- Howdy everyone.

- Howdy.

And I'm glad to see everyone here, full house today, and then welcome to the Texas A&M Architecture for Health, 2022 spring lecture series.

Today is my honor to introduce my good friend and Ms. Whitney Fuessel, AIA.

RID, it stands for register interior designer, right?

And then ACHA, American Culture of Healthcare Architecture, NDAP.

And Whitney is a principal and health practice leader in the HKS Houston office.

And she's a proud graduate of Texas A&M, class of 1996.

- Ooh.

- So she has over 25 years of experience in disciple health, especially focusing on the experience of human in the building environment.

So her fresh ideas draw from her team of designers and partners working on academic health projects, creating a collaborative balance approach.

So she is a leading voice for the healthcare in architecture at HKS, and she has so many career highlights.

So I just mentioned a few.

And she chaired American Institute of Architects Committee on architecture for health in Houston, along with serving on committee as student liaison and a sponsorship chair for more than 10 years.

That's how we met in 2015, when I brought a group of a student from Texas A&M to join the SES, the student design competition.

And we haven't met for two years because of COVID.

That's unfortunate.

So in 2017, she received the AIA Presidential Citation for the work done while working with the AIA.

That's the incredible achievement.

And she's the founding board member of women in healthcare, serving as sponsorship chair and currently on the National Advisory Council.

And she was selected as one of the 2015 Ty West Business Journals' Who's Who in healthcare.

And she also participated in American College of Healthcare Architecture.

And as I mentioned, it's ACHA portfolio review committee.

And her recent works at HKS ranging from a tactical urbanism side in Fifth Ward Houston, children's and advocacy center in her hometown of San Angelo, Texas to the work she's gonna talk about today is the in Uganda.

And she visited Uganda just a while ago and during COVID and it's a neonatal unit.

So please join me to welcome Whitney Fuessel for today's lecture.

(audience clapping) - Thank you so much.

It's an honor to be here.

So I have to say that doing work outside of the United States was never really appeal to me growing up.

The very first project experience that I had was actually with George Mann.

And it was a clinic in Guatemala.

And I was my first taste, also my favorite professor here at A&M and a huge influence on my career going into health.

But then we were given an opportunity with HKS to submit, to go and to work on a project in Bali Uganda.

Again, it wasn't an appeal to begin with, but it honestly has changed my life and direct, and my trajectory in my career.

Today, I'm just gonna talk about some of the statistics, the current state passive design, and in the architecture that our team came up with.

So born on the edge is a foundation that was founded by two doctors, Cathy and Adam.

And they're both, one is from England, the other from Cornwall.

If you ever watch Poldark that's Cornwall, it's a beautiful place.

And their ideas they want to go into communities to help babies that are not surviving.

Adam is a anesthesiologist while Cathy is a neonatologist.

We as HKS, we have citizen HKS, we do one, we give 1% of our fees back to pro bono work.

So all the work that you're seeing today is free work that we did for them.

So we'll go through a couple of the regional statistics.

They are a rural hospital.

Under staffing is a big piece in lack of specific training.

So whenever I say a rural hospital, the draw is from two or three hours away, even from Kenya.

So they're coming over the border from Kenya into Uganda.

There are 13 hospitals that are actually part of the region that feed into this hospital as well.

Some of the statistics that we're staggering, whenever we first were reading on this, one and nine children die under the age of five, a third of these are neonates.

Uganda has the highest population in the world for neonates dying and the three main reasons prematurity, brain injury, because a lot of times they're not delivering babies in a hospital, but they're doing 'em in the village, and then infection.

They also have a lot under staffing.

When I was there, there were 400 square feet.

They designed the initial space in this regional hospital for 10 moms and 10 babies.

They have 52 babies in this 400 square foot room.

They have two nurses and one doctor overlooking.

In the United States, we have a one to two nursing ratio, there they have a one to 25.

They also have a lack of training because they don't have the facilities.

Like we are very fortunate here at A&M to be able to teach and have technology.

They don't have that.

And that is just a part of the lacking there.

So the current state where they are today, I already spoke about the nurse patient ratio.

We're gonna talk about the mother, how they sleep, the village model and the lack of separation.

