On Aug. 18, Build Health International’s Jaresiah Desrosiers 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’s recovery efforts—from offloading and delivery of emergency equipment flown in from the U.S. to constructing a temporary trauma and orthopedic surgery center to treat the injured.
The BHI-built Saint Boniface Hospital, which has seismic resistance and rooftop solar, survived the Aug. 14 quake relatively unscathed.
Photo by Terry Sebastian
Desrosiers, a BHI project manager with a background in facilities management, was also hand-delivering critical surgical supplies to Saint Boniface Hospital in Fond-des-Blancs, expanded by BHI for the nonprofit operator, Health Equity International. The HEI complex has solar power and seismic and hurricane resistance—hallmarks of BHI designs for health care facilities in under-resourced regions. The hospital had survived the quake relatively unscathed, as had the more than 15 BHI projects in the disaster zone, of a total of 60 built in Haiti since 2010.
BHI learns to adapt projects to local construction methods, especially in Haiti.
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.
BHI is “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.
Photo courtesy of BHI
Photo courtesy of CHAI
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.
The driver’s plight further strengthened Desrosiers’ resolve to aid the less fortunate. “Being a part of a community of local and international members that live and breathe the impossible every day is both my inspiration and motivation,” he says.
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.
Haiti’s Mirebalais hospital, 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
BHI makes “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.
“Almost overwhelming” is an understatement. 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.
Travel is expensive to the far-flung sites, but worth it, especially to confer with construction personnel, he adds. But even that came to a grinding halt in March 2020, when COVID-19 changed everything. Projects have been delayed, even with online meetings.
Still, BHI’s U.S. team is excited about the work. Allison Denisky, a senior architectural designer who has been with BHI full time since graduating from college in 2018, says BHI affords the opportunity to create socially conscious architecture. “It’s more meaningful than designing a pretty house,” she says.
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.
The 300-bed hospital, which provides primary care to about 185,000 people, was built for PIH in partnership with local nongovernmental organization Zanmi Lasante and Haiti’s Ministry of Health. The teaching hospital, which opened in 2013, was a response to Haiti’s magnitude-7 earthquake on Jan. 12, 2010, which killed more than 200,000 people and left the nation in shambles.
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.
BHI also 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.
BHI is 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.
BHI opened 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.
BHI has 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
“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.
Some experiences are unnerving. As a BHI senior 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.
BHI runs two warehouses, brimming with donated construction materials and health care equipment destined for far-off sites.
Photo courtesy of BHI
Like a Scavenger
BHI has created its own supply chain for its sites. Like a scavenger, it relies on its considerable network of support in the Boston area to fill its two warehouses with new and used objects, including construction materials, tools, furniture and equipment. BHI runs the warehouses like a business. Supplies get packed into containers and flown abroad on cargo planes.
“Jim has everything figured 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.
BHI has made great progress since 2014. According to preliminary figures, as of June 30—the end of fiscal year 2021—BHI revenue was more than $7.2 million, including about $3 million from construction management services and nearly $2.4 million from architecture and engineering services. Grants totaled more than $600,000 and donations nearly $132,000. Expenses were nearly $7.4 million, with $6.4 million for projects. To make up any shortfalls, there is a restricted endowment as well as a line of credit, says Ansara.
BHI is 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.
BHI is 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.
Photo by Nadia Todres
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.
“My wish is that other [groups] doing any kind of development in resource-constrained regions partner with BHI to better implement culturally appropriate and resilient infrastructure that can deliver value over the long term,” says Macpherson. “The BHI principles go beyond health care.”
Editor's note: This article was updated on Jan. 7, 2022