THE WHARE HAUORA O
              NGATI POROU




                               ©
                              2009
     ...
CRITICAL HEALTH PRAXIS
                         
The state of health of most of the people in the world is appalling. That...
NGATI POROU
                           
Ngati Porou are a tribal group of
North Island Maori who occupy the
remote East Co...
MAORI HEALTH STATISTICS
                             
 As their culture suffered under colonial
 assimilationist policies,...
EAST COAST HEALTH
                           
For most of the last 100 years, the
predominantly Maori population of the
Ea...
BUILDING NEGLECT
                        
With the inauguration of the District
Health Boards (DHBs), together
with     Bu...
CERVICAL CANCER CRISIS
                             
•   Since the bulk of the non Maori population served by Tairawhiti H...
A DEVELOPMENT PROPOSAL
                          
 That same year, the CEO of the Hauora, approached the School of
 Archit...
COMMUNICATIONS MEDIUM
                           
 The project commenced with a joint team of
 Architecture and Planning s...
MAINTENANCE AUDIT
                       
Simultaneously, two members of
the Architecture Faculty, Drs.
David Leifer and T...
DESIGN PROJECT
                         
Over the next two semesters, a total of 24
architecture students, three staff and...
BUILDING A BRIEF
                             
From all of this, a design brief slowly emerged. The Brief presumed a holii...
Te Whare Hauora o Ngati Porou
                            
 Comprehensive Development Plan 2001
 Community Design Studio, ...
EXISTING SITE PLAN
               

                                        Te Ao Marama
                                 ...
KAUPAPA
                          
  When Ngati Porou Hauora took possession of Te Puia Springs
  Hospital from Tairawhiti...
STATUS QUO 2000
             
Neglect, poor maintenance and planning
THE VISION
                      

To make Te Whare Hauora o Ngati Porou
a model of excellence in:
• Local Health Care
• R...
THE HOLISTIC HEALTH MODEL
                    
Health is a multi-faceted, interactive phenomenon
                         ...
AIMS
                        

• There is a need for the Whare Hauora to confront
  ALL facets of Health to better to addr...
OBJECTIVES
                       
Rehabilitate and expand the facilities and services to:
    • Model Good Health practic...
DESIGN DEVELOPMENT PROGRAMME
                        
   1. Assess Maintenance Issues
   2. Assess Seismic Issues
   3. As...
ECONOMIC SUSTAINABILITY
Develop economic self-sufficiency by:
                    
• Improved Accounting Practices
• Infras...
ECONOMIC HEALTH  EMPLOYMENT
   Promote job-creation opportunities through:
                           
   • New laundry se...
ENVIRONMENTAL SUSTAINABILITY
  Create a model of sustainability by
                     
    • A potable water system
    ...
HE AO MAORI
Develop the Whare Hauora as a truly Maori world by:
                    
   • Acknowledging Hikurangi Te Maung...
DESIGN ISSUES 1
                      
  • Confusing Entrance
                                                          St...
DESIGN ISSUES 2
                           
• Inaccessible Outpatient Clinic
• Lack of privacy for Mental Health
• Dilapid...
DESIGN ISSUES 3
                          
• Serious seismic damage
• Dilapidated Thermal Pool
• Small Physiotherapy space...
DESIGN ISSUES 4
                          
                                                Jumbled Buildings
 • No Library...
Existing Entrance

ENTRANCE DESIGN
                              
  • Prominently visible Entrance
  • Welcoming Entrance
...
ACCESSIBLE ADMINISTRATION
                              
 • One visible Receptionist for all enquiries
 • Administration c...
MEDICAL
                              
 • Residential Care expanded with:
                                                ...
THERMAL POOLS
                                                    
            • Public/ Private Spa
            • Differe...
WORKSHOP / LAUNDRY
                      
• Remove disused diesel tanks
• Reinstate Laundry
• Heat exchange boilers
• Gas ...
KITCHEN / STAFF ROOM
                       
