AFYA MTAANI ADAPTABLE HEALTHCARE. In an honest servitude, we must allow ourselves to be entirely incomplete. We must set aside a part of ourselves that reacts to, empathizes with, and is filled by those we serve. The AFYA MTAANI medical unit is an impressionable architecture which reacts to location,culture, change and the people it serves.
PROBLEM STATEMENT-AN HIGHLIGHT ON INADEQUACIES OF HOME AND HEALTH CARE DURING COVID 19 AFYA MTAANI ADAPTABLE HEALTHCARE. In the last months, the already daunting inadequacy of healthcare systems in Kenya has evolved into an outright emergency. The government in the month of June launched the Home Based Isolation and Care Guidelines, for patients with Covid 19 in the management of the increasing numbers and the anticipated surge in cases. Currently, the available data in the country shows that 78 per cent of the infected persons, admitted in hospitals are either asymptomatic or mildly symptomatic and therefore can be managed at home provided proper laid down procedures are followed. Home-based care in the informal settlements where households share small spaces will require identification of institutions within the community that meet the recommendations for providing such care and herein. ‘Nyumba Kumi’ Initiative can play a role in supporting the care in the community. Is this sufficient?
Cities and Major towns in Kenya
13 55/95 10/32 21/40
IN EVERY 10
IN EVERY 2
Households living in these Households living in these cities live in informal cities are poor settlements
BY FORMODE
CONTINUITY OF HEALTH SERVICES DURING COVID 19 PERIOD
PER 100,000 Current ratio per pax of Nurses vs recommended
PER 100,000 Current ratio per pax of Doctors vs recommended
PER 100,000 Current ratio per pax of Clinical Officers vs recommended
Carolina for Kibera (CFK), a local health NGO; health data on continued health and education services in Kibera during the pandemic
Proportion of Poor household Households living in informal areas
Kisumu
62%
49%
Nairobi
41%
43%
Eldoret
30%
69%
Mombasa
26%
59%
Thika
18%
47%
Embu
13%
49%
Kericho
11%
71%
Kakamega
8%
48%
Kitui
6%
74%
Machakos
6%
63%
Malindi
5%
64%
Nakuru
5%
62%
Nyeri
5%
50%
Garissa
2%
47%
INFORMAL HOUSEHOLDS Propotion of households living in informal areas
3 HOUSEHOLDS CAPACITY Distribution of Urban Households by Housing type
3
OUT OF 5 Urban households have access to piped water
INFRASTRUCTURAL CAPACITY Accessibility to drinking water nationally
OUT OF 10 Urban households have no access to toilets
SANITATION (TOILETS) AT NATIONAL LEVEL
>5 KM
>10 KM
>20 KM
IN KIBERA
39.1%
Over 350,000 Residents live in 5 SQ KM
POVERTY LEVELS (% OF TOTAL POPULATION) 36 out of 100 Kenyans are poor
Of Households
19.8%
ROAD NETWORK ACCESSIBILITY
Of Households
7.7%
Of Households
PROGRAM +DESIGN DEVELOPMENT AFYA MTAANI ADAPTABLE HEALTHCARE.
FORMODE
Sustainable and adaptable health services designed specific to community requirements can transform the social economic and environmental well being of a settlement. Health is a key area that is both cause and symptom of viscous poverty cycle. Afya mtaani provides medical infrastructure and appropriate system design for off grid,under served communities by understanding the issues of basic health care in informal and rural contexts. Like the ever rowing versatile and locally compatible nature of trees ,this healthcare unit approaches modularity with a keen focus on the user access,developments and empowerment. The unit is specially designed to be utilized by governments,NGOs,private entities and individuals that work on critical health based issues in lacking areas especially during this covid 19 pandemic
Incremental Adaptable Growth Modules COVID 19 Intensive Care Unit Nursing space +Observation area/charting rooms Stack Isolation Unit Stand Alone Isolation Units
POST-COVID 19 (Modules adapt based on needs) Doctors room+pharmacy Immunization facility +Cold Storage Basic procedure facility +Lab testing facility Specialised Facility(Dental care/eye care etc)
MODULE DESIGN Breaking down the functions into modules has various positive implications • The design can be easily adapted to varying space availability • The setup can be done depending on fund availability where and entire health Centre need not be constructed all at once • Single Modules can be constructed/Attached to existing infrastructure where only certain additional facilities are required and not entire health facility.
