Bro Daniele Giusti: “What did we learn as missionaries from the Covid-19 epidemics?”

I am not an “expert” but just a practitioner in the field of health care with background missionary experience who, for the last ten years or so has worked in Italy. The only title I can “claim” to be here is that I was involved in the organization of health care since the very outset of the epidemic, having to learn how to cope with it. As matter of fact, I was asked to enter a completely different field of work just in the middle of an epidemic which has, so far, not ended, and perhaps has something else to teach us. This passage was somewhat abrupt and, without interruption, I plunged into a different world without much time to organise my thoughts and feelings. Hence, I feel unprepared to make an organized exposition of the synthesis of my experience. Only the words of Fr Peter Baekelmans convinced me that I could come before you, because he asked me that I should simply share my experience, giving a kind of witness. This is exactly what I will do, apologizing if it will fall short of your expectations.

Before closing my preamble I must say that when I started working on this presentation we were just about to enter the new crisis of the war – we can use the word – between Russia and Ukraine. It’s a new crisis for those, like me, who look at things from the perspective of the West. Those hearing or reading these words coming from other parts of the planet may object that they have already been “experiencing” the devastating effects of one or more of the many localized wars of what has already been defined by Pope Francis the “piecemeal” WW3 . The potential of escalation, of globalization of this new “piece” of war fought on European soil is nonetheless unprecedented, and I am sure that very soon we will have to learn to cope with acute energy crises,  food crises and new financial crises; I am also sure that in some parts of the world food and power have already started becoming rarer and more expensive, thus threating the livelihood of families and communities, and causing social and political turmoil.

What started off as an epidemic outbreak – the Covid related crisis that we thought was almost over is now taking up new colours: those of war and those of impending famine on much larger proportions than those experienced at a smaller scale in many parts of the world thus far. There is more to come, and all these crises are interlinked and connected.

Hence the legitimate question: is it possible for us who qualify as missionaries – i.e. those people who by specific call and mandate by Jesus and in the Church have to “look at the broader horizon”, at the frontiers of our own culture and identity, have go out towards the periphery of human experience… etc. to avoid the challenge of the deeply interlinked processes that are developing world-wide? In other words, the challenge of complexity in this era of shifting paradigms is an ever-growing awareness that accompanies our human adventure.

It’s not an epoch of change but an epochal change – the Popes have been repeating -; well now we seem to start realizing that indeed it is so. This very challenge risks to overwhelm us because we feel – and most of us are – ill equipped to face complexity at a global scale. It’s true. But this is not my direct concern because my experience is limited to the narrower field of healthcare; I hope nonetheless to be able to share with you, before closing, a pacifying thought that I keep in store for all the times I feel overwhelmed by too much complexity and too many challenges. Having ended the preamble I will start my presentation.

“We are quite often denied the reward of seeing the fruits of our labour”

I arrived in my new post in Rome one year after the outbreak of the epidemic. I had spent the first seven months of the epidemic in our nursing home in Milan: Milan and its surroundings have been the epicentre of the outbreak of Covid-19 in the western hemisphere, hence we were the first to be hit, caught completely unawares and ill equipped to face it; it hit us with an unimaginable violence. In a few days all that we knew as way of life and work – especially healthcare work – had to be reprogrammed without knowing exactly how. Later in the same year I had to move to the other bigger nursing home near Verona where a much worse outbreak had occurred in the second wave of the epidemic. In a few months I lost to the Covid-19 disease 15 confreres I cared and treated. The first among them – our first confrere to succumb to the Covid-19 - was the superior of our community in Milan, a confrere I had asked and convinced to join me in Milan in the service of our old and sick brothers. I signed the death certificate of most of them. Some of them had to be admitted to the hospital and I soon discovered that I was unable to visit or communicate with them, despite my professional status. I could not attend their burial: they simply disappeared from my eyesight, taken away by an ambulance, and that was all. Sometimes I was even unable to follow them through contacts with my colleagues in the hospital: they too were so overwhelmed and unable to manage the contacts with relatives and friends of their patients. This experience was so distressing that eventually we stopped referring patients to hospital.