 • Centralised Kitchen
 • Direct Access to Wards
                            ...
SUPPORT AREAS
                                
   • Whanau Room with:
                                                    ...
BASEMENT PLAN
                 



       Hikurangi                 Creche

                                      Public l...
GROUND FLOOR PLAN
                         

                                Whanau Room


                               ...
FIRST FLOOR PLAN
Administration above Entrance for Access and Privacy
                     




                         a...
ROOF PLAN
Integrating and Reconciling Existing Roof Forms
ATRIUM
                             


              Whanau Room
                                                 Whanau R...
PROPOSED OVERALL PLAN
                     

                                                                Reremoana
   ...
COMPREHENSIVE DEVELOPMENT PLAN
       In addition to the actual Hospital design, it was also important to
       develop p...
COMPREHENSIVE DEVELOPMENT
          PLAN            
 Clinical Services
     • New satellite health Clinics were opened at...
FINAL REPORT AND ANIMATION
                  

  Finally, the design was completed and a 250 page
     Comprehensive Desig...
Upcoming SlideShare
Loading in...5
×

Critical Health Praxis.2

1,363

Published on

The design and refurbishment by architecture students of a community hospital for a Maori health provider (Ngati Porous Hauora) in New Zealand

Published in: Health & Medicine, Technology
1 Comment
0 Likes
Statistics
Notes
  • all killer true health info points!! http://www.fithuman.net/
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

No Downloads
Views
Total Views
1,363
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
16
Comments
1
Likes
0
Embeds 0
No embeds