STAKE HOLDER COMFORT AND EMPOWEMNT • patients-ease of access and use • medical staff-organized internal spaces ,ample storage and other support facilities • Funder-flexibility in choosing need and resource based facilities +can opt for incremental growth of health care • Locals-empowerment through livelihoods generation(construction+maintenance) • healthy ,hygienic and comfortable
SUSTAINABILITY • Going local-use of local materials and craftsmanship • Energy-use of passive colling techniques +off grid solar power • Maintenance-Systems that are easy to maintain and replicate in case of damage
BUILD ABILITY AND MODULARITY • Technology-all components can be made by local carpenter and fabricator-no factory /pre-fabrication required • Setup-Systems are simple to understand and to install(and re-install) • Growth-modular system lets one build as per need necessary
UNIQUE SERVICES • Audio Visual aids for health awareness ,education and telemedicine services • GPS equipment that provides information on nearest health service(hospital/pharmacy/ambulance) • Intra Afya Mtaani Server which provides up-to -date information on medical stock between all centers
SYSTEM DESIGN AFYA MTAANI ADAPTABLE HEALTHCARE.
FORMODE
Performance and Design principles
Materials
Foundation Grid
The structural geometry is based on the triangle, the strongest and simplest of structural solutions. A triangular section offers high ceilings to naturally dissipate heat, as well as steep roofing for a fast water run-off. This basic structure allows for a large open-plan system without columns, with flexibility of distribution of spaces over time. Flooring is thin and cool, but where more controlled spaces are required (surgery space, toilets or medic storage) specific materials are used to create a “box in a box system� meeting the specific requirements of the function. This allows for targeted material allocation where necessary and a better use of resources
The materials used for construction are repeated in every module. This helps to keep the material selection as small as possible, as well as interchangeable. The main parts of the structure locally cut and bolt ready at the closest local manufacturer. All facades are impermeable ply or polycarbonate. If the facade is translucent, the solar shading is derived of local materials covering a rigid modular frame.
The structure of the building is based on a grid of 3,00 x 3,00 m. This provides the use of standard material sizes in every module. Foundations can be concrete or car tire based according to context and the building is raised allowing for eventual flooding. The building structure slides into the foundation structure, permitting the building to be dismantled and moved.
Aluminum
Polycarbonates Effective Heat Deflection
Fast Rain run-off
Formica Elevated Construction for flood resilience
Cross Ventilation
Local wood
EPS Sandwich Panel
Steel Profile
Flexible access connectivity
Frame
Basic Module
The basic frame is composed of steel C sections and square tubes, easily cut to form the basic triangular structure. This basic system is also be easily raised and bolted to trusses to make the first module stable. It is the simplicity and strength of this system that gives the efficiency in plan to the project
Additions to this basic module can be easily added by continuing the procedure and even allowing for additions once the building is constructed. This adds great flexibility to the project, which permits future growth of services to the community
Frame
Basic Module
Cladding
Modularity
FUNCTION +ADAPTATION AFYA MTAANI ADAPTABLE HEALTHCARE.
