Evidence-Based Design and Healthcare Vernacular

Posted on December 13, 2011


In architecture, vernacular is a word used to define a local, learned design tradition, professionally-untrained yet refined and endemic to a geographic region and culture. Vernacular can refer to a material or spatial / organizational knowledge that usually becomes aesthetically identifiable as well.  For instance, some third-world countries have developed a sophisticated way of building based on materials available—corrugated metal, CMU blocks, mud / adobe—which provide a distinct richness to a particular people or neighborhood.

In catching up with some back reading, I noticed GreenSource had a nice profile on the Butaro Hospital in Rwanda by MASS Design Group in its September / October 2011 issue.  Butaro is an excellent example of vernacular applied to healthcare.

The project had major hurdles:  a mountainous, rural site; a destitute community; poor community health and no existing healthcare infrastructure (hospital or doctors); little access to skilled labor or equipment.

However, in the end a 155-bed hospital was built for $4.4 million, amazingly about $64 / sq.ft. The program included separate wards for men, women, maternity and pediatric care, as well as pre- and post-operative care, ED, OR, pharmacy, lab and support spaces.

Although financially-poor, the project was idea-rich in evidence-based design. Terraces and interior landscaped courtyards provide patient access to nature. Passively ventilated by necessity, including operable windows and ceiling fans, the project produces an astounding 12 air changes an hour. Double-loaded corridors were not used and buildings were broken apart to thwart germ multiplication.

Make no mistake:  this is not a hospital most would recognize or likely accept in the U.S.  It is low-to-no tech with group ward beds and none of the systems infrastructure like medical gases required in U.S. hospitals. Still, Butaro’s power is in using design ideas with little cost and major impact; design as equilizer to maximize the building’s functional impact and performance for its community.

Vernacular design has many benefits, two of which are very evident in Butaro:  local material and building skill in its construction and environmental appropriateness. Coupled with current evidence-based thinking, the project is a strong prototype for future facilities in similarly-challenged areas.