Health Facilities in resource-limited setting
Started by Maria Norina Liccardo on 09 Sep 2009
Dear All,
I would like to pose a question on a matter partially discussed during last training in Building Design and Engineering Approaches to Airborne Infections.
I work with MSF – Doctors without Borders as log-constructor and we operate often in resource-limited setting (no electricity). Taking as an example my last work experience in Lesotho I would like to receive more feedback on that issue by others facing similar situation.
In Lesotho MSF is running an HIV project, the co-infection rate HIV-TB is very high (more then 80%) we are operating in remote areas with no electricity, facing an additional constraint: the climat. During winter season (mid-May till mid-October) the temperature goes below 0 C° (-5-8 C°), the most common heating system (when available) is charcoal stove. During the winter the days are generally sunny, cold and dry.
We have been requested to rehabilitate-extend the existing clinics in order to reduce the nosocomial infection of TB.
In a resource-limited setting where windows cannot stay permanently open due to cold weather, what solutions have others implemented to ensure sufficient air flow and maintaining patients comfort?
Thanks
Norina
Keywords: Administrative Controls, Engineering Controls
Grigory Volchenkov, MD
Dear Maria Norina,
Good to hear from you.
Without electricity and in cold season the only environmental control available is passive ventilation using stack effect, if enough heat can be produced by stove. More important are appropriate separation, preferably one bed rooms, appropriate treatment and cough hygien.
Kind regards,
Dr. Grigory V. Volchenkov
Head Doctor
Vladimir Oblast TB Dispansery
Sudogodskoe shosse, 63
Vladimir 600023 RUSSIA
8:29 AM, 9 Sep 2009 | Permalink
Menno Goedhart
Dear Maria Norina,
I totally agree with Grigory and would like to add :
Cooking and heating with solid fuels on open fires or traditional stoves results in high levels of indoor air pollution. Indoor smoke contains a range of health-damaging pollutants, such as small particles and carbon monoxide, and particulate pollution levels may be 20 times higher than accepted guideline values. source WHO
When you need heating and around 0°C you surely do, build proper stoves with chimney to prevent carbon monoxide poisening of the patients.
kind regards,
Menno Goedhart ,
Field Support Unit
MSF OCA
Plantage Middenlaan 14, 1018 DD Amsterdam
9:34 AM, 9 Sep 2009 | Permalink
Edward Nardell, MD
Hi Norina,
I was going to suggest that you visit the PIH site in Maseru where both MDR-TB and HIV are treated. In the OPD there windows are indeed kept open even in cold weather, but space heaters are used for warmth - as suggested by Grigory. The air changes are likely greater than stack effect only, but obviously there are limits to patient tolerance to cold. No easy solutions here without electricity.
Ed
10:30 AM, 9 Sep 2009 | Permalink
Maria Norina Liccardo
Dear Grigory, Menno and Ed
Thank you all for yours answers.
Ed, I actually went to visit PIH site, but as you know in Maseru electricity is avealeble. You said it: "no easy solution without electricity".
I agree with Grigory on improving administrative and personal infection control measures and in my experience it is not always done.
But still I believe there must be a better solution for the structure in itself even in that condition: we need to ventilate and to keep it warm....with no electricity. Not easy at all, but I'll continue thinking about it.
Thanks once more
Norina
1:02 PM, 9 Sep 2009 | Permalink
Hans Mulder
Dear all,
The only thing I can think of to improve temperature within the building is with glazing like in the old "Winter Gardens"/glass houses. If you, in your case, would have a glazed verandah / "stoep" facing to the north, on sunny days people might feel the warmth behind the glass without feeling a draft. In general not much sun is needed to get a warm feeling behind glass. This area should only be used as a buffer zone, as trying to heat these areas with a heater might be ineffective, unless double glazing is used. If a small amount of windows at the top could be opened, natural draft could be created without feeling could. In some European countries, the so generator heat is brought in to the house to heat up the house on the inside.
Hans Mulder
1:53 PM, 9 Sep 2009 | Permalink
Tariq Alexander Qaiser
Norina,
I hope all is well with you.
The solutions to your problem lie in using a hybrid of passive solar heating methods and conventional fuel heating to create air movement. How could you create a convective current of air and warm it as it comes into your spaces?
On sunny days stone floors and walls facing north (south of the equator) will heat up and radiate warmth. Move the air through this. You prob have a lot of cloud cover, so will have to burn coal or other fuel for warmth. Take the smoke out of the space, but use the smoke stack to warm the air around it. Enclose the fire place with stone so that the heat is absorbed and radiated out for longer. You must have seen these fire places / ovens in europiean farm houses.
i would place these towards the entrance of fresh air, use the rising hot air and stack effect to create a directional air flow out. You do not want to have the prevalent wind (cold air) blowing into the room. I would have convection pull air in. Insulate the walls, earth bearms or artificial insulation. These sugestions may seem generic but their applications are however very site specific. A lot of creative work can be done for this. When you have designs \ ideas, i would be pleased to give you my comments. Taq
2:26 PM, 9 Sep 2009 | Permalink
S. Mehtar
Dear Marina
This is indeed an interesting problem, one we face every day in Africa. I wonder whether it is at all possible to use solar panelling for heating in the winter. Regarding open windows, it is probably impossible unless these are quite high up (like sky lights or similar). I thought MSF was using Wirly Birds in Khayelisha with great success. Can't you have a chat with them about it?
Talk soon
Shaheen
Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital & Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town
http://www.sun.ac.za/uipc
3:55 AM, 10 Sep 2009 | Permalink
Jean Pierre Tarika
Thank you for the information about TB infection control you give me regularly. In some developing country these different means of control are difficulty. The prevention method used by staff who work in TB wards is the use of masks when they are in contact with TB patients. Another way of contamination of staff is during consultation and treatment of outpatient and inpatient before diagnosis because they don't know who has TB infection or not.
Sincerely.
5:01 AM, 10 Sep 2009 | Permalink
Rod Escombe
Dear Marina,
Prof Mehtar above mentioned 'Whirly Birds', and these are indeed in use in Khayelitsha in a number of waiting rooms and consulting rooms. They are wind driven roof turbine ventilators, which are likely to be also use the stack effect. We have been investigating them in Khayelitsha, and the preliminary results are encouraging. We have measured 4-10 air-changes per hour in various rooms, and we are now trying to look at the determinants of their effectiveness in more detail. Obviously Cape Town has 2 ocean's worth of wind, and it may well be that they are no good in areas with only light winds. We will find out! It is important to have grilles in doors or other apertures, because they do not work well against resistance. Thus they will draw air in from the outside, or in from a corridor. I guess in your situation in winter, corridor air would likely be warmer than outside air.
best wishes
Rod Escombe
3:47 AM, 17 Sep 2009 | Permalink