November 24, 1999
In the morning, you wake to the high-pitched squeals of a pig, protesting the ropes that restrain his limbs in preparation for slaughter. If you're accustomed to rising to the jarring but comfortably inanimate buzz of an alarm clock and encountering bacon only as a cellophane-wrapped package in the grocery store freezer aisle, this morning ritual at Haiti's l'Htpital Albert Schweitzer is a fitting introduction to life in a region so different from your own.
A country of contradictions, Haiti is one of the poorest nations in the world but was once one of the richest colonies in the Caribbean. The health of many of Haiti's residents closely mirrors the country's economic status; Haitians commonly suffer from malnutrition and all types of infectious diseases. A single place of hope in the populous and particularly poor Artibonite Valley region of Haiti is the Albert Schweitzer Hospital, founded in 1953 by William Larimer Mellon, who graduated from Tulane's School of Medicine that same year.
In his middle 30s, Mellon, a member of the wealthy Pittsburgh family, fell under the spell of Schweitzer, the Nobel laureate, physician and humanitarian who ran a rural hospital in the African country of Gabon. Following in his mentor's footsteps, he enrolled in medical school, became a physician and built a hospital that has survived nearly half a century in a country with a paucity of industry and natural resources and more than its share of political discord and poverty.
Mellon died in 1989, but his spirit lives on in his wife, Gwen, and in the Haitians and the foreign volunteers who staff the hospital. One such volunteer is Tulane's own Paul Dyment, vice president of academic affairs at the Tulane University Medical Center, professor of pediatrics and director of the university's Student Health Center. Dyment has volunteered his services as a pediatrician at the hospital and elsewhere in Haiti for a few weeks each year for the past three years.
When he retires this year, he will devote two months of each year to working in the hospital. Like Mellon and so many other doctors, Dyment's inspiration to give of his time and expertise came from reading about Schweitzer. "When I was premed, I read everything Albert Schweitzer had written," Dyment says. "Anyone who reads about his works is inspired."
An armchair historian and teacher of the course on the history and philosophy of medicine on both of Tulane's campuses, Dyment begins every slide show on his experiences in Haiti with a short history about the hospital and the country. "Forty years ago," Dyment says, "Dr. Mellon went to Tulane medical school late in life, knowing he was going to set up a hospital and knowing it was going to be in Haiti." To trace the history of l'Htpital Albert Schweitzer, one first has to travel to another hospital in Lambarini, Gabon, then French Equatorial Africa.
In 1913, at age 30, Albert Schweitzer, an acclaimed authority on Bach, theologian and newly graduated physician, formed a hospital in an impoverished region of Africa and devoted his life to improving the health care for the area's residents. In 1952 he won the Nobel Peace Prize for his work and philosophical writings. News of Schweitzer and his hospital had spread worldwide when a 1947 article in Life magazine on his works reached the desk of William Larimer (Larry) Mellon at his ranch in Arizona.
As described in biographer Peter Michelmore's book, Dr. Mellon of Haiti, Larry Mellon was something of a misfit among others of his social standing. Son of Pittsburgh financier and industrialist Andrew Mellon, Larry Mellon had decided early in his life to pursue an unconventional career path. Shunning Princeton after his freshman year, he married hastily and endured a brief stint in the family banking business before heading out west to try his hand at cattle ranching.
Settling in Arizona, Mellon's spirits soared and so did his ranch's profits. His marriage, on the other hand, came to a hasty finish when his young wife visited from Pittsburgh and saw the tiny shack her husband called home. In addition to the ranch, Mellon devoted himself to his music and study of languages (he played a variety of instruments and was fluent in numerous languages). It didn't take Mellon long to find a woman who shared his love of the outdoors and industrious work ethic, however.
Also newly divorced, Gwen Grant Rawson worked at a nearby ranch teaching horseback riding to support her three children. They were married after Mellon's tour of duty in World War II and it was with Gwen that Larry sat down and read the Life article on Albert Schweitzer after a hard day's work on the ranch. Although the article made a big impression on both, Gwen was stunned when Larry announced he was going to quit the ranch, go to medical school and start a hospital for the poor.
And it was with hesitation that Tulane University School of Medicine dean Max Lapham admitted the 37-year-old ex-rancher, college dropout and reluctant millionaire. Gwen trained as a lab assistant and worked at the school while Larry earned his degree. Tulane was no picnic for Larry, who first enrolled in the College of Arts and Sciences to take the required premedical courses.
Once in medical school, he had to struggle to make average grades. Gwen worked tirelessly in a nearby laboratory, hardly ever seeing her husband. Schweitzer himself took an interest in Mellon and wrote to him with encouragement and suggestions.
