Oftentimes a chronic illness, such as chronic fatigue syndrome, or chronic pain like migraines or back pain, is undetectable to those around them. It may surprise you to know that, according to the U.S. Census Bureau, approximately 96% of the people who have an illness do not use an assistive device, like a cane or a wheelchair. Pain is nearly always invisible. Those that are ill usually do everything that they can to get to church. They want to be part of the church community and they appear to be healthy. Still, just sitting through the service can be extremely difficult.



I remember one specific day that I tried to make it through a church service. My rheumatoid arthritis was flaring badly, but since I had gotten there, I was determined to stay. "Please stand" they announced during worship and I took a deep breath and carefully pulled myself up, using the pew in front of me for leverage and balance. At the age of 24, fifteen years of living with this disease has left my feet deformed and painful, and my knees need joint replacements as soon as possible. I rolled my eyes as they sang a worship song and the lyrics declared, "I will stand in spite of pain."

Even as I was surrounded by people in a church I loved, I still felt as though no one understood what I was going through-physically or emotionally.

It's obvious that churches already have an overwhelming amount of needs that must be fulfilled. Some of these needs are obvious and they often rise to the top of the priority list. So when people don't even verbalize about their pain level or illness symptoms that change their lifestyle, it's hard to understand where a church could begin to help. Pastors ask, "If they aren't speaking up, then doesn't that mean they are coping with it fine? They believe in God and we have a healing service every six months. Isn't that enough?"

Let's take a glimpse at some astonishing statistics:

- Despite what we may assume, 60% of those who live with daily illness or pain are between the ages of 18 and 64. - The divorce rate among the chronically ill is over 75 percent. - Depression is 15-20% higher for the chronically ill than for the average person. - Various studies have reported that physical illness or uncontrollable physical pain is major factors in up to 70% of suicides.*

There is cause for great concern. Despite whether you can see the illnesses that are impacting people's lives or not, your church body has many ailing bodies. And those who are hurting physically are often hurting emotionally and spiritually too. When Jesus speaks of the broken-hearted, I believe the chronically ill are a great portion of those who have fragile spirits.

So the question remains, if people don't talk about their pain, but they still have a need to learn how to cope with it and find hope, how does a church reach out to them most effectively?

(1) First, do a survey in your church to find out what some of the needs are that people may not be talking out loud about. This is particularly important if you are in a large church; this is because a recent Barna group study discovered that larger churches were the least likely to mention congregational care ministries as a priority (Church Priorities for 2005 Vary Considerably). When people don't feel a personal connection to the church staff or others, they are less likely to share their vulnerabilities. Too frequently, they are given a list of healing scriptures and sent on their way.

In your survey ask questions such as, "If we provided a van for transportation to church events, would it increase your attendance? If our service was online as a web cast, would you listen or watch it when you were too ill to attend? Do you know who to contact at our church if you have personal needs for personal assistance (especially when your condition is chronic, not acute)? Would having the song lyrics available on paper be easier for you to see than just having the overhead? How could we make the service more comfortable for you, for example, are the seats comfortable?" Sit down with a group of people who manage daily chronic pain and ask them for a wish list. Then prioritize what your church can do immediately and what should be longer term goals.

(2) Start a small group/Bible study for people who cope with illness. Rest Ministries is the largest Christian organization for the chronically ill and they have a program called HopeKeepers. You can find resource materials, group studies, leader support, and books, CDs and more for training. Though a church may assume their current small groups are meeting this needs, people with illness grow weary of talking and praying about their illness week after week with people who don't understand the daily-ness of illness. When there is a place where everyone can "speak the same language" and even laugh at the same tales can be reviving. Even if just two people show p, it can be life-changing for those two. Be a church that recognizes chronic illness is difficult to live with and provide an oasis from it.

(3) Ask special guests to come and speak at your church. There are many people who have physical disabilities that go to churches and share their testimony; they will encourage everyone in your church. Allowing them to stand on the stage and share what God has accomplished in their lives, despite physical challenges, demonstrates to the people in your church, especially the chronically ill, that you do recognize their needs. They will feel you care, and perhaps most importantly, that you believe they are still worthy to be used by God. People such as Nick Vujicic, Lisa Copen, Joni Eareckson Tada, and many others, minister to the masses, not just those with disabilities.

(4) Discuss the possibility of adding a parish nurse to your church staff. The number of parish nurses in United States is estimated to be about 6000, according to the Marquette University College of Nursing. If you church has a lot of seniors this may be an obvious need and she will help organize the ministries to this group of people. There are a lot of retired nurses who are discovering this kind of ministry engaging and parish nurse certification can be found at most hospitals. The parish nurse position description includes a variety of duties, depending on your church's needs and goals. For example, the role of the parish nurse may include going to homes of church members to monitor high blood pressure or diabetes, organizing health screenings and fairs, starting walking groups, and even assisting with chronic illness and disability ministries. The parish nurse would network closely with the congregational care pastor.

(5) Be a clearinghouse of helpful resources for the ill that are available for borrowing. Many people with chronic illness are on a fixed-income and yet they are trying to find encouragement. Stock your church library with books on living with chronic illness such as "Why Can't I Make People Understand?" or "Beyond Casseroles: 505 Ways to Encourage a Chronically Ill Friend," by Lisa Copen or the exceptional book on suffering, "When God Weeps" by Joni Eareckson Tada. Buy a few subscriptions to magazines such as "HopeKeepers", "Guideposts" and even "Arthritis Today." Remember to have books on tape, audio presentations and large-print materials whenever they are available. Post flyers or have brochures available about chronic illness or disability ministries, such as Joni's "Wheels for the World" program or Rest Ministries' annual outreach, "National Invisible Chronic Illness Awareness Week." A volunteer could collect materials of local and national ministry resources for a binder; items could include lists of local resources and national ministries and put them in binder; lists of organizations, magazines and newsletters on topics for Christian seniors, those with disabilities, caregivers, and assisted living to name a few.

(6) Finally, and this is an important point, recognize that people who live with illness want to serve others. Not just be served. Proverbs 11:25 tells us that "He who refreshes others will himself be refreshed." So when a woman tells you that she must resign from the church choir because she can no longer make rehearsals, make sure that she understands that your church body will miss her in that area, but that there are other areas you will welcome her service when she is ready and able. For example, she may find that writing notes of encouragement to members of the church who live with illness and feel alone, may be a way to share her gifts on her own schedule. A man who can no longer commit to leading a weekly small group may find that he enjoys mentor another man one-on-one, perhaps even one who lives with illness and feels there is no one to be authentic with. People in the church need to know that the church body values wounded healers and that the church believes that God comforts us "so that we can comfort those in any trouble with the comfort we ourselves have received from God" (2 Corinthians 1:4).

Roughly twice a month someone shares their broken heart with me because, after much prayerful consideration, they have gone to their pastor to ask him to consider allowing them to start a HopeKeepers small group. The response is "You can minister to others once you are healed." It makes me so saddened to see people who believe they are no longer useful to their church-or God-until they are healed from their illness.

In Luke 14:21 Jesus shares a parable of a great banquet. When the host's hospitality is turned down by his friends he responds by commanding, "Go out quickly into the streets and alleys of the town and bring in the poor, the crippled, the blind and the lame." This is still a mandate to us today, but we must remember that to provide a place where we offer hospitality, we must first "go out" into our own pews and provide a place of refuge; as we make small changes in our church to create that oasis for people with illness, then these people in our church will naturally be comforted. And then they will go out into the community with open arms of understanding and minister to others along this journey.