The demands coming from the organization of service were daunting: in a few months I had to write 4 plans of service delivery reorganization of our nursing homes for the sole reason of satisfying the demands of the National Health System in the application of the continuous development of rules and health regulations. In the first weeks I spent many hours every day over the internet, in the futile attempt of finding and buying the badly needed of protective gear we did not have and that seemed to be the only protection we had against the onslaught of the virus.

In retrospective, it is possible that such heavy work pressure – and need to ensure performance - had kept me going. I never had the time to pay too much attention to my emotions, and it did not even cross my mind that it would have been wise or necessary to do so. I, and the other staff, simply had to go on because we could not afford the privilege to lower our guard. That was it. In retrospective I do not have regrets also because, compared to other nursing homes in the area, we did not perform badly: elsewhere death rates were much higher.

After about one year, as soon as the second wave of the epidemic started relenting, I received the request to report to our Rome’s Headquarters to undertake the service of Secretary General in the phase of preparation of the Chapter; my superiors had identified a young confrere, a medical doctor like me, who could take over my service and he rapidly reached Milan. Hence, after a brief handover I moved to Rome, soon after the beginning of the “vaccination campaign” phase in the outbreak. It was not easy leaving my post but the fact that we started having the concrete hope of a tool to stop the epidemic made it easier.

If I had been asked only a few months earlier if vaccines were to be expected within the course of the epidemic I would have burst out in laughter: it simply looked impossible. Yet, there we were: on the 6^th January 2021, ten months after the outset of the pandemic; I, all my confreres and all the staff in Milan’s Nursing home and health care facilities received their first shot of vaccination, followed by a second one three weeks later. What had been accomplished in that short period by the Pharmaceutical Industry Complex is simply staggering and undisputable: we may have reservations about motives, methods and the modus operandi of Big Pharma, but we must recognize that the end-result is something that goes beyond our most optimistic expectations.

Our Nursing Home was even one of the first to be selected because all the plans we had drafted gave enough confidence that we were able the handle the complexity of the vaccination campaign of an extremely expensive, difficult to handle and still rare vaccine. So, by the time I left all my confreres – and the staff – had received the “two shots” which, at that time, represented the highest level of protection; hence I was confident that I was not betraying my old confreres.

A few days after my arrival in Rome we had a community meeting and the superior asked me to say something about my experience, what I had gone through etc. The community of Rome too had its own moments of acute distress but, on the whole, things were much better; I must also say that on my arrival I found a community where measures of protection had been established and obeyed without grumbling by almost everybody. Perhaps this high level of compliance was due to the shock caused by the death of the former superior which had sadly occurred few months earlier – the only death in a community of 50 and over.

I started my sharing on a safe ground, speaking of the wisdom of the behaviours the community of Rome had adopted, how I was impressed by the sensible self-imposed discipline and by the great compliance of confreres… It all went smoothly until I had to start mentioning my experience, how I had gone through that past year at the frontline in a nursing home:  I soon I realized that I could not. I started off with few words and I had to stop because words were competing with tears; I had to choose silence to avoid a show of emotion that was quite unusual for me. It was the first time in my adult life that I could not control my emotions in public. It came as a shocking surprise to me, something out of the blue, unexpected. The respectful silence that surrounded me was louder than words and gratefully welcome. After a while the chairman who was conducting the meeting thanked me and mercifully moved to another point in the agenda.

I could say with regret that it was a missed opportunity of giving names to the causes of the distress that affected me or that it was an aborted “healing session” but, in retrospective, I must say that the simple fact that there was an audience eager to listen to my silence, unsolicited and respectful, had an unexpected healing and liberating effect. I realized that I had strong emotions buried in my heart and that I did not pay to them the attention they deserved. I realized also that I needed to recognize them and share them. I realized that no matter how professional habit had educated me to sustain emotions with a certain degree of “aplomb” I had to mourn my losses like anybody else, recognizing the healing power of human solidarity and affection.

What did I learn, then? Here is the first lesson. As consecrated people, charged with the demand of the offices entrusted to us, we feel the pressure of performance and we are bound to the outward appearance of our role. I certainly felt the pressure of performance, as I said, both as professional of health and as religious. More in general, as missionaries, people who must move always further where Jesus has not yet been known and encountered, we are quite often denied the reward of seeing the fruits of our labour. On those rare occasions when we do it, we enjoy it so much that “moving further on towards the frontier” entails a great deal of sacrifice. In any case the pressure of performance is there.

