Graduate Thesis Project: A Teaching Hospital in Haiti

HEALING AND LEARNING

Nikhita Bhagwat M.Arch Independent Study 2019

M.ARCH THESIS 2019

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ACKNOWLEDGMENTS This book is dedicated to Mike and Missy Wilson. I hope that myLifeSpeaks will soon be able to convert this project into reality.

I would also like to dedicate this book to my grandmother, whose love for birds and trees made me realize the importance of the outdoors for mental peace. I am sure she would have loved to see this campus being built.

I would like to thank my academic advisors, Prof. MaryLou Arscott, Prof. Kai Gutschow, Prof. Valentina Vavasis and Prof. Hal Hayes for always patting me on the back for doing something right and pushing me forward when I fell behind. This project would not have been what it is without you.

I would also like to thank Ar. Tom Rhodes for being so responsive and patient throughout the design process.

You made me realize the importance of immersing myself into the project so deep that I visualized it mentally, experientially and spiritually.

Special thanks to my parents, whose steps towards improving public health I inadvertently ended up following, and hope to continue doing so in the future.

Finally, I would not have completely changed my aspirations and experienced so much within a semester without the help of Journeyman International, who introduced me to this project and were kind enough to take me on board as a fellow Humanitarian Designer. I hope this book finds a spot in your archives.

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CONTENTS

CHAPTER 1. INTRODUCTION CHAPTER 2. SITE ANALYSIS CHAPTER 3. THESIS STATEMENT CHAPTER 4. DESIGN GUIDELINES

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CHAPTER 5. CONCEPTUAL DESIGN CHAPTER 6. DESIGN DEVELOPMENT CHAPTER 7. FINAL DESIGN CHAPTER 8. CONCLUSION

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CHAPTER 1

INTRODUCTION EXPLORING THE UNPREDICTABLE NEEDS OF HUMANITARIAN ARCHITECTURE: MYLIFESPEAKS CENTER, HAITI Build what matters most”- that is the motto that Journeyman International stands by. It is a firm that carries out humanitarian design practices across the globe. Their niche is to tap into the academic world and university students studying architecture, engineering, construction management, or landscape architecture and doing thesis projects. The student program is almost more of a training program to inspire young people. There are several layers of quality control before projects are built: the student needs a mentor from the university that they choose to work with and in ad dition to that, the Journeyman team, which also reviews projects. Every student is also paired with another mentor, typically a licensed professional near them who they can meet with on a weekly basis. Then the team partners with an organization in the project’s countrythis could be a local architecture firm or an organization like Habitat for Humanity who know the materials and what is culturally appropriate. On top of that, all of the drawings and designs are run by a local architect and engineer.

For the thesis program, it depends on the university and its specific criteria. The selection process for Journeyman International depends on the student’s talent and their passion for humanitarian work. The filtration process requires one to submit a resume and a portfolio for thorough consideration. Once selected, the project goes through a screening process in the university to check whether it fits into the existing curriculum.

PROCESS a. Application sent to Journeyman International to be considered for a possible thesis in collaboration with various organizations (May 2018) b. Contingent on the acceptance of said application, the steps to proceed will include research to back the above-mentioned first design principle, based on the given project and location (May-September 2018) c. Once decided on the various considerations to be taken into account, selecting of mentors from the University to aid with said processes d. Several communications with the various organizations willing to collaborate on said project e. Site visit to location allotted for the project to gain a better understanding of the existing conditions- physical, geographical, political, demographic (December 2018) f. Beginning of preliminary design process based on site analysis and experiential context (January 2019) g. Continuation of design process with regular supervision from various abovementioned guides and agencies (January-April 2019)

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PROPOSITION A look at JI’s portfolio reveals that although the contextual limitations are set in stone, the designers (collaborating students) have the liberty to exercise their formal choices with the constructed project and each of these projects, though defined by its location, stands out amidst its surrounding buildings in terms of its spatial configuration and character. The types of projects range from post-disaster construction to community centers and schools, predominantly in countries of South America and Africa.

My inspiration to do this project grew even further after conducting a recent interview with Professor Esther Charlesworth of RMIT University, Australia, where she said, “just because it’s a poor or vulnerable community doesn’t mean it has to be all grass with sticks sitting around a gum jar. Whether it’s aesthetic or sustainable good designvulnerable communities deserve that just as much as the normal communities.” Since the firm I wish to collaborate with is student-centric, it promises to be more than a volunteer project that I propose to do as part of a firm. It will be more on the lines of my design decisions that cater to the community and the firm supervises the adherence to the requirements of the project.

PROJECT DETAILS The selected project is a campus planning/development project in Neply, Haiti. ‘myLIFEspeaks’ is a humanitarian organization that is passionate about creating a Christ-centered community through education. Providing a higher level of learning for children in Neply, Haiti is an enormous step in helping create a more successful Haiti.

The project is an integrative school, LIFE Academy, which can create the confidence and opportunities that both general and special education students need in order to transform their future and their generation. LIFE Academy aims to create students who are able to critically think and solve problems inside and outside the typical classroom.

This level of integration and higher learning is a new concept for education in Haiti and myLIFEspeaks is trying to lead the cultural transformation from conventional classrooms to a more active way of learning. My role as the designer for the project will be to develop the master plan for the campus, which will include Orphan Care & Prevention, Educational and Public Health facilities. The deliverables required by the firm are Notfor-Construction site drawings and detailed planning of one building, a rule set by Journeyman International. . All drawings will be not for construction and stamped by a Haitian architect and engineers for permitting purposes.

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FRAMEWORK The first principle is to base the design on thorough research about the vernacular context of the project in Neply, Haiti. This includes a study of the real estate market, the readily available construction material, climatic conditions of the location and feasibility. It also includes a study of the local agencies involved in the specified location, which includes architects, construction labor-force, funding companies and external collaborators for the specific cause. It also includes collaboration with a designated mentor from Pittsburgh who is willing to help out with the logistics and design conditions for the project.

The second baseline principle is based on the initial research about regional context to make it responsive to the environment. Passive Strategies used to control the interior environment of the building will help in creating a comfortable space that does not require other sources of energy to be utilized in large amounts, making it feasible in the long run. Since Haiti has a tropical climate, several case studies of existing passive design in similar climates is necessary for preliminary research and also to make sure that suggested practices end up being successful in theory as well as in practice.

The third baseline principle is to make the project design as close to modularity as possible, in order to enable the same building to be recycled for various purposes simultaneously. This involves research about the local carpenters and craftsmen and knowledge about their ability to maneuver difficult designs with agility. Although modularity may not be achieved in defined tangible terms due to the permanent nature of the project and the very fact that they aim to address one particular facet that needs immediate attention to uplift the community, it can be achieved in functional terms by mere reconfiguration of certain programs within the building that can help reshape the interior spaces and aid in changing spatial distribution-this could include movable walls, reconfigurable floor levels and temporary circulation aids like ramps and steps which are sturdy enough to carry large weights but also movable. This particular aspect of the design will ensure that almost any public space that is built can eventually be turned into a community space- thereby encouraging interaction, a primary goal of the thesis project.

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ORGANIZATION JOURNEYMAN INTERNATIONAL

STUDENT DESIGNER NIKHITA BHAGWAT

MENTORS (UNIVERSITY) KAI GUTSCHOW STEFANI DANES VALENTINA VAVASIS

MENTORS (EXTERNAL) TOM RHODES

(BRADFIELD, RICHARD, RHODES AND ASSOCIATES)

BRIAN O’NEIL

(THIRD LENS MINISTRIES)

JANUARY 2019 APRIL 2019

MAY 2019

FINAL DELIVERABLES SITE ANALYSIS BOOKLET PRECEDENT RESEARCH STANDARDS SOCIAL CONTEXT CONCEPT DEVELOPMENT-CONCEPTUAL DRAWINGS

FINAL DELIVERABLES

TAKE OVER

SEPTEMBER 2018DECEMBER 2018

SITE PLAN HOSPITAL BUILDING DESIGN (NFC) RENDERS

FINAL THESIS PROJECT

HANDED TO HAITIAN ARCHITECT

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FACTS ABOUT HAITI

More than half the population, 4+ million people, lives on less than the equivalent of two (US) dollars a day with an unemployment rate estimated to be as high as 80% Almost half the population in Haiti is under the age of eighteen The US Government spends approximately $9000 per patient per year medical care.

Haiti, in comparison spends $70 per patient per year Children are malnourished and in need of nourishing food and quality medical care One in seven children in Haiti dies before their 5th birthday - mostly of preventable diseases 60% of Haitian children do not have access to the most basic medical care 25% of infants suffer from low birth weight 24% of children suffer from stunted growth as a result of malnutrition 48% of the adult population is illiterate Child-headed households are becoming more common as potential guardians succumb to disease or other causes of death

ABOUT MYLIFESPEAKS (AS TOLD BY THE ORGANIZATION)

myLIFEspeaks would like to create a state of the art Medical School and General Teaching Hospital in partnership with the Haitian government, in Leogane, Haiti.

This is an area in the Ouest Department of Haiti, which currently does not have this type of Medical school or General Hospital care to properly train/treat people in this region. The model of this school and hospital comes from research and gathering information from the local health care professionals on what is lacking and needed in this area. The MLSMSH would work in conjunction with Universities and Physicians in the US for excellent high-level training. They would in turn be creating excellent teachers and physicians of Haitian descent to take their place.

This facility will be a catalyst to the community and the entire Southern Peninsula of Haiti, teaching a level of excellence in Global Health training and care.

This initiative allows special needs individuals to be treated in a safe and secure location without fear of retribution from the community, medical staff, or caregivers, as well as trains medical professionals on best practices for treatment of individuals with special needs.

Upon review, the ‘Local Government: Private Model’ is tested and considered best practice in the developing world (I.e. Partners in Health, AMPATH). An academic focus addresses sustainability issues by focusing on increasing capacity of Haiti to care for its own. This initiative exposes countless people from privileged backgrounds (faculty and trainees from US) to the hurting and poor in a manner that inspires them to change their focus and fight for the downtrodden.

