Clinica XY[b}

XY Improving an Island Through Designclnica

[b]

YabarillosNaihao FanNathan GeierKelsie KremerAshley SimpsonDanielle SmithAndrew Stith

A Graduate Thesis

4XY Improving an Island Through Designclnica

[b]

5Preface

Semester X background the situation initial concepts team design team tigrillo team yaba ding ding

Semester Y return visit next steps final proposal [b]amboo preparation construction testing outcome

Studio Conclusion

Acknowledgements

Contents

2 261y e a r s t u d e n t s+ =+professors

PrefaceTeam Yabarillo would first like to thank professors Dragoslav Simic and Jim Jones, the people of Roatn for input and hospitality, and all the medical professionals in both communities, Roatn and locally, for helping us push our project to its greatest potential. None of this would have been possible without your help.

Studio 73, comprised of thirteen graduate-level students and thirteen third-year students, was a collaborative studio led under the guidance of Professors Jim Jones and Dragoslav Simic.

An urgent design need was presented at the beginning of the Fall 2012 semester. Roatn, Honduras is severely lacking adequate medical facilities, and we were asked to design a medical clinic that is more centrally located and better serves the demand by providing proper medical attention on the island.

The studio was divided into five design groups, each consisting of fifth-year and third-year students, to collaborate and rise to the challenge of meeting this request. This project, spanning an entire year, included two trips to the island, many design iterations, and a final group merge. This book will guide you through the year-long design process.

PicturedCoxen Hole street view

XSemester

How can we

inspire

positive habits through design?

semester x: background

16

Studio VisionStudio 73 was given the opportunity to design a much needed medical clinic for the island of Roatn. As a group, the studio established a design philosophy which sought to address the social, economical, and environmental challenges facing the island and people of Roatn. Through this philosophy, our designs would improve the lives of the locals. These ideas were implemented and elaborated in the design project.

Tigrillos + Yaba Ding Dings.

This is our story.

AboveNathan Geier marketing the work of Studio 73


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PicturedLocal Honduran outside the existing Roatn Hospital


18

Located approximately thirty-five miles off the north coast of Honduras, Roatn stretches forty miles long and roughly five miles across at its widest point. The largest of the Bay Islands, Roatn is home to approximately 30,000 islanders. Boasting the second largest coral reef system in the world, the Mayan Barrier Reef, Roatn is a thriving Caribbean island accommodating thousands of tourists each year. The topography ranges from lush tropical hillsides to beach fronts and mangroves. With a mild climate, beautiful sea, and relaxed lifestyle, more and more people are making their way to the island each year.

Location


19

You become an islander, not by blood or race. It gets into your blood. You smell it. You breathe it. Its in you. -Governor Hyde

LeftRoatn highlighted in orange


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A Little Piece of HistoryRoatn has a long history of multiple groups claiming ownership of the island. The lucrative location and its riches make it clear why everyone wanted to get their hands on the island. In 1502, Christopher Columbus discovered the Bay Islands on his fourth voyage to the New World. He landed on the island of Guanaja on July 30th to find it inhabited by the Mayan Indians. Columbus named the island Isla de Pinos. While he did not land on Roatn, in his log he noted a larger island to the west of Guanaja.

Upon setting foot on what is now mainland Honduras, he claimed the land for Spain. From 1516 to 1536, Spaniards enslaved the Indian population of the Bay Islands, capturing most and shipping them to modern-day Jamaica and Cuba. British buccaneers took over the Bay Islands in 1564 and began using the islands as a base from which to plunder Spanish galleons. During the next century, Spain lost hundreds of galleons to the pirates and buccaneers. The first English attempt to permanently

settle in the Bay Islands was the Puritan Party in 1639. They renamed Roatn the Rich Island in honor of Lord Henry Rich. After four years, the Spaniards ousted the colonists. In 1742 under the command of Mayor Caufield, the English settled again on the island. However, in 1782, the Spaniards again regained control, and the English completely abandoned Roatn for fifteen years. In 1797, approximately 5,000 Africans, Caribbeans, and Arawak Indians, giving origin to what is now referred to as the Garifuna tribe,


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LeftTraditional Mayan building ornament

RightCeramic Yaba Ding Ding artifact

Far LeftDance demonstration by Punta Gordians demonstrating Garfuna heritage at Paya Bay

staged an uprising against the British authorities on St. Vincent Island in the Eastern Caribbean. The British authorities forcibly removed the Caribs to Roatn and landed them at Port Royal. The Garifuna moved to the North shore and established the town of Punta Gorda. It is the oldest continuously inhabited community on Roatn. In 1834, slavery ended in the Cayman Islands, and in 1852, England decided to make the Bay Islands a British Crown Colony. English subjects from the Caymans began to migrate

to the Bay Island. It is estimated that over 600 people from the Caymans made the Bay Islands their new home during this twenty year period. The United States became aware of the English colonial move and saw it as an infringement of the Monroe Doctrine. Under pressure, they turned sovereignty of the Bay Island over to Honduras in 1859. During the 1860s-70s, exportation of bananas, plantains, and coconuts, mainly to the U.S., was booming. By 1875, trade between these

two countries was so brisk that the U.S. opened an American Consul on the island. However, the prosperity ended abruptly when a major hurricane leveled most of the plantations in September 1877. In need of new business, the island turned towards the sea as a means to maintain their economy. The island now supports one of the finest shrimp and lobster fleets in the Caribbean.


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Life on the WaterThe beach is a vital part of the culture and daily life on the island. People live, come together, and grow up on the beach. The Honduran government has laws in place to protect wildlife and the reef in order to preserve Roatns ecological heritage. You can often find families gathered outside with each other or selling their hand-crafted goods to tourists on the island; family is a vital element in the life of locals. Fishing, diving, dancing, and craft-making are daily activities on the island. Although the island as a whole is a close community, differences can be seen from village to village. For example, in Oak Ridge where the English settled, homes were built right on the water (similar to Venice), while in Punta Gorda where the Garifuna tribes settled, the water front is preserved with homes and buildings pulled back from the beach. Some differences in the language can also be heard between the Garifuna people and the Spanish-speaking population.


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Bottom LeftHonduran boy fishing for food to give to his family

TopLocals taking a canoe out on the water

Bottom RightPiece of coral photographed while snorkeling along the reef.


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PicturedTypical sunset viewed over the East end of Roatn


25

ClimateThe island has a tropical climate with an average temperature of 80 degrees Fahrenheit and humidity values ranging from 65-70%. Due to its geographical location, the regions temperatures remain fairly constant throughout the entire year. The warm season lasts from July 21st to October 2nd, and the cold season from November 17th to February 16th with average temperatures ranging from 53 to 86 degrees Fahrenheit. The island sees an average annual rainfall of 120 inches. The rainy season lasts from July to January, with the heaviest accumulations seen from October to January. Strong winds can accompany the rain leaving the windward side to see more rain than the leeward side. The island is located outside of the hurricane belt, protected by the mainland of Honduras that juts out from Central America. Only seven hurricanes have passed by in the last 120 years. Of these, Hurricane Mitch, which hit in 1998, proved to be the most destructive to the island and its people. The studio had never worked in a location such as this. These climate issues had to be carefully studied throughout the design process to find the best methods of construction.


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27

The influx of expatriates has given a boost to the island economy. Nearly 100 hotels are in service, catering to every taste and need. The Honduran Government is in strong support of the tourism business and offers attractive tax-incentives to those who capitalize on tourist related businesses. Activities such as sport fishing, dolphin encounters, snorkeling, scuba diving, zip line canopy tours, and many others are offered to visitors. The island sees 11 cruise ships daily during peak tourist season. An exit tax has been imposed on all visitors of the island, which is intended for projects to build up the island and the tourist industry; however, a large percentage is sent back to mainland Honduras. The booming tourist industry has brought more than just smiling faces. Honduras has become the number one country in crime per

Tourism

LeftStreet vendors in Coxen Hole

Far LeftCruise ship docked at the West End

capita in the world. Seen as more of a problem on the mainland, increasing accounts of attacks have led to increased security measures on the island. Widespread poverty and unemployment, along with significant street gang and drug trafficking activity, contribute to the extremely high crime rates. In November 2012, the U.S. Department of State Bureau of Consular Affairs issued a travel warning for American citizens visiting to Honduras. The warning was issued for the country as a whole, and Roatn has taken several measures for increasing special tourist police forces to provide safety to those visiting the island. Coxen Hole is the largest town in Roatn, providing a home to government offices, the airport, and cruise ship docks. Its narrow streets are crowded with people and honking cars. Street

vendors offer everything from fruit to hammocks to local goods. The French Harbor is the second largest community of the island and is a thriving business center complete with shopping, restaurants, and banks. Punta Gorda, located on the East side of the island, has the largest settlement of Garifuna people. The Garifuna, with their colorful native costumes and drumming, entertain tourists visiting the island. Dance has become a way of actively preserving the heritage of their communities. The West End is the tourist hub of the island, catering to visitors with numerous restaurants, shops, beaches, and hotels.

