August 25, 2020
Game Changers 2020: Diana Anderson and General Architecture Collaborative on Wellness and Community
Next in our annual Game Changers series, Diana Anderson and General Architecture Collaborative discuss architecture, wellness, and community, informed by their unique on-the-ground experiences, research, and hybrid roles as designers.
As era-defining events continue to unfold around the world, digital platforms have catalyzed civic debate as never before. So for our annual spotlight on Game Changers—that is, the practitioners and researchers reshaping the A&D field—we used videoconferencing to connect people from different parts of the globe and from disparate spheres of design. Over one-hour sessions, our Game Changers discussed social justice, health, technology, and urban place-making—all topics implicated in the maelstrom of 2020. In the following text, we recap highlights from those conversations. An important takeaway is that our most pressing problems must be solved through interdisciplinary, networked approaches.
For most of us, there has never been a more poignant time to examine inequities in health care. Through a pandemic that has tested the mettle of health-care infrastructure and supply chains—to say nothing of the toll exacted on frontline workers—it’s clear that human health is a complex network of access, economics, education, and yes, design. In a conversation earlier this summer, Game Changers Diana Anderson and General Architecture Collaborative gathered their perspectives on architecture, wellness, and community, informed by their unique on-the-ground experiences, research, and hybrid roles as designers.
DIANA ANDERSON is the founder of the collaborative “dochitect” model for approaching health care from the fields of medicine and architecture concurrently. A board-certified physician in internal medicine and a health-care architect, Anderson is currently a clinical fellow in geriatric medicine at the University of California, San Francisco. She has worked on hospital design projects within the United States, Canada, and Australia, specializing in medical planning of inpatient units, intensive care units, and subspecialty geriatric departments, in addition to the application of evidence based design. She has also worked as a research fellow with the Perkins and Will Human Experience Lab.
LEIGHTON BEAMAN, JAMES SETZLER, AND YUTAKA SHO founded General Architecture Collaborative (GAC), a nonprofit architecture and landscape architecture design firm, in 2008. Dedicated to projects that serve underrepresented, vulnerable, and developing communities, the studio—which is based in both New York and Kigali, Rwanda—has been involved with projects in Albania, Bangladesh, Burundi, Nepal, Rwanda, Uganda, the United States, and more. Among the group’s projects are the Masoro Health Center, a no-cost health-care campus; the Masoro Learning + Sports Center; prototype housing for urban environments in developing countries; and the Jabana Playground.
DIANA ANDERSON: In the context of COVID-19 we’re seeing quite a convergence of architecture, health care, policy, public health—lots of different care and health-oriented fields. I think architects have really spoken up and started to advocate more to be included in some of these discussions around policy and public health.
The “dochitect” model is a collaboration of architecture and medicine created to push the envelope in health-care design. I’ve always noted a gap between architecture and medicine, and the model serves to try to link that gap or fill it in a way. Architects can walk the halls of healthcare buildings or interact with the clinicians, but it’s difficult to know exactly what it entails to treat a patient or utilize an OR.
The building block of medicine is now evidence-based medicine. We don’t treat a patient without turning to the literature, and architecture has moved in that direction as well, with more focus on methodology. It’s an exciting time, and I do think we’ll see the emergence of more hybrid professionals.
JAMES SETZLER: Part of the reason that we founded our practice was to have a way for architects to take over more of the process itself. Our Masoro Health Center project in particular was one in which we acted as the design architect, but also as the construction manager. We also controlled the funds for the project.
It was donor-funded. We assembled a team, and a couple of local NGO firms helped support our work as consultants: management support, a company called Health Builders, and then a firm crafted around nutrition programming that works alongside us to help facilitate our connection to the community.
YUTAKA SHO: Through the design process, we realized that a lot of diseases were caused by the water quality in the village. We were able to propose the installation of the water tank and a filtration system so that it becomes water kiosks for the neighborhood—so clean water is available for anyone for free. Before, you had to walk many, many hours to go get it. But that was only possible because of this dual or triple role that we were playing. So that is key for us to aggressively [integrate] ourselves into the decision making process. And be heard.
JAMES SETZLER: I want to stress the importance of the design and construction process in achieving an outcome that best serves the users. What we see, [in terms of ] general project delivery in the context of what we’re working on in Rwanda and other places around East Africa, is that if there’s a need for a maternity ward, there is a stock building plan that gets implemented, and then it gets dropped. It’s almost delivered like a product.
And we found a lot of problems as we dug into the design of that building and proposed changes, because we had the opportunity to sit with the director of the health center and actually ask him questions about how things were working, talk to the nurses about how they use the spaces, and then work with them to make it more usable and accessible to patients in general.
YUTAKA SHO: In Rwanda, and perhaps other financially challenged environments, [a health center is] a place that incites fear; you don’t go there unless you have the money. So taking away that fear, and also inviting the community into the facility so that they feel ownership over it, was a very important aspect in our design process.
Health comes with financial burdens. You have to stay healthy, and for that, you have to eat, you have to have access to clean water. It goes all the way back to what kind of house you live in. But to build your own house—which is the cheapest way to do it—you have to take a break from your regular job, and that is not an option for many people.
Wellness is the overall goal. We are trying to use the architectural and construction process as a whole movement, not just to build the final product at the end but to use every step as a way to gain skills or to be able to read something or to express wishes and be incorporated in the design process. All of that becomes architecture.
DIANA ANDERSON: That’s really powerful, Yutaka, about welcoming people into health-care spaces. And I think the way we’re designing to do that mimics some medical trends. Medicine used to be a much more hierarchical field, and I’m not sure if physical spaces have entirely reflected that [shift]. I’ve been working with other designers to think about design equity in some of these spaces.
