Architectural Articles

The Architecture of Hope: Designing a Hospital in Haiti

I entered the profession of architecture with altruistic motives to create beautiful yet functional environments for people. While my expectations have become more realistic in recent years, I have not abandoned these lofty goals. I have sought to work with design professionals and builders as a team, in which members are respected for their skills and experience.

In an ongoing effort to be an authentic Christian, I have searched for ways to use the gifts and talents God has given to me for the benefit of others. Having worked with missionaries for a number of years through my church, I was hoping to travel overseas. Surprisingly, many of my dreams were realized in eight days in Haiti.

Last Fall, I traveled to the poorest country in the Western Hemisphere to meet several engineers, a planner, a nurse, and a student intern in a volunteer effort to help design an addition to a hospital on the north shore of the island. The project was organized by Engineering Ministries International (EMI). Departing from California, Minnesota and Colorado, we were to rendezvous in Miami, Florida. But when I arrived, I found only two members of the team (Chuck and Dixie Lewis, a structural engineer and a nurse). I learned that the others had been grounded in a snow storm in Denver. Undaunted, we took off for the capitol city, Port au Prince, in an air bus crowded with islanders.

I had heard about EMI from a soils engineer and his wife who joined a team in Uganda, Africa, to develop an orphanage. Eventually I e-mailed a note to EMI asking if they needed any help. Within 24 hours, I received an invitation to go to Haiti. "Why not?" I thought. It was only a matter of time, money and health. The cost of the trip was funded by donations from my church, other architects, builders and clients. I was on a plane three weeks later.

Arriving in Port au Prince, we passed through customs easily, but outside the terminal we were confronted by a crowd of young men eager to take our baggage. We were rescued in the parking lot by Mrs. Yvonne Trimble, a resident missionary, who navigated us through the assertive crowd, down a bumpy road, and into a small terminal operated by Missionary Aviation Fellowship (MAF). While waiting for the next flight, we relaxed on a hotel verandah sipping fruit juices and listening to fascinating stories about life in Haiti.

Click to Enlarge(Click Pictures to Enlarge)
In a small Cessna, we were flown high over the arid mountains to the north shore. As we descended into the city of Port de Paix, people were visible washing in a muddy river. I was astonished to see people crossing the dirt airstrip ahead. We landed safely and circled back, not to a terminal, but adjacent to a dusty hut with walls of woven sticks. A few pieces of laundry hung nearby. A woman on a small donkey passed by. I just stared at the hovel not fully comprehending what I was witnessing. Curious young Haitians surrounded the plane. Apparently, we were the event of the day.

Click to EnlargeDr. Paul Eckhoff loaded us into his Jeep and we were soon driving down the crowded road toward Center Medicale Beraca, the trauma center for 100,000 people. The ensuing drive through Port de Paix was a remarkable sight. Dr. Paul expertly navigated the potholes in the narrow dusty road clogged with people, markets, mopeds, cars and trucks. The congested traffic squeezed along between run down, plaster buildings covered with words in Creole (a simplified version of French), some brightly painted. Dr. Paul pulled aside to let a huge dump truck negotiate passage. People were everywhere, right next to the car and at the edge of the road walking, talking, selling everything and anything under straw mats propped up for shade. All along the road without a break, makeshift boutiques were set up to sell wares of all descriptions.

Click to EnlargeA half hour later, we passed the walled hospital compound in La Point and a block later we were entering through the security gate of the residential compound. The accommodations were surprisingly pleasant. We were assigned our quarters and given instructions not to drink the tap water and how to use the electric heating unit for mosquito repellent. A meal schedule was placed on the table and towels were laid out. Paul gave me a package of malaria pills because of an outbreak of a particular strain in that part of Haiti. I was to take two pills a week for five weeks. After dinner, I went to bed early and slept soundly.

Day 2, Sunday: It is hot in Haiti, really hot. I never saw a thermometer while there but I guessed the temperature was usually in the 90's with humidity just as high. At night it is still in the 90's. The public source of electricity goes off about 9 PM (and so do the fans) and does not come on again until about 8 AM. The hospital has two electrical systems, one supplied by the public utility and another from a generator on the premises.

