All in This Together At the beginning of this year, few of us could have foreseen how quickly our lives, both personal and professional, would be transformed by the COVID-19 crisis. In the midst of the upheaval, the pandemic has forced us to re-think the ways in which we work, and has also led us to surprising and exciting opportunities to collaborate across international borders as designers look for ways to address critical issues of infrastructure and design. When colleagues at Mazzetti asked LS3P to join an effort led by the World Health Organization (WHO) and the International Federation of Healthcare Engineering (IFHE), we were honored and humbled by the opportunity to help. The directive was to present strategies for circulation, physical distancing, PPE, and ventilation for an existing healthcare facility in Dedougou, Burkina Faso to prepare for a potential influx of COVID-19 patients. The urgency of the situation was reflected in the ambitious timeline- eight days from kickoff meeting to final draft. The exchange of information was rapid as we conducted a “deep dive” into cultural and site conditions. Bolstered by an initial WHO training session and existing protocols for drawing standards and formats, we worked with our partners through virtual meetings to develop a targeted plan to provide safer spaces for COVID-19 diagnosis and treatment using readily available materials, technology, and on-the-ground expertise. We began with very basic information, including photos of the site, elevations, and floor plans. We developed a long list of questions: what were the funding sources available? What is the standard of care? What construction resources are available? How does the facility currently operate? Conversions between metric and imperial measurements, and from French to English, added layers of complexity on a tight timeframe, but together the team was able to achieve a quick turnaround and viable solutions for the clinic. Program spaces included treatment areas (mild to moderate, severe, and critical), laundry, restrooms, offices, donning/doffing areas, morgue, incinerator, and circulation. The team used existing information to analyze flow of patients and providers to minimize opportunities for cross-contamination. The design included new strategies such as the addition of double doors for separation of staff and patients and clean/dirty areas. The existing facility relies on natural ventilation; the design proposes a hybrid system with natural ventilation with mechanical exhaust to keep clean air flowing into patient rooms and prevent contaminated air flowing back into corridors. Staff areas are constrained, but the design directs staff, patient, and visitor flow for maximum efficiency and safety as well as strategic use of PPE. Staff can observe patients from a central corridor to reduce donning and doffing needs. Cultural considerations greatly impacted the decision-making process. While in many countries visitors to COVID-care units are prohibited, the team determined that in Burkina Faso, family members are considered to be critical to recovery and therefore visitors would be strongly encouraged to visit (albeit with PPE, physical distancing and other safety protocols). The design accommodates visitors with dedicated circulation routes in and out of the facility depending on the patient level of acuity. Our very positive experience with the Burkina Faso project has led to opportunities to mentor other international teams participating in the same process for other facilities in Brazil. As we await updates on our project from the field, we are optimistic that similar efforts by firms working around the globe are having far-reaching positive impacts, one clinic at a time. We are truly all in this together, and our success at navigating the COVID-19 crisis globally will depend upon our willingness to collaborate across borders and explore new avenues for treatment and recovery in diverse locations from next door to half a world away. About Kristie Kristie Nicoloff, an award-winning, nationally accredited designer with over 23 years of healthcare experience in interior design and facility project management, serves as Healthcare Sector Leader for the Greenville office. Kristie’s previous professional experience includes project management and design while working as a Senior Project Manager and Space Planner at major healthcare systems in Asheville, NC and Greenville, SC; she has also worked as an interior designer at firms in North Carolina and Illinois. Kristie is actively engaged in community and professional service as a member of the IIDA Carolinas Chapter, and has served on the Board of Directors in various roles at the Vice President level for 10 years and volunteered with multiple Upstate universities as an adviser for program accreditation review and in student reviews. Kristie is an avid supporter of the Girl Scouts of America, having served at the local troop level and the Service Unit level for the past decade.