Over 100 million people in the USA, about 1 in 2, have a chronic illness. That means, if you are not the one suffering from chronic pain, chances are someone you care about is dealing with it silently.

Chronic illnesses are often invisible. In fact, according to the U.S. Census Bureau, approximately 96% of the people who have an illness do not use an assistive device, like a wheelchair or cane, and may not show any effects of the illness. Pain from a car accident, or the pain and fatigue from an illness such as lupus or fibromyalgia, is nearly always undetectable. But many of these people who suffer still get up and get to church, despite the chronic pain because they desire to stay a part of the church body.

I remember one specific day that I tried to make it through a church service. My rheumatoid arthritis was flaring badly, but since I had gotten there, I was determined to stay. "Please stand" they announced during worship and I took a deep breath and carefully pulled myself up, using the pew in front of me for leverage and balance. At the age of 24, fifteen years of living with this disease has left my feet deformed and painful, and my knees need joint replacements as soon as possible. I rolled my eyes as they sang a worship song and the lyrics declared, "I will stand in spite of pain."

Even as I was surrounded by people in a church I loved, I still felt as though no one understood what I was going through-physically or emotionally.

It's obvious that churches already have an overwhelming amount of needs that must be fulfilled. Some of these needs are obvious and they often rise to the top of the priority list. So when people don't even verbalize about their pain level or illness symptoms that change their lifestyle, it's hard to understand where a church could begin to help. Pastors ask, "If they aren't speaking up, then doesn't that mean they are coping with it fine? They believe in God and we have a healing service every six months. Isn't that enough?"

Let's take a glimpse at some astonishing statistics:

- We usually assume the chronically ill are the elderly, but 60% of people who live with illness or daily chronic pain are between the ages of 18 and64. - 75% of marriages where one of the spouses have a chronic illness end in divorce - When you are chronically ill, depression is 15-20% higher than it is for the average person - Many studies have found that physical illness or uncontrollable physical pain are major factors in up to 70% of suicides.*

So there is a cause for concern. Whether a pastor or church leadership can see it or not, those church pews are packed with ailing bodies. And the suffering bodies are filled with broken spirits. These are the broken-hearted that Jesus promises blessings for.

So the question remains, if people don't talk about their pain, but they still have a need to learn how to cope with it and find hope, how does a church reach out to them most effectively?

(1) Perform a survey about what people may desire that they are not mentioning to the church leadership. This is especially vital if you belong to a large church. People are less likely to ask for help when they don't know the church staff intimately and reluctant to mention their illness. They are afraid they will be bombarded with all the scriptures about healing. A recent Barna group study discovered that larger churches were the least likely to have congregational care ministries listed as a priority (Church Priorities for 2005 Vary Considerably).

Ask questions on a survey such as, "If we provided transportation, such as a van ride, would it increase your ability to attend church? If you were too ill to attend church, would you listen to the service on the internet? Do you know who to call at the church if you occasionally need personal assistance (especially when the illness is chronic and not acute)? Are you able to see the worship song lyrics on the overhead, or would having them available on paper also be helpful? Please rate the comfort level of our seats." Sit down with a group of people who live with chronic pain and brainstorm ideas with them about what would increase their church attendance or connection with the church and then prioritize what they say.

(2) Provide a small group/Bible study setting for those with illness. For example, Rest Ministries, the largest Christian organization for the chronically ill, has a small group program called HopeKeepers which provides a wide variety of resources, Bible studies, and leader support for this purpose. You may find that although people enjoy the small groups they are in, they can start to feel that talking and praying about their illness week after week is a burden to others in the group. They often enjoy having a specific place where everyone "speaks the same language" and even giggles at the same jokes. It can be invigorating. And if only a few people come, that's okay. It brings people comfort to know the church has this oasis when they need it.

(3) Invite guest speakers who have physical disabilities or live with chronic illness. There are amazing people that speak at churches, sharing their testimony and a wonderful message. By letting them be on stage and reveal what God has done in their lives, despite physical challenges, lets people in your church who are ill see that you do in fact recognize their needs. It reminds them that you care, and perhaps most importantly of all, that you believe that people with physical challenges are still worthy to be used by God (a message few hear from their church). Speakers such as Dave Dravecky, Lisa Copen, Joni Eareckson Tada, Nick Vujicic, and many others, minister to the masses, not just those with disabilities.

(4) Consider adding a parish nurse to your staff, especially if your church body has a lot of seniors. Marquette University College of Nursing, which has an excellent parish nursing program, reports there are about 6000 parish nurses in United States. Many retired nurses are finding this area of ministry appealing and most parish nurse certification can be given by many hospitals. The parish nurse position description depends on your church's needs and goals. For example, they may go to homes to monitor diabetes or high blood pressure of church members, organize walking groups, health fairs and screenings, and even help out with the chronic illness small group. The role of the parish nurse may be a better choice than a disabilities coordinator, depending on your church's demographics. This person would help cover the disability ministry needs and work closely with the congregational care pastor.

(5) Be a clearinghouse of helpful resources for the ill that are available for borrowing. Many people with chronic illness are on a fixed-income and yet they are trying to find encouragement. Stock your church library with books on living with chronic illness such as "Why Can't I Make People Understand?" or "Beyond Casseroles: 505 Ways to Encourage a Chronically Ill Friend," by Lisa Copen or the exceptional book on suffering, "When God Weeps" by Joni Eareckson Tada. Buy a few subscriptions to magazines such as "HopeKeepers", "Guideposts" and even "Arthritis Today." Remember to have books on tape, audio presentations and large-print materials whenever they are available. Post flyers or have brochures available about chronic illness or disability ministries, such as Joni's "Wheels for the World" program or Rest Ministries' annual outreach, "National Invisible Chronic Illness Awareness Week." A volunteer could collect materials of local and national ministry resources for a binder; items could include lists of local resources and national ministries and put them in binder; lists of organizations, magazines and newsletters on topics for Christian seniors, those with disabilities, caregivers, and assisted living to name a few.

(6) Finally, and perhaps most importantly, keep in mind that people with illness want to help serve. Not just be served. Proverbs 11:25 says, "He who refreshes others will himself be refreshed." For example, if a woman with a chronic illness explains that she must resign from teaching Sunday school, make sure she knows that she is welcome to serve in other ways when she is ready. Though she no longer is physically able to teach four-year-olds, she may discover that she loves writing notes to people who have just been diagnosed with a chronic illness. A man may discover that he prefers mentoring another man with a chronic illness one-on-one, instead of leading a weekly Bible study. Let people know that you value wounded healers and that your church believes that God comforts us "so that we can comfort those in any trouble with the comfort we ourselves have received from God" (2 Corinthians 1:4).

About twice a month someone tells me that they went to their pastor with a request to start a chronic illness HopeKeepers ministry and they were told, "Come back when you are healed and then we will talk. You can't very well minister to others with illness when you aren't even healed yourself." The broken hearts that arise from these comments is unbearable. It's devastating to feel like God is using your illness for His glory and then be told you are no longer useful to the church-or even to God-until you are healed.

In Luke 14:21 Jesus shares a parable of a great banquet. When the host's hospitality is turned down by his friends he responds by commanding, "Go out quickly into the streets and alleys of the town and bring in the poor, the crippled, the blind and the lame." This is still a mandate to us today, but we must remember that to provide a place where we offer hospitality, we must first "go out" into our own pews and provide a place of refuge; as we make small changes in our church to create that oasis for people with illness, then these people in our church will naturally be comforted. And then they will go out into the community with open arms of understanding and minister to others along this journey.