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HAITI: a second response JACMEL SCHOOL OF MEDICINE Tyler Colville | Winter 2013 | Neis University Of Oregon - Portland

THESIS REPORT I image source: http://pepbonet.com/2010/01/portfolio/haiti-earthquake/


“When disaster strikes, we are all aware of it immediately, as the media is quick to convey human suffering and chaos. But after initial attention subsides, the arduous efforts by people from and beyond the region through years of recovery go less noticed during a time, when people are still vulnerable to public health and societal risk that can have permanent and transformative consequences. Architects and builders are part of the wave of second responders, workers who help communities re-establish and heal their internal social, economic, infrastructural and political structures after crisis.� -Symposium on Housing and Disaster Resilience, ACSA Fall 2011


TABLE OF CONTENTS Introduction Earthquake History and Conditions Site and Urban Design Proposal Haitian Vernacular Architecture Building Programming Case Studies Bibliography & Appendix

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INTRODUCTION On January 12, 2010 a magnitude 7.0 Mw earthquake hit Haiti causing catastrophic damage throughout the country. According to government estimates about 316,000 people were killed, another 300,000 were injured, and about 1,000,000 people were left homeless. Roughly 250,000 residences and 30,000 commercial buildings collapsed or suffered severe damage. Much of the damage took place in the capital city of Port-au-Prince, which is located about 16 miles east of the epicenter of the quake. Building standards are very low in Haiti and as a result, few buildings were able to withstand the forces of the earthquake. The quake damaged communication and transportation facilities, hospitals, and electrical infrastructure throughout the small country, which shares the island of Hispaniola with the Dominican Republic. This left Haiti crippled, unable to muster an effective emergency response, which forced many citizens to sleep on the streets and construct makeshift villages with whatever materials they could gather while awaiting help. Many foreign nations sent aid in the form of disaster relief funds, workers, food, medicine, potable water, and temporary facilities, but the damage to Haiti’s infrastructure greatly hindered the relief efforts and delayed recovery. Today there are still over 400,000 Haitians living in tents and temporary facilities in Portau-Prince. Although there is some funding available to rebuild Haiti there is still a massive amount of debris that has yet to be cleared to make room for new construction, and much of the promised funding has yet to be released to Haiti. Disorganization and political debate has also slowed the rebuilding process. http://pepbonet.com/2010/01/portfolio/haiti-earthquake/

Tyler Colville | Winter 2013 | Neis

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2010 EARTHQUAKE

http://pepbonet.com/2010/01/portfolio/haiti-earthquake/

Tyler Colville | Winter 2013 | Neis

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THE NUMBERS PEOPLE KILLED BY THE 2010 EARTHQUAKE

316,000

280,000

ESTIMATED BUILDINGS THAT COLLAPSED OR SUFFERED SEVERE DAMAGE

HIGHER EDUCATION UNIVERSITIES IN HAITI

8

53

INFANT MORTALITY RATE (deaths per 1000 live births)

85

PERCENT OF COLLEGE-EDUCATED HAITIANS WHO LIVE ABROAD (BRAIN DRAIN)

62

(YEARS) LIFE EXPECTANCY

52.9%

HAITI’S LITERACY RATE

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CONDITIONS AID Only 52.9% of the aid that was pledged for reconstruction in Haiti has actually been disbursed. The money that is being disbursed is often poorly allocated and focused more on immediate relief (tents, food, supplies) and less on long term rebuilding of the country. FAILURE Haiti has a history of failure when it comes to development projects and the 2010 earthquake has presented a host of new challenges for the Haitian government and people. One example (paraphrased from an interview with Hannah Carr): “Former dictator Francois Duvalier built residential structures north of Port-au-Prince in a town now called Cabaret in the 1960’s (then called Duvalierville). The attempt was to lure aid monies. It worked, and the structures built were quickly inhabited. What never materialized were running water, education, employment, all of the things necessary to make a place truly inhabitable. So, in your project, you must consider what’s been tried and promised, be reasonable about what can be done with the resources available, and really examine the motivations behind projects.”

Tent city outside of Port-au-Prince

FEAR In the aftermath of the earthquake, the trauma psychology of most Haitians now is to avoid multistory buildings. Presidential Palace after the 2010 quake Tyler Colville | Winter 2013 | Neis

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CROWDING OF SERVICES Existing Hospital

Cap Haitian

Project Site

Port-au-Prince

Jacmel

Tyler Colville | Winter 2013 | Neis

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CONDITIONS One of the main reasons that the 2010 earthquake was so deadly was because of the fact that the area (the city of Portau-Prince in particular) was so densely populated. The major cities of Port-au-Prince, Carrefour, Cap-Haitien, Petit Goave and several others are severely overcrowded due to the fact that they are the few places where Haitians believe that they can find jobs and earn a living. As illustrated by the map to the left, there is also an extremely unbalanced amount of services such as health care facilities in the larger cities. Haiti is a country where the “if you build it, they will come� theory holds very true. Services must be disbursed more evenly throughout the country or else Haitians will continue to flock to these already overpopulated centers in unsustainable numbers. For this reason I chose to design my project (a hospital/ medical university) outside of these major cities, in the town of Jacmel.

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JACMEL, HAITI

(pop. 140,000)

TO PORT-AU-PRINCE

EXISTING ACTIVITY HUB MAJOR HIGHWAY

RIVIÈRE DE LA GOSSELINE

PROJECT SITE AIRPORT TOWN SQUARE

TO MARIGOT

CEMENT FACTORY

BAIE DE JACMEL

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URBAN DESIGN Everything in Haiti is fractured and no two systems seem to be connected. Throughout the country, utilities, roads, and other public services are either in severe disrepair or are non-existent. Haiti has natural resources in the form of sun, rain, and wind but doesn’t have the means to utilize these resources. Aid money from all over the world continues to pour into the country but it seems to have no effect on the living conditions in cities. I believe that real change could be made with organized and focused urban planning throughout the country. In order to generate an interconnected self-sustaining city in Jacmel, solar and wind energy production and water catchment and treatment should be linked on a reliable public utility system. Requiring sustainable design elements such as passive cooling and PV panels at all new commercial buildings would also allow surplus energy production to be fed back into the electrical utility. Although the initial cost of building the required infrastructure would be high, the return on that long term investment would far outweigh initial costs. The majority of aid money is spent on temporary solutions such as bringing clean water to people, so if Haitians were able to produce their own clean water and energy locally it would put an end to this bottomless foreign aid money pit. I also propose developing higher education facilities in Jacmel and building upon the existing industrial production and tourism industries. I propose building an engineering school along with the hospital/medical university and improving the existing primary schools of Jacmel. The cement factory that is located in the southeast, near the bay could be tied to the new engineering school and an industrial waterfront area. The waterfront area to the west of the factory seems to have much potential as a pedestrian corridor. Building a tourism/information center here could help to grow the tourism industry, bringing more capital into the city. HT-4 is the highway running north out of Jacmel to Port-au-Prince and it is in very good condition. I propose treating this as the main artery, developing downtown Jacmel to the south of the intersection where HT-4 enters the city. New policies could be implemented that would also promote positive change. Enforcing a building code that addresses the seismic, wind, and water issues in Haiti would help to prevent disasters such as the 2010 earthquake in the future. Restrictions on deforestation, especially on slopes and areas susceptible to mudslides, would also help to prevent future damage.

