The movement has also resulted in projects like Kenema Hospital's Lassa Isolation Ward in Sierra Leone; the Brooklyn Chest Hospital in Cape Town, South Africa; the redesign of the Nyanza maternity wing in Rwanda; and the 320-bed Mirebalais Hospital in rural Haiti, which is due for completion in July this year. South Africa – which has the world’s seventh-highest rates of TB – is currently building nine new TB wards in which airborne infection control is the overriding design priority.
To see the ultimate representation of future hospitals, Salt recommends a trip to one of the most remote areas in Rwanda. The Butaro Hospital in the Barera District was built in collaboration between the Rwandan government and Partners in Health, an NGO which is headed by Farmer. Murphy’s MASS Design firm has provided the plans. It is built on the site of a former military base that participated in the Rwandan genocide – it had to be cleared of grenades and other munitions before former US President Bill Clinton arrived for the groundbreaking ceremony in 2008. But now it has been transformed into a new and innovative 150-bed hospital. Built for just $4.4 million (£2.8 million), the hospital serves a province in Rwanda that previously had not a single doctor to serve its 400,000 residents.
The cluster of single-storey buildings that now occupy the site include effective but inexpensive design changes that the collaborators hope will be replicated across the developing world. Colour-coded signs for wards greet patients, many of whom might be illiterate, and wards are reached through open-air walkways to reduce transmission of infections. Air-conditioning systems have been discarded in favour of natural ventilation to mitigate the spread of airborne diseases, such as TB. This natural system uses air-pressure differences, wind-funnelling and even patient body heat to get rid of contaminated air. The hospital’s administrator, Dr Peter Drobac, says that a system featuring large windows beneath high wooden louvres and giant industrial ceiling fans changes the air in its wards up to 15 times per hour, with no need for mechanical ventilation at all. Courtyard gardens have been landscaped deliberately to lure patients to exercise outdoors.
For Murphy, his drive to improve health through design was a direct result of his own experience of hospitals: “My father had a terminal illness, and I spent a lot of time in hospitals. I thought they were atrocious, depressing and undignified spaces,” he says.
To take on this challenge he founded MASS Design while he was a graduate student at Harvard.
He said Butaro Hospital was built at a cost of $30,000 a bed, compared with “$3 million per bed for a new American hospital”, and that is for a site that includes three operating theatres, a neo-natal intensive care unit and digital X-ray technology.
Drobac says that another key for future hospitals is to empower local communities. With the exception of a bulldozer used to level the site, the hospital was built entirely without construction machinery – 2,500 Rwandans built the 6,000 sq m facility with hammers, machetes and hoes, a strategy designed to provide both an economic boost and community acceptance. “Every window, rain gutter and door was made on site,” says Drobac. “We brought in a master welder, a master carpenter and a master mason, and established workshops at the site. There are now a number of Rwandans skilled in those areas as a result.”
Butaro Hospital celebrated its first anniversary in January this year. It has yet to record a single case of hospital-acquired infection.
As a result, Rwanda's Ministry of Health has asked Drobac to do something which no hospital in the country had been able to do before: offer treatment to cancer patients. He said the immune systems of patients under chemotherapy were generally considered too weak to risk the threat of infection in traditional hospitals.