When Michael Shirley and Steve Kopp, designers in our Houston office, were approached by Texas Children’s Hospital to help improve cancer care for children in sub-Saharan Africa, they didn’t have to mull it over.

Global HOPE (Hematology-Oncology Pediatric Excellence), they learned, is an initiative between three institutions – Texas Children’s Cancer and Hematology Centers; Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital (BIPAI); and Bristol-Meyers Squibb Foundation – focused on building long-term care facilities. They also educate healthcare staff to improve the odds of thousands of children with cancer, 90 percent of whom currently die from the disease each year. The ask? To design care centers that are economical to build, self-sufficient to operate and maintain, and flexible enough to address the difficult site conditions and contexts of the region.

It’s a special cause, that’s for sure,” said Michael. “When they asked for help, we got really excited about it.

Prognoses are so poor in Africa because cancer isn’t typically diagnosed until it’s too late and treatment is difficult to access. Families sometimes have to travel for weeks to get to the closest cancer care center.

“Steve and I took a two-week trip to Africa to meet with health officials in three countries,” said Michael. “It was an eye-opener. We saw families camped out on a floor of a ward where there were only eight beds, open windows and stifling tropical air. You have to ask yourself: How do these folks ever get healed?”

After realizing the limitations on the ground – unreliable electricity, lengthy and unpredictable construction timelines, limited access to materials, poor city infrastructure, Michael and Steve got to work. “We had to get creative,” said Steve. “Finding the right mix between something they can maintain and something that will meet expectations was a challenge.”

Based on past Texas Children’s projects in Africa, hospital administrators knew it was hard to manage the quality of construction. “We knew upfront that offsite prefab construction was the way to go. That, and speed, were our guiding principles,” said Michael. “What we came up with is rather complicated and insular – a large building made out of shipping containers with cooling capabilities and lots of sunlight and fresh air.”

Exterior design concept

Robust generators, window cooling units, rainwater harvest and stormwater control were all integral to the success of the design, but high importance was also placed on cultural preferences. “We discovered that people in Africa want to be outside,” says Michael. “They live outdoors and want connection with nature and daylight, so we made sure that there are operable windows and the ability to open the building up to prevailing winds. This really helps formulate a sense of place.”

With construction of the prototypes, Texas Children’s will be able to send additional physicians to the region to educate in-country doctors and nurses.

“The first step is to build these temporary facilities and the long-term goal is to build inpatient pediatric cancer hospitals,” said Steve. “Texas Children’s has been sending one physician over at a time, but the goal now is to be able to send rotations through these countries to train even more professionals.”

Interior design concept

Michael and Steve hope to continue working with the team at Texas Children’s to also design the permanent care facilities. “I think it’s incredible that we’re able to offer the children in this country medical care,” said Michael. “The effect that this will have is critical. It feels like we are doing something that will really make a difference.”

“This is a great opportunity to provide care in that setting,” said Steve. “This is going to change the state of care in Africa and have a huge trickle-down effect to other areas of care beyond cancer. We’re honored to play a role.”