Butaro Hospital

Butaro Hospital in Butaro, Rwanda by MASS Design Group, 2011

Inside and out, hospitals in the United States and other developed countries tend to be instantly recognizable as just that: medical facilities. This most likely stems from a small number of architects carrying out the design of hospitals (they are some of the most highly specialized environments around), from a reliance on heavy-duty mechanical systems for venting interior spaces (one of a number of technologies that hospitals rely upon), and a related emphasis on hospital functions over a connection to a place. Some distinctive architecture is still produced, but there is still plenty lacking in terms of how hospitals serve their contexts via architecture.

The Butaro Hospital, on the other hand, is a building -- or more accurately a group of buildings -- that does not scream, "hospital." The fact that the building is in Rwanda and not in, say, New York City might have actually pointed to a result that would parallel the generic hospital architecture in the United States, as if the exported expertise (architectural and medical) would have stood out even more in its rural African context. But what Boston's MASS Design Group achieved is a sensitive design that recognizes the place, the people, and the long-term use of the building. That it does not resemble a hospital may just be one of the strongest compliments to the design.

In applying the highest standards of design and building to the poorest places and the most underserved communities, what is constructed first and foremost is dignity. -MASS Design Group, from Empowering Architecture

As Iwan Baan's photograph at top makes clear, the site plan is an important means of responding to the place. Occupying the hilltop site of a former military base near the Ugandan border (the symbolism of this shift should be acknowledged), MASS eschewed stacked, courtyard, and bar layouts, instead opting for a campus plan that breaks down the buildings into separate wards toward limiting the spread of diseases, increasing ventilation across the site, and allowing for future expansion. The buildings also work with the slope of the site to create a partial perimeter vehicular access at the lower level, leaving the central spaces between the buildings open for pedestrian movement. Color-coded signage designed by Massimo Vignelli means that navigating the courtyards and covered walkways is intuitive for people who need to make a visit to the hospital.

Much of what MASS pulled off is vernacular common sense artfully elevated. They used local materials and labor for the construction, a mix of passive and low-tech active strategies for ventilation, and other means of reducing the spread of illnesses, and they reconsidered long-held ways of doing things, such as how hospital beds are laid out in a ward. (These are all well-documented in Empowering Architecture, a book from MASS focused on the design and construction of the Butaro Hospital; the last point is discussed in this week's book review.) What is most remarkable about the project is the way site planning, materials, form, building sections, ward layouts, circulation, everything coheres into a complex that belongs on the hilltop. Rwanda, and other African countries, could surely use more hospitals, and the Butaro Hospital is an excellent model for making better hospitals into better places.