RE-HUMANIZING HEALTHCARE

ALTAF MANSOORI

FINAL YEAR B.ARCH DESIGN DISSERTATION

2018-19

ST. WILFRED’S INSTITUTE OF ARCHITECTURE

PANVEL
 ABSTRACT
The journey of anything tangible depends on its ability to evolve in response to its
environmental context. Evolution is a never-