When Dr.’s Ramon and Sarah Lull first glimpsed the city, neither wanted to call it home. They had already accepted a call to a rural missions hospital, where they envisioned their children climbing mango trees and attending school in the Rift Valley while they cared for the sick in Jesus’s name. Neither of them was eager to abandon that vision for the clutter and dilapidation of this East African city, with its smog blotting out the horizon and where walls fringed with razor wire threatened to confine their children.
Then they toured the government hospital. With too few beds to meet the demands of the community, sick and dying children spilled out into the hallways. They slumped against walls and sprawled on pieces of cardboard flung upon the floor. Ramon and Sarah took in the horror of it, the desperate need, and they both knew they had to come.
It wasn’t the first time God had steered these two doctors in an unexpected direction. Nor would it be the last.
Doctoring for the Gospel
Sarah Lull received the call to missions early in life, and in college she served with the Navigators in Southeast Asia. “As I was riding on the train and seeing people working in the fields,” she recalled, “it struck my heart that these people didn’t know Christ because no one was there to tell them.”
She decided to attend medical school, and her memory of those field workers soon informed her philosophy on doctoring. She perceived meaning in medicine only where it intertwined with the gospel. “Not for the love of money, not for the love of my family, not to make my parents happy and proud,” she prayed as she completed her medical school applications, “but it has to be for you, Lord.
“To serve other people, to make you known. And if not for that, I shouldn’t do this.” She specialized in pediatrics and anticipated a future caring for ill children, with a love for the Lord guiding her hands.
Her husband, Ramon, walked a similar path but initially with different motivations. “Early in my Christian life, although I was a professing evangelical Christian, I was a practical legalist,” he recounted. “I didn’t want to be a missionary at first, but then as I found the seriousness of my sin and my deficits, I tried to make up for it with works.”
For Ramon, missions was a vehicle of penance. He specialized in general surgery because it promised the broadest range of skills he could imagine, yet when he saw cases of burn scarring and congenital deformities at a missions hospital during his training, his expertise still felt insufficient. “I thought that if I could do plastics as well as general surgery,” Ramon remembers, “I could do everything.”
Although a theology of works-righteousness inspired Ramon’s decision, God would use it to open Ramon’s eyes to the doctrine of grace. Ramon was assigned to the University of Minnesota for his plastic surgery training, and the couple moved to Minneapolis, a city far from family and encased in long winters that appealed to neither of them.
While there, they joined Bethlehem Baptist Church under the shepherding of John Piper. His mentorship would prove critical to Ramon’s spiritual maturity.
“Pastor John would say, ‘I used to think when I was a young man that obedience to God and my personal pleasure were mutually exclusive.’ I really identified with this,” Ramon says. “Because of my shift in theology, I was far more sure that we were going to be missionaries. I would no longer be doing missions because it was the hard or the obedient thing, but because I wanted to.”
With their hearts and minds set, their theology refined, and their faith deepened, the Lulls prepared to serve at a rural missions hospital in East Africa. They both knew the hospital, loved the idyllic landscape into which it nestled, and already felt they belonged among the staff. The hospital even featured a school for missionary children, ideal for their family. All seemed to unfold perfectly.
But as they finalized their plans, the Lulls received a startling phone call. A Christian relief organization asked Ramon to help start a children’s hospital in a different East African location and to run its plastic surgery division. Rather than integrate into a seasoned program, he and Sarah would have the opportunity to build an institution from its inception.
A plane ride later, Ramon and Sarah were standing in the government hospital amid children languishing on the floor. The setting felt like an urban jungle, with crime and pollution rampant. And in the faces of the children, they saw a dire need for Christ.
The Lulls accepted the call. Leaning into their faith, they embarked upon a three-year journey neither of them had anticipated.
Strategizing for the Gospel
As they traveled to their new home, Ramon and Sarah entertained no delusions about improving the health care of the country. In fact, they considered such notions hubris. Their goal wasn’t to revamp the system but to use their medical expertise to advance the gospel.
Even with this honed goal, logistics overwhelmed them. They learned that the country’s population was in the tens of millions. Their host city alone contained millions. As Ramon and Sarah considered the meager numbers of patients whom they could treat, accounting for limited manpower, resources, and time, discouragement threatened to stall their efforts.
Yet as they brainstormed and researched, one number arose from the data that they could conceptualize: thirty. Of the 120 distinct peoples in the country, thirty were unreached by the gospel, and five had never even heard of Jesus at all.
“For five of those groups, two thousand years, and no gospel,” Ramon recounted. “But now, here God put us right on the cusp of those unreached peoples. And perhaps we could be the tip of the spear, helping to gain access to some of those thirty. If what we did could set off a series of missions so that two hundred years from now, one of those unreached peoples would be full of Christ worshipers, then that seemed, to me, worth living, laboring, and dying for.”
Rather than flinging wide their doors and advertising to the general public, the founders of the new children’s hospital served peoples who did not know Christ. They nurtured relationships with local missionaries who could identify children in need, to strengthen Christian influence within those communities.
“Their goal wasn’t to revamp the system but to use their medical expertise to advance the gospel.”
To accomplish this, Ramon and Sarah needed to focus on a clinical problem that lay missionaries could easily diagnose, yet which significantly affected the lives of those afflicted. The answer was surprising.
Ramon had cultivated the broadest possible skillset to equip him as a medical missionary. Yet God used the simplest, most specialized operation to minister to the unreached: cleft lip and palate repair. The operation was short, low risk, and impactful, restoring a disfigured child to a normal appearance with minimal side effects. Furthermore, missionaries in the field could easily identify the defect without specialized training.
The staff organized a program specifically geared toward treatment of cleft lip and palate deformities, and they spread the word among missionaries working in hostile areas of the country. The influence of their efforts was profound.