28sem

ester x: the situation

The charm of the island cannot amend the hardships faced by locals everyday. Honduras is the second poorest country in Central America. Most citizens live off approximately $1 per day and have limited access to education exceeding sixth grade. Even with the growing tourism industry, locals rarely see any of the profit generated. Most of the resorts and beaches are primarily run by non-locals; the gap between the rich and the poor continues to grow rapidly. The island remains largely underdeveloped despite the amount of tourism. Its location and distance from the mainland leave the islanders cut off from the basic needs and medical facilities. There is limited access to clean water, consistent electricity, and properly working septic systems. Due to the influx of cheap processed goods, 50% of the population suffers from diabetes; this disease often remains untreated or undiagnosed as a result of low or non-existent income. Also, with a rate of 220 times that of the U.S., the number of cases of HIV/AIDS is the highest in all of Central America.

WHAT + WHY Professor Jim Jones owns a home a short boat ride away from Roatn on the island of Helene. While living there, he has established connections with many locals on the island. Having experienced the lack of medical facilities has made him aware of the difficulties on the island and the need for this new facility. After hearing about the project and introducing us to the locals, everyone felt a strong desire to help the island. By visiting the island on two occasions, we were able to see first hand that we have the ability to improve the conditions for these new friends.

29sem


PicturedAn afternoon filled with drums and dancing by the youth of Punta Gorda

30sem


After two weeks of initial research and programming, it was evident the only way to undertake a project so sensitive to the community in which it is located was simply to visit it first hand. A few games of phone tag and hours of negotiating with United Airlines, flights were booked, and we were off! ...or so we thought. Eleven graduate-students and seven third-year students agreed to make the trip. Our flight left the morning of Saturday, September 8 from

How do we begin this endeavor?

Kansas City. Followed by a quick layover in Houston, we were to be in Roatn by late Saturday afternoon. We caught wind that our original flight had been cancelled about six hours prior to departure. Frantically, all concerned parties were called and rushed to the airport to catch the next available flight. The next flight quickly filled, leaving half the group stranded in Kansas City to wait for an even later departure time. The first wave made it to Houston with some time to spare

31sem


Far LeftThe countryside near Tegucigalpa

LeftOlid, a passionate islander, sharing a hug with his costumed daughter

Bottom RightLounging in the shade on a beautiful day at Paya Bay

Top RightStudio 73 swapping travel stories over wine and cheese

before the connecting flight; naturally, we begged them to hold the flight until the rest of the group to arrived. Failing at this task, seven students found themselves Roatn bound, professor-less. Waiting for the first group to arrive on island was Jims good friend, Olid. The bags were all claimed, except for one, and the crew was transported to the resort at the far East end of the island. Greeted with quaint living quarters and a tropical drink, the next twenty-four hours

was filled with free time in the forms of hikes, snorkeling, and laying on the beach. The second group arrived on the island late Sunday afternoon just in time for a wine social at sunset. Finally, the group was reunited and ready to begin a week of meetings, observations, and, of course, a little fun. We attended many meetings throughout the week but made time for fun activities to experience all aspects of the island. We went on

various boat rides, snorkeled, swam with dolphins, ziplined in the jungle, hiked on trails around the resort, and ended every evening with a yoga session and a swim at sunset. The food was incredible! Every morning we were greeted with a plethora of fruits, juices, and other breakfast foods. We looked forward to dinner every night. From honey glazed lobster to seafood paella to fresh sea bass, the seafood was delectable!

32sem


On September 10th, our research began. The first stop was Punta Gorda, the village Olid is from. As Olid told us of the great need for the facility, we realized our project had the true potential to be built. To learn about the culture, we walked around the village, saw some local construction methods, and played soccer with the kids. Soon after, we loaded back up and headed to Oak Ridge, the village where Mayor Perry Boddens office is located. During our meeting, we shared our project intentions and heard what he thought was essential for the island. He emphasized the necessity for promoting traditional medicine and education, since they dont have access to some of the amenities as the U.S. He was very interested in the project, so he arranged a for us with the governor that same day! We headed back to Punta Gorda where we indulged in a traditional island meal and met the governor. Before he arrived, we visited with another friend of Jims, Dioxi. She was very helpful in giving us a feel for what is important

A Visit with Mayor Boddento the locals and the identity of the island. She expressed the importance of the beaches to the communitys events and activities. We wanted to be sure that our designs didnt interfere with this important aspect of their lives. It was during this meeting, we learned about the extent of diabetes and lack of awareness. An analogy was given about teaching a man to fish instead of giving him a fish; this emphasizes the necessity of learning what one needs to do to take care of oneself.

33sem


PicturedThe municipal hall in Santos Guardiola

34sem


LeftGovernor Shawn Hyde spoke to the group about the importance of a new medical facility

RightJim and Dragoslav analyzed local building techniques

35sem


We were amazed that Governor Hyde was willing to meet us right away; it showed us how important this facility is for the island and how interested he is in the matter. During our conversation with the governor, he reinforced the point of how important the water and beaches are to the community and culture of the island. Interfering with these would not be an option for us. He began speaking about the current lack of focus on sustainability in architecture in Roatn. He stressed the expense of electricity and how sustainable features should be considered in order to dramatically cut the operational costs of the facility. This would become a central focus for all designs because Honduran public health care is not-for-profit; they cannot turn away anyone who cant pay for the medical attention they need because it is a government funded program. While speaking about sustainability, Governor Hyde referred to it on multiple levels, from performance to longevity to staffing. Taking these points into consideration, we determined

Lunch with Governor Hydethat it is important to design efficiently to allow for the successful operation of the facility both environmentally and economically. Another point of emphasis was the need for a building that is not only beautiful but easy to upkeep because they have neither the time nor the funding to continuously provide maintenance to the building. Security was an aspect that was stressed as well. It needs to have the capability to be locked up and secured, especially after hours. More programming issues discussed were: a room to be used for educational purposes, operating rooms, ICU rooms, holding rooms, delivery rooms, housing for visiting doctors, and spaces to be used by private practices during after hours. Providing a scheme, with these essentials, that has the capability to be expanded upon in the future was a crucial element to give the island hope that a brighter future is on the way.

36sem


September 11th was another full day beginning with a meeting in Coxen Hole with the mayor of the West End, Julio Galindo. This meeting was extremely beneficial, as the mayor brought in the municipalitys architect, engineer, and doctors from the hospital. We were able to hear from the doctors about the capacity of their hospital, how many patients they see per day, and their limitations in space and technology. The architect gave advice that was taken into account when designing such as materials, construction methods, and typical systems that are used on the island. We were also able to see the drawing set of the hospital that was proposed but wasnt completed. It was beneficial to see the direction the island wanted to go, but could not afford. From there we identified the critical needs of the island. Everyone seemed to be enthusiastic about the intentions of the project, knowing their current facilities do not meet the needs of the island. At the end of our meeting, Mayor Galindo informed us that we were going to have the opportunity to visit the current hospital that afternoon. In gratitude, he gave us the chance to swim with dolphins the next day.

A Day with Mayor Galindo

37sem


Top LeftStudio 73 listened to Mayor Galindo speak

Bottom LeftThe French harbor

RightJim spoke with a local news crew about our goals

38sem


Many of the problems with the current hospital boil down to the need for a more sustainable and functional facility that addresses the core needs of the island. The current situation is overcrowded, unpleasant, poorly organized, and leaves no room for expansion. The island identifies the need for a new facility, but lacks the resources to fund and staff a fully functioning hospital. In 2011, the government hired architects to develop plans

Proposed Hospitalfor a new medical center to be centrally located. The proposed hospital would contain functions including surgery, obstetrics, radiology, and cafeteria. While there is no doubt these are all desired amenities, it was over designed in relation to the clients ability to fund the project. The previously proposed hospital is a $60 million project. Mayor Galindo took the plans to Tegucigalpa, the capital of Honduras, to visit

39sem


LeftSite plan of previously proposed hospital

RightExterior rendering of the front entrance

several banks about this proposal, and all of them persuaded him not to pursue this facility. The capital is currently facing issues with their newly built hospital due to the low income of patients and the high costs of healthcare. They are still relying heavily on government subsidies to supply operating costs which are about $50,000 per bed per year. With Roatn being a quarter the size of Tegucigalpa, the financial strains on the island

would be far more strenuous on the government. We are seeking to design the first phase of construction on this site with the ability to expand. Our proposed medical clinic will not be the permanent end solution; rather, it is the first step in providing an adequate facility to meet the current health needs of the entire island.

