12.28.2013 SS - DR. PAUL BRAND; yancey

i spent the last 4 years of the 1960s as a college student.
everything in america seemed to be cracking apart then:
the vietnam war chiseled away at our national ideals,
revelations about abuse of the environment challenged the industrial ethic that had built our country
and the youth counterculture exposed the hollow materialism of business and the media.
the issues have since become familiar, even hackneyed,
but to those of us who were forming a view of the world then,
the sixties left a profound and permanent imprint.

i recall my emotions in the subsequent years as being primarily anger, loneliness and despair.
i saw bright and talented friends give up on society and seek a new path through LSD and mescaline.
others never came back from the jungles of vietnam.
i plodded through bleak existentialist novels
as well as nonfiction accounts of the Holocaust and the soviet Gulag.
looking at the church through such jaundiced eyes,
i saw mainly its hypocrisy and its irrelevance to the world outside.
although people like chesterton had led me back to God,
i was still having difficulty distinguishing God from the church
and cultivating a stable personal faith.
questions swirled.
even while editing a christian magazine i wrote books with titles like
where is God when it hurts,
unhappy secrets of the christian life, and
disappointment with God,
outward projections of my own struggles of faith.

i now see that my writing partnership with dr. paul brand helped me weather that volatile period.
i spent hundreds of hours interrogating him on global issues, life and God.
on trips to india and england i tracked his life, interviewing former patients and colleague...

i first learned about Br while writing Where is God when it hurts?
as i was holed up in libraries reading books on the problem of pain, my wife
while cleaning out the closet of a medical supply house,
came across an intriguing essay he had written on The gift of pain.
Br's approach, implied by the title itself,
had about it the paradoxical quality that had about it
the paradoxical quality that had so drawn me to Ch.
he had a different conception of pleasure and pain than any i had encountered.
i had interviewed scores of people who wanted desperately to get rid of pain;
Br told of spending several million dollars trying to CREATE a pain system for his patients.

as i inquired further and talked to people who knew Br personally,
i became so captivated that i called him out of the blue from chicago and asked for an interview.
'will, they keep me pretty busy here, he replied, a bit nonplussed. (render utterly perplexed).
'but i'm sure we could carve out some time in between meetings and clinics.
come ahead if you like.'

we met on the grounds of the only leprosarium in the continental U.S.
after flying to new orleans..i found the road that led to the backwater town of carville,
and then a smaller road that ended at the National hansen's disease hospital and research center.

louisiana authorities who founded the hospital situated it well away from population centers.
(due to myths about the disease, 'not in my backyard' sentiments
tend to reach a feverish pitch when a leprosarium is proposed.)
laid out in sprawling, colonial style under massive live oak trees,
carville resembled a movie set of a philippine plantation.
i could see patients on crutches and in wheelchairs
moving slowly along the double decker arched walkways that connected the major buildings.
surrounding the hospital on three sides were
a golf course and ball diamonds, a vegetable garden and an enclave of staff housing.
to the west lay the mighty mississippi, hidden from view by a 20' levee.
i opened the car door and stepped into a fog of delta humidity.

i knew of Br's stature in the world medical community in advance of my visit:
the offers to head up major medical centers in england and the US.'
the distinguished lectureships all over the world,
the hand surgery procedures named in his honor,
the prestigious albert lasker award,
his appointment as Commander of the Order of the british empire by queen elizabeth II,
his selection as the only westerner to serve on the mahatma gandhi foundation.
yet i awaited our interview  in a cubbyhole of an office hardly suggestive of such..
stacks of medical journals, photographic slides and unanswered correspondence
covered every square inch of an ugly government-green metal desk.
an antique window air conditioner throbbed at the decibel level of an unmuffled motorcycle.

finally a slight man of less than average height and stiff posture entered the room.
he had graying hair, bushy eyebrows and a face that creased deeply when he smiled.
in a british accent-a striking contrast to the bayou tones heard in hospital corridors
-he apologized for the flecks of blood on his lab cat,
explaining that he had just been dissecting armadillos,
the only nonhuman species known to arbor leprosy bacilli.

that first visit lasted a week.
i accompanied Br on hospital rounds, hugging corridor walls
to avoid  the whirring electric wheelchairs and bicycles customized with sidecars.
i at in the examination room as he studied the inflamed, ulcerated feet and hands of patients,
whom he quizzed like a detective in an effort to determine the injuries' cause.
we grabbed bits of conversation in his office, sometimes interrupted by a call from overseas:
a surgeon in venezuela or india or turkey shouting through the static to ask advice on a difficult procedure.

at night in their wooden bungalow on the hospital grounds,
i would share a rice and curry meal with Br and his wife, margaret a respected ophthalmologist.
then paul Br would prop up his bare feet (a trademark with him)
and i would turn on the tape recorder for discussions that ranged from leprology and theology
to world hunger and soil conservation.
every topic i brought up, he had already thought about in some depth
and his travels gave him a truly global perspective:
he had spent a third of his life in england, a third in india and now almost a third in the US.
during breaks he taught me such things as how to select a ripe fig
(watch the ones butterflies light on several times, testing),
how to stroke skin with a stiff hairbrush to stimulate nerve cells and relieve pain...

we made an odd couple, Br and i.
i was a young punk in my mid twenties with bushy art garfunkel-style hair;
Br was a dignified, silver haired surgeon characterized by proper british reserve.
in my role as a journalist i had interviewed many subjects:
actors, musicians, politicians, successful business executives, olympic and professional athletes,
nobel laureates and pulitzer prize winners.
something attracted me to Br at a deeper level than i had felt with any other interview subject.
for perhaps the first time, i encountered genuine humility.

