Dr. David Walton and Jim Ansara are no strangers to Haiti and its challenges.
The pair — a Boston physician and the founder of Shawmut Design and Construction — helped plan and build a 300-bed hospital north of the capital of Port-au-Prince after the 2010 earthquake. They also helped transform and expand a small hospital in southern Haiti into the only round-the-clock medical facility for the area’s 2.3 million people.
Now, Walton and Ansara have turned their attention to the coronavirus and its potentially devastating impact on an impoverished nation where many people, already hobbled by a fragile health care system, have suspicions that the disease is a myth.
“This could be devastating, not only in lives lost but as an economic catastrophe,” said Walton, a Brigham and Women’s physician who, with Ansara, cofounded Build Health International, www.buildhealthinternational.org a Beverly-based nonprofit organization that brought design and construction expertise to the hospital projects.
“There’s almost no testing to speak of in the country, and there are very few critical-care beds,” said Ansara, who lives in Essex. “We’ve been raising the alarm about Haiti now for about three months. We have no idea how many people are COVID-positive. We’ve been airlifting supplies to Haiti for weeks, but it’s not nearly enough.”
In early June, the Haitian Ministry of Health projected that 9,000 beds would be needed for COVID patients, a figure 20 times greater than the 450 beds then available. The country’s death toll stood at 92 on Friday with 5,429 confirmed cases, according to the World Health Organization, but those numbers are believed to be a small fraction of the fatalities and infections.
Many Haitians are dying at home from what they term a “fever epidemic,” avoiding hospitals for fear of being stigmatized for contracting a disease they don’t understand, health officials say. But its spread appears to be broad and deep.
“The stigma issue is very strong,” said Dr. Inobert Pierre, the director of Haitian operations for Health Equity International, a Newton-based organization that operates St. Boniface Hospital in southern Haiti and partnered with Walton and Ansara’s group to add COVID beds there.
“To be diagnosed with COVID or go to a hospital for it is seen as a death sentence,” Walton said. “If there were an effective therapeutic agent, I think the stigma would be significantly different.”
Adding to a maze of difficulties, social isolation is nearly impossible in a country that desperately needs to work. Hand sanitizers are rare, and frequent hand-washing is difficult.
At St. Boniface and the University Hospital at Mirebalais, the work by Built Health International to accommodate an expected surge of COVID patients has been quick, particularly in a country where building projects are often plagued by delays and defects.
At St. Boniface Hospital in Fond des Blancs, the organization has added 36 new COVID beds and repurposed an additional 14 beds for COVID patients, Walton said. At University Hospital, three new wards with 50 COVID beds, all with piped oxygen, are being added. Another 50 beds there are being repurposed to care for patients with the disease.
Build Health International also is helping both hospitals plan for a second phase if the added capacity becomes overwhelmed with COVID patients.
“I’m guesstimating that fewer than 20 percent of beds in the country have access to oxygen. Then, it’s simple math, and what you have is an unmitigated catastrophe,” Walton said.
“Ventilators don’t exist in a vacuum. If you’re without oxygen, ventilators don’t matter,” Walton added. “We let others handle the ventilator issue. Oxygen was the absolutely critical component.”
In addition to the COVID beds and oxygen, a building is being constructed at University Hospital for staff needs, including changing and breaks.
“All of this will be completed in another two weeks with an overall schedule of four weeks,” Walton said. “Super-fast for anywhere, but especially in Haiti.”
Conor Shapiro, president of Health Equity International, said the design and building support that St. Boniface Hospital has received cannot be measured in simple square footage.
“When we first started working with David and Jim seven years ago, we were a small rural hospital,” Shapiro said. “We have grown by three or four times in terms of the number of patients we can serve. It has made a difference in hundreds of thousands of lives.”
Maintaining that momentum is a priority for the Massachusetts nonprofit groups, but attracting other support could prove difficult at a time when the coronavirus has killed more than 125,000 people in the United States — not least because of the mixed legacy of the international response a decade ago to the Haiti earthquake.
“There’s extreme donor fatigue in Haiti. We have seen so many aid organizations pull out and cut back over the last few years,” said Ansara, who has lost a brother-in-law to COVID. “Some individual donors are just tired of hearing about Haiti. They feel it’s hopeless.”
Nevertheless, Ansara and Walton have stuck it out.
“It is a generations-long effort, but here’s the thing: In my short tenure, I have seen dramatic improvement,” said Walton, who lives in the South End of Boston.
Walton has been connected to Haiti since the 1990s when he was a Harvard Medical School student, and the bond has continued ever since. He reached out in 2009 to Ansara, who had retired from Shawmut, with a cold-call e-mail.
‘I asked him, ‘Would you be willing to help?’ He happened to be in the right place in his life, digging his teeth into something after retirement,” Walton recalled.
The pair joined forces in planning a 100-bed hospital for Boston-based Partners in Health. But then the earthquake came, and the project tripled in size to become the national teaching hospital at Mirebalais.
“I spent about three years getting that hospital built,” Ansara said. “For two years, I commuted every week, leaving at 5:30 a.m. Monday to go to Haiti and flying back again on Saturday night.”
And now, with yet another crisis unfolding in Haiti, Walton recalled the beginnings of his commitment there and the profound impression that its needs and possibilities made on a young medical student.
“It was an incredible experience to see all the things I had been working on playing out before my eyes,” Walton said. “I thought, ‘This is what I want to be doing. This is my life’s work.‘ “
Brian MacQuarrie can be reached at firstname.lastname@example.org.