Eben-Ezer Medical Clinic Addition

Site Plan

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

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

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

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

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

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

Street elevation

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

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

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

Ground Floor Plan with paving patterns

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

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

View of circulation under green screen from back of site

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

 

Programming Diagrams

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

 

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

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

Section C : Cutting through observation/laboratory/exam spaces

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

Massing Site Axon showing ideal water collection routes

View looking into waiting/education spaces from back of site

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.

Reflection: After the Foundry

My group (Tiffiny Hall and Alyssa Nealon) presented both the Emergency Medical Response Unit and the schematic design of the Eben-Ezer Medical Clinic expansion.  We felt the mobile medical unit was valuable in the development of the clinic’s expansion.  Many of the lessons learned through the first project were essential in understanding the cultural and medical needs of Haiti; this confidence in our knowledge of the projects and culture helped us communicate more easily with professionals and professors. 

Floor Plan: Program and Square FootageThe Foundry was beneficial in many ways.  The professionals as a whole were very supportive of both our projects and did not point out any glaring issues.  They commended our research, circulation solution, and site usage.  One of our reviewers, who grew up in Southern California, gave us an interesting perspective for design development; she suggested looking at buildings in similar climates and how they address sustainability and circulation—where she thought we could use assistance.

Site Plan: Access and Circulation Parti

From this point, we need to further develop our design.  Many decisions have to be made involving the sectional qualities of the buildings.  The building in plan takes advantage of the sun and wind; however, the section of the building could negate this if not designed correctly.  The concern of non-sheltered circulation is an issue that needs to be addressed.  Also, the materiality and construction methods will greatly affect the look and feel of the environment; research of local materials and methods is needed to determine the best options for our design.

 Sectional Options

Foundry Board Presentation