Ratcliff Architecture News

Team of Healthcare Providers, Architects and Engineers Return from Hinche, Begin Design for St. Therese Hospital Upgrade. April 29, 2011

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.

“Our three biggest challenges will be providing clean water, providing power and providing medical gases there at the hospital,” Steinberg said. The building’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.

“In 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,” said Steinberg. He cites examples where fresh air has successfully combated TB and influenza infection. “Open-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,” he said.

Incorporating 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 “off the grid.”

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 late 2011.



Hinche is about a 3.5 hour drive from the capitol, Port au Prince, which was badly damaged by the earthquake of 2010. A new “super road,” 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.

RATCLIFF’s Steinberg and Bruce Berg accompanied the team on this recent trip to Haiti.  The trip was organized by Medical CARE’s Dr. Olajire Idowu of Children’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 hospital’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. “The Haitian people we encountered are highly appreciative of our team’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,” he said. 

The St. Therese Hospital, Haiti, Team:

  • Medical Care for Children of All Races Everywhere (Medical CARE), Dr. Olajire Idowu, Pediatric Surgeon at Children’s Hospital, Oakland, California.  www.medicalcareforchildren.org.
  • Emergency Physicians International (EPI), Dr. Rick Spurlock, Assistant Medical Director of Piedmont Fayette Emergency Department, Georgia.  www.epinternational.org.
  • Ratcliff, architects, planners, interior designers, Emeryville, California.  Steven Steinberg, Principal.  www.ratcliffarch.com
  • M+NLB Mazzetti Nash Lipsey Burch, mechanical planning engineers of San Francisco, Ron Bourgault, Associate Principal.  www.mazzetti.com
  • Miyamoto International, structural engineering, Bob Glasgow, Principal. www.miyamotointernational.com

In addition to the pro bono efforts of the team, donations of medical equipment are sought.  Amico Corporation, medical equipment providers, has already committed to providing patient bed headwalls.  To help with equipment, supplies or funds, please contact Steinberg at RATCLIFF.


RATCLIFF provides architecture, interior design, and planning services to healthcare, higher education, and civic clients throughout the Western United States. The firm is rated as one of Interior Design magazine’s Top 40 Healthcare Design Firms in the United States, and is the winner of the AIA California Council 2005 Firm of the Year Award.  Recent healthcare projects include the new John Muir Medical Center, Walnut Creek.



1  http://epinternational.org/?page_id=21