1. 1
AFGHANISTAN
AND BEYOND
Developing a prototype for
community healthcare in the
World’s most challenging
environments
2. 2 3
Afghanistan and Beyond
Where do we start?
Developing a prototype for community healthcare in the World’s most challenging environments
Table of Contents
1.0
Introduction
1.1
A Scalable Idea
Through a modest project for the International Or-
1.2
Case Study- Afghanistan
ganization for Migration and USAID we were given
1.3
Case Study - Zambia the chance to design multiple hospitals to serve
1.4
Case Study - St. Lucia
the people of Afghanistan. At first glance these
1.5 are basic structures built locally by tradesmen
Case Study - Guizhou Province China
1.6
and staffed in their final forms by local healthcare
Affiliations
workers. Western ideas of how healthcare is deliv-
ered are only as relevant as their ability to be suc-
cessfully implemented.
In areas of cultural or political transition, basic
needs like healthcare serve as the building blocks
for new communities. Our permanent, scalable and
expandable strategies for these facilities reflect the
values of cultures and access to natural resources
that each context has to offer in Afghanistan and
beyond.
3. 4 5
Off the Grid: A Different Direction in
Bringing Healthcare to Developing Nations
As the team was developing the design for the Afghan 100 bed prototype, there ap-
T
peared to be a specific niche that the project was addressing. A confluence of a
particular need, a particular quantity of services, and an architectural solution that is
simple, flexible and transferable to many sites. We recognized that the model being he idea is a healthcare prototype that bridges a
designed can fill a void in the healthcare fabric of many developing nations; and that
if this void is filled, it could bring a leap in the quality of life of thousands at a minimal gap in the society of developing nations. The gap be-
investment. So when an ideas competition was announced within the firm, we start- tween rural clinics and urban hospitals. The gap that is
ed discussing what made this project different from similar efforts in the past:
stranding millions, especially women and children, on the
When aid agencies build healthcare clinics, they tend to be either for immediate di- wrong side of history. By providing right sized, flexible,
saster care, or urban settings. They are either small and temporary, or large and in-
frastructural. The 100 bed model is something else, but has the flexibility to provide simple hospitals that can bridge this chasm, an entire na-
both experiences. It is large enough to demonstrate a permanent commitment to the tion can stabilize its population and move up the hierar-
community, yet small enough to be placed in villages, near rural areas. There have
been many architectural competitions about bringing, small, portable, often temporary, chy of security and wealth. It’s not just about access
healthcare facilities to underserved populations. This project takes another approach to care; it’s about access to the future, by putting down
by proposing a permanent, site-specific building that encourages the participation and
investment of the locals. It is not trying to import Western solutions, it is using uni- roots and investing in local, long term growth. The no-
versal techniques to adapt to the cultural, and medical needs of the visitors. grid hospital is the seed that stabilizes the shifting sands
Size is key in another critical area: utilities. In Afghanistan and other developing con- of the community, allowing time for the grid, and educa-
texts, there is no “grid” for water, power and waste. The ability to package these im- tion, to take hold.
provements at the right scale is one of the vectors via which these projects can trans-
form the community. They must be small enough to operate off the grid, yet large
enough to achieve an economy of scale in water and power production. We think of
these buildings as more than health centers, but rather social centers: places for edu-
cation, security, and employment. By providing a hub of infrastructure, the 100 bed
hospital becomes a community catalyst, an engine for change.
4. 6 7
1.0 World Health Indicators
There are literally hundreds of sites in need of permanent, scalable healthcare. Using World health data, we selected four sites including Afghanistan for
further study. Using indicators including infant mortality, life expectancy and skilled professionals at live births a picture of need begins to evolve. More
Newborn life is fragile.
than half a million women die every year of complications during pregnancy or childbirth. Most of these deaths can be avoided as the necessary medical
interventions exist and are well known. The key obstacle is pregnant women’s lack of access to quality care before, during and after childbirth. Investing
Almost four million children
in health systems - especially in training midwives and in making emergency obstetric care available round-the-clock -- is key to reducing maternal mortal-
ity.
Nearly 10 million children under the age of five die every year - more than 1000 every hour. These children could survive and thrive with access to
simple, affordable interventions. Helping countries to deliver integrated, effective care in a continuum, starting with a healthy pregnancy for the mother,
through birth and care up to five years of age is crucial. Investing in health systems is key to delivering this essential care.
die every year within a month
We have identified 3 other case study sites in addition to Afghanistan to further explore the implications of our strategies. of their birth.
