Butaro Oncology Support Centre

This article appeared in the May 2020 issue of ARCHITECT.

A 2017 report from Partners in Health (PIH), the organization behind the Butaro Cancer Center of Excellence (BCCE) in Butaro, Rwanda, says that the outpatient facility has treated an average of 1,700 patients per year since it opened in 2012. For most of these patients, an appointment at the BCCE is not a day trip: They travel from all over the region for treatment, including from surrounding countries such as the Democratic Republic of Congo, South Sudan, and Burundi. A chemotherapy treatment might mean arriving on day one, having a multi-hour infusion on day two, and leaving on day three. A biopsy could add another day, surgery even more; some need to be close by for weeks. “While [the BCCE] was meant to be an outpatient clinic, there were a lot of travel costs that patients were incurring,” says Sarah Mohland, a principal at Boston- and Kigali, Rwanda–based MASS Design Group. “The most extreme was lodging near Butaro—there aren’t a lot of options.” The problem became: Where could PIH house patients?

The solution manifested as the new Butaro Oncology Support Centre, which was designed by MASS and opened last year. MASS, which designed the BCCE, has been collaborating with PIH and the Rwandan Ministry of Health on the Butaro medical complex since the design of the main hospital—which opened in 2011. Given that history, the team knew the support center did not want to be another medical facility: Instead of open wards with lines of beds, the center is more residential in feel, providing a relaxing environment where patients can live while receiving treatment. Often, patients do not travel alone, but with families or caregivers, all of whom also need housing. Facilities were also needed where patients or caregivers could prepare food.

Practically, the support center needed to be adjacent to the BCCE and accessible, and there the logistical challenges began: The BCCE is on a hill, and the only site that fit the bill for the support center is further down the steep slope. Excavating a series of terraces allowed for a two-story structure to house patients, but leaves the main entrance on the second floor, connected to the BCCE via a bridge.

The structure is built primarily from concrete masonry units on a concrete foundation. On the north façade, which faces a valley, are stacked colonnades with arches formed from locally fired brick. Surfaces are coated in white plaster, making the building stand out in the lush landscape.

The colonnades “create living rooms where patients can convalesce together, looking at the amazing landscape,” says MASS founding principal and chief design officer Alan Ricks, AIA. They are articulated to follow the topography of the site, meaning that there are nooks and crannies with wooden chairs and benches that serve as public social areas. But “the way it works in plan, it also really provides a sense of privacy,” says design intern Amani Rwibasira, who traveled each week from Kigali to oversee construction. “There are corners that you can go in and not see people.”

The colonnades serve as single-loaded corridors for a row of bedrooms in varying sizes on each floor. “We were trying to maximize the number of patients we could accommodate, but also think about how there could be different family structures or patient needs,” Mohland says. Some rooms have a single bunk bed, while others have two or four; there are 72 beds in all.

A thin line of windows runs from floor to ceiling in each room, allowing in light and, more importantly, air, which is exhausted out through louvers over each door. Ventilation is an important part of a strategy to minimize the risk of infection, as many patients are immunocompromised as a result of their treatments. The team looked at the distance between each bed to minimize the chance of particulate transmission and designed low-slope ladders to make it easier for patients, who may have reduced strength, to access the bunks.Above the first-floor kitchen at the east end of the building is a meeting space and counseling center where patients can receive support about treatments—a social service that didn’t have a dedicated venue before. Having returned to see the center in use, Rwibasira reports that the colonnades are full of people relaxing, free from the burden of having to find housing. “I think this project is really going to help patients in their recovery,” he says.

Project Credits
Project: Butaro Oncology Support Centre, Butaro, Rwanda
Client: Rwanda Ministry of Health; Partners In Health
Architect/Interior Designer/Landscape Architect/Lighting Designer: MASS Design Group, Kigali, Rwanda, and Boston . Alberto Cumerlato, Kelly Doran, Aziz Farid Shyaka, Allie Iaccarino, Sarah Mohland, Christelle Muhimpundu, Brad Pickard, Alan Ricks, AIA, Amani Rwibasira,
Jean Paul Sebuyahi, Megan Suau, Theophile Uwayezu, Jean Paul Uzabakiriho (architecture project team); Sierra Bainbridge, Greg Dalke, Jessi Flynn (landscape project team)
Structural/Civil Engineer: MASS Design Group . Louise Foulkes, Zani Gichuki,
Rosie Goldrick, Jenny Kay, Harriet Kirk, Shakira Nyiratuza, Obed Sekamana (project team)
MEP Engineer: Elie Carter Ndayizeye
Geotechnical Engineer: HICE Consult . Alain Bayavuge
Construction Manager: MASS Design Group
General Contractor: BETEX Ltd
Size: 750 square meters (8,073 square feet)
Cost: $500,000 (construction)