the Iringa Diocese of Southern Tanzania
“Sometimes I have difficulty walking up small mountains,”
replied the 62 year old pastor when asked if he had any concerns about his
health. He was participating in one of 3
day-and-a-half seminars held in January 2012 in Iringa, Tanzania. These seminars were planned and sponsored by
the Iringa Diocese of the Evangelical Lutheran Church of Tanzania in
conjunction with the St Paul Area Synod of the Evangelical Lutheran Church of
America. The seminars, entitled “Day of
Grace” were conceived and organized in response to the perceived need for
support of physical and emotional health and stress management for a group of
185 pastors in the Iringa Diocese. The
seminars included worship and fellowship time, small group discussion, and a
lecture on stress management.
Participants were also offered the opportunity to undergo individual
physical health assessments.
Data without personal identifying information was reviewed
from 155 of 159 pastors (24 female and 131 male) that volunteered to
participate in the physical health assessment component of the Day of Grace
events. All were offered screening for
hypertension and diabetes and underwent assessment of visual acuity, height and
weight. A health questionnaire was
devised with the help of Tanzanian leadership so that only culturally
appropriate questions were asked.
Pastors completed the health questionnaire and physical exam with the
aid of an interpreter when needed.
Female pastors were interviewed by female medical staff, counseled on
breast self-exam and offered pelvic exams.
Volunteer medical staff included physicians, nurses and pharmacists from
the Minneapolis-St Paul area and 4th year medical students and
pharmacy students from the University of Minnesota
Pastors in the Iringa Diocese have completed secondary
education and theology training at the college level. The age range of pastors
participating in the health assessments was 23 to 80 with a median age of 45
years. Most pastors had never undergone
a comprehensive physical exam although most had sough health care for treatment
of malaria and a significant minority had been treated for typhoid. Most pastors live on an income less then $2
per day but many supplement their income with subsistence farming. Nearly all pastors were married. The median number of children per married
couple was 4 (range 0-10) and a median of 6 persons (range 1-15) lived in each
household. Female pastors had a median
of 3 children per married female pastor.
Forty percent had a water source in the home however some pastors had to
walk up to 30 minutes to obtain safe drinking water. The majority of pastors used mosquito bed
nets routinely and the prevalence of tobacco and alcohol use was nearly
zero. The most frequent complaints were
dental-related and related to presbyopia.
Gastrointestinal/gastritis symptoms and musculoskeletal complaints were
the next most frequent. The
musculoskeletal complaints were suggestive of degenerative arthritis or
complications of prior accidents. Few
pastors had ever undergone surgery with orthopedic procedures following trauma
being the most common. It as very rare
for pastors to be on medications on a daily basis
Visual acuity was strikingly normal with most pastors having
distance vision of 20/20. A significant
number, however, were in need of corrective lenses for near vision and reading.
Only 12% of the pastors examined had an elevation of blood pressure greater
than 140/90 mm Hg however 30% of the pastors above the age of 42 had an
elevated blood pressure. Relatively few
abnormal physical exam finding were identified and when present included issues
such as soft tissue infections, hydroceles and hernias. No abnormal breast or pelvic exam findings
were noted. Only 8 of the 155 pastors
tested had an elevated fasting blood sugar above 110mg/dl.
For the medical examiners, the physical assessments were an
opportunity to understand the health and lifestyle of a relatively homogenous
group of Tanzanians. Moreover, the
standardized history and physical exam forms allowed for systematic evaluation
of many of the social determinants of health of this population. The presence of interpreters allowed
examiners to enhance their own knowledge of Swahili medical terms
The medical examiners were perhaps surprised at the overall
general good health of this cohort of pastors.
Pastors are a relatively highly educated group. In developed countries, educational level and
marital status are both associated with improved health outcomes. In addition, “healthy worker effect bias” may
help explain the relatively good health of this group. This bias would suggest that those with
underlying health problems and disability are unable to remain employed as
pastors. Therefore, only healthy workers
remain as part of the cohort examined.
Overall, pastors were highly satisfied with the Day of Grace
events and felt the physical assessments were the most important component of
the health, wellness, stress and spirituality seminar. Most indicated they would like to see the Day
of Grace concept repeated with the opportunity extended to spouses to also
undergo physical health assessments.
This first attempt at a health, wellness, stress and
spirituality retreat for pastors was, in some respects, also a feasibility
study. The co-leaders now have a better
understanding of what can be accomplished in a day-and-a-half event. Evaluation forms and a post-seminar
debriefing have generated ideas for improvements and for future events. Having an understanding of baseline health
issues will allow closer tailoring of these assessments to better meet the
needs of this underserved population.
