In 2005, 53 patients with HIV entered a relatively well-resourced hospital in the rural town of Tugela Ferry in South Africa. Within weeks, all but one were dead. Their death certificates would record that they died from a new drug-resistant form of tuberculosis. But behind the diagnoses lay a more shocking truth: they were killed by visiting the place where they had hoped to find treatment.
The incident at the Church of Scotland hospital was an enormous wake-up call for public health officials across the world. Experts like Paul Farmer at Harvard University are convinced that life-threatening microbes, allowed to thrive in congested, dirty hallways and waiting rooms, are turning countless hospitals into deathtraps. “Millions of people die each year from diseases for which safe and effective treatments exist,” says Farmer. “In Haiti, these are known as ‘stupid deaths’. Among the stupidest deaths are those caused by illnesses acquired in the clinics and hospitals intended as places of healing.”
The problem is that hospitals in the world’s poorest countries have been generally built in the image of their western counterparts, and this was making them dangerous to patients’ health.
But now a new school of thinking aims to make events like this a thing of the past. It is being driven by a small band of academics, architects, NGOs, the World Health Organization and a new breed of architects, and their chief weapon is simply a matter of better, intuitive design.
A room with a view
Forget the traditional image of a stark, multi-storey hospital. From Pakistan to Haiti and from Sierra Leone to South Africa, hospital buildings are being constructed that look to all intents and purposes like safari lodges. Patients enter single-storey buildings dotted between lush, green courtyards. Wards have towering ceilings, there are no hallways and waiting areas are breezy and open plan. On the wards, patients recuperate in beds that face out towards giant, open windows, and feel natural ventilation on their face.
“We have to change the way we think about these buildings completely,” says Michael Murphy, co-founder of the not-for-profit Boston based architect firm MASS Design. “Successful health architecture is going to be rated not on how great the building looks, but by how many lives it improves.”
Most hospitals in poorer countries are based on designs from other countries, regardless of whether or not they are appropriate, according to Matthew Salt, a co-author of the WHO’s new guidelines on design for infection control. For instance, despite their warm climate, Africa’s sick have generally been crowded together in waiting rooms and enclosed hallways designed for the colder winters of rich, northern hemisphere countries. The problem is compounded by a desire to fit them out with complex technology, but without the resources for its upkeep.
“Ventilation solutions used for the developed world were simply applied to places which did not have the resources or skills to maintain that equipment,” says Salt. With slow diagnostic systems and high co-infection rates with HIV, Salt says this creates “a perfect storm” for diseases like TB to become a lethal threat. “Twice the ventilation at the Church of Scotland Hospital would have halved transmission,” adds Professor Edward Nardell, associate professor of immunology at the Harvard School of Public Health.
Nardell is another one of the proponents of this new wave of thinking. In response to the Church of Scotland incident, he helped to set up the world’s first programme aimed at preventing disease through design. “One of our first students was a designer who came over from Pakistan with plans for a new hospital in Karachi,” he says. “After the course, he tore up the plans and redesigned it. The Indus hospital now features some of the best principles of infection control.”