You are sitting at your desk with a paper and pencil. You draw a rectangle on the paper and start looking at it from different angles. It represents the layout of an operating room. You draw a larger box around the inner one. This represents the whole perioperative area. What do you put inside these boxes? How many water stations do you need? Hand washing basins? What about oxygen pipes or electrical outlets? Or back-up generators for the unstable electrical system in the low-resource setting? These are all things Jim Ansara and his team and Build Health International (BHI) are trying to tackle – creating low-cost but robust surgical facilities in places like Haiti. Listen in as we discuss the complex planning that is required for the design, construction, and maintenance of surgical facilities, infrastructure within health systems, and creating sustainable teams (both construction teams and surgical teams!). We are sure you will learn a lot about what goes on behind the scenes in the creation of medical structures and things you should think about as part of the surgical workforce using these facilities – we know we did!