Katherine L Borrazzo
Designing Sustainability
The Role of Architecture in Guiding Social Impact
By Ha D.H. Le, Crimson Staff Writer

In 2006, a student at the Harvard Graduate School of Design attended a lecture by Dr. Paul E. Farmer, one of the founders of the Boston-based nonprofit healthcare organization Partners in Health. The talk, which focused on hospitals built in Haiti, inspired the student to approach Farmer and ask about his own possible contributions, only to learn that architects played little role in the development—some designs were drawn on the back of a napkin by Farmer himself.

Now as Michael P. Murphy, the student of the story, Skypes in from Rwanda, he reflects on the interaction. His shock came from a realization that Farmer and his colleagues, despite their work in constructing buildings in developing nations, lacked the design expertise that students were learning across the street at the GSD. “I knew that it wasn’t a problem of vision per se,” he says. “It was really a problem of access.” According to Murphy, he registered that most architects lack access to global health and development projects, and this gap motivated him to pursue further correspondence with Farmer.  

Years later, on Jan. 24, 2011, the Butaro Hospital opened its doors in the Burera district of Rwanda. The hospital is the product of years of collaboration among Murphy, other architects from his firm Model of Architecture Serving Society Design Group, PIH, the Rwandan government, and Rwandan citizens. Hailed by PIH as an example of the ideal way to build a modern hospital in rural Africa, the project created over 2,000 jobs for the Burera population and provided the opportunity for world-class care in a region that, at the time, had little access to healthcare.

The Butaro Hospital, a collective endeavour across Harvard schools and affiliated groups, serves as a model of thoughtful construction while also occupying a position in a general discussion concerning the architecture profession. This conversation is one regarding the discipline’s relevancy to the public despite usually serving a small patronage. It is one about the design knowledge required for developmental projects and architecture’s connection with humanitarianism. And as the talk moves past building walls to the Harvard classroom and even museum exhibitions in New York, a new perspective about the field is emerging: one in which architecture exists as more than a pinnacle of aesthetics but also as an ethical contribution to society.  


When Dr. Michael L. Rich, a physician in the Division of Global Health at Brigham and Women’s Hospital, first received news of a volunteer architecture student coming to help him, he was skeptical. “I was like, ‘Oh, God, no. The last thing I want is to have to babysit an architect student,’” he says in a Skype call from Madagascar. But PIH had plans for new buildings and repairs. So Rich, stationed in Rwanda at the time as the director of PIH’s program in the country, decided to give the student Murphy a six-week trial period. Murphy left an impression; he ended up staying for much longer than six weeks and began a collaboration between PIH and himself that would eventually lead him to the Butaro Hospital and Rwanda.  

What Murphy and Alan A. Ricks, co-founder and COO of MASS Design Group, discovered in Rwanda was what Murphy described as a nation without the proper infrastructure for growth. According to Murphy, when he arrived in 2008, Rwanda had fewer than 10 architects—if they could be called that, as the country did not have an architectural licensing board. “There wasn’t a dialogue about designing things in ways that reflected the need for sustainability,” he says.

The country fared no better in terms of healthcare. Rich says there were hospitals and health centers in most of Rwanda’s 40 districts with community health workers to staff them, but there were some, like Burera, that lacked hospitals. According to Rich, this meant PIH needed to consider building blocks like health services and infrastructure, medical staff, medical products, health financing, medical information, and building management. The position architecture had in these essential ingredients, however, was initially uncertain.


Even before the Butaro Hospital, architects had already begun considering their roles in developing infrastructure and serving the public. Months before the hospital opened, the Museum of Modern Art featured 12 such projects in the exhibition “Small Scale, Big Change: New Architectures of Social Engagement.” Running from October 2010 to January 2011, it showcased buildings that highlighted architects interested in taking responsibility and changing local traditions through their works. For instance, one design was a primary school in Gando, a village in Burkina Faso whose school was greatly damaged. Another project displayed was the upgrade of Rio de Janeiro’s Manguinhos district, a large urban area where some 28,000 people lived in informal settlements close to industrial plants.

The uniting factor among all the works in “Small Scale, Big Change” was the improvements the designs made for the inhabitants in the community. “One of the most important criteria…was to show…projects that already had a measurable success in the community,” says Andres Lepik, the curator of the exhibition and presently a professor at the Technical University of Munich and the director at the Architecture Museum of the Pinakothek der Moderne.

Though some interest in developmental projects exists, Lepik feels more introspection is paramount because the majority of architects do not serve the general public. “Most architects in our developed world work for a very small percentage of the global population,” he says.

Rahul J. Mehrotra, a professor at the GSD who specializes in urban planning and design, agrees. “In today’s politics, architecture as a profession [has shifted] to focus on where the patronage is, and the patronage is where there’s big capital,” he says. According to Mehrotra, the rise of neoliberalism, an economic philosophy that emphasizes the market, contributes to this change, which he sees as a troubling conversion.

According to Ricks, the shift away from designing something with a fundamental effect on people’s lives was what contributed to his decision to work on the Butaro Hospital. “It was a little bit disheartening as an architecture student to see surrounding work just focused on form finding, trying to create novel shapes that were disconnected from the people who used the buildings,” he says.

In that way, Mehrotra believes projects like the Butaro Hospital show that venues are available for aspiring architects to design buildings with social impact. “The hospital project is important because it not only shows an enlightened architect, but more importantly it shows an enlightened patronage,” he says.


Murphy had never designed a hospital, let alone a building, when he was commissioned to work on the Butaro Hospital. Merely graduate students at the time (Murphy would graduate in 2011 and Ricks in 2010), Murphy, Ricks, and other colleagues first produced a building draft that was soon discarded due to its unfeasibility. “We weren’t really in the community,” he says.  

