Hooked on Haiti
The Western Hemisphere's poorest nation is plagued by poverty, violence, and disease. But for 2 SPH grads (described below and at right), Haiti is a place of hope, and they can't stay away.
The final 10 miles of the journey between Port au Prince, Haiti, and the little town of Fond des Blancs are the toughest. The road is unpaved and riddled with ditches and potholes. The trip takes over an hour and includes two river crossings without bridges. Sarah Hackett, MPH ’73, estimates she’s made the journey more than a hundred times in the past 17 years. Each time, her body aches for days.
Last October, shortly before her 84th birthday, she made the trip again. Although she’d been battling colon cancer all summer, and although Haiti remained in chaos ten months after a catastrophic earthquake, Hackett flew from Boston to the Haitian capital and climbed into an old Toyota diesel with a wooden bench and a driver and drove to Fond des Blancs. She knew it might be her last visit. When she returned home to Massachusetts in November, she’d find out whether her chemotherapy had been successful.
The people of Fond des Blancs call this sturdy, white-haired New Englander “La Reine”—The Queen—because that’s what she is to them. In just over a decade, Hackett’s Haiti Projects—a collection of sustainable initiatives that includes an embroidery cooperative, a family-planning clinic, a library, and an education program—has become the second largest employer in Fond des Blancs, a town of some 25,000 in the mountains 70 miles southwest of Port-au-Prince.
Two years ago, Haiti Projects won an Espiritu Award from the Isabel Allende Foundation. Fellow winners were the St. Boniface Haiti Foundation and physician Paul Farmer, founder of Partners in Health.
When he read about Hackett’s award in the Boston Globe, former U.S. President Bill Clinton sent a fan letter. “I was impressed that even after your retirement you chose to continue to give,” Clinton wrote, adding that because of her work, “Haiti’s future is brighter than ever.”
His letter was dated December 16, 2009. Less than a month later, a 7.0-magnitude earthquake shattered the small Caribbean nation. Hackett was in Fond des Blancs on the afternoon of January 12 and felt the earth buckle beneath her and saw trees sway and bicycles topple. She threw herself on the ground for what “seemed like forever. I knew what it was—it was either an earthquake or the end of the world.” Fond des Blancs was spared, but thousands of refugees came streaming into the small town. Hackett was airlifted home.
Friends have since urged her to abandon her Haiti work. She is now old enough, they suggest, and fragile enough, to stay home. And Haiti itself is unstable. Hackett admits they’ve got a point, but she says they’re missing a greater truth. “What they don’t understand is that I’m in love with the place.”
Sarah Hackett is not entirely sure where her strength comes from. Perhaps it’s the way she’s made—obsessive, single-minded. Or perhaps it’s a legacy from her late father, a dentist who was “very, very focused.”
Or maybe, she reflects, her brown eyes drifting off, it dates back to the day in January 1965 when her first husband was murdered, and Hackett, then 39, was left alone with three teenagers and a five-month-old baby to raise. The killing took place in Berkeley, California, where David Hackett was a biochemistry professor, and although the crime was never solved, his widow is convinced a disgruntled graduate student did it.
“It’s something you never get over,” she says quietly.
As it happened, she’d completed a degree in nursing a few months earlier, so she was able to support herself and her children, but these were tough years. Eventually she remarried and moved to Michigan. She became interested in public health, and in 1971 began a master’s program in community health nursing at the University of Michigan School of Public Health. She was 46. “It was the best thing I ever did.”
She’d long wanted to work in the developing world and had even imagined herself building “the perfect latrine.” When one of her SPH professors mentioned that the only place outside Africa where one could encounter severe childhood malnutrition was a country just a 90-minute flight from Florida, Hackett knew she wanted to go there.
But it took the better part of two decades to do it. By then she was divorced and had moved back to Massachusetts to care for her elderly parents. She’d settled into the clapboard home her great-great-grandfather built in 1829 in the seaside village of Annisquam, north of Boston, and taken a job as a visiting nurse. In 1990, at age 64, she retired and began looking for a way to get to Haiti. Someone told her the St. Boniface Haiti Foundation had opened a hospital in Fond des Blancs and needed nurses. Hackett volunteered.
