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Follow us on TwitterHaiti Earthquake Recon: Back in Port-au-Prince Part II
Posted by Walt Vernon on April 12, 2010 at 1:45am
Tent Hospital; 3 farthest tents house patients, many of whom since the earthquake. 2 nearest are for outpatient care.
The volunteer dorm at HSC.
Patients in triage. Patients wait on the 2nd floor balcony at top right. Overhead feeder lines hang low; I bumped my head.
Solar-powered water heater to be used for the people, which is not yet functional. Gift of Project HOPE and Saint Doug.
HSC Generator Room
HSC medical waste incinerator, which is adjacent to a children's center.
Vendor in front of the hospital.
I did not remove this panel cover. This is pretty typical for electrical systems at HSC.
Water heating for admin. This is an OSHPD approved detail.
Family member of HSC patient. Women here carry filled 5-gallon buckets on their heads, as no one has water into their homes.
This is the waiting area for the clinic. I bumped my head on the lower line.
UPS for the HSC ORs.
HSC Emergency Department; note surface-mounted wiring.
HSC - headwall wiring; see receptacle with a 50' extension cord and a plug strip.
TV inside the Emergency Department at HSC.
HSC surgery waiting area.
Patients use the power lines between the tents to hang laundry.
View from the HSC roof. Across the road is the generator building at right, behind the compound wall.
Wheelcair made from a plastic garden chair.
Patient families preparing dinner. They are peeling and cooking yams.
The local population.
View of the rubble that is prevalent throughout Port-au-Prince.
And more...
And more...
One of many tent cities in Port-au-Prince.
I am trying to learn how to do this.
Park Hotel--second home after being kicked out of La Plaza after one night.
People make a living any way they can in Port-au-Prince.
Doing laundry in Port-au-Prince. Editor's question: Is that detergent from Costco?
We called on the UN today, seeking to find out how to help rebuild.
The roads in Port-au-Prince.
Well, I have hit and missed so many times, I am going to give up on the attempt to make this a chronological travelogue.
I will tell you, however, that we had quite the adventures with lodging here. We came to Port-au-Prince (PAP) yesterday, after having been assured that we had reservations here at a hotel called La Plaza. My partner John Pappas had been talking to some structural engineers who were here last week who said this was the only hotel you should stay in in PAP, so we were looking forward to it. Unfortunately, reservations mean something different to the people in this hotel than they mean to other people. We had four energetic people working with the two front desk people, so I sat down and watched. Eventually, my fellow Project HOPErs wrangled us two rooms, and were delighted at the thought of John and I sleeping in the same bed. We said we were going to get a picture of us so engaged, but we never did – something I am sure our fans will be disappointed to hear.
We worked late last night, finishing up our reports for Hôpital Sacré Coeur (HSC).
This morning, we got up, and Terry [U.S. Army medical equipment planner] and I got on the road early. We had volunteered to be the guys to go to drop off some ultrasound units to some hospitals. Apparently, Siemens donated 20 portable ultrasounds to HSC, which they could not use. Once again, Project HOPE helped to arrange the distribution of many of these units to other hospitals, and we were the deliverers.
The bad news was that our hosts here told us in no uncertain terms that CNN had taken over the hotel, and they had done us a favor to let us stay the one night, and that it was time to hit the road. John kept reminding us that the Degenkolb guys had said that there was no other place in the city worth staying at, and this refrain was eagerly taken up by a loud woman who eagerly told us about all the bugs we were sure to see in other hotels. Ultimately, Terry and I headed for the deliveries, leaving our comrades behind to haggle and find alternatives, if necessary. Fortunately, I brought the Lonely Planet Guide to Haiti, and I left it with them so that they were armed for the struggle.
Ultimately, they found us a new hotel that has the front fallen off, and looks pretty bad. Then I look across the street, where there is a city of tents and probably thousands of people now sleeping in the rain, and I feel pretty selfish and grateful to have anything.
Anyway, Terry and I set off with a driver for our first port of call, Hôpital Notre Dame de Lourdes. I had not realized the devastation of Haiti until this drive, and, even more, the drive that followed. It was one thing to see poverty in the mountains of Haiti, and at these hospitals that were in villages far from the earthquake. It was a very different thing to drive through the rubble of this city and see how these people have been hurt, and how miserably they were living before, and how much worse things are now. We drove past so many people, and so many collapsed buildings, and so much misery it was sobering. We have been pretty upbeat during this whole trip—this was very very sobering.
The hospital was closed when we arrived, and our driver had to call the doctor in charge. She came driving up a few minutes later, and offered to give us a tour of her hospital. She had had several doctors from Amsterdam after the earthquake, and that had allowed her to continue to operate, as the hospital usually charges some money to the patients, even though heavily subsidized. However, last week the Dutch went home, and recently the government extended its mandate to require hospitals to provide free care. This has resulted in this hospital’s needing to shut down at night, and send home all the patients, so that it is, strictly speaking now an outpatient clinic.
