Building Health: An Interview with Jim Ansara

JON: Obviously I have gotten to know you a bit over the
last few years and I am quite familiar with your work especially in connection
with Partners in Health (PIH), but I wonder if we could maybe start fairly
broadly, and I would love to know a bit more about you, Jim, and what your
background is, where you grew up, what has influenced you, and how you, as
someone with a construction background, found yourself invested in global heath
and international development.

JIM: Right, so, I grew up in Boston/Cambridge and my
family, my mother in particular, was very progressive politically, especially
for the time, which had a great influence on our whole family. I am the youngest
of four and most of my siblings have gone into some sort of social or political
action work. I ended up on a different path. I was very focused in high school
and college initially on playing sports and having fun. I started at Brown
University and lasted almost one semester, and then dropped out and played
hockey on a minor league team for a year and a half. I was then accepted to
Amherst College and went there and lasted a year and a half there! At the same
time, I met Karen [my wife and co-founder of the Ansara Family Foundation] and
found myself back in Boston needing a job, and talking my way into work as a
carpenter. This then started a long
adventure in construction for me. Very quickly I began working for myself doing
small projects in Dorchester and Roxbury and started a little company which became
a little bigger and eventually grew to become a very large company, Shawmut,
which we sold in 2006 to the employees. Our family had had a small foundation which
we started in 1999 but, with the sale of Shawmut, we took half the proceeds
from that sale and started a much larger philanthropic foundation.

Also, we had
adopted 4 children, 3 from South America and had traveled a lot, and especially
throughout Latin America, and had become much more involved in international
development. My wife Karen had a background in international development which
began at Wellesley where she went to college.
My interested in international development really came from our travels and
from my children. I began to think about
key issues of women, children, poverty and equality which is how Karen and I
began to shift our focus from domestic giving to a more international
focus.

JON: I am interested to know a bit more about how Build
Health International came to be, it makes sense and I definitely understand the
progressive roots and the interest in international engagement but Build Health
International in particular, how did that originate?

JIM: For many
years my wife Karen was involved with Oxfam America where she worked very hard on
a capital campaign. Through Karen’s work with Oxfam, we met Cate Oswald and Paul
Farmer and others involved in an economic development project in the Central
Plateau of Haiti. In traveling to Haiti,
I was really shocked by the level of poverty, injustice and inequity. At this time I was no longer running Shawmut and
was really trying to find something to plug into that was of real value. I had tried a number of things – boat
building, fishing, etc. – but it was sort of indulgent and wasn’t adding a lot
to the world. I was really looking for
something deeper in which to become involved and make a significant
contribution. Then, in the summer of
2009, Dr. David Walton from PIH called and said PIH was building a community
hospital in Mirebalais in Haiti’s Central Plateau. David explained that my background in
construction could be of great help for the project, after which I immediately
became involved. I then started
traveling to Haiti in September of 2009 with David working on plans for what
was then a 100-bed hospital in Mirebalais. Then…in January 2010, the earthquake
struck in Haiti, and everything changed.

So that is
how I became involved in PIH and in Haiti.
The hospital in Mirebalais was finished in late 2012 and officially opened
in May 2013. At that time, I began thinking
I was going to be a part-time volunteer who would maybe travel to Haiti once a
month. But, over the course of the
Mirebalais project, I didn’t realize I was going to be essentially living in
Haiti and building a team of people who would work together to complete the
project. I often say it would be a
completely separate interview to discuss the process experienced in the
Mirebalais project and touch on the mistakes and lessons learned which were
numerous, but very  helpful. The entire project was a very unique
situation.

As we
continued work in 2011, Haiti was still very much in the vortex of the
earthquake. There were really good and
bad parts of the Mirebalais experience, but it was a very unique way to learn
how to approach building in such a unique environment with a very distinct set
of circumstances at play. The project
was funded and collaborating with David [Walton], who had worked in Haiti for
so long, was a really direct way in which to learn, and re-learn, everything I
thought I knew about planning and design and construction and hospitals. I also had to quickly unlearn ways in which
we had operated at my company for so many years. I had an unusual background where I had
started my career in the building trades during which time I gained direct hands-on
experience. I then had experience
running a large company which provided another set of skills in terms of
management and project overview. As it
turned out, I was also uniquely well suited for the work we were doing in Haiti
– because I had been an electrician, plumber and carpenter and had also worked
on large-scale projects as well, I could see the overall project from both the
macro and micro levels.

JON: So how did you go from constructing the Mirebalais
hospital, a huge endeavor with many challenges and many successes, to founding
Build Health International and creating the organization that it is now?

JIM: My plan was to finish the Mirebalais hospital in the
spring of 2013, stay for the inauguration in May of 2013, and then re-retire. I
was thinking to continue working with PIH as a consultant on different
projects. However, we came to the
realization that there was a lot more work to do in Haiti for PIH, a lot more
to do at Mirebalais, and so much more to do in the rest of the health care
delivery system within Haiti overall.

We had also
learned so much, and survived so many mistakes and missteps that I felt like we
couldn’t let those lessons learned go to waste. At the same time, other
organizations working in Haiti, like the Saint Boniface Haiti Foundation were coming
to us for help. These organizations were
telling us that they just couldn’t figure out how to move forward on
infrastructure, planning, design, and construction to ensure their essential
health care delivery programs could be executed in the most impactful way
possible. On the surface Mirebalais is
such a big success, there are a lot of things I’d do differently, but to people
looking from the outside, it’s sort of unbelievable. Here’s this huge hospital that was done so
quickly for comparatively far less cost than other big development projects
and, from that, other organizations were hoping to learn how to move ahead with
their own projects. 

