Haiti became the world's first black republic in 1804, but in the next nearly 200 years, its misery remained largely unchanged. For North Americans, it was an easy place to ignore, in good or bad conscience, and the great Mellon banking family of Pittsburgh was no different from the rest. Mellons do not have to work, but the best of them always have. Most worked at making money, and brilliantly. One of them would work for sick people in the poorest country of the Americas.

The Haitians have a Creole proverb:
Maladi gate' vi a-sickness spoils life.

Albert Schweitzer had a motto:
"Help life where you find it."

Larry Mellon had a mid-life identity crisis.

William Larimer Mellon, Jr. was the grandnephew of Andrew W. Mellon, the U.S. Secretary of the Treasury, and heir to part of a family fortune which rivaled that of the Rockefellers. "I was born in opulence," he said. "There were times when I felt ashamed to be from a family that was known only for wealth."

At college, he evinced no interest in the banking business: "In those days everyone wanted to be a bond salesman and belong to the right clubs. I didn't know what I wanted, but I knew I wouldn't get it at Princeton." He dropped out after a year and reluctantly joined the family enterprises. But Larry Mellon's happiest times were spent in his pickup truck or on his horse, riding out as far as he could get from Pittsburgh. In 1935, he used part of his inheritance to buy a ranch near Oak Creek Canyon, Arizona, and became a dawn-to-dusk working cowboy; he built fences, rode herd, did his own branding, and learned to wield an ax and a blacksmith hammer. During World War II, he joined the Office of Strategic Services and served in Spain, spying on enemy ships in Spanish harbors and sometimes traveling behind the lines.

Back in Arizona in 1946, he met his match in all ways-Gwen Grant Rawson, a Shipley-and Smith-educated maverick not unlike himself. She was an excellent horsewoman, lover of the outdoors, and mother of three. The two families joined forces.

Ranch life was satisfying but not spiritually fulfilling. In 1947, Mellon came across a Life magazine article about Albert Schweitzer's work in Gabon, West Africa, and was hit hard by Schweitzer's words: "It struck me as incomprehensible that I should be allowed to lead such a happy life, while I saw so many people around me wrestling with care and suffering." Schweitzer had insight, like the Creole proverb above, into the way pain diminished human beings.

Paul on the road to Damascus had no greater conversion. Mellon's need for an extraordinary challenge was like Schweitzer's. He wrote to say he was inspired to establish a medical mission of his own. Schweitzer wrote back: "On reading your letter, I was very moved&. I consider you a dear brother, and will refer to you as thus." They corresponded for life.

Mellon wasn't even a college graduate, much less a doctor. Nevertheless, at 38, he enrolled at Tulane University with students half his age, while Gwen studied to be a medical technician. Schweitzer offered some shrewd med-school advice: "Do not plan to pass your examinations brilliantly; be content with getting through them honorably. Do not have any pretensions with your doctoral thesis&. do just what is necessary to complete the task."

The Mellons first met Schweitzer in 1949 and later visited him in Lambaréné. In 1952, they went to Haiti in order for Larry to write a thesis on tropical ulcers. The beauty of the islands stunned them as much as the poverty and disease-chains stronger than slavery's in a country with the lowest life expectancy and highest infant mortality rate in the hemisphere. The once-fertile paradise with its maho-gany forests was now deforested and eroded. Gone were the rich sugar, indigo, coffee, and cotton industries. Malnutri-tion was as chronic as overpopulation. Two thousand people inhabited every square mile of tillable soil. A healthy ratio of doctors to population is 1 to 2,000; in Haiti, it was 1 to 10,000.

The Artibonite Valley,-Haiti's rural mid-section, was even worse. That 600- square-mile-area with 200,000 people contained not a single doctor in private practice and only two small government clinics. The need was there, and it was there that the Mellons decided to build their hospital and to name it in honor of Schweitzer. A unique charter worked out between Mellon and President Magloire granted the Albert Schweitzer Hospital a rent-free site and 15 out-buildings on a former Standard Fruit Company banana plantation in the little town of Des-chapelles. A 100-acre farm was included. "I have a great concern for you and your activities," Schweitzer wrote, "for, without knowing it, having drawn you into this career, I know well its difficulties, and feel that yours are even greater than mine." The abysmal state of public health in Haiti was a situation everyone had lamented for generations, but Dr. Mellon was ready to do more than lament. While he finished up his internship in the United States, Gwen supervised construction of the hospital at Deschapelles. It opened its doors in 1956, at a cost of US$2 million.

On that first day, the Mellons held their breath: Would anyone come?