40sem


41sem


We were able to tour the current hospital with the doctors from our meeting. Right now, only one public medical facility serves the entire island. The hospital lacks both facility size and location, taking 50 minutes to get to and from Punta Gorda. In many cases, this is too far of a distance to travel in emergency situations. Private hospitals exist throughout the island, but are extremely unaffordable for most of the local population. With only five beds available, the current facility struggles to service the 20-25 patients that come through daily. One to two critical patients are forced to be transferred by air to the mainland daily. The most common trauma cases that are seen are injuries sustained from motor vehicle accidents, 70% of which are caused by drunk drivers. In addition to these trauma cases, 10-15 women give birth each day, putting more stress on the function of the hospital. Because of these demands on medical care, staffing becomes another issue for the hospital with only two surgeons and a handful of doctors and nurses.

Current Situation The entrance to the emergency room is not only difficult to find but also difficult to traverse, which is located down a narrow cluttered alleyway. Not only is the hospital lacking a proper entry sequence, equipment, and space, but it is also lacking storage. Cluttered with medical storage boxes in the hallways, items are placed seemingly in random places wherever one can find room. It is essential, for the health, safety, and welfare of the island, that a facility be developed to help reverse the current struggles.

Far LeftExam room in the existing facility, also serving as office space when needed

Top LeftBoxes stacked in the hallway due to lack of storage

RightSignage for Hospital Roatn

42sem


Before the trip to Roatn, we had the opportunity to visit Mercy Hospital in Manhattan, Kansas. This gave us an example to compare our findings on the island to. The doctors walked us through the step by step procedures of their emergency ward and shared what they thought did and did not work. Many important items were discussed such as materials used that should have the ability to be easily cleaned to kill bacteria. Ventilation was also identified as a key element, as measures need to be taken to prevent airborne illnesses. In addition, theft is always an issue. Storage, supplies, and pharmaceuticals need to be secured to prevent the chances of stolen items. The doctors expressed the importance of an open ward style patient care, having the ability for families to be a part of the process. Another important element was for nurses to have direct visuals into the rooms from their working stations in case an emergency situation arises. The need for a generator room was also stressed, as the hospital needs to be able to continue functioning in the event of a power outage. Information was given to us as to identify the size and necessary equipment to service traumatic injuries pertaining to the head, heart, etc. All these issues brought up were given careful consideration during our trips and design process.

A Trip to Mercy

43sem


LeftMercy Regional Health Center located in Manhattan, Kansas

Top Entrance into the emergency ward of the hospital

44sem


SiteThe plot of land to be developed sits about 200 feet above sea level and a half mile away from the ocean. The land was donated to the government and is situated between Coxen Hole and French Harbor. While the site is more centrally located on the island than the current hospital, the accessibility is still lacking, lying 45 minutes from the far East end and only 20 minutes from the West end.

As we made our way to the site for our preliminary documentation, we found ourselves stranded at the entrance as our fifteen passenger van was incapable of traversing the rugged hillside. We knew we were in for an adventure when a single-cab, light duty pickup truck pulled up beside us ready to transport us to the top. We went in two groups hauling ten at a time in the bed of the truck. As we started our ascent, we

moved at a snails pace, getting jostled left and right as the small truck rolled over large, sharp rocks protruding from a washed out dirt road, up the slope greater than thirty degrees. At one point, several people moved down off the edge of the truck-bed for fear of being thrown from it. After about twenty minutes of travel time, we arrived at the top. Luckily, the government agreed to provide any site excavation and road construction

45sem


Top Photo montage of sitenecessary to make this site more accessible, but

will be no small undertaking. Once at the top, we found that the site had already been partially cleared, and there were spectacular views to the ocean and over the lush rolling hills. From this aspect, the site seems to be an ideal location to promote healing.

46sem


47sem


LeftArticle published in The Manhattan Mercury

RightLetter from Mayor Galindo expressing appreciation

48sem


49sem


As stressed by Governor Hyde, sustainable design must be an important consideration for the design of the medical clinic. In the near future, water will cost more than the price of gasoline. Because of this and the large quantity of water a medical clinic will use, rainwater collection becomes essential for our designs. In addition, we discovered electricity is four times more expensive than it is here in the U.S. For this reason, more sustainable practices, such as natural ventilation and natural daylighting, become a central piece of the design in order to limit the use of electricity as much as possible. Electricity is also very unreliable on the island, so providing a backup generator in the event that the medical clinic loses power but still needs to function is a must. We researched the possibilities of either solar or wind power to generate electricity for the clinic. For the first phase of this project, these extra means of power realistically do not meet budget, but perhaps it is an element that can be implemented in the future to help deter some of the utility costs.

A Need for Sustainable Practices

LeftLittered beach shore

RightWashed-up ocean debris

50sem


During our time on the island we observed typical building vernacular. Concrete masonry unit (CMU) is a key structural element, not only because of its production on the islands, but also of its easy upkeep. The island harvests its own wood, mostly pine. Not only does using local materials maintain the islands character, but it will also help boost the local economy. We plan on utilizing

Local Materials & Methods

LeftPalms used as traditional roofing material

CenterVernacular construction detail

RightLocal wood for building

51sem


the local labor force to spur the economy and employment. In order to do this we researched these specific building materials and how they can be used most efficiently. We believe our efforts can truly help the island by means of economy, finances, and hope.

52sem

ester x: initial concepts

After our trip to Roatn, the programming and schematic design phase finally began. The first step was for each student to individually create a concept and design solution for the challenges presented to us.

Ready, Set, GO!

53sem


AboveStudio 73 professors, Jim Jones and Dragoslav Simic

54sem


Programmatic DesignAs a collaborative studio, a first priority was to define a Medical Clinic. After a long conversation as a group about what we thought were essential components, we found that we werent going to be able to figure out all the odds and ends on our own. We recruited the help of medical professionals in our community to advise us of the intricacies in this facility. After much collaboration with each other and professionals, we nailed down the programmatic requirements of our medical clinic, including an emergency ward, operating rooms, neonatal care, pharmacy, and flex rooms for ICU and private practice. Community elements were put into place such as a large room that could double as an education and meeting room. Apartments were also included with the hope that visiting doctors would have the ability to travel to the island to provide services in order to relieve the issues of short staffing.

RightProposed program and square footages

55sem


ER UNITOperation Room -Adjacent Prep Room (100sf.)

350sf.Admitting and Nurses Station (200sf.) -Small desk -Overlap with reception -Storage of records -Phone capabilities -Adjacent Restroom -Adjacent Break Room (80sf.)

280sf.

Medical Equipment Storage (100sf.) -Clean/dirty separation -Centrally located -Adjacent laundrey facilites (100sf.) -2 washers/2dryersDrug Storage -Close proximity to nurses station for surveillance -Centrally located

200sf.

50sf.

ICU UNIT

Examination Ward -six beds -Adjacent shower and rest-

1000sf.1880sf.

Neonatal Care Room (200sf. each) -Complicated labor and birthing equipment -Overnight stay -Guest stay

400sf.

Intensive Care Room (150sf. each) -Recovery room -Overnight stay -Guest stay -Possible adjacency to OR

300sf.

Nurse Station -Visibility into rooms -Centrally located -Possibilty to be combined with ER station -Storage with possible halllway alcove for a Crash Cart

100sf.

Covered Ambulance Bay /RFDWHGDZD\IURPSHGHVWULDQWUDIF

800sf.

Community

Support

Apartments (700sf. each) -2 bedroom for visiting medical staff -Kitchen -Bathroom -Adjacent usable outdoor space

1400sf.3450sf.

Janitor Closet -General maintenance and cleaning supplies -Hazardous material disposal (Possible separate structure)

100sf.