We end up by thinking think that we cannot afford to appear as lost as everyone else, as confused as everyone else; whether we like it or not, we are often the only point of secure recourse and help for many people, especially those who are less equipped to go through crises without severe damage or even total loss. The Covid outbreak has deprived many of us of the known tools of secure performance and when, in the year of the epidemic at the frontline, we did perform, we often did it with great emotional distress. I did perform, as I said earlier, but my heart had become cold as a stone.

To be clear: I do not regret the fact that I was able – with the help of some confreres and of a group of employees who were startingly quite often heroic in their duty – to minimize the devastating effects of the outbreak on my confreres. But that revealing moment in Rome made me realize that something had gone amiss: that weakness, recognized and accepted weakness, embraced by a community of people gathered by Jesus, could bring about a liberating and heart-warming experience.

How often had I read and said and meditated upon the fact that Jesus saved me, saved the world, keeps saving me and the world, through the acceptance of his annihilation? We have given a name to this process: kenosis. But what about our humiliations and failures and incapacitations such as those we have experienced during the Covid epidemic? Have we learnt, have I learnt to embrace them not just because I cannot do anything to avoid them, but because I recognize that my humiliation, my failure, my helplessness, embraced through an act of free assent, is missionary, and eventually also gladdening?

Perhaps we need to have more of these moments when we accept, embrace and communicate weakness – not simply because sound psychology teaches us that it’s something good to do. What I learnt, what I think we ought to learn better, is that, perhaps, performance is not always attractive; it can be admired, but it does not necessarily attract. When, instead, we feel glad because we’ve recognized and accepted our weakness under the influence of the sympathy of a loving gaze upon us – as I did during that sharing session on my arrival in Rome - there is chance there for us to be attractive. The perceivable gladness we are sometimes able to project when we feel loved, welcome and embraced in our weakness is attractive.

The Popes have kept telling us that the Gospel spreads because it makes people who embrace it attractive. The Gospels we announce spreads and is accepted because it attracts through us. Quite often I thought that admiration – like the admiration that good performance may create – would do the trick, but now I seem to understand that admiration and attraction are different and that, to be missionaries, we absolutely need to be attractive.

There is another thing that I learnt through the Convid-19 experience. It concerns the “vaccine yes-vaccine no” saga we have seen in many parts of the world. I am not forgetting here the fact that in many other parts of the world there was no such saga because there were no vaccines, or very few doses of them. I am referring to the utter surprise that I registered when in my Country -Italy -we witnessed the development of a quite strong and socially vocal movement opposing the use of vaccines and in particular the vaccines against Covid that had so surprisingly been developed and distributed free.

I have already said that when vaccines against Covid appeared in the late 2020-early 2021 I felt quite relieved, so much that I did not fear leaving my place of work because, in my mind and in my expectations, I surmised that the worst was over. My trust in vaccines is almost absolute. I am quite aware that they are not a magic-pill, and I am also quite aware that, sometimes, their protective effect has limitations; I also know that sometimes they have side effects. My trust is not even based on the studies I have done. It comes from experience, from sheer experience; it’s because I have seen with my own eyes their amazing power.

When I went to my mission station in Matany Hospital in Uganda in the mid-eighties, I found that there was an unexpected ward: it was called “measles’ ward”. It was quite big: it had about 25 dedicated beds over a total of 200 or so beds in the whole Hospital. When the duty rota assigned me to that ward, it was always a heart-breaking experience. The ward was filled by anguished mothers nursing very sick infants and some children: these mothers knew that the chances of their child’s survival were not many. In fact, about one out of four would not make it, despite our efforts in treating them.

