Hope for improved medical care in Haiti took another step
toward reality in early April, when a group of medical planners, architects and
engineers visited St. Therese Hospital in Hinche, Haiti, where the mission to
build a new emergency department (ED), intensive care unit (ICU) and post
anesthesia care unit (PACU) has begun. Steven Steinberg, principal in the
health care division of San Francisco Bay Area architects RATCLIFF, saw the
existing conditions and appraised the challenges of bringing western-standard
health care design and construction into the impoverished country.
â€œOur three biggest challenges will be providing clean water, providing power
and providing medical gases there at the hospital,â€ Steinberg said. The
buildingâ€™s infrastructure is crumbling and technology is far behind that
considered standard in developed nations. Patients are admitted to
shared, open air wards. There are no private rooms save for a few
isolation rooms for Tuberculosis (TB) patients. There are no CAT scans, no
EKGs, no ventilators. The current ER is literally a room that is too
small and ill equipped to care for patients in an efficient manner.1
Of great concern is the high incidence of Tuberculosis and HIV, as well as
recent outbreaks of cholera in Hinche and the surrounding countryside.
The design team is considering building with natural ventilation as an
effective means of reducing the spread of infections.
â€œIn Europe, many hospitals rely on natural ventilation and have lower infection
rates than their U.S.
counterparts, where we typically are prevented from incorporating natural
ventilation by governing codes,â€ said Steinberg. He cites examples where
fresh air has successfully combated TB and influenza infection. â€œOpen-air
tented hospitals were erected in four days to treat the pandemic influenza in
the early 20th Century. Many sanatoria were literally open-air
in design, mortality rates were extremely low compared to closed-loop hospitals
of the day, and deep breathing of cool air and sleeping in the open were
extremely effective in combating TB and influenza infection,â€ he said.
daylight and fresh air into the proposed new facility at St. Therese will also
be an obvious means of building in harmony with the natural environment and a
prudent use of available resources, methods and technology in an area that is
literally â€œoff the grid.â€
St. Therese is the main hospital for Hinche and much of the surrounding area,
serving an estimated 220,000 people. It was built in the 1930s by the
U.S. Marines and is run by the Haitian Ministry of Health, assisted by Partners
in Health and Project MediShare, based in the nearby village of Thomonde.
St. Therese provides a variety of services including surgeries, deliveries,
dental, HIV and TB care. Last year it served as a trauma center when an
outbreak of cholera hit the country. Beds were set up under tents in the
courtyard adjacent to the operating room. That same courtyard will become
the building site for the hospital addition, anticipated to break ground in
is about a 3.5 hour drive from the capitol, Port au Prince, which was badly
damaged by the earthquake of 2010. A new â€œsuper road,â€ built with funds
from the European Union, connects the capitol with the outlying
highlands. The road is used by everyone: pedestrians (especially
women balancing heavy loads on their heads), livestock, scooters, cars and
trucks. Traffic laws appear nonexistent. An unintended consequence
of this improvement is an increase in traffic accidents; St. Therese now must
cope with many more trauma cases than before the road was built, thus the
urgency for an expanded ED in Hinche.
RATCLIFFâ€™s Steinberg and Bruce Berg accompanied the team on this recent trip to
The trip was organized by Medical CAREâ€™s Dr. Olajire Idowu of Childrenâ€™s
Hospital, Oakland, and Dr. Rick Spurlock of EPI, who had previously visited the
site and met with the Haitian Ministry of Health and the hospitalâ€™s medical
director, Dr. Pierre Prince, to discuss options for elevating the current level
of care. Once the project is complete and effectively self sufficient,
the facility will become part of the EPI foundation. Haitian medical
personnel will be brought to the U.S. for training.
Steinberg says a compelling motivation for the team is the inspirational
character of the Haitian people who have faced great deprivation with courage
and cooperation. â€œThe Haitian people we encountered are highly
appreciative of our teamâ€™s efforts and willing to help in any way
possible. Our brief encounters with people in Thomonde and Hinche were
truly inspirational and we look forward to bringing improved medical services
to such a deserving country,â€ he said.
The St. Therese Hospital, Haiti,
Care for Children of All Races Everywhere (Medical CARE), Dr. Olajire
Idowu, Pediatric Surgeon at Childrenâ€™s Hospital, Oakland, California.
Physicians International (EPI), Dr. Rick Spurlock, Assistant Medical
Director of Piedmont Fayette
Emergency Department, Georgia.
architects, planners, interior designers, Emeryville, California.
Steven Steinberg, Principal. www.ratcliffarch.com
Mazzetti Nash Lipsey Burch, mechanical planning engineers of San Francisco, Ron
Bourgault, Associate Principal. www.mazzetti.com
International, structural engineering, Bob Glasgow, Principal. www.miyamotointernational.com