When the fire started in the canteen on February 9th at Tenwek Hospital in Bomet, Kenya there was little they could do to stop it from engulfing the entire upper floor and roof of the building. This building also contained the hospital kitchen, statistics offices, laundry, sterilization and (of most concern) a small portion of the orthopedic ward. Staff rushed to evacuate patients from the building only to discover they had not been waiting around to be rescued. Patients with limited mobility managed to get out and get moving. Hospital beds and wheel chairs were later located far away from the hospital.
Praise God that no one was injured or killed by this fire. Fearing that it would spread from one building to another in the congested campus, they began to dismantle the timber roof of the nearest building and made desperate efforts to beat back the flames with small water hoses and any fire extinguishers they could get their hands on. As disastrous as it was for this building to be destroyed, the results could have been much more traumatic if other adjacent clinical patient buildings had been affected. The results were about as good as they could have been for an event like this and it was clear that God’s hand of protection was present.
The fire left everyone at Tenwek Hospital well aware of how much worse this could have been and thanking God for sparing so many lives. The question that came to everyone’s mind is how they could prevent such a disaster from ever happening again. The potential for over reaction could be great, but in everyone’s mind, something must be done.
EMI has been a long time partner with Tenwek Hospital, helping them design several buildings and master plan the hospital campus. Shortly after the fire, Tenwek asked EMI to come help them plan for rehabilitation, consider impacts to the campus master plan and evaluate fire resiliency and preparedness. With plans already in place to come to Tenwek in the next few months to begin preparations for their new cardiothoracic center and water/wastewater system rehabilitation, we decided to move up our trip and help them make lemonade out of these lemons. So, myself and another EMI staff member left a few days later to assist them in whatever way possible.
Recovery from something like this is not fast, but the good news is that Tenwek hospital will recover and will be better off in the future. During our visit to Tenwek, we noticed that a couple simple construction techniques, like firewalls and replacing combustible materials, could be retrofitted into existing buildings to prevent fires from spreading and causing such a tremendous impact. They could also provide protection in high fire risk areas, such as kitchens that would stop fires from getting out of control.
In developing world design, many times it is hard to find a balance between what is necessary and what is ideal. In the US, we design to codes that help make buildings safe and functional. To expect this level of design and construction in most developing world contexts is not practical and often too costly. Instead, we normally have to make compromises in design standards that we would consider to be ideal in order to be appropriate for the context. At EMI, we explain this in terms of a development ladder. Our goal is not to take them from step 2 to step 10, but to incrementally increase safety and functionality in our designs. Step 3, step 4…etc. We look to find the practical things that they can do to improve using local labor, materials, and equipment and without dramatic increases in cost. This is engineering at its core. It is challenging, it is outside the normal confines, and it can also be very frustrating.
As we evaluated fire resiliency and preparedness at Tenwek Hospital, it became clear that we (EMI) have not always done a great job prioritizing and stressing the potential hazards of fires in our designs. Fire hazards at facilities like hospitals are especially high considering the concentration of people, many with restricted mobility. This was a wake up call for Tenwek, but it was also a wake up call for EMI. The building that burned at Tenwek Hospital was not an EMI designed building, but in all our years working at Tenwek and other mission hospitals, we have not often recommended major changes to existing structures just for fire resiliency. Granted, prioritization for such things would likely not be very high where budgets are tight, but we shouldn’t let that stop us from making such recommendations.
Now that news of this disaster at Tenwek Hospital has spread throughout mission hospitals in Kenya and sub Saharan Africa, awareness of fire hazards is likely increasing. EMI also recognizes this as an opportunity to share information with our many hospital clients so that they can be better prepared and more resilient for a similar disaster.