In the western world we have forgotten that measles is a very serious disease; nowadays also Africa has almost forgotten it, but it was not so thirty – forty years ago, before the launching, by UNICEF and WHO, of the Expanded Programs of Immunization.  These programs were simply aiming at making vaccines available and administrable at the grassroot in poor countries which could not afford to spend money on prevention. This program reached Karamoja in the mid-eighties (just about the time I reached Matany). The Karimojong tribe living around Matany is nomadic and the culture and wellbeing of “Karimojongs” turns around cows. Because of this detail, they had come to learn through experience that vaccines were good for cows. Having seen their protective effects on cows they had no resistance in accepting that vaccines were good also to protect their kids. Karamoja was therefore a “no-vax free” region: on the contrary, people would flock to the immunization sessions we held in the hospital’s outstations. The success of the mass vaccination campaigns in Karamoja was such that in less than five years we could close the “measles’ ward” simply because measles had disappeared. The same happened also for other bad diseases as polio, whooping cough, diphtheria, neonatal tetanus and other less known diseases that had ravaged also the west in the past centuries, up to the middle of the XX century.

Compared to the West, it took some 30 to 50 years to make mass vaccination a routine in Africa, but when these campaigns went under way, they quantitatively saved many more lives in history than all the treatments, drugs and other medical gadgets developed ever since the beginning of anthropocene. Anthropocene is the era of increasing human control – and eventually of permanent modification - over nature’s ecosystems: some geologists date its beginning at the outset of the industrial revolution, some others would want it to start towards the middle of the XX Century. I leave these discussions to the scientific circles. In medicine the fact remains: vaccines are the most powerful tool humanity has developed to save lives from the scourge of epidemics.

I think it will be clear then to understand how puzzled I was when, towards the middle of last year, we had to accept that quite a good number of people had become opposed to the Covid vaccine for the most disparate reasons. Even in our ranks there have been confreres that started resisting the suggestions to go for vaccination. Some became quite entrenched in their beliefs and arguments, argumentative and sometimes actively trying to convince others not to go for vaccination. I am sure that in all our institutes we’ve had (and still have) brothers and sisters who have turned no-vax and even no-vax activist. I have no intention of examining the reasons and giving medical explanations in support of my very strong belief to the contrary. There is an argument which I consider the most important for human groups like ours that live in community. Being vaccinated makes common life much easier and uncomplicated. There is, in my understanding, also a moral obligation to do our best to avoid being the cause of contagion of other persons living with me, no matter how involuntary and unintended that may be.

I think it is a common experience for those of us who live in communities where there are members holding a strong no-vax stand (or no compliance with the indicated prudential measures – mask, distance, hand’s hygiene) that community life becomes difficult to manage. We are in fact a mixed-lot: we have confreres that quite adaptable and compliant out of simple rational conviction; we have confreres that are compliant out of fear; we have confreres that are convinced no-vax; others that are scared no-vax; others that are bordering obsessive-compulsory behaviours and freak-out when someone gets too close; others that are reckless and like to show that they have no fear whatsoever of any contagion.

To cut matters short: I maintain that resisting vaccination against Covid is wrong; I am not one inch less convinced than I ever was. But there is something I had to learn; we are brothers and sisters, and a mixed lot: how do we learn to live together in a peaceful way when opposed convictions are strong (such as mine is) and when there may be a real danger of contagion brought about by the uneven protection we have developed? This is the dilemma we face, a dilemma I have not solved. But I did instead learn something.

Differences are a fact of life, thanks to God. In our context as missionary and international congregations this aspect is magnified and it is no surprise that, sometimes – or perhaps more often than we would like - differences are difficult to harmonise and compose. Because of that many Institutes have dedicated to this aspect of life paths of formation to help us manage the challenge of multiculturality. One thing is sure: Jesus entrusted to unity, to the visibility of our unity, the effectiveness of our witness: «…that they may be one as we are one in them and you in me, so that they may be brought to complete unity. Then the world will know that you sent me and have loved them even as you have loved me…» (Jn 17, 22-23).

So, we have certainly learnt that differences are no threat to unity and that harmony and uniformity are two different things. Those of us who have had some formation in the understanding of the many hues that can be attached to words like unity, difference, culture, bias, prejudice, harmony... and, also, in the management of conflicts arising in communities, could give a real help in teaching me some necessary skills. This is not what I want to speak about. But I will use an example drawn from my experience to explain what I learnt.

