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."
Sylvia Smith is a television and radio producer and a print journalist. Her main personal and professional interest is Islamic culture in Africa and the Middle East.
Television producer and photographer Richard Duebel travels widely in the Islamic world and contributes regularly to print and broadcast media.