In response to this detachment, the architects left for Rwanda to work closely with Rich, Bruce Nizeye, who was the construction director for the hospital, and the people there and to gain the knowledge needed to create a sustainable design. “We tried to design [the hospital] so that it’ll have the correct flow of patients and the correct infection control measures,” Rich says.

According to Murphy, the architects’ education did guide a portion of their planning; he cites insights from professors at the GSD and the Harvard School of Public Health as valuable in helping him understand hospital design and factors like airborne infection control. He adds, however, that a large part of their knowledge came from on-site experience. “We have to work on architecture with the community...which we’re serving,” Murphy says. “That was a big part of my architectural education.”

David A. Sanderson, a professor at the Norwegian University of Science and Technology, echoes Murphy’s sentiments. Sanderson’s work focuses on both development and disasters, and he says that designing for developing nations requires a different understanding than what most traditional training provides; for instance, it depends on greater engagement with the people who will use the buildings rather than the ones who commission it. “I had to really unlearn everything I learned as an architect,” he says. “Architects are trained…to be orientated around the product. But a lot of disaster response is often around the process, not the product.”

If the process of engaging with the people and area is a crucial part of constructing a successful building, then Butaro’s architects were able to fulfill the criteria. According to Murphy, the architects focused on interactions with the community to create a hospital that was locally sourced and influenced. Inspired by the form of a typical Rwandan single story building, the design used only materials from the region, including volcanic rock from the nearby Virunga Mountains.

Stephanie Kayden, who teaches a course on international humanitarian response at the School of Public Health, says that the Butaro design exhibits certain ingenuity and awareness about the local environment; this, she claims, is what makes it so successful. Specifically, she cites the use of porches and natural breezes over air conditioning to cool the building—an important detail to consider because the maintenance of air conditioning would have been more costly. “The Butaro Hospital specifically takes advantage of things like the natural breezes that come through the building and uses it in an appropriate way,” she says. “[The architects] did a good job of understanding what it means to try to maintain a building.”


If the role architecture played in developing health infrastructure was unclear before, then MASS Design Group’s work asserted the discipline’s significance in global health. “I always kind of thought we had to build the buildings, and it’s not that complicated,” Rich says. “But there’s a huge field that is related to global health that needs architects and engineers.”  

Through its influence on global health, the Butaro Hospital indirectly touches upon questions about architecture’s relevance, its purpose, and humanitarianism. Technically, according to Kayden, “humanitarian” refers to only international disasters and emergency relief, rather than developmental work, but for architects like Ricks, Murphy, and Mehrotra, such distinctions are irrelevant in architecture’s grand scheme.

For them, architecture is innately humanitarian and social. “Architecture is a social act because it involves people…. The relevance of the profession depends on how we serve society,” Mehrotra says. “If we serve a marginalized piece of society, we marginalize ourselves.”

Furthermore, to the architects, the discipline’s commitment to development is crucial to consider not only for the profession itself but also for society. Ricks says good design is important for infrastructure and functionality, citing how poorly designed hospitals can make people more ill but how well-designed clinics can become a long-term investment in improving a nation through its health.

Murphy concurs, saying that architecture is important in improving people’s lives because, unlike proper perception, it does not produce simply commodities or objects to be used. “If we think about buildings as components of the social fabric, they are key to the creation of resilient and stronger communities,” he says.

For Sanderson, this idea of social significance is what underlies architecture and its aesthetics. He describes a photo he took of a woman sitting in a shack after the Gujarat earthquake, and how the shack—though humble—gives her a livelihood and functions as a source of pride. According to him, this image represents the true aesthetic of architecture. “The aesthetic is built on social and economic, not only the visual,” he says. “The aesthetic comes from what it does for you, not what it is.”


The Butaro Hospital has flourished since its initial construction. One year after its inauguration, it unveiled the Butaro Cancer Center of Excellence, which offers services like chemotherapy, previously not available in the area. The effects of the hospital’s construction extend beyond its boundaries, moreover. According to Murphy, the government is now drafting new standards for hospitals and buildings and PIH hopes to build a university close to the hospital. In a land decimated by genocide two decades earlier and a community that lacked electricity until 2007, the recent progress is staggering. “It’s more than the completion of a building,” Murphy says. “It’s a creation of the system.” Lepik agrees, saying, “There’s a new typology of hospitals now coming out of [the project].”

Meanwhile, MASS Design has implemented the strategies from its work on the Butaro Hospital into other areas and countries. According to Ricks, the company has worked on two clinics in Haiti in response to earthquakes—a tuberculosis hospital that cares for the treatment of multidrug resistant TB and a facility for cholera. In the wake of the Ebola crisis in Liberia, the firm is currently working with the government to develop a better infrastructure for healthcare.

As for the profession itself, new developments are occurring among the next generation of architects. In 2013, students graduated from the Kigali Institute of Science and Technology in Rwanda with architecture degrees—the first in the nation and a sign of a growing awareness towards architecture’s significance in developing society. “We are seeing...young Africans who are really going to have a different vision on how architecture can serve their countries,” Rich says.

Lepik affirms Rich’s thoughts, though on a more global scale. “There’s a strong resonance by the students to these kind of topics,” he says. “That gives me the hope that there is some change that is happening in the next generation of architects.” And while the profession continues to assert its place within the development community, the Butaro Hospital and its profound effects demonstrate that steps are being taken.

--Staff writer Ha D. H. Le can be reached at ha.le@thecrimson.com