Mechanical Room -Generator room -Noise, air, and exhaust buffer (Possible separate structure)

60sf.

General Storage -Possibility to be combined

200sf.

Multi-purpose Room -Bathroom -Kitchenette -Used as a training facility/seminar/meeting space -Converted into off hour overnight stay

1000sf.

Consultation Room -Adjacent to waiting area -Private practice capabilities

150sf.

Waiting Area -40 patient/family -Covered

900sf.

Equipment Maintenance -Conditioned workspace -Counter space

150sf.

SiteParking -staff and patient *dependant on number of beds and staff -300sf per stallGarden -Water collection 50,000 gallon cistern

510sf.

Total:10,000sf. 1.5% scaling factor

56sem


This design focuses on a simple grid-ordered building layout with a central nurses station that serves many functions in order to serve many functions. It is oriented to utilize winds for ventilation, thus mitigating electricity costs. Focus was placed on keeping construction methods as simple as possible for the ease and timeliness of the building phase.

Andrew

57sem


LeftExterior rendering showing community interaction with the facility

Top RightModel - emphasizing the circulation bar

Bottom RightBirds-eye view of exterior

58sem


Top LeftModel showcasing the central courtyard

Top RightHand rendering of exterior walkway

Bottom Section through community and medical ward

59sem


The idea of healthcare does not start and stop with the patients, rather, the family needs to be taken into consideration as well. If you want the best healing environment, not only do the patients and caretakers need to be in the right state of mind, the family does too. This being said, in this project space was created while thinking about all of the users of the building. The healthcare portion is separated from the public community center, waiting, and private apartments. All three of these sections are placed around a central courtyard giving everyone access to a natural, calming environment. The reason behind separating these elements is to provide the families with their own space away from the patients rooms to clear their mind. Because these spaces are divided up, more opportunity is given to allow for natural daylight and ventilation to penetrate through the building. Providing these separate spaces ensures the clarity of mind is present.

Ashley

60sem


Sectionally driven, the medical clinic is designed to harness the positive attributes of Roatns climate. The narrow wings allow for light and breezes to reach deep into each of the rooms. Angled down towards the center circulatory path, the roof provides for an elegant collection of water. The absence of a water supply and electricity guided many design decisions. The organization of the spaces set the public entities apart from the medical. The public spaces open upon the medicinal herb garden while the medical spaces encircle the nurses station. This drastically changes the experience, depending on where you are in the building and medical process. The structure creates an expressive rhythm which reaches out to the site. This repetition sets up the opportunity for pre-fabricate and efficient construction as well as an opportunity for future expansion. Creating a cradle of structure allows for an immense freedom for sectional qualities for different functions as well as allowing for topography changes below the floor.

Danielle

61sem


Top LeftConceptual sketch

Top RightButterfly structure

Bottom Model - Southern elevation

62sem


KelsieThis design focuses on the separating and clustering of like spaces. The negative spaces created by the placement of each building lends to community gathering spaces while allowing breezes to circulate through the whole construction. A large butterfly roof covers the whole complex to not only unify all these spaces, but allow for maximum collection of rainwater.

LeftSectional progression through medical ward

RightFunction separation

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65sem

ester x:initial concepts

This design focuses on creating not only functional and flexible space within the building, but also a healing and sustainable environment. To achieve this, the building is made flexible and therefore sustainable with regards to future demands for changing use and function. Every programmed space is carefully laid out in relationship to each other. A courtyard exists between the part of the building used by doctors and the part of the building used by the public. A hallway makes up the spine of the building and gathers together different functions in a clear manner. The layout of the main functions of the building minimizes walking distances and optimizes daily operation as well as adjusting to the special needs of the different areas of activity. The louvre system on the facade makes it possible to filter the light into the building under different weather conditions.

Naihao

TopSite plan

CenterBuilding floor plan

Bottom Wire-frame building model placed on site

66sem


Healing + Helping + Harmonic. These words were kept in mind throughout the design process. The two primary concerns during this phase were to make sure the space was correctly designed for ease of access by patient and doctor, and to give proper consideration to medical equipment. These two things are essential for the healing of the patient. Helping focuses on sustainability. The

Nathandesign takes into consideration how the building can adequately capture breezes from all four sides of the building to reduce the need for mechanically cooled rooms. The roof is also designed so it will direct all rain water to the interior of the building where a bioswale and cistern will be placed. Harmonic focuses on the context of the medical clinic. The site of the building is very

67sem


Top LeftSketch depicting roof water drainage

Bottom LeftBuilding on site

RightPedestrian approach

mountainous; the form of the building is designed to reflect the soaring peaks that surround it.

68sem

ester x: team design

69sem


A mix of fifth-year and third-year students formed five teams of five members within the studio. The teams represented in this book are Team Yaba Ding Ding and Team Tigrillo. Both names were inspired by the island: tigrillo - the equivalent to a Honduran wildcat, and yaba ding ding - a historical artifact. At this point in the design process, each team selected a path of collaboration, either by selecting a single project or selecting the best elements from multiple projects.

Team Formation

LeftTeam Tigrillo

RightTeam Yaba Ding Ding

70sem


Throughout the multiple iterations of design, we were fortunate to get feedback from medical professionals regarding the functionality of our buildings. Dr. Luis Fuentes and Dr. Sager were kind enough to visit and talk about the successes and downfalls of our projects. The critiques focused on sizes of rooms, circulation paths, and exterior development. The meetings proved beneficial to our studio seeing as we had never designed a facility of such complexity.

Medical Guidance

RightA critique with Torgeir Norheim, Dragoslav Simic, Jim Jones, and Dr. Sager

71sem


Medical Guidance

Can thelive

to

u

pDESIGN

the agility of the tigrillo?

74sem

ester x: team tigrillo

Design DevelopmentComing together as a group, Team Tigrillo focused on design aspects that made each individual scheme successful. We added and revised our initial concepts to both strengthen the simplicity and the constructability of the idea. Some of the things we desired were: a double roof system utilizing the island breezes for ventilation, a multi-faceted nurses station for maximum connection within the facility, an exploration of operable shading devices to keep the building from overheating, and a structure system that freed the building of interior columns. Using these key design elements, we worked on to creating a project that fit many core needs for a clinic on the island.

75sem


Far LeftExploded roof diagram

Center LeftPedestrian view of entry

Bottom LeftInteractive nurses station

Top LeftFloor plan

Top LeftModel of roof plan

76sem


Mass Separation

Grid Organization

360 degree Nurse Awareness

Circulation Paths Passive Ventilation

77sem


Revising a DesignDesign 1: The program was separated into sections allowing for building phases throughout the construction process. A circulation bar was created to connect all stages of the facility and create unstructured waiting spaces for visitors. To help keep electricity costs down, the roof and floor were given separation for maximum ventilation properties, and the nurses station was centered to provide sight lines to all major functions of the facility. A 15 foot modular grid created to help organize the spaces.

Design 2: Technical refinement of key functions was the next step. The addition of a functional wall separating the waiting area and medical ward were made. For better flexibility in spatial order, the 15 foot grid was changed to a 4 foot modular grid system.

Design 3: To get to a more refined design, the team focused on many issues. The roof system was rethought for better ventilation performance. The addition of a skin wrap system provided shading, security, ventilation, and aesthetics. Reflection gardens were used between the building separations for visitors. The entry overhang became connected to the nurses station creating a promenade for the visitor upon entry.

PicturedVarious diagrams focusing on design intent

Reducing Solar Gain

Wrapping of the Skin

78sem


Team Tigrillo sought to create a project that was representative of the people and qualities seen on our initial site visit. We looked to make design decisions that, even further, strengthened the simplicity. User gradients, central bridgeways, passive strategies, a central nurses station, and modular grid structural organization were used to create many different types of spaces throughout the clinc and keep costs low. Using these key design elements, we created a project that we feel fits many core needs of the medical clinic and the betterment of the Roatn community as a whole.

The Final Design

Top LeftSite plan

Bottom LeftSection through waiting area, ER ward, and OR

Page RightRenderings focusing on key points of the clinic

79sem


80sem


Far RightBuilding floor plan

Page BottomImages of physical models

Top LeftCommunity space

81sem


Ca

n the designthe test ofSTANDtime

just like a yaba ding ding?