In addition to the hospital, they operate an orphanage and care for about 70 girls who will in all likelihood stay there until they are 20. Interestingly, I had somebody ask me, when she heard I was leaving, to bring her a baby. I told someone here that, and they were quick to tell me that the government was forbidding all foreign adoptions. Apparently, people here are so poor, they will give away a child to allow it, and them, to eat. (The person who asked me to get her a baby wasn’t serious, and neither was I).
Let me tell you something about this orphanage – they are so poor they do not even have mattresses for the kids; they are sleeping on slats I have tried everything humanly possible to add photos to this and failed, so you will have to rely on my words and try to make them make sense. While the Dutch were here, they got by; without that help or the ability to generate funds from patients, they must rely on donations, and these are too few to allow them to do much.
One other note; this was the first hospital we found a nurse-call system. Here, there was a doorbell in one area that rang in another.
In general, we are starting to find some themes we are using to try to better help them plan their development.
- We are finding the Haitian hospitals to be a very robust set of buildings.
- Generally, they have a lot of stuff that has been donated but that doesn’t work, or that they don’t know how to make work, or that works for a little while and then breaks down.
- Also, the hospitals cannot rely on municipal utilities for much of anything. Rather, they must stand-alone at least a lot of the time.
- Water treatment is a serious business. Getting safe, potable water into the building is essential to the operation of the facility, and treating the waste before it is ejected is similarly essential from a public health perspective.
- They have a serious problem with waste. Getting rid of waste is almost a bigger problem than getting materials.
- About 100% of the things we worry about in the U.S. are, to the people here, like arguing about how many angels can dance on the head of the pin. I remember fights I have with U.S. codes people over silly things like how to show wire counts, or whether we need special protection in the ORs because they are wet. The doctors here operate without any of that, and they do it quite successfully.
- We have to plan these facilities to accommodate lots of people all the time. Basically, the healthcare workers here do not take care of the patients when they are in beds. Rather, this falls to the families, and, if you are an orphan, to the charity of others.
- We way overdo medical care and number of outlets, and other things in the U.S.
- People in countries like this do not have access to the things we have. Every single fluorescent fixture I have seen requires T40 lamps. At my first hospital, I was working with a facilities engineer who was trying to knock down his power demand, and so, I suggested to him that he do a lighting retrofit, and use T8 lamps. I found out today, they don’t sell T8 lamps in Haiti, and this would be a stupid move. And, because these things are not offered, the Haitians are forced to take junk stuff.
- Sustainability writ large can work in a hospital. In all of these hospitals, almost all spaces are naturally ventilated; very few have air conditioning, almost all of them make massive use of natural light, none of them have hot water, and almost all of them have very low energy use, such that they could meet a large part of it through the use of renewables, if they could afford them (I will try, when I get back, to help them find a way to afford them).
- We have heard, though have no way to document it, that there are fewer nosocomial infections in Haitian hospitals than in U.S. hospitals. We have heard several theories for this “fact” such as: doctors and nurses here don’t go from patient to patient, resulting in fewer handwash problems; or, that people here are just heartier and can better ward off infections.
- People here don’t over-use antiobiotics, so almost all microbe-based diseases can be treated with first-line antibiotics.
This has changed our thinking greatly since we have been here. We are thinking differently about how to build these things so they can run, and we are developing certain patterns and templates for how that needs to happen.
So the HSC consisted of four discrete areas – the old hospital, the power plant and other support spaces, the tent hospital, and the volunteers living area (more of a residential and admin area). Each of these areas is separated by walls high enough to keep people out. At all times, guards patrol these walls and especially the gates. The first night we were there, the volunteers were kind of grumbling because there had been some warnings from the local UN people; we were told not to go out at night. Apparently, some of the volunteers went out that night anyway, telling others that one of the people in charge at the hospital told us not to go out. As a result, that person got death threats, as he and the volunteers going to these bars and buying things is a big part of the local economy. Indeed, every day, as we walked from the volunteers’ compound to whatever site we were working on, we were accosted on all sides by salespersons of paintings, carvings, etc. As the electrical engineer, I was busy tracking various overhead power lines, and so I spent a lot of time in the streets and talking with some of these folks. I also bought a bunch of stuff from them, so I think that helped.