We had been invited to join Dr. Paul and his children to visit a small church where he had been asked to give a message. After breakfast we walked down the road a bit past the ever-present boutiques, then turned onto a trail leading uphill. The terraced hills were a vivid green and the ocean a deep blue but the water was a muddy color along the shore, due to soil erosion we were told. Like many other buildings in the area, the church was a modest structure of concrete block and plaster left unpainted. The tin roof was supported with simple wood trusses. I questioned how the roof remained attached to the walls during a severe storm.

Click to EnlargeThat afternoon Dr. Paul gave us an extensive tour of the hospital grounds. I recognized many of the buildings from a video that I had been sent to me weeks before. The hospital was grossly overcrowded and consequently the staff was overworked. For each patient, there was one or more family Click to Enlargemembers in attendance. They would prepare meals and wash clothes for the patients in a separate building on the campus. They would sleep in the rooms or out on the concrete porches at night. Despite the suffocating heat, it was common for Haitians to close up the wood shutters after dark. This was partly out of superstition about night spirits, but also out of concern for personal security. Many of the buildings, particularly the patient wards, were in need of serious renovation or replacement. They were made partly of rammed earth walls with wood pole rafters and rusting tin roofs.

Day 3, Monday: Back at the hospital the next morning, we were ushered into a conference room on the second floor of the newer Surgery Building where we set up shop for the week. On a long conference table under two large fans we rolled out tracing paper over blueprints and started sketching. While Dixie made rounds with Dr. Christina Eckhoff (Paul's wife), Chuck and I measured the area between the House of Hope (an extended cared facility for children with TB) and the newer Surgery Building where the new hospital would likely be located. We had decided with Dr. Paul that a more remote site chosen in a previous study was no longer desired. A typical patient room with four beds had been determined to be 14'x20'. Laying out two rows of paired rooms plus a nursing station and pediatrics, Chuck and I drew Scheme A totaling about 40 beds. We knew we could make something work so we developed two schemes. We developed a 5-bed room in a pattern of truncated squares that yielded outdoor patios between rooms. Scheme B totaled about 45 beds. When explaining the two layouts to Dr. Paul, I called the first scheme "meat & potatoes" and the second scheme "salad & desert." Both schemes were organized around the concept of each patient room as an individual building with a higher roof structure spanning above. This would allow for easier movement of people and air through the complex. Dr. Paul picked up on the advantages of Scheme B immediately and became its advocate -- larger patient rooms, more beds, more space between the rooms, more space between the new and existing buildings, more light and breezes. Searching for a word to summarize the advantages of Scheme B, I offered the French-English word "ambiance." I felt like a language expert after only a few days in a new country.

Day 4, Tuesday: Meals in the residence compound were impressive. Breakfast menus offered strong Haitian coffee, local juices, pancakes, oatmeal or scrambled eggs, with homemade bread. I remember a delicious Haitian stew for lunch. Dinners included a selection of Haitian style pizza, hamburgers, and chicken (I had seen them running about in the yard a day earlier). I particularly enjoyed the various rice and bean dishes. Drinks included deliciously cool juices or soda. I drank more Pepsi in one week that I would normally consume in a year.

I walked the block to the office about 8 AM as if it were my long established routine. When the two schemes were explained to Harry, the administrator, he asked a key question for which we did not yet have an answer: "Which scheme costs more?" We agreed to investigate. By noon the other members of the EMI team arrived. For the first time, I meet Michael Orsillio, the founder of EMI, and John Linquist, a new staff member from Alaska. At the office, John jumped right in and assisted in the comparison of the two schemes, while Michael and the rest the group started surveying the hospital complex. John and I crunched the numbers for both schemes: square feet for wall area, floor area, roof area, doors and windows. Surprisingly the two schemes were close in comparison in most categories with the one unknown -- the upper roof structure. John concurred that Scheme B was preferable.

Day 5, Wednesday: At breakfast I learned that Chuck was ill. Dr. Paul put him on an IV so that he would not be dehydrated. Diarrhea is called "Haitian Happiness," but Chuck did not look very happy. Rather than walking directly to the office in the surgery building, I spent a few minutes photographing visitors and patients. I asked one man sitting on a bench holding a child if I could take his photograph. He responded affirmatively in clear English and asked me to take another photograph. The second picture shows him smiling and proudly holding up his bright eyed child like a trophy. That morning John and I completed the comparison of the two design concepts. Everyone agreed to go with Scheme B. Because Harry had to attend a hospital board meeting in Port au Prince, I spent the afternoon sketching out several small drawings of the typical patient room and building elevations. Chuck walked into the conference room holding his own IV bag. He was bit peaked but he said that he felt guilty about not working that day.

