On Friday, April 4, in the Piper Auditorium of the Graduate School of Design, Michael Murphy (MArch ’11) and Alan Ricks (MArch ’10) presented “Beyond the Building,” a series of short films documenting MASS Design Group’s work over the five years since its founding. Murphy and Ricks discussed the evolution of MASS Design Group, which they established while students at the Design School, into an award-winning, internationally acclaimed organization. MASS Design Group has since expanded their work outside of Rwanda to projects in Kenya, Uganda, Malawi, Haiti, and the Congo, to name a few. Their Butaro Ambulatory Cancer Center, the first-ever cancer treatment center to align with the official guidelines of Rwanda, graces the cover of Architect magazine this month.

In grad school, working on their first design project in Rwanda, the pair first began to question the role of architecture in society. “Giancarlo Di Carlo, this late 1970s architect, was and is kind of our hero,” Murphy said. “There was this debate of whether you could have a social practice with political impact or you had a high-design practice. And he called these a false dichotomy, saying it shouldn’t be an either-or, that it should be both.” With this duality in mind, Murphy and Ricks have grown MASS Design Group into an organization that has been praised for its design excellence and its commitment to empowerment of local laborers. ”This intersection of design excellence and societal impact is…where architecture really facilitates a broader discussion of its role in society,” Murphy said.         

A fortuitous encounter at Harvard with Dr. Paul Farmer, co-founder of the global health organization Partners In Health (PIH), would change Murphy and Ricks’s trajectory and push them to think about how their design could have human impact. Farmer mentioned that he was in the process of building homes and a hospital, which caught Murphy’s attention. “I went up to him afterwards and asked him who were the architects involved, could I get involved, maybe make a connection, and he said, ‘Architects? Why would I ever use an architect? I drew the last hospital on a napkin,’” Murphy said. “It’s an interesting challenge. Why would one of the key, leading health professionals in the world, [who] could snap his fingers and get an architect to work for him for free, not think about using architects to design the crucial elements of the infrastructure he was building?” Murphy’s desire to work with Farmer surpassed his need for a generous paycheck, and in 2008 he joined Dr. Farmer and PIH in Rwanda to construct the Butaro District Hospital.

Murphy soon learned from Farmer of an instance where a lack of sound architecture cost lives. In Tugela Ferry, South Africa, an extremely drug-resistant strain of TB spread to 59 patients who stood awaiting treatment in hallways—hallways that lacked proper ventilation, allowing the deadly disease to kill those 59 patients. If buildings could make people sicker, thought the co-founders, how might a building function to improve health instead? “This notion of a performance of the building, this transformation of architecture affecting our lives, was exactly how we were able to compose a series of solutions to this question we were pondering,” Ricks said.

The MASS founders knew little about the Rwandan region where they would work, a place so remote that before Dr. Farmer’s arrival, the population of 400,000 was served by not a single doctor. To address these needs, PIH began to develop a multi-building system in partnership with the Rwandan Ministry of Health. “This hospital was to be the kind of flagship of these ideas,” Murphy’s cofounder Alan Ricks said . “So we started to address [the question of] ‘What is a hospital that can respond to these challenges, that doesn’t make us sicker, but might actually make us better?’” Ideas were simple but effective, such as building a hospital with open-air hallways. Yet while single rooms were a good solution to the problem of infection control, the MASS partners learned that isolated patients would be more likely to die, as that room configuration would further stress already-scarce human resources. “Instead, we created these spacious open wards that capitalize on cross-ventilation,” Ricks said.

Ricks also explained that the goal of MASS Design Group is not only to construct a building that positively impacts lives but to positively impact as many lives as possible during the construction process through on-site job training and the creation of jobs for local labor. “A typical Rwanda wall for us was very interesting, because most of the stone is obscured by cement…. We wanted to see if there was an opportunity to actually highlight the craft over the material. Through that process of engagement with the masons, we really saw an opportunity to expand the [project’s] impact,” Ricks said. “We had them keep pushing, and their skills just continued to get better and better.” The original team of masons for Butaro District Hospital, after working all the way around the building to the corner of the building where they had first begun, had so improved their skills that they asked their foreman if they could “tear down the first one and rebuild so it would match” the improved technique.

“We continued to try and push what elements were there [locally] that we could utilize,” Ricks said. But now the Minister of Health wants to turn the Butaro project into the second major teaching hospital in Rwanda, a $100 million investment that would transform a previously remote region into a university campus. As Ricks said, “What started as this one idea about building a better hospital has actually become an entire decade of work.”