Thinking Inside the Box: Rebuilding the High Rock Clinic
Following the destruction caused by Hurricane Dorian on Grand Bahama, Build Health International and Direct Relief took an innovative approach to rebuilding the High Rock Clinic.
When Hurricane Dorian, a category 5 hurricane, struck in September 2019, it was the worst natural disaster in the history of The Bahamas. The hurricane mainly hit the islands of Abaco and Grand Bahama, leaving 60% of Grand Bahama submerged underwater and destroying most of the already sparse healthcare infrastructure on the island. Among the facilities decimated on Grand Bahama was the High Rock Community Clinic, which served the entire east end of the island.
Located outside the main urban area of Freeport, Bahamas, it took days for help to arrive in High Rock as the damage and high water made the town hard to access. Upon arrival at the site, CNN described, “The obliterated health clinic is an unrecognizable heap of rubble, an overturned bed being one of the few clues of what used to be there.”
To rebuild and restore the community’s healthcare infrastructure, the Ministry of Health tasked Build Health International and Direct Relief with reconstructing the High Rock Clinic as sustainably and cost-effectively as possible. To do so, the two organizations needed to think — inside the box, by constructing and outfitting the new health clinic completely within a collection of prefabricated modules.
Why prefabricated? And can a fully operational healthcare facility really be built this way?
Recognizing that High Rock was susceptible to future natural disasters, as demonstrated by Hurricane Dorian, the Bahamian Ministry of Health was interested in the idea of building modular clinics to both replace infrastructure that was lost and implement a hurricane resistant facility that would be resilient in the face of climate change and the increased likelihood of future natural disasters.
Composed of 30 inhabited islands which lack major ports, The Bahamas is a difficult location for delivering materials and facilitating construction. Of the islands, Grand Bahama is the most centralized and well connected. Through this project, The Bahamian Ministry of Health and Direct Relief wanted to see if this same approach to building a prefabricated clinic on Grand Bahama could be applied and replicated on the country’s smaller and more rural islands in the future.
In addition to the challenges inherent to building in The Bahamas, with the heightened travel restrictions imposed by COVID-19, pre-fabrication offered the opportunity to complete the majority of construction before the materials even arrived. The construction process began in Alma, Georgia where seven 40 foot modules were prefabricated.
Pre-fabrication also enabled the team to complete the project in a more cost-effective way. Given the extremely high cost of construction materials and specialist expertise in The Bahamas, as well as the costs associated with shipping materials from the United States, by pre-fabricating the modules within the US, BHI was able to bypass excess expenses. Once the modules were fully outfitted with walls, flooring, cabinets, and equipment, they were shipped to West Palm Beach, Florida and then departed to Grand Bahama.
Meanwhile, on-site, BHI worked with local contractors to construct a concrete foundation for the clinic. All that was left to do once the modules arrived was position them into place on the foundations, securely fix them down to ensure they were hurricane resilient, finish the mechanical, electrical, and plumbing (MEP) work, and deliver medical equipment and furniture from BHI’s Beverly, Massachusetts warehouse. All in all, this allowed the assembly portion of work to be wrapped up in less than 3 weeks.
While the assembly itself was quick, the project as a whole certainly faced its hiccups. As the first modular clinic of this kind on the island, High Rock’s Site Supervisor Bill Rogers shared, “I have a whole list of lessons learned that I have ready to share and pass on to improve this process in the future.”
Bill first arrived in High Rock in February of 2021 when the foundation for the clinic was being built. He identified a mistake in the way the foundation was initially set up and spent the next 2 month completing the foundation to ensure it was up to par to support the clinic long-term. After corrections were made, Bill led the process of placing and securing the modules from late March to early April. He then returned in June to oversee the installation of medical equipment and furniture as well as finalize aspects of the MEP such as the water source, delivery of piped medical oxygen to exam rooms, and power connections. On July 11th, the clinic was ready to open its doors.
As with many first-of-their-kind projects, the challenges and delays faced offer a blueprint for how modular clinics can be installed more quickly and efficiently in the future.
“I think that this type of clinic is something that could definitely be replicated in the future”, shares Bill. “If they are able to manufacture modules and get them to the sites effectively and efficiently, this entire process could be completed in 2 months. If some of the planning is done a little differently and contacts are made earlier, it could be done a lot quicker.”
Since The High Rock Clinic re-opened in July, it has served as the primary healthcare facility for the eastern half of Grand Bahama. In addition to restoring the primary healthcare services offered by the previous High Rock Clinic, this facility added 4 more exam rooms with piped oxygen.
September 2021 marked the two year anniversary of Hurricane Dorian’s devastation on the island of Grand Bahama. As we reflect on this anniversary, and the devastation that the hurricane brought to the island, we are heartened to know that The High Rock clinic is once again seeing patients — equipped to be more accessible, comprehensive, and resilient than ever before.
Olivia Duggan is Build Health International’s Communication Manager. She writes about the intersections of health and infrastructure, with a focus on the impact of BHI’s work on fragile health systems.
