Moral Injury Among Western Healthcare Missionaries: A Qualitative Study




Moral Injury, Healthcare Missions, Spiritual Determinants, burnout, missionary retention, Medical missionary support, resilience



Moral injury among healthcare missionaries leads to negative consequences for the individual, healthcare team, patients, and sending agencies. Conflicting values in clinical care, culture, and spirituality provide unique potentially morally injurious experiences. The purpose of this qualitative study is to explore the phenomenon of moral injury among healthcare missionaries to develop effective support and treatment strategies.


A qualitative interview guide was developed based on the existing literature on moral injury. Twenty-one key informant interviews were completed by two former healthcare missionaries. Participants were based in Africa, Asia, and Eastern Europe healthcare mission settings. Questions were based on clinical, cultural, and spiritual domains of potential ethical and moral conflicts. Protective factors were also explored based on one’s faith and spiritual practices. Interviews were transcribed and coded independently by two analysts. The team reviewed the codes and determined themes from across the three domains.


Seven themes emerged from the interviews ranging from morally injurious experiences with cultural leadership practices and unfamiliar clinical care experiences to guilt over practicing outside of one’s scope of practice and addressing suffering alongside God’s sovereignty. The themes led to the development of an injury/growth pathway as a potential model for helping healthcare missionaries describe and move through potentially morally injurious experiences.


The themes allow for healthcare missionary sending agencies to develop strategies, training, and support systems for teams preparing to enter the mission field and for individuals already in the field. Recommendations for growing through potentially morally injurious experiences are suggested to guide practice and support for missionaries in the field. The growth values and strategies could inform the development of a screening tool to assess moral injury among healthcare missionaries.

Author Biographies

Jason Paltzer, Wisconsin Lutheran College

Dr. Paltzer is a visiting professor at Wisconsin Lutheran College and the founder/director of the Meros Center. Dr. Paltzer consults with faith-based health organizations in the areas of community assessment, evaluation, and program planning. His research interests include substance abuse in Central Africa and the implementation of faith-based integral mission health models in low-income communities. He received his PhD in Population Health Sciences in 2014 from the University of Wisconsin-Madison and his MPH from the University of Minnesota in 2003.  

James Ritchie, MedSend

MD, MedSend's Longevity Project. 

Doug Lindberg, Christian Medical & Dental Association

MD, Director, CMDA Center for Advancing Healthcare Mission.

Michael Toppe, Marquette University

DMSC, PA, Associate Professor, Physician Assistant Studies

Andrew Theisz, Concordia University

Graduate student in the Concordia MSW program. 

Taylor Van Brocklin, Concordia University

An undergraduate students and a Student Enrollment Counselor at Concordia University. 


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How to Cite

Paltzer, J., Ritchie, J., Lindberg, D., Toppe, M., Theisz, A., & Van Brocklin, T. (2023). Moral Injury Among Western Healthcare Missionaries: A Qualitative Study. Christian Journal for Global Health, 10(2), 58–73.

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