In 2012 I began working with Global Health Initiatives on a small project in rural Rwanda. Although the focus of their work is orthopedic surgery, this particular facility was in desperate need of attention. We launched a new design and construction division to start working on the hospital complex. The first project involved an abandoned isolation ward, built in the 1930’s, centrally located which held promise of rehabilitation as a new pediatric ward. I quickly discovered my roles were to encompass those of structural engineer, architect, landscape and interior designer. Available for construction were only local materials, labor force, means and methods. Although it took 3 years, the pediatric ward was completed in June of 2015. We then begin the programming and design for a new surgery center built in the location of another centrally located structure, of which only the foundation remains. Construction is slated to begin in January of 2018. The benefits of this work goes well beyond facility improvements. The impacts on local people, an adjacent orphanage and its children from the genocide, as well as community and economic benefits have resulted in an experience of a lifetime.