The facility will begin to impact the Leogane region in five specific areas to start: 1. Pediatrics (Special Needs Speciality) 2. Laboratory Services 3. Urgent Care (Pediatrics and Adults)/Small Operating Rooms 4. Maternity/NICU Care 5. Internal Medicine (Specialty Clinics) 6. Rehab (All Therapy Departments)

FINANCIAL SUMMARY FOR THE FACILITY MLSMSH will operate with full integrity and will be transparent with the uses of all funds.

As needed amounts are defined, MLSMSH will coordinate concentrated partnerships and fundraisers to secure those funds. The finances of MLSMSH will come from tuition, donors, partnerships, sponsors, and organizations that desire to help others grow in Global Health. The general operating and administrative costs of MLSMSH will be secured through corporate and private donors for the first 3 years of operations, with the desire to bring in enough revenue in those first 3 years to maintain a sustainable budget from that point forward. MLSMSH will also look for long-term partnerships to help in the areas of shortcomings on the budget, after the first 3 years.

The estimates for this initiative include: $1 million annual operating budget for the first 3 years $500,000 annual staffing budget for the first 3 years $5 million construction of MLSMSH Complex myLIFEspeaks currently has a connection with the US Based nonprofit, Third Lens to help oversee the design and construction of its future campus. This relationship will continue with the MLSMSH initiative. $0 land cost*. The land is donated by a local Haitian (David Decayette) who both sees the need for and desires this project. (Estimated Land Value: $250,000 USD)

HEALTHCARE IN LEOGANE In the Leogane Region of Haiti there is a significant lack of basic medical care in many areas. Within a 25-mile radius outside of Port Au Prince, the following medical services/ supplies are unable to be found on an ongoing/regular basis: 1. Oxygen/Oxygen Tanks 2. Emergency Medical Services 3. Diagnostic Services (X-rays, Ultrasounds, CT Scans, MRI) 4. Trustworthy Lab Results 5. Proper Medications readily available MLSMSH desires to create a Global Medical atmosphere that allows the Region to feel confident in their medical care through the following: Excellent Administrative Structure Excellent Education for Staff (Doctors, Nurses, Techs) Partnering with Haitian Government Excellent Services offered Administration Structure: We wish to have an Administrative staff, which will strive for excellence in developing strong Policies and Procedures, Billing Processes and excellent standards in Medical Education and Care as well as those who are passionate about their role.

Education for Staff: The MLSMSH will partner with American Universities, Doctors, and Hospitals to bring in the top-level professors and teaching staff, in order to bring the best Medical Education to Haiti. Educators will work with Resident Students as well as Nursing Students, Techs, etc. to train them and have the supplies available to test their skills and allow them the best opportunity to succeed in the future.

Partnering with the Local Government: MLSMSH will partner with the Haitian Government to work alongside to create an excellent Global Health Initiative. Our goal is for MLSMSH to be partnered with the Haitian Government to receive any assistance possible as well as being privately funded (Government: Private Model). We will work closely with Chief Deputy Hippolite (the Leogane representative in Parliament as well as the Chief Deputy of Haitian Parliament), and he has agreed to help us navigate the necessary steps to have proper government approval.

Services Offered: 1. Pediatrics (Special Needs Speciality) • Pediatricians • Specialists: will be physicians from each of the other areas • 10 beds in this area dedicated for Special Needs Care 2. Laboratory Services • Lab Techs 3. Urgent Care (Pediatrics and Adults)/Small Operating Rooms • ER Physicians • ER Nurses 4. Maternity/NICU Care • OB Physicians • Neonatologists • Nurse Practitioners • Nursing Staff 5. Internal Medicine (Specialty Clinics) • Physicians • Nurses 6. Rehab (All Therapy Departments) • Occupational Therapists • Physical Therapists • Rehab Technicians

RESEARCH

The site is located in a remote area, away from civilization but has great proximity to natural resources like the sugarcane field adjacent to it that can help add to the natural, healthy food for the patients; the gravel field adjacent to it towards the west that can provide for the raw materials for the cement used for construction; the River Momance only 1.6 miles away that also provides raw material for the cement from its river bed. In addition to these factors, the water table is only 10ft. below ground level, and due to the heavy rainfall has the ability to be constantly replenished. the ground water has sustained the entire village so far and there have been no problems related to water shortage. Also, the water is said to be so pure (as tested), that the villagers drink it straight from the well, a trait that is extremely beneficial for the healthcare facility.

CHAPTER 2

SITE ANALYSIS

CLIMATE DATA

Drawings generated using Climate Consultant 6.0

Drawings generated using Climate Consultant 6.0

CLIMATE DATA

Drawings generated using Climate Consultant 6.0

INFERENCES Climate data is helpful in incorporating passive strategies in the building as they help the designer understand the positioning of openings in the building walls, heights and dimensions of said openings, building orientation to optimize these conditions, placement of trees on campus as methods of passive shading for both light and wind, shading requirements, wall thicknesses determined by temperature differences, etc.

Hence, this data was heavily utilized to design the interior and exterior spaces in the campus, i..e design at the micro as well as macro level. In addition to annual data, daily averages were also calculated and the daylight directions throughout the day in different seasons and months were determined, so that necessary precautions can be taken within the facility to avoid glare but at the same time allow adequate daylight to light up all the interior spaces.

The wind rose is an important diagram for the development of the site plan as it also helps one determine the orientation of buildings in relation to each other.

Drawings generated using Climate Consultant 6.0

SITE GEOTECHNICAL REPORT

The site is located less than two kilometers offshore. The general topography of the project area is generally planar and has a slight dip facing north. However, the immediate area of the project is very inclined.

GEOLOGICAL CONTEXT The geological formation encountered in the project area is an alluvial formation dated Quaternary.

SEISMIC INFORMATION The seismic hazard maps prepared by the USGS * ( US Geological Survey) on behalf of USAID and following the earthquake of 12 January 2010, constitute the basic documents for the evaluation of the seismic characteristics of the site studied. These maps were based on probabilistic considerations, considering, first an earthquake with an exceedance probability of 10% on a 50 year interval (which corresponds to a return period of 475 years) and earthquake with a probability of exceedance of 2% over a 50 year period. The maximum horizontal acceleration at the rock will be referred to hereinafter as the English term PGA ( Peak Ground Acceleration). These cards, presented in Appendix B of this document, provide the following information: PGA 10% probability over 50 years: a max = 0.40g (3.92 m / sec 2); PGA to 2% probability in 50 years: a max = 0.60g (5.87 m / sec 2); g being the acceleration due to gravity which is about 9.81 m / sec 2.

The site can be considered high seismicity. The aforementioned seismic characteristics may be included in any calculations for checking the safety of the building projected visĂ -vis the earthquakes. Also referring to the document International Building Code (IBC) 2006 (Section 1613.5.2, Earthquake loads) on the construction in earthquake zones and considering the nature of the basement and Vs30 corresponding to the construction site (130.1 m / s <Vs30 <134.0 m / s), the latter can be classified as E . These data can be used for seismic calculations of the building structure to be further specified by a specialist structure.

EXISTING SOCIAL CONDITIONS ETIQUETTE

INFERENCE

Reverence for the aged.

-More facilities for older people. Perhaps segregate a few spaces?

-ADA compliance a must

Men and women maintain boundaries in public, platonic or not

-Segregation of menâ&#x20AC;&#x2122;s and womenâ&#x20AC;&#x2122;s wards -Special ward for those who do not identify as one particular gender

Poverty stricken country where people may or may not be able to afford hospital resources Food: Tropical fruits and mostly starch 3 medical schools in Haiti. The number of doctors per 100,000 people in Haiti is 25, 155th in the world.

Haiti has the highest rates of infant, underfive and maternal mortality in the Western hemisphere. Diarrhoea, respiratory infections, malaria, tuberculosis and HIV/AIDS are the leading causes of death.

Numerous schools and hospitals have closed because teachers, social workers and health providers could not go to work for fear of violence.

High rates of infant mortality, neonatal mortality, under-5 mortality.

Greater security within the facility to avoid unwanted soliciting Can grow fruit trees in the landscape: Mango trees especially for shade and for food; coconut trees More emphasis to be laid on teaching hospital so they are able to produce more doctors, and the students/residents are good enough to provide assistance in case doctors are not available.

Provisions for regular vaccines.

Increased security.

Focus on neonatal care, pediatric care.

Increased sanitation needs

HAITIAN HEALTH FACTS AT A GLANCE Population (as calculated in 2017): 11.8 million 2017 Fertility Rate: 3.1 2017 Educational Attainment: 4.9 years

LIFE EXPECTANCY

MORTALITY TRENDS IN UNDER-5 AND UNDER-1 AGE GROUPS

IHME. 2017. Measuring What Matters Most: Haiti. http://www.healthdata.org/haiti.

TOP CAUSES FOR DEATHS

TOP CAUSES FOR PREMATURE DEATHS

TOP CAUSES FOR MOST DISABILITIES

CHAPTER 3

THESIS STATEMENT As a resident of a highly ‘developed’ country, one might not always be able to imagine the seemingly ‘basic’ amenities that are unavailable to most people of Haiti. In addition to the fact that more and more people from the country’s more infrastructurally developed neighbors volunteer to participate in its development, progress in Haiti has been a slow process with constant obstructions due to natural disasters, and a weak social and political situation that reduces the development pace even further. Some of the major chronological landmarks in its recent past can also attest the fact that Haiti is in serious need of good governance for steady growth. At a glance, the facts speak for themselves: 2010: Earthquake •January 12, 4:53 pm.: A magnitude-7.0 earthquake hits Haiti, on the island of Hispaniola, near Léogâne, about 16 miles west of the capital, Port-Au-Prince.

