Washington, USA - The calls come in at all hours: patients reporting broken bones, violent coughs, deep depression.
Prue Lewis listens as they explain their symptoms. Then Lewis -- a thin, frail-looking woman from Columbia Heights -- simply says, "I'll go to work right away." She hangs up, organizes her thoughts and begins treating her clients' ailments the best way she knows how: She prays.
This is health care in the world of Christian Science, where the sick eschew conventional medicine and turn to God for healing. Christian Scientists call it "spiritual health care," and it is a practice they are battling to insert into the health-care legislation being hammered out in Congress.
Leaders of the Church of Christ, Scientist, are pushing a proposal that would help patients pay someone like Lewis for prayer by having insurers reimburse the $20 to $40 cost.
The provision was stripped from the bill the House passed this month, and church leaders are trying to get it inserted into the Senate version. And the church has powerful allies there, including Sens. John F. Kerry (D-Mass.), who represents the state where the church is based, and Orrin G. Hatch (R-Utah), who said the provision would "ensure that health-care reform law does not discriminate against any religion."
But opponents of spiritual care coverage -- a coalition of separation-of-church-and-state advocates, pediatricians and children's health activists -- say such a provision would waste money, endanger lives and, in some cases, amount to government-funded prayer.
"I think if most Americans knew what's being proposed on this issue, they would be shocked," said Annie Laurie Gaylor, co-president of the Freedom From Religion Foundation.
As the health-care debate enters its final stages, the clash over spiritual care has become essentially a referendum about whether the government recognizes prayer as a legitimate and viable health-care option.
Lewis, 66, works out of a small rented space in Northwest Washington, but her real office is her cellphone. She sleeps with the phone tucked under her pillow at night.
She doesn't see most of the patients she treats. That isn't necessary, she said, for her prayers to be effective.
Each prayer is a cerebral search for resolution to the patient's problem. And the answer often comes in the form of an idea or feeling: "God is here," "God is life," "We are created in God's perfect image."
Such thoughts, she said, drive out the fear causing the sickness: fear of pain, death, hopelessness. And as she and her patients reconnect with God, healing comes naturally.
Her faith in prayer comes from experience. About 10 years ago, she said, before she retired from her job as a federal environmental negotiator, she was cured of what she thinks was breast cancer.
"I noticed a lump in my breast and felt the pain," she said.
But after weeks of prayer, the lump, pain and fear all went away. "It just proved to me how much this does work," she said, "and I felt a calling to devote my life to helping others."
She set out to become one of the church's 1,400 trained practitioners. She completed a two-week intensive course and collected testimonials of healing from people she had worked with, including a man who was injured in a fall and a woman with persistent anxiety. Four years ago, she was listed in the church's registry.
A child's death
The belief that God is capable of miraculous healing exists in all branches of Christianity and most other major religions. Some research has shown a link between prayer and improved health; other studies have not.
But Christian Scientists have made healing through prayer a central tenet in their 1,200 churches. The denomination's two main texts are the Bible and "Science and Health with Key to the Scriptures," written by Mary Baker Eddy, who founded the church in 1879.
In her book, Eddy lays out an alternative system of health care, one with prayer practitioners and nursing facilities where attendants bandage and comfort but do not provide drugs or perform procedures as basic as setting bones.
Church leaders say this system should be recognized and protected in the health-care legislation, but their efforts to prohibit discrimination against "religious or spiritual health care" has some critics seething.
"You can't just think away cancer," said Gaylor, of the Freedom From Religion Foundation.
There are also constitutional objections over using tax money for religious purposes, said Sean Faircloth of the Secular Coalition for America.
But some of the most impassioned arguments have come from such people as Rita Swan, a former Christian Scientist who said the prayer practices put children at risk.
"We live in a modern era with antibiotics, immunization, advanced diagnostic procedures. Why would you risk the life of your child when they could easily be saved?" Swan asked.
It is a question that has haunted Swan since the death of her son in 1977. Swan was a lifelong Christian Scientist. So when 15-month-old Matthew came down with a fever, she and her husband took him to church leaders.
"The practitioner prayed, and the fever went away," she said. "At first, we thought that Christian Science had accomplished something strong and real, but then he just got worse."
Soon, the toddler could not walk or sit up. Swan considered taking Matthew to a doctor, but church leaders told her that if she did, they couldn't pray for him anymore. By the time she took him to the hospital, it was too late.
A week later, he died of bacterial meningitis, which doctors said could have been cured with antibiotics and today can be prevented with a vaccine.
Swan now attends a United Methodist church near Sioux City, Iowa, and spends her days fighting Christian Science, lobbying against the church on state child-protection laws and sending letters to congressional leaders on health-care reform.
"I feel I owe it to my son," she said, "to do anything I can to save other children out there facing what he faced."
It's been two decades since a Christian Scientist was prosecuted for the death of a child treated with prayer instead of medicine. The church doesn't pressure people to avoid doctors, said spokesman Phil Davis, and prayer treatment is now seen as a substitute for or as a supplement to medical treatment.
"The issue here is insurance coverage and has nothing to do with child-protective laws," Davis said.
The church has suggested that its health-care proposal might be amended to apply only to adults. The church is also considering language to avoid having government subsidies pay for prayer.
Its leaders point to government policies as precedent for their proposal. The Internal Revenue Service allows prayer treatments to be itemized on income tax forms as medical expenses. And a few federal insurance programs, such as those for military families, already reimburse for prayer.
"It's not just what's at stake for us as Christian Scientists," Davis said. "You look at the spiraling cost of health care, and you look at the low cost and positive results of spiritual care. How could you leave that out?"
But to Swan, the provision amounts to the government endorsing prayer as an alternative to proven medical treatment. "God protects and God loves, but He also gave us the ability to heal ourselves through medicine," she said. "Why would you just throw that away?"