DISCLAIMER: Since I want all my readers to glean some level of enjoyment from my blog, the following post is primarily dedicated to the engineer types out there who would read my blog if it included more of the nitty gritty design detail and less personal story. This isn’t to say that the rest of humanity will not enjoy this post, but it is to forewarn you of the intent of this post. As such, I will give you some of the pretty picture stuff first (from the architects of course) and will have other pertinent pictures (with captions) spaced periodically throughout so that you can skim through to get the idea of what I am discussing. You have my permission to check out whenever you reach your maximum capacity for consuming detail. If there are any hyper-engineer types out there, I also want you to be aware that the level of detail that you may be anticipating after a disclaimer like this will likely exceed my capacity to write, so I welcome any follow-up questions that you have and can likely get you a spreadsheet or two to help quench the desire for additional data. The final design should be complete in December and I can let you take a look at that as well.
THAT BEING SAID…
Below is a picture of the master plan that was drafted by our architect intern (Jihea Kim) while we were in Ecuador and also a picture of the master plan model that we built as a surprise for the ministry at the end of our trip. The architects in our group were very gracious to let a civil engineer touch the model, so I was able to get my hands stuck together with super glue making some of the buildings you see there. The architects eventually took over and made it look good though!
Our time with the ministry brought up questions that they were not anticipating and therefore could not answer immediately. We also repeatedly requested to get written copies of any applicable building regulations (especially regarding the medical clinic), which we were unable to obtain while in-country. Developing countries are notorious for not providing written regulations, either because they just don’t have any enforcement of standards OR EVEN WORSE because they want to be able to arbitrarily enforce standards as they see fit in order to exercise control. Unfortunately, I am afraid the latter is the case in Ecuador as the government appears to be moving more and more towards a dictatorship.
For example, due to increasing regulations on medical clinics (again which we could not get in writing), Dr. Ayo has been forced to stop providing surgical procedures in his clinic. They now require him to have multiple doctors on staff and prohibit the collaboration between public and private medical professionals. These regulations have rendered the poor of Quininde helpless if they need surgical service. In fact, even the government run hospital in Quininde is not currently providing surgical procedures either (though they do plan to offer that service in the future). For a person in Quininde to have a necessary surgical procedure performed at this point in time they are forced to travel 4 hours to Quito (that alone is too expensive for most people in Quininde, not to mention the cost of the procedure). On top of that, you can only be treated at the government run hospitals if you have insurance (even in Quito). Insurance is actually a misnomer because the government runs that as well and they decide what care you can receive. But, in order to even have insurance you have to have a full-time job. Employers are required to pay for government insurance for all full-time employees. This makes hiring full-time employees too expensive for most employers, so they typically only hire part-time. This disincentive to hire leads to less sustaining jobs for the people to acquire and less people with access to healthcare. According to information provided by the local hospital, they are only able to treat approximately 10-20% of the people in and around Quininde. This makes me thankful for ministries like CMSL that are actively making an effort to help these people, but at the same time it also concerns me for the future well being of the people in Ecuador and the parallel path our own country seems to be taking in some respects with the new healthcare laws and increasing regulation in general.
These are sad truths of the current political climate of Ecuador, but knowing this helps you understand some of the challenges we now face with designing a medical clinic.
Since returning home, the ministry has had more opportunity to think about the vision for this property, come up with answers to some of the questions that initially caught them off guard and they have also located SEVERAL (somewhat conflicting) regulatory resources that were not initially known or made available to us. None of these resources are official Ecuadorian standards, but appear to be what they are currently using to pick and choose the regulations that they are enforcing. With our design we are forced to take a very conservative approach, assuming that they are adopting the most stringent regulations from each resource. This has led to some modifications to the overall master plan and building layouts from our first drafts as you may be able to indicate below (but that is bound to happen with almost any design regardless of these things). Still the major elements of the master plan and the ministry program have thankfully remained consistent.
Walking through the master plan:
Starting at the front of the property we have a multi-purpose public access building that will include storefronts, the ministry headquarters office, the medical clinic, and some second-story apartments for ministry teams to stay in. Ministry teams will include outside specialist doctors and medical professionals that will assist in the operation of the medical clinic as well as teams that will be working with the community children and teams that will be assisting with some of the construction efforts. They have not fully determined the uses that will be employed in the storefront areas, but they would like to have a pharmacy in one unit and are anticipating using at least one of the units for micro-industry training purposes. They would like the uses in the store fronts to support the ministry operations and provide Christ-centered functions that are beneficial to the community.
