26 Feb 16 06 May 16

CAR: Building in a war zone

MSF’s work is always focused on saving lives, reducing suffering from ill health and restoring dignity to people in distress. Our doctors, nurses and other medical professionals are core to achieving these objectives.

Buildings not fit for purpose

But what does MSF do when the buildings that the care is provided in are so difficult to clean that many patients acquire more diseases in the hospital than they arrive with? What happens when the wards are so overcrowded that three or four children are forced to share a bed with their mother? When the rooms become so hot during the day and so cold at night that fevers and hypothermia become the biggest cause of death? How do you respond when the places that are meant to provide hope and healing are dark, damp and derelict structures not fit for purpose?

That’s where I come in. I have recently returned from the town of Bossangoa in Central African Republic (CAR), a country that is still reeling from a coup d’état in 2013 and the subsequent destruction and violent reprisals that followed. In some areas of the country the conflict continues, and in most areas there are few – if any – hospitals or clinics.

After MSF started work in Bossangoa regional hospital in 2014, it quickly became clear that the vast majority of patients could not be adequately treated in the existing hospital. The buildings were simply not equipped to cope with so many people.

Checking the brick courses as the hospital begins to take shape.

Time to build

A decision was quickly made to build a number of new structures to increase the capacity of the hospital and provide design solutions suited to the hospital’s new needs. My role was to design and manage the construction of a new intensive care unit and tuberculosis (TB) department.

Whenever you’re building for TB patients, a key concern is cross-contamination between patients. To address this, I designed the buildings, layout and window openings to maximise natural ventilation. This was partly for patient comfort in the tropical heat, but primarily to minimise the bacterial count in the air, thus reducing the risk of contamination between patients.

Transparent roofing was also used to increase natural lighting in the rooms, as the bacteria are killed by exposure to UV light. Separating patients with suspected, confirmed and drug-resistant TB is also vital to prevent the disease from spreading. The hospital we designed and built provided not only separate wards, but also separate cooking, bathing and sanitation facilities.

We also ensured that large, shaded verandas were used in each building to encourage patients to spend time outdoors, where airborne infections are more quickly and easily dispersed.

Wherever I work with MSF, I aim to use construction methods that are familiar to local builders and to help make use of local markets. This ensures a ready supply of skilled labour and also means that it will be straightforward to carry out any future alterations or repairs.

The builders at work in Bossangoa.

Hijacking is commonplace

As with all MSF activities, construction requires a large financial commitment. Even though labour is relatively inexpensive, the lack of infrastructure and markets mean that most materials that are not made locally are far more expensive than in Europe. Transporting these materials is often a high-risk endeavour, as hijacking remains commonplace, resulting in some costs that are disproportionately high.

Although we always aim for the most cost-efficient solutions, we never take shortcuts when it comes to design or construction. After all, we want to leave a structure that will still be there for patients long after MSF has left the area.

I’m proud that the hospital we built in Bossangoa is appropriate to its setting, sustainable in the long-term, and has helped create an environment where staff can take pride in their work and patients can receive lifesaving care. With the support of our donors, we were able to build a legacy that will help care for patients for decades to come.

Find out more about MSF's work in Central African Republic

The finished intensive care unit and TB department.