by Pastor Kirk Milhoan, MD, PhD

originally published on Romans One website

I became a pastor in January 2014 after thirteen years in the Air Force as a pediatric cardiologist and flight surgeon and over four years as an international medical missionary. In my first four years as a pastor, we serially occupied three different places of worship.  As we prayed and waited the six months for the appropriate country approval to occupy our now leased home, I confess many days I doubted the county would approve our plan, wondered if our church would flounder, and imagined, as many had, that the pediatric-cardiologist-becomes-a-pastor experiment would finally fail. But as I prayed, I was continually impressed with two thoughts: 1) the large gathering hall in a church is called a sanctuary, and 2) there was a time in our nation when churches did not lock their doors. Although building security regulations forbid me from keeping our doors open 24-hours per day as I wish, I have been certain of God’s directive for our church to truly be a sanctuary for those in need. Through the COVID-19 crisis, the Lord has provided that opportunity seven days a week.

Our sanctuary in Maui, Hawaii has 210 chairs. Prior to this crisis, we averaged around 100 people at each of two services on Sunday and fifty at our Wednesday mid-week service. We had a food pantry that was open three days a week, serving around 600 people per month. My wife, who is also a physician, and I have a federally-recognized mobile free medical clinic so we can serve the homeless, under-insured, visitors without travel insurance, and members of our congregation, helping them avoid the emergency room or late-night urgent care visits. The food pantry and free medical clinic gave us the ability to be deemed an “essential” business under Maui’s stay-at-home order, despite primarily being a place of worship.

I started speaking from the pulpit on COVID-19 on March 1. I advocated hand and respiratory hygiene and staying home if ill, in or living with someone in a high-risk category, or simply concerned. Following a further explanatory letter to a concerned congregation on March 14, we met as usual on Sunday, March 15, desiring to participate as a body in the national day of prayer declared by President Trump. Although the size of gatherings on Maui was restricted over the next week, organizations were given leeway to exercise their best judgment. We were one of the last churches on Maui to meet, on March 22. We cleaned all potentially contaminated surfaces. We made hand sanitizer available at the door. We did not serve our usual donuts and coffee. We had congregants pick up their own single-service communion cups. We did not have our usual greeting time. That day Maui Mayor Victorino announced a stay-at-home order effective March 25. A 14-day quarantine of travelers arriving in Hawaii started on March 26. As I prayed and sought God regarding our next steps, a simple phrase filled my mind: “Keep the doors open.”

My elders and I sought God through prayer and study of the Word. My personal motivation was to serve the risen Christ, my Good Shepherd, avoiding the temptation to serve either an idol of safety or an idol of liberty. We meditated on verses about gathering together and verses about authority. We reflected on the actions of historic and contemporary persecuted churches throughout the world. The Lord impressed upon me the recurring ideas of sanctuary and keeping our doors open, as well as true fellowship for the body of Christ and not being ashamed of Jesus. Even though I did feel our rights under the constitution were being violated, I did not feel specifically called to address that right.

I believe the Lord placed me and my wife, with our particular experience and skill set, in our body of Christ for such a time as this. We have participated in short-term international pediatric cardiac medical mission trips for over twenty years, with numerous trips per year to places such as Bolivia, Honduras, Iraq, Kenya, Kosovo, Kurdistan, Liberia, Malawi, Mexico, Mongolia, Nepal, Papua New Guinea, Sudan, Tibet, Uzbekistan, and Zambia. During the height of the SARS epidemic, I safely accompanied a child with heart disease from Toronto to Mongolia via high-risk Vancouver and Beijing. I was in Liberia during the Ebola crisis. Both of us traveled to Iraq during the MERS crisis. I deployed as a flight surgeon to Iraq in 2005 and 2007. One of my duties was to oversee public health officers at Balad AFB, responsible for the health of approximately 30,000 people.

As the news of COVID-19 broke, it was relevant not just for our church body but for us personally on many fronts. We still travel for international medical missions. My wife practices as an anesthesiologist in Maui. We both serve one week each month in short-term physician contracts in hospitals in Texas and Arkansas. My 80-year-old mother with heart disease lives with us. We did conduct a medical mission trip to Iraq in January. We also traveled to New York City and Las Vegas in late January and early February. I was in San Antonio, TX when the first COVID-19 cases were reported there. Kim was in Little Rock, AR, with her 79-year old mother and her same age friend, when the first COVID-19 case was reported in Arkansas. We had continued our travels, not ignoring the rumblings of COVID-19 but employing our standard precautions of hand and respiratory hygiene, and advising those with us to do the same.

