Eben-Ezer Medical Clinic, Ft. Liberte Haiti

            Three main focal points of the project include passive ventilation, the patient-family dynamic, and visibility and wayfinding. In our research we found that the healthcare experience in Haiti is often highly crowded and chaotic. Large crowds of people gather all day to wait to be seen by a doctor. This level of social desperation made an impression on our group. Our design eases this chaos by providing spaces that are well ventilated, that include room for family members, and that are easy to navigate. There are three main wings of the design. The front volume of space houses entry and exit sequences with housing lying above. The angled wing houses the path of the common care patient. Patient exam rooms fill the wing and its directionality points the patients in the direction of entry and exit. The patient rooms have double circulation that leads to a secondary greenspace. This greenspace houses outdoor extensions of the rooms so that the doctor and patient can go out into the direct sunlight to make a tough diagnosis but still maintain privacy to the space. The rooms remain private because clerestory windows face the main courtyard while larger CMU block windows face the private secondary space. The west wing houses space for patients who need additional care such as observation, isolation and surgery.

            These wings are filled with volumes that are pulled apart and isolated from one another such that wind can pass through the site with ease. The spaces are arranged around a central courtyard to increase visibility so that patients have a much more thorough and obvious understanding of what goes on around the site and where they need to be (or not be) at all times. The east wing swings open to increase visibility to the site and to extend the view of the skyline. This way the space will not feel daunting and compressed. Instead it is open and inviting. In the center of the courtyard are four blocks of concrete seatwall with trees in the center to provide shade and activate the space for those who are waiting.

            The patient-family dynamic is approached by providing instead of negating space for the family members to wait. It is a cultural norm for the families to all come together and to want to know what is going on with the doctor and the patient. Instead of pushing these people out, the design gives heed to social and cultural trends and provides comforting space for these individuals. This cuts down on chaotic behaviors from the patients and the family members and allows for a more comfortable experience.

Eben-Ezer Medical Clinic Addition

Site Plan

FROM THE OUTSIDE-IN:  to maximize cooling within the buildings, waiting spaces for patients and their families occur in outdoor courtyards and covered areas.  Further waiting for children, families, and patients alike may also occur below the mango trees planted throughout the campus.  By keeping patients and families on the outside, security and sanitation are maximized while heating is minimized.  With these factors in mind, the addition and existing must be designed from the outside-in so that the buildings contain multiple layers of privacy rather than a clear-cut line.      

THE ROTATED CENTER BUILDING:  rotated to align directly east-west for ventilation and solar benefits, the center building creates a more subtle turning angle into the site from check-in.  Additionally, by splitting the building into two parts, the center pinwheel point creates a resting space and area for recollecting families or thoughts before moving to the pharmacy or other parts of the campus.  This space may also be used for waiting and rest for the entirety of the site due to its central access.            

DOUBLE-HEIGHT ENTRANCE:  this entrance (section below) provides an indication of entrance (though patients line up infront of the existing building) and allows views into the complex.  This glimse into the campus gives patients a chance to understand or view what to expect from their visit.  This glimse is not intensive--visitors and patients waiting for check-in are not looking into exam rooms--but it would allow for a showing of activity, circulation, and waiting within the campus.

Concrete covered walkway (green), walkway in under building roof (blue)Patient paths

CONCRETE CONNECTIONS:  to cover the patient paths and general walkways, two different methods have been used.  Spaces in blue indicate wooden trusses and metal roof overhead that would extend from the building structure itself.  Spaces in green indicate a concrete connecting cover that would form from the side of the buildings and extend over walkways and seating.  This covering would be somewhat lower than the roof overhangs to allow provide shading.

OUTDOOR WAITING SPACES:  a variety of waiting spaces have been designed to discourage a feeling of mundane similarity.  Linear waiting is provided near the exam rooms and laboratory so that patients may be called in order and moved quickly through the space.  In the pharmacy and central pinwheel area, waiting is clustered into an area or zone with the understanding that these spaces tend to see a high volume of patients and families.  

Street elevation

SIMPLE AND LOCAL:  As per the heuristics SIMPLICITY and LOCAL AVAILABILITY, the campus must be feasible within the scope of Haitian technology and construction methods.  After much research and precedent studies--all resembling those directly below--it became clear that concrete frame with block infill was the most popular and practical.  In this sense, this method of construction does not stretch the technological methods available in Haiti and can build off the strengths of their existing construction industry.  Overhead, wood site-fabricated trusses and metal roofing (Haitian-made of course) take further advantage of the construction methods existing in Haiti.  Additionally, all materials that comprise the building should be found locally with exception given to the wood elements, in which case, Ft. Liberte’s proximity to the Dominican Republic is very beneficial.    

Eben-Ezer Medical Clinic Expansion | Ft. Liberte, Haiti

Haiti is a very impoverished nation where organized, public healthcare is virtually non-existent. The majority of the population has never experienced a clinic-type setting before and often time suffers from disease and sickness caused by unclean water. More than anything, there is an overwhelming sense of chaos and disorder throughout the nation.

Ground Floor Plan with paving patterns

Because Haiti is still a developing country, it was a necessity for the design of this medical clinic to accept and implement passive strategies with natural daylighting and natural ventilation. Using a series of screens to not only act as shading devices from harsh direct sunlight, but also as a permeable ‘wall’ in the main served spaces to allow for ventilation, these passive goals were able to be achieved.  