84sem

ester x: team yaba ding ding

LeftER ward and corridor

RightTransverse section

TopExterior +community garden

85sem


Design DevelopmentAs we began working as a group, we determined what was successful in each individual design and included those aspects into our overall project. In conjunction with this process, we established rules to help us reach our design goals. These included the use of wide corridors for easy access and circulation, breaking the program up by functions to establish a public to private gradient, utilizing the building form to allow for natural daylighting and ventilation, creating a form to maximize water collection, creating a central nurses station, and including a medicinal garden and waiting area. These main ideas aided us in creating a project that would meet the needs of the island.

86sem


REF.

DN

DN

DN

DN

DN

restroom

receptioncommunity room

waiting room consultation

med. equipment + storage

ICU ICU ICU ICU

prep roomdrug storage

OR

equipment maintanence

break room

restroom

dirty + clean linens

janitors room

mechanical

restroomsisolated ER ER bed ER bedER bed ER bedtriage room

nurse station

ambulance

living room

master bed

bedroom

restroom

bedroom

restroom

living room

master bed

commons kitchen

atient ntrance

87sem


Revising a DesignDesign 1: To meet the potential need for phasing this project, the program of the medical clinic was broken up by function. The different functions were placed around a large central corridor with the medical unit occupying one side and community spaces occupying the other. To further help organize the spaces, a 30 foot grid was established using our butterfly structural system. This system allowed for all of our passive strategy goals to be accomplished: channeling water to the center for collection and opening up for natural daylighting and ventilation. Our hope was to leave the spaces as open as possible to allow cool breezes to reach all interior spaces and lessen the likelihood for the spread of disease.

Design 2: Upon receiving feedback, refinements were made to our current design. We maintained the corridor, but the circulation passes back and forth from interior to exterior. The entry sequence was enhanced with the waiting and community spaces being able to open up and provide exterior seating area for the patients and families. The medical facility was combined into one enclosed volume and took on a linear progression from public to private. More prominence was given to the medicinal garden.

88sem


Revising a DesignDesign 3: Our final revision consisted of an extensive study on the sectional quality of our roof and how we can best bring in light, breezes, and collect water at the same time. We landed on a design that spoke to the hierarchy of the spaces and brought light in to the most important areas. We further enhanced our medicinal garden to provide a place for herbs to be grown and for patients and families to retreat to. Focusing on the people, we also gave our community and waiting space the ability to open up into each other allowing for expansion.

Top RightFloor plan

BottomLongitudinal section

Top LeftSite plan

89sem


R

E

F

.

DN

DN

DN

DN

DN

DN

DN

patient entrance

community room

waiting room

restroom

records

consultation

med. equipment+ storage

nurse reception

triage

ICUICUICUICU

drugstorage

ER bedsER beds

nurse station

operating room

prep roomequipment maintanence

break room

restroom

isolated ERrestroomrestroom

mechanical room

janitor closetdirty + cleanlinens

commonskitchen

living room living room

master bed

bedroombedroom

master bed

bathroom bathroom

90sem


The Final DesignOur teams ultimate goal was to create a facility that meets the needs of the island and represents the importance of community in Roatn. We focused on creating a beautiful, yet simple design that embraces the potentials for sustainability and function. The sectional quality of our facility helped us reach many of these goals, as well as the prominent corridor. The structure provided the opportunity for an aesthetically pleasing design while organizing our functions. The generous corridor allowed us to maintain our central nurses station that has a 360 degree view of the facility. Through these key design elements, we designed a facility that meets the needs of the island in a beautiful, affordable manner.

Apartment

Medical

Community/PublicSupport Space

91sem


Bottom LeftCommunity entrance

Top RightMedical section

Top LeftFunction diagram

Bottom RightAerial rendering

YSemester

Wh

a

t

d

o

CROSSyou get when you

a yaba ding ding and a tigrillo?

96sem

ester y: return visit

After multiple iterations and design critiques, we felt the projects had reached a level of schematic completion that ultimately deserved a review from the client. We knew there was more work to be done and wanted feedback, so we started exploring the possibility of a second trip to the island. Having self-funded the first trip, we began looking into alternative funding options. The projects gained significant support from the university and local medical community. With the nature of the trip being to present our work, we qualified to apply for the Graduate School Travel Grant. We each filed the grant application and found out in early January that we had been rewarded roughly $300 each to put toward our travel expenses. Each student evaluated their financial situations, and, in the end, seven students decided they would go to represent the studio as a whole. We arrived back in Manhattan from winter break refreshed and eager to prepare for our return trip. Excited to have been recognized by the

Trip Prep

LeftModel packaging and transportation

RightUnited Airlines plane ticket

provost and the university for the work we had put in thus far, thank you notes were written to all the parties who had supported and guided us to this point. The first week of class was filled with constructing protective packaging for the models to be transported, creating one page summary boards, and reprinting a full set of drawings for each group. To represent the university and Department of Architecture, small cars, trucks, and ambulances were laser cut to be handed out to the children on the island. It was our desire to increase awareness of the universitys involvement with the medical clinic through a small memento we could leave behind.

97sem


98sem


Ready to escape the bitter Kansas winter, and praying for smoother travels the second time around, we found ourselves Roatn bound once again. Packed into two vehicles, each with a model on our lap, we made our way to Kansas City in preparation for another early morning flightthis time, not cancelled. Apart from the unaccommodating efforts of the airline and the numerous stares and questions geared our way,

Activitiesall connections were made, and we successfully arrived in Roatn by early afternoon. We were greeted at the airport by Jim, Dragoslav, Olid, and the local news crew. After a brief interview, we were taken to our condo. We had the evening and following day to get reacclimatized with the island and prepare ourselves for the presentations ahead. Since Jim and Dragoslav had arrived on the island the week before, our appointments and

99sem


LeftStudio meeting on the roof patio of Club Natale

Top RightTeam Tigrillo preparing for the meetings

Bottom RightGarric Baker taking notes for Team Lionfish

presentations were scheduled. Sunday evening, we met as a studio on the rooftop terrace at sunset to discuss our plan of action.

100sem


Monday, January 28, 2013A meeting with over a dozen of the existing hospitals doctors and staff was first on the agenda. While waiting for our appointment, we started handing out the laser cut cars and trucks to the kids; they were a hit! Once in the room, the summary boards were arranged to allow the overall conceptual ideas to be shown, while large scale plans were presented directly in front of the group to allow for a clear visual understanding of the building layout. Once each group had presented, we were able to hear comments from the doctors and nurses. We found positive approval for a much more economical design that can address the current issues and be further expanded in the future as the needs on the island continue to evolve. Although the doctors were all very adamant about the large hospital, by the end of the presentations we gained their support and received very important feedback for continuing our conceptual development. First, they helped us hone our programming from trauma to a general emergency clinic. We realized this was the main

The Doctors Responsereason there was some initial hesitation from the doctors since the true need on the island is not a trauma center but a refined hospital. One of the biggest critiques found in all of the projects was the lack of separation between the medical zones. Having a surgical ward requires a level of sterilization and quality control that we had not yet identified. The doctors referred to what they called the zoning method. The green zone refers to those spaces that can be accessed by all. This leads to the grey zone, which encompasses those spaces that require more privacy and limited access, such as preparation areas and examination spaces. The third and final white zone includes the operation spaces which requires a fully controlled, sterilized area. Other programmatic issues that were brought to our attention included an x-ray and laboratory. These spaces were not included in our original program, but they were necessary spaces for the future facility. Adding a testing laboratory would provide a place for blood work and various other screenings to be performed. The addition of

an x-ray room brought up the question of building materials that would be used, seeing as the unit requires lead walls when the machine is in use. The addition of both of these functions would be a tremendous aid to their daily operation. A more accessible pharmacy was also desired. We included a pharmacy in our original program; however, they stressed the need for a window to the exterior in order to act more as a clinic so patients dont have to go inside the facility to fill their prescriptions.

