It was 1985 when an Aboriginal man called Yami Lester, desperate for a solution to his community’s healthcare crisis, gathered three whitefellas together in a room in Central Australia and implored them to help him achieve his goal: to “stop people getting sick”.
As Director of the Nganampa Health Council, Yami had run a health service employing doctors, nurses and Aboriginal health workers for many years in his own community, but had not seen any improvement in the overall health of his people.
The men Yami assembled (a doctor, an environmental health officer and an architect, Paul Pholeros) agreed to the challenge.
The outcome was Healthabitat, an organisation still run by Pholeros, Stephan Rainow and Dr Paul Torzillo. In the last 30 years, they have gone into communities throughout the world – over 200 in Australia, as well as Nepal, Brooklyn, New York, Johannesburg, New Guinea and Bangladesh – to improve the health of poor people by improving their habitat.
But Pholeros insists the real revolutionary here is Yami, who had the foresight to bring the three men together in the first place, and the ability to articulate the problem so clearly. Thirty years on, those four words – stop people getting sick –remain at the core of the Healthabitat mission.
“It was a profound brief,” Pholeros marvels, “and it didn’t come from a university, a government policy or a think tank. It came from someone who had a need and who knew their own community. He saw his people getting crook all the time and realised that we could reduce the number of visits to his clinic by 80 per cent by improving their living environment. “Your job,” – he said to the three of us – “is to work out how”.”
Healthabitat is in the business of helping people, but it has a very different approach to traditional aid organisations. They listen to what communities need, whether it’s skills or knowledge, and work with them to integrate these sustainably, so that they can become more self-sufficient and live with dignity.
“Our relationships are long-term and they build up slowly,” Pholeros explains. “We build two toilets and let them sit for six months, a year, before we do any more. In actual fact, we don’t build the toilets,” he corrects himself, “the community builds the toilets. Each family has to put in cash, in kind. We have a complex set of negotiations around that.”
This approach makes Healthabitat extremely effective and respected within the communities they work with. “It’s almost the exact opposite of the top down ‘we will give you this’ approach,” he says.
Pholeros believes communities are ecologies, as complex as the problems they come together to solve. “To wash a child seems like a really simple goal, but it involves finding water, getting water out of the ground, transporting it long distances, storing it, getting it to each individual kid and making sure that it’s used and disposed of responsibly. So what starts out being a simple aim, to wash a child, ends up being a complex problem.”
He also believes that diverse skills and knowledge, and complete equality between all members of the community, is vital. To continue the child washing analogy, which is a common goal in Healthabitat’s work, “If you’re trying to wash a kid, the bore mechanic or the plumber is every bit as important as the doctor. Hierarchy is often destructive because it somehow rates one part of the puzzle as more important.”
Traditional aid methodologies can be too obtuse to be of any real help. “Often it’s a case of go in, talk to people, have meetings, produce a report. All of which can be done in good faith, but it might take a month, two months, three months,” Pholeros says.
By contrast, Healthabitat always makes some small improvement on the first day of any project, whether it’s fixing a couple of taps or adding a few electrical sockets. For him, action is far more important than paying lip service. “True respect is about the way you work and behave, not just saying the right words,” he asserts.
Pholeros sees his work with Healthabitat as a kind of gift. “I’ve worked with some of the smartest people on the planet. Definitely the best professionals, but also with some of the most extraordinary people in the communities, whose names you’ll never know.”
But it’s also a personal challenge. “Architecture, like medicine, has a huge amount to offer, but it all comes down to how you use it. Architects can be like an ashtray on a motorbike, doing nothing for society except consuming large amounts of money. Or, you can take the skills that are inherent in architecture and apply them to real-world problems.”
Gathering with others to benefit the wider community is the essence of Healthabitat and its goals and outcomes leave little room for ego. “My biggest learning curve was when I worked my backside off and did what I thought was really good work and then the medics went in to test the infection rate of kids, and it hadn’t changed. They came back and said, ‘You have to start again. It isn’t good enough.’ If the infection rates are high, you simply aren’t doing your job properly. It’s a real measure – it means fewer kids contract preventable illnesses which could cripple them for the rest of their life.”
A large focus of Healthabitat is children under five years of age, because this is where they can make the most difference. Unhealthy living conditions during this period can result in a 30 per cent reduction in hearing, 30 per cent reduction in lung capacity and diminished eyesight.