Afghanistan Afghanistan
St Lucia St Lucia
Guizhou Guizhou
China China
Zambia Zambia
5. 8 9
1.0 World Bank Data
257 babies per 1000 born
The World Bank tracks data related to World economies. Overlaid with health data from these countries a picture emerges of high mortality rates and high
birth rates in countries like Afghanistan and Zambia.”Developing” countries like India, China and in this case St. Lucia, represent the middle of the pack
while the United States, not surprisingly, consistently ranks near the top of all categories related to health of its citizens
will die in Afghanistan be-
fore they reach their fifth
birthday.
6. 10 11
1.0 Hierarchy of Health Access
The development of responsive building solutions is inextricably linked to the social conditions and the aspirations and limitations of the individuals these
building’s serve. Our projects serve a population that in in transition. A population whos upward mobility is being severly limited by a lack of primary
health services. Understanding the development of stable communities is essential in setting the right expectations for the projects and evaluating pos-
Our projects bridge this gap. Bringing
sible sites. We call these sites
“Permanent and Disconnected”.
“
resources where needed, linking the
the hierarchy of development
Resources
1
Meaning
Fulfilment Sustainable Medical
Growth Capitol School & Research
Creativity
Esteem & Achievement
Needs:
Responsibility,
Status, Reputation
City Grid &
Backup 2 Nursing
School & Elective
Social & Emotional
Needs:
Family, work,
Relationships
Town Grid
Intermitant 3 Acute &
Specialty Care
Safety & Stability
Needs:
Security, Law,
Protection
Village Permanent
Disconnected 4 Primary Care &
Public health
Biological & Immediate
Needs:
Clinic
Portable, Mobile /
Air, Water, Rural Emergency
Disconnected
Shelter Shelter
Individual Needs Group
Infrastructure
Level
Trauma
Level
Facility
Level
Growth Growth
7. 12 13
1.1
A Scalable Strategy
“... freedom translates into having a supply of clean water, having electricity on How do you create an affordable, sustainable,
tap; being able to live in a decent home and have a good job; to be able to send
your children to school and to have accessible healthcare. I mean what’s the and locally viable healthcare solution that can
point of having made this transition if the quality of life ... is not enhanced and
improved? “
become a building block for healthy communi-
ty growth?
— Desmond Tutu
8. 14 15
1.1 A Scalable Strategy Areas in crisis in need of healthcare resources need to balance the immediate needs of care with the rebuilding of physical com-
munities. We believe that the community hospital built to reflect the communities needs through expedient and simple construc-
tion can serve as the rebuilding blocks needed. The fundamental planning modules represent a simple and achievable outcome for
areas of the world most in need of quality, permanent healthcare. An expandable strategy of building in rural areas accomplishes
this.
Mobile units circulated from clinic to community
hospital as bridge between expansion strategies
Clinic with
Mobile Care Units
20 Bed Hospital 50 Bed Hospital
Flex into Mobile Units
100 Bed Hospital 150 Bed Hospital
9. 16 17
100
1.1 A Scalable Strategy THE FULL TEMPLATE:
The 100 Bed Hospital is the starting point for consideration of this
Bed Hospital strategy. One can subtract elements but keep the essential drivers of
Mobile surgery support interface
services the ED Surgery and Outpatient keeping places for support
and administrative functions to begin and expand as need increases.
E.D.
A key difference between this and other solutions implemented is
Generators the clinical model. The prototype can provide all the basic services
needed for community health and education, with enough space to
house a couple of key specialties. In Afghanistan, the need for train-
Mech.
Bedded Care ing mid-wives and female care-givers is essential to lowering infant
mortality rates. Orthopedic services are also in high demand due to
land mine injuries. The 100 bed module provides enough space for
basic medical-surgical services, as well as an emphasis on O.B. and
Ortho. In other parts of the World, other specialties would be de-
Ambulance
Sterile livered, along with training and public health. One of the planning
Port Pharmacy Process Outpatient Clinic innovations proposed is a six bed unit that can be operated as a 3-
bed unit when staff levels permit. By dividing the units into gender-
specific wards of 24, then into rooms of 6, then into groups of 3,
there is tremendous flexibility. Depending on care model, service
Food line, staff level, and cultural preference, the units can be managed in
Service many configurations without renovation.
