Architect 2014-07.pdf

AIAFEATURE
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In 2013, RKTB/Perkins Eastman completed the first component of
the plan, a satellite clinic in downtown Abuja dedicated to reducing
infant and maternal mortality. The second phase will be a larger
American Specialist Hospital for Women and Children, to be installed
in an existing building in Abuja, in late 2015.
The plan’s third phase, the American Hospital, itself, will come
last: a 70-bed, 205,200-square-foot hospital designed by RKTB/
Perkins Eastman near Abuja’s airport. Expected to be completed
in 2017, it will provide fee-for-service specialist care and will
concentrate on the four deadliest, non-communicable diseases:
diabetes, hypertension, cardiovascular and cerebrovascular
conditions, and cancer.
The design follows a radial-symmetrical plan centered around
the southwest side of a working reservoir, with clinical and support
spaces on the central arc and patient rooms on spoke-shaped wings
radiating to the rear. The 200-acre site, donated by the government,
is “a weird landscape, to say the least, with a geological formation
which is unlike any you’d see in this part of the world,” says RKTB
principal Carmi Bee, FAIA, who cites Alvar Aalto’s Paimio Sanatorium
in Finland as an inspiration for the kind of healing environment he’s
aiming to create.
Ultimately, the hospital campus will include treatment facilities,
classroom space for the American-Nigerian University of Medical
and Environmental Sciences and Research, and a residential area for
doctors and family members visiting long-term patients. But the Field
of Dreams adage—“If you build it, they will come”—is a little more
complicated in Nigeria. First, it costs money to build a healthcare
system, let alone a hospital; and Abuja’s poorest and ailing citizens
certainly won’t come if they can’t afford the services.
“The hook, if you will, to capturing a wealthier population as the
target demographic for the hospital is to say, ‘Look, our medical staff
is American- or British-trained,’ ” says Joseph Shein, AIA, a healthcare
design specialist and principal at Perkins Eastman who believes the
first step is to lure back Nigerian doctors trained abroad. Then lure
the nation’s wealthiest patients—who commonly fly to Europe or the
Middle East to treat everything from the a cold to cancer.
Reversing the flow of medical tourism should put the hospital in
a strong position for the project’s final phase: a dedicated medical
university that Obiakor predicts will turn out 1,000 doctors and
24,000 allied health personnel each year. But the RKTB/Perkins
Eastman team has a few challenges to address first. Abuja’s energy
grid is unreliable, for one, but Bee’s team is working to find ways for
the hospital to generate up to 70 percent of its own power through
waste-heat recapture. Photovoltaic arrays will also capture something
that seems to be abundant in Nigeria—sunlight.
Another challenge is political instability. “There’ve been three
changes of administration since we started,” says Peter Bafitis, AIA,
another RKTB principal, “and it’s a whole new ballgame [each time]
when new people are in town.” Still, Bafitis notes, the hospital
project has a great deal of momentum behind it, from the likes of
General Electric as well as French and Dutch financiers—although
nobody is wagering heavily on precise timetables.
It seems fair to wonder—as the U.S. medical system is itself
undergoing self-appraisal and restructuring—whether the American
healthcare model is the optimal choice for Nigeria (rather than,
say, Britain’s, with its universal coverage and deeper cultural ties
to the country). Obiakor observes a distinction between healthcare
financing and healthcare itself in American access and cost barriers,
in spite of advanced American medical technologies.
However, healthcare’s physical footprint is just as important as its
operational details. When an architect in the U.S. like Michael Graves
treats efficiency and sustainability as equal partners, a new future for
regional or local clinic-based healthcare starts to emerge. Shore Ortho,
a small rehabilitation clinic located along a strip-mall-and-chainmotel
arterial road, may seem like an unlikely client for Graves’s firm,
Michael Graves & Associates (MGA), or its sister company, Michael
Graves Design Group (MGDG). Somers Point is, after all, where the
1980s shore band B-movie Eddie and the Cruisers was shot. (Eddie: “We
ain’t great. We’re just some guys from Jersey.”) You get the idea.
But because an increasing number of Americans receive treatment
from small local specialty clinics like Shore Ortho, the design of the
patient’s experience is central to the success of a medical business.
“Our goal was to enhance the orthopedic patient experience
and include as many evidence-based design elements as possible.
You may ask how much evidence-based design can be utilized in a
10,000-square-foot building outpatient facility,” says MGA project
architect James Wisniewski, AIA, who notes that Shore Ortho is
certainly not the first healthcare project to implement evidencebased
design. “MGA approaches every project both aesthetically
and empathetically—how the space impacts the individual is just as
important as how it looks. During programming, we considered the
unique populations that would be using the building and how they
would move within the building. All design decisions were made
through that lens.”
MGA managing principal Karen Nichols, FAIA, says that the MGA
team began with what she calls a “patients first” approach. Before
floor plans, fenestration, or furniture, says Nichols, “We considered
solutions to relevant issues faced by patients and their caregivers. We
took our cues from research for a transport chair we designed, where
the relevant problems were infection control, tripping and falling
hazards, the difficult process of getting in and out of a wheelchair,
and back strain for clinicians—whose rate of strain-related injuries is
double that of construction workers.”
“These were critical design drivers for the design of an outpatient
rehabilitation project where most patients would be in wheelchairs,”
adds Wisniewski.
july 2014