Together, but worlds apart

Sahiwal, Pakistan - The X-ray machine at the Christian Hospital here is emblazoned with a USAID sticker to promote the US government's donation of top-of-the-line medical equipment. So is the blood bank refrigerator, the auditorium for medical lectures, and the radiology computer -- all sparkling new messages of help for the people of Pakistan, a crucial ally in the war on terrorism.

With a cleanliness and order that are in stark contrast to the crowded and filthy municipal hospital across town, the Christian Hospital, run by the Christian group World Witness with US government assistance, seems an easy choice for the nearly all-Muslim community it offers to serve. The public hospital is understaffed and underequipped, with patients slumped in dirty hallways and anxious parents holding crying, sickly babies awaiting a doctor's attention.

But like many Christian facilities in this Muslim nation, the Christian Hospital is an entity apart. It cares for 14,000 to 15,000 patients a year, compared with 1 million at the municipal hospital, and the neediest patients say they can't afford the few dollars for admission and a few blood tests.

Only a dozen or so patients sat in the waiting room during a recent visit, their traditional Muslim dress looking out of place in a facility with tile crosses in the walls and a New England-style chapel in the courtyard.

A rifle-carrying guard patrols the entrance -- a grim sign of the danger Christian groups face in a nation whose citizens believe their Muslim faith and brethren around the world are under attack by the largely Christian West.

Christian groups are running health care, education, and disaster relief in many Muslim nations, and USAID has awarded about $53 million from 2001-05 to fund projects by Christians in Pakistan, Indonesia, and Afghanistan alone. Both the aid organizations and the US government hope the projects will sow good will in a region growing increasingly wary of the West.

But the war in Iraq and the detention of Muslims at Guantanamo Bay have greatly angered Muslims, and residents are finding it hard to separate the policies they vehemently oppose from the activities of Christian aid groups, said local Islamic leaders.

``People hate America as a whole. People in general think the West, and Bush especially, have a double standard for Muslims. They are killing Muslims," said Ameer-Ul-Azim , secretary of the Jama'at-e-Islami party in Lahore. ``It can come to the point where it can affect the relationship between the Muslim community and the Christian community."

Fighting terror with Christ

While Christian Hospital officials insist they are there to heal, not to proselytize, World Witness's own literature suggests that part of its mission is to spread Christianity.

A brochure for the hospital says ``The Jesus Film" ``is shown to all patients," and goes on to say that ``the hospital and staff feel that through Christ, terrorism will be eliminated in this part of the world," a phrase that offended Muslim leaders who say Islam is about peace, and not violence.

``If I am given such a message, I ask, `Why are you spreading hatred among human beings? What is your agenda?' " said Abdul Rauf Farooqi , a Lahore-based member of the board of the National Religious Schools Council.

Christian groups say that view is mistaken. The Rev. Frank van Dalen , World Witness's executive director, said ``The Jesus Film" is only shown in the waiting room, and not constantly. He winced when he was shown the brochure's reference to eliminating terrorism through Christ.

``That's a dumb thing to say. It doesn't work that way," he said.

Still, critics say, the Bush administration's special efforts to reach out to faith-based providers, the vast majority of whom are Christian, almost can't help but raise suspicions in Muslim countries.

``I think it's important to step back and look at the wisdom of putting faith-based components into a program like this that is operating in a Muslim nation. The last thing we want to do is create the impression in the Muslim world that the US government is funding groups that seek to convert Muslims to Christianity," said Rob Boston , spokesman for Americans United for the Separation of Church and State. ``When USAID gives money to religious groups that put Christian symbols in their facilities, and leave evangelical tracts lying around, it's hard to draw any other conclusion [than] that it looks like proselytizing."

Defenders of the Christian groups say religion shouldn't come into play. ``As long as it effectively delivers the good the government offers -- such as medicine -- the organization should not be discriminated against simply because it is motivated by faith," said Ryan Messmore , a religion specialist with the Heritage Foundation.

