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Following the completion of the surgical facility, the campus (top of page) grew to include seven structures in total. The first and largest addition is the patients’ ward (1 & 2). Photos © Russell Pictures Entertainment (1), Will Boase (2), click to enlarge.

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The village of Kyabirwa was once famous for the rapids found there—this stretch of the river is known as the White Nile for the clay sediment it carries, but the name could just as easily have described the choppy waters. After visiting Kyabirwa on a kayaking expedition, Dr. Jessie Stone built a clinic in 2003, and the village soon became a hub for medical treatment in the region—and thus GSI’s location of choice. In 2012, a hydroelectric dam, paid for by the Aga Khan Fund for Economic Development, tamed the waters. But the power generated there is almost entirely sold off to neighboring Kenya, necessitating the surgical center’s off-grid approach.

After building the solar-powered facility a few hundred feet from the clinic, GSI quickly realized the campus needed a ward for overnight patients, and it engaged GKG on the design in 2020. Running parallel to the operating facility, and connected to it through a short passageway, the 11,800-square-foot ward also houses a pathology lab, genomics bank, surgical-simulation center for training, administrative offices, and an open-air cafeteria, all under a corrugated-steel secondary roof, elevated above the building for airflow. This canopy mitigates the intense equatorial solar-heat gain, and its rippling form recalls the rapids. The undulating roof channels rainwater into tanks and underground cisterns totaling 42,000 gallons. This collected water is processed through reverse-osmosis and ultraviolet filtration systems and is then used throughout the campus, which has no other source of water. The varied trusses that form the canopy were fabricated in a nearby shop, with the purlins between them and the metal sheets above bent on-site. “The local builders are very good with steel,” explains George. “They’re willing to weld together simple shapes to make any form you like.” The concrete-block exterior walls are clad in scalloped clay tiles, custom-made by a local potter hired by the contractor.

The ward includes an open-air cafeteria, screened by mahogany slats. Photo © Will Boase

The next major addition was housing for doctors and trainees. Starting in 2022, GKG designed a two-story building shaped like an extruded lozenge, with six bedrooms and a double-height lounge. The roof and three of the exterior walls are of the same corrugated-steel sheets common in the region, but the primary facade is a screen of staggered wood slats layered behind a run of Y-shaped steel columns. The slats, which can rotate to allow for greater airflow and visibility, are made of teak, a precious hardwood that, along with mahogany, is cultivated in Uganda. The ceiling of the common room is clad in tessellated panels made of woven reeds pulled directly from the Nile—again, crafted by local artisans. Like the other buildings, the roof is designed to collect rainwater for reuse on-site.

Like the doctors’ quarters, each pavilion explores local materials. Photo © Will Boase

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Rotating teak planks form the facade of the doctors’ quarters, and woven-reed panels line its ceilings (3 & 4). Photos © Will Boase

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The formal inventiveness found on the Kyabirwa campus is striking compared to medical facilities in the United States, which are often standardized and sterile. GKG achieved this not by cutting corners—it followed Facility Guidelines Institute recommendations—but through close collaboration with the contractor, Selemani Construction, which took an active role in advising what was and was not possible in such a challenging context. “We as architects tend to beat up on ourselves when we have to compromise, but making compromises helped push the design even further,” explains George. Given the remoteness of the site, construction management was limited to weekly Zoom calls. “If you are willing to give up some control, maybe you can get something even better.”

Developed piecemeal as its needs became apparent, the campus now serves as a model for future centers. GSI is working with GKG on its second location, planned for Chiredzi, Zimbabwe. The team is taking lessons from the Kyabirwa Surgical Center, learning not only what a remote self-sufficient facility needs but also how to build it.

Images courtesy GKG