Shipping-Container Clinics Could Be the
Future of Mobile Hospitals

About 42 million
shipping containers moved through American ports last year, and one
organization had a bright idea for repurposing these ubiquitous steel boxes:
Make them into mobile clinics that could be shipped around the world to
developing countries in need of better access to healthcare or to disaster
zones where brick-and-mortar hospitals have been damaged.

By
Chris Sweeney

When a magnitude 7.0
earthquake rocked Haiti last year,
80 percent of the buildings at Grace Children’s Hospital in the capital,
Port-au-Prince, toppled. Grace’s inpatient ward, which provided care to more
than 300 children each year with tuberculosis, HIV and other ailments, was
condemned and demolished. As much of Haiti’s critical infrastructure crumbled
after the disaster, the hospital pushed on by stringing up tarps outdoors and
salvaging old cribs and beds so it could continue helping patients, including
those sickened by cholera, the first outbreak in the nation in decades

Around the same time the quake hit, a Massachusetts-based organization called
Containers2Clinics (C2C) and its partners were busy overhauling two 8 x 20-foot
shipping containers into a maternal-care clinic. Founded in 2008, the nonprofit
was based on the idea that these easy-to-move industrial containers could take
on a new life as boxy hospitals-on-the-go, boosting healthcare access in remote
areas of developing nations, particularly for children and women. The prototype
container-turned-clinic was slated to go to Bani in the Dominican Republic. But
when C2C learned about the destruction at Grace Children’s, the company made a
course correction and sent that first clinic to Haiti, where it helped Grace
care for thousands of patients.

Given shipping containers’ reputation for sturdiness and longevity–not to
mention their sheer ubiquity–it’s not surprising that eco-minded engineers and
designers have been transforming the utilitarian steel boxes into all sorts of
spaces, including DIY wet labs and cozy vacation homes. Crews battling forest
fires have hauled them into the field as makeshift bunks. Retrofitted
containers are increasingly proving useful in disaster relief; they have also
have caught the attention of agencies such as FEMA and the Red Cross.

But retrofitting an old, dirty steel box into a sanitary mobile clinic requires
innovative design, precise fabrication and a fondness for using every last
square inch of a tight space. To make it happen, C2C turned to Anshen + Allen
Architects and to Stack Design Build, a construction service firm adept at
retrofitting containers. The firm’s portfolio includes the aptly named Box
Office, a three-story complex in Rhode Island made from 32 recycled shipping
containers that, among other things, serves as Stack Design Build’s
headquarters. “We got a layout of the two shipping containers, and some
very basic schematics and plans,” Andrew Keating, principal and co-founder
of Stack Design Build, says.

Shipping containers aren’t the most forgiving material to work with–space is
limited and incorrect cuts are costly. And because mobility is the clinics’ key
feature, the building specs had to stay within the “ISO
Envelope”–precise dimensions set by the International Standards
Organization that allow containers to be neatly and securely stacked for
shipping. So before putting plasma cutter to steel and busting out the welders,
Keating and colleagues plotted out every detail, down to the angle of the exam
tables. “When it comes time to take tool in hand and make a cut in a
shipping container, there’s no hesitation,” he says.

To make an entire clinic fit into two shipping containers, the first had to
include two exam rooms, similar to a doctor’s office. The second container
needed to be a small pharmacy and laboratory, equipped with a refrigerator,
microscopes and basic diagnostic equipment. The original sketches Keating
received didn’t include mechanical space, so his team needed to create a place
within the already tight confines for basic electric and plumbing systems. The
solution: Build a small partition near the far end, just in front of the
shipping container’s front door, and then sandwich the mechanical guts of the
clinic into that space. This setup ensured easy access for maintenance without
interrupting the flow of the clinic; doctors and patients enter and exit
through doors cut in the middle of the containers.

Making room for the electronics was only half the challenge. Because C2C
intends to send these clinics to remote locations, Keating built the electrical
system to handle irregular power flows and pull power from a variety of
sources. “I think the electrical system is one of the best parts of the
prototype. We came up with a system that would allow the clinic to be powered
from absolutely any source available–local grid power, any kind of generator,
or any nearby house panel,” Keating says. “The proto was shipped with
this long heavy-duty cable that extends from the clinic to whatever the power
source is going to be, and some twist-lock connectors that could plug into
anything.”

The specs for the prototype called for no air conditioner, either, and Stack
Design Build was acutely aware that a steel box sitting in the Haitian sun
would heat up quickly. To keep the clinic cool, Keating’s team applied a 2-inch
layer of closed-cell spray-foam insulation before putting up easy-to-clean
walls made from fiberglass reinforced panels. The team also added through-wall
fans powered by photovoltaic panels and passive ventilation to keep the air
moving. Keating and company applied a few coats of highly reflective white
paint and built a custom canopy.

The operational C2C prototype arrived in Port-au-Prince at the end of 2010.
Kathleen Flemming, C2C programming director, says Grace Children’s Hospital’s
staff has used the shipping-container clinic to care for nearly 4500 patients
in the roughly eight months since then. Patients receive primary and preventive
services, including vaccinations, pre- and postnatal care, infectious disease
testing and treatment, and nutrition counseling.

With its first mobile clinic a success in Haiti, C2C is scaling up. The
organization is scouting locations and securing partners for future clinics. To
increase production, C2C has begun working with Allied Container Systems, one
of the largest providers of prefabricated containers in the world. Lee Hayes, a
project manager at Allied who oversees the C2C work, says the second clinic
will be similar to the prototype, though there will be a few tweaks, including
air conditioners.

Allied is scheduled to finish its first container clinic for C2C in the coming
months, which will go to Haiti. But Hayes says demand for retrofitted
containers is growing across the board. Allied–a major supplier of containers
for the military–has been approached about retrofitted operating rooms and even
large-scale housing developments. And though C2C is focused on bolstering
healthcare infrastructure in developing nations, and not necessarily disaster
relief, its work with Grace Children’s Hospital shows that container clinics
can quickly go where they’re needed.

Considering that more than 42 million containers moved through U.S. ports last
year, the raw material is available. And we certainly know how to move them.