By December
of 2013, the team that had worked on Mirebalais had sort of disbanded, a few people
had gone to work for PIH and I was continuing to help in directing them. Eric
Benson [Build Health International’s Director of Construction and Senior
Project Manager] was working at Saint Boniface with me at this point but I had
no office and we had no infrastructure, no team. Carroll Huss [Build Health
International’s Director of Internal Operations and Finance] who had worked
with me on the Mirebalais project was interested in continuing the work as
well, so that was really the genesis of Build Health International. From there, we rented a little office and
warehouse in Beverly and began working as BHI in early 2014. At that point, we were still working as the
infrastructure arm of PIH which continued until about a year ago. Since then, BHI has really taken on a life of
its own.

JON: It seems like it!
I wonder if you could talk about some of the other projects you have
been engaged with, and what else you are excited about within Build Health
International.

JIM: During 2015, BHI was pretty well focused on doing
work almost exclusively for PIH and Saint Boniface, with the majority of work
concentrated on PIH in Haiti, Malawi, and West Africa. For example, we helped organize a logistics
team during the Ebola response. During this time we also had people consistently
reaching out to us for help. We
continued working with St. Boniface and experience success replicating what we
had done in Mirebalais and improving on it.
We focused on how we could even further improve, while also simplifying,
the facilities we were constructing, looking at sustainability, not just in the
green sense, but from an operations and maintenance management
perspective. This extended to work on
renewable energy sources, especially in Haiti where energy is such a huge
operating expense. We continued to take lessons
learned from Mirebalais, such as best practices for operating budgets, and
examined ways to challenge preconceived notions of building in resource
constrained settings. By looking at ways
to build ‘less’, we could examine impact on both budgetary planning and also
facility longevity, allowing resources to be allocated to towards maintenance
and repairs, rather than just on the initial cost of the capital investment. These are certainly challenging, but
important, conversations to have.

JON: It’s almost unimaginable, it’s a huge amount of work
and really incredible to hear the breadth of it, honestly. I am interested to know what your view is on
the broader field of global health construction and infrastructure. Obviously,
players like the World Bank and USAID have some funding and have done
infrastructure projects in the past, but do you see other organizations perhaps
taking on the work of designing and building appropriate health oriented
infrastructure?

JIM: That is
a very good question and a very important one.
Within the sector it appears there are two extremes…there are the large
organizations such as the USAID contractors.
There seems to be a struggle to clearly define the role of these
companies in terms of mission and ability to deliver sustainable facilities
that meet the needs of the communities in which they are constructed. That then becomes one type of international
development delivery in which European and North American style hospitals and
clinics, which are often very expensive capital costs and usually don’t have
much funding for sustained operating budgets, become the norm in places like
Haiti. As it happens, the buildings constructed
in this model don’t really end up being sustainable for geographic locations
like Haiti, given its climate and the feasibility of continued operating
support. We have certainly experienced some of these same challenges in our
past projects, and have learned from our experiences as we try to match the
capacity of the community in which we’re working with the scale of the project.

So there is
a huge void between the widely accepted status quo, and what BHI is trying to
address. There are definitely other
organizations also trying to fill this void.
Organizations like MASS Design are addressing the design and
architecture challenges – BHI is currently working with MASS Design on a number
of projects such as Redemption Hospital and JFK Hospital in Liberia. Another organization, Construction for Change
in Seattle, is a spinout from a foundation working with PIH on projects in
Malawi. And there are organizations such
as Building Goodness who BHI is working with in Haiti. The central point which I keep returning to is
that if you amass all of the work done by these various organizations, it can still
feel that the work is only a tiny drop in the bucket of what is needed. There
are thousands of facilities globally (in places such as Haiti, Sub-Saharan Africa,
parts of Asia, etc.) which are operating in rapidly declining conditions and
are in need of equipment, infrastructure, running water, sewage, improved ventilation
systems and so on.

Keeping all
of this in mind, one of the larger scale questions that I am always trying to
address is: beyond the immediate work we do, how our organization Build Health
International can have greater, more direct impact. I recently turned 60 and
was reflecting that if I work like a maniac for another 20 years until I am 80,
I still really believe we will only accomplish a tiny fraction of the larger
scope of the work that needs to be done. So, the continuing challenge is to try
to figure out how to capture what we are learning in each of our projects and
disseminate this information to help other organizations leverage their impact
as well. To this end, we are currently working
with a number of universities on a range of projects so that students at the
forefront of their academic training can begin to interface with ideas of best
practices in architecture, engineering, design and so forth. We are also just finishing a pilot project
examining the Emergency Department at Mirebalais where Drs. Reagan Marsh and
Shada Rouhani from PIH just did a presentation at a national emergency medicine
conference around that project and what we have been doing. BHI has also started a pilot project that we
are calling, for lack of a better title, the Mirebalais Learning Project, in
which we are documenting the vitally important lessons learned from Mirebalais as
well as the other facilities in which we have been involved. Rather than sort of just celebrating what we
did right, it is so important to really look at what could have been done
differently and learn from those challenges moving ahead.

JON: It is a
fascinating thing. I mean, how do you digest the deep lessons that you all have
learned along the way while continuing to pioneer this work to galvanize more
support and encourage more people to take it on. It is a really fascinating
challenge. As we wrap up, it would be
great to learn a little about the BHI outlook as you move ahead into the
future.

JIM: Certainly a
great question – I think at this stage looking ahead, BHI is in a unique position
to continue pushing forward. We will
continue focusing on individual projects while also contributing to the larger
conversation about health care delivery, infrastructure frameworks and ways in
which building and design can impact successful outcomes. Together with our partners, we are certainly
looking forward to this next phase of Build Health International’s evolution.