The Haiti-Boston connection

jim ansara looks out over the sprawling 180,000-square-foot National Teaching Hospital under construction in Mirebalais, a town in the central plateau of Haiti. Audacious in conception, innovative in execution, the hospital is a joint effort of the Haitian Ministry of Health and Partners In Health, the Boston-based global health organization founded by Paul Farmer.

Top: Dr. David Walton and Jim Ansara of Partners in Health with former President Bill Clinton. Middle: Volunteer and Haitian electrical workers. Above: People bring vetiver grass and bamboo to plant near hospital to prevent erosion.

Ansara, the founder of Shawmut Design & Con­struction in Boston, is working as the director of construction for Partners In Health. A staunchly pro-union employer, Ansara is using his connections back home to recruit dozens of skilled volunteers from Boston-area building trades unions to help a large local workforce of local Haitians and Dominicans construct the hospital. The Boston workers are also training Haitian workers so that they will have the skills to continue the work after the volunteers leave.

As Haitian Kreyol and Boston accents mingle on the construction site, Ansara says: “Mirebalais has become a suburb of Boston.”

The project is a model of how determination, creativity, and an innovative use of cross-cultural resources can produce a transformative facility in a country that has been plagued by devastating hurricanes, earthquakes, the onset of a cholera epidemic, and a series of frustratingly disappointing recovery programs. In Mirebalais, workers from Haiti and America are building a hospital and changing their own lives in the process. Local workers are gaining much needed employment and the Massachusetts volunteers have found a remarkable outlet for their craft skills.

As an example, apprentices at the New England Carpenters Training Center in central Massa­chu­setts retrofitted 300 doors and union carpenter volunteers hung the doors in their frames 1,600 miles away. Union electricians from Massachu­setts have been installing electrical panels and light fixtures and union plumbers have been hooking up the medical gas systems in the wards.

“The work was the same that I do at home,” says Carpenters Local 40 member Mike Biasella, who lives in Revere. “But I got to see a country and culture I never saw before.”

Leo Purcell, a retired labor leader and IBEW Local 103 member from Whitman, has worked with a Haitian crew of electricians on his two visits. “By the time the hospital opens,” he says, “they should be able to deal with the ongoing maintenance of the generators and electrical systems.”

Bonds have been built across language and cultural barriers. Iguenson Joseph, a young electrician from Mirebalais, named his newborn son after one of his Boston counterparts.

I visited Mirebalais in early February, driving on Route Nationale #3 from Port-au-Prince into some of the poorest communities in the western hemisphere. An hour from the coast, the road leads through the town’s central square, over a rutted detour, and opens onto the construction site.

Zanmi Lasante’s (“Partners In Health” in Kreyol) footprint in Haiti dates back to 1983 with the creation of a small clinic in the village of Cange; a dozen more health care facilities followed. In 2008, the Ministry of Health asked the organization to build a new 110-bed community hospital in Mire­­balais, a town that is the hub of a population of 140,000 in the highlands. However, in the wake of the January 12, 2010 earthquake’s destruction of much of the nation’s medical infrastructure, the ministry suggested replacing the original proposal with a far more ambitious program that would represent a quantum leap in medical delivery systems.

“The earthquake changed everything,” says David Walton, the 35-year old director of the Mire­balais project. “The Ministry of Health said build it bigger and faster.” Walton has been working in Haiti with Partners In Health since 1999 when he was a first-year medical student. Now a physician at Brigham and Women’s Hospital and an instructor at Harvard Medical School, he divides his time between Boston and Haiti.

Walton is largely responsible for the reconception of the 320-bed facility, with outpatient and inpatient care, an emergency ward, six operating rooms with modern sterilization procedures, an intensive care unit, a neo-natal intensive care unit, ante-natal and post-partum facilities, spacious wards, mental health services, dentistry, radiography, CT scans, electronic medical records, and all the other characteristics of a contemporary comprehensive care center. In addition, there are conference and seminar rooms with high-speed Internet and video-conferencing capabilities to provide medical and nursing education that can be linked to Harvard Medical School and other teaching institutions around the world.

Cutting edge it may be, the hospital is unmistakably Haitian, surrounded by rice paddies and mountains. The front entrance is a wall of medallions crafted by local metalworkers out of 55-gallon steel drums. The design fosters a light and airy environment with open-air courtyards, corridors, and waiting areas. Air-conditioning is limited to rooms requiring strict temperature control, as ceiling fans provide comfort and air flow in areas open to the outdoors.