COVID 19 SEASON STANDALONE STAND ALONE ISOLATIONUNITS UNIT ISOLATION Asymptomatic patients living in high density ASYMPTOMATIC PATIENTS LIVING Areas unable to (DENSITY self isolate due toIN HIGH inadequate COMMUNITIES UNABLE TO HOME ISOLATE DUE TO INADEQUATE SHELTER WITH THEIR Shelter with their families. FAMILIES) Each sub module contains two fully contained Isolation units with a small kitchen ,Washroom And a living/bedroom. The units are mirrored against other COVID 19 SEASON STANDALONE Foldabale each exercise Bed mat the abutting Limiting interaction possibilities with ISOLATION UNITS ISOLATION UNIT neighbor. coach A
( ASYMPTOMATIC PATIENTS LIVING IN HIGH DENSITY COMMUNITIES UNABLE TO HOME Verandah ISOLATE DUE TO INADEQUATE SHELTER WITHDN THEIR FAMILIES) 5
FD
wc
2
3
4
wc
COVID 19 SEASON OBSERVATION AND CRITICAL CARE AREA 4 MODULE OBSERVATION/CRITICAL CARE AREA
( ASYMPTOMATIC PATIENTS LIVING IN HIGH DENSITY COMMUNITIES UNABLE TO HOME ISOLATE DUE TO INADEQUATE SHELTER WITH THEIR FAMILIES)
A critical care unit for symptomatic patients with pre-existing conditions such as Diabetes that need close attendance and monitoring The sub module hosts two isolation unit,Each unit fitted with a hospitable bed,with ventilators And other monitoring equipments. COVID 19 SEASON The stack units are highly Dependant of a Critical careISOLATION unit,shown next. UNITS PATIENTS LIVING HIGH The units can( ASYMPTOMATIC adapt based onINneeds DENSITY COMMUNITIES UNABLEUNIT TO HOME ISOLATION And can be incrementally added ISOLATE DUE TO INADEQUATE SHELTER WITH THEIR B
The area of the unit the most frequented is the nursing space for outpatient treatment. It covers basic medical needs such as patient reception, information and counseling Post covid 19; the care area can adapt and serve as center for small treatments as well as vaccination and other standard procedures. COVID 19 SEASON OBSERVATION The nursing care zones can be rearranged corresponding to specific SMALL CRITICAL CARE AREA AND needs given the TEMPRATURE EQUIPMENT KITCHENopen plan structure
5
WAITING SPACE
3
2
LINKAGE POSSIBILITY TO ISOLATION UNITS
B
ISOLATION UNIT
DN
NURSING SPACE
wc
wash whb room
Verandah DN 1
2
3
4
5
A
4
3
2
ISOLATION UNIT
1
B
wash room
wc
RAMP UP
WAITING SPACE Verandah DN
LINKAGE POSSIBILITY TO ISOLATION UNITS
CORRIDOR
FD
SUB MODULE
SUB MODULE
kitchenette
INTENSIVE CARE UNIT
CORRIDOR
coach ISOLATION UNIT
FD
D
C
SMALL KITCHEN
5
CONTROLLED STORE ROOM
CORRIDOR
1
FD
Foldabale Bed
WASHROOM Accessed by disabled
FAMILIES)
coach ISOLATION UNIT
exercise mat
D
C
Foldabale kitchenette exercise Bed mat
Verandah DN 1
COVID 19 SEASON ISOLATION UNITS STACK ISOLATION UNIT
wash room
A
wash whb room
4
FORMODE
WASHROOM Accessed by disabled
NURSING SPACE TEMPRATURE EQUIPMENT CONTROLLED STORE ROOM
INTENSIVE CARE UNIT
CORRIDOR
D
C
DN
ISOLATION UNIT
coach
NURSING SPACE
( A SUB MODULE CONTAINS TWO UNITS ISOLATION UNIT EACH FULLY CONTAINED MIRRORED TO AVOID THE ABUTTING UNIT exerciseCONTACT WITH Foldabale BREATHABLE CEILING Bed TO ALLOW FOR STACK mat VENTILATION ,DOUBLE LAYER ROOF PROVIDING ADEQUATE INSULATION AT THE SAME TIME)
RAMP UP
PUBLIC ACCESS
A B
Stand alone module plan 1:50
Stack module plan 1:50
SUB MODULE
4 SUB MODULE THE CARE MODULE ( COMPOSED OF 4 SUB MODULES COMBINED TO FOR THE CARE UNIT WITH ABILITY TO ADAPT INTO AN OUTPATIENT CARE FACILITY)
C
SUB MODULE
( A SUB MODULE CONTAINS TWO UNITS EACH FULLY CONTAINED MIRRORED TO AVOID CONTACT WITH THE ABUTTING UNIT BREATHABLE CEILING TO ALLOW FOR STACK VENTILATION ,DOUBLE LAYER ROOF PROVIDING ADEQUATE INSULATION AT THE SAME TIME)
PUBLIC ACCESS
NURSING SPACE
4 module observation area plan 1:50 D
4 SUB MODULE THE CARE MODULE ( COMPOSED OF 4 SUB MODULES COMBINED TO FOR THE CARE UNIT WITH ABILITY TO ADAPT INTO AN OUTPATIENT CARE FACILITY)
STANDALONE UNIT
WASHROOM
STANDALONE UNIT
ISOLATION UNIT
CORRIDOR
ISOLATION UNIT
INTENSIVE CARE UNIT
Waste Mangment cistern
Stand aloneSTANDALONE module section WASHROOMA 1:50 STANDALONE UNIT
UNIT
4 module observation area section D 1:50
Stack module section B 1:50 ISOLATION UNIT
CORRIDOR
ISOLATION UNIT
INTENSIVE CARE UNIT
FUNCTION +ADAPTATION +GROWTH AFYA MTAANI ADAPTABLE HEALTHCARE.