Br was still adjusting to life in the US.
he worried about the impact of television and the popular music culture on his children.
everyday luxuries made him nervous and
he longed for the simple life close to the soil in village india.
when i talked him into going to a restaurant in the evening, he could hardly stand watching
the waste of food scraped uneaten off diners' plates.
he knew presidents, kings and many famous people,
but he rarely mentioned them,
preferring instead to reminisce about individual leprosy patients.
he talked openly about his failures
and always tried to deflect credit for his successes to his associates.
every day he rose early to study the bible and to pray.
humility and gratitude flowed form him naturally,
and in out time together i sensed a desperate lack of these qualities in myself.

most speakers and writers i knew were hitting the circuit,
packaging and repackaging the same thoughts in different books
and giving the same speeches to different crowds.
meanwhile Br, who had more intellectual and spiritual depth than anyone i had ever met,
gave many of his speeches to a handful of leprosy patients in the hospital's protestant chapel.
at the Br's insistence, i attended the wednesday evening prayer service during my week at carville.
if i recall correctly, there were 5 of us in the choir and 8 in the audience.
margaret Br had drafted me into the choir, pleading,
'we haven't had a male voice in ever so long.
paul is giving the sermon, so he's not available.
you simply must sing with us'.
she brushed aside my mild protests.
'don't be silly. half the people who attend are deaf
because of a reaction to a drug we use in treating leprosy.
but a guest chorister would be such a treat-they'll enjoy just watching you'.
to that motley crew, Br proceeded to deliver an address worthy of westminster abbey.
obviously, he had spent hours meditating and praying over that one semon.
it mattered not that we were a tiny cluster of half deaf nobodies in a sleepy bayou chapel.
he spoke as an act of worship, as one who truly believed that God shows up
when two or three are gathered together in god's name.

later that week Br admitted to me, somewhat shyly, that he had once tried writing a book.
some years before, when he had delivered a series of talks to a medical school in vellore, india,
other faculty members encouraged him to write them down for publication.
he made the effort, but the material filled only 90 pages, not enough for a book.
twenty years had passed, and he had not touched the manuscript since.
i persuaded him to dig through closets and bureau drawers
until he located the badly smudged third carbon copy of those chapel talks,
and that night i sat up long past midnight reading his remarkable meditations on the human body.
i was staying in the hospital's antebellum guest room
\and a ceiling fan periodically scattered the onionskin pages around the room.
i kept gathering them up and resorting them though, for i knew i had struck gold.
the next day i asked Br if we could collaborate and those 90 pages eventually became 2 full length books.

sometime later we worked on a third volume, The gift of pain.
in all i have spent almost 10 years following the threads of Br's life.
i have often felt like james boswell, who tailed the great man samuel johnson
and loyally recorded every morsel of wisdom that fell from his lips.
Br's daughter pauline once thanked me for bringing some order to
'the happy jumble of my father's life and thoughts'.
little did she know the role her father played
in bringing some order to the unhappy jumble of my own life.
true friends get their measure, over time, in their effect on you.
as i compare the person i was in 1975, on our first meeting
and the person i am now,
i realize that seismic changes have occurred with me, with Br responsible for many of those tremors.

Br is both a good and a great man
and i am forever grateful for the time we spent together.
at a stage when i had slight confidence to write about my own fledgling faith,
i had absolute confidence writing about his.
my faith grew as i observed with a journalist's critical eye a person
enhanced in every way by his relationship with god.
i came to know him as an actual living model whom i could watch in action:
at carville with his patients, in the villages of india, as a husband and father,
as a speaker at both medical and spiritual conferences.

after retiring from medical practice, Br moved to a small cottage overlooking puget sound in seattle,
the only home he has ever owned.
he served a few terms as president of the international christian medical and dental society,
consulted with the world health organization
and into his eighties has continued to lecture throughout the world.
as the years passed, our roles inevitably reversed.
he started calling me for advice on such matters as
which word processing software to use, how to organize notes and how to deal with publishers.
he suffered a stroke on a trip to turkey and a mild heart attack in london
(a sympathetic reaction to his wife's more serious hear attack).
for a time his speech slurred noticeably and his ability to recall names and events faded.
our conversation moved to issues of aging and mortality.

as i proceed through stages of life, now approaching Br's own age at the time of our first meeting,
before me i have his slight but strong figure showing me the way.
deprived of my own father in infancy, i received as an adult from Br much that i had missed.
as much as anyone, he has helped set my course in outlook, spirit and ideals.
i look at the natural world and environmental issues, largely through his eyes.
from him i also have gained assurance that the christian life i had heard in theory
can actually work out in practice.
it is indeed possible to live in modern society, achieve success without forfeiting humility,
serve others sacrificially and yet emerge with joy and contentment.
to this day, whenever i doubt that, i look back on my time with paul brand.

is the universe a friendly place? einstein asked.
a scientist, he searched for an answer in the vast reaches of the cosmos.
anyone who has survived the wounds of a dysfunctional family or church
knows the more personal side of that question.
an uncle or perhaps a priest, sexually abuses a young child;
a mother flies into an alcoholic rage;
a six year old sibling contracts leukemia.
for one who grows up in such an environment, the questions never go away.
is the world a friendly place?
can people be trusted?
can God?

i need not brood long over my own childhood to recognize
these fundamental questions gnawing at my soul.
in adolescence, as i read books like sartre's nausea, camus's the plague and wiesel's night,
i had little reason for optimism.
and then i found myself collaborating with a man who had spent much of his life
among the most mistreated human beings on the planet.
unexpectedly, instead of intensifying my questions, Br pointed toward something of an answer.

