by Drs. Pete and Julie Rosá

“In alert expectancy such as this, we’re never left feeling shortchanged. Quite the contrary—we can’t round up enough containers to hold everything God generously pours into our lives through the Holy Spirit” (Romans 5:4-5, MSG)

Obedience is THE love response to God’s mercy.

Though the Father had started the preparation long before my official first, “YES,” my heart’s first step occurred at Antioch Church’s World Mandate Missons Conference’s challenge: “Say YES to the call to which someone else said NO!” I, being one of several who prayed these words that day, found that the Father was listening.

I attended a Perspectives in the World Christian Movement’s course as a hesitant first timer; was all-in on my second Perspectives attendance as an emcee; became an InMed’s master’s in international health student; became an All Nation’s intern. Each step flowed supernaturally from application to completion. Until I found myself on an airplane headed to Kanad Hospital in Al Ain, UAE, one-half a world away from Kansas to complete my field experience/clinical capstone and thesis paper entitled “New Family Medicine Residency in a Middle Eastern Context.” The vision: open the UAE government’s requested new Family Medicine Residency at Kanad Hospital led by the Family Medicine department’s staff physicians. He had called me…now to tackle the HOW:

GO Preparations by Category:

Medical: Host Country medical license requirements, national work VISA expense and requirements, training for diseases and medical needs of the host country, cultural learning about your host country.

**Provided by InMed’s master’s in international medicine degree: inmed.us/masters-in-international-health/

Financial: Host country’s hospital contractual obligations for salary and reliability for that salary (Fundraising recommended), U.S. tax obligations of international salary, medical malpractice requirements including tail coverage for U.S. practice, management of U.S. savings: 529, 401K, IRA, etc.

Leadership: Hospital administration training, expectation/preparation for mentorship.

** Remember, hospital instability is the norm.

On-Field Needs: In-country helper for initial settling and cultural adaptation, In country transportation with a driver’s license, car, insurance, public clothing and laundry, food acquisition and eating, weather acclimation, vaccinations and endemic illness prevention (malaria prophylaxis), host country’s safety and security training, language learning.

** In country language acquisition tutor: acquirelanguage.net/

U.S. Home Needs: house/vehicle, pets, parental needs, leave from previous employment

**Sender’s U, presented by All Nations, is a terrific mini-conference preparation for your home church and for development of a home team: allnations.international/senders-university

Host Cultural Competence: Understanding worldview (fear/power, guilt/innocence or honor/shame). Hofestede’s Cultural Dimensions, defined by the power distance index, individualism vs. collectivism, masculinity vs. femineity, uncertainty avoidance index, indulgence vs. restraint, short-term vs. long-term orientation.

Culture Shock Management: Initial culture shock simple triggers like food, climate, clothing, child-rearing choices. Harder ones: worldview, conflict resolution, communication style, leadership culture.

**Our expectations of the people of the host culture will affect the culture shock experience.

WHY is this so hard? Loss of assumed knowledge, loss of autonomy, loss of support (family, friends, workplace), values dissonance (injustice, inequality, fallen culture) could be expounded upon at length. The Holmes Rahe Stress scale merely quantifies what the culture shocked intentional feels: Scores of 200 for a normal American (death of a spouse – 100, pregnancy – 40, marriage – 50, etc.), is dwarfed by the 400 of the normal cross-cultural worker or 1000 + normal first two years of a cross-cultural worker.

Unhelpful Culture Shock Strategies: Cultural colonialism, stressing myself to conform, “I have to do everything NOW!” or failure to assess my strengths and acknowledge my weaknesses. Lastly, having undefined goals all extend or exacerbate that culture shock.

Helpful Strategies:

1. “LORD, renew my energy when I feel tired and weak.” Psalm 103:5…PRAY a lot
2. Manage your Mindset: Assume the posture of a learner – Franklin Covey’s “Seek first to understand, then to be understood.”
3. Embrace language with a learning coach – Carol Lewis with Acquire Language Acquisition Training.
4. Know Thyself – cultural adaption/resiliency tendencies? Are you risk adverse/rigid/resistant? Or open-minded/adaptable/flexible? Do not resist adaptation. Short circuit self-protection tendencies. Lower expectations to avoid anger at unmet expectations.
5. Have FUN and make friends – Saltwater aquarium and Starbucks
6. Journal
7. Travel
8. Lean into culture and do things that give LIFE and joy! Say yes to new cultural experiences
9. Creative supports like gifts from Amazon, Zoom gatherings, etc.
10. “LORD, renew my energy when I feel tired and weak.” Psalm 103:5…PRAY

Beyond culture shock, culture stress lives within the grief cycle in part due to an accumulation of circumstantial losses (six to eight months) and again with an accumulation of abstract losses (18 to 24 months) as discussed on Apple podcast, Resiliency with Silas West: creators.spotify.com/pod/profile/antioch-resiliency/episodes/Episode-41–Overcoming-the-Stress-of-Cultural-Adaptation-with-Silas-West-ev1fjd

So, to circle back to the opening sentence: Obedience is THE love response to God’s mercy. That statement seems so simple, so obvious, but when couched to the above-mentioned costs, the priority of obedience becomes: “If this call is truly from God, then what must change in my life today?” When we obey God:

• He reveals Himself increasingly to us.
• God’s peace calms our hearts and gives us courage.
• The fruit of our lives will not be lost but remain beyond our days.

Jesus Calling states on page 282: “When your energy fails you, do not look inward and lament the lack you find there. Look to Me and My sufficiency … Go gently through this day, leaning on Me and enjoying My presence.” Moving from self-reliance to trust occurs beyond the boundaries of our own resources of time, strength, energy, knowledge and ability.

Joshua 1:9 “Have I not commanded you? Be strong and courageous. Do not be afraid; do not be discouraged, for the Lord your God will be with you wherever you GO” (NIV)!

Or, as the Message says: “STRENGTH! COURAGE! Don’t be timid; don’t get discouraged. GOD, your God, is with you every step you take.”

Drs. Pete and Julie Rosa have spent over 25 years as Jesus-following, full-spectrum Family Medicine physicians committed to whole-person care through medicine, leadership, and education. Dr. Julie has focused on women’s and pediatric health, mentoring students, and loving Arabic-speaking peoples. Passionate about worldview-expanding experiences, she engages others through speaking, outdoor adventure, and global medical education trips with Medical Education International (MEI). After serving in the UAE, she and her husband now live in Kansas. As of July 1, 2025, she serves as MEI’s Director, mobilizing healthcare professionals to serve the world—especially in Creative Access countries.