Architecture as a Vehicle for Trust
Trust in healthcare is often viewed as the byproduct of community relationships and individual patient-provider interactions. While trust is created on an interpersonal level, for Build Health International, building trust also means designing infrastructure with dignity in mind.
In 2015, BHI’s co-founder, Jim Ansara, visited the Koidu Government Hospital in the Kono District of Sierra Leone with a team from Partners in Health (PIH). At the time, Sierra Leone was still in the midst of the Ebola epidemic and home to the highest maternal mortality rate in the world. This visit began BHI’s relationship as the trusted infrastructure partner of PIH Sierra Leone and the Koidu Government Hospital.
Through this relationship, the hospital’s capacity and quality began to improve, but still PIH knew that more could be done to address the barriers to safe and dignified maternal healthcare that existed in the Kono District. That’s when PIH teamed up with BHI to design and build the Maternal Center of Excellence.
The Maternal Center of Excellence (MCoE) will be an iconic 10 building, 143 bed facility. The design includes a maternity ward, outpatient department, NICU, and surgical suites, as well as waiting rooms, courtyards, and dormitories. It will be fitted with quality biomedical equipment and highly trained clinical staff to prevent as many maternal deaths as possible.
The state-of-the-art MCoE will aim to decrease maternal deaths in Sierra Leone. However, maternal mortality is not the sole issue that this facility will combat. There is also a longstanding distrust of the healthcare system in Sierra Leone amongst citizens. This distrust was sewed through a decade of civil war from 1991 to 2002, and worsened after hospitals became vectors for disease during the 2014 to 2016 Ebola crisis. When BHI began designing the MCoE, they knew that for the hospital to successfully fight maternal mortality, it would have to simultaneously rebuild trust in the nation’s healthcare system.
“Every aspect of the hospital has been designed with trust in mind, wanting to create a more dignified space to encourage women to be in charge of their reproductive health and their pregnancy journey,” says Allison Denisky, BHI’s senior architectural designer.
For example, generous outdoor spaces are a prevalent part of the MCoE, creating an oasis for patients and providing a place for their family members to wait comfortably.
Denisky recalls Isata Dumbuya, the Manager of Reproductive, Maternal, and Neonatal health at Partners In Health Sierra Leone, pushing for large, shaded outdoor spaces. Dumbuya knew that if these spaces were included in the design, they would become a gathering area — presenting the perfect opportunity for clinical staff to provide community education programs. Such programs will, in turn, instill trust by strengthening the relationship between community members and hospital staff.
To help patients find their way through the abundant outdoor area and between the MCoE’s 10 buildings, BHI’s project team knew they would need to create an intuitive wayfinding system. Many people are scared or anxious upon arriving at the hospital. “When you add that anxiety to getting lost down endless mazes and corridors it creates a feeling of distrust,” explains Jay Verspyck, BHI’s director of design. “A lot of hospitals are designed with the idea of efficiency, prioritizing efficiency for the doctors and the nurses and the staff first. Yes, efficiency is of primary importance for a hospital to function well, but the design also needs to look at the patient’s perspective and experience.”
BHI is determined to make the MCoE easily navigable. Rather than relying on words, the wayfinding system will use color and graphics as guides, since many of the people living in Sierra Leone are illiterate. These considerations led to the idea of mosaic work. Verspyck says that they first noticed the technique in Sierra Leone’s local restaurants and hotels, “They use the old broken shards of tiles to make mosaic patterns on the floors. This idea of repurposing a waste product intrigued us.” The MCoE’s wayfinding system is still in its early stages, but the team plans to utilize local culture and make navigation as simple as possible in the hopes of easing distrust.
The idea of trust also guided BHI’s design of the MCoE’s isolation rooms. During Ebola, the disease was often spread in clinical spaces that lacked proper ventilation and layout, making hospitals themselves vectors for the disease. As a result distrust toward hospitals still lingers. Every isolation room at the MCoE will have two entrances and exits, so that infected patients are not being wheeled through a ward of people. This will prevent the spread of disease and help patients feel safe and comfortable, easing the fear that they’ll contract an illness while at the hospital to access maternal healthcare.
Trust can be facilitated by infrastructure, and that is BHI’s goal at the MCoE. Verpyck explains, “If you can create welcoming, comforting environments, that takes off one layer. It gets you closer to building trust.”
BHI and PIH broke ground on the Maternal Center of Excellence on April 23, 2021.
“This is a dream come true. We’re sitting here today as the result of a small thought, that has now become this huge thing,” Dumbuya said during her groundbreaking statement, “We’re all going to benefit from it — staff, parents, mothers, babies, children, the whole of Sierra Leone. Today is the start.”
The Maternal Center of Excellence plans to begin accepting patients in 2023.
Pamela Kapolka is Build Health International’s Development and Communications Intern. She is a fellow of the Madeleine Korbel Albright Institute for Global Affairs and a junior at Wellesley College. She is passionate about improving healthcare accessibility and affordability for underserved populations.