The attention to air movement serves both a design and an infection-control function by limiting the spread of hospital-acquired tuberculosis and other infectious diseases. Ultraviolet lights are installed seven feet above the floor in all the open areas to create a “kill zone” for TB bacteria. Similarly, patient flow from one area to the next follows a common sense design that moves ambulatory patients through sequential steps and limits contact bet­ween the sick and well, inpatient and outpatient.

The demands of the design exceeded the capacity of Haiti’s building industry. No project had ever incorporated the plan’s level of construction sophistication, let alone the medical technology, and the earthquake had de­stroyed the country’s already limited construction infrastructure.

Walton enlisted Ansara to inject additional expertise. Ansara opened Shawmut in 1982, signed a union agreement three years later, and quickly expanded the firm’s business, which ultimately allowed him to sell the then-$600 million company to his employees in 2006. While staying on as chairman of the board, he stepped back from the company’s day-to-day activities, setting up a foundation with a focus on international philanthropy.

Walton and Ansara first connected on the original concept for Mirebalais in 2009. Both went to Haiti immediately after the earthquake, knee-deep in what Ansara describes as “battlefield medicine.” Returning with a new expansive mandate from the ministry, they threw out the original drawings and began to redesign the hospital.

Ansara drew on his years in the Massachusetts industry, soliciting donations of services from local companies he had worked with. J.C. Cannistraro of Watertown designed, pre-fabricated, and donated the mechanical and medical gas systems. John Penney Co. of Cambridge designed the electrical system. Sullivan & McLaughlin of Dorchester designed and built the photovoltaic system, installed the IT infrastructure, and directed the Haitian electrical team. Mark Richey Wood­working of Newbury­port designed, manufactured, and donated the architectural millwork.

Construction began in July of 2010 with site contractors from the neighboring Dominican Republic. With unemployment over 80 percent in and around Mire­balais, the hospital project has served as the primary economic development engine in the region. Hundreds of hopeful workers lined up at the project gates when the structural, foundation, and block work began. So far, over 600 have found employment. “There is a very strong work ethic and a high level of consciousness about worker solidarity,” says Ansara, “but a limited exposure to high-level trade skills.”

In post-earthquake Haiti, there were few heavy equipment machines, earth movers, or large concrete mixers, particularly in rural communities. The quality of the available concrete could not support the plan’s demanding earthquake and hurricane resistant specifications. Ansara and his team built a batch plant on site to produce their own concrete.

The site includes its own wastewater treatment plant, an essential response to the recent and ongoing cholera epidemic. Walton and Ansara recognized that in order to provide uninterrupted electricity to the hospital, they would need to supplement the unreliable grid generated by the nearby Peligre Dam. The hospital will rely on 1,800 solar panels to power the building during the day. Three large generators will seamlessly back up any breakdowns in service from the grid at night.

The issue of permanent staffing for the hospital will present an even bigger challenge. “The ministry’s mandate to be bold pushed us to consider how far we could go without going too far,” says Walton. “There’s no point in creating a white elephant that can’t be sustained or maintained.”

The newly trained tradesmen can be the core of a maintenance staff, but the hospital will need more than 800 doctors, nurses, technicians, aides, orderlies, and custodians when fully operational. On the first day applications were accepted in February, 300 people applied, but Walton worries about matching positions with training. There has also been a tradition of out-migration of skills from Haiti, a problem that was only exacerbated by the earthquake.

“Haiti has hemorrhaged medical and other allied health professionals,” says Walton. “Fully 80 to 85 percent of the recent graduates of Haiti’s medical schools are no longer in Haiti.”

Zanmi Lasante has a long and effective history of recruiting and training local community health workers, but the Mirebalais hospital could also serve as a beacon for the Haitian diaspora in the US and Canada. According to former Massachusetts state representative Marie St. Fleur, the first Haitian-American to hold public office in Massachusetts, one of the side-effects of the earthquake has been to heal old political and social wounds and to re-energize a commitment to providing assistance.

“There are associations of Haitian physicians and nurses in Boston, Miami, New York, and Montreal,” St.Fleur says. “The quality of care at Mirebalais could draw some of them back.”

The Ministry of Health and Partners In Health have signed a 10-year agreement to jointly manage the new facility after it opens this summer. St. Fleur marveled at the effort after a visit in early February. “There’s been plenty of money pledged to Haiti since the earthquake,” she points out, “but a lack of leadership and excessive bureaucracy has limited the impact. The sheer will to drive the Mirebalais project forward in the face of massive hurdles is nothing short of amazing.”  

Mark Erlich is the executive secretary-treasurer of the New England Regional Council of Carpenters and a frequent writer on labor and political issues.