THE LEPROSY MISSION

A Legend has passed into history Dr Paul Wilson Brand – 1914-2003 Obituary

An Extraordinary, Gifted Orthopaedic Surgeon who Straightened Crooked Hands and Unravelled the Riddle of Leprosy

by Ms Janet Walmsley

This week countless thousands and millions around the world mourn the passing of Dr Paul Brand, world-renowned orthopaedic specialist and leprosy surgeon who solved a riddle that has plagued the world for centuries; “Do the hands and feet of leprosy-affected people just fall off? What causes the terrible deformities of leprosy? Can anything be done to prevent them or restore the damage?”

Dr Brand, a modern-day Father Damian, died on Tuesday, 8th July 2003 at Swedish Hospital in Seattle Washington, aged 89, surrounded by his wife, Dr Margaret Brand and family.

The son of missionary parents, Dr Brand spent his early years in the mountains of southwest India. At age nine, he went to London, England for his education and later completed medical school at London University, becoming a Fellow of the Royal College of Surgeons.

Together with his wife Margaret, whom he met at medical school, Paul Brand returned to India in 1946 to teach surgery at the Christian Medical College and Hospital in Vellore.

Paul Brand did not set out to become a doctor. Initially he refused to follow in his father’s footsteps and study medicine, and he trained as a carpenter and builder. This skill he later used in a remarkable way – teaching leprosy-affected people with damaged, insensitive hands how to do carpentry and woodwork without further injuring their fingers and hands.

It was in India that the Brands first came across “leprosy beggars”, deformed, blind and crippled by the disease. Deeply affected by the acute anguish and isolation of people afflicted with leprosy, he and his wife dedicated themselves to relieving their suffering.

Very little was known about the true cause of leprosy deformities. It was generally believed that the hands and feet of infected people simply disintegrated or rotted away as a direct result of the disease. A senior colleague, Dr Robert Cochrane, challenged Dr. Paul Brand to use his skills as an orthopaedic surgeon to find out why people with leprosy developed deformed hands, and to try to find an effective treatment.

Dr Brand drew on experience he had gained during WWII with polio-paralyzed and war-injured hands. He undertook extensive research on damaged hands to test muscle strength and sensation. There were many obstacles to overcome – not the least being prejudice and resistance to using surgical skills on people with leprosy, and allowing them access to hospital care.

Through his research in South India, Dr Brand changed forever the world’s perceptions and treatments of leprosy-affected people:

First, he pioneered the startling idea that the loss of fingers and toes in leprosy was due entirely to infection and was thus preventable. Because leprosy attacks chiefly the nervous system, resultant tissue abuse occurs because the patient loses the warnings of pain – not because of inherent decay brought on by the disease. Paul Brand discovered the gift of pain, claiming that because leprosy destroyed the sensation of pain in affected parts of the body, pain-deprived people inadvertently injured and destroyed themselves.

Second, as a skilled and inventive hand surgeon, he pioneered tendon transfer techniques with leprosy patients, and opened up a whole new world of disability prevention and rehabilitation for the most vulnerable and helpless in society.

In the late 1940s, he became the first surgeon in the world to use reconstructive surgery to correct the deformities of leprosy in the hands and feet. Dr. Margaret Brand devoted herself to researching methods to prevent blindness in persons with leprosy. Later, Dr. Paul Brand was able to apply similar techniques to treat the limbs of persons with diabetes, as both diseases destroy pain sensation.

In 1953 the Brands joined the staff of The Leprosy Mission, and continued to develop their research and training work at Vellore and at the nearby Schieffelin Leprosy Research and Training Centre, Karigiri, newly founded and funded jointly by The Leprosy Mission and American Leprosy Missions. In 1964 after over 17 years in India, Paul Brand was appointed as The Leprosy Mission’s Director of Surgery and Rehabilitation which offered worldwide opportunities to share his life-changing skills.

Two years later they were seconded to the United States Public Health Service Hospital in Carville, Louisiana, which is the only leprosy hospital in the US and a world-famous centre for leprosy research. Here Paul was Director of the Rehabilitation Branch until his retirement in 1986 and continued to act as Medical Consultant to The Leprosy Mission. From 1993 to 1999, Dr Brand was President of The Leprosy Mission International.

In retirement Dr Brand continued to contribute to leprosy work through his advisory role to The Leprosy Mission and to the World Health Organisation. He moved to Seattle and became Clinical Professor of Orthopoedics, Emeritus at the University of Washington.

A gifted speaker and writer, Dr Brand has received many honours and awards in recognition for his outstanding achievements: he was Hunterian Professor of the Royal College of Surgeons in 1952; in 1960 he received the Albert Lasker Award for outstanding leadership and service in the field of rehabilitation; in 1961 he was honoured by Queen Elizabeth II with a CBE (Commander of the British Empire) for promotion of good relations between the Republic of India and Great Britain; in 1977 the Damian-Dutton Award for outstanding contributions in prevention of disabilities due to leprosy; and the US Surgeon General’s Medallion for his rehabilitation work in Carville, LA.

Dr Brand authored 100 scientific papers and seven books, including Clinical Mechanics of the Hand, which is the premier handbook for hand surgeons, physiotherapists and other hand specialists. Co-author with Philip Yancey of three inspiring books, “Fearfully and Wonderfully Made” “In His Image”, and “Pain – The Gift Nobody Wants”, Paul Brand is also the subject of Dorothy Clarke Wilson’s biography, “Ten Fingers for God”.

Dr Paul Brand died from complications related to a subdural hematoma. He is survived by his wife Margaret, their six children, Estelle, Chris, Jean, Mary, Patricia and Pauline, and twelve grandchildren.

A man of deep faith and passionate commitment ,Paul Brand brought great dignity, humour and humility to the role of greatness that was laid on him. He was truly great, but with a natural humility that maintained to the end a hint of surprise that others should think that he had done anything outstanding.

Eddie Askew, a friend and colleague of Paul Brands at The Leprosy Mission, said of him: “From his work many thousands of individual lives have been transformed and enriched. . it wasn’t just the surgical techniques that Paul worked on, it was the people. I have often watched him as he engaged with patients, assessing their disabilities and deciding what would best meet their needs. I noticed that he never concentrated solely on the hand or foot he held so gently and intimately. He looked at the patient’s face, looked into the eyes. Paul was concerned for the individuals, their personalities, acknowledging and valuing our common humanity.”

Dr Paul Brand spent a lifetime working with people affected by leprosy, doing his utmost to destroy the stigma of the disease, and rebuild the lives of those destroyed by it. In doing so, he recognised the extraordinary gift of pain that the rest of the world usually takes for granted. Within each person he treated, he saw a broken spirit full of pain, as well as a broken body which felt no pain. And in each person Paul Brand saw the image of God.

11 July 2003

The Leprosy Mission contact details in Australia: Stuart Brown, Director, The Leprosy Mission Australia, PO Box 293, Box Hill, Victoria 3128 tel +61-3-3980 0577

Fiona Ellen Thomas Communications Officer The Leprosy Mission International http://www.leprosymission.org Tel: +44-20 8326 6767 Fax: +44-20 8569 7808

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