No notes for slide

Critical Health Praxis.2

  1. 1. THE WHARE HAUORA O NGATI POROU © 2009 Tony Ward To download this and other free PDFs visit: www.TonyWardEdu.com. THE COMMUNITY DESIGN STUDIO, UNIVERSITY OF AUCKLAND 2001
  2. 2. CRITICAL HEALTH PRAXIS The state of health of most of the people in the world is appalling. That of indigenous peoples is the most appalling of all. Statistically, those indigenous peoples living in previously colonised countries like the United States, Australia, New Zealand, , Canada, etc. have the worst incidences of unemployment, incarceration, alcohol and drug abuse, suicide, mental illness, diabetes, asthma, heart failure and so on. In New Zealand the picture is very much the same. 150 years of subordination and discrimination has left the Maori at the very bottom of the health statistics. No amount of increased revenue to the Health budget has succeeded in closing the disparity in health between Maori and non-Maori. In recent times, Maori have begun to claim the right to determine their own health treatments, and to control the budgets of the treatments they receive. This tino rangatiratanga of self-determination model has been adopted in Health, Education, and to some extent Justice systems. This is the story of one example of Maori self-determination in Health. It is the story of Ngati Porou Hauora, and their small regional hospital at Te Puia Springs on the East Coast of the North Island.
  3. 3. NGATI POROU Ngati Porou are a tribal group of North Island Maori who occupy the remote East Coast of New Zealand‘s North Island. They were the first native inhabitants of Aotearoa to encounter Captain James Cook in his voyage on the Endeavour on 8th October1769 at what is now Gisborne. Since that time, Maori have lost much of their productive capacity and been reduced to conditions of economic servitude by the increasingly predominant British culture. By the 1950s, the Maori language had all but disappeared, save in remote areas like the East Cape. Children were punished for speaking their native tongue at School and parents, fearful for their well- being, insisted on speaking English at home.
  4. 4. MAORI HEALTH STATISTICS As their culture suffered under colonial assimilationist policies, so also did their health. Increasingly, introduced European diseases took their toll upon the indigenous people, most significantly in the ‘flu epidemic of 1918. Maori also suffered enormously from the two world wars with some tribes - like Ngati Porou - losing a large proportion of the adult male population. Gradually, they, along with other Maori were absorbed into treatment under the State Health System. But it was a system that failed to heal or help them to a large degree. Maori life expectancy and infant mortality rates are both significantly worse than that of non-Maori (right). And although there has been an improvement in the health of Maori, the disparity continues.
  5. 5. EAST COAST HEALTH For most of the last 100 years, the predominantly Maori population of the East Coast has been served by two hospitals. The Gisborne Hospital and the small and remote Te Puia Springs Hospital. The latter served the scattered rural population of the East Coast, while Gisborne served mainly its own City residents - except for services that the smaller hospital could not deliver. It was a small, autonomous hospital, employing dozens of locals in its gardens, orchards, maintenance staff and laundry - as well as the numerous medical staff in its employ. Most of the people on the Coast were born there. Its one major resource is the natural thermal springs that initiated its existence.
  6. 6. BUILDING NEGLECT With the inauguration of the District Health Boards (DHBs), together with Bulk Funding regimes established in the 1980s - part of a Government move to increase efficiency, cut costs and duplication of services, Te Puia Springs Hospital was absorbed into the larger new Tairawhiti Health Board located in Gisborne, some two hours drive away. Thus began a gradual process of cutting services (laundry, elective surgery, maintenance etc.) to the satellite hospital. Deferred maintenance was not done, and gradually the state and condition of the physical plant and equipment declined.
  7. 7. CERVICAL CANCER CRISIS • Since the bulk of the non Maori population served by Tairawhiti Health Board (composed of mainly non-Maori members) lived in or close to Gisborne, it was the majority Maori population of the Coast that suffered most from the cuts. This issue came to a head in the 1990s. Between 1990 and 1996, Dr. Michael Bottrill the cytologist responsible for checking cervical smears for severe abnormalities, failed to detect 129 out of 157 such cases (68%) out of a total diagnosis of 22,000 slides. He was sued by one of his patients in 1994, It is not known how many of his patients were Måori women, but that same year, Ngati Porou formed a working party to wrest control of Coast health care from Tairawhiti Health. In 1997, Dr. Bottrill was found to be guilty of negligence by the Medical Practitioners Disciplinary Committee, and in 1999, the Government contracted Ngati Porou Haouora to be the primary Health provider to the East Coast, and transferred ownership of all Coast health assets (including the now- dilapidated Te Puia Springs Hospital) to the Hauora.