•January 20: While multiple aftershocks are recorded soon after the initial quake, the U.S. Geological Service reports the strongest aftershock is a 5.9 temblor on January 20 that collapses many already damaged buildings.

•October: A cholera outbreak begins and spreads rapidly.

2010 to 2014: Continuing challenges •2011: UNICEF, the U.N. children’s agency, reports 1 million Haitians are still in temporary shelters.

•2012: Hurricane Isaac and Hurricane Sandy cause damage and flooding. More than 400,000 people still live under tents and tarps.

•2013: By August, more than 8,000 Haitians have died from cholera. Haiti is in the midst of a major food and nutrition crisis.

2015 to 2018: Prioritizing development amid setbacks •2015 through 2016: More than 1 million people are affected by drought because of El Niño conditions.

•October 2016: Category 4 Hurricane Matthew causes massive destruction and displacement.

•2018: While progress has been made, some of the issues prior to the earthquake still persist in Haiti, such as weak political governance, lack of infrastructure, and limited access to basic resources.

Based on these facts, it is evident that the country could benefit from the additional help provided by external organizations as it is unable to sustain itself on the present available resources.

Reid, Kathryn. 2018. World Vision 2010 Haiti earthquake: Facts, FAQs, and how to help. June 20. Accessed January 2019. https://www.worldvision.org/disaster-relief-news-stories/2010-haiti-earthquake-facts.

THE NEED FOR BETTER EDUCATION

The site for the Teaching Hospital project proposed by the organization myLifeSpeaks, is located in Neply, a village very close to Leogane, where the epicenter for the 2010 earthquake was located. Neply, as a village, faces numerous challenges of overpopulation due to lack of family planning, combined with inadequate resources and finances to raise said large families. The average Haitian family has 4-5 children (average fertility rate 3.1) and inadequate resources to support them. As a result, children are abandoned at foster homes, some of which have been known to be involved in child trafficking. Most residences also do not have attached toilets, which leads to open-air defecation. A few interventions by organizations like Red Cross, which attempted to set up shared composting toilets within the village, proved to be unsuccessful as the villagers saw it as â&#x20AC;&#x2DC;forced laborâ&#x20AC;&#x2122; to empty the pits onto the field to use as compost.

The organization also runs a school that goes up to grade 2, with about 20-25 students per classroom, and will continue to increase its grade levels up to the 12th grade as the children keep growing. Language acts as a major barrier in the education process, since most schools use Creole as their primary language, with all the textbooks also in Creole, but the National level examinations for college are conducted in the French language.

Hence, it is necessary to create a more cohesive education system within the country.

Most children, although quite intellectually brilliant, are forced to withdraw from further education and take up agriculture instead due to these limitations.

The root of a majority of the diseases in Haiti is poor lifestyle choices, which can be rectified through proper education. Education at a young age can ward off a lot of the superstitions and unhealthy habits formed among the people by virtue of their ignorance.

The primary occupation for the residents of Neply is agriculture. The site for the project is currently a sugarcane field amid other sugarcane fields, but the village also grows vegetables and fruit like bananas, passion fruit, apples, potatoes, carrots, okra, etc. myLifeSpeaks has also begun to train them in these practices, along with educating them about the soil conditions, water requirements, the sale of these products; in short, the life cycle of these agricultural products to involve them in more entrepreneurial activities for self-sustenance. This goes to prove that the first step towards the development of Haiti is the provision of quality education.

Waste management is another field that needs serious consideration in Haiti. There is no civilized system for waste disposal. All waste is disposed of on the streets, outside houses or in water bodies, thereby contaminating even those resources that might be of use to make the site self-sufficient in terms of energy production. This poses a concern in healing environments, where hygiene should be of utmost priority and yet, not all spaces are sterilized or even regularly cleaned. Educating the masses, and especially ancillary healthcare professionals, about the need for hygiene can also help improve the existing conditions in various institutions.

Hence, although not all problems can be alleviated by mere lifestyle changes, it is clear that the issue of education needs to be addressed on a broader scale as well as at a micro level so that ignorance can be eradicated as a factor causing slow progress in the village.

THE NEED FOR BETTER MEDICAL FACILITIES Patients prefer to have their family help them with basic necessities like food and cleaning, rather than let the nurses provide help. This often leads to their visitors bringing them unhealthy, fried food from street vendors which is not ideal for consumption in ill health.

A visit to a medical clinic in and around Neply costs $2.5 as a one-time fee, but many of the villagers are unable to afford this cost. The locality, especially, is in dire need of more affordable medical care so that more people can receive the treatment that is needed to cure their ailments as opposed to self-treatment that can often exacerbate their problems. The existing hospitals in the country have also not always been successful in treating the patients, not always due to a lack of infrastructure. Some of the common problems seen in Haitian hospitals are lack of hygiene which can lead to the spread of more diseases; lack of available medication for proper treatment of patients; lack of segregated facilities for different operations, which might lead to overflow of patients and services. There is no real question of nurses not being around, as they are paid on time and most people do not ask to be taken care of by nurses as they need to pay extra for nurse care and for hospital bedsheets/bed covers/blankets. They choose to be attended to by family members instead. If a person does not have any family, there are always people hanging around in the hospital, willing to help with basic amenities for lesser pay than the nurses. Gender segregation creates the need for separate wards for males and females.

Although general wards that can hold multiple patients at the same time seem like an absolute must, but it would be also be preferable to provide more private or semi-private wards rather than general wards, for the purposes of safety and disease control. These also make it easier to handle the hospital patients for the doctors.

Lack of easy availability of infrastructure like clean water, electricity, waste management, etc. means that the campus needs to be independently run and self-sustained in all of its functions so that there is minimum dependency on the city for basic resources. This calls for the use of more costeffective, passive strategies to run the campus.

THE NEED FOR A SELF-SUSTAINED CAMPUS Although a lot of the major parts of Haiti face the problem of inadequate water, the village of Neply has adequate sources to be able to provide for all facilities within buildings as well as to water the crops. However, the region does not get sufficient electricity to power the various facilities, and since a hospital, especially, cannot afford to run without a consistent source of power, it is vital to design a building that can be self-sufficient in terms of electricity. The site has great potential for power generation through PV panels, and through small hydro since there is a river running towards its west only 3 km away, and the ocean only 3.5 km away.

Despite the provision of nearly 300 beds assigned to different areas and programs of the hospital, one should expect to see a lot of overflow of the patients due to a much larger population, for which special overflow services need to be providedthis means that there is always a need for extra residents or nurses as opposed to a standard nurse-patient ratio. The main problem that is often faced in hospitals in the immediate availability of medication for the patients. Although most hospitals have attached pharmacies which are supposed to sell all the medicines prescribed by the doctor, every patient must go through a 4-5 step process just to be able to purchase the medicine. Oftentimes, the pharmacies are not stocked with all the required medication. This can be attributed to the lack of funding, inability to deliver the medicines on time, or reduced frequency of the help personnel from developed nations that carry the medications to these hospitals, sometimes as part of NGOs, sometimes as donations. The issue of easy accessibility to required medication needs to be addressed within the hospital- not only systematically but also physically, as not all hospitals have attached pharmacies.

Existing physical therapy clinic in Neply, Haiti

Another drawback that the site faces is the problem of transportation- the nearest tar road is 3km away from the site, in the south. The adjoining roads and all the connecting roads are mud roads, approx. 10ft. in width. This proves to be a major problem for the ambulances and for patients to have easy access to the hospital site. An optimistic turn was however posed by recent events, where a soccer field about 1.6 km from the site has been chosen as a Landing Zone for an air ambulance service (Ayiti Air Anbilans) that caters to around 200 sites across the country. This comes as a great opportunity to make the hospital one of the central hospitals in the region that can cater to patients from long distances. However, the organization has only 2 such air ambulances, only one of which of operates at a time and the other act as the back-up for the operating one. One of the problems faced by the organization is the fact that they had to refrain from providing the best quality of paramedic facilities within the helicopter, less due to budget constraints and more due to the fact that they cannot be followed by the same quality of facilities once they reach the hospital, thereby affecting the patientâ&#x20AC;&#x2122;s health by a greater extent. This brings to light the fact that opportunities for better development in the medical field are being hindered by the fact that prior development required for them is insufficient. For instance, the landing of the air ambulance in the vicinity will only be beneficial if there is enough for connectivity for ground transportation to be able to transfer the patient from the helicopter to the hospital.

This leads one to the conclusion that the hospital has the ability to sustain itself if it is allowed to develop the areas beyond its boundaries and utilize the resources in its near vicinity.

One of the problems faced by the organization is the fact that they had to refrain from providing the best quality of paramedic facilities within the Ayiti Air Anbilans helicopter, less due to budget constraints and more due to the fact that they cannot be followed by the same quality of facilities once they reach the hospital.

The Air Ayiti Anbulans

SUSTAINABLE HOSPITAL- A PLATFORM FOR EDUCATION

One of the main aims of the teaching hospital is also to make sure that it provides good education to the students- an education that will encourage them to stay back in Haiti and improve medicine, rather than move to another country to be able to practice better, with better pay and job security. This means not only better infrastructure within the hospital, but also higher quality of education with the right resources to be able to have practical knowledge rather than textbook-learning, which is often the case in Haitian medical schools.

The reason behind the integration of these seemingly independent fields is also to set a precedent for more such institutions. Over time, this institution aims to become a mutually-educative process, where the students learn the need for better medicine in a country like Haiti, and in return can propose to educate the patients, or at least those visiting these patients on a regular basis, how to practice a healthier lifestyle. The first step in improving the medical education system is to integrate practical learning with theory, and a hospital provides the best platform for said practice.

