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Building a new kind of health care

MASS Design Group aims to improve care delivery from Rwanda to Uganda to Haiti to back home

MASS Design Group’s Michael Murphy (left) and Alan Ricks.Suzanne Kreiter/Globe Staff

Michael Murphy was 26 years old, and deep into final exams during his first semester at the Harvard Graduate School of Design, when Dr. Paul Farmer came to campus to speak. Murphy knew of Farmer, who in 1987 cofounded Partners in Health, to serve Haiti’s neediest.

It was 2006, World AIDS Day, and Murphy headed over to hear what Farmer had to say. He had no idea that the speech he crammed into his busy schedule would determine the direction of his life’s work.

Farmer told the students about the homes and hospitals Partners in Health (PIH) was building in rural Haiti, Rwanda, and Peru. Murphy was moved. “This guy was talking about architecture, but he’s calling it health care,” he recalls. “As a student, I thought it was an interesting reframing of architecture as a key piece of the health care delivery system.”


After the speech, Murphy found Farmer and asked how he could help.

MASS Design fellows Sarah Mohland and Christian Benimana, project manager Commode Dushimimana, local engineer Christian Uwinkindi, and fellows Ben Hartigan and Jennifer Gaugler discuss construction strategies in Rwanda in May 2012.MASS Design Group

“Architects?” responded Farmer. “Why do I need an architect? I just draw it all out on the back of a napkin.”

But an e-mail correspondence began, and at the end of his first year in graduate school, Murphy spent the summer in rural Rwanda, working with Partners in Health. Farmer’s team was treating some of the poorest people in the world, people whose lives had been devastated by the 1994 genocide that killed 800,000 in 100 days.

Murphy’s lofty aim: to show how architecture fits snugly into the health care cause. Farmer and his colleagues, who had already built clinics and hospitals, agreed that professional architects could indeed help. Shortly after Murphy returned to Harvard, they asked if he could help build a state-of-the-art hospital in Rwanda. It would serve Burera, a district with a population of 400,000, one doctor, and no hospital.

“I didn’t know how to build a hospital,” says Murphy, now 32. “But when Paul Farmer calls you, you say yes.”


First vision, then plans

Murphy’s classmate Alan Ricks, 29, offered to help, along with a few other students and professors. Murphy spent the winter term in Rwanda, puzzling the project out with Farmer and the Rwandan minister of health. “We realized it was more than just helping draw up a few plans,” says Murphy. “It really was about a new vision of architecture.”

In 2010, that vision would become MASS Design Group, a Boston team of architects committed to projects that will improve both the health and the lives of a community. With nonprofit status pending, MASS — Model of Architecture Serving Society — has often teamed up with Partners.

MASS Design Group has won several awards. In December, Ricks was named by Forbes magazine to its “30 Under 30” list of change-makers in arts and design. Contract magazine, devoted to architecture and interior design, recently named MASS Design Group “Designer of the Year” for its work in “improving people’s lives through design.”

Farmer is a fan, too, of course. “I think their work — ensuring that the world’s poor reap the benefits of architectural advancement, beauty, and safety — is so important to the global community,” he says.

Why does architecture matter in health care? Because, he says, the poorest have to endure disease and premature death “in dismal conditions, in clinics that are unclean, unlovely . . . grim, dank, and sometimes deadly.”


Farmer, who has hand-built fish ponds and planted gardens at Partners clinics and hospitals, believes in what he calls “dignificacion,” bringing dignity to buildings, and thus to people’s lives. “Butaro Hospital advances the cause for dignity,” he says.

In 2008, Murphy took a leave from Harvard and moved to the Rwandan village of Butaro, where the hilltop hospital would be located. He and Ricks, who spent the summer in Rwanda, soon realized they needed to bring in more expertise. They posted jobs on architecture websites and were flooded with responses. Their timing was perfect: It was 2009, shortly after the economy tanked.

“Architects had lost so many jobs in 2008, and people were just terrified,” says Murphy, executive director of MASS Design. Through grants, they raised money to pay some positions; the rest were volunteer. Landscape architect Sierra Bainbridge left her job designing the acclaimed mile-long park, The High Line, on Manhattan’s West Side, and moved to Rwanda to join the team. Garret Gantner, a teaching fellow at the Yale School of Architecture, signed on.