Outpatient
Exam Diagnostic and Treatment Because the project is site specific, and expandable, it uses a univer-
sal module, and is buildable with any common material. The 15 me-
Staff Courtyard: ter clear span, single story, single slope roof, provides an architectur-
50 Female Bed Unit al building block, a "widget", that can accommodate many types of
space, in any part of the World. The walls can be built from brick,
Lab P.T. & Prosthesis adobe, concrete, or sandbags. The roof trusses can be shipped as a
kit of parts and assembled on site. High windows encourage natural
Support Space ventilation and daylighting.
X-ray
We know that education, especially for girls, is the key to stability
and wealth in the long term. In places like Afghanistan, rural India,
Dental and central Africa, poor healthcare is preventing the education gap
from closing.
Education and Administration
Public Courtyard:
MAIN Cultural &
ENTRY Educational Events
50 Male Bed Unit
Classrooms
10. 18 19
The 100 Bed Prototype- Design Process
On the way to the simplest solution, we ex-
plored schemes based on an original layout
from our client. By standardizing the 15 meter width throughout
the building in the final scheme we were able to radically simplify construc-
tion and build the conceptual basis for our scalable hospital.
11. 20 21
50
1.1 A Scalable Strategy GENDER SEPARATED HOSPITAL:
The 50 Bed Hospital accommodates the separation of sexes, a critical
Bed Hospital feature in Muslim culture and in a multi-patient wards. From the main
Mobile surgery support interface entry, men and women can reach the inpatient services along separate
routes.
At this scale, specialty hospitals are ideally suited to address major
y
er
rt
needs. Afghanistan is planning 50 bed women’s hospitals to target pre-
v
po
co
RI
p
natal care, and blunt the momentum of high infant mortality. By desig-
CT
M
Re
Su
E.D.
nating the entire facility for women, cultural boundaries in education and
access are removed. Education facilities are expanded, to train specialty
Ambulance Bedded Care care givers.
Port Generators
The main courtyard creates a secure, public space and orients visitors to
Surgery Recovery circulation flows around it.
Mech.
Sterile This scheme is the lowest level of fully “permanent and off grid”.
Process Power generation and sterile processing are brought into the building, no
Outpatient Clinic longer using mobile resources.
Staff Courtyard:
Lab
Lab
Diagnostic and Treatment
Dining/
Waiting
Outpatient
Exam
Public Courtyard:
Cultural & 25 Female Bed Unit
Educational Events
Support Space
X-ray
Dental
Reception 25 Male Bed Unit
Education and Administration
MAIN Classrooms
ENTRY
12. 22 23
20
1.1 A Scalable Strategy
DAY HOSPITAL:
Mobile surgery support interface Bed Hospital At the 20 bed scale, the facility can swing between outpatient day
hospital, and inpatient care. The inpatient exam rooms receive the rush
of visitors in the morning, then convert to extended recovery for the last
rt
Ambulance surgery cases of the day.
po
RI
p
Port
Su
R
CT
M
O
The classrooms can be leveraged as public health screening and inocula-
tion places. This modest hospital can grow to the 50 Bed and then the
Mobile
100 Bed by:
Utilities
Bedded Care
E.D. Generators 1. Building some shell treatment spaces and using the space for
Surgery Recovery interim support
Mobile 2. Reserving places for future functions like bedded care
Sterile Process
Mech.
Outpatient Clinic 3. Reusing public health spaces in the future in new programs like
healthcare workers training classrooms
Endo. Scopes
4. The use of mobile modality trailers and trucks can greatly lever
Staff Courtyard:
Lab age staff and resources across large distances.
X-ray
Staff support Diagnostic and Treatment This scheme allows the sterile processing to be accomplished with mo-
& Housing bile units, as an interim step between, bulk storage and an SPD dept.
MAIN Dining/
ENTRY Waiting
Reception As the number of highly trained personnel increase for inpatient services,
the need to recruit and train staff from the community must be accom-
modated. This scheme uses on-site housing, built to house the trades
Public Courtyard: during construction, as a dedicated dormitory. Together with the educa-
Cultural &
Support Space tion and administration spaces, a complete school of nursing is possible.
Educational Events
OUTPATIENT
EXAM &
EXTENDED
RECOVERY Education and Administration
Dental
Physical Classrooms
Therapy
13. 24 25
Clinic
1.1 A Scalable Strategy
No inpatient beds, the basic care hub
THE HUB:
Mobile mass casualty The no bed “clinic” is the most basic building block. The fundamental structure that
houses the kernel of a much larger structure, but can also stand alone. This kernel is
uniquely adapted to support major surges due to catastrophic events. This allows the
dual mission of primary and routine surgical care during normal periods, and triage cen-
ter during mass casualty.