Tyler Colville | Winter 2013 | Neis

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JACMEL, HAITI

Tyler Colville | Winter 2013 | Neis

(pop. 140,000)

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SITE CONDITIONS Jacmel is a tourist destination located in the south of Haiti on the Baie de Jacmel, situated in a small valley surrounded by steep hills and a river which flows into the Caribbean Sea. Several relatively well-kept highways lead to Jacmel (from the north and the east) and it is only a 2-3 hour drive from Port-au-Prince. The airport - located northeast of the city center - is still operational. Due to its relatively high level of accessibility and its location outside of, yet nearby the overpopulated regions to the north, I chose Jacmel as the site for designing a teaching hospital. There is an existing hospital (Hospital Sainte Michel) in Jacmel which is located on the banks of the Grand Riviere de Jacmel. The hospital was mostly destroyed in the 2010 earthquake, with some parts being temporarily repaired. Currently there are tents which have been set up outside the hospital along with a semi-permanent structure within the hospital to hold the growing number of incoming patients. The hospital continues to operate but there is a definite need for an improved permanent structure. The site appears to be level, with a slight slope to the west, down to the riverbed. The city center lies just to the east and based off of the images that I was able to gather, there is somewhat of a grid pattern to the downtown development. The climate of the site is typical of Haiti tropical with a good deal of rainfall, high humidity, wind, and the area is subject to severe droughts and floods due to deforestation. Left: Flying into Jacmel Right: Photos of the Sainte Michel hospital after the 2010 earthquake Tyler Colville | Winter 2013 | Neis

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VERNACULAR ARCHITECTURE

Clockwise from top left: Typical house in Cap Haitien; Cemetery in Hinche; Bamboo house in Milot; Houses in Pignon Tyler Colville | Winter 2013 | Neis

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VERNACULAR ARCHITECTURE The Haitian lakou (right) is a compound of several buildings, each occupied by a different family, surrounding a shared common space (traditionally an outdoor courtyard). The design is believed to originate from communities that maroons (runaway slaves) developed during the French occupation and War of Independence. The orientation of the buildings surrounding an inner courtyard made a more easily defensible compound. The materials and building technology aspect of my project will need to be carefully considered due to Haiti’s damaged infrastructure and weak manufacturing sector. I would like to set a goal of using only locally available, recycled, or inexpensive materials and building systems that reduce (if not eliminate) dependence on utilities. Adaptive re-use of materials should be utilized wherever possible. Concrete, corrugated sheet metal, CMU, and bamboo appear to be the most readily available building materials in Haiti. The hospital should be designed to a much higher standard than typical Haitian structures, which rarely have proper foundations and reinforcement.

Above Right: Traditional Haitian Lakou (http://sites.duke.edu/lawandhousinginhaiti/files/2012/04/haiti-house7-537x3571.jpg) Right: Napkin sketches, preliminary design Tyler Colville | Winter 2013 | Neis

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PROGRAMMING MATRIX Values

Goals

Facts

Needs

Ideas

HUMAN individual and group activities

Create a community hospital and medical university that will serve not only the people of Jacmel, but Haitians throughout the country.

Current hospital was badly damaged in the earthquake and has undergone some reconstruction of parts of the hospital, but is still in poor condition.

The hospital is inadequate and needs to be able to house the growing number of patients that are arriving in Jacmel.

Rebuild the hospital with salvaged materials on the same site, expanding it greatly and incorporating a medical university.

CULTURAL societal context

To incorporate social and educational functions.

The hospital is currently not particularly welcoming or accommodating. It is not a source of pride for Jacmel.

The city would benefit from a social center or gathering place.

Incorporate a university and meeting rooms that could be used by groups outside of the hospital.

AESTHETIC artistic context

To provide therapeutic spaces that are comfortable for patients and staff.

The hospital consists of battered materials with bland colors and unwelcoming spaces.

Needs pleasing spaces, calming spaces, inspiring spaces.

Use colors, natural lighting and ventilation to create beautiful space.

TEMPORAL physical context

Design for future expansion and flexibility of spaces.

The current hospital is basically just a shelter with very few amenities and fixed spaces.

Needs flexible spaces and Medical wards and other potential for easy future expan- applicable spaces should sion. be flexible and construction should be simple enough for easy replication and expansion.

CLIMACTIC exterior site context

The design should be appropriate to the tropical climate in Haiti.

The current hospital is basically CMU walls and a wood roof.

The new design needs to take Louvers, operable windows, advantage of natural light and & clerestories will contribute ventilation. to spaces that are adaptable to climate changes.

ENVIRONMENTAL interior psychrometric requirements

Use locally produced materials and sustainable systems to reduce energy consumption by the building and reliance upon public utilities.

There are several buildings that have been constructed elsewhere in Haiti which utilize PV, passive solar and other sustainable systems very effectively.

The hospital will be a huge energy consumer by nature and it needs to offset this consumption by producing some of its own energy to reduce load on pub utilities.

The Haitian government is very poor and disorganized and donations will likely be the main source of funding.

The hospital will need to control The more energy & consummaintenance and operating ables that the hospital can costs to succeed in the long produce itself, the better. run.

The hospital will have to be ECONOMIC fiscal requirements built and operated with limited funding.

PV arrays, daylighting, natural ventilation, green roof, composting toilets or living machine, and cooling towers are all viable sustainable design options.

TECHNICAL practical and scientific requirements

Build a hospital and university The equipment currently available The hospital needs technowith modern medical techis outdated and insufficient. logically advanced equipment nology. and facilities capable of treating illnesses that would normally require treatment outside of Haiti.

Secure donations from PIH and other organizations, build flexible facilities capable of housing advanced medical equipment.

SAFETY codes and ordinances

Hospital should be able to resist seismic activity, hurricanes, and other natural disasters frequent in Haiti.

Use reinforced concrete or CMU block construction paired with other methods to build a resilient, long-lasting building.

Tyler Colville | Winter 2013 | Neis

Haiti experiences many natural disasters due to its geographic location and is very poor, which is a deadly combination.

The hospital needs to be able to resist large earthquakes, hurricanes, flooding, and other nat’l disasters.

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PRINCIPLES My reasoning for designing a teaching hospital in Jacmel is that it would be a comprehensive response to the existing problems in Haiti, addressing immediate medical and humanitarian needs while helping to build Haiti’s capacity to care for its own people in the future. Health care is a human right that the people of Haiti do not currently have. The same is true for education. Statistically, Haiti has the poorest education in the Caribbean, putting it very low on worldwide education rankings. People leave the country to get educated and don’t return after school. A teaching hospital in Jacmel would both educate and provide jobs for these individuals. Partners in Health (PIH), a charitable organization co-founded by Dr. Paul Farmer, has just opened a new teaching hospital in Mirebalais (below) that I used as my primary precedent study. The hospital was built outside of Port-auPrince and it is an outstanding model for what can be done to solve some of Haiti’s health care and education problems. I used it along with a programming matrix to help form my program for a similar university/hospital in Jacmel and I am using PIH as my theoretical partner organization for this project. Some general goals that I set for the project were to design a building that employs sustainable systems, allowing it to be nearly (if not fully) self-sustained, to design a building that is more than a hospital (a community resource), to design a building that is appropriate for Haiti’s tropical climate, to provide only the needed spaces and combine spaces where appropriate, to design a therapeutic environment, and to bring Haiti’s culture into the hospital. There will be much to consider when designing this project but I think that the most challenging and crucial element will be finding a way to preserve Haiti’s cultural identity while rebuilding anew. Due to the fact that the existing buildings in Haiti were so poorly built, not many structures remained standing after the earthquake. And most of what is left is not adequate to rebuild from. Pretty much everything will have to be rebuilt from the ground up, so the question is how does a city preserve what little existing culture remains while completely rebuilding and moving forward technologically? Tyler Colville | Winter 2013 | Neis

