March 3, 2022 • 44 mins
Throughout the COVID-19 pandemic, so many of us found ourselves looking at the places we visit in our daily lives, weighing factors like ventilation and ability to social distance, and asking ourselves a new question: will going here make me more or less likely to become sick?
For architect Michael Murphy, this is the kind of question he has spent his life thinking about. As the Founding Principal and Executive Director of MASS Design Group, one of the most innovative architecture and design collectives working today, Michael is devoted to designing better buildings that improve health, bring people together, and promote equality and dignity. In this episode, Michael joins President Clinton to talk about projects they’ve worked on together in Haiti and Rwanda, his new book “The Architecture of Health” and the simple design elements that can limit the spread of disease, and his involvement with the National Memorial for Peace and Justice in Montgomery, Alabama. They also share personal reflections on the impact that their mutual friend and partner Dr. Paul Farmer, who passed away unexpectedly the day before this conversation, had on their lives.
Learn more about your ad-choices at https://www.iheartpodcastnetwork.com
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Throughout the COVID nineteen pandemic, so many of us found
ourselves looking at the places we visit in our daily
lives and asking ourselves a new question, well, going there
make me more or less likely to become sick. From
elevators and office buildings to supermarkets and restaurants, people began
weighing decisions around factors like ventilation and the ability to
(00:23):
social distance. For most of us, it was a completely
new way of looking at our world. Now why am
I telling you this, because now, more than ever, it's
clear that the buildings we use every day are about
more than style and structure. Their design affects our health,
how we interact with one another, and ultimately what we
(00:45):
value as a society today. I'm so grateful to be
joined by someone who spent his life thinking about these
questions and trying to answer them in a way that
promotes healing, equality and dignity. Michael Murphy is the founding
principle and executive director of Mass Design Group, one of
the most innovative architecture and design collectives working today. From
(01:08):
hospitals and schools and some of the most remote places
on Earth, to the National Memorial for Peace and Justice
in Montgomery, Alabama. His work has changed the way the
world looks at design. I've had the chance to work
with them many times through the Clinton Global Initiative and
to see some of his projects firsthand, including Central Africa's
(01:28):
first comprehensive cancer hospital, the Buitaro Center for Excellence in
Rural Rwanda. Michael's new book, The Architecture of Health examines
the history of hospitals and the simple ways they can
be built better today to control disease and promote healing. So, Michael,
thanks so much for joining me. Thank you, Mr President,
(01:50):
It's an honor to be here with you. Let's start
at the beginning. How did you realize that this design
work was your calling, both in becoming an architect and
also the specific kind of work that Mass Design Group does.
You know, the beginning is as a powerful moment for
me and as meaningful today. You know, the beginning of
(02:11):
the work really started with my introduction to Dr Paul Farmer,
who we lost yester yesterday, and um, I was, excuse me,
it's hard loss for us. All. I was a young
student of architecture and I think, you know, like many students,
(02:38):
was wondering, how are work had meaning and what his
purpose was, and was learning all around about the work
around the world and famous architects and influential architects, but
questions of architecture's purpose and who had served and who
(02:58):
deserved it. We're sort of lingering out there until I
met Paul. And I met him at a lecture. He
was giving a lecture on World AIDS Day December one,
two six actually, and instead of talking about all the
incredible work that he and your organization we're doing to
(03:20):
provide anti richer virals to communities that never had them,
to lower the price of those drugs, to serve so
many more communities around the world, and really fight the epidemic,
he was talking about systems design and buildings, talking about
clinics and hospitals and schools and housing that they were
building under a program the Partners in Health Paul's organizations
(03:43):
started called the POSER Program Program on Social and Economic Rights.
And I tell you it shook my world. I thought,
you know, here's a visionary doctor talking about architecture but
calling it healthcare. Yeah, you know, and I never heard
I never thought of it framed that way or heard
(04:04):
it framed so persuasively that way. And then I went
up to him afterwards, like so many students did, and
waited for him to talk to every single person in
the room as he often did, and said, Hey, I'm
a student of architecture. Who are the architects you're working with?
Who's building these houses these clinics? And he said, funny
(04:25):
you should ask you know, none of you, none of
the architects I've ever seen how they can help serve us.
We end up having to do it ourselves. When what
could you do to help bring architects to rural Haiti,
to to rural Rerwanda's and serve our organization instead of
waiting for us to ask you how you can be
of help. It's kind of an amazing call to action,
(04:45):
you know. He gave me his email. I sent him
an email later that night. You got right back to me,
as he often does. And eight months later I was
working with his organization in Rwanda, um thinking about what
it means to be in service of their organization and
what it means to build healthcare that's truly healing and dignifying.
(05:07):
First of all, since you mentioned Paul, I think that
I should tell our listeners if you don't know who
if Paul Farmer is. He died suddenly on the job
in Rwanda, near Butaro, where the University of Global Health
Equity is and where this wonderful hospital and what was
(05:30):
Central Africa's first cancer center was built with the leadership
of Michael Murphy and the Mass Design Group. He also
was a man with a million followers. Chelsea has been
a devotee and acolyte of Paul Farmer since she was
in Stanford, and he's become a very very close friend
(05:52):
of mine, and just like everybody else who really knew him,
we loved him very much. So yesterday is one of
the toughest days and that my family has had a long,
long time. I decided we should go forward with his
program today because Michael feels the same way, and Paul
inspired his work, and I know that he if he
(06:16):
were a little bird sitting on my shoulder, he'd say, Okay,
that's enough of that, Let's go to work. What what
are we gonna do? Anyway, that's the backdrop. If you're
interested in Paul Farmer, you should look up one of
his many great books, or read Tracy Kidder's account of
his life. He's the only guy you will ever run across.
(06:37):
I think you graduated from Harvard Medical School, but grew
up in a bus that was converted for he and
his five siblings. Um. This mom of the teacher's dad
was a traveling salesman and they were rich in love
and books, and he made it into an astonishing life.
(06:57):
So let's go back to you. You founded masses on,
which stands for a model of Architecture serving Society, because
you believe that architecture has a critical role in driving
social change. So for people who have never thought of
architect this way, give us some examples of how architecture
(07:20):
can solve social problems and micro society healthier and safer
and bring us closer together. You know, I do think
that question of how does architecture serve us and serve
our public better? UM is also about reflecting where it
hasn't fully lived up to its potential as well. And
(07:41):
UM we learned this in Rwanda. We learned most specifically
about how buildings are actually are making us healthier or
sometimes making us sicker. We learned that on the hilltop
and Pataro, where Dr Farmer passed away and where our
first project was because at that time, in two thousands,
six and seven, as you know with your work, the
(08:02):
epidemic um then was multi drug resistant tuberculosis, a disease
that was being transmitted primarily in hallways of rural clinics,
of patients with some drug resistance, transmitting through coughing in
the hallway to other patients, and then patients coming out
(08:24):
with this extremely drug resistant strand. And that was a
design flaw. That was a hallway which wasn't designed for
enough air flow. Here is a place that makes you sicker,
but could be designed very quickly to make us healthier,
to protect us. That simple lesson that if you turn
the hallways on the outside, you designed the building around
(08:45):
air flow. You made it a thinner building so that
more air movement could go through it. Simple lessons turn
out to be very prescient to what we're going through today.
You know, all of us are looking around I mean
all I say all of us, I mean all eight
billion of us around the world are simultaneously going through
(09:05):
this I would say, shared spatial awakening, that buildings around
us are threatening us and also wondering how they could
make us healthier. First of all, to give our listeners
a little more context. Lutaro is a beautiful little place
high in the mountains of northeast Rwanda near the Ugandan border,
(09:29):
and uh because it's very steep, the angles of the
building had to reflect that. And what started out is
people thinking about a treatment center for primarily t B
actually became a focus for how you could design a
hospital so that it was a healthy place, not a
place that made people more likely to get sick from
(09:51):
touberquet losses. Rwanda. It's like one of the most beautiful
places in the world is as you know, it's called
the Land of a Thousand Hills, is rolling beautiful, lush,
farmed hills um all over this very small country, but
very populous country. And this district does as you said,
Mr President, is on the border of Uganda. But it's
(10:13):
also it was one of the least served in terms
of medical infrastructure, so it was around four thousand people
in this district and no tertiary care medical facilities. So
the government, with the support of Partners in Health and
and the Clinton Foundation or CHAIM, prioritize this district as
as the place to invest in a new hospital. When
(10:35):
you drive there, you pass these majestic lakes nestled into
these hillsides with these backdrops of the Verunga mountain chain.
