“Disasters are going to happen.” A rather innocuous comment from George Mann, AIA, Professor, The Skaggs-Sprague Endowed Chair of Health Facilities Design, College of Architectre, Texas A&M University—and a member of the HEALTHCARE DESIGN editorial board—in the wake of the tragedies in Haiti and Chile, but also one that has a powerful and expansive impact on the design, and specifically healthcare design, community. “It’s not whether a disaster is going to happen; it’s when and where and how. Getting ready for the next time—it’s about lessons learned.”

Through his extensive time in the healthcare design field and travelling the globe, Mann has acquired a mass of ideas concerning worldwide healthcare facilities, what will be needed in the future, and what can be done with our current resources to better the lives of those around us through design. And these ideas manifest themselves in the various projects and concepts that are produced in the Texas A&M program, which he describes as a “think tank.”

“We try to direct between 15-20% of our efforts at the developing countries and areas of need, inside the United States, as well as outside,” says Mann. “We worked on different projects like the surge hospital project. Surge hospitals are places like hotels or arenas that can quickly be turned into medical facilities. Haiti is a special case. It’s unbelievable what happened there.”

Mann insists that a solution to healthcare disaster planning in developing, at-risk countries is multifaceted and more far-reaching than it may be originally thought. One of the primary problems is trying to understand the strained, limited resources of many of these countries. “The developing countries are outside the frame of reference of anything anyone inside this country has seen. The lack of what they have in terms of the most elemental things, with continuing population increases, is incredible,” he says.

“Our society is so unique. There are standards, building codes, fire departments, enforcement; on all levels. We’re such a sophisticated country that we’re at a loss sometimes when we encounter a country that’s not. Where do you start?”

Mann notes that the implementation of enforcement and building codes will begin the process toward making these at-risk countries safer and more prepared for the next disaster. However, the application of worldwide building codes and their subsequent enforcement are nearly impossible, even though the impact it would have can be seen by contrasting the events of the two recent disasters. “These two earthquakes are in contrast to one another. In Chile, they were designing their buildings with these codes in mind—that’s my understanding,” says Mann. “And so there wasn’t as much damage. The buildings became part of the problem in Haiti. I think prevention in earthquake prone areas is important.”

But that’s not to say that the solution is to simply build modernized, Americanized hospitals in remote locations with building codes in mind. “You want to design something conceptually that fits into their culture. We have such a tendency to plop these Holiday Inns and Hyatts and office buildings that could be in anywhere in the world, and it doesn’t take any sensitivity into account of the feelings of local people,” cautions Mann.

Once a disaster has occurred though, there are various responses and concepts in the works. Mann believes that it’s best to use the existing infrastructure of the country if it hasn’t been destroyed like in Haiti. Trying to establish a surge hospital plan (more prevalent in the United States) is one answer to the problem. He says that in many developing countries, authorities are just as likely to use a field or local school instead of a more appropriate location such as a hotel—because of the presence of beds and hospitality features—for surge locations. Mann also notes several different mobile—and a few still conceptual—clinics as possible responses to disasters, including boat clinics for remote villages on rivers or oceans, and projects such as the Project Orbis, a flying eye hospital that visits countries around the world performing procedures.

More than anything, though, Mann’s motto on the topic is simple: “Expect the unexpected.” No two disasters are the same, he stresses, and countries need to begin designing the infrastructure to sustain proper medical services in the face of crushing, unexpected tragedies.