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BUILDING PROGRAM Jacmel School of Medicine (Design Scope) • • • • • • • • •

3 Classrooms Library 4 Research Laboratories Community health clinic focusing on malnutrition issues Dispensary Kitchen and cafeteria School Administration offices and meeting rooms Hospital Administration offices and meeting rooms Community meeting rooms

Partners in Health Hôpital Universitaire de Jacmel (HUJ) 53,500 square foot, 150-bed facility • Women’s health outpatient clinic (7 rooms) • Women’s health inpatient clinic (40 beds) • General and Orthopedic Surgery (4 operating rooms) • Pharmacy • Men’s, women’s, & children’s wards (50 beds total) • TB isolation ward • Mental health ward • Emergency Medicine Clinic • Morgue • Administration center with community meeting room • Kitchen and cafeteria • Bathrooms • Janitorial/Sanitation Rooms

Partner Organization: Partners in Health Educational Partner: Université d’État d’Haiti Tyler Colville | Winter 2013 | Neis

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SPACES Name

Square Feet  

Quantity

Total SF  

Classrooms Research  Labs   Outpatient  Clinic   Women’s  Outpatient   Community  Clinic   Women’s  Inpatient   Operating  Rooms   Pharmacy   Men’s  Ward   Women’s  Ward   Children’s  Ward   TB  Isolation  Ward   Mental  Health  Ward   Emergency  Medicine   Morgue   Administrative  Center   Community  Meeting  Room   Kitchen   Cafeteria   Bathrooms   Janitorial  Rooms   Circulation   Total  

900 700   200   200   200   4000   400   2000   1500   1500   1500   2000   1500   3000   1500   4000   1000   900   1000   800   100   10000    

2 2   15   7   10   1   4   1   1   1   1   1   1   1   1   1   1   1   1   8   5   1    

1800 1400   3000   1400   2000   4000   1600   2000   1500   1500   1500   2000   1500   3000   1500   4000   1000   900   1000   6400   500   10000   53500  

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DESIGN BARRIERS In the aftermath of the 2010 earthquake, the trauma psychology of most Haitians now is to avoid multi-story buildings, so stacking the program is likely not a realistic solution.

Rebuilding requires a great amount of resources, which Haiti doesn’t have, so the project will have to rely on a charitable organization (PIH) for funding.

Tyler Colville | Winter 2013 | Neis

$ 20


ORGANIZATION The courtyard form appears frequently in both traditional and contemporary Haitian architecture. This form lends itself well to a hospital program in which views to nature, security, and variation between shared and private space are all very important considerations.

Tyler Colville | Winter 2013 | Neis

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MAJOR SPACES The main spaces of the building will be very important as this is where patients, hospital staff, and visitors will be spending the majority of their time. These spaces need to foster healing, calm environments while housing (and being able to adapt to) the latest medical technologies and equipment. Views to the landscape will be critical as studies such as that by Roger Ulrich in 1984 have proven that patients with a view to nature actually heal faster than those without.

Tyler Colville | Winter 2013 | Neis

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CONNECTIONS The smaller connecting spaces of the building (circulation in particular) will be very important as well. They too will need to foster healing and have views to nature. Haiti’s tropical climate could even allow for unenclosed circulation paths.

Tyler Colville | Winter 2013 | Neis

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EFFICIENCY One of the major limitations of this project will be the budget. Funding for the hospital will be secured from charitable organizations (mainly Partners in Health), so it is crucial that every design decision be carefully examined with cost in mind. One means of increasing the economic efficiency of the building will be consolidating spaces that can be grouped or shared in a logical way and examining which adjacencies are most sensible/cost effective.

$$

Tyler Colville | Winter 2013 | Neis

$

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LASTING

appropriate

CHANGE

Due to the lack of a building code and the limited availability of financial and material resources it is rare to find a building in Haiti that is made to endure. Since sustainability is one of my major focuses in this project (and the fact that the most sustainable building is one that lasts) my design will need to incorporate solid building methods and materials. The challenge will then be to design something that is both enduring and appropriate to the culture and conditions in Haiti.

Le Ecole de Choix - Mirebalais

Tyler Colville | Winter 2013 | Neis

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TEACHING HOSPITAL

(Mirebalais, Haiti)

>>NICHOLAS CLARK ARCHITECTS LTD.

- Completed: July 2012 - National Teaching Hospital for Haitian nurses, medical students, and resident physicians - 180,000 square feet, 320 beds - Natural ventilation & lighting, water-efficient plumbing, 400kW of high efficiency photovoltaic roof-mounted solar collectors (1,800 panels) - Funded by Haiti’s Ministry of Health and nonprofit group Partners in Health - Steel reinforced cast-in-place concrete - Locally produced oil barrel artwork ornaments the building

Tyler Colville | Winter 2013 | Neis

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TEACHING HOSPITAL

(Mirebalais, Haiti)

>>NICHOLAS CLARK ARCHITECTS LTD.

From an interview with PIH about their new hospital in Mirebalais: “Based on PIH’s experience opening a full-service hospital in the rural settlement of Cange, the town of Mirebalais can expect to see remarkable growth and opportunity with the opening of the hospital. We anticipate seeing larger economic growth in the form of new hotels, restaurants, and other small businesses to cater to the increased flow of goods and people in and out of Mirebalais.” “Ultimately, we expect HUM will affect the community’s economy on three levels. First, direct employment of more than 1,000 staff in Mirebalais; second, the benefit of those salaries on their families (the ability to keep their kids in school, for example); and third, business growth that will stem from fulfilling the needs of these new professionals.” “On most sunny days, the system’s 1,800 solar panels will generate more electricity than the hospital consumes, allowing the surplus energy to feed back into the electrical utility. On the roof, reflective white coating keeps the building cooler and makes the solar panels up to 15 percent more efficient. All this new technology is being introduced with an eye toward sustainability—all the equipment will be regularly serviced by professionally trained Haitian staff.” - http://www.pih.org/news/entry/mirebalais-hospital-construction/

Tyler Colville | Winter 2013 | Neis

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TEACHING HOSPITAL

(Mirebalais, Haiti)

>>NICHOLAS CLARK ARCHITECTS LTD.

Tyler Colville | Winter 2013 | Neis

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L’ECOLE DE CHOIX

(Mirebalais, Haiti)

>>STUDIO DRUM COLLABORATIVE, MALCOLM MORRIS

FIRST PHASE SITE PLAN Tyler Colville | Winter 2013 | Neis

1. Classroom 2. Administration 3. Lavatory 4. Computer Lab 5. Kitchen 6. Open-air Dining Hall 7. Mechanical 8. Future Expansion

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L’ECOLE DE CHOIX

(Mirebalais, Haiti)

>>STUDIO DRUM COLLABORATIVE, MALCOLM MORRIS

- Completed November 2011 - Budget: $900,000 - Houses 200 students K-4 - 3 single-classroom buildings, 6 double-classroom buildings, administration area, nurse’s office, kitchen, & open-air dining hall - Reinforced concrete columns with CMU infill walls. Steel trusses support corrugated metal roofs - Rooftop ridge vents, clerestories, and open-air windows provide daylight & natural ventilation - Windows and doors feature hand-woven grass affixed to steel frames, utilizing native materials and local craft tradition Tyler Colville | Winter 2013 | Neis

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L’ECOLE DE CHOIX

(Mirebalais, Haiti)

>>STUDIO DRUM COLLABORATIVE, MALCOLM MORRIS

Tyler Colville | Winter 2013 | Neis

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ECOLE LA DIGNITE

(Jacmel, Haiti)