Again, I already told you about the nursing ratio, but this is a snapshot, not at maximum capacity, but you can see how busy this facility is.

The babies are extremely dependent on their mom.

There is no way a nurse can take care of the babies the entire time.

So there is kangaroo care in which the mom actually wraps skin to skin with the baby.

And they are the incubators, 'cause again, they do not have incubators within the facility.

There's also a lot of AIDS.

So whenever a mom test positive for AIDS, you don't to have mixed milk.

So they are very particular on how express milk is.

It never leaves a mom's site, they don't want a healthy baby to get that.

And the most staggering thing, if you know much about babies in the United States, you leave the hospital five pounds or greater as a grower feeder as a healthy baby.

Here they leave at 1.1 kilograms, which is two and a half pounds.

So these moms need to know what they're doing as they walk in.

Because all the babies are taking up the moms sleeping cots now.

So you can see in some of the pictures where they're arranged side by side, the moms are sleeping outside on grass mats or in the quarter.

It's not the best situation, but it's all that they have because they don't wanna leave their babies.

There's also the village mentality, a lot of times the mom will be by themselves.

So they'll ask someone else, can you watch my baby, so I can go take a nap or I can go eat something or they bring an auntie or someone else with them.

There's a lack of privacy.

At the end of this unit, there are windows.

And of course moms have to, you know, breastfeed and do different things and everyone's just peering in.

And it's not conducive to the best way to care for your baby.

When I was there, I conducted a tremendous amount of different interviews.

There were a lot of fun and I learned a lot.

Whenever I first went over, I created surveys.

And surveys here are very different than what you would survey someone there.

So instead of what's your scale, 1 through 10, you need to have a sad face to a happy face.

And there was language barrier.

I had to deal with a lot of translators.

So it was quite interesting.

So the participants, I was able to interview many moms, friends, family, and staff.

75% of the moms were married, but the whole time I was there, which was a little over a week, there was only one male that was there to help.

So a couple of findings with the moms and the fathers.

The women's perspective, they're fine.

As long as the baby's getting good care, they're fine.

It's okay, they're uncomfortable.

It's okay that they just had a baby a couple days ago and they're sitting on a one by one wood stool in front of their baby.

The father said when I was in there, I heard the mom's complaining a lot.

So, you know, you hear two different stories, but it's interesting when you hear that.

The moms really would like to have all their babies in a bassinet.

They're very baby centric, not thinking so much about themselves.

And the father said, you know, it'd be great to have a waiting room and a TV, maybe watch sports.

So things are not different between Uganda or here.

Sports are still quite important.

So moms are in there, 14 hours straight or longer.

So they are sitting and being there for quite a long time.

And that can be dangerous.

A mom is fatigued and she's tired.

And there have been situations where the mom has fallen over and landed on her baby.

So it's not good.

The environment in that aspect for for these children.

Well, this is a video that we took, and this is just overnight.

So this is at the nighttime whenever it's not as busy, there are about 40 babies here at the time, you can see that the lights are bright.

I'm gonna go more in detail on other things that are happening in here.

As soon as this video ends, but it's very active.

And you would think these moms might wanna be outside sleeping, but they're not.

- This was this past year, 2021?

- This was three years ago, yes.

And COVID has changed a lot of things to where the mortality, the one in nine has changed because women are no longer coming to the hospital because they're afraid they're gonna get COVID.

And so more babies are passing, unfortunately.

So what those lot of the situations that we have in Uganda, passive design is the way to go.

We cannot depend on water, electricity.

It's very different.

You can be there and they will shut off the electricity for two to six hours or more without any notification.

They have the very sickest babies at the front of the room that are relying on electricity for ventilators.

If those ventilators go off, they do not have any other means of getting what they need.

So at HKS, we have what is called a lab and a bag.

And you can see my face, someone was trying to take a picture and I'm trying to work.

But we had to work in again in the room for over a week's time among all the moms and the babies.

But we needed to collect data.

The interviews I was able to do elsewhere, but in the room, we were getting sound, humidity, temperature, CO2.

Seeing what it is, 'cause later when this is completed, we can benchmark and say, look, we did better.

You can also see the gentleman up on the water tower that they're putting in a weather station.

So we can track even more specifics for the area.

So with temperature, there are a couple highlights, but we had seven different temperature logs.

