Building Care

For me, to be an architect is to think constantly about death. It’s to know that what we build today will likely outlive us. It will house a community far in the future, people we cannot know and will never know.

I know that isn’t always the opinion of architects. Often, architecture is talked about as a nonessential cost, and architects are seen as driven by their own egos and the construction of monuments to themselves. Maybe these are some examples. They want to build their dreams, not our dreams.

But what is the cost of not having architecture built for us and for our families? What is the cost to our lives today if we fail to consider the impact of our future built world, the one we can’t fully inhabit?

During my first final exams in architecture school, I was thrown face-first into this very question.

I had been up for three nights straight. That’s the narrative of architects working all the time, that kind of frenetic work where I didn’t even check my phone. Can you believe it?

When I finally did look after three days, I saw that I had missed about 30 phone calls. All of them were unanswered, and all of them were from my mother, with increasing frequency.

I know that might not be uncommon, but I realized it was something really problematic. I collapsed in the school lobby. I knew that something horrible had happened.

A year before, my father had been diagnosed with an extreme form of cancer. He had been fighting it, but it had returned, and he had now gone into septic shock.

My mother was in an ambulance, calling frantically en route to New York City to save his life.

“You might not see him again,” she said in the first voicemail.

“Get here as soon as you can,” she said in the second.

But what was in voicemail number 20, I thought? What was in number 30? Had he died while I had been sitting there being humiliated by a group of senior architects?

It was a horrifying thought.

Just then, as I was sitting there thinking about this, a family friend appeared in the lobby. She had also been calling me, and she was there to drive me to New York City.

He was alive, but barely. We left that minute, without even packing.

When we arrived at the building, we had heard how famous the cancer care was, and we had great hope that he would survive. But as we approached, I couldn’t help but feel a sense of doom surround me.

Was this impenetrable fortress the final resting place for his life?

We lived off this hallway for the next three weeks. We were there through the holidays, at this very time of year, and I saw his hope waver.

For exercise, he was told to walk around the interior floor plate in loops a number of times to keep his blood moving. You’ll notice there are no windows to look out of. The walls seemed designed to protect against medical equipment banging into them, and the floors seemed designed to make insufferable noises even louder.

This building may have prolonged his life, but it didn’t seem to think about nourishing it. It was, I thought, devoid of design.

All the things we were taught about the beauty of architecture, where was that beauty when my father faced his own demise?

It was, I thought, the cost of not having design. It was the price of indignity.

When my father finally did leave, now with a clear expiration date in the future, I had one thought in my head: If I was going to become an architect, I had to design a hospital.

I found a chance to do that sooner than I could have dreamed.

At school, I attended a lecture by this amazing man, Dr. Paul Farmer, a leading health advocate for the global poor. In his talk, he said something profound.

He said, “Buildings are making people sicker.”

For the poorest people in the world, he said, this was causing problems on an epidemic level.

In a hospital hallway in South Africa, patients who walked in with, say, a broken leg left with an extremely drug-resistant strain of tuberculosis. Simple designs for infection control, like airflow and windows, had not been considered. People had died because of it.

“Where are the architects?” he asked. “If buildings are making people sicker, where are the architects who can make buildings that allow us to heal?”

The following summer, a few classmates and I moved into a rural village in the mountainous hills of Rwanda. For the next year, we lived in a town called Butaro. We stayed in a dormitory that had been used as a jail during the genocide.

We were there to design a new medical facility with Dr. Farmer and his team.

We were young. We were outsiders. But we applied ourselves to questions that had been neglected or taken for granted, and we searched for new answers.

If hallways were making patients sicker, what if we turned the hospital inside out and had people walk on the exterior?

If mechanical systems rarely worked, what if we made a facility that could breathe through natural ventilation?

And what about the patient’s experience? Evidence shows that a simple view through a window can radically improve health outcomes. What if we could make a hospital where every patient had a window with a view?

Simple, site-specific designs can create a building that heals, we thought.

I learned something else on that hill. Designing a medical facility that heals is one thing. Getting it built is quite another.

This is me at that time, when we were building the Butaro hospital. I trained under this amazing man, a brilliant engineer named Bruce Nizeye. He taught me about construction quite differently than I had learned in school.

When we had to excavate a hill, for example, and a bulldozer was expensive and difficult to get to the site, Bruce suggested doing it by hand, using a process in Rwanda called ubudehe, which translates roughly to “community works for the community.”

Hundreds of people came to the site with their own shovels and hoes, and we excavated that hill in half the time and at half the cost of the bulldozer.

Instead of importing furniture, Bruce started a guild, bringing in master carpenters to train others to make furniture by hand.

On this project site, only 15 years after the horrific Rwandan genocide, Bruce insisted that we hire people from all ethnic backgrounds and that half of them be women.

If Dr. Farmer had taught me that buildings can heal, Bruce taught me that building processes can heal. They can heal not only those who are sick, but the entire community. All of us.

Using this local way of building, even formal and aesthetic decisions can transform people’s lives.

In Butaro, we chose to use local volcanic rock, which was often considered a nuisance by farmers and piled on the side of the road, sometimes for free.

We worked with masons to hand-cut these stones and form them into the walls of the medical facility.

They began at this very corner that you can see. By the time they wrapped around the entire building, they had become so good at cutting and assembling the stones that they asked if they could take down the original wall and rebuild it.

We said, “If you do it quickly.”

But you can see what is possible. It is a thing of beauty.

The beauty, to me, comes from knowing that hands cut each and every one of these stones. They formed them into this thick wall, made only in this place, with rocks from this soil.

It made me think: What if, with every building we encounter and inhabit, we asked not only what its environmental footprint was, but what the human handprint was of those who made it?

