To adapt an existing building on the campus into the new ambulatory cancer center, MASS Design Group turned to hand-sawed formwork for concrete mixed on site, and used CMUs formed on site to replace much of the original structure.

To adapt an existing building on the campus into the new ambulatory cancer center, MASS Design Group turned to hand-sawed formwork for concrete mixed on site, and used CMUs formed on site to replace much of the original structure.

Credit: Iwan Baan


Michael Murphy and Alan Ricks are cofounders of Boston-based MASS Design Group, which also has offices in Port Au Prince, Haiti, and Kigali, Rwanda. They, along with project architect Sarah Mohland, discuss the process of designing the first-ever cancer treatment center in Rwanda.

The cancer center is part of a 15-year master plan for this rural site. How does the new building fit into the work you’ve already done there?
Michael Murphy: Our partners, Boston-based Partners In Health, as well as the Ministry of Health of Rwanda who run the Butaro District Hospital [which MASS completed in 2011], have a commitment to bringing the best healthcare that they can to the poorest communities that they serve.

A lot of the funding for healthcare in emerging economies in the Global South aligns with communicable diseases, such as tuberculosis, malaria, and HIV. Partners in Health is now looking to the future, to noncommunicable diseases such as cancer, obesity, and diabetes—the kinds of things that start to affect people as they live longer. And so they chose to start what is now the first outpatient cancer center in East Africa, I believe—the first cancer treatment in Rwanda for sure.

Surrounding the center are landscaped pathways lined by locally sourced volcanic stone, leading to the entrances and gardens for patients.

Surrounding the center are landscaped pathways lined by locally sourced volcanic stone, leading to the entrances and gardens for patients.

Credit: Iwan Baan


Is it drawing people from a much wider area because of that?
Murphy: It will certainly draw people from all over Rwanda ... as the referral center for cancer. [Also] I think, ambitiously, [from] the neighboring countries, the Congo and Uganda, which are in close proximity.

A butterfly roof, topped by metal material from Tolirwa, contains concealed gutters that funnel rainwater into cisterns for use elsewhere 
on the site.

A butterfly roof, topped by metal material from Tolirwa, contains concealed gutters that funnel rainwater into cisterns for use elsewhere on the site.

Credit: Iwan Baan


What’s been the larger impact of this center on the local community?
Murphy: The economic impact of the hospital has been substantial. When I first got to Butaro in the beginning of 2008 there was no electricity in the town; there were mostly empty businesses. Not even six years later, there’s a hydroelectric dam in town. In the whole village below the hospital, there’s lots of fresh coats of paint on businesses. A Bank of Kigali has opened up there, not to mention middle-class families are moving to this community because there’s ongoing work at the hospital both in terms of service, nursing, as well as in construction.

A large overhang protects the entrance to the ambulatory cancer center and provides a sheltered gathering space. The design team was able to work with skilled local labor to create detailing such as the projecting concrete jamb around the custom steel windows.

A large overhang protects the entrance to the ambulatory cancer center and provides a sheltered gathering space. The design team was able to work with skilled local labor to create detailing such as the projecting concrete jamb around the custom steel windows.

Credit: Iwan Baan


I know that this project has also involved developing construction skills in the local population, building infrastructure.
Murphy: One of the privileges of getting to invest more than five years into this one site is that we’ve been able to grow relationships with a variety of team members. MASS is bringing expertise, and that’s being melded with the wealth of knowledge from people in the local community and with Rwanda regionally. Over the course of these projects we’ve been able to find really skilled workers. But what’s even more exciting is that we’ve seen these people take those skills and find other jobs because of the recognition they’ve received for the work on these projects. We’ve seen that in different trades such as masonry, welding, weaving, and pottery.

A view into the infusion room, past one of the existing buildings on the hospital campus.

A view into the infusion room, past one of the existing buildings on the hospital campus.

Credit: Iwan Baan


Alan Ricks: It reminds us that so much of the architecture is about maximizing the potential of labor. And in order for us to achieve high-quality results with limited resources, by necessity our practice began with trying to see what high-skilled local labor we could leverage to maximize the impact, the dignity, the beauty, and the outreach this process could potentially have into the community.

Outdoor colonnade, which overlooks the landscaped garden areas surrounding the structure.

Outdoor colonnade, which overlooks the landscaped garden areas surrounding the structure.

Credit: Iwan Baan


How did you focus on patient care in the design of the cancer center?
Sarah Mohland: The infusion center is a place where patients spend six to eight hours at a time receiving treatment, so we tried to make the space as comfortable and peaceful as possible. The interior is a very bright yellow and it creates a calm space. Patient care is centralized along three infusion pods, and it allows for the patients to have visitors. A chair provides seating for up to two family members. We emphasized patient care by allowing for easy access for the physicians and the nurses to reach them in a centralized place.

The infusion room was designed so that patients can be accompanied by family members during their treatment.

The infusion room was designed so that patients can be accompanied by family members during their treatment.

