Fearfully and Wonderfully

by Dr. Paul Brand

  I think of my own mother, from a society home in suburban London, who went to India as a missionary. When Granny Brand, as she was universally called, reached sixty-nine, the mission asked her to retire. She did . . . until she found a new range of mountains where no missionary had ever visited. Without her mission’s support, she climbed those mountains, built a little wooden shack, and worked another twenty-six years. Because of a broken hip and creeping paralysis, she could only walk with the aid of two bamboo sticks, but on the back of an old horse she rode all over the mountains, a medicine box strapped behind her. She sought out the unwanted and the unlovely—the sick, the maimed, and the blind—and brought them treatment. When she came to settlements who knew her, a great crowd of people would rush out to greet her.

  My mother died in 1974 at the age of ninety-five. Poor nutrition and failing health had swollen her joints and made her gaunt and fragile. She had stopped caring about her personal appearance long ago. The villagers in that mountain range, though, saw beauty in her leathery, wrinkled skin. She was part of the advance guard, the frontline presenting God’s love to deprived people.

  In the spiritual Body, skin represents the membrane lining that defines our community and expresses God’s presence in the world. The watching world sees our skin, and Jesus stated clearly what we should make visible to a watching world: “By this everyone will know that you are my disciples, if you love one another” (John 13:35, emphasis added). Skin—soft, warm, touchable—conveys the essence of a God who is eager to relate to us in love.

  As the world makes initial contact with the church, what is its texture, its appearance and “feel”—its skin? Do people see “love, joy, peace, forbearance, kindness, goodness, faithfulness, gentleness and self-control” (Galatians 5:22-23)? We judge people by appearance, studying facial expressions for some hint of mood or glimpse into them. In the same way, we as a Body are being scrutinized as others draw conclusions about God from our appearance.

  Chapter Nine

  The MOST

  TRUSTWORTHY SENSE

  JUST AS I REACHED THE PODIUM to deliver an address, I began to feel feverish and nauseated.

  I was in New York on the final leg of a tour across the United States funded by the Rockefeller Foundation. I had visited renowned hand surgeons and pathologists to investigate why leprosy causes paralysis. Now I faced one last assignment, a scheduled lecture before the American Leprosy Mission.

  Although I managed to get through the talk, the fever continued to rise as I made my way to the subway station. At one point during the journey I swayed and fell to the floor of the subway car, too dizzy to sit or stand. Other passengers ignored me, no doubt assuming I was inebriated.

  Somehow I staggered to my hotel. In a fog, I dully realized I should call a doctor, but the hotel room had no telephone. The illness so overwhelmed me that I could only curl up on the bed and moan. For several days I remained there, aided by a kind bellboy who daily fetched me orange juice, milk, and aspirin.

  Though weak and unsteady, I recovered enough to make my ship’s voyage back to England. I spent most of the time in my cabin, resting to regain strength. After we docked at Southampton, I rode a train to London, sitting in a cramped corner, hunched over, and wishing the interminable trip would end.

  At last I arrived at my aunt’s house, emotionally and physically drained. I collapsed like a sack of potatoes into a bedside chair and removed my shoes. Then came probably the darkest moment of my entire life. As I leaned forward and pulled off my socks, I became aware that my left heel had no feeling. A dread fear worse than nausea seized my stomach. After working with leprosy patients, had it finally happened? Was I now to become one of them?

  I stood stiffly, found a straight pin, and sat down again. I lightly pricked a small spot of skin below my ankle and felt no pain. I jabbed the pin deeper, longing for a reflex, but there was none—just a speck of blood oozing out the pinhole. I put my face between my hands and shuddered, longing for pain that would not come.

  For seven years my team and I had battled against centuries of tradition to gain new dignity and freedom for leprosy patients. We had proudly torn down the barbed-wire fence surrounding the leprosy village at Vellore. Now, images of my patients’ faces ravaged by the disease filled my mind. Was this to be my future?

