My experiences in Haiti began shortly after the earthquake in 2010. Available medical staff struggled to keep pace with the volume of casualties needing care. Much of the treatment came from volunteers, who often were poorly equipped.
Because a large amount of the medical care was provided on an emergency basis, and without proper equipment or experience, frequently the treatment of choice was amputation. The result of this strategy is a country with an abundance of amputees, often unsupplied with needed prosthetics.
One of the many volunteer groups that responded and quickly sent facilities (in the form of a hospital ship), as well as volunteers and equipment, was Project Hope. Project Hope managed to secure a number of modular prosthetic labs that needed to be installed, but these facilities required sufficient infrastructure. In addition, Project Hope had to understand which organizations it should support because it had only enough infrastructure to maintain the systems it was given.
So, Project Hope recruited a team of volunteers to analyze various healthcare facilities throughout the country. The team consisted of architects, engineers, and a biomedical engineer. I was one of the engineers who volunteered for this mission.
That first mission started in the mountains of the island, beyond the big cities, where the devastation was relatively less severe. Eventually, though, we found our way back to the raw, oozing wound that was (and is) Port au Prince. What I saw in all of these places moved me such that I could not return from that first trip, could not leave those people, without promising them and promising myself that I would come back and do what little I could to help them.
Over the next several months, I contacted and met with various UN officials, as well as Haitian government officials. Reaching the Haitian officials was more difficult, as most government facilities had collapsed and the officials, who were struggling before the earthquake, became even more powerless.
Over the last year, I have worked with the Haitian government on a mostly collapsed tuberculosis hospital; with Europeans on a hospital that, due to government rules that patients could not be charged in the aftermath of the earthquake, was subsequently forced to shut down operations and convert into an orphanage; and with a hospital on the North Coast of the island, where I led a team of volunteers armed with hundreds of thousands of dollars of donated equipment to completely replace the electrical distribution for the system, radically improving their ability to support caregivers and the reliability of services. We are currently providing pro bono design services for a new emergency department/ICU in Hinche, the site of the recent cholera outbreak on the island.
When I first entered Haiti, I had considered myself an expert in the area of green buildings, and, especially, green healthcare buildings. Like many in the West, I fancied that I knew a lot about what it meant to create a sustainable set of solutions for a healthcare organization. When I thought about where, outside the United States, I might learn more lessons about green healthcare buildings, I thought of Europe, where many of us have made a tour through hospitals that are doing some remarkable things.
What I found in Haiti (and, later, in China and India, as well as in Central America and Africa) was that while we can learn a lot about how to better develop sophisticated green solutions, like those in Europe, we can learn more about how to make our buildings greener through simplicity and moving with the rhythms of nature. Following are some of things I have learned.
Primacy of engineering for water and power systems over all other concerns
In the United States, working for an engineering firm, I most often am a consultant to the architect. As an example of this experience, we have many meetings where the majority of time is spent on detailed architectural solutions, which typically are about design and more interesting to people. Discussions of engineering systems normally are relegated to the last half-hour of the day, when everyone is exhausted and there is only enough time and energy left to address surface considerations. In the United States, engineering often seems like a necessary evil, always just a cost, and typically boring and rarely central to the need.
In Haiti, it is just the opposite. You learn very quickly that access to clean water is vital. People there generally pump from groundwater and have to do on-site treatment. There is a very small municipal water supply, and where there is, it is intermittent. So the practice of storing water in tanks on the roof to ensure against inevitable disruptions is commonplace.
Similarly, every building has its own generator, or learns to live without power. In many of the hospitals we visited outside of Port au Prince, the only reliable electricity came from the diesel generators powering hospitals. Most of the hospitals are built in long series of nearby compounds, and, in one hospital, one of the major sources of injured patients is the electrical lines strung between these compounds.
That is, because the rest of that village has no electricity, people pay young children, who are the only ones light enough, to climb trees, cut the insulation around the hanging electrical wiring, wrap a bare wire around the cut (bare, so it can’t be seen by the hospital employees who check the lines every day), and drop the wire to a nearby residence. Many of these children are shocked or otherwise fall from the trees, and many of these children end up in the hospital from which they were stealing power.