Day 6, Thursday: It was back to the office in the morning. I felt the pressure to schedule the remaining work on interiors. We had only two days to go. We cranked out a workable layout for a nursing station and the nurse manager's office. As expected, Dr. Eckhoff and Dr. Mozart (a Haitian surgeon) dropped in between rounds to share new thoughts, respond to our questions and review our sketches. Two volunteers took the sketch of the typical patient room and built a full scale mock up of the floor plan in the grass between buildings. They even rolled in a gurney to check clearances.

After lunch we walked a couple of blocks to the ocean. To our disappointment, the beach was littered with debris. Where were those images of Caribbean cruise ships and white crystalline beaches? That afternoon, the survey crew walked into the conference room with bad news. The dimensions of the site where we planned the new hospital did not check out. The new design spilled over the property line at one end. We measured again and sure enough, we had miscalculated. For the next couple of hours, I reshuffled the design until we had a workable scheme once again.

Day 7, Friday: It was another hot sunny day. We had very little rain during the week. We were scheduled to leave after lunch so we had only a few hours to finish the interior layouts. Working with Dr. Paul, Chuck went to work on the medical records and dental lab while I worked out the pediatrics wing. Dr. Paul was asking questions and resolving issues right up to the last hour. Just after lunch, I sketched out a scheme for a new apartment in the residence compound. We left Dr. Paul with copies of each of the 8 1/2" x 11" sketches of building plans. Looking back, I am impressed with what seven people accomplished in a few days. We took a final group photograph, said our good-byes, and hopped in the Jeep. Again we were bumping down the main road toward town. We arrived at the airstrip to discover that we were over the weight limit so John left a bag to be sent on a later flight. Soon we were airborne climbing above the mountains. Back in Port au Prince, I noticed that the MAF terminal was built, at least conceptually, the same way we proposed the new hospital to be constructed, as a series of self-contained structures under a higher roof spanned with steel trusses.

Our reservations for overnight accommodations in the city had been canceled, or perhaps never taken. Again one of the MAF pilots came to our rescue and offered his place as an alternative. We were quick to accept. So we were back in a four-wheel drive vehicle driving though the outskirts of the capitol city, which to a foreigner like myself, can only be described as bizarre. For a time, we were surprised to be traveling on a paved road until it was pointed out that were passing the president's estate.

More concrete block homes were under varying stages of construction on both sides of the road. When I asked why it was so common to see steel reinforcing bars sticking haphazardly out of concrete roofs, it was explained to me that this was the "architecture of hope." Builders would add a few cement blocks at a time as they could afford it, eventually building the first floor with a flat roof, which would serve as the platform for the second floor. Zoning is unheard of here. Next to hovels with thatched roofs would be a modern gas station. The now familiar entrepreneurs were all along the roadside. While passing these intriguing sites, a MAF pilot was telling a gripping story of how he and his family, along with twelve other families, barely managed to evacuate their base camp in Zaire at gunpoint.

Day 8, Saturday: Although I would have liked to have seen more of Port au Prince, I was ready to go home. EMI staff stayed to greet a second group of architects and engineers for a new school project elsewhere on the island. We thanked our hosts for their hospitality and waited for our plane in the first air conditioning we had felt in a week. As we flew north toward the U.S. mainland, Caribbean islands could be spotted below. We all agreed that, next time, we would have a debriefing on St. Croix. Three flights and about eight hours later, I was back in California. At church the next morning with my family, I found myself looking out of the windows, not across the lettuce fields in Salinas Valley, but over the tops of banana trees to the mountains of Haiti. I thanked God for the trip of a lifetime.

Site Plan


Epilogue: Over the last few months we have converted hand-drawn sketches into computer drawings for construction (as shown here), and continue to revise the plans via e-mail messages from Haiti. We hope to finish our drawings soon so that the hospital administration can secure funding and begin construction.

For more information: Contact Tom Carleton . Tom has given presentations about the Haiti trip to a variety of groups. To contact EMI: call 719-633-2078, fax 719-633-2970, e-mail or search their website at for a listing of future trips.

Published in the AIAMB Eagle Quarterly, Spring 1998, and Residential Architect, May-June 1999.
© 1998-2000 Thomas J. Carleton

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