THE LIMBE MEDICAL CLINIC
The Limbe Medical Clinic
content I. Project Overview 04 II. Context 05 III. Preliminary Research 06
Malamulo Hospital: The Limbe Medical Clinic
IV. Thesis 07 V. Complete Abstract 08-09 VI. Design Intent 10-11
by Jacquelyn Nemitz Project presented to the Faculty of the Department of Architecture College of Architecture and the Built Environment Philadelphia University In partial fulfillment of the requirements for the degree of BACHELOR OF ARCHITECTURE
VII. Research Objectives 12-14 VIII. Investigative Methods 15-19 IX. Context and Site Analysis
21-22
X. Program Study 23-24 XI. Precedents 25-26 XII. Process Documentation 27-28 XIII. Final Design Documentation
29-43
Design 9: Research and Design Faculty Chris Harnish
XIV. Analysis 44-45
Philadelphia, Pennsylvania
XV. Works Cited and Credits
December 2015
XVI. Bibliography 47
46
context
project overview The Limbe Medical Clinic will operate as a for-profit medical clinic that will help to run the Malamulo Hospital nearby.The Limbe Medical Clinic is a hub for a wide variety of users such as the community of Blantyre, an international community, donors, the client, patients, visitors, conference-goers, international doctors, Malawian staff, and contractors. This provides a complicated dynamic between the community and the international users and doctors. The inter-cultural relationships at the clinic should be celebrated and all cultures should be able to use the space in separation or together. The Limbe Medical Clinic should hold vernacular tendancies, but will be carried out in a more contemporary way. The construction will be traditional enough that the community can help during the building process initially and with repairs in the future, further integrating all users together.
04 | project overview
S15° 49.255’, E35° 03.084 Limbe, Malawi, Africa
Limbe is a small city outside of Blantyre, Malawi which is the second largest city in the country. Limbe has summer sun that comes almost directly from above with a slight angle towards the South. In the winter the sun comes at a winder angle in towards the North. While the light can be very direct and should be diffused through different methods, it should also be able to be let into the building to provide daylight in case the clinic needs to operate off the grid. The wind comes steadily from the East/North-East and is enough to ventilate the spaces. The specific site is sloped from Northwest to Southeast and has a drop of 34 feet. It is bordered on two sides by a road that is the primary access from the town of Limbe.
05 | context
thesis
what makes up a healing environment? Preliminary research was done on the factors that make up a healing environment. After evaluating all found options, the research that was the most crucial to me was that when people are under stress their immune sysems are proven to fail faster. As humans, we have an inherent craving for nature when we are stressed, so it is important that there is an interaction with outdoor spaces through the user experiences in the Limbe Medical Clinic.
connection to outdoor
spaces in a medical
environment is an essential piece of improved well being, and can enhance the user’s experience
views to nature
proper artificial and natural light
covered outdoor space
proper ventilation to reduce the spread of disease
06 | preliminary research
transitioning through gardens and outdoor spaces
having the choice to be together or alone
blocking out harmful noises and letting in sounds from nature
patients being located equal distance to nursing stations to reduce anxiety 07 | thesis
The Limbe Medical Clinic The Limbe Medical Clinic located outside of Blantyre, Malawi will operate to fund the Malamulo Hospital nearby. The clinic will primarily serve an international community, but will also be used by the communities of Limbe and Blantyre. It needs to be able to successfully accommodate the range of users that will circulate throughout the day by means of both inter-cultural and separated spaces. The sloping land that the clinic will sit on provides opportunities for moments of both gathering and intimacy that can occur outdoors in response to the physical and climatic elements of the site. The connection to these outdoor spaces in a medical environment is an essential piece of improved well-being, and can enhance the user’s experience while healing. Through understanding programmatic adjacencies, user circulation, site conditions, the relationship of indoor and outdoor, and human scale and experience, a variety outdoor spaces will be created that offer patients a sense of choice, and bring moments of relief from the high-stress atmosphere of a medical complex.
