Healthcare Design - November 2017 - 100

In Focus

6/10

ENGINEERING

L E S S O N S F R O M R WA N D A
African healthcare facilities adapting to high energy
costs, unreliable power, and insufficient resources have
implemented sustainable design solutions that merit
consideration around the globe
By Kelly Doran and Arash Guity

100

NOVEMBER 2017

FINDING THE RIGHT SOLUTIONS

The narrow design of
the buildings and the
long interior courtyard at
Munini District Hospital,
scheduled to open in
2018, mean fewer interior
rooms, promoting natural
ventilation and more exposure to natural light.

HCDMAGAZINE.COM

Nowhere were these simplified solutions more
evident than in ventilation systems. Rwinkwavu, for example, resides in one of the hottest regions in the country; the old NICU occupied an
interior room with no access to fresh air, which
made the room hot and infection control more
difficult.
North American hospitals rely on sophisticated HVAC systems to control airflow to
mitigate airborne diseases. In fact, design standards in American hospitals generally prevent
windows from being opened for outside air to
enter. But Western HVAC systems aren't practical in Rwanda, so the MASS-Mazzetti team
created a standard sectional design that optimizes cross-ventilation through a combination
of passive and mechanical strategies. A system
of windows located in high and low positions
on the exterior walls facilitates natural cross
breezes, while stack vents ensure airflow to
interior wards. Stack vents create a chimney
effect; heat from the sun forces air in the vents
to rise, creating suction and causing air in the

MASS DESIGN GROUP

WANDA, ONCE DEVASTATED by conflict, now enjoys a
fast-growing population and economy. But most of the
East African country's limited healthcare infrastructure dates from the 1960s and '70s, and in some areas
there are no hospitals at all.
Since 2012, MASS Design Group and Mazzetti have
been partnering to help address that need. In collaboration with the Rwandan Ministry of Health and the
nonprofit Partners in Health, the firms have worked on several projects
in the small nation, including a new OR and neonatal intensive care unit
(NICU) for a hospital in Rwinkwavu, a new district hospital in Munini
(which serves as a template for other district hospitals), and a new district hospital in Nyururgenge. The Rwinkwavu project earned MASS a
SEED Award for Entrepreneurship in Sustainable Development, a program that recognizes innovative, eco-inclusive enterprises in countries
with emerging economies.
Addressing the inherent challenges that accompany projects in
Rwanda-including insufficient resources, budgetary constraints, and
a shortage of locally available experience in maintaining Western-style
mechanical systems-required project teams to shift their thinking. Architects accustomed to projects in North America had to accommodate

tropical weather and conditions that make
climate-controlling HVAC systems impracticable. The inconsistency of Rwanda's power
grid dictated how designers thought about everything from lighting design to backup power.
And the country's high energy costs put premiums on efficiency and conservation.
While conditions in Rwanda limited some
options, in other ways the experience was liberating. Unlike North America, costs for materials in Rwanda far outweigh labor costs, and
most building materials are locally sourced. For
example, North American architects choose
doors from a catalog and design around them.
In Rwanda, craftspeople custom-make the
doors on-site, giving architects more freedom
to consider form and function and design accordingly. Similarly, building codes in Rwanda
are nascent and basic and there are no formal
design standards for healthcare facilities. (At
the Ministry of Health's request, MASS and
Mazzetti are establishing those standards
in their projects.) Instead of being bound by
standards designed for Western hospitals that
depend on complex, energy-guzzling systems,
the project teams were free to pick and choose
which Western-style approaches made sense
for Rwanda, while also innovating their own
context-appropriate solutions that were decidedly non-Western.

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Healthcare Design - November 2017

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