OVERSEAS HOSPITAL CONSTRUCTION
A ribbon-cutting ceremony with former President of Ghana, John Mahama, and local community leaders.
that is mindful of the needs of patients and their families, many of whom travel – often on foot – not inconsiderable distances to be seen by a doctor, and it is vital that any new facility works within its surroundings.
First African hospital project Our first African hospital project was the Shai-Osudoku District Hospital in the Greater Accra region of Ghana, which was delivered in 2015. The core model for the hospital was for a 120-bed scheme featuring two operating theatres and other departments – including diagnostics, accident and emergency, dental, traditional medicine, and outpatients. When it came to developing the project, from the outset we had to completely re-think the concept of a hospital. We had to re-consider several aspects of how hospital care works in Africa, versus our experience of the UK model, not least around the expectations of patients when they come in. For example, in rural African hospitals
there isn’t an appointment system; if someone has a heart condition and they need to see a doctor they will know that Cardiology day is, say, a Tuesday. They will attend a clinic or a hospital on that day, often with several members of their family in tow, and they will wait to be seen, often for long periods of time. Understanding this and other dynamics
A welcoming waiting room for patients and their families is an important feature.
around African healthcare informed the design process. We created large waiting areas for patients and their families, often including outdoor spaces so that people could be in the fresh air, along with awnings to offer protection from the sun.
Need for cooking areas We saw that cooking areas would be needed, again outside, since families tend to cook both for their sick relative and themselves while they are at the hospital. The same consideration was given to those people coming to the hospital to collect the body of a relative; we created a large, covered area outside the mortuary in response to local customs. When a body is retrieved for burial, it is a cause for coming together and celebration of a life, and so space needs to be created for a large number of people who will gather in order to take part. Addressing the local climate, a flow of
fresh air is beneficial to patients, visitors, and hospital staff alike. We aim for our hospitals in rural areas to be ‘shallow plan’; that is to say they are usually single-storey in construction, relying less on electricity and air-conditioning for ventilation and light, and more on fresh air and natural light. Where possible everything is naturally ventilated, with deep overhanging blinds shading the windows, walls and external walkways, which give patients and
visitors further outside space – and are cheaper to build.
Sustainable power sources With intermittent power, natural ventilation and light come into their own. Obviously, some aspects of a hospital will always rely on electricity – lighting in operating theatres, refrigeration in the mortuary, for example – but elsewhere in the building we can depend on more sustainable sources. Staying on the subject of sustainability, a key aspect of the design and delivery of these hospitals is a ‘kit of parts’ concept, where components and building materials are adaptable to different terrains, different budgets, and different requirements on the ground. For a hospital we designed in Côte
d’Ivoire we used steel frame for the walls sitting on a concrete base. The steel frame was made on site using 3D cutting and folding technology, and simply bolted together, the walls then being filled with insulation and clad in concrete sheets. The machine used for folding and cutting the steel frames was based on site for the construction period, and then moved to the next site.
Various stages of assembling the ‘kit of parts’ system at Bouake Regional Hospital in Côte d’Ivoire.
76 Health Estate Journal October 2022
Modular aspect of design Where there is demand and available land, the modular aspect of the design, and its standardisation, mean extra units can be added as and when required. We also looked to generate sustainable and renewable energy, not least through photovoltaic panels, and generating power on site by delivering factory-built plant and oxygen-generating rooms. As one might expect, connection with the community is important, which includes employment for both hospital staff and those who maintain it. As much as possible the fabric of these hospitals is designed to be locally maintained. Materials and finishes are chosen on the basis that they can be repaired by a local team of builders – for example, installing a floor made from local terrazzo that can have chips and damage repaired on site, rather than using sheet flooring that would have to be sourced from further afield, or even overseas, if it needed replacing.
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