Master of Architecture student designing hospital for small north Tanzanian village

Last fall, when Southern Ellis, a Master of Architecture student at Texas A&M,was pondering his thesis project, he knew he wanted to design a healthcare facility serving impoverished patients in the developing world. What he didn’t know was a short four months later he’d find himself deep in rural Africa, gathering data for his dream project.

“I wanted to do something that was a real project that would actually help people; something I probably couldn’t do once I’m working for a firm,” said Ellis, who hails from San Antonio. “But I really didn’t know the avenue to go about that.”

An answer came from Father Paul Fagan, a Roman Catholic priest who’s been working in Tanzania since his ordination in 1960. The priest contacted George J. Mann, the Skaggs-Sprague Endowed Chair of Health Facilities Design at Texas A&M, seeking help with a project aimed at converting his modest medical clinic located in the northern Tanzanian village of Nkololo, near Lake Victoria and the famed Serengeti reserve, into a hospital.

When Mann accepted the project for his fall 2010 undergraduate studio, Ellis was working as the professor’s graduate assistant. While Mann’s students developed their own design concepts for the rural African hospital, Ellis pitched his idea to Fagan for making the proposed Nkololo hospital his thesis project. The priest agreed with one condition. Ellis had to travel to Tanzania, meet the doctors, nurses and patients who would be using the new facility, and use their input to create his final design.

During his Christmas break, with assistance from Roads to Life Tanzania, a non-governmental organization that supports Fagan’s work, Ellis did exactly that.

He embarked Dec. 7, flying first to Amsterdam, then to Dar es Salaam, Tanzania's largest city, where he emerged in a different world.

“I felt like I was in a scene from National Geographic,“ he said. “I knew I was traveling to a developing country,” said Ellis, but what he found was a place that differed wildly from his expectations.

Traveling by car along the bumpy dirt roads to Nkololo, he encountered streams of people walking on the road, many carrying weighty loads balanced atop their heads. At night, small fires of mysterious origin intermittently illuminated the roadsides.

“You knew right away you weren’t in the United States,” he said.

After arriving in Nkololo, Ellis met with the dispensary’s physicians and nurses, as well as with the clinic’s alumni — doctors and medical school students who had begun their careers working at the facility and had returned at Fagan’s request to meet with the young American architecture student and explain the nuances of health care in rural Tanzania.

Fagan’s plan, Ellis said, is to first upgrade the dispensary's inpatient area into a maternity ward connected to a new surgical ward, with the rest of the hospital to be built in phases. As his thesis project, Ellis is creating a master plan for the conversion that includes a surgical theater, an intensive care unit, several men’s and women’s wards, pediatric wards and housing for the staff.

The hospital’s layout will vary greatly, he said, from the standard design of U.S. hospitals, which tend to be huge, mall-like structures.

“One thing I had to learn is there’s no air conditioning in Nkololo,” he said. Electricity that is available comes from solar panels and gasoline-poweredgenerators.

“Everything in an African hospital has to be long and narrow to allow wind to flow through the structure so it won’t be unbearably hot inside the rooms during the day,” said Ellis. To facilitate ventilation, as well as the project’s phased construction, his plan calls for the hospital’s various units to be housed in separate buildings.

Ellis’ observations also revealed the major role Tanzanian families play in a patient’s treatment and recovery.

“If someone’s sick, the whole family comes to the hospital, so you have to provide room for the family to stay close to the patient and also create facilities where they can cook for the patient,” he said. “If you don’t provide a kitchen,” he said,“they’ll just cook on the ground outside the hospital.”

A laundry for visiting families will be another essential component of Ellis’ hospital design, as they are responsible for providing clean clothing and linen for patients. In fact, in Tanzania, many of the nursing responsibilities taken for granted in the United State, are put on the family,” he said.

Another major difference in African hospitals, he said, is the need to keep patients together in a large open ward, rather than in individual patient rooms.

“Lack of staff is a big issue,” said Ellis, “so it is important to locate a station so one nurse can view the maximum amount of beds and be close to supplies so they can easily grab a bandage and attend a patient when the need arises.”

As he gathered more and more data, Ellis began sketching his ideas for the new facility and sharing them with Fagan and the hospital staff and making revisions based on their feedback.

“We tried to get the flow right,” he said, “the flow of staff and the flow of patients.”

The budding architect also had to become familiar with local building techniques and the locally available building materials.

“I took tons of pictures to figure out the differences between Tanzanian and U.S. building techniques,” said Ellis. “I walked around Father Paul’s parish and many other surrounding villages to see how their buildings actually came together.”

"The residents of Nkololo have already begun making concrete bricks for use in the future hospital's construction," said Ellis. “They take sand from the river, bring it up to Father Paul’s parish area, and mix it with concrete to make the blocks. They can make 200 blocks a day; I even made a couple while I was there just to see how it’s done.”

Ellis also received a great deal of help from Fagan, who, as a result of overseeing the construction of several churches, was familiar with both standard U.S. building techniques and the local construction practices used by Tanzanian builders. He also knew what type of roof keeps bats out, whether a roof is too steep or too flat, or whether it will leak because of too many connections.

“If I was just meeting with the Tanzanians,” he said, “they would say ‘this is how we do it in Tanzania,’ but that might not necessarily be the best way. Father Paul was able to bridge the gap between different building techniques to maximize cost and resources."

Ellis said he’ll complete his master plan for the Nkololo hospital this spring, but will continue working on fundraising for the facility with Fagan and Roads to Life Tanzania.

“We’re looking for some major foundations to fund the project because the hospital’s construction costs will be in the millions of dollars and that far exceeds Father Paul’s typical range of fundraising,” said Ellis.

A completed master plan, he said, will be particularly helpful to the fundraising effort.

“If you have the actual design and can say ‘this is exactly what we want to do, all we need to get started is money to do it,’ it legitimizes the project,” said Ellis.

Ultimately, once funding is in place, Fagan will serve as the project manager and the people of Nkololo will build the hospital from the cement bricks they locally manufacture.

“Father Paul has built many churches in the area,” said Ellis. “Throughout the process of constructing these buildings he has refined his construction skills, which are mainly based on structural soundness and keeping water and bugs out, with an emphasis on cleanliness and cost-effectiveness.”

Though the Nkololo hospital project is allowing Ellis to fulfill his dream of designing a hospital in the developing world, many of the benefits he’s reaped from his African adventure have been less tangible.

“I felt a strong urge to really help these people, which I guess I felt before, but seeing the people’s faces, how they live and how they treated me only strengthened my resolve,” he said.

“By Western standards they had nothing, but they treated me like royalty and offered me pretty much everything they had while I was there,” he continued. “They really appreciated that I had come to invest in their lives and I’m glad I got this opportunity to use this time as a student to invest in their lives as much as they invested in mine.”

- Posted: Jan. 28, 2010 -

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