The Nobel laureate counseled his protigi to concentrate on anatomy, physiology and surgery in medical school and refrain from choosing an esoteric thesis topic. Mellon had yet to choose a location for his own hospital when he sailed to Haiti to study tropical ulcers for his med school research project in 1952. There, he found a spot where a hospital was desperately needed. It was the Artibonite Valley, long denuded of its rich mahogany forests and suffering from an abundance of residents and a scarcity of fertile land.
The 610-square-mile area held 180,000 people, with only two small public health clinics to serve them. Haitian president Paul Magliore granted the Mellons some land and buildings on the site of an abandoned Standard Fruit Co. banana plantation in the small town of Deschapelles. They started construction of the modern facility in the backwoods some five hours north of the teeming city of Port-au-Prince. Today, the hospital building itself has changed little from when it opened in 1956. T
he 108-bed, one-story, fieldstone hospital has two operating rooms, a laboratory, X-ray facilities and a pharmacy. The hospital has its own water system, electric power, machine and vehicle shops, laundry and food services. Although the physical structure of the main hospital is much the same, the services and programs have expanded to include 12 satellite health clinics staffed by trained Haitian volunteers and preventive and community education activities with a special emphasis on HIV and women's health.
Annually, hospital staff members perform about 2,000 surgical procedures and see more than 60,000 people in the outpatient clinic. Nearly 100,000 outpatients are treated each year in the outlying health clinics. Haitians make up 90 percent of the hospital staff of 550. Most of the area has no electricity, limited access to safe water and no community sewer system. Contact is limited to e-mail four times a day for 15 minutes or mail delivered each day from Port-au-Prince by a hospital driver.
The Schweitzer Hospital, the only hospital the Nobel laureate ever allowed to use his name, provides essential services to the Artibonite Valley residents. "The Albert Schweitzer Hospital is known as the best in the country," Dyment says. "But most Haitian doctors don't want to work there." Remote and lacking conveniences such as telephones, televisions and newspapers, a position at the hospital may seem unattractive to any up-and-coming physician.
"Western doctors who visit are really needed, and it's obvious that when you get there they really appreciate your helping out," Dyment says. "They're very organized with their volunteers--so organized it's a blessing." Volunteers pay their own way to Haiti, where a hospital employee meets them at the airport and takes them on the five-hour drive along the coast and through the river valley from Port-au-Prince to Deschapelles. Once there, they are greeted by signs in Haitian Creole, written as if an English speaker were phonetically spelling 17th-century French.
The hospital entrance sign, written "Antre lopital," is derived from the French "Entrie l'htpital." The sign pointing to the administrative offices reads "Administrasyon." Volunteers are put up in one of the 12 cabins on the hospital grounds, which each volunteer shares with six other people. Electric generators supply power to the hospital and cabins.
The compound wakes at dawn and so begins a day in the hospital and clinic. Dyment and three other pediatricians begin their rounds in the hospital, each with an interpreter. They will care for more than 100 pediatric inpatients each day, sometimes caring for two children in each bed.
During one month at the Schweitzer hospital, physicians have said they see more diseases and distress than they would in a lifetime at most institutions in industrialized countries. Dyment's experiences have been no different. The diseases he has encountered during his trips to Haiti are ones seldom seen in developed areas. "The conditions most often seen are kwashiorkor, which is protein malnutrition, and marasmus, which is calorie malnutrition," Dyment says. "Other common ones are tuberculosis, pneumonia, newborn sepsis, and typhoid fever. Tetanus and malaria are some of the diseases that are seen routinely, but rarely, if ever, occur in the U.S."
Dyment treats plenty of these maladies during his brief experiences at the hospital and takes photographs of the representative cases to show to students and colleagues back home. The goal is not only to educate, but to spur others to volunteer their time. The images and stories behind them are heartrending and shocking.
"This is kwashiorkor," Dyment explains during a recent slide presentation. The image of a frowning young girl fills the slide screen. "The hair gets red and it falls out. There is a swollen abdomen, swollen hands, swollen face and a very unhappy look. This is protein malnutrition. Even when you start feeding them high protein food, they may still die."
Another slide shows a toddler whose face is swollen nearly twice its normal size. "This little girl walked about six hours from her village," he says. "She had an insect bite that got infected. She may lose one eye. Due to starvation, these children's resistance is down and they aren't able to fight off small infections." After a morning in the hospital, the doctors see clinic patients, many of whom have been in line since the early morning to quietly wait their turn in the open-air clinic. They are mostly women and children who have walked miles to reach the compound.
The hospital charges them a nominal fee for the visit, but trades of produce or a chicken are routinely accepted in lieu of money. Each doctor examines dozens of kids in the afternoon, Dyment says. In the hot and humid summers, physicians must take pains to place a piece of wax paper between their hand and the patients' medical charts to keep sweat from smudging the ink.