Br achieved fame in the medical world mainly through his pioneering research on
the world's oldest and most feared disease.
before moving to the carville hospital, he had directed a large medical college and hopital in vellore, india
and founded a leprosy center known as karigiri.
leprosy disproportionately affects the poor.
left untreated, its victims can develop the facial disfigurement, blindness and loss of limbs
that so frighten people,
who in turn respond with abuse and mistreatment.
in a place like india, people with leprosy are the outcasts of society,
often doubly so as members of the untouchable caste.

in biblical times leprosy victims kept a wide berth and shouted 'unclean!' if anyone approached.
in medieval times they lived outside town walls and wore warning bells.
even today in modern india, home to 4.000,000 leprosy victims,
a person showing signs of the disease my be kicked-literally with a shoe-out of family and village
to lead a beggar's life.
interviewing Br's former patients, i heard stories of human cruelty almost beyond belief.
if anyone has a right to bitterness or despair, it should be someone who works with these unfortunates.
instead, the single characteristic that most impressed me about Br was his bedrock sense of gratitude.
for him, the universe is assuredly a friendly place.

i remember well our first conversation, for somehow i neglected the press the red 'record' button
on the cassette recorder i was using.

that evening, after discovering the error, i took a ferry across the mississippi, sat in a crayfish's cafe
and frantically tried to recall our conversation.
i had a list of all my questions and his answers had so impressed me
that  i found i could construct them almost verbatim.
\as i dipped into the basket of shiny red crustaceans with one hand,
i feverishly wrote down everything i remembered with the other,
occasionally dripping drawn butter on my notebook pages.

how could a good God allow such a blemished world to exist?
Br had responded to my complaints one by one.
disease?
did i know that of the 24000 species of bacteria, all but a few hundred are healthful, not harmful?
plants could not produce oxygen nor could animals digest food without the assistance of bacteria.
indeed, bacteria constitute half of all living matter.
most agents of disease, he explained, vary from these necessary organisms in only slight mutations.

what about birth defects? he launched into a description of the
complex biochemistry involved in producing one healthy child.
the great wonder is not that birth defects occur but that millions more do not.
could a mistake proof world have been created so that the human genome with its billions of variables
would never err in transmission?

no scientist could envision such an error free system in our world of fixed physical laws.

'i've found it helpful to try to think like the creator, Br told me.
'my engineering team at carville has don just that.
for several years our team worked with the human hand.
what engineering perfection we find there
i  have a bookcase filled with surgical textbooks
that describe operations people have devised for the  injured hand:
different ways to rearrange the tendons, muscles and joints,
ways to replace sections of bones and mechanical joints -thousands of surgical procedures.
but i know of no procedure that succeeds in improving a normal hand.
for example, the best materials we use in artificial joint replacements
have a coefficient of friction one fifth that of the body's joints
and these replacements only last a few years.
all the techniques correct the deviants,
the one hand in a hundred that is not functioning as God designed.
after operating on thousands of hands, i must agree with isaac newton:
'in the absence of any other proof, the thumb alone would convince me of god's existence.'.

i kept proposing exceptions and Br dealt with each.
even at its worst, he continued, our natural world shows evidence of careful design.
like a tour guide at an art museau, he excitedly described the beautiful way torn muscle filaments reconnect,
'like the teeth of interlocking combs', after an injury.
'and do you know about the ductus arteriosus?
a bypass vessel, it routes blood directly to a developing fetus's extremities, instead of to the lungs.
at the moment of birth, suddenly all blood must pass through the lungs
to receive oxygen because now the baby is breathing air.
in a flash, a flap descends like a curtain, deflecting the blood flow
and a muscle constricts the ductus arteriosus.
after performing that one act, the muscle gradually dissolves and gets absorbed by the rest of the body.
without this split second adjustment, the baby could never survive outside the womb.

our conversation was the first of many anatomy lessons i would receive from Br.
his ability to recall what he had studied in medical school 30 years before impressed me, certainly,
but something else stood out: a childlike enthusiasm, an ebullient sense of wonder at God's good creation.
listening to him, my own chestertonian sense of wonder reawakened.
i had been focusing on the apparent flaws in creation;
this doctor who spent all day working with those flaws had instead an attitude of appreciation, even reverence.
that attitude, i would learn, traced back to a childhood spent close to nature.

son of missionary parents in the remote hill country of india,
Br grew up in a world of tropical fruit trees,and of butterflies, birds, and other animals.
his artistic mother tried to capture its beauty with her paints.
his father, jesse, a self taught naturalist, saw everywhere in nature the fingerprint of the creator.
he would lead his son to a towering termite mound and explain the marvels of cooperative termite society:
'10,000 legs working together as if commanded by a single brain, all frantic
except the queen, big and round as a sausage, who lies oblivious, pumping out eggs'.
he would point to the sandy funnel of an ant lion trap or the nest of a weaver bird,
or a swarm  of bees hanging from a tree branch.
paul did his school lessons in a tree house high up in a jackfruit tree
and sometimes studied at night by the throbbing light of a firefly jar.

education interrupted Br's paradise when he was sent to england at the age of nine.
five years later,a teenager far from family and home,
he received a telegram announcing that his father had died of blackwater fever.
a letter soon arrived, mailed by ship weeks before his father's death,
which became for him a kind of final legacy.
jesse Br described the hills around their home and concluded,
'God means us to delight in His world.
it isn't necessary to know botany or zoology or biology in order to enjoy the manifold life of nature.
just observe. and remember. and compare. and be always looking to God with thankfulness and worship
for having placed you in such a delightful corner of the universe as the planet earth'.

jesse Br's son kept his advice and keeps it to this day;
whether hiking on the olympic peninsula or staling birds in the swamps of louisiana
or lecturing to medical students about the wonders of the bodies they will be treating.
first in the hills of india and later through his study of the human body,
he came to realize that the natural world conceals traces of God
and the God he found there was good.
it was a message i needed, from a messenger i learned to trust.

