Cholera Treatment Center in Haiti

July 9, 2012 / no comments

Recently we were asked by MASS Design Group to do a daylighting study for their new Cholera Treatment Center (CTC) in Port-au-Prince Haiti. This is the second time that we have had the opportunity to work with them. Since the earthquake on January 12, 2010, Haiti has suffered enormous economic, structural and environmental distress. Cholera, which previously did not exist in Haiti, broke out shortly after the earthquake and according to the World Health Organization, as of November 30, 2011, there were 515,699 reported cases of cholera and 6,942 deaths.i The new CTC will be a year-round center for the care and treatment of patients suffering from the illness. This project presents an unusual opportunity to engage lighting on such fundamental levels, and to think about basic human needs as they relate to light. It’s even more unusual to be facing these issues in a country like Haiti. As designers in the United States, our typical projects include commercial, residential and institutional projects in major developed cities. While many basic principles of good lighting remain universal, working on a project like this exposes us to significant cultural, financial and climatic differences.

What we learned

MASS Design Group is a non-profit architecture and design firm dedicated to helping improve the health and overall well-being of communities through design. Their most well-known and highly-praised projects include the Butaro Hospital and the Girubuntu School, both in Rwanda.

During our design conversations, members of the MASS team shared with us examples of the kinds of design and technology challenges that they have encountered in their work. One team member, Elizabeth Timme, shared a few experiences from Butaro Hospital. The hospital is tailored for the treatment of tuberculosis, so enormous fans are suspended from the ceiling and UV lights shine from the walls. The fans keep air moving (a critical element in tuberculosis treatment), and the UV lights kill airborne bacteria. Patients however, worried that the fans were “stealing their air” and that the lights were “burning their skin”. To some extent both comments are true, but negotiating the relationship between the function of the space and the occupant use and comfort highlights a fundamental mission of design.

For decades Western hospitals were built to enhance efficiency and hygiene, and only recently has there been more evidence that daylight, views and good design are equally critical factors to providing the best health care. In fact, Timme is now starting her own firm, Más, in order to bring a similar design approach as used at MASS to the issues facing the American health care system.

MASS has encountered other issues that have to do with climate and resources. In one case, they told us that in Rwanda, surface brightness was a serious design consideration. The sun at that latitude can cause surfaces to be so bright that they create visual discomfort. An article by Martin Schwartz about Louis Kahn’s proposal for a U.S. Consulate in Luanda illustrates this issue. In it Schwartz quotes Kahn:

“I …noticed that when people worked in the sun-and many of them did-the native population …usually faced the wall and not the open country or the open street. Indoors, they would turn their chair toward the wall and do whatever they were doing by getting the light indirectly from the wall.” ii

Not only do these types of realizations help us to understand better how to work in under-served countries, but they help to inform our approach to design for our typical projects. Working on a cholera treatment center can help us to recognize and consider factors in our day-to-day work that we may not have previously considered to be important or necessary.

What we did

The center is 7,700 square feet and consists of a general ward, an intensive care ward, as well as an administration office. The roof consists of 15 roof modules, each 23′ x 23′ oriented in different directions. Four central modules serve as the top of a cistern designed to collect water, while the remaining 11 are pitched, both to allow for light and ventilation as well as to direct water towards the cisterns. The building is primarily open on all sides, although there are fixed screens on the North and East sides and sliding screens hung on the West side.

Since construction had already begun when we joined the team, the project manager, David Saladik, emphasized that we needed to quickly and efficiently produce a series of clear and useful daylighting studies. There was no possibility for bells or whistles. We had to make simple and effective recommendations that could be executed within the time and resources available. It was important to set our criteria immediately, and use tools that would help us achieve our goals. For all of the simulations we used the daylighting program DIVA-for-Rhino.

Our analysis focused on three key issues: sufficient light levels, glare, and heat gain. To test for adequate light levels, we ran a daylight autonomy test using a horizontal calculation grid at the height of the beds, and vertical grids at the headboards. We used a threshold of 500 lux because light levels need to be relatively high, since nurses and doctors will be conducting procedures and treating patients at their bedside. We were pleased to see that the daylight autonomy results for the existing design showed that we can expect 500 lux over the majority of the ward space for 50% of the year.

1_Blog CTC DA 500 plan.jpg

Daylight Autonomy calculation (500 lux threshold)

Having established a general sense for annual daylight levels, we wanted to look more closely at the lighting conditions during specific points in time when we could estimate there might be problems. The East side is most vulnerable to overlighting and heat gain because there are no structures directly to the East of the center. We wanted to test a variety of material options for a proposed set of panels, which would serve as shading. We chose three materials to test: opaque panel with 50% reflectance, a translucent panel with 40% transmission, and 40% open screen.

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Evalglare Glare Analysis

Summer Solstice 9am Glare Analysis 40% Open Screen (top right)

Winter Solstice 9am Glare Analysis of (3) different panel options (bottom)

Our results show that only the opaque panels will have a significant effect on minimizing the overlighting on the East-side ward. The translucent and 40% open screen still allow a significant amount of light and, by extension, heat into the building. In addition, when we ran the glare tests for the three material options, the 40% open screen performs the worst in terms of glare for the patients in East-facing beds. This only gets worse during the rest of the year when the sun is lower in the sky; on the Winter Solstice at 9am, the Evalglare Daylight Glare. iii Probability result showed there would be intolerable glare . Since the preferred solution is to use the screens, we recommended modifying the open percentage of the screen to be less than 40%.

