Expansion to Eben-Ezer Medical Clinic Project Completion

Project Complete Final Blog

Expansion to Eben-Ezer Medical Clinic in Fort Liberte, Haiti   

 

Haitian people die senseless deaths every day from treatable diseases and injuries simply because they cannot reach or afford medical attention. Poverty and the lack of basic life skills are the primary catalysts for the spread of infection and disease. Clean water, adequate sanitation, and access to medical care and medicines are essential in reducing unnecessary suffering and premature deaths. This project is a design expansion to an existing medical clinic in Fort Liberte, Haiti. The Eben-Ezer expansion will not only serve those Haitians typically turned away from the larger government-run hospitals because of their inability to pay; it will provide the poor health security through education and preventative care.

 The physical location of the Eben-Ezer expansion made it impractical to incorporate foreign materials in the design, due to Haiti’s inadequate infrastructure and the additional expense of shipping materials into the country. Situated 100 yards from the Atlantic Ocean, the building site’s composition is back-filled land once covered by salt water. These two conditions made drilling a well impractical due to saltwater contamination. Haiti experiences two rainy seasons a year, in late spring and in the fall; harvesting rainwater was a practical and economical solution. A cooling northeast ocean breeze harvested into the design process provides natural cooling. A technical school is located on the southwest side of the site. The school teaches woodworking, sewing, and culinary skills. A generator for electricity and an orphanage is located on the northeast side of the site.  

 Before beginning the design process, I gained insight through the research and analysis of the design and form of the Center for Disabled Workers building located at Orange Farm, South Africa. Both site locations experience extended daylight and longer daylight heating from the sun, extreme poverty, and an inadequate infrastructure. The roof system designed for the Center for Disabled Workers, created natural ventilation by allowing air to circulate between the roof and the building, insulating and cooling the interior space below. I also incorporated this duel roof for cooling and ventilation. My roof form is also expressed in shifting volumes creating shaded secondary outdoor circulation. I also relied on medical guidance from an assigned nurse, studio desk critiques, and project reviews.

There were several driving factors in my design. To eliminate the expense of shipping foreign manufactured materials, I relied on regional materials, local art, craftsmen, and culture traditions. Not only does this concept reduce the environmental impact and cost of transportation; it will create much needed jobs. By utilizing the community as a whole, my intent is to nurture confidence and trust in the community’s cultural, endogenous potential, and individual self-worth.

In Haiti, a doctor’s visit is rare and often very stressful; therefore the entire family accompanies the patient to the doctor. As most Haitians cannot read, healthcare facilities and pharmacies are identified by the color green. I incorporated a green, calming, monochromatic color scheme to help alleviate the stress and anxiety associated with uncertainty, sickness, and injury. The more intense the shade of green the more public and interactive the space. I relied on lighter shades of green to represent the more private and calming spaces.

The waiting area has a visual connection to the exam area, observation area, and pharmacy. This program arrangement allows both patient and family members to keep up with each other and where they need to go next in the treatment process. This is also helpful because each phase of treatment is separate and requires payment for services rendered. Payment is required at check-in before seeing the doctor, at the lab for any lab work, and at the pharmacy for any supplies needed and medication.

I incorporated World Health Organization educational banners in the waiting/educational area to visually teach life care skills such as: wound care, hand washing, vaccination, and nutrition. These banners can be changed as needed to stress any current medical crises.

Louvered exam room doors provide ventilation and allow patients to see out while obstructing views into the rooms. Louvers and skylights filter daylight into interior spaces negating the need to generate power for lighting. Skylights also serve as ventilation chimneys drawing cooler air into the building’s interior through screened louvers and pulling the hot stagnate air out through the open, screened skylights.

As I reflect on my design, I realize there are aspects of it that could have been stronger. I realize I should not have incorporated a waffle slab concrete roof. The form work would be very labor intensive and costly. A flat roof with punched openings would have been more practical. I should have extended the tree canopy all the way down to the entrance. This would have provided consistent shade throughout the site; not just at the back as indicated in my design.

The staff green space behind check-in and waiting also needs more trees to create a thicker, private, woody canopy area.

My waiting area needs openings between the education banners to allow visual connection to the private staff green space outside.

It is my opinion; my design is well thought out and addresses the criteria I established through my research and analysis of the Haitian people and their culture. The clinic expansions also supports the important work of staff and doctors in treating the medical needs of Fort Liberte’s poor.

Expansion to Eben-Ezer Clinic

Concept diagram and abstract

After further investigation, I have decided to adjust my two entries by emphasize a primary entryway in my site plan for the new court-yard clinic and visually shrinking the secondary entrance between the technical school and the original clinic structure. To accomplish this, I am adding more green space to scale down and narrow the secondary entrance. The design modification will create a defined, main entry and a separate green space for the classroom.

I am happy with my roof pitch, covered waiting area, and circulation.  The awing serves as a light shelf to reflect light into the interior spaces and also provides shade for circulation and patient waiting area.  The interior exam rooms have been arranged to take advantage of the light shelf and organized to eliminate glare.  The two separated roof pitches allow air to circulate through the spaces.

Tree Clinic Medicine Mobile Unit

Poverty and the lack of basic life skills rather than microbes and parasites are the primary catalysts for the spread of infection and disease.  Cuts, sores, and open wounds are left untreated and exposed to filth and flies.  Among the Haitian people, inadequate sanitation, clean water, good hygiene, and basic first aid knowledge contributes to their suffering and death.

Tree Clinic Medicine is addressing these inequities.  The key component to Tree Clinic Medicine's realization is the medical packs.  Light-weight, durable, and compact in size, the medical packs permit medical volunteers access to remote villages in Haiti with essential medical supplies; and basic first aid and nutritional education.

Donkeys with medical packs on the move.

Volunteer medical teams hike to remote village with donkeys to carry their medical supplies.  Upon arrival the team tethers a rope between trees, remove the medical packs from their water proof sacks, and hang the packs from the tethered rope.  The trees also provide shade for the staff and patients.  In case of rain, a tap can be hung across the tethered rope and tied off at the corners.

Demonstration of set up

The manufacture of the packs could be an added source of income in Haiti. Donations could cover materials, labor, and eliminate the expense of shipping. On the back of each pack, local visual art would depict proper wound care and hygiene, facilitating volunteers with the language barrier and illiteracy. Donkeys and their owners (handlers) could be hired to transport supplies and teams, while helping provide a much needed service to their people.

Perspective of Tree Clinic Medicine

In critiquing this project, I should have used benches instead of the three legged stools.  Folding benches would have been more practical, when pulled together they could have provided a flat surface for patients to lie on for medical exams.   Folding benches could also provide additional seating for people waiting.

The area was too open.  If I had designed the medical packs to zip together, this would have enclosed the space created more privacy and providing a more secure area for the medical supplies.  I should have investigated colors more.  My medical pack colors should have been green and white; colors associated with Haitian hospitals.

I thought that having the medical supplies and medicines together would be more convenient for the medical staff but I later found out that having the supplies and medicines together would create too much congestion in one area.  They needed to be separated.

Update on Monday, February 18, 2013 at 1:30PM by Emmie Corgan

I think that this is a great design for a compact design solution that complies with the culture of Haiti.  The use of bags and tarps as a way to create and organize spaces when there is no built environment is a great idea. The bags could also be hung one right next each other to create a little more privacy.