I wanted to take a moment to truly thank you for following along on this journey with me through Grace in Action. Your prayers, encouragement, and support have meant more than I can put into words.
As many of you know, ministries grow and evolve just like people do. Right now, I’m stepping into a season of focused obedience as I pour my time, energy, and leadership into Harvest Health Missions, a 501(c)(3) nonprofit that is experiencing incredible growth and expansion as a new ministry. What began as a step of faith is quickly becoming a work that is touching lives, building partnerships, and laying foundations for long-term impact.
Because of this shift, you’ll begin receiving newsletters and updates directly from Harvest Health Missions moving forward. While the name and platform may look different, the heart behind the work remains the same. It is still about compassion, faithfulness, and serving others with excellence, putting grace into action in tangible ways.
Thank you for walking with me, believing in the calling God has placed on my life, and supporting the work He is doing through this ministry. I hope you’ll continue this journey with me as part of the Harvest Health Missions family, and I look forward to sharing what God is doing in this next chapter.
The impact of human resources on US international missionary retention
By Esohe Iyamu-Osagiede, MD Masters in Nonprofit Administration and Development Candidate
Introduction
U.S. missionaries serving abroad often encounter significant challenges in retention and well-being. While pastoral care and mentoring are somewhat common, the integration of formal human resource management (HRM) within missionary-sending agencies is less standardized. Drawing from both nonprofit HRM and missionary attrition research, there is evidence that structured HR support could reduce attrition and improve the sustainability of international mission work.
Missionary Attrition Trends
High Attrition Rates: Research from the World Evangelical Fellowship Missions Commission (2010) reported U.S. missionary attrition at nearly 43%, a figure that threatens long-term organizational stability.
Key Causes of Attrition: Sears (2017) surveyed 739 former missionaries and found that family-related issues and team/agency conflicts accounted for almost half of reported reasons for departure. External host-country challenges, while significant, ranked only sixth.
Implication: Most attrition is tied to organizational and interpersonal factors, rather than purely external threats; areas where HRM can make a difference.
Human Resource Management in the International NGO Context
HR as Retention Mechanism: Akingbola (2013) demonstrated that effective HR practices are a critical factor in volunteer and employee retention within international NGOs. This suggests that structured HR approaches could address the family and agency/team conflicts highlighted in missionary attrition data.
Challenges of HR Abroad: Walk et al. (2013) noted that external cultural and logistical barriers often impede the implementation of standardized HR frameworks across international locations. This is echoed in NGO literature, where adaptation to local contexts is key.
Current Gaps: Most studies on NGO HRM focus on crisis or security management (Fee & McGrath-Champ, 2016), leaving a gap in the literature around everyday HR structures for missionaries.
Potential HR Interventions for Missionary Retention
1. On-field HR Representation: Establishing HR managers or liaisons abroad to address grievances, mediate conflicts, and provide organizational continuity.
2. Family Support Systems: HR-driven programs for spouse employment guidance, child education support, and family counseling to reduce family-related attrition.
3. Conflict Resolution and Mediation: Formal HR policies for resolving interpersonal/team conflicts, addressing one of the leading causes of attrition.
4. Standardized Performance and Development Plans: Clear role definitions, feedback structures, and professional development opportunities can strengthen engagement and reduce burnout.
5. Cultural Training and Re-entry Support: HR-led orientation and debriefing programs can smooth transitions into and out of host countries, mitigating stress and attrition risk.
Implications for U.S. Missionary Agencies
Strategic Retention: By embedding HR practices, sending agencies may reduce attrition rates tied to internal issues.
Well-being Focus: HR approaches tailored to family and interpersonal needs can directly impact missionary well-being, enhancing long-term sustainability.
Toward Standardization: Although contextual adaptation is necessary, developing baseline HR standards for international missionary support could professionalize sending practices and improve retention.
Conclusion
The evidence indicates that effective human resource management plays a critical role in reducing attrition and enhancing the well-being of U.S. missionaries serving abroad. While pastoral care and mentoring remain important, HRM offers a structured, professionalized framework that addresses the main drivers of missionary attrition: family strain and team/agency conflict. Future research and pilot programs introducing standardized HR practices in missionary-sending agencies could yield valuable models for international nonprofit management.