Now, MASS Design has 24 staffers, 10 living in Rwanda, four in Haiti. Home base is an airy space in the South End where architects work around a long table, looking for solutions big and small.

Designs for offering health

Nothing in the classroom had prepared Murphy, Ricks, Bainbridge, and Gantner for Rwanda, where architecture was part of the problem. “A poorly built environment led to people getting sicker,” says Ricks, MASS Design’s chief operating officer. “We wanted to be part of the solution.”


Butaro made them think: about ventilation, lighting, patient flow, even views. With multi-drug-resistant tuberculosis a huge problem, they needed a design that would reduce infection. Their plans would ultimately include natural air ventilation inside and shaded patient seating areas outside.

At Harvard, Murphy, Ricks, and Bainbridge took a class on infection control at the School of Public Health. At Butaro, they installed ultraviolet lights in the wards and waiting spaces, which purified the air. They built high ceilings and exterior, not interior, hallways to cut down on disease transmission.

And instead of having wards in which sick patients faced other sick patients, they turned the beds around to face windows with views of lush gardens and valleys.

Butaro held another lesson: Health care was about more than just a hospital. The people needed decent housing and jobs. A mix of 4,000 skilled and unskilled locals were hired by Partners and the Rwandan Ministry of Health.

The men and women worked with Bruce Nizeye, a builder who has worked with Farmer in Rwanda for years, and who became the general contractor at Butaro. Only local materials were used. Carpenters were trained on site, and designed and built most of the furniture, doors, and window-frames. Masons carved local volcanic rock to construct beautiful walls. Men and women helped excavate the site. For many, their new skills have translated into careers.

MASS Design project manager Garret Gantner, Murphy, and COO Alan Ricks in Rwanda in November 2011.MASS Design Group

The 140-bed hospital opened in February 2011, and MASS Design is building doctors’ housing, the better to attract and retain staff. There are also plans to build a community center and a training center that will bring residents together.


When the MASS Design team learned that there were only 10 architects in Rwanda, all of them educated elsewhere, they decided to start a degree program at the Kigali Institute of Science and Technology. They wrote the curriculum, and Bainbridge, the program director for Rwanda, headed the fledgling department. Gantner took over from her, and the first class of 25 will receive their five-year degree in 2013.

There was more to do: The team designed the Girubuntu School in Kigali, which opened in July 2011 and hosts 300 vulnerable children in seven buildings, including a library, computer room, and kitchen. At night, adult classes are held to promote literacy. At Rwinkwavu Hospital in eastern Rwanda, which Partners built five years ago, MASS Design is building a neonatal intensive care unit and staff housing.

Busy in Rwanda when the 2010 earthquake rocked Haiti, Murphy and Ricks nevertheless knew they had to help. During the quake, the tuberculosis hospital collapsed, and in the aftermath, a cholera epidemic exploded.

In October 2011, Chris Scovel, who had 20 years of experience as an architect, joined MASS Design, where he is program director for Haiti. His team recently broke ground on a cholera treatment center in Port-au-Prince and next week will break ground on a tuberculosis hospital.

Cholera in Haiti had been treated in tents, but Scovel’s team has designed a building with natural ventilation that can be used for other patients during the dry season, when cholera cases wane.

With USAID, MASS Design is writing standards for global health infrastructures. The team is starting to design a hospital and School of Public Health in Uganda, in partnership with Massachusetts General Hospital.

Rather than exporting US methods and materials to developing countries, MASS Design says that lessons learned in the developing world are being applied to the firm’s more upscale clients, including the renovation of an aging hospital in Westchester County, N.Y.

“What's happening in Haiti and Rwanda is a precedent for how health care can be improved in the [northern hemisphere],’’ says Scovel. Despite costly facilities in the United States, 100,000 people die each year from hospital-borne infections, according to the Centers for Disease Control and Prevention.

Another south-to-north lesson: A hospital should be a welcoming space instead of a forbidding institution.

“For us, the big takeaway is that what we’re learning in the global south is helping us improve infrastructure in the global north,” says Murphy. “We’re interested in buildings that have a direct, positive impact on people’s lives.”

Bella English can be reached at english@globe.com.