Paul looked quizzically at Derek, who went on to explain about some work he had done with cats ten years before. Derek told Paul that he surmised that it wasn’t nerve swelling alone that caused damage and paralysis. That occurred only when the swelling was constricted, as it might be by the sheath around the nerve. Such pressure on the nerve would greatly diminish the blood supply and eventually kill the nerve.
Dr. Denny-Brown got out some of his own slides to illustrate what he was talking about. As he and Paul studied the slides under the microscope, the nerve swelling visible on them was identical to that on Paul’s slides. It was an enlightening moment for Paul as he thought he was beginning to close in on the cause of the nerve damage that led to paralysis in leprosy patients. But Paul still had unanswered questions, such as why the nerve swelling occurred where it did in the bodies of leprosy patients.
Paul learned from other great doctors in the U.S. cities he visited. In San Francisco he spent two weeks with Dr. Sterling Bunnell, one of the world’s leading authorities on hands, whose procedure Paul had followed in his early surgeries on leprosy patients. It was not until he arrived in New Orleans, however, that Paul met the only surgeon outside India who had operated on the hands of leprosy patients. Dr. Daniel Riordan spent one day a week at the only leprosarium in the continental United States, in Carville, Louisiana. He took Paul with him to the leprosarium, which resembled a small rural town set behind a high wire fence on a loop of the Mississippi River.
At Carville, Paul assisted Dr. Riordan with some hand surgeries and was able to demonstrate some of the techniques he had perfected at Vellore. In turn, Paul observed some useful techniques Dr. Riordan employed in his surgeries. At the end of Paul’s visit to New Orleans, Paul and Dr. Riordan agreed to stay in touch.
In New York City, Paul was interviewed on a television program on which he was pleased to promote the medical work being done at Vellore. He was also delighted to show the audience some wooden toys the men at the New Life Center had made.
In April 1953 Paul sailed back to England, where he spent a few days with his aunts in London. During that time he completed conversations he had started with Donald Miller, secretary of the British Mission to Lepers. Paul was now in the forefront of leprosy medicine, and the British Mission to Lepers offered to help support the Brand family financially.
With a happy heart Paul said good-bye to his aunts and boarded his first commercial airplane flight. He was bound for Johannesburg, South Africa, where he would be reunited with Margaret and the children. As he sat in the airplane, Paul looked down first at the European continent and later at the African continent as they passed far below. The trip was long, and Paul was grateful when the airplane touched down in South Africa and he was reunited with his family. Everyone looked sun-tanned and happy. Paul spent four days with Margaret’s parents, and then the Brand family took a two-day train trip to Durban on South Africa’s east coast, where they boarded the SS Karanga for the trip across the ocean back to India.
On the voyage, Paul had time to tell Margaret about all he had learned during his time in the United States. He was frustrated that he did not have more answers about leprosy but pleased to know that in working in a small Christian hospital in South India, he and his colleagues were performing world-class surgeries.
As the Karanga sailed eastward, Paul looked forward to five more years in India. He told himself that perhaps that would be enough time to find the answers he was searching for. It would certainly be long enough for his next project: building a prototype operating room at the New Life Center. Paul already had the plans for it in his head. Instead of purchasing an expensive, foreign operating light, he would make one by hammering a sheet of aluminum into the right shape, polishing it, and attaching it to a two-hundred-watt lightbulb. He imagined suspending the light over a simple wooden operating table with a series of ropes and pulleys.
As soon as he arrived in Vellore, Paul set the men at the New Life Center to work on the project. The men made the operating table, scrubbed out a small room and whitewashed it, made the lamp, and suspended it over the table. On January 30, 1954, Paul performed the first surgery in the small operating theater. It should have been a day of celebration, but the day turned to tragedy. Twelve members of the Vellore facility were on their way to a picnic when their station wagon crashed and flipped over. Paul raced to the hospital, where he helped to evaluate and operate on the accident victims.
Thankfully, no one was killed in the accident, but one of Paul’s favorite former students, Dr. Mary Verghese, was paralyzed from the waist down, and her face was horribly disfigured. Paul was distraught when he saw her, but he vowed to do everything he could to help Mary find a new path.
Mary spent many months in a rotating bed in the hospital. Sometimes she was right side up, and sometimes she was tilted to one side or the other, or even upside down. Whatever position she was in, Paul spent hours squatting beside her, talking to her about her faith in Christ, and encouraging her in her recovery.
Eventually Paul was able to fuse some of the bones in Mary’s back so that she could sit in a wheelchair. Now Paul’s real challenge began. He encouraged Mary to help him evaluate leprosy patients, and one day he suggested that she learn how to do hand surgery.
“Surgery!” she protested. “Have you forgotten, Dr. Brand? I am a paraplegic!”
Paul laughed. “But Mary, this is one of the few operations you have to perform sitting down,” he countered.
Over the next months, Paul and Mary spent many hours operating together in the tiny theater at the New Life Center. Every time Paul watched the adoring way the leprosy patients listened to this Indian woman doctor in a wheelchair, he thanked God that he had been allowed to play a part in Mary’s remarkable recovery and transformation into a gifted hand surgeon.
