Global health pioneer Partners In Health (PIH) partnered with the Rwandan Ministry of Health in 2005 to extend health care access throughout rural Rwanda—particularly to the Burera District’s population of 340,000 who had limited access to care. Recognizing an opportunity to leverage design for improved health outcomes, PIH partnered with MASS Design Group (MASS) in 2008 to build the Butaro District Hospital.
Through interdisciplinary collaboration, including immersive learning alongside the doctors, nurses, staff, and community, the project cultivated new ideas about how to design for better health. Yet it also uncovered a pivotal challenge in health delivery: the new facilities would only be sustainable if they can continue to attract and retain the best staff over the long term. MASS, PIH, and their partners, led by the Daniel E. Ponton Fund at the Boston-based Brigham and Women’s Hospital, launched a multi-phase housing initiative to help attract and retain the best medical expertise in this rural region. By providing a space of respite and recovery, this housing provides a key service in the provision of the best level of care to the community.
Design And Construction
Four two-bedroom homes (roughly 1,300 sq. ft. each) now step down a terraced hillside, five minutes from the hospital by foot. The project sets an example for quality construction by focusing on innovative, earthquake safe, and sustainable practices that use local materials. The four duplexes were constructed with compressed stabilized earth blocks (CSEBs), bricks fabricated in a workshop on location with soil excavated from the worksite. Compared to the traditional construction methods of concrete block or fired brick, building with CSEBs reduced the use of cement, negates the need for transportation of materials, eliminates the need for firing (thus reducing deforestation), and creates jobs through block production.
After testing that the area’s soil was appropriate for CSEB production, MASS brought in a block press and set up a training workshop on site. This skill development for reinforced CSEB construction was emphasized in order to build capacity for safe and sustainable building as the community grows. Ten newly trained members of the community led a full-time block production crew, and fabricated 29,000 blocks over the course of three months. This unique press and corresponding molds allow for reinforcement, a feature necessary in this seismic zone.
A reinforced concrete frame further supports the CSEBs’ seismic strength, plaster and white paint polish the walls, and a second layer of the volcanic rock from the local Virunga Mountains highlights the high- quality local craftsmanship. Likewise, all interior furnishings are custom-fabricated: the cypress and pine furniture, poured-in-place concrete sinks, metal light fixtures, as well as artisan-made doors, crafted with angled pieces leftover from the muvura wood roof trusses.
Educating Through Process
Besides attracting expert doctors to Butaro, MASS used this customization process to foment the skilled labor force in the community. Everything from the CSEBs to the light fixtures was fabricated by local masons, carpenters, and artisans who worked reciprocally with the MASS team, providing local knowledge and receiving training through the process. Over 275 people received training in new expertise that is marketable throughout Rwanda. Furthermore, by implementing rotational hiring to foster more extensive community ownership and extend the economic distribution, MASS was able to employ over 900 individuals in the construction process, and distribute over $400,000 into the local and regional economies for replicable impact. The Butaro Doctors’ Housing project, completed November 2012, created an improved, sustainable building practice as well as new Rwandan ambassadors of better building.
Constituent Of A Broader Health Care Network
The homes now house both Rwandan and expatriate doctors, fulfilling the mission for the first phase on which has become known as Umusozi Ukiza—the Healing Hill. Future phases will add further housing for staff and patient families undergoing treatment in the country’s first outpatient cancer center, which MASS has designed and is currently overseeing construction on a nearby site. It is in this context that the Doctors’ Housing represents an integral step of a multi-phase, broad-reaching strategy to both build the facilities, as well as the social capacity, economic opportunity, and knowledge needed for improving community health in the entire Burera region.