And there were four distributed in the room, one in the hallway where women were sleeping, one outside and one in the office.

And you see the light blue.

That is a typical range for human 72, 79 comfort level.

Above that to the next dash line, if you can see that, that's where it's good for a neonate.

And a neonate needs to be around 90 degrees.

You can see a lot of those lines, especially in the middle of the day are well beyond that.

Getting up to 98 degrees in that room, there's not any air flow, there are are smells.

The ventilators are also causing a lot of additional heat.

You don't have shoes on your feet are burning.

It's not the best environment.

But I will say since Cathy has been there and teaching different things, babies are thriving.

Does sound logger, with a sound logger was another thing we put in the middle of the room.

The women were a little skeptical, at first.

They were thinking we were recording their conversations, but we tried our best to explain.

We just wanna see what the sound is like in here.

Again, this is a problem because for a neonate, 45 decibels, it's allowed, as you want.

In this room, we were getting up to 85 decibels, which is like a vacuum cleaner and close to a lawnmower.

And that's a continual sound that these babies are hearing and their brains are growing and it's not the best for them.

When we are looking into power for the future, I already spoke about how they have the intermittent power.

We are now relying on what the world, what the earth gives us, what the sun gives us, because we are going to have some electricity, but we wanna bring in as much light through the building as possible.

The top diagram shows everything isn't red is great because you're getting optimum lighting.

And then the bottom diagram, if you see any purple, that means it's a space in which you are getting glare and we wanna stay away from that.

But we did pretty well running our models and achieving not perfection, but close.

I spoke about the weather station earlier that we had mounted.

You can see that 171 kilometers and 48 kilometers away, there were other weather stations, but we really wanted to see what is it like there, where the wind's coming from.

We wanted to design and orient this building so that it could be passive.

And we learned that the wind comes from all directions when there is wind.

It's hot, the majority of the time, so doing different modeling, we found that adding the clear story and doing stack effect was the best way to solve that.

Trying to capture and orient the building to bring wind in, bring it through and getting that hot air out through the top.

We also are doing natural ventilation.

And along with that, the thermal massing to be able to keep the hot out and the cold in whenever needed.

So this is a water tower where we did mount the weather station, but water is a scarce resource.

Whenever we were there, water went out for two days.

Again, the ventilators need water.

But with doc, with Cathy being there, she implemented hand washing.

They didn't hand wash, they didn't know about it, they do that now.

They went from 50% mortality in that unit to 25%.

Babies are living longer because the moms are hand washing.

And one of the things from the interview that one of the moms said, "I'm gonna go back to my village and I'm gonna tell people about hand washing," which is fantastic.

But when you don't have it at a medical facility, it's really tough.

Cathy was on the phone calling six hours away to the administrator, we need water, we need water, we need it yesterday.

They finally got a fire truck that got some water out of a lake or river, dirty water, put it in the tank, and that's what we used.

So it still wasn't the best.

The climate, like I said earlier, it is hot.

We're on the equator, so there's not a lot of give.

And they also have a rainy season for about seven months of the year.

And the graph with the black and the gray show where it's at the peak is when the months in which it rains the most.

So with all of that, we thought, you know, the butterfly is quite interesting because the butterfly is able to reflect the heat, but also absorb it and we needed into the structure.

So when we were looking at our roof, we were looking at the dorsal basking to where the butterfly wings are up to be able to take that heat out when needed.

We also know that it will be hot at certain times during the day.

So we took, we needed 3000 square feet of roof area to put our solar panels on, to be able to give them enough electricity when there were outages.

Because the neonatologist is not just taking care of babies or checking their heart, there are babies coming in and really dire and situations.

I don't mean to be too graphic, but I was there when a baby didn't have, was born with the insights out.

And so this baby is being taken in through all the other moms, and a surgery is being performed right there.

It's not the sterile environment, but it is something to try to help this baby at that time.

So electricity is important, at least for exam lights.

When we were exploring that design, we were looking at the courtyard, the spine, and multi-building, we ended up using all three of these concepts because they worked really, really well in the overall.

Again, this has more to do with the way the sun is oriented in June, September and December.

And it also helped influence what areas of the building need overhang so that there's comfort and the sun is not directly going into the windows.