>>ARCHITECTURE FOR HUMANITY

SITE PLAN Tyler Colville | Winter 2013 | Neis

1. New Building 2. Campus Entrance 3. Existing Building

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ECOLE LA DIGNITE

(Jacmel, Haiti)

>>ARCHITECTURE FOR HUMANITY

- Completed November 2011 - Budget: $75,000 - The only free private school in Jacmel - 300 students from grades 1-6 - 2 classroom, 2,100 sf building - Stones used for the foundation walls and entrance facade were collected from a nearby riverbed. - CMU blocks make up the remaining walls and concealed reinforced concrete columns and beams provide structural stability - Wood trusses anchored to a concrete ring beam support a corrugated metal roof - Openings covered with locally fabricated steel and bamboo screens allow for natural ventilation -Cistern holds clean water on site

Tyler Colville | Winter 2013 | Neis

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ECOLE LA DIGNITE

(Jacmel, Haiti)

>>ARCHITECTURE FOR HUMANITY

“If you’re going to do a building, do it well, stand on principle, and don’t compromise.” - Eric Cesal (Architecture for Humanity)

Tyler Colville | Winter 2013 | Neis

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COLLEGE BON BERGER

(Montrouis, Haiti)

>>ARCHITECTURE FOR HUMANITY

- Completed February 2012 - Budget: $306,000 - The school was forced to demolish its two preexisting, structurally unsound buildings following the 2010 earthquake - 2 stories, 8 classrooms - 400 student private school - Steel trusses support the corrugated-metal roof - Decorative metal screens made by local artists cover the doors and windows and allow for natural ventilation

Tyler Colville | Winter 2013 | Neis

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COLLEGE BON BERGER

(Montrouis, Haiti)

>>ARCHITECTURE FOR HUMANITY

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BUTARO HOSPITAL

(Rwanda)

>>MASS ARCHITECTURE

Opened January 24, 2011 -150-bed district hospital -Burera District, Rwanda to receive a district hospital, which now serves a population of over 400,000 people. -Partners in Health and the Harvard Medical School -mitigate and reduce the transmission of airborne disease through several systems, including overall layout, patient and staff flow, and natural cross-ventilation. -local materials - volcanic rock from the Virunga Mountain Chain – and labor intensive practices in an effort to deliver appropriate and sustainable design, as well as stimulate the local economy -design and coordinated construction reduced the cost of this hospital to roughly two thirds of what a hospital of this size would typically cost in Rwanda, saving 2 million dollars in construction fees. -systems that ensured its long-term, independent sustainability. -four basic services (maternity, internal medicine, surgery, and pediatrics), the new hospital will include an emergency department, a full surgery ward with two operating rooms, a neonatal intensive care unit (NICU), an intensive care unit (ICU), outpatient ophthalmology and gynecology services, an ear nose and throat clinic (ENT), and significantly expanded laboratory capabilities. -natural cross-ventilation through clerestories, secluded patients wards around courtyards, effective spatial triage system allowing for separation of patients based on their condition. -Partners In Health = main contractor. Volunteer architects for site design and on-site supervision of construction. -Construction led and carried out by a Rwandan team. project created over 2000 jobs for the population of Burera. Rapid construction made possible by around the clock work schedule. Tyler Colville | Winter 2013 | Neis

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BUTARO HOSPITAL

(Rwanda)

>>ARCHITECTURE FOR HUMANITY

Tyler Colville | Winter 2013 | Neis

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TE MIRUMIRU

(New Zealand)

>>COLLINGRIDGE & SMITH ARCHITECTS

TE MIRUMIRU MAORI CHILDHOOD CULTURAL CENTER Kawakawa, Northland Area: 572.0 sqm Year: 2012

Tyler Colville | Winter 2013 | Neis

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TE MIRUMIRU

(New Zealand)

>>ARCHITECTURE FOR HUMANITY

Tyler Colville | Winter 2013 | Neis

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BIBLIOGRAPHY Birch, Eugenie L., ed. and Susan M. Wachter, ed. Rebuilding Urban Places After Disaster: Lessons from Hurricane Katrina. Philadelphia: University of Pennsylvania Press, 2006. Print. This book explores the rebuilding of urban places post-disaster, focusing on Hurricane Katrina in particular. Four major issues are addressed in the book: making cities less vulnerable to future incidents, reestablishing an economy after disaster, responding to disaster victims’ long-term needs, and rebuilding the sense of the city. The book proves that in order for the rebuilding to be a success, priorities must be set by the government (or preferably by the community as a whole) and decisions must be made in accordance with these priorities. There are many challenges that impede these necessary organized efforts. The book discusses these challenges in the light of lessons to be learned from Hurricane Katrina. Farmer, Paul, and Joia Mukherjee. Haiti after the Earthquake. New York: PublicAffairs, 2011. Print. This is a book focused on the work of Dr. Paul Farmer (one of the founders of the Partners in Health charity organization). He has dedicated much of his life to providing medical aid in struggling developing countries and is very well known for his work in Haiti. The book describes the conditions in Port-au-Prince and other cities in Haiti through interviews and stories from aid workers and Haitians. It lays out the multitude of challenges that the country faces today. This book was very helpful to me as it gave me an idea as to what kind of human problems exist in Haiti and what the people really would need in a hospital. It opened my eyes to just how little these people have and how something as simple as clean drinking water would revolutionize their world. The book sparked many ideas for what I could propose with my project and urban design proposal and gave me a good view into the daily lives of Haitians. Aquilino, Marie Jeannine, ed. Beyond Shelter: Architecture and Human Dignity. New York: Metropolis, 2011. Print. Beyond Shelter describes the current challenges that our rapidly changing environment presents to the (built) human world. It illustrates the need for long-term solutions that will allow cities to recover from disasters. It explores the role that architects should play in disaster relief and recovery. Beyond Shelter details the work of many architecture and engineering firms that have been trying to tackle these issues in the last few years. The book sends the message that architects must play a crucial role in solving the world’s increasing number of social, environmental, and economic issues. “Haiti’s Lost Children | A Multimedia Documentary.” 22 October 2012. <http://www.haitiedstories.org/stories/>. This documentary presents the current state of education in Haiti, detailing the lack of schooling that children are receiving and the challenges that the current education system faces in the light of recent natural disasters. Some facts from the film: 65% of Haiti’s population is under the age of 25. About half of the country is illiterate and has an income of less than $1.25 USD per day. In the Caribbean, Haiti has the highest rates of illiteracy and absolute poverty. Tyler Colville | Winter 2013 | Neis

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BIBLIOGRAPHY Kidder, Tracy. Mountains Beyond Mountains. New York: Random House, 2004. Print. Charlesworth, Esther. Architects without Frontiers: War, Reconstruction, and Design Responsibility. Oxford: Elsevier, 2006. Print. Kennedy, Joseph F., ed. Building without Borders: Sustainable Construction for the Global Village. Gabriola Island, B.C.: New Society, 2004. Print. Ramroth, William G., Jr. Planning for Disaster: How Natural and Manmade Disasters Shape the Built Environment. New York: Kaplan, 2007. Print. Watson, Donald and Adams, Michele. Design for Flooding: Architecture, Landscape, and Urban Design for Resilience to Climate Change. Hoboken, New Jersey: John Wiley & Sons, Inc., 2011. â&#x20AC;&#x153;Haiti Post-Disaster.â&#x20AC;? Architectural Record v. 200 no. 3 March 2012: 88-93. ADDITIONAL SOURCES: Interviews and email correspondence with Hannah Carr (right) and Tim Myers (engineer with Haiti School Project). http://pepbonet.com/2010/01/portfolio/haiti-earthquake/ http://www.pih.org/news/entry/mirebalais-hospital-construction/ http://www.wbdg.org/design/hospital.php http://www.nicholasclarkarch.com/projects/mirebalais/project.html http://archrecord.construction.com/features/humanitarianDesign/Haiti/ http://www.pih.org/news/entry/mirebalais-hospital-construction/ http://www.acieriedhaiti.com/ http://www.wbdg.org/design/hospital.php

