今年的8月18日,构建健康国际JaresiahDesrosiers landed at the airport outside the shaken city of Les Cayes in Haiti’s southwestern Tiburon Peninsula. It was four days after a magnitude-7.2 earthquake devastated the region, killing more than 2,200 people, injuring nearly 12,300 and damaging or destroying nearly 136,800 mostly one- and two-story buildings. And it was just two days after Tropical Depression Grace dealt another blow to the Americas’ poorest nation, which hasn’t recovered politically from the assassination of its president, Jovenel Moïse, on July 7. Desrosiers, who was joining the Beverly, Mass.-based BHI’s Haiti staff already at work doing damage assessments at hospitals and a few schools, was on a mission to help coordinate the logistics of the nonprofit health care infrastructure consultant’srecovery efforts从出售和交付与进入紧急状态nt flown in from the U.S. to constructing a temporary trauma and orthopedic surgery center to treat the injured.

BHI建造的圣博尼法斯医院具有地震抵抗和屋顶太阳能，在8月14日地震中幸存下来。
Photoby Terry Sebastian

具有设施管理背景的BHI项目经理Desrosiers也正在为Fond-Des-Blancs的Saint Boniface医院提供手工交付的关键手术用品，该医院由BHI扩展到非营利性运营商Health Equity International。HEI综合体具有太阳能，地震和飓风的抵抗，这是资产不足地区医疗机构的BHI设计的标准。自2010年以来，海地总共建造了60座BHI项目，医院在地震中毫发无损地幸存下来。新利18备用网址

BHI学会了将项目适应当地的建筑方法，尤新利18备用网址其是在海地。
Photo courtesy of BHI

A silver lining of the earthquake is that it had tested—and proven—BHI’s strategy of delivering high-quality, sustainable and resilient health care infrastructure. The group has its roots in Haiti, a Caribbean nation of 11.6-million people, notorious for subpar medical services and construction (see p. 23).

A full-service consultant, BHI also helps its nonprofit clients, which it calls “partners,” develop clinical plans and operational budgets. And it often operates and maintains the projects—not a simple job in areas that have broken supply chains and few spare parts.

bhi’s mission is to “enable dignified, affordable and high-quality health care” for all “regardless of location or a patients’ ability to pay.” It fulfills its mission in low- and middle-income regions outside the U.S., primarily in the Caribbean and Africa, but also in Peru.

“If you are not motivated by the mission, you don’t put up with the tough conditions” that make U.S. work seem like child’s play, says Jim Ansara, BHI’s co-founder, managing director and main driver.

bhiis “unique” in this arena, says Conor Shapiro, HEI’s president and CEO. No one else is “dedicated to high-quality cost-effective [medical] buildings,” he adds.

Co-founder Ansara (center, at left) discusses plans with Hernandez (right) and Denisky in BHI's Beverly HQ. In 2012, Ansara and co-founder Walton (right), review plans at the Mirebalais hospital with President Bill Clinton.

At the airport outside Les Cayes, the 30-year-old Desrosiers got a ride to the city center in a truck full of food going from a mission in Les Cayes to St. Louis du Sud, a hard-hit area between Les Cayes and Fond-des-Blancs. In Haitian Creole, he struck up a conversation with the driver, who shared that the quake had killed two of his children and his mother. His wife survived, but with a crushed arm.

The driver’s staggering losses hit close to home. Though Desrosiers was born, raised and is living in Plymouth, Mass., most of his father’s family, whom he knows from visits to Haiti since he was 11, live in the quake-torn village of Robert, an hour by car from the city of Jeremie and then a two-hour hike up a mountain.

Desrosiers’ extended family was lucky by comparison to the driver’s family. Though they had lost everything material—their homes, their bakery business—no one had lost life itself. “They were outside when the quake hit” at 8:30 a.m., says Desrosiers.

驾驶员的困境进一步加强了Desrosiers的决心，以帮助不幸的人。他说：“成为每天生活和呼吸不可能的地方和国际成员社区的一部分是我的灵感和动力。”

The work helps save lives by allowing “clinicians to practice medicine and not be hamstrung by their environment,” adds Dr. David Walton, BHI’s co-founder, former CEO and current advisor.