“You aren’t prepared,” she says, remembering her first, heart-stopping impressions of the impoverished island country. “The picture that comes to mind is a woman selling vegetables on the side of the road, where there’s an open sewer running right next to her.”
Because Haiti’s then-President Jean-Bertrand Aristide had been overthrown just as she was due to travel, Hackett delayed her arrival by ten months. She reached Fond des Blancs in the summer of 1992 and spent three weeks training with a French nurse who showed her how to sew up a machete wound and revive dehydrated babies. Then he left for France, and Hackett was on her own.
She’d taken a five-week crash course in Creole but couldn’t say much more than how are you? There was no doctor on the hospital staff, just a cleaning lady, a lab technician, and a nurse’s aide. On her first day by herself, Hackett walked into the hospital clinic and saw a sea of brown faces waiting for help. Some had walked five miles to see her.
She took to praying for help on her way to work each morning.“At night I was exhausted. If somebody’s catheter got blocked, they would come down to the rectory where I slept and wake me up, and I’d go back to the hospital.” When she and her staff were unable to treat someone, they would put the patient on a donkey and send him over the mountain to a Salvation Army hospital in another town. Locals thought she would never last.
Gradually Hackett took over the day-to-day management of the hospital. She learned Creole and hired nurses’ aides. The experience, she says, brown eyes twinkling, was frightening and exhilarating and “very brave—I think.”
Two days before she was due to fly back to Boston, a group of French-Catholic nuns sent by the St. Boniface Haiti Foundation arrived in Fond des Blancs and took over the hospital. They told Hackett she had to close its family-planning clinic. Furious, Hackett marched down the dusty street outside the hospital, found a private house with rooms to rent, paid for half a bedroom, and promptly moved the clinic into it. The local parish priest told her, “Family planning is all right—just don’t advertise it.”
Seventeen years later, more than a thousand women are enrolled in programs through Hackett’s family-planning clinic, and eight mobile clinics serve villages in the nearby hills.
It was the women who lured her back—the women who managed to scrape up a dollar for a health consultation but couldn’t afford the medications Hackett prescribed. The women who possessed exquisite embroidery skills but lacked needles and thread and cloth. The women who were desperate to earn a living. Hackett couldn’t resist. On a return trip to Fond des Blancs she assembled embroidery materials and persuaded a handful of women to join her on the steps of the rectory, and they began stitching pillows and bedcovers. It was the start of Haiti Projects. “I told them the first couple had to be free, and after that I’d pay them $1 for each one, because this wasn’t going to be charity.”
Handouts, she believes, are not the answer to Haiti’s problems. The embroidery cooperative Hackett launched in the mid-1990s now employs nearly 90 people and generates a $5,000 monthly payroll. Cotton nightgowns with intricately stitched bodices and French seams are the biggest sellers, but the women who sew for Haiti Projects also turn out decorative table linens and other household items. Sales are both in person and online.
Hackett went on to create a micro-lending program to help peasant farmers buy tools, animals, and other necessities; a tuition program to help fund childhood education in Fond des Blancs; and a lending library with 3,000 volumes, a multimedia room, and a weekly storytelling program. Users pay a modest annual fee to borrow books. She also continues to fund the family-planning clinic she founded in 1994. All told, Haiti Projects costs around $300,000 a year to run. Nearly half of that is earned income, and the rest comes from donations, although Hackett hopes over time to reduce the organization’s dependence on charity.
For the past 17 years, Hackett has gone to Haiti every year for as long as eight months at a time to oversee Haiti Projects. For a number of those years she lived in a house without electricity or running water. “I liked that,” says this child of the Depression. If she stays longer than a few months, she gets irritated, because “it’s so hard to make anything work in Haiti.” But coming back to the States is difficult too. “I used to have to take three days to get acclimated,” Hackett sighs. “I couldn’t go to the grocery store and see all that affluence. I couldn’t stand it.”
Haiti may be a thousand miles away, but inside Sarah Hackett’s sunlit house in tiny Annisquam, it feels close by. Tucked among the antique tables and oriental rugs that Hackett inherited from her New England ancestors are signs of her other “family”: a tin wall-hanging hammered into pristine beauty by craftsmen from Fond des Blancs, cartons of delicately embroidered nightgowns.