Using these qualities and rules for each of the four types of outdoor spaces made the process more logical moving forward when designing each of the spaces on the site. A site analysis was done to explore environmental and contextual information that could inform the placement, organization, and orientation of the clinic. The sloped land stood out as something to take advantage of for being able to provide different levels of access for different users. It should be noted that while the outdoor spaces can be at different levels, that each relationship to its corresponding interior program is happening on the same level so that it is fully accessible for the patient to experience it without needing assistance from staff. It was also important to look at procession and proximity of these spaces as well as program adjacencies of the clinic. In a medical complex, density is important for practical reasons, but so is being spread out to allow for light, ventilation and open space. Finding a balance of the two was integral to fitting these spaces into the larger context.
Clinics can often times have chaotic moments. Indoor spaces of a medical facility must be designed in such a way that they provide comfortability and clarity to users, but there is still a sense of confinement. This feeling can be alleviated through outdoor spaces that provide a physical and mental release. When studying what the key components were to creating a healing environment, there was a strong emphasis on enhancing the human experience through the use of outdoor spaces, among other things such as light, materiality, and adjacencies. The relationship between these hectic indoor spaces and the outdoor spaces becomes very important. They need to have a certain harmony with one another.
The program was ultimately arranged where the phase one medical component is at the same level as parking for easy access for more urgent needs, phase two is more community oriented and located nine feet below the main medical clinic for privacy, and the phase three social and housing spaces are located further up the slope for access without interfering with the medical areas. Each programmatic element is arranged so that the user is encountering these outdoor spaces along the way. Each user’s experience was designed to promote healing through the connection to the outdoor spaces.
Studying the programmatic elements of the medical clinic informed what types of complimentary outdoor areas were needed. These spaces were initially analyzed as to what their function was, who used them, when they were used, and how they related to their corresponding interior spaces and to each other. The outdoor spaces fit in between and adjacent to the interior program pieces, whether it was a more long term place to pause in or a more temporary space to move through. I concluded that there were multiple different types of relationships between indoor and outdoor such as connecting, overlapping, intersecting, complimenting, enclosing, adjacent to, and free standing. Each of these outdoor spaces that I dissected had one of four common functions. They were either a reflection space, a waiting space, a gathering space, or a transitional space.
The connection to the outdoors is just as important when you’re inside one of the programmatic spaces. Using a concrete post and beam structure, I was able to design a tectonic wall panel system where different walls are infilled according to the program, function, and user of the space that they are in so that there is always a unique and consistent connection to the outdoors.
I then analyzed what it meant to be in one of these categorized spaces. I set out to study how each of these spaces can individually promote healing, and came up with a set of rules for each of them that gave standards, as well as room to flex to fit their corresponding program or the site. They were looked at in terms of qualities such as enclosure, transparency, light, sound, smell, threshold, scale, views, seating, protection, and materials. Each of the four spaces varies in certain qualities, but the element that is evident in each of them is that they relate to human scale and enhance the user experience. Each are key to a medical facility because there are moments when a user needs to be alone, around others, or have the opportunity to decide which they’d rather do. They should have a choice whether to engage or remain intimate. Spaces of reflection, waiting, and gathering all provide a moment of pause throughout the busy day at a medical clinic. In addition to these gardens and breaks, there are other outdoor spaces that are transitional and just as important to be designed well because they are getting users from point a to point b all day long. This process should not be an afterthought, and is important as an outdoor space because it promotes constant air exchange for the users and reduces infection. 08 | complete abstract
09 | complete abstract
design intent
Through
understanding
a medical space should be considered on both macro and micro scales when it comes to it’s connection to the outdoors Precedent was found in the Paimio Sanatorium by Alvar Aalto that provided healing on both large and small scales. On the macro scale, the site plan was designed to allow for gardens to infill the program space, and for spaces to connect patients to the outdoors like on the sun balconies. On the micro scale, fixtures and furniture were designed and interior colors were taken into consideration when to improve the patients day.
programmatic
adjacencies, user circulation, site conditions, the relationship of indoor and outdoor, and
outside
macro
micro
human scale and experience, a variety outdoor spaces will be created that offer patients a sense of choice, and bring moments of relief from the high-stress
inside
atmosphere of a medical complex. The feeling of confinement and chaos that comes within medical spaces can be alleviated through outdoor spaces that provide a physical and mental release.