FORMODE
Adaptable isolation care for symptomatic patients with pre existing conditions
Isolation Unit
Isolation Unit
Isolation Unit
Isolation Unit
Critical care /observation area
Isolation Unit
washroom
Isolation Unit
Waiting area
Washroom accessed by the disabled
1
Temprature controlled room
Temprature controlled room
2 3
DN
corridor
4 5
corridor DN
corridor
5
Intensive care unit
DN
4 3 2 1
Isolation Unit
Isolation Unit
Isolation Unit
washroom
Isolation Unit
Combined Health Facility plan showing the critical observation area and isolation units merged 1:50
Combined Health Facility elevation showing the critical observation area and isolation units merged 1:50
Nursing space
Isolation Unit
Ramp up
Isolation Unit
Nursing space
SUSTAINABILITY+THERMAL PERFORMANCE AFYA MTAANI ADAPTABLE HEALTHCARE.
FORMODE
COVID-19 spreads through direct contact or indirect contact with a contaminated person, object, or airborne droplet. Simple design principles can thus be used to curb the spread of infection and make our health centers, homes, and workplaces healthier for living even today. Thermal stratification in this built form is enhanced in the geometry of the pitched roof design, causing Stack Effect
Flooring is thin and cool, but where more controlled spaces are required (surgery space, toilets or medic storage) specific materials are used to create a “box in a box system” meeting the specific
Cross Ventilation achieved through narrow plan layout, high ceiling and raised floor Wind driven ventilation, where the air flows into the building due to the differences of air pressure between the outdoor and indoor environment.
Thermal Performance-Stack Ventilation
TThe air in a room is often thermally stratified, and the air temperature at occupant level can be significantly higher than the exhaust temperature.a better use of resources Stack effect is the condition of vertical air movement when the cool air has been warmed up by human activities and operations of indoor machinery, and the warm air move vertically and its discharged from the building through the permanently ventilated openings in the roof’s pitch. Air entering a building that is not air-conditioned tends to rise, because it warms up and its density decreases, and therefore its weight, is lower than that of the outside air. The warm air escapes through the opening at the top, and is replaced by the outer, colder and heavier air, which enters from the bottom.
Thermal Performance-Cross Ventilation Natural ventilation is a key design strategy implemented. Airborne transmission is the most dangerous for a few seconds after leaving the host, so ensuring an adequate airflow across spaces is a simple and effective measure to reduce possible infections—though droplets, once they settle on surfaces can remain infectious for much longer Natural light is often overlooked in the prevention of disease outbreaks. Daylight influences air quality, because the high-energy ultraviolet rays in direct sunlight is a natural disinfectant because it breaks DNA bonds and helps to kill germs. Beyond that, natural light has psychological health benefits and contributes to faster recovery. Third, reducing the spread of germs from person-to-person through commonly touched surfaces is key.
NARRATIVE AFYA MTAANI ADAPTABLE HEALTHCARE.
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NARRATIVE AFYA MTAANI ADAPTABLE HEALTHCARE.
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NARRATIVE AFYA MTAANI ADAPTABLE HEALTHCARE.
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NARRATIVE AFYA MTAANI ADAPTABLE HEALTHCARE.
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FORMODE mas con menos Kipkemei Kiplelgo Symon skiplelgo@gmail.com Musyoki Charles Mbatha mbathacharles561@gmail.com Mubothi Brian Murimi mmubothi@gmail.com Njeri Malcom Mwathi mwathimalcom@gmail.com