Lessons from Nicaragua

DENNIS KOWAL ARCHITECTS designed this new health care facility in the village of asaya, Nicaragua outside of the capital city of Managua using strategies for resilient design. This approach allows the facility to function without electricity while relying on natural building systems.

DENNIS KOWAL ARCHITECTS designed this new health care facility in the village of asaya, Nicaragua outside of the capital city of Managua using strategies for resilient design. This approach allows the facility to function without electricity while relying on natural building systems.

Designing a new healthcare facility in Nicaragua is much different than in the United States.  But the US can learn lessons from a third world country where electric is spotty, contamination is likely, and water is untreated. When a disaster like Superstorm Sandy strands eleven States without power, many US healthcare facilities like the NYU Medical Center were crippled and couldn’t function. However, Dennis Kowal Architects (DKA) applied the principals of “resilient” architecture to their healthcare facility design in Managua, Nicaragua.  Since power failures are common, DKA designed the facility to use natural ventilation and natural lighting. To reduce the risk of cross-contamination, another very common occurrence, DKA created outdoor waiting rooms open to the air but covered from the sun thus reducing the chance of contact and airborne contamination. The interior walls have an application of plaster that naturally contains calcium hydroxide, a mineral that resists the growth of bacteria while providing a durable and easy to clean surface. Kowal explained: “in essence, the facility takes care of itself, especially during a natural disaster”.

Vida Maysay Perspective-3.jpg

High  window openings in the exam rooms ensure privacy yet allow light and air to naturally circulate. A large covered, but open,  atrium at the center of the complex creates a natural ventilation stack for all of the surrounding rooms. The atrium brings light and air into the rooms that ring the courtyard and simultaneously creates an outdoor waiting room.  A landscaped courtyard surrounds the facility to allow the families a place to play while a family member is receiving treatment; at night the same wall provides security.


Some of the children that have been treated by the doctors of Caring Partners International using temporary facilities,  pose for the camera. Others may walk all night (as did this woman assisted by her grand-daughter) to get to a care center. Existing conditions can be dirty, dusty and contaminated by animal waste and garbage dumps. Ubiquitous volcanic ash often covers the village in dust (see photo of girl in dress). The new medical facility provides a clean, healthy, and resilient environment as well as a model of sanitation for the villagers to follow.

Planning the healthcare facility on-site in Nicaragua is only the first step in a master plan for a new village. Dennis Kowal Architects met with local doctors to select the site, visited with the mayor to solidify support and caucused with nurses and staff to design the facility. Local Architectural student, Maria, helped with translation of the complex medical and architectural terms.   Since the site is near an active volcano, resistance to earthquake forces factors into all of the reinforced concrete construction in the area.


DKA worked with local architects to assess the building materials, climate, and standards of construction.  A low impact design was desired that could operate during a disaster. Above, Maria (a student of architecture) was also a translator for Dennis Kowal Architects as they interviewed the doctors and patients to design a facility that would meet their needs but also provide a resilient design. 

While many developed countries are still reeling from the many natural disasters that have occurred, lessons can be learned from our third world neighbors who daily face a world without power, public transportation, or central air conditioning.  Beyond sustainable design which minimizes the impact on the environment, DKA understands the simple principals of natural systems that can adapt and survive during periods of stress, loss and disaster.

“Dennis Kowal Architects designs buildings that are resilient
can take care of themselves in a disaster.”

Hospital or Hotel?

“Can you make it feel like we are in a spa and less a hospital?” was the request of staff in the renovations of the Transitional Care Unit. Pivotal to the elevator arrival and central to the floor plan, the nurses’ station would set the tone for the entire floor. A “peaceful” solution included a transition from a lot of little elements to larger and less elements. For example, walls which had been covered in numerous decorations and notices, were quieted with large pieces of art which harmonized with the new color scheme. The heavy crash rails at the front of the nurses’ desk were replaced with scratch resistant panels embedded with real leaves and calming colors. The existing soffit was highlighted with tangerine coloring and new art glass lights to create a focal point away from the harsher “hospital lighting” and the old telephone booths were converted to a media center and brochure rack to remove the barriers of displays and hand-outs that once lined the desk.


The BEFORE photos show the wear and tear this nurses station received. The completed project provides durable materials that are easy to clean and maintain.

The color scheme and new brown linoleum flooring resulted from matching the wood tones in the patient room floors which were required to remain. To encourage patients to walk as part of their therapy,  a brochure was devised that describes the new wall art. Patients are asked to match a list of artwork titles to the piece it best describes. The entire floor needed to be renovated in 90 days, and the key to the renovation was not changing a lot of the structure including the pre-wired nurses’ desk walls. New quartz counter tops, furniture and finishes made a quick transition easy, reduced waste, minimized dust and eliminated noise and shuffling additional parts through the hospital. 

To further calm the space, every other 2’ x 2’ corridor light was replaced with a pendant fixture wrapped in an art metal design of branches to relate to the trees in the wall art. These fixtures were put on a second circuit to allow staff to reduce the ambient lighting when possible.   When the newly renovated floor was opened three months later, the staff could not believe the transition and how “serene and relaxed” it now felt.


DENNIS KOWAL ARCHITECTS is changing the face of Health Care.