So with everything I just talked about, this is the over all piece of what we did on the building.

We're rainwater harvesting, so we have additional water if needed.

And we're collecting that from the roof, the shape of the roof is allows it to drain and to collect in barrels that are covered so that we do not attract mosquitoes.

We, again, we have the solar panels, we have the clear storey that helps bring in light, but also helps with the venting through, with the air, the thermal mass.

I didn't talk about the interiors, but we will have light colored materials on the inside.

Also helping to keep the, the space cool.

Now to the meat of it, the architecture and the, you know, I never stop working.

I am at the hotel in Uganda, and I'm still working here because there are tweaks and different things to keep this project and budget.

And the client also had different ideas that I wanted to respond to.

So certain things that were really important when we were planning the building was the security of belongings and actually protection of oneself, lack of trust, I'll explain that further and then construction materials.

So we went through the initial program and I can tell you the big number now, we're like at 800 square meters, which is about 8,000 square feet.

Remember 400 hundred square feet.

We're now at 8,000 square feet.

This is providing every single mother their own bed, every baby, their bassinet.

It's also keeping the infectious babies away from the non-infectious.

Babies don't sneeze, but if they touch one another, they can infect.

So while they're in the beds right now, next to each other, one sick baby can infect everyone else on that bed.

Here everyone is separated and isolated.

We have an isolation room that holds 10 babies.

And so those moms will not be sleeping in there, so we provide a dorm, a separate dormitory for them.

So the site has some topography to it.

The site that we're utilizing is in green to plan northeast.

There's a banana plantation.

We have the gynecology ward is what they call it.

So we wanted to have direct access after babies that are born, they can get directly into this facility.

We did not want to bring in anything we wanted to dig out, but we wanted excavate, but we didn't want to bring in soils because we don't trust what they would be bringing in.

And there are things that we had to deal with on the site, like a placenta pit and other things.

It's not glamorous, but it's reality.

So with security planning for 10, they only had 10 lockers, so no one gets a locker.

And a lot of people get their belonging stolen.

When we were there, we had taken a lot of flip flops.

You can get flip flops, pretty cheap, but Old Navy.

So some of the moms were like, thank you so much I don't have shoes anymore.

Someone stole my shoes.

You don't wear your shoes in there because no telling what you're walking around and outside.

So you take your shoes off, you're supposed to go in and wash up.

Doesn't always happen when you don't have water, but they try to be as sanitary and as clean as possible around the babies.

There is a lack of trust.

And part of it is because, you know, they do hear that the babies are not making it there.

They have different ideas from the way they do things in the villages.

But they, we feel that with a new facility, something that's new, shiny build it, they will come philosophy that will build more trust with those than the region and more babies will come.

Materials.

Oh, you know, as architects, we would love to do like these fantastic designs that we have to be cognizant of what they have there.

So clay brick, this all gives individuals work, too.

If you have a brick mold, it is like gold.

And you can create your bricks on site.

They have concrete, still trusses, metal, et cetera.

And we saw this over and over whenever we benchmark different facilities.

Plus we have built enough the facility in Cottonball, which was a maternity ward, so we already knew.

Just a couple of elevations to show how we are going to use the materials on the building.

Very simple five materials, plus what we would have on the inside.

Another example of an elevation, but I also wanna talk about solar jaundice unit.

Again, the earth gives us our resources and prior photos, you might have seen moms outside with their babies.

The best way to treat jaundice is through the sun.

But some of the harmful rays are not great.

So what you can do is actually have a plexi glass.

It does not emit the harmful rays in and moms can go and have their babies treated in there.

So you don't have to depend on electricity or equipment or things that you would not be able to get there.

We also went and we looked for materials, sourcing them while we were there.

We wanted to make sure that we were building with materials they could get, because it would be a huge mistake if they can't get it.

One huge lesson learned, they can only put a truss about 20 feet long on a truck.

That's it.

So if we are going to build a facility that's 21 feet, you're not gonna be able to get the truss there.

So it was really good for us to know our constraints.

And we were able to modify that the materials will work.

This is at both Cathy and Adam's house.

They have three precious little girls, which is really funny, cause they're being taught by Texas teachers in Uganda.