While Paul was set to prove with his prototype operating theater that sophisticated surgery could be done under simple, rural conditions, his influence was spreading around the world. In October 1954 he was invited to visit a hospital in North India where several of his former students were working. After that he was invited to Calcutta to deliver a series of lectures at the Calcutta School of Tropical Medicine. The net was cast wider when the government of Nigeria asked him to visit and demonstrate his surgery techniques on leprosy patients.
Paul set off on this adventure, glad that he would get to see his sister Connie and brother-in-law David Wilmshurst, who were serving as missionaries in Gindiri, Nigeria. He also relished spending time with his African counterpart, John Dreisbach, an American doctor based in Kano who was ahead of Vellore in the care of leprosy patients’ feet.
When Paul returned home, he was determined to take what Dr. Dreisbach had shown him and improve on it. From the time he had started making regular visits to the leprosarium in Chingleput, he had been aware that shoes were a problem for leprosy patients. One day Paul had found a pair of sandals outside the hut where patients were having the ulcers on their feet dressed. As he examined the sandals he was horrified to see nails sticking up through the soles. Paul took the sandals inside and found their owner. Sure enough, the ulcers on the man’s foot matched perfectly with the nails sticking up through the sandals. The patient had not even realized the nails were there! Paul now knew that he would have to focus more on feet and on helping leprosy patients take better care of them.
In Kano, Nigeria, John Dreisbach had shown Paul how they were making shoes fitted to the patients’ feet. The shoes offered good support and protection as well as a level of comfort that reduced the pressure spots. Paul began experimenting with shoes fitted to leprosy patients’ feet. His helper, or test patient, in this was Sadagopan, whom Margaret had invited to their home on College Hill and whom Paul had first met on the veranda. Sadagopan began wearing the various styles Paul made, from wooden clogs to molded rubber shoes. He would happily wear the shoes for days, weeks, sometimes months, without getting any ulcers. But when Sadagopan eventually did get ulcers, Paul would modify the shoes, which Sadagopan would then begin wearing.
Paul worked at the process methodically, just as he had when studying the hands of leprosy patients. He came to realize that the perfect shoe for his patients needed both a soft, pliable innersole that could adapt to the contour of the foot and a well-constructed outer shoe that gave good protection and support. He imported several pairs of a new microcellular rubber sandal called a thong that was popular in Hawaii. He used the base of the thongs to craft innersoles, and when he was convinced he was on the right track, he traveled to Calcutta to meet with representatives from Bata, a large shoe manufacturer. The company agreed to work with Paul, mixing various batches of microcellular rubber in differing degrees of softness until they settled on the right rubber mix for the job.
At the same time, “Uncle Robbie” Robertson showed up in Vellore. Dr. Robertson was a recently retired orthopedic surgeon in charge of prosthetic workshops in New Zealand. He had arrived to live out the rest of his days at Vellore helping people. Paul put him to work on shoes for leprosy patients. A patient and gifted man, Uncle Robbie was soon fashioning leather shoes shaped to the contour of a patient’s foot. Paul marveled at the workmanship of each pair of shoes the orthopedic surgeon made.
Not long after Uncle Robbie arrived, John Girling showed up at Paul’s door. He was a young Englishman disillusioned with British society and was traveling the world to find something meaningful in his life. He offered to do anything Paul wanted him to do to help leprosy patients. All Paul could offer him in return was the paltry sum of one hundred rupees a month for his labor. John jumped at the opportunity. Soon he was hard at work making shoes. In fact, in no time at all he was a recognized expert in making custom shoes for leprosy patients.
Eventually it was determined that the best kind of sole for these shoes was one that was slightly curved long ways, causing the patient’s foot to roll forward as the person walked. This seemed to produce the least amount of rubbing on the foot and so lessened the chance of ulcers forming. The design had just one drawback: it was easy for the wearer to twist over sideways onto his ankles, causing torn ligaments and sometimes fractures. Careful instruction in how to walk in the shoes had to be given to those who wore them. All the while Sadagopan continued to work with Paul, trying out all sorts of new shoe designs and styles.
While new people were showing up to work with Paul and his team at Vellore, the Brand family was changing and expanding. Christopher was enrolled in boarding school in the Nilgiri Hills in Ootacamund, a town not far from Kotagiri, where he was used to spending the hot season. Margaret gave birth to another baby, a fourth daughter, whom they named Patricia.
The slow, methodical work of improving the lives of leprosy patients and many others continued. Paul often thought back to what he had learned on his trip to Africa. He wished he had a better way to share his team’s latest findings with isolated doctors working with leprosy patients. When Paul met Carlo and Paxey Marconi, a motion picture producer and his wife from Bombay, he asked them to extend their filmmaking expertise to make a movie about the work with leprosy patients at Vellore and the New Life Center. The Marconis agreed. Paul and Paxey wrote the script, and Carlo directed and filmed the movie, Lifted Hands. Paul was very satisfied with the end result. He then suggested that Carlo film one of Paul’s hand surgeries. Later, while Paul performed a tendon-free graft on a patient, Carlo filmed every facet of the surgery.