10 | design intent
outside 1
2
11 | design intent
macro scale
there are 4 different types of outdoor healing spaces at the Limbe Medical Clinic
outdoor spaces were determined based on the medical clinic’s program and users food garden
community and education space
visitor waiting
users: doctors, Blantyre community
users: doctors, staff, temporary patients, Blantyre community
users: family of patients
outdoor conference space
staff eating
staff healing garden
users: administration, conferencegoers, doctors, international visitors
users: staff, doctors, nurses, administration
users: staff, doctors, nurses, administration
patient waiting
doctor healing garden
patient healing garden
users: patients, staff, nurses
users: doctors
users: patients
maternity healing garden
primary users outpatients
maternity patients
reflect patient healing garden
wait patient waiting
gather
transition
food garden
exterior circulation
maternity healing garden
outdoor conference space
thresholds
staff healing garden
staff eating space
doctor healing garden
community and education space
community
doctors
users: maternity patients
12 | research objectives
13 | research objectives
qualities + rules
one size does not fit all
each of the four types of outdoor spaces holds different qualities
a diagrammatic model was made to explore the different conditions of each of the four outdoor spaces in respect to the different qualities
protection
enclosure
qualities
light
sound transparency seating
14 | research objectives
outdoor spaces
15 | investigative methods
spatial qualities vignettes of different spatial conditions for the rules of different qualities that each of the outdoor spaces have
gather: to bring together 3 views:
choice:
wait: to stay in a place until an expected event happens, until someone arrives, until it is your turn to do something 4 seating:
16 | investigative methods
reflect: to think quietly and calmly 5 choice:
seating and views:
transition: movement, passage, or change from one position, state, stage, subject, concept, etc., to another; change 6 movement:
seating:
17 | investigative methods
micro scale
panel tectonics
outpatient observation room
wall panel infills transitional or perforated brick wall for reflection spaces
the connection to the outdoors is just as important when you’re indoors. different wall types were designed to infill
brick wall
a concrete post and beam structural system, and serve
for thermal enclosure, and visual and noise privacy
as a connection to the outdoors according to program, funciton, and user.
green wall for transition spaces
18 | investigative methods
fabric panels fabric panels for natural ventilation can be fixed or revolve in areas that don’t need to be thermally enclosed
metal panels
frame
custom panels infill in operable perforated operable panels frame that is cast into panels for and door for patient panels for waiting areas observation rooms patient exam concrete structure rooms
19 | investigative methods
site analysis
site analysis The site is located near an important hub of Limbe that has a taxi and bus station, as well as the Limbe Market. Proximity to the taxi and bus station allows for more patients to reach the medical clinic. The approach to the clinic would occur on Dunduzo Road and happen from the Southeast.
winter
summer
ya
tta
ive
access from road
ad
keeping access points off of the existing road and maintaining a buffer from the south side of the site for privacy from future development
20 | site analysis
zo nd u Du
park
mun ity com
med
ical
soci entering mid-way up the slope and keeping phase one program on relatively level ground from the entrance
live
phas e 01 entrance
taxi
Dr
al
the site’s slope creates a water flow towards the Southeast
Ke n
Ro
climatic conditions
market
large scale program layout on site allocating spaces on the site for different programmatic pieces according to circulation patterns and adjacencies
21 | program study
inside to outside spatial relationships
organization of space has a significant impact when it comes to how someone heals
An importance was placed on the study of the designed outdoor spaces and their connection to their adjacent indoor program pieces
Different spatial adjacencies or distances can cause anxiety instead of healing, and should be noted and avoided. Places of healing should be of human scale and transcend their functional aspects with the fusion of their surroundings.