Mere observation in a hospital can help one know that the cause for illnesses amongst Haitians is also due to their lifestyle choices. Haiti has the highest rates of infant, underfive and maternal mortality in the Western Hemisphere. 2% of the people are living with HIV, which in turn also leads to children being born HIV +ve. High numbers of children die before the age of 5 due to malnutrition, a lot of them because of their ignorance about the certain NGOs that specifically cater to child nutrition and health. It is a known fact that the right kind of nutrition is also vital in the recovery of a patient, yet many patients are known to have family members take care of them in hospitals instead of nurses to avoid extra costs. These visitors most often tend to secure food from nearby street vendors to avoid the extra travel- food that is fried, food that is prepared in unhygienic facilities- which can easily harm the recovery process of the patient. They do not realize that in doing, they are also inadvertently prolonging the hospital stay, which will also add to their expenditure.

How then, can one carry out a process that can help the students simultaneously teach and learn? Can a mere hospital building reach its arm far out towards community medicine? Integrating a learning environment with a healing environment might also give the medical students a greater incentive to stay back and help their nation grow.

Simple steps within the household can greatly add to the communityâ&#x20AC;&#x2122;s growth. Is it possible that a hospital can accommodate spaces that can help carry out these tasks of educating its visitors about the importance of safe practices before, during and after healing? HOW CAN A MEDICAL FACILITY COMBINE HEALING WITH LEARNING?

CHAPTER 4

DESIGN GUIDELINES Since Haiti does not have its own set of guidelines for th construction of healthcare facilities, multiple guidelines have been used as reference for the design of the main program spaces, and more liberties have been taken in the design of corridor spaces, open spaces, etc. Since the guidelines used by the United States would not be the most ideal set of rules to go by, other guidelines that have been referenced are the Indian Public Health Standards (due to its easy availability and similar rural conditions as Haiti), Maldives Handbook (due to similar financial conditions, and also similar climatic conditions as Haiti), AIA Guidelines and FGI Guidelines 2018.

Apart from these, different sources were also referred to for developing bubble diagrams, adjacency programs, departmental connectivities, proximities, circulation, etc. Based on the understanding of required spaces for the indoor and outdoor facilities, the campus site plan is schematically developed to accommodate all of the required areas. This exercise is especially helpful in developing all the spaces on the site and determining strategies to save space for future expansion.

REHABILITATION CONNECTIVITY

CARDIAC REHAB

HYDRO THERAPY

RECREATION ROOM

GENERAL REHAB

PHYSICAL THERAPY

TREATMENT ROOM

LOCKERS

OCCUPATIONAL THERAPY

REGISTRATION/ WAITING

COMMUNICATIVE DISORDERS

RECREATION /FITNESS

RECEPTION/ WAITING

OUTPATIENTS

PUBLIC/MEMBERS

INTRADEPARTMENTAL INTERDEPARTMENTAL

INPATIENT CARE FACILITIES

FLOOR SUPPORT

ADMITTING SERVICES

PRE-ADMITTING TEST CENTER

PATIENT CARE UNIT

SUPPORT SERVICES DIETARY MATERIALS MGMT. HOUSEKEEPING

DISCHARGE HOME

ADMITTING

DIAGNOSTICS/ TREATMENT EMERGENCY ROOM (ADULT/PEDS)

OBSERVATION BEDS E.R/TRAUMA

INPATIENT SURGERY/POST ANAESTHESIA RECOVERY

INPATIENT DIAGNOSTIC IMAGING

OTHER

TRAUMA UNIT

CATH LAB ENDOSCOPY CARDIAC DIAG. EEG/EMG

Drawings made on the basis of information gathered from ‘Building Type Basics for Healthcare Facilities’

SNIPPETS OF EXISTING GUIDELINES

A SOURCE OF DESIGN REFERENCE STANDARDS: Handbook to Build a Hospital (Male, Maldives) 7. Circulation •

Circulation ways have to be dimensioned for the most important circulation.

- Access passages: 1.5m wide, - Passages for lying patients’ transfer: 2.25m wide minimum, - Ceilings in passages: 2.40m high minimum, - Maximal distance between two windows in a passage way: 25m, - Width of passage ways mustn’t be reduced by any object or post, - According to the regulations fire doors are required in passage ways.

•

Doors: - Coverings have to be resistant to the maintenance and disinfectant products.

- The same sound insulation as the one for walls is required: a leaf with two walls can absorb noises up to 27 dB minimum.

- Height of doors: 2.1-2.2m, - Height of over designed doors for cars: 2.5m, - Height of doors for the passage of transport vehicles: 2.7-2.8m, - Minimal height of doors for access to a hall for lying people: 3.5m.

8. Circulation for handicapped people •

Circulation in a wheelchair requires a specific design of the circulation ways (Picture 1) - Passages: 1.30m wide minimum, better if 2m wide, - Doors: 0.95m wide minimum, a magnetic closure is advised, - Switches, handles, windows closure... have to be within easy reach: 1-1.05m high, - Wide pushbuttons are required, - Access ways: 1.20-2m wide, - Slopes: 5% maximum, 6m long maximum, - Width between handrails: 1.20m.

•

Connections have to be as short as possible.

9. Duration of use •

Equipment and second work have to be changed every 10-15 years.

So a sufficient space has to be planned for assembling and dismantling.

Cross, French Red. 2006. A Source of Design Reference Standards. Male, Maldives: Construction Délegation.

6

1. Area • •

A hospital has to be placed: - In a quiet place, - On a healthy and flat plot without dust, bad smells, insects…

Some vacant places have to be planned for future extensions of the hospital.

2. Layout

•

A hospital consists of several sectors: - Treatments, cares, examination, - Administration, - Technical and storage zones, - Waste water discharge, - Hotel, - External areas: park and parking.

•

There are two main types of building layouts: - Wings/Pavilions for specialized sectors, - A central space and rays.

•

It is necessary: - To differentiate main sectors/annexes/circulation passages, - To separate hospitalized patients and other patients, - To minimize distances between services.

•

Note that: - A park is required for acoustic isolation of rooms, - A maximal partition in isolated sections is required.

3. Plot orientation (in the northern hemisphere) •

Treatment zones and storage locals: in the North, North-West or North-East.

3

Cross, French Red. 2006. A Source of Design Reference Standards. Male, Maldives: Construction Délegation.

SNIPPETS OF EXISTING GUIDELINES

vided under the they are deemed all services in the rdering new sets, ould be properly

t wherever the xure no. 6 may be

t. It is estimated udget is necessary ts.

(Desirable)], one ne for laboratory, HC. No Sharing of ould be done. equipment are Bureau of Indian ny equipment are cifications for the d by the technical r the process of

rgency drugs are

d in the Guidelines drugs are being

ith one Operation aboratory facility. following are the

delines as below le only to centres d priority is to be HCs. e centre should e of the block mprove access to



The area chosen should have the facility for electricity, all weather road communication, adequate water supply, telephone etc.



It should be well planned with the entire INDIAN PUBLIC HEALTH necessary infrastructure.

It should be well lit STANDARDS (IPHS) and ventilated with as much use of natural Guidelines for Community Health Centers light and ventilation as possible.

CHC should be away from garbage collection,2012) (Revised



cattle shed, water logging area, etc.

Disaster Prevention Measures: (For all new upcoming facilities in seismic zone 5 or other disaster prone areas).

Building structure and the internal structure should be made disaster proof especially earthquake proof, flood proof and equipped with fire protection measures.

Earthquake proof measures: Structural and nonstructural elements should be built in to withstand quake as per geographical/state govt. guidelines. Nonstructural features like fastening the shelves, almirahs, equipment etc are even more essential than structural changes in the buildings. Since it is likely to increase the cost substantially, these measures may especially be taken on priority in known earthquake prone areas.

evaluated followed by necessary changes in the Plan and training of the staff.



The CHC should be, as far as possible, environment friendly and energy efficient. Rain-Water harvesting, solar energy use and use of energy-efficient CFL bulbs/equipment should be encouraged. Provision should be made for horticulture services including herbal garden. Outpatie The building should have areas/space marked for the following:

Entrance Zone Signage 



CHC should not be located in low lying area to prevent flooding.

CHC should have dedicated, intact boundary wall with a gate. Name of the CHC in local language should be prominently displayed at the entrance which is readable in night too.

Fire fighting equipment: Fire extinguishers, sand buckets, etc. should be available and maintained to be readily available when needed. Staff should be trained in using fire fighting equipment. Each CHC should develop a fire fighting and fire exit plan with the help of Fire Department. Regular mock drills should be conducted.

All CHCs should have a Disaster Management Plan in line with the District Disaster management Plan. All health staff should be trained and well conversant with disaster prevention and management aspects Surprise mock drills should be conducted at regular intervals. After each drill the efficacy of the Disaster Plan, preparedness of the CHC, and the competence of the staff should be

ndian Public Health Standards (IPHS) Guidelines for COMMUNITy HEALTH CENTRES









 



Prominent display boards in local language providing information regarding the services available and the timings of the institute.

Directional and layout signages for all the departments and utilities (toilets, drinking water etc.) shall be appropriately displayed for easy access. All the signages shall be bilingual and pictorial.

Citizen charter shall be displayed at OPD and Entrance in local language including patient’s rights and responsibilities.

On-the-way signages of the CHC & location should be displayed on all the approach roads.

Safety, hazards and caution signs shall be displayed prominently at relevant places, e.g. radiation hazards for pregnant woman in x-Ray. Fluroscent Fire-Exit signages at strategic locations.

Barrier free access environment for easy access to non-ambulant (wheel-chair stretcher), semi-ambulant, visually disabled and elderly persons as per “Guidelines and Space Standards for barrier-free built environment for Disabled and Elderly Persons” of Government of India.

Ramp as per specification, Hand-railing, proper lightning etc must be provided in all health facilities and retrofitted in older one which lack the same.



Registration cum Inquiry counters.



Pharmacy for drug dispensing and storage.

