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.

Eben-Ezer Medical Clinic Expansion

View from Waiting Area to CourtyardNestled in the unique culture and landscape of Fort Liberte, Haiti, the Eben-Ezer Medical clinic helps fill the gap in healthcare that plagues the northeast corner of the country.  To increase their scope of services, the current clinic is in dire need of an expansion.

Our proposal reacts to both the culture and environment of Fort Liberte.  The existing building’s structural grid is to remain intact; however, it is being modified to hold the waiting and check-in areas.  To prevent confusion for the returning patients after the renovations, the new entrance is located near the current location.  Opening of the building allows for better cross ventilation through the existing building—which was previously an issue.  This creates an area sheltered from the harsh sun, but still connected to the natural landscape of the site.

First Floor PlanTaking advantage of all the sustainable aspects of the environment, the new buildings are oriented to the natural wind and lighting patterns of the site.  This is even more apparent in the building section; clerestory windows allow more natural light to penetrate into the building, as well as, vents at the base of the walls promote stack ventilation to cool the occupants and let contaminated air to clear out faster. Typical Building Section

Because doctor visits are family affairs, ample space is allowed for the family to be included in the healthcare process and education by varying scales of indoor and sheltered outdoor spaces, while being surrounded by plants used for both eating and medicinal purposes, and orienting gathering spaces around the class pavilion.  

Materials Palette

Eben-Ezer Medical Clinic

Final Presentation Boards

Front entrance to the clinic.The expansion to the Eben-Ezer Medical Clinic in Haiti posed several unique problems that resulted in thoughtful results. The programmatic elements already present within the clinic were expanded upon to give the town a larger and more efficient clinic to serve the people of Fort Liberte. The design was driven by eight main heuristics: clear circulation, simple construction, passive ventilation, natural lighting, water collection and filtration, landscape architecture, regional materials, and privacy and security. These goals were implemented into the program: a waiting and check-in area, exam rooms, a lab and pharmacy, observation room, and staff facilities.

Floor Plan

The heuristics were the main driving factor behind many of the design decisions made within the clinic. The clear circulation determined the simple u-shape. This allows patients to clearly find their designated exam space and other key points within the clinic. The consistent eight inch grid overlaying the entire space, allows simple and easy construction for the Haitians. Passive ventilation and natural lighting were a given because of the lack of guaranteed electricity in Haiti. Louvered windows allows for natural light to filter into all interior spaces, as well as to take advantage of the north, north-eastern winds coming off of the neighboring bay. Water collection and filtration is also an important element in the design. There is no current system to provide running water to the people of Haiti, nor is there any filtration system. A system within the clinic would allow the rain water to be collected during the rainy season to provide the clinic with running water when needed.

Front elevation of the clinic.Section of the Eben-Ezer Medical Clinic.The last few heuristics were accomplished by establishing a central courtyard for additional waiting space and an area for educational purposes. The main concrete structure with the lighter wood columns uses common materials already found in Haiti. Iron work used for security purposes also uses regional materials and creates job for the local community. The privacy is accomplished by providing exam rooms for a single patient and curtains around the beds in the observation room. The clinic will provide medical help to the people of Fort Liberte through a simple and thoughtful design.

Transitional circulation space between exam rooms and courtyard.

Haitian Clinic

Design for the expansion of the Eben-Ezer Medical Clinic, Fort Liberte, Haiti

The problems associated with constructing a viable clinic in an impoverished nation such as Haiti are many.  With problems ranging from malnutrition, lack of medical supplies, poverty, illiteracy, and natural disasters this countries people are destined to a hard life and an early death.  To mediate the severity of this crisis in Haiti I concentrated on the positives of the natural environment.  The early explorations into the site lead to the development of a module that was orientated to capture both the wind and the light.  This design gave way to the final design scheme which oriented the visitors to the site by positioning them within the center.  This approach to orientation was essential to locals due to their inability to read and their unfamiliarity with the steps involved with receiving medical care. 

                The program that was associated with the project was the inclusion of six exam rooms.  These rooms were to allow plenty of ventilation and limited occupancy through their small size.  Two rooms for empower and advance were provided these would serve as bases of operation for the outreach from the clinic.  A six space observation area was designed to isolate a severely contagious person and to provide viewing areas of patient reactions to medical treatment.  Other programmatic elements included a check-in, dormitory, physician’s residence, and office space.  The major element of incorporated into the existing building was the combination of a lab/ pharmacy area.  This was located in the renovated ground floor and was to serve as a secure and easily accessible location from the central waiting area. Due to the pay as you go approach to health care that is associated with this clinic it thus became very important to limit areas where monies would be collected and stored. 

 To provide for the educational component to the project vegetable gardens, herb gardens, and orchards were provided to teach the local peoples of the importance of proper nutrition and its ability to prevent many of the most common ailments like different forms of skin disease.  Due to the rise of cholera following the earthquake of 2010 the site would also host composting toilets to educate the local populace on the importance of waste disposal.  There would also be a cistern buried on the site with a G E purification device to provide potable water for drinking and bathing.       

Medical Clinic Addition

Summer solar path diagram

The parti is derived from existing mirrored circulation spaces, extension of the grid, and site conditions.  Parti first developed from mirroring existing circulation spaces so that the scale of the addition would remain the same.  Extension of the grid guarantees that the scale and structural grid will relate and integrate well (and similarly to the existing).  Deviation from the existing design occurs at the rotation of the structural grid.  This grid pivots ~25 degrees clockwise so to be aligned west-to-east for maximum northern light exposure in exam spaces and ventilation accessability to the north-northeastern breezes. Circulation is kept to the exterior so that minimal people are inside the building and the temperature is kept down (more people = warmer building).  Progression from the check-in to the second (middle) building for general exam and observation is direct and private.  Circulation is on the southern face and covered to provide protection from the rain for those walking and shading from the sun for the exam rooms.  

Site section facing east. The biggest critique was to examine the relationship between the two grids (the original and the east-to-west) and articulate the intersection between the two.  At the time of the critique, the two grids were overlayed on top of each other with no articulation at the intersection or pivot at the edge.  One suggestion was to create a breezeway that slices through the addition in line with the original grid.  At this time, the intersection and connection has been articulated through the pathways so that pathways leading to and from the addition (to the original building) are on the original grid.   

Roof structure encourages ventilation into the building while shedding rain.

Next steps include further examining the circulation, roof structure, and phasing of the project as a whole.  The courtyards (central and rear) will be further developed for privacy, seating, and ventilation.  Any seated area will be shaded.  Windows to exam rooms face north and are unobstructed.  Pathways and the first waiting area will be further developed and more closely analyzed.