In the clinic, a doctor might see any of a variety of maladies, perhaps even a case of tetanus in a newborn child from a remote village. The bacteria that cause the disease are introduced to the infant through the mud and ash rubbed on the umbilical cord after birth in an effort to heal the stub.
Although hospital health-education programs have reduced this practice, it's not entirely eliminated. In the two weeks he spent at the hospital last year, Dyment says he saw two such cases. Voodoo, the native folk religion, is evident throughout the country, although hospital staff members are careful not to intrude on voodoo practices unless they are obviously harmful. Neither does the hospital take sides in Haiti's political struggles, a position that many attribute to the institution's survival over the past turbulent decades.
The hospital has instead focused on improving the lives of the area's residents by public health and education efforts such as immunizations and nutritional counseling. The hospital also has helped residents set up small micro-businesses to increase their personal finances. Improving agriculture and animal farming techniques is also a goal of the hospital.
No medical professional can visit or work in Haiti's Schweitzer Hospital without realizing that an emphasis on the preventive and educational objectives of public health is the best way to improve the health of the Haitian people. So was the impression of Donald Krogstad, who, as a young Harvard medical student, spent part of his senior year at the hospital in 1969.
Krogstad--now William Henderson Professor and chair of the Department of Tropical Medicine in Tulane's School of Public Health and Tropical Medicine--says his time in Haiti made a huge impression on him.
"It was a real eye-opener," he says. By way of introduction to the country, the Tontons Macoute, notorious dictator Francois "Papa Doc" Duvalier's military henchmen, shot at Krogstad and his fellow students on their way to the hospital. Once there, they were safe from violent harassment, but their introduction to a different type of horror began. "The poverty where the hospital is located is just overwhelming," Krogstad says.
Particularly striking was the extent of malnutrition, seen in the valley residents' red hair, a common symptom of the disease. "When I was there, the poverty and malnutrition was such that essentially every kid had red hair," Krogstad says. "It was just amazing." As part of the hospital's public health component, Krogstad took on a project to demonstrate the prevalence of tuberculosis in the valley. "We found that 8 to 10 percent in our census track had active tuberculosis," he says. "By our standards, [this number] was just truly off the charts and beyond what people can imagine."
On a personal note, Krogstad befriended the Mellons, who visited him in Boston while he was a resident at Massachusetts General Hospital, and where Larry Mellon came for medical treatment for heart problems. During one trip, Krogstad and his wife invited Larry and Gwen Mellon to their student hovel.
"It was a typical student apartment with an oven door that you had to keep a chair in front of because the hinges were gone," Krogstad says. "Larry, having grown up in the Mellon millions, didn't appreciate that, but Gwen did, and she tried to stop him when he grabbed the chair from in front of the oven, but she wasn't fast enough."
After returning to Haiti, the Mellons sent the Krogstads a postcard claiming they had always felt embarrassed about the primitive quarters provided to Harvard students at the Schweitzer Hospital--until they visited the Boston couple's apartment. "We salved their conscience," he says. Another letter from Gwen Mellon remains close to Krogstad's heart. She wrote it in honor of his investiture into the William Henderson Chair at Tulane in 1993. Krogstad read the letter at his investiture ceremony.
Gwen Mellon's letters are to be treasured, agrees Margaret Smith, professor emeritus of pediatrics, and a longtime associate and friend of the Mellons. "I feel guilty not keeping in touch now," Smith says. "Gwen's a wonderful letter writer."
Smith, who met the Mellons during their time at Tulane, also worked with them at the Schweitzer Hospital in the 1960s. "They took me to live in their house with them," she says. "I ate and worked very much alongside them." To demonstrate Larry Mellon's informality and kinship with the valley residents, she relates a story about an event that occurred three decades ago as she and Mellon walked from the house to the hospital on their way to work.
As they made their way through the woods, a man jumped in front of them and complained to Mellon that he had nothing to wear to church. He needed a new shirt-- chemise in French parlance. "Dr. Mellon said, 'What about the chemise I have on?' and the young man said, 'Oh yes, that's very appropriate,'" Smith says. "So Dr. Mellon said, 'Let's exchange.' They stood in the woods and exchanged and the young fellow went off with his chemise on. I don't know whether he went to church with it; I suspect he did. He probably did for the rest of his life."
Editor's note: For more information on volunteer opportunities at the Albert Schweitzer Hospital, contact The Grant Foundation, the stateside office of the Albert Schweitzer Hospital, in Sarasota, Fla., at 941-752-1525. E-mail: email@example.com. Web site: www.homestead.com/hashaiti/.
Judith Zwolak is managing editor of the Tulane University faculty-staff newspaper Inside Tulane, and is a frequent contributor to Tulanian magazine. This article originally appeared in the Fall/Winter 1999 issue of Tulanian.
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