MIREBALAIS: HOSPITAL CONSTRUCTION COMPLETE

The construction of Hôpital Universitaire de Mirebalais, just north of Port-au-Prince, Haiti, is complete, thanks to the support of hundreds of people in Haiti, the United States, and around the world. Drs. Maxi Raymonville and David Walton, physicians for PIH/Zanmi Lasante and members of the executive leadership team of Mirebalais National Teaching Hospital, give us an update on its progress—and what’s to come.

Q: Why did PIH/Zanmi Lasante decide to build Mirebalais Hospital?

After the January 12, 2010, earthquake devastated Haiti’s largest public teaching hospital, nursing school, and other critical medical infrastructure in Port-au-Prince, Haiti’s Ministry of Health asked us to dramatically scale up our existing plans for a small community hospital we were planning to build in Mirebalais, just 60 kilometers north of the capitol. The result is the Hôpital Universitaire de Mirebalais—HUM for short—a 205,000-square foot, 300-bed facility. The hospital will fill a huge void, locally and nationally, for people who previously had limited access to quality health care, as well as improve access to training for Haitian physicians, nurses, and allied health professionals.

Q: Now that construction is nearly complete, what is your team focused on?

At this point we are currently focused almost exclusively on operational planning—we’re setting up structures for governance and staffing, developing plans for hiring, and creating standard operating procedures for how everything will run when the hospital opens. We’re also working on curricula, developed with our main educational partners at the Université d’État d’Haiti to train Haitian nurses, doctors, community health workers, and other health professionals, which will strengthen the next generation of health providers.

We're also looking forward to Nov. 6, when Dr. Jim Yong Kim, a PIH co-founder, makes his first official visit to Haiti in his role as president of the World Bank. In honor of his visit, ZL and the Ministry of Health will host a ribbon-cutting ceremony that will mark the completion of our hospital construction efforts. This event celebrates PIH/ZL’s partnership with Haiti’s public sector, and we’re especially excited that President of the Republic Michel Martelly will attend.

We’re continuing to work with the Ministry of Health to open the hospital as soon as possible and will have a dedication ceremony in early 2013 to celebrate the culmination of this work and the partnerships that have made it possible.

Q: How many people do you expect will use the hospital?

The hospital will provide primary care services to approximately 185,000 people in Mirebalais and two nearby communities. But patients from a much wider area—all of central Haiti and areas in and around Port-au-Prince—also will be able to receive secondary and tertiary care at this facility. We could see as many as 500 patients every day in our ambulatory clinics when we are fully operational.

Q: What are some of those primary care services?

They include everything from community health services to HIV/AIDS and TB care, care for non-communicable diseases, and prenatal care. Patients will receive vaccinations and treatment for malnutrition, for example, as well as basic primary care and dental services. We will also offer secondary level services including mental health, emergency medicine, and general and orthopedic surgery. Our women’s health services include family planning, reproductive health, and comprehensive emergency obstetric care. We aim to provide the same services you would find at any U.S.-based hospital.

Once the hospital is running at full capacity, we’ll have more than 30 outpatient consulting rooms, six operating rooms, and space to host trainings for 200-plus participants.

Q: How many people will the hospital employ?

We’ll eventually employ more than 1,000 people—including 175 community health workers—drawn primarily from the Mirebalais area.

Q: How much did it cost to build the hospital? And how much will it cost to run each year?

Thanks to incredibly generous supporters, we have raised $17 million to design, build, and outfit the hospital and residences, and we have received another $5-6 million in in-kind donations. When it opens, the hospital’s operational budget is estimated to be about $12.5 million for each of the first two fiscal years. PIH/ZL and the Ministry of Health are still finalizing the budget and both entities will share the cost of running HUM, providing high-quality health care to poor people through Haiti’s public sector.

We will continue to rely on our friends and supporters who believe we can—and should—provide health care to people everywhere, and especially to people living on the margin of extreme poverty. We are also working out a mechanism for long-term financing with the Ministry of Health and other sources.

Q: Explain more about the hospital’s role in improving nursing and medical education in Haiti.

Haiti’s public health sector lacks resources to provide attractive career options for young health professionals—many decide to work in private facilities and a vast majority leave the country altogether. We want to help retain health professionals for the public sector here by creating an environment that offers the tools, resources, supervision, and mentoring and academic environment they need to be satisfied in their jobs and advance in their careers.

To that end, PIH/ZL is working with l’Université d’Etat d’HaÏti, l’Ecole Nationale des Infirmières [the national medical and nursing schools, respectively], and other international partners to develop academic programs to train future generations of nurses, doctors, and other health professionals. We will offer medical residencies at HUM in several areas, including internal medicine, obstetrics and gynecology, and surgery.

The hospital also will serve as a site for clinical rotations for Haiti’s national nursing schools, and offer nurses advanced training in several specialty areas, including emergency care, neonatal intensive care, and surgery.

Q: How will HUM impact the economic life of 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.

Q: Talk about some of the building’s “green” aspects—how did the hospital incorporate sustainable building practices and green technology?

Our green technology plan incorporates electricity conservation measures, natural ventilation and lighting, water-efficient plumbing, and a solar energy system that’s among the most ambitious health sector solar projects ever undertaken in a developing country. In fact, according to publicly available data, HUM will be the largest hospital in the world that can be powered entirely by solar energy.

Working with the Ministry of Health, we chose to use solar power as a cost-effective, reliable, and environmentally responsible way to help power the facility and avoid the burden of Haiti’s frequent blackouts. 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.