It is one of the most beautiful things I've certainly
ever seen in the world. And at the top of
a hill was was a clinic. It was really just
(10:56):
an outpatient clinic. And those clinics looked the same all
over the countryside. They were the same design, basically an
open room with beds along the perimeter, you know, beds
looking at other beds, a central hallway down the middle.
And even though that room might have been designed to
hold let's say twenty six beds or patients in beds,
(11:20):
what you saw and you walked into them were two
patients to a bed, sometimes a patient under the bed,
not twenty six beds, but fifty beds, all filling the
entire room and the hallway. You saw an overcrowded environment,
which was increasingly dangerous, especially if you have something like
an airborne disease like tuberculosis. So there was a design
(11:44):
flaw in that, which was how do we keep these
rooms from being overfilled? Can we change the orientation of
the beds, can we give the patients a different experience,
and tried to protect against over crowding or overfilling. So
one of the designs of the wards came from some
(12:06):
studies that we looked at that showed that patients got
healthier if they had a view of the outdoors. It
took less pain medication, they recovered more quickly if they
just had a view of a window, and kind of
incredible study from the early eighties UM and then also
research into the work of Florence Nightingale and others who
thought about the war design. It's something to make sure
(12:30):
that it wasn't overfilled and could be appropriate place for
for the medical staff to make sure that they're seeing
all the patients at once and can protect them. So
we can we change the orientation of the bed around
a central wall that was sort of half height. Each
of the beds looks out, so instead of a central hallway,
there's two halways on the on the edge between the
(12:50):
window and the bedfoot, and that allowed us to kind
of have a slightly more rigid floor plans. You couldn't
fill more beds into the to the ward and try
to protect against overcrowding. His subtle adjustments like that help
the care program, help the nurses and staff for saying, hey,
this is now an overcrowding problem. We need to create
(13:13):
a new award or have a temporary ward, or we
need to use other spaces and never to over fill
it in and you know, and trigger this other injury
you infectious disease transmission. Um to at second point, we
started to study how disease was transmitted in the airborne route,
(13:34):
and we found from the w h O that twelve
what's called twelve air changes prour, which means the volume
of the air in the room is transferred every hour,
and if you do it twelve times, it's enough air
movement to basically reduce infectious disease transmission. And you can
do that if you have enough open windows, enough air movement,
(13:56):
if you have a big enough room that has air
moving in the kind of upper story. So we implemented
that there on that hilltop, and um I think really
learned about how the building is like a living thing.
You know, it's not this fixed object, it's this it's
a performative living part of the care program, of the
healthcare delivery program. And if we treated it like that,
(14:19):
if we paid for it that way, if we designed
it that way as a system, we might actually have
better performing infrastructure serving more people around the world. Your
new book, The Architecture of Health talks about all this,
and I found it fascinating. It's it's not just a
book for other architects and designers. It's a it's a
(14:41):
book that we'll tell us how in an increasingly crowded
world we can navigate both peril and promise. Tell us
a little about how you came to write this book.
We were working with doctors, so they were telling us,
you know, proved to me, proved to me that these
designs are going to improve the health of our patients,
(15:01):
show us through evidence. We had to look at a
time when buildings were designed around their climate and their microclimate.
They were designed specifically around um, the places they were in,
the environments they were in, the cities they were in.
And that was of course the case of all buildings
until the introduction of widespread mechanical ventilation or the control
(15:25):
of indoor air environments through a heating, ventilating and cooling
systems in the mid century, in the in the nineteen fifties,
in sixties. So every building before then has a sort
of inherent intelligence. Not every building, but a lot of
buildings have an inherent intelligence that they were designed around
their climate. You go to New Orleans, you know, you
(15:46):
look at the buildings from the nineteenth century or mid
nineteent century. They've really tall ceilings and really tall windows,
triple pane windows, and they have these big tall ceilings
because air is hot and humid, and you've got to
get the air into the room. You've got to bring
it up into the top of the room, you gotta
ventilated with a fan, and you've got to keep people cool.
You go to the Northeast in the United States where
(16:07):
I'm from, Upstate New York, the buildings have really small ceilings,
the old Hugueno stone buildings and outside of New York
City up north and Hudson Valley from the seventeenth century,
you know, the stone buildings with really small, big chimneys
and short ceilings because they had to keep them hot
and warm in the cold climate. You know, buildings design
(16:31):
can tell you about the climate. That all changes in
the mid century when you know, technological advances allow us
to be able to control indoor air climates in a
much more comprehensive and a much more sophisticated way. But
it also has a sort of devil's bargain. And now
that we are required to have mechanically ventilated spaces everywhere
(16:53):
we go, um, it's increasing carbon offsets into the climate itself.
It's uh making us more and more reliant on buildings
that are mechanically run, and it loses some of the
inherent intelligence of building themselves. So we learned that on
that hilltop because we didn't have the money to pay
for a big mechanical system, and we had to look
(17:15):
backwards and design something that was naturally ventilated. So this
book is that journey. It's looking backwards to see where
were the design examples that really showed how buildings are
directly addressing our health And turns out so many of
them are hospitals because that the hospitals are designed with
(17:37):
that healthcare outcome in mind. So they give us a
kind of roadmap, you know, roadmap for how we might
emerge out of this pandemic and think again, Um, we
think differently about how we might design the buildings around
us to serve us better. Yeah. I think that's so
interesting that because of the financial constraints, we might actually
wind up designing healthier buildings. One of the lessons Paul
(18:00):
always taught us as a resource limitation creates incredible resourcefulness,
you know. And in that condition where we didn't have
access to massive supply chains, you know, Rwanda is still
rebuilding from the genocide. UM, we had to make do
with what was available locally, which you know, forced us
(18:20):
to think or or search out for examples which um
have universal applicability, which is what which drove us to
look at people like Florence Night and Gale and her
work in the eighteen fifties, Look at Albert Alto in
Finland in the thirties, look at the incredible work of
hospible designers for less century and what they were trying
(18:41):
to solve for. And so this book is that kind
of uh, you know, we're using use it as a
my own research project, but also a sort of defense
in some way of why why architecture matters so much
to our own ability to live, you know, a healthy life,
keep us protected. So yeah, we're excited about the book. Also,
(19:03):
we have a show at the Cooper Hewitt which I'm
ball plug now, but the Cookie Hero Design Museum, which
is related to the show, which is how design and
designers have responded to epidemics historically and to this epidemic
that we're in the middle of. Our world is defined
by it in many ways. You know, I think you're
a fan of incredible book Ghost Maps, which Dave Johnson's
(19:26):
book Ghost Map, incredible book, Steve Johnson's book. Yeah, and
you know the story of John Snow's map of Soho,
his cholera map of Soho in the eighteen fifties. And
for the listeners, it's a there's eight fifty John Snows,
he's a scientist before really epidemiology emerges. He takes out
(19:46):
a map of the Soho district where there was an
outbreak cholera. He makes a tick mark at every household
where there's a case, and he sees that there's a
concentration of cases around this one part of the street. Um,
it goes and looks at that part of the street
and there's a water pump. It takes up the manhole
(20:07):
cover and sees that there's a waste of human you know,
like a sewage pipe broken and putting basically sewage into
the water source famously or you know, So the story goes,
takes off the handle of the water pump and the
epidemic subsides, and hence cholera is not, let's say, morally born,
(20:27):
but as water born. I think is one of the
great statements in the book that the whole way in
which we thought about the solution for solving this scourge
cholera was transforming cities across the world for and huge
pandemics from the beginning part of the nineteenth century into
(20:48):
the mid part of the nineteenth century and threw up
into the end of the nineteenth century, just completely ravaging
cities and countries around the world. And this changed everything,
and interestingly enough, an incredible movement of design emerged called
the sanitation Era, where people's governments and city plants started
(21:10):
to plan their cities around health outcomes, about separating waste
and water, about getting air movement into streets and buildings.