Sarah Hackett was born inside this house, and her mother and father both spent their last years here. Hackett cared for them until the end. “I’m big on people dying in their own beds,” she declares, and it seems obvious she intends to do the same. During her trip to Haiti last fall, she turned 84. She celebrated by drinking a beer.
A few weeks later she flew home to Massachusetts and underwent a CT scan to see whether her cancer had returned. While she waited for the results, she sent out a letter announcing that after 17 years as president of the board and executive director of Haiti Projects she was stepping down. “I’m satisfied,” she said shortly after the letter went out. “I’ve been a one-man band, to tell the truth, and I’m so tired.” Haiti Projects is now in the hands of executive director Lucy Levenson.
Shortly before Christmas, as Haiti lurched into yet another crisis—this one sparked by allegations of fraud over presidential elections—Hackett got the results of her CT scan. Her chemotherapy had worked. She celebrated that night with her children and grandchildren and great-grandchildren.
Now that her health is back, she wants to go to Haiti again, although she admits it will probably be to visit rather than work. Still, she dreams of more projects. She’s been thinking lately about starting a cooperative to help the men of Fond des Blancs make and sell decorative hammered-tin objects. Otherwise, she says, they just hang around with nothing to do because the soil is too poor to sustain farming. “I thought, before I croak, maybe I’ll try to get something going.”
Lots of people go to Haiti, she notes. “Some of them just go and they’re horrified, and there are other people who fall in love with it, and they just get hooked and they can’t get unhooked, and that was me.”
On her way out of Fond des Blancs last November, as she bumped along the road to Port-au-Prince, Hackett turned to her driver and said, “Tell everybody I’ll be back when they fix the road.”
—Articles by Leslie Stainton
The Reluctant Missionary
During her first visit to Haiti, Rosemarie Rowney, MPH ’77, became so sick she was bed-ridden. She vowed never to return. That was in 2008. Since then, she’s been back two more times. A fourth visit is in the works. Haiti, she says, “pulls you in.”
A public health nurse with 20 years’ experience as the chief—and first female —health officer for the Oakland County (Michigan) Health Department, Rowney got interested in Haiti when she was 65 and on the verge of retirement, a grandmother of four who was grieving the recent death of a loved one. “There was a bit of a vacuum in my life,” she remembers.
Ruth Barnard, a professor emeritus of nursing at the University of Michigan and a fellow member of Ann Arbor’s First Presbyterian Church, which sponsors several Haiti missions, asked Rowney if she could lend a hand to the Haiti Nursing Foundation. Barnard had founded the organization in 2005 and needed help. The foundation supports nursing education throughout Haiti and funds some 120 student nurses a year at Haiti’s only baccalaureate program in nursing, the School of Nursing in Léogâne. “Ruth said, ‘Just come down to Haiti one time,’” Rowney recalls. “So I did.”
Today Rowney is president of the Haiti Nursing Foundation. “It means I haven’t retired,” she smiles. The work is tough and the fundraising constant, but Rowney believes nurses are critical to the future of the beleaguered Caribbean nation. Below is a scrapbook of this reluctant missionary’s love affair with Haiti.
A Haitian Journey
by Rosemarie Rowney
February 2008: What have I gotten myself into? Flying in over Port-au-Prince, I’m taking my photos, and I see this mist, and it’s a little pastel-looking, and I think it’s just a beautiful setting. And that mist happens to be garbage burning, because they have no way to handle their trash. Then we get into our vehicle, and the next thing I see are the drainage ditches meant to take the runoff from the mountains, which comes fast and furious because the mountains are denuded—they cut the trees down for charcoal. And the runoff ditches are filled to the brim with trash. Traveling out to Léogâne, you can’t see anything after dark except for these individual kerosene lamps that merchants have out so that people going by can see what they have for sale. There’s no rhyme or reason to what’s for sale—old U.S. T-shirts that people have sent down, a basket of over-the-counter medications. You see people without adequate foot coverings, children sitting in the dirt. And then you go by a heap of trash on the ground, and there are wild pigs rooting through it. My first ride out to Léogâne was like, “Oh my gosh, what have I gotten myself into here?”
