James and Rachel O’Hare Fernando use lessons from Union to heal patients.

James Fernando’s mother jokes that he got his degree in camping. As an international rescue and relief major at Union College, James did spend quite a lot of time roughing it, as well as studying science, learning rescue techniques, practicing patient care and developing problem solving skills. Now a mission doctor in Sierra Leone, James and his wife, Rachel, are continually grateful for his “camping degree.”  

“A lot of the things I learned in the IRR program may not have been as useful stateside, but they’ve really helped here. I’ve found a good use for my education,” James says of the program that gave him a variety of rescue certifications and taught him to provide medical care in less-than-ideal conditions. “Practicing medicine in this environment is a whole different world than what we learned in medical school.”

Finding a calling

James and Rachel’s lives intersected at Union College, but their goals were taking them on diverging tangents. James had come to Lincoln because of his passion for mission trips. To him, the International Rescue and Relief Program was the perfect key to open doors to medical school and then the world. 

Rachel was a future physician assistant with plans to stay much closer to home. When they started dating, she didn’t share James’ yearning to be a missionary. In fact, she recalls watching friends embark on student missionary journeys and being decidedly not jealous of their travels. “I have very clear memories of thinking that was not for me—that I was not called to go overseas,” she says. 

She credits James’ excitement for the mission field and her college experience for helping shape her plans. “My time at Union was a time of spiritual growth and making my relationships and my religion my own,” she says. “Union is very mission oriented, and the spiritual atmosphere was strong. It fostered growth in me. The relationships we built there changed our lives.” Over time, serving as a missionary became not just his dream but a shared calling.

After graduating, the two married and moved to Loma Linda University where James completed medical school. With overseas missions their ultimate goal, they signed up for the Deferred Mission Appointee program. Funded by the university and the General Conference, the program enables young graduates to pay for their education while working for the Adventist church in underserved areas of the world. 

Shortly after James completed his residency, the Fernandos received a call. They signed on for a five-year stint, and within weeks they were on a plane to their new home at Waterloo Hospital in Sierra Leone. James serves as a family medicine doctor while Rachel is a physician assistant in the female and children’s wards. 

Finding a new home

Life is hard and money is tight, even in the best of times in Sierra Leone. Waterloo Hospital is run by Adventist Health System, and it receives no government support despite serving nearly 10,000 patients a year. 

“More than 70 percent of our patients can’t pay their entire bill,” James says. “Paying staff is hard, and sometimes we have to delay payments. We’re on the absolute edge of viability.” He adds that country-wide inflation further raises prices, making it harder to meet financial obligations. Patients are often very ill and require intense treatment as financial concerns keep many from seeking early medical intervention or preventative care. However, the hospital never turns away patients based on their inability to pay.

Still, the Fernandos find joy in the little victories, and they appreciate the network of support they've found. “Going to Union really helped us connect with people of a similar mindset,” James says. “We lean on those contacts with mission-minded people.” Along with their friends and Union connections, they’re also grateful for the systemic support they receive as Adventist missionaries. As the only Adventists in the entire country not of African descent, they’ve watched missionaries from other denominations struggle without the support and connections they enjoy.

Time, too, has made their lives easier and more comfortable. “We fit in so much better than we did when we arrived in 2019,” James says. “We have a good community, social support and the language is easier for us.”

Along with patient-care duties, one of James’ main goals is educating local health care providers about best practices. “Here, you can buy basically any antibiotic over the counter, even dangerous medications that are no longer used in the United States,” he says. “Education is the thing that will outlast us here if we can pass on that knowledge.” 

Sharing their faith is also an important aspect of their outreach. In a country that’s 70 percent Muslim, he and Rachel hope to share the gospel with others. “We want our lives to be a resource for others and an influence for the church,” he says. “There are a lot of opportunities here.”

Finding personal joy in the midst of pandemic

The early months of 2020 brought new challenges. With COVID-19 related lockdowns and border closings, the Fernandos were given an ultimatum by the US embassy: get on the last flight out of the country or be prepared to stay no matter what happened. 

“I’m a doctor, and I’m at a hospital—but I’m running away when things get tough? It was a super-difficult decision,” James says. “But it was time for us to go on leave, and all of the Westerners we knew were leaving. There’d be no support for who knew how long. We’re planning to be here long-term, and we didn’t want to burn out early in our careers with a traumatic experience.”

Reluctantly they boarded the repatriation flight, eventually making it to Rachel’s hometown of Bismarck, North Dakota, for a three-month stay with her parents. The Fernandos were itching to get back to help their adopted community. 

But a new—and exciting—complication to their service arose. Two days before their flight, the couple found out Rachel was pregnant with their first child. After repacking their bags with maternity items, the Fernandos flew back to Sierra Leone to resume their mission despite the continued uncertainty and changes brought by the pandemic.

Rachel, enjoying what she calls a “fun, charmed pregnancy with no morning sickness or pain,” worked 10-hour days alongside the rest of the hospital staff. She was also enjoying reactions from those around her. “People here make a lot of comments on your size and that you’re gaining weight,” she says. “Complete strangers would yell at me, ‘Belly, belly! Belly-woman!’ I kind of liked it—people were excited and happy for us.”

Five weeks before her due date, Rachel returned home, with James expecting to join her before the baby arrived. But Rachel went into labor a month early, leaving James scrambling to get a last-minute COVID test and a ticket out of Sierra Leone. He arrived at the hospital 52 hours after their son, Liam, made his appearance. After a week in the NICU, the whole family reunited at their temporary home.

The Fernandos' experience in an American maternity ward was full of reverse culture shock. Infant and maternal mortality rates in Sierra Leone are some of the highest in the world. Just three days before Rachel went into labor, James was on the other side of the world working through the night, unable to save the premature baby of a nurse who had gone into labor early. 

“The first thing I did when I got back in the States was go to the NICU to see my baby,” James says. “Everything was calm and the equipment worked. I thought of our nurse’s baby that was almost the same gestational age as ours. There was zero chance her baby would have died in the States, but we couldn’t save him.”

Rachel agrees that the grief for their adopted country is heavy despite their personal joy. “It’s so common that people almost expect to lose a child,” she says. “I’m thankful we have all we need, but there’s guilt that my baby made it because I’m here and my friend’s baby didn’t because she was there.”

The couple are choosing to focus on the lives they can save when they return soon as a family of three. It will be challenging raising an infant with mosquito nets, no hot running water and no disposable diapers, but the Fernandos say they’ll find ways to ease into family life while caring for their patients.

And Rachel knows the lessons they learned at Union will continue to echo in their daily work. “Pastor Rich Carlson always said, ‘If it’s important to God, it will be clear in His word,’ and those words have come into play in my life a lot,” she says. “In the Great Commission, it’s pretty clear what God is telling us to do. Not everyone is asked to leave home, but God made it clear to us that He wanted us in Sierra Leone, and He led us here.”

Read stories and follow the Fernandos’ journey in their words: https://farflungfernandos.blogspot.com/. 

By Lauren Bongard Schwarz ’04