  I had assured staff members that leprosy was the least infectious of all communicable diseases and that proper hygiene would practically guarantee they would not contract the disease. Now I, their leader—a leper. That vicious word I had banned from my vocabulary rose up accusingly. How glibly had I urged patients to overcome stigma and prejudice.

  My thoughts and emotions churned. I would need to separate myself from my family, of course—the children of patients were the most susceptible to infection. Perhaps I should stay in England rather than return to India. But what if word leaked out? I could envision the headlines. And what would happen to our leprosy work? How many health workers would continue in view of the risk?

  I lay on my bed all night, fully clothed except for shoes and socks, sweating and breathing heavily from tension. I pictured the disease spreading across my face, my feet, my fingers. Scenes flickered through my mind, vivid reminders of what I would lose as a leprosy patient. Hands were my stock in trade, and my career as a surgeon would soon end. How could I use a scalpel, lacking fine finger control and response to pressure? Much else would slip away. Feathers, a dog’s fur, silk, wool—touch filled my world, and because I treated leprosy patients who had lost most of these sensations, I cherished them.

  Dawn finally came and I arose, unrested and full of despair. For a moment I stared in a mirror, summoning up courage, then picked up the pin again to map out the affected area. I took a deep breath, jabbed in the point—and yelped aloud. Never have I felt a sensation as welcome as that live, electric jolt of pain synapsing through my body. I fell on my knees in gratitude to God.

  Soon I was laughing sheepishly and shaking my head at my foolishness of the night before. In retrospect, everything made perfect sense. As I had sat on the train, weakened enough to forgo the usual restless motion of muscles in a cramped place, I had numbed a nerve in my leg. And then, exhausted, I had exaggerated my fears and jumped to a false conclusion. There was no leprosy, only a tired, anxious traveler recovering from influenza.

  A World of Touch

  That dismal affair, which I was too ashamed to mention to anyone for years, taught me a lasting lesson about perception. Since then I have resolved to feel, really feel the sensations of touch. Forests, animals, fabric, sculpture—these beg for exploration by sense-hungry fingertips. Sensors on the body’s surface hum with reports on the surrounding environment.

  Rolled thin like pie dough, the skin abounds with half a million tiny transmitters reporting their discoveries. Think of all the stimuli your skin monitors each day: wind, particles, parasites, pressure, temperature, humidity, light, radiation. Skin has the toughness to withstand the rigorous pounding of a marathon run, yet the sensitivity to detect a mosquito landing on it. One tap of the fingernail can tell me if I am touching paper, steel, wood, plastic, or fabric.

  Of all the senses, touch is the most trustworthy. Give a baby an object to play with and she will finger it, then bring it to her mouth and tongue it. To her, touch is primary, and auditory and visual senses are secondary. Later, she may touch a magician’s props to see if they are real; she cannot trust her eyes. A mirage may fool the eye and the brain but not the skin’s touch. And even adults trust tactile senses more readily, hence “tangible” proofs. The disciple Thomas doubted visual reports of Jesus’ resurrection, declaring, “Unless I see the nail marks in his hands and put my finger where the nails were, and put my hand into his side, I will not believe” (John 20:25).

  I recall when my daughter Mary, three years old, was trying to overcome a fear of thunderstorms. Although she believed we were safe inside our house, as the lightning flashed closer and closer, she ran to me and put her small hand in min
e. “We aren’t afraid, are we, Daddy?” she said in a wavering, uncertain voice. Just then a tremendous clap of thunder crashed nearby and all the lights went out. Mary, breathing in short gasps, cried out more urgently, “Daddy! We aren’t afraid, are we?” In her little hand, trembling with fear, I could read past her brave words to her true state. Skin communicates to skin.