Central Park and Frederick law Olmstead is a big part
of that movement. Many of our cities in America are
driven by those ideals, and they really in a lot
of ways, began with John Snow's map, which was this
perfect intersection of epidemiology, visualization, visualization tools, and design all together.
(21:36):
To a large degree, tuberculosis and cholera were solved diseases.
At the end of the nineteenth century, you know, we
had figured out a way to design our buildings, design
our cities to address it. And that's not doesn't mean
that it was gone. It was still endemic in certain areas,
but we knew how to solve for it and could
implement it with enough resources. But that starts to change,
(21:59):
and increasingly more and more places start to see cholera.
More and more cities are emerging in unique ways, like
you're mentioning, Mr President, which the cities were designed for
quarter Prints, I think it is designed for about four
dred thousand people and has you know, three or four
million in it, So the density, um, it's just completely overwhelming.
The systems that they have to separate waste and water
(22:21):
very specifically, and old Port of Prints does have a
wastewater treatment system, has piped waste in water underneath certain
streets in the kind of gritted historic city. But it's
the new parts of the city, the neighborhoods that have
emerged on very very steep inclines of hills, or this
(22:44):
neighborhood called City of God, which was built on the
runoff of the big the big drains that were coming
down from the mountains and bringing kind of runoff like
loose ground into the water's edge, kind of extend the beach.
Seventy people live in this largely informal part of the
(23:06):
city which has no piped waste and water infrastructure, so
it is a perfect breeding ground for something like cholera
to take hold and create the kind of epidemic that
we saw. So you know, when the design UH request
was put out there, we had to ask ourselves, Okay,
how does the building address that systemic problem? And the
(23:29):
most simple answer as well, if people with cholera are
coming to this place, how do we create a building
that separates that waste and doesn't recontaminate the ground soil
into the city itself and actually collects it, decontaminates it
on site and shows as an example how a building
can actually cleanse the water it's collected and cleanse the
(23:49):
waste it's collected. One of the things you did was
put the water treatment above the ground and then put
a grass cover on it. Correct and you actually might
have like a stylished part of a new sort of design.
Talk about that a little bit, because that was the
key to to making the place safe. How did you
(24:10):
do that? Yeah, well, I mean I think understanding the
problem was the first one. You know, what's not just
the issue of contaminated water, but what are the kind
of social conditions of the disease. Dr Bill Pop was
bringing patients. Here was a concentration of of sick patients,
and we knew that we would have a lot of
contaminated waste we'd have to deal with so big. The
(24:33):
way to deal with that is to actually use one
of the lawns or in that case was a parking
lot and turn it into a grass field that's lifted up,
which has the um. The waste that's collected goes through
a series of chambers. Each chamber cleans it a little
bit more. Nine chambers and what's called anaerobic biodigester, that's
the technical term. And then it uh you know, puts
(24:56):
the water that that waste water back into the ground.
So distributes back into the ground and if it's decontaminated
at the ninth chamber, that water is totally clean and
able to be put back into the groundwater. That's the
way in which your septic system works, of course in
your house, and it's the same the same way, it's
just a slightly more comprehensive sifting process. We'll be right back.
(25:32):
You worked in Liberia, another country that Child works in
on in the aftermath of the Ebola problem and the
outbreak there was deadly, especially in Liberia and Guinea, and
say ear leone and tell us what you did there
and how you dealt with the Ebola health challenge. At
(25:54):
each of these epidemic outbreaks, we find ourselves, you know,
trying to serve the organizations that are trying to address
these things in infrastructure becomes a key piece of it.
You know, each one of these diseases introduces another type
of infrastructural solution. So, you know, Bola, the issue there
was physical transmission touching each other or any kind of
(26:16):
contamination through skin to skin contact or tears or bodily fluids,
and so beyond all of the kind of socialization trauma
of not being able to take care of your loved
ones or touch them or see them, and sometimes all
of that really really horrific outcomes of the Bola upbreak.
(26:36):
It was really a space planning problem as well. How
do you create basically cleaned, sanitized zones that were decontaminated
where caregivers could make sure that they could what's called
don and doff, you know, take off their protective equipment
and put it back on, so they could walk through
(26:57):
areas that they knew were safe and then serve the
patients and other patients weren't infecting the caregivers, you know,
and caregivers if caregivers start getting sick, as we learned
with the COVID pandemic, and that's sort of the canary
in the coal mine where there's a problem that is
systemic and we need to address it. And what we're
seeing with the Bola was that the medical infrastructure didn't
provide enough isolation, separation and decontamination spaces so that patients
(27:23):
would be protected and caregivers would be protected. So designing
a hospital that has really really carefully um thought about
each of these threshold spaces where you walk in, you know,
you know the contamination level, you're protecting, you're not contaminating
the space that you just left, you're not contaminating the
patients that are in the spaces where they think they're safe.
That's a really really important kind of space planning strategy
(27:46):
and something we implemented on a new hospital design for
the country. You know, the other lesson I think we
learned from that is um after these outbreaks, after these emergencies,
there's a ton of out porring of resources and money
and and care and interest. And that was the case.
(28:06):
You know, billions of dollars were committed to Liberia to
sire leone UM, a lot of energy, a lot of
emergency response, but there isn't always the investment. There's investment
in emergency response, but not always in the long term
infrastructure that is going to be necessary to stem the
next outbreak or the next crisis. And then I thought
(28:29):
it was really telling that the Ministry of Health and
Liberia said, you know, we want the money for these
this outbreak, but we also want money for investing in
our health care system to strengthen that system so that
we're protected and prepared for the next one. And they
had been thinking about that for a long time. The
President Ellen Johnson Sirleaf, who so visionary, UM you had
(28:51):
said early on before the outbreak, the health system needs
to improve in strength in order to protect the country.
So UM, I thought they were really ahead of the game.
Actually to push back against let's say the aid UM
let's say the development industry, which would only pay for
let's say emergency of bowla treatment units that would last
(29:12):
for a year, and say that's fine, we need those,
but we also need the money for a permanent medical
facility UM and that was a really powerful outcome, and
we've been working on the design of their new central
hospital in downtown on Rovia that will bring in all
of these lessons from air flow that we learned in Rwanda,
(29:33):
waste management we learned in Haiti, and then UM separation
of patients in UM, the treatment of ebola, so that
all of those are inter twined in the design of
this new tertiary care facility that's under construction. I was
really thrilled when you started doing that, because when the
ebola outbreak happened in Libraria, the government asked try our
(29:55):
health group to help them deal with it and stay
around if we could, and four of our people actually
never left the country and they were miraculously none of
them got sick, but a lot of people did. UM.
Tell us what you think the implications of what the
first line workers front line workers have been through with
(30:18):
COVID and what we've learned from that, and is there
a way we could design better to deal with such
things in the future. Yeah, you know, I thanks for
asking that, because I think these lessons in many ways.
We were preparing for this moment for last decade, all
of us together, working in these epidemic moments and trying
(30:40):
to figure out what the spaces could do to help
address the diseases were facing. You know, when COVID broke
in February, UM, you know, all of us obviously we're
thinking about what to do. UM, But it was in
April where March and April we started getting calls from
our partners, UM, folks that we had worked with in
(31:01):
the healthcare industry, saying, how can we immediately you know,
support our our constituents, are our clients that people were
serving and UM one of them was this amazing group
called Boston Healthcare for the Homeless, their network of UM
health care services for homeless populations and serving really incredibly
(31:25):
marginalized groups suffering in a huge way, and they were
getting COVID really in a big way. First, you know,
another kind of canary in the coal mine example. And
we got a call from an old friend named John Bukavalis,
who was at the Cincinnati Children's Hospital. UM, and when
I had a research amazing guy, and he had moved
recently to Mount Sina Hospital in New York and was
(31:47):
leading a lot of their research there. And that was,
as some of you somebody might know or may not know,
really kind of the epicenter of the outbreak in New
York during April, which is really spiking a and um.