Few weeks ago, a confrere arrived in our community in Rome, to stay for a few days. I have already told you that our community in Rome has been very “obedient”: all vaccinated, all respectful of the measures of mutual protection.  We have a group of old confreres and amongst them there are some who, to date, are – understandably - quite scared at the perspective of contagion. Among them, some few were disturbed by the presence of this confrere and asked me “to do something about it”.

Unfortunately, in our hyper-medicalised culture, doctors are often called upon to handle much more than diseases. All types of behavioural troubles are quite often looked at as diseases and we are asked to intervene. I can live with that.  What instead I do not like at all is when doctors are called upon to become law-enforcers. But I must live with it, too. So, reluctantly, I approached this confrere and asked him why he had not received the vaccination. I just wanted to open the dialogue to find a point of entry to bring forward my suggestion of a need of change of stand (of course, his, not mine!). Even though I had approached him with no predisposition towards confrontation (I had no intention to fight a holy war in favour of vaccine but simply with the intention to trigger some kind of moral evaluation of the situation in front of the uneasiness that his presence was creating) I saw my “good predisposition” vanish in front of this confrere’s staunch ideological no-vax stand. Hence, I limited my dialogue with him to a simple suggestion that he, as religious and bound to live in a community, should feel the urge of responsibility towards the fragile members of this community.

As I said earlier, in my mind this is the most convincing argument and the least controversial: it hinges on the mutual obligation of “custody” we all share. I did not challenge his beliefs and his ideology. I tried to click another, more fundamental, button, thinking that it was the right approach. But while I was doing this, I realized that in my heart I had already passed a judgement on that confrere: not on his choices or on his behaviour: on him. I also immediately realized that he had clicked on a defensive position and that I has lost contact with him.

Effectiveness in our mission stems first from the visibility of our unity. There is a big difference between unity built on human skills – undoubtedly desirable and even necessary – and unity built on the centre that attracts us all: Jesus. Before all our differences there is a point of unity among us that hinges on the fact that we are a gift to each other: we are given, drawn together in a mysterious way to be companions on a journey towards our destiny. Religious life, at its essential, is nothing else that this. When religious life his faithful to its own nature, it is attractive, and therefore, by nature, missionary. When Jesus approached the Samaritan Lady, or Martha, or Simon, He did reproach them; He corrected them, but He did so by evoking in them first the awareness of their dignity in the eyes of God. This must have shown in some way in his gaze, in his touch, in His “style”, because the result we see in the memorable pages of the Gospel narrating the stories of these encounters, all point to the fact that He was perceived as an exceptionally attractive presence. He was so attractive that those relating to Him felt such original correspondence of heart that all resistance, all self-defence disappeared. Then, but only then, He also gave a name to what was wrong, and sometimes it was not even necessary. The rest, conversion, change of behaviour, came as consequence.

What I really learnt from this recent experience is the need of a better “hygiene” of my heart’s position. I cannot relate to my confrere, and even less pretend to correct him, if my heart and my gaze on him are not pure, if they are tainted by prejudice. My prejudice might even be objectively right, but if not cleared first, it will be perceived as prejudice, and therefore undermine our mission. Soon after I lost contact with my “no-vax” brother I mentioned earlier I felt sorry, even though we did not have any argument. I simply realized that I had lost contact with him. I did re-state with kind finality the truth I perceived and that was all. In retrospective I might even be tempted to consider it a victory of sort. To the scared confreres who questioned me about “what I had done with him?” I simply said “I told him!”, with the implied false inference that I had scored success. But my heart was telling me another story.

My heart does not betray me: it speaks, and it speaks the truth. But it does so in a discrete way: I must work to listen to its voice. What did it tell me? That I had deprived my confrere with the only solid basis of dialogue: the recognition of his dignity, of that “given” that comes before his opinions, his being right or wrong, his being a good guy or a bad guy. This is not Jesus’ approach. What I really learnt is that I have work to do to improve my capacity of recognizing the dignity of the person in front of me before anything else. Dignity is not attribute by me: it is objective, and I must simply recognize it. I think that this work is called ascesis. In other words what I really learnt from this recent experience is the need of a better “hygiene” of my heart’s position. I cannot relate to my confrere, and even less pretend to correct him, if my heart and my gaze on him are not pure, if they are tainted by prejudice.

