Infrastructure plays key role in COVID fight

Greater international investment, collaboration needed

AMONG THE NEARLY 3 million people worldwide who have died from COVID-19 are thousands of frontline healthcare workers – doctors, nurses, and others – many of whom contracted the virus while caring for infected patients. While healthcare workers around the world have been celebrated for their bravery and commitment, the pandemic has underscored the personal risk they take on in order to provide care. Wednesday marks World Day for Safety and Health at Work, and honoring the heroic work that doctors, nurses, and other providers do every day requires meaningful investment in solutions that will help them do their jobs more safely and effectively, including high-quality healthcare infrastructure.

As a nurse, I know firsthand the importance of working in high-quality, thoughtfully designed settings. From using design to thwart the spread of infectious diseases, to creating barriers to external threat – everything from gun violence to environmental hazards, to ensuring that critical equipment functions safely – physicial infrastructure is a critical piece of the puzzle when it comes to protecting both patients and staff.

COVID-19 has highlighted the risks facing doctors, nurses, and other staff in healthcare settings, but the challenges are not new – and they are especially pronounced in regions with fewer health resources. In many low- and middle-income countries, existing healthcare infrastructure is outdated and at risk of being overwhelmed by pandemics, infectious disease outbreaks, and even daily challenges created by the social, political, and environmental conditions in particular regions.

The consequences can be devastating. During the Ebola outbreak in West Africa that began in 2014, more than 500 health workers in Guinea, Liberia, and Sierra Leone died; in Liberia, specifically, 8 percent of all doctors, nurses, and midwives succumbed to the virus. There were many factors that contributed to the death toll, but infrastructure and equipment challenges that made effective isolation and safe treatment difficult played a large part.

Creating safe physical environments requires an intentional focus on a number of interrelated priorities. Particularly in the context of infectious disease outbreaks, the ability to effectively isolate patients, create sterile environments, and prevent “community spread” within the hospital or clinic is critical, and has everything to do with how healthcare facilities are designed, laid out, and constructed.

At an even more basic level, the ability for doctors, nurses, and staff to safely navigate a facility without being at risk of slipping and falling, being exposed to the elements, or other environmental hazards is key.

Equipment plays a role, too. An estimated 40 percent of biomedical equipment is out of service in low- and middle-income countries, and in some places the number is much higher. When equipment breaks, it impacts patient care, but it can also create a hazard for providers; oxygen concentrators, for example – in demand during the COVID-19 outbreak – contain a highly-flammable substance and can pose a significant fire risk when they malfunction.

Building higher-quality health infrastructure can go a long way towards protecting the physical health and safety of patients and staff, and it can also inspire greater trust and confidence. When doctors, nurses, and staff know that the facilities they work in have been designed and constructed intentionally to protect their safety – with reliable power, effective ventilation, isolation spaces, protected areas, and more – they will feel more comfortable coming to work, and be able to focus more of their energy on patient care. And members of the community will feel more comfortable seeking care if they know that the hospital or clinic is a safe, clean, protected space.

It’s important to note, too, that safety doesn’t just mean from disease or accidents within the hospital. In countries experiencing civil unrest or widespread violence, healthcare workers are often targets, so infrastructure must be designed to protect against violence from outside the hospital itself.

Greater international investment and collaboration is critical to improving medical infrastructure in lower and middle income countries, but we must also be cognizant that best practices in the United States or across the global north may not be best practices in other regions.

Meet the Author

Patricia Meservey

Chair of board of directors, Build International
Efforts to use infrastructure to improve safety will be undermined if local doctors, nurses, and communities don’t feel engaged and comfortable providing feedback on design and construction. Practices and features transplanted from the US or other developed nations that fall afoul of local norms or customs may make local staff and patients less likely to abide by them, creating even more unsafe environments. That’s why it’s so important that international organizations work in deep partnership with local communities to understand what resources they have at their disposal, what cultural factors are key, and how both of those things can be incorporated into design and construction.

COVID-19 has provided, yet again, a forceful reminder of the danger doctors, nurses, and medical staff put themselves in to care for their patients. But COVID-19 did not create these dangers – they exist every day. As we work toward an equitable, long-term recovery for communities around the world, the international community must work alongside local partners to identify, invest, and build infrastructure that protects the safety and health of healthcare workers and empowers sustainable, high-quality care – now and in the future.

Patricia Maguire Meservey is a nurse and president emerita of Salem State University. She currently serves as chair of the board of directors of Build Health International, a Beverly-based nonprofit that works to address global health equity through the design and construction of high-quality health infrastructure.