The green-blue hills of northern Rwanda are likely not the first place most people would look for a public health revolution. One of Africa’s tiniest countries, Rwanda is best known for one of its worst moments: the 1994 genocide, when an estimated 800,000 people were killed over 100 days of brutal violence.
In the 18 years since, the country has thrown itself full-throttle into every kind development, resisting the image of post-conflict chaos with globally praised progress in infrastructure, business, and public health. The northern city of Butaro is fighting a resistance battle of a different kind—against airborne diseases like tuberculosis.
Before we get to Butaro, a quick diversion into epidemiology: One of the biggest airborne threats in the developing world is the lung infection tuberculosis (TB), which spreads through contact with airborne germs. In 2010, the World Health Organization counted nearly nine million TB cases, resulting in more than a million deaths globally. The most basic form of the disease can be treated with a combination of drugs, but recently, drug-resistant strains have taken root. In 2011, 77 countries had patients diagnosed with “extremely drug resistant” TB.
Doctors and public health specialists have been looking for innovative ways to stop the spread of drug-resistant disease. To test the answer in Butaro, they teamed up with unexpected partners: architects.
“The core problem was that the buildings were making people sicker,” says Michael Murphy, founder of MASS Design, a nonprofit architecture firm that designs public hospitals. Poor ventilation meant that stale, germy air hung around hospital beds, making hospitals places that literally transmitted, rather than treated, disease. “This forced us to rethink the design of the hospital itself—to think around its performance for reducing infection [and] improving people’s health.”
Murphy and his design team joined international public health organization Partners in Health. They focused on improving the number of “air changes per hour”—how often the air inside of a room is replaced by new air—by designing tall ceilings and wide windows and incorporating big ceiling fans. These aren’t changes that need big budgets; the mantra is “locally appropriate”. So are the materials: They wrapped the new hospital in gray rock from the Virungas, a volcanic mountain chain that surrounds Butaro. They used local steel and cement and trained community members as builders and masons. There’s still a shop on the grounds where construction workers can fix doors, cut replacement pipes, or otherwise mend materials on site.
This “simple design strategy”, as Murphy calls it, is making its way through other parts of the world as well. MASS Design is working on clinics and hospitals in Haiti, Liberia, Burundi, and Uganda. But MASS isn’t the only player in the game. Dr. Rod Escombe, an honorary research fellow at Imperial College in London, has retrofitted older hospitals in Peru by moving waiting rooms outside and adding skylights or bigger windows. In two of the hospitals he studied, the TB risk in the modified rooms dropped from 79 percent to 30 percent.