Diagram: Natural Ventilation and daylighting from green screen within exam rooms

View of circulation under green screen from back of site

Positioning the check-in at the entrance, seen instantly through the newly renovated existing clinic (which I had turned into a lower level colonnade), allowed an immediate recognition of the sequence and order of programmatic pieces. From the check-in one would move directly into the waiting area. With a direct correlation to the exam rooms, divided only by an elongated courtyard and the screens, the patient can begin to understand and visualize the next space they will most likely inhabit. From there, one would either move towards the observation and lab area, or on to the exit of the complex, where the pharmacy is located for a smooth and easy transition back out onto the street of Ft. Liberte.

 

Programming Diagrams

The clinic has been designed to blanket outside chaos with a calming sense of organization and wayfinding, applying bright colors found all around Haiti into the different programmatic elements within, also creating a sense of comfort and familiarity. Mostly, this medical clinic has been designed to allow the patient to leave with something more than they came in with: new-fangled knowledge.

 

Section A : Cutting through waiting/exam rooms and adjacent screens

Section B : Cutting through pharmacy/laboratory rooms with green screen in background

Section C : Cutting through observation/laboratory/exam spaces

Because of the lack of clean water in most regions of Haiti, I chose to implement a simplistic system of water collection, allowing this visual process to take place in the check-in and waiting area, where most, if not all, patients would find themselves at some point or another. From here, they would move into an exam room. En route, patients would pass by the central focus of the exterior courtyard, a solar still, which would be constantly distilling and filtering water throughout the day for the use of the clinic, providing them with a better understand of the way in which anyone can produce clean water.

Massing Site Axon showing ideal water collection routes

View looking into waiting/education spaces from back of site

Clinic Community

FUNCTION

Clinic Community strives to provide a variety of services to the citizens of Fort Liberté. In addition to serving as an innovative local clinic, the complex also provides educational services as well as opportunities for community involvement.

The clinical component is composed of standard medical program such as triage, exam rooms, observation rooms, laboratory, and pharmacy. The clinic provides anywhere from basic medical services to eye and dental care. In the proposed third phase of the project, a medical suite is included in order to fully encompass the needs of the local population. The waiting area of this component takes place in a designed intermediate space for comfort and ventilation. It is also articulated with a strategic color system in order to provide way-finding.

PREPARING FOR RAIN

When it rains, it pores in Haiti. So its important to keep rain from blowing into the building. woven palm wscreens used as windows and doors allow air to flow while keeping the rain out.

FORM

The plan of the complex is organized in a way that allows for both easy way-finding as a visitor of the clinic and also provides a sense of community. It achieves these things through the use of a courtyard scheme. The primary programmatic components of the structure are organized around a central courtyard that provides not only a large community space, but also allows adequate ventilation throughout the complex.

The courtyard is divided by a series of stepped concrete walkways. The steps of these pathways allow for additional seating and the pathways are placed in a way that relates exam rooms to the observation room, laboratory, and pharmacy. The pharmacy is located upon exit of the complex and can also be easily accessed from the street.

MADE IN HAITI

Another underlying concept of the Clinic Community is the commission of local artisans and craftsmen to create a comforting and recognizable environment for its visitors. These commissions would take form in everything from furniture and millwork to seasonal murals and wind chimes.

SEATING

The seating is made from painted #5 rebar and sealed palm wood and would be made by local craftsmen. Since much of the seating is in a semi-enclosed area slats afford a surface that would allow rain to run off.

Final Boards

Eben-Ezer Medical Clinic

     After an in depth study of Haitian culture it was evident that our project would include several aspects of Haitian life.  Our concept integrated the Haitian culture with a focus on the patient’s needs.   After working through a conceptual design surrounding Haiti’s hibiscus flower, we turned our focus on combining this with the programmatic elements. This process led us to a schematic plan surrounding a centralized courtyard that’s functions serves as a waiting room that accommodates the larger Haitian families. Most Haitians visit a medical facility once if ever in their lifetime, and when they do they are typically scared and nervous. Then central courtyard removes the mystery of where family members are being taken to.

     Circulation plays a key role in designing a Haitian clinic.  There are many different patient paths that could easily become confusing to a first time visitor.  We spent a large portion of our design development focusing on how to incorporate patient circulation with program adjacencies.  We therefore created the most direct patient access to the specific needs of each individual patient. In the clinic the circulation translates into a "U" shape following the exterior of the courtyard.  The "U" shape creates one single path of circulation minimizing confusion and congestion.

      The program of the clinic includes a check-in area with plenty of storage for records.  It is located in the front of the clinic parallel to the fence opening.  Once passing through the check-in one would enter the waiting area which combines an interior and exterior experience that proceeds to the central courtyard.  The exam rooms are next on the circulation paths.  There are six exam rooms and two specialty exam rooms that are designed with clerestory windows and pitched roofs to allow for ventilation and natural light.  On the back of the site is the lab area: because of its limited patient access it is blocked from the public courtyard by a lattice system. Opposite the exam rooms is the observation facility which also has clerestory windows and a pitched roof system to allow for ventilation and natural light.  The final stop on the patient path is the pharmacy.  The pharmacy is located in the front of the site adjacent to check-in and records.  It is important for the pharmacy to be near the exit due to the large amount of congestion that will occur there and they fact that almost all of the patients will need to go there before leaving.