Living Schweitzer's Legacy

Look, you want to get right to the point?" asks Paul Farmer, pausing only briefly during his rounds at Brigham and Women’s Hospital. His words come quickly, as if anticipating interruption by his beeper or a page. "Humble service. And, data driven. That’s what you want to remember. Gretchen and Warren remind us that you can care about the world and still be good scholars."

For a quarter century, Gretchen Glodé Berggren, S.M.H. ’66, and Warren Berggren, M.P.H. ’63, D.P.H. ’67, have combined their appointments at Harvard with continuous service across the third world, from Afghanistan to Zaire. But their home base, from 1967 right up to the present, has been the Hopital Albert Schweitzer in Deschapelles, Haiti. And during their time there, over 200 HSPH students have served at the hospital under their tutelage on field projects lasting from several months to several years.

Farmer met Gretchen Berggren a dozen years ago when he was lying on his sick bed in Port au Prince. "I’d heard of them, of course," he says. "Gretchen is known as the Mother Superior of Public Health in Haiti. But I look up and here’s this woman at the end of my bed singing in Creole what sounds like a lullaby. It was a song for mothers of newborns about preventing diarrhea."

Gretchen and Warren Berggren at 1998 HSPH Alumni Day, where they received the Alumni Award of Merit

The Berggrens’ work and quiet example encouraged and guided Farmer in his own efforts to establish new assistance programs. (The recipient of a MacArthur Foundation Fellowship, Farmer still spends half his time in Haiti.) But Farmer, who was originally trained as a medical anthropologist, recalls one bit of direct advice Gretchen Berggren once gave him. "I hope," Gretchen said to him, "we won’t lose you to impracticality."

That the Berggrens value practicality perhaps can be attributed to their Midwestern upbringing. They come from Nebraska, the American heartland. Gretchen is from Chadron in the northwest, where the land rolls round like great green ocean swells into the Black Hills of the Dakotas. Warren comes from Aurora in the Willa Cather country of the southeast, where, he notes drily, a local saying held that the land was "so flat, you could see so far that you could see the back of your head."

For both Gretchen and Warren, the church had been a center of family and community life as they grew up, and it was from listening to reports about missionary efforts abroad at church gatherings that they independently decided to become medical missionaries. They met in medical school at the University of Nebraska at Omaha. Warren was three years ahead of Gretchen, and when he finished his internship he left for the Belgian Congo, where he began his medical service at a mission in Badja Baya in the north, among hills along the great bend of the Ubangi River. The two were married in early 1959 in Brussels, where Gretchen was studying tropical medicine at the Prince Leopold Institute. The following year, they began their work together in Kimpase, in a Congo shortly to become independent.

Amidst the turmoil and strife that followed independence–including once having to be helicoptered away to safety–Warren and Gretchen persevered in their commitment to healing: attending to births and injuries, performing surgery, and serving the isolated countryside.

"That’s when we learned," Gretchen says, "how important getting to the people themselves is. A family would take their sick child back home when their indigenous healer said it was dead. But the child’s chances actually might still be good; we could save it."

She pauses, then continues. "We could save lives simply by teaching healers to use a stethoscope, so they could see for themselves that the heart was still beating and there was hope."

In 1962 the Berggrens came to study disease prevention at the School. "So much of what we had been working with," says Warren, "was illness that should never have happened." In 1967, with a grant from the nih and the encouragement of Tom Weller and Hilton Salhanick, heads of the departments of Tropical Public Health and Population Sciences, they left for the Hopital Albert Schweitzer in Deschapelles. Their first year there, Warren says, the hospital saw 650 children with tetanus, 550 of them newborns. "With the hospital doing its best, we were able to save half of them."

Tetanus was not the only illness they saw, but it was one that should have been "easily" prevented simply by vaccinating mothers. The Berggrens began a vigorous tetanus immunization and education program, reaching out to indigenous midwives, setting up information and immunization stations in the marketplace, going directly to villages.

Today, the hospital hasn’t seen one case of tetanus in nine years, even though its population area is over three times larger than the 70,000 people it served when the Berggrens started.

The Berggrens also introduced modern record-keeping and other practices that facilitate the use of social science measures in evaluating the effects of public health programs. Of the many studies that have resulted, perhaps the most influential was their 1981 New England Journal of Medicine article, "Reduction of Mortality in Rural Haiti Through A Primary Health Care Program," co-authored with Douglas Ewbank. It demonstrated with acceptable social science rigor that their interventions had had positive effect; and, it established their efforts in Deschapelles as a model for others.

Today, the people of Deschapelles know the hospital’s public health building as "Kay Berggren," Creole for "the Berggrens’ house." Over the past three decades, the Berggrens also have raised two daughters; taught at the School (she was affiliated with the Harvard Center for Population and Development Studies from 1974-1989, he was an associate professor of tropical public health and population sciences from 1972 to 1981); guided public health students through field work and special projects; and worked with unicef and similar organizations, including 10 years with Save the Children Federation and, currently, World Relief. Awards have come: a Presidential citation from Bill Clinton; the Donald McKay Medal of the American Society of Tropical Medicine; and, having perhaps the greatest personal resonance because it was presented to them by Mother Theresa, the International Health Award. This spring, the Berggrens received the HSPH Alumni Award of Merit–the highest honor bestowed by the School on its graduates.

Pressed to offer insight or lessons about their work, Gretchen remarks: "You know, we do laugh and joke a lot. We’ve had much joy. And the courage of Third-World mothers is a constant inspiration." Warren politely sidesteps the question. "I don’t think I’m very effective at preaching," he says. Besides, he has work to do. He’s about to leave for Bangladesh to evaluate a program that attempts to improve nutrition by bringing mothers of malnourished children together with more successful mothers in the same village. "Two-thirds of Third-World children are malnourished," says Gretchen. "All need better nutrition. This is where we need to be working."

"They don’t talk about themselves," says Dr. Lachlan Forrow, Executive V.P. of the Albert Schweizer Fellowships. "But on peoples’ talk-to-do ratio, they score very high." Forrow admires the Berggrens for having "consistantly created a life out of their values," for really living out the Albert Schweitzer admonitions they’d been inspired by in their youth: "reverence for life," and "my life is my argument."

Paul Farmer would agree. "Gretchen and Warren are something pretty rare in the academic world," he says. "They’ve never lost their commitment to serving the less fortunate–that means the poor.

That’s their commitment: serving."

- Robert F. Zalisk