And they're trying to unteach the way they say water because they want them to say "water" or I don't say it very well, but these little girls are getting a little Texas accent all the way in Uganda.

So we had many times when we got to sit across the table with them and eat and enjoy time.

So this is what we ended up with as our floor plan.

And you can see to the right, we have infectious.

And then to the left, we have non-infectious.

We are using medical gases in the non-infectious and in the isolation room.

And then at the back we do have the solar jaundice area.

Right now they do not have facilities for washing, restroom, shower.

So we have created that, but it is not within the unit.

It's directed, we placed it down wind and a way so that smells, et cetera, would not be permeating through the space.

We also have a courtyard and the courtyard will have fencing our gates.

So it keeps everyone in their space, no one else from, this is a large campus, no one else from the campus is coming in.

So it creates an additional layer safety.

There are plenty of lockers for everyone.

You can triage babies before they're going into the unit now, before or what they currently have.

The babies come all the way through.

So everyone in there sees what's going on and what's wrong with the baby.

So it gives a bit more privacy, they don't always accept the babies either.

Sometimes there are cases that the baby's not gonna make it, unfortunately.

So we did our flows through to make sure that they worked as well.

We, you know, as we do in healthcare, we wanna have more of that on stage and that off stage.

And so we wanted in the mother's piece to be at the front and that's more the on stage, and then in the back be able to have the physicians and the nurses working and not colliding too much.

But again, the mother is part of the caregiver system.

So we have different hand washing sinks and formula prep and things in strategically placed so that they can better care for their babies.

This is a view of what the ward would look like.

The team station or nurse station is central, so that you can look down any one of the legs at the building and be able to see everyone.

We also have mosquito nets and we'll have screens on the windows because you can get malaria or other diseases from the mosquitoes.

Just another view of the building And a rendering.

- And how do you say that?

- Kipepeo, I think so.

You probably said it better than I did.

And the reason to save lives, and you know, I'm not one to want to tell sad stories, but I have been doing healthcare for a long time, and I have never been in an environment like this.

I have never experienced death.

You walk through healthcare facilities here and you're like, oh, there's some morgue.

You know, it's not like that there.

when I was there, there were four babies that died.

One of 'em was Teddy that gave a quote earlier.

She had been there for an entire month and her baby didn't make it.

But when I was there, this family while walked in with this one little boy and he had labored breathing.

And for three days I just watched him, and on day four, he was in the middle table where we were tracking the sound.

And the doctor was looking over him, but there are so many other, there are, you know, 40 other babies in there.

So she did what she could and there was nothing else.

And at the end you just see this little baby raise his hands up, and then he puts his hands down.

And those were the last breaths that he took.

And it had such an impact on me that I've never been the same working in healthcare.

So it is, we are saving lives.

If you're in here to do healthcare, you're going to be able to save lives.

And that is what is so special and sets those in healthcare architecture apart from anyone else.

So with that, I thank you.

And if there are any questions I would love to.

(audience claps) - We have my here, if you have questions to come here to ask so they can hear you, okay.

- So that's a fantastic presentation with me.

- Thank you.

- Especially last part you mentioned, you know, you witnessed four children die at the time.

And then I think, you know, you mentioned several things that I'm really impressed with.

And one thing is that, you know, you mention a hand washing itself can reduce the, you know, the mortality rate from 50% to 25%.

- Yes.

- Yeah, that's the, you know, that's significant, I dunno how you realize that, you know, for the students and for the 50%, is it the neonatal mortality?

- Yes, and so in Uganda, the neonates death accounts for the greatest death population in the world.

I think they hover around 50%, but just with simple things that Cathy is implementing with hand washing in her unit, when half of the baby were not making it.

Now you have three quarters of them are making it.

And it's just fantastic.

And it's a simple thing as washing hands or even the kangaroo care or knowing, 'cause whenever you kangaroo care, it's not only the warmth from the mom, but the heartbeat and the movement of the mom will continually kinda jar the baby and wake 'em up.

And it's amazing.

- It's right.

One thing I noticed that you have done a lot of research, programming.

And then when you went into first time into the, you know, the Uganda, a unfamiliar environment.

So we are teaching our student at this is in them knowing, you know, how to do design research, how to program so that I think that's the really important part of the design.