  In many dictionaries the definition for touch runs the longest of any entry. I can hardly think of a human activity—sports, music, art, cooking, mechanics, sex—that does not rely on touch. It is the most alert of our senses when we sleep and the one that seems to invigorate us when awake: the lovers’ embrace, cuddling a baby, a contented sigh after a massage, the sting of a hot shower. Helen Keller, blind and deaf and yet a cum laude graduate of Radcliffe and author of twelve books, shows what the brain can accomplish with input from touch alone.

  From the skin, I better understand one requirement on the frontlines of a spiritual Body: to sensitively perceive the people we contact. Beginning counselors, eager to help people, must remind themselves, “First, you must listen. Your wise advice will do no good unless you begin by listening carefully to the person in need.” Skin provides a more basic kind of perception than what passes through the eye or ear—a tactile perception compiled from thousands of sensors.

  If skin sensors detect a minute change in air pressure or temperature, they fire off messages to the brain. In the same way, followers of Jesus, “in the world but not of the world,” encounter a constant stream of signals about the environment around them. The Body is universal, and its sensors report in from lakeshore apartments in Chicago, the slums of Nairobi, the jungles of Peru and Sri Lanka, the deserts of Russia and Arabia. In earlier days, foreign missionaries did not always sense the worth and beauty already present in different cultures. Today, Christian missions are more sensitive to culture, and to physical and social as well as spiritual needs. The best, most effective kind of love begins with a quiet attention, a tactile awareness that senses a need and responds appropriately and personally.

  I do not believe humanitarian or mission work necessarily becomes more effective as it grows more specialized. Advances in technology may offer benefits, for example in medical work, but I have seen Christian medical agencies in India gradually lose their original mission as they become institutions with buildings and staff to support. The quality of treatment rises, but so does the expense, and to sustain the work they then focus on techniques that attract patients who can pay. Meanwhile the poor and unloved, unable to afford the mission hospital, must turn to a government clinic for help.

  Tactile Awareness

  In contrast, I recall the impact my parents had in a remote, mountainous region of India. Although they went to India to preach the gospel, by living in tactile awareness of people’s needs they began to respond instinctively. Within a year they were involved in medicine, agriculture, education, evangelism, and language translation. They adapted the work to their perception of needs.

  My mother and father worked for seven years before anyone converted to Christianity, and, in fact, that first conversion came as a direct result of their compassion. Villagers would often abandon their sick outside our home, and my parents would care for them. Once, when a Hindu priest was dying of influenza, he sent his own sickly, nine-month-old daughter to be raised by my parents. None of his swamis would care for the frail child; he knew they would just let her die. My parents took her in, nursed her to health, and adopted her as their own. I gained a stepsister, Ruth, and my parents experienced an upsurge of trust from the villagers, some of whom embraced Christ’s love for themselves.

  Years later, when my widowed mother turned eighty-five, she helped forge a medical breakthrough. She had often treated gross abscesses on the legs of mountain people by draining the pus and excising a long, thin guinea worm. By studying the problem she learned that the worms spend their larval stage in water. From her familiarity with the villagers’ habits, she concluded that wading in water was the likely means of transmission. As villagers waded in the water, guinea worms in their infected legs released larvae into the water supply, which the people then drank, perpetuating the cycle.

  Having built up trust through decades of personal ministry, my mother rode her horse from village to village, urging the people to build stone walls around their shallow wells and to avoid foot contact with the water. People who had ignored government health workers listened to Granny Brand. Within a few years this elderly widow, a foreigner, singlehandedly caused the eradication of all such worms, and their resulting abscesses, in two mountain ranges.

  My wife, Margaret, had a similar experience with a condition afflicting the eyes of children. Whenever she encountered this condition, I could read it in the despair on her face that night. I would look at her and sympathetically murmur one word, “Keratomalacia?” and she would nod yes.