101sem


PicturedTeam Tigrillo presenting to medical staff

102sem


Back to Coxen HoleTuesday, January 29, 2013The next day we headed to Coxen Hole to meet with Mayor Julio Galindo, the municipalitys architect and engineer, and a couple doctors who were present for our previous presentations. We presented our designs in the form of powerpoints, models, and one page summary boards. There was an aura of excitement and appreciation as each team presented their scheme. The members

of the mayors staff gave valuable critiques and praise. The mayor reminded us of the need to overcome high operating costs. He informed us of many of the social issues in Honduras, one being that they cannot deny people medical services. The services become free, meaning the government funds it. He stressed that our projects must apply sustainable practices to offset the operational costs, as well as create an

organized plan that requires minimal staff.The mayor and doctors told us to think of the facility as a small scale hospital with the possibility of expansion, rather than limiting it to strictly trauma services. By expanding the vision, the facility could have the potential to become a multi-faceted center, specializing in surgery, pediatrics, obstetrics, and/or internal medicine. These flexible spaces would also have the ability

103sem


LeftRepresentatives of Studio 73 and Mayor Galindo

RightProfessor Dragoslav Simic and Jim Jones talked with a local doctor

to host doctors and their private practices, which would further help fund the facility. The architect brought to our attention again that the building needs to be as maintenance free as possible. While our original designs all incorporated wood exteriors, it was advised to explore using concrete or CMU instead. The upkeep of the wood would be far too difficult due to the high salinity in the air, and it would most

likely need to be replaced on a regular basis. This issue was also applicable when choosing a roofing material and fenestration. We were informed of another issue our designs had to overcome. Originally, we thought raising the building would aid in the cross ventilation of the space to help mitigate heat. However, we were informed that this technique, which we had all implemented, creates a breeding

ground for mosquitoes. Mosquitoes on the island are known to carry Malaria and Dengue fever. A need for sewage treatment and an incinerator were also addressed. As Mayor Galindo had mentioned before, he again stated that all landscaping and road work would be performed by the municipality. The engineer estimated construction costs to be in the range of $100-120 per square foot.

104sem


After our presentation, Mayor Galindo had one serious question he posed to us, So, how did you get the names for your teams? We explained to him the initial research we did, and how we were drawn to these titles. His response was, Well, do you want to see yaba ding dings and tigrillos in real life? We were ecstatic! In typical island hospitality, he dropped everything and took us by boat to his private island a few miles off the shore. There was a zoo housing tigrillos along with other native Honduran animals. A Mayan temple had also been reconstructed at the top of a hill which contained numerous artifacts, including yaba ding dings. After a tour, he treated us to a traditional island lunch of fried sea bass, coconut rice and beans, and fried plantains. He shared his story and how much Roatn means to him and his family.

A Little Escape

105sem


Far LeftRepresentatives of Studio 73 on the Mayan ruins

Top LeftA native Honduran tigrillo

Top RightA native Honduran parrot

BottomOn Mayor Galindos boat headed to his island

106sem


LeftCouncilman Bodden gave design feedback

Top RightNathan Geier and Kelsie Kremer presented the courtyard scheme

Bottom RightJim discussed the presentation outside of the Oak Ridge classroom

107sem


Wednesday, January 30, 2013Our final presentation was given on the East end of the island with Mayor Wally Bodden and three city council members. In an Oak Ridge classroom, we presented only two of the five designs: a bar scheme and a courtyard scheme. We gathered around the models and explained additional details from the summary boards. The Santos Guardiola Municipality is not as financially endowed as the West End and Coxen Hole due to the influx of cruise ships and tourism the West End receives. Although, the East end is more rural, it is home to several local communities. The needs of immediate medical attention for residents and tourists is an issue they asked us to consider. The mayor and council members were excited about the idea of bringing a medical facility to their side of the island. They desire a second facility to serve the East end municipality. Seeing as financing the project would be even more difficult, they desired a multi-functional, sustainable clinic that centered around the community. The only design critique they saw as an issue not yet addressed was a hurricane-proof design. This would include, again, the use of a CMU exterior instead of wood construction and the use of glass sparingly.

East End Presentation

108sem

ester y: return visit We have the sick, but can we afford the sick?

-Mayor Galindo

109sem


RightLetter from Mayor Galindo to Dean de Noble

LeftMayor Galindo was interviewed by news crews.

110sem


111sem


After another week in paradise, we felt like we recieved the guidance necessary to push our projects to their fullest potential. Once back in Kansas, our findings were presented to our classmates who did not make the trip, and as a studio, we decided to pursue two separate facilities for the island. A bar scheme would be most suitable for the existing site and a courtyard scheme would better serve the East end. Presenting in Honduras taught us more than what to fix in our designs. As the week went on, our audiences evolved. This changed our terminology, method of display, level of detail, and approach. From political and financial discrepancies to professional advice and encouragement, each meeting gave us much information to process. The series of presentations kept us on our toes. We did not know the specifics of whom, where, or when we would be presenting our designs until arriving at the location. Island time is much different than we are used to. All in all, we gained a real world experience of client interaction that cannot be grasped on campus.

Things to Take Away

LeftBeautiful sunset on the West End

112sem

ester y: next steps

Precedent While working to incorporate our new knowledge and reconfiguring studio groups, we recruited the help of Diane Cable. She is a surgical nurse who has made multiple trips to Haiti working in a medical clinic with a surgical team. From past experiences, Diane was able to identify several security issues that come with a facility of this manner. She related personal accounts of her time in Haiti and stressed the need for proper security measures including bulk pharmacy storage space, a secure surgical suite, and a double lock system within the living quarters. She walked us through the plan of an existing facility in Haiti, identifying opportunities for storage and clerical spaces. In addition, ways of dealing with sustainability were suggested such as conditioning only spaces that were in use, allowing rentable spaces within the complex, and creating ward space that can double as education space when not in use. This was all new information, and she left us with hope that we can positively impact the community of Roatn.

RightFloor plan of an existing trauma center in Haiti

LeftLiving quarters of the medical staff

113sem

ester y: next steps

114sem

ester y: next steps

When Teams Merge:

Yaba Ding Dings + Tigrillos = Yabarillos

115sem

ester y: next steps

116sem

ester y: final proposal

The Best of BothHaving similar design processes and thoughts on implementing these strategies, it only made sense that our two teams combine the strengths of our individual projects into one bar scheme. Both projects focused their parti around a prominent circulation path; this remained a strong concept we wished to keep. By incorporating team Yaba Ding Dings structure and organization of the linear medical facility with team Tigrillos procession of spaces and permeability, we began working through the feedback and programmatic changes.

PicturedSpatial formation diagram

Mass

117sem


Circulation Path Function Separation Centralized Entry

118sem


In addition to these changes, we gave more consideration to the proposed hospital. It was clear while on the island that the more we worked to preserve the hope of expansion to a larger hospital in the future, the more accepted our design would become. We did this by pushing our building to the edge of the hillside to take up as little of the site as possible. This worked in our favor, as it gave us an easy way to access the cisterns under the building.

Phased Design

119sem


CenterOur facility and original plan with shared parking

RightAlternative proposal

LeftPhased design diagram

120sem


Design Changes

Heavy vs. Light

Many changes took place in our design from exterior finishes to programming. Some of these included change in materiality from a wood exterior to a CMU exterior and lowering the building to the ground. The interior saw some changes including rearranging spaces to meet the zoning requirements, giving the ICU rooms the ability to serve multiple functions, and changing the apartments from single rooms to dorm style. Revisiting the sustainable aspects of our design, more exploration was done on the roof in order to maximize water collection.

121sem


LeftMateriality diagram

RightMedical Zoning

non-sterile

minimally sterile

moderately sterile

highly sterile

Levels of Sterility

122sem


Revision of ProgrammingProgram that was added after further exploration and development included a recovery room, a surgeon locker room, an outpatient surgery room, an x-ray and lab, a utensil wash room, an office for the administrative side of the medical facility, a bulk pharmacy storage, an extra janitor room to avoid cross-contamination between the medical and public side, a smaller, private classroom, and a shed to house the incinerator and generator.