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APPENDIX A October 17, 2012 Email from Hannah Carr: “Hey Tyler, I’ll write more eventually, or hopefully we can just chat in person sometime, but I wanted to add a couple of comments in reply. I am glad you looked into the PIH hospital. I am a huge supporter of their work. I think an engineering school would be great. Construction is one of the largest economies there, as you can imagine after so many buildings were lost. I would check out what already exists. In regards to location, I would, after seeing what already exists, think outside the PAP (Port-au-Prince) box. So much of the death from the earthquake was a result of too many people living in PAP already. The more opportunities that ate there, the more people will continue to migrate into the overcrowded area. I would check out places like Cap Haitian, Gonaives, or Leogane. All three are major cities, each with its own unique history and need for site-specific engineering training. Respectively, one is a port city with great potential, history and environmental degradation; one a historically devastating hurricane hub and place if insane flooding in 2008; and the third the 2010 earthquake’s epicenter. I’ve never spent time in Cap Haitian but have in the other two. I’d rather tell you about my time in person, there’s just so much I could say! In the meantime, please feel free to send questions my way. I’m enthused by your project and I thank you in advance for your intentions and thoughts for Haiti! Mesi (Kreyol for thank you), Hannah”

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APPENDIX A October 27, 2012 Notes from Interview with Hannah Carr: -Current hospital in Leogane is decent. Pick another site -Port au prince...don’t draw more people there -Hannah has contact info for husband and wife who took over port au prince hospital -Beautiful and new, realistic. Not high quality. -New hospital? Put it in a smaller place. Create jobs. -No money in agriculture in Haiti -They import 1,000,000 eggs from Dominican Republic -Put jobs (international organization) near agricultural area, develop a market. -Might feel obscure and crazy, but it would work. -Engineering school? Hannah likes the idea. Depends on where you put it-maybe better than a hospital. Where there are more people? -If you put a hospital somewhere, people might not even be able to afford it. -Partners in Health is rare and helpful for financial problems. They have benefactors in the USA who help. 95% money they raise they use for patient care. -Location dictates what you should build. -Engineering school...most younger kids and adults don’t get great education... -Maybe it’s a trade school. You won’t find people with a high school degree. -There are tons of people who want to go into construction. -Building codes? None -Engineers without borders. -Location? Choose hospital. -Engineering school? Anywhere. -Hospital? Anywhere else BUT port au prince or cap Haitian. NW or SE -Dominican Republic very close to the east. -Haiti has 9 million people!!! Very dense. -No localized place. No density. -Urban design? Urban plan overall? -Funding and teaching from outside. Train locals, even if there is no education. -Ignore academic credentials. Local staff. It drops your budget. -Site: Engineering school? Port au prince is easy. Engineers without borders...anywhere! -Don’t just pick the easy place. Tyler Colville | Winter 2013 | Neis

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APPENDIX A October 28, 2012 Interview with Hannah Carr: -Should choose a city that is outside the Port-au-Prince and Cap Haitian area for a hospital. -Jacmel? -Concrete and CMU should be your materials as they are pretty much the only affordable and readily available materials around Haiti. -Jacmel is located on the Baie de Jacmel in a small valley with steep hills surrounding it and a river which flows into the Caribbean Sea. -There is an airport that is still operational. -It’s a larger city (pop: 26,000; 40,000 metro) – from Wikipedia -Relatively shallow port unable to harbor large ships. It is run by the Autorite Portuaire Nationale. -Tourist destination. -2-3 hour drive from Port-au-Prince. -Highways into Jacmel are in fairly good condition. -There is a big celebration called Carnival during Mardi Gras. -Stairs are useless in a hospital and in Haiti an elevator is always broken. -Should be 2 stories max. -Brain drain in Haiti = all of the smart people go to foreign countries to get educated and they don’t return. -Hannah thinks that there is a hospital in eastern part of the city but doesn’t know what it’s like. Assumes that it is on a hill. -Milot hospital in Cap Haitian is a good one to research. -Hospital Saint-Michel in Jacmel.

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APPENDIX B PARTNERS IN HEALTH INFORMATION ATTACHED

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Partners In Health

1

Partners In Health Partners In Health

Founded

1983

Headquarters Boston, Massachusetts Area served

Worldwide

Focus

Humanitarian

Method

Aid

Employees

14,000

Motto

Providing a preferential option for the poor.

Website

http:/ / www. pih. org

Partners In Health (PIH) is a Boston, Massachusetts-based non-profit health care organization dedicated to providing a "preferential option for the poor". It was founded in 1987 by Dr. Paul Farmer, Ophelia Dahl, Thomas J. White, Todd McCormack, and Dr. Jim Yong Kim.[1] PIH strives to provide an alternative to the conventional curative method of treatment for the sick and instead tries to prevent diseases before they occur. This model believes that primary health care is essential because health is a right and therefore, it should be available to everyone.[2] PIH strives to bring good medical care to the poor by establishing long-term partnerships with local sister organizations.

A family receives medical attention at one of PIH's Port-au-Prince-based clinics after the 2010 earthquake.

The organization's model is described as being one in which: clinical and community barriers to care are removed as diagnosis and treatment are declared a public good and made available free of charge to patients living in poverty.[3] For people living in poverty stricken areas, the treatment of AIDS and multidrug-resistant tuberculosis (MDR-TB) has been made possible by this model of care. The idea for Partners In Health first began when Paul Farmer and Ophelia Dahl helped set up a community-based health project in Cange, Haiti known as Zanmi Lasante ("Partners in Health").[4] For a number of years the organization focused its efforts almost exclusively on treating HIV/AIDS patients in rural Haiti. In the past decade, the organization's mission has expanded to include a more holistic approach to tackling disease and poverty. PIH devotes considerable resources to providing food, water, education and housing to sick patients. The organization also advocates for human rights both at the governmental and international NGO level. In 1993, Dr. Farmer founded the Institute for Health and Social Justice (IHSJ), which is the research and advocacy arm of PIH. The IHSJ was founded using the proceeds of Dr. Farmer's John D. and Catherine T. MacArthur Award. The mission of the IHSJ is to analyze the impact of poverty and inequality on health, and to use these findings to


Partners In Health

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educate and train students, academics, donors, policy makers, and lay people. As of 2006, the IHSJ is under the direction of Dr. Joia Mukherjee, PIH's Chief Medical Officer.[5] PIH is a Harvard-affiliated NGO. The organization works closely with Harvard's School of Public Health and the Brigham and Women's Hospital. One of the defining features that separates PIH from other NGOs is its commitment to hiring and training people who live in the communities where the organization works. Of the nearly 15,000 employees working for PIH, fewer than 150 are American. PIH is an official supporting organization of Healthcare Information For All by 2015, a global initiative that aims to improve the availability and use of reliable healthcare information in low-income countries.

