As an outreach health worker in Mauritania, Taiya spends much of her time in
villages distributing food and offering basic health care. Several times a week,
she has to bring patients to the hospital in her four-wheel-drive, crossing
kilometers of fine sand and more kilometers of bumpy rocks. As often as she has
seen it, her delight and amazement at the building are undimmed.
This is hardly surprising: The Kaedi Regional Hospital stops first-time
visitors in their tracks. It is a breath of fresh air in the world of hospital
architecture, a field that tends to be more imitative and impersonal than
innovative and intimate. The only oblong, rectilinear building is the original,
tiny hospital that now houses administrative offices, the reception area and a
small part of the maternity ward.
It is now dwarfed by constellations of circular, mud-brick modules whose
domes look like the top halves of eggs; they are connected by catenary-arched,
tendril-like passageways. It looks as futuristic as a Star Wars film set
and as organic as a melon patch. It is a daring architectural departure, all the
more surprising since Kaedi is an otherwise nondescript, dusty town of 50,000
people along the Senegalese border, 250 kilometers (155 mi) southeast of
Nouakchott, the capital of the West African nation of Mauritania.
The hospital serves 750,000 people in the district of Gorgol, of which Kaedi
is the chief city, and in the more remote districts of Assaba, Trarza and
Brakna.
On the day I visit Fatima Taiya, the hospital's main entrance is busy with
patients who are well enough to walk themselves in, nearly always accompanied by
extended families. Most of them seem to know Taiya. So does the noisy cluster of
fruit sellers in bright dresses and head wraps, and the uniformed security guard
sitting on the main step. A gang of enterprising young boys is selling water and
bottles of soft drinks.
There is an air of informality, with patients arriving by various sorts of
transport, from battered bush taxis to donkey-carts. Only real emergencies
arrive by ambulance. The scene is colorful and relaxed. Fodie Wagui, an urbane,
French-speaking Mauritanian who was the local site architect, explains how the
hospital serves the community.
We pass from the blazing sun into the quiet, calm interior. Wagui points out
that even the original building has undergone a small change: The reception area
is now decorated with murals showing mothers nursing babies and having their
babies vaccinated; others warn of sexually transmitted diseases. "Pictures
like these are far more effective in getting the message across than any amount
of written material," he says. "Illiteracy is fairly common, and
anyway people like to look at these colorful murals. They can relate to what
they see here."
Wagui tells me that there is no air-conditioning in most of the hospital,
even though temperatures soar during the summer months. The natural breeze
wafting through the reception area is cool, and it is carried throughout the
wards, thanks to the clever way openings to the outside have been placed to draw
air along the covered passageways between modules.
As Wagui shows me how the hospital works, I feel that if he weren't with me I
would quickly get lost in what feels like a labyrinth. "Don't visitors
spend hours wandering around?" I ask. "No, it's actually
straightforward and easy," he replies. "Mauritanians wouldn't follow
complicated instructions and signs." He points to a door on our left.
"The color of the door signifies the department or unit to which the ward
belongs. This is the gynecology section. We're now near the general wards.
Individual rooms are off these corridors."
The overall plan looks as if it grew as organically as a plant, with each
medical unit grouped along a main circulation route. From this lead smaller
walkways within each department that in turn lead to the wards. At either end
there is a surgical suite. In between are housed pediatric, surgical and
ophthalmic departments, as well as a maternity and a general medical unit. There
are kitchens, supply rooms, a workshop and a laundry.
The hospital is one of several projects supported by the Association for the
Development of Traditional African Urbanism and Architecture, founded in 1975,
headquartered in Ouagadougou, Burkina Faso, and known by its French acronym,
ADAUA. The organization aims to revive and promote indigenous African
architecture and to train local inhabitants in appropriate technologies.
"Once you understand the idea behind the design," Wagui tells me,
"you'll come to appreciate how it answers lots of the medical problems of
the area." The extraordinary spiderweb of domes and ribbed arches gives the
impression of being an expensive experiment, but architect Fabrizio Carola,
assisted by Birahim Niang, was told to build an affordable extension, big enough
for 120 beds, that would also house facilities for preventive medicine and serve
as a new form of public building that could be replicated at modest cost.
Wagui was involved from the start. He points out that in order to balance the
privacy needed by the sick with the family conviviality for which Mauritania is
famed, the individual wards were designed as a variety of beehive-like shapes
linked by the arched tunnels. Each ward has two doors: One leads outside to the
large inner courtyard, and another opens onto one of a network of covered
walkways that connect every part of the extension.
"The design allows the sick person to be surrounded by family but
without being overlooked by anyone else. So we don't need to have separate men's
and women's wards," he says.
Much of the design evolved over time, for one of the unusual aspects of the
building is that there was no formal plan to begin with. The final extension, as
it stands today, emerged from consultation with people using the original
hospital and from two years of experiments on the site. Wagui enjoyed this.
"We built all sorts of different domes. It really was trial and
error," he laughs. "We wanted to have the feeling of the mosque but
not to have just one shape. And then of course we played with different types of
arch. We kept going until we got it right." Part of his job was training
the local men so they would have skills to find employment later. He also helped
take the craft of bricklaying about as far as it would go: "We hardly used
imported reinforced concrete because of our limited foreign currency. We didn't
use any timber, to save sparse local trees."
Thus it was people more than materials who were crucial to the hospital's
success. "Our workers held the key, and they were brilliant. They had to
learn how to do basic things like bricklaying. At the same time they were
improvising, because none of us had ever done anything like this before."
This joint effort between professional architects and previously unskilled
workers paid off handsomely: The hospital extension won an Aga Khan Award for
Architecture in 1995.
Luis Monreal, a member of the Aga Khan Award master jury, praised the use of
local material: "I could see echoes of Islam, echoes in the use of pointed
arches, and I see the echoes of southern Sahara mud-brick architecture. It is a
remarkable project in all respects, both iconically and functionally."
In building it, 40 workers made 2.5 million bricks by hand from local soil
and fired them in nearby kilns. Locally fired lime made a good finish for areas
where hygienic conditions were required, such as in operating theaters and
sterilization rooms. Cement was plastered on exterior walls to reflect sunlight,
thus helping to moderate interior temperatures. Inside, brickwork in the
circulation areas was left exposed.
Keen to show that the architecture served the hospital's medical functions,
Wagui took me to meet Etienne Odimba, a surgeon from the Democratic Republic of
Congo. We waited while he finished operating on a patient with an inflamed
appendix. The operating suite is the only part of the hospital with
air-conditioning. I looked out a slit window to the main courtyard, where
patients were making their way to the outdoor communal areas. Women had prepared
lunch under arched, domed structures open on all sides, like mud-brick gazebos.
Goats were wandering around. The smell of charcoal was in the air. It looked
like a series of family picnics, not at all a hospital scene.
When Odimba emerged, we went to his office near the reception area. He
confessed he'd never seen a building like this before he got here, even though
he'd worked in hospitals all over the world. "I like the way everything is
on one level. That makes life easier for doctors and nurses." He told me
that although most of the surgery he performed was routine, patients seemed to
recover more quickly here than elsewhere. "There is something about being
in a hospital that has won international recognition. People around here are
really proud that Kaedi has produced something so beautiful and so practical. It
seems to help them get better quicker."
