Design, health care students fuse disciplines to improve Rwandan clinic

Students from four of Arizona State University’s graduate programs traveled to a country known as the Land of 1,000 Hills to study health care and building design in one of Africa’s most impoverished areas.

For two weeks in September, 17 students from architecture, landscape architecture, and the health care and healing environments programs in The Design School in the ASU Herberger Institute for Design and the Arts and the Master of Healthcare Innovation program from the College of Nursing and Health Innovation traveled across the Rwandan urban and rural landscape to a community health clinic on one of those hillsides.

For the students, navigating the cultures of an unfamiliar country proved as challenging as understanding and absorbing each other’s professional disciplines.

“It was life changing. We were given the opportunity to make a significant difference in other people’s lives,’’ said C. J. Rogers, an architecture student in The Design School and part of the international traveling design studio invited by RwandaWorks, a Rwanda-based non-governmental organization, to study health care facilities in three villages.

The students’ task was to recommend ways to improve the clinic's current design to improve quality of health care delivery and lower costs. RwandaWorks builds clinics in partnership with the Rwanda government and, with Access Health NGO, trains community members to run them.

The students divided into teams and met with an assortment of community members, observing and interviewing patients and professionals at RwandaWorks clinics and learning from experts about Rwanda’s economic development and health care systems. James Shraiky, director of the Herberger Institute’s Healthcare Design Initiative, led the trip with Gerri Lamb, associate professor at the ASU College of Nursing and Health Innovation, and Linda Voyles, a recent graduate of the college’s masters of health innovation program.

“This kind of inter-professional research experience is unique and very effective,’’ said Shraiky. The Healthcare Design Initiative taps the inter-professional disciplines of design and healthcare to provide students an unprecedented approach not only to designing buildings, interiors and landscapes that enhance healing but that are also functional for and sensitive to health care providers.

“The students – 11 graduate design and seven health care master’s students – arrived in Rwanda worlds apart in terms of perspective and focus,’’ Shraiky said. It was this difference that proved challenging and exhilarating and is the strength of the overall program, according to Shraiky and Lamb.

“Students learn how each profession thinks and solves problems. They generate ideas using different models and tools,” Lamb said. “Hopefully, they discover that their ideas and solutions are much stronger because they are working together.’’

“In my profession, we have to collaborate and my roles as respiratory therapist and innovator in health care are different than a landscape architect’s,’’ said Donna Pachek, a respiratory therapist in the ASU School of Nursing and Healthcare Innovation master’s program. “We have to look at the context and we all have key perspectives that can contribute to the whole. We all respect each other’s perspective.’’

The students were overcome with the Rwandans’ gratitude for their presence. When they asked women in the community what improvements they wanted in the clinic for themselves and their children, they were hard-pressed to come up with examples because they were so grateful for what had been provided, said architect student Scott Nye.

Although Rwanda has made tremendous strides in health care, the country is committed to improving its outcomes in key areas including maternal and child health and lowering infection rates. Malaria and respiratory infections are among the top causes of death. During their visit, the students gained first hand knowledge not only of the culture and its people but also of practical, every day things such as local building materials, cooking practices, traveling distances and patterns of socializing. The architecture and landscape architecture students jumped at an opportunity to work side by side with community members to lay clay bricks in a new home, Lamb said. They gained first-hand knowledge of local building materials and techniques. The students followed patients and their family members through typical clinic visits and attended community meetings including one at the edge of a volcano in rural Musanze, careful to observe and not to impose their own cultural values and priorities.

By December, the students will have taken their field research of the community needs, its culture and history combined with the country’s health care system, economic development and service needs and create a schematic and operational design for a community-based clinic that will serve more than 18,000 people from 31 villages.

The initial navigation of learning each discipline’s approach to everything from organizing data to prioritizing needs and solving problems will be expanded and deepened during this phase. “I think of it as collecting more tools in my tool belt,” said Megan Mohaupt, who is pursuing her master’s in health care and healing environments.

“We were invited by RwandaWorks to assess their current center design and propose refinements,” Lamb said. “RwandaWorks will continue to work with the class on evaluating the refinements and plans for building the new center."

The students want to honor the Rwandan villagers’ culture. They are careful to avoid superimposing their experiences and biases on any design plan they create. “This is a critical design change,” said Ashley Brenden, a landscape architecture student. “The way Rwandans perceive and interact with their landscape is dramatically different than in the U.S. We have to create an environment that is productive and functional in ways we may never have thought of before. Learning to work with community members is really powerful.”

For architecture student Alyssa Matter, one of the studio’s biggest impacts is in her own realization of what her design skills can contribute. “It makes you realize how much you can completely change someone’s life,’’ she said.