Building Emergency Infrastructure in Haiti Requires Speed and Teamwork
How Build Health International built a 100-bed COVID-19 Treatment Center in two months
Caitlin Candee’s “punch list” list has 45 items on it, ranging from ‘patch hole in roof’ to ‘touch up paint on doors’ — the final to-dos before the COVID-19 Treatment Center at Hôpital Universitaire de Mirebalais begins welcoming patients in early August.
The new Treatment Center adds 100 dedicated COVID-19 beds to Haiti’s premier teaching and referral hospital, located a few hours north of Port-au-Prince. Hôpital Universitaire de Mirebalais treated Haiti’s first two confirmed COVID-19 patients at the end of March 2020. But as coronavirus cases rose rapidly in April, Zanmi Lasante — the local sister organization to Partners In Health, which runs the hospital — recognized that they would need additional bed capacity to continue providing high-quality care to all patients.
At the outset of the pandemic, Haiti had fewer than 50 intensive care beds for a country of almost 11 million people. The new Treatment Center at Hôpital University de Mirebalais adds an additional 100 dedicated COVID-19 beds, each with a bedside wall-mounted oxygen connection.
The novel coronavirus has strained even the most advanced health systems. “The disease is spreading all over the world — it’s not only the U.S or Haiti that are being affected,” says Jean Alex Paul, BHI’s Carpentry Foreman. “I feel it is my duty to get the job done as fast as possible, so when people get the virus, we can have a place for them. If the illness gets worse, then we will have a place ready for those who are infected.”
Jean Alex’s recognition that time is of the essence is shared by the whole BHI team, from Haiti to Massachusetts. This collective urgency has fueled a rapid project timeline, with the Treatment Center set to open approximately two months after BHI first broke ground.
Teamwork and collaboration were also critical to meeting this tight timeline. All aspects of the construction process were led by Haitian supervisors and foremen, many of whom have worked with Build Health International since the organization’s founding. The foremen’s teams worked concurrently, supporting each other and coordinating details. Jean D’honneur Volcy led the plumbing team in laying pipes, as Site Supervisor Jimmy Forest was supporting the team building forms and pouring concrete foundations for the new wards. As the concrete set, Alexis Othenile and Jean Alex led construction of the wall framing, and when it came time to stand up the walls, 20 team members lined up to help lift.
Because the COVID-19 wards were designed to be built with local materials, construction could continue even with borders closed and local movement significantly restricted. Wood framing reduced the construction time compared to concrete block. Inside, the walls are insulated and covered in plastic to make sanitization as efficient as possible.
Despite their relatively simple construction, the wards meet the World Health Organization’s standard of 12 air changes per hour, a threshold set to reduce the risk of airborne transmission. The wards are designed to maximize passive ventilation with high and low louvers, and are also equipped with ceiling fans and wall-mounted air conditioning units. To further reduce the risk of airborne transmission, isolation rooms in each of the wards will enable clinicians to safely perform aerosolizing procedures, such as intubation for mechanical ventilation.
Of the six new wards, three are new construction and three have been repurposed from existing hospital facilities. These three buildings — Kay Manito (“Mother’s Home”), the Acute Diarrheal Center and Center for Excellence in Rehabilitation — were all designed and built by BHI between 2015 and 2019, making retrofits fast and efficient. BHI also built a new covered triage area and a staff workroom to complete the nine-building Treatment Center.
Even with these efficiencies, BHI’s team worked around the clock to complete the Treatment Center as quickly as possible. “Even though you are tired,” Jean D’Honneur says, “we do not pay attention to our tiredness because life is so important. You have to do whatever it takes to save lives.”
With Hôpital Universitaire de Mirebalais today serving a catchment area of 3.3 million people, it must be prepared to offer life-saving care of all sorts.
“Heart attacks, trauma cases, HIV/AIDS — they don’t stop just because there’s a pandemic,” notes Dr. David Walton, Build Health International’s CEO who also helped with the original planning and construction of the hospital from 2010 to 2012. “It is critical that hospital clinicians can continue to serve patients with all types of illnesses and conditions, not just COVID-19.”
Ela Hefler is Build Health International’s Development & Communications Specialist. She writes about the intersections of health and infrastructure, with a focus on the impact of BHI’s work on fragile health systems. Edouard LeBrun conducted the staff interviews for this piece.
You can visit Build Health International’s website to learn more about our work and how you can support. You can also download open-access versions of our COVID-19 Treatment Center designs and construction documents.