You know, John reached out and said, look, you know,
caregivers are getting sick. We're you know, we're getting sick.
(32:08):
We don't know where diseases coming from. We don't know
fully all about it. We're just we're in the middle
of it. Is there anything we can think about spatially, um,
that could protect us, to help us. And so we
did this very rapid design research project. We attached go
pro cameras to these doctors heads and we did some
(32:31):
you zoom based recordings, and we mapped with them how
the hallways again of the hospitals we're changing, they were
getting filled with equipment. Um. Everyone didn't you know, donning
and doaughing was happening in different places. And then we
did these exercises too with doctors to figure out where
they perceived the risk of the disease and where they
(32:54):
were safe and where they weren't safe. And I mean
I'm talking, we just took plan It's like the fire
escape maps from the walls, and we had them with
crayons draw on those maps, you know, green, yellow, and red.
And it was shocking and also I mean not fully surprising,
(33:14):
but each map was different. Everyone had a different perception
of where there was safe space and where there was
contaminated space. And it's really illustrative just to see it
together because you knew that, oh well, you can work
from this. We can visualize like John Snow visualized the
cholera epidemic. You can use this visual tool to start
(33:37):
to create rules inside the hospital that maybe incrementally would
help the caregivers in the middle of the outbreak, just
to kind of create clearer lines of delineation between protection
and risk. It's amazing, and they were just you know,
I just say that it's the doctors and the caregivers
that were designing the spaces, redesigning in real time. I
(34:00):
think we have the most to learn from about how
they're operating within those terrible conditions, and they deserve really
all that credit. More After this, you also were involved
(34:20):
in the design of the National Memorial for Peace and Justice.
Many people believe it's the most important structure that's been
built in the last several years in America. And so
tell us a little about that. Tell us what it
is and how you got involved in it. Well. The
National Morpha Peace and Justice is a memorial in Montgomery,
(34:42):
Alabama that was conceived, of, imagined, and designed by Brian
Stevenson of the incredible Equal Justice Initiative. Just Mercy just
a profoundly visionary and impactful organ zation and seat of
thinkers that are I think fundamentally changing the narrative around
(35:06):
our country's history of racial oppression and terror. I had
been a fan, like many people, and I saw an
article in The New York Times where he mentioned that
their legal work. Keep in mind, Brian, Brian and his
team are lawyers. They're fighting for people who are incarcerated,
often unjustly, and trying to get them the services they deserve.
(35:30):
And he said, we can't do this work without addressing
the history of racial terror in America and starting to
change the narrative around our history of racism in America.
And he said, I want to mark every site of lynching,
the lynching of African Americans in America, and I want
to build a national memorial to those victims to rise
(35:51):
from the ground this hidden history of our country, bring
visibility to it, say their names, and recognize that the
landscape of of how our public spaces around the country
are marked and named and who is recognized UM is
not a full and comprehensive list of those who have
suffered and died for our freedom. And this is a
(36:13):
necessary piece of infrastructure to help heal our nation. So
the project is a memorial to the victims of lynching
from really the dates are between eighteen eight and nineteen
fifty to a large degree, and it's organized by UM
the counties across the country and the names of those
(36:36):
individuals in those counties who were often publicly terrorized and
killed in in particular the post reconstruction kind of Jim
Crow era before the advent of civil rights movement. I
think the memorials that really succeed are the ones that
UM what I would call, transmit the intimate and the infinite.
(36:59):
They show the totality of the loss, the totality of
the of the crisis. In volume, you know, you can
see it it's not just a number on a page
or in the newspaper, which is to some degree hard
to understand what that is. Four million, six million, ten million,
that's hard to understand. But if you see, you know,
(37:20):
six million stones in a pile, for example, to commemorate
the Jews that were murdered during the Holocaust, that's a
huge enormous thing that you can spatially experience. When you
see the names on the Vietnam Veterans memorial and you
walk and you see the list of names as a volume,
it's hard to ignore. Um. It shows that sense of
(37:44):
the infinite. But then you have to move past that
and create a link to find that individual name in
the Vietna Veterans memorials very influential to us because that
idea of people coming and finding the name of their
loved one, their brother or their father, and rubbing a
piece of paper with a pencil and taking away that
(38:08):
name on a on a piece of paper and framing
that that kind of memento. That experience, I think is
really powerful one. You know, it's one where you're like
transcending just the legibility of the wall and you're touching it,
you're building it. Into your deep memory that experience. It's unforgettable,
and then you feel it. You feel the weight of
(38:30):
all of those markers above you as um um, the
kind of weight of history that we haven't fully uncovered.
You know that we don't fully know that weight of history.
You feel it in your body, and that to me
is where architecture is doing necessary things. You know, Um,
(38:51):
this is a very pull Farmer way of thinking about it.
But is the question of what can we not accomplish
without spatializing it? Yeah, memorialization is necessary because we need
to create a space or a location where we can
go and wrestle with pay tribute, understand, but also um,
(39:15):
create a unique memory in our own selves that we
witnessed this history. So where where are you going from here?
With all this? I returned often to this amazing quote
from you know Dr King and his letter from Birmingham Jail,
where he talks about the garment of destiny. Whatever affects
(39:35):
one affects all, that we're all tied in an inescapable
network of mutuality. I love that line. I think buildings
are the places where we experience that mutuality, that garment
that connects us all is found and forged in the
public realm and the public places that we have to
(39:56):
go and choose to go. And if it's the post
office or the hospital waiting room, or if it's the
school where we attend, those places transform us. And I
think periods before I think of the w p A,
I think about the New Deal, I think about these
moments where we understood that as a country, where we
(40:16):
invested not just in the infrastructure that was necessary to survive,
but that we invested a sense of dignity and artistry
and commitment to the beauty of it as essential as elemental.
And we've done it before. I think we can do
it again. I think we could really take that mantle.
(40:39):
We ourselves can enact change through our buildings and through
the world around us. I think those are the lessons
I hope to carry forward. Thank you, Michael Murphy, your
inspiration and mentor. Paul Farmer was very proud of you,
and I'm very grateful to you, and I can't wait
to see what you do next. And I urge all
(41:00):
of you who are interested in these things to look
up mass design on the internet and read about them,
and look at the architecture of health. This is very
important stuff. But as I hope Michael has persuaded you,
it's also a challenge to the modern world that is
(41:20):
accessible to us, one that we can make a den end,
often without spending enormous amounts of money, are bringing in
from somewhere else, staggering amounts of expertise. It's what they
have accomplished that mass design is largely a feat of
(41:42):
the imagination, possibility of wonder being made out of things
that are at hand and people that are handy. We're
all in your debt, and I wish you will thank you.
I thank you so much for this conversation, and thank
you for um the opportunity to speak with you today.
(42:03):
In the passing of our friend Michael, and I will
began to sound silly if we don't stop this. But
once you to watch in a lifetime you might meet
somebody like Paul Farmer, somebody so extraordinary and yet so real,
so commanding and yet so human and hilarious, uh that
(42:25):
it changes your life forever. And we're dealing with that
loss now. A man who was sixty two and should
have lived twenty years longer or thirty years longer, but
who did outlive his own father about thirteen years in
a family prone to heart disease. She was a social hero,
(42:50):
if you will, but he was a wonderful personal friend.
Thank you, Michael, Thank you, Mr President. Why am I
telling you? This is a production of My Heart Radio
the Clinton Foundation and at Will Medium. Our executive producers
are Craigmanascian and Will Malnadi. Our production team includes Jamison Katsufas,
(43:14):
Tom Galton, Sarah Horowitz, and Jake Young, with production support
from Liz Rafferee and Josh Farnham. Original music by What White.