There were crowds at dawn and from that day forth, two-thirds of them women and children. The average Haitian woman has six children in her lifetime, twice the Western world average, and tetanus was the number one killer of Haitian newborns, because the midwives' custom of rubbing mud, dung or charcoal on unhealed umbilical cords. The Mellons were determined to immunize every woman in the valley against tetanus, and soon their mobile immunization teams were inoculating 114,000 people a year.

Many called it "Mme. Mellon's Hospital," and still do. It was she who collected the small fee from patients, though it was hard for many to pay, on the theory that if it's free it's not valued in Haiti or anywhere else. Often a bag of rice or fruit was accepted instead. The hospital's 108 beds hold 2,500 patients a year, and an additional 50,000 are served as out-patients by the 12 physicians and 85 nurses. Nowadays, the hospital employs 250, a roughly equal mix of Haitians and expatriates, in its nursing, pharmacy, laboratory, records, and X-ray departments, and on its farm which provides much of its food. HAS (the French initials for the hospital named for Schweitzer) provides patients with meals. Elsewhere, relatives of the sick must bring in food. Of the 300 cases on clinic days, half are children, most acutely ill with malnutrition and diarrhea, many having traveled a day on foot to get there.

The care is immediate and personal. HAS doctors are often called upon for more than just 10- and 12-hour days: Dr. Mellon gave pints of his own rare O-negative blood when necessary. On "days off," his hands dug ditches with the locals or dipped deep into plaster-of-paris, learning how to make clubfoot casts. Later came the HAS TB village, L'Escale, which deals with more than 1,000 cases of pulmonary tuberculosis a year. Dr. Mellon rejected proposals to establish a tropical disease center at Deschapelles. "These are our patients, not guinea pigs," he said, and though many religious organizations sent valuable aid and personnel, they were advised, "This is not a missionary hospital. Religion is a means of sustaining oneself and is not to be disseminated." Mellon disliked evangelism and, in typically strict fashion, once asked some Catholic nuns to remove a crucifix from their HAS office.

"What amazed me first in 1962 and continued to impress me later," says Schweitzer's daughter Rhena, "is the wonderful balance of curative and preventive medicine for which HAS is a model of what a hospital in a developing country ought to be."

Over the years, HAS' miracles have included the virtual eradication of neonatal tetanus and a major upgrading of health care for the entire Artibonite Valley. Life expectancy was about 30 when the hos-pital was established; today it is 54. The district now is almost free of vitamin A deficiency and measles, and typhoid has been greatly reduced. The infant mortality rate is half that of the rest of the country. Doctors at HAS see more patients in 24 hours than most American doctors see in a year. The strain and pain get to some of them, but it never got to Larry Mellon. What most sustained him, aside from his wife, was a deep love of music. He was a self-taught expert on the clarinet, cello, accordion, guitar, French horn, and oboe.

The power of music fit perfectly with the philosophy of L'Hôpital Schweitzer and with the Mellons as people: Music was balm for body and soul. One day, a little girl arrived with a cancer that had gnawed her mouth and nose horribly. She stood quietly in distress, looking up at Dr. Mellon for help, her face half-pretty and half-raw flesh. After some ministrations, he picked her up in his arms, carried her to his house, sat her on a divan on the porch, and then went to a beloved spot-his outdoor music stand-and played the flute for her. After an hour, he carried the girl back to the hospital and put her in a clean bed. He smoothed the hair back from her forehead and bent close to whisper, "Au revoir, cherie." In the morning, she was dead.

A tour of L'Hôpital Schweitzer is both heart-wrenching and heartening, upon inspection of the TB and AIDS wards and patients with a shocking range of other diseases. Most common are kwashiorkor and marasmus. Under the staggering weight of their tasks, HAS physicians maintain their sanity and their optimism thanks to a phenomenon unique to Deschapelles, as former executive director Bill Dunn explains:

"Dull people don't come here. You become honest with one another, because you can't be phony when you live and work together in this environment. So much needs to be done that, pretty soon, you find it's simpler and more productive just to be yourself." The Mellons set the example for that here.

"There were no fancy words with Dr. Mellon; it was straight, accurate and simple. He had an uncanny ability to cut through the fluff, and he didn't deal with 'situational ethics.' Things were right or they were wrong. His goal was to simplify, and there is virtually no lag time here. You can make a decision at noon and implement it by 4 p.m., as opposed to the United States with its planning agencies and state health departments, where it takes months and months for approvals. When I came here, it was a professional rebirth because of the freedom, the ability to create change. It's an extremely re-freshing thing."

As refreshing as the Haitian people themselves. It is easy to fall in love with them and with a country whose very falling-apartness constitutes a celebration of the poetic over the functional. In Haiti, nothing quite works the way it should, but the most ubiquitous phrase is "Pas de problème!" ("No problem!") regardless of whether there's really a problème, which there always is.