entry community /education space
staff healing garden
outdoor conference space
staff eating space
patient healing garden
patient waiting space
doctor healing garden
food garden
visitor waiting
community and education space
patient waiting
maternity healing garden
outdoor conference space
staff eating
patient healing garden doctor healing garden
food garden
22 | program study
maternity healing garden
visitor waiting
23 | program study
healing space precedents
3
4
5
6
7
material precedents Spatial, material, and structural precedents helped understand different possibilities for design decisions. Healing space precedents captured qualities of scale and light. Material precedents explored different options for facades and walls that could be used. Structural precedents showed a contemporary, yet vernacular style of building. 8
9
10
12
11
structural precedents
13
24 | precedents
14
15
16
17
25 | precedents
preliminary design + concept decisions
previous site organization strategies
each iteration of site strategies has had an emphasis on a courtyard scheme and focused on the connection to outdoor spaces
Design decisions made in the mock Stewardson exercise at the beginning of the project brought forth the understanding of vernacular construction methods in Malawi and the importance of outdoor spaces in a medical environment.
26 | process documentation
27 | process documentation
phasing each phase should be able to function beautifully either sequentially or as a whole composition
phase 01
28 | final design documentation
phase 02
phase 03
29 | final design documentation
programmatic adjacencies
site plan outdoor program the procession and relationships of the four types of outdoor spaces shape the masterplan from the way the users circulate through them
indoor program both outdoor and interior spaces in a medical facility need to hold a certain harmony with one another for their users. programattic adjacencies are important in a medical facility where circulation needs to be carefully thought out for the health and safety of users. program of the medical clinic was determined based off of adjacencies to other appropriate indoor and outdoor spaces.
30 | final design documentation
31 | final design documentation
outpatient experience
wait_transition_reflect entry The outpatient experience starts with transitioning through a bioswale, waiting either indoor or outdoor, and spiritually healing before entering the medical components of the clinic.
32 | final design documentation
33 | final design documentation
reflect spiritual healing garden
In Malawi, besides medicinal healing, spiritual healing is a large part of the culture. A spiritual healing garden and sanctuarty were designed to give the patients and families waiting a place to reflect while at the Limbe Medical Clinic.
34| final design documentation
wait outpatient waiting space
A tranquil outdoor waiting space was designed for patients to feel comfortable while waiting to enter the outpatient services of the clinic.
35| final design documentation
outpatient observation room The outpatient observation room is where a patient would stay overnight, or for hours at a time. The infill panel in this room is thermally enclosed operable metal panels with a revolving door that has transparent panels for a direct view to nature from the height of a patient lying in bed. The outpatient observation room is surrounded on either side by the outpatient waiting area and the outpatient reflection garden.
outpatient reflection garden
36| final design documentation
outpatient waiting area
37| final design documentation
38| final design documentation
doctor’s off-hour experience
maternity experience
transition doctor’s housing
wait materinity waiting area
39 | final design documentation
transition_gather_wait section through phase oner medical clinic Although emphasis was placed on circulating throughout the clinic through the series of outdoor spaces, Malawi experiences a monsoon season during their summer months. A double roof system allows the corrugated metal roof to overhang and create covered circulation for those months, and additional shade and protection year round.
winter 40| final design documentation
summer 41| final design documentation
community experience The community of Limbe enters the clinic at a lower level allowing them to access medical offices and disease prevention clinics that have been rented out by various doctors. They also have access to a food garden and a recreation area for children to play.