海地的米雷巴莱医院, finished in 2013, set the stage for BHI’s other high-quality health care facilities in limited-resource regions—all with solar power and resilient infrastructure.
Photo top courtesy of BHI; below courtesy of Kat Kendon

A Huge Difference

bhimakes “a huge difference,” says Dr. Regan Marsh, director of clinical systems for global health care provider Partners in Health (PIH). “No other [builders] focus on low-income nations,” she adds.

PIH gave Ansara his start building in Haiti. It is currently a BHI partner there and also in Africa.

“Jim and his team have a “deep dedication to justice,” and are “so generous with their time,” says Marsh.

The work takes its toll. “Improving health care for vulnerable populations is almost overwhelming, but giving up is not a thing we do,” says Walton, associate physician at Brigham and Women’s Hospital in Boston and senior director of global health for Butterfly Network, which makes medical imaging accessible to all.

“几乎压倒性”是一种轻描淡写。bhi’s partners and its full-time staff of architects, engineers, designers, construction professionals, facilities managers and support personnel—40 in the U.S. and 11 outside—are “doing the very things that many in the international [health care] community had deemed impossible,” says Desrosiers.

“It took us a long time but we figured out how to do this work effectively,” says Ansara. “It is possible to build to a higher standard in Haiti, with Haitians.

“We have proven you can do this with training, good engineering and good supervision,” Ansara adds, recalling that on his first project in Haiti, before BHI formally existed, the Dominican contractor, which eventually deserted the job, hired a local strongman to recruit petty thieves for the work. “It took 30 or 40 guys months to build a simple trench,” says Ansara. “With 80% unemployment, jobs are the currency of the realm,” he adds.

With BHI’s track record, the projects themselves have gotten a bit easier. Still, designing to provide a healing environment on a limited budget in far-off places is challenging for the BHI home team. Pile on projects in different nations, with different languages and cultures. “The documents have to be extremely clear and concise,” says Gerard Georges, BHI’s director of architecture.

他补充说，对于遥远的网站来说，旅行很昂贵，但值得，尤其是与建筑人员交流。但是，即使在2020年3月，当Covid-19改变了一切时，即使到了这一点。新利18备用网址即使在在线会议上，项目也被推迟了。

尽管如此，BHI的美国团队仍然对这项工作感到兴奋。艾莉森·丹尼斯基（Allison Denisky）是一位高级建筑设计师，自2018年大学毕业以来一直在BHI全职工作，他说BHI为建立具有社会意识的建筑提供了机会。她说：“这比设计漂亮的房子更有意义。”

In Haiti alone, BHI has five full-time staff, about 75 part-time staff and crews it hires regularly. Worldwide, it has trained 1,300 local workers since Ansara and Walton’s first project—Haiti’s 205,000-sq-ft Hôpital Universitaire de Mirebalais (HUM), 55 kilometers northeast of the capital, Port-au-Prince.

这家300张床位的医院可为约185,000人提供初级保健，是为PIH建造的，与当地的非政府组织Zanmi Lasante和海地卫生部合作。该教学医院于2013年开业，是对2010年1月12日海地7级地震的回应，该地震造成了200,000多人丧生，并陷入了混乱。

HUM was built with BHI’s signature infrastructure, including wastewater treatment, solar electrification and medical oxygen plants. There was a stiff learning curve, but despite myriad setbacks, BHI and its team finished the project in half the time and for 30% to 40% less money than the other post-quake hospitals, says Ansara. More significantly, BHI had developed a replicable model that incorporates and respects local customs, culture, efficiencies and resources.

Medical oxygen production plants (above) and wastewater treatment systems (below) have become an integral part of BHI's health care infrastructure that renders facilities less dependent on the local supply chain and fully functional without local utilities.
Photos courtesy of BHI

Structural and civil engineer Omar Hernandez, a Dominican native who is Ansara’s heir apparent, caught the BHI bug on the HUM project, which he worked on from 2010-13. While driving around Haiti for the first time, Hernandez was struck by the abject poverty. He was most shocked by the many pregnant women lying along the sides of the streets. “That hit my heart,” says Hernandez, BHI’s director of construction and engineering since 2016.