Haiti's unique flora and fauna include 1,200 varieties of palm, frangipani and poinsettia trees. Gorgeous flamboyants, cousins to the mimosas, surround the Mellons' house, and a spring pops out through the middle of Gwen's living room when it rains hard. A hundred yards away are the great 100-foot-tall remnants of an aqueduct, part of an 18th century French colonial sugar mill whose ruins are as eloquent as anything left over from the Romans.

Voodoo influence is everywhere-not the Hollywood voodoo of sticking pins in dolls, but a lofty set of beliefs in African spirits called loas, who can be summoned to take possession of your mind and body, and who rule daily life. Voodoo was the only thing that couldn't be beaten or stolen from the slaves over three centuries. It was cleverly grafted onto French Catholicism. Voodoo in Haiti is Africa reblended. It is the religious practices of Congo, Dahomey, and Yorubaland merged with Christian beliefs. It is a way of life more than a religion. "Unlike Christianity, voodoo is not aggressive," says voodoo artist, Andre Pierre. "It doesn't make people build churches or try to convert you. Voodoo is inside every Catholic church!" he adds with a sly smile.

The meshing of voodoo and medicine parallels the meshing of voodoo with Catholicism. Most Haitians consult their voodoo doctors before visiting the hospital, but there is no conflict-in fact, there is cooperation. Only arrogant Westerners use the term "witch doctor." There are no mental hospitals in Haiti, but there are as many disturbed people there as anywhere, and voodoo priests (houngouns) often tend to them. Dr. Mellon recognized that their function was frequently similar to a psychiatrist's, and that most of them were simply wise men who understood their people and herbal medicine.

Larry Mellon was also a wise man who understood the people. In Haiti, one of his early insights was that medicine alone-no matter how well practiced-could make only a dent in the underlying Haitian dilemma, and that to cure people and then return them to the same environment that produced the disease did not help them much in the long run.

Accordingly, Dr. Mellon only "doctored" for about three years, at which point he turned his attention to the creation of a vast array of ambitious community health projects. Henceforth, if you wanted to find Larry Mellon, you went outdoors, and often a long way, for as of 1959, the HAS Community Health and Development program and outreach centers began feverish activity. An elementary school was started on the campus. There and at the centers, reading, writing, basic health, sewing, carpentry, and child care were taught. Dozens of sanitation projects were initiated. Old wells were collared and new ones dug for the clean cooking and bathing water that hadn't been obtainable in generations. Latrines were built-Dr. Mellon always among the laborers-along with rammed earth houses, dams, canals, and other irrigation systems that soon saw rice paddies flourishing for the first time. With agronomist Gus Menager, he introduced into the Artibonite Valley a new strain of rice that doubled the yield.

Mellon had no engineering degree. "Neither had the Romans when they built their aqueducts," he said. Among his more significant projects were the following:

• In the 1960s, he went to visit the excavated Etruscan tombs at Tarquinia and examined their ancient hydraulic structures; he then inspected some new elevated irrigation flumes-50-foot U-shaped concrete sections joined to maintain shape and conduct water to adjacent fields. Six months later in Haiti, several kilometers of very similar flumes led from a dam site on the Tapian River. In that short time, he had adapted and built the forms using local lumber, somehow acquired and poured the cement, and transported the sections weighing several tons apiece over rough trails, working side by side with Haitian laborers. They are still in place and serving that district's farmers.

• At the town of Valereux, he initiated a project to irrigate the whole area and stayed to plant grapefruit and bananas himself. Schweitzer advised him to plant only trees that produced edible fruit. In the HAS courtyard, for example, are almond, cherry, and breadfruit trees. The Mellons have long been involved in grafting projects, one of which spliced new varieties of mango onto existing trees to produce five different kinds of fruit and-since grafted trees produce in one-quarter time-to quicken productivity. o Gwen Mellon's reforestation projects, in conjunction with the Mennonite Central Committee, have planted 20,000 seedlings.

• The Mellons produced motion-picture films in Creole, for traveling exhibitions in villages, on the prevention of neonatal tetanus and on pig-raising, plus a wide variety of other programs for livestock-veterinary improvements.

Larry Mellon loved to work alongside the Haitians; he helped dig graves for the unclaimed dead in his own cemetery. He was exhilarated by doing, not pondering. Haiti was the little part of the world he could and did affect. Yet at the same time, says Dunn: "Dr. and Mrs. Mellon demonstrated the rare ability to discon-tinue an unsuccessful project-to recognize when something wasn't working. Over and over, he would try something and if it didn't work or he wasn't satisfied with it, he closed it, and that was it. Most of us put so much of ourselves into something we start that, when it isn't working, we drag it on. Dr. Mellon had a leather-tanning operation here, two different kinds of tile-making, fish production, dairy cattle, broom making&. He tried things, and if they didn't work-so long. No regrets."

