The much-famed Butaro Hospital.

In writing about work, I have often mentioned Butaro Hospital, Burera's district hospital which, until about a month ago, had been under construction.  The hospital, built by Partners in Health and designed by MASS Design Group , is big news in Rwanda.  It's the first hospital in the country (and probably in the entire region) designed from the ground up with the quality of patient care and the patient's experience in mind.  It was inaugurated by President Paul Kagame on January 24th, and I was lucky enough to get to be there (I've been working with the pharmacy during their transition from the old site to the new, shiny location).  A post specifically on the inauguration event will follow.

I'll let the professionals who have written news items give the back story and a lot of the details.  The South African Times put out an in-depth and well-written article about the hospital.  I really suggest you read it.  The New Times in Rwanda wrote a more brief article concerning the recent inauguration.  Partners in Health also has a fantastic write up as well as a slideshow with some truly stunning photos that I did not have the talent or the access to present to you myself.

If you don't have the time or the inclination to read any of the above articles (although you really should find the time), I will at least set the stage by saying that before Butaro Hospital, the district of Burera did not have a hospital nor a single doctor for its more than 400,000 residents, some of the poorest in an already poor country.  When Peter Drobac, the country director for Partners in Health Rwanda, was quoted in the South African Times article as saying "Butaro is an allegory for the rebirth of Rwanda itself", I don't feel like he's exaggerating.  Built on a former military base with some of the most incredible views in the district, Butaro really might turn out to be "Rwanda's Medical Miracle".

(As always, you can click on the pictures for larger versions)

 

This is the ambulance entrance, allowing emergency vehicles to pull directly up to the emergency room and operating theatres.  There are two operation rooms in the hospital.

You can immediately see that this hospital, while located in one of the most remote areas of the country, has a modern and aesthetic design.  The hospital was constructed entirely by hand using local labor and local materials (that's volcanic rock you see).  Over three thousand jobs were created for local citizens during its construction, giving people not only a source of income, but skills to gain employment in the future as well.

Creating a visually appealing and calm space was of paramount importance to the designers.  This tree, obviously original to the site, was saved by meticulously digging around its root system.  The site was originally at the level of the ground immediately around the tree - the rest was dug out.

Each ward is color-coded to facilitate patient flow and the ability for illiterate patients and family members to find their way around the hospital.  It's done in America all the time, but this kind of purposefulness in design, as it relates to the patient's experience, is unheard of in Rwanda.  Note that the Women's Ward is coded in orange...

...and also painted orange in the ward itself.  The beds you see, although simple by western standards, have the ability to elevate the patient's head and also have storage space built in, to help keep the ward more organized. 

It might surprise you to find out that hospitals and health centers rarely provide mosquito nets for patients to sleep under.  Although Burera is, in general, too cold to worry much about mosquitos, I think any self-respecting health institution should provide them just in case, as well as set the standard for practices we expect local people to follow.  It might also surprise to you know that the presence of clean sheets, blankets, and pillows, is also a bit of an anomaly.  Hospitals and health centers rarely have the money to provide complete bedding for patients (or the capacity to wash bedding once its used).  Some hospitals have even been known to RENT bedding during national assessments, and then return the bedding after the inspectors have left. 

It should also be mentioned that each bed has its own connection for oxygen, and the hospital has its own oxygen concentrator, so it doesn't have to transport oxygen tanks from Kigali.

While we're inside a ward, let's see what else is there.

These big ass fans are conveniently made by the company Big Ass Fans.  They spin at low velocities, but move large amounts of air to facilitate air transfer within the ward.  Not only in Africa, but all across the world, the issue of patients getting sick from air contaminated by other patients is a serious issue.  Tuberculosis and other air-borne diseases are present in Rwanda, and it's important to make sure that stale, contaminated air doesn't sit around, but rather flows back out of the ward.

Patients, who normally wear their own clothes during hospital stays, are given clean gowns/scrubs to wear at Butaro.  This makes it easier to figure out who is a patient, and keeps the wards smelling fresher and looking more professional.

Personally, my favorite ward feature are these awesome med carts, which I can say with confidence are likely the only ones existing in Rwanda outside of Kigali's private hospital, King Faisal.  I've gotten to design how these will be used (the small drawers you see on the front correspond to a patient bed) and they're an integral part of the patient medicine distribution and recording system we're putting into place.  These help us limit the number and quantity of drugs present in the wards to only those which are needed by the inpatients currently admitted.  In the hospital's old location, the internal medicine ward kept over 150 different drugs stocked on the ward at all times.  Now, we've limited that number to about 20 emergency injectables, in addition to the limited number of pills needed for the patients' regular prescriptions mentioned before.

 

Paul Farmer, founder of Partners In Health and one of my personal heroes, is known for liking ponds.  There are four different ones located throughout the hospital.

This general gathering area (veranda?) has a fantastic view, as does the patio outside of the laboring women's ward.  Perhaps I'll come here several days before my first due date just to wander around, look at Rwanda's beautiful scenery, and attempt to get the kid to drop.

This is a highly boring photo, but show Butaro's own personal cell phone tower.  We get impeccable cell phone service, as well as decently fast wireless internet thanks to the hospital's tower.  The hospital itself is wireless throughout, and each service has their own laptop, another integral part of the medicine organization and recording system we're putting into place.

I'll close with a picture of my favorite part of the whole hospital. 

It might seem a bit excessive to spend extra money building a children's play area, especially when there are so many other places you could put the cash.  However, when you consider the play rooms in hospitals in the States, full to the brim with books, toys, PlayStations and the like, it seems ludicrous that you'd NOT put in a place for fun and laughter for children when designing a hospital with the patient experience in mind. 

That's the thing that I love about getting to work at Butaro hospital.  It's not an example of what every hospital in Rwanda or the East African region will be, but rather what can and should be possible.

Finally, one of my favorite quotes from Paul Farmer himself:

"It's embarrassing that piddly little projects like ours should serve as exemplars. It's only because other people haven't been doing their jobs."