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Glare experienced from hospital bed on Summer Solstice at Noon (bottom left)

Roof module and assembly (bottom right)

Cholera outbreaks in Haiti are the most frequent during the rainy season, which happens in the summer. Knowing that, we were particularly interested in the summer conditions since those are the times the wards will likely be most full. In particular, we looked for problems with glare and overlighting. The orientation of the roof modules on the East side allowed, rather than prevented, direct early morning and noontime sun to stream into the building. We confirmed this by running several glare simulations, and made the recommendation that two of the roof modules be rotated 90 degrees in either direction to eliminate the problem.

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Illuminance Calculations Summer Solstice 12pm

Existing Glazing Design (left). Glazing replaced with 80% Opaque Panels (right)

The last issue we wanted to tackle was the glazed portions of the roof that would direct water into the cisterns. Those sections would be glazed in order to let light into the center of the building, and be directly above a small, planted garden. We ran several tests on the Summer Solstice, which showed that there would be dramatic overlighting, glare and potentially great heat gain. While we understood the design intent to create a small lush area in the middle of the ward, we suggested some simple louvers to mitigate the quantities of incoming daylight.

While absent of high-technology or complicated details, our solutions answered the key daylighting questions and will contribute to providing the patients and staff with the most functional and comfortable space possible. Even with the demanding constraints of a project like this, in the end, we’ve shown that with targeted thinking and the right tools, we can come to useful conclusions and make effective recommendations, which is definitely a lesson we can bring back to our everyday work.


i World Health Organization, “Health Cluster Bulletin: Cholera and Post-Earthquake Response in Haiti”, 21 December 2011.

ii Louis I. Kahn Writings, Lectures, Interviews, page 123, quoted by Martin Schwartz in “Louis I. Kahn: Finding Daylight in Luanda”, February 7, 2011.

iii Evalglare calculates glare according to several factors such as brightness and size of glare source, and gives a result called the Daylight Glare Probability, which was calibrated by user-assessments. The categories of glare perception from least severe to most are: Imperceptible, Perceptible, Disturbing and Intolerable. For more information see: Evalglare.

Image Credits: Kera Lagios/Lam Partners

Happy Winter Solstice

December 23, 2011 / no comments

Lam Partners

Yesterday was the winter solstice. It is a time that we often associate with Christmas, Yuletide, Hanukkah, or the Feast of Saint Lucia. Candles are lit, trees and rooftops are decorated with strings of light, parties are held, and gifts are exchanged. The lighting of lights to relieve the cold and dark of this time of year symbolizes hope and perseverance. It might be surprising, then, to learn some of the other ways that the longest night is celebrated throughout the world.

Lam Partners

The word “solstice” is derived from Latin words meaning “the standing still of the sun”. While the winter version is most commonly referred to as the shortest day of the year, it is actually a point of inflection which occurs at a specific time: this year it was December 22 at 5:30 UTC. The time refers to the precise moment when the northern hemisphere has reached its furthest distance from the sun before dramatically shifting directions.

Historically, celebrations surrounding the solstice are as much about this critical turning point as they are about darkness and light. Many, such as Goru among the Dogon people of Mali, mark the end of the harvest season and the beginning of winter.

Other traditions, however, reflect the transition by taking on a subversive form, where participants engage in activities that upend the standard order. Bacchanalian festivals in Ancient Rome and Greece such as Brumali or Saturnalia were times of casting off social restraints, of drinking and merriment, and of some other, more unusual, customs: slaves would enjoy a banquet served to them by their masters.

Lam Partners

Lam Partners

This reversal of order is achieved elsewhere by wearing disguises. In the Junkanoo festivals celebrated in the Carribbean, parades feature elaborate, symbolic costumes. The Cornish custom on Mummer’s Day is to march through town with blackened faces or masks. In several traditions, ghost stories are told, and spirits are said to haunt the living, as in the Scandinavian Feast of Saint Lucia, during which the demon Lussi is said to frighten children who have not been good.

Lam Partners

Lam Partners

Other cultures simply embrace the longest night by staying awake for its duration, such as the Persian festival Yalda, or Shab-e Chelleh, in which families gather together to feast on pomegranates and dried fruits, stay up all night, and listen to poetry. Celebrating throughout the night was also the custom of the Inca and of the Mapuche of Chile (though their rituals for the longest night of the year in the southern hemisphere took place on the opposite solstice in June). The observers would stay up several nights waiting for sunrise, celebrating the assurance that the sun would return.

The eventual triumph of light over darkness and the symbolism of renewal are some of the strongest themes prevalent in these celebrations. Sol Invictus from the Roman Empire translates as “the undefeated sun”. The Kurdish _ewy Yelda portrays the sun as being reborn after the solstice. In contrast, Dong Zhi in China celebrates the “arrival of winter” and the interrelationship between darkness and light as part of the yin and yang philosophy. Families gather, and a sweet soup made with pink and white rice dumplings is served.


While we often think of the winter solstice as simply the shortest period of daylight in the year, throughout history and the world, there is a richer picture. However you are celebrating, have a happy solstice.

Photo Credits: NASA Goddard Space Flight Center (1), Andrea Rota (2), Antoine-François Callet – Musée du Louvre (3), MissChatter (4), Fredrik Magnusson (5), Eliza Tasbihi (6), Oranje (7)