References
Akingbola, K. (2013). A model of strategic nonprofit human resource management. Voluntas: International Journal of Voluntary and Nonprofit Organizations, 24(1), 214–240. https://doi.org/10.1007/s11266-012-9286-9
Fee, Anthony & McGrath-Champ, Susan. (2016). The role of human resources in protecting expatriates: insights from the international aid and development sector. The International Journal of Human Resource Management. 28. 1-26. https://doi.org/10.1080/09585192.2015.1137617
Sears, A. (2017). Why do missionaries leave? A survey of 739 former missionaries. Missio Nexus / Global Mapping International.
Walk, Marlene & Schinnenburg, Heike & Handy, Femida. (2013). Missing in Action: Strategic Human Resource Management in German Nonprofits. Voluntas. online first. https://doi.org/10.1007/s11266-013-9380-7
World Evangelical Fellowship Missions Commission. (2010). Global missionary attrition: An international study. World Evangelical Alliance.
Over the past four years, I have poured my heart into caring for others’ health as a missionary physician; often at the cost of my own. In prioritizing clinic, medical brigades, and the physical and spiritual well-being of underserved communities, I postponed seeking care for my own health needs.
But now, my health is knocking at the door and I can no longer ignore it.
Last November, I fell ill with Typhoid fever, and imaging revealed concerning signs that initially raised the alarm for possible cancer. Praise God, follow-up tests confirmed it was not cancer. However, I was diagnosed with a chronic condition that continues to cause daily gastrointestinal symptoms and recurrent pain.
This condition also carries the ongoing risk of acute complications that could require emergency surgery, especially challenging while serving in the developing country of Honduras. Although recent imaging shows it is not worsening, it has also not improved. To avoid emergency intervention and manage the condition wisely, I must begin consistent medical treatment now.
To make this possible, I am humbly seeking $400 in monthly pledges to cover ongoing health care expenses, appointments, medications, diagnostics, and emergency preparedness, so I can remain on the field with strength and sustainability.
If you are able to partner in this need, whether with $25, $50, $100, or any monthly amount, your support would mean the world. Together, we can continue to bring healing to others, without sacrificing the healing I also need.
Thank you for your prayers, compassion, and partnership.
This summer, lives were touched and hope was shared across mountain communities in Honduras!
500+ patients received essential medical care in remote rural areas. 30+ children were given the gift of clear vision through school-based eye exams and new eyeglasses. 700+ people heard the message of the Gospel through Vacation Bible School, Space Camp, and daily devotionals.
Thank you to all our short-term volunteers, interns, partners, and supporters who made this impact possible!
Scroll through the gallery below to see the moments that made this summer unforgettable.
Going out into the mission field this time around was different…I knew how, where, and why last time around. I had almost two years of preparing and planning to enter the field. I had resources and the security that the logistics of the upcoming two-plus years were taken care of. I had faith, but it was easier to take a step of faith into the mission field when I could see in the physical that God had already provided all that I needed.
On February 1st, I returned to my mission country as an independent missionary, waiting for God’s direction in choosing a long-term sending organization. I knew I was called to return, but I did not have the how, where, and why already established this time. What has continued to remain the same is the who. The one who called me and is leading me remains the same. He is the same yesterday, today, and tomorrow.
Ten years ago was my first time moving away from home and to another country. From then on, whenever I moved to a new location, God would bring to my mind the song Oceans by Hillsong. Two weeks after my return, as usual, the song Oceans was brought to my recollection through a Facebook post…however, it was different. Along with Taya Smith singing Oceans, Naomi Raine singing Jireh was beautifully woven through it. I knew God was letting me know that he is calling me out into the unknown but also assuring me that I could walk in peace because He would provide for me, and He was and is enough.
I returned to Siguatepeque, Honduras, on February 1st. After unpacking and settling into my new apartment, I returned to Houston for a week to attend the mobilizing medical missions (M3) conference. If you read my about me section, you will recognize that this conference was crucial in directing me to the mission field. Once again, it reminded me of the purpose that God has not just for me but for those he is calling me to serve.