Project Locations Haiti Zanmi Lasante (“Partners In Health” in Haitian Kreyol) is PIH’s flagship project – the oldest, largest, most ambitious, and most replicated. The small community clinic that first started treating patients in the village of Cange in 1985, has grown into the Zanmi Lasante (ZL) Sociomedical Complex, featuring a 104-bed, full-service hospital with two operating rooms, adult and pediatric inpatient wards, an infectious disease center (the Thomas J. White Center), an outpatient clinic, a women’s health clinic (Proje Sante Fanm), ophthalmology and general medicine clinics, a laboratory, a pharmaceutical warehouse, a Red Cross blood bank, radiographic services, and a dozen schools. ZL has also expanded its operations to 11 other sites across Haiti’s Central Plateau and beyond. Today, ZL ranks as one of the largest nongovernmental health care providers in Haiti – serving a catchment area of 1.2 million across the Central Plateau and the Lower Artibonite. ZL employs over 4,000 people, almost all of them Haitians, including doctors, nurses and community health workers. PIH's community-based model has proven successful in delivering effective care both for common conditions like diarrhea, pneumonia, and childbirth that often prove

Construction workers will soon complete the second story of Mirebalais Hospital's primary building.

A rendering of PIH's Mirebalais Hospital, set to open in January 2013.


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fatal for Haiti’s poor and malnourished, and for complex diseases like HIV and tuberculosis. A key to this success and to the PIH model of care pioneered in Haiti has been training and hiring thousands of accompagnateurs (community health workers) to prevent illness, monitor medical and socioeconomic needs, and deliver quality health care to people living with chronic diseases such as HIV and tuberculosis. The use of accompagnateurs is one of the most effective ways of removing structural barriers that prevent adequate treatment of HIV and other chronic diseases while increasing job growth in communities that desperately require employment to further benefit the social structure of the community. Focussing on minimizing the implications of structural violence is the key to the PIH model's success and to the improvement of treatment of chronic disease in rural Haiti.[6] As ZL has expanded, it has partnered with other nongovernmental organizations and the Haitian Ministry of Health to rebuild or refurbish existing clinics and hospitals, introduce essential drugs to the formulary, establish laboratories, train and pay community heath workers, and complement Ministry of Health personnel with PIH-trained staff. Clinics that previously stood empty now register hundreds of patients each day across twelve sites—Cange, Boucan Carré, Hinche, Thomonde, Belladère, Lascahobas, Mirebalais, Thomonde and Cerca La Source in the Central Plateau plus additions in the Artibonite region, Petite Rivière, Saint Marc and Verrettes. In 2008, ZL recorded more than 2.6 million patient visits at clinical sites. Pulitzer Prize-winner Tracy Kidder's book Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World, details PIH's work.

Peru

Socios En Salud staff at a rally in Lima, Peru, in early 2011.

Since 1994, PIH’s sister organization in Peru, Socios En Salud (SES), has been treating disease and training community members to provide prevention and care for their neighbors in the shantytowns around Lima. Based in the northern Lima town of Carabayllo, SES is now Peru’s largest non-governmental health care organization, serving an estimated population of 700,000 inhabitants, many of whom have fled from poverty and political violence in Peru’s countryside. As a valued partner to Peru's Ministry of Health, SES has also had an impact on national policies for prevention and treatment of drug-resistant tuberculosis and HIV and provides important training and support to help implement those policies nationwide.

SES also provides food baskets, transportation, lodging and social support for impoverished patients whose needs have been confirmed by an extensive interview and evaluation. The project also provides opportunities for income generation projects, job skills training, and small loans to start businesses. One example is Mujeres Unidas ("Women United"), a cooperative workshop that participates in crafts fairs in Peru and has sold handicrafts as far away as the United States, Japan and Switzerland. SES is currently in conducting the world's largest TB research study, called the EPI Project. Funded by a National Institutes of Health grant, the project seeks to understand how MDR-TB and XDR-TB spreads between people living in close quarters.

Chiapas, Mexico The residents of the southern Mexican state of Chiapas, including millions of indigenous Maya, have long struggled with poverty, political violence, and dismal health conditions. Chiapas is burdened with extremely high rates of maternal mortality, infant mortality, and tuberculosis when compared to other states in Mexico. Work aims to provide a more reliable, community-based alternative by training and employing local community health promoters, called promotores.


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El Equipo de Apoyo en Salud y Educación Comunitaria (EAPSEC, The Team for the Support of Community Health and Education) was established in 1985 by a small group of Mexican health promoters. They initially worked with Guatemalan refugee communities in the Chiapas border region, and later expanded their work to other marginalized people in Chiapas. EAPSEC believes that "a life of dignity" is a human right. This includes a strong public health system that responds to the most pressing health needs of the population, and access to high quality health care. Since 1989, PIH has collaborated with EAPSEC to improve medical infrastructure in the region and to recruit and train hundreds of promotores. Over the past two decades, EAPSEC has partnered with dozens of indigenous and rural communities throughout Chiapas to develop local health capacity. Recent work has focused on a network of communities in the area of Huitiupan in the highlands and in the area of Amatan. EAPSEC is dedicated to helping communities build self-sufficiency and counts many successful community health groups throughout Chiapas among its "alumni.”

PIH's project in Mexico gave illiterate women cameras, allowing them to document their lives.

Many of the women took images of family members, but a surprising number were of stoves, kitchen shelves, and wells.

See more images here: [7]

Guatemala Equipo Técnico de Educación en Salud Comunitaria (ETESC, Technical Team for Education in Community Health) was founded by refugees of the Guatemalan civil war who returned to help rebuild their country. Today it has evolved into a community nonprofit that seeks to revitalize and repair the social fabric in the rural communities of Huehuetenango, Guatemala, through holistic development. The organization provides health care, legal accompaniment, and education to each of the communities with which it works.

Boston The Prevention and Access to Care and Treatment (PACT) project serves the sickest and most marginalized HIV-positive and chronically ill patients living in the Greater Boston area. Adapting the accompagnateur model developed in Haiti, PIH’s only domestic health care program trains and employs community members as community health workers (CHW). These CHWs check in on some of the most marginalized and sick patients on a daily or weekly basis, making sure they attend medical appointments, take their medications, and have access to other essential needs and social services. PACT’s health promotion and directly observed therapy programs target the hardest-to-reach patients: poor people of color living in inner-city Boston neighborhoods who have fallen through the cracks of other health care delivery systems. Often these people confront racial and language barriers, social isolation, mental illness, and drug or alcohol abuse. Some are homeless. Almost all live in poverty. These obstacles often mean that patients have difficulty taking all of their prescriptions on a regular basis.


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In spite of these challenges, PACTâ&#x20AC;&#x2122;s community-based approach has proven to significantly improve the health of their clients, and has reduced costs to Massachusettsâ&#x20AC;&#x2122;s Medicaid system. For example, a recent study showed that HIV-positive patients enrolled in the program for 12 months experienced an average increase in CD4 count (a measurement of immune system strength) from a dangerously low 133 cells per microliter, to a much-improved level of 293. One Boston-area hospital reported that hospitalizations of AIDS patients enrolled in the PACT program decreased by 17 percent, and the costs for inpatient stays dropped by 37 percent.[8][9][10][11]

Russia

A patient living with MDR-TB receives care in Russia.

Partners In Health's work in Russia has a narrower medical focus over a vastly wider geographical area than any of other projects. From a base in the region of Tomsk Oblast, Siberia, PIH has been working since 1998, in collaboration with the Russian Ministry of Health, to combat one of the world's worst epidemics of drug-resistant tuberculosis (MDR-TB). In partnership with the Division of Social Medicine and Health Inequalities (DSMHI) at the Brigham and Womenâ&#x20AC;&#x2122;s Hospital, PIH has focused on improving clinical services for MDR-TB patients in Tomsk while undertaking training and research to catalyze change in treatment of MDR-TB across the entire Russian Federation.