42 | final design documentation
43 | final design documentation
THE LIMBE
MEDICAL CLINIC critique of completed project Reflecting back on the design process of the Limbe Medical Clinic, I met my expectations, and pushed myself to understand the components of the clinic on a macro site level and a micro tectonic level. The speed of the evolution of my design was an appropriate pace for me to achieve what I wanted to. I made a set of rules for myself that I would follow for the remainder of the design process, which made my project in its entirety tie back to my thesis. Exploring media types such as watercolor and model making to a level that I have not yet was an exciting achievement for me during the semester. A lot of time spent on this project was trying to wrap my head around the expansive program of the medical clinic and all that it entailed to create a successful site organization. A goal that I made for myself at the beginning of the semester was to explore this project down to the scale of the human being and their senses. During the final push of the semester I was able to get down to the tectonic level of the clinic through the infill walls that I incorporated into my structural system, which I was glad to accomplish. However, no project is ever perfect. There are components that could change, grow, and become more figured out if given more time. Designing the Limbe Medical Clinic has been my favorite studio project throughout my time at Philadelphia University, and I am happy to have gotten experience designing not only a complicated medical program, but in an area out of my comfort zone such as Malawi.
44 | analysis
45 | analysis
works cited
bibliography
Image Citations:
Anderson, Diana. “Humanizing the Hospital: Design Lessons from a Finnish Sanatorium.” US National Library of Medicine. National Center for Biotechnology Information, 10 Aug. 2010. Web. Sept. 2015.
1
Tumblr. Alvar Aalto, TB Sanatorium, 1929-1935, Paimio, Finland. N.d. Tumblr. Web.
Crisp, Barbra. Human Spaces. Gloucester: Rockport, 1998.
2
Designboom. Splash Free Sinks, Paimio Tuberculosis Sanatorium, Alvar Aalto. N.d. Designboom. Web.
3
Spaceshift Studio. N.d. Dezeen. Web.
Heikinheimo, Marianna. “Paimio Sanatorium.” Paimio Sanatorium. Marianna Heikinheimo, 8 Sept. 2014. Web. Sept. 2015.
4
Gamo, Rafael. La Tallera / Frida Escobedo. N.d. ArchDaily. Web.
5
Modern Drought Tolerant Landscape. N.d. Pinterest. Web.
6
Salas, Armando. Fuente De Los Amantes, Los Clubes, 1966 Luis Barragan. N.d. Design Museum. Web.
Merriam Webster. “Gather.” Def. 1. Merriam Webster. Merriam Webster, Incorporated, n.d. Web. Sept. 2015.
7
N.d. Landscape Online. Comp. Yu-Ju Liu. Web.
Merriam Webster. “Wait.” Def. 1. Merriam Webster. Merriam Webster, Incorporated, n.d. Web. Sept. 2015.
8
Dujardin, Filip. Woesten Community Center / Atelier Tom Vanhee. N.d. ArchDaily. Web.
Merriam Webster. “Reflect.” Merriam Webster. Merriam Webster, Incorporated, n.d. Web. Sept. 2015.
9
Engraved Plate: Constitution Hill. 2012. Wordpress. Web.
10
Grandorge, David. Maggie’s Centre. N.d. Dezeen. Web.
11
Young Architects Boston Group. Parti Wall, Hanging Green by Young Architects Boston Group. N.d. Archinect. Web.
12
Medlin, Taylor. Experimental House. 2007. Galinsky. Web.
13
Kere Architecture. Primary School / Gando / Burkina Faso. N.d. Kere Architecture. Web.
14
Kere Architecture. School Extension / Gando / Burkina Faso. N.d. Kere Architecture. Web.
15
Mass Design Group. Lupani Primary School. N.d. Mass Design Group. Web.
16
Mass Design Group. The Umubano Primary School. N.d. Mass Design Group. Web.
17
Mass Design Group. Mubuga Primary School. N.d. Mass Design Group. Web.
46 | works cited
Marcus, Clare Cooper, and Naomi A.. Sachs. Therapeutic Landscapes an Evidence-based Approach to Designing Healing Gardens and Restorative Outdoor Spaces. Hoboken (N.J.): Wiley, 2014. Print
Merriam Webster. “Transition.” Def. 1a. Merriam Webster. Merriam Webster, Incorporated, n.d. Web. Sept. 2015.
47 | bibliography
“How one moves through space and interacts with its geometric forms and sensory stimuli defines the realm of our experience in a specific environment or place. This dynamic relationship with the environment is the basis for manifesting an architecture that privileges the person and is body centered rather than place or object specific.