Ruth Pfau

Ruth Katharina Martha Pfau was born on September 9, 1929, in Leipzig, Germany, one of several children in a middle-class Protestant household ^[1]. Her childhood coincided with the rise of the Nazi state and then the Second World War. Allied bombing raids damaged the family home, and the collapse of Germany in 1945 left Leipzig inside the Soviet occupation zone, later East Germany.

As a teenager Pfau watched the new communist administration tighten its hold on Saxony, and like many young Germans of her generation she crossed to the West. She fled East Germany around 1948 and settled in West Germany, where she took up the study of medicine ^[2]. She trained at the universities of Mainz and Marburg, qualifying as a physician in the 1950s at a time when few German women completed medical degrees.

Her student years also brought a religious turn. Raised without strong confessional attachment, Pfau was drawn to Catholicism partly through the example of a Dutch concentration camp survivor whose capacity for forgiveness impressed her deeply. She was baptized a Catholic in 1953, and in 1957 she entered the Daughters of the Heart of Mary, a French congregation founded during the Revolution whose members live without a habit and work in secular professions ^[1].

The turn that defined Pfau's life came about almost by accident. In 1960 her order assigned her to southern India, but a visa problem stranded her in Karachi, Pakistan's largest port city ^[3]. While waiting, she visited a leprosy colony behind the McLeod Road railway station, a settlement of patients living in conditions she later described as barely human. Anyone asking who was Ruth Pfau usually hears this story first: a delayed visa, a slum visit, and a decision to stay.

Leprosy, or Hansen's disease, was then widely believed in Pakistan to be incurable and divinely inflicted. Patients were cast out by their families, and physicians rarely treated them. Pfau chose to remain in Karachi and work at the small dispensary that Sister Berenice Vargas had started for lepers, and within a few years she transformed it into the Marie Adelaide Leprosy Centre, named for the founder of her congregation ^[4].

Money, staff, and drugs were all scarce. Pfau raised funds from German donors and church networks, trained Pakistani paramedics to diagnose and treat the disease, and pushed treatment out of Karachi into the countryside. She traveled by jeep, camel, and on foot into Sindh, Balochistan, and the mountain valleys of the north, tracking down patients who had been hidden away by relatives ^[2].

Among Ruth Pfau achievements, the largest was institutional. The Marie Adelaide Leprosy Centre grew into a network of over 150 treatment centers across all provinces of Pakistan, staffed overwhelmingly by Pakistani workers she and her colleagues had trained ^[4]. In 1968 the government invited her to run the National Leprosy Control Programme, and in 1979 she was appointed Federal Advisor on Leprosy to the Ministry of Health, giving a Catholic nun a formal seat in the public health apparatus of an Islamic republic ^[3].

The campaign worked. In 1996 the World Health Organization declared that leprosy had been brought under control in Pakistan, meaning the prevalence had fallen below one case per 10,000 people, and Pakistan reached this benchmark ahead of most of its neighbors in the region ^[5]. Multidrug therapy, systematic case-finding, and the slow erosion of stigma all contributed, and Pfau's organization was central to each part.

Recognition followed from both her countries. Pakistan granted her citizenship in 1988 and awarded her the Hilal-e-Imtiaz in 1979 and the Hilal-e-Pakistan in 1989, while Germany gave her the Order of Merit; she also received the Ramon Magsaysay Award in 2002, often described as Asia's equivalent of the Nobel Prize ^[6]. Later in her career the centre widened its work to tuberculosis and blindness prevention, applying the leprosy network's methods to other neglected diseases ^[4].

Pfau never married, in keeping with her vows, and she lived with striking simplicity in quarters at the Karachi centre. Colleagues recalled a woman of dry humor and blunt speech who disliked ceremony, chain-drank tea, and answered her own correspondence well into old age ^[2]. She spoke German, English, and Urdu, and she moved easily between European donor meetings and remote village clinics.

She was also a writer. Pfau published a series of books in German reflecting on her work and faith, several of which were translated into English, including the autobiographical accounts published under titles such as To Light a Candle ^[1]. Royalties and speaking fees went back into the leprosy program.

Her faith remained the engine of her work, but she was careful about its place in a Muslim country. She did not proselytize among patients, and she often said that serving the sick was itself the message. That restraint earned her trust across religious lines, and among ordinary Pakistanis she became known simply as the German mother of the lepers ^[7].

Pfau formally handed over leadership of the Marie Adelaide Leprosy Centre in 2006, when Mervyn Lobo became its head, though she stayed on as an active presence and continued visiting field stations ^[4]. Age slowed her travel but not her advocacy: she pressed the government to fund disability care for cured leprosy patients, whose deformities outlasted the bacteria.

Disaster relief occupied much of her final decade. After the 2005 Kashmir earthquake and the catastrophic 2010 floods that displaced millions in Sindh and Punjab, the centre's rural network became a channel for medical aid, and Pfau, then in her eighties, toured flooded districts to organize relief ^[3].

Her health declined in 2016 and 2017 with kidney and heart problems. She was admitted to the Aga Khan University Hospital in Karachi, where she died on August 10, 2017, a month before her 88th birthday ^[5]. Prime Minister Shahid Khaqan Abbasi announced a state funeral, and on August 19 her coffin, draped in the Pakistani flag and honored with a gun salute, was carried to Saint Patrick's Cathedral in Karachi before burial in the city's Gora Qabaristan Christian cemetery ^[7].

Few foreigners have been mourned in Pakistan as Pfau was. The state funeral placed her alongside founder Muhammad Ali Jinnah and philanthropist Abdul Sattar Edhi among the handful so honored, and commentators across the political spectrum called her Pakistan's Mother Teresa ^[5]. In 2017 the Sindh government renamed the Civil Hospital Karachi, one of the country's oldest public hospitals, as the Dr. Ruth K. M. Pfau Civil Hospital ^[7].

Her institutions outlived her. The Marie Adelaide Leprosy Centre continues to run leprosy, tuberculosis, and eye-care programs across Pakistan, and the paramedic training model she pioneered remains a template for community health work among poor and remote populations ^[4]. Germany remembers her through the Ruth Pfau Foundation and through schools and streets bearing her name.

Any Ruth Pfau biography ultimately turns on a single choice made in a Karachi slum in 1960. The basic Ruth Pfau facts, a Leipzig birth, a flight from East Germany, a medical degree, a delayed visa, then 57 years among patients others refused to touch, describe a life in which accident and conviction worked together. Google marked what would have been her 90th birthday with a doodle in 2019, one more sign that her story now belongs to both of her countries ^[6].