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A  few days after Haiti’s catastrophic earthquake in 2010, Jim Ansara arrived at the damaged General Hospital in the hard-hit capital of Port-au-Prince to assist with medical relief efforts. In the quadrangle, he came upon a shocking scene—more than 1,400 seriously injured Haitians lying on the ground in pain.

“People were just pouring in night and day with injured or dead relatives and friends,” says the veteran buildings contractor, based near Boston. “It was chaos.”

On his first trip to Haiti in 2009, Ansara was appalled by the poverty. But those desperate circumstances paled by comparison to the horrors endured by nearly 10 million Haitians after the Jan. 12 quake, which had killed an estimated 300,000 people and injured another 300,000.

Ansara assisted with all forms of medical relief in the aftermath of Haiti’s destructive 2010 earthquake.
Photo courtesy BHI

Intent on repairing the hospital’s main generator, Ansara had to go back and forth across a parking lot covered with lifeless bodies of men, women and children, in various stages of decay. To focus on the fix, he became desensitized to the carnage, but he says he never became desensitized to the “absolute agony and trauma” of the survivors.

To get to Haiti after the quake, Ansara had first flown from Boston to Fort Lauderdale, transporting 5,000 lb of medical supplies and equipment. In Florida, he found a pilot who would fly a cargo plane to the shuttered Port-au-Prince airport. But first, he raced to Home Depot to buy hacksaws, chisels and hammers for the two surgeons flown into Haiti on a private plane a couple days earlier, who were operating using head lamps because there was no power.

“It was Civil War medicine,” says Ansara, who in 2010 was still chairman of the board of Shawmut Design and Construction, which he founded in 1982 and sold to his employees in 2005. “Not only did I see many amputations up close, I got to hold instruments or retract occasionally when they were shorthanded,” he adds.

Ansara’s previous trip to Haiti in 2009 was as a volunteer for the nonprofit Partners in Health. When the quake hit, he was about to begin construction of a 100-bed community hospital in Mirebalais at the request of Dr. David Walton, a Haitian native who then worked in Boston for PIH. Walton, who flew to Haiti the day after the quake via the neighboring Dominican Republic, had insisted that Ansara join him in Port-au-Prince.

While in Port-au-Prince after Haiti’s 2010 quake, Ansara fixed the generator at the General Hospital (top right). His witness to the carnage (top left) inspired him to build the modern Mirebalais hospital (bottom), which in turn laid the foundation for Build Health International.
Photo upper left AP Photo/Francois Mori; upper right and bottom courtesy BHI
*Click on the photos for greater detail

Working full tilt for several weeks, Ansara was constantly dehydrated, hungry and exhausted—at first sleeping in a car, then on lawns in a safer neighborhood. He ultimately got the generator going and set up an emergency operating room. Yet instead of a sense of accomplishment, he felt “deep frustration, shame and impotence” at his inability to do better, more quickly, he says.

“People died because of my ignorance of Haiti, including the Creole language, and my inability to muster resources and get the work done,” Ansara adds. 

“The entire experience—the Haitian inertia and hierarchy, the utter ineffectiveness of the international aid community, the arrogance of the U.S., French, Canadian, Japanese and Spanish governments but most of all my own ineffectiveness—made me laser-focused and obsessively determined to build a new hospital that would defy all that negativity and show what could be done,” he says. 

And build a hospital he did, in collaboration with Walton and PIH. Walton and Ansara were propelled by the grandiose scheme of the late global health visionary, Dr. Paul Farmer, PIH’s co-founder and chief strategist, who also went to Haiti after the quake. Farmer’s sudden death from a cardiac event on Feb. 21 at age 62 sent shock waves through the public health community.

Rather than an incremental expansion of the Mirebalais community hospital, as envisioned by Walton and Ansara, Farmer insisted on a 300-bed teaching hospital that would offer a dignified, energy-efficient and quake-resistant setting for patients and clinicians.

Building a self-sustaining hospital seemed like an impossible dream. But Walton and Ansara plowed ahead.

According to Jim....

