AIF Blog

Health by Design

Jun 21, 2014

John Cary Blog

We rushed into a nondescript building, seeking shelter from the relentless deluge of Malawi’s rainy season. A roomful of women stared back at us—19 on that day, but the number had been known to double. At nine months pregnant, these brave women had walked hours from their villages in order to be closer to critical care, should they need it during labor. In this case, that care was a low-tech clinic, just a stone’s throw away from this brick box, with little more than a dozen straw mats on the cold dirt floor. With only a few remaining panes of glass in the window frames, paint peeling from the plaster walls, and no electricity, this abandoned building had been repurposed as a refuge for expectant mothers.

It was a year ago that Aspen Global Health & Development invited my partner and me—a journalist and a designer, respectively—to travel to Malawi as part of a delegation focused on maternal health and safe motherhood. Joyce Banda, the president of this small country in East Africa, was a member of Aspen’s Global Leaders Council on Reproductive Health, and had made improving the country’s maternal health rates a top priority of her administration. A centerpiece of the initiative was a commitment to build 150 maternal waiting homes to replace the crowded brick boxes like the one we observed.

At the time of our visit, 1 in 36 women died during or as a result of childbirth in Malawi—the second-worst rate in the world, second only to Sierra Leone. In the U.S., for the sake of comparison, the rate is 1 in 2,400.
At face value, maternal health and design would seem to have little to do with one another. Even after flying around the world, the connection still wasn’t clear to me, until I stepped into that building, located in Malawi’s Dowa District. I was familiar with low-cost, life-saving health devices, such as the Embrace infant warmer, which is an alternative to difficult-to-maintain incubators. I was also familiar with a groundbreaking partnership between nonprofit architecture firm MASS Design Group and Paul Farmer’s Partners in Health, improbably resulting in a state-of-the-art hospital in rural Rwanda.

But Malawi’s challenges very clearly transcended a single product or building. The cultural challenges and implications—for mothers, their families, traditional birth attendants, and countless others—required a systems approach, coupled with infrastructure, like the waiting homes. Such an approach, centered around the needs of expecting mothers, is where design has a huge role to play.

Design dignifies. Whether a light-filled building that does more than provide shelter, a life-saving product where traditional health devices have failed or never even reached, or access to health services in those “last mile” settings, the thoughtful design of each reflects back to people that they have worth. And, of course, it saves lives.  
It’s in this spirit that the new “Spotlight: Health” program of the Aspen Ideas Festival has identified design as one of four tracks. Speakers will teleport us to the front lines of global health, in places like Africa and rural India, but the track will also pose tough questions about the design of our U.S. healthcare system. A candid, solutions-oriented discussion about how we’ve designed—and can better design—the healthcare experience for people around the world is long overdue.

John Cary is the author of The Power of Pro Bono and founding editor of He was a 2007 Aspen Ideas Scholar and will be a speaker at the Festival’s Spotlight: Health, June 24-27, 2014.

NOTE: This was originally posted Jan. 29, 2014

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