Yes, engineering solutions that are simple and provide access to clean water and to electricity are the difference between life and death. In Haiti, engineering matters a great deal.
Maintenance is everything
Too often, the systems in Haiti are limping along and barely operational. Indeed, one of the key strategies of those who donate to Haiti is to find facilities that have some kind of infrastructure, some kind of expertise capable of operating and maintaining a system so the donor has a fighting chance of providing something that will make an actual difference. This need is even greater given the fact that “beggars can’t be choosers,” and the people operating Haitian hospitals receive what somebody wants to give them, not necessarily what they want or need. As a result, the Haitian facility operators must exercise tremendous creativity to keep things working.
One hospital we visited had been given a small DC-powered water treatment system it wanted to use to supply water to the families of the patients who camped on the front lawn of the hospital. However, the only power available to them was AC power. Creatively, or perhaps in desperation, a local boy with a moped was hired to come to the hospital every day with a full gas tank to run his moped, which powered the DC generator normally used to charge the battery. This boy and his moped offered the life-saving power needed to run the water treatment system and provide clean water to those people.
Perhaps the greatest indication of the value of skilled operations people is seen in the fact that hospitals can’t keep them. In a Haitian hospital, once people are trained, they leave and go to work for one of the embassies, a bank, or another organization that has the money to pay for skilled help. The hospital once again has to scramble to find staff, making it that much more difficult to provide medical care.
Indeed, at one point, I had worked out a deal with the American Hospital Association’s American Society of Healthcare Engineers (ASHE) to provid
e volunteers from U.S. hospitals—“buddies”—for Haitian hospitals. Each Haitian hospital engineer would have a volunteer engineer to call on for advice and counsel. The Haitian hospital engineer would only be able to take advantage of this counsel while at the hospital; as soon as the engineer left, that lifeline to the United States would be lost. Despite the willingness and resources of a national organization like ASHE to do this, the lack of infrastructure within Haiti has unfortunately stymied this initiative from moving forward.
Human resilience and adaptability show that many of the things we do for buildings are not necessarily necessary
As a simple example, Haitians do not waste precious fuel on heating water to be used for handwashing. Granted, the local water sources are relatively warm to begin with; but, even if this were not so, fuel is so precious that it only is used for the most important needs. And hot water is not one of them.
After I returned to the states, I started researching this issue and discovered that, from a clinical perspective, there is no benefit to the warmth of water. Rather, there is a perception that warm water is more comfortable and it’s used so people won’t avoid washing their hands. Based on this insight, I am now looking at water schemes for U.S. hospitals. A single, tepid temperature of water will save tremendous first costs to design and build these systems, and save tremendous amounts of water, energy, and money associated with the convenient but unnecessary heating of water.
Use of increasingly complex systems creates some problems even as it solves others
Every time I fly to Haiti, I find myself on the plane with a sea of volunteers, each wearing his or her distinctive “Volunteers for …” shirts. I especially enjoy medical professionals, as we talk about using engineering solutions to rebuild hospitals, and how I can and want to help them. A long time ago, I gave up regretting that I was not a doctor and devoted myself, instead, to creating the best possible conditions for them to exercise their healing talents.
One hospital we worked with primarily serves rural villagers. The facility staff in this hospital has terrible problems trying to remove rocks from the sewage systems serving the toilets inside the hospitals. “You see,” the facilities engineer told me, “these people have never seen toilet paper, which these things were designed for, so they use the only things they know how to use: rocks. And we have to constantly fix our plumbing systems as a result.”
I am currently providing volunteer design services for a hospital where we will provide only composting toilets. They will use no water (and, therefore, no energy and no chemicals). The effluent in a tank is composted using focused heat from solar energy. The result will be completely inert, high-quality soil amendment—something this denuded island desperately needs. And, oh yes, if someone throws in a few rocks, the system will handle them.
