Site location and development aren't always a matter of zoning, occupancy, and financing. In some areas of the world, they are a function of profound religious and philosophical beliefs. Case in point: the planning and design of Dhaka Apollo Hospital in Bangladesh. The country, formerly East Pakistan, hosts a 334,000-square-foot facility that is divided into three components—outpatient, main hospital, and service building. This division was not only to encourage efficient operations, but to conform to the principles of Vastu, a system of design principles similar to (and predating) Feng Shui, reflecting specific values of Hinduism. (Bangladesh is primarily a Muslim country, but its public facilities and spaces are often Hindu in influence). Recently, Matthew Richter, AIA, ACHA, principal with SmithGroup, and lead planner/designer of the facility, discussed the design and its exotic challenges with Healthcare Design Editor-in-Chief Richard L. Peck.

On Religious Influences

“To quote Rohit Arya: ‘The Indian art of placement. It is an amalgam of science and religion, design, and instinct’.

“Vastu, specifically, is a system of four quadrants, each representing a basic element of Earth, Air, Fire, and Water. It is generally believed that if a project does not conform to the principles of Vastu, it will not be successful. Thus, the greatest massing of the project should be on the Earth quadrant (toward the southeast); the Air side on the northwest should be occupied by no building elements, but can be devoted to landscaping; and the Water quadrant should incorporate any water feature that's planned. Vastu also influences the location of public space, the shape of the site—square or rectangle is prescribed—and the directional alignment of the facility on the site.

“In the Vastu-inspired three-building arrangement, the service component had to be disconnected from the main hospital, while the atrium (see below) had to be located at the very center, or heart, of the project. The atrium was designed with a large amount of glass to admit natural light, which is valued as health-giving.

“Other religious influences more closely related to Muslim requirements are avoidance of having patients' feet point toward Mecca and observing formal separation of sexes—for example, providing male and female waiting areas.”

On Local Customs

“Local patient populations are provided with six-bed wards, quads and doubles. These rooms have operable windows because there is no air conditioning, which tends to make patients uncomfortably cold and is deemed unhealthy. However, because Dhaka Apollo is also envisioned as an international destination for healthcare, the VIP rooms on the top floor are more Western in design, with double-sized rooms and individual fan-coil-unit air conditioners.

“For indigenous patients, it is customary for entire families to want to visit. This can become an issue when you have 400 patients in the building, so there is very tightly controlled access, with a security gate and two hall passes permitted per patient. The large, glazed pedestrian atrium, which is open but under shade, is designed to comfortably accommodate large groups who literally want to camp out at the hospital. This is a very popular facility; the day it was opened it was full.”

On the Exterior

“The main hospital is in the shape of a pinwheel, with two 30- to 40-bed units hooked together by a central core and situated so that all patient rooms have views to the outdoors. All plumbing chases are on the exterior of the building because leaky plumbing is accepted as routine in this country, and channeling the chases to the outside prevents interior water damage and expedites needed repairs. Needless to say, bathrooms are not located over operating rooms or treatment rooms. This special approach to the handling of plumbing is a ‘top of the mind’ issue in Bangladesh and is quite common in buildings in that part of the world.”

On Dealing with the Delta

“Bangladesh occupies essentially the largest river delta in the world, and it is flooded every year by the monsoon rains. That means that the working floors of the hospital have to be a minimum of 4.5 meters above grade. The lowest floor is designed to accept routine flooding without major damage to furnishings or important mechanicals, which are located elsewhere. Sometimes, in fact, the only way to get to the hospital is by boat.”

On Working with Local People and Agencies

“The Indian architectural firm ArchiMedes under Cherukuri Sansidhar obtained all the necessary approvals and was instrumental in accomplishing this project. So many overseas projects never get completed or go off in a totally new direction and are completed years later—projects I can think of in Turkey, Mexico, and Thailand, for example—but here, we got the project built (with some value engineering, to be sure, on the atrium canopy, for example) at about one-tenth the square-footage cost of American hospitals. This also involved constant discussion of sourcing for furniture and the like to make sure it was modern, yet economical. Some Western designs for equipment and furnishings have been copied in China and obtained from that country.

“All of this has added up to a very successful project, a well-received, heavily used new hospital that also serves Apollo in the international healthcare market.” HD