Partners in Health began working with local clinicians to improve treatment of MDR-TB in Tomsk in 1998. Joint effort got a major boost in 2004, when assisted partners in Tomsk in securing a five-year $10.8 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria for efforts to improve prevention, diagnosis and treatment of TB and MDR-TB. Key components of clinical effort include improving diagnostics in order to detect cases earlier, developing a comprehensive strategy to promote adherence among patients, improving infection control in hospitals and clinics and decreasing transmission of TB to HIV-positive patients. Work in Tomsk also encompasses health education for the public and clinical and program management training for medical personnel in Tomsk.[12][13]

Burundi In a country torn apart by civil war, extreme hunger and poverty, the village of Kigutu faced crippling disease, poor health, and misery in 2006. In an effort to respond to this crisis of care, Deogratias Niyizonkiza founded the nonprofit organization Village Health Works (VHW) to bring high-quality health care to this rural Burundi community, as well as to address the root of the village's poor health: poverty.

Community Health Workers in Lesotho receive monthly trainings.

From its very beginning, VHW fostered close ties with PIH. VHW founder Deo met PIH founder Paul Farmer while studying at the Harvard School of Public Health, and he soon began working with PIH's partner organizations in Haiti and then in Rwanda (another country torn apart by genocide and civil war). Deo wanted to bring help to Burundi as well, and decided to create a health clinic in Kigutu, a village where his parents came to live when they returned to Burundi from refugee camps.


Partners In Health

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Lesotho PIH's project in Lesotho was PIH's second project in Africa and the first in a country suffering from extremely high prevalence of HIV. Approximately one quarter of Lesotho's adult population is HIV-positive and life expectancy in the tiny mountain kingdom has plummeted to less than 40 years. In addition, the Basotho people are being ravaged by a second epidemic: tuberculosis. Lesotho's TB rate is among the highest in the world, and TB spreads rapidly and is particularly deadly where many people's immune systems are weakened by HIV. The PIH project in Lesotho was launched in 2006 following an invitation from the government of Lesotho and consultation with partners in Rwanda, the Clinton HIV/AIDS Initiative (CHAI, now known as the Clinton Health Access Initiative), about where to replicate that successful model elsewhere in Africa.[14]

Rwanda

An aerial image of PIH's new Butaro Hospital, the largest public facility in Rwanda.

Rwandan President Paul Kagame and PIH's Paul Farmer at the Butaro ribbon cutting ceremony in 2011.

Partners In Health/Inshuti Mu Buzima (PIH/IMB) has been working in Rwanda since 2005. In partnership with the Government of Rwanda and the Clinton Health Access Initiative (CHAI), work supports the Ministry of Health to comprehensively strengthen the public health system in rural, underserved areas of the country. Initially, PIH and CHAI began by implementing a pilot project in two rural districts in Rwandaâ&#x20AC;&#x2122;s Eastern Province, Kayonza and Kirehe. Building off of PIHâ&#x20AC;&#x2122;s approach in Haiti, the project was designed as a comprehensive primary health care model within the public sector. The approach used HIV/AIDS prevention and care as the entry point to build capacity to address the major health problems faced by the local population. Haitian physicians, nurses, and managers traveled to Rwanda extensively in the early years of the program to provide training and program design assistance. By the end of fiscal year 2011, PIH/IMB is on schedule to support 40 health facilities in three target districts, with over 1,280 clinical and support staff, and work with a network of 6,175 community health workers. In early 2011, PIH opened the largest public hospital in Butaro, Rwanda.[15][16][17]

Malawi In early 2007, PIH and Abwenzi Pa Za Umoyo (APZU; Partners In Health in Chichewa), started treating patients and training community health workers in the southwestern corner of Malawi, one of the poorest and most densely populated countries in Africa. The Clinton-Hunter Development Initiative (CHDI) targeted Malawi as a country desperately needing a rural health project to address the devastating HIV/AIDS epidemic in the region. About 14 percent of Malawi's adult population is infected with HIV and hundreds of thousands of children have been orphaned by the disease. CHDI asked PIH to replicate the rural initiative programs that have proven so successful in delivering HIV treatment and comprehensive primary health care in Rwanda and Lesotho. The Malawi Ministry of Health directed PIH and CHDI to the impoverished rural area of Neno, and in early 2007, the partners began to implement an ambitious plan to combat the disease.


Partners In Health

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In 2010, APZU tested 17,606 patients for HIV. The organization clinics logged 332,619 patient visits. APZU supported 889 children, allowing them to attend school and receive food.[18]

Kazakhstan In 2010, Partners In Health launched a new partnership to combat drug-resistant tuberculosis (MDR-TB) in Kazakhstan, a central Asian country that borders regions in Siberia where PIH-Russia has spearheaded a successful MDR-TB program since 1998. Because of PIHâ&#x20AC;&#x2122;s track record of curing and curbing the spread of drug-resistant tuberculosis in the Russian Federation, the Kazakhstan Ministry of Health invited PIH to help fight one of the highest rates of drug-resistant TB in the world.

Dominican Republic The Partners In Health project in the Dominican Republic is a cross-border collaboration under the leadership of PIH's Haitian sister organization, Zanmi Lasante. Consistent care is crucial to treating chronic diseases such as HIV and TB effectively. Because border populations are particularly vulnerable to lapses in care, making sure that everyone has access to care on both sides of the border is crucial for the long-term health of all those living in the border region, particularly people who are infected with HIV or TB. This project works to integrate past cross-border experiences between Haitian and Dominican Republic providers of care, many of whom have worked in the border region for a decade or longer. The Zanmi Lasante site of Belledare in Haiti and health care providers in the Dominican Republic program in Elias Pena are working together to make the goal of consistent care a reality.

In Rwanda, PIH treats thousands of people throughout In Lesotho, PIH works with families affected by HIV, the Butaro District every day. tuberculosis, and poverty. PIH staff in Malawi celebrating after a training session.


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Partner Projects PIH also supports partner projects in the following countries: • Africa: Project Muso [19] in Mali; Tiyatien Health [20] in Liberia • Asia: Nyaya Health in Nepal

Response to the Haiti earthquake When the earthquake struck Haiti on January 12, 2010, PIH/ZL resources were in place to deliver aid. In addition to providing care to the hundreds of thousands who fled to Haiti’s Central Plateau and Artibonite regions, ZL established health outposts at four camps for internally displaced people in Port-au-Prince. ZL also supported the city’s General Hospital (HUEH) by facilitating the placement of volunteer surgeons, physicians and nurses, and by aiding the hospital’s Haitian leadership. In March 2010, PIH/ZL announced a 3-year, $125 million plan to help Haiti build back better called the Stand With Haiti [21] campaign. Part of this plan includes the construction of Mirebalais Hospital [22]. This National Teaching and Referral Hospital is one of the first public-sector projects to start in Haiti since the earthquake.[23]

After the earthquake in Haiti, PIH sent hundreds of volunteers to the island nation and mobilized an existing staff of nearly 5,000 Haitians.

Before January 12, 2010, PIH had been planning to build a new community hospital in Mirebalais. Then the earthquake struck, leaving most of the health facilities in and around Port-au-Prince in ruins, including Haiti’s only public teaching hospital and nursing school. Responding to an urgent appeal from the Haitian Ministry of Public Health and Population (MSPP), quickly scaled up plans. Less than six months after the earthquake, the MSPP and PIH/ZL broke ground not for a community hospital but for a world-class national referral hospital and teaching center. When the hospital opens its doors in early 2013, the main medical campus will encompass seven buildings offering a level of care never before available at a public hospital in Haiti.[24] And at a time when Haiti desperately needs skilled professionals, Mirebalais Hospital will provide high-quality education for the next generation of Haitian nurses, medical students, and resident physicians.

