For the past decade, not-for-profit architecture and design collective, MASS Design Group has been creating industry standards in the developing world for sustainable and equitable development that is accessible, purposeful, and healing. The Boston and Kigali, Rwanda-based group got its start by designing hospitals in Africa and to date, has constructed more than 15 medical facilities on the continent, including a massive medical campus in Butaro, Rwanda that includes the firm’s first project, the Butaro District Hospital (completed in 2011). The firm– founded in 2008 by Harvard University Graduate School of Design graduates Michael Murphy and Alan Ricks– has established itself as one of the leading design firms working the frontlines of public health crises that have included the Ebola outbreak in Liberia and Haiti’s cholera outbreak in 2010.
MASS, which is an acronym for Model of Architecture Serving Society, employs its standards of architecture that promotes health-conscious design across not just its medical facilities, but also its office spaces, educational institutions, affordable housing, public memorial spaces, and more. But it is the firm’s pioneering work in healthcare facilities that has put them in high demand for advice on how to build functional spaces that also address infection control and overall enhanced public health, especially as the world continues to reel from the Covid-19 pandemic.
Since its inception, MASS has designed health, educational, affordable housing, and other commercial projects in at least a dozen sub-Saharan African countries. Rwanda houses the bulk of these projects, with a dominant emphasis on providing the community with medical facilities that are both functional and beautiful. Christian Benimana– a Rwandan native who studied architecture in Shanghai, China– currently serves as Senior Principal & Managing Director of MASS’s Kigali-based office, overseeing a team of more than 100 members, and has been with MASS since 2010 when he started as a design fellow. Outside of Rwanda, Benimana has also overseen projects in Malawi, Liberia, and Gabon; each one centered on health standards and social welfare. When confronted with Covid-19, instead of panicking, the firm and Benimana’s team viewed it as yet another chance to prove to the rest of the field why putting public health and sustainability at the forefront of design priorities is critical.
“This pandemic has actually reinforced the message that we’ve been trying to send out for the last 10 years,” says Benimana in an interview, “and it’s that health issues are spatial issues. We have been singing this song from the beginning with the research and data to support our work, so nothing has really changed for us at MASS,”he explains. “It’s more a matter of everyone else finally understanding what we have been preaching for the last decade.”
The Butaro hospital set the framework for future MASS projects and cemented the importance of injecting public spaces for marginalized communities with beauty and elements that promote health. Working with Partners in Health , limited funding and local materials like the volcanic rock from the Virunga mountain chain, MASS was able to not only ensure that 85 percent of the costs of building were invested into the local economy, but it also resulted in an overall savings cost of more than 30 percent of other hospitals built in Rwanda. All the while, boasting design features like ultraviolet germicidal irradiation lights that neutralize airborne pathogens; shaded seating areas throughout that encourage patients to remain outside where the chances of airborne disease transmission are greatly reduced, cross-ventilation, large operable windows that all mitigate and reduce the transmission of airborne diseases, and positioning as many hallways as possible along the building’s exterior, allowing patients and staff to move throughout the hospital in open-air.
“The Butaro hospital has allowed us to develop a set of healthcare design standards which deviates quite a lot from the conventional ‘mechanized’ hospital found in the West where emphasis has been put on the wrong things,” Benimana explains. “The standard Western hospitals are very sterile and very efficient in maximizing how many patients can get in and out, but they de-prioritize things like patient wellness, inclusivity, family, and sense of space in maternity wards.
Deviating from the standard design for hospitals has afforded MASS the ability to define a new set of principles for basic healthcare facilities in Africa that honors local customs and cultures, while also building sustainably and with local resources. One of the projects that, arguably, best serves as an example of MASS’s culturally-aware healthcare centers is the Maternity Waiting Village in Malawi. The 670-square-meter facility, completed in 2015, was the result of an initiative put forth by the president of Malawi and the country’s Ministry of Health in 2015 to mitigate the high maternal mortality rate (for reference, in 2010 in Malawi, about one in thirty-six women had a lifetime risk of dying during pregnancy or delivery, largely from preventable causes).
