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staff resources, and cultural preference, the units can be managed and women can reach inpatient services along separate routes.in many configurations without renovation. Because of their A main courtyard creates a secure public space for visiting familyadaptability, these health centres also function as social centres members, between wings and oriented towards Mecca. 50-bedfor education, security and employment, positively impacting the women’s hospitals target prenatal care to blunt Afghanistan’scommunity as a whole. momentum of high infant mortality. By designating the entire facility for women, cultural boundaries in education and access areTHE PROTOTYPES removed. Education facilities in the hospital can be expanded toThe 100-bed hospital includes bedded care, outpatient clinic, train speciality caregivers, increasing the employment of women indiagnostic and treatment, emergency department surgery, x-ray, the community.dental, support space, education and administration, and an The 20-bed day hospital, also supported by mobile surgery, canambulance port. The 15-metre clear span, single story, single slope rotate as an outpatient day hospital or overnight inpatient care.roof accommodates many types of space. The hospital can provide Inpatient exam rooms can receive day visitors, and then be quicklyall the basic services needed for community health and education, converted to overnight recovery as needed for the last surgeryas well as allow enough space to house key specialities. An cases of the day. Classroom space can double for public healthemphasis on obstetrics and orthopaedics can be accommodated, screenings and inoculations. This smaller hospital can grow to thealong with basic medical-surgical services. Flexible bed units allow 50-bed and 100-bed size by building shell treatment spaces andthat a six-bed unit can be operated as a three-bed unit when staff using the space for interim support, reserving places for expandedlevels permit. Gender-specific wards of 24 are possible and can be bedded care, reusing public health spaces for new healthcarefurther divided into rooms of six or three, for many configurations worker programmes, and leveraging staff and resources acrosswithout renovation. long distances with mobile modality trailers and trucks. As the The 50-bed hospital, supported by mobile surgery, number of highly trained personnel increase for inpatient services,accommodates the separation of the sexes, an important cultural so will the need to recruit and train staff from the immediateconsideration, and multi-patient wards. From the main entry, men community. On-site housing that was built to house construction A strong connection to place makes these permanent, scalable hospitals a part of the communities in which they are built. Universally understood building-organising principalslike courtyards are combined with local influences in colour and materials. Knowing that mechanical ventilation would not be maintained or was unavailable, the naturallyventilated architecture responds to both summer and winter conditions 036 HOSPITAL BUILD & INFRASTRUCTURE MAGAZINE ISSUE 1 2013
workers can be converted to a dedicated dormitory. Combined their resources across much larger areas, and react to catastrophe.with the 20-bed hospital’s education and administration spaces, a They also allow outside organisations an opportunity to contributecomplete school of nursing is possible for the community, further with a proprietary platform and controllable logistics. This means thatcontributing to productivity. imaging equipment companies, for example, could access markets that The no-bed clinic is the prototype’s most basic building block. This are not currently available. Services that are highly technical, such asmodule is adaptable to support major care surges during catastrophic cardiac cath, can be brought to many new patients. Services that areevents. Primary and routine surgery care is conducted during normal too specialised for wide use, such as lithotripsy and cataract surgery,periods, with a triage centre during mass casualty. Divided into high can be brought to rural areas. The hub clinic provides an interface forand low acuity, the building is further divided into public and support the local and international community to interact, via technology andfunctions. Every side of the building specialises in a group of functions, expertise. In Afghanistan, it is the beginning of new expectations forbased on access and privacy. The plan creates a hub for future both the patient and the care industry. Higher expectations are thatexpansion or addition of mobile units. The ‘hub’ clinic serves as the suffering is no longer acceptable and that medicine is not just availabledocking platform for mobile medical units, which can carry medical for those in urban centres or for only the wealthy who can travel toresources throughout large remote areas, reaching people without access healthcare.access to healthcare of any kind. CONCLUSIONTHE HUB CLINIC Mortality, education and productivity, all of these can improve inAs an outpost in a developing nation’s health network, the hub clinic Afghanistan by providing a new system for delivery of basic medicalis the ideal docking platform for mobile medical units. These units may services. A flexible, transferable hospital plan makes a commitment toreside at other facilities, or in storage, but would be installed here to communities that urgently need not only healthcare, but also learning,respond to a temporary or overwhelming need. The mobile units can jobs and a better way of living. Women and children will be the mostalso serve as an interim step prior to a permanent addition. These dramatic winners, and will be far better able to contribute to themobile units provide developing governments the ability to leverage positive transformation of their ravaged nation.The main courtyard is situated just east of the main public entrance and provides a central gathering space for communal events. This courtyard creates a secure, public spacefor worship and education events. This central feature also orients visitors to the campus’ key services 038 HOSPITAL BUILD & INFRASTRUCTURE MAGAZINE ISSUE 1 2013