After returning to Honduras, I soon began a two-day Journey to work alongside 3 other doctors from Honduras and two dentists to provide medical services and spread the love and message of Christ to the Miskito people. The Miskito people are an indigenous group that spans the Honduras and Nicaragua border. Due to rugged terrain and bodies of water, this area is isolated from the rest of the country. To drive from the Capital of Honduras to Rus Rus requires 18 hours of driving and crossing into Nicaragua before crossing back into Honduras. Thankfully, I flew on commercial and MAG flights.
The first two days, I worked with just one other doctor, and combined, we saw over 200 patients. Each day following, another doctor joined our team. By Friday, there were 4 of us, and we had collectively seen over 800 patients. More importantly, some patients gave their lives to Christ, and many others were prayed for and encouraged.
A huge recent update is that I have joined a team of missionary medical professionals and pastors in starting a hospital here in Honduras! Find out more by visiting https://www.hospitalyojoa.org
I am now serving at a missions clinic here in Siguatepeque. When not serving on brigades or at events with other Ministries, this clinic will be my base of service.
God has once again called me out to take a step of faith unto unknown water, but I know He is with me and continues to show me that He will provide all that I need. I will be content no matter where He leads me and what happens because He WILL provide, and He IS enough. God has continued to be my faithful anchor throughout this missionary journey. I know he will remain so in this new and hopeful season.
Prayer Requests:
Please pray for God’s direction in choosing a long-term sending agency.
Please pray for God to provide monthly supporters so that I can continue providing free medical care to those who need it.
Pray that the seeds of hope sown through my work here find fertile ground and grow good fruit.
Pray for the continued God directed progress of the Hospital Yojoa Project
It took me 4 months to write this. I battled with how open to be and waited until I felt the holy spirit lead me in what to write. I held back out of worry of retaliation or any backlash from writing this. I know that what I write might direct focus, thus bringing into view many things that are uncomfortable for many to address.
However, throughout the course of the decision to post this blog, I started thinking back to when I was in ‘good graces’ and I began to wonder about whose hurt or mistreatment I overlooked because I was not at that time the one experiencing it. What conversations did I take part in casually that were to someone else’s detriment?
I think about how I feel now after weeks of being on the other side. I think about how much I pray and hope that spirit-filled and discerning persons truly look and listen saying this is not right…this is not Christ.
I choose not to endure the guilt of being complicit by not speaking the truth or by hiding it.
A friend referred the book ‘Something’s Not Right’ to me. On reading this book, I realized that there is no benefit to staying quiet. While it may protect you, it allows others to be hurt.
Who would I be if I stayed silent and did not at least try to shine a light into a dark area, if I cared more about what might be thought of me than about the safety and well-being of my fellow brethren in Christ or God’s children that he has called me to serve in another country?
If God allowed me to be in the situation I was in, I believe there was a purpose outside of the psychological and spiritual wounds. Even if one person is helped by this, it will all be worth it.
We are all called to be light in the darkness and not to hide. This may mean things the enemy may want to be hidden are revealed but it is for the glory of God that we stand strong with the full armor of God. This speaks to this situation and also to individuals. Don’t let the enemy hide in your actions or thoughts. Look at the fruit of what you sow. Seek help. Even if it results in consequences, better consequences on the earth than consequences when standing before our omnipresent God.
I pray that this is read with the discernment of the holy spirit just as I pray that it is written with the discernment of the holy spirit. I will not go into details or say more than what needs to be said here, but I will communicate in detail what happened when directly asked about it. This blog post is my personal reflection/experience of my first several weeks at my mission hospital and the events leading up to my arrival.
My experience at the hospital in 2020 was overall amazing. Enough so that when I felt God calling me to return long term it was a very easy yes. I happily spent the next almost two years preparing for this with the intent to hopefully stay and serve indefinitely.
Everything changed when I began to question an action that did not seem right. I thought there was something I misunderstood so I asked questions hoping for a simple explanation for clarity. However, the response to my questioning was a progressive series of several quite obvious lies. I was shocked as I did not all expect this or know what to do about what was occurring. I could not reconcile that the people lying to me were the same people I trusted enough to leave my entire life in the US to serve under. I could not reconcile that these were Christian leaders and would be my mentors. However, I still felt that God was calling me to go to the hospital.