But far from discriminating, USAID has become a growing source of funds for Christian groups in the Muslim world. USAID spent $57 million from 2001-2005 (out of a total of $390 million to nongovernmental agencies) to fund almost a dozen projects run by faith-based organizations in Pakistan, Indonesia, and Afghanistan, according to records obtained by the Freedom of Information Act. Only 5 percent of that sum went to a Muslim group, the Aga Khan Foundation of the USA, which was given approximately $3.5 million for projects in Afghanistan and Pakistan.

And even that amount is well below what the Aga Khan Foundation received under the Clinton administration, including $4.9 million in fiscal 2000 alone.

In the wake of the devastating 2004 tsunami, no Muslim organization has been awarded a prime USAID award for relief work in Indonesia -- a sore spot among Muslim groups that want to help there.

In fact, of the nearly 160 faith-based organizations that have received prime contracts from USAID in the past five years only two are Muslim.

Mark Ward, USAID's senior deputy assistant administrator for Asia/Near East, speculated that Muslim groups may be disadvantaged because larger, more established groups have mastered the grant-application process.

``We like the diversity it shows in a program if we have a group that is tied to Islam," Ward said, adding that Islamic groups are encouraged to apply.

Bush's faith-based initiative is geared to help faith-based groups navigate the application process. But it has worked mostly for Christian groups, whose share of USAID funding has roughly doubled under Bush and accounts for 98.3 percent of all money to faith-based groups.

For its part, the Pakistani government says it has no problems with Christian aid groups, as long as they do not break laws against blasphemy. But the tension between what is perceived as the largely Christian West and the Muslim East is evident.

``I have never had a problem with any Christian organizations. Charity work has no religion," said Tasmin Aslam , the Pakistani Foreign Ministry spokeswoman. ``It's certainly not like Muslim organizations in the West, who are seeing that they are perceived that if they are collecting money they must be doing it for terrorist purposes."

Christian relief officials say they understand the rules, and know they probably could not survive -- and might even be in physical danger -- if they engaged in proselytizing.

``If the community ever was against us, we would have been out long ago. They could kick us out tomorrow," said van Dalen, a former missionary who has spent 12 years in Pakistan and has mastered the very difficult language of Urdu to communicate directly with locals.

But since 9/11 and the Iraq war, religion has been melded with politics in Pakistan, religious and political officials say, and the Christian groups have been caught up in a virulent anti-American sentiment.

Local newspapers are filled with articles critical of Bush's Middle East policy. A large billboard in Lahore displays a fearsome caricature of the American president with fangs, above a depiction of a crying infant and a man who appears to have been wounded in a bombing. ``Who's Next?" the billboard slogan asks.

Even a visit by actress Angelina Jolie, who has done humanitarian work around the world in her capacity as a special UN envoy, was received with some trepidation because she is American.

Linking US, Christianity

Christians operating in the Muslim world must also contend with local worries that they are only there to spread their religion -- a concern that reflects fears that Western foreign policy has an anti-Islam agenda.

Since Islam is linked with government in Muslim countries, Muslims often have difficulty seeing that religion is officially separate from government in the United States, Boston said. Any activity that could be seen as proselytizing becomes associated with the US government.

Faith-based groups receiving USAID grants may not tie assistance to religious participation, but the symbols and religious tracts are enough to provoke discomfort in many Muslims, who are deeply resistant to conversion.

The tension became lethal for The Christian Hospital Taxila. The facility, located next to a mosque in the northern Pakistan town of Taxila, was attacked in 2002 by Muslim extremists, who killed four nurses and damaged the hospital's chapel. Now, the hospital, which does not receive US funds, is protected by a thick concrete wall and armed security.

Another Christian group, Evangelistic International Ministries, declined even to say where it is operating in Pakistan, citing security concerns. The group, which received a $291,000 USAID grant, but for operations outside Pakistan, has been involved in helping earthquake victims, said the group's president of project development, Michael Goodwin . The group's website states that it has handed out 700 Bibles in Pakistan.

The Christian Hospital in Sahiwal evacuated its staff after Sept. 11, 2001, and doctors have been trickling back since then. Until recently, local police protected the century-old hospital, fearful that the Western staff might be targeted, van Dalen said.

Workers at Christian facilities say they must be careful to accommodate Muslim sensibilities. At Sahiwal hospital, for example, men and women stand in separate lines to collect prescriptions, and are housed in different parts of the hospital.

