Clinical Detachment

Can an innovative design bring medical treatment to the remote villages of AIDS-stricken Africa?

With the establishment of the Global Fund to Fight AIDS and agreements by pharmaceutical companies to supply discount anti-retroviral drugs to poor countries, the international community is beginning to tackle the runaway HIV epidemic in the third world. But treating AIDS in places like Africa involves more than just drugs. African countries don’t have the infrastructure to provide health care to much of their populations. Urban shantytowns and rural villages lack not only doctors and clinics but electricity, clean water, and passable roads.

This is where Architecture for Humanity (AFH) comes in. New York-based architect Cameron Sinclair founded the organization in 1999, hoping to bring a design perspective to humanitarian problems. “What struck me was not just the need for designers within humanitarian assistance but the lack of [designers’] response to date,” he says. In 1999 Sinclair organized a competition to design housing for Kosovar refugees. In 2001 he came up with the idea of a mobile clinic for AIDS treatment and prevention. An advisory board of architectural luminaries including Frank Gehry and third-world AIDS experts such as Zimbabwe’s Dr. Sunanda Ray worked out a set of criteria, and last May AFH announced a design competition.

More than 500 entries came in from architects, designers, and students everywhere from Winnipeg to Pretoria. The winning designs, announced on December 1, adopted no fixed approach. One involved housing mobile pods in locally built earthen granaries. Another, the bright orange aluminum Aid-Mobile, looked like a donut cart crossed with an iMac.

First-prize winners Mikkel Beedholm, Mads Hansen, and Jan Søndergaard, of Denmark’s KHRAS Architects, took a more pragmatic approach. “The goal we set was to be realistic and cost-effective,” Hansen says. Their design comprises modular pavilions of shipping-container-size frames with a variety of “membranes” for walls, floors, and ceiling. Floor-to-ceiling metal shutters can be locked for security or opened for transparency. Local artisans can use indigenous materials, like thatch or fabric, to create shaded areas. In urban settings the modules hook up to electrical and water grids; in the bush they rely on solar power and whatever they can find.

One of KHRAS’s objectives was transparency—to emphasize the human presence of the staff and create a dialogue with different landscapes. Transparency also speaks to the issue of denial, as most African societies have had difficulty bringing AIDS out into the open. But this approach may not work so well in practice. “It’s important to make the buildings closed, not open,” says Alex Abalo, of the West African HIV-positive activist group Espoir Vie. “You have to protect people’s privacy. If they’re seen at an AIDS clinic, they’ll be discriminated against.”

Hansen suggests arranging the modules in a circle, Bedouin-style, creating a private courtyard in the center. In any case, such problems can be solved. The more important question is whether the mobile AIDS clinic will ever be built. Doctors Without Borders has expressed interest, as has the Global Business Coalition on HIV/AIDS. But at present the clinic is purely conceptual. Of course, the same could be said of the $500 million to fight worldwide mother-to-child HIV transmission that President Bush promised in June but later scaled back. For now, like so much of the West’s commitment to fighting AIDS in Africa, the mobile AIDS clinic exists only on paper.

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