Special thanks to John Sykes, John Davidson on hell Orina,
Corey Ganstley, Kevin thurm Oscar Flores, and all our dedicated
staff and partners at the Clinton Foundation. Hi, I'm back
(43:39):
a Courtsield and I'm a Deputy director at the Clinton
Global Initiative. President Clinton established the Clinton Global Initiative to
create a new kind of philanthropic community. To address the
complex realities of our modern world. We're problem solving required
the active partnership of government, business and civil society. Over
the years, are Proven model has grown to include action
networks that can quickly mobilize in the face of emergencies,
(44:02):
whether that's helping Puerto Rico and the Caribbean recover in
the wake of Hurricanes Rman and Maria, or advancing an
inclusive US Economic recovery amid COVID nineteen. To learn more
about this work and see how you can get involved,
visit Clinton Foundation dot org. Slash Podcast
Throughout the COVID nineteen pandemic, so many of us found
ourselves looking at the places we visit in our daily
lives and asking ourselves a new question, well, going there
make me more or less likely to become sick. From
elevators and office buildings to supermarkets and restaurants, people began
weighing decisions around factors like ventilation and the ability to
(00:23):
social distance. For most of us, it was a completely
new way of looking at our world. Now why am
I telling you this, because now, more than ever, it's
clear that the buildings we use every day are about
more than style and structure. Their design affects our health,
how we interact with one another, and ultimately what we
(00:45):
value as a society today. I'm so grateful to be
joined by someone who spent his life thinking about these
questions and trying to answer them in a way that
promotes healing, equality and dignity. Michael Murphy is the founding
principle and executive director of Mass Design Group, one of
the most innovative architecture and design collectives working today. From
(01:08):
hospitals and schools and some of the most remote places
on Earth, to the National Memorial for Peace and Justice
in Montgomery, Alabama. His work has changed the way the
world looks at design. I've had the chance to work
with them many times through the Clinton Global Initiative and
to see some of his projects firsthand, including Central Africa's
(01:28):
first comprehensive cancer hospital, the Buitaro Center for Excellence in
Rural Rwanda. Michael's new book, The Architecture of Health examines
the history of hospitals and the simple ways they can
be built better today to control disease and promote healing. So, Michael,
thanks so much for joining me. Thank you, Mr President,
(01:50):
It's an honor to be here with you. Let's start
at the beginning. How did you realize that this design
work was your calling, both in becoming an architect and
also the specific kind of work that Mass Design Group does.
You know, the beginning is as a powerful moment for
me and as meaningful today. You know, the beginning of
(02:11):
the work really started with my introduction to Dr Paul Farmer,
who we lost yester yesterday, and um, I was, excuse me,
it's hard loss for us. All. I was a young
student of architecture and I think, you know, like many students,
(02:38):
was wondering, how are work had meaning and what his
purpose was, and was learning all around about the work
around the world and famous architects and influential architects, but
questions of architecture's purpose and who had served and who
(02:58):
deserved it. We're sort of lingering out there until I
met Paul. And I met him at a lecture. He
was giving a lecture on World AIDS Day December one,
two six actually, and instead of talking about all the
incredible work that he and your organization we're doing to
(03:20):
provide anti richer virals to communities that never had them,
to lower the price of those drugs, to serve so
many more communities around the world, and really fight the epidemic,
he was talking about systems design and buildings, talking about
clinics and hospitals and schools and housing that they were
building under a program the Partners in Health Paul's organizations
(03:43):
started called the POSER Program Program on Social and Economic Rights.
And I tell you it shook my world. I thought,
you know, here's a visionary doctor talking about architecture but
calling it healthcare. Yeah, you know, and I never heard
I never thought of it framed that way or heard
(04:04):
it framed so persuasively that way. And then I went
up to him afterwards, like so many students did, and
waited for him to talk to every single person in
the room as he often did, and said, Hey, I'm
a student of architecture. Who are the architects you're working with?
Who's building these houses these clinics? And he said, funny
(04:25):
you should ask you know, none of you, none of
the architects I've ever seen how they can help serve us.
We end up having to do it ourselves. When what
could you do to help bring architects to rural Haiti,
to to rural Rerwanda's and serve our organization instead of
waiting for us to ask you how you can be
of help. It's kind of an amazing call to action,
(04:45):
you know. He gave me his email. I sent him
an email later that night. You got right back to me,
as he often does. And eight months later I was
working with his organization in Rwanda, um thinking about what
it means to be in service of their organization and
what it means to build healthcare that's truly healing and dignifying.
(05:07):
First of all, since you mentioned Paul, I think that
I should tell our listeners if you don't know who
if Paul Farmer is. He died suddenly on the job
in Rwanda, near Butaro, where the University of Global Health
Equity is and where this wonderful hospital and what was
(05:30):
Central Africa's first cancer center was built with the leadership
of Michael Murphy and the Mass Design Group. He also
was a man with a million followers. Chelsea has been
a devotee and acolyte of Paul Farmer since she was
in Stanford, and he's become a very very close friend
(05:52):
of mine, and just like everybody else who really knew him,
we loved him very much. So yesterday is one of
the toughest days and that my family has had a long,
long time. I decided we should go forward with his
program today because Michael feels the same way, and Paul
inspired his work, and I know that he if he
(06:16):
were a little bird sitting on my shoulder, he'd say, Okay,
that's enough of that, Let's go to work. What what
are we gonna do? Anyway, that's the backdrop. If you're
interested in Paul Farmer, you should look up one of
his many great books, or read Tracy Kidder's account of
his life. He's the only guy you will ever run across.
(06:37):
I think you graduated from Harvard Medical School, but grew
up in a bus that was converted for he and
his five siblings. Um. This mom of the teacher's dad
was a traveling salesman and they were rich in love
and books, and he made it into an astonishing life.
(06:57):
So let's go back to you. You founded masses on,
which stands for a model of Architecture serving Society, because
you believe that architecture has a critical role in driving
social change. So for people who have never thought of
architect this way, give us some examples of how architecture
(07:20):
can solve social problems and micro society healthier and safer
and bring us closer together. You know, I do think
that question of how does architecture serve us and serve
our public better? UM is also about reflecting where it
hasn't fully lived up to its potential as well. And
(07:41):
UM we learned this in Rwanda. We learned most specifically
about how buildings are actually are making us healthier or
sometimes making us sicker. We learned that on the hilltop
and Pataro, where Dr Farmer passed away and where our
first project was because at that time, in two thousands,
six and seven, as you know with your work, the
(08:02):
epidemic um then was multi drug resistant tuberculosis, a disease
that was being transmitted primarily in hallways of rural clinics,
of patients with some drug resistance, transmitting through coughing in
the hallway to other patients, and then patients coming out
(08:24):
with this extremely drug resistant strand. And that was a
design flaw. That was a hallway which wasn't designed for
enough air flow. Here is a place that makes you sicker,
but could be designed very quickly to make us healthier,
to protect us. That simple lesson that if you turn
the hallways on the outside, you designed the building around
(08:45):
air flow. You made it a thinner building so that
more air movement could go through it. Simple lessons turn
out to be very prescient to what we're going through today.
You know, all of us are looking around I mean
all I say all of us, I mean all eight
billion of us around the world are simultaneously going through
(09:05):
this I would say, shared spatial awakening, that buildings around
us are threatening us and also wondering how they could
make us healthier. First of all, to give our listeners
a little more context. Lutaro is a beautiful little place
high in the mountains of northeast Rwanda near the Ugandan border,
(09:29):
and uh because it's very steep, the angles of the
building had to reflect that. And what started out is
people thinking about a treatment center for primarily t B
actually became a focus for how you could design a
hospital so that it was a healthy place, not a
place that made people more likely to get sick from
(09:51):
touberquet losses. Rwanda. It's like one of the most beautiful
places in the world is as you know, it's called
the Land of a Thousand Hills, is rolling beautiful, lush,
farmed hills um all over this very small country, but
very populous country. And this district does as you said,
Mr President, is on the border of Uganda. But it's
(10:13):
also it was one of the least served in terms
of medical infrastructure, so it was around four thousand people
in this district and no tertiary care medical facilities. So
the government, with the support of Partners in Health and
and the Clinton Foundation or CHAIM, prioritize this district as
as the place to invest in a new hospital. When
(10:35):
you drive there, you pass these majestic lakes nestled into
these hillsides with these backdrops of the Verunga mountain chain.
