Curar en condiciones extremas

El hospital de N’Djamena, la capital de Chad, donde ingresaron a Famou era un lugar desolador: habitaciones oscuras y malolientes, atestadas de pacientes y familiares; pasillos estancos e insalubres; pabellones de hormigón en un terreno árido y un calor sofocante: el diseño de hospitales no es una prioridad en algunos lugares del mundo. En su caso falló todo: la prevención, el diagnóstico y el tratamiento, pero lo que tampoco le ayudó fue yacer en un espacio desamparado de uno de los hospitales más pobres del planeta. Una historia que se repite en numerosos países donde la salud es precaria y la atención sanitaria es mínima.

“Un espacio digno puede marcar la diferencia en la calidad de la asistencia sanitaria en cualquier lugar del mundo”. Así define la misión de su equipo el arquitecto Christian Benimana, director de MASS Design Group. Con el hospital de Butaro, en Ruanda, demostraron que el diseño de hospitales puede ser una oportunidad para mejorar la experiencia del paciente y los resultados de los tratamientos. Proyectaron la instalación con el objetivo de mitigar y reducir la transmisión de la tuberculosis mediante una estudiada distribución de las estructuras, del flujo de tránsitos tanto de pacientes como de personal médico, además de facilitar la ventilación natural de los espacios.

Años después, aplicaron los mismos principios en el Centro de Tratamiento del Cólera en Haití, donde incorporaron un innovador sistema de depuración de aguas contaminadas, un elemento clave para combatir la propagación de la epidemia. Al igual que en el hospital de Ruanda, parte del trabajo fue llevado a cabo por profesionales del lugar, con recursos materiales propios de la zona, aumentando así la sostenibilidad de la construcción y favoreciendo la economía local.

Resilient Buildings

“In my country, when we talk about sustainability, we’re referring to finding a local material, using it in a sustainable way, and inspiring others to do the same,” explains architect Francis Kéré –born in Burkina Faso– when he describes how he convinced his people to use clay bricks. “For them, being up-to-date means using techniques from abroad, but here, if we use concrete for our buildings, the indoor temperature is insufferable,” he explains in an interview. Now some of Keré’s constructions, such as the Health Care Center in Léo, in the south of the country, are informally known as “refrigerator” buildings.

Local materials in response to an extreme climate. Innovative solutions that can be applied with limited resources. Local labor in combination with state-of-the-art methods. And, above all, resilient structures should be considered in hospital design.

Salvi Ros, an architect working for Architects Without Borders (ASF) in Mozambique, has first-hand experience of building in a country recurrently hit by natural disasters. “The last cyclone damaged half of the health facilities in this province,” he explains. According to the World Health Organization (WHO), the huge investment that certain countries make in health infrastructures –hospitals account for up to 70% of the Ministry of Health’s budget– can be lost if they are damaged or destroyed. In addition, Ros points out the need for maintenance as another key consideration in architectural design. “There are health care centers in outlying areas that are full of non-functioning solar panels, because if there isn’t enough money for gasoline for the ambulance, there certainly isn’t enough for technical repairs,” notes Ros, who urges professionals to immerse themselves in the underlying reality of the place where they work.

“We have to stop prioritizing material aspects and try to understand the psychology of the space we’re working in, of the place and of its people.”

Integrating the Native Culture

The anecdote of the project in which the latrines were built facing Mecca is an extreme but real case that illustrates the need for architecture to listen to the population, leave preconceived notions behind, and seek a deep understanding of the psychology of the place, especially in foreign contexts. As architect Ole Scheeren explained in an interview, “We have to stop prioritizing material aspects and try to understand the psychology of the space we’re working in, of the place and of its people.”

ASF in Mozambique followed this approach in its project for two Integrated Care Centers for victims of gender-based violence. “We are using brick, straw, and metal sheeting on the roofs, following the structure of traditional houses. We believe that feeling like you’re in a recognizable space can help reduce post-traumatic stress for the victims,” says Ros.

For Paul Cabrera, Construction & Shelter Advisor at the NGO Doctors Without Borders (MSF), it is a priority to design structures that contribute to the quality of service. Considering criteria such as durability, legal aspects, the type of building depending on the type of patients – “it’s not the same to design a nutrition center for highly vulnerable children or a health care center for refugees”– and, above all, the human resources for implementing the projects. MSF teams work in the harshest of settings, placing the emphasis on the facilities’ flexibility.

“Any hospital design should take into account the possibility of being extended with tents or modules, or have multi-purpose spaces that can be transformed in the event of an emergency. There should even be plans for the possibility of isolating areas if an epidemic breaks out,” adds Cabrera.

This need for flexibility, both in terms of service and location, prompted MSF teams to design a mobile surgical unit to treat war casualties on site. The result is MUST, a robust trailer with several cabins capable of withstanding harsh conditions in the field. “It only takes a few hours to deploy, allowing surgical procedures to be performed with aseptic protocols that are almost comparable to those applied in Europe,” notes Paul Cabrera.

Architecture, engineering, design, and creativity push all the boundaries to create spaces where people can receive treatment even in the harshest of conditions.

Main image: Butaro Hospital by MASS Design Group. Photo © Iwan Baan