Farmer (second from left), who died Feb. 21, flanked by Ansara (left) and Walton and with PIH co-founder Ophelia Dahl. Farmer inspired the creation of the Mirebalais hospital.
Photo courtesy BHI

Ansara on Paul Farmer:

“In the week following the 2010 Haiti earthquake, as Dr. David Walton and I worked on supporting medical relief efforts at the General Hospital in Port-au-Prince, I experienced for the first time Dr. Paul Farmer’s true superpower and unique genius—his ability to be audaciously and unyieldingly unreasonable.

Paul rushed to Haiti a few days after the earthquake, despite having just had knee surgery after being struck by a car. That evening, as we started to discuss the disastrous state of Haiti’s post-earthquake health system and how Partners in Health could help rebuild, we broached the idea of redesigning our 100-bed community hospital in Mirebalais to be a larger referral hospital.

Paul, as was his way, immediately dismissed our thoughts as to how we might add additional beds or clinical services as too timid and narrow in focus. Instead, he began to talk about building a new national teaching hospital that would not only be 400% larger than our current plan, but would be beautiful, dignified and include state-of-the-art equipment and a robust teaching component.

He then took it a giant step further and said that we would build the hospital in six months or less. From my vantage point in post-earthquake Port-au-Prince, surrounded by total chaos and devastation, no heavy construction equipment available and a traumatized population with a decimated central government, this entire venture seemed to be ludicrous and fueled by hubris.

But Paul’s directive to us was to go design and build the biggest and best hospital possible, as quickly as we could. And we did. The hospital was not finished in six months, but Paul forgave us.”

Excerpted from WBUR’s Cognoscenti: What I Want People To Know About Paul Farmer, by Jim Ansara

Ambitious Undertaking

The ambitious undertaking was full of roadblocks. There was no local skilled labor or heavy equipment. There was no supply chain for tools and materials. The roads were often impassable. Violent gangs ruled. And the Dominican contractor deserted two-thirds of the way through the job. 

“Jim thought Mirebalais would be hard, but it blew us back on our heels,” says Walton, currently associate physician at Brigham and Women’s Hospital in Boston and senior director of global health for the Butterfly Network, which makes medical imaging accessible to all. “But giving up was not [an option], so we dug in our heels,” Walton adds. 

In 2012, Ansara and Walton completed the Hôpital Universitaire de Mirebalais. It has solar electrification, seismic resistance and wastewater treatment. 

“We were able to finish most of construction” before the start of the other major hospital projects being built by international agencies and governments,” says Ansara.

Based on their exponential learning curve at Mirebalais, which opened in April 2013, Walton and Ansara hatched their own grandiose plan during late-night talks in their shared single-room “bunker.”  They would form a nonprofit, name it Build Health International (BHI), and construct health care facilities in impoverished areas.    

Ansara built up Shawmut’s reputation by executing difficult renovations, speedily. Many early jobs were for Harvard University.
Photo courtesy Shawmut

In those days, “we were in a minority in thinking about the importance [or the possibility] of quality medical infrastructure in resource-limited settings,” says Walton, BHI’s CEO from 2016-19 and its current advisor. 

The Beverly, Mass.-based BHI, formed in late 2013, is unique. A full-service nonprofit focusing exclusively on low-income nations, its mission is to enable clinicians to provide “dignified and high-quality health care, regardless of a patient’s ability to pay.”

With help from 34 nongovernmental organizations, 25 funding partners and U.S. contractors and suppliers that offer in-kind services and supplies, BHI’s portfolio has grown to 223 medical infrastructure projects—planned, underway or completed—at facilities in 28 nations in Latin America and sub-Saharan Africa. It has organized donations of $1.2 million worth of medical equipment, provided 2,239 hospital beds, installed solar arrays that generate 1.4 MW of power annually and trained 1,300 local workers (read the article here). 

For his unswerving dedication to health care access for the needy; for enabling clinicians to save thousands of lives; and for the creation of a replicable model for sustainable and resilient medical infrastructure in impoverished regions, the editors of Engineering News-Record have named Jim Ansara the winner of the 2022 ENR Award of Excellence. 

