In the basement of St. Paul’s Lutheran Church in Allentown, PA, Deb Gilbert sits at the head of a diagonally placed folding table in a small room. She is surrounded by black garbage bags overflowing with winter coats of every color and style. Gilbert both blends in—she’s wearing head to toe purple—and stands out—she is clean, orderly and perfectly manicured. From each of her earlobes dangles a tiny snowman earring. Outside the door, about 60 homeless men and women mill about in a loose queue, waiting for lunch to be served. The basement smells like winter air, like stale alcohol, like food prepared in large quantities. And like bodies that haven’t been washed today, but maybe yesterday or the day before.

Gilbert is a registered nurse and director of the Parish Nursing/Community Outreach Department of Sacred Heart Health Services, a Catholic hospital founded in 1912 by a monsignor and the Missionary Sisters of the Most Sacred Heart. Gilbert meets with patients in this coat-filled basement room every week to practice her version of holistic medicine, which is part first aid, part prayer, and part close listening. She is not Catholic, she tells me, so she is able to refer patients to whatever denominational services they desire. “The first question I ask,” Gilbert says of her approach to patients, “is ‘Tell me about your spiritual journey.’”

Parish Nursing is a movement nestled squarely within the Christian tradition of caring for the ill, a commitment that reaches back to Catholic “hospices” during the Crusades of the Middle Ages. This mission has led Christians of all denominations to the institutionalized operation of hospitals, care facilities, elder homes, and hospices across the country and the globe. It is impossible to understand modern medicine, its development, prejudices, practices and the complicated relationship between faith and science, without examining this history.

Parish Nursing is an international organization that employs RNs “concerned not only with the body and mind but also with the spirit,” according to the Evangelical Lutheran Church of America’s website. Nurses of any (Judeo-Christian) denomination are encouraged to act as counselors and educators to their congregation and community, helping individuals to connect with local health resources, create support groups, train volunteers for outreach, and “clarify issues and or reinforce the strong tie between faith and health.” While parish nurse training programs exist across the country, the number of acting parish nurses is hard to estimate; some sources count them in the thousands. They are employed by their local churches, by hospitals’ community outreach programs, or by faith-based foundations.

The heart of the movement, however, is the life and teachings of Granger Westberg, who wrote the 1961 Minister and Doctor Meet, and the 1971 Good Grief: A Constructive Approach to the Problem of Loss, which sold more than two million copies. A 50th anniversary edition was published in 2010. Westberg served on both the medical and theological faculties of the University of Chicago.

He was the first hospital chaplain to formalize the role by emphasizing both clinical and theological training and is often wrongly credited with founding the College of Chaplains (today known as the Association of Professional Chaplains) in 1971, although the organization has existed since 1946. Westberg did, however, establish clear guidelines and accreditation for hospital chaplains through the College while serving as director.

At the time of her father’s death in 1999, Granger Westberg’s daughter Jane said, “Dad challenged the prevailing didactic model of theological education and proposed that theological education be a blend of theory and practice.” She continued, “Starting in their first year of seminary, Dad said that students should have clinical community-based educational experiences in churches, hospitals and other settings.” Granger Westberg’s legacy has been championed and expanded by Jane and his other daughter, Jill Westberg McNamara, who in 1990 coauthored The Parish Nurse: Providing a Minister of Health for Your Congregation with her father.

The Westberg Institute, located in Memphis, Tennessee has also continued his work training parish nurses. “Throughout scripture, God calls people of faith to healing,” the Westberg Institute’s website reads, “As an integral part of a healing ministry, faith community nursing is one of the best ways a congregation can promote health and wholeness.” After Westberg’s death, the Chicago Daily Herald estimated that more than 3,000 US nurses had been trained in parish nursing.

Today, the Parish Nursing movement provides a key to understanding the failures and achievements of the health care delivery system. Health care policy, as the current president quickly discovered, is complicated. Particularly when appropriate efforts must cross various service providers, like Medicare, Medicaid and other government entities, and attempt to simultaneously provide preventative care. When affordable housing, employment, accessible healthy food, and effective mental and drug addiction treatments are all necessary approaches to improving health care, institutions with limited resources and good intentions are most often left to make interventions that feel good, that sound good, but that do little to improve long-term health outcomes.

