Local Jump-Start by Liz Oyas

A PEDIATRIC + OBSTETRIC CLINIC IN CATMON CEBU, PHILIPPINES

REDEFINING BOUNDARIES FOR HEALTHCARE NEEDS OF RURAL COMMUNITIES THROUGH PREFAB PACKAGING SOLUTIONS

By Liz Marie M. Oyas

A PEDIATRIC + OBSTETRIC CLINIC IN CATMON CEBU, PHILIPPINES

A Thesis Presented to the Faculty of NewSchool of Architecture + Design A Partial Fulfillment of the Requirements for the Degree of Master of Architecture

By Liz Marie M. Oyas San Diego 2013

ABSTRACT OF THESIS REDEFINING BOUNDARIES FOR HEALTHCARE NEEDS OF RURAL COMMUNITIES THROUGH PREFAB PACKAGING SOLUTIONS

A PEDIATRIC + OBSTETRIC CLINIC IN CATMON CEBU, PHILIPPINES BY LIZ MARIE M OYAS

PROBLEM Current healthcare establishments throughout the rural, developing world are often designed and delivered with either a lack of design quality, sanitation, or cultural sensitivity. The most difficult obstacle is the distance between existing quality care and need for immediate response. Too frequently, immediate response applications such as, disaster relief or medical missions, are delivered with a lack in initiating long term economic progress or the design lacks appropriateness towards the user and context. In the infrastructure of healthcare, there has yet to be a successful way of engaging permanent application. Current facilities within these areas suffer from insufficient air and water quality, with a need of specialty care that is flexible enough for a community’s need and budget. METHOD A two week field visit to Catmon Cebu provided experience to understand the culture and environment of the area in order to apply appropriate context and user design. Visits to various forms of hospitals and health clinics, within the region, allowed for key observations in studying cultural behavior and responses within a

healthcare setting. Various case studies related to Southeast Asia assisted in design development toward this culturally sensitive project, which evaluated materials, program and building construction methods conducive to the local culture. Literature review of global health statistics and current healthcare trends, such as tele-medicine, furthered the study to provide suitable technical applications while still encouraging local methods and techniques. RESULT In order to improve healthcare delivery in rural, developing countries, providing a standard of sanitation, care and user experience was essential. Through prefab packaging design solutions, accommodating to user, program and context, helped to develop modular units that are readily available, easy to ship and flexible according to location. Because these units are prefabricated with design features that provide all the essential medical needs within the unit, it eliminated the need to ship multiple parts and provided easy assembly at a human scale while also catering to existing delivery methods. The exterior shell of the clinic provided architectural language that spoke to the area’s culture and climate. The ac-

tual application of the prefab units utilize local methods of construction, which also use materials available within the area. Developing the design in two separate architectural systems; 1)health units and 2) the exterior shell, the design allowed for flexibility according to site context and ensured the ability to maintain the structure if damages occurred. The design not only speaks to the community’s knowledge and skill, but their ability to provide hope for its people.

LOCAL JUMP-START:

REDEFINING BOUNDARIES FOR HEALTHCARE NEEDS OF RURAL COMMUNITIES THROUGH PREFAB PACKAGING SOLUTIONS

A PEDIATRIC + OBSTETRIC CLINIC IN CATMON CEBU, PHILIPPINES

A Thesis Presented to the Faculty of NewSchool of Architecture + Design A Partial Fulfillment of the Requirements for the Degree of Master of Architecture

By Liz Marie M. Oyas San Diego 2013

BOUNDARIES FOR HEALTHCARE NEEDS OF RURAL COMMUNITIES LOCAL JUMP-START: REDEFINING THROUGH PREFAB PACKAGING SOLUTIONS

A PEDIATRIC + OBSTETRIC CLINIC IN CATMON CEBU, PHILIPPINES

NewSchool of Architecture + Design By Liz Marie M. Oyas

Approved By:

_______________________________________________________________________________________ Kurt C. Hunker, Director of Graduate Programs Chair Date Graduate Department of Architecture

_______________________________________________________________________________________ Vuslat Demircay, PhD. , Thesis Advisor Date

iii

DEDICATION + ACKNOWLEDGEMENTS In dedication to my loving and supportive family who have taught me life lessons in the importance of helping others in need and to always enjoy what I do, I wouldn’t be who I am today. My dad for teaching me the motto of, “Good, Better, Best” and how to analyze with a critical eye...who knew how useful that would be in architectural school! Lastly, to my boyfriend and best friend for putting up with me during midterms and finals. Thank you for always making me smile and supporting me...

I would also like to acknowledge: The Oyas Family and all those who took me around in the Philippines and gave me the jungle experience! I miss you all and can’t wait for another visit! Karen Kinney for taking the time out of her busy schedule to edit through my research document, I greatly appreciate your work. Vuslat Demircay and all the graduate thesis instructors for a wonderful year!

A young boy with a new found pet snake in the Barnagy Tabili of Catmon Cebu Philippines (by author, September 2012)

TABLE OF CONTENTS 1 INTRODUCTION 1.1 General Introductory 1.2 Statement of the Challenge 1.3 Importance of Challenge 1.4 Background + Historical Context 1.5 Project Statement 1.6 Methods of Investigation 1.7 Theoretical Framework

14-26

2 RESEARCH STUDIES 2.1 Literature Review 2.2 Design Research 2.2.1 Theoretical 2.2.2 Psychological 2.2.3 Ecological 2.2.4 Socio-Economic / Political 2.3 Case Studies 2.4 Legal Issues 2.5 Financial Issues 2.6 Preliminary Building Systems 2.7 Specialized Building Performance Criteria 2.8 Parking

28-67

3 DESIGN RESEARCH + ANALYSIS 3.1 Pre-Design & Field Analysis 3.1.1 Regional Analysis 3.1.2 Local Analysis 3.2 Programming

68-99

17 18 19 21-23 24 25 26

31-35 36-47

49-59 60 61 62-65 66 67

71-89 90-99

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TABLE OF CONTENTS CONTINUED... 4 DESIGN PROCESS 4.1 Schematic Design 4.1.1 Sketches + Sketch Models 4.1.2 Charette Results 4.1.3 Final Presentation Work 4.1.4 Notes + Conclusions 4.2 Design Development 4.2.1 Sketches + Sketch Models 4.2.2 Midterm Presentation Work 4.2.3 Final Presentation Work 4.2.4 Notes + Conclusions

100-161

162-165 166-168 170-171 173

CONCLUSIONS

BIBLIOGRAPHY FIGURES + SOURCES STUDENT BIOGRAPHY APPENDIX

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103 104-111 112-115 116-127 128-129 131 132-135 136-141 142-159 160-161

175-178

A water buffalo and goat try to cool off in the hot and humid climate (by author, September 2012)

1 INTRODUCTION

1 Barangay Tabili in Catmon, Cebu Philippines by author, september 2012

With no trail to follow, we hiked into the plowed fields, returning from a visit to a family friendâ&#x20AC;&#x2122;s house. We asked this local farmer for reassurance in that we were going in the right direction...

General Introductory

As technology advances, society has the means of accessibility to almost everything across the globe. Yet with that in mind, , it is almost shocking to realize that most of the world still live without access to clean water, air and basic healthcare. The things that allow us to survive have still yet to significantly improve in developing countries. Although statistics have provided information towards the improvement of health and economy, the percentages are still small, especially in relation to the outreach of knowledge and technologies that are available today.

1.1

An example of many children who struggle on a day to day basis for the search of basic necessi ties, such as water(fl ickr/S.Desai, June 2012)

Statement of the Challenge

Too frequently, rural healthcare projects are delivered with immediate response with a lack in initiating long term economic progress. Temporary applications, such as disaster relief and medical missions, have provided the necessary care needed, but are not frequent enough and in some cases, such as disaster relief, have not engaged the appropriateness of culture and context. In the application of permanent facilities, they lack a standard of indoor air quality, sanitation and maintenance.

1.2 Left: The left over destruction in Haiti (flickr/uusc4all, Haiti) 1.3

Right: Application of disaster relief called Clinic in a Can (flickr/Clinic In A Can, Haiti)

Importance of Challenge

Health is of importance to every human being. What is unfortunate is the lack of healthcare availability to underdeveloped countries, especially rural areas where it is difficult to access. Most of the time, health related issues are directly correlated to poor sanitation, usually air and water. Too often, developed societies take for granted the simple luxuries in life, such as clean running water, or a simple phone call to their healthcare provider. Many developed societies have forgotten to be thankful for many basic amenities that many of the developing world still do not have easy access to. Therefore, the issue of developing a way to provide healthcare to these areas, is an important issue in order to provide, what should be, a necessity.

1.4 Locals plowing the fields using water buf falo to get ready for the next season (by author, September 2012)

Background + Historical Context RURA L 45%

GLOBAL HEALTH

55%

URBA N

Providing rural health care has long been a global issue. An estimated 45% of the developing world live in rural areas(FAO, 2012). Of the 3.1 billion living in these regions, 80% depend on agriculture for their livelihood and agriculture provides 30% of the worldâ&#x20AC;&#x2122;s gross domestic product (GDP). Life styles such as these are associated with higher fertility rates and poverty due to a lack of diversity in the industry. One reason for the higher fertility rate is that having more children will provide the family unit with more labor. This would allow for contributions to family income as well as income to the elders in their communities. A total of 18% of the worldâ&#x20AC;&#x2122;s population is included in these rural health care issues of increased fertility rates: Sub-Saharan Africa and parts of near East and South Asia to name a few (FAO,2012). In addition, these regions also experience a lack of availability of decent health care that is within reasonable distances. Because most healthcare facilities are located in urban centers and central towns, the unreasonable distance results worsening illnesses and at times causing death.

3.1

BILLION LIVING IN RURAL AREAS

Those most affected by inadequate delivery of healthcare in rural areas are children under the age of 5 years old. Malnutrition, sanitation, and acute chronic illness are the main contributors to 70% of deaths in this vulnerable

80% AGRICULTURE AS PRIMARY SOURCE OF LIVING

1.5

Infograph (by author, September 2012) Source Credit: FAO,2012

Life styles such as these are associated with higher fertility rates and poverty due to a lack of diversity in the industry. Reasons contributing to this problem suggest that living in poverty and bearing more children will provide the family unit with more labor.

age group (World Bank, 2012). In the first year of a child’s life they are most vulnerable and susceptible to many illnesses. Fortunately, many of their conditions are preventable and treatable, but only with the availability of healthcare workers and monitoring of their condition. It can be argued that the mothers also contribute to this problem. Pregnant women are the vessel in which these children are carried for around 9 months before the children enter the world. During the 9 months in the womb, the fetus is slowly being introduced to various bacteria that the mother produces in order to build the child’s immunity before its birth (Park, 2012). Therefore, it is safe to say, that the health of the mother is essentially a piece of the puzzle of possibly improving healthcare within these rural regions. However, there are still many maternal deaths occurring during birth due to lack of proper facilities, medical staff and malnutrition. What makes this so disturbing is that pregnancy is a natural part of life and their death is only contributed to their unfortunate living conditions. It can be understood that pediatric and maternal health are vital in the development of ones’ overall health in order to survive the harsh conditions of their context, but without proper health delivery at these stages improvement is far. Healthcare Present, Past & Future In the Philippines, the current issue is that there is a lack of specialty care in rural health clinics and therefore rural residents have been traveling to the inner-cities for check-ups. This problem then contributes to overcrowding of facilities and the inability to provide health care services efficiently to the public. Not only does this increase the importance of health care availabil-

ity, but it increases the need for specialty services in the more remote areas to help prevent this problem. A rural area of the Philippines had surveyed its population to indicate how many of their residence have been receiving healthcare services. It was reported that 65% had some form of chronic family illness, yet only 15% of its residents had a medical check-up the previous year (Reyes; Aday, 2005). A national survey had indicated that 77% have used some form of healthcare clinic the past year, but majority who had made this claim were from urban areas (NEDA,2011). This may suggest that because of the need of specialty health care and the distance that must be traveled to receive it, there is a lack of routine check-ups to help prevent complications and the monitoring of any current health issues. If annual routine visits were to become more regular in these areas, the possibility of improving an individual’s health and increasing their overall well-being may be within reach. Importation has become a popular way of providing physicians to areas that are able to provide higher pay. Although this may seem beneficial to some countries, other developing countries have made an effort to provide higher education in medicine in its urban centers. They have been able to provide doctors and nurses, but have not been able to reap its benefits. The Philippines presents this problem very well. It has been a large exporter on nurses; more than 164,000 have been imported to other countries within the last decade (Harden, 2008). Between 2000 and 2008 11,000 doctors have decided to retrain as nurses, just so they can work overseas (Harden, 2008). This is due to financial benefits in which they will be able to bring more money back to their families. Areas of India are going through the similar struggle. They

are actually having shortages on doctors and are importing from places such as the Philippines, while at the same time the U.S. is importing from India. It seems like the world has begun some sort of trading system, but only for those with the highest bid. It seems ironic in the sense that these areas are struggling for healthcare, yet they are actually producing healthcare professionals who are well qualified, but are not practicing where it is truly needed. On the positive side, it proves that these areas are

70% of deaths under 5

years of age are attributed to malnutrition, lack of sanitation and acute chronic illnesses

able to promote interest, determination, and the will to succeed in what they wish to endeavor. A good trait to have in society when there is a need for change.

1.6

Health Diagram (by author, Septem ber 2012)Source credit: FAO, 2012

pediatric and maternal care are vital healthy development. although environmental conditions affect individuals, it is the knowledge and practice of preventative care and the maintenance of health, that can establiah healthier living.

SOUTHEAST ASIA

SUB-SAHARAN AFRICA

Rationale + Goals -Looking into forms and sizes for delivery -Encourage sense of place and social cohesiveness and physical health -Create serialized space: layers of spaces and the in between -Balance between local vernacular traditions and non-local technological imperatives -Initiate long term economic progress -Phases in clinical integration, determined by local needs and budget -Appropriateness of context and user variables

Project Statement

This thesis looks into improving the delivery of healthcare in rural, developing countries by providing a standard of sanitation, care and user experience through prefab packaging design solutions, accommodating to user, program and context. A 2 week field visit was taken to completely understand the culture and environment of Catmon Cebu, Philippines in order to apply appropriate context and user design.

Methods of Investigation

Visits to various forms of hospitals and health clinics, within the region, allowed for key observations in studying cultural behavior and responses within a healthcare setting. Many case studies related to Southeast Asia assisted in design development toward culturally sensitive projects that evaluated materials, program and building construction methods conducive to the local culture. Literature review of global health statistics and current healthcare trends, such as tele-medicine, furthered the study to provide suitable technical applications while still encouraging local methods and techniques.

1.7

The delivery area within a small clinic in Cebu Philippines (by author, September 2012)

With a general approach on this framework, a focus on integrated systems will help accommodate health, culture and the environment. The systems which further investigate these issues are: Human Culture – Behavior & Environmental Responses – Community Health Patient/Family – Doctor/Nurse – Clinic/Hospitals Architecture Foundation – Structure – Interior – Envelope

Theoretical Framework

A holistic approach is needed to provide lasting changes that will not only preserve culture, but provide the capability of advancing forward. In this project, it is crucial to look into global health, its issues and current solutions being practiced in order to improve and implement design strategies that will benefit the developing world. Another part of this framework is looking into cultural differences that effect an environment in order to design for specific regions. In western healthcare, there is a standard in care and design, but does not consider cultural impact as a variable. Understanding the variables that differ from culture to culture, will assist in developing a design that will be flexible enough to function in different parts of the world.

1.8

Coastal town of Danaue. An example of the cultural differences in the way of life and aspects to consider when analyzing a culture (by author, September, 2012)

2 RESEARCH STUDIES

2 Little Girl from Catmon, Cebu Philippines by author, september 2012

During a site visit, this young girl ran up to me so excited to see me with a camera. Seeing so much excitement in her eyes reminded me of how much we have to be thankful for and how much we can affect someoneâ&#x20AC;&#x2122;s life , positive or negative, through the simplest actions.

Literature Review

Although as these rural areas struggle with many obstacles, on the other hand , they are deemed for high life expectancy rates because of the environment of untouched nature. Back in the late 19th and early 20th century, research was being conducted on the effects of being in nature, which this paper will later go into further detail. Architects such as Frank Lloyd Wright, Robert Neutra, and Alvar Aalto, realized from a very early start, how important nature was to oneâ&#x20AC;&#x2122;s self-healing. Places such as the Sunlight Clinic in the Swiss Alps and Paimo in Finland, became the set standard for developing healthcare at the time (Sternberg, 2009). Examples such as these were to understand the response of emotional effects from the encompassing environment. Buettner (2012) tells the story of Stamatis Moraitis of Ikaria, Greece as an example of what possibilities lie ahead when surrounding oneself in nature and social health. Diagnosed with cancer with only 6 months to live, Moraittis decided to move back to Greece from America so he can die in his homeland and be relieved of financial burden from chemotherapy and funeral expenses. The longer he stayed in Ikaria and the more he became involved with his faith, community life and gardening, the stronger he became. Before he knew it, 6 months had past and his cancer was gone. Ikarai, having a population of 10,000, has always been known for itâ&#x20AC;&#x2122;s clean air and water and has a reputation of

2.1

Mainit Springs(flickr/R.Soriano, April 2009)

2.2

A patient at the Chennai Telemedicine center con sults a doctor via video conferencing. (Healthnet Global, Jan 2012)

averaging a life expectancy of100. It can be argued that it differs from rural developing countries in that Ikarai has clean air and water. People in Ikaria eat a Mediterranean diet which is one of the healthiest on the planet (Sternberg, 2009). At the same time, the cultural aspect of faith, social interaction and agriculture is relatively the same in developing countries. This provides reasoning that rural areas of developing countries have the possibility to improve life expectancy through their way of life in community and slow paced lifestyles. In order to attempt any positive change, air and water issues need to be addressed, as well as better health care during the early stages of life. The effects that nature has on the human spirit and human body are still being researched and evaluated for solidarity. Areas with strong ties to nature have the ability to provide long life expectancies if approached with the correct knowledge of the culture

and environment.

TECHNOLOGIES Traveling many hours in search of decent healthcare can cause many complications to arise and at times, even death. However, when primary care is available, diagnosis may not always be correct due to the lack of specialty doctor’s availability (pediatrics, women’s health, orthopedic, etc.). It can be very challenging to try and convince those in the medical field to relocate to these remote areas due to concerns of geographical isolation, poor infrastructure and living conditions, as well as, the lack of funding (Doctors Outreach, 2005). Within the last decade, pilot studies have been conducted to help remedy these concerns and encourage physicians to provide care to rural residents through the use of the Internet. Due to the advancements in telecommunications and its availability throughout the word, the term “E-Doctors” and “telemedicine” are slowly becoming a healthcare norm. The terminology relates to the use of the internet which allows communication between physician and patient, diminishing the boundaries of availability in rural areas. In the Indian village of Hari Ke Kalan, a group of medical related workers did just that. What first started off as an area to receive clean water, Al Hammond, a doctor and entrepreneur, developed small clinics known as “healthpoints” where locals can go to receive medical attention via internet (E.Singer, 2011). For only 80 cents, the locals can go to one of the many healthpoints to receive health care consultations by well trained and experienced

physicians from the city. These small clinics provide health workers the ability to take essential vitals, then “send” the patient to the doctor (via Internet) to conclude diagnosing his/her results. Results and records are kept electronically to provide access to the health workers as well as the physician. The bridging of this gap has so far proved successful, but can also be argued that the physical human interaction between patient and doctor is lost. With so much focus on technology and telecommunications, it forces the visit to a clinic to be less personal. The doctor is no longer there to take the patients hand and discuss the evaluation of possible life threatening diagnosis, yet at the same time not all doctors have good bedside manners. So is there really a right or wrong in the delivery of healthcare? In cases of rural areas where good healthcare is hard to come by, physical interaction or webcam interaction is something that all locals within these remote areas can be grateful for and is truly a step forward in positive applications of technology. Not all technology has been proven to be a success. Medical equipment that has been donated to developing countries tends to be outdated; therefore, is not providing accurate diagnosis. This is not to say that new medical devices are a perfect fit either. In fact, since the more modern devices were marketed for western medicine, the technology may not be as effective in these regions. This causes equipment to be non-functional or unable to provide long term use through the lack of trained operators to maintain it, as well as acquiring expensive parts (Rattue, 2011). The lack of functional technologies may require alternative approaches, or maybe partnerships with humanitarian efforts that have the ability to invent affordable devices that

will provide a standard of care. Emily Pilloton (2010) showcases individuals’ efforts in providing design alternatives for those less fortunate throughout the world. These examples provide inspiration as to the possibilities of design when we truly integrate knowledge of culture and location.

ATTEMPTS OF IMPROVEMENT The United Nations include organizations that aid developing countries. Whether providing food, shelter or health relief, the UN is involved with groups like the World Food Programme (WFP), the Food and Agriculture Organization (FAO), and the International Federation of the Red Cross and Red Crescent Societies (IFRC). The IFRC has been the most involved in providing healthcare to developing countries. Although they are mostly known to aid in disaster relief efforts, other applications of relief are providing primary health care and focusing on the youth. Locally known as the Red Cross, the IFRC is the Federation of all 186 Red Cross organizations throughout the world. Their efforts have been noted since 1865 when their Swiss founder, Henry Dunant, gave birth to the idea during the battle in Solferino, Italy. The international federation didn’t become official until 1919, but even before that year; the Red Cross itself was already providing aid in their local regions. IFRC approaches health care through a holistic method providing long term and immediate goals. With volunteers and leaders in long term initiatives (such as the education and AIDS prevention; maternal, newborn and child health; and water, sanitation and hygiene promotions) the organizations gives communities the opportunity to develop more permanent health infrastructure without

2.3

2.4

A Zulu man wearing liquid glasses, an example from Emily Pilloton’s ‘Design Revolution.’ (M. Lewis, December, 2008)

Cover of “Design Revolution, ” where many life changing designs are showcased (website/ Inhabitat , 2009)

“Today, we recognize the millions of people who count on us for their very survival. The one billion people afflicted by hunger. The tens of millions forced to flee their homes because of disaster and conflict.The children who die from diseases we know how to cure. The women and girls who are brutalized by sexual violence. We need to tackle these problems at their root. But until we do, lives will hang in the balance. And the humanitarian community will be on the scene, rushing bravely towards danger, determined to help people in need.” Secretary-General Ban Ki-moon Remarks to launch the first World Humanitarian Day UN Headquarters, 19 August 2009

relying on aide. A few examples of immediate responses that stimulate the holistic methods are shelter and food relief, blood services, vaccinations, and psychosocial support (providing mental rehabilitation from life changing events). The aide in psychosocial support really defines the idea of an all-inclusive strategy to help rebuild communities in order to adapt to their future. The principles of IFRC have a strong founfolklore, superstitions and economical roles in local and global society. With these factors, the most affected design aspects are the sizes of space and program requirements. For example, patient rooms in the United States are very accommodating for overnight visitors, providing fold out sofa beds, accommodating restrooms, and storage space for personal belongings. The difference in many cultures, such as the Philippines, lies in the fact that visitors would not be limited to the immediate family, but they include extended family, grandparents and the children’s nanny’s (usually one for each child). Cultural differences such as this would call for a need to create a larger, more flexible spaces to house the amount of people while trying to provide comfort for the patient. Although there could be options to implement regulations in the number of visitors for a patient, it might affect the experience of the visit and make it feel unwelcoming or offensive. Various methods of healing may be integrated within the program to accommodate alternative forms of medicine. A popular country that integrates this idea into its practice is China. Ancient Chinese methods of healing have become internationally popular and are now mainstream in western medicine; such as acupuncture, acupressure, herbal treatment, cupping and moxibustion. Programming for such

spaces would require careful analyses to understand the requirements of each room. For example, moxibustion is the use of acupuncture needles with herbal incents burned at the ends creating smoke. It may seem relevant to provide some sort of exhaust to remove the smell of the room, when in fact the scent may actually contribute to an overall healing for other patients. It may also represent a superstition where releasing such healing smoke would simply cause bad luck. Whatever the belief, design detail such as that mentioned, is crucial in providing culturally appropriate design. The Chinese have a very strong cultural background with varying traditions in medicine, ancient beliefs and superstitions. To not honor their tradition, or any country’s for that matter, brings us another step closer in homogenizing. Therefore, cultural evaluation of new program opportunity would be valuable in order to preserve the world’s diverse societies, while encouraging healthy development for the future.

IMPORTANCE OF AIR When it comes to healthcare design, air is arguably the most important factor in preventing the spread and worsening of illness. There are many illnesses that are considered airborne due to densities of pathogens found in the air, such as; tuberculosis, aspergillosis, chicken pox, influenza, and SARs (Zimring, 2008). Sources of airborne particulates vary from outdoor matter, but are usually transmitted from patient to nurse, doctor or visitor and in worse case scenarios, from poorly maintained HVAC systems. In older facilities that don’t have proper filters and aren’t regulated for frequent maintenance, are prime candidates for harboring dust and mois-

ture which could eventually turn into mold and fungi. Once developed within the HVAC systems, the spread of these harmful spores are released into the air, dispersing throughout a building. The best way to approach airborne dilemmas is to provide the facility with proper filters and target the source. HEPA filters, high efficiency particulate air filters, are proven to remove 99.97% of particulate matter as small as .3 um (.00003 cm) in diameter and is therefore the filter of choice in healthcare design. Another factor to consider is the direction of air flow during the ventilation process. In cases of infectious diseases, it is recommended that there is negative pressure to prevent cross contamination. It would be ideal for spaces such as this to be located along the perimeter of a building for accessible exhaust to the exterior. In cases where HEPA filters and high efficiency HVAC systems are not affordable, methods of natural ventilation strategies will have to be utilized. In the developing world, luxuries such as mechanical systems are not always an option. Providing air quality relatively comparable to developed countries should be placed as a top priority to improve the quality of care. Along with natural ventilation, research in vegetation might be a viable option to provide cleaner air, but will have to undergo careful research to determine what species of plants will be appropriate to the geographical context and health settings. Another aspect of air quality contributes to human comfort. It is important that thermal conditions are evaluated and reflected upon the psychrometric chart, to help indicate appropriate environmental settings. The chart is broken up into four areas of measurement with interrelated spaces that indicate the conditions of an environ-

ment. The measurements are wet-bulb temperature, relative humidity, absolute humidity and temperature. The interrelated spaces are characterized by “wetter, hotter, dryer and colder” (Lechner, 2001). Our bodies react to such factors as air temperature, humidity, air velocity, and the mean radiant temperature. When experiencing spaces, research has proven that by providing comfortable air quality, work efficiency increases and stress and anxiety are reduced. This is a very important quality especially in hospitals with high amounts of stress and anxiety. Each building will require different approaches according to their physical location. In order to achieve optimal results, environmental conditions must be manipulated to attain settings within the ‘comfort zone’ of the psychrometric chart. This zone is determined by the temperature and humidity of a space and can help in determining what methods of air control should be used. Factors that also determine this zone are differences in culture, changes in seasons, amount of clothing worn, amount of fat content on the human body and physical activity (Lechner, 2001). The methods used may also vary from mechanical systems to passive systems (the use of natural methods) in order to achieve desired environments. Some strategies may include HVAC systems with individual control systems, gas powered systems, natural ventilation, dehumidifiers, electric fans, daylighting, shading systems and many more methods. Cost will be heavily weighted in selecting the system and therefore evaluating energy saving strategies will be advantageous.

Design Research

THEORETICAL Prefabrication Methods There are a variety of prefabrication methods that have been implemented in architecture. Prefab strategies have the advantage of less time spent on construction because of implemented standardization of the design. Although the argument still remains standing on the issue in the lack of design, it still provides the advantage of financial benefits. When trying to implement building strategies for developing countries, it is very significant to consider these issues of cost and time. Anderson (2007) discusses various methods of prefabrication; panelized 2x4, CNC timber framing, concrete systems, steel framing, sandwich panels and modular systems. When considering these options it is important to evaluate the materiality and the method of assembly, especially when trying to establish construction strategies suitable for different geographical locations. Modular Methods: Shipping Containers The utilization of shipping containers has been becoming more popu-

2.5 Left: Prefabrication done off-site (designventurer,website)

2.6

Right: Transportation of prefabricated parts (lovile, website)

lar as a method of applying architecture. A reason to its success has been due to the fact of its abundance in coastal ports in which receive imported shipments. The re-use of these shipping containers provide a sustainable method of architecture that promotes recycling and the innovation of ordinary things.

Project Delivery: Lean Construction What many designers oversee in the development of a building is the understanding of the best options in project delivery. Because of a holistic approach in this thesis, determining its feasibility is a significant process. After careful evaluation of project delivery methods, the most successfully implemented practice is lean construction. This method is still fairly new in the design field, but has proven itself to be efficient while providing quality. As mentioned earlier, issues of providing successful permanent health facilities will require cost efficiency, thoughtful design to the user and context and the efficiency of construction, characteristics that are embodied in this method. The method of lean construction was developed based on the principles from the Toyota Production System (TPS). It essentially represents craft production of the preindustrial era with integration of mass production provided by the movement of standardization. Forbes and Ahmed (2011) describe a lean system as providing what is needed, in the amount of time needed, when it I needed. The argument made between the successes of this method versus the traditional method (such as designbid-build) is that the traditional approach lacks emphasis on owner satisfaction and performance. This method originally start-

ed with Frank Gilbreth in the 1890’s with his approach in manufacturing processes and their advantage of increased speed and labor productivity. With this in mind, he then applied Fredrick Taylor’s principle of improved labor process. What Taylor had realized was that those laying bricks had spent more time bending down to retrieve the masonry , including pauses for back pain, than actually assembling the structure. He then devised a platform that eliminated the time for pain and bending and therefore increased productivity and reduced labor fatigue. Later on, Lauri Koskela was the one to implement the Toyota Production System and in 1993, along with Glenn Ballard, held their first International Group for Lean Construction. Lean methods can also be viewed as a business plan, stated as “(Our)Final conclusion is that lean cannot be reduced to a set of rules or tools, it must be approached as a system of thinking and behavior that is shared throughout the value system (Diekmann, 2004).” This method is holistic in ways such as addressing the root causes of waste, poor work layout, lack of standardization, management orders, error in communication, and operation errors. With this form of application, the delivery process will result in better uses of resources, especially in labor and material.

PHYCHOLOGICAL Human Behavior and the Environmental Experience Neurological technologies have taken a great step forward in the field of science. The field of neuroscience has become a large contributor in the design field be-

cause of its findings in physical and behavioral responses from human experiences. Evidence-based design (which will later be discussed) relies on many of these findings in order to better understand the built environment and the opportunities it has to improve our lives and essentially our health. In understanding how our brain analyzes our experiences, which then relate to physical and even physiological responses, we must understand the process from experience and the chemical make-up of our body. Because neuroscience research is so extensive, it will be beneficial to focus on a general overview of our senses and how it responds to the environment, while also looking back at our origins of understanding health. Even in ancient times, such as Roman and Greek Empire’s, people had an understanding of the effects the environment had on their health. Placing patients near open windows for fresh air and natural sunlight was a common reaction in response to disease and poor health. Hippocrates was actually the first to implement medicine into philosophy and to determine the importance of the surrounding environment on our health (Verderber, 2010). Understanding the changing of seasons and the impact it had on health conditions, provided strategy in the orientation of buildings. The approach was essentially to provide wellness to the public; a regime of community with nature and the outdoors, involving exercise, water, vegetation, sunlight, and improvement in nutrition and immersion in landscape (Verderber, 2010). Treatments even varied from horseback riding, daily baths and reading under a tree (Verderber, 2010). Similar to Greek methods was the Roman’s use of the bath house to promote human wellness. These bath houses were first used to help Ro-

man soldiers recover from battle and then eventually became the core of the city by promoting personal hygiene, spiritual worship and social interaction. By Medieval times, European cities had declined with regard to health related facilities and the Middle East became innovative with their design strategies of hospitals. Replicating their Prophet Muhammad’s home in Medina, hospitals provided courtyards throughout their facility (Verderber, 2010). They also used screens to provide privacy in required areas, which allowed for continuous air flow and the penetration of sunlight. When the Europeans came to colonize, they built their own infirmaries for their wounded soldiers. The infirmaries soon spread throughout the MiddleEast and contributed to the diminishing of their cultural response to their health care facilities. It wasn’t until 1855 when a nurse, Florence Nightingale, was tending to wounded soldiers during the Crimean War in Turkey, that there was a realization of needed improvement in the infirmaries. Florence Nightingale began to initiate a revitalization of hospitals by authoring books on guidelines she felt were essential design strategies for a “health-promoting environment”(Verderber, 2010), such as, clean air and water, adequate drainage, cleanliness and natural light. This movement lasted from 1860-1945 when World War II ended. Again, these are repeated characteristics that have already been addressed and utilized to promote wellness even in ancient times. Yet throughout history, there has been a recurrent appearance that encourages and neglects these ideas. The argument for providing natural settings with clean air, clean water and natural light can be seen in history as an essential aspect of hospital design to promote healthy, healing environments.

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It is only recently that we have been able to scientifically measure why the design characteristics above, stimulate positive well being and how it occurs in our brain and affects our body. There are many theories relating to human-environment relationships, as well as theories of human perception of the environment, but to examine environmental psychology in its entirety will distract from the main focus: to understand the importance of research contributing to evidence based design strategies and why it is most useful in health care design. Providing a simplified understanding of human and environment interaction, categorizing through our sensory experience may help in this discussion.

Sight

Our visual perception contributes to 80%-90% of the data registered to interpret experience of an environment (Hegger; Fuchs; Stark; Zeumer , 2008). The other senses then contribute by producing a 3-dimensional understanding of space. Prbably the most argued topic related to vision is aesthetics. When we come across preferred settings or scenes registered through our visual cortex, an increase in density of receptors initiate endorphins, which are responsible for putting us in a good mood. It is also suggested that we are wired to have an attraction to fractals, the branching out into smaller parts. Researchers identify the rhythm of pattern as the factor for this aesthetic expression being desirable (Sternberg, 2009). In healthcare design, wayfinding is essen-

tial in getting around a hospital. When we enter a space, we immediately search for visual cues that help us understand the environment and what we should anticipate to look for next. Internal cues help to distinguish past experiences of location through its connection to the balance system of the inner ear and the sensation of muscle and joint movements (Sternberg, 2009). Because internal cues may be altered due to ones’ weakened physical condition, hospitals and clinics should provide clearer methods of wayfinding.

Danaue Hospital under construction while patients wait among the construction workers. An example of how the senses can be affected by this environment (by author, September 2012)

Sound Sound is translated through hairs arranged in a tonotopic map in the ear that detect air movement and frequencies. The brain is a “parallel processor” (Sternberg, 2009), which means that when sound is detected from the ear, it processes through analysis, reconstruction and revision. Through distinctive rhythms, timing and patterns of high and low frequencies, perception of music is evaluated. Daniel Levitin was the first to follow the pathways that interpret sounds as music in relation to emotion through fMRI’s (functional magnetic resonance imaging) of the brain. It was found that music not only affects one electrically and chemically, but some sound signals go straight to the cerebellum (the area of your brain related to balance and movement). When exposed to the same level of sounds for a long period of time, it almost becomes unnoticeable; this is called habituation. So as there are contrasts in sound, the nerve endings will respond better to those actions and stimulate alertness. When too much contrast occurs over a long period of time, it can also negatively affect our health. Rhythms received from an external party can affect the re-

alignment of circulatory rhythms for internal organs, which means that undesirable sounds will produce undesirable results. In general, because sound and music have a strong connection to our emotional response,(e.g.) desirable compositions initiate high levels of oxytocin (love hormone) .This hormone reduces stress and so as stress levels fall, pain tolerance increases and therefore contributes to the need for fewer narcotics or painkillers. Smell Our sense of smell was the last sense scientists researched. One of the reasons why smell is so difficult to interpret is the fact it has a strong relationship to memory, a process developed through Pavlovian conditioning (or classical conditioning) (Sternberg, 2009). The variable of memory is going to be different for each individual because of the dependent relationship of experience. Factors of smell will relate to the amygdala, associating emotional connections, while also affecting the hippocampus, the area in charge of associative learning. It was determined; however, that there is actually a superfamily of 1,000 genes that assist in recognizing odors (Sternberg, 2009). Lind Buck and Richard Axel were the researchers who discovered this breakthrough in 1991, where odor molecules fall into the protein folds that distinguish varying odors. This becomes an important aspect of design when dealing with air quality, especially for healthcare facilities. Contributing factors of odor perception also include temperature and humidity, which if increased actually reduces the perception of smell (Bradshaw, 2006). Pregnant women in particular, produce an increase of estrogen hormones which contribute to their heightened sense of

smell. Strategies of eliminating strong odors would be beneficial when dealing with this user group to reduce the feeling of nausea. Some strategies of design desire the complete opposite and request an emphasis on odors, such as a bakery shop. Many times, restaurants desire their exhaust from the kitchen to expel at their storefront to entice customers. Comfort foods often bring back positive memories of being home, which psychologically lures customers into their establishment. Smell is a very important aspect in developing environments , and depending on program and user group, will require strategic inquiry.

Touch Touch has the ability to provide human comfort and through haptic sense, recognize an object. The idea of ‘comfort contact’ provides “lower blood pressure and respiratory rate, reduces harmful stress hormones like cortisol and raises the level of oxytocin…promotes feelings of well-being” (Howard, 2012). Examples such as this remind us of the importance of not only human touch, but of the importance of animals as well. Recent integration of therapy animals have made its way into hospitals to visit patients and provide comfort to reduce anxiety, while also encouraging physical movement in those who are receiving physical therapy. It was as early as the 18th century that people started to discover the therapeutic value of animals. A British mental hospital had rabbits and chicken roam around the hospitals ground. Through this intervention, they discovered the amount of self-control mental patients had acquired through this inter-

vention (Howard, 2012). Human contact has also been demonstrated to improve health conditions especially in the NICU (Neonatal Intensive Care Unit). Research has shown that by providing a massage, one hour to forty-five minutes after feeding, these neonates show an increase in weight gain, better sleeping patterns, infant behavior that allows better bonding time with the mother and a reduction in stress (Kulkarni; Kaushik; Gupta; Sharma; Agrawal, 2010). As the massage stimulates the circulatory and gastrointestinal systems, stress is reduced due to the reduction in serum cortisol and norepinephrine. Although this aspect of the senses is strongly integrated with the healing process, design strategies are much more difficult to evaluate. Possible considerations could relate to the arrangement of furniture and promoting closer contact between patients, visitors and doctors. With provided scientific evidence of the environment and our behavior, it is important to integrate such knowledge when dealing with a hospital. Patients in poor health make them more susceptible to not only worsening their condition, but suppress their will to get better through the lack of design consideration.

Evidence- Based Design Robert Ulrich was the first to implement studies regarding patient recovery from abdominal cholecystectomy surgery and the effect of having window views. The study consisted of views of a brick wall versus views of trees, and the result was that patients that had tree views required less narcotics and a shorter stay at the hospital(EDAC, 2008). This study was done

before the term evidence-based design (EBD) was used for healthcare. Although this term EBD is used for a very broad range of topics, it provides relative studies for health care design and therefore is a usable process in determining solutions for patient-focused care. In the specialty of healthcare design, it can be said that there are two main approaches: the traditional approach and the EBD approach. “The difference of EBD is that it incorporates available relevant evidence that educates the project team and guides the development of design strategies and 2) it creates new evidence that links design strategies to outcomes which can be shared with the industry to enhance the body of knowledge”(EDAC, 2008). Currently, the use of EBD has been implemented in various hospitals and facilities all over the world. With the help of technological advancements, those using EBD processes have been able to develop successful investigations that further design solutions in healthcare. It can be argued that there are three types of EBD organizational functions used when strategizing for research application. One type is the” research for justification.” This approach primarily focuses on providing data on improved outcomes for key stakeholders that help justify design decisions, which help persuade those of the health community on why changes need to made (Becker, 2011). Another type of research is “research for incremental change.” This method focuses on the concept of small changes made by the implementation of surveys provided by those who experience the spaces being researched. Unlike “research for justification”, this method focuses more on the perspective of the users and identifying what issues are problematic, rather than the success of outcome

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2.9

Top Left Evidence Based Design example from Lurie Children’s in Chicago. Using elements of nature and exterior views to promote healing. (Lurie Children’s/ website)

Bottom Left: Patient room from Lurie Children’s. An example of patient privacy and family accommodations. w(Lurie Children’s/ website)

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Top Middle: Touch therapy with dogs (Chavez, Michael Robinson, September 2008)

2.11

Top Right: Touch therapy with horses (B12patch/website, June 2011)

and the root cause of the situation. The last type of research is, “research for innovation.” Becker (2011) characterizes this approach as emphasizing discovery rather than hypothesis testing and that the goal isn’t based on some scientific research, but more on the designers’ insight into creativity to improve user quality experience. Evidence collected for these approaches are categorized in 5 sections; 1) Health related outcomes, 2) Operational performance and process, 3) Design strategies, 4) Experience and 5) Sustainable design (EDAC, 2010). Through an evaluation of literature reviews by the two leading researchers in the field of EBD (Ulrich and Zimring), they have provided an outline of guided principles that have a correlation in design strategies delivering strong evidence in patient improvement. These principles provide useful strategies when designing for healthcare facilities and should be taken into consideration.

ECOLOGICAL Water Pollution A common issue involving the developing world has always been sanitation, specifically the involvement of water or air: the two biggest contributors to spreading illness and disease. At the same time, the spreading of illness and disease can be prevented. Preventative care is the easiest way to increase health in rural regions and education is a key role in this matter.

The most successful venture in

preventative care has been the filtering of water. Water is an essential part of who we are and the need to survive. “Lack of clean water and basic sanitation is the main reason diseases transmitted by feces are so common in developing countries (World Bank, 2012).” Another contributor to unclean water is industrial runoff from innercities, pollutants found include: organic matter, metals, minerals, sediments, bacteria, and toxic matter (World Bank, 2012). Fortunately, there have been many efforts in providing water filters to developing areas, from the most portable to the most ecological. The most natural way of filtering water is done through the use of clay, a more vernacular approach and an appropriate method for rural areas. The process is simple, the materials needed are clay and organic material ( ie coffee 2.12 grinds), water, and cow dung. After mixing the water and clay, cow dung is used to heat the clay. The use of manure is due to its ability of high temperature heat, it burns up to 1743 F in 30 minutes. During this pro2.13 cess, the organic material in the clay burns and provides porous areas to help filter the untreated water that remove pathogens and most E.coli (96.4%-99.8%). This method can produce .25 gallons of drinkable water in 2 hours (Pilloton, 2009).

Example of water pollution that many parts of the world still have to struggle with. (charitywater/website)

Using natural methods of filtration through clay material(Asia Transpacific Foundation, website)

Because most rural regions in developing countries have high track records of diarrhea and malaria cases, clean water must be attained. Having access to clean water will have most success in regions that have frequent rainfall because of the ability to provide catchment systems and therefore eliminating hazardous or unsanitary contact from soils or runoff. In regions with low annual rainfalls, rely on underground water systems that have unpredictable variables

that may affect the water. In either case, filtering water through portable systems or built structures that are appropriate to available local materials will have a significant outcome in preventative care. Air Pollution Health problems related to air is a lot harder to control in comparison to water. Many of these areas rely on dung, wood, crop waste, or coal in order to provide themselves with energy, usually used for cooking and heating.

2.14

Pollution on the streets (flickr/Frisno, July 2008)

This results in indoor and outdoor air pollution, in which children under the age of 5 years old are diagnosed with acute respiratory infection, causing 1.5 million deaths a year (World Bank, 2012). This is a vulnerability to this age group because they are still developing their respiratory system and do not have the ability to fight off undesirable matter. Another large contributor to air pollution is the use of fossil fuels resulting mostly from industrial plants and forms of transportation. Many other illnesses are attributed to pollution such as respiratory disease, lung cancer, and heart disease. The two key deadly ingredients to this issue are sulfur dioxide and nitrogen dioxide. When these elements pollute the air, it has the ability to produce acid rain and that is when it becomes most dangerous. The water will reach the soil and crops and further endanger the health of those that live within these areas. Seeing that it has the power to affect water sources, it

might be that this issue of air quality needs further investigation. Wright and Diab (2011) conducted a study of air pollution in Durbau, South Africa in order to asses at risk communities and help develop interventions to reduce health impacts. Pollutants found attributing to the health effects were sulfur dioxide, nitrogen oxide, carbon monoxide, particulate matter, ozone, lead and benzene. Although location plays a significant role as to what pollutants are contributing to the problem, this example just provides more evidence as to the realization in the number of hazardous material found in the air. Contributing factors to the spread of pollutants was concluded as; 1) the wind speed and direction, providing concentrated areas in different places; and 2) solar radiation by developing photochemical reactions by producing hydrocarbons and oxides of nitrogen. This assessment determined that vulnerabilities within the population were identified as the general population, health, exposure, socioeconomics and environmental disasters. Their intervention suggested media as a method in communicating this problem and by empowering people to promote community awareness, perceptions, observations and actions in order to reduce health impacts. Analyzing both situations holistically, it seems that the root cause may be from the way energy is produced in these areas because of the presence in sulfur dioxide and nitrogen dioxide. More efforts on education of clean energy may provide some relief to this troubling dilemma. Renewable Energies There are many forms of renewable energy that have been successfully imple-

mented in developing parts of the world. Careful consideration must be taken into account on the geographical location to determine the most viable form of producing green, clean energy. There are four sources that are renewable; they are solar, wind, biomass, hydroelectric and geothermal. Renewable energies are so important in the developing world because it provides delivery of electricity and heat without compromising air quality. In the case of solar energy, its decentralization allows availability throughout the entire world by methods of passive solar, active solar (photovoltaics) and daylighting. When considering active methods like photovoltaics, technical issues and cost will arise; however popularity in application, accessibility and improvement provide more benefits in the long run. Wind is another source in providing clean energy, but will only flourish in areas that contribute an annual average wind speed of 9 miles per hour. In history, this source provided energy to many rural areas, usually as means to pump water for agricultural purposes. A significant disadvantage of this application is the unpredictably of wind and its fluctuating availability. In cases like this, hybrid systems are used integrating PV (photovoltaic) cells to compliment the wind and initiate continuous electricity. In terms of biomass, there are two forms; 1) certain plants grown for their energy content and 2) organic waste from agriculture, industry, or consumers (Lechner, 2001). Biomass energy is considered carbon neutral because the plants grown used for this source remove the same amount of CO2 that it releases when burned. Its disadvantage is that if too much biomass is removed from the earth, it essentially deprives the soil of enriching material that allows for future vegetation. Another form of renewable energy is hydroelectric power which consists of hydro-

electric systems (dams) and water turbines. Hydro-electricity has been around since the Roman Empire using watermills, while water turbines are still currently being improved to generate more power by harnessing the waters current. Dams are the best at storing energy, but have been known to endanger ecological systems that rely on these locations. The last form of renewable energy is geothermal; the use of ground temperatures shallow below the surface. As this reduces energy consumption by 70% in comparison to HVAC systems, it is very efficient because of the exchange in cooler ground temperatures during the summer and warmer ground temperatures during the winter (Lechner, 2001). All these sources of clean energy indicate the vast amount of opportunities the natural environment provides us. Interpreting this information to best accommodate geographical location is our best bet in improving not only air and water quality, but improving the culture and standard of living for the future.

SOCIO-ECONOMIC Global Economy Outlook There has been great successful effort in reducing global poverty during the past four years of international economic struggle. Areas as mentioned earlier; Sub-Saharan Africa and South Asia, are still engaged in high poverty rates due to their lower rates of education and poor health. Through the passing years, East Asia and the Pacificâ&#x20AC;&#x2122;s have been able to decrease poverty by over 50%, but

because of high populations, still hold for top poverty standings (World Bank, 2012). The reoccurring theme of the global economy is its fluidity and dangers of ecological and social effects if not approached properly. Currently there is a relation with high energy consumptions and gross domestic product (GDP), which provides the interpretation that as agricultural areas become more industrialized, there is a greater need for energy (Hegger; Fuchs; Stark; Zeumer , 2008). As demand for energy increases, more developments of renewable sources must be applied or more initiative must be encountered to preserve local technique in agriculture. As a society, communities also need to unite in order to integrate healthier civic projects that allow short term financial gain and provide long term design quality (Foster, 2012). The use of architecture permits the evaluation of challenges contributing to political issues, economic struggle and the opportunity of urban development. An example of an architect that has been attempting to resolve social issues through architecture is Teddy Cruz. He engages in projects that usually involve social issues as a design generator, like property rights and other legal restraints. By addressing concerns such as this, it provides opportunity for local economy to improve. As of right now, the emerging market is referred to as ‘System D.’ Foster (2012) explains “ In 2009, the Organization for Economic Co-Operation and Development (OEeD), a think tank sponsored by the governments 30 most powerful capitalist countries and dedicated to promoting free-market institutions, concluded that half the workers of the world (close to 1.8 billion) were working in System D; off the books, in jobs that were neither registered or regulated; getting paid in cash;

and most often avoiding income tax… System D is multinational, moving all sorts of products ( machinery, mobile phones, computers) around the globe and creating international industries that help billions of people find jobs and services…particularly in the developing world, System D is growing faster than any other part of the economy, and it is an increasing force in world trade…The spontaneous system, ruled by the spirit of organized improvision, will be crucial for the development of cities in the 21st century.” It is truly the time for communities to engage in innovative local interventions to develop small incremental changes. The idea of networking becomes something of a necessity between not only the government agencies, but by neighboring countries or local society. We must analyze the possibilities of globalization and its complex influences from various networks.

“Communities of all kinds need to work together, thinking about the problems they face in holistic ways, and strengthen the fabric that binds them together” (Steffen, 2006).”

2.15

Establishment of wind turbine for power collection(flickr/P.Gerardo, February 2013)

2.16

Butterfly House woven bamboo detail (webs ite/TYINarchitects, 2007)

Case Studies

C2C Container 2 Clinic

Bamboo School

Friend Center

Tangential/Analogous

Building Systems

Climatic + Social

Bahay Kubo

Butterfly House

Loblolly House

Local Building Systems

Building Systems + Climatic

Building System + Performative

22 | LOBLOLLY HOUSE

BUILDING INFORMATION MODEL AWARDS 2007

C2C Container 2 Clinic Tangential/Analogous

ARCHITECT TYPOLOGY LOCATION COMPLETED SIZE Wide windows that sit high on the walls to preserve privacy while letting in light, and circulating air which both cools and prevents infection

ASHEN + ALLEN MOBILE CLINIC NAMIBIA, AFRICA 2006 160 SQFT

About

Analysis

This organization provides healthcare services for women and children by utilizing 8’x20’ shipping containers to low-income communities. Local women are taught to run the facility, which then provides the community with improved woman and child morality rates.

The use of shipping containers is a popular method of providing quick structure in areas exposed to environmental challenges. Although able to provide essential programmatic services, the use of shipping containers is not always appropriate for it’s context. The ability to reuse shipping containers is a good idea when there is an abundance in port areas of importing countries. Even then, many issues arise such as reinforcing the structural integrity and the stripping away of hazardous material.

Adaptable water and power hook-ups for low-resource settings; Climate-controls using solar-powered fans, windows and insulation; Space for comprehensive care: o Two private consultation areas o A laboratory and pharmacy o Areas for recordkeeping o A shaded waiting and patient education area; Mobility: Our clinics can be loaded onto flatbed trucks and re-located to address infrastructure challenges, transient populations or the consequences of disaster. Referenced from: http://www.containers2clinics.org/ what-we-do/innovation/

The key of this design is it’s module application of program. To allow more customization, smaller units should be made. Unfortunately, shipping containers are only fabricated as 20’ or 40’ long units and therefore may not always provide the desired customization. What could be beneficial with this modular idea are integrated design strategies that help promote mental and physical healing.

Bahay Kubo Local Building Systems

ARCHITECT TYPOLOGY LOCATION COMPLETED SIZE

VARIOUS VERNACULAR HOUSING PHILIPPINES N/A VARIES

About

Analysis

The bahay kubo utilizes natural material within the region. The structure responds to the natural environment and weather related conditions. The interior of the spaces is an open floorplan to allow flexibility for the family needs, such as storing food and areas to sleep. The natural ventilation is the most beneficial feature because of the tropical conditions of high humidity and temperature.

The construction method utilizes only natural materials, including the connections of members. With itâ&#x20AC;&#x2122;s ability to absorb seismic conditions makes it an ideal structure to use in this area. Because it is the regions traditional method of building, it makes it resilient for the townspeople to easily reconstruct and gather materials.

NATURAL VENTILATION REDUCE SOLAR AGIN RESPOND TO INSECTS & FLOODS

structure connections roofing envelope

bamboo dried rattan bundled cogon grass nipa palm & other grass

Bamboo School Building Systems

ARCHITECT 2BW STUDIO TYPOLOGY SCHOOL LOCATION THAILAND COMPLETED 2012 SIZE --

About

Analysis

This project was completed for a competition regarding Thailandâ&#x20AC;&#x2122;s Burmese refugees and based on the concept that as humans, we need to learn and teach, no matter the circumstances. The premise of the competition was to develop and design a school that would cater to refugee relief. In this proposal the design involves a modular approach that can be assembled and disassembled when needed. The design is essentially a system of parts with a paneling system that provides its own connectors in order to disassemble and inner change.

The modularity of this project presents a very flexible approach in the design, especially when dealing with refugees. Although the paneling system design is very well executed with provided connectors, ideally the use of only local materials and methods should be used. Because of the connectors plastic composite, if any damages occurred or a piece went missing, it would be much more difficult to replace. The ability to replace and repair the structure by the local community themselves is an important factor when designing for remote areas. A design should provide self sufficiency with accessibility to all the parts needed.

The building of a new school in Thailand, for Burmese refugees, highlights the need we as humans have to learn and to teach, no matter what the circumstances we may find ourselves in. PLANT (11.9 sq m)

CLASSROOM BLOCK (53.5 sq m, each 17.8 sq m)

STORE (11.9 sq m)

As Burma is responsible for more refugees than any other country, there is a poignant importance to providing an environment, which is educational, caring, and protective for displaced children. Part of this provision must include finding new responses to educational buildings and refugee relief. Traditionally school buildings are a valued part of the community they serve, adding both character and focus to their environment.

SERVING AREA (11.9 sq m)

REFECTORY (35.7 sq m) BREAKOUT AREA / FUTURE EXPANSION COURTYARD PLAYGROUND

BREAKOUT AREA (23.8 sq m)

TOILETS (17.9 sq m) OFFICE (35.7 sq m)

This design proposal responds to the above situation by providing a series of sheltered spaces and enclosures that encourage children to learn play and be rehabilitated into the local community. The design is intended to be colourful, warm and promote a feeling of safety and sanctuary where children will be able to develop and learn new skills. The design is based on a modular construction system which allows the buildings to easily expand to suit future uses or a different site if required. The arrangement of the building blocks creates a protected space that is easily visible from most angles ensuring that staff members can monitor the children and ensure their safety whilst they learn and play within the school grounds. The primary entrance is from the south and all visitors must pass by the office / admin area thus ensuring a high degree of visual security.

PLAN 1:200

CLASSROOM BLOCK (53.5 sq m, each 17.8 sq m)

Two primary ideas were considered, firstly the need to create an environment that would serve as a hub of learning. A school that encouraged Work, Play and Rest. We envisaged a plan to bring this about by incorporating a series of perimeter buildings, with a central play area. This is easily adaptable, allowing the school to remain functional and reflect any changing requirements of sites. Linked with this was the need to ensure the school would relate to its environment and would â&#x20AC;&#x2DC;sitâ&#x20AC;&#x2122; lightly on the landscape.

WORK

PLAY

REST

All access to the site passes the administration building to ensure some level of security and presence at all time. Deliveries and plant maintenance are separated to the east of the site and pedestrian movement to the south.

Four buildings form the courtyard, the two facing buildings as highlighted being the classroom with the administration building to the east containing reception and office facilities and store room with the plant room adjacent.

Play facilities located within the courtyard and a football pitch behind the toilet block form recreation space for students.

Alongside the refectory, sheltered areas have been provided to provide protection from the weather during school breaks; opportunities for class breakout space and future expansion of the school.

The second primary idea considered was the design and construction of the school and the need to ensure that the building was not only easily constructed, but equally easily dismantled as having to be relocated at short notice being a real possibility with the future. This focus upon the construction detail, the materiality and aesthetics would then drive the design.

COMBINED DETAIL

BAMBOO SCHOOL 1 OF 4

EXPLODED DETAIL

DETAIL The walls are made of panels; 610mm x 1220mm, with each corner having a quarter of a circular hole cut out (to accommodate the through bolt), there is a horizontal strengthening strip of wood fixed to each panel (top and

BTI4757

ACCESS

REAR VIEW OF CLASSROOM BLOCK

Butterfly House Building Systems + Climatic

ARCHITECT TYPOLOGY LOCATION COMPLETED SIZE

TYIN TEGNESTUE ARCHITECTS ORPHAN HOUSING NOH BO, THAILAND 2009 3,800 SQFT

About

Analysis

The butterfly house is designed for orphaned children in Thailand in hopes to increase social interaction, and provide individual private spaces. The structural members in the design are locally found within the region and prefabricated to be easily assembled on-site and treated for moisture and rotting. The paneling is then produced by local artisans to encase the structure, and because of Thailandâ&#x20AC;&#x2122;s hot, humid climate, the design allows for natural ventilation to help circulate the air.

The practicality of the project is an ideal approach toward applying sound architecture while engaging in local laborers and traditions. The scale of the project is also very appropriate, not only for the user, but for the context of the site. It provides the essential features that are encouraging toward the development of a child, such as, play areas and private spaces to help themselves reflect on their day to day experiences. With such specific users like orphans, it is important to understand their needs and make sure they can grow in the right kind of environment

Constructability:

Materiality:

Local laborers and artisans have the ability to showcase their talents and provide jobs. The attention to detail bring life to the architectural language and provides playful characteristics, appropriate for children.

Friends Center Climatic + Social

ARCHITECT TYPOLOGY LOCATION COMPLETED SIZE

Gallery spaces are removable for exhibition spaces

Energy Recovery Ventilator. Captures & recirculates heat to reduce electrical load Locally designed ceramic tile and sink basins

Entry to face quiet side + vestibule id airlocked to maximize A/C efficiency

COOKFOX ARCHITECTâ&#x20AC;&#x2122;S OUTREACH PAVILLION SEAM REAP, CAMBODIA 2008 3,800 SQFT

About

Analysis

This pavilion is an extension from the Childrenâ&#x20AC;&#x2122;s hospital in Angkor. The purpose of this building is to provide cultural history of Cambodia and educate visitors on what the country has to offer and how to save it by sustainable approaches, It serves as a gallery space, showcasing photographs from around the country, as well as showcasing cultural exhibitions. It is located within the top pediatric center in Cambodia and therefore wants to also promote health education.

The program provides visitors a sense of culture and respect for Camobia. The openness and flexibility of the program is ideal, in that it can accommodate according to use. The sustainable strategies are apparent, yet very simply done, appropriate for a developing country. The symbolism of water is an important factor and possibly something to focus on, as it is within the same region of South-east Asia.

Sustainable Strategies Sustainably harvested bamboo louvers The overhang is designed to shade the interior glazing from the tropical sun. The bamboo louvers are acting like a double skin facade, allowing ventilation to occur, cooling the glazing. Rainwater reservoir channels water to a cistern for later use Sustainable harvested bamboo louvers overhang is designed to shade the interior glazing from the tropical sun. The bamboo louvers are acting like a double skin facade, allowing ventilation to occur, cooling the glazing. The roof angles itself to allow the rainwater to trap itself in the center of the building, creating a cistern space. The water is then harvested for later use. The design being central in the floorplan also develops a focal point that draws users to want to understand how and why there is a glass encasement. It provides sustainable education and focuses on the symbolism of water, such as, healing, tranquility and providing life. Roof also allows for photovoltaic panels to provide energy

Loblolly House

Building System + Performative

ARCHITECT TYPOLOGY LOCATION COMPLETED SIZE

REGONITION 2008 Institute Honor Award for Architecture, American Institute of Architects

2007

R&D Award, Architect Magazine, Light weight Facade Systems (with Melvin J. and Claire Levine Hall-Universityof Pennsyl vania and Sculpture Building-Yale University)

2007

Citation Award, Technology in Architec tural Practice Building Information Model, American Institute of Architects

KIERAN TIMBERLAKE SINGLE FAMILY RESIDENCE TAYLORS ISLAND, MARYLAND 2006 1.,800 SQFT

About

Analysis

This prefab residence is derived from the concept of the local loblolly tree. Itâ&#x20AC;&#x2122;s methods of prefabrication are unique in a sense that it has various systems within a system. They categorize the parts by 1) The Scaffold 2) Cartridge 3) The Block and 4) The Equipment. By the use of integrated BIM programs and business collaboration, this project was a success.

The prefabrication system used in this project is what intrigued me. I wanted to focus on the assembly process and how it all came together. They way they defined the system as the scaffold, cartridge, block and equipment simplified the process. The cartridges provided the power and could become the floor or ceiling. The spaces that required mechanical were built into blacks and placed on one side of the design ( assuming that the connections are easier when placed on the same side). Because the systems already provide the integrated parts, assembly becomes easier, although the delivery method must be taken into consideration, according to location.

Legal Issues

Although the International Building code is the means of standard guidelines, rural developing areas provide flexible restrictions. Most legal issues will vary community to community, and will require discussion between local councils and neighboring residents. Considering its healthcare typology, ADA applications are required, but due to relaxed guidelines, they are not necessary in these areas. In the example of this project, ADA policies will apply toward ramp slope designs for the ease of access during emergency situations.

2.17

Ramps at Danaue hospital (author, September, 2012)

Financial Issues

The target market of this project caters toward the lower income areas of rural, developing countries. In a real-world situation, this project would act as a satellite clinic , or extension of a government hospital. It is up to that government to determine what areas will benefit from certain specialty care. Possibilities with private investors or organizations will be encouraged in order to implement â&#x20AC;&#x2DC;Local Jump-Start Clinicsâ&#x20AC;&#x2122;. The communities receiving these units will have the control of application and therefore have control over budget and labor in this process. This provides an opportunity for the community to come together and apply design, unique to their culture and way of life, making it a symbol of hope and community.

Preliminary Building Systems

Primary Structural System With the location of the Philippines and its tropical climate, degradation of the material and the resilience to structural performance must comply with possibilities of typhoons and other forms of natural occurrences. A post and beam system composed of exposed bamboo will not only lie on a pile foundation system to accommodate fluctuating water heights, but the materiality itself naturally reduces seismic conditions. Bamboo is locally grown and has been proved to withstand environmental conditions when constructed appropriately, as displayed in vernacular architecture throughout history. When damaged, this material is easily replaceable and grows rapidly compared to other natural woods. With a vernacular approach, no alternative forms of connections will be made. Only traditional techniques of joinery and connections will be utilized to accommodate cultural knowledge and technology. Providing aerodynamic forms of the envelope will be essential in decreasing the chances of uplift during typhoon season, but will still need to accommodate to natural ventilation techniques to provide consistent air circulation.

2.18 Marked bottoms of bamboo (website/bambooroo.net, May 2011) 2.19 Bamboo (website/bambooroo. net, May 2011)

Envelope Form Typhoon prone areas require design features that respond to wind forces and reduce the chances of damage to the structure. Figure represents the ideal forms that reduce the chances of up lift during high wind speeds. While trying to develop the exterior envelope for uplift, it is also important to incorporate strategies for stack ventilation, which will later be discussed.

Preliminary MEP Considerations Due to natural methods of ventilation and thermal comfort, having the structural system on a pile foundation allows for a large crawl space which will provide connections for plumbing requirements (most likely the use of septic tanks), as well as electrical needs. Heat pumps maybe considered for the heating of water, in order to assist in sterilizing equipment. Storage placement of this water maybe most beneficial above the roof for natural heating of the water. Independent air handling units will be a viable option, especially for delivery rooms. Providing individual control for each unit will allow efficiency in construction and delivery, while also catering to the opportunity of an active cooling system, when natural ventilation is not sufficient. The use of a dehumidifier, such as a desiccant system, was considered, but due to high temperatures, this system would only remove the humidity and therefore increase temperatures that are still considered a discomfort. Opportunities for solar energy are available, and require proper placement for optimal results. Although electrical needs may be provided on the site, solar panels

should be included in every package to reduce long term cost. Integrating solar panels will also encourage the surrounding community to start thinking sustainably and initiate greener technology. These considerations encourage locations that are more flexible and therefore present criteria of ideal sites for the design, which will later be discussed in Chapter 4.

Preliminary Sustainable Considerations In order to apply sustainable strategies, the geographical location provides information needed to design appropriately towards the context.

2.20

Sketches exploring methods of traditional bamboo construction. Source Credit: website/ guaduabam boo.com

Philippine Climate Cebu, Philippines is classified as a tropical zone and provides characteristics such as: -Relative humidity averaging around 80% -Direct solar radiation -Low air pressure -Tropical storms like cyclones, typhoons and hurricanes -Annual average rainfall of 5â&#x20AC;&#x2122;4â&#x20AC;? -Annual temperatures ranging between 78.2 â&#x20AC;&#x201C; 92 degrees Fahrenheit (Hegger, Fuchs, Stark, Zeumer, 2008) Hegger, Fuchs, Stark, Zeumer (2008) suggest that building requirements for such areas should require air circulation to promote heat dissipation (resulted from transpiration), appropriate building form and orientation, shading systems to relieve heat storage from direct solar radiation, and finally good ventilation and rainwater drainage to prevent damage of water saturation.

Issues of Heat and Humidity Moderate to extreme heat and humidity poses physical threat and structural damage to a built environment. The most important reason why heat is so significant is that it deals with our physiological makeup of the human body. Reactions such as heat stroke may occur due to the lack of blood reaching the brain in time from increased heart rate from the heat (Bradshaw, 2006). When working in hot and/ or humid environments, work efficiency is compromised due to the sensitivity of the skin and on an individual basis, amount of body perspiration; elements regarding the human comfort factor. Possible design applications to reduce the chances of this reaction may involve; color, shading, orientation, form, vegetation, insulation, daylight and control of interior heat sources (Hegger, Fuchs, Stark, Zeumer (2008). A successful example of a traditional approach towards heat avoidance is from Japan. By providing lightweight construction, shoji screens (which are light and movable) and movable walls to create outdoor spaces called engawa, air is able to cool down through constant circulation and through the avoidance of thermal storage by using lightweight material. The most common design application towards this issue are shading devices. There are many approaches that are inexpensive and very effective in reducing solar heat. In regards to the Philippine climate, lightweight, breathable materials, such as membrane tension structures, are ideal because of itâ&#x20AC;&#x2122;s ability to provide ventilation. When vegetation is in abundance, it may be the most inexpensive option. Tall trees with large canopies allow air to pass through an area, while providing shaded

ground cover. Lower shrubs and bushes are not as effective because they actually block prevailing winds from circulating through an area. Plants in general also collect moisture in the air, creating smaller, more humid zones. It will be best to use smaller plants along the perimeter of a site rather than placement along areas that will benefit from natural ventilation. Opportunities with Rainfall The amount of annual rainfall provided by the Philippineâ&#x20AC;&#x2122;s tropical climate zone allows for opportunities with rainwater harvesting. Taking advantage of this natural occurrence will provide a beneficial environmental impact as well as preservation of the structure, decreasing the likelihood of water damage and rotting mostly at the foundation. With features to collect rainwater, some criteria must be met. The location of the basin is the most important element. To prevent algae growth, it must be placed away from direct sunlight, yet have a location where the water may naturally fall into the catchment system (Bradshaw, 2006). Downspouts and gutters are a good way to redirect water if the form of the roof does not directly lead the water into a cistern. Rainwater harvesting will provide the opportunity for toilet water, landscaping irrigation and drinking water. Water requiring a pump for functions such as plumbing and landscaping, may be more beneficial in a larger cistern with a built in pump and sediment filtration, whereas if the water is used for drinking, the storage itself may have a filtration system already built inside for immediate use. Cistern materiality ranges from galvanized steel, concrete, erro-cement, fiberglass, polyethylene or

durable wood, but should always be large enough for the function of the intended use (Bradshaw, 2006).

2.21 2.22

An example of a concrete water cistern (flickr / picturing our world,2011)

Girl harvesting water (flickr / global water partnership, Feb 2011)

Specialized Building Performance Criteria

Acoustics The application of acoustics towards consultation rooms and exam rooms benefit patient and doctor privacy with personal, sensitive information. Security Security is required with each unit delivered, to protect equipment and medications that are administered. Circulation Due to the pediatric and obstetric program, circulation is divided into two different parts of the clinic. This provides specific experiential qualities for each user group that is highly recommended for their development and/or recovery. Separating areas of well check-ups and sick visits is an essential design feature to promote healthy lifestyles.

Parking

The most common form of transportation is walking and the motorcycle. This resulted in the development of motorcycle parking at ground level at the entry of the site. Delivery truck pathways are accessible through the site to provide routine treatment, vaccination drop off and the delivery of modular units

2.23

Motorcycle on road (author, September 2012)

3 DESIGN RESEARCH + ANALYSIS

3 Barangay Tabili by author, september 2012

This view was taken before the hike. Hidden and scattered through the landscape were small homes of local residences and somewhere along the tree lines, our destination.

Luzon

Pre-Design & Field Analysis

Regional Analysis

MANILA

Cebu lies in the central area of the Philippine archipelago , the Visayan Islands. It consists of 42 municipalities in which only 8 are considered ‘cities’. Its geographical location indicates seismic conditions, typhoons,

CEBU

Mindanao

Located within South-East Asia, Cebu Philippines is part of the central Visayas Islands. Cebu has become a major exporter of high end furniture and mangos and has a growing population of 4 million within it’s province. Cebu City holds a major exporting harbor and has become the 2nd most populated city in the Philippines. Cebu also holds a lot of history regarding the Spanish infiltration. When the Portuguese explorer Ferdinand Magellan came to the Philippines, Cebu is where he landed. With a long story short, his wife had given the natives a statue of baby Jesus and from then on, the natives have celebrated this gift, giving them Catholicism. Every year a national fiesta is held in Cebu in honor of Santo Nino (the baby Jesus) called Sinulog. This elaborate event has grown in scale and is slowly being recognized throughout the world as an event to visit (held beginning of January). The island is rich in natural resources, but most importantly, religion.

Visayas

Cebu, Philippines

Capital: MANILA Population: 103,775,002 7,000+ Islands divided into 3 main areas: Luzon Visayas Mindanao

3.1 Diagram(author, 2012) Source Credit:

It’s geographical location makes it prone to earthquakes and typhoons, but provides it with rich biodiversity.

LL RA NT CE EY TE U FA

CATMON

T UL FA

CEBU CITY

EA ST

RA NT CE

S RO EG LN

L HO BO

LT FAU fault line approximate fault line 112-134 MPH 89-112 MPH 67-89 MPH

3.2 Diagram (author, 2012) Source Credit: Department of Science & Technology Philippines, February 2000

december wind direction july wind direction

and with the islands typography, it shows that there are mountainous ranges that divide the entire island between its western and eastern half, limiting the access roads to the inner city making traveling distances longer. Visit to Cebu, Philippines The most valuable information regarding the research of this project was found through my own personal experience to Cebu Philippines in September 2012. I spent two weeks in Cebu City with trips to northeastern coastal towns such as Danaue and Catmon. Being full Filipino with my family from Cebu, I was fortunate enough to visit many times as a young girl. This last trip was my first time visiting on my own, as well as having a new outlook on the experience at hand. Now that I am

older and more aware of social and political situations, I was able to experience the visit with a new perspective.

My goal during this trip was to evaluate human behavior in the healthcare setting, healthcare trends that could be approved upon, cultural habits that would affect the built environment and ways in which sustainable strategies may be implemented. During my visit, I was fortunate enough to tour various types of health facilities ranging from public hospitals, private clinics and smaller facilities. The number of users

varied depending on the type of funding the facility receives. As assumed, Cebu City Medical Center, a public government hospital , was the most crowed and least maintained, whereas the private hospital, Perpetual Succour, is facilitated by nuns and provides well designed spaces. Perpetual Succour encouraged the process of healing through the environment and therefore included pocket gardens and started to adopt the concept of healing through visual arts, such as paintings and photography displayed as a gallery. Another privately owned clinic I had visited was, Mt. Zion Maternity Home. This was the cleanest facility I had been to so far, but it is also owned by a very selfless individual who takes the time and effort to provide quality care at a very reasonable price. The furniture used in the facility was actually her own furniture from her house. She was kind enough to take me around to other maternity homes to show why she provides the services that she does. The first stop was a maternity home about 15 minutes away from her clinic in Bacayan. Although a fairly small facility, it was able to provide the healthcare needed. The spaces inside were divided by partitions and curtains for privacy, but it was the walk there that made the location unfit for maternal use. This was because of the steep flight of stairs that spanned a good distance, enough to observe the uncomfortable experience for the patience walking to the clinic. It wasnâ&#x20AC;&#x2122;t until the following day I was accompanied by a co-worker of Mt. Zion to a much more distressed maternal home. The location itself was among the high density housing of the lower income areas of the city. One would have to live there in order to know how to get to the clinic. It was my first time walking through the populated slum ar-

eas of the city and it was quite the experience. Upon arrival, it was required that we take of our shoes because of sanitary purposes. The clinic itself was adequate, but due to the lack of space, it was hard to move around and patients had no sense of privacy. When asking the nurse as to how long the women would stay, she had replied that most stay for a few days only because they can not afford it, but need the recovery. Apparently, it is very common that these women have postpartum depression due to unwanted pregnancies and most of the woman that came have been raped either by a stranger or their own family. There are so many unfortunate events that happen in our lives, that every so often we need to be able to get away from it all. Thatâ&#x20AC;&#x2122;s what these woman were trying to do. This situation signifies the importance of patient privacy and architectural elements that will allow to improve the human spirit. Just north of Cebu City is Danaue, a smaller seaside town and the destination for Catmon locals for when they need to go to the hospital. On the day of my visit the city hospital of Danaue was still going under construction. Although, in most settings when construction is in progress, the healthcare facilitators may shut down wings or relocate to temporary facilities, but in this case there was no enforced restrictions. Just a few feet away from the welder were parents and their kids with ivy bags, hanging from a wooden beam. Even though it sounds unsanitary and harmful, one thing that I did admire about

3.3

Cebu City Medical Center waiting lines (author, 2012)

this area was the lifestyle and positive attitude of the locals within the community. It provided the thought of hope for new ideas that could help improve these areas and strengthen the idea of community.

3.4

3.5

3.6

Left Page/Top Left Column: Upon arriving to the Bacayan Health Center, we first had to walk a long set of stairs , an example of accessibility (author, September 2012) Left Page/Bottom Left Column: Inside the maternity clinic. The small space had curtains and thin plywood partitions to divide the spaces. (author, September 2012)

Left Page/Top Right Column: Inside Mt. Zion Maternity clinic. The privately owned clinic provided the cleanest facility and the beds were from the owners own home. (author, September 2012)

3.7

Left Page/Middle Right Column: Inside Mt. Zion Maternity clinic; delivery room. (author, September 2012)

3.8

3.9

Left Page/Bottom Right Column: Perpetual Succour pocket gardens to promote healing and tranquility. (author, September 2012) Right Page/Top Left Column: Inside Paanakan Maternity in Mandaue. (author, September 2012)

3.10

Right Page/Bottom Left Column: On the way to Paanakan Maternity in Mandaue, walking through the residential tight spaces. (author, September 2012)

3.11

3.12

3.13

Right Page/Middle Left Column: A monkey in a rusty cage along the way to Paanakan Maternity in Mandaue. (author, September 2012) Right Page/Top Right Column: Danaue Health center(author, September 2012) Right Page/Bottom Right Column: Parents with their children receiving treatment near the construction site.(author, 2012)

DISTRIBUTION ANALYSIS

AGRICULTURAL DISTRIBUTION

jan feb march april may june july aug sept oct nov dec

Economic and geographical conditions overlay information that will allow better placement for this healthcare network. Relating areas of frequent weather related conditions, areas of rural families and agroforestry and current accessibility to health services, will inform and generate an appropriate system to help improve rural healthcare.

sugarcane corn camote banana mango carrots coconut onions cassava palay cabbage

AGRICULTURAL DISTRIBUTION

3.14 3.15 3.16

Agricultural Distribution (author, September 2012) Source: Department of Agriculture, 2011 Healthcare Distribution (author, September 2012) Source: Philippine Development Plan, 2011-2012 Health Network Opportunities (author, September 2012)

This chart provides demographic assumptions and opportunities where healthcare may be less accessible. Crops indicate contextual environmental conditions and diet of the community.

HEALTHCARE DISTRIBUTION

HEALTH NETWORK OPPORTUNITIES

xisting healthcare ution informs us ural health units

e distributed evenly, et are still very unerutilized due to a emand in spealty care. This as forced nercity hostals to ecome v e n o r e opuatd.

“cities” (opposed to municilaplities with fewer financing) public hospitals

areas to benefit from “jump-start” clinics

CURRENT HEALTHCARE DISTRIBUTION

HEALTHCARE NETWORK OPPORTUNITIES

It is important to understand the relationships between current public healthcare facilities so that connections can be made between rural areas with the lack of healthcare accessibility. Research has shown that even though primary facilities are available within each municipality, they remain under utilized due to the desire of specialty care. This forces locals to populate government city hospitals where specialty care can be found.

Combining the agriculture and healthcare distribution maps, we can find reasonable distances in which locals would travel to Local Jump-Start project clinics. Indicated are opportune areas where these clinics will thrive.

3.17

Along a small windy road through the hillsides marks the crossroads (author, September 2012)

Local Analysis Catmon, Cebu

trips to the town center for daily events or errands by those living further into the mountains.

Catmon, Cebu, is a municipality north of Cebu City with a totaling population of just under 30,000. This area is rich in culture, religion and environmental awareness. It is currently a top producer of coconuts and holds the second highest peak on the island, Mount Kapayas. This area is very lush in vegetation and provides many springs and caves that made it a popular hiding area during World War II. Its central town center consists of three Barangays, San Jose, Corazon and Flores, which are bordered by two major rivers, Bawo River on the northern end and Naghalin River on its southern end. Catmon recieved its name due to a language barrier between Spanish explorers and native Filipinos. When asked the name of the area by the foreign visitors, the locals thought they had asked the name of the tree of which they were sitting under to hide themselves from the heat. So in a misunderstanding, they replied â&#x20AC;&#x2122;Catmonâ&#x20AC;&#x2122; and since then the name has remained. Within each Barangay of Catmon, there is always a story to be told of the past that has been passed down from generation to generation. This reflects the strong family ties between communities and the lifestyle that they still practice. Although still equipped with some modern technologies, such as telecommunication systems, there are still many areas that are less inhabited and provide a simpler lifestyle. The location of this clinic will be located within this area due to its access roads and centralized facilities, used by the entire area. This provides convenience in visited

3.18

Barangay of Tabili (author, September 2012)

BARANGAY’S OF CATMON

SAN JOSE DUYAN

POBLACION | CENTRAL AREA

CORAZON

SITE LOCATION

FLORES CAN - IBUANG TABILI MACAAS TINABYONAN

AGSUWAO

BACTAS GINABUCAN

ANAPOG

CATMONDAAN

CABUNGAAN

BONGYAS

CAMBANGKAYA

PANALIPAN

AMANCION BASAK BINONGKALAN

3.19

Barangay Map (author, March 2012)

POPULATION & ACCESS

AGRICULTURE ACCESS SAN JOSE

MULTI PURPOSE CO-OP.

DUYAN

PUBLIC MARKET

CORAZON

MAJOR ACCESS ROAD PROVINCIAL ROADS

CAN - IBUANG

POPULATION

TABILI

16 000 TOTAL 2 000 - 3 000 7 000 +

MACAAS TINABYONAN

29 863 TOTAL # OF HOUSEHOLDS POPULATION DENSITY

FLORES

5,996 268.9

AGSUWAO

BACTAS GINABUCAN

ANAPOG

CATMONDAAN

CABUNGAAN

BONGYAS

CAMBANGKAYA

PANALIPAN

AMANCION BASAK BINONGKALAN

3.20

Population and Access Map (author, March 2012)

TYPOGRAPHY & NATURAL FEATURES

R BAW O RIVE

MT. KAPAYAS (CAMBANGKAYA) MT. TABAYAG (DUYAN)

G HALI N RIVER

AS RIVER MACA

984’ - 1639’

GA UN

IV AN R

NATIONAL ROAD

1640’ - 2296’

T ES SEA O CA M

000’ - 985’

3.20

VI E

NE G

P AN

Land Features Map (author, March 2012)

A LIP A N R I V

LAND OCCUPANCY BASED ON ENVIRONMENTAL FACTORS

1 HR WALKING DISTANCE areas best for crop production due to variations in slope, locations of available water and consistant solar acces solar availablity can only be accessed in the morning hours due to it’s easterly location of the Cambangkaya mountains. vegetation will not be as successful in these areas. mostly rugged coastline. only area to not promote vegetation.

water patterns in addition to locations of access roads, it can be argued that these areas are occupied by resident’s of Catmon. (undetermined locations for remaining 16,000 population)

WATER PATTERNS

3.21

Land Occupancy Map (author, March 2012)

SAN JOSE, CATMON

VE R

BA W

BARANGAY

SAN JOSE DUYAN

POBLACION | CENTRAL AREA

RO A

RELIGIOUS INSTITUTIONS

CORAZON

SITE LOCATION

FLORES CAN - IBUANG TABILI MACAAS TINABYONAN

AGSUWAO

BACTAS GINABUCAN

ANAPOG

CATMONDAAN

CABUNGAAN

BONGYAS

CAMBANGKAYA

Old Catmon Cemetery

San Guillermo Church

Catmon Municipal Cemetery

PANALIPAN

AMANCION BASAK

EDUCATION

BINONGKALAN

3 11

12 13 14

Catmon Central Elementary School

Jurado Foundation School

Passionist Sister’s School

BUSINESSES 5

ET RE

NATION

AL ROA

3.22 San Jose Map (author, March 2012)

N BO

IFA

IO C

Pryce Gas

Catmon Consumer’s Multi-Purpose Cooperative

Rural Bank

Petron Gas Station 10

GOV’T INSTITUTIONS NA G HA L IN

Municipal Hall 11 RIV ER

Multi-Purpose Complex 12 Public Market

Rural Health Center 14

3.23

San Guillermo Church #2 (wordpress/ capricornbeartakeshi, November 2008)

3.24 Catmon Municipal Hall #11 (wordpress/pi-

noybyahero, July 2012)

3.25 Multi-Purpose Complex #12 (facebook/

DISTANCES & CIRCULATION

15 min

m in

. 6-8 min

6-7 min

This provides information that indicates how the roads and streets are being used by the local community. Paths with heavier vehicular traffic can be noted to provide wider crossings, where as paths with pedestrian and motorcycle use are much narrower in scale. Everything within the selected area can be reached within 15 minutes by walking and when overlaid with the context map, provides true scale of existing local architecture.

IPALITY MUNIC D O SUG N BLACIO SE PO SAN JO

in. 8m

6-7 min

6-8 min

SAN JOSE POBLACION CORAZON POBLACION

vehicular traffic motorcycle 3.26 Distance and Circulation (author, March 2012)

pedestrian

major destinations site

528â&#x20AC;&#x2122; = .1 miles

Bawo River

ay Roa

Barang

Central Elementary School

3.26 Man pedaling on a tricicad (author, September 2012)

3.27 Two men on a motorcycle on Barangay Road (author, September 2012)

3.28 A truck delivering pigs (author, September 2012)

san guillermo church municipal hall

rural scale

residence 87

SITE ANALYSIS

NATIONAL ROAD

BAWO RIVER

SITE CATMON CENTRAL ELEMENTARY SCHOOL

BARANGAY ROAD

scale: 160’:1

3.29 Site Analysis (author, March 2012)

528’ = .1 miles

Connection to the river allows for opportunities in providing water, while also utilizing water’s calming properties for future users.

delivery truck access

*width clearance

funnels circulation to channel public vs. patients

411’

playscapes that vary according to child developmental stage placement for future phases

3.30 Bawo River (author, September 2012)

3.31 Bawo River (author, September 2012)

353.31’

It’s fertile soil provides lush landscape which may be advantageous for natural shading systems and acoustical buffers for privacy.

3.32 Center of Site (author, September 2012)

3.33 Tall Trees in Site(author, September 2012)

60.4’

3.35 Across Barangay Road (author, September 2012) Develop public open space at entry for community interaction and street activity.

Lot 723, CAD 991-D 22,000 SQFT

3.34 Barangay Road (author, September 2012)

Programming

Healthcare Program The scope of this project will include essential program for a pediatric and obstetric clinic. The following charts will provide a look into needed spaces, square footages, and design feature opportunities for specified functions. Pediatric Goals -Aid in the different developmental stages of adolescence -Promote social interaction -Provide central play areas for visual security Obstetric Goals -Encourage stress reducing environments -Promote self relaxation and tranquillity -Encourage intimacy to engage with personal relationships for maternal support

3.36

Nurse and child at Cebu Medical Center (author, September 2012)

3.37

ER at Cebu Medical Center (author, September 2012)

PEDIATRIC CENTER Space

1,823 sqft + CIRCULATION

Proposed Use

waiting area

will accommodate around 20 visitors; include sick area and well patients

reception administration

accommodations for 2 employees providing patient services.; office work; records

exam area

basic exam area for height / weight / infant station

nurses station

storage for vaccines; hazardous material; prep work for patients; testing

exam rooms

where the physician will examine the patient; accommodations for parents & family

physicians office

storage

Approx. Sqft

Primary User

Features

700+ sqft

children 0-18 parents family members

indoor/outdoor spaces for play areas; restrooms; TVs; reading area for kids

16 x 20

220 sqft

staff

connections to nurses station for increased communication; flexible spaces for office equipment

10 x 8

80 sqft

children 0-18 parents family members *nurses

specialty equipment for infants; restroom nearby for urine samples; semi-privacy

15 x 15

225 sqft

nurses

10 x 10

100 sqft

for the purpose of analyzing patient diagnoses; small meetings; office work

10 x 15

150 sqft

office supplies; maintenance equipment; cleaning supplies

6x8

48 sqft

refrigerators for vaccines and certain medications; medical equipment storage; area for basic tests;sink

children 0-18 parents family members physicians

exam table; sink; seating for parents/family; medical equipment; natural light

physician

desk; seating; book shelves; connection to clinical staff; privacy

custodian staff

shelves; areas to store large equipments

Split office exam rooms admin

waiting area

office

Back of House

nurse

exam 1 exam area

exam 2

Patient Access

Liz Oyas . Studio 902 . Thesis Overview: Site and Program . Winter 2013

exam 3

exam 4

OBSTETRICS / MATERNAL CENTER Space

Proposed Use

3,273 sqft + CIRCULATION Approx. Sqft

Primary User

Features

700+ sqft

patients family members

visual connection to play areas for when they bring their kids; restrooms; TVs

16 x 20

220 sqft

staff

connections to nurses station for increased communication; flexible spaces for office equipment

basic exam area for height / weight

10 x 8

80 sqft

patient *nurses

restroom nearby for urine samples; semi-privacy

nurses station

storage for vaccines; hazardous material; prep work for patients; testing

15 x 15

225 sqft

nurses

refrigerators for vaccines and certain medications; medical equipment storage; area for basic tests;sink

exam rooms

where the physician will examine the patient; accommodations for family

10 x 10

100 sqft

patient family members physicians

exam table; sink; seating for family; medical equipment; natural light

mammogram testing

sole purpose for mammogram testing; images process at off-site location

10 x 10

100 sqft

patient

mammography machine; diagnosing equipment

delivery room

delivery for birth

15 x 15

225 sqft

patient family members physicians

delivery beds; delivery equipment; flexible space for nurse movement; infant cleaning area

outpatient rooms

post delivery; few overnights

20 x 15

300 sqft

women family members physicians

bed; lounge for family; restroom; TV; sink; closet

physicians office

for the purpose of analyzing patient diagnoses; small meetings; office work

10 x 15

150 sqft

physician

desk; seating; book shelves; connection to clinical staff; privacy

storage

office supplies; maintenance equipment; cleaning supplies

6x8

48 sqft

custodian staff

shelves; areas to store large equipments

waiting area

will accommodate around 20 visitors; include sick area and well patients

reception administration

accommodations for 2 employees providing patient services.; office work; records

exam area

Patient Access admin

office delivery

waiting area

nurse exam area

Liz Oyas . Studio 902 . Thesis Overview: Site and Program . Winter 2013

outpatient

Back of House mam exam exam exam

exam 4

Patient Access

TELEMEDICINE SYSTEM Space

112 sqft

Proposed Use

Approx. Sqft

for non-appointments who telemedicine TELEMEDICINE SYSTEM need questions answered or

station

have concerns

Space

Proposed Use

telemedicine station

outdoor telemedicine stations

8x6

used as a “triage” station, emergencies and monitoring illneses. all medical diagnosing equipment will need no medical facilitator.

The idea of the outdoor telemedicine stations would be a service product implemented into the program as a “feature”because it is not an “architectural” idea, but more of product design. I would like to eventually provide details of how this feature would work because I feel that this idea is truly what could provide and improve healthcare in rural developing The idea of the outdoor telemedicine stations would countries. be a service product implemented into the program as a Allows “feature”because it is not “architectural” for self monitoring of an disease, health and up to idea,date but more of product design. I would like towithin a information on any illnesses increasing eventually stationsprovide radius. details of how this feature would work because I feel that this idea is truly what could provide and improve healthcare in rural developing triage stations rural countries. clinic

48 sqft

Approx. Sqft

for non-appointments who need questions answered or have concerns

used as a “triage” station, emergencies and monitoring illneses. all medical diagnosing equipment will need no medical facilitator.

8x6

TBD

48 sqft

# 4

Primary User children 0-18 parents family members

TBD locals

* what would be provided inside the clinic; for physician consultations and non-appointments

Features

112 sqft

seating; small pullout exam table for when requested by physician on the other end

Features architecturally: platform andexam awning seating; small pullout

table for when requested by devices : physician on the other end basic 1st aid tourniquet aed machine architecturally: preganacy sterile kit platform and awning stethoscope blood testing devices : blood pressure orthoscope basic 1st aid webcam tourniquet speakers aed machine solar panelssterile kit preganacy -providing energy and stethoscope telecommunication power blood testing blood pressure * what would be provided in triage orthoscope stations webcam speakers solar panels -providing energy and telecommunication power

* what would be provided inside the clinic; for physician consultations and non-appointments

* what would be provided in triage stations aed machine

stethoscope

Allows for self of disease, health and up to citymonitoringrural date information illnesses increasing within a triage stations hospital on anyclinic stations radius. rural rural clinic clinic

triage stations triage stations stethoscope

Liz Oyas . Thesis Overview: Site and Program . Winter 2013 city . Studio 902 rural triage stations hospital clinic

rural clinic

aed machine

triage stations

Liz Oyas . Studio 902 . Thesis Overview: Site and Program . Winter 2013

COMMUNITY PARK Space

Proposed Use

community rooms

social gatherings; health lectures; activities

restrooms

restroom

park area

play, activity, social family gathering

675 sqft OF BUILT SPACE Approx. Sqft

Primary User

Features flexible spaces that will be able to be outdoor and indoor space, depending on activity

public

TBD

public

filtration system

whatever is left over

public

playgound; built in outdoor activities; seating; tables; shade

15 x 15

225

remaining sqft for commnuity park pediatric clinic maternal clinic telemedicine mechanical circulation

AVAILABLE SQUARE FOOTAGE 22,000 sqft ESTIMATED SQUARE FOOTAGE program 5,883 sqft circulation 1,470.75 sqft mechanical 753 sqft total 8,106.75

5,883 x 25% circulation = 1,470.75 sqft of circulation 7,353.75 x 10% mechanical = 735 sqft (will utilize environmental strategies) 22,000 - 8,106.75 = 13,893.25 sqft available for community park space Liz Oyas . Studio 902 . Thesis Overview: Site and Program . Winter 2013

PROGRAM APPROACH

PHASE 1

CORE PLACEMENT

phase 1 program 2 nurses 1 admin 2 telemedicine stations

grid size

services

CORE

ventilation

Physician O Physician H Exam Room

sterile air

Nurse Delivery Room Administration (2) Telemedicine Stations

natural light

TO INCLUD

visual privacy

TO INCLUDE:

acousitcal privacy

When it is dete munity can af visiting phys monthly and and exam roo ibility of these minimized sq cost.

1280 sqft incl. circulation

PHYSICIAN

The core will consist of essential needs for preventative care with the application of telemedicine stations. Using these clinics as extensions of government hospitals, the purpose of the core is to establish a health foundation. Nurses will be the main care giver of these facilities and spaces will be adaptable with the use of interior partitions.

program features

In order to allow flexibility and expansion, the concept of developing in phases presents the idea of clinic integration that is determined by the communityâ&#x20AC;&#x2122;s need and budget. The design begins to evolve by understanding essential services and spaces that require indoor spaces versus outdoor spaces. This present the idea of a modular approach in the architecture, to accommodate the programs flexibility. A grid system will be explored to help assist in program placement, size and adjacency.

4x8 8x8

restrooms

8x16

delivery and labor unit

16x16 D

nation that that is determined by the need and and budget. is determined by community’s the community’s need budget.

1 1 SE

CEMENT LACEMENT

PHASE 2 2 PHASE

PHASE 3 3 PHASE

PHYSICIAN INTEGRATION PHYSICIAN INTEGRATION

“AS“AS NEEDED” NEEDED”

3 is 3any additional spaces it is determined that that the comst of essential Phase is any additional spaces When it is determined the com- Phase consist of essentialWhen according to budget. Spe-Specan can afford the next phase, tive carecare with withmunity needed according to budget. munity afford the next phase, needed entative can can nownow be integrated rotate telemedicine cial spaces be integrated visitingphysicians physicianswill will rotate cial spaces of telemedicinevisiting of community culture, and and share housing unitsunits as aaspart clinics as extena part of community culture, monthly share housing ese clinics as exten-monthly as; prayer areas, public com-comexam roomroom office spaces. Flex-Flex- suchsuch t hospitals, the theand and as; prayer areas, public exam office spaces. ment hospitals, rooms, public restrooms, of these spaces is desired to to munity isore to isestablish a aibilityibility munity rooms, public restrooms, of these spaces is desired to establish implementation etc. etc. square footage and and parkpark Nurses will will be beminimized implementation minimized square footage on. Nurses of these faciligiver of these facili-cost.cost. be will adaptable be adaptable orterior partitions. partitions.

program exam room combined

physician housing unit lecture space

grid size

services

phase 2

ventilation

600 sqft incl circulation

sterile air

PHYSICIAN INTEGRATION

natural light

All Metioned All Metioned Special Spaces Special Spaces (according to community) (according to community)

visual privacy

Physician Office Physician Office Physician Housing Physician Housing Exam Rooms Exam Rooms

acousitcal privacy

TO TO INCLUDE: INCLUDE:

program features

m on e Stations cine Stations

TO TO INCLUDE: INCLUDE:

4x8 8x8 8x16 16x16

SITE STRATEGY The approach of this site will be unique due to itâ&#x20AC;&#x2122;s narrow nature and lush landscaping. It is important to not only engage its surrounding context appropriately, but to also apply the healthcare program accordingly in order to promote health and wellness for the community. The following diagrams will discuss the approach in site design and its development.

HOUSING private

CLINIC

semi-private

PARK / USED AS WAITING AREA semi-public

PARK public

PROGRAM HIERARCHY Develop transitions between layers and provide appropriate designs according to program and users.

ss delivery acce

anticipated high volumes of social interaction

s n ces odes ac

natural ventilation

allow for modular connections

us sha er re d ex pe pro g rie nc ram e tra spa c ns itio e n

individual reflection with reduced social interaction

PLACEMENT / USE OF GRID Design strategy for grid approach and program placement.

USER EXPERIENCE Differentiating between user experiences and how to treat transitional areas. *Required access for delivery trucks.

100

4 DESIGN PROCESS

4 The Simple Life by author, september 2012

We had finally reached our destination. After enjoying a traditional feast of lechon, roasted pig, it was a nice relaxing afternoon. In this photo, it was nice to observe and lookout down the lush hillside and take note of the lifestyle and architectural detail.

101

102

Schematic Design

Modularity + Expansion Prefabrication and modular techniques will be developed in order to provide flexibility and cost efficiency, and in doing so, it will provide a standard of care and sanitation.

103

Sketches + Sketch Models

MIDTERM These set of sketches explore the concepts of basic forms and their ability to expand and connect with one another. Exploration in creating outdoor spaces from forms was examined.

104

105

FINAL As the scale of the project is established, the health units become more defined and detailed according to itsâ&#x20AC;&#x2122; designated program. Delivery methods of the units are explored and investigated with attention to operable options. Design development of the site is explored.

ea. unit max. weight: 877 lbs total sqft: 540 *Allows for more program, but provides less space

MODULE SKETCHES Foldable options to fit within delivery truck parameters. ea. unit max. weight: 1,096.8 lbs total sqft: 576 *More space, but less program

106

By defining the size of the units, it was crucial to break down the program requirements into only the essential needs for each module. This is where the packing system concept was explored.

107

SITE DESIGN Indicated in Chapter 3, the site was divided into four sections. These sketches explore concepts of the park design and how to develop transitions between the hierarchy of spaces.

All paths require sufficient widths to provide delivery trucks access to the clinic entrance. This is to provide the drop-offs of unit modules and any vaccination deliveries.

108

CLINIC DESIGN Exploring the placement of program according to site conditions explained in Chapter 3.

109

ROOF DEVELOPMENT These concepts explore form that relate to a rainwater catchment system.

110

ENCLOSURES These sketches investigate the development of the interior and exterior skins and their enclosure systems.

111

Charette Results

EXPLORATION 1 “Making Connections”

Minimal On-site Assembly Based on circulation and programmatic units

housing units

exam units 196 sqft core units 750-900 sqft

delivery units circulation paths 18’= 2 units 36’= 4 units pediatrics

This design concept relies on the use of circulation paths which allow additional units to extend from the core, as needed according to program and budget. These circulation units (built open or closed) provide the connections that are needed in order to expand the design while also allowing minimal on-site assembly to offer faster delivery. Opportunities of vertical connections may be a possibility if site constraints are too challenging.

housing

BAWO RIVER

obstetrics

Presented are refined ideas based on the growth of modular expansion within the chosen site. (PRE-MIDTERM)

park space transportation parking

BARANGAY ROAD

112

circulation units may be designed open or closed

EXPLORATION 2 â&#x20AC;&#x153;Redefining Boundariesâ&#x20AC;?

BAWO RIVER

core

possible connections

obstetrics

Utilizing the grid according to the programs structural framing, it will provide the paths for future expansion. Prefabricated panels will provide the enclosure that will be placed within the grid and allow for customized opportunities according to program and site context. Open grid areas may serve as the circulation of spaces and may provide extended shaded areas. Vertical expansion may also be explored.

housing

On-site assembly of panels Expansion based on on structural grid

pediatrics

delivery units exam units

housing units

park space opportunities for open spaces

BARANGAY ROAD

113

CONFIGURATIONS Exploring connections and possibilities of various forms that have the ability to develop according to site and environmental factors

EXPLORATION 3 â&#x20AC;&#x153;Playing with Formâ&#x20AC;? The hexagon The hexagon form was explored to provide more connections and to help with multidirectional growth. Structural Concept Stilt Construction: Will allow for minimal ground disruption and provide natural ventilation and shaded areas. Materiality Steel Framing: Prefabricated for panel integration and connections between program Bamboo and other natural wood: Used in circulation paths Environmental Features Materials: Taking advantage of local resources to provide construction materials Ventilation and Cooling: Integrating natural ventilation through the use of material and construction methods. Allowing program to be placed vertically provides shade in areas where patients will be waiting. Rainwater: Devising attachments that will provide a rain catchment system to harvest drinking water; will include water reservoir. Daylighting: Placement of program allows natural lighting by opening up towards the western region.

114

PEDS

MAT

PEDS

MAT

PEDS

Examples of possible connections

In order to allow flexibility and expansion, the concept of developing in phases presents the idea of clinic integration that is determined by the community’s need and budget.

EXAMINING AREA

NURSE

ADMIN

BAWO RIVEROR PHYSICIAN OFFICE AREA

PHASE 1

MAT PEDS

Housing Units

EXAMINING AREA

TELEMEDICINE AREAS

Using the hexagon to relate spatial requiremnts towards the form

EXAMINING AREA

PHASE 2

BAWO RIVER

PHASE 3

CORE PLACEMENT

PHYSICIAN INTEGRATION

“AS NEEDED”

When it is determined that the community can afford the next phase, visiting physicians will rotate monthly and share housing units and exam room office spaces. Flexibility of these spaces is desired to minimized square footage and cost.

Phase 3 is any additional spaces needed according to budget. Special spaces can now be integrated as a part of community culture, such as; prayer areas, public community rooms, public restrooms, park implementation etc.

Exam Rooms Nurse/Midwives Delivery Room Lecture Rooms Administration (2) Telemedicine Stations

Pediatric Core Physician Office Physician Housing Exam Rooms

Housing Units

Delivery

Maternal Core All Mentioned Larger Waste Rooms Incinerator Rainwater Harvesting

Delivery

MAT Exam Rooms

Liz Oyas . Studio 902 . Thesis: Proposal 1 . Winter 2013

PEDS

Maternal Core

Pediatric Core

Community Units Circulation is exposed to the exterior

Circulation is exposed to the exterior

Community Units BARANGAY ROAD

BARANGAY ROAD

115

Final Presentation Work

Key design elements focused in this presentation were project scale, delivery and the debate between manufactured vs. on-site fabrication. Health modules were further investigated to provide essential needs within a small amount of space.

OPTIMIZED DELIVERY

It is safe to say that rural communities are often involved in the export of their local products. By taking advantage of common delivery methods that are currently being used, the size and scale of units being delivered may benefit by accommodating to fit within these parameters. Not only in the Philippines, but internationally, the Izusu Elf Truck is a common delivery system in many imports and exports within each country, such as: lumber, animals, produce, etc. Because delivery paths, trucks, truck drivers, and parts are already available and routine, it provides a practical approach in the first step in designing deliverable health modules. Although this system increases carbon footprint, it still yields practicality in budget and the likelihood that this design can become realistic. By taking advantage of local technique and material availability, the actual assembly and placement will incorporate natural connections to avoid alternative metal joinery, to reduce the replacement of parts that are not always readily available. Another key element in the design is the actual weight and size of the units. Lack of machinery in parts of the world must be recognized and therefore providing a size that is manageable at a human scale is essential. Distinguishing between what is manufactured and what is not, is still a debate of conversation at this point. Recognizing that there is a an idea of a generic design (the health modules) and an application of site specificity, the resolution to the architecture is still in process.

116

1,096.8 lbs 1,096.8 lbs

MOST COMMON DELIVERY METHOD “ISUZU ELF”

DESIGN PARAMETERS Max. weight: 4,387.2 LBS Bed dimensions: 16.5’x6.7’

total sqft 576

SCALE OF RURAL ROADS

3’

8’

motorcyles + pedestrians 8’

117

HEALTH UNITS + CONTENTS (142SQFT EA)

RECORDS KEEPING USERS Nurses

DELIVERY UNIT + EMERGENCY

FUNCTION Organizing Info.

USERS Nurses Patients Surgeons

REQUIREMENTS Seating Storage Organizing solutions Lockable storage

plan view

USERS Nurses Patients

Surgeries

REQUIREMENTS Surgeon Comfort (AC) Sealed Procedural Bed *Storage Prep-Area + carts

plan view

TOILET UNIT

CONSULTATION ROOM

FUNCTION

FUNCTION Telemedicine Consultation

OPPORTUNITY FOR SELF-EFFICIENCY Photovoltaic panels Rain water harvesting Sink to Toilet water cycle

5’ MIN REQUIREMENTS Privacy Seating T.Equipment plan view

plan view

NURSING STATION + PRE-EXAM AREA USERS Nurses Patients

plan view

118

FUNCTION Pre-Examination

REQUIREMENTS Sink Fridge Storage Prep-Area Seating

EXAM ROOM + OFFICE (PHASE 2) USERS

FUNCTION

Physicians Patients

Examination

plan view

REQUIREMENTS Sink Exam table Storage Prep-Area Seating Office area

o bs

ri c

p e d i a tr

Private Enclosure Public Enclosure

PHASE1: +- 1428 SQFT SCALE : NTS

119

ASSEMBLY AND CONNECTIONS

MANUFACTURED PARTS This sequence goes over the process of the potential system on how to assemble the units onto a site.

parallel grid layout

6’

120

9’

6’

A grid was developed to provide an easy application of the modules (defined by opened unit dimensions)

Displaying the connection applied in order to place unit on grid

Decided by program requirements + exterior conditions

INTERIOR

ENVELOPE SITE STRUCTURE

SERVICES

Peg connection to provide placement on the grid

Grills to connect and lock in unit onto grid system

Placement of circulation paths

Although not resolved, this discusses the application of the envelope as the last procedure

121

ON-SITE LOCAL TECHNIQUES Traditional methods of bamboo connections and joinery were displayed for the presentation to assist in the idea of the envelope/shell to include these basic concepts as part of the architectural language.

Connection With Inner Plug

With a drill, provide a hole for the connection of the lashing tie on the horizontal member. If the lashing is tight enough and the inner plug provides the right fit, both can resist transitional force, but nonetheless it is still very durable.

Connection With Inner Plug

122

Plug-In Connection

This technique is used for poles with greater diameters by using a hardpin bolt and wedge. Considered to be a more extravagant connection, it utilizes 5 holes with a bolt that provides a conical form to ensure safety in all directions.

north-west

south-west

ENVELOPE A preliminary attempt towards the exterior envelope of the clinic. This shows responses as to form of the envelope.

PLAN VIEW

waiting area

north-west

south-west

PLAN VIEW

waiting area

123

WOMAN’S WAITING AREA

124

delivery truck access

*width clearance

funnels circulation to channel public vs. patients

h o u s i n g area (to be resolved (integrated with Phase 2)

playscapes that vary according to child developmental stage placement for future phases

2 1

125

126

PEDIATRICS WAITING AREA

127

Notes + Conclusions

MIDTERM How to respond architecturally Question telemedicine feasibility and how the community would feel about western medicine practices and technology Research local materiality Defining and applying generic designs while initiating site specificity Prefabrication and the â&#x20AC;&#x2DC;kit of partsâ&#x20AC;&#x2122; The midterm presentation displayed site analysis which is to be explored in order to inform the architectural design. Technology, construction methods and materiality raised questions on appropriateness towards this specific area.

128

FINAL Drop the background on the boards. Great drawings. Enhance hand drawings. Need to consider climate VS material and how one impacts the other. What happens when this area gets hit by a storm? Work on the space between skin and the module.

specificity relating to the architectural system. The grid system that was applied might be too invasive on the soil because of the amount of footings needed. Maybe redeveloping the grid so it becomes less invasive might provide a better opportunity for placement. Overall, now that the general application of the concept is applied, the next step is to develop the outer shell to provide site specific architectural language.

Solid idea, good deign concept. Work on minimum requirements to be applied in any site. What are the preferred conditions? How do you anchor modules?

The final had successfully applied a concept that could become feasible for this project and would now require more

129

4.1 Bamboo Structure (web

site/holcimfoundation.org, March 2013)

130

Design Development

Structural Detailing Now that the program details of the clinic have been established and the architectural modular concept defined, the shell structure and system properties need to be developed.

131

Sketches + Sketch Models

MIDTERM The form of the units were re-explored due to the feasibility in light weight material and the possible inclusion of circulation. More simplified design and processes of connections in application were driving factors. Less parts = Easier assembly.

Again, using a grid to provide easy placement for units. This concept includes circulation rather than having to assemble and construct on-site.

132

Configurations

Looking into minimal foundation footings to reduce the scale of the grid system; developed in the schematic phase. These sketches display the idea of using the least amount of footings to withstand the load of the modular units.

133

STRUCTURE Derived from a more contemporary approach towards vernacular designs, the responses of form were developed from the same principle of traditional architecture, which are environmentally driven. These concepts focus more on the resistance of uplift and providing air ventilation.

Using the same principles in response to environmental factors, this concept provides a more contemporary form in design. The asymmetry of the angle creates a more dynamic aesthetic.

This approach uses the more traditional form relating to a dutch gable roof. This focuses more on the aspect of natural ventilation through the stack effect.

134

Also evoking a more contemporary design, it provides a very clean and simplistic form. The repetition of form will also allow workers to easily duplicate the structure in other areas of the building.

135

Midterm Presentation Work

LOCAL : Shell / Envelope

LOCAL : Structural Components Designed as 2 separate systems; the module units and the shell, provide the an opportunity for boosting local economy with labor and ease of repair in cases of natural disasters LOCAL : Circulation Pathways

MANUFACTURED: Interior Walls

MANUFACTURED: Module Health Units

LOCAL : Foundation

136

Passive System + Shell Formation Located in a typhoon prone area, designing for fluctuating water levels and increasing wind speeds are essential in forming the shell of the structure. Because this occurs only a portion of the year, natural ventilation and program requirements are largely focused on in this project.

137

delivery truck access

*width clearance

funnels circulation channel public vs. patients

M 5’’ MIN

5’ MIN

h o u s i n g area (to be resolved (integrated with Phase 2)

138

playscapes according t developmental stage placement future

Entrance to site / Park area

139

Entrance to Clinic

Units + Shell Formation The design of the units have finally developed into a detailed module. The attachment of the units to the site and its varying parts, has been simplified into a design element along the perimeter of the floor. The shell structure has taken form towards a more contemporary design and informs responses to its environmental context.

140

141

Final Presentation Work

142

Unit Delivery

Placement 2

3 4

Assembly 143

MODULE DETAILS Integrated storage units Pull down, lockable doors to provide the security of documents and health related risks Electronic equipment will be provided Integrated plumbing for hand washing and toilets Fridge for maintaining vaccines Surgical tray and basic equipment Surgical bed

Nursing Station

Consultation Room

with telemedicine services Provided Nursing with Unit needed mechanical Provided Consultation Unit as a basic necessity for when inand plumbing connections in order person physicians are not available. Provided with needed mechanical and Provided with telemedicine services as a ba-

to qualityplumbing standards in the delivery connections in order to provide of quality standards in the delivery of care. care.

144

sic necessity for when in-person physicians are not available. Customization of panels are designed to cater varying user groups.

Toilets

Included with t tached sink wh water for flushing be required for sa

Records Keeping

Emergency/Delivery Room

Basic Equipment and surgical bed inNeeded toRecords provide updated health cluded,Delivery with /necessary mechanical the toilet Toilets is an atKeeping ER records for required vaccinations, connections. Partitions provided for hich will recycle itâ&#x20AC;&#x2122;s Included with the toiletsand is Needed to provide updated health records equipment surgical bed included etc. with hopes to progressively post-opBasic same dayand recovery. g. A septic tank will an attached sink which will for required vaccinations, etc. and with with necessary mechanical connections. electronic. recycle itâ&#x20AC;&#x2122;s watergo flushing. A hopes to progressively go electronic. Partitions provided for Post-Op same day anitation purposes. septic tank will be required for sanitation purposes.

recovery.

145

Pediatric Consultation Unit *Highlighting the idea of interchangeable panels to cater to user groups.

Wall Assembly and Variations Type1 4â&#x20AC;? panels providing an acoustical barrier and moisture barrier treatment

Type 2 2â&#x20AC;? recycled resin panels providing visual barrier

Lock in place panels

146

Movable panels to provide extra space during high volumes Panel to also provide customization for varying user groups.

photovoltaics bamboo roofing hard pin connections and lashings SIP structural insulated panels

OSB engineered flooring

2 1

bamboo beams moisture barrier

A|WALL SECTION SCALE: 3/4” = 1’-0”

netting under open floor crossed pegs 147

LEGEND 1 2 3 4 5 6 7

Parking Seating Area Activity Area Health Clinic Obstetrics Waiting Area Spaces Reserved for Expansion Housing Units

6 5

Access Entry From Street Into Park

Areas near site entrance provide market vendor space for when volumes increase during â&#x20AC;&#x2DC;vaccination daysâ&#x20AC;&#x2122;. Developing an inviting and open entry was important in order to engage community involvement and continuous use of the public park.

2 1 148

149

Clinic Floor Plan

Acting as a satellite clinic from the government hospitals, doctors are rountinely assigned a month-to-month rotation. This allows for rountine vaccination and pharmecutical deliveries. Vaccination days will take place throughout certain days of the month, allowing those that live further out to plan their trips to the clinic. In order to cater to volumes of 200-300 patients, the movable wall panels may accomodate to such high demands and the park will provide waiting spaces.

150

Interior View of Clinic; Facing Records Unit View From Clinic Into Pediatric Waiting Area

151

Womanâ&#x20AC;&#x2122;s Waiting Area

152

Longitudinal Section

153

INTEGRATED STRATEGIES Rainwater Harvesting

Passive Ventilation

With moderate rainfall, there is a great opportunity for the collection of rainwater for daily uses. Filters within the barrels will provide an easy way of accessing drinkable water

The sites elongated form develops an opportunity for passive ventilation that passes through the building with the open floors and the process of stack ventilation.

Air Conditioning Units Humidity is a discomfort in high temperatures and therefore areas in tropical regions such as the Philippines will benefit from this active system. Each module will have the option to have AHUâ&#x20AC;&#x2122;s included and will have floor registers built in.

South Elevation 154

Photovoltaic Panels With high temperatures and high solar paths, photovoltaic panels are a great way to provide self-sufficiency. They will be located on the south facing roof .

155

STRUCTURAL DETAIL

Double Column Detail

Hard pin connections are made to secure columns and lashings, from strips of bamboo, hold the structure in place

Exterior Panelling Detail Culms of the bamboo are flattened and made into a board that is then woven through the structure.

156

Roofing Detail

Splitting the bamboo and removing the nodes, allow the pieces to interlock and are then pinned to the roofing structure.

157

Sink 1 Fold out table 2 Toilet 3

Kitchen

4 Bathroom

Basin / Shower head 4 Storage 5

Bedroom 6

Murphy Bed 6 Closet 7 *1 Office and/or additional room 8 *2 Built on-site; Outdoor 9 space

7 8

*1 Office

*2 Living Area

Housing Modules

Housing Floor Plans

West Elevation

158

Housing modules are divided into two types of units; 1) Rooming Units and 2) Mechanical Units. This allows for housing units to expand and extend or easily duplicate. They may be provided for nurses on staff, but are mainly in use for live-in physicians.

159

Notes + Conclusions

MIDTERM Show us more about aesthetics Refine the design concept: open VS Clean and insect free Provide better site plan for existing conditions What are the exterior panels/walls for units? Materiality and morphology Prefab vs local arch

The midterm presentation went fairly well. The form of the envelope needed more reason as to itâ&#x20AC;&#x2122;s morphology and also

160

needed representation on boards. Start focusing on details and discuss materiality.

FINAL Completed and well thought out Could have included preferred conditions The main rendering is indicating some type of platform , fix The final presentation went very well. A few challenges they had made were related to the choices of foundation, such as, the choice of concrete footings and its application in rural areas. Overall, it was the modest scale and realistic vision that brought the project recognition.

161

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5 CONCLUSION

5 Papaya Tree by author, september 2012

Even though smaller communities, such as Catmon, donâ&#x20AC;&#x2122;t have as much as other parts of the world, they have been able to take advantage with what they have. The positive attitude they reflect should teach us to be thankful and try not to take things for granted.

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CONCLUSION

Although this thesis has not quite formulated a recipe to save the world, it at least concludes to provide a feasible opportunity for a chance to initiate long term success in health improvement and local economy. Ideally, it would have been a bit more convincing if applications of this concept were applied in different cultural and geographical settings to display the adaptability and customization of the architectural system. If including the application to other culturally rich areas, it would have also furthered the debate of how important it is to be culturally and environmentally sensitive when designing for any given context. Overall, the process and outcome have proposed a successful architectural system that will cater to healthcare needs of rural communities everywhere.

â&#x20AC;&#x153;We, who have so much, must do more to help those in need. And most of all, we must live simply, so that others may simply live.â&#x20AC;? -- Ed Begley, Jr.

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BIBLIOGRAPHY Abidan Derakshani, F. (2012). Appropriating, Reclaiming and Inventing Identity Through Architecture. Architectural Design, November / (220: Human Experience and Place: Sustaining Identity), 30,31. ACCH. (1987). Child Health Care Facilities (p. 329). Washington D.C.: ACCH. AIA for Health, & FGI. (2001). Guidelines for Design and Construction of Hospital and Health Care Facilities (2001 Editi., p. 176). Washington D.C. and Dallas, TX: AIA and FGI. Allen, E., & Iano, J. (2009). Fundamentals of Building Construction: Materials and Methods (Fifth Edit.). Hoboken, New Jersey: John Wiley and Sons, Inc. Anderson, M., & Anderson, P. (2007). Prefab Prototypes: Site-Specific Design for Offsite Construction. (S. Tennent, Ed.) (First Edit., pp. 7–18, 83–85, 111, 147–148, 183–184, 252–254). New York, New York: Princeton Architectural Press. Association, P. H. (2012). Hospital Code of Ethics. Retrieved from pha.ph/coe.htm BASICS II, & USAID. (2004). Newborn Health in the Philippines (p. 29). Arlington,VA. Retrieved from http://www2.wpro.who.int/phl/files/ unangyakap/usaid.pdf Babisch, W., Schulz, C., Seiwert, M., & Conrad, A. (2012). Noise Annoyance as Reported by 8 to 14 Year old Children. Environment and Behavior and Behavior, 44(1), 16. Balling, J. D., & Falk, J. H. (2012). Evolutionary Influence on Human Landscape Preferance. Environment and Behavior, 42(4), 479–493. doi:10.1177/0013915609341244 Bauer, B. (2012). A Healthy New Approach to What Ails You. Time Magazine with Mayo Clinic, 6–7.

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Becker, F. (2011). Integrated Healthscape Strategies: An Ecological Approach to Evidence-Based Design Introduction. Health Environments Research & Design Journal, 4(4), 114–129. Retrieved from http://www.herdjournal.com/print/article/integrated-healthscapestrategies-ecological-approach-evidence-based-design Bradshaw, V. (2006). The Building Environment: Active and Passive Control Systems (Thrid Edit.). Hoboken, New Jersey: John Wiley and Sons, Inc. Brislin, P. (2012). Introduction: Identity, Place and Human Experience. Architectural Design, November /(220: Human Experience and Place: Sustaining Identity), 8–20. Cheng, J. C.-H., & Monroe, M. C. (2012). Connection to Nature: Children’s Affective Attitude Towards Nature. Environment and Behavior, 44(1), 31–49. Retrieved from eab.sagepub.com Colino, S. (2012). The Sound of Healing. Time Magazine with Mayo Clinic, 57–59. Day, C. (2007). Environment and Children: Passive Lessons from the Everyday Environment. (A. Press, Ed.) (First Edit.). Burlington, MA: Elsevier Ltd. Division, C. (2008). Implementing e-Health in Developing Countries Guidance and Principles, (September). EDAC. (2008a). 2 Building the Evidence Base (Second Edi., p. 149). Concord, CA: The Center for Health Design. Retrieved from healthdesign.org/edac EDAC. (2008b). 3 Integrating Evidence Based Design (Second Edi., p. 179). Concord, CA: The Center for Health Design. Retrieved from healthdesign.org/edac EDAC. (2008c). 1 An Introduction to Evidence Based Design (Second Edi., p. 193). Concord, CA: The Center for Health Design. Retrieved from healthdesign.org/edac

BIBLIOGRAPHY CONT... Food and Agriculture Organization of the United Nations. (2012). FAO Statistical Yearbook 2012: World Food and Agriculture (p. 369). Rome, Italy. Forbes, L. H., & Ahmed, S. M. (2011). Modern Construction: Lean Project Delivery and Integrated Practices (Industrial.). Taylor and Francis Group. Foster, M. (2012). The Future in Unwritten Global Culture, Identity and Economy. Architectural Design, November /(220: Human Experience and Place: Sustaining Identity), 60–63. Frampton PhD, S. B. (2012). Healthcare and the Patient Experience: Harmonizing Care and Environment. Health Environments Research & Design Journal, 5(2), 3–6. Retrieved from herdjournal .com

Heeger, M., Fuchs, M., Stark, T., & Zeumer, M. (2008). Energy Manual: Sustainable Architeture. (I. fur I. A.-D. G. & C. KG, Ed.) (Detail Edi.). Basel, Switzerland: Birkhauser. Hendrich, A., & Chow, M. (2008). Maximizing the Impact of Nursing Care Quality. Healthcare Leadership, 4 of 5(September), 22. Howard, B. (2012). Doctors with Four Legs. Time Magazine with Mayo Clinic, 51–55. International Federation of Red Cross and Red Crescent Societies. (2012). 90 Years of Improving the Lives of the Most Vulnerable (pp. 1–16). Retrieved from ifrc.com

GGHC (Green Guide for Health Care). (2008). Best Practices for Creating High Performance Healing Environments (Vol. Version 2., p. 372). Retrieved from gghc.org

Lecchner, N. (2001). Heating, Cooling, Lighting: Design Methods for Architects (Second Edi.). New York, New York: John Wiley and Sons, Inc.

Habarth, J. M., Graham-Bermann, S. A., & Bermann, E. A. (2009). Coping in Context: Community and Natural Resources in LowIncome Woman’s Environments. Environment and Behavior, 41(2), 25.

Loukaitou-Sideris, A., & Sideris, A. (2010). What Brings Children to the Park? Journal of American Planning Association, 76(1), 89–102.

Hamilton, D. K., Orr, R. D., & Raboin, W. E. (2008). Culture Change and Facility Design: A Model for Joint Optimization. Healthcare Leadership, 2 of 5(september), 15. Haq, S. (2012). Space Syntax in Healthcare Facilities Research: A Review Introduction. Health Environments Research & Design Journal, 5 Summer(4), 98–117. Retrieved from http://www.herdjournal.com/print/article/space-syntax-healthcare-facilitiesresearch-review Harden, B. (2008, September). In Rural Philippines, a Dearth of Doctors. The Washington Post Foreign Service, p. 3. Retrieved from http://www.washingtonpost.com/wp-dyn/content/article/2008/09/19/AR2008091903678.html

Malone, A. (2011). Crossing Paths with Nature. Green Source, 28–29. Retrieved from greensourcemag.com McCullough, C. s. (2009). Evidence Based Design for Healthcare Facilities (First., p. 252). Sigma Theta International. Murdock, M. T. (2010). Cultural Differences Impact Hospital Architecture. Architecture Interior Planning. Retrieved August 25, 2012, from ahldesign.com/blog/2012/02/cultural-differences-impact-hospital-architecture/ National Economic and Development Agency. (2011). Philippine Development Plan 2011-2016 (p. 387). Pasig City, Philippines.

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BIBLIOGRAPHY CONT... Park, A. (2012). Your Friendly Microbes. Time Magazine with Mayo Clinic, 10–15. Pilloton, E. (2008). Design Revolution (p. 303). NY: Distributed Arts Publishers. Rattue, P. (2011, September). Appropriate Healthcare For Developing Countries’ Conference Evaluating Medical Device Use In Poor Countries. Medical News Today, 1. Reyes-Gibby, C., & Aday, L. (2005). Access to health care in a rural area of the Philippines. (Vol. 15, pp. 104–109). Houston, Texas. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15720056 Sadler, B. L., DuBose, J. R., Malone, E. B., & Zimring, C. M. (2008). The Business Case for Building Better Hospital Through EBD. Healthcare Leadership, 1 of 5(September), 15. Schweitzer, L., & Zhou, J. (2010). Neighborhood Air Quality, Respiratory Health, and Vunerable Populations in Compact and Sprawled Regions. Journal of American Planning Association, 76(3), 363–371. Seo, H.-B., Choi, Y.-S., & Craig, Z. (2011). Impact of Hospital Unit Design for Patient-Centered Care on Nurse’s Behavior. Environment and Behavior, 43(4), 443–468. doi:10.1177/0013916510362635 Singer, E. (2011). From No Doctor to E-Doctors in Rural India. Technology Review. Retrieved from http://www.technologyreview.com/ news/425429/from-no-doctor-to-e-doctors-in-rural-india/ Sternberg, E. M. (2009). Healing Spaces (p. 343). Cambridge, Massachusetts and London, England: The Belknap Press of Harvard University Press. Strasser, R. (2003). Rural health around the world: challenges and solutions. Family Practice, 20(4), 457–463. doi:10.1093/fampra/cmg422 Steffen, A. (2006). World Changing: A User’s Guide for the 21st Century. (A. Steffen, Ed.) (pp. 211–217, 307–331, 501). New York, New

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York: Harry Abrams INC The International Bank for Reconstrution and Development / The World Bank. (2012). World Bank Indicators 2012 (p. 462). Washinton D.C. Ulrich, R. S., Zimring, C., Zhu, X., DuBose, J. R., Seo, H.-B., Choi, Y.-S., Quan, X., et al. (2008). A Review of the Research Literature on Evidence-Based Healthcare Design. Healthcare Leadership, 5 of 5(September), 76. Verderber, S. (2010). Innovations in Hospital Architecture (First Edit.). New York, New York: Routledge. Wagenaar, C. (2006). The Architecture of Hospitals. (Co. Wagenaar, Ed.). Beeldrecht, Amsterdam: NAi Publishers. Wilson, A. (2012). The Nutritional Life of Buildings. Green Source, 15–16. Retrieved from greensourcemag.com World Food and Agriculture. (2012). FAO Statistical Yearbook 2012 (p. 369). Wright, C. Y., & Diab, R. (2011). Air Pollution and Vunerablility: Solving the Puzzle of Prioritazation. Journal of Enviromental Health, 73(6). Yoneda, Y. (2009). Butterfly Bamboo Homes are Hope for Thai Orphans. Archdaily. Retrieved from http://inhabitat.com/soeker-tie-butterfly-houses-are-homes-and-hope-for-thai-orphans/ Zeighami, B., Zeighami, E., Mehrabanpour, J., Javidian, I., & Ronaghy, H. (1978). Physician importation--a solution to developing countries’ rural health care problems? American journal of public health, 68(8), 739–42. Retrieved from http://www. pubmedcentral.nih.gov/articlerender.fcgi?artid=1654092&tool =pmcentrez&rendertype=abstract Zimring, C. M., Augenbroe, G. L., Malone, E. B., & Sadler, B. L. (2008). Implementing Healthcare Excellence: The Vital Role of the CEO in EBD. Healthcare Leadership, 3 of 5(september), 18. \

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FIGURES + SOURCES Front Matter A

A young boy with a new found pet snake in the Bar nagy Tabili of Catmon Cebu Philippines (by author, September 2012)

A water buffalo and goat try to cool off in the hot and humid climate (by author, September 2012)

Chapter 1 Introduction 1 Barangay Tabili in Catmon, Cebu Philippines (by au thor, september 2012 1.1 An example of many children who struggle on a day to day basis for the search of basic necessities, such as water(flickr/S.Desai, June 2012) 1.2 The left over destruction in Haiti (flickr/ uusc4all,Haiti) 1.3 Application of disaster relief called Clinic in a Can (flickr/Clinic In A Can, Haiti) 1.4 Locals plowing the fields using water buffalo to get ready for the next season (by author, September 2012) 1.5 Infograph (by author, September 2012) Source Credit: FAO,2012 1.6 Health Diagram (by author, September 2012) Source credit: FAO,2012 1.7 The delivery area within a small clinic in Cebu Philip pines (by author, September 2012) 1.8 Coastal town of Danaue. An example of the cultural differences in the way of life and aspects to consider when analyzing a culture (by author, September,2012)

Chapter 2 Design Research 2 2.1 2.2

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Little Girl from Catmon, Cebu Philippines (by author, september 2012) Mainit Springs(flickr/R.Soriano, April 2009) A patient at the Chennai Telemedicine center con sults a doctor via video conferencing. (Healthnet

Global, Jan 2012) 2.3 A Zulu man wearing liquid glasses, an example from Emily Pilloton’s ‘Design Revolution.’ (M. Lewis, December, 2008) 2.4 Cover of “Design Revolution, ” where many life changing designs are showcased (website/Inhabitat , 2009) Prefabrication done off-site (designventurer,website) 2.5 2.6 Transportation of prefabricated parts (lovile, website) Danaue Hospital under construction while patients wait 2.7 among the construction workers. An example of how the senses can be affected by this environment (by author, September 2012) 2.8 Evidence Based Design example from Lurie Children’s in Chicago. Using elements of nature and exterior views to promote healing. (Lurie Children’s/ website) 2.9 Patient room from Lurie Children’s. An example of patient privacy and family accommodations w(Lurie Children’s/ website) Touch therapy with dogs (Chavez, Michael Robinson, Sep 2.10 tember 2008) 2.11 Touch therapy with horses (B12patch/website, June 2011) 2.12 Example of water pollution that many parts of the world still have to struggle with. (charitywater/website) 2.13 Using natural methods of filtration through clay material(Asia Transpacific Foundation, website) 2.14 Pollution on the streets (flickr/Frisno, July 2008) 2.15 Establishment of wind turbine for power collection(flickr/P. Gerardo, February 2013) 2.16 Butterfly House woven bamboo detail (website/TYINarchi tects, 2007) 2.17 Ramps at Danaue hospital (author, September, 2012) 2.18 Marked bottoms of bamboo (website/bambooroo.net, May 2011) 2.19 Bamboo (website/bambooroo.net, May 2011) 2.20 Sketches exploring methods of traditional bamboo construction. Source Credit: website/ guaduabamboo. com 2.21 An example of a concrete water cistern (flickr / picturing our world,2011) 2.22 Girl harvesting water (flickr / global water partnership, Feb 2011)

2.23

Motorcycle on road (author, September 2012)

Chapter 3 Design Research and Analysis 3 Barangay Tabili by author, September 2012 3.1 Diagram(author, 2012) Source Credit: 3.2 Diagram(author, 2012) Source Credit: Department of Sci ence & Technology Philippines, February 2000 3.3 Cebu City Medical Center waiting lines (author, Septem ber 2012) 3.4 Upon arriving to the Bacayan Health Center, we first had to walk a long set of stairs , an example of accesibility (author, September 2012) 3.5 Inside the maternity clinic. The small space had curtains and thin plywood partitions to divide the spaces. (author, September 2012) 3.6 Inside Mt. Zion Maternity clinic. The privately owned clinic provided the cleanest facility and the beds were from the owners own home. (author, September 2012) 3.7 Inside Mt. Zion Maternity clinic; delivery room. (author, September 2012) 3.8 Perpetual Succour pocket gardens to promote healing and tranquility. (author, September 2012) 3.9 Inside Paanakan Maternity in Mandaue. (author, Septem ber 2012) 3.10 On the way to Paanakan Maternity in Mandaue, walking through the residential tight spaces. (author, September 2012) 3.11 A monkey in a rusty cage along the way to Paanakan Maternity in Mandaue. (author, September 2012) 3.12 Danaue Health center(author, September 2012) Parents with their children receiving treatment near the 3.13 construction site.(author, September 2012) 3.14 Agricultural Distribution(author,2012) Source: Department of Agriculture, 2011 3.15 Healthcare Distribution(author, 2012) Source: Philippine Development Plan, 2011-2012 3.16 Health Network Opportunities (author, September 2012) 3.17 Along a small windy road through the hillsides marks the crossroads (author, September 2012) 3.18 Barangay of Tabili(author, September 2012) 3.19 Barangay Map (author, March 2012) 3.20 Population and Access Map(author, March 2012) 3.20 Land Features Map(author, March 2012) 3.21 Land Occupancy Map (author, March 2012)

3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 3.34 3.35 3.36 3.37

San Jose Map (author, March 2012) San Guillermo Church #2 (wordpress/capricorn beartakeshi, November 2008) Catmon Municipal Hall #11 (wordpress/pinoybyahero, July 2012) Multi-Purpose Complex #12 (facebook/ Distance and Circulation (author, March 2012) Two men on a motorcycle on Barangay Road (author, September 2012) A truck delivering pigs (author, September 2012) Site Analysis (author, March 2012) Bawo River (author, September 2012) Bawo River (author, September 2012) Center of Site (author, September 2012) Tall Trees in Site(author, September 2012) Barangay Road (author, September 2012) Across Barangay Road (author, September 2012) Nurse and child at Cebu Medical Center (author, September 2012) ER at Cebu Medical Center (author, September 2012)

Chapter 4 Design Process 4 The Simple Life (author, September 2012) 4.1 Bamboo Structure (website/holcimfoundation.org, March2013)

Chapter 5 Conclusion 5

Papaya Tree (author, September 2012)

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STUDENT BIOGRAPHY LIZ MARIE M. OYAS M.Arch B.A. in Interior Design With a large imagination and endless creative thought, Liz aspired to be a ‘My Little Pony’ growing up. After much heated debate a 4 year old and 7 year old can get into, Liz’s older sister finally made her realize it would never happen...

ther, she has a love for humanitarian projects. With previous involvement with Habitat for Humanity, she hopes to continue further with projects that encourage community and social awareness.

Always thinking that anything is possible, Liz has always been driven and determined in everything she does. Growing up in a family with medical backgrounds, it seemed that it was the only option. Until one day in 8th grade she did a report on Frank Lloyd Wright and discovered the field of architecture. It wasn’t until upon her high school graduation that she convienced her parents to pursue the design field, and then later enrolled for interior design at the Interior Designers Institute in Newport Beach, CA. Throughout the course of her undergraduate program, she was able to develop her creatively and apply it towards forward thinking designs, which led her to recieve the award for ‘Most Creative’ of her graduating class in 2009. Within that last year of graduation, she was fortunate enough to work on an independant project, designing a new restaurant in Downtown Los Angeles, Yojie’s Japanese Fondue and Sake Bar. As her career begins to develop even fur-

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A PEDIATRIC + OBSTETRIC CLINIC IN CATMON CEBU, PHILIPPINES

SCALE OF RURAL ROADS

ASSEMBLY 1 ONSITE FOUNDATION

EXAM ROOM + OFFICE (PHASE 2)

FUNCTION Pre-Examination

USERS

FUNCTION

Physicians Patients

Examination

REQUIREMENTS Sink Exam table Storage Prep-Area Seating Office area

6’

USERS Nurses Patients

9’

CURRENT ISSUES

9’

REQUIREMENTS Sink Fridge Storage Prep-Area Seating

LACK OF SANITATION Water + Air Quality LACK OF SPECIALITY CARE + IMMEDIATE ACCESSIBILITY Travel long hours to the city DISASTER RELIEF APPLICATIONS Lacks appropriateness towards context and user MEDICAL MISSIONS Temporary and not frequent enough

70%

UNITS + CONTENTS EA.@142 SQFT

NURSING STATION + PRE-EXAM AREA

parallel grid layout

Improving healthcare delivery in rural, developing countries by providing a standard of sanitation, care & user experience through prefab packaging design solutions, accomodating to user, program & context.

6’

9’

6’

2 OFFSITE DELIVERY

3’

plan view

DELIVERY UNIT + EMERGENCY

RECORDS KEEPING

8’

FUNCTION Organizing Info.

USERS Nurses

USERS Nurses Patients Surgeons

FUNCTION

REQUIREMENTS Surgeon Comfort (AC) Sealed Procedural Bed *Storage Prep-Area + carts

Surgeries

8’

pediatric and maternal care are vital in healthy development. Although environmental conditions affect individuals, it is the knowledge and practice of preventative care and the maintenance of health, that can establish healthier living.

of deaths under 5 years of age are attributed to malnutrition, lack of sanitation and acute chronic illnesses

motorcyles + pedestrians

MOST COMMON DELIVERY METHOD “ISUZU ELF”

total sqft 576

THESIS STATEMENT

REQUIREMENTS Seating Storage Organizing solutions Lockable storage

plan view

USERS Nurses Patients

SUB-SAHARAN AFRICA

plan view

TOILET UNIT

CONSULTATION ROOM

SOUTHEAST ASIA

OPPORTUNITY FOR SELF-EFFICIENCY Photovoltaic panels Rain water harvesting Sink to Toilet water cycle

FUNCTION Telemedicine Consultation

3 UNIT PLACEMENT 5’ MIN REQUIREMENTS Privacy Seating T.Equipment

PROJECT GOALS Encourage sense of place + social cohesiveness + physical health Create serialized space: layers of spaces and the inbetween Balance between local vernacular traditions + non local technological imperatives Initiate long term economic progess Phases in clinical integration, determined by local needs + budget Appropriateness of context and user variables

# OF HOUSEHOLDS POPULATION DENSITY

CEBU MANILA

CEBU CITY

INTERIOR

ENVELOPE SITE

SERVICES

BAMBOO Pins Lashing Wedging Plugs

PUBLIC MARKET MAJOR ACCESS ROAD PROVINCIAL ROADS

29 863 TOTAL

SAN JOSE

DUYAN

CEBU

Developed through the relationship or nonrelationship of interior and exterior responses. Becoming the ‘generic’ to ‘specific’

STRUCTURE

MULTI PURPOSE CO-OP.

5,996 268.9

16 000 TOTAL 2 000 - 3 000 7 000 +

6 ENVELOPE

Decided by program requirements + exterior conditions

Peg connection to provide placement on the grid

ACCESS

POPULATION

5 INTERIOR DIVISIONS

On-Site Development

CATMON. CEBU CATMON

plan view

4 PATHWAY PLACEMENT

METHODS OF JOINERY + CONNECTIONS

CORAZON

CAN - IBUANG

FLORES

TABILI MACAAS

ANAPOG

p e d i a tr

CATMONDAAN

Private Enclosure Public Enclosure

CABUNGAAN

BONGYAS

CAMBANGKAYA

BASAK BINONGKALAN

o bs

Aid in the different developmental stages of adolescence

PANALIPAN

AMANCION 528’ = .1 miles

BACTAS

GINABUCAN

PHASE1: +- 1428 SQFT

Encourage intimacy to engage with personal relationships for maternal support

SCALE : NTS

PLACEMEMNT + CIRCULATION Program responses ACOUSTICS + RAINWATER HARVESTING COLLECTION

PLAN VIEW

Environment responses SHADE + VENTILATION

SITE PLAN

SCALE : 1:20

Promote self relaxation and tranquillity

Provide central play areas for visual security

BARANGAY ROAD

Encourage stress reducing environments

Promote social interaction

BAWO RIVER

ri c

TINABYONAN

AGSUWAO

waiting area

Investigating the relationships between the responses to develop exterior and interior form

delivery truck access

*width clearance

funnels circulation to channel public vs. patients

h o u s i n g area (to be resolved (integrated with Phase 2)

playscapes that vary according to child developmental stage placement for future phases

north-west

south-west

ENVELOPE Promoting air quality through efficient ventilation throughout the facility

SECTION CUT 1 MAIN ENTRY + PEDIATRIC SIDE Strong connection to park to engage social interaction

2 MATERNITY WAITING AREA Developing a tranquil experience through intimate spaces

1 river interaction with maternal side private

use sha r e red xp p eri rog en ra ce m tra spa nsi ce tio n des no

access

natural ventilation

PEDS

community interaction with residential porosity

individual reflection with reduced social i n t e r a c t i o n

TRANSITIONAL EXPERIENCE

public

allow for modular connectio

restrict visual connection

GRID ORIENTATION

LIZ OYAS . AR 902 . WINTER 2013 . VUSLAT DEMIRCAY

semiprivate semipublic

PROPOSED INTERACTIONS

PROGRAM HIERARCHY

APPENDIX

Accessibility to rural roads Local assembly of parts : Local methods : No use of metal connections or joinery Managable at a human scale : Lack of machinery 1,096.8 lbs 1,096.8 lbs

CLINICS TO START A HEALTHIER FUTURE

OPTIMIZED DELIVERY 1,096.8 lbs 1,096.8 lbs

LOCAL JUMP-START

anticipated high volumes of social interaction

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