Building health in Rwanda
Boston architects combat disease - with a bold hospital design
FOR YEARS, doctors working in Africa have been wrestling with a problem: the hospitals were making people sicker. A patient brought in with a broken leg might die of extremely drug-resistant tuberculosis, having contracted the disease in the hospital. Traditionally, this would be viewed solely as a public health problem. But a group of young Boston-based designers have come up with an innovative new solution: architecture.
In 2006, Michael Murphy, an architecture student at Harvard’s Graduate School of Design, went to hear a speech by Dr. Paul Farmer of Partners in Health, and was intrigued by Farmer’s plans to build a hospital in Rwanda in a district that had a population of 340,000 and no doctors. “Who is the architect?’’ Murphy asked Farmer after the talk. Farmer said there wasn’t one; he and his colleagues had sketched the hospital’s plans on a napkin. Murphy volunteered to help, and traveled to Rwanda. He was joined on the project by his Harvard classmate Alan Ricks and other members of their MASS Design team.
The designers quickly realized that the challenge was not simply to draw up plans, as they had first thought, but rather to understand the spread of airborne disease and design a building that would combat - and in some cases sidestep - the unhealthy conditions common to so many hospitals.
Learning from health care workers that hospital hallways were known sites of contagion, poorly ventilated, and clogged with patients and visitors, MASS Design decided that the best solution would be to get rid of the hallways. Taking advantage of Rwanda’s temperate climate, they placed the circulation outdoors, designing open verandas running the lengths of the buildings. Color-coded interior walls showed illiterate visitors where to go, and minimized the chance that contagious patients would accidentally wander into wards where they didn’t belong.
MASS Design also re-thought the traditional configuration of the wards. Instead of placing the heads of the beds against the outside walls, the designers positioned the beds against a low partition running down the center of the ward. Removing the beds from the perimeter allowed for large windows; patients could look out at the landscape, and ventilation was significantly improved. The partition was designed to house electrical systems and oxygen, and to be adaptable to future technological upgrades. Large fans, vents placed just below the ceilings, and germicidal ultraviolet lighting fixtures further improved ventilation and cleaned the air. And, in their quest for natural ventilation, the designers recommended siting the hospital on a high, breezy hill that was being used by Rwanda’s military - and the military agreed to move.
When it came to building, MASS Design looked at the Partners in Health model of involving local poor communities in health care, and realized that they could apply the same ideas to the construction process. The hospital was built entirely using local labor, providing food and health care for the workers. Unskilled workers received training that would help them get more work; and skilled laborers, notably the Rwandan masons who built the hospital’s exterior from carefully fitted together local volcanic stone, refined their craft and found themselves in demand all over the country. The construction process also beefed up local infrastructure - new roads and a hydroelectric dam - creating more jobs and literally paving the way for future projects.
According to Murphy and Ricks, all over Africa one finds the shells of disused hospitals, built by outsiders with lots of money, new equipment, and good intentions, but with no local involvement. The goal in Rwanda was to create a hospital that would be a part of the community even before it opened - and would be sustainable not just in environmental terms, but also as a long-term source of health care, jobs, and infrastructure for the local community.
Architecture isn’t just an aesthetic product - beautiful buildings - it’s a process of problem-solving. All buildings solve problems in some way, whether the problem is how to contain 60 floors of office workers or how to showcase works of art. But we don’t usually think of buildings as a means to address infectious disease or endemic local poverty. Murphy and Ricks show us in fresh, startling ways the scope of the problems architects may help to solve in the future - producing not only buildings, but improvements in people’s lives.
Joan Wickersham’s column appears regularly in the Globe. Her website is www.joan wickersham.com.