Br's career centered on perhaps the most problematic aspect of creation, the existence of pain.
i was writing the book Where is God when it hurts:
he invited me to consider an alternative world without pain.
he insisted on pain's great value,
holding up as proof the terrible results of leprosy
-damaged faces, blindness and loss of fingers, toes, and limbs
-ALL OF WHICH OCCUR AS SIDE EFFECTS OF PAINLESSNESS.
as a young doctor in india, Br had made the groundbreaking medical discovery that leprosy does its damage
merely by destroying nerve endings.
people who lose pain sensation then damage themselves by such simple actions
as gripping a splintered rake or waring tight shoes.
pressure sores form, infection sets in and no pain signals alert them to end to the wounded area.
i saw such damage firsthand in Br's clinics.

'i thank God for pain, Br declared with the utmost sincerity.
'i cannot think of a greater gift i could give my leprosy patients'.
he went on to describe the intricacies of the pain system that protects the human body.
it takes firm pressure on a very sharp needle for the sole of the foot to feel pain,
whereas the cornea of the eye senses one thousandth as much pressure,
calling for a blink reflex when a thin eyelash or speck of dust brushes the surface.
intestines do not sense pain from being cut of burned
-dangers these internal organs do not normally confront
-yet they send out the urgent pain signal of colic when distended.

'we doctors experience a rude awakening after medical school, Br continued.
'after studying the marvels of the human body,
suddenly i was thrust into a position much like the complaint desk of a department store.
not once did a person visit my office to express appreciation for a beautifully functioning kidney of lung.
they came to complain that something was not working properly.
only later did i realize that the very things they complained about were their greatest allies.
most people view pain as an enemy.
yet, as my leprosy patients prove, it forces us to pay attention to threats against our bodies.
without it, hear attacks, strokes, ruptured appendixes and stomach ulcers
would all occur without any warning.
who would ever visit a doctor apart from pain's warnings?

'i noticed that the symptoms of illness my patients complained about were actually a display of bodily healing at work.
virtually every response of our bodies that we view with irritation or disgust
-blister, callus, swelling, fever, sneeze, cough, vomiting and especially pain-
demonstrates a reflex toward health.
in all these things normally considered enemies, we can find a reason to be greateful'.

i had often puzzled over the bible's dramatic scene when Job, the prototype of innocent sufferers,
confronts God with his complaints about suffering.
the speech God gave in reply has endured as one of the great nature passages in literature,
a superb celebration of wildness.
to the problem of pain itself, however, God gave no direct answer, only this challenge to Job:
if I, as Creator, have produced such a ma4rvelous world as this,
which you plainly observe,
can you not trust Me with those areas you cannot comprehend?

as i listened to Br,i realized that i had been approaching God like a sick patient
-as if the creator were running a complaint desk.
i anguished over the tragedies, diseases, and injustices,
all the while ignoring the many good things surrounding me n this world.
was it possible, i wondered, to retain a chestertonian enthusiasm for
the marvels of the natural world despite its apparent flaws?
like the psalmists, could i learn to praise and lament at the same time,
with neither intonation drowning out the other?

Br responded to this same dilemma with a twin spirit of gratitude and trust
-gratitude for those things he could see and appreciate
and trust regarding those things he would not.
i remembered Ch's description of an 'ordinary' person who accepts the world as a gift,
the proper response to which is gratitude.
to Br's surprise, faith in God's trustworthiness deepened
even as he worked among people least likely to feel gratitude,
leprosy victims in india, cause he saw transformations in the lowest of the low
resulting from simple compassion and a healing touch.

as i began working with Br and following him around the world,
i met many other dedicated christians who devote their lives to healing the wounds of humanity.
in india, for example, where less than 3 percent of the population claims to be christian,
nearly a fifth of all medical work is performed by christian doctors and nurses,
many of them trained at Br's old hospital in vellore.
i accompanied them on mobile visits to villages,
where they treated tropical infections, set bones and performed minor surgery,
often outdoors under a tamarind tree.
they served hindus, moslems, sikhs, jains, parsis, and communists alike.
if you say the word 'christian' to an indian peasant-who may never have heard of Jesus Christ
-the first image to pop into his mind may well be that of a hospital, or of a medical van
that stops by his village once a month to provide free, personal care.

watching these people serve in difficult conditions with low pay and few benefits,
i saw a sharp contrast between their approach and my own.
i sat home in chicago and wrote books demanding answers from God about the problems of this world.
they volunteered for the front lines in a truly incarnational response.
like the Br.s, they showed a level of personal fulfillment and even happiness
that i had not found among many famous people i had interviewed.

i learned that part of the answer to my question, 'where is God when it hurts?
is a related question: where is the church when it hurts?
as the jewish theologian abraham heschel wrote, 'the cardinal issue,
why does the God of justice and compassion permit evil to persist?

