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Follow us on TwitterHaiti Earthquake Recon: Adventist Hospital Haiti
Posted by Walt Vernon on April 13, 2010 at 8:44pm
Adventist Health Hospital. Each patient room has its own patio--many sleep outside due to the heat (it is over 100 degrees).
Terry and I arrived late to the hospital because we had been engaged in delivering portable ultrasounds to Hôpital Notre Dame (HND) and to the Port-au-Prince (PAP) office of Hôpital Albert Schweitzer. There was a meeting going on, and we kind of stumbled in. In a weird quirk of fate, the people who were there were the leaders of Loma Linda Medical Center; a hospital just a few miles from one of my offices. Apparently, the Adventists own and help operate hospitals around the world, for the benefit of the people there, and they are trying to help the people here. Once again, it was our job to try to analyze the facility and to make recommendations for improvement.
One of the interesting things I discovered in surveying this hospital is that it took me about 30% as long as my first Haitian hospital. I think this is good - I am obviously getting more efficient. I worry, though, that maybe, thinking I now know what I am looking at, I might look less deeply and miss something. On the other hand, every time I do one of these, I learn something new, and I have to go back and rethink what I thought about the previous hospitals. In fact, once I get home, I intend to pull them all out and to go item by item, system by system, through each of them, comparing and remembering and contrasting. Very often, what I saw in one place can trigger a thought in another. What I need to do is to look across all three, issue by issue, leavened by what else I have learned, and see what new patterns emerge. In fact, as I type this, I am sitting across the table in the Project HOPE compound while the Haitian Director, Dr. Prospere is working on his reports. One of the things I have done for him is to try to summarize general conclusions that might be of use.
One of the things I want to do very very soon is to bring back a team of electricians to work with the folks here and to help them fix the things that need fixing.
At AHH, the biggest difference I think is that they get utility power. Of course, it only works about half the time. So, here is their system. The plant ops shed (for it is not much more than that) has no lights in it. So, they have installed one light bulb that must somehow be connected to utility power but not to generator power, because it is only on when the utility is on. When the light goes out, the staff knows that the utility has failed, and they must run over to the generator room, start a generator, and throw three manual transfer switches to get the hospital back on line. Then, when they see the light come back on, they know that utility power is available again, and they reverse the process. Both of these events happen several times a day.
One new thing we started to notice at this hospital was anesthetic gas. None of the hospitals we looked at had any anesthetic gas exhaust system. Instead, they simply blow it into the room. One thing we know from our work with anesthetic gas recovery systems is that the human body only absorbs 3% of the anesthesia that is delivered to it during an operation; the rest is exhaled. This means that the doctors, nurses, anesthesiologists, etc are breathing in all this anesthetic gas all day long. We are going to propose a very simple systematic fix, of simply putting in exhaust tubes and piping it outside to the atmosphere. In HND, we saw that staff had used a breathing tube to do precisely this (okay—so we stole the idea from them). However, in this hospital, for some reason they have piped the anesthetic gas into the public corridor and not to the outside. Maybe that was on purpose.
In general, we saw the same problems we have seen everywhere else: problems generating and distributing power; problems disposing of waste; problems problems problems.
But, you know what, I was going to copy for you the list of concerns that we had in general for these facilities, but I am so depressed by having to leave tomorrow, that I have decided to shift gears. Instead of writing yet one more memo of what is wrong, I want to take a few minutes to talk about what is RIGHT with these facilities, and things that, in fact, we might be able to learn from:
- Natural light!!! In every instance, the topmost floor makes extensive use of natural light, as well as long skinny wings with natural light to almost all spaces. Once we give them a little bit of controls, this will be a big energy saver for them.
- Natural ventilation. In every instance, they make use of natural ventilation. In at least one hospital, we found significant potential improvements. They manage their patients such that the ones who need to be isolated are isolated. The ones who do not require isolation have open the windows.
- No hot water. They save tremendous amounts of energy through no use of hot water. I wonder if we could do this.
- Provide 100% on-site power; do it efficiently.
- Provide 100% on-site water; treat it and release it into a lagoon. (I think we can reduce the amounts used, and treat and return some of it to further reduce the amounts used, but that is for the next post).
- Provide clean water for the neighborhood to protect their health.
- Use everything to the nth degree.
- Eliminate all communication systems. Use only cell phones.
- Don’t overdo it with medical equipment.
- Engage the families in care-taking.
- Minimize use of heating, cooling, fans—even in a hot, humid climate.
- Bottle your own oxygen on site.
- Forget about special grounding systems in ORs.
- Do laundry on site. Use solar thermal to provide heat.
- Aboveground fuel oil storage tanks are the best.
- Keep a supply of on-site potable water.
These are the ones I can think of off the top of my head.
So, now it is late, and I need to get to work on some other things. In 12 hours, I will be in Miami, if we can find enough fuel. Wish me luck!!
Comments
It is so good to hear about the GOOD rather than the BAD! Of course, there are always things that need to be improved. But for once, I’m reading an article about the stuff that is good in Haiti. I would say, though, that a lot of that list is something that would never work in the US. No hot water? Yeah, right…! Thanks for sharing this!
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