RightBuilding floor plan

CCBB GFEDCBA

6

12

13

5

4

3

2

11

10

9

8

7

AA

scale: 1/8 = 10

1

scascalscalscalscalcalcalalscalcalcacalscaaasca e: 1e: 1e: 1e: 1e: 1e: 1e: 1: 1e: 11e: 1e: 1e: 1e: : 1e: 1e: 11e: 11e: 1e: 111ee 11/8 //8/8/8/8/8/8////8/8/8 =scacascalascscascs e: 1e: 1e: 1: 1e: 1e 1/////

1111121112

13

1111111111

10110101010101010101000011

9999999

8

4

3333333333333333333333

22222222222222222222222222

BBBBBBBBAAAAAAAAAAAAAAAAAA BBB

0

ER ward

family waiting

recovery suitedoctor

locker roomlaboratoryX-ray

X-ray dark room janitor (medical)

outpatient surgery

operating room

prep/sterilization surgical suite lobby

maintainence +storage

bathroom

delivery +ER suite

utensil wash room

clinic:internal medicine

clinic:internal medicine

clinic:pediatrics

nurse station

generator

incinerator

A B

1

123sem


IH MLKJ PON Q R T US

1

14

QQ RRRRRRRRRRRRRRRRRRRRRRRRR SSSSSSSSSSS UUUUUUUUUUUUUUUUUUTTTTTTTTTTTTTTTTTLLLLLLKKKKKKKKKKKKKKKKKK

consultation administration

reception +pharmacy

clinic:pediatrics

pharmacy storage

break room

laundry +janitor

records

waiting area

community room

private classroom kitchen

laundry dining + commons

storage dorm 1 dorm 2 dorm 3

public bathroom

public bathroom

ambulance entrance patient entrance

apartment

C D

124sem

ester y: final proposal Further consideration was given to sustainability as our projects became one. The roof system was redeveloped to form a large, central gutter to maximize rain water collection. The water flows to the community and waiting space where it is funneled to the cisterns which sit right below the space. This allows for easy access to the cisterns for water treatment and repair. Placing the downspouts in the open community and waiting space also minimizes potential water damage from leaks. The community and waiting area is opened up to allow for breezes to flow through and naturally cool the space while patients are waiting. This cuts down on utilities while keeping waiting patients comfortable, which minimizes the chances of contagions spreading due to the air constantly circulating.

Sustainability

LeftWater collection diagram

Top RightGutter detail

Bottom RightPassive strategies diagram

125sem


4x16 Honduran Pine Roof Girder

4x16 Honduran Pine Roof Beam

3/4 Plywood SheathingRadiant BarrierCorrugated Metal

4x12 Honduran Pine Roof Column

Pine Sheathing2x4 Stud

5/8 White Gypsum BoardRecessed Can Light

Vapor BarrierMetal Flashing

Plywood Sheathing

2x6 Stud

1 Steel BoltStainless Steel

Joist Hanger

Stainless Steel Shear Angle

Gypsum Board Tape

2x10 Honduran Pine Corrugated Metal

126sem


PicturedExterior rendering viewed from approaching vehicles

127sem


128sem


LogisticsFunctionsThe facility is broken up into three primary functions. Upon entry, people are greeted with an open, welcoming community and waiting area overlooking the distant ocean. This portion is shifted to create shaded, multifunctional spaces. Immediately to the left are dorm-style apartments which function primarily to house visiting surgical teams. The medical portion of the facility is to the right, which contains all medical functions of the building. The generator and incinerator are located about sixty feet away from the medical unit. PhasingThe facility has been designed to allow for phasing if full funding isnt immediately available. First, site excavation will occur as well as building the tool shed that houses the incinerator and generator. This will be built initially to secure construction tools, then the incinerator and generator will be put in place when construction is complete. Following this, the medical unit will be built, as it is the most important function. The cisterns will be installed so water can be collected. The community and waiting space will be the next portion to be constructed, followed by the apartments. It is anticipated that further site excavation and hospital construction will take place in the future.

1 2

2.1

3 4

11 Excavation + Construction Tool Shed*2 Medical Unit + 2.1 Cistern3 Community Space 4 Visiting Surgery Team Apartments*Tool shed will temporarily keep construction tools secure. It will house the generator and incinerator when construction is complete.

Construction Phasing

Utilities Shed

2 3 4Medical Unit Community

CisternApartments

1

Functions

129

Community Room / Sala ComunitariaWaiting Area / EsperaPrivate Classroom* / Aula PrivadoPublic Bathroom* / Bao PblicoPublic Bathroom* / Bao Pblico

Storage* / Almacenaje

902 sf892 sf497 sf

95 sf95 sf

197 sf

*Part of the Apartment structure but functions as part of the Community Space.

semester y: final proposal

2 3 41

CMU walls and slab / lumber roof structurelumber flooring system / lumber roof structure

Medical Director / Oficina del DirectorBathroom / BaoBathroom / BaoBreak Room / Sala de Descanso del PersonalClinic: Internal Medicine / Clinca: Medicina InternaClinic: Internal Medicine / Clinca: Medicina InternaClinic: Pediatrics / Clinica: Medicina InternaClinic: Pediatrics / Clinica: Medicina InternaConsultation / Oficina de ConsultacinDelivery/ER Suite / Sala de Expulsion + UrgenciasER Ward / Sala de UrgenciasJanitor (medical) / Conserje (Mdica)Laboratory / LaboratorioLaundry + Janitor (public) / Lavadero + ConserjeMaintenance + Storage / Mantenimiento + AlmacenajeNurse Station / Enfermera EstacinOperating Room / Sala de OperacionesOut Patient Surgery / Sala de Ciruga AmbulatoriaPharmacy Bulk Storage / Almacn de FarmaciaPrep/Sterilization / Preparacin + EsterilizacinReception + Records / Almacn de RegistrosRecovery Ward / Sala de RecuperacinSurgeon Locker Room / Vestuario de los MdicosUtensil Wash Room / Lavado y EsterilizacinWaiting - Secondary / Espera SecondariaWhite Zone Lobby / Area BlancaX-Ray / Unidad de Rayos XX-Ray Dark Room / Cuarto Oscuro

197 sf75 sf51 sf91 sf

209 sf209 sf209 sf209 sf209 sf282 sf874 sf

64 sf91 sf99 sf

427 sf--

266 sf166 sf105 sf130 sf372 sf253 sf110 sf

56 sf--

254 sf131 sf

61 sf

Generator Room / GeneradorIncinerator Room / Incinerador

381 sf90 sf

Utilities Shed

Medical Unit

Community Space

Dining Commons / Comedor + ComunesDorm 1 / Dormitorio 1Dorm 2 / Dormitorio 2Dorm 3 / Dormitorio 3Laundry / Lavadero

1089 sf347 sf347 sf328 sf

32 sf

Apartments

Construction Types

1 2 3 4

1 Utilities Shed 2 Medical Unit 3 Community Space 4 Apartments

Total Gross Floor Area Total Gross Internal Area Gross Floor Area: measured from the external face of external wallsGross internal Area: measured from internal face of external walls

Construction Types

598/4718287/80065847/49423290/3088

18022 sf16507 sf

130sem


131sem


LeftEast Elevation

RightWest Elevation

BelowSouth Elevation

BottomNorth Elevation

132sem


106

124 100

120

116 136 380150

100150150 150

93

250110

Top LeftSection through the community space and cistern

Top RightSection cutting through the medical ward

BottomLongitudinal section

133sem


90124150 158210

150 100 300 150

116 136260 116

134sem


Construction Document Details

2 Steel Bolt

1 Steel Bolt

Stainless SteelJoist Hanger

4x16 Honduran PineRoof Beam

4x12 Honduran PineBuilt-up Column

1 Steel Bolt

2 Steel Bolt

Stainless SteelShear Angle

18x18 Reinforced ConcretColumn Footing

Stainless SteelBearing Plate

Pine Shim

4x16 Honduran Pine Roof Gurder

Stainless Steel Shear Angle


Stainless Steel C Channel

2x4 Pine Block


3/4 Plywood Sheathing

Radiant Barrier

Corrugated Metal

Pine Base Board

5/8 White Gypsum Board

12x12 Non-Slip Linoleum Tile

2x4 Stud Wall

Plywood Substrate

6 Concrete Slab-on-Grade

Waterproofing Membrane

Drainage Course

Built-In Wood Louver System

1x4Pine Block


PicturedBuilding techniques

135sem


2x2 Slat Frame

18x18 Reinforced ConcreteColumn Footing

4x16 Honduran PineFloor Girder

2x2 Honduran Pine Slat

4x16 Honduran PineFloor Beam


2x6 Honduran Pine Floor Boards

2x2 Slat Frame

4x12 Honduran PineBuilt-up Column

2x2 Honduran Pine Slat

4x16 Honduran PineFloor Girder




3 Core 8x8x16Concrete Masonry Unit

3/8 Type O Mortar

Pine Base Board

Foundation Anchor Bolt


Foundation Drain

Concrete Reinforcement

6 Thickened EdgeConcrete Slab-on-Grade

Waterproofing Membrane

Drainage Course

Precast Concrete Lintel

Sliding Wood Window Fixed Head

Sliding Wood Window Fixed Jamb

Precast Concrete Sill

Single Pane Glass

136

21960.5 sf x .024 ft = 530.7 ft x 7.48 = 3969.91 gallons per minute


Roof Drainage

Average:

Inches of Rain Per Month:

Warm Season: July 21- October 2Cold Season: Nov 17- February 16

Rainy Season: July-January with heaviest in October-January

January 8.6February 4.7March 3.2

April 2.3May 2.7June 5.8

July 10.4August 6.0September 6.1

October 17.8November 16.4December 14

Average:

8.6+4.7+3.2+2.3+2.7+5.8+10.4+6+6.1+17.8+16.4+14

128.17in/12 = .69ft

Roof Square Footage: 21960.5 sf

Total Roof Catching Capability:.69ft x 21960.5sf + 15152.745 ft x 7.48 = 113,350.4 gallons

3

Cistern Size: 12 (15) = 6782ft x 7.48+ 50,732 gallons x 2 = 100,000 gallons

32

Worst Case Scenario:Heaviest amount of rainfall per hour interval= 17.4 in/12 + 1.45 ft per hour/ 60 = .024 ft per minute

3

Using local weather data, we analyzed the average monthly precipitation. Possible collection capabilities were calculated based on the roof surface area and gutter size necessary to support the demands of the facility. Cistern sizes were determined from the average daily demand of the medical clinic. Downspouts were then sized based on these calculations.