I sought the counsel of an experienced missionary who was my missionary member care. The recommendation was to ask for clarity about what was happening. I did so and was told that something important that was told to me multiple times, as recently as a conversation that occurred just a month prior, was never said to me. This blatant attempt to re-frame actual events is called gaslighting. This was the first time that I saw and became truly aware of tactics of psychological manipulation. This lie was so huge yet so obvious, that even though they denied what was said in several conversations, I was able to provide evidence written by them that directly contradicted the lie. A plausible excuse was given as to the original misunderstanding, there was no admission that they lied, and somehow the conversation was directed into all of this being my fault for taking what they said as fact and not being flexible. More psychological manipulation. This was the conversation where my two years of dreaming began to be overshadowed by reality. The betrayal I felt from those I trusted and my broken dreams presented themselves in my cracking voice during part of the conversation and I was told that I was emotional and they would keep this in mind in the future. Throughout this conversation, I still felt that God was calling me to continue this path. I choose to respond with grace despite what was being said to and about me and to not escalate things. The conversation ended peacefully with the planning of upcoming travel.
I believe that when I provided the written evidence from them to them, this showed that I was not receptive to being lied to or gaslighted. I would not believe whatever they told me just because it came from them. While I believe my fall from their grace began in October of 2021, the first time I questioned something and the first time I truly heard and recognized a blatant lie. (A response to my informing of my parent’s plans to visit me sometimes during my years of service was “We do not allow non-medical persons to stay at the hospital” Thankfully, someone stepped in and responded that the great majority of my family members are doctors and nurses. Though, I personally knew of many nonmedical persons that served at this hospital and was confused as to why this conversation was even taking place.) I officially fell out of their grace with this last conversation that occurred a month prior to arriving in mid-June.
I assumed that as I was the one obviously wronged in all of this, if I forgive and show respect, grace, and kindness to them, all would be well. I was unfortunately wrong. Despite my arriving to begin my service having two years more years of medical experience, being a licensed and board-certified family physician, and a having new ability to converse in Spanish, I went from being told that I was trusted during my service in 2020 (enough to be left to run the clinic alone in 2020 as a 2nd-year resident physician who did not speak Spanish) to suddenly being told I was not trusted because my Spanish is good but not great and patients are lying to me.
Due to the positive differences in my circumstances between my time serving in 2020 versus 2022, it is obvious that this increase in negative perception was obviously a retaliation to what occurred prior to my arrival.
From my very first day of arrival, I found myself in a position where I was not focused on serving or spreading the gospel but just trying to survive a pointedly hostile environment, one markedly different from how I was treated by the same people during that month in 2020. Even my Mother, who was with me to help in moving, noticed how she and I were being treated or quite simply being given the silent treatment by certain persons. This continued for a while (at least two weeks) and then slowly improved. However, the lack of basic kindness and hospitality never quite resolved and certainly did not compete with the pervasiveness of the regular negativity spoken about US medical providers as a whole and the regular belittling I personally experienced.
The presence of and kindness from short-term missionaries serving at that time was more of a blessing than I think they will ever know. To at least have someone asking me how I was settling in and making me feel welcome was a much-needed lifeline that helped me last for as long as I did.
I know that this is the plight of many new missionaries starting out, however, I hoped that even if had to figure missionary life out alone, it would not be with the forces opposing me consisting of the ones who were meant to support and aid me. I expected to be used for God’s agenda and to further the Kingdom, not for man’s agenda or to be complicit in the detriment of myself or fellow brethren in Christ via speech and actions not in line with the gospel of Christ.
When I made the hard decision to leave, all I had was a mustard seed size of faith that God would work it all out. I had no backup plan. This was all I looked forward to and planned for over the past two years.
That exact day, the 25th of July 2022, I walked away from the hospital and directly away from the person who was supposed to be a mentor, who was supposed to advise and teach, not dictate and control my life as a missionary or personal life. This mustard seed of faith gave me the strength to walk away from the inappropriate belittling (that day, like most times, spoken in a closed “provider meeting”), to not be forced against my will by an authority figure into breaking the Hippocratic oath and to stand against the proudly declared practice of “arbitrary and non-scientific” medicine. It gave me the strength to say repeatedly that I will not have any more conversations alone without an advocate present even as I was told that the person to whom I was speaking was the only authority figure over me and I was contractually bound to do whatever they said. That faith the size of a mustard seed gave me the strength to walk out and make a phone call that I had previously been scared to make because I did not want to throw anyone under the bus and still hoped that God would change and soften their hearts. It gave me the strength to say yes when asked if I needed to leave, despite weeks prior being openly told a story by the director of the hospital about how he blacklisted another Honduran physician, preventing them from serving at another missionary hospital because he did not choose to serve at the hospital with them. It gave me the strength to walk away from that place that I once dreamed and hoped would be my future for the next two years and beyond. It gave me the strength to forgive every hurt, every lie, and every negative word said to and about me by intended spiritual leaders and mentors yet still stand up against injustice and wrongdoing.