Surge triage Mobile surgery support interface
Bedded Care The building is divided into high and low acuity from top to bottom. It is further
divided into public and support function from side to side. This allows every side of
y
the building to specialize to a group of functions, based on access and privacy. This
er
al
g
t
v
Ambulance
in
organization creates a hub for the addition of future expansion, or mobile units. Tre-
or
ic
co
ag
rg
pp
mendous flexibility is permitted, depending on the medical and financial needs of the
Re
Mobile Port
Su
Im
Su
community, to configure the facility over time.
Decon.
Mobile Outpatient Clinic
Bulk Utilities
Storage Generators
Recovery Surgery
Med-Surg Hub
ED High Acuity
Mech.
Equipment & Staff Diagnostic and Treatment
E.D. & O.R.’s
Out Patient
Open Court: Light/ Air / Security Clinic
M
or
Screening
gu
X-ray Education
e
Support Space MOBILE UNITS:
Su
pp
As an outpost in a developing nations health network, the “hub” clinic is the ideal
le
Dining/ docking platform for mobile medical units. These units may reside at other facilities,
s
MAIN
Waiting St Mobile or in storage, but would be installed here to respond to a temporary or overwhelming
ENTRY Reception af Surge need. The mobile units can also serve as an interim step prior to a permanent addition.
fs
up Support
po Shown here are the seven basic families of mobile units and how they interface with
Classrooms rt Education and Administration the clinic.
Mobile These units provide developing governments the ability to leverage their resources
Pandemic across much larger areas, and react to catastrophe. They also allow outside organiza-
tions an opportunity to contribute with a proprietary platform and controllable logistics.
testing & This means that imaging equipment companies, for example, could access markets that
Vaccination are not currently available. Services that are highly technical, such as cardiac cath.,
can be brought to many new patients. Services that are too specialized for wide use,
such as lithotripsy and cataract surgery, can be brought to rural areas. The “Hub”
clinic provides an interface for the local and international community to interact, via
technology and expertise. It is the beginning of new expectations for both the patient
and the care industry. A higher expectation, that suffering is no longer acceptable,
that medicine is not just for the urban and the wealthy.
14. 26 27
Clinic
1.1 A Scalable Strategy
No inpatient beds, the basic care hub
Clinic Outposts
The clinic module of the scalable hospital is at
once the basic building block to the future and an
important destination in and of itself for those in
need.
The facility can operate in it’s most basic clini-
cal care configuration as permanent built spaces
as well as allowing the mobile care units to dock
into the core care spaces of the facility in clearly
delineated areas.
15. 28 29
1.2
Afghanistan is not kind to children. Afghanistan
Thirty years of war have marred the land, decimated Afghanistan, with a per-capita income of less than
US$ 200, is among the least developed countries in
Total population: 26,088,000
the economy, and exposed Afghans to human loss the world with 70% of the population living in extreme
poverty and health vulnerability. The social indicators,
on a grand scale. The country ranks second to last on which were low even before the 1979 Soviet invasion,
rank at or near the bottom among developing countries,
Life expectancy at birth m/f (years): 42/43
the United Nations' human-development index, and preventing the fulfillment of rights to health, education,
food and housing. Since the fall of the Taliban almost
Healthy life expectancy at birth m/f
(years, 2003): 35/36
for children, the consequences have been especially five years ago, important progress has been achieved
in all sectors, but much remains to be done in order to Probability of dying under five
acute. Afghanistan has one of the world's highest reach a significantly strengthened social infrastructure,
realize the rights to survival, livelihood, protection and
(per 1 000 live births): 257
maternal mortality rates, according to UNICEF, and participation, and reach the Millennium Development
Goals (MDGs).
Probability of dying between 15 and
60 years m/f (per 1 000 population): 500/443
a child mortality rate second only to Sierra Leone's. The health of women and children is among the worst
in the world. One woman dies in Afghanistan every 27 Total expenditure on health per capita
More than 2 million Afghan children are orphans. minutes from pregnancy-related complications, 25,000
every year. Morbidity and mortality among children are
(Intl $, 2006): 29
More than half are malnourished, and one-third are due to measles, diarrhea, acute respiratory infection,
malaria, malnutrition and poor sanitation. 20% of chil- Total expenditure on health as % of GDP
underweight. dren have a low birth weight and 85,000 children under
five die from diarrhea each year. Anaemia prevalence is
(2006): 5.4
high among women and children.
