St. Kitts & Nevis: Ensuring design, construction standards for a paediatrics unit

In 1998, Hurricane Georges caused serious damage to many buildings, including Joseph N. France Hospital. The laboratory roof was gone and support services such as storage facilities, laundry and the central sterile supplies department all had sustained damage. An estimated 90% of the hospital could not function. This good practice example discusses the rebuilding of the hospital.

The event that prompted action

Citizens of the small Caribbean nation of St. Kitts and Nevis in the Eastern Caribbean had a sense of déjà vu as they awoke on 21 September 1998 to survey damage caused overnight by Hurricane Georges. Roofs were lost and other buildings seriously affected at Joseph N. France Hospital. The laboratory roof was gone and support services such as storage facilities, laundry and the central sterile supplies department all had sustained damage. An estimated 90 per cent of the hospital could not function. With its 174 beds, Joseph N. France Hospital is the only referral hospital on the island, serving a population of 33,000 people on St. Kitts and 9,000 on Nevis.

Three years earlier, almost to the day, Hurricane Luis had ripped through the island, damaging the same hospital severely. In fact, JN France Hospital has suffered moderate to severe damage from hurricanes on no less than 10 separate occasions since it opened in 1966.

Action taken

A phased redevelopment plan of the Joseph N. France Hospital, which called for incorporating disaster mitigation measures into the building of a new accident and emergency and outpatient department, operating theatres, a laboratory and radiology unit, medical records and a pharmacy, was already on the drawing board.

In the phased redevelopment plan, the paediatrics ward was slated to be replaced by a new building at a later date. In the interim, certain disaster mitigation measures, such as strengthening the roof and reinforcing the walls, were taken and equipment was replaced. Yet some key items of equipment continued to deteriorate due, in large part, to the longer-term effects of water damage.

The arrival of Hurricane Georges (1998) forced the Ministry of Health and Environment to step up its plans for the JN France paediatrics ward and, within the framework of the larger development project, work was completed in 2001 to:

  • Construct a new 24-bed paediatrics unit, using appropriately modified design standards and incorporating disaster mitigation and risk reduction measures with respect to natural hazards;

  • Procure and install equipment for the JN France and Alexandra hospitals to support paediatric service at these institutions; and

  • Provide training in post-disaster stress management for up to 25 persons, disaster management training for 20 persons, and training on equipment maintenance for up to five people.

A key step to building a safer hospital

Building standards to protect facilities have been around for years, but unfortunately, simply incorporating risk reduction (prevention, mitigation and preparedness) measures into the design is no guarantee that they will be followed during construction. Cost restrictions and time constraints can lead to shortcuts to meet deadlines. However, in the rebuilding of the JN France paediatrics ward, one important measure was taken to ensure that design standards were adhered to. A bureau de contrôle (quality control firm) was hired. A bureau de contrôle is an independent firm, licensed by the state to check designs and make site visits during construction. Certification by a bureau de contrôle determines whether or not insurance coverage and a mortgage may be obtained for a building. The earlier Hurricane Luis (1995) revealed an important lesson about this concept.

In addition to St. Kitts and Nevis, Hurricane Luis also impacted neighbouring Saint Martin/Sint Maarten, an island jointly administered by France and the Netherlands. Interestingly, there were clear differences in the amount of damage on the two sides of the small island, and there was a reason for this. As it happened, the French side fared much better than the Dutch and it was suggested that this was due, at least in part, to the French custom of using bureaux de contrôle to monitor design and construction of infrastructure. In fact, based on the apparent success of this approach in Saint Martin, the use of independent check consultants has become a standard recommendation with respect to the design and construction of retrofitting and new health facility projects.

A check consultant was also used during the rebuilding of the JN France paediatrics unit. A consultant reviewed the design in terms of the disaster mitigation and other risk reduction measures proposed for natural hazards and provided supervision and advice during construction. An initial report was provided to the architects early in the process and modifications were made to the designs. Site visits during construction were carried out and reports submitted to the architects and the Ministry of Health and Environment.

Lessons learned

  1. The redevelopment of Joseph N. France Hospital was already underway and an overall master development plan for the site had been prepared when Hurricane Georges struck St. Kitts and Nevis in 1998. The subsequent decision to rebuild the paediatrics ward, and the speed at which it was developed and implemented, illustrated the importance of having such a master plan in place to coordinate multiple projects and funding sources.

  2. The main project partners, national and international, were based in different countries. A Project Steering Committee representing all interested parties met regularly and this was important to monitor timelines and facilitate communication and decision making.

  3. The use of an independent check consultant engineer to review the designs and audit the construction with regard to natural hazard mitigation ensured, to the extent possible, the construction of a health facility safe from natural hazards. This approach continues to be promoted in the Caribbean with governments and funding agencies. Fortunately, the measures incorporated into the construction of the paediatrics unit—primarily to reduce the risk and impacts of hurricanes and earthquakes—have not yet been tested in an actual disaster situation.

More information is available from:

David Taylor
Regional Advisor, Hospital Administration
Pan American Health Organization/World Health Organization (PAHO/WHO)
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