A Building Designed to Solve Haiti’s Cholera Problem

In 2010, a major earthquake sparked the worst cholera outbreak Haiti has seen in recent history. Five years and nearly 9,000 lost lives later, there’s an interesting question to be asked: Could better architecture have saved lives?
A newly opened cholera treatment center in Port-au-Prince might provide a tentative answer to that question. Despite cholera’s deadly grip on the country, the open-air clinic (designed by Boston architecture firm MASS Design Group in partnership with Haitian non-profit Gheskio) is the first permanent treatment center in Haiti dedicated to battling the highly contagious disease.
It’s a simple metal structure that looks more beach cabana than hospital. Unlike typical healthcare architecture in the United States, where hospitals are designed as hermetically sealed, one-stop ailment shops, MASS’ building is designed specifically to treat cholera in a tropical climate. The CTC smartly embraces Haiti’s warm temperatures and sea breezes rather than fighting its natural environment.
It’s framed by ocean-hued walls that that allow light and air to sweep through the space, adding cooling cross breezes and ample sunlight to help kill bacteria. Aesthetically speaking, it’s an attractive building, but its looks are by far its least important feature. Hidden below the structure is a mini waste-water management system, which will process up to 250,000 gallons of waste over the next year.

The perforated walls allow breezes to flow through the center while sunlight helps kill bacteria. The center can treat up to 100 patients.  MASS Group

Treating Waste Is Treating Patients

Haiti’s biggest foe when it comes to preventing the spread of cholera has always been a lack of sanitation infrastructure. With no city-wide waste management system, the treatment centers in Port-au-Prince rely on outside contractors to remove and transport waste. Spillage is a risk, as is the possibility that the contracted companies will still mismanage the waste. Instead of sewers, the city has traditionally relied on bayakou, workers who clean latrines in the middle of the night, and who often stealthily (and illegally) ditch waste. But living in Haiti’s slums, even a latrine is a luxury. This meant more often than not, waste water would end up back in the city’s water table, effectively creating a never-ending cycle of infection.
MASS’ design relies on a five-chamber anaerobic biodigester to turn solid waste into clean water. As waste makes its way through the five vertical chambers, anaerobic bacteria helps to break it down into liquid form. Whereas many anaerobic biodigesters stop at three chambers, the CTC’s employs another two, with the final chamber adding a dose of chlorine to kill 99.9 percent of the bacteria before the water is routed to a garden adjacent to the building.
Despite being hidden, the treatment system is the centerpiece of the CTC. It’s also supported by a handful of equally clever design details that ensure the center stays as clean as possible. For instance, the structure’s roof collects rainwater (particularly helpful in Haiti’s rainy season), which is funneled down into a tank underneath the building to be used for cleaning. Because the center will be washed with a solution of bleach and water multiple times a day, the epoxy floor is subtly sloped, which directs the dirty water into the waste processing tank below. The deep sinks are also built directly into the building’s foundation to prevent unwanted spillage.
The 36,000 apertures in the facade are arranged to promote both privacy and airflow (aided also by several 12-foot in diameter fans positioned through the center). The perforated walls, originally designed in software, were hand punched by local Port-au-Prince metal workers before being painted shades of sky blue.

A local artisan building the facade. MASS Group

The Architecture of Health

So why invest so much into a single-use center? Architecture and health are inextricably linked, says Dr. William Pape, head of Gheskio. “How do you think that we got rid of tuberculosis?” asks Pape, while noting that while not entirely eradicated, the disease is under control. “It’s not the drugs, it’s the fact that you have better ways of living.” It’s no surprise that quality of life plays a major role in how healthy we are, and architecture is certainly part of that. On a basic level, the impact of our built environment is direct: If you live in a closed-off, unventilated space, the potential for you to become sick is greater. But when you begin thinking about architecture as a more systemic solution to chronic diseases, its potential becomes much more powerful.
The cholera epidemic in Haiti and ebola in West Africa are enabled by what Michael Murphy, a co-founder of MASS, calls “the plague of shortermism.” When an outbreak occurs, the reaction is to slap on a band-aide as quickly as possible. In Haiti, this came in the form of temporary treatment centers. Patients rested in tents lined with cots. The structures did little to keep already-dehydrated patients cool and were easily demolished in Haiti’s tempestuous weather. “When there was a hurricane, I prayed that the tents wouldn’t be blown away,” says Pape.
When an epidemic is raging, there’s little time to consider the failings of the underlying infrastructure—you do what you can as fast as you can. It was a necessary stop-gap effort, and it did work to stem the spread of cholera. Now that the disease is under control, Pape and Murphy hope to begin addressing bigger issues like sanitation infrastructure and cholera treatment training for medical professionals.
Still in many ways, this first clinic is a proof of concept, an experiment almost, to test best practices for cholera treatment. If it goes well, Pape and Murphy envision similar designs being rolled out to other areas of Haiti. “One building isn’t going to solve the cholera problem, but as a piece of architecture we must ask, how does it represent bigger, systemic challenges?” says Murphy. “How can it work as a beacon for catalytic change?”