Later on at the jobsite, Hernandez noticed a pregnant teen among the women who would come daily to fill 5-gallon buckets from HUM’s clean water supply. When the teen didn’t show for a week, Hernandez sought out her parents. She had died in her sleep.

Hernandez recognized that decent prenatal care—unavailable for Haiti’s poor at the time—could have saved her life. He resolved then and there to “work to change the world,” and he is doing just that.

bhialso works in the Bahamas, Peru, Liberia, Sierra Leone, Ethiopia, Tanzania, Niger, Uganda, Malawi, Kenya and Zambia. It has a portfolio of more than 180 jobs, either completed or underway. BHI has organized donations of $1.2 million worth of medical equipment, provided 2,239 hospital beds and installed solar arrays that generate 1.4 MW of annual power.

The group’s scope of services is expanding. One four-month-old initiative, a partnership with the DAK Foundation and other members of the Every Breath Counts Coalition is a response to COVID-19 and the Delta variant. Its goal is to replace broken pressure-swing-adsorption (PSA) oxygen generators in 15 nations in sub-Saharan Africa, beginning with assessments of nonfunctioning plants.

PSA generators eliminate reliance on liquid oxygen tanks—often in short supply—by filtering the gas from the air.

“PSA plants are not part of our primary mission but we are one of a few nonprofits experienced designing, installing and maintaining them,” says Ansara, who became skilled in construction, including electrical and plumbing work, instead of finishing college.

bhiis his second career. Ansara, 64, started Shawmut Design and Construction in 1982. In 2006, he finished the sale of Shawmut—which then had grown to $700 million a year in revenue—to its employees. “My wife and I committed half the proceeds to the Ansara Family Fund,” he says. Some of that later went to start and endow BHI.

Shawmut is one of BHI’s supporters, both through direct donations and in-kind services. “Jim is a force of nature,” says Les Hiscoe, CEO of Shawmut, which had $1.5 billion in annual revenue in 2020.

“In hindsight, I think of Shawmut as preparing me for this,” says Ansara, whose annual compensation at BHI amounts to 80% coverage of his family’s health insurance.

bhiopened its doors in January 2014. But Walton and Ansara met in 2009, when Walton, who was working for PIH, contacted Ansara, then a PIH donor, to get advice for a planned 100-bed community hospital in Mirebalais. After the 2010 quake, the project morphed into HUM.

During that job, from 2010-13, Walton and Ansara shared a 15 ft x 20 ft room in a rented house, generator-powered and without air conditioning. During one of their many late night talks, “Jim said he couldn’t just build HUM and walk away, he needed to continue to help,” says Walton, who calls himself BHI’s “co-founder in absentia” because he had full-time job commitments until 2016, when he became CEO for three years.

In Haiti especially, security is a concern outside the jobsites. To keep crews from carrying cash on payday, BHI helps open bank accounts. Shipments at certain ports and on some roads are vulnerable to theft. Gang violence has “greatly impacted our work,” says Jocelyn Bresnahan, president and CEO of the Saint Rock Haiti Foundation, which is BHI’s partner on a planned 12,600-sq-ft hospital in Carrefour, on the peninsula.

The hospital, on hold because of COVID-19, high fuel prices and gangs, is not the only Haitian job affected. Gangs reign in Martissant, where they control access to Route 2—the main supply route from the airport in the capital to the peninsula.

bhihas projects in many African nations, including Malawi (above) and Sierra Leone, where there is a maternal center under design (below).
Photo courtesy BHI; Rendering by ArtPixel 3D designed by BHI

Extremely Dangerous

“It is extremely dangerous to travel through Martissant,” says Bresnahan, but the alternate route along unpaved roads through the mountains is equally treacherous for large trucks.

Gangs aside, minor snags balloon into big headaches, especially in Haiti. Workarounds are commonplace, as are delays. And that was before COVID-19 and the quake further complicated conditions.

