Solving The Most Pressing Social and Urban Problems Of The World

Architecture has yet to emerge as a keystone in solving the world’s most pressing social and urban challenges. Architects who aspire to produce a positive social impact often find themselves confined to the discipline's limited boundaries. When does design truly serve as a tool used for making the world a better place rather than for just turning profit? The case of Butaro Medical District, designed by MASS Design Group, greatly exemplifies a moment in which innovative design was a driving force for positive humanitarian impact. What ended up as an autonomous medical district in Rwanda started with an inquiry by Michael Murphy during a Paul Farmer lecture at Harvard University.

In 2006, Murphy, approached Paul Farmer, chief strategist and co-founder of Partners In Health, and chair of the Department of Global Health and Social Medicine at Harvard Medical School after a lecture at Harvard. The aspiring social entrepreneur asked which architects Dr. Farmer had worked with to build the clinics, housing, schools and even the roads he had described in his talk. Murphy was hoping to learn from the humanitarian architects helping Dr. Farmer fulfill his vision in Africa. Dr. Farmer revealed however that he has not been working with designers and that heI drew the last clinic on a napkin. Soon after, Partners in Health brought in the newly founded MASS Design Group to design the Butaro District Hospital in Rwanda. Michael Murphy developed an understanding of complex social and urban issues during his years growing up in Poughkeepsie, New York. A once bustling town, more than half of the buildings in Poughkeepsie are boarded up today.

The “urban renewal” approach which drove several government decisions in the 60s transformed a lot of fringe cities like Poughkeepsie to the worse. This was mainly due to the desire to create faster inroads and outroads to the city to allow people to move from the downtown area into the more suburban lifestyle and move through the city at a much faster rate. Consequently, the city was no longer walkable, making it much harder to move through the city and access the businesses on main street. Such context drove Michael’s unique awareness of, social justice, diversity, and identity. Additionally, Michael’s time studying literature at the University of Chicago allowed him to investigate issues involving politics, anthropology, and human rights. When michael arrived to the Harvard Graduate School of Design in 2006, he was ready to explore how his humanitarian background would intersect with architecture to create social impact, a goal he achieved through his partnership with Dr. Farmer that same year.

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Running in parallel with Michael’s path to Harvard, Rwanda was facing an uphill climb in the recovery of its economy, politics, and health system post-genocide. Rwanda, a small, densely populated country the size of Vermont, witnessed Africa’s largest genocide in modern times. The magnitude and intensity of the mass slaughter resulted in a challenging road to recovery. But over the past 15 years or so, Rwanda has built a near-universal health care system that covers more than 90 percent of the population, financed by tax revenue, foreign aid and voluntary premiums scaled by income. The Rwandan Constitution of 2003 formalized the inalienable right to health. Soon after, the community-based health insurance and performance-based financing systems were each piloted in three of the country’s 30 districts and evaluated before being scaled up nationwide in 2004 and 2005.

As late as 2008, the Burera District in Northern Province of Rwanda was one of the last two districts in the country without a functioning hospital. The population lacked access to a single doctor. Consequently, Burera District had very poor health indicators compared to other areas of Rwanda. In late 2007, Partners In Health began working in with the Government of Rwanda to rebuild the Burera district’s health system. And in 2008, MASS Design Group was brought in by PIH to help plan and design a first-rate facility that would help reverse these conditions. Partners In Health has served as the main contractor for the hospital construction. Volunteer architects from MASS Design Group created the site design and provided on-site supervision of construction activities.

In January 2011, the Rwandan Ministry of Health and Partners In Health (PIH) opened the 140-bed Butaro Hospital in the Burera District of Rwanda. Architecture and design’s role in this project was not just limited to building four walls and a roof that could host a hospital. The design was carefully created based on medical and architectural research, careful observation of other hospitals on Africa and the world, and by upholding the premise that a building doesn’t stand alone, but exists in a particular context.

Since a hospital is by definition a place for healing, MASS Design Group decided that the physical form of the hospital should contribute as much as possible to that process. Special attention was given to air circulation to avoid the transmission of airborne diseases; interior corridors were eliminated, wards were designed to have louvered windows and large, slow fans were included. On top of tham, the floors were covered by a continuous, non-permeable material, to avoid bacteria from growing in joints and facilitate its disinfection. Germicidal UV lights were also placed in the ceilings to avoid bacteria growth on hard to reach places. The gardens have semi permeable surfaces that avoid the formation of pools of water that could also host bacteria.

However, the architects and designers were not content with just aiding in the prevention of disease spreading, and decided to also include health promoting features in the hospital. In order to improve the mood of the patients, reduce stress and pain perception, the landscape was planned to be a welcoming, calming, beautiful space that would incentivize patients to spend time in nature. The interior layout also allows for all patients to have a view of the landscape, instead of facing walls or other beds. Every aspect of the project’s design was thought at a human-scale, with the person as the main focus of all decisions. On top of that, the implementation phase was also seen as an opportunity to involve the community, to give even more to Butaro that just the one project, in the form of skill training, recognition of local traditions, economic development and empowerment, and a sense of ownership over the new hospital.

To achieve this goal, MASS Design Group decided to employ 100% local labor, and to do so by assembling six teams of workers on two-week shifts which allowed them to give jobs to six time as many people. On top of the usual wages, workers also received benefits like water, food and healthcare. In the end, almost 4 thousand local residents worked on the construction of the hospital and all of them received training in excavation, construction, crafts and management.

Under this model, the hospital is no longer just a service that the government or a private entity introduces in a community, but the residents can really feel ownership and co-responsibility of the institution. It builds trust in “modern medicine” in a context where there has been little penetration of it, and contributes to save lives not just by bringing healthcare but by building bridges for people to seek such care. Once the project is done, not only will Butaro residents have a new Medical Center, but many of them have now acquired skills that they can use to seek better employment, like volcanic rock masonry and compressed-earth-block creation. The significance of the project lies beyond the building. By initiating one project in the Burera District, several components followed to form a self-sufficient, human-centered entity which would become a major healthcare destination in Africa.

Following the Burera District Hospital, the Butaro Doctors’ Housing was designed to attract and retain skilled physicians at the new hospital. This effort was followed by the Butaro Cancer Center for Excellence, the Butaro Oncology Support Centre, and the University of Global Health Equity, reflecting Mass Design Group’s intention to aggregate several interrelated components into a system that would help the Burera district sustainably develop and grow. But once again, MASS Design and the Government of Rwanda were not satisfied, and decided to push further by also opening an Architecture school in Rwanda. In doing so, the hope is that future doctors and architects won’t have to come from other countries (even though we have seen in this project that such endeavors can be very successful), but Rwandans themselves can learn and work for the improvement of their country from these positions.

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