- Yes, I agree.

And I don't think that you should ever go into a project with preconceived notions that you should listen.

It's extremely important to listen and to hear what they want.

For me personally, I like to be in the shoes of whoever I'm working with.

And if it takes me watching YouTube videos of patients that are suffering with something or staying the night at the ed or shadowing a nurse, that's what I'll do that way.

I design the best for.

- That's incredible.

And another one I noticed that is, you know, and when you going to Uganda, the passive decide is the only thing you can do.

Yeah, and that's right.

And then for infection control.

And then when we are seeing, you know, five beds in the hospital, in the room and plus five babies over there, how to do the infection control, that's quite challenging.

- It is quite a challenge.

And so right now you saw that quarter in the center where everyone was walking.

They're trying to put the infectious babies here, the non-infectious here, but you're in a small room and.

- That's right.

What's your timeline for the, you know, for the project?

- That's a very interesting question.

Before COVID we were full steam ahead.

Since COVID has hit, it has hurt some of the fundraising for the physicians.

They've applied for grants through different entities in Europe, et cetera, but they're still needing to get some additional funding to go forward.

I would also like to mention that, Arab out of their London office also gave their time with HKS to do this in conjunction.

So the engineering was also done in kind as well.

- Right.

And for the large space, you have the other concern, is that the noise.

You know, one baby crying, the other, you know, the whole group, you know, the cry I was crying.

How do you solve that because you know, you use this kind of design approach.

You may, you may have already thought about that.

You know how to control the noise over there.

- Well, baby crying will happen, but the, just by the sheer size, different size in the room, it should help with that.

It's really hard to put different acoustical treatments there just because you don't want things that can get soiled and dirty, 'cause we will have hard ceiling and floor and walls.

So there will be reverberation of sound.

But we just feel that with some distance in some of their own space, it should help with that.

- Right.

And also for the, you know, I have too many questions coming off and yeah, go ahead.

Come here.

- So you mentioned about education and, can you speak a little bit about, you know, I know you said that there were some delays because of COVID as far as getting, you know, the funding and getting on board.

But really kind of on the sustainability there in that town.

And I don't know, it, maybe you can speak about, you know, is that like the largest town or there others, but how local labor can kind of be involved in actually building that together.

And then if you could speak on how that education can maybe help for some of the other towns that may have similar issues.

Thank you.

- So Bali is definitely the largest town.

It's a regional catchment, but it is about six hour drive from Entebbe, which in that area is really large.

That's where the big international airport is.

So they are serving a region that is far detached.

I'm trying to recall the risk of the question.

- How, you know, like the, the local labor?

Yeah, and then kind of service an education.

Hey, they come and they work on this one project and then maybe.

- So whenever we're there they'll point at us and call us mzungu which if you are not African, everyone is the same.

Everyone looks the same to them.

Then that means basically a white person.

And so there is a lack of trust with the mzungu, 'cause I think they're gonna come in and they're gonna take over their job.

So the thought here, especially like with the brick, we want to bring in their locals, teach them skills, but also teach those in healthcare training.

Part of the plan, there was a training room in there so that they can bring people in, but the hope is also be able to send out through televised communication and teaching programs, but more people have to step up to work too.

- Any more questions?

If no, I'm gonna continue.

- Okay.

(both laugh) So we are so accustomed to, you know, single back room over here.

- Yes.

- So when you, first time, you know, went to Uganda and we had this mindset and then how, you know, the conditions over there change your mindset.

- So this was not my first experience with the single person room.

I actually worked on a mission neuroscience project with Memorial Herman, where they had eight and four beds per room in a ward setting.

They've, they've changed that since, but I could compare the two they're very much alike, very, I would say chaotic.

There's a lot to say for the single room, but there's also a lot because with one physician and two nurses, you can keep your eye on every baby at one time.

And so it's almost necessary to have them all within view.

- Yeah.

Good.

And then for, for the budget, you have not talked about that yet.

- I haven't?

- How they going to build it?

You know, I have seen a lot of projects that done by the villagers.

They use their own labor and then that created, you know, top opportunity as well.

- Yes.

So anyone have an idea of how much this might cost?

8,000 square feet.

Medical.

It's about $400,000.

- $400,000.