“There’s just so much good that’s happening from the work of BHI and Jim,” says Conor Shapiro, president and CEO of Health Equity International. The nonprofit provides health care in Haiti, primarily through St. Boniface Hospital, which BHI has transformed. “Jim could be retired on a beach somewhere, but instead, at 11 p.m., he’s trying to fix our generator while on FaceTime with our team in Fond du Blanc,” he adds.

 “I can’t believe what Jim’s been able to pull off,” says Neil Lemieux, director of preconstruction at Columbia Construction, which has given BHI salvaged wooden doors and frames, casework, used tools in need of repair and even lightly worn hard hats and vests. “Jim has everything figured out,” Lemieux adds.

Joe Speicher, head of impact at Autodesk, which supports BHI in many ways, says, “Jim is the ultimate human-centered designer. His team considers the whole system—the social and the environmental.” 

Ansara’s boosters describe him as a hands-on problem-solver and a team player. They say he is humble, authentic, generous, compassionate and committed. He is also sharp, down-to-earth, energetic, fair and playful. 

Omar Hernandez, BHI director of construction and engineering, met Ansara on the Mirebalais project. “He has such a big heart,” says Hernandez, who moved to the U.S. from his native Dominican Republic with Ansara’s help, to get treatment for his son who has cerebral palsy. 

Ansara’s fans also describe him as dogged, intense and impatient—at times to a fault. “Jim’s always been somebody with an enormously high sense of urgency,” says his brother, Michael, who is his senior by a decade. Michael inadvertently launched Ansara’s career in construction by giving him a pro-bono summer job remodeling his kitchen.  

Young Jim (crouched in top right photo), with his brother Michael (second from right). Baby Jim with his family (top left). Father Jim with his wife Karen and children (from left): Lucia, Maria, Alicia and Michael.
Photos courtesy BHI
*Click on the photos for greater detail

Ansara views his younger self as arrogant. He maintains he can still be overwhelming and domineering if he is anxious, amped up or irate. “I’m trying to treat everybody better,” he says. “I haven’t always done a good job at that, especially when I was running Shawmut.”

He might not have treated all people well, but he has long treated all people equally, regardless of their station. He credits his late mother, Alice, for setting the example.

“My mother was indignant about inequity,” he says.

Ansara also credits his mother for a “relentless” work ethic. In his youth, when money was tight, Ansara recalls her working through the night editing educational journals. As BHI managing director, he works 12 hours a day for six days, and half a day on the seventh. His only pay is 80% of his family’s health insurance. 

The youngest of three siblings, Ansara spent much of his youth living as if he were an only child. His late father, James Michael Ansara, who died in 1983, was a first-generation Lebanese Christian, born into an unassimilated family. In 1931, he graduated from Harvard University. “At that time, that was very unusual for someone from an immigrant family,” says Ansara, who turns 65 on May 24.

Ansara’s parents, who met in the 1930s, lived as Bohemians. His father was an aspiring novelist and his mother, a Communist, was an artist and artist’s model. According to her son Michael, she posed for Speedy Angels, a Joseph Colletti frieze that still graces the portals of Boston’s Sumner Tunnel. 

Though from a Jewish family, which prompted a rift with her in-laws, Ansara’s mother denied her heritage. Instead, she concocted a tale that she was descended from Russian aristocrats, according to Michael Ansara, the family historian.

According to Jim....

Ansara (center) credits the late Tom Feeley (left), an outside advisor, with saving Shawmut from bankruptcy in the mid-’80s. The two, pictured with Chett Walsh, became fast friends.
Photo courtesy Kelly Feeley

Ansara on Tom Feeley:

“One of the most underrated but essential elements in successfully growing a business is having outside advisors blunt enough to tell you the hard truth. I was lucky enough to have Tom Feeley to tell me, at every critical juncture at Shawmut, exactly and in very clear and unequivocal terms what he thought I should do. He pushed me relentlessly.

We met in 1982, when I was applying for my first bank loan to buy an old mill building. The bankers asked to look at my balance sheet. Not knowing what that was, I handed them my checkbook. I got the loan, on the condition that I hire a CPA.

One suggestion was Tom. He was animated, aggressive and brash. He said Shawmut was headed for catastrophe, but he could help us. And he would only charge us $25,000 for the first year.

