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Monday, March 13, 2023

Are Public Hospitals Prepared for Disasters?

The good news: There is a plan to bring Costa Rica’s public hospitals up to First World fire safety standards.

The bad news: It could take as many as 20 years – and cost as much $160 million – in a country with a cashstrapped government notorious for taunting its people with an almost never-ending list of pending public works projects.

“A fire like we saw two years ago could almost certainly happen again,” said Hector Chaves, director of Costa Rica’s Firefighter Corps. Chaves appeared as a witness Tuesday in the second week of the trial of Juan Carlos Ledezma, a hospital assistant accused of arson for the 2005 fire at the CalderónGuardiaHospital in San José that resulted in the deaths of 19 people.

That inferno left bare the national healthcare system’s inadequate fire safety protocol and infrastructure, but after two years, institutions are still scraping together the funding and resources to meet heightened fire code standards that were approved in the tragedy’s aftermath.

“It’s a matter of resources. Costa Rica has a long list of hospitals in need of improvements, and we can’t just do them all at once,” explained Gabriela Murillo, director of operations at the country’s Social Security System (Caja), which manages the nation’s socialized public health-care system.

She said work has been done to improve things at public hospitals, but the scale of many of the projects prevents immediate action.

“We have installed emergency exits, fire extinguishers and other security devices, and developed training programs and evacuation plans. But many of the larger projects could take years,” she said.

She explained the onus for improving fire safety measures in hospitals lies with hospital management – and not the Caja – so not all of the country’s 29 public hospitals have seen improvements.

All government buildings in Costa Rica suffer from lack of fire safety infrastructure, but hospitals, said Chaves, are perhaps the most alarming – as so many bedridden people have no choice but to rely on the government and its plans. There is little or no enforcement and no countrywide fire plan, so it’s anybody’s guess – even the firefighters – what will happen next time a fire rages.

On a recent informal tour of one of the largest hospitals in the country, the San Juan de Dios Hospital in downtown San José, The Tico Times confirmed that the oldest portion of the building, constructed more than 150 years ago, lacks basics such as fire hoses, alarms and sprinklers.

Chavés was hardly surprised when The Tico Times described these observations. He said the hospital is virtually a death trap – and pointed out that the hospital’s laundry is located almost in the center of the sprawling hospital, which occupies multiple city blocks.

Laundry rooms, he said, are notorious for fires, and its central location would mean smoke would spread throughout the building, asphyxiating patients who might be unable to escape.

“Smoke inhalation is the most common cause of deaths in building fires, not burns,” he said.

Some hospitals – including the antiquated San Vincente de Paúl hospital in Heredia, built in 1890, are working hard to make improvements despite lack of funding and resources.

Jorge Fonseca, director of the hospital, said he’s spent the past two years working to improve fire safety equipment – including 138 new fire extinguishers, fire-safe doors, fire hoses in almost all the departments and walkways, sprinklers in high-risk areas and emergency lighting.

“We’re doing the best we can with the resources we have,” explained Fonseca, who gave the example of fire-safe doors in the hospital. “They were too expensive, so we bought one, and copied the design,” he said during a tour of the hospital this week.

Calderón Guardia has also made significant steps in improving its emergency system in the two years since the fire, though officials admit there is more work ahead of them than behind them (see separate story).

Others are not faring so well. Farther afield, in Golfito, on Costa Rica’s southern Pacific coast, Murillo said the region’s primary hospital is made of wood, a veritable tinderbox and a relic from the former United Fruit Company.

“We would love to move our patients out of these hospitals, and put them somewhere else, somewhere safer,” says Caja’s Murillo. “But where?”

Many of Costa Rica’s busiest hospitals are dinosaurs that the state inherited with the creation of the Caja in 1941, explained Murillo, who is charged with directing building maintenance and safety at the Caja’s more than 1,000 hospitals, clinics, community health centers, administrative offices and other buildings.

She said it costs $300 per square meter to retrofit an old building with the necessary measures to prevent fires, such as sprinklers, fire extinguishers, spark containment devices and fire hoses.

Murillo says Costa Rica just doesn’t have the pocketbook for needed improvements. “It’s not like the Caja doesn’t have a plan. It has a giant plan,” she said, “but it requires a big investment.”

The Caja is putting aside $2.3 million a year to invest in the plan, intended to bring Costa Rica’s hospitals up to international norms – not just for fire safety, but for all kinds of disasters – earthquakes, chemical spills and natural disasters.

Murillo’s man in charge is Pedro Armijo, a bright-eyed and enthusiastic fire safety and electro-mechanical engineer who studied at the University of Ulster, in Ireland, one of the world’s leading fire safety schools, on a grant from Caja.

His enthusiasm is contagious and his shelves refreshingly lined with hefty engineering books sporting titles like “The Fire Pump Handbook,” “Heat Transfer” and “Structural Design for Fire Safety.”

But most importantly, he has a plan – one which he will present to the Board of Directors of the Caja next week. It’s ambitious, but Armijo says it’s absolutely essential, and would bring the country to First World standards.

It calls for an investment of $160 million, to be distributed through the next 15 to 20 years, and for the development of a National Fire Safety plan, an advisory board that would review vulnerability, fire codes and programs in both existing and new buildings, and of course, a massive sum of money for revamping the existing hospitals and associated buildings. He hopes such a plan would eventually be the model for all of the government’s public buildings – not just Caja.

“All of the country’s public buildings are in need of fire safety plan and equipment,” he said.

The all-encompassing plan would also ensure that all new buildings are constructed with the most modern fire safety plans and equipment and meet the safety recommendations of the U.S. National Fire Protection Association.

“The number seems shocking, but when you divide it out and compare it to our expenses in other areas, it is very viable,” he said.

Murillo, who has reviewed the plan and approves it despite the hefty price tag, said it is up to Caja directors to decide whether the program is financially feasible.

“The way it’s proposed, we think it’s feasible – and necessary,” she said.

Armijo agrees. He explains the 29 hospitals are just the tip of the iceberg – and that the huge sum of money, while intimidating, is absolutely necessary to revamp all of Caja’s buildings – to ensure safety in the country’s hospitals and continuity of medical supplies.

He used he Caja’s major medical supply warehouse, located in La Uruca, as in example. He said it, like so many other auxiliary buildings, lacks basic fire safety equipment and plans – and would burn like a tinderbox in the event of fire.

“If that building burned, I think more people would die from the lack of supplies than would if another hospital burned,” he said.

He said he understands funds are tight, but is skeptical that money is the limiting factor.

“They have the money to do it. Until recently, it was simply something they’d chosen not to consider,” he said, adding that this is almost unthinkable because of the lives at risk.

He said he believes that beating the country’s fire safety problem and putting an appropriate plan into place begins at the top.

“You can have the best plan in the world, but if no one is willing to administer it, it doesn’t matter. The most important step is that our leadership recognizes we have a serious problem,” he said.

Tico Times Reporter Blake Schmidt contributed to this story.


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