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Reflect & Share: Prefabrication

Case Study: High Rock Health Clinic, Grand Bahama (Bahamas)

Category: Design & Build

Sector: Healthcare

Footprint Area: 320 m²

Partners: Build Health International, Direct Relief, Grand Bahama Health Services

Project Manager: Andy Sharp

Site Supervisor: Bill Rogers

Photos: Bill Rogers

High Rock health clinic location shown on High Rock (left) and Grand Bahama (right).

The reflection: Choosing prefabricated construction for this project was a very different course of action from how we typically like to operate; always aspiring to maximise the engagement of the local community and designing with local materials and culture in mind.

Although we weren't able to fulfil these commitments in all project phases, it is important to remember that the community considered during this project extended far beyond the users of the single health clinic. We were working towards developing a solution that suited an emergency situation, and had the potential to support many more communities throughout the Bahamas. With that in mind, we prioritised the most appropriate community engagement available; the input of Doctors, Nurses and other medical professionals that would be using the clinic on a day-to-day basis.

This first-time project provided a number of key lessons in how to successfully plan and deliver prefabricated construction in a remote location.

Community Beyond Construction will aim to build upon this knowledge; figuring out how to incorporate prefabricated elements into our future designs and building projects, whilst continuing to highlight vernacular architecture and local construction culture.

The setting: Hurricane Dorian hitting the Caribbean in September 2019 was perhaps the worst natural disaster to befall the Bahamas. The Category 5 hurricane mainly impacted the islands of Grand Bahama and Abaco; hovering overhead for more than 48 hours and critically damaging much of the health and education infrastructure. In an effort to return healthcare services to East Grand Bahama, I managed the recovery efforts of the High Rock health clinic, working in partnership with Build Health International and Direct Relief.

The Bahamas is made up of 16 major islands, 30 inhabited islands and over 700 islands in total. This geography, along with a number of challenges arising from Hurricane Dorian and then Covid-19, factored into the team’s decision to design and rebuild the High Rock clinic using prefabrication.

The observations: Our project assessments unearthed the following challenges, constraints and considerations:

  1. Many essential buildings were destroyed during the hurricane and widespread rebuilding projects were demanded. A modular design could be easily replicated on other islands, allowing for the rapid reconstruction of future health clinics.

  2. Over ¾ of the buildings in some areas of Grand Bahama and Abaco were destroyed. Therefore, it would be extremely beneficial if relatively simple alterations could be made to the design to suit other forms of building and uses.

  3. Widespread disaster recovery efforts on Grand Bahama and Abaco resulted in the temporary shortage of local construction personnel.

  4. After the hurricane, many Bahamians with the means to do so relocated away from Grand Bahama and Abaco, to other islands in the Bahamas and abroad. This migration included construction professionals, compounding the shortage of local experts.

  5. Travel restrictions from Covid-19 made it extremely difficult to send technical experts and international project personnel to make up the local shortfall.

  6. A reduction in international shipping and trade made construction materials in the Bahamas, most of which are imported from the US, very expensive.

  7. Delivery and shipping times for imported materials were also consequently unpredictable.

The way forward with prefabricated design & build: The above challenges led our team down the route of designing for prefabricated construction. We worked with a prefabrication partner to build seven 40ft modules in a construction yard in the US. The prefabricated build allowed us to much more easily control procurement of materials and quality of construction. Once the modules were complete, all seven were transported from yard to port, and then shipped to Grand Bahama from the US. After arriving, the modules were convoyed to their final destination at High Rock. In coordination with the team of local construction workers completing the foundations, a handful of experts finally lifted, positioned and connected all seven modules in only two days!

Prefabricated construction helped us to achieve our original goals:

  • Modular design solution that can be replicated on future projects, with minimal alterations required for implementation on different islands or to fulfil other needs.

  • Impacts from local construction worker shortages were mitigated by minimising the number of personnel required on site during each phase.

  • Fewer construction personnel were required during the build in general, helping to navigate travel restrictions and comply with social distancing during Covid-19.

  • The seven modules were assembled in the US and shipped all in one go, reducing logistics costs and minimising delays due to shipping problems. We were also able to ship spares and any remaining construction materials inside the clinic modules themselves.

The outcomes: The High Rock health clinic successfully reopened its doors to patients in July 2021 and is now, once again, the primary healthcare facility in the eastern half of Grand Bahama. The new clinic capacity has expanded on the same footprint and now provides 4 exam rooms, including the hospital’s first dental exam room.

A lot of experience was gained by all stakeholders in this project, including the Grand Bahama Health Services and Ministry of Health in the Bahamas. A fully functioning design is now available for use on other islands throughout the Bahamas, or in preparation for potential future natural disasters. Many challenges, such as; hurricane resilient design, procurement, shipping and quality control, were discussed and overcome collaboratively. A successful project legacy now remains, which local partners can replicate in the future.

by Andy Sharp.

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