At the time I paid myself $100 per week, so $25,000 seemed like a fortune. I thought to myself, “Well, it will be a cold day in hell when I call that jerk and pay him all that money to tell me what a loser I am.”

That cold day soon arrived. Somehow, I managed to lose $660,000 on $2 million in revenue. We were headed for bankruptcy.

I was devastated. On the urging of my older brother, I reluctantly called Tom, who then laid out a simple plan to save the company.  In our next meeting with our bankers, they were worried they had no choice but to put Shawmut into default. Tom convinced them to give us 30 days to regroup.

Six months later, after following Tom’s strategy, we had made back $400,000 of the $660,000 by putting in the internal controls and systems that Tom had relentlessly pushed for since our first meeting in 1982. By the end of the next fiscal year, we had billed $6.8 million and made back all of the loss, plus another $500,000.”

Excerpted from Who Will Tell You the Truth (when you don’t want to hear it)? by Jim Ansara

Jim Ansara didn’t know his mother was from a Jewish family until after she died in 1981. He does, however, have vague early childhood memories of experiencing Jewish customs during visits to his grandparents. When questioned about his Jewish uncle, a cardiologist in Boston, his mother claimed her brother had converted. 

During World War II, Ansara’s father failed his army physical. In 1943, the Board of Economic Warfare recruited him to Washington, D.C., because he was fluent in Arabic. After the war, he moved to the State Department. In 1947, Ansara and nine colleagues were summarily fired as security risks. 

“The only common factor for the 10 was that they worked closely with Robert Miller,” a suspected but never prosecuted Soviet spy, says Michael Ansara, a retired political activist. Several years later, their father was accused of having been a spy. After an exhaustive multiyear investigation, the FBI turned up no evidence of espionage, says Michael. “His firing and the investigation were crushing blows for him, and in many ways he never recovered,” he adds.

The Ansara family eventually moved back to the Boston area. There, James Michael  had a series of failed jobs, including as a taxi driver, until the first of a series of heart attacks, in 1964. After that, he never worked.

“I had a complicated relationship with my father, who was very unhappy because he did not accomplish great things,” says Jim Ansara. “I’m sure in some way that drove me to want to achieve things and be recognized.” 

After 1964, home life was tense. Ansara’s mother, who had not gone to college, was always trying to make ends meet. Ansara recalls constant money struggles, many moves and even a couple of evictions, though he always had food, clothes and a roof overhead. And his mother, who ultimately became a nationally recognized authority on teaching students with dyslexia, was “fierce” about finding her youngest child opportunities to thrive.

Though a voracious reader, Ansara found school tedious. Sports, beginning in junior high, helped him escape his family’s troubles. He spent his senior year and a post-graduate year of high school on scholarship at the prep school Choate, playing hockey. “I wasn’t a gifted athlete but I outworked everybody,” says Ansara, who adds that he left adolescence with a chip on his shoulder.

He had troubles fitting in at Brown University. He quit and soon enrolled at Amherst College.

Coming up is a maternal center in Sierra Leone.
Rendering by ArtPixel 3D Designed by BHI

In the summer of 1979, during the remodel of his brother’s kitchen, Ansara was more interested in Karen Keating, his brother’s assistant, than in the job. “Karen had a tremendous influence on me,” says Ansara. “She always puts other people first and is collegial and collaborative.” They married in 1983. 

When September rolled around, Ansara stayed in Boston with Keating, doing small jobs while still enrolled at Amherst. Eventually, a professor noticed his truancy. For that reason and other infractions, he got expelled. Yet in 2015, Amherst granted him an honorary degree.

When he started Shawmut, Ansara was flying by the seat of his pants. “The first 10 years, we were constantly reinventing the wheel,” he says. 

Ansara’s first commercial job was Steve’s Ice Cream shop in Boston. He promised to complete the renovation in 10 weeks, with a $500-per-day penalty if late and a bonus if early. “I had an unbelievable advantage” over others, who said it would take 16 to 18 weeks and cost twice as much, he recalls. “I was self-taught and didn’t know any better.”

His crew did finish in seven weeks, working almost nonstop. The income provided enough money to incorporate Shawmut in 1982. 