It is one of the most beautiful things I've certainly
ever seen in the world. And at the top of
a hill was was a clinic. It was really just
(10:56):
an outpatient clinic. And those clinics looked the same all
over the countryside. They were the same design, basically an
open room with beds along the perimeter, you know, beds
looking at other beds, a central hallway down the middle.
And even though that room might have been designed to
hold let's say twenty six beds or patients in beds,
(11:20):
what you saw and you walked into them were two
patients to a bed, sometimes a patient under the bed,
not twenty six beds, but fifty beds, all filling the
entire room and the hallway. You saw an overcrowded environment,
which was increasingly dangerous, especially if you have something like
an airborne disease like tuberculosis. So there was a design
(11:44):
flaw in that, which was how do we keep these
rooms from being overfilled? Can we change the orientation of
the beds, can we give the patients a different experience,
and tried to protect against over crowding or overfilling. So
one of the designs of the wards came from some
(12:06):
studies that we looked at that showed that patients got
healthier if they had a view of the outdoors. It
took less pain medication, they recovered more quickly if they
just had a view of a window, and kind of
incredible study from the early eighties UM and then also
research into the work of Florence Nightingale and others who
thought about the war design. It's something to make sure
(12:30):
that it wasn't overfilled and could be appropriate place for
for the medical staff to make sure that they're seeing
all the patients at once and can protect them. So
we can we change the orientation of the bed around
a central wall that was sort of half height. Each
of the beds looks out, so instead of a central hallway,
there's two halways on the on the edge between the
(12:50):
window and the bedfoot, and that allowed us to kind
of have a slightly more rigid floor plans. You couldn't
fill more beds into the to the ward and try
to protect against overcrowding. His subtle adjustments like that help
the care program, help the nurses and staff for saying, hey,
this is now an overcrowding problem. We need to create
(13:13):
a new award or have a temporary ward, or we
need to use other spaces and never to over fill
it in and you know, and trigger this other injury
you infectious disease transmission. Um to at second point, we
started to study how disease was transmitted in the airborne route,
(13:34):
and we found from the w h O that twelve
what's called twelve air changes prour, which means the volume
of the air in the room is transferred every hour,
and if you do it twelve times, it's enough air
movement to basically reduce infectious disease transmission. And you can
do that if you have enough open windows, enough air movement,
(13:56):
if you have a big enough room that has air
moving in the kind of upper story. So we implemented
that there on that hilltop, and um I think really
learned about how the building is like a living thing.
You know, it's not this fixed object, it's this it's
a performative living part of the care program, of the
healthcare delivery program. And if we treated it like that,
(14:19):
if we paid for it that way, if we designed
it that way as a system, we might actually have
better performing infrastructure serving more people around the world. Your
new book, The Architecture of Health talks about all this,
and I found it fascinating. It's it's not just a
book for other architects and designers. It's a it's a
(14:41):
book that we'll tell us how in an increasingly crowded
world we can navigate both peril and promise. Tell us
a little about how you came to write this book.
We were working with doctors, so they were telling us,
you know, proved to me, proved to me that these
designs are going to improve the health of our patients,
(15:01):
show us through evidence. We had to look at a
time when buildings were designed around their climate and their microclimate.
They were designed specifically around um, the places they were in,
the environments they were in, the cities they were in.
And that was of course the case of all buildings
until the introduction of widespread mechanical ventilation or the control
(15:25):
of indoor air environments through a heating, ventilating and cooling
systems in the mid century, in the in the nineteen fifties,
in sixties. So every building before then has a sort
of inherent intelligence. Not every building, but a lot of
buildings have an inherent intelligence that they were designed around
their climate. You go to New Orleans, you know, you
(15:46):
look at the buildings from the nineteenth century or mid
nineteent century. They've really tall ceilings and really tall windows,
triple pane windows, and they have these big tall ceilings
because air is hot and humid, and you've got to
get the air into the room. You've got to bring
it up into the top of the room, you gotta
ventilated with a fan, and you've got to keep people cool.
You go to the Northeast in the United States where
(16:07):
I'm from, Upstate New York, the buildings have really small ceilings,
the old Hugueno stone buildings and outside of New York
City up north and Hudson Valley from the seventeenth century,
you know, the stone buildings with really small, big chimneys
and short ceilings because they had to keep them hot
and warm in the cold climate. You know, buildings design
(16:31):
can tell you about the climate. That all changes in
the mid century when you know, technological advances allow us
to be able to control indoor air climates in a
much more comprehensive and a much more sophisticated way. But
it also has a sort of devil's bargain. And now
that we are required to have mechanically ventilated spaces everywhere
(16:53):
we go, um, it's increasing carbon offsets into the climate itself.
It's uh making us more and more reliant on buildings
that are mechanically run, and it loses some of the
inherent intelligence of building themselves. So we learned that on
that hilltop because we didn't have the money to pay
for a big mechanical system, and we had to look
(17:15):
backwards and design something that was naturally ventilated. So this
book is that journey. It's looking backwards to see where
were the design examples that really showed how buildings are
directly addressing our health And turns out so many of
them are hospitals because that the hospitals are designed with
(17:37):
that healthcare outcome in mind. So they give us a
kind of roadmap, you know, roadmap for how we might
emerge out of this pandemic and think again, Um, we
think differently about how we might design the buildings around
us to serve us better. Yeah. I think that's so
interesting that because of the financial constraints, we might actually
wind up designing healthier buildings. One of the lessons Paul
(18:00):
always taught us as a resource limitation creates incredible resourcefulness,
you know. And in that condition where we didn't have
access to massive supply chains, you know, Rwanda is still
rebuilding from the genocide. UM, we had to make do
with what was available locally, which you know, forced us
(18:20):
to think or or search out for examples which um
have universal applicability, which is what which drove us to
look at people like Florence Night and Gale and her
work in the eighteen fifties, Look at Albert Alto in
Finland in the thirties, look at the incredible work of
hospible designers for less century and what they were trying
(18:41):
to solve for. And so this book is that kind
of uh, you know, we're using use it as a
my own research project, but also a sort of defense
in some way of why why architecture matters so much
to our own ability to live, you know, a healthy life,
keep us protected. So yeah, we're excited about the book. Also,
(19:03):
we have a show at the Cooper Hewitt which I'm
ball plug now, but the Cookie Hero Design Museum, which
is related to the show, which is how design and
designers have responded to epidemics historically and to this epidemic
that we're in the middle of. Our world is defined
by it in many ways. You know, I think you're
a fan of incredible book Ghost Maps, which Dave Johnson's
(19:26):
book Ghost Map, incredible book, Steve Johnson's book. Yeah, and
you know the story of John Snow's map of Soho,
his cholera map of Soho in the eighteen fifties. And
for the listeners, it's a there's eight fifty John Snows,
he's a scientist before really epidemiology emerges. He takes out
(19:46):
a map of the Soho district where there was an
outbreak cholera. He makes a tick mark at every household
where there's a case, and he sees that there's a
concentration of cases around this one part of the street. Um,
it goes and looks at that part of the street
and there's a water pump. It takes up the manhole
(20:07):
cover and sees that there's a waste of human you know,
like a sewage pipe broken and putting basically sewage into
the water source famously or you know, So the story goes,
takes off the handle of the water pump and the
epidemic subsides, and hence cholera is not, let's say, morally born,
(20:27):
but as water born. I think is one of the
great statements in the book that the whole way in
which we thought about the solution for solving this scourge
cholera was transforming cities across the world for and huge
pandemics from the beginning part of the nineteenth century into
(20:48):
the mid part of the nineteenth century and threw up
into the end of the nineteenth century, just completely ravaging
cities and countries around the world. And this changed everything,
and interestingly enough, an incredible movement of design emerged called
the sanitation Era, where people's governments and city plants started
(21:10):
to plan their cities around health outcomes, about separating waste
and water, about getting air movement into streets and buildings.
Central Park and Frederick law Olmstead is a big part
of that movement. Many of our cities in America are
driven by those ideals, and they really in a lot
of ways, began with John Snow's map, which was this
perfect intersection of epidemiology, visualization, visualization tools, and design all together.