We kept abreast of the medical literature on COVID-19, desiring not to be ignorant of appropriate warning signs. An analysis of the Diamond Princess on March 4 was reassuring, because a cruise ship is a perfect laboratory for human-to-human infectious disease transmission. Thoughtful analysis from this closed population showed the case fatality rate for COVID-19 could actually be between 0.05 and 1%, better than the World Health Organization’s estimate of 3.4%, and confirmed elderly adults were at risk for severe disease or death. A March 4 analysis of temperature, humidity, and latitude, which has held up as of an April 6 revision, also seemed encouraging for Maui. At the time of the travel quarantine and stay-at-home orders, the disease burden in Hawaii was low. I was much more concerned about the unintended consequences of shuttering Maui’s tourism-dependent economy.

I had no desire to test the Lord, as Jesus had proscribed when Satan had tempted Him in the desert. I also made no faith claim that, if we believed or prayed hard enough, the Lord would keep us free from disease. I believed the medical science supported that, with appropriate precautions, we could decrease the risk to any participant at our church. I also had no particular reassurance from the Lord that our body would remain free of infection or even death. In fact, I wondered if those outcomes, and my subsequent public humiliation as a pastor and physician, would be part of my sanctification. Unsure of the outcome, I was confident that the Good Shepherd was leading.

At our last Wednesday night service, before the stay-at-home order went into effect at midnight, I taught on Matthew 10:16, where Jesus said, “Behold, I send you out as sheep in the midst of wolves; so be shrewd as serpents and innocent as doves.” The Lord had provided an opportunity for us to keep our doors open by serving a suddenly needy Maui community with food and hope in the gospel. He was also allowing us to be shrewd in the face of opposition to churches gathering at all. I announced our decision that our food pantry would be open from 9 a.m. to 2 p.m. seven days per week, that any and all church activities would be in support of that ministry, and that our language and communication would support that truth. As an unplanned object lesson in the gravity of our new normal, we did have two police visits during this service in response to public complaint. They ultimately expressed support for our plans.

In my subsequent conversation with the mayor’s office confirming our “essential” services, I did notify them I would be conducting regular meetings with singing and teaching for the encouragement and education of our volunteers. When I found out that Alcoholics Anonymous meetings were not “essential,” I was able to begin medically supervising the 6 a.m. each week day meeting that had already begin going on at our church so that it could continue. Another phone call from the police was part of the approval for this plan.

Conservatively, we had well over 50 people participate in our daily endeavor over the initial 6 weeks, picking up food from donors, stocking shelves, cleaning and sanitizing surfaces, greeting and ministering to guests in our sanctuary, staffing the pantry itself, providing security, providing lunch for volunteers, delivering food to those who cannot or will not come to our facility, praying, and even attending twice weekly meetings. As guidelines changed, we changed with them. Volunteers wore masks and gloves. Visitors were greeted at the door with hand sanitizer and a touchless thermometer. We moved the chairs in the sanctuary so family groups could sit in compliance with social distancing guidelines. We served as many as over 1100 people per week compared to our previous 125. If any volunteer had any concerning symptoms, they were required to stay home. No volunteers tested positive for COVID-19 during this time frame..

We made it clear as soon as March 1 that there was no pressure to be involved at church in any way and if we could serve those at home through prayer, shopping, delivery of food, or any other service, we would. We educated our members on our understanding of their risk and many, including many of retirement age, my 80-year-old mother among them, increasingly chose to be involved. We marveled and thanked the Lord that, because we had been faithful to answer His call to love and serve others, He had blessed us with the freedom to fellowship and worship with one another.

Our philosophy was shrewdness but also transparency and compliance with authority.

As we informed the mayor’s office, we had meetings in support of the food pantry every Wednesday afternoon and twice each Sunday (we added a by-invitation-only sunrise meeting on Easter for congregants over 65). Everyone who supported our food pantry ministry, either as an active volunteer, or by prayer or tithe, was invited to our meetings. We opened with an update on the food pantry ministry and I usually gave a medical update on the COVID-19 crisis. Then we sang an acapella hymn, had a teaching, shared communion, and ended with another hymn. These meetings were not available by LiveStream but members could receive a video by DropBox. Meetings were in compliance with current public health guidelines and offered a model for how churches could gather: clean all potentially contaminated surfaces, make hand sanitizer available at the door, have families sit in socially distanced groups, have congregants pick up their own single-service communion cups. forego usual greeting time.

Our volunteers did share a meal together every day. Since contact with contaminated surfaces was considered one of the primary ways the virus was shared at that time, everyone sanitized their hands before going through the line. For these church family times, when the public was not present, we took off our masks when we were around each other and didn’t sit socially distanced. We hugged each other. We even hugged food pantry patrons when they asked for it. That moved many to tears. We believed the medical science supports that we could do this safely. More importantly, at that time, we had more than six weeks of evidence supporting that we could do this safely. We actually hoped to write about our experience and outcomes as a medical case report.

The gospel of Jesus Christ is “essential.” Our loving and serving our neighbor is “essential” to our call as followers of Christ. As we have served Him and others, He has rewarded us with the blessings of fellowship and worship. May we lead many to righteousness and glorify Him in all ways.