is bound up with the problem of how man should aid God so that His justice and compassion prevail'.
from the gentle touch of health workers like paul and margaret brand, leprosy patients in india have learned
that cast is not fate and disease is not destiny
and in that some touch many first sense the tactile reality of God's own love.

although i have great respect for dr. Br and his service to God,
i also confess relief that he is not a 'saint out of the mold of francis of assisi or mother teresa.
i needed an up close model of someone i could relate to more naturally.

paul Br consulted with mother teresa, served on committees with gandhi's disciples
and knew some of india's traditional 'holy men'.
in his own life, however, he chose the middle way of balancing off the material and the mystical,
the prophetic and the pragmatic.
older acquaintances at the hospital in vellore remember him
not only for his spiritual dept and sacrificial service
but also for his practical jokes, love for marmalade and mangoes and fast driving.
as i emerged from the 1960s, a decade never accused of a sense of balance,
i needed an example of someone who lived a well rounded life in the midst of modern society,
not off in a monastery or ashram.

Br has struggled with the tensions facing modern civilization while not yielding to either side.
on the one hand, he lived a counter culture lifestyle long before such a phrase entered the vocabulary.
in india he insisted on receiving indian wages, not the much higher amount usually granted foreign doctors.
the Br.s have always eaten simply, relying mainly on homemade breads
and vegetables grown in their organic garden.
dr. Br acknowledges a few reasons for discarding clothes-unpatchable rips, for instance
-but lack of stylishness is certainly not one of them.
furniture in his home and office is, to put it kindly, unpretentious.
he opposes wast in all forms.

Br admits he would shed no tears personally
if all advances from the industrial revolution suddenly disappeared;
he prefers village life in india, close to the outdoors.

on the other hand, he has learned to use the tools made available by modern technology.
under his leadership, a hospital in the dusty town of vellore
grew into the most modern and sophisticated facility in all of southwest asia.
later, Br came to carville in the US because that research center offered
the technological support needed to benefit millions of leprosy patients worldwide.
and when personal computers were introduced in the 1980s,
he signed up with boyish enthusiasm for one of the first IBNs.
he gratefully uses electron microscopes and thermograms and jet planes,
believing that technology's tools used wisely and not destructively
can serve the higher goal of human compassion.

my conversations with Br have often strayed to the question of lifestyle,
for his experiences in india, england and america have afforded him a unique perspective.
he has lived in one of the poorest counties and two of the richest.
affluence in the west, he recognizes, offers a deadly temptation.
the enormous gap in wealth can widen the moat separating the west from the rest of the world,
dulling us to the cries of need and justice.

the lifelong tension over lifestyle traces back to Br's childhood in india.
after her husband's death from blackwater fever, paul's mother
took on the style of a saint in the traditional sense.
she lived on a pittance, devoting her life to bringing physical and spirual healing
to villagers in 5 mountain ranges.
she cared nothing for her personal appearance, to the extent of banning all mirrors from her house.
she continued making hazardous journeys on her pony
even after suffering concussions and fractures from falls.
although tropical diseases ravaged her own body,
she gave all her energies to treating the diseases and injuries of the people around her.
sometimes 'granny Br' would embarrass paul with an intemperate outburst;
at an official dinner in vellore, for example, she might ask in horror,
'how could you possibly dine on such fine food when i have people back in the hills starving to death
this very night!
she died at age 95 and at her funeral thousands of villagers
walked for miles to honor her in the chapel her husband had built by hand.

from his parents paul learned the enduring lesson that love can only be applied person to person.
they left behind few lasting institutions,
only their permanent imprint on thousands of lives to whom they had taught
health, sanitation, farming and the christian gospel.
single handedly, granny Br rid huge areas of a guinea worm infection that had persisted for centuries.
she had earned such trust that villagers followed her instructions on building stone walls
around the open wells where the larvae bred;
no government program had been so effective.

yet her son, paul Br, made his most lasting impact through rigid scientific disciplines.
at vellore he fought his wife, margaret, for space in the icebox,
preserving cadaver hands on which he could practice surgical techniques by lamplight.
for years he puzzled over the physiology of leprosy symptoms:
which cells does it attack and why?
the answer, his most important medical discovery,
came during an autopsy, when he concluded that the leprosy bacillus only attacked nerve tissue.
proving that theory required more years of research,
in which he had to identify the precise cause of every patient's injuries.
the results of such research had a dramatic effect
on the treatment of leprosy and other anesthetic diseases worldwide.
fifteen million victims of leprosy gained hope that, with proper care,
they could preserve their toes and fingers and eyesight.
later, he applied the same principles to the insensitive feet of diabetics helping to prevent,
by one estimate, seventy thousand amputations annually in the US alone.