  8. 8. A DEVELOPMENT PROPOSAL That same year, the CEO of the Hauora, approached the School of Architecture at the University of Auckland seeking help in developing refurbishment proposals for Te Puia Springs Hospital. It was the Hauora’s aim to transform the seriously under-maintained institution into a model for Maori Health provision. Clearly, the State health system had not served Maori well, and the Hauora had decided that Maori Health could only be improved if it was administered by Maori, for Maori, in a manner consistent with Maori cultural beliefs and tikanga. This kaupapa fitted in directly with many of the previous projects carried out in the Community Design Studio in support of Maori sovereignty. An initial visit in the first week of the new millennium led to an agreement for the Community Design Studio to develop a design proposal for the Hospital, and in preparation of the study a survey of the site was carried out and a second visit was made in February
  9. 9. COMMUNICATIONS MEDIUM The project commenced with a joint team of Architecture and Planning students building a 3 dimensional model of the existing facility (bottom left) from on-site and aerial photographs. (top right). This allowed for a very direct medium of communication with both staff and members of the community about necessary changes to the existing buildings. A series of hui (meetings) were then organised in different locations throughout the Coast to consult with community groups about what needed to be done, using the model as a means of communication and demonstration. This had the advantage of circumventing professional jargon and made communication user-centred.
  10. 10. MAINTENANCE AUDIT Simultaneously, two members of the Architecture Faculty, Drs. David Leifer and Tony Ward completed a maintenance audit of the facility. This noted the sorry state to which the facilities had been allowed to deteriorate by Tairawhiti Health and made recommendations for a graduated maintenance programme to be carried out alongside any major changes to the physical plant. It was clear that significant upgrading was necessary for seismic and sustainability issues. The heavily corroded and neglected natural spa pool
  11. 11. DESIGN PROJECT Over the next two semesters, a total of 24 architecture students, three staff and one consultant worked with the Hauora and the community to develop design proposals for Te Puia Springs Hospital. They began by developing a design brief, consulting continuously with staff and community groups. From this a series of design proposals were formulated and presented at regular intervals to the Ngati Porou Hauora Board for their consideration. These proposals were supported by statistical and anecdotal data culled from the community meetings.
  12. 12. BUILDING A BRIEF From all of this, a design brief slowly emerged. The Brief presumed a holiistic model of health based upon prevention rather than cure, - the normative model of ill- health-treatment. This involved a consideration of the different issues that affected the health of individuals in the community: • cultural health • physical health • emotional health • spiritual health • intellectual health • economic health • social health • environmental health All of these were seen to be necessary components of the parameters driving the design. It was understood, for instance, that any design of the facilities must have as a main consideration the creation of employment opportunities for the Coast community. What follows is a synopsis of the major findings and design considerations produced by the students.
  13. 13. Te Whare Hauora o Ngati Porou Comprehensive Development Plan 2001 Community Design Studio, School of Architecture, University of Auckland With Ngati Porou Hauora Whanau Pool
  14. 14. EXISTING SITE PLAN Te Ao Marama Accommodation Reremoana accommodation Accommodation Doctors Admin y wa Wards ig h in h Main Entrance Ma Pool Tawhiti Staff Physio AE Radiology Workshops Mortuary
  15. 15. KAUPAPA When Ngati Porou Hauora took possession of Te Puia Springs Hospital from Tairawhiti Health Board, the facility was dilapidated and close unsustainable. It had suffered years of neglect and poor maintenance and offered services which did not adequately serve the health needs of the East Coast community. It suffered: • Structurally unsafe Buildings • Impossible maintenance needs • High running costs • Economic unsustainability • Environmental unsustainability • Poor water quality • Tikanga (cultural practices) difficulties • Staffing difficulties • Local Health Care difficulties • Regional health care difficulties There was a need to solve ALL these problems
