Health centres and facilities
MASS Design Group began working in Haiti on the design and construction of a tuberculosis hospital with Les Centres GHESKIO—a Haitian leader in healthcare—in early 2011, one year after the earthquake that unveiled just how vulnerable to shock destitute poverty renders communities. Cholera—a curable, preventable disease that had not existed in Haiti—emerged and ran rampant through the tent cities of Port-au-Prince and surrounding hillsides, enabled by Haiti’s dearth of sanitation and public infrastructure, overcrowded housing, and weakened population. Cholera patients were treated in temporary tents, which were difficult to keep sanitary, hot in the Haitian climate, and deficient at ensuring one’s longterm prevention from infection; the right to dignified health care. In partnership with GHESKIO, we knew there existed an undeniable need to address both sides of the cholera debate: treatment and prevention, building not only Haiti’s first permanent diarrheal disease treatment center to treat cholera, but also incorporating an on-site wastewater treatment facility to thwart recontamination of the water table and consequent spread of the disease.
The urgency for investment in health is incontestable: Haiti ranks lowest in Latin America and 119/137 globally in achieving the Millennium Development Goals that establish targets for improvements in nutrition, education, sanitation, gender equality, and maternal and infant mortality.
Haiti’s first permanent diarrheal disease treatment center serves a catchment area of 60,000 Haitians—most of who reside in a neighboring informal settlement—and treat up to 250,000 gallons of wastewater annually. Yet this center will only enable accessible care for less than one percent of Haitians, and authorities have documented over 680,000 cases since the initial outbreak. Cholera’s stomp on Haiti demonstrates the stark need for health facilities and public health infrastructure, without which, the oft-cited goal of “rebuilding Haiti back better” risks falling short.
DESIGN AND CONSTRUCTION:
The GHESKIO CTC is the first purpose-designed permanent cholera treatment center in Haiti, and has a 100 patient capacity for thirty-five mild cases and sixty-five severe cases. The CTC includes a specialized wastewater treatment system which removes all waterborne disease pathogens on-site to ensure that there is no recontamination of groundwater, and no need for off-site treatment. The roof also collects rainwater in an underground cistern which will be treated for use within the facility for cleaning, bathing, and drinking. As the Haitian climate is so humid, high roof peaks provide efficient natural ventilation of hot air through stack effect and allow for clerestory day lighting; on the interior, a drop ceiling provides thermal break to cool that space. The building is made from compressed stabilized earth blocks (CSEBs). All materials were fabricated in-house and sourced locally, which allows for complete oversight and quality control, ensuring high grade product. The CSEBs reduce CO2 emissions as they require half the cement, and create jobs, since a team of 10-12 is required to operate the manual machine for each production shift. On the interior, there are distributed hand wash sinks and pour flush toilets for direct access to clean hands and waste disposal, and distributed floor drains for collecting soapy water from floor washing. A 1.5m perimeter access corridor around the building allows for expedited movement of beds and staff, and nurse stations are situated in each patient bay for direct observation.
MASS worked with local contractors and hired exclusively local labor to build the cholera treatment center, including providing job training to many. Especially unique to the design process is the handcrafted metal shade screen façade that optimizes privacy, daylighting, and ventilation. Designed through MASS at Harvard University specifically to leverage local expertise in craft, the screens were then fabricated by metal workers in Croix des Bouquets, Haiti. Because each perforation is adjusted to maximize airflow and reduce heat within the facility, they create a comfortable, well-ventilated atmosphere without comprising patient privacy (especially important for such an undignified disease).
ClientLes Centres Gheskio
Gross Floor Area (mq)693
ArchitectsAdam Saltzman, Nathan King
Design teamDavid Saladik, Chris Scovel, Alan Ricks, Michael Murphy
ConsultantsMazzetti Nash Lipsey Burch (M+NLB), Fall Creek Engineering, Nathan King + Virginia Tech Center for Design Research
Photo CreditsIwan Baan
MASS Design Group is a design studio with offices in the United States and Rwanda. For the past five years we have worked to create a new practice of architecture that promotes dignity, opportunity and health. Our projects in over twelve different countries have proved the effectiveness of best-practice design to help otherwise under-resourced communities thrive. As an architecture and design firm, MASS identifies the potential for infrastructure to improve service delivery outcomes, and scales these ideas by working with government on national policy. As a research and training lab, MASS uncovers and evaluates new best-practice methods, and trains architects and designers to grow the next generation of buildres in the regions in which we work. MASS’s work hinges on thorough community engagement at every phase of design and construction, to identify unique opportunities and to train artisans in new skills, an ethos we call the Lo-Fab (local fabrication) design practice.