Br told me of a comment made by mother teresa as he consulted with her on a leprosy clinic she was opening in calcutta.
'we have drugs for people with diseases like leprosy, she said.
'but these drugs do not treat the main problem, the disease of being unwanted.
that's what my sisters hope to provide'.

in one of our conversations, Br mused on why there are christian missions
devoted exclusively to leprosy.
much of his work in india was funded by the leprosy mission of england,
sister organization to the american leprosy mission.
'i know of no arthritis mission of diabetes mission', he said.
'the answer, i think, relates to the incredible stigma that has surrounded leprosy for so many centuries.
to work with leprosy required more than a natural instinct of compassion;
it required a kind of supernatural calling.
people such as father damien, who ministered to leprosy patients in hawaii
and then contracted the disease himself,
believed that human beings, no matter what their affliction, should never be cast aside.
it was up to the church to care for the sick, the unwanted, the unloved'.

as i studied the history of leprosy in my writings with Br, i got acquainted with the saintly few who,
defying society's sigma,
looked past the unsightly symptoms and ministered to leprosy's victims.
as the disease ravaged europe during the middle ages,
orders of nuns devoted to lazarus, the patron saint of leprosy,
established home for patients.
these courageous women could do little by bind wounds and change dressings,
but the homes themselves, called lazarettos, may have helped j
break the hold of the disease in europe, by isolating  leprosy patients and improving their living conditions.
in the  nineteenth and twentieth centuries christian missionaries who spread across the globe
established colonies for leprosy patients,
and as a result most of the major scientific advances in treating leprosy came from missionaries.

the carville hospital itself (recently closed in a government cost saving measure)
has a history typical of leprosy work worldwide.
the first 7 patients, chased out of new orleans,
were smuggled by authorities up the mississippi on a coal barge,
since 19th century laws forbade people with leprosy from traveling on any form of public transportation.

they landed at an abandoned, rundown plantation, which the state of louisiana had quietly procured.
a few slave cabins were still standing, populated mainly by rats, bats and snakes.
the 7 patients moved into the 'louisiana leper home',
but the state had difficulty recruiting workers for the leprosarium
until finally the daughters of charity, an order of catholic nuns, volunteered.
these women, nicknamed 'the white caps', did much of the initial labor.
rising 2 hours before daylight to pray, wearing starched white uniforms in the bayou heat,
the nuns drained swamps, leveled roads  and repaired buildings for the new leprosarium.
their successors were still serving at carville when i visited Br there.

in india, a melting pot of religions, Br observed how other religions responded to the problem of pain.
buddhists taught a serene acceptance of suffering,
an attitude that we in the hypochondriacal west could surely learn from.
hindus and muslims often faced suffering with a spirit of fatalism:
to the hindu it results from sins of a former life and it is the will of allah to the muslim.
in contrast, christianity has traditionally responded with the paradox modeled by Jesus:
we must trust the goodness of God despite the suffering and injustice we see around us
and yet do all we can to relieve it during our days on earth.
paul Br gave me a living example of that response.

in his twilight years, dr. Br has accepted many invitations from medical schools
that want him to address the dehumanization of medicine.
today, high tech medicine, HMO insurance policies and increasing specialization
conspire to squelch the very instincts that draw many of the best students into the field.
Br expresses the guiding principle of his medical career this way:
'the most precious possession any human being has is his spirit
-his will to live, his sense of dignity, his personality.
though technically we may be concerned with tendons, bones and nerve endings,
we must never lose sight of the person we are treating'.

although our conversations together cover a broad range of topics,
inevitably they drift back to stories of individuals, Br's former patients.
most often, these patients are the forgotten people,
ostracized from family and village because of their illness.
a medical staff can repair much of the physical damage.
they can also provide that most basic human need, touch.
but what can they do for the spirit of the patient, the corroded self image?
for hours at a time i have sat and sistened to Br tell me stories of these patients and their families
and the extraordinary treatment they got in the karigiri leprosarium.
i am amazed that an orthopedic surgeon knows so much about patients he treated decades before,
and more amazed at the tears that freely flow as he tells their stories.
quite obviously, they made as great an impression on him as he made on them.

it takes a few pennies a day to arrest leprosy's progress with sulfone drugs.
it takes thousands of dollars, and the painstaking care of skilled professionals,
to restore to wholeness a patient in whom the disease has spread unchecked.
Br began with the rigid claw hands, experimenting with tendon and muscle transfers
until he found the very best combination to restore a full range of movement.
the surgeries and rehabilitation stretched over months and sometimes years.
he applied similar procedures to feet,
correcting the deformities cause by years of walking without  a sense of pain
to guide the body in distributing weight and pressure.

restored feet and hands gave a leprosy patient the capability to earn a living,
but who would hire an employee bearing the scars of the dread disease?
Br's first patients returned to him distraught, asking him to reverse the effects of surgery
so that they could return to begging, a profession that exploited obvious deformities.
paul and margaret Br worked together to correct that cosmetic damage.
they learned to remake a human nose by entering it through the space between gum and upper lip,
stretching out the skin and most lining,
then building up a new nasal structure from the inside with bone transplant.
they sought to prevent blindness by restoring the ability to blink.
leprosy deadens the tiny pain cells that prompt a healthy person to blink several times a minute
and eventually the dryness leads to blindness.
margaret learned to tunnel a muscle that is normally used for chewing up under the cheek
and attach it to the upper eyelid.
by chewing gum all day long, her patients simultaneously moved their eyelids up and down,
lubricating the eyes and thus averting blindness.
finally, the Br.s replaced lost eyebrows on the faces of their patients
by tunneling a piece of scalp, intact with its nerve and blood supply, under the skin of the forehead
and sewing it in place above the eyes.
the first patients proudly grew their new eyebrows to enormous, bushy lengths.

all this elaborate medical care went to 'nobodies',
victims of leprosy who had mostly made their living from begging.
many who arrived at the hospital barely looked human.
their shoulders slumped, they cringed when other people approached
and the light had faded from their eyes.
months of compassionate treatment from the staff at karigiri
could return that light to their eyes.
for years people had shrunk away from them in terror;
at karigiri nurses and doctors would hold their hands and talk to them.
unrevolted, unafraid, the staff listened to the new patients' stories, and used the magic of human touch.
a year or so later these patients, lazarus like, would walk out of the hospital
and proudly head off to learn a trade.