This hospital, like the Hôpital Albert Schweitzer (HAS), has its own wells and its own water treatment plant. In addition, it discharges its effluent directly into the municipal system after what John calls a three-stage septic tank (he will need to explain that one). We are both rapidly coming to the conclusion that we must develop in-house expertise in water pumping and treatment (to make it potable) and treatment (after discharge). Indeed, one remarkable thing dawned on me here. Usually, in the states, we do projects, and the architects are always the important people. We spend tons and tons of time thinking about adjacencies and travel distances and design, and the patient experience. We engineers are more of a necessary evil; our utility systems things to be hidden. Here, it is completely different. There are three elements that matter more than anything: how do we get clean water; how do we get enough power to do what we need to do; and how do we get rid of waste. Almost nothing else matters. It makes the work that John and I do of much greater importance, and we are taking that seriously, and trying hard to provide them with solutions that will help them.
One of the other exciting things, to me, about all this, is the degree to which I can reach out to my wider circle for various kinds of help. I already have Laura Brannan from my firm helping me to design waste disposal solutions we can implement here. I have had some of my electrical engineers helping me get catalog information and other things that helped me better analyze the systems. At the HSC, they had battery back-up systems everywhere, and some of them had error codes I could not read. I was able to send emails to my CFO, and he spent his vacation day helping me track down the vendor in the states, getting me manuals, and helping me to interpret what the warnings were, and what response this hospital needed to give (we were able to determine that the batteries could no longer hold a charge, and needed to be replaced; also, probably, that the staff are not performing required maintenance on the system).
Anyway, the hospital also generates its own power. It was interesting to me that HAS has a 400 kW generator that powers 115 buildings, and they are trying hard to reduce demand and get a lower-capacity generator to save on fuel costs. HSC is a larger hospital, especially considering the tent hospitals. Yet, the generators there are half the size. In fact, I heard somewhere that the number of in-patients at the HSC is about 500. That equates to 40 watts per patient. (I have struggled with rules of thumb metrics here, as none of my U.S. rules work). With a capacity of twice that, and a patient load of half that, HAS has a capacity four times as great. Thinking about new rules of thumb like how much power do we consume per patient, rather than per square foot, is helping me to think a bit differently about how I might think about designs for U.S. hospitals in the future.
Also, the generators at HSC don’t run especially well. However, one of the things I found shows there is an urgent problem here. This site kept pretty good logs of loads on their system—up until the end of 2009. Remember, the earthquake occurred in early January 2010, and there are no records for 2010. What the records showed was that the generators were near capacity in 2009. And, while they are operating fine now, the peak loads come much later in the year – and we have added a ton of loads to the system. This means we need to immediately upgrade the hospital infrastructure to help them get through the summer, or they will have problems. I have devised four or five options to help them through this, and I want to continue to work with them to improve their situation.
One thing I have found at all four hospitals we have visited is that none of them have records of any of their construction. I am now going through and creating single-line diagrams for them, as I go. The distribution diagrams are pretty simple, and I think I can provide them with a huge service with just this little thing. I have to say, again, that doing this, and thinking about what these people are able to accomplish with such few resources, makes me think even harder about what we are doing with building codes in the U.S.
Let me give you an example. In the U.S., we must have three kinds of emergency power, and one kind of nonemergency power. We have some things on a life-safety branch, some on a critical branch, some on an equipment branch, and some on a nonemergency branch. Each of these branches has very detailed rules about what can go on them, and require a lot of special and expensive equipment to make them work. We spend a lot of money on U.S. hospitals designing these extremely intricate electrical systems. In Haiti, they lose power to the whole hospital twice a day while they switch between generators. They don’t have branches, and people don’t die from the switch. Watching how they make things work here makes me realize how overly complicated we make things in the states, and how needlessly expensive. I think that we might have much to learn from people like this.
Another big issue at all of these places is the amount of waste. It is interesting that, despite the primitive lifestyle we thought we were living as volunteers at these hospitals, we volunteers generated tons more trash per person than the average Haitian every day. Yet, the Haitians have a lot of garbage to get rid of. The HAS people landfill some and burn some. During our site visit, John and I came to a big open-air fire, where they were burning the trash. This fire went on at least all day. I don’t know if it happens every day or not, but I suspect that it does. They are burning everything in this fire. And, it sits right next to the children’s center. We know that combustion of some of these things creates serious toxins. Something that each of these hospitals urgently needs is a way to take the thing they have a lot of and can’t get rid of – waste – and turn it into something they have little of, and need a lot of – energy. This is true alchemy; turning lead into engineering gold. There are systems out there that do this; they are not perfect, but they are so much better than the open burning of these substances We have to start moving in these directions.
Anyway, I must stop for a bit, as it is 1 in the morning. We are coming to the end of this phase of our Haitian trip. I can tell you I have been thinking a lot about a book I have seen recently. This was a book about some guy at Microsoft. He quit his job and went to Afghanistan to build schools for the kids there. As I look at the needs here, and think about what I do, I sometimes wonder if I am spending my time in the right way. I often look at things like what is going on in Haiti and have to fight the depression that they might bring, by concentrating on my personal mantra to choose lighting a candle to cursing the darkness. The question for me is always which is the biggest candle I can find to light.
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