The motto is to expect the unexpected. Take the experience of Sony Benjamin, a BHI site supervisor for a women’s health center in Boucan-Carré, northeast of the capital. One day in April, he set out at 7 a.m. to drive east to pick up foam blocks from customs at the border with the Dominican Republic. The 73-kilometer trip each way would normally take two hours due to poor road conditions. On his way back, the flatbed, with its lightweight load, got stuck on the last big hill, causing a traffic jam in both directions.

Tow trucks are not readily available. Luckily, a truck driver who had once delivered supplies for BHI was among those in the jam up. He recognized Benjamin and hooked the two trucks together to move the flatbed. Instead of by about noon, Benjamin arrived at the site at the 4 p.m. quitting time.

In an incident last year during a torrential downpour, three BHI staff members in a truck were trying to get from a BHI PSA plant to their lodgings. They got delayed by the vehicle of a young woman, which was stuck in the mud of what seemed like a river, causing traffic to back up in both directions. Dozens of people were yelling at her.

While one staff member carried the distraught woman over to the side, two more went one by one to 30 or 40 cars to request they back up so the stuck car could be towed out, using a rope that was in the BHI truck.

有些经历让人不安。作为一个BHI高级engineer tells it, in 2019 in Mirebalais, the engineer and an external contractor were flown in from the U.S. to fix a large generator. They finished up at midnight. On their return trip to the capital, they became trapped between two roadblocks with armed guards, set up in expectation of protests the following day. Getting through took tense negotiations and some phone calls.

bhiruns two warehouses, brimming with donated construction materials and health care equipment destined for far-off sites.
Photo courtesy of BHI

像一个清道夫

BHI为其站点创建了自己的供应链。像清道夫一样，它依靠其在波士顿地区的大量支持网络来填充其两个仓库，并用新的和二手的物体，包括建筑材料，工具，家具和设备。BHI像企业一样经营仓库。物资被包装到容器中，并在货机上飞行。

“吉姆一切位的ed out,” says Neil Lemieux, director of preconstruction for Columbia Construction, which has donated salvaged wood doors, casework, church pews, used toilets from a hotel renovation and more. When Columbia rebranded, it donated its outdated hard hats and vests.

Ron Nash, president and chief operating officer for North America of coating maker Laticrete International Inc., is another supporter. “They are the real deal,” he says. “What you see is what you get,” which is not always the case, he adds.

Laticrete has sent two teams of volunteers to Haiti, to teach local crews how to sanitize concrete hospital floors using the company’s donated coatings.

自2014年以来，BHI取得了长足的进步。根据初步数据，截至6月30日（2021财政年度末），BHI收入超过720万美元，其中包括建筑管理服务中的约300万美元，来自建筑和工程服务的近240万美元。赠款总计超过60万美元，捐赠近132,000美元。费用接近740万美元，项目为640万美元。新利18备用网址Ansara说，为了弥补任何缺口，有受限的捐赠和信誉。

bhiis so successful that it is too busy. “We were struggling before the earthquake to keep up with the demand for our services,” says Ansara, adding that the post-quake workload is not sustainable. Relief may come soon. BHI is seeking seven to 10 “interested and committed” new hires. And a search for an executive director is underway.

bhiis a full-service consultant, able to plan, design, build, equip, operate and maintain hospitals to enable clinicians to provide care without being hampered by their environment.
纳迪亚·沃德斯（Nadia Todres）的照片

Salaries are on the low end of the for-profit market. “It’s not all about salary,” says Hernandez. “We give people an opportunity to do good.”

For the future, “BHI should do what it’s doing on a much larger scale,” advises Ryan Macpherson, portfolio and investment manager for the Autodesk Foundation, which gives BHI grants to build out its organization.

麦克弗森说：“我的希望是，其他[小组]在资源约束地区与BHI合作进行任何形式的发展，以更好地实施具有文化适当和弹性的基础设施，从而可以长期实现价值。”“ BHI原则超出了医疗保健。”

编者注：本文于2022年1月7日更新