Credit: Iwan Baan


Murphy: There was potential here to take advantage of this amazing landscape. By customizing the doors and opening the façade, we knew we could create an open space for these patients to feel dignity and respite. In order to open the view, we created a butterfly roof, which is also represented in the Y-shape of the columns themselves. So there’s a thematic strategy in the engineering as well as the holding up the roof of this kind of lifting, this branching up, in order to create a more lively open space.

There’s a lot we can learn about medical space in the U.S. from what is being prototyped in Rwanda. Open air, leveraging the environment—those are things that have been largely designed out of U.S. medical facilities. I think it behooves us to remember how those kinds of open air environments can also be very valuable and protective and safe for patients.

In the infusion room, patients can sit with family members in custom furniture that sits on SAJ floor tile while they receive their treatment. Large-scale doors can open to the outside to promote cross-breeze from the Big Ass Fans fixture installed overhead.

In the infusion room, patients can sit with family members in custom furniture that sits on SAJ floor tile while they receive their treatment. Large-scale doors can open to the outside to promote cross-breeze from the Big Ass Fans fixture installed overhead.

Credit: Iwan Baan


Describe the structure and the building materials. Were there any unique decisions that you had to make because of climate or culture?
Murphy: The way we approach every project is through an initial immersion. The idea is not only to uncover the challenges on the project, but also to uncover opportunities that we can leverage to amplify the impact. When Rwanda labor costs for a good-paying job are still low relative to materials, it creates a real opportunity for customization on a larger scale. And so we said, “Okay, we’re creating this custom hand-sawed wood formwork, and isn’t this a chance to do something more unique with the structure of the space to give it a character that reflects that opportunity?” And so we worked with our Rwanda engineering team to look at how we could optimize the structure to create this spacious, airy open space while using the form of the structure to highlight that.

Inside the infusion room, which is the centers largest space, custom millwork and a nurses station are all painted in vivid yellow shades from Ameki Color. A custom light fixture hangs from the steel frame and painted plywood ceiling.

Inside the infusion room, which is the center’s largest space, custom millwork and a nurse’s station are all painted in vivid yellow shades from Ameki Color. A custom light fixture hangs from the steel frame and painted plywood ceiling.

Credit: Iwan Baan


It’s clear that your work in Butaro shows the value that good design can bring to the country in a way that is often not appreciated in the developed world.
Murphy: I think we forget that it’s possible to design an architecture that improves people’s lives first and foremost, rather than the aspirational object that could be value engineered out. Our system is so overdesigned in terms of liabilities and litigiousness that it’s hard to sift through it to see the value and the potential that’s right in front of us to change the built environment we’re already living in. I think working in Rwanda shows us that it’s not only possible, it’s absolutely imperative. If we don’t do it, we’re going to see our infrastructure continue to corrode and fall apart in the U.S. We’re going to see job opportunities that are lost. We’re going to see a lack of investment in health and safety in our communities if we don’t think about the infrastructure we live within as part of the methodology to improve our lives.

In other words, the U.S. can learn a lot from Rwanda if we take these things seriously. 
Murphy: I really believe that.

Infusion room, with a view to the outdoor colonnade and the offices and private consultation rooms.

Infusion room, with a view to the outdoor colonnade and the offices and private consultation rooms.

Credit: Iwan Baan

Large operable doors allow the infusion room to be opened to natural ventilation, and allow access to a patio beyond.

Large operable doors allow the infusion room to be opened to natural ventilation, and allow access to a patio beyond.

Credit: Iwan Baan

Conference room, with a view to the main entry beyond.

Conference room, with a view to the main entry beyond.

Credit: Iwan Baan


Custom millwork is seen again in the private exam room.

Custom millwork is seen again in the private exam room.

Credit: Iwan Baan


A pavered patio wraps the cancer center, providing outdoor space for patients and family members to congregate.

A pavered patio wraps the cancer center, providing outdoor space for patients and family members to congregate.

Credit: Iwan Baan


The terraced landscape of the hospital site in Butaro.

The terraced landscape of the hospital site in Butaro.

Credit: Iwan Baan



Drawings


Project Credits

Project  Butaro Ambulatory Cancer Center, Butaro Hospital, Burera District, Rwanda
Client  Ministry of Health in partnership with Partners in Health
Architect  MASS Design Group, Boston and Kigali, Rwanda
M/E, Civil, and Structural Engineer  MASS Design Group with Kayihura Nyundo from Ubatsi 
Interior and Lighting Designer  MASS Design Group
General Contractor  Partners In Health
Construction Manager  Joas Peter Ngendabanga
Size  4,307 square feet

Materials and Sources

Ceilings  Custom-fabricated steel frame and painted plywood
Concrete  Hand-mixed on site
Exterior Wall Systems  CMUs produced on site
Fabrics and Finishes  Locally sourced African patterned fabric
Flooring  Terrazzo; SAJ Tile
Furniture and Millwork  Custom-fabricated
HVAC  Big Ass Fans 
Masonry and Stone  Locally sourced volcanic stone
Paints and Finishes  Ameki Color
Roofing  Tolirwa
Wayfinding  Custom-fabricated signage designed by MASS Design Group
Windows  Custom-fabricated steel windows