(21:36):
To a large degree, tuberculosis and cholera were solved diseases.
At the end of the nineteenth century, you know, we
had figured out a way to design our buildings, design
our cities to address it. And that's not doesn't mean
that it was gone. It was still endemic in certain areas,
but we knew how to solve for it and could
implement it with enough resources. But that starts to change,
(21:59):
and increasingly more and more places start to see cholera.
More and more cities are emerging in unique ways, like
you're mentioning, Mr President, which the cities were designed for
quarter Prints, I think it is designed for about four
dred thousand people and has you know, three or four
million in it, So the density, um, it's just completely overwhelming.
The systems that they have to separate waste and water
(22:21):
very specifically, and old Port of Prints does have a
wastewater treatment system, has piped waste in water underneath certain
streets in the kind of gritted historic city. But it's
the new parts of the city, the neighborhoods that have
emerged on very very steep inclines of hills, or this
(22:44):
neighborhood called City of God, which was built on the
runoff of the big the big drains that were coming
down from the mountains and bringing kind of runoff like
loose ground into the water's edge, kind of extend the beach.
Seventy people live in this largely informal part of the
(23:06):
city which has no piped waste and water infrastructure, so
it is a perfect breeding ground for something like cholera
to take hold and create the kind of epidemic that
we saw. So you know, when the design UH request
was put out there, we had to ask ourselves, Okay,
how does the building address that systemic problem? And the
(23:29):
most simple answer as well, if people with cholera are
coming to this place, how do we create a building
that separates that waste and doesn't recontaminate the ground soil
into the city itself and actually collects it, decontaminates it
on site and shows as an example how a building
can actually cleanse the water it's collected and cleanse the
(23:49):
waste it's collected. One of the things you did was
put the water treatment above the ground and then put
a grass cover on it. Correct and you actually might
have like a stylished part of a new sort of design.
Talk about that a little bit, because that was the
key to to making the place safe. How did you
(24:10):
do that? Yeah, well, I mean I think understanding the
problem was the first one. You know, what's not just
the issue of contaminated water, but what are the kind
of social conditions of the disease. Dr Bill Pop was
bringing patients. Here was a concentration of of sick patients,
and we knew that we would have a lot of
contaminated waste we'd have to deal with so big. The
(24:33):
way to deal with that is to actually use one
of the lawns or in that case was a parking
lot and turn it into a grass field that's lifted up,
which has the um. The waste that's collected goes through
a series of chambers. Each chamber cleans it a little
bit more. Nine chambers and what's called anaerobic biodigester, that's
the technical term. And then it uh you know, puts
(24:56):
the water that that waste water back into the ground.
So distributes back into the ground and if it's decontaminated
at the ninth chamber, that water is totally clean and
able to be put back into the groundwater. That's the
way in which your septic system works, of course in
your house, and it's the same the same way, it's
just a slightly more comprehensive sifting process. We'll be right back.
(25:32):
You worked in Liberia, another country that Child works in
on in the aftermath of the Ebola problem and the
outbreak there was deadly, especially in Liberia and Guinea, and
say ear leone and tell us what you did there
and how you dealt with the Ebola health challenge. At
(25:54):
each of these epidemic outbreaks, we find ourselves, you know,
trying to serve the organizations that are trying to address
these things in infrastructure becomes a key piece of it.
You know, each one of these diseases introduces another type
of infrastructural solution. So, you know, Bola, the issue there
was physical transmission touching each other or any kind of
(26:16):
contamination through skin to skin contact or tears or bodily fluids,
and so beyond all of the kind of socialization trauma
of not being able to take care of your loved
ones or touch them or see them, and sometimes all
of that really really horrific outcomes of the Bola upbreak.
(26:36):
It was really a space planning problem as well. How
do you create basically cleaned, sanitized zones that were decontaminated
where caregivers could make sure that they could what's called
don and doff, you know, take off their protective equipment
and put it back on, so they could walk through
(26:57):
areas that they knew were safe and then serve the
patients and other patients weren't infecting the caregivers, you know,
and caregivers if caregivers start getting sick, as we learned
with the COVID pandemic, and that's sort of the canary
in the coal mine where there's a problem that is
systemic and we need to address it. And what we're
seeing with the Bola was that the medical infrastructure didn't
provide enough isolation, separation and decontamination spaces so that patients
(27:23):
would be protected and caregivers would be protected. So designing
a hospital that has really really carefully um thought about
each of these threshold spaces where you walk in, you know,
you know the contamination level, you're protecting, you're not contaminating
the space that you just left, you're not contaminating the
patients that are in the spaces where they think they're safe.
That's a really really important kind of space planning strategy
(27:46):
and something we implemented on a new hospital design for
the country. You know, the other lesson I think we
learned from that is um after these outbreaks, after these emergencies,
there's a ton of out porring of resources and money
and and care and interest. And that was the case.
(28:06):
You know, billions of dollars were committed to Liberia to
sire leone UM, a lot of energy, a lot of
emergency response, but there isn't always the investment. There's investment
in emergency response, but not always in the long term
infrastructure that is going to be necessary to stem the
next outbreak or the next crisis. And then I thought
(28:29):
it was really telling that the Ministry of Health and
Liberia said, you know, we want the money for these
this outbreak, but we also want money for investing in
our health care system to strengthen that system so that
we're protected and prepared for the next one. And they
had been thinking about that for a long time. The
President Ellen Johnson Sirleaf, who so visionary, UM you had
(28:51):
said early on before the outbreak, the health system needs
to improve in strength in order to protect the country.
So UM, I thought they were really ahead of the game.
Actually to push back against let's say the aid UM
let's say the development industry, which would only pay for
let's say emergency of bowla treatment units that would last
(29:12):
for a year, and say that's fine, we need those,
but we also need the money for a permanent medical
facility UM and that was a really powerful outcome, and
we've been working on the design of their new central
hospital in downtown on Rovia that will bring in all
of these lessons from air flow that we learned in Rwanda,
(29:33):
waste management we learned in Haiti, and then UM separation
of patients in UM, the treatment of ebola, so that
all of those are inter twined in the design of
this new tertiary care facility that's under construction. I was
really thrilled when you started doing that, because when the
ebola outbreak happened in Libraria, the government asked try our
(29:55):
health group to help them deal with it and stay
around if we could, and four of our people actually
never left the country and they were miraculously none of
them got sick, but a lot of people did. UM.
Tell us what you think the implications of what the
first line workers front line workers have been through with
(30:18):
COVID and what we've learned from that, and is there
a way we could design better to deal with such
things in the future. Yeah, you know, I thanks for
asking that, because I think these lessons in many ways.
We were preparing for this moment for last decade, all
of us together, working in these epidemic moments and trying
(30:40):
to figure out what the spaces could do to help
address the diseases were facing. You know, when COVID broke
in February, UM, you know, all of us obviously we're
thinking about what to do. UM, But it was in
April where March and April we started getting calls from
our partners, UM, folks that we had worked with in
(31:01):
the healthcare industry, saying, how can we immediately you know,
support our our constituents, are our clients that people were
serving and UM one of them was this amazing group
called Boston Healthcare for the Homeless, their network of UM
health care services for homeless populations and serving really incredibly
(31:25):
marginalized groups suffering in a huge way, and they were
getting COVID really in a big way. First, you know,
another kind of canary in the coal mine example. And
we got a call from an old friend named John Bukavalis,
who was at the Cincinnati Children's Hospital. UM, and when
I had a research amazing guy, and he had moved
recently to Mount Sina Hospital in New York and was
(31:47):
leading a lot of their research there. And that was,
as some of you somebody might know or may not know,
really kind of the epicenter of the outbreak in New
York during April, which is really spiking a and um.
You know, John reached out and said, look, you know,
caregivers are getting sick. We're you know, we're getting sick.