I choose better for myself and my patients while praying for those who came before me and those who, unless things change, will come after. I pray that those who have eyes to see, see and ears to hear, hear and stand up with the full armor of God against the enemy.
“Therefore, put on every piece of God’s armor so you will be able to resist the enemy in the time of evil. Then after the battle you will still be standing firm. Stand your ground, putting on the belt of truth and the body armor of God’s righteousness. For shoes, put on the peace that comes from the Good News so that you will be fully prepared. In addition to all of these, hold up the shield of faith to stop the fiery arrows of the devil. Put on salvation as your helmet, and take the sword of the Spirit, which is the word of God. Pray in the Spirit at all times and on every occasion. Stay alert and be persistent in your prayers for all believers everywhere.”
Ephesians 6:13-18 NLT
Look at what is uncomfortable to see and defend those who can not defend themselves.
I have never before in my life experienced true psychological manipulation, though I have treated its victims as patients. Ironically, the manipulators in many cases actually do not realize what they are doing as it is not being carried out consciously. They need help and intervention just as much as their victims.
“For we are not fighting against flesh-and-blood enemies, but against evil rulers and authorities of the unseen world, against mighty powers in this dark world, and against evil spirits in the heavenly places.”
Ephesians 6:12 NLT
I forgive but I do not forget and will be praying daily for better for all those involved.
I am currently working in the U.S. as a family physician and being reminded of how a normal work and life environment functions. I have gained increased self-esteem through my interactions with colleagues, friends, family, and other spiritual leaders. It is daily helping me recover, though the memories of negative things said and certain situations still arise, they progressively occur with less frequency and I can quickly counter them with the truth.
If you have experienced anything even similar to this in the mission field, please reach out for help to anyone you trust. Seek the advice of an experienced and trusted spiritual advisor to help you in differentiating what is and is not right. If you would like to support my efforts in helping prevent this from happening in the mission field please visit the page on the site called Accountability In Missions.
Donations are currently on pause while I transition between organizations but should be up and running again in the next month. Please pray about your contributions once things get back up and running. I will be in need of regular monthly donors. Please pray about setting up a recurring donation. Found on the Projects/Needs page is a spreadsheet of my current missionary living expenses. It will be further expanded as I return to Honduras and get a more concrete idea of expenses such as gas. I also will continue posting specific mission projects that you can individually support. I am still returning to the US to practice periodically to supplement my income. I hope to eventually have enough donor support to fund all of my expenses and time in missionary service.
Today was my last official day of Spanish Language School!
…In a week from now I will be moving to my mission hospital!
I am so blessed to have had the chance to spend almost 9 months being supported by such an amazing group of missionaries. I cannot believe that I have learned as much as I have! Not just in regards to language but also culture. These teachers are not only unbelievably great people but also truly gifted in what they do.
The following is a brief summary of my past few months in Honduras and my answer to the question that many people think but only few ask. …Why…?