Ministering to the Unreached
Soon after the program launched, children began to arrive from remote areas. The scene was often dramatic. A helicopter would touch down in a community that had never seen electricity, and a missionary and local family would board. Weeks later they would return with a child cured of a lifelong disfigurement. Missionaries reported that as a result of this service, interest in the local churches grew massively.
One family, in particular, stands out in the Lulls’s memory. A father arrived with his six- or seven-year-old son for treatment of cleft lip. “Other kids torment him, and he comes home crying,” the father explained. “I feel terrible as a father because there’s nothing I can do to help. Then I was told about your hospital, and now we have some hope.”
After a short operation the boy’s cleft lip, which had caused anguish for so many years, was repaired. His father was so moved that without realizing the scriptural importance of his words, he exclaimed, “It’s like my son has been born again!” That conversation sparked others, and he asked to learn about the gospel. Before returning to his community, he professed his faith in Jesus—a decision he knew would endanger his life within his village.
The cultural implications of such conversions and the dangers were never lost on the staff. In many cases, anti-Christian sentiments were so firmly entrenched that sharing the gospel seemed an impossible goal. In one case, a child with a large facial tumor arrived from a remote village known for contempt for outsiders. The child’s family interacted coolly with staff, suspicion stiffening their dialogue. At best, they smiled a few times when the child recovered, but throughout the entire visit, no scales fell from their eyes.
Still, Ramon and Sarah rested in the certainty that even in these encounters, God would use all things for good (Rom. 8:28). “It was easy to be discouraged,” Ramon said. “But you have to hope that perhaps they’ll go back to their village and say, ‘These Christian people took really good care of us.’ And maybe that will open doors for future missionaries in that community.”
Medicine as Witness
Within the hospital walls, the Lulls considered high-caliber clinical care to be vital to their ministry, and they prioritized the training of personnel to achieve excellence. “Doing work with integrity and quality is always a witness,” Ramon said. Sarah taught the nurses to use unfamiliar but essential equipment, and she emphasized the crucial role staff played in nurturing children back to health.
“I wanted to teach them that they brought value,” she said. “They gave us data that we could use to give kids the best care.” Thanks to these efforts, the Lulls built a plastic surgery program that boasted a zero percent mortality rate.
“His father was so moved that without realizing the scriptural importance of his words, he exclaimed, ‘It’s like my son has been born again!’”
Ramon and Sarah also strived for a hospital culture that emphasized Christian love. “Many of our patients were social outcasts and poor,” Sarah recalls. “We worked with the staff to ensure every family was greeted warmly, and provided with showers for the duration of their stay. We taught them that our purpose was to love every patient who came through our doors, and to let them know we cared for them. That was part of our witness.”
For Sarah, a ministry of compassion and Christian love meant a special emphasis on pain control. “A lot of the kids had initial orthopedic surgical procedures at other hospitals, and the only pain medication they had was Tylenol,” she reported. “They were extremely frightened going into their second procedure. We were the first hospital to have morphine, and anytime a kid’s pain was poorly controlled, I urged the staff to address it.”
For three years the Lulls worked in the hospital they helped to found. They spent their days healing children, teaching staff, and alleviating pain, all with the goal of sharing the gospel with those in the dark. They loved the unreached because Christ had loved them first (1 John 4:19). The landscape that at first had seemed so foreboding soon evolved into home—into the place they intended to grow, to worship, and to plant permanent roots.
Then the Lord averted their course yet again.
Sarah had been battling a medical condition. In their years in Africa, it progressed beyond the capabilities of the local hospitals, even their own. Three years into what the Lulls had believed was a lifelong commitment, they were compelled to pack up their belongings and return to the US.
The transition was unwelcome—and shattering. “There was never a time [in East Africa] when we thought we should be somewhere else,” Ramon recalled. “Leaving was very challenging because it felt wrong. It felt like we were supposed to be there.”
Returning to Western medicine also proved difficult because the intermingling of faith and work that was so seamless in Africa evaded them in American practice. “All healing is by the grace of God. And yet it’s easier to actually believe that when you’re in a place with less resources,” remarked Sarah. “I found myself praying more for my patients in Africa compared with in America, because the patients were sicker.” Additionally, “in missions, people want to know why you came all the way across the world to help them. It’s such an easy way to share Christ.”
Ramon encountered similar challenges. His career in plastics is inextricably tied to his faith, but few opportunities arise to convey this link to others. With the American aspirations of prestige and financial security taken for granted, “no one in the United States ever asks why I’m a plastic surgeon,” he said.
Yet the Lulls continue to labor for the gospel and to trust in God wherever he might lead them. “There is nothing on this planet, no person or event, that can foil God’s plans,” said Ramon. “And so here and now, this is the best place for us.” In 2013, they adopted a child who was abandoned as an in vitro fertilization embryo, whom Sarah had the joy to carry to delivery. They continue to teach, to care for patients, and to raise their growing family to know the Lord. Their attendance at Bethlehem Baptist continues to strengthen and uplift them.
And they continue to cherish their time in East Africa and thank the Lord for opportunities to combine medicine with ministry. “We all should look at our vocation as integrated with disciple making and a way of life,” commented Ramon.
Sarah agreed. “Christ went to heal the sick and the lame and the poor, so he could heal their inner need, which was spiritual,” she said. “Medicine is such a great avenue to share the gospel.”
Kathryn Butler (MD, Columbia University College of Physicians and Surgeons) is a trauma surgeon turned writer and homeschooling mom. She has written for The Gospel Coalition, Desiring God and Christianity Today, and her book Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care (Crossway) will be released in April 2019. She blogs at Oceans Rise.