(32:08):
We don't know where diseases coming from. We don't know
fully all about it. We're just we're in the middle
of it. Is there anything we can think about spatially, um,
that could protect us, to help us. And so we
did this very rapid design research project. We attached go
pro cameras to these doctors heads and we did some
(32:31):
you zoom based recordings, and we mapped with them how
the hallways again of the hospitals we're changing, they were
getting filled with equipment. Um. Everyone didn't you know, donning
and doaughing was happening in different places. And then we
did these exercises too with doctors to figure out where
they perceived the risk of the disease and where they
(32:54):
were safe and where they weren't safe. And I mean
I'm talking, we just took plan It's like the fire
escape maps from the walls, and we had them with
crayons draw on those maps, you know, green, yellow, and red.
And it was shocking and also I mean not fully surprising,
(33:14):
but each map was different. Everyone had a different perception
of where there was safe space and where there was
contaminated space. And it's really illustrative just to see it
together because you knew that, oh well, you can work
from this. We can visualize like John Snow visualized the
cholera epidemic. You can use this visual tool to start
(33:37):
to create rules inside the hospital that maybe incrementally would
help the caregivers in the middle of the outbreak, just
to kind of create clearer lines of delineation between protection
and risk. It's amazing, and they were just you know,
I just say that it's the doctors and the caregivers
that were designing the spaces, redesigning in real time. I
(34:00):
think we have the most to learn from about how
they're operating within those terrible conditions, and they deserve really
all that credit. More After this, you also were involved
(34:20):
in the design of the National Memorial for Peace and Justice.
Many people believe it's the most important structure that's been
built in the last several years in America. And so
tell us a little about that. Tell us what it
is and how you got involved in it. Well. The
National Morpha Peace and Justice is a memorial in Montgomery,
(34:42):
Alabama that was conceived, of, imagined, and designed by Brian
Stevenson of the incredible Equal Justice Initiative. Just Mercy just
a profoundly visionary and impactful organ zation and seat of
thinkers that are I think fundamentally changing the narrative around
(35:06):
our country's history of racial oppression and terror. I had
been a fan, like many people, and I saw an
article in The New York Times where he mentioned that
their legal work. Keep in mind, Brian, Brian and his
team are lawyers. They're fighting for people who are incarcerated,
often unjustly, and trying to get them the services they deserve.
(35:30):
And he said, we can't do this work without addressing
the history of racial terror in America and starting to
change the narrative around our history of racism in America.
And he said, I want to mark every site of lynching,
the lynching of African Americans in America, and I want
to build a national memorial to those victims to rise
(35:51):
from the ground this hidden history of our country, bring
visibility to it, say their names, and recognize that the
landscape of of how our public spaces around the country
are marked and named and who is recognized UM is
not a full and comprehensive list of those who have
suffered and died for our freedom. And this is a
(36:13):
necessary piece of infrastructure to help heal our nation. So
the project is a memorial to the victims of lynching
from really the dates are between eighteen eight and nineteen
fifty to a large degree, and it's organized by UM
the counties across the country and the names of those
(36:36):
individuals in those counties who were often publicly terrorized and
killed in in particular the post reconstruction kind of Jim
Crow era before the advent of civil rights movement. I
think the memorials that really succeed are the ones that
UM what I would call, transmit the intimate and the infinite.
(36:59):
They show the totality of the loss, the totality of
the of the crisis. In volume, you know, you can
see it it's not just a number on a page
or in the newspaper, which is to some degree hard
to understand what that is. Four million, six million, ten million,
that's hard to understand. But if you see, you know,
(37:20):
six million stones in a pile, for example, to commemorate
the Jews that were murdered during the Holocaust, that's a
huge enormous thing that you can spatially experience. When you
see the names on the Vietnam Veterans memorial and you
walk and you see the list of names as a volume,
it's hard to ignore. Um. It shows that sense of
(37:44):
the infinite. But then you have to move past that
and create a link to find that individual name in
the Vietna Veterans memorials very influential to us because that
idea of people coming and finding the name of their
loved one, their brother or their father, and rubbing a
piece of paper with a pencil and taking away that
(38:08):
name on a on a piece of paper and framing
that that kind of memento. That experience, I think is
really powerful one. You know, it's one where you're like
transcending just the legibility of the wall and you're touching it,
you're building it. Into your deep memory that experience. It's unforgettable,
and then you feel it. You feel the weight of
(38:30):
all of those markers above you as um um, the
kind of weight of history that we haven't fully uncovered.
You know that we don't fully know that weight of history.
You feel it in your body, and that to me
is where architecture is doing necessary things. You know, Um,
(38:51):
this is a very pull Farmer way of thinking about it.
But is the question of what can we not accomplish
without spatializing it? Yeah, memorialization is necessary because we need
to create a space or a location where we can
go and wrestle with pay tribute, understand, but also um,
(39:15):
create a unique memory in our own selves that we
witnessed this history. So where where are you going from here?
With all this? I returned often to this amazing quote
from you know Dr King and his letter from Birmingham Jail,
where he talks about the garment of destiny. Whatever affects
(39:35):
one affects all, that we're all tied in an inescapable
network of mutuality. I love that line. I think buildings
are the places where we experience that mutuality, that garment
that connects us all is found and forged in the
public realm and the public places that we have to
(39:56):
go and choose to go. And if it's the post
office or the hospital waiting room, or if it's the
school where we attend, those places transform us. And I
think periods before I think of the w p A,
I think about the New Deal, I think about these
moments where we understood that as a country, where we
(40:16):
invested not just in the infrastructure that was necessary to survive,
but that we invested a sense of dignity and artistry
and commitment to the beauty of it as essential as elemental.
And we've done it before. I think we can do
it again. I think we could really take that mantle.
(40:39):
We ourselves can enact change through our buildings and through
the world around us. I think those are the lessons
I hope to carry forward. Thank you, Michael Murphy, your
inspiration and mentor. Paul Farmer was very proud of you,
and I'm very grateful to you, and I can't wait
to see what you do next. And I urge all
(41:00):
of you who are interested in these things to look
up mass design on the internet and read about them,
and look at the architecture of health. This is very
important stuff. But as I hope Michael has persuaded you,
it's also a challenge to the modern world that is
(41:20):
accessible to us, one that we can make a den end,
often without spending enormous amounts of money, are bringing in
from somewhere else, staggering amounts of expertise. It's what they
have accomplished that mass design is largely a feat of
(41:42):
the imagination, possibility of wonder being made out of things
that are at hand and people that are handy. We're
all in your debt, and I wish you will thank you.
I thank you so much for this conversation, and thank
you for um the opportunity to speak with you today.
(42:03):
In the passing of our friend Michael, and I will
began to sound silly if we don't stop this. But
once you to watch in a lifetime you might meet
somebody like Paul Farmer, somebody so extraordinary and yet so real,
so commanding and yet so human and hilarious, uh that
(42:25):
it changes your life forever. And we're dealing with that
loss now. A man who was sixty two and should
have lived twenty years longer or thirty years longer, but
who did outlive his own father about thirteen years in
a family prone to heart disease. She was a social hero,
(42:50):
if you will, but he was a wonderful personal friend.
Thank you, Michael, Thank you, Mr President. Why am I
telling you? This is a production of My Heart Radio
the Clinton Foundation and at Will Medium. Our executive producers
are Craigmanascian and Will Malnadi. Our production team includes Jamison Katsufas,
(43:14):
Tom Galton, Sarah Horowitz, and Jake Young, with production support
from Liz Rafferee and Josh Farnham. Original music by What White.
Special thanks to John Sykes, John Davidson on hell Orina,
Corey Ganstley, Kevin thurm Oscar Flores, and all our dedicated
staff and partners at the Clinton Foundation. Hi, I'm back
(43:39):
a Courtsield and I'm a Deputy director at the Clinton
Global Initiative. President Clinton established the Clinton Global Initiative to
create a new kind of philanthropic community. To address the
complex realities of our modern world. We're problem solving required
the active partnership of government, business and civil society. Over
the years, are Proven model has grown to include action
networks that can quickly mobilize in the face of emergencies,
(44:02):
whether that's helping Puerto Rico and the Caribbean recover in
the wake of Hurricanes Rman and Maria, or advancing an
inclusive US Economic recovery amid COVID nineteen. To learn more
about this work and see how you can get involved,
visit Clinton Foundation dot org. Slash Podcast
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com