EMERGENCY CARE FACILITIES SILVIA SILES PAREDES – HOSPITAL ARCHITECT, VAMED ENGINEERING, BOLIVIA
Adapting ICUs to take more COVID-19 patients
Silvia Siles Paredes of VAMED Engineering explains how the privately-run Angel Foianini Clinic in the Bolivian city of Santa Cruz underwent a transformation to cope with COVID-19 patients during the height of the pandemic.
Figure 1. Intensive therapy adults (first expansion to 11 individual spaces).
Bolivia is one of the countries with fewer intensive care units per capita and one of the most vulnerable countries in South America.1
The idea of individual intensive
care cubicles per patient has not even been applied in the latest health facilities projects. A void in the Bolivian design norm allows any ceramic-covered room to be considered a proper space to house intensive care units. The COVID pandemic began in Bolivia
on 10 March 2020. With the first COVID case in the country, Santa Cruz de la Sierra became the most vulnerable region in Bolivia due to its high arrival of foreigners. The Ángel Foianini Clinic is one of the main private care centres. In the face of the imminent arrival of massive COVID cases, an emergency committee was formed by the clinic that weighed the changes or necessary provisions. Little was known about the virus, and Bolivia
Figure 2. Typical ICU area in Bolivia, Japanese University Hospital, 2018.
was rapidly falling into chaos: essential supplies to fight the virus were depleted, facemasks and alcohol were unavailable almost anywhere.
Need for change Given the need for growth, various options for space and environments within the clinic were analysed, which were reviewed with the hospital’s board of directors, and included the medical assistance staff in the decision, explaining the operation and virtues of the change, the resources invested and the team implemented to meet this challenge. The pandemic posed the board with
a great dilemma as there was a lack of medicinal oxygen and a lack of physicians. The challenge – as for all healthcare institutions - was to triple the number of people that they could be accommodated in intensive care units (ICUs) without
Silvia Siles Paredes
Silvia is a hospital specialist architect at VAMED Engineering GmbH. She has a Master’s degree in hospital infrastructure. From the beginning of her career, she felt a broad passion for hospital design and planning, developing extensive experience over
15 years in the field, including the construction management of several projects. She is a member of the board of directors of the Bolivian Association of Hospital Architecture and Engineering (ABAIH), and a member of the Departmental Accreditation Committee of Hospitals of Santa Cruz in charge of Departmental
Secretary of Health (SEDES). Silvia is also a lecturer at health and hospital infrastructure events and postgraduate teacher at several universities.
IFHE DIGEST 2022
Figure 3. Beni intensive therapy dome with space for several patients, 2020.
losing their healthcare professionals in the process. People, unlike facilities, are an asset impossible to build or replace. Therefore, the solution and the real challenge was to create or adapt the working environment for the intensive care professionals so they, and their patients, could be safer. The team studied all available
resources, resolving to have a staggering growth strategy, but with the premise of keeping its staff safe. They had only six adult intensive care beds available, recently remodelled and converted into individual care cubicles.
Strategy adopted - first steps The first expansion of the service occurred by addressing the spaces assigned to pediatric therapy, reaching a capacity of 11 ICU spaces. By April 2020, however, it was evident that this number was not enough since it was the only clinic with certification of quality of care and infrastructure (Certification of the Technical Institute for Accreditation of Health Establishments – ITAES) and all patients wanted to be assisted there. The clinic began to be permanently full of severe cases of intensive therapy of the department for COVID-19, which drove the hospital’s board of directors to make a more significant effort and move on to the next stage of expanding the service (Fig 1). The challenge was to obtain ICU spaces
that retain the best support characteristics for patient care that had already been
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