Tropical healing: Healthcare design adventures on the island of Tobago
It's 80°F. Looking through the open window, down a steep hillside overgrown with lush green vegetation, the Caribbean Sea stretches out to the horizon. Inside, a gentle breeze keeps the humidity at bay, while a hummingbird alights on a bright yellow hibiscus by the windowsill.
Paradise? Perhaps, but for residents of Scarborough on the tiny island of Tobago, this is no more than a standard patient room at the new 100-bed, 165,000-square-foot local hospital—or at least it will be, once the facility opens its doors late in 2008.
When Stantec Architecture, Ltd., was hired to design the project, its designers were brought in as the foreign experts with the technical knowledge and expertise required to design a first-class healthcare facility for the island. As Stantec Architecture Principal-in-Charge Bruce Raber explains, “We introduced Tobago Regional Health Authority (TRHA) to a series of consultative exercises that engaged users in the integrated design process. While typical for us, this was a completely new approach for our client, and it led to a highly interactive two-way learning process.”
The process helped the firm uncover local values and traditions that would inform the design of the hospital, while at the same time educating the designers around local limitations in construction materials and expertise. The resulting key design principles—comfort, context, and home—would serve as a touchstone for all remaining design decisions throughout the process.
Comfort related to both patients and staff, and the careful introduction of nature's elements into the facility to enhance the healing process—maximizing the positive attributes while addressing the potential for it to negatively impact the facility during inclement weather.
Context focused on creating a sense of familiarity for patients via a facility that emulates the basic characteristics of the villages of Tobago—their scale, color, texture, and community spaces—to reduce the stress associated with receiving medical treatment.
Home served as a reminder to the design team of the role played by family within the local culture as an intrinsic part of the healing process.
These design principles were manifested during the planning and design of the facility by means of creating the usual series of building “blocks,” each defined by the functions accommodated within—diagnostic/treatment areas, inpatient wards, administration/education, public amenities, and plant and services. However, these blocks were strategically placed along covered corridors or routes along one story to provide a sense of scale and identity characteristics of the community. The roof overhangs protect from the sun and rain, and the “breathing” walls allow the passage of cooling winds. Semipublic and semiprivate areas are strategically placed along circulation routes and throughout the facility to encourage family involvement in the healing process, while porches, verandas, and stoops are all offered as open-space waiting-room alternatives to the enclosed, cramped waiting areas of traditional hospitals.
“The percentage of social space is significantly higher than in our traditional healthcare facility models,” notes Raber. “In North America, a visit to a clinic might take an hour or two; in Tobago it can easily evolve into a full-day affair, with only a small percentage of that time actually allocated to any kind of medical procedure.”
The arrangement of building blocks in a simple, rectangular shape had other advantages: increased flexibility to accommodate future growth and change, easier natural ventilation of the inpatient rooms, and facilitation of the construction process. “On an island with a population of 60,000, there is no significant pool of skilled labor,” says Raber. “Simple structures reduce the likelihood of errors on site.”
Natural ventilation is one of several features of the design that also make it surprisingly green—surprising, largely because the design predates the advent of LEED and the Green Guide for Health Care. The rooms are naturally ventilated, but so are most of the connecting corridors between the major spaces. The patient rooms are also daylit, and solar energy supplements the output of boiler tanks. These energy-saving measures have the added benefit of reducing the facility's dependence on the local power grid, which is prone to frequent failure.
Other sustainable design features include construction and landscaping material choices focused on the use of indigenous materials, and a grey-water collection system for landscape irrigation.
For all its success from a design standpoint, however, the project is currently on hiatus. For more than a year, while the local need for the facility grows more urgent, this majestic spot atop Signal Hill has sat idle; construction is suspended pending a government investigation into allegations regarding certain activities undertaken by the contractor.
This has meant a change of pace for Stantec's on-site project manager. “Fifteen months ago I was managing the construction of a $40 million hospital,” says Principal and Project Manager Dan Zak. “These days, I'm helping our government client secure a favorable court ruling against a questionable contractor. I have revised my definition of ‘full architectural services.’”
Stantec Principal and Edmonton, Canada-based Project Manager Marshall Opyr has borne witness to the project's complexity from the very beginning. “Between government project managers and representatives, the ministry of health, financial partners, local consultants, users, and our own project team's mandate to design a facility to international standards, it's been a daily challenge keeping everyone moving in the right direction,” he says.
But Zak is optimistic about the project's future. Now that the contractor has been removed from the site and arbitration is coming to a close, construction startup is expected in late 2007, and should last 12 to 18 months.
Raber is also excited to see the project come back online. “I was truly shocked by conditions in the existing facility,” he recalls. “Laboratory items scattered about in unsanitary conditions, chickens wandering through the hallways, equipment rusty and in disrepair, 40-person wards. I think the impact of this new hospital on the community will be significant.” HD