Children's healthcare for 21st-century Egypt
The overall desire of The Children's Cancer Hospital in Cairo, Egypt, was to incorporate the U.S. model of healthcare delivery, while integrating the region's local practices and culture to provide a new standard of healthcare excellence for the children of Egypt. The hospital wanted a full-service teaching facility and to promote the advancement of the staff and medical technology in the field of research.
Accommodating 185 inpatients, the hospital was designed to allow for 350 inpatient beds and can be expanded to double its size both horizontally and vertically. The campus master plan also incorporated a 90,000-square-foot municipal park and a 150-space subgrade parking area.
The facility houses Intensive Care and Bone Marrow Transplant units, as well as a comprehensive surgery department able to conduct complicated tumor surgery such as neuro-, micro-, and ophthalmic surgery, and state-of-the-art diagnostics and laboratory facilities. It also includes a large outpatient facility that accommodates 300 patients per day, and provides an education program for children receiving long-term hospital care so they can maintain their education.
Much attention was paid to establishing and adhering to rigid guidelines for protecting immune-compromised patients and overall infection control. The highest standards for addressing environmental issues, such as waste and water management and energy consumption, were key factors in the overall design. For instance, although the building's large structural screens mounted on the exterior skin of the bed towers were specifically designed to emulate sails atop vessels navigating the Nile River, these forms, besides being metaphorical, are functional, providing shade and energy conservation for this fully sealed glass building.
A four-story domed structure spanning the lobby's atrium tends to mesmerize patients and visitors. This lyrical sphere serves as a main entrance landmark for daily commuters traveling through the arches of the ancient aqueduct from the Old City. Patients and families also enjoy the security and comfort of the therapeutic gardens adjacent to the hospital's outpatient center.
The project did have a setback: After the client had completed the facility planning, it was ascertained that the proposed space design was too generous, as well as unaffordable. The project was being completely funded through donations, and the original final design called for too massive a project. Consequently, when a new and smaller site was donated, the building layout had to be reduced. Jonathan Bailey Associates' (JBA) design team was faced with the challenge of maintaining as much of the original programmed space as possible on a very limited parcel of land.
JBA's solution was to employ the principle of vertical design as an overall strategy to reduce redundant, inefficient corridor lengths and space requirements. Via the central elevator core, or circulation spine, the layout of the floor plan provides equal travel distances from the central core, as opposed to the more traditional hospital “racetrack” designs that create lengthy, horizontal movement. The nurse-to-patient proximity dramatically improves time management and efficiency. The vertical circulation also delivers patients conveniently from patient room to a diagnostic or treatment area, and public and patient flows are separated.
The design team also faced new challenges during the construction phase. For instance, Cairo's local economic culture is more familiarly based on “conversation and handshakes.” This often resulted in final decisions on materials, timing, and labor being open to further negotiation because there was minimal record of minutes or documented agreed-upon deliverables.
The project also had challenges with respect to building techniques and quality standards, some of which challenged local traditional techniques. International crews were brought in to train and work with local contractors and installers. This mutual exchange resulted in new standards of best practices.
A key example of this involved the choice and installation of flooring for the hospital. The floor specification was for a resin terrazzo that offers many benefits, one of which being a seamless waterproof surface that allows for a “bucket of water” approach to cleaning. It provides a unique and colorful floor pattern. It is also extremely hard-wearing, requiring limited maintenance.
However, this flooring technique was relatively new to Egypt, and required specialist flooring expertise to be brought from Italy to instruct local builders and installers on installation. Due to budget constraints the specialist flooring company could only install a limited area of the floor, with the rest being left to the recently trained builders. The local installers were able to master the technique and are now using the resin terrazzo floor on other projects needing the same required seamless, hard-wearing floor surfaces.
This was also the first project to offer the children and families of Egypt and the Middle East state-of-the art Western standards of technology and care, using sensory design/visual imagery that provides a calming effect for patients, staff, and families on entering the facility. The five elements of sensory design are sight, sound, touch, smell, and taste.
Part of this approach involved thoughtful environmental graphics that reference universal childhood themes to engage patients and provide a playfulness and positive distraction—critical to pediatric treatment and recovery. These help to alleviate young patients' and their parents' fears and anxieties. Careful consideration was given, however, not to use stereotypical Western iconography of the region. The focus was more to integrate the culture of a modern Egypt without being too stereotypical—therefore, no cats, no pyramids, no Sphinx, no ancient Egypt motifs. A model of the Solar Boat was put into the Atrium at the client's request. The rest of the installations were animals, airplanes, rocket ships, kites, fish, and other typically child-focused items.
The hospital also expresses the “Colour for Peace” initiative in an environmental graphics framework. In the Colour for Peace concept, the overriding theme is a “Voyage of Discovery.” The client asked for graphics that Egyptian children might be able to relate to, as well as those that would be new to them. For example, in the underwater theme, JBA selected fish local to the Red Sea diving resort. In the sports area, football (soccer) was referenced. The design team also displayed American football images, representing sporting events from around the world. In general, the hospital has received and commissioned its own artwork, such as paintings, murals, and interactive sculpture to be used throughout the hospital. The floors are themed, and the contributed artwork will reflect those themes. The wayfinding is also linked to the colors and graphics of the themes.
The Muslim faith is intrinsically woven into the daily culture of Cairo, like a subtext which neither dominates nor is subservient to day-to-day life. As such there were no strict provisions put on the design team to incorporate any particular faith within the hospital, nor was there a need to design any part of the facility with reference to the traditions of one particular religion.
Because the site is located near many local mosques, staff and visitors have convenient access for prayer times during the day without causing extended interruptions. However, acknowledging the daily practices of the local population's faith, JBA included dedicated prayer rooms with adjoining ablution rooms to provide foot and body cleansing before prayer time. The prayer rooms provided are not significantly different from those provided in most other hospitals worldwide. People can also pray where they wish, as offices and private rooms are provided with quiblas (signs pointing in the direction of Mecca).
Additionally, large sitting areas were provided with the option for traditionally observed gender separation. In general, these communal environments offer refuge for groups of family members who often travel long distances to see loved ones.
In an overall sense, JBA's efforts have resulted in a successful blending of Cairo's cultural and social tone with western practices and design, bringing the benefits of modern medicine to Egypt's 21st-century children. HD
For further information, contact Jonathan Bailey Associates at 469.227.3900 or visit http://www.jonathanbaileyassociates.com.