  16. 16. STATUS QUO 2000 Neglect, poor maintenance and planning
  17. 17. THE VISION To make Te Whare Hauora o Ngati Porou a model of excellence in: • Local Health Care • Regional Health Care • Preventative Health Care • Holistic Health Care • Maori Health Care • Sustainability • Socially • Culturally • Environmentally • Economically
  18. 18. THE HOLISTIC HEALTH MODEL Health is a multi-faceted, interactive phenomenon Physical Economic Mental Environmental HEALTH Spiritual Cultural Intellectual Social
  19. 19. AIMS • There is a need for the Whare Hauora to confront ALL facets of Health to better to address : • cultural health • physical health • emotional health • spiritual health • intellectual health • economic health • social health • environmental health
  20. 20. OBJECTIVES Rehabilitate and expand the facilities and services to: • Model Good Health practices • Embody Tikanga Maori in design and practice • Improve in-patient care • Improve out-patient care • Develop as a Regional Administrative Hub • Improve and expand Regional Health Care • Expand to provide cradle to grave support • Improve and expand local and emergency services • Attract and retain premium staff • Create employment opportunities in community • Provide quality accommodation for staff and patients • Provide educational and training opportunities
  21. 21. DESIGN DEVELOPMENT PROGRAMME 1. Assess Maintenance Issues 2. Assess Seismic Issues 3. Assess Tikanga Issues 4. Assess Social Issues 5. Community Survey 6. Assess economic sustainability 7. Conduct an Environmental Audit 8. Assess natural resources 9. Assess market potentials 10. Long-term environmental strategy 11. Comprehensive Design Brief 12. Building Plans and Design Report 13. Te Whare Hauora - He Ao Maori 14. Phased Development Programme 15. Fundraise Phase1
  22. 22. ECONOMIC SUSTAINABILITY Develop economic self-sufficiency by: • Improved Accounting Practices • Infrastructure Economies • Centralised Administration • Outreach Clinics • Internalise Economy • Use Physical Resources • Maximise Natural Resources • Thermal water Pool • Natural gas • Solar heat • Horticulture / farmland • Use human resources • Use cultural resources • Training and Education
  23. 23. ECONOMIC HEALTH EMPLOYMENT Promote job-creation opportunities through: • New laundry service • Cleaning service • Construction and maintenance contracts • Residential construction programme • Vehicle fleet maintenance programme • Catering services • Nutrition training programmes • Organic horticulture market gardening • Landscaping design/build programme Pool • Rongoa nursery development • Cultural tourism ventures • Health tourism ventures • Community Education programmes • Trade Training programmes • Health Training Education programmes Initiate Possible Joint Ventures
  24. 24. ENVIRONMENTAL SUSTAINABILITY Create a model of sustainability by • A potable water system • Rehabilitating the Lagoon • Sustainable waste disposal • Passive solar heating • Building insulation • Natural gas for heating Pool • Commercial thermal spring • Native Planting • Organic produce planting • Rehabilitate fruit trees • Develop neglected areas first The Lagoon where treated effluent is discharged • Outdoor spaces to face North
  25. 25. HE AO MAORI Develop the Whare Hauora as a truly Maori world by: • Acknowledging Hikurangi Te Maunga • Expressing Tikanga Maori in design • Supporting Te Reo Maori in practice • Articulating Tapu/Noa in design • Developing Main Entrance / Waharoa • Incorporating a Marae Atea • Integrate whakairo and raranga • Native planting programme Pool • Rongoa nursery programme • Developing Kaumatua Housing • Developing connection of communities • Incorporating Kohanga Reo / Creche • Acknowledging Life Cycles • Incorporating Whanau Support Facilities • Developing Active And Passive Healing Heal the environment to heal the people
  26. 26. DESIGN ISSUES 1 • Confusing Entrance Staff Room • Inaccessible Receptionist • Accessible Administration • Confusing AE • Poor ambulance parking • Difficult manakitanga • Inadequate Kitchen / Staff Room Reception? Ambulance Parking Main Entrance
  27. 27. DESIGN ISSUES 2 • Inaccessible Outpatient Clinic • Lack of privacy for Mental Health • Dilapidated Mortuary Chapel • Mortuary/Workshop conflict Mortuary/Chapel • Small cluttered Workshops Mortuary/Chapel • Surplus disused equipment Pool Workshops Mortuary Workshops Outpatients/AE
  28. 28. DESIGN ISSUES 3 • Serious seismic damage • Dilapidated Thermal Pool • Small Physiotherapy space • Expensive off site Laundry Maternity wing • Small maternity unit • Poor staff accommodation • Poor long-term wards • Lack of storage Thermal Pool Reremoana Former Laundry Reremoana Long-term wards