Another Christian group operating in Muslim countries, World Vision, said it goes so far as to ban its Muslim staff from attending Christian prayer meetings in Pakistan and Afghanistan to make sure no one thinks the group is proselytizing, said spokeswoman Dineen Tupa . World Vision receives USAID funding, but not for projects in Pakistan and Afghanistan.

While the organization's stated mission includes spreading the love of God and Jesus, ``We're not here as evangelicals. For our staff's protection, we don't do it. For our Muslim staff, it could get them killed," said Tupa, World Vision's sub-regional director for Central Asia.

But with tensions simmering between Muslims and the West, local Muslims say they are growing suspicious of what they see as obvious shows of Christianity .

At the Taxila hospital, the walls are dotted with Bible verses, and a book room features tomes on Christianity. Muslim leaders in the town said they are offended by reports that the Christian hospital is handing out religious books at the door.

``Of course, we want them to stop this," said Amir Shahzad , head of the mosque that is right next door to the walled Christian hospital. ``This is a Muslim country. Our feelings are hurt by this."

The Taxila hospital's administrator, Dr. Joseph Lall, said the staff does not proselytize. ``If you don't want to get hit on the head, you don't do it," he said.

In Sahiwal, local mullahs said someone was passing out Christian leaflets near the hospital on Pakistani Independence Day in August; van Dalen said hospital staff had nothing to do with it.

That distinction is lost on some Muslim leaders.

``In general, we feel the NGO [nongovernmental organization] sector is directly trying to spread Christianity in this area," said Qari Tahir Rashidi , a mullah in Sahiwal. And while it is only a few ``fanatics" that have committed deadly attacks on foreign Christians in recent years, moderate Pakistanis are becoming more suspicious of all things Western, he said.

Some urge secular focus

Given the mistrust, some critics wonder why the US government is aiding Christian groups in Muslim nations instead of secular organizations that might draw less controversy.

``The problem with faith-based funding, whether domestically or internationally, is that their orientation is often proselytizing. We may be funding them in one area, but they are using other funds for proselytizing," said California Representative Henry Waxman, senior Democrat on the House Government Reform Committee, which does oversight and investigations.

``If it's a Christian hospital in a Christian area, then I think that would be helpful [to the United States] for the public to see us supporting it. But if it's a Christian hospital in a Muslim area and we're not helping the Muslim charities, it's a bit of an insult," Waxman said.

Still, some Muslims do patronize Christian hospitals, saying the quality of care is more important than any religious differences.

Mukhtiar Bibi , a 19-year-old who is learning the Koran by heart, appeared embarrassed when asked why he brought a family member to the Taxila Christian Hospital. ``We have more faith in the care at this hospital," he said.

Patients at the Sahiwal facility said they had heard positive things about the hospital; Alir Rezwan , 34, said he traveled a long distance and spent 300 rupees -- about $7 -- to bring his wife to Sahiwal for treatment of arthritis. ``I have been to many different doctors for this, maybe here, she will be cured," he said.

But for all the good intentions of the hospital staff, the gleaming new equipment paid for by USAID is not benefiting most of the people who need it in the community. One of the radiology machines is not used to its full capacity, a hospital administrator said, because the facility doesn't have a specialist who knows how to use it.

In addition, the cost -- while stunningly inexpensive by Western standards -- is still too much for destitute Pakistanis who desperately need medical care. ``Sure, if it were two rupees, I would go" to the Christian Hospital, said Rani Nazeer , 30, as she awaited her turn at the municipal hospital. Two rupees -- the price of registering at the public hospital -- is less than four cents; a Muslim patient at the Christian Hospital showed that his bill for a blood test was 130 rupees, less than three dollars.

Van Dalen said the Christian hospital does not operate for profit, keeping its prices as low as it can. Further, he said, accident victims are required by law to go to the public hospital, meaning World Witness's doctors can't treat them.

For those who do come to the Christian Hospital, van Dalen promises top-quality care and an environment ``very sensitive" to Muslim customs.

``We have to be very careful that we live out our faith more than we talk about it," van Dalen said. ``I want Muslims to become Christians. But I can't make someone become a Christian. Only God can do that."