In addition to solar power, the hospital minimizes energy needs through high-efficiency fluorescent light fixtures, motion sensors for lights that will save up to 60 percent in energy usage, and natural ventilation that reduces both the spread of infection and the need for air conditioning. 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.

Q: What does this hospital symbolize for you?

HUM offers an incredible opportunity to raise the standard of health care for our patients in Haiti. In partnership with the government, we have the capacity to provide high-quality services drawing on international best practices for healthcare delivery, administration, and education. We hope that our work will improve care both throughout our PIH/ZL network and across Haiti.

The following article, written by Andrew Johnston (Mirebalais Project Coordinator), was published in late April, 2012, upon the arrival of 1,800 solar panels at Mirebalais Hospital.  It describes the many benefits of bringing solar energy to Haiti.  The panels are now fully installed on the hospital's roof and will require very little ongoing maintenance as they provide clean, reliable power for an estimated 25 years.

Solar panels arrive at Mirebalais National Teaching Hospital

Mirebalais, HAITI -- This month, the Mirebalais Hospital construction team began a very exciting phase of the project, the installation of solar panels. With construction of the 320-bed facility nearing completion, much of the hospital roof is now being equipped with the solar panels that will provide economically and environmentally sustainable energy to the hospital. 

With 1,800 panels providing 400 kilovolt-amperes (KVA) of electricity, Mirebalais now houses the largest solar energy project in Haiti. The electricity generated will power the hospital during daylight hours and, importantly, save PIH a great deal of money on the utility bill that it can put to use for patient care. Based on current energy prices in Haiti, the panels will pay for themselves in less than three years. The use of solar energy is one of the many innovative components of the Mirebalais Hospital that, in aggregate, set the stage for providing a higher level of care and treatment to the citizens of post-earthquake Haiti.

The use of solar energy is not new to PIH. The organization uses solar energy at its 60-bed Lacolline Hospital in Haiti, Centre de St Michel in Boucan Carre, and the majority of the organization's hospitals and clinics in Lesotho and Rwanda, an achievement made possible through a longstanding partnership with Solar Electric Light Fund (SELF). These projects demonstrate that sustainable energy is not only possible in resource poor settings, but preferable.

As PIH Co-founder Paul Farmer has said, "You can't do this without electricity. Because you're not going to have an operating room. You're not going to have a laboratory. You're not going to see people at night … So it's one of two things -- either generate your own electricity with a diesel generator or go solar."

Part of the reason for President Clinton’s visit the Mirebalais Hospital in March was to draw attention to its use of solar energy on this project and, in doing so, the tremendous potential of solar energy in Haiti. Clinton emphasized that the Caribbean has the highest energy prices in the world, and Haiti has the highest energy prices in the region. Haiti, the poorest country in the Western Hemisphere, simply cannot afford continued dependence on expensive, non-renewable power.

With its abundant sunlight, Haiti is well positioned to benefit from recent improvements in solar technology. Clinton emphasized that increased use of solar power is fundamental to “building back better.”

I spoke with Stephen “Steve” Hopkins a solar energy expert on his recent visit to the hospital.  Steve oversees renewable energy initiatives at Sullivan & McLaughlin Companies, the Boston-based electrical contracting firm that is partnering with PIH to install the solar energy system.

Andrew: What is the most important thing that you would tell people about solar energy in Haiti?

Steve: Solar is a very good choice for situations where you need to supplement the power supply.  Solar works regardless of the strength of the local infrastructure. It is particularly well suited for Haiti because there is so much sunlight.

Andrew: How is the design of this project different from the projects that you normally do back home in New England?

Steve: First, we had to plan for lots more sun. The panels will generate more electricity than they would back home. Second, we planned for higher levels of heat on the roof, which can interfere with power generation and damage the panels. We compensated for the higher prevailing temperatures by mounting the panels 10 to 12 inches above the roof to allow the heat to dissipate. We also painted the roof white, which lowers the temperature of the roof and increases the amount of light on the panels. It’s quite bright up there now.

The panels are facing south and, to maximize exposure and tilted at a 10-degree angle using sun charts from the University of Oregon. It’s a much less steep angle than is required in Boston.

We are also building for long-term sustainability and reducing ongoing operating costs by building redundancy in the system in a way that is not done in the U.S. Multiple investors and independent function between banks of panels reduce ongoing maintenance costs and ensure that if there is a problem in one area, the system as a whole will continue to generate needed electricity.

Importantly, unlike diesel generators frequently used by aid agencies, solar energy requires very little ongoing maintenance. You don’t need to do scheduled engine maintenance and filter replacements, you just need to keep out the birds so that they don’t nest in the panels. In its current design, this system can provide 25 years of trouble-free power.

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The solar panels used in this project are manufactured by Solectria Renewables LLC of Lawrence, Massachusetts, a partner of Sullivan & McLaughlin on previous projects, and were chosen for their durability. Once the system is up and running, the public will be able to track the yield of solar power at the hospital online at: http://www.solren.com/SolrenView/index.html. 

Overall, the project represents an important step forward in the use of sustainable energy in relief and reconstruction projects. Experienced aid workers are often accustomed to the noise, smoke, and expense of generator power. While solar power is cleaner and more cost-effective in the long run, restrictions by government and international donors often make it difficult for aid agencies to switch to solar power. Through its solar projects, PIH “shows what can be done,” says construction team member Jack Manderson.