References [1] Kidder, Tracy (2004). Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World. Random House. pp. 317. ISBN 978-0-8129-7301-3. [2] Farmer, Paul E., Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. 2006. Structural Violence and Clinical Medicine. PLoS Medicine, 1686-1691. [3] Famer, Paul E., Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. 2006. Structural Violence and Clinical Medicine. PLoS Medicine, 1686-1691. [4] Kidder, Tracy (2004). Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World. Random House. ISBN 978-0-8129-7301-3. [5] "Advocacy & Policy" (http:/ / www. pih. org/ pages/ advocacy/ ). Partners In Health. . Retrieved 6 May 2011. [6] Farmer, Paul; Bruce Nizeye, Sara Stulac, Salmaan Keshavjee (2006, October 24). "Structural Violence and Clinical Medicine". PLoS Med 3 ((10)): 1686–1691. [7] http:/ / www. pih. org/ news/ entry/ women-in-chiapas-mexico-document-their-lives-advocate-their-concerns/ [8] Rosenberg, Tina (28 February 2011). "A Housecall to Help With Doctor’s Orders" (http:/ / opinionator. blogs. nytimes. com/ 2011/ 02/ 28/ a-housecall-to-help-with-doctors-orders/ ?hp). A Housecall to Help With Doctor’s Orders (The New York Times). . Retrieved 28 February 2011. [9] Zimmerman, Rachel. "From Haiti To Harvard: Crucial Foot Soldiers Of Health Make Housecalls" (http:/ / commonhealth. wbur. org/ 2011/ 03/ health-workers-make-housecalls/ ). WBUR - Boston's NPR affiliate. . Retrieved 25 March 2011.


Partners In Health [10] Alpert, Jessica. "Home Healthworkers Make Getting Healthy Easier" (http:/ / radioboston. wbur. org/ 2011/ 03/ 29/ home-healthworkers). Home Healthworkers Make Getting Healthy Easier. WBUR-Boston's NPR affiliate. . Retrieved 9 May 2011. [11] Brigham and Women's Hospital. "Boston (PACT)" (http:/ / www. brighamandwomens. org/ Departments_and_Services/ medicine/ services/ socialmedicine/ pact. aspx). Harvard Medical School. . Retrieved 6 May 2011. [12] Partners In Health. "Russia" (http:/ / www. pih. org/ pages/ russia/ ). PIH-Russia. . Retrieved 11 May 2011. [13] Splete, Heidi. "Partners In Health Treats TB in Russia" (http:/ / www. ehospitalistnews. com/ index. php?id=760& cHash=071010& tx_ttnews[tt_news]=19605). Partners In Health Treats TB in Russia. Hospital News Digital Network. . Retrieved 11 May 2011. [14] Partners In Health. "Lesotho" (http:/ / www. pih. org/ pages/ lesotho). PIH. . Retrieved 6 May 2011. [15] Partners In Healh. "FROM NO DOCTORS TO THE "FINEST HOSPITAL IN CENTRAL AFRICA" (http:/ / www. pih. org/ index. php/ news/ entry/ from-no-doctors-to-the-finest-hospital-in-central-africa/ ). PIH. . Retrieved 6 May 2011. [16] Philp, Rowan. "Rwanda's Medical Miracle" (http:/ / www. timeslive. co. za/ sundaytimes/ article865727. ece/ Rwandas-medical-miracle). The Times (South Africa). . Retrieved 6 May 2011. [17] Kagire, Edmund. "Kagame opens new hospital in Butaro" (http:/ / newtimes. co. rw/ index. php?issue=14516& article=37694). New Times (Rwanda). . Retrieved 6 May 2011. [18] Partners In Health. "Annual Report 2010" (http:/ / www. pih. org/ annual-report/ entry/ annual-report-malawi/ ). Annual Report 2010: Malawi. . Retrieved 9 May 2011. [19] http:/ / www. projectmuso. org/ [20] http:/ / www. tiyatienhealth. org/ [21] http:/ / www. standwithhaiti. org/ haiti [22] http:/ / www. pih. org/ mirebalais [23] Sawyer, Tom. (http:/ / enr. construction. com/ buildings/ sustainability/ 2011/ 0406-HospitalsRiseinHaiti. asp), Engineering News-Record, April 6, 2011 [24] Nicholas Clark Architects. "Mirebalais Hospital" (http:/ / www. nicholasclarkarch. com/ projects/ mirebalais/ project. html). Mirebalais Hospital. . Retrieved 11 May 2011.

External links â&#x20AC;˘ Partners In Health (http://www.pih.org/index.html) â&#x20AC;˘ A Conversation with Tracy Kidder about Mountains Beyond Mountains (http://www.huffingtonpost.com/ mark-klempner/a-conversation-with-tracy_b_91799.html/) by Mark Klempner, 2008.

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Article Sources and Contributors

Article Sources and Contributors Partners In Health Source: http://en.wikipedia.org/w/index.php?oldid=531205206  Contributors: Ada33333, Alan Dawrst, AvicAWB, BGRWANDA, Badagnani, Beast of traal, Beland, Candyswirlgirl, Chinesejewboy, Cjmadson, Cowsandmilk, Cricobr, DarkAdonis255, Download, Eupedia, Gary King, Goldfishbutt, Gypsydoctor, H0n0r, Ihopethisusernameworks, Jasper Cirkel, JerryKong2000, Jtmarv, Kellyzac, Khazar2, Kjkolb, Lambiam, Mean as custard, Mervyn, Mistsrider, Mnupp, MrOllie, Namiba, Neilpw1, Neutrinostar, Oliver Lineham, Racerx11, Rjwilmsi, Roger Wellington-Oguri, Saintoni, Sameerrajwani, Smk5126, SocialMarketingVA, Sross (Public Policy), Tchussle, Tnxman307, WereSpielChequers, WulfTheSaxon, 50 anonymous edits

Image Sources, Licenses and Contributors File:PIH-logo-color-outlines-200.jpg Source: http://en.wikipedia.org/w/index.php?title=File:PIH-logo-color-outlines-200.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:Haiti 0110 AMarx-274-EJF.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Haiti_0110_AMarx-274-EJF.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:Mirebalais Wiki.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Mirebalais_Wiki.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:Mirebalais rendering Wiki.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Mirebalais_rendering_Wiki.jpg  License: Creative Commons Attribution-Share Alike  Contributors: PIH File:SESStaffwithbanneratTBDay.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:SESStaffwithbanneratTBDay.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:Cincodemayo magdalia.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Cincodemayo_magdalia.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:Honduras adriana 2.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Honduras_adriana_2.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:Rb manuela 2.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Rb_manuela_2.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:Russia TB Wiki.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Russia_TB_Wiki.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:Lesotho Training Wiki.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Lesotho_Training_Wiki.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:Butaro Wiki.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Butaro_Wiki.jpg  License: Creative Commons Attribution-Share Alike  Contributors: Cjmadson File:Rwanda Butaro Opening Wiki.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Rwanda_Butaro_Opening_Wiki.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:ST Lesotho Snow 036.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:ST_Lesotho_Snow_036.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:PIH 71 Staff dancing 24x32.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:PIH_71_Staff_dancing_24x32.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:080Rwanda 0609 BCampbell 21.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:080Rwanda_0609_BCampbell_21.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson File:Haiti EQ Wiki.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Haiti_EQ_Wiki.jpg  License: Creative Commons Attribution-Sharealike 3.0  Contributors: Cjmadson

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10

Thesis Research Book  

Research portion of thesis design project: Jacmel School of Medicine (Jacmel, Haiti)

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