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GSD Students Assist in Designing Hospital Prototype in Rwanda to Reduce TB Epidemic
Collaboration with Harvard School Of Public Health/Partners In Health to Create Systematic Change in Healthcare Delivery
In Rwanda, architecture is transmitting airborne disease rather than controlling it. Ambulatory patients sit in tiny, dark, unventilated hallways waiting for consultation and care. Ward patients keep windows tightly closed and shades drawn, a cultural practice that would stump any designer. In this environment, even with UV lighting and heating, ventilation and air conditioning (HVAC) systems, airborne infection is rampant.
To create a more healing environment in Rwanda hospitals, 11 GSD students have teamed up with Partners In Health, based at the Harvard School of Public Health, The Clinton Foundation, and Rwanda's Ministry of Health, to design the Butaro Hospital, the first in the Burera region of Rwanda. The hospital aims to be a prototype of innovative health care design by seeking to reduce airborne disease transmission through architectural solutions. It is a problem that The New York Times recently mentioned is becoming a serious threat to global health.
The project will also include retrofitting existing clinics in Rwanda, to confront this problem more specifically. GSD students will turn in the finished drawings for the Butaro Hospital at the end of March 2008. Construction will begin in the fall with a local contractor and construction crew using local materials and building techniques. Professor Hashim Sarkis and Associate Professor Marco Steinberg are the GSD faculty advisors on the project.
At the invitation of Paul Farmer, MD, founder of Partners In Health; and PIH Country Director Dr. Michael Rich, GSD architectural students Michael Murphy, Alda Ly, and Marika Shioiri-Clark traveled to Rwanda in January to meet the country’s district governor, community health workers, and the minister of education, among others, to study the design challenges posed by existing health conditions.
“I saw firsthand that a patient’s itinerary and her daily comfort are architectural issues; they are culturally flexible and contextually based,” says Murphy. “In this light, architecture can help to provide a crucial missing component in the multi disciplinary fight to eliminate airborne disease--principally tuberculosis and nosocomial (hospital-induced) infection. Architects must recognize the urgency of their role as designers in helping to save lives.”
Key design components of the hospital include:
- Passive ventilation strategies, such as using clerestory (upper window) openings which promote cross ventilation
- Optimum building siting that takes advantage of wind flow, daylighting and views
- Redistribution of related program (departments/services) onto three adjacent hilltops
- Secluded and hygienic inpatient environments by locating wards around the perimeter of courtyards
- Use of exterior circulation paths
- Carefully engineered patient and staff pathways
- Terraced gardens overlooking the valley below
- Use of locally found and produced materials, including brick, masonry blocks and volcanic rock
- Rainwater collection for irrigation
Reflecting the local cultural tradition, the hospital will grow out of a community-based need for a social center where residents can come for consultation and other social services as well as health care.
Upon returning to school, the GSD students were asked to conduct several other projects. Among these were assisting in the design of a medical residence for physicians and nurses in Burundi, as well as undertaking research on airborne disease control and prevention, including the role of healthcare design, in collaboration with the Harvard Institute for Global Health at the School of Public Health. As a result, the GSD students formed MASS, (a Model of Architecture Serving Society), a not-for-profit organization [(501(c)(3) status pending] that will partner with governments and NGOs in resource-constrained areas to provide architectural design and consulting services for healthcare facilities and other civic building infrastructure.
“The problem of airborne disease in developing countries is so huge and complex that a multidisciplinary approach is the only way to address these issues,” continues Michael. “We believe that architecture can save lives through effective healthcare design, but we also understand that any effective solution must include cooperation with governments, local constituents, NGOs, and other designers. To this end, MASS will take a holistic, systems-based approach to improving global healthcare through design.”
The GSD students have received financial support through the GSD from the International Community Service Fellowship, the Paul M. Heffernan Travel Abroad Scholarship Fund, and the Aga Khan Foundation Travel Grant.
For additional information on the Butaro Hospital project and other MASS projects, visit www.mass-group.org.
images courtesy of MASS:
1. Rendering of the entrance to Butaro Hospital upon completion
2. Present site of proposed entrance to the hospital
3. Michael Murphy, Alda Ly, Marika Shioiri-Clark, and Dr. Paul Farmer on the Butaro Hospital project site in January, 2008