  29. 29. DESIGN ISSUES 4 Jumbled Buildings • No Library Resource • No staff or patient childcare • No Whanau (family) facilities • Ad hoc/piecemeal development • Incoherent planning • Jumbled building shapes • High heating costs • Lack of outdoor North access • Poor mobile lab parking Ad hoc development • Neglected landscaping Lab parking at Entrance No outdoor access North Face
  30. 30. Existing Entrance ENTRANCE DESIGN • Prominently visible Entrance • Welcoming Entrance • Highly visible Reception • One Receptionist Pool New Main Entrance Out Patient Care
  31. 31. ACCESSIBLE ADMINISTRATION • One visible Receptionist for all enquiries • Administration centralised • Improved security • Private Administration (1st Floor above Entrance) • Good separation of public and private domains Entrance Pool Reception
  32. 32. MEDICAL • Residential Care expanded with: Residential • Improved accommodation • Good indoor/outdoor access • Accessible Accident and Emergency • Improved ambulance parking Outpatients • Expanded Maternity suite • Outpatients more accessible Outpatients • Separate Mental Health environment • Central whanau support facilities Men. Health Residential Residential Mobile Services Whanau Mental Health Rongoa Mirimiri Maternity Entrance AE Gymnasium Outpatiens Ambulances
  33. 33. THERMAL POOLS • Public/ Private Spa • Different Pool Experiences • Physiotherapy • Rongoa • Mirimiri Residential • Gymnasium • Refreshments • Views of Hikurangi Mirimiri Rongoa Pool Long Term Care HIKURANGI Residential Private Pool Maternity Kai Rongoa Office Mirimiri Public Rongoa Mirimiri Changing Rongoa Maternity Gymnasium Entrance Gynasium
  34. 34. WORKSHOP / LAUNDRY • Remove disused diesel tanks • Reinstate Laundry • Heat exchange boilers • Gas powered dryers • Redevelop Workshops • Install insulation • New and separate: Existing • Vehicle bays • Carpentry shop • Metalwork shop • Storage sheds • Fleet garaging • Relocate mortuary • Replace with memorial garden Proposed
  35. 35. KITCHEN / STAFF ROOM • Centralised Kitchen • Direct Access to Wards Central Atrium • Kitchen serves: • Staff Café • Residents • Separate Public • Private realm for Staff • Staff close to Creche • Staff Changing North facing atrium Basement Plan Staff Cafe
  36. 36. SUPPORT AREAS • Whanau Room with: Central Atrium Privacy Cooking bathing facilities Creche Public Café Views of Hikurangi Library Kitchen Library Whanau Pool Mental Health Creche below Mental Health Library Kitchen AE Whanau above Creche below Maternity
  37. 37. BASEMENT PLAN Hikurangi Creche Public lift atrium Staff cafe Service Lift kitchen Stair changing
  38. 38. GROUND FLOOR PLAN Whanau Room Library atrium Long Term Care Cafe Mental Health Reception Main Entrance Hot springs AE Maternity Outpatients entrance workshops
  39. 39. FIRST FLOOR PLAN Administration above Entrance for Access and Privacy administration atrium Entry below administration
  40. 40. ROOF PLAN Integrating and Reconciling Existing Roof Forms
  41. 41. ATRIUM Whanau Room Whanau Room Staff Mental Health Kitchen North Side of Atrium Café Seating Reception Administration Main Entrance Atrium View Thru to Cafe Hikurangi Doctors Consulting Atrium Internal
  42. 42. PROPOSED OVERALL PLAN Reremoana Accommodation Mental ay Admin ighw over Wards Main nH Entrance Mai Maternity Doctors AE Entrance Hot Springs Workshops Public Entrance To Springs Mortuary
  43. 43. COMPREHENSIVE DEVELOPMENT PLAN In addition to the actual Hospital design, it was also important to develop proposals for the wider contextual issues • Clinical Services • Staff Residential • Kaumatua (Elder) Housing • Health Education • Staff Training • Health Tourism
  44. 44. COMPREHENSIVE DEVELOPMENT PLAN Clinical Services • New satellite health Clinics were opened at Kaiti (Gisborne), Ruatoria, Tokomaru Bay, Te Araroa) Staff Residential • Plans were completed to remodel one of the existing houses into a 7 bed nursing hostel Kaumatua (Elder) Housing • Space was allocated around the Lagoon for the inclusions of Kaumatua Housing Health Education and Staff Training • Proposals were developed to rehabilitate Reremoana Health Tourism • Proposals were developed to purchase the nearby Te Puia Springs Hotel with its own thermal spring to separate the Hospital and Tourism functions of the existing pool. These were never carried through In addition, new Gisborne premises were leased to house Research projects, Mental Health Advocate, a Rehabilitation programme, Problem Gambling Counsellor and the Tairawhiti Innovative Nursing Team.
  45. 45. FINAL REPORT AND ANIMATION Finally, the design was completed and a 250 page Comprehensive Design Report was developed to document the proposal. This included: • Phased Development Plan • Complete “Pattern Language” of design principles • Full cost estimates • Phased economic sustainability plan This was accompanied by a computer simulated fly- through developed to: • Make the proposals more comprehensible to the wider community • Use as a basis for fund-raising
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×