The public access buildings also serve to block off the remainder of the property and enable increasingly private access as you go into the site. Immediately behind this public area is a home for the caretaker of the property who will maintain site security while also keeping up with regular maintenance of the buildings and infrastructure that are put into place. Beyond that is a large pavilion and a series of small pavilions that will provide areas for Dr. Yeny to provide preventative care training and host teams/events/retreats. The large pavilion has a kitchen and bathroom block attached. Past the pavilion is another set of apartments to house more ministry teams and a large field for sports and other activities. Moving towards the back of the property there is an area that will be sectioned off to allow for a private access area for the future addition of an abused children’s shelter and housing for a full-time missionary family.
The ministry is currently working on completing a wall around the property to secure the site, and will start on the Phase 1 buildings and infrastructure after the wall is complete. There is a residential subdivision and an unfinished Catholic Church on the North side of the property, a main road along the West side and vacant land covered in palm trees along the other two sides.
The site has relatively reliable electric service compared to most developing countries due to efforts by the government to enhance the nations power grid. The government currently subsidizes propane for cooking, but will soon stop that in order to swap everyone to electric energy. As a side note, the government also subsidizes gasoline for autos, so the price per gallon was incredibly low. However, low gas prices are not much consolation for all the control the government is enacting.
There is a public water supply on site that provides water about 6 hrs a day. The ministry plans to supplement with a water well that they will install on site. We tested water from a neighboring property from both the municipal supply and a hand dug well. Both sources had pretty significant contamination. We will be recommending disinfection for the water that the ministry will be using on site.
There are not any sewer mains near the property; however, the government does have plans to extend sewer to this property and the neighboring subdivision in the future. We will be designing onsite wastewater disposal systems (i.e. – septic tanks and leach fields) because even when sewer is extended to the property, it will not be taking the wastewater to a treatment facility. Wastewater from areas that currently have sewer collection is discharged directly to the river that runs through the city. I guess as the old adage goes, the solution to pollution is dilution! Because of this, we are recommending that the ministry be good neighbors and properly dispose of their wastewater onsite. Speaking of being good neighbors, they currently have some residential neighbors who are allowing their sewer to run across the ground onto the ministry’s property. We are also going to design a drain system that will protect the ministry property from future damages caused by these illicit discharges.
Structurally and architecturally we are recommending local building materials and construction practices and are designing the buildings to withstand earthquakes. Most buildings in the city are reinforced block masonry or concrete with steel frame truss roofing systems. We would like to see more quality control during construction (e.g. – making sure steel reinforcement is centered in the concrete and not showing through the bottom surface of the ceiling/floor). One of the ways we are getting around this particular issue of improper steel placement is utilizing a concrete flooring system that is fairly new to Quininde which uses a corrugated steel plate on the bottom that interlocks to the concrete that is poured on top of it. This also creates cleaner construction and final product that the ministry really liked. We are also providing ventilated roofing designs (which have been installed in some buildings in Quininde) that will allow these building to be much cooler during the year round HOT & HUMID climate that they experience (made me think of AL summers, only without AC). The medical clinic will however be equipped with AC units in the exam rooms.
As with all eMi designs, we are not designing to American standards. Generally speaking, an American design would not be practical in most developing countries and could not be built. The last thing we want to do is provide them a design that is impractical to build or maintain. Our goal is to take what they are currently doing in terms of construction materials and methods and bring them up a notch in a developmental sense that will give them a more sustainable and safer design.
This project might be more similar to American standards than some of eMi’s projects would because it is in a slightly more developed area that has more ready access to a wider array of material resources and construction methods, but there is still a pretty wide gap in what we typically see in America and what is practical and possible in Quininde. They also have some enforcement of building regulations (as I have mentioned), though not near in the sense that we think of in America where we have codes enforcement inspections. Their inspections do not go near to that level of detail, and are not focused on ensuring safe or accessible construction practices.
We are currently in the process of getting the drawings together and a design report written with the hope that it will be completed and delivered to the ministry in December. After the ministry has begun work on the first phase, we may even be asked to bring another team in to provide a more detailed design for future phases of the project.
That is all the details I can manage to put into words at this time. Thank you to those that pressed on to the end. And for those that skimmed to the bottom, here is another picture to make your scrolling more meaningful!