I have been part of an amazing church full of national and international missionaries. It is a blessing to be serving in a local church, especially one that sows into the local community. As far as my medical service. I have become sort of a missionary concierge doctor. I am available to help when needed. I’ve given health talks and have also gotten connected with a local missionary clinic to serve in a few brigades during my time in Siguatepeque before moving to my mission hospital. This has given me a chance to grow my medical Spanish and has kept my medical skills active. Through my medical experiences here, I’ve realized that there are many similarities and differences between Honduran and US allopathic medicine. With guidance and wisdom from the lord, I am figuring out how to balance the difference in treatment guidelines and in resources. My second week of language school was Semana Morazánica. (This is week is pretty much three holidays in one honoring Honduran soldiers and the military.) This meant that the language institute along with many schools and businesses had a week of vacation. Taking advantage of this unexpected time off, I was blessed to be able to travel to Rio Viejo for a few days. While there, I saw patients in the clinic and also was able to see the progress of the houses being built for long term missionaries. From performing a paracentesis using a bucket to debriding a extensive gluteal pressure ulcer in a diabetic patient, those few days of clinic were not at all benign. After my couple months off after residency, it felt great to practice medicine again. I did not realize how much of an ingrained habit practicing medicine has become over the past decade. I thought that I lost my hobbies during medical school but I am now realizing that one (emphasis on one) of the activities, I actually enjoy doing is what I have been trained to do for a living. Practicing medicine. I have since had another short trip to my mission hospital in order to introduce the hospital to another medical missionary from Siguatepeque that was looking for a place to serve long-term.
My past several months here have been nothing at all like I have expected. I honestly assumed that I would spend my days studying Spanish with my free time spent in isolation. However, God has provided unexpected friendship, mentorship and family. Almost nine years ago, I moved to another country called Dominica for two years and was blessed with lifelong friends who also happen to be amazing children of God. In every stage of my journey from Texas, to Dominica, to Georgia, to Florida, to Louisiana, and now Honduras. God has brought into my life mentors, supporters, prayer warriors, friends, and family. God has brought you all into my life to guide, teach, mentor, support, and encourage me along this journey. I cannot thank you all enough. This stage of my journey is just beginning I can not wait to continue it with you all. If you would like to keep up with what has been and will be done through my medical mission work. Please subscribe at the bottom of this page. There is also a support page that lists the many ways you can support my mission work here in Honduras.
I truly feel at home here in Honduras and remain expectant for all that God is going to do during my time here.
Now to get to the tough questions… or really tough question (singular). The question that many people ask when hearing about my current path is why. Why sacrifice over a decade of hard, grueling and expensive medical training only to get to the point of finally being “free” and able to earn a six figure salary (mind you this would mostly go towards loans) and instead turn down dozens of job offers, choose to leave all of your family and friends….again, and work for free in a foreign country. I would like to refer to Luke 18:18 -30.
“Now a certain ruler asked Him, saying, “Good Teacher, what shall I do to inherit eternal life?” So Jesus said to him, “Why do you call Me good? No one is good but One, that is, God. You know the commandments: ‘Do not commit adultery,’ ‘Do not murder,’ ‘Do not steal,’ ‘Do not bear false witness,’ ‘Honor your father and your mother.’ ” And he said, “All these things I have kept from my youth.” So when Jesus heard these things, He said to him, “You still lack one thing. Sell all that you have and distribute to the poor, and you will have treasure in heaven; and come, follow Me.” But when he heard this, he became very sorrowful, for he was very rich. And when Jesus saw that he became very sorrowful, He said, “How hard it is for those who have riches to enter the kingdom of God! For it is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God.” And those who heard it said, “Who then can be saved?” But He said, “The things which are impossible with men are possible with God.” Then Peter said, “See, we have left all and followed You.” So He said to them, “Assuredly, I say to you, there is no one who has left house or parents or brothers or wife or children, for the sake of the kingdom of God, who shall not receive many times more in this present time, and in the age to come eternal life.”
I do not at all believe that this verse is saying not to have riches on earth. When I read this, I envision this antique scale with two sides.
On one side are treasures in heaven and on the other riches on earth. I believe that Christ wants us to realize that the scale is tipped so heavily in favor of treasures in heaven that there really is no comparison.
There is no comparison.
So thinking back to the story, how crazy is it that the rich young ruler turned down such heavenly treasure just for earthly riches. Also how sad is it that earthly riches can so easily obscure our perception of the great treasure that awaits us in heaven. I don’t think God is telling everyone to sell everything, leave your family and go be a missionary… even though that is exactly what I have done haha… No, I believe that in our everyday lives we are faced with decisions where we have the opportunity to choose to between building up treasures in heaven over treasures in earth. I encourage you to join me in asking yourselves….What opportunities have arisen in my life where I can sow into the kingdom of heaven and build up my heavenly treasure? May we all be mindful of the greater treasure that results from making kingdom choices.