The bakery and tile-making operations were among the casualties. But the weaving, carpentry and ceramics operations have survived. So have Mrs. Mellon's sewing centers and her cotton-ginning and rug-weaving enterprises for the old and blind that support 100 families in the valley.

From the late 1950s to the end of his life, Mellon's daily routine consisted of visiting the hospital by 6:30 a.m., spending as little time as possible with administrative chores, which he loathed, and then getting out-life was "out there." By 7 a.m. or so, he was gone for the day, working on an irrigation project, figuring out what the carpenters' problems were, deciding whether to put in a pipeline from this spring to that community.

"Reverence for Life," Schweitzer's motto, is inscribed over the hospital entrance at Deschapelles, and Larry Mellon applied it to all life. Once, he couldn't stand to see a horse in agony and got out of his truck to deliver the coup de grâce; the Haitian bystanders thought it was the height of blanc (white) idiosyncrasy.

In his last years, when Dr. Mellon was himself hospitalized at HAS, he insisted on the same room, bed, sheets, and food as everybody else: "We don't have two types of sick people here." His 35-year labor in Haiti ended on August 3, 1989, at age 79, when he lost a long battle with cancer and Parkinson's disease. A few weeks earlier, he had gone with Gwen to buy a cheap coffin of wood and cardboard carton-an inspirational example to people who often spent as much as half a year's income on their funerals.

"The Haitians have an interesting theory about Dr. Mellon's death," says former HAS medical director Dr. Michel Jean-Baptiste. "They don't know anything of Parkinson's disease. They think what happened to Dr. Mellon was that he was too active when he was younger and he used himself up. In a sense, they are right." At his memorial service, Mellon's dynamic wife described her husband's spirit as "like a crystal with many facets, it is found on the handle of a door, the end of a stethoscope, the edge of a scalpel&. It is a letter of love written by illiterates on the rocks, the hills, and with the homes of thousands in Haiti. Having seen it is a legacy to teach by. It cannot be stifled. It is a real and living thing."

What does it mean to give and care?

"The first time you send a man home to die of pulmonary tuberculosis-and probably infect his family-you're sympathetic," said one HAS doctor. "By the hundredth case, you can feel almost nothing; you've become a monster."

He had despaired. But others like Dr. Harold Lear-a visiting surgeon there for three tours of duty in the 1960s-considered it the most satisfying experience of his life. In Deschapelles, he said, "One felt at least within shouting distance of the Hippocratic Oath."

In the face of overwhelming obstacles, Larry Mellon was never overwhelmed. "It's never too late and it's always too later to start helping others," he once said. "If you get discouraged, you become impotent." Look after the little picture, he used to say, and the big picture will take care of itself.

Dr. Jean-Baptiste, a brilliant Harvard-trained surgeon, warns against comparison between Dr. Mellon and the man who inspired him. Says Dr. Jean-Baptiste, "One of the main differences between them is that Dr. Mellon came to a country that had been independent for many years and had its own culture and government. The Haitian people are very proud. Their first reaction to a foreigner is to keep their distance. The first thing Dr. Mellon had to do when he came here was to gain their trust and confidence, and it didn't take him long to do that, because they realized that this guy was serious. He meant business. He set the example right away. The first day he opened up the clinic, he didn't stay down there at his house while the other doctors worked. He and his wife worked here till 11 o'clock at night&.

"It's one thing for me to say I understand Dr. Mellon's philosophy, but I have to translate that into action. More important, I have to pass it on to the staff-especially the Haitian staff. If somebody believes in Mrs. Mellon, he's going to take care of the patients properly because that's what Mrs. Mellon does-she comes every Sunday and visits every single patient in the hospital. I am here then and I see it. You have no idea how good that makes the patients feel. It's very important. They love it. Dr. Mellon used to do that too&."

Dr. Jean-Baptiste adds, "It's a real challenge for us to try to keep his spirit alive, and we have to do it through our work. This is not just 'a great hospital'-there are many great hospitals in the world, but there's only one like this. It's unique because of the people who founded it and the people who work in it."

Schweitzer wrote that anyone contemplating a course of action similar to his own should have no thought of heroism, only of a spiritual adventure. "There are no heroes of action, only heroes of renunciation and suffering," he said. "There is no reward for the work except the privilege of doing it."

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Barry Paris who lives in Pittsburgh, PA, is the author of "Song of Haiti: The Lives of Dr. Larimer and Gwen Mellon at the Albert Schweitzer Hospital of Deschapelles."

Return to the Contents page of Perspectives in Health Volume 5 - No.2