DESCHAPELLES, Haiti — Walking down the narrow dirt road, Marie Roline Castor makes her way past the busy, crowded market. Soon, her path leads to a small stone home. There the health care worker talks with a young mother about immunizations and proper nutrition for her children. She reminds the mother to use the clean water from a nearby community fountain, built as part of a recent sanitation project. She chats with the mother about effective and confidential sexual health and family planning decisions.
Ms. Castor’s walks take her through the green Artibonite Valley, its nearby mountains and the community of Deschapelles. She is a longtime nurse turned health care administrator. She trained in Port-au-Prince, the capital of Haiti, about 60 miles south of this town, at the National School of Nursing.
She grew up in southern Haiti and said she always knew she’d be a nurse. As a young girl, she had a desire to help people feel better, she enjoyed studying “medical stuff,” and she possessed a serving attitude. The people in the community called her the girl with the “sensitive hands.”
Ms. Castor is now the head nurse at the 131-bed L’Hopital Albert Schweitzer, which was founded by Pittsburgh’s William Larimer and Gwen Mellon in 1956. The couple, now deceased, were deeply influenced by the philosophy of Nobel Peace Prize winner Albert Schweitzer and believed that they could live in the community and devote their lives to helping Haiti’s most vulnerable populations improve their lives.
In many ways, Ms. Castor is the face of today’s L’Hopital Albert Schweitzer, or HAS. She represents the hospital’s evolution toward a long-held goal: that the hospital was for the people of the valley and would eventually be administered by Haitians.
At Albert Schweitzer Hopital in Haiti, Community Health medical director Dr. Edwidge Pierre, Marie Roline Castor, and a Deschapelles dispensary nutrition nurse discuss HAS' malnutrition treatment protocol. (Ervin Dyer)
Although the hospital was first staffed by medical and surgical specialists from the United States and Europe, it was never the Mellons’ intention that it should stay that way. On the wall of Mr. Mellon’s study in his airy Deschapelles home, copied in the philanthropist’s own handwriting, is a guiding quote from his friend, Y.C. Yen, a teacher and international advocate against poverty who visited the hospital. It reads:
Go to the people. Live among them. Learn from them. Love them. Serve them. Plan with them. Start with what they know. Build on what they have.
Today, 98 percent of the 500 employees of HAS — nurses, physicians, support staff — are Haitians. Up to 100 employees work in the rural areas in community health centers, mobile clinics and do home visits. HAS believes that in a region where most people earn less than a dollar a day, the hospital can be an engine of care, but also have a positive economic, agriculture and environmental impact by allowing Haitians to be involved in helping themselves fight disease and poor nutrition. One guiding belief is that “economic health equals physical health.” In other words, to protect the health of the lush Artibonite valley, a vital rice-producing region to the island nation, is to protect the health of Haiti.
The hospital, built on the campus of a former fruit plantation, is enmeshed with the local community. After the horrific 2010 earthquake near Port-au-Prince, it became a haven for throngs of displaced Haitians seeking care and refuge.
These days, patients sit among its flat-roofed one-story buildings, shaded by the blooms of the flamboyant trees, and wait for care that now includes pediatrics, internal medicine, surgery, health education and increasingly emergency and trauma treatment. Last year it operated at 102 percent of capacity. Part of the HAS mission is to make care accessible. Its price structure — with fee waivers, extended and discount payment plans — and social service outreach are all designed to bring families in. In 2013, community health fees accounted for 7 percent of the revenue for HAS, and, in recent years, board leaders have launched a fundraising strategy to sustain the hospital services.
After finishing nursing school, Ms. Caster took her first job at the L’Hopital Albert Schweitzer. It was 1997 and she stayed at the hospital for 18 months and then went back to Port-au-Prince to work in emergency care before realizing that her “heart and soul” remained with the Hopital Albert Schweitzer and the people it was serving.
At L'Hopital Albert Schweitzer, families help care for relatives who are patients. Here, a young girl collects clean clothing from courtyard where they are able to wash and dry bedding and clothing. (B. Denise Hawkins)
Part of continuing its mission is supporting staff training. Ms. Castor is now taking classes in epidemiology and statistics with the University of Bordeaux in France and will move to France for a year to finish her course work. At HAS, she has served in the departments of maternity and urgent care. She was then promoted to train nurses in the gynecology department. Soon after, she was charged with integrating HAS’ maternal health program into community health work that focused on HIV education and prevention. This work was supported by the Gates Foundation.
Ms. Castor next helped to expand HAS’ family planning program into the four local dispensaries, reaching more of the people in the valley and mountains surrounding the hospital. It is needed: HAS is the only hospital in the region. It serves 350,000 people; compare that to Pittsburgh, where there are at least 11 hospitals to care for a similar-sized population.
As a working mother, whose two children have been treated for asthma and received their vaccines at HAS, she knew it was critical to listen to local residents.
“I asked the hospital to allow me to visit and survey the community. I thought it was important to see families directly and hear and see the kinds of health issues they were dealing with.” Creating a mobile clinic was one of her initiatives.
In 2008, she was promoted to be the coordinator of the Functional Units, a new initiative in Haiti that trains local citizens to offer health education, immunizations and health services in their communities.
In many ways, Ms. Castor’s work outside of the hospital, trying to vanquish chronic disease and disinformation, embraces the hospital’s core value: to have a reverence for life. The Mellons built wells, literacy programs and farms to heal the whole society. Like Ms. Castor, they believed that it was not much help to cure people and then return them to the same environment.
Last month, Ian Rawson, 75, the stepson of Mr. Mellon, resigned from the HAS board after he and his wife, Lucy, had worked tirelessly on behalf of the people in the Haitian community. The hospital also received a $150,000 grant from the Richard King Mellon Foundation to increase awareness and improve marketing in the hospital’s Pittsburgh office.
Mr. Rawson last month said the hospital “is in excellent shape, it’s financially solid, it has a wide support base in Pittsburgh and elsewhere.”
The Mellons’ work virtually eradicated tetanus in Deschapelles, reduced the episodes of typhoid and improved life expectancy in the community by 23 years. Ms. Castor and the residents of the valley face new challenges: HIV/AIDS, tuberculosis, poverty and high infant mortality. But, as she walks the roads to survey local residents on their needs, she knows that by working in partnership with community, she and L’Hopital Albert Schweitzer can make a difference.
Ervin Dyer, a former Post-Gazette staff writer, is senior editor at the University of Pittsburgh’s Pitt Magazine and a Ph.D. candidate in Pitt's Department of Sociology (firstname.lastname@example.org).