Shawmut’s first big commercial job was at the Harvard Faculty Club. Ansara pledged to complete the renovation over a summer. Other bidders said it would take one year. His crew finished the job on time, again working nearly 24/7.

Carving Out a Niche

Shawmut soon carved out a niche: small “horrendous” commercial renovations that nobody else wanted. Ansara says the firm never would have thrived if not for the late Tom Feeley—a CPA outside advisor who rescued the company from bankruptcy in the mid-1980s.

Shawmut’s CEO Les Hiscoe, who joined the firm in 1998, says Shawmut, with $1.3 billion in 2021 revenue, still has Ansara’s “get-it-done-whatever-it-takes culture.”  

After 20 years at Shawmut, Ansara decided he needed a big change. He wanted to spend more time with friends and, especially, with his wife and their four young children.

Patients wait for hours at St. Boniface Hospital
Photo courtesy BHI

Using half the proceeds from the 2005 sale of Shawmut to his employees, the Ansaras formed a foundation they would eventually use to start and endow BHI.  Ansara views Shawmut as preparation for his true calling as a philanthropist. “We owe a debt to people who don’t have opportunities and advantages,” he says.

Ansara has a growing following. “Whatever Jim and BHI need, I’m at their service,” says Andy Leonard, the owner of WW Contracting Corp., an excavator and BHI’s long-time trade partner in troubled areas, starting with Haiti. “When I get to a place, I can’t wait to get back,” he says. “When I get back, I can’t wait to go back.”

Mark Richey, president of Mark Richey Woodworking and a BHI trade partner, adds, “If you tell Jim Ansara there’s something he can’t do, he will find a way.” 

Richey echoes the sentiments of others when he says, “We need more people like Jim.” 

Concentrating on the Next Chapter

BHI's staff is focused on providing a written record of lessons learned doing hospital construction in regions with limited resources.
Photo by Bruce Buckley for ENR

Since the death in February of Partners in Health’s visionary, Dr. Paul Farmer, Build Health International’s Jim Ansara is hyperfocused on passing along BHI’s institutional knowledge about delivering quality medical infrastructure for the needy.

“Paul’s death at 62 made me feel my age,” says Ansara, the nonprofit BHI’s co-founder and managing director, who turns 65 in May. “I am now concentrating on building BHI for the chapter beyond me.”  

Ansara already had the next generation on his mind. An example is Sarah Sceery, who joined the Beverly, Mass.-based BHI a year ago. Her role quickly expanded from development to partnerships, public policy and nontechincal operations.

Going forward, Omar Hernandez, director of construction and engineering, and Gerard Georges, director of architecture, have the technical slots covered. All three are committed to the cause. BHI’s work is “changing the landscape of global health,” says Sceery, director of external relations and engagement. 

Another preparation for the future is to pass down all that has been learned about the work. In 2020, BHI and Autodesk published the first version of the 175-page How We Build. Primarily for novices, the illustrated primer touches on every aspect of building medical infrastructure in places with broken supply chains, few resources and mostly unskilled labor.

In response to COVID-19, BHI wrote a 30-page Coronavirus Treatment Center Guide in collaboration with Partners in Health. BHI also is sharing its plans and drawings for COVID-19 treatment centers in any low-resource setting.

COVID-19 resources are based on BHI’s experience. In 2020, it led construction, from afar, of Southern Haiti’s first COVID-19 isolation wards, at the St. Boniface Hospital. The job was done in two weeks. A new treatment center at Hôpital Universitaire de Mirebalais added 100 dedicated COVID-19 beds, each with a wall-mounted oxygen connection. 

In Africa, with the DAK Foundation and other members of the Every Breath Counts Coalition, BHI is conducting  rapid, independent assessments of broken medical oxygen plants for all respiratory illnesses. The ultimate aim is to fix them.

Among BHI’s standard projects that continue is Sierra Leone’s 55,000-sq-ft Maternal Center of Excellence. But the 55-person BHI, just 35 people a year ago, needs help with funds and more to expand further. “I hope more companies will get on board, donating materials and sending volunteers,” says David Rothberg, chairman of Laticrete, a BHI partner that makes flooring adhesives. “It’s the right thing to do and good for morale.”