16. 30 31
1.2 Case Study - Afghanistan
Afghanistan’s ethnically and linguistically mixed population reflects its location astride historic trade and invasion routes leading from Central Asia into
South and Southwest Asia. While population data is somewhat unreliable for Afghanistan, Pashtuns make up the largest ethnic group at 38-44% of the
population, followed by Tajiks (25%), Hazaras (10%), Uzbek (6-8%), Aimaq, Turkmen, Baluch, and other small groups. Dari (Afghan Farsi) and Pashto
are official languages. Tajik and Turkic languages are spoken widely in the north. Smaller groups throughout the country also speak more than 70 other
languages and numerous dialects.
Afghanistan is an Islamic country. An estimated 80% of the population is Sunni, following the Hanafi school of jurisprudence; the remainder of the pop-
ulation--and primarily the Hazara ethnic group--is predominantly Shi’a. Despite attempts during the years of communist rule to secularize Afghan society,
Islamic practices pervade all aspects of life. Islamic religious tradition and codes, together with traditional tribal and ethnic practices, have an important
role in personal conduct and dispute settlement. Afghan society is largely based on kinship groups, which follow traditional customs and religious prac-
tices, though somewhat less so in urban areas.
17. 32 33
100
1.2 Case Study - Afghanistan
Bed Hospital - Site Plan
Utility Courtyard Before the first building foundation is poured, utilities must be secured as there
Dining Courtyard is no grid or local water infrastructure. A masonry wall is built around the site to
KABUL (60 miles)
protect resources as well as materials and laborers throughout construction. Water
is extracted from a well via deep boreholes, and pumped through a treatment facil-
ity. A water tower provides two days of reserves in case of a power failure.
Future Ambulance
Entrance 12’ Perimeter Security Wall
Fuel tanks for the generators are sized for a three month reserve. The building
Water Tower
must be able to sustain itself in case roads become impassable and and fuel cannot
Generators Inside Mechanical Room be delivered to the site. Once the community is on the grid, a power substation will
be needed on-site.
Underground Fuel Tank
Future Electrical Substation
Islamic law dictates that wastewater generated from food production is collect-
ed and treated separately from other wastewater. The separate treatment tanks
EMERGENCY
SERVICE ENTRY
then discharge effluent into a sand filter bed.
ENTRY
Courtyards between the wings allow for light and ventilation and add a social
and religious component to the plan. The geometry of each courtyard is oriented
Separated Grey and Black towards Mecca. Courtyards between the inpatient wings provide views of nature
Water Waste Treatment from the beds. South of the dining hall is a courtyard with spaces for eating. The
Below Grade main courtyard is situated just east of the main public entrance and provides a cen-
tral gathering space for communal events.
Filter Bed
Public Courtyard
MAIN ENTRY
Men’s and Women’s areas are separated
by a metal screen wall with Islamic in-
spired patterns.
Gated Entry With
Guard House Central paving design to be developed
GARDEZ (5 miles)
and constructed by the local community.
Public Courtyard A steel frame trellis provides a sense of
enclosure.
Inpatient Courtyards
18. 34 35
1.2 Case Study - Afghanistan
Developing nations require multi-patient wards due to resource limitations. Our goal is to maximize staff coverage, while minimizing the privacy and
infection control issues that wards create. An open 4-patient room, with a bed in each corner, is common in these settings. Our scheme improves upon
this model by using a 6-bed space that is subdivided to act as a 3-patient room. Efficiency is increased in staffing and area, with a layout that is easier to
flex at night or with low nursing levels. All while maintaining a higher level of privacy because views are blocked from foot to foot.
n
sicia
1 Phy
ist. /
ass
rse
Nu
ients /2
Pat es
24 urs
2N
day
nts es t
rs gh
atie Nu i
Team Station
1 2P -2 rse n
1 u & Support
1N
nts
atie
6P
nts
atie
3P
Isolation
or VIP
Room
Screened Nursury
Porch or Procedure
Room
Family
Room Key features of 6 Patient room layout:
100
Bed Hospital - Courtyard between
bed units
• Privacy- No casual observation from pillow to pillow, or across the room
• Leverage- Nurse can access both sides from central sub-station
• Family- Dedicated space for visitors to participate in care
19. 36 37
1.2 Case Study - Afghanistan
Readily available materials and simple construction techniques help make this an achievable strategy. The building forms are compact and repetitive with
opportunities for expression of entries and hospital symbolism in key areas. In Afghanistan, large extended families often come to the facility together-
flexible and safe interior and exterior space is a priority.