137

7.38 x 286.416 ft = 2114.89 ft x 7.48 = 15,820.47 gallons

1/2(5.83x1.04) = 3.031/2(8.37 x 1.04)= 4.35


Gutter Capacity:

3

15,820.47 > 3969.91 OK

4 downspouts: 3 in main area, 1 at end of the medical center21960.5/4 = 5490.125sfArea drained per sq ft of downspout: 60 ft5490.125/ 60 = 91.5 ft minimum area per downspout91.5 = r r= 5.3

Down Spout Analysis:

2

LeftWater collection calculations

RightDrainage diagram

138sem


Cost EstimationIn order to find a design suitable for the island of Roatn, cost estimations were made. This provides the client with an idea of the financial means necessary to build this clinic. Thinking about how the building is constructed, calculations for the concrete foundation were completed. The next step was figuring the amount of CMU required. Once these calculations were finished, the numbers were taken with average pricing figures to find an estimated cost.

Preliminary Foundation Design:

Load Analysis: Roof Dead Load=15psf

Roof Live Load= 35psf

Total Load: 50psf + 10psf (extra)= 60psf

Spread Footing Design (south facing):

Load: 60psf ( tributary width) = 60psf ( 16 ) = 960plf = P

Soil Bearing Capacity: q= 3ksf for clay soft broken shale

Required Footing Area: A=P/q

A=0.96k/3ksf= 0.32 , use b=2

Design a Single Footing Under Column:

Load: P= TA (DL+LL)

300sf ( 60psf ) = 18 kips = P

Footing Area Required:

A= P/q = 18kips / 3 = 6sf

b= 6 = 2.45

Material Weight: Timber= 35pcf

Total Column Weight:

35pcf ( 12.25 ) = 428.88 lbs/ft

Column self-weight 10% of total supported load

42.88 lbs

Load Per Column: w= ( 60 )( 8.33 ) = 500 lbs/ft

Total Column Weight: 428.75 lbs/ft

Total Gravity Load= 928.75 lbs/ft

Column Self Weight = 9.28 lbs/ft

Total Design Load = 938 lbs/ft + 30% for lateral load= 938(1.3) = 1219.4 lbs/ft PicturedPreliminary cost estimations

139sem


Foundation with several corners:

Mason- 6.5-10 hrs

Laborer- 7.5-12 hrs

Exterior walls 40 high:

Mason- 6-9 hrs

Laborer- 7-10.5 hrs

Exterior walls 48 above ground or floor:

Mason- 7-10.5 hrs

Laborer- 7.5-12 hrs

*use 7.5 mason work hours per 100 sf & 9.5 labor work hours per 100 sf

65.341 hundred sf x 7.5 = 490 mason work hours

65.341 hundred sf x 9.5 = 621 laborer work hours

*assuming a bare labor rate of $14.25 for masons and $10.00 for laborers per work hour

Mason labor cost = 490 work hours x $14.25 per work hour = $6,982.50

Laborer labor cost = 621 work hours x $10.00 per work hour = $6,210.00

Total Labor Cost = $13,192. 50

*note: 1. The more corners and openings, the more man hours

2. If using lightweight concrete, work hours decrease by 10%

3. Work hours include simple pointing and cleaning required

4. Special bonds and patterns increase work hours by 20-50%

Accessories to account for: control joints, wall ties, flashing, weep holes, lintels, sills, coping, reinforcement bars, etc.

Material/Labor Cost Estimates:

CMU Block: @ nominal size 10 x 8 x 16

Total building face openings = 6534.1 sf

*using 10 x 8 x 16 cmu = 1.125 blocks per sf of area

6534.1 sf x 1.125 = 7351 blocks

Waste @ 6% = 441 blocks

Total = 7,792 blocks @ $2 = $15,584

*Factors to account for in cost: 1. Size of units

2. Shape of units

3. Color of units

` 4. Type of bond (pattern): running bond is cheapest

5. Shape of mortar joints

6. Color of mortar joints

7. Any other special requirements (such as fire rating)

Mortar: @ 3.2 cf per 100 sf of face area

65.341 squares of face area x 3.2 cf per square = 209.1 cf

Waste @ 40% = 83.64 cf of waste

Total = 292.74 cf

Labor: calculating work hours per sf

Simple foundation:

Mason- 6-9 hrs

Laborer- 7-10.5 hrs

140sem


141sem


LeftExterior rendering of emergency entrance

Top RightWaiting area

Bottom RightDoctor living quarters

142sem


143sem


LeftCommunity room

RightCommunity porch

144sem


Top LeftReception area

Bottom LeftMedical unit

RightMedical unit

145sem


146sem


PicutredEntrance

147sem


148sem

ester y: final critique

106 124 100120

116 136 380150

100150150 15093 250110

Section C // Community + Waiting

106 124 100120

116 136 380150

100150150 15093 250110 106 124 100120

116 136 380150

100150150 15093 250110

Section C // Community + Waiting

90124150 158210 150 100 300 150

116 136260 116

Section B // Medical Unit

Section D // Apartments

Section A // Surgical SuiteSection A // Surgical Suite

Real World Problem Solving // Other than the dire need for sustainability in all categories, a number of other issues required our attention. The largest is the islands desire to build a $60 million hospital. As helpful as such a facility would be, it is not plausible due to its large financial demand. The proposed design occupies the same site as our proposed clinic. To compromise and keep hopes for future growth alive, we designed our facility on the edge of the site. In the future, these two medical facilities can function as one. Other problem solving include cost analyses, construction phasing, rain water collection needs and capabilities, and other applications.

PicturedPhotographs from critique

149sem

ester y: final critique

In summation of a year of work, a final critique was held in Seaton Hall. Torgeir Norheim, Gary Coates, and Dr. Sager joined Dragoslav and Jim in commenting on our final work. Overall, they were pleased with the progression and thought the design had matured greatly. They praised the elegance and execution of the project. The conversation reflected on where this project could ultimately go. A fourth phase was suggested. This phase would include adding alternative power sources to replace the need for a diesel fuel generator. It was recommended to add a screen to block the entrance of gurneys passing through the waiting room. This could be resolved by using one of the garden screens used to secure the facility at night. It could simply rotate out to extend the existing ambulance drop off screen. The size and placement of windows could change the quality of ambient daylighting and emphasize the structure. How to improve upon our presentation was also advised. Although we spoke about cost estimations, showing these numbers is crucial when presenting to real clients. Expanding upon the versatility of conditioning throughout the building would have demonstrated the level of detail included in our design considerations. The year long process would benefit the overall evolution and understanding of the design.

Final Critiques

[b]amboo

architectsWhat happens when

start thinking like engineers?

154sem

ester [b]: preparation

155sem


In addition to the medical clinic designs, our studio also explored the opportunity to fabricate a structural system using the islands local and easily accessible resources. This was a continuation of last years studio research. The system is a bamboo truss with fiberglass and resin connections. The goal was to design, build, and test these trusses to see if they could physically uphold the loads that would potentially be applied to them on the island.

Vision

Left8ft. long bamboo poles

156sem


The 2012 graduate studio explored this structural system by constructing 2-eight foot trusses. The structural members were tested by using water weight. To their surprise, the trusses ended up holding more than 5,000 pounds (156

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