as Br reflects now, the process of following patients through the full rehabilitation cycle
ultimately challenged his whole approach toward medicine.
somewhere, perhaps in medical school, doctors acquire an attitude that seems suspiciously like hubris:
'oh, you've come just in time.
count on me.
i think i'll be able to save you.'
working at karigiri stripped away that hubris.
no one could 'save' leprosy patients.
the staff could arrest the disease, yes, and repair some of the damage.
eventually, however, every leprosy patient had to go back and against overwhelming odds,
attempt to build a new life.
Br began to see his chief contribution as one he had not studied in medical school:
to join with his patient as a partner in the task of restoring dignity to a broken spirit.
'we are treating a person, not a disease', he says.
'that is the true meaning of rehabilitation.'

the great societies of the west have been moving away from an underlying belief
in the value of a single human soul.
we tend to view history in terms of groups of people:
classes, political parties, races, sociological groupings.
we apply labels to each other
and explain behavior and ascribe worth on the basis of those labels.
after prolonged exposure to dr. Br,
i realized that i had been seeing large human problems in a mathematical model:
percentages of gross national product, average annual income,
mortality rate, doctors per thousand of population.
love however is not mathematical;
we can never precisely calculate the greatest possible good
to be applied equally to the world's poor and needy.
we can only seek out one person and then another and then another, as objects for God's love.

...on my last trip to india with paul Br, in 1990, he showed me his childhood home in the kolli malai mts.
our jeep ascended a remarkable highway featuring 70 switchbacks
(each neatly labeled:38/70,39/70,40/70).
a motorcycle passed us, a woman passenger clinging to the back of its driver, her sari flowing out behind her like a flag.
the hairpin curves stirred Br's memories.
'there was no highway then, he said.
'as a child i rode in a canvas contraption slung from porters' shoulders on bamboo poles.
when i grew old enough to walk, i used to totter along at eye level with the porters' legs.
i watched for the tiny leeches that would leap from the shrub,
fasten to those legs and swell with blood.

on this trip, however, we worried more about overheating the radiator than about leeches.
finally the road leveled off  and wound across a high plateau,
giving us spectacular views of the verdant green rice paddies below and the pale, curvy lines across the horizon that marked other mountain ranges in the distance.
then the asphalt ended and the road dove down into a small valley.
gravel gave way to dirt, then to a pair of ruts running along a line of eucalyptus trees.
we followed  the ruts for half an hour without seeing a single person
and i began to wonder if our diver had lost his way.

suddenly the jeep crested a small hill and an amazing sight met us.
150 people were waiting alongside the road-and had been waiting , we soon learned, for 4 hours.
they surrounded our car, greeting us in the traditional indian fashion,
palms held together, head bowed.
women, colorful as tropical birds in their bright silk saris, draped floral leis around our necks
and led us to a feast spread on banana leaves.
after the meal everyone crowded into the mud walled chapel built by paul Br's father
and treated us to an hour long program of hymns, tributes and ceremonial dances.

i remember one speech especially, by a woman who spoke of paul's mother.
'the hill tribes didn't practice abortion, she said.
'they disposed of unwanted children by leaving them beside the road.
granny brand would take in these children, nurse them back to health,
rear them and try to educate them.
i was one of the unwanted ones, left to die.
there were several dozen of us, but she treated it more like an adoption center than an orphanage.
we called her Mother of the Hills.
when i did well in studies, he paid for me to go off to a proper school
and eventually i earned a master's degree.
i now teach nursing at the university of madras,
and i came several hundred miles today to honor the
Br.s for what they did for me and many others.'

after he had made a little speech and wiped away the tears,
dr. Br led me outdoors to see the legacy his parents had left.
he pointed out the hand sawn wooden house his father had build,
capping the stilts with upside down frying pans to foil the termites.
a clinic was still functioning, along with a school
-his parents founded nine in the hills-and carpentry shop.
citrus orchards spread out across the hills,
one of granny br's pet agricultural projects.
her husband, jesse, had set up half a dozen farms for
mulberry trees bananas, sugarcane, coffee and tapioca.
paul kept remarking on how tall the jacaranda trees had grown
since his father planted them 7 decades before.
their fallen lavender blossoms carpeted the ground.
when the time came to leave, he took me to the site of his parents' graves,
just down the slope from the bungalow where he grew up.
'their bodies lie here, but their spirit lives on, he said.
just look around you.

paul chose a different course in life than his general missionary parents,
becoming an orthopedic surgeon.
in order to see his legacy, i visited his former patients.
one man, namo, had a 20 year old photo of Br on his wall,
captioned MAY THE SPIRIT THAT IS IN HIM LIVE IN ME.
when namo told me his story, i could easily understand the affection he feels for his former surgeon.

as a youth namo had to leave university in the middle of his final year;
telltale patches of leprosy had appeared on his skin
and his hand was retracting into a claw position.
rejected by his school, his village, and finally his family,
namo made his way to the leprosarium in southern india
where a young doctor was trying out some experimental hand surgery techniques.
there were 4,000,000 people with leprosy in india and 15,000,000 worldwide,
but Br was the only orthopedic surgeon attempting to treat their deformities.

namo recalled that dark day:
'i was so angry at my condition i could hardly speak.
stuttering, i told dr. Br my hands were now useless to me.
soon my feet would be too.
for all i cared, he could cut them off.'
namo made a slashing motion with one hand across his other wrist.
'anyway, he could do anything he wanted if he thought he might learn something'.

