To say that Butaro, Rwanda, was inadequately served in terms of health care is to make an understatement. Before the Boston-based nonprofits Partners in Health and MASS Design Group completed a hospital there in 2010, the entire 320,000-person Burera region of Rwanda had no hospital and only one physician. Working with the Clinton Foundation and the Rwandan Ministry of Health, Partners in Health selected the district for intervention. Now the hospital has eight permanent doctors and attracts some of the top medical-school graduates from the National University of Rwanda as residents.
Location Butaro, Burera District, Rwanda
Gross area 65,014 ft2 (6,040 m2)
Cost $4.4 million
Program (phase 1) 155 beds, two operating rooms, laboratory, delivery, maternity, ER, 10 isolation rooms, referral rooms, X-ray, mental-health clinic
TEAM & SOURCES
Fans Big Ass Fans
Lighting fixtures Lumalier
Cladding, windows, doors, skylights, cabinetwork Custom, fabricated on-site
The doctors live in a new complex of houses that were completed in December 2012 as phase 2 of this growing project. An outpatient cancer center is now under construction, and phases 4 and 5—a housing complex for visiting clinicians and a tuberculosis ward—are being planned. Meanwhile, Butaro Hospital has become the hub for a network of 15 health centers and over 1,500 community health workers that reaches every village in the district.
"Mortality of children under 5 years old has declined by 65 percent, and maternal mortality has been cut in half," reports Jamie O'Neill, Rwanda external-relations coordinator for Partners in Health. These dramatic improvements are only partly attributable to newly available health care, however. Both the hospital itself and a hydroelectric project that supplies electricity to the hospital and the surrounding area have spurred economic growth, with a visible change in the quality of housing and availability of jobs. "A place that was once left behind, Butaro is now a destination for families from around the country and beyond, seeking care for cancer and other diseases, as well as a livelihood and all-around prosperity," says O'Neill.
The hospital was also designed to provide a healing environment, with extensive natural ventilation through louvered windows, large fans in every ward, and outdoor waiting spaces. The open-air corridors and windows in each room give staff and patients alike a direct connection to the outdoors.
Research on the effectiveness of these strategies at improving healing and reducing infection in Butaro is just getting under way, but the local team is convinced that they "keep the hospital feeling fresh, clean, and free from your typical hospital smell," according to O'Neill, and that they help prevent the spread of airborne diseases such as tuberculosis. And the project has convinced Partners in Health of the value that good design professionals can bring to their work throughout the developing world.
MASS Design Group and Partners in Health paid as much attention to how the hospital was constructed as they did to its design. Overall, they estimate that more than 2,000 locals learned new skills in the construction of Butaro Hospital, and about $550,000 was distributed into the local economy through the use of local labor. They intentionally rotated labor crews to spread the economic opportunity as widely as possible, developing programs that led to the training of over 275 people in the subsequent doctors' housing project (see graph). These economic-development and training programs have expanded through construction of the additional phases.
Building techniques developed for the hospital, using locally available, low-impact materials, were replicated and improved for subsequent phases. These techniques include the use of compressed-earth blocks, manufactured on-site using the excavated soil (after testing) and small amounts of cement. This system is designed to accommodate structural reinforcement because the region is seismically active. Exterior facades and retaining walls are clad in another local material: a volcanic rock that can be readily shaped to fit snugly with little mortar. "We've been hearing more and more instances of the Butaro masons being sought elsewhere in the region to replicate their craft," says Holly Jacobson, junior associate at MASS Design Group. In particular, she says, they are being asked to replicate "the beautiful rock walls of Butaro."
The designers also noted that soil erosion is a serious problem in the hilly, highly cultivated Rwandan countryside, so they created terraces to stabilize the hillside around the doctors' housing, and trained local workers in terracing practices that can be replicated elsewhere to reduce erosion and preserve the topography. By empowering the community and protecting the natural environment, this project has benefits that reach far beyond its transformation of local health-care services and prove the value of professional design and planning in the development of facilities like this one.