Now I come to the last thing I learnt. I said in my preamble that it was my intention not to deal with “broader picture”. With this I mean the complexity we are facing in the era of “epochal change” inhabited by the real possibility of the three apocalyptic scourges of plague, famine and war becoming a reality for us. There is nonetheless a quote I came across that I have always found inspiring when confronted with unsolvable dilemmas. It is taken from the book “After Virtue” of Alasdair McIntyre:

“A decisive turning point in that earlier history came when men and women of good will turned away from the task of supporting the Roman imperium and stopped identifying the continuation of civilization and the moral community with the preservation of that imperium. Instead, the task they set for themselves was the construction of new forms of community within which moral life could be sustained, so that both civilization and morality would have the possibility of surviving the epoch of incipient barbarism and obscurity.”

It is a quote referring to the early days of the Benedictine’s experience and perhaps of Celtic Monasticism that along centuries – from its humble and almost invisible beginnings – would spread everywhere in Europe and would shape it, equipping the church – without having planned it - with the “unum necessarium” to move through – meaningfully - in that era of epochal change and apocalyptic scourges.

I said earlier that I exercised my first ministry of missionary doctor in that remote hospital of North-western Uganda – in Karamoja. Karamoja’s environment and story are frequently confronted with violence related to customary cattle rustling, with recurrent waves of epidemics and famine. In this kind of environment, strongly resilient to the penetration of the Gospel, I was often confronted with the apparent futility of patching bodies and bones shattered by gun-shot wounds of cattle-rustlers )often of opposing factions) who only seemed to look forward to the time when, cured, could go back to their main occupation: using violence to steal the cows needed for their marriage, causing poverty and devastation that would later become hunger and disease…. Sometimes I was so disheartened that I started doubting that my tireless medical and missionary work had a meaning.

At one of this “down points” of my heart I came across this quote, and I found solace and comfort in it. The hospital was a community of people, some linked by the bond of religious vows (my brothers and sisters), whose life was shaped by the bond created by the “unum necessarium”. Around them a small but growing number of Karimojong had started living according to a different set of values, attracted by what they were seeing, albeit not necessarily always converted. Some were simple workers of the hospital. They were no longer attracted, though, by the old customs of the place. In my mind I started comparing the community of the Hospital to that of a Monastery. This is perhaps a preposterous thought, but it consoled me enough to go ahead without suffering scandal, and enough to remain faithful to my vocation there.

When things seem to be overwhelming – I spoke earlier challenge of complexity at a global level – and of the possible uncertain future that epidemics, war, food and power shortages seem to be preparing for us, we need to go back to what is essential. The Founder of my Congregation, St Daniel Comboni, always referred to the missions he wanted his missionaries to give life to as a “Cenacle of apostles”. There I was, challenged and tempted to give up and at the same time sustained day after day by a company whose presence embodied His Presence – the presence of the Lord. His was the task of attracting people towards Him. For us the “unum necessarium” was to sustain each other’s memory, in the daily tension to catch, in the sequence of circumstances of which time is made, the Mysterious Presence of our Redeemer. A Redeemer who is at work, tirelessly, to make everything new, even the Covid epidemic, and, perhaps, even this ghastly war developing under our eyes. That is what I am learning and that I want to keep learning.
Bro Daniele G. Giusti, mccj
SEDOS – Bulletin 2022, vol. 54, n° 5/6 – May-June

Bro Daniele Giusti is a Comboni Missionary brother. A medical doctor by profession, he joined the Comboni Missionaries from Uganda where he was serving as volunteer doctor in Northern Uganda. Posted back to Uganda in 1986 after his first vows he practiced his profession in a diocesan Hospital in Karamoja, as clinician fist and director later. After eleven years he was asked to join the Catholic Medical Bureau as Health secretary of the Bishop’s Conference of Uganda, representing all catholic hospitals, health units and nursing schools belonging to the Church. In 2009 he became member of the General Council of the Comboni Missionaries. In 2016 he served as director and coordinator of the nursing homes of the Comboni Missionaries in Milan, the epicentre of the epidemic appearance in the West. He is now Secretary General of the Institute.