Prototype in afghanistan-Hospital Build Apr 2013

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  • 1. Courtyards between the inpatient bed units allow for light and ventilation and add a social and religious component to the plan. The geometry of each courtyard is oriented towards Mecca. Courtyards between the inpatient units provide views of nature from the beds. Gender segregated circulation pathways flow around the perimeter of the courtyard, offering patients dignity and privacy in accessing their care. Images © Cannon Design (unless where noted)A PROTOTYPE IN AFGHANISTANTHE STORY OF THE DEVELOPMENT AND CONSTRUCTION OF APROTOTYPE HEALTHCARE FACILITY TO HELP TRANSFORM CULTUREBy: Deborah A. Sheehan, Principal and Health Market Leader, Cannon Design, Chicago, USAW omen and children in many parts of the world are only to Sierra Leone as a result of measles, malaria, malnutrition and thwarted from leading productive lives due, not only, more. Access to quality healthcare for pregnant women and their to lack of education but also basic healthcare. The children before, during and after childbirth would eliminate most of design of a new prototype healthcare facility to serve these deaths and immensely improve the education and productivityas a template for the delivery of medical services in Afghanistan would picture for the Afghan society overall. Based on World Health data,meet that country’s dire need and help improve its social progress. Afghanistan was selected as one of four sites to be part of a project With a per capita income amongst the lowest of all developing by the International Organization for Migration and USAID (U.S.countries, Afghanistan is second to last on the United Nation’s human Agency for International Development) to create a template fordevelopment index, with a life expectancy of 43 years for women, and delivery of basic medical services. Public health services would provideone of the highest maternal mortality rates in the world, according to disconnected rural communities with a way to bridge the gap to moveUNICEF. The long war-torn country’s child mortality rate is second upward in cultural development. 034 HOSPITAL BUILD & INFRASTRUCTURE MAGAZINE ISSUE 1 2013
  • 2. FEATURE PLANNING 035SIMPLE, FLEXIBLE DESIGN health and education, with enough space to house a couple ofWhat would be the ideal building block to make this progress key specialities. In Afghanistan, the need for training midwives andpossible? Architects answered with plans for a simple, flexible, female caregivers is essential to lowering infant mortality rates.transferable community hospital that could demonstrate a Orthopaedic services are also in high demand due to land minepermanent commitment, yet be small enough to be placed in rural injuries. The 100-bed module provides enough space for basicvillages. The basic 100-bed model requires a minimal investment, medical-surgical services, as well as an emphasis on obstetrics andyet is capable of bringing a leap in the quality-of-life to thousands. orthopaedics. One of the flexible planning innovations proposedThe solution distinguishes itself in that it invites participation and is a six-bed unit that can be operated as a three-bed unit wheninvestment of the local people. The plan uses universal techniques staff levels permit. By dividing the units into gender specific wardsto adapt to the cultural and medical needs of the visitors. of 24, then into rooms of six, then into groups of three, there is The size for the hospital prototype is especially supportive tremendous adaptability of use over time of day, shift, or season.of sustainability. Because water, power and waste removal are Depending on evolving care delivery model, clinical service line, assumed unavailable, the hospital must be small enough to operateoff the grid, yet large enough to achieve an economy of scalein water and power production. Depending on the size, power Bed configurations can adapt to future change in patient acuity togeneration and sterile processing are either in the building or support elevated care at bedsidesupported by mobile resources. Several architectural featuressupport low energy consumption. Roof overhangs, for example,protect the south façade from direct sunlight during the hottestpart of the day. Air is brought in through low windows whileoperable clerestory and openings in the ceiling allow warm air toescape. Basic fans facilitate air movement. In the winter, a lower sunangle allows direct sunlight and heat gain deep into patient rooms.Baseboard units provide radiant heat, while fans bring in temperedfresh air and circulate it throughout the building. The plan’s flexibility emphasises changes in size, accordingto a community’s needs. Three smaller modules can be createdbased on the 100-bed prototype: a 50-bed women’s hospital,a 20-bed day hospital and a clinic. Because the modules areflexible and expandable, a hospital can be reconfigured as needs Flexible Nursing Models flex staff to patient census over time of daychange. By selecting the necessary module for a particular location,construction and operational costs are kept low. Modules can bebuilt with any common material, including walls of brick, adobe,concrete or sandbags. Construction of the modules requires thatutilities be secured and protected on the site. Water is extractedfrom a well by deep boreholes and pumped through a treatmentfacility. A water tower provides a two-day reserve in case of powerfailure. Fuel tanks for the generator are sized for a three-monthreserve. Wastewater generated from food production is collectedand treated in separate tanks, as required by Islamic law. The tanksthen discharge into a sand filter bed.ADAPTED TO SPECIALITIESA key difference between this and other solutions typicallyimplemented on a semi permanent basis is the clinical model. Thisprototype can provide all the basic services needed for community Illustration shows financial investment in ratio comparison to healthcare efficacy measured by mortality rate. Reprinted with permission © World Bank Group IN SHORT   he design of a new prototype healthcare facility to serve as T a template for the delivery of medical services in Afghanistan would meet the country’s dire need and help improve its social progress   ortality, education and productivity could all be improved M in Afghanistan by providing a new system for the delivery of basic medical services   he size for the hospital prototype is especially supportive of T sustainability because water, power and waste removal are assumed unavailable www.lifesciencesmagazines.com
  • 3. 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
  • 4. 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