Early in my travels to this remarkable country, I listened to U.S. medical professionals talk, amazed at the way they were able to use first-line antibiotics, medicines that are completely useless in the United States due to our overuse of such substances on our own and by agriculture. That is, in Haiti, they can use simple, safe, inexpensive interventions for health because they still work. I think there is much for engineers to ponder on this idea. Are our very complex, very expensive, very sophisticated systems really the best solutions?
Hospitals, properly understood, are the heart of a community
Every hospital we visited turned out to be one of the largest—if not the largest—employer in the area. Often supported by foreign donations, these hospitals are one of the few sources of employment and one of the few ways to earn a living. Many of the hospital employees see clearly their responsibility for being this economic lifeline to the community they serve.
The hospital we are helping to rebuild helps support various social programs in local schools and other institutions. Early this year, when my children’s soccer league decided to change uniform colors, I gathered up tons of used soccer equipment and sent it down to that hospital, and they distributed it to people through the schools in many of the surrounding villages.
The first hospital I visited was Hôpital Albert Schweitzer in Deschappelles, which lies in the mountains to the east of Port au Prince. This hospital contains the only water treatment system in the village. Every day, for one hour at two different times, water is distributed to two hand pumps located in the village. The people start to gather with their buckets and other water containers well beforehand, as they do not want to miss the opportunity to get clean water. The facility operator at this hospital told me it was generally acknowledged that the hospital probably provided more health through those hours of providing clean water than through any medical services it offered to the acutely injured or sick.
At the hospital we are rebuilding, there is a compound for the volunteers to sleep in that is separate from the hospital compound, the generator compound, and the tent hospital erected to serve earthquake and cholera victims. The only street lights in that village are the ones lighting the road for the volunteers who serve in that hospital. One night, I was walking down the street from the hospital compound to the volunteer compound when I noticed children in their school uniforms huddled together, doing their homework under those lights, the only ones available anywhere in the village. Hospitals are sacred places with the power to heal not only our bodies, but also our minds and our souls.
Family and community are the most important factors in a successful life (even more important than engineering!)
At the hospitals in Haiti, there is no money to provide food to patients. Indeed, the nursing care is certainly often less than ideal. If a patient wants to have food, family members have to bring it in and prepare it. One hospital has a farmers market on the front of the main entrance every day for just that reason. The first time I was there, I saw so many orphans. I am reminded of the story one American nurse told me about a child with TB whose father dropped him off at the hospital. The father had no money, no home, nothing. His wife had been killed in the earthquake. The father had no way to care for his child and did the only thing he could do to give the child some chance for a life: He left the child at the hospital with the volunteers who could care for him like they do for the rest of the community.
My time in Haiti has shown me the fundamental, vital importance of our communities to our physical, mental, and emotional health.
Every time I leave Haiti, I feel raw and it takes me two or three days of almost total seclusion to be able to re-enter the “real world.” One of the volunteer electricians who went with me in January has not been able to shake the depression that followed his return home. Every time I leave, I think I will never forget what it was like (and every time I go back, I am shocked again). And, every time I leave, I promise myself I will be back with more help for these people.
In fact, this propensity to take on causes and raise money and volunteers finally drove my CFO to exasperation. Because our company isn’t a nonprofit, we are not set up to take donations. He suggested we create a separate nonprofit organization to do this work, and so, the Sextant Foundation came into being. The Sextant Foundation (www.sextantfoundation.org) serves two purposes. First, it striv
es to make the world a better place by improving and supporting healthcare organizations in developing countries, in places where simple, cost-effective engineering solutions are so critical. And second, we are undertaking a number of research projects focused on helping everyone build better healthcare facilities. In the end, better engineering can help everyone. Maybe more than anything else, this is what Haiti has given me. HCD
Walter N. Vernon is CEO and Principal of engineering and consulting firm Mazzetti Nash Lipsey Burch. He serves the World Health Organization as a consultant on greening healthcare buildings and founded the consulting group BLUE, which helps organizations develop coherent green strategies. Walt can be reached at email@example.com.