Rwanda Hospital Tour: 'Effective' has a new meaning

Previous post (Day #2)

International "Benefit" Tour - Africa Day #3

Today was our first day in Rwanda.?

Rwanda is an extremely important part of our work here, as we designed the engineering systems for two hospitals here. Both of these hospitals, Nyarugenge District Hospital in Kigali, Rwanda, and Munini District Hospital in Rwanda’s Nyaruguru District, have now been constructed and operated through the Covid crisis. The architect for both of these projects was the brilliant team of people at the MASS Design Group .?Having the chance to perform a Post-Occupancy Evaluation will be invaluable, when we land in Burundi.

In designing these two sister-hospitals, both Mazzetti and MASS brought their best thinking and experience to bear on the challenges of designing a hospital that can work over time in places challenged by lack of resources, especially, human resources.?

Nyarugenge District Hospital

Today, we visited the Nyarugenge District Hospital in Kigali with our friends from MASS. Our primary goal was to learn from the design, now in operation for several years, including during the height of the COVID crisis. This hospital is a government-run hospital, serving the poorest of the poor. It has no facility management staff at all and no contracts for service.?

This hospital contains no mechanical ventilation with the exception of two Operating Rooms. Each of the ORs has a dedicated fan with filter banks. The balance of the rooms all use a form of convection (i.e. natural ventilation) with grills mounted low near the ground and exhaust high up on the wall.?We supplemented this system with large fans in many of the rooms, together with permanent?UV lights for disinfecting. The hospital, however, is not running either the fans or the UV lights (we believe that the UV lights have all burned out, and the hospital has not had the funds to replace them). The hospital consists mostly of multi-bed wards, where patients with similar health issues co-habitate. Architectural planning for this building includes maximum use of outdoor space for waiting, circulation, patient-respite, and staff-respite. This strategy of physically separating different types of patients served the hospital well during COVID surges when its 125-bed capacity was strained by patient loads exceeding 200. The weather in Kigali is very mild and very consistent, so, except for the ORs, the hospital has no ventilation system. Nonetheless, the current design is always comfortable. There has been no discernible hospital acquired infection. In one area of the hospital, the staff have blocked the lower set of grills. The staff who escorted us were not certain why they had done that, but it made a marked difference in the ventilation in that particular space. This particular space is the one that probably needed it most of all — the emergency department.?

The hospital reported that they have NO maintenance staff and no contracted maintenance. The grounds were well tended, so they must have some services. But the lack of maintenance staff did not appear to have any substantial impact on the efficacy of this ventilation system.?

The hospital has a small plant generating all of the medical air and oxygen needed by the campus. This system, too, appears to be working effectively.?

The hospital derives water from a municipal supply system and discharges the effluent into a set of cisterns and leach fields immediately outside the building footprint. This system appears to be working as well, with the exception that some of the patients and visitors are unfamiliar with toilets. On at least two occasions during the last year, people have stuffed foreign objects into the toilets, blocking them, and causing them to vacate one entire unit.

The local utility company provides relatively reliable power to the hospital. It has one diesel generator which assumes all of the load upon loss of the utility. In addition, the hospital has added a bank of solar panels to serve the business office in the event neither the utility nor the generator are functional. The hospital uses low-energy LEDs for all lighting. All other building loads, including sterilization and laundry, are electric. The only combustion in the entire building is bottled gas for cooking. This system works well, except that it has a large carbon footprint, given the fuel mix of the grid in Rwanda.?

All in all, this appears to be a very successful project. The architecture and medical planning work very well, blending the indoors and outdoors in wonderful ways. The simple, rugged, inexpensive, and low-carbon sets of engineering design strategies are working well, despite the lack of on-site service staff. In general, we were pleasantly surprised and very impressed at the effectiveness of this building.

Maybe most important, when we talked to the staff about what they did NOT like, and what they did NOT find effective in the building, they were all unable to come up with something.?