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Morning over the bay

For Mud and Soil

A Doctor’s Environmental Epiphany

Herman Daly

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Dr. Paul Brand was the son of British missionary parents in South India. He returned to England to study medicine, then went back to take care of people with leprosy in India, mainly doing reconstructive hand and foot surgery – some three thousand operations. He did similar work in Ethiopia, and as chief of rehabilitation at the only leprosy hospital in the United States.

Medically, Dr. Brand is credited with having established that leprosy is not the direct cause of decay or necrosis of the hands and feet. Rather the damage to extremities is self-inflicted, resulting from the loss of sensation and inability to feel pain. Without pain there is no feedback to tell you that you are damaging yourself. Brand developed routines and practices to help avoid self-inflicted injuries, and later wrote a book entitled Pain: The Gift Nobody Wants.

Which brings me to something Dr. Brand wrote in 1985:

I would gladly give up medicine tomorrow if by so doing I could have some influence on policy with regard to mud and soil. The world will die from lack of pure water and soil long before it will die from a lack of antibiotics or surgical skill and knowledge.

A physician treats our internal organs – heart, lungs, liver, kidneys – in order that we may live longer and better. But our lives depend on external organs as well, environmental life support systems. What good are our lungs if there are no trees and grasses capable of photosynthesis? What good is our digestive tract if the land won’t grow food? What good are our kidneys if the rivers run dry, or are toxic? It is not much of a stretch for a good physician to realize that health and wellness now depend as much on care of our collective external organs as on our individual internal organs. Reconstructing a patient’s hands and feet, and then sending him to slowly starve on eroded farmland is at best a partial cure.

What led Brand to such a statement? Living in India, Ethiopia, and Louisiana – and witnessing the same thing in each place.

In India he received his first lesson in soils management at age six, from an old Indian farmer who reprimanded him and some other boys who carelessly broke the little turf dams on the terraced rice paddies along the mountainside while chasing frogs in the wet level terraces. The old man scooped up a handful of mud and said, This soil will feed my family year after year. But the soil has to stay up here. The water wants to carry the soil down the mountain to the river, and then to the sea. Do you think the water will bring it back up? No, they answered. Will you be able to bring it back up? No, grandfather. Will rocky hillsides without soil feed my family? No. Well, that is why the dams must be cared for. Do you understand? Yes, grandfather, we’re sorry.

Returning to this area many years later Brand observed barren rocky hillsides – the result of government programs to use ex-prisoners to grow potatoes, but without first teaching them the wisdom of the old farmer.

In Ethiopia most of his leprosy patients were farmers. That brought him again to farms where he witnessed terrible erosion. The Nile carried Ethiopian soil to Egypt. Farms grew poor crops, and the fields were full of large stones. But the stones were not so large that they could not be rolled to the edge of the field where they could have made walls instead of obstacles to tilling and harvesting. Why were such simple improvements not made? Brand asked. The peasants explained that if they made their fields look good and productive they would lose them to the ruling class. Someone from the city would claim that his ancestors had owned it, and the peasants had no chance in court. So injustice, as well as water and wind, contributed to his patients’ deprivation. People with leprosy who returned to the eroded farms did not have a good prognosis even if their leprosy was now under control.

The leprosarium at Carville, Louisiana, was just a stone’s throw from the Mississippi river. It dated from before levies had been built to contain the river. Therefore all the buildings and houses were built on stilts. For a week or so each year, water swirled under your house, but you got around in a skiff or pirogue. Meanwhile the water deposited its silt before returning to its banks, transferring Midwestern topsoil to the Louisiana delta or rebuilding the eroding marshlands or barrier islands. Now the river is contained between levies to eliminate annual floods, so the silt is deposited in the river bottom rather than on the land, necessitating higher levies. Or the silt flows all the way out into the Gulf of Mexico and over the continental shelf, no longer rebuilding coastal marshlands that are now disappearing – and would have served New Orleans as a buffer against Hurricane Katrina. In addition to silt, the Mississippi carries fertilizer and pesticide runoff from Midwestern farms into the Gulf, creating a dead zone the size of New Jersey.

“But what can be done,” Dr. Brand asked, “if the destroyers of our earth know what they are doing and do it still?” Environmental destruction is not just the result of ignorance. Mostly, we know what we are doing. Yet we are caught up in structures that demand fast growth, rapid turnover, and quick profits. And that is facilitated both by ignorance of environmental costs, and by willingness to shift those costs onto others. Simple denial also plays a role. We all seem to suffer from a symptom of leprosy – we do not feel pain in our external organs and structures (our environmental extremities), and therefore do not stop the behavior that is damaging them.

In part this is because often the benefits of the damaging behavior go to the people responsible for the behavior while the costs fall on others – the painful feedback is diverted to people who did not cause the damage. The fishermen in the Gulf of Mexico pay the cost of pesticide and fertilizer runoff caused by careless farming.

The growing scale of the economy means that environmental and social cost-shifting is ever larger and more dangerous. Consequently there are now many more environmental problems than soil erosion: climate change, biodiversity loss, ozone layer depletion, and modern warfare, to name a few. Many environmentalists look at this list and despair. But Christians like Dr. Brand, and other thoughtful people as well, cannot take that attitude, because as humans we bear the capability and responsibility of the “image of God.”


Herman Daly, a professor at the University of Maryland, was Senior Economist in the Environment Department of the World Bank. A longer version of this essay appeared on his blog The Daly News.

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