New York Times, Jan 18, 2010

by Henry Fountain

A week ago, Elizabeth Sheehan, the founder of Containers to Clinics, a nonprofit organization in Dover, Mass., was preparing to deploy the group’s first medical clinic overseas. Made from two shipping containers, it was to be sent to the Dominican Republic, where it would begin to fulfill the group’s long-term goal of building health care infrastructure in developing countries through networks of small container clinics in rural areas.

Then, last Tuesday, a magnitude 7 earthquake struck the Dominican Republic’s neighbor, Haiti. Hospitals in the capital, Port-au-Prince, were destroyed or damaged, and basic medical care was practically nonexistent. Ms. Sheehan said her donors immediately started calling her. “They all said, ‘Why don’t you send it there?’ ” she said.

Now, the group may dispatch the clinic, which has two examining rooms, a laboratory and a pharmacy, to Port-au-Prince if a medical team and supplies can be arranged.

“It can be used in this disaster situation,” Ms. Sheehan said, and then left in Haiti or sent on to Bani, on the Dominican Republic’s south coast, to fulfill the original mission. “We are committed to long-term primary health care for women and children.”

Containers to Clinics is one of many innovative approaches to building or rebuilding infrastructure in developing countries, to help forestall disasters or, as in Haiti, recover from one. Among them are new ideas and projects to supply quality housing, clean water, proper waste treatment and affordable energy, in addition to health care.

Their promoters share a belief that while the conventional top-down approach, by governments and large relief agencies coming in with large projects, works for initial relief and recovery, long-term reconstruction — “building back better,” in the parlance of redevelopment specialists — requires more involvement of local people.

“You can’t just sweep in from outside and drop something in and say, ‘This is exactly what you need,’ ” said Laura Sampath, manager of the International Development Initiative at the Massachusetts Institute of Technology. “It has to be almost driven from the community.”

The M.I.T. effort includes the D-Lab, whose instructors and students work on low-tech solutions to infrastructure problems and spend time in the field implementing them. Among the projects are ones to manufacture ceramic water filters in Ghana; install chlorine dispensers to treat drinking water in Kenya; and develop a bicilavadora, a pedal-powered washing machine, in Peru.

“We’re graduating engineers who realize it’s important to talk to people first,” Ms. Sampath said.

Ms. Sheehan said converting old shipping containers into clinics was just a first step; her group must find doctors and nurses to staff them, as well as drugs and supplies. “We’re committed to putting in the human system as well,” she said. So partnerships with local health groups are crucial.

At the Appropriate Infrastructure Development Group, a small nonprofit organization in San Francisco, projects are also developed from the ground up by providing support to local entrepreneurs, said Peter Haas, its founder.

Mr. Haas spoke while traveling to Haiti, where, before the earthquake, his group had been set to announce a competition for local entrepreneurs to develop plans for infrastructure projects. The competition has been delayed, and the group has added a new category: earthquake-resistant housing.

In Haiti, Mr. Haas’s group has already been helping Coopen, a business cooperative in Cap Haitien that will collect organic waste and human waste from public toilets and convert it to biogas, a fuel, for cooking. And in Guatemala, the group has aided a small company, XelaTeco, that builds hydroelectric projects for rural villages.

“We’re really not trying to dump some new expert solution on the population,” Mr. Haas said. Working through local businesses, he said, ensures that ideas that do not work do not stay around. “If a business fails and the market doesn’t accept the product, it disappears,” he said.

Malcolm G. Anderson, a professor in the School of Geophysical Sciences at the University of Bristol in England, said: “With a bit of support, the poorest people can provide infrastructure, they can do things. The fundamental thing is to change people’s behavior” by involving them in the effort.

With help from the World Bank, Dr. Anderson has undertaken projects in St. Lucia and elsewhere in the Caribbean to reduce disaster risk in hilly shantytowns. These unplanned urban areas typically have no drainage infrastructure, and heavy rains can saturate the ground, leading to mudslides.

Dr. Anderson’s solution is to help local people understand the drainage problem, work with them to design a solution (usually involving a simple network of drains to move rainwater off risky slopes) and hire them to build it. “People have a really good understanding of the fundamentals of what’s going on,” he said.

Many of these infrastructure projects are small in scale, dwarfed by the scope of disasters like the earthquake in Haiti. But some redevelopment specialists say that by training government and relief agency officials in their bottom-up methods, the efforts can be scaled up.

After studying reconstruction work in western India following a 2001 earthquake that killed more than 20,000 people, Elizabeth A. Hausler, an engineer, founded Build Change to help communities build earthquake-resistant housing. In India, she found that the top-down approach did not work. “Homeowners were not really involved,” she said. “Contractors would swoop in and build a bunch of houses for people and leave.”

Those houses were often not appropriate for the culture or the climate, she said. For example, they might have the main door on the street, when homeowners wanted it on the courtyard. “If a door is in the wrong place, then the homeowner is going to knock a hole in the wall — and that’s not good for the structure,” she said.

Dr. Hausler’s approach, carried out in Indonesia after the 2004 earthquake and tsunami and in China after the 2008 Sichuan quake, has been to involve homeowners in the design and building process, modifying traditional designs to improve earthquake resistance. Along the way she has trained aid officials and worked with local governments to enforce building standards. “That was a good way of reaching more homeowners,” she said.

Her organization is now developing a plan to help rebuild homes in Haiti, where many of the destroyed buildings were made of concrete block, without adequate reinforcement against shaking. “I imagine we’ll have the same kind of program in Haiti,” she said.

She said she was convinced that the bottom-up method was best for rebuilding after that kind of disaster: “Really, you’d have to have your head in the sand to not buy into this approach.”

Original Article available at:

http://www.nytimes.com/2010/01/19/science/19reli.html