- Yeah.

Which is bargain.

- Yeah, just bargain as well.

- It's, you know.

- Plus annual operating costs.

- Which exactly the sun and.

- And how's the situation, you know, for the nursing, you know, the nurses shortage or physician shortage or what they would the impact, the use of the facility.

- You know, I can't tell you directly because I haven't had a conversation with Cathy or Adam about that specifically.

But one thing I negate to say it's that when Cathy and Adam were married, they were physicians not in the same town.

And they wanted to find a place where they could lay in their family and give their services.

So they do this for free, and they're quite amazing physicians that they go and they live there and they give in that way.

So they're always teaching and helping those to increase their skills that are there.

- Yeah.

Thank.

- Do they come and go or they.

- They are there the majority of the time.

When Cathy had her third baby, they did go back to England for about six weeks.

And then back as normal.

I cross the street from them is actually a sibling of an HKS colleague in London.

So there is that connection in it's small community.

- And you said, I know there was a delay because of the pandemic, but so the design is done but they haven't started construction.

- That's correct.

The design is fully done, we're just waiting.

And we have multiple teams that'll go, we'll have a team that will go during construction.

And then we wanna do a POE, post-occupancy evaluation on this.

Cause we did all that data collection at the beginning.

We wanna see how well we did.

- Is there a PHAs construct that they can, you know, start part of it at least earlier.

- Because we have multiple buildings, yes.

- So the facing part of it.

So the audience cannot.

- We hadn't anticipated facing, but you could because of the multiple buildings.

- Okay, so we have two questions from the audience on Zoom.

And then Century, you can come here to ask the question later.

So one question from Sophie who she is, that this is a great presentation.

She want to ask a question about that, you mentioned on the slides that, you know, lots of babies are lack of trust of public health system.

And she would like to know more about that.

- So a lot of the individuals are in villages, and they have done things the same way for a very long time.

And so it's hard to trust the mzungu or someone else that comes in and says, no, this is the way to do it.

And the way that they're building that trust is that that one person from the village comes in and they're able to go back with a healthy baby and say, this is what happened.

- Okay.

And the other question is from Ray Penegas.

He said that he regretted not being able to come here.

So, and then he's asking, in the United States, clients often position their projects in a referral pattern, upstream to more sophisticated levels of care or down downstream to follow up or lower levels of care.

What do they do in Uganda where the referral network facilities may not assist for these facilities?

Is there referral system over there?

Or they just go through that?

- This is a referral hospital.

So there are 13 other hospitals that are fed into this hospital.

So yes.

- Okay.

So Century come.

- Hi, I'm Century.

I just wanted to know, like you mentioned that there was a water scarcity and they started, they could manage to bring some water and that might be dirty.

So did you face any challenges regarding waterborne diseases in the beginning?

And how did you manage that in according to, along with all the challenges you were facing right then?

- So there definitely are diseases or mosquitoes can grow and thrive in water.

So we are harvesting water.

The roof is designed in such a way that it drains and goes into water reserve.

So you have somewhat, you know, clean water depends on what it was on the roof, but we also made sure that it is mosquito proof and the out it is safe to use.

Wouldn't recommend drinking any of the water though.

- Okay.

And another thing is you mentioned that butterfly concept there.

So how did you implemented that butterfly concept in that?

- It's a good question.

So I don't know.

Oh, so I don't know if we can pull back up the PowerPoint, but whenever you look at the roof, it's almost like a double roof.

So we have the wings that are taking the heat and then you have underneath where it stays cooler.

- Okay, yes.

Thank you so much.

- Hi, I'm (indistinct).

I wanted to, I don't know if you addressed that before, but is this completely public driven or privately driven?

Is there any involvement from like the public sector in Uganda as to how this project is going, which they can then take to other parts of the country?

- That that's a good question.

And, and yes, it would be the thought was that this could be a model that could be replicated throughout.

It is public and there is government involvement.

We were dealing with the city engineer and having conversations with him while we were there.

I hate to say this, but there is a level of corruption.

And so there's a lot of red tape that you have to get through to get things done.

- Okay.

So any more question from the audience?

Okay, thank you so much for a wonderful presentation, Whitney.

- Sure, appreciated.

(audience claps) (upbeat music)