  Keratomalacia results from a deficiency of vitamin A and protein among young children between one and two years old. A baby would thrive as long as it was breastfed, but soon a new brother or sister pushed it from its mother’s breast. The new diet of rice failed to provide essential vitamins, making small bodies especially susceptible to infection. Finally, an outbreak of conjunctivitis, or pinkeye—an easily treatable infection for a well-nourished person—would attack the malnourished child’s eyes. My wife, examining those eyes, saw a jellied mass, as if a strange heat ray had melted all the parts together. A glimpse of one of those children, fearfully squinting to keep out light, never failed to dishearten Margaret, regardless of how many successful procedures she had performed on other patients that day.

  Spurred by Margaret’s sense of urgency, some medical college researchers discovered that a common green herb, which grew wild all over our region, contained a remarkably high concentration of vitamin A. They also learned that peanuts, a local crop grown for oil, possessed the missing protein. Until then, the villagers had been feeding peanut residue to their pigs after mashing the nuts to produce oil.

  Now the task became one of education. Margaret and public health nurses spread the word, and soon mothers were excitedly telling neighbors that the green herb and peanuts could prevent their children’s blindness. The news traveled like gossip through the villages, protecting many children from the dreaded keratomalacia.

  These two examples are hardly typical. Much of humanitarian work consists of exhausting labor with less dramatic results. Yet they demonstrate the importance of tactile Christian love. Although government health agencies and agricultural experts had sufficient knowledge to attack keratomalacia and the guinea worm, they had not gained the trust of villagers. A medical advance came, instead, from workers who were “in touch with” the suffering people and who had built up enough trust and respect to supply a remedy. I wonder how effective Granny Brand would have been had she dropped educational leaflets from a helicopter.

  Dr. Pfau’s Legacy

  One scene captures for me in a single image all the elements of the skin of Christ’s Body. In the 1950s I visited a nun, Dr. Ruth Pfau, outside of Karachi, Pakistan, amid the worst human squalor I have ever come across. As the taxi neared her clinic, a putrid smell burned my nostrils, a smell you could almost lean on. Soon I saw an immense garbage dump by the sea, the city’s accumulated refuse that had been stagnating and rotting for many months. The air was humming with flies.

  At last I could make out human figures—people covered with sores—crawling over the mounds of garbage. They had leprosy, and more than a hundred of them, banished from Karachi, had set up home in this dump. Sheets of corrugated iron gave them a bit of shelter, and a single, dripping tap in the center of the dump provided their only source of water.

  There, beside this awful place, I found Dr. Pfau’s neat wooden clinic. She told me a bit of her life story: of the destruction of her childhood home in Leipzig by Allied bombers, of a scary time after the war when she walked at night with a teddy bear tucked under her arm to escape from Soviet-occupied East Germany,
of her decision to convert after learning about forgiveness from a Dutch Christian who had survived Nazi concentration camps.

  After training as a doctor, Pfau was sent to southern India by her order but ended up in Pakistan because of a visa issue. There, she visited a leprosy colony, where she met one of the million Pakistanis afflicted with the disease. She described the scene: “He must have been my age—I was at this time not yet thirty—and he crawled on hands and feet into this dispensary, acting as if this was quite normal, as if someone has to crawl there through that slime and dirt on hands and feet, like a dog.”

  The experience stunned her. “I could not believe that humans could live in such conditions,” she said. “That one visit, the sights I saw during it, made me make a key life decision.” That was when she moved to the little hut by the garbage dump to care for leprosy patients. A few years later she came to the hospital in Vellore to study our new surgical treatments for leprosy patients.

  Throughout, Dr. Pfau lived in a single room, rising at 5 a.m. to pray and worship before tending to patients. When I visited her in Karachi, she proudly showed me her orderly shelves and files of meticulous records on each patient in the garbage dump. The stark contrast between the horrible scene outside and the oasis of love and concern inside her tidy clinic seared deep into my mind.

  In the years after I met her, Dr. Pfau went on to establish 157 leprosy clinics across Pakistan. She became known as “Pakistan’s Mother Teresa.” Due to her efforts, in 1996 the World Health Organization declared Pakistan the first country in Asia to have controlled leprosy.