Working at a hospital in Sierra Leone is a far cry from the well-funded modern medical facilities in America, but for graduates James and Rachel Fernando, Union College planted a seed that grew into a calling the two now live daily serving this African community. 

The Fernandos work at Waterloo Hospital, where James is a family medicine doctor. Rachel is a part-time physician assistant in the female ward of the hospital, sometimes helping on the children’s ward. Their journey together began at Union.

James wanted a way to turn his passion for mission trips into a career. So he enrolled in Union College’s International Rescue and Relief program on the pre-med track, knowing that being a doctor could help him reach his missionary goals.

While at Union, he met physician assistant student Rachel O’Hare. She didn’t initially share James’ yearning to be a missionary. In fact, she recalls watching friends embark on student missionary journeys.

“I have very clear memories of thinking that was not for me—I was not called to go overseas,” she said. But, over time, serving as a missionary became her dream too.

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 said. “Union is very mission-oriented, and the spiritual atmosphere was strong. It fostered growth in me. The relationships we built there changed our lives.”

After graduating, the two married and moved to Loma Linda University so James could complete medical school. With overseas missions their ultimate goal, they signed up for the Deferred Mission Appointee program, which matches graduates with mission opportunities. The program repays a portion of participants’ student loans, making it possible for recent graduates to pay for their education and live their calling. 

Shortly after James completed his residency, the Fernandos received a call. They signed on for an initial five-year stint, and within weeks they were on a plane to their new home in Sierra Leone.

Both say that the education they received while at Union has made their professional lives easier. “A lot of the things I learned in the IRR program that may not have been useful stateside have really helped, and I’ve found good use for my education here,” James said. “Practicing medicine in this environment is a whole different world than so much of what we learned in medical school.”

Life can be hard, and money is tight. Waterloo Hospital receives no government support for finances or supplies, despite seeing nearly 10,000 patients a year.

While the hospital is close to the country’s capital, endemic poverty strains the system. “More than 70 percent of our patients can’t pay their entire bill,” James said. “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 their inability to pay keeps many from seeking early medical intervention. The hospital never turns away patients based on their inability to pay, though, even though that adds to the financial strain.

Still, the Fernandos find joy in the little victories, and they appreciate the network of support they have while overseas. “Going to Union really helped us connect with people of a similar mindset,” James said. “We lean on those contacts with like-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 two American Adventists in the entire country of Sierra Leone, they say they’ve watched missionaries from other denominations struggle without similar support or connections.

Along with his daily patient-care duties, one of James’ main goals is educating local healthcare 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 said. “Education is the thing that will outlast us here if we can pass on that knowledge.” 

He admits that witnessing is also an important factor of their work. 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 said. “There are a lot of opportunities here.”

Rachel said that lessons she learned while at Union often echo in her daily work. “Pastor Rich 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 said. “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.”

Follow the Fernandos’ journey on their blog,

To learn more about Waterloo Hospital and to support its mission, visit or

Lauren Schwarz is a Union College graduate and freelance author based in Bozeman, Montana.