20. 38 39
1.2 Case Study - Afghanistan
A strong connection to place makes these permanent, scalable hospitals a part of the communities that they are built in. Universally understood building
organizing principals like courtyards are combined with local influences in color and materials.
.
21. 40 41
re
1.2 Case Study - Afghanistan
A Simple Approach
Knowing that mechanical ventilation would not
be maintained or was unavailable, the naturally
ventilated architecture responds to both Sum- Summer
The roof overhang protects the south facade from direct sunlight during the hottest part of the day. Air
mer and Winter conditions. Cooler air brought in off the shaded
is brought in from low windows while operable clerestory windows and openings in the ceiling allow
warm air to escape. Basic fans in the plenum facilitate air movement.
courtyards while the volume of the patient care wings works to draw warm air away form the pa-
tients in the summer. Winter conditions allow direct sunlight into the building while basic fans help
circulate the air.
Winter
A lower sun angle allows direct sunlight and heat gain deep into the patient room. Baseboard units
provide radiant heat, while fans bring in tempered fresh air and circulate it throughout the building.
22. 42 43
1.2 Case Study - Afghanistan
Because the project is site specific and expandable, it uses a universal module, and is buildable with any common material. The
15 meter clear span, single story, single slope roof provides an architectural building block - a "widget", that can accommodate
many types of space, in any part of the World. The walls can be built from brick, adobe, concrete, or sandbags. The roof
trusses can be shipped as a kit of parts and assembled on site. High windows encourage natural ventilation and daylighting. 1
v
2
100
Bed Hospital - West Elevation
100
Bed Hospital - East Elevation
1
v
2
23. 44 45
1.2 Case Study - Afghanistan
100
Bed Hospital - Courtyard Eleva-
tion - East
100
Bed Hospital - Courtyard Eleva-
tion- South
24. 46 47
1.3
Zambia
Zambia, a country that has experienced five successful Total population: 11,696,000
multiparty elections since 1991, is a peaceful, democrat-
ic country with enormous economic potential grounded
in its rich endowment of natural resources. The country
has altogether held 10 elections since its independence Life expectancy at birth m/f (years): 42/43
in 1964. Kenneth Kaunda, was the country’s first presi-
dent and ruled for 27 years. In 1973, Zambia became Healthy life expectancy at birth m/f
a one party state after all the political parties were (years, 2003): 35/35
outlawed. Zambia’s copper dependent economy dete-
riorated after the fall of copper prices in the eighties. Probability of dying under five
The nationalization of the copper mines and generally (per 1 000 live births): 182
poor economic management turned Zambia into one of
the poorest countries in Africa with 64 percent of the Probability of dying between 15 and
population living below the poverty line and 51 percent 60 years m/f (per 1 000 population): 644/597
considered in extreme poverty according to 2006 data.
Like many mineral dependent countries, Zambia has not Total expenditure on health per capita
escaped the global economic crisis. The price of copper (Intl $, 2006): 62
fell significantly at the onset of the crisis, leading to clo-
sures of mines and a scale back in investments. Prices
of copper have since recovered, although not to historic Total expenditure on health as % of GDP
high levels. In order to attain the national vision of be- (2006): 5.2
coming a middle-income economy by the year 2030,
the Zambian economy will have the daunting task of
accelerating growth to 6-7 percent from existing levels
of about 5 percent in order to achieve the Millennium
Development Goals, while combatting high levels of pov-
erty, insufficient economic diversification, and devastat-
ing levels of HIV/AIDS and Malaria.
25. 48 49
1.3 Case Study - Zambia
Natural ventilation, solar shading,thermal mass and proper building
orientation will provide the most benefit to the inhabitants. Buildings cre-
ate the potential not only for health services but to generate clean power
through building integrated wind turbines, photovoltaics and a biofuel gen-
eration system. Africa is the world’s largest consumer of biomass energy
(firewood, agricultural residues, animal wastes, and charcoal), calculated
as a percentage of overall energy consumption. African nations have made
considerable advances in the use of photovoltaic (PV) power. PV’s are
readily available in Africa - in 1998, Sweden and Zambia agreed to a PV
rural electrification project.
