Constructing any major hospital is a challenge, but building a 320-bed state-of-the-art teaching hospital for $16 million in the highlands of Haiti is fraught with difficulties.

Yet the aid group Partners in Health (PIH) is doing just that, using funds that come not from the government or the United Nations but from donations collected by the Boston-based group, which has worked for 23 years to boost the capacity of Haiti’s public health sector. The materials, services and cash contributions are coming from private companies and organizations, especially from companies in the U.S. construction sector.

The hospital, which will have six operating rooms, is rising in Mirebalais, 35 miles north of Port-au-Prince. “This is one of the first major public-sector projects to start in Haiti since the earthquake,” says Jim Ansara, PIH’s director of construction on the project. Founding Shawmut Design and Construction, based in Boston, in 1982, Ansara sold the business to its employees in 2006. While he still serves as Shawmut’s chairman, his main job these days is pushing the Haiti project. “I go down every week,” he says.

This is not new territory for PIH. Prior to the quake, the organization was co-operating 12 facilities with the Haitian Ministry of Health. But the Mirebalais hospital is its biggest project yet and requires construction of a safe, sustainable, high-tech facility in rural Haiti, where materials are scarce and workers are untrained in sophisticated construction. “The first day we started to lay block,” Ansara says, “we had 1,500 to 1,800 men line up to see if they could get jobs.” Thirty were hired. “We have people who are really good at stone, masonry and tile,” he says, but not so skilled in electrical systems, control wiring, acoustical ceilings and millwork. “We are desperately trying to gather volunteers willing to go to Haiti and work for a week.”

Planning for the project predates the Jan. 12, 2010, earthquake that killed an estimated 220,000 people and flattened much of Port-au-Prince. Originally, PIH aimed to build a 108-bed regional hospital. But the quake destroyed Haiti’s main teaching hospital in Port-au-Prince, killing an entire 150-student nursing class, so at the request of the ministry, PIH scaled up plans for the Mirebalais facility. The design was donated by Nicholas Clark Architects, Chicago.

Construction of the 180,000-sq-ft teaching hospital for all of Haiti began in July. Plans call for it to be operational by Jan. 12, 2012. Despite challenging conditions, including a refugee crisis and a raging cholera outbreak that began in a camp a mile away, work is well under way. “We are about to pour our first big roof slab, which is a milestone,” said Ansara in early April. “It is a complicated slab—complicated reinforcing for what is normally done on the island. We are very particular about connections between beams and columns, which is really important seismically,”

Even with the oversight of a fairly well-trained general contractor and engineers brought in from the Dominican Republic, it is a challenge to create reinforcing plans that can be executed by untrained workers, says John Looney, principal of JML Engineering, Winchester, Mass., the structural engineer. “The labor pool in Haiti is extremely unskilled,” he says. Designs for roof slabs, such as the one about to be poured, need to be straightforward so that they can be applied to all situations. While a more complex solution may require less rebar, it is more prone to error.

Looney says the hospital’s 24-ft to 28-ft spans and load-bearing walls are unlike the 10-ft by 10-ft unreinforced modules that typically are found in Haiti. “Imagine a table with four legs on it … a building that is a concrete slab with ring beams around it and four columns. For a larger building they add more modules. To go taller, they stack them up,” Looney says.

New techniques have to be learned. In a country where even large concrete pours are hand-mixed by big crews filling and passing along buckets, the proper use of a concrete mixer became a priority. At first, Looney says, they were getting very low strength because of poor mixing. “Instead of getting 3,000 psi concrete, we were lucky to get 1,000,” he says.

Workers also had to improve their block-laying skills. “It didn’t seem to bother them that joints are 3/8 inches thick in some places and up to three inches in others,” Looney says. Now, not only is the block work better, but the walls also are vertically reinforced with rebar, bonded to columns and grouted internally to serve as bearing walls and resist lateral loads. “The idea is to train the locals in a different type of construction than they are used to and to use as little material as we could,” Looney says. “It’s been a steep learning curve.”