The Maternity Waiting Village provides a monitored space for expectant mothers starting from their thirty-sixth week until their delivery and was designed to accommodate family members who accompany the expectant mothers, as well as spaces for outdoor activity during both rainy and dry seasons. This project, along with others designed by MASS in Sub-Saharan Africa, have been embraced by the communities in which they serve.
“The question of community acceptance really hasn’t been an issue for us because many communities know what they want,” says Benimana. “The people in these communities understand that the health centers are not good, so there is a general acceptance of what is being provided. The majority of skepticism comes from other people working in the public fund sector who may disagree with the way we prioritize our designs.”
It’s not uncommon for many design and construction firms to push for quick completions of projects at the lowest cost possible, however, Benimana firmly believes that the framework for building public facilities in sub-Saharan Africa cannot positively improve if there isn’t a change in approach. “We need to reframe the field of architecture from that of a model practice to a necessity, not just a commodity that people can purchase at the highest cost,” he says. “Given that we engage in a practice that erects, designs, and promotes spaces that can heal there needs to be a greater understanding that we have the power to start rendering some justices to communities that are underserved.” What he advocates most for is sustainable, low-cost developments that showcase award-winning architecture but most importantly, create real and quantifiable positive impacts on the people they service.
These days, MASS finds itself busier than ever with healthcare-centered projects in Africa. Among these are two more general hospitals that are currently under development in Rwanda, along with another in Liberia’s capital city, Monrovia. The Rwandan hospitals are the products of hospital standard plans developed by MASS in 2014 and adopted by the Rwanda Ministry of Health.
One, named the Nyarugenge District Hospital, will feature 300 beds– including a 120-bed referral hospital with an emergency department, a high dependency unit, labor/delivery and postpartum wards, adult and pediatric medicine wards, and an outpatient clinic with dentistry programs, among other services. It will imply the same infection control fittings as the Butaro hospital while incorporating green elements into the urban landscape with elements like shaded courtyards, an early labor walking garden for expectant mothers, and an expansive living wall.
The second MASS-designed hospital in Rwanda is called the Munini District Hospital and will also be a 300-bed hospital, though this one will be located in one of the country’s most remote districts.There will be both private and open wards that are “set back from the building’s face to provide dedicated balconies, shading, and outdoor space throughout the facility,” three building bars–connected by bridges– that are bent in accordance with the natural contours of the condensed site and strategically opened for natural airflow, and a central courtyard and garden. Both hospitals are being constructed using concrete to allow for replication across Rwanda, however, they will employ local materials like fired clay brick and local stone, where applicable.
In Monrovia, the New Redemption Hospital is the result of a collaboration with the Liberian Ministry of Health and USAID-funded Rebuilding Basic Health Services. As part of phase one of the project, there is a two-story facility with 155 beds, pediatric, and maternity services. The hospital’s design follows the Architectural and Engineering Standards and guidelines that MASS created for all future healthcare facilities in Liberia and makes use of “innovative ventilation strategies” like solar chimneys for air purification and reduced energy consumption. The solar chimneys work by heating up and drawing contaminated air out of the ward spaces, even when the windows are closed, thus providing the hospital with clean air up to twelve times per hour. They also naturally cool off the wards while the air is disinfected by Ultraviolet Germicidal Irradiation (UVGI) fixtures.
In addition to leading the Kigali office, Benimana is the Founding Director of the African Design Centre– a field-based apprenticeship that hosts architects from various African countries in Kigali to complete a multidisciplinary curriculum with a design-build project for real-world experience. He highlights in his 2017 TED Talk that in order to meet the demands of Africa’s rapidly growing population, there needs to be a “uniquely African model of sustainable and equitable development.” By creating the African Design Centre, Benimana is fostering an environment for like-minded designers with socially-driven design principles to get involved in the work.
“It’s the only way we are going to succeed in this fight to address Africa’s societal inadequacies,” Benimana explains. “I think that it is the right thing to do and when we put our minds together, we can create something really unique.”