Above: Butaro Hospital in northern Rwanda is MASS Design Group’s first project—and through its architecture, it promotes healing. Bottom: MASS Design group employed local labor, craftspeople and materials to construct the Kasungu Maternity Waiting Village and Ilima Primary School. Photos: Iwan Baan.

Michael Murphy co-founded the Boston-based MASS Design Group, an interdisciplinary architecture and design collective that has used this principle in working with hospitals in Rwanda and Haiti; schools in the Democratic Republic of Congo; clinics in Malawi; and Montgomery, Alabama’s National Memorial for Peace and Justice, a site for reflection on the history of racial inequality in the United States.

“I believe that architecture is the most potent, profound, nimble and beautiful trade,” Murphy says. “Its richness is its constraints, its real-world applications, and its ability to force us to imagine ourselves as part of something greater than ourselves—its civic role—and allow us to dream for something better for ourselves—its distribution of dignity.”

Murphy—a designer, writer and teacher—delivered the Global Health and Wellness Summit keynote address during Greenbuild 2020.

Q. How can building design affect people’s health?

COVID-19 reveals what many of us have long learned: that buildings shape our health and our ability to access health every day.

We were founded on this idea 12 years ago, when MASS Design Group first formed to design and build the Butaro District Hospital in northern Rwanda. There, it became clear that many health care facilities lacked the necessary precautions to prevent the transmission of disease. Hospitals often had small, poorly ventilated waiting rooms in which a patient with an injury, such as a broken leg, would be waiting in proximity to a patient with tuberculosis. Architecture and spatial care protocols, in this case, were directly putting people at risk.

Our collaboration with our partners on the Butaro Hospital resulted in a facility with architecture that supported healing. Rather than weak infrastructure, poorly lit spaces, and institutional recovery rooms devoid of hope or personality, [we designed] a solid, medically sound facility with natural light, wide hallways, courtyards and spaces for families to gather, oriented to take advantage of the beauty of this mountainous region. Thanks to these and other changes in health infrastructure in Rwanda, average life expectancy has gone from less than 30 years to almost 70 over the last three decades.

Health and safety standards for the design and construction of health care and related facilities are widely accepted throughout the world. However, we still need to push the design field to transform these spaces from a place to treat symptoms to a place of healing. From memorials to schools, we are having similar conversations about the need to go beyond the symptom to a holistic path to success.

Q. Can you explain how buildings can be designed to help people heal?

In our work, form follows facts. Mortality rates in some of the world’s most vulnerable areas are being exacerbated by poor architectural provisions, which allows disease to run rife in health care settings and causes medical professionals to flee. Yet thoughtful design can improve physician retention rates, encourage people to seek medical assistance and improve their health prospects when they do—all at relatively little cost.

Today, there is a new demand for a movement where architecture follows evidence. Medical professionals, governments, clients, developers and communities want evidence and measurement of architecture’s impact—especially as it applies to health—to prove it is worth the investment. Julio Frenk, the former head of the Harvard School of Public Health, has said, “Scientifically derived evidence is the most powerful instrument we have to design enlightened policy and produce a positive social transformation.” Data can help us to design enlightened architecture, too.

Of course, facts only get us so far. Architecture’s intangible qualities, like beauty and dignity, are also necessary for us to rethink and improve the world in which we live. Great architecture is functional and aspirational. Hospital architecture, in particular, provides the opportunity to make environments that improve lives measurably by investing in the dignity of the communities they serve. Architects might be the difference between whether a space offers hope or not.

Architecture can be a transformative engine for change. When looking at many of our first projects, including the GHESKIO Cholera Treatment Center in Haiti, the Ilima Primary School in Congo and the Kasungu Maternity Waiting Village in Malawi, we asked a simple question: “What more can architecture do?” By asking that question, we were forced to consider how we could create jobs, how we could source regionally and how we can invest in the dignity of the communities in which we serve. Architecture can be a transformative engine for change.

MASS Design group employed local labor, craftspeople and materials to construct the Kasungu Maternity Waiting Village and Ilima Primary School. Photos: Iwan Baan.

MASS Design group employed local labor, craftspeople and materials to construct the Kasungu Maternity Waiting Village and Ilima Primary School. Photos: Iwan Baan.