2008: I don’t think I can do it. I am a reluctant missionary. I’m not brave, particularly. I’m not gung-ho. I became very ill on my first trip, and two students took care of me. They did a nursing assessment, tested how dehydrated I was, and got me fluids. I came home and told some of my friends, “That’s it. It’s hard. I don’t think I can do it.” Part of the heartbreak was the abject poverty. What changed me? I think it was the students, Martha and Shirley (pictured at top of page), who took care of me. They were the valedictorian and salutatorian of the first class. And then just coaching myself to “get over it. If these other women can go, I think you can probably step up to the mark here, Ms. Rowney.”
January 10, 2009: We were crying, all of us. After I saw the first graduation I was really hooked. There we were, standing in the yard of that beautiful Episcopal cathedral that was later destroyed in the earthquake. Here came the families, all dressed up. I remember this one open-bed truck had a grandmother dressed up in a rocking chair. She was surrounded by the rest of the family. It was all pride, all pride. Then we were settled in the cathedral, with the bishop up front. Here came the dean, Hilda Alcindor, in this white suit, with her military bearing—one hand behind the back—and the students coming behind, two by two by two, the same way. The respect they had for themselves. The potential. Look what I have done. I can be somebody. I have some hope. I’ve done this, and now I have a future. It was incredible to see them walk in. We were crying, all of us.
2009: Change-agents. One thing we like to say is that we’re changing Haiti one nurse at a time. I truly believe that they can change Haiti. They are more than nurses. They represent a very small minority of people with a college degree—a baccalaureate. Not only are they educated in nursing, they’re educated people. They have liberal arts, sciences, languages. They can write and talk and interact. That positions them as leaders and change-agents in the country. I firmly believe that one of them will be in the Ministry of Health as its leader someday. But the most important aspect is that nurses care. As a result of that, they’re less apt to throw up their hands, turn their backs, and say, “Well, I don’t think we can do anything.” When somebody’s in trouble, nurses are pretty good at that. And Haiti is in trouble.
January 12, 2010: Earthquake. Hilda, our dean, was in the classroom when it happened. She was thrown from one side to the other, and fell on the desk. The students were terrified. Hilda knew she had to get them out into the courtyard, but she could not get the door open. She tugged and pulled and finally somebody came and was able to bash it in. The students ran out into courtyard and threw themselves on the ground. The aftershocks kept coming. The students were screaming and crying. After about a half-hour of this, people started rushing into the school, because the wall was breached. The school itself stood. After a half-hour, Hilda said, “I didn’t ask you to come here to be nurses. You wanted to be nurses. You are nurses. Now you stand up here, and you help us. We’re going to help people.”
2010: Aftermath. Without any outside help, with nothing more than their own knowledge and the skills
they’d learned at that school, the students saved lives and took care of people. They
used whatever they had on hand—cardboard for splinting, clinical laboratory supplies
for dressings. They delivered eight babies. There was a little girl who had a traumatic
amputation of her right arm, but it wasn’t complete. One of the students completed
the amputation and bandaged it.
Ninety percent of Léogâne was destroyed in the quake, but the school held. Here was this oasis. A tent city with 5,000 people sprang up on the property, and for months afterward everyone lived in a compound in the courtyard, with all the related sanitation and security issues.
All in all, six accredited schools of nursing were flattened in the quake, including the flagship school, the National School in Port-au-Prince, which collapsed with the entire sophomore class inside. Ninety students died. A number of hospitals were also destroyed. Our foundation is helping to rebuild Haiti’s health infrastructure.
Today: A public health petri dish. I can’t explain Haiti—why this country, with approximately the same population as Michigan, should be suffering so much, when it’s a 90-minute flight from Florida. It’s in our back yard. We should be outraged about that. You don’t have to go all the way to Africa and all the way to China to be involved in what I think is one of the major public health disasters in the world. Every single public health problem that you can imagine is there—environmental health, health education, hospital administration, nutrition, epidemiology, biostatistics. Haiti is a public health petri dish, and students and faculty here need to consider what kind of commitment they have to such a near neighbor. I get all impassioned and emotional—but it’s true.
If you truly are a public health person, then you adopt more than the theory and the practice. You adopt public health as a way of life. Haiti just fits naturally with that kind of philosophy. It was just a set of circumstances of time and geography for me—that I’d be in Ann Arbor, and I’d be at this church, and I’d know these nurses who were involved, and I had this skill set. Haiti pulled me in.<