It’s not that the parish nursing movement is misguided, it’s that it lacks the muscle – or perhaps the will – to change policies that produce, for instance, homelessness, or unemployment, or any of the root problems faced by communities. The result can look a lot like the craven “prayer for porridge” programs of old. Prayer can be uplifting, but it won’t cure liver failure. And because parish nurses can lack a broader understanding of just how complex social service systems are, their efforts are limited to hearty prayer, warm coats, and immediate interventions that won’t cure longstanding and profound medical issues.

Furthermore, parish nursing is hindered by another structural flaw: the belief that charitable efforts can improve national health outcomes. Indeed, charity seems to be the go-to answer to today’s escalating poverty and all its attendant vagaries. Republican legislators like Paul Ryan, who ascribes to a Randian “you get what you deserve” philosophy that denies systemic inequality, have long harped on how community and faith-based charity are the answer to poverty, including health care inequality. He even penned an op-ed, with Wisconsin Republican Ron Jonson, for USA Today in 2016, that praises a charitable program, the Joseph Project, for bussing workers to their jobs, writing:

This is how you fight poverty: person to person. The Joseph Project is an example of what community leaders are doing across Wisconsin and America. They are developing homegrown solutions based on their neighbors’ unique needs — in this case, after noticing a shortage of workers in one place, a shortage of work in another. But to expand opportunity, the federal government needs to stop competing with these social entrepreneurs.

Notice what’s not mentioned in the op-ed: the federal policies—or lack thereof—that contribute to economic inequality. Instead Ryan prefers to consider the government as a benevolent business, charged with protecting its profit generators, businesses, and keeping its “competing” hands out of social services. Rather than address the root causes of poverty, legislators like Ryan emphasize local interventions that serves their laissez-faire ideology. (Of course no such local interventions regarding, say reproductive rights, would ever meet Ryan’s approval.) In this way, Ryan and his colleagues are able to simulate compassion for the ill without ever having to legislatively and meaningful address the policies and deregulation that have put so many Americans in crisis.

At the same time, Sessions-esque legislators are using their emphasis on charity as a cover for overt discrimination against minority groups defined by race, class, gender, sexual identity, or any other characteristic, like drug use, deemed politically expedient.

The crutch of charity is by no means used only by the right. Even left-leaning, tech-funded philanthropists, like Bill Gates, who buys immediate and limited relief for populations suffering from rising housing prices, for instance, lack the will or imagination to address political dysfunction. Government is seen as either too cumbersome or too dysfunctional to care for its people. By throwing bundles of cash at quick fixes rather than mass political and institutional change, they too are abetting a system predicated on feel-good works rather than lasting solutions.

Inadequately filling this compassionless maw are faith-groups, like parish nurses, left to rally whatever minimal resources they can from their generous congregations (and the government’s treacly faith-based condescension).

Today, Parish nursing is a “growing specialty” and it’s easy to understand why. On the demand-side of the equation, healthcare is increasingly becoming less affordable and less accessible at the same time that our elder population is rapidly increasing. And on the supply side, there aren’t enough doctors^[1] to go around—and nurses’ salaries are much lower than doctors’, making their employment more desirable to financially-strapped institutions.

What nurses are able to do, and do well, is get close to patients, something doctors can rarely offer with their high case loads and regulated billing hours. Nurses, particularly those embedded in grass-roots organizations like a church, can meet the needs of communities who lack health care (and the insurance or out-of-pocket wealth to access it), have minor health needs, and are on the front lines of medical access. Parish nursing makes a lot of sense in today’s medical landscape.

But what was made clear to me during my time in Deb’s little room is that no number of parish nurses can fill the void left in communities where gross inequality is created by a health care industry that has either abnegated its responsibility or been prevented by a callous government from fulfilling it. Deb may be efficient but she doesn’t have the resources the homeless around her suffer without—jobs, mental health care, rents that can be covered by unskilled (or even skilled) labor.

Healing a soul that has only a broken body for housing is a tall order. Our god may be awesome, but his mission to heal the sick is not getting through to Washington’s leaders, the only men (and a handful of women) too removed from the parish or the street to recognize their dire obligation.

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^[1]Although, some claim that the problem is not a shortage of physicians but their poor distribution.

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Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016) and a visiting scholar at The Center for Religion and Media, NYU.

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Published with support from the Henry R. Luce Initiative on Religion in International Affairs.