In Kenya, a series of rural electrification and other programs has resulted in
the installation of more than 20,000 small-scale PV systems since 1986.
These PV systems now play a prominent role in decentralized, sustainable
electrification.
Shaded courtyards create an environmental buffer zone at the perim-
eter walls as well as areas for social interaction and cultural use.
Water runoff from the roofs is captured for building use or released
into natural filtration areas. Waste from buildings can be effectively recy-
cled into biogas through anaerobic bioreactor or digester to create electric-
ity and even cooling through cogeneration. Evaporative cooling may also
be employed.
Approximately 5% of Africa’s power generation comes from geo-
thermal sources. There are two major geothermal energy developments
currently under development in Zambia. One is the Kapisya Geothermal
Project, located in Sumbu on the shores of Lake Tanganyika. Geothermal
heat pumps use the Earth’s constant temperatures to heat and cool build-
ings. They transfer heat from the ground (or water) into buildings in winter
and reverse the process in the summer.
Organic Waste Stream - Organic wastes are to be collected on-site
and composted for integral urban farming or sale to exterior farming cen-
tres.
Material Resource Recycling Stream - Relatively benign materials such as
paper, cotton, plastics are to be collected, sorted and recycled. Ventures
may be established with manufacturing industries to create closed loop
resource cycles.
26. 50 51
1.3 Case Study - Zambia
The Afghan version of the prototype
is designed to resist very high siesmic
risks. This resulted in smaller opening in
exterior walls, which support the roof.
In other parts of the World, the high
walls of the patient wards could utilize
more open area and increased natural
ventilation, as shown here.
The shaded courtyards act as green-
houses to control sun and water expo-
sure. Large gardens in these elevated
containers supplement food production
and reuse site water. These areas are
accessed via doors directly off each
of the 6 bed patient rooms. The tend-
ing of these gardens by family and less
acute pateints creates another venue for
healthy distraction.
27. 52 53
1.4
St. Lucia
St. Lucia , with a total land area of 238, 616 km2 is Total population: 163,000
an island of the Caribbean. The majority of the popula-
tion inhabit the coastal areas and the less mountain-
ous regions of the north and south. It has a democratic Life expectancy at birth m/f (years): 72/78
system of government similar to the Westminster model.
St. Lucia is a member of the Commonwealth of Nations Healthy life expectancy at birth m/f
, the Organization of Eastern Caribbean States (OECS) (years, 2003): 61/64
and the Caribbean Community (CARICOM). Although the
official language is English, a French patois is commonly Probability of dying under five
used, particularly among the rural population. (per 1 000 live births): 14
Various departments within the MOH are responsible for
the implementation of health programs such as health Probability of dying between 15 and
education, environmental health, preventive services, 60 years m/f (per 1 000 population): 202/104
hospital and curative services. Primary health care ser-
vices are mainly provided at the 34 health centers and Total expenditure on health per capita
two (2) district hospitals. In addition to routine general (Intl $, 2006): 421
medicine clinics, special services are offered in obstet-
rics/gynecology, pediatrics, surgery, sexually transmitted
infections and mental health. Special clinics and basic Total expenditure on health as % of GDP
services are offered to diabetic and hypertensive clients (2006): 5.9
at the primary care facilities. Secondary and specialized
care and services are provided at the three general hos-
pitals and the psychiatric hospital. Although clients may
seek care at any facility, the administration and man-
agement of health facilities are based on the catchment
population.
28. 54 55
1.3 Case Study - St. Lucia
Small developing island nations are among the most impacted by cli-
mate change because of their vulnerability to extreme weather and rising
sea levels. However, because of their small size and low levels of energy
use, they have the potential to convert to renewable sources much more
easily and can serve as models for other countries. Saint Lucia’s govern-
ment is currently seeking to become the first “Sustainable Energy Dem-
onstration Country” amongst small island nations in the Caribbean. The
country is hoping to diversify its energy market by ending its nearly exclu-
sive reliance on diesel generators for production and rely more on its natu-
ral setting that is ideal for solar, wind, and geothermal power.
The building’s orientation follows the surrounding village’s NE to SW axis
to take advantage of prevailing tropical trade winds. Breezes pass over
the sloping roofs and are channeled through wind turbines, then continue
on to cool the courtyards. Solar hot water panels take advantage of the
abundance of sunlight. Photovoltaics could also be used to assist in power
generation.
Shaded courtyards create an environmental buffer zone at the perim-
eter walls as well as areas for social interaction and cultural use.