fortunately, namo was wrong about his prognosis.
drugs halted the spread of the disease.
and after undergoing a painstaking series of surgical procedures over a five year period,
he regained the use of his hands and feet.
he took training in physiotherapy, began working with other leprosy patients,
and went on to become chief of physical therapy at the All India Institute.

later that day i visited sadan, another former patient.
he looked like a miniature version of gandhi:
skinny, balding, with thick spectacles, perched cross legged on the edge of a bed.
the door to his modes apartment was open and small birds flew in and out.
a mangy dog lounged on the step.
sadan showed me his feet, which ended in smooth, rounded stumps instead of toes.
'i met the brands too late to save these, he said.
'but they gave me shoes that Let me walk.

in a high pitched, singsong voice sadan told me wrenching stories of past rejection:
the classmates who made fun of him in school,
the driver who forcibly threw him off a public bus,
the many employers who refused to hire him despite his raining and talent,
the hospitals that turned him away with a brusque
'we don't treat lepers here'.

'when i got to vellore, i spent the night on the Br's veranda, because i had nowhere else to go.
that was unheard of for a person with leprosy back then.
i can still remember when dr. Br took my infected, bleeding fee in his hands.
i had been to many doctors.
a few had examined my hands and feet from a distance,
but drs. paul and margaret were the first medical workers who dared to touch me.
i had nearly forgotten what human touch felt like.
even more impressive, they let me stay in their house that night
and this was when even health workers were terrifiied of leprosy'.

sadan then encounted the elaborate sequence of medical procedures
-tendon transfers, nerve strippings, toe amputations and cataract removal
-performed by the Br.s.
 by transferring tendons to his fingers, they made it possible for him to write again,
and now he kept accounts for a program that gave free leprosy care through 53 mobile clinics.
he spoke for half an hour.
his past life was a catalog of human suffering.
and the stigma continues to this day:
just recently he had sat in a car alone and watched his daughter's wedding from a distance,
afraid his presence would disturb the guests.

as the Br.s and i sipped our last cup of tea in his home,
just before leaving to catch a plane to england, sadan made this astonishing statement:
'still, i must say that i am happy that i had this disease'.
'happy?' i asked, incredulous.
'yes, replied sadan.
'apart from leprosy, i would have been a normal man with a normal family,
chasing wealth and a higher position in society.
i would never have known such wonderful people as dr. paul and dr. margaret
and i would never have known the God who lives in them'.

two days later, our reception in england made for a striking contrast
to the royal welcome we had received in india.
there, too, Br and i retraced the steps of his past.
we visited the ancestral home where his missionary parents had spent their furloughs.
his mother had come from wealth and the house, located in one of london's better neighborhoods,
was easily worth a million dollars.
its upper class occupant came out to see what we were staring at
and Br treated her to a room by room tour,
describing how the house used to look 60 years before.

that afternoon we stood on the hospital roof where
as a medical resident he had fie watched during the german bombings.
no one garlanded us with leis and no one gathered around us to sing hymns and give testimonials.
to the guards and staff workers at the hospital,
Br was a confused old man interfering with their work.
offices had moved, wings had been torn down, security procedures set in place.
in the setting of his early medical career Br seemed, if anything an anachronism.
we wandered from receptionist to receptionist at university college hospital
inquiring after former faculty colleagues.
'who? could you spell that name?
was the typical response.
finally, in a darkened hallway, we found a row of photos of some of Br's teachers
-doctors who were as famous in their day as christian barnard or c. evrett koop are in ours.

i caught myself wondering how paul Br's career
might have played itself out had he stayed in london.
even working in a remote indian village among outcast leprosy patients,
he had achieved world renown.
if he had stayed in a research capacity at a well equipped laboratory,
who knows what honors might have come his way.
a nobel prize perhaps?

but what then?
his picture would join the others in the darkened hallway, now dusty and beginning to yellow.
his name, like theirs, would appear as a footnote in the medical textbooks.
fame in the annals of medicine rarely lasts long;
microsurgery techniques have already outdated most of the procedures
considered breakthroughs in  Br's youth.
in contrast, his work as a missionary surgeon in india continues to bear fruit,
in the transformed lives of name and sadan and hundreds like them.

coming so close together, the encounters in india and england became for me a kind of parable
contrasting the transience of fame with the permanence of investing in service to others.
whether we live out our days in india or england or clarkston, georgia,
the rue measure of our worth will depend not on a curriculum vitae
or the inheritance we leave,
but on the spirit we pass on to others.
'whoever finds his life will lose it and whoever loses his life for My sake will find it,
said Jesus in His proverb most often repeated in the gospels.
each career path offers its own rewards.
but after sitting with Br in the homes of namo and sadan
and then touring the Hall of Fame at the Royal College of Surgeons,
i had no doubt which rewards truly last.

in one of our last conversations, dr. Br turned reflective.
'because of where i practiced medicine, i never made much money at it.
but i tell you that as i look back  over a lifetime of surgery,
the host of friends who once were patients bring me more joy than wealth could ever brig.
i first met them when they were suffering and afraid.
as their doctor, i shared their pain.
now that i am old, it is their love and gratitude
that illuminates the continuing pathway of my life.
it's strange-those of us who involve ourselves in places where there is the most suffering,
look back in surprise to find that it was there that we discovered the reality of joy'.
he then quoted another saying of Jesus:
'happy are they who bear their share of the world's pain:
in the long run they will know more happiness than those who avoid it'. (translation by j.b.phillips)