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Follow us on TwitterHaiti Earthquake Recon: More on Hôpital Albert Schweitzer
Posted by Walt Vernon on April 08, 2010 at 10:44pm
Salsa Air--Plane to Port Haitian
Thursday, 4/8/2010; 1:15pm
So last night at dinner (last night was Wednesday night, I am writing this from the plane on Thursday), we were talking to the folks from Project HOPE. They said that on every mission, they select one person to be the official blogger. It is that person’s duty to write two paragraphs and put up one or two photos every day, to help communicate the work of the team.
One or two paragraphs!! I think I am way over-achieving. But I can’t stop, so you will have to put up with it.
We are right now flying into Port Haitian. I am looking out over the clusters of homes all around, interspersed with some actual trees. We are on a very small plane with three women who have been working at the hospital for about two months, which apparently is a long time for medical people to work in Haiti. They are working at the hospital we are going to survey tomorrow, a placed called Sacré Coeur. One is a physical therapist, another is the Charge Nurse, and the other is a psychotherapist.
I should note that John Pappas has been predicting rain ever since we got here, and today is our third day in a row without rain.
Anyway, landing now, more later.
Thursday, 4/8/2010; 8:30 pm
We are sitting on the porch of the volunteer dorm building at Sacré Coeur Hospital in Milot, Haiti. I want to write a bit about the Hôpital Albert Schweitzer (HAS), and how it operates…
Again, the building has four “wings” arranged in a square with each wing consisting of a double-loaded corridor. One wing, radiating to the right as you enter, consists of a lab, radiology, and surgery (in the corner). Where it turns left, that wing is Central Sterile, library, IT, and storage. From its corner, turning back to the left, is a long wing of patient “rooms.” The first set of rooms ends where the final wing turns back to the left and the entrance to the hospital. That final wing, from the patient wing, consists of a pharmacy, OB, “ED”, and back to the front door. However, additional patient rooms extend beyond this wing, ending in an “isolation” space for TB patients (TB is a serious problem in Haiti). Finally, running parallel to the patient wings is a newer building, called the Annex. As you look at it from the patient wing, to the left is a nutrition center, where they feed certain lucky children (they do not provide food for anyone else in the hospital). Next to that is the IT department, and some administrative areas.
So, some observations… First, they are like a small, self-contained city. When we drove up, it was about 9pm and quite dark. All around us, we passed through numerous houses and little villages. There were maybe a half dozen lights we saw on the entire trip. But, about half an hour before we arrived at the hospital, we saw this blaze of light up on a mountain. It turned out that this was the hospital; the only source of electricity and clean water for miles and miles and miles.
The hospital generates its own power using a diesel generators. It has four generators, including two new ones rated at 410 kW. They run one generator at a time, and they alternate between the two 410s, every 12 hours. They are really concerned because it is very expensive to get fuel for the generators; the tanker trucks have to traverse this arduous four-hour journey from Port-au-Prince. Right now, they are able to get fuel from Venezuela at a fairly low price. But, they operate on such a thin margin that they are constantly looking for ways to reduce their fuel consumption.
The hospital actually has 115 buildings scattered around it, including various clinics and a lot of residential buildings. At dinner last night, one of the volunteer surgeons noted that the presence of these residential buildings made it much easier for people to come and volunteer their time, as they did not have to live in the mud. The residential facilities were remarkably nice, and he was exactly right. However, they are expensive for the facility to operate, and the facility is struggling to make ends meet—the need here is infinite.
Anyway, the point is, the hospital has approximately seven circuits that serve buildings other than the hospital. These are 480 volt circuits, and go for hundreds of feet. They are about #2 conductors, generally, protected by 150 amp breakers. The problem with these feeders is that the rest of the community that surrounds the hospital has no electricity. And, there are trees that grow up next to the power lines. So, the people hire children to climb the trees, and cut into the insulation. If they survive, they thread a bare wire around the bare part of the feeder and pull it into the tree. From there, it goes down, and eventually to the inside of a house, where they wrap it around a coil and create a transformer to provide their home with a little bit of usable electricity.
So, the hospital chief engineer is a terrific guy, and we were very impressed with everything he does. One of the things he has to do is to deal with this problem. He estimates that there maybe 50 of these “prises” (that’s a Creole word) at any one time. He has to send his guys out daily to try to detect these things and take them down. The problem is, his guys are probably some of the people taking some of the power, so he has to send them out to the lines that are not near their houses, and then rotate who looks at which lines. The electricians remove prises every day.