Q. You’ve spoken about “lo-fab” building construction. How does this philosophy work in practice?

In practice, Lo-Fab (Locally Fabricated) approaches values [in] the way a building is made as much as the building itself. We seek to highlight and scale local innovation and ideas, bolster and develop local crafts, hire local labor, and invest in capacity-building and job training. Lo-Fab means supporting the local economy through the use of local contractors and locally fabricated and sourced materials.

Working with these locally sourced materials and labor, we can assess the entire supply chain for environmental impact and ensure that the majority of capital invested in construction flows to the community we are serving. We are implementing lean construction practices, which seek to continually find ways to achieve our partners’ goals, while minimizing wasted effort, time and resources. Lo-Fab engages the community in the building and creation process so they can be a part of the building’s success. It also means we can create a lower carbon footprint.

A good example of our Lo-Fab process in practice is the design of The Rwandan Institute of Conservation Agriculture (RICA) in Bugesera, Rwanda. It is RICA’s mission to train the next generation of leaders in conservation agriculture to attain healthy and sustainable food independence in Rwanda. The campus features innovative methods of power generation, water use and green infrastructure, and is estimated to be carbon-positive by the 2040s. It has begun to achieve this by reducing the embodied carbon of the buildings, sourcing 96% of materials by weight from Rwanda, installing a 100% off-grid solar farm, sourcing and treating all water on-site, and offsetting the remainder carbon by restoring parts of the savannah woodland and reforesting key areas within the campus.

Left: The GHESKIO Cholera Treatment Center engaged the local community in its construction. Photo: Iwan Baan. Right: The Gun Violence Memorial Project shows how memorials can help guide toward healing and reconciliation. Photo: MASS Design Group

Left: The GHESKIO Cholera Treatment Center engaged the local community in its construction. Photo: Iwan Baan. Right: The Gun Violence Memorial Project shows how memorials can help guide toward healing and reconciliation. Photo: MASS Design Group

Q. What role can the national memorial for peace and justice play in the racial justice reckoning happening in the u.S. Right now?

Our nation is in the middle of a new social awakening. History is often written by the [most powerful], and when that history is challenged, it can cause physical and emotional fissures. The design and lessons of memorials can’t solve our past problems, but they can offer a guide toward progress, healing and reconciliation as long as everyone is willing to go along on the journey.

Our Gun Violence Memorial Project has shown us that successful memorials must oscillate between the infinite and the intimate. In that flicker, a pathway reveals itself. Into the individual life [goes the] the story, their spirit. We surrender to the magnitude of shared loss; we feel each loss is also our loss. If, in this process, we are given the tools to engage, the rituals to enact, the stories to hear and the spaces to hear them, we may find [that] memorials are living actors in constructing cultural transformation. And in this way, architecture can be healing spatialized.

Our hope is that people can learn from a memorial devoted to truth-telling, reconciliation and healing. We hope that individuals and communities can come to the memorial, engage in this process of acknowledgment and reconciliation, and claim their monuments by placing them as markers in their own communities.

Q. Has the worst pandemic in a century changed the way you think about urban design?

The pandemic has brought to light a much larger, existential moment in [buildings and spaces]. We have seen a growing spatial awareness of the built spaces around us, and how these spaces can protect us, or potentially injure us.

We created a COVID-19 Design Response team to share strategies when retrofitting spaces for infection control. We’re engaging with design and health care thought leaders to guide our work. Early on, research explored how the coronavirus was transmitted in the air. As we adopted social distancing, we saw a need to investigate the design of our built spaces, where such distancing did not come easily.

Prisons, in particular, were especially vulnerable. These are environments where social distancing is very difficult, and the guards and people who have been incarcerated are in tight, poorly ventilated spaces for large periods of time. We looked at homeless shelters, hospitals, schools and senior housing spaces, as well as restaurants and hotels. These materials were made public to the community as they became available at massdesigngroup.org/covidresponse.

Q. What design lessons should we take away from the coronavirus crisis?

The primary design lesson is that COVID-19 reveals a fact we in the profession have overlooked or forgotten: that the buildings around us manage our right to breathe. Breathing air free of environmental contaminants, airborne diseases, forest fire smoke—and more symbolically, toxic injustices—is determined by which building one might be in or have access to be in. To acknowledge this is to radically change our profession towards the distribution of rights, not the provision of services. It is to accept the power [that buildings and spaces have] on people’s daily lives, and to begin to wrestle with and work within that great responsibility.

MASS Design Group supports healing and happiness