I talk a lot about how the design pendulum has swung, at least in the United States and Canada, maybe a little bit in Australia. We used to design more for staff and think about the users of the space who spend much of their life there—36-hour call shifts, 120-hour weeks in some cases. The pendulum has swung to the opposite direction, to design where the patient’s satisfaction is key. How can we bring it back to settle more in the middle?
We recently worked on an emergency document for field hospitals for COVID-19. And it was interesting because there are certain things, like patient beds, that are nonnegotiable. Then there was one line about staff wellness and there was a question mark saying, “Staff break room or break area for respite?” We have to have that kind of space. It’s really important.
JAMES SETZLER: I’m seeing how some of those extra spaces that were deemed to be excessive fall by the wayside. But now, especially during a crisis, you start to realize that they’re crucial to the success of an institution and a place. And a lot of our work, I think, is often seen as extra. We face an uphill battle convincing donors that we need to invest in spaces that are generous and accommodate different community needs.
Handling the funds while we’re also the designers has helped us achieve some of those goals. But I would say in terms of community outreach, it comes with education. For the Masoro Learning + Sports Center, we conducted several local workshops and held extensive interviews and meetings with local cooperatives and schools, speaking to people about what they might need and want.
And then as we opened it, we always stressed that it’s a work in progress. But we designed it in a way that encourages people to take ownership. And we try to continue to plan activities and programs that encourage that.
YUTAKA SHO: At Syracuse University, I just finished a design studio and seminar called Architecture as Evidence, which focused on the climate crisis. How can we become the evidence so that we can have a platform to start the conversation? Diana, you were saying architecture needs to work a lot more with evidence. That is not something that we are good at or taught to do. It’s as if observation is enough, or our creative artistic drive is enough. And that’s a very antiquated or macho idea—
JAMES SETZLER: It’s irresponsible.
YUTAKA SHO: Very irresponsible. At the same time, we see in the climate crisis deniers and COVID deniers that evidence alone is not enough. There’s a whole bunch of scientific evidence proving that the earth is under stress and you should wash your hands and stay six feet away, but people still deny it. So evidence alone is not enough; neither is the creative narrative power that architecture has. There needs to be some way to bring those together somehow.
DIANA ANDERSON: Jamie, you mentioned that the evidence-based process is expensive and time consuming. And maybe I’ll just be controversial and say, should we even be doing it? Should architects be the ones to lead that, or is there room for a new subspecialty of health-care architecture that would lead the research? Do we need grant funding that comes not from architecture firms that are footing the bill but from public health organizations? I wonder if maybe we shouldn’t take the onus ourselves.
JAMES SETZLER: I think that architects need to be stronger advocates for that kind of work. And architects in particular have a tendency to assume the burden of everything. It’s been a very steep learning curve for us entering this NGO world, where we see ourselves almost as a nonprofit architect, whatever that means.
We have essentially been learning an entire other discipline, and I think it’s important that we do, if we’re going to go into that field and embrace evidence-based design and finding intelligent ways to respond to it, we need to understand it at least. [We need to search] for people who know it better and can execute it, and then convince the people who are paying for the work that it can’t be overlooked.
LEIGHTON BEAMAN: One of the things that architects are trained to do through practice is coordinate a lot of different things—to be able to take a big-picture view and see how all these things fit together. And I think part of that now is a responsibility on us to see what other people need to be part of that conversation. Whether it is people that are dealing with climate change, whether it’s doctors, whether it’s sociologists, whatever that case may be.
DIANA ANDERSON: Charles Jencks once said that architecture even may help prolong our life. That’s really impactful. The idea of the Maggie’s [Cancer Care] Centres having very supportive homelike spaces is a great model.
I have to say I have quite a bit of challenge when I talk about international models here in North America. There’s comfort in staying close to home and knowing what works within our country, which is understandable to a degree. But I think we can learn a lot from other countries. Specifically in long-term care and the nursing home model, there are some great innovative approaches going on in Europe—the neighborhood approach, smaller-scale buildings. And that yields well for pandemic preparedness, right? Buildings that you can quarter off, and not these double-loaded long corridors that we see in a lot of our nursing homes here.
JAMES SETZLER: We’re talking about such fundamental things, like paying attention to client user needs and sufficient daylighting—things that are just so basic. I think in a way we can look abroad to models, but America needs to realize that they’re just not the sole exception in the world, and open up to this idea that there are things to learn everywhere.
LEIGHTON BEAMAN: What we see in Rwanda is that people work and live outdoors. Part of that has to do with the climate. But the interaction with the environment in other countries is different than in the U.S. We tend to make things that are very hermetically sealed and climate controlled. With COVID-19, we’re seeing some of the ill effects of that. Things that we’re doing in the U.S. or Asian countries may be technologically advanced, but that doesn’t necessarily mean they’re performing better. That’s one of the things we’re learning as we are exposed to work with other locations, other cultures, especially ones that are seen by the West or the Global North as being somehow less-than. In many ways they’re more advanced because they’re thinking about how they’re working in their environment in ways that we’re just not even considering anymore.
DIANA ANDERSON: I think these conversations are extremely important. Cross-disciplinary approaches are the way of the future.
To me, if there’s one message, it’s that there’s a place for evidence-based design and research in health care, but there’s also room for design thinking innovation, and basic design ideas: Light, air, looking to historical examples and international examples. And hopefully, that is propagated to the clinical colleagues and within our architecture schools, too.
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