Water runoff from the roofs is captured for building use or released
into natural filtration areas. Waste from buildings can be effectively recy-
cled into biogas through anaerobic bioreactor or digester to create electric-
ity and even cooling through cogeneration.
The Eastern Caribbean has significant geothermal potential since most
of the islands lie on dormant and active subsurface volcanoes. Saint
Lucia alone has approximately 680 MWe of geothermal power poten-
tial. Saint Lucia’s island neighbor, Nevis, has begun constructing a large
geothermal plant that will provide 10 MW of power, and the Saint Lucian
government is attempting to pass legislation funding similar geothermal
endeavors.
Organic Waste Stream - Organic wastes are to be collected on-site
and composted for integral urban farming or sale to exterior farming cen-
tres.
Material Resource Recycling Stream - Relatively benign materials such as
paper, cotton, plastics are to be collected, sorted and recycled. Ventures
may be established with manufacturing industries to create closed loop
resource cycles.
30. 58 59
1.5
Guizhou China
Guizhou is a relatively poor and undeveloped province. China
It also has a small economy compared to the coastal Total population: 1,328,474,000
provinces. Its nominal GDP for 2008 was 333.34 billion
yuan (48 billion USD). Its per capita GDP of 8,824 RMB
(1,270 USD) ranks last in all of the PRC. Life expectancy at birth m/f (years): 72/75
Its natural industry includes timber and forestry. Other
important industries in the province include energy Healthy life expectancy at birth m/f
(electricity generation) and mining, especially in coal, (years, 2003): 63/65
limestone, arsenic, gypsum, and oil shale. Guizhou’s
total output of coal was 118 million tons in 2008, a 7% Probability of dying under five
growth from the previous year.[1] (per 1 000 live births): 24
Guizhou adjoins Sichuan Province and Chongqing Mu-
nicipality to the north, Yunnan Province to the west, Probability of dying between 15 and
Guangxi Province to the south and Hunan Province to 60 years m/f (per 1 000 population): 143/87
the east. Overall Guizhou is a mountainous province
however it is more hilly in the west while the eastern Total expenditure on health per capita
and southern portions are relatively flat. The western (Intl $, 2006): 342
part of the province forms part of the Yunnan-Guizhou
Plateau.
Other cities include: Anshun, Kaili, Zunyi, Duyun, Liu- Total expenditure on health as % of GDP
panshui and Qingzhen. (2006): 4.5
Guizhou has a subtropical humid climate. There are few
seasonal changes. Its annual average temperature is
roughly 10 to 20 °C, with January temperatures ranging
from 1 to 10°C and July temperatures ranging from 17
to 28 °C.
31. 60 61
1.5 Case Study - Guizhou China
Because of Guizhou’s mild climate with low seasonal change, an east-
west orientation of the inpatient wings is ideal. The taller walls of the
wings can face south to maximize daylighting. Roof overhangs and sun-
shades further protect the facades from direct solar gain but allow reflect-
ed light to enter the rooms.
The UN Environmental Program estimates that CO2 levels in Beijing
could be reduced by 80% if the city meets its goal of greening 70% of
their roofs. Developing areas can be proactive by greening new roofs now
rather than retrofitting later. Additionally, as rural farms are lost to urban
development, green roofs provide an opportunity for food production. In
this application, the roofs could also be used to grow plants for traditional
Chinese medicines.
Shaded courtyards create an environmental buffer zone at the perim-
eter walls as well as areas for social interaction and cultural use. Native
plantings can be used to eliminate the need for irrigation.
The Guizhou province receives abundant rainfall but lacks the means
to provide an efficient and reliable water infrastructure. Managing and
reusing stormwater runoff is therefore a key element in the roof and court-
yard design. The green roofs slow drainage during heavy rains, and filter
the water for reuse in the building.
China has been exploring and using geothermal energy for 40 years
and its use is currently growing by 10% each year. Uses of geothermal re-
sources in China are widespread including domestic heating, tourism spas,
and aquiculture. The utilization of a ground source heat pump is a better
renewable alternative to photovoltaics given the Guizhou region’s high
percentage of overcast days.
Organic Waste Stream - Organic wastes are to be collected on-site
and composted for roof farming or sale to exterior farming centres.
Material Resource Recycling Stream - Relatively benign materials such as
paper, cotton, plastics are to be collected, sorted and recycled. Ventures
may be established with manufacturing industries to create closed loop
resource cycles.
