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