We took this philosophy of local fabrication and started a practice that asked, “What more can architecture do?”

MASS, which stands for a Model of Architecture Serving Society, is a collective of like-minded designers committed to the idea that our built environment changes who we are and can improve the lives we have.

We tested this around the world, including in the dense urban conditions of post-earthquake Haiti.

After the earthquake in 2010 and the subsequent cholera outbreak, emergency shelters were necessary to house hundreds of thousands of displaced people. But before long, these tents revealed deep structural issues.

Haitians needed shelter, but they also needed long-term, permanent healthcare facilities.

A doctor had heard about our work in Rwanda and asked if we could design a new medical center in Port-au-Prince to help reduce the transmission of multidrug-resistant tuberculosis from patients to doctors. It was the same disease we had encountered in Rwanda.

In this center, where all the patients had the disease, our research revealed a different pathway of risk. This time, the risk was not to other patients, but to nurses, doctors and janitorial staff.

We designed a simple layout of rooms and hallways that allowed for open-air consultations between doctors and patients, providing better protection.

We also added a simple extra door to the bathroom from the hallway, which protected cleaning staff from the most infectious patients in the rooms.

In this facility, we’re seeing much better adherence to the intensive drug regimen required to treat tuberculosis. Infection rates are down, and adherence to personal protective equipment is up.

But maybe the most striking outcome is this one.

When the clinic was still housed in fabric tents behind barbed wire, patients taking these drugs would often experience terrible psychotic reactions, including extreme anxiety and hallucinations. Attempted suicide in this camp was incredibly common.

In our new facility, doctors told us how much the design had calmed patients and that attempted suicide rates had dropped to zero.

Our bodies and minds are deeply influenced by the spaces we design and inhabit.

If we strive to design for the dignity of all individuals, we may discover outcomes we never dreamed of. That was the case in Port-au-Prince.

There is another way architecture can heal. It can create spaces where our traumas can find a resting place.

Rwanda, as a country, has committed to this. It has built hundreds of memorials around the country over the last 20 years. The country has tracked genocide ideology, and it has radically declined, creating more resilience in communities and reducing conversations centered on ethnic difference.

But these successful lessons from Rwanda are not shared by everyone.

Today, ideological divisions are rising around the world and in our own country, dividing our communities and making us adversaries.

In London, a new project speaks directly to the need for architecture to fight intolerance: a commission for a new national memorial to the Jewish victims of the Holocaust.

With architect John McAslan and landscape architect Lily Jencks, we designed a memorial that seeks to imagine a more tolerant future and reveal the invisible strands that keep us apart.

Our idea begins with the stone.

In Jewish tradition, when someone dies, family members place pebbles or stones on top of the grave. This honors their loved ones and binds generations together.

The word for stone in Hebrew also has rich meaning. It is pronounced even. When you split the word, it contains two other words, av and ben, which translate to “father” and “son.”

The stone’s name carries within it one of the most beautiful thoughts: continuity between one generation and the next.

The centerpiece of our project is a pile of six million stones in the center of London, one for each of the six million Jews murdered during the Holocaust.

But instead of merely reflecting on this enormous pile of stones, we will invite visitors to take a stone home with them.

This act and choice allows them to participate in the fight against intolerance in all its forms.

Each stone begins a new journey, its own diaspora, into homes, schools and families, where it can educate and serve as a physical reminder of that pledge.

Eventually, after 10 years, the pile will diminish. It will be proof that six million hands have chosen to join this fight.

When it disappears, what remains will be a space of healing in the center of London, inscribed with the traces of these stones and the traces of these lives.

In America, of course, we have not committed to these spaces, and there is much trauma to overcome.

Recently, at an opening, two women came up to me and shared the stories of their sons, who had been taken by gun violence.

They expressed the need for a space to commemorate their lives and the lives of all those dying in this national epidemic.

I came back completely transformed by this idea.

The artist Hank Willis Thomas, a good friend of ours, joined us in this effort. We proposed our newest project, a national memorial for victims of gun violence, which seeks to pay tribute to the lives lost and give us space as a nation to change our narrative around this epidemic.

The memorial begins with a grassroots campaign that we will launch in the coming year.

We will create a national conversation, asking any victim’s family to reach out to us. When they do, we will send them a glass box.

In that box, they can contribute an artifact, token or memory of their loved one.

We will gather those artifacts and cast each one into a permanent glass brick. We can then use those bricks to construct glass houses.

These haunting structures will hold our hopes and nightmares. They will be structures of vulnerability and fragility, standing as beacons of memory and transformation.

In this work, I’m not naive enough to imagine that memorials will end gun violence.

But I have become convinced that without spatializing these figures, without giving them names, locations and physical dimensions, we cannot fully lay our burdens down. We cannot fully heal from these traumas.

Without healing, more injustice is certainly in our future.

My father eventually succumbed to cancer.

What had been a three-month death sentence became the gift of two and a half years together.

Here he is, a month before his death. He said goodbye to his closest friends in our home and spoke about his life’s work in civil service and all the unfinished projects he was proud to advance and fight for.

Standing there, I felt that he was passing the baton and handing me a stone.

Buildings make us think about legacy and the future, our lives and something we would like to see.

In this way, buildings are not simply expressive sculptures. They make visible our personal and collective aspirations as a society.

Architecture is one remnant we leave behind. It can give us fuel. It can give us hope. It can help us overcome loss and lay our burdens to rest. It can pass the baton.

Architecture has opened a way for me to see the world anew, not as sculptures to genius, but as many batons left for us by generations before.

It is architecture that, every day, allows me to heal from loss.

Thank you very much.