The hospital dislikes this prise problem for at least two reasons. First, it is causing injuries to the kids in the community they serve. Second, it creates a constant leakage of power and this costs them money. As I wrote, they are completely dependent on their diesel fuel and their generators to be able to operate at all. And, because they depend almost entirely on donations, they are highly affected by dramatic swings in fuel prices. And, apparently, Haiti is subject to such swings. They currently receive inexpensive Venezuelan fuel, largely because that government is looking for friends. However, because fuel prices are so highly politically dependent, prices can change rapidly, and can create tremendous financial problems for the hospital.
Other than that, there were few remarkable things about the hospital electrical systems. They do rely heavily on daylight. Their fixtures are terrible old T12 lamps and still some incandescents. They have very few lights anywhere, and keep them off as much as they can. They have converted everything they can to electric to save overall energy. For instance, they have an on-site laundry, and it is powered entirely by electricity. They used to have steam for laundry, but they decided there was no value to hot water, so they got rid of the steam boilers and use only cold water. They dry the laundry by hanging it out. They have recently replaced their steam boilers for the sterilizers with electric boilers. (Because they are working so hard to drop their total energy consumption, we considered suggesting solar thermal to preheat the sterilizer water, but John Pappas thinks this is not enough benefit for the trouble. [I still think it is a good idea, and I might look for donations for this]).
They rely heavily on daylighting. In fact, in many ways, this is kind of like the perfect green hospital—self-provided water (from a continuously refilled aquifer, daylight, natural ventilation). This is such an elemental place and an elemental way of life, that the facility is sort of the poster child for being a green building icon.
Anyway, back to the narrative… They have no overhead paging system, no fire alarm, no nothing. They depend almost entirely on cell phones for all communication needs. They do have a data network, are using the U.S. Department of Veterans Affairs medical records system, and have a very strong patient record database. But, they are very very elemental in the way they get things done.
Their water, as I say, comes from an underground aquifer. They are a bit worried that the rain has slackened seriously over the past few years, and if it does not replenish, loss of the aquifer would kill the hospital. The hospital pumps about 55,000 gallons a day from the aquifer, puts a little chlorine in it, and stores it in a large tank behind the hospital. They do not heat the water at all, as it comes from the ground at a relatively warm temperature. They provide water to the hospital 24/7, but to other areas only three hours a day—6-7am, 12-1pm, and 6-7pm. During that time, they also provide water to the village at various fountains, and consider this as a public health service.
They have very little water in the hospital. Each patient wing has exactly one sink that is shared by all patients, staff, and visitors (and there are lots of visitors). Each wing of the hospital has one set of three toilets for men, and one set of three for women in communal rooms. The people here do not know how to use toilet paper, and often rely on rocks, which they put down the drain and cause problems for the facilities staff.
All waste from all plumbing fixtures goes to a set of three bio-digesters behind the facility. The waste digests there, and the effluent flows out to a series of lagoons. The water is clean enough that the lagoons were very popular with ducks and other birds when we were there. The lagoons have been operating thus for more than 50 years.
The hospital uses only oxygen from bottles and no other gases.
For ventilation, the hospital relies almost completely on natural ventilation. There is a sort of isolation area, but my understanding is that it is not well-ventilated. TB is very common here, and this is a pretty serious issue.
They do not heat any space in the hospital, but they do provide some level of cooling in the library, the IT space, and the ORs. There is no humidity control of any kind. There is only minimal filtration and no pressure control.
And that is about all there is to say about engineering systems at HAS. This hospital provides the most remarkable kind of services imaginable under very difficult circumstances. They make use of every possible resource, and they do it with skill and patience and courage. We were so impressed with the people we met, and with what they were able to accomplish with what resources they have available. They have a sliding scale of payment—people from the surrounding area pay almost nothing for services, and people from farther pay a little more. But, they don’t turn anyone away. It puts into perspective the things that we expect and that we obsess over in our facilities in the states. In some ways, it makes me think we worry a lot about how many angels can dance on the head of a pin—compared to what they people here are doing.
At the end of the day, I hope that we were able to provide these folks with something that can help them do their job a little bit better and take better care of a few more people.
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