The facil maximum future ex

Name of charges s

Layout of functiona

Enqu Clinic Digno

Clinics fo include g obstetric welfare. surgery w (privacy) rooms fo examinat table, ch basin w couch an 



Directorate General of Health Services Ministry of Health & Family Welfare, Government of India. 2012. Indian PublicDelhi Health .Standards (IPHS) Guidelines for COMMUNITy HEALT IndianNew Public Health Standards (IPHS) Guidelines for Community Health Centres.

to Obstetric to Obstetric & Gynaecology. & Gynaecology.

Family Family Welfare Welfare counselling counselling roomroom should should be provided. be provided. 

 Waiting Waiting roomroom for patients. for patients.



 Pharmacy The The Pharmacy should should be located be located in aninarea an area conveniently accessible all clinics. conveniently accessible fromfrom all clinics. dispensary compounding The The dispensary and and compounding roomroom should dispensing windows, should havehave two two dispensing windows, compounding counters shelves. compounding counters and and shelves.

The The pattern of arranging counters pattern of arranging the the counters and and shelves depend on the of the shelves shall shall depend on the size size of the room. medicines which require room.

The The medicines which require cold cold storage and blood required for operations storage and blood required for operations and and emergencies be kept in refrigerators. emergencies may may be kept in refrigerators.



Ancillary  Ancillary rooms rooms 

Nurses rest room. rest room.  Nurses

There should should be anbearea an area separating separating OPD OPD  There and Indoor and Indoor facility. facility.

Operation theatre/Labour theatre/Labour roomroom  Operation  Patient  Patient waiting waiting Area.Area.  Pre-operative  Pre-operative and and Post-operative Post-operative (recovery) (recovery) room. room.  Staff  Staff area.area.  Changing  Changing roomroom separate separate for males for males and and females. females.  Storage  Storage area area for sterile for sterile supplies. supplies.  Operating  Operating room/Labour room/Labour room. room.  Scrub  Scrub area.area.  Instrument  Instrument sterilization sterilization area.area.  Disposal  Disposal area.area.  Newborn  Newborn care care Corner Corner (Annexure (Annexure 1A). 1A). 



 Emergency Room/Casualty: Atmoment, the moment, Emergency Room/Casualty: At the emergency are being attended the the emergency casescases are being attended in OPD during in inpatient in OPD during OPD OPD hourshours and and in inpatient afterwards. is recommended unitsunits afterwards.

It isIt recommended to to a separate earmarked emergency havehave a separate earmarked emergency area area be located the entrance of hospital to betolocated nearnear the entrance of hospital preferalbly having 4 rooms for doctor, preferalbly having 4 rooms (one(one for doctor, Newborn Newborn CareCare Stabilization Stabilization Unit:Unit:

oneminor for minor OT, for oneplaster/dressing) for plaster/dressing) one for OT, one 1B 1B and for onepatient for patient observation (At least 4 Annexure and one observation (At least 4 Annexure beds). beds).

Public Public utilities: utilities: Separate Separate for males for males and and female; female; for for patient patient as well as well as for as paramedical for paramedical & Medical & Medical staff. staff.

Treatment Treatment Room Room Disabled Disabled friendly, friendly, WC with WC with washwash basins basins as specified as specified  Minor  Minor OT OT under under Guidelines Guidelines for disabled for disabled friendly friendly environment environment  Injection  Injection RoomRoom and Dressing and Dressing RoomRoom should should be provided. be provided.  Observation  Observation RoomRoom 

Wards: Wards: Separate Separate for Males for Males and Females and Females 

 

Physical Physical Infrastructure Infrastructure for Support for Support Services Services

 Nursing Nursing Station Station : The: The nursing nursing station station shall shall be centered be centered such such that that it serves it serves all the all clinics the clinics fromfrom that place. that place.

The nursing The nursing station station should should be be spacious spacious enough enough to accommodate to accommodate a medicine a medicine chest/a chest/a workwork counter counter (for preparing (for preparing dressings, dressings, medicines), medicines), handhand washing washing facilities, facilities, sinks,sinks, dressing dressing tables tables with with screen screen in between in between and and colour colour coded coded bins bins (as per (as IMEP per IMEP guidelines guidelines for community health centres).

It should for community health centres).

It should provision for Hub cutters needle havehave provision for Hub cutters and and needle destroyers. destroyers.

 



and dressing Examination and dressing table.table.  Examination Patient AreaArea  Patient 

between Enough spacespace between beds.beds.  Enough



separate for males and females.

Toilets; separate for males and females.  Toilets;



space/room for patients needing Separate space/room for patients needing  Separate isolation. isolation.



 Central Central Steritization Steritization Supply Supply Department Department (CSSD): (CSSD): Sterilization Sterilization and Sterile and Sterile storage. storage.  Laundry: Laundry: Storage Storage should should be separate be separate for dirty for dirty linenlinen and clean and clean linen.linen.

Outsourcing Outsourcingis isrecommended recommendedafterafter appropriate appropriate training training of washer of washer man man regarding regarding segregation segregation and and separate separate treatment treatment for for infected infected and non-infected and non-infected linen.linen.  Engineering Engineering Services: Services: Electricity/telephones Electricity/telephones /water/civil /water/civil Engineering Engineering may may be outsourced. be outsourced.

Maintenance Maintenance of proper of proper sanitation sanitation in toilets in toilets and and otherother public public utilities utilities should should be given be given utmost utmost attention. attention.

Sufficient Sufficient funding funding for this for this purpose purpose mustmust be kept be kept and the and services the services may may be outsourced. be outsourced.  Water Water Supply Supply : Arrangements : Arrangements shallshall be made be made to supply to supply 10,000 10,000 litreslitres of potable of potable waterwater per per day to daymeet to meet all the all requirements the requirements (including (including laundry) laundry) except except fire fighting. fire fighting.

Storage Storage capacity capacity

IndianIndian PublicPublic HealthHealth Standards Standards (IPHS)(IPHS) Guidelines Guidelines for COMMUNITy for COMMUNITy HEALTH HEALTH CENTRES CENTRES

with other departments.

SNIPPETS OF EXISTING GUIDELINES

The functional program shall describe the type and location of all special equipment that is to be wired, plumbed, or plugged in, and the utilities required to operate each.

atient beds. r those floors that es.)

0 beds, the numfrom a study of vertical trans-

rs shall have te a patient bed st 5 feet 8 inches meters) deep. Car not less than 4 2.13 meters) high. at can accommoy will not be

for visitors and an noted above, or disabled access.

d with a two-way with an accuracy

e for material independent ing all landing button calls only.

controls shall not t beams, if used s without touch, oor-edge safety with a system of light control fead should it

shall be made th written certifi-

ear opening of not less

deration should be given rators used to dispose of

n a manner fully consistent th, both on-site and offocal statutes and regula-

Note: Refer to NFPA code requirements applicable G E N E R A L H OtoShospital P I TA L laboratories, including standards clarifying that hospital units do not necessarily have the same fire safety requirements as commercial chemical labocation stating that the installation meets the requireratories. ments set forth in this section as well as all applicable safety regulations and codes.

GUIDELINES FOR DESIGN AND CONSTRUCTION OF HOSPITAL AND HEALTH CARE FACILITIES 7.30.C. Waste Processing Services 7.30.C1. Storage and disposal. Facilities shall be provided for sanitary storage and treatment or disposal of waste using techniques acceptable to the appropriate health and environmental authorities. The functional program shall stipulate the categories and volumes of waste for disposal and shall stipulate the methods of disposal for each.

7.30.C2. Medical waste. Medical waste shall be disposed of either by incineration or other approved technologies. Incinerators or other major disposal equipment may be shared by two or more institutions. a. Incinerators or other major disposal equipment may also be used to dispose of other medical waste where local regulations permit. Equipment shall be designed for the actual quantity and type of waste to be destroyed and should meet all applicable regulations.

2

b. Incinerators with 50-pounds-per-hour or greater capacities shall be in a separate room or outdoors; those with lesser capacities may be located in a separate area within the facility boiler room. Rooms and areas contain54 ing incinerators shall have adequate space and facilities for incinerator charging and cleaning, as well as necessary clearances for work and maintenance. Provisions shall be made for operation, temporary storage, and disposal of materials so that odors and fumes do not drift back into occupied areas. Existing approved incinerator installations, which are not in separate rooms or outdoors, may remain unchanged provided they meet the above criteria.

In this edition c. The design and construction of incinerators andappendix material trash chutes shall comply with NFPA 82. appears in the main body of *d. Heat recovery. the document; however, it *e. Environmental guidelines. remains advisory only. tions. Toward this end, permit applications for incinerators and modifications thereof should be supported by Environmental Assessments and/or Environmental Impact Statements (EISs) and/or Health Risk Assessments (HRAs) as may be required by regulatory agencies. Except as noted below, such assessments should utilize standard U.S. EPA methods, specifically those set forth in U.S. EPA guidelines, and should be fully consistent with U.S. EPA guidelines for health risk assessment. Under some circumstances, however, regulatory agencies having jurisdiction over a particular project may require use of alternative methods.

7.13 Rehabilitation Therapy Department 7.13.A. General Rehabilitation therapy is primarily for restoration of body functions and may contain one or several categories of services. If a formal rehabilitative therapy service is included in a project, the facilities and equipment shall be as necessary for the effective function of the program. Where two or more rehabilitative services are included, items may be shared, as appropriate.

7.13.B. Common Elements Each rehabilitative therapy department shall include the following, which may be shared or provided as separate units for each service: 7.13.B1. Office and clerical space with provision for filing and retrieval of patient records.

7.13.B2. Reception and control station(s) with visual control of waiting and activities areas. (This may be combined with office and clerical space.)

7.13.B3. Patient waiting area(s) out of traffic with provision for wheelchairs.

*ENVIRONMENT OF CARE 2.1 Energy and Other Resource Conservation The importance of energy conservation shall be considered in all phases of facility development or renovation. Proper planning and selection of mechanical and electrical systems, as well as efficient utilization of space and climatic characteristics, can significantly reduce overall energy consumption. The quality of the health care facility environment must, however, be supportive of the occupants and functions served.

Design for energy conservation shall not adversely affect patient health, safety, or accepted personal comfort levels. New and innovative systems that accommodate these considerations while preserving cost effectiveness are encouraged. Architectural elements that reduce energy consumption shall be considered part of facilities design.

7.13.C If phy ing, at

7.13.C screen less th floor a

7.13.C within station

7.13.C

7.13.C

7.13.C

7.13.C and su

7.13.C patien shall b

7.13.C diathe require

7.13.D If this be inc

7.13.D chair a

NTRODUCTION

*1.5 Provisions for Disasters In locations where there is recognized potential for hurricanes, tornadoes, flooding, earthquake, or other regional disasters, planning and design shall consider the need to protect the life safety of all health care facility occupants and the potential need for continuing services following such a disaster.

When consistent with their functional program and disaster planning, acute care facilities with emergency services can serve as receiving, triage and initial treatment centers in the event of nuclear, biological, or chemical (NBC) exposure. These facilities shall designate specific area(s) for these functions. *1.5.A. Wind- and Earthquake-Resistant Design for New Buildings Facilities shall be designed to meet the requirements of the building codes specified in Section 1.1.A provided these requirements are substantially equivalent to ASCE 7-93. Design shall meet the requirements of ASCE 7-93.

The following model codes and provisions are essentially equivalent to the ASCE 7-93 requirements: ■

1988 NEHRP Provisions

■

1991 ICBO Uniform Building Code

■

■

1992 Supplement to the BOCA National Building Code 1992 Amendments to the SBCC Standard Building Code

1.5.A1. For those facilities that must remain operational in the aftermath of a disaster, special design is required to protect systems and essential building services such as power, water, medical gas systems, and, in certain areas, air conditioning. In addition, special consideration must be given to the likelihood of tem-

porary loss of externally supplied power, gas, water, and communications.

1.5.A2. The owner shall provide special inspection during construction of seismic systems described in Section A.9.1.6.2 and testing described in Section A.9.1.6.3 of ASCE 7-93.

1.5.A3. Roof coverings and mechanical equipment shall be securely fastened or ballasted to the supporting roof construction and shall provide weather protection for the building at the roof. Roof covering shall be applied on clean and dry decks in accordance with the manufacturer’s instructions, these Guidelines, and related references. In addition to the wind force design and construction requirements specified, particular attention shall be given to roofing, entryways, glazing, and flashing design to minimize uplift, impact damage, and other damage that could seriously impair functioning of the building. If ballast is used it shall be designed so as not to become a projectile.

1.5.B. Flood Protection, Executive Order No. 11988, was issued to minimize financial loss from flood damage to facilities constructed with federal assistance. In accordance with that order, possible flood effects shall be considered when selecting and developing the site.

Insofar as possible, new facilities shall not be located on designated floodplains. Where this is unavoidable, consult the Corps of Engineers regional office for the latest applicable regulations pertaining to flood insurance and protection measures that may be required.

1.5.C. Should normal operations be disrupted, the facility shall provide adequate storage capacity for, or a functional program contingency plan to obtain, the following supplies: food, sterile supplies, pharmacy supplies, linen, and water for sanitation. Such storage capacity or plans shall be sufficient for at least four continuous days of operation.

APPENDIX

A1.5.A. The ASCE 7-93 seismic provisions are based on the National Earthquake Hazards Reduction Program (NEHRP) provisions (1988 edition.) developed by the Building Seismic Safety Council (BSSC) for the Federal Emergency Management Agency (FEMA).

A study by the National Institute of Standards and Technology (NIST) found

■

1992 Supplement to the BOCA National Building Code

■

1992 Amendments to the SBCC Standard Building Code

Executive Order 12699, dated January 5, 1990, specified the use of the maps in the most recent edition of ANSI A58 for seismic safety of federal and federally assisted or regulated new building construction. The ASCF 7 standard was formerly the ANSI A58 standard. Public Law 101-614

SNIPPETS OF EXISTING GUIDELINES

FGI GUIDELINES

Examination/treatment room and/or multipurpose diagnostic testing room (1) Location. Where this room is used for obstetric triage, it shall be immediately accessible to the units where births occur (LDR, LDRP, and cesarean delivery rooms) and not in the postpartum unit.

(2) Space requirements (a) This room shall have a minimum clear floor area of 120 square feet (11.15 square meters). (b) Where used only as a multipurpose diagnostic testing room, a minimum clear floor area of 80 square feet (7.43 square meters) per patient shall be permitted.

(3) Patient toilet room (a) A patient toilet room shall be directly accessible from the examination room. (b) Where a patient toilet room serves more than one examination room, measures shall be provided to limit patient access to other examination rooms.

Antepartum and Postpartum Unit Separation of postpartum and antepartum beds is recommended; however, in some obstetrical services there is a need to use these beds flexibly and to combine them in one unit.

Antepartum room. For requirements, see Section 2.2-2.2.2 (Medical/Surgical Patient Care Unitâ&#x20AC;&#x201D;Patient Room).

Postpartum room (1) The postpartum room shall meet the requirements in Section 2.2-2.2.2 (Patient Room) with the exception of Section 2.2-2.2.2.2 (1) (Patient Roomâ&#x20AC;&#x201D;Area).

(2) Space requirements. Patient rooms in the postpartum unit shall have a minimum clear floor area of 150 square feet (13.94 square meters) in single-patient rooms and 124 square feet (11.52 square meters) per bed in multiple-patient rooms.

Examination/treatment room and/or multipurpose diagnostic testing room (1) Location. Where this room is used for obstetric triage, it shall be immediately accessible to the units where births occur (LDR, LDRP, and cesarean delivery rooms) and not in the postpartum unit.

(2) Space requirements (a) This room shall have a minimum clear floor area of 120 square feet (11.15 square meters). (b) Where used only as a multipurpose diagnostic testing room, a minimum clear floor area of 80 square feet (7.43 square meters) per patient shall be permitted.

(3) Patient toilet room (a) A patient toilet room shall be directly accessible from the examination room. (b) Where a patient toilet room serves more than one examination room, measures shall be provided to limit patient access to other examination rooms.

GUIDELINES IN FEASIBILITY

COST OF THE FACILITY

The rough costs for the facility act as an important constraint in the planning of spaces and also to decide on the materials to be used. Locally produced materials are the most suitable for this site in terms of the cost as well as well the local laborers, who are skilled only in specific assets and are mostly uneducated hence may not be fast learners if a new skill is introduced to them.

Hence, cost estimation is an important guideline to follow throughout the design process to make sure that no extravagant proposals are made which in all probability might not even get constructed.

FGI. 2018. FGI Guidelines for Design and Construction of Hospitals. FGI. Accessed 2019. http://www.madcad.com/store/ subscription/FGI-Guidelines-Hospital-2018/.

DESIGN

CHAPTER 5

CONCEPTUAL DESIGN

The early stages of the design process include conceptualizing the way various spaces are planned and designed. The initial phases thus include multiple diagrams and quick sketches to visualize how each space might look. The concepts are based on the need to improve the prevailing social conditions within the country and also to be able decide how to clearly integrate the educational aspect of the site (the medical school) with the â&#x20AC;&#x2DC;healingâ&#x20AC;&#x2122; facility, that is the main hospital.

Through various sketches and decision-making processes one reaches the conclusion that although the education and healing facilities can be functionally and performatively integrated, they should in a way be physically cohesive too, for a smoother functioning of the institute. A lot of the services provided by doctors and other healthcare professionals can also be provided by the students, hence it is necessary to get them involved in the practical aspect of their training early on.

Students are given great importance within the facility as the expectation is that they can replace practicing doctors when the need arises, at least in areas like triage, rehabilitation, etc. A typical day in the life of a resident is a fair amount of theoretical studies and practice in different facilities.

Here, the typical life of a third year resident is shown, where the day starts in a classroom as a normal medical student and the moves onto different spaces within the campus where they can take on different responsibilities based on the building program.

The reason behind including them in a professional capacity is two-fold: a. Decreasing the work load on doctors since the facility is expected to have crowded situations and including the resident students in these activities can help attend to more patients b. Their medical knowledge will have a considerable amount of growth that can be gained by the combination of academics and practice Integration of education and healthcare within the region is specifically aimed at bettering the youth of the region, so that they in turn can help the next generation and so on. It is small steps like these that can aid in the development of the region.

Existing clinics within the village, which could also do with the help of student medical professionals

BUILDING ITERATIONS

Composting toilet

Composting toilet

Smell prevention on land Composting toilet

Smell prevention on land Composting toilet

PREFERRED LAYOUT

COMMON NURSING UNIT FORMS

ADVANTAGES

Easy access to all rooms within the building

DISADVANTAGES

Connectivity to other units might be limited

N

Ease of wayfinding COMPACT CIRCLE

Easy access to all rooms within the building N

Connectivity to other units might be limited

Ease of wayfinding

COMPACT SQUARE

N

Easy access to all rooms within the building

Connectivity to other units might be limited

Ease of wayfinding

Not ideal for patientsâ&#x20AC;&#x2122; supervision

Ease of wayfinding

Segregation in supervision

DOUBLE -LOADED

N

N

Better for segregating different programs

RACE TRACK

Easy access to all rooms within the building N

Connectivity to other units might be limited

Ease of wayfinding

COMPACT TRIANGLE

N

N

N

N

CROSS

Communication between nursing rooms is more efficient

Circulation might be limiting

SCHEMATIC DESIGN

The schematic bubble diagram here is the realization of an idea that begins to visualize the campus as the combination of outdoor landscape and indoor spaces such that there is free-flowing circulation and every space is easily accessible to everyone who works within the facility and also visits it.

Adjacencies of the spaces have been decided based on their programmatic similarities and also the urgency of the programs. Circulation is also lightly segregated into primary circulation and secondary circulation based on the user and the need for the program, along with the landscape that acts as fences for the separate programmatic buildings and also as open spaces to accommodate the overflow of visitors within the buildings.

The following diagrams were made based on the bubble diagrams created earlier in order to visualize the quality of the spaces, both indoor and outdoor, and also think about how aspects like daylight and circulation are affected by the relative placement of the buildings.

The two schemes shown here represent a central circulation spine that has the ability to access all buildings on site, so that there is ease in wayfinding and also all vehicular movement is restricted to the center of the site.

The disadvantage here, however, is that pedestrian and bicycle circulation is constantly hindered by vehicular movement within the site, which is not ideal for a campus that encourages movement in the open spaces provided.

The schemes shown here are based more on the fact that all kinds of circulation should be allowed throughout the campus and that every building should be accessed by vehicular transportation and by pedestrians and cyclists, so that there is freedom to access any program of urgency.

The disadvantage here is that there is lack of security in the individual programmatic facilities, and also free-flowing movement within the facility is restricted as there needs to be constant vigilance for the vehicles. In addition to that, it is not ideal for service vehicles to move between facilities in the open spaces.

CHAPTER 6

DESIGN DEVELOPMENT A thorough process of area programming is followed 5 ‘schemes’ for the site plan.

THE CLUSTER This scheme forms a separate ‘cluster’ of buildings for each set of programmatically similar buildings, so that all the patients within the facility have easy access to the departments that they are in need of, and at the same time segregates the separate programs that also aids in infection control. In addition to these advantages, this scheme also ensures that each ‘Cluster’ has its own outdoor courtyard that caters specifically to those patients, thereby helping in the aspect of security and supervision while also adhering to the idea of bringing the outdoors into the indoors.

This scheme also creates a set of ‘classroom’ clusters for the students within the facility, where each cluster is available to a specific set of students so that by the end of their education they will have covered all the facilities.

THE CENTRAL SPINE Similar to â&#x20AC;&#x2DC;The Clusterâ&#x20AC;&#x2122;, this scheme also separates the different programs into separate spaces so that each facility has its own identity, but also they are all connected through a pedestrian + vehicular pathway that runs centrally through the site so that there is ease of Wayfinding.

All the separate clusters have open courtyards that face away from this central road so that the patients have a sense of security and privacy even while out of the building.

THE FUNNEL Every visitor, whether on a vehicle or on foot, spills out into the open space through a central road that connects to all of the emergency facilities, namely the pediatric emergency, the adult emergency and the maternity emergency. The â&#x20AC;&#x2DC;open spaceâ&#x20AC;&#x2122; here corresponds to the facilities of lesser urgency, like the rehabilitation center and the student classrooms.

Hence, this scheme highlights the priority given to the proximity of the more important urgent facilities to the entrance.

THE STUDENT SPINE Since the project highlights the importance of students within the facility and how they play a central role in all its goings-on, the iteration tends to literally, physically, place the students in a central space within the facility so that they all have access to all of the available programs within the facility.

This also increases the dependency of the facility on the students, and they can cater to more and more programs with ease, which is the whole essence of the myLifeSpeaks campus.

THE LIGHTNING A combination of all the aforementioned schemes, this scheme combines the advantages of each scheme: the students have direct access to the programs, which puts them in a central position functionally and physically. The access road is a spinoff on the ‘CENTRAL SPINE’ and all of the programs have been arranged in clusters with open courtyards to give them a sense of privacy and security.

In addition to these schemes, all the patients’ buildings are oriented in the same direction so as to maximize passive ways of gaining more daylight, solar energy and ventilation.

SCHEMATIC EXPERIENTIAL DESIGN Once the different schematic layouts were decided for the site plan, site sections help one understand the experiential quality of the spaces, along with the visual and physical constraints inside and outside the buildings. It also helps decide the spaces where landscaping needs to be given more importance functionally, and where it is more for aesthetic purposes.

This also the stage where certain colors are identified for the buildingsâ&#x20AC;&#x2122; interior and exterior walls to add a layer of subtlety to the atmosphere and at the same time make it appear more playful. Since this is the first attempt at imagining the experience of the space, the takeaway is that th buildingsâ&#x20AC;&#x2122; vocabulary needs to be a similar language. Apart from that, it is important to respond to the vernacular language of the buildings. Hence, while these drawings are useful as first attempts at imagining the campus, they also help in gauging the amount of refinement needed for the design thinking process.

CHAPTER 7

FINAL DESIGN The final design aims to integrate the indoors with the outdoors, ensuring that the outdoor landscape is designed such that it caters specifically to the spaces it is adjacent to.

Apart from trying to make the outdoor landscape an important part of the design, the campus also has spaces designed specifically to accommodate visitors of patients, namely friends and family.

HEALING AND LEARNING An urban ‘healing’ facility plugged into the village of Neply, Haiti on a site that currently houses a sugarcane field. The facility responds to the rural context-socially, economically and culturally- while merging the virtues of education and healing to provide for the local population as well as for the people of the surrounding villages who have been deprived of such facilities. This remote medical campus aims to address issues related to the aforementioned factors architecturally, and to simultaneously provide to the people the basic facilities of healthcare by making the most of what is readily available: THE YOUTH, that can educate itself on campus and get professionally involved in the provision of quality healthcare LOCAL LABORFORCE, that can be educated on site to use the available material for construction of the facility and continue to work in the management of the facility NATURE for its abundant resources that provide a welcome intervention to accelerate the process of healing THE DESIRE TO DEVELOP- socially, economically, culturally.

The aim of the project is to answer a relevant fraction of the questions that arise when one combines the terms ‘healing’, ‘education’ and ‘Haiti’: How can one empower the local youth to be more involved in the progress of the population? How can said youth aid in the ‘healing’ of the economy? How can nature in its truest form accelerate the recovery process for the ailing? How can you effectively change the local lifestyle to reduce said ailments?

HOW CAN YOU ACCELERATE HEALING THROUGH INTEGRATED LEARNING IN A RURAL HAITIAN CAMPUS? One of the main aims of the ‘teaching hospital’ is also to make sure that it provides good education to the students- an education that will encourage them to stay back in Haiti and improve medicine, rather than move to another country to be able to practice better, with better pay and job security. This means not only better infrastructure within the hospital, but also higher quality of education with the right resources to be able to have practical knowledge rather than textbook-learning, which is often the case in Haitian medical schools.

The reason behind the integration of these seemingly independent fields is also to set a precedent for more such institutions. Over time, this institution aims to become a mutually-educative process, where the students learn the need for better medicine in a country like Haiti, and in return can propose to educate the patients, or at least those visiting these patients on a regular basis, how to practice a healthier lifestyle. The first step in improving the medical education system is to integrate practical learning with theory, and a hospital provides the best platform for said practice.

As an architect, one can modulate the circulation within the facility and the adjacencies of spaces so to form a smooth-flowing center that eases the movement of hospital-staff as well as works as the signage that encourages them to take up voluntary education. A successful facility will help make basic education a privilege rather than an imposition, where the visitors and patients feel lured towards the knowledge of how to achieve a better tomorrow. This, encompassed within a facility that is largely self-sufficient, aims to become a precedent for all future health facilities in Haiti.

The site plan laid out here is a guide to the phasing of the site based on the need of the hour and the urgency of the program, and the subsequent placement of these programs closer to the main entrance so that construction activities are not hindered by visitors, and also so that the activities of the users and visitors are not hindered by the construction work.

Circulation plays an important part in the planning of the site to segregate the different programmatic buildings and also to add to the connectivity of all the different ‘Clusters’ to each other. The students are given a wide, sprawling cluster in the central region of the site so that they hold a significant position within the campus and also have easy connectivity to all facilities within the campus, thereby successfully merging their medical education with professional medical practice.

The site is to be constructed in 3 phases, depending on the availability of funding for the project. Since the available sources are not always constant, care has to be taken maintain steady nancial levels for optimum functioning of the site.

The phases are thus based on their urgency within the site, their role, thir priority in relation to the other programs, and accordingly positioned on the site. The Phases are also developed in the form of CLUSTERS, where prorgammatically similar buildings are placed in close proximity to each other to create an open courtyard that caters speciically to that cluster.

In addition to the location of each building, the orientation of each programmatic building also plays a major role in making the facility economically and environmentally sustainable.

ANALYSES FOR USE OF PASSIVE STRATEGIES

PHASE-III

PHASE-II

PHASE-I

PLYWOOD TO HOLD TRUSSES

Material and technique carefully selected to make the construction economically feasible and the building to incorporate passive methods of lighting and ventilation, thereby reducing the need for electricity.

The final design aims to integrate the indoors with the outdoors, ensuring that the outdoor landscape is designed such that it caters specifically to the spaces it is adjacent to. Other strategies incorporated include the use of composting toilets so that the solid waste is used as manure for the outdoor landscape, and the water can be used for the landscape and also can be recycled so that it can be reused in the toilets.

SCHEMATIC DESIGN

DESIGN DEVELOPMENT

DRAFTED IN USA

FINAL DESIGNS

PRODUCTION DRAWINGS

BUILDING DETAILS

SITE PLAN ITERATIONS

BUBBLE DIAGRAMS/CONCEPTS

ACADEMIC WORKP

CON DOC

WORK FORCE SIZE=5-8 (ARCHITECT, ENGINEERS, CONSULTANTS, ETC.)

WORK FORCE SIZE=1 (+5 CONSULTANTS=3 ACADEMIC+2 PROFESSIONAL ADVISORS)

JANUARY 2019

EXHIBIT WORK AT MILLER GALLERY, CMU

MAY 2019

DECEM

TAKEN OVER BY AN AMERICAN LICENSED ARCHITECT

STAMP ARCHIT

Based on the final design, a timeline has been made that can be used as the rough schedule for future activities regarding the construction of the facility. Although this may change according to the need of the hour and based on the availability of funding, the facility has been designed such that it can be constructed in phases and yet, at every stage the facility has the ability to fully function in the department that has been constructed, making it selfsustained and completely independent and functional at every stage of the design and construction process.

Constructing the facility in phases allows for every succeeding phase to be developed on the basis of post-occupancy evaluation, where the users and clients act as the consultants that can help future phases be improved and designed to minimize the inconveniences faced in the earlier phases.

MBER 2019

PED BY HAITIAN TECT

INTERNS, DRAFTSMEN, CONSULTANTS, ETC.)

BIDDING JUNE 2021

USUALLY TAKES 5% OF THE WORK AND TIME, BUT THE CONTRACTORS TO BE CHOSEN ARE ALREADY IBN AGREEMENT WITH MYLIFESPEAKS

WORK FORCE SIZE= UNKNOWN (MEP, CIVIL, STRUCTURAL ENGINEERS; CONSTRUCTION LABORERS

RECRUITING OF SKILLED/UNSKILLED

NSTRUCTION CUMENTS WORK FORCE SIZE=20 (ARCHITECT, ENGINEERS,

UNDER HAITI JURISDICTION

ROFESSIONAL WORK

CONSTRUCTION

OCTOBER 2021 PHASE-1

PHASES TO BE CONSTRUCTED OVER EVERY 3 YEARS

This timeline also allows one to create a grid of how the jurisdiction process might take place, and the challenges faced in the schedule for the project that might hinder the progress of the project. In addition to that, the various stages in the completion of the project, starting from the research, continuing to the design and then ending in construction, have been carefully laid out keeping in mind the various players and parties involved.

Hence, the tables that follow in the succeeding pages aim to list out these factors, as guessed by the student after careful calculation of all factors involved.

THE JURISDICTION

HOW TO BRING THIS PROJECT TO FRUITION?

THE WORKFLOW

CHAPTER 8

CONCLUSION

The project is a multi-fold combination of contextual, social, cultural, technical, political aspects which were all taken into consideration at different stages of the schematic design process. Hence, some of these criteria had to be compromised in different parts of the design based on the priority given to certain positions. While it cannot be determined whether or not this design can be successful unless it is actually constructed and the post-occupancy evaluation is developed, there are aspects of the project that pose strong concerns about the sustainability of the project: 1. The Patientâ&#x20AC;&#x2122;s Experience: While a considerable amount of time was spent in determining the ideal experience for the patient, not enough research went into how the different positions of the patient - laying in bed, sitting on a bed, sitting on a chair, sitting in the corridor, walking in the park - might affect their view, or the optimal height of each window, or the most favorable length of the corridor. While existing standards might aim to provide the minimum numbers required for the comfort of the patientâ&#x20AC;&#x2122;s movement, not a lot of them are suitable for a free-flowing crowd that wants to move around the campus amidst various demographies: doctors, students, patients, visitors, service people, possible construction workers, etc. Part of this can be based on postoccupancy evaluation reports, but a lot of it needs to be developed as a pre-emptive measure to avoid overcrowding or lack of security.

2. Affordability: The facility aims to provide quality treatment that might also require expensive equipment. Will the general public be able to afford this kind of treatment.

Since the first few years of the facilityâ&#x20AC;&#x2122;s functioning are dependent on multiple sources of funding, it is not logical to allow free treatment for the patients, especially if the equipment being used requires a lot of maintenance. How then, can the patients pay for the services rendered by the facility. If they are unable to pay for them, are they rejected treatment by the facility? Are there other ways of payment? Is a barter system of services a viable option?

3. Gauging the Demand for Services: In an ideal setting, the hospital will have about 100 patients a day for the outpatient facilities, and exactly 10 patients each for all of the different wards: no more, no less. This is so because if the number exceeds 10 per ward, the facility is not yet equipped to provide additional beds or additional healthcare professionals to provide services. However,if the number of patients is far less than the expected, then the facility might face multiple challenges in the maintenance and smooth functioning of all services, based on the tight budget and lack of a consistent source of funding.

4. Time Frame: Although the phasing for specific facilities has been done keeping in mind the budget constraints as well as the urgency of the need for certain facilities, it may vary depending on the time of the construction and available funding then. It may also be possible that more phases than just 3 might be required for the construction of the facility completely. Although it is ideal to assume that the separated â&#x20AC;&#x2DC;clustersâ&#x20AC;&#x2122; are conducive to carrying out construction activities while the rest of the buildings still function, it may turn into a chaotic set of events with the noise from construction and the operating of critical patients and the influx of unskilled and, in all probability, illiterate laborers. One cannot theoretically determine ALL of the problems that this turn of events might pose.

5. Climate Change: Haiti, with its rather consistent climate through the year, is still prone to hurricanes and earthquakes. While design conditions have been determined by these factors and respond with one-storey buildings and sturdy walls through reinforced concrete, the butterfly roof may not be the most ideal design for a climate that suffers from these phenomena, and if the detail was designed to match with the surrounding, it requires more structural justification than just bolt-attachments to the walls.

6. Cultural Context: How far did the design go to address the cultural aspects of the region? Although the campus plan and the open spaces were informed by the familyoriented culture of the people, and also began to address certain mild interventions that might be able to encourage more lifestyle changes, how much of it might still feel foreign to them? There are certain regional nuances that may play an important role in the informing the design of such facilities, but a week-long trip to the village was probably insufficient to know these minor details. The same can also be said about the peopleâ&#x20AC;&#x2122;s religious preferences. While the campus does have a sprawling space allotted for praying, it remains ambiguous in its adherence to a particular religion, even though the 2 predominant religions within the country are Christianity and Voodoo.

7. Education vs. Health: One of the challenges that the myLifeSpeaks teaching hospital is bound to face,possibly throughout its lifespan, is the tug-of-war between the two seemingly independent yet completely symbiotic relationship between the roles of education and healthcare on campus. On the one hand, it wants to provide a higher level of education to the youngsters within the region so that they feel encouraged to stay back within the country and aid in its development. But on the other hand, this encouragement also has to be exuded by the quality of healthcare provided. Since the quality of healthcare is in many ways also dependent on the students who are educated within this campus, the first few years might prove to be challenging and in ways quite confusing and chaotic for the facility owners and users to distinguish between the two.

8. Science vs. Traditional Health: While no known healthcare customs or routines native to Haiti were researched, it i fairly concerning to know that not all interventions proposed by western medicine are welcomed by the Haitians. Cases like 14-year pregnant girls, stomach infections due to poor eating habits, gangrenes due to poor hygiene conditions- all of them can be prevented with proper awareness or education.

Mental health is a highly stigmatized topic as it is often superstitiously linked with “bad spirits” in the voodoo culture, yet, with the high amount of trauma that the people might have faced, it is a topic that needs to be addressed early and aggressively.

On the whole, even though the thesis design is based on extensive research and very immersive experiences, the success of the end result cannot be gauged by mere theory.

The concept is relatively new within the region and the popularity of the subject among the people remains to be seen. Whether a facility this large that challenges the beliefs of the public will be welcomed by the villagers right away, will further determine a lot of the factors on which the functioning of the hospital will be contingent.

The youngsters in the village are able, but are they motivated enough to make use of this opportunity and actually go to medical school? The villagers, although quite comfortable with foreigners helping them out, are quite stubborn regarding their lifestyles. One concern that erupts is that it might make them lazy as there might be a case where they might end up relying more on western medicine as their ‘savior’ rather than stick to simple lifestyle changes that could easily bring about a difference. Hence, this Teaching Hospital might prove to be a boon as well as a bane.

â&#x20AC;&#x153;We understand the impact that will be made in Haiti goes beyond healthcare. The impact that MLSMSH will make in the area, region, and eventually the country of Haiti will be widespread.â&#x20AC;?

-The Wilson Family

WE ONLY MOVE FORWARD...

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IHME. 2017. Measuring What Matters Most: Haiti. http://www.healthdata.org/haiti.

Cross, French Red. 2006. A Source of Design Reference Standards. Male, Maldives: Construction DĂŠlegation.

The American Institute of Architects Academy, The Facility Guidelines Institute. 2001. Guidelines for Design and Construction of Hospital and Healthcare Facilities. Washington, DC: The American Institute of Architects.

Directorate General of Health Services Ministry of Health & Family Welfare, Government of India. 2012.

Indian Public Health Standards (IPHS) Guidelines for Community Health Centres. New Delhi .

FGI. 2018. FGI Guidelines for Design and Construction of Hospitals. FGI. Accessed 2019. http://www. madcad.com/store/subscription/FGI-Guidelines-Hospital-2018/.

Richard L. Kobus (Author), Ronald L. Skaggs (Author), Michael Bobrow, Julia Thomas, Thomas M. Payette, Stephen A. Kliment. n.d. Building Type Basics for Healthcare Facilities, Second Edition. Wiley.

Charlesworth, Esther. 2016. Architects Without Frontiers: War, Reconstruction and Design Responsiblity .Elsevier Ltd. Elleh, Nnamdi. 1997. Vernacular Architecture: Towards a Sustainable Future. McGraw Hill.

Heath, Kingston W. 2009. Vernacular Architecture and Regional Design-Cultural Process and Enivornmental Response. Elsevier Ltd. 2009. Journeyman International. http://www.journeymaninternational.org/.

Lewis, Elizabeth. n.d. Sustainaspeak: A Guide to Sustainable Design Terms. 2018: Routledge.

Mileto, Vegas et al. 2014. Vernacular Architecture: Towards a Sustainable Future. CRC Press.

Piesik, Sandra. 2017. Habitat: Vernacular Architecture for a Changing Planet. Harry N. Abrams.

Willi Weber, Simos Yannas. 2013. Lessons from Vernacular Architecture. Routledge.

(Dr. Coburn Allen , www.haitifacts.org , www.haitiangovernment.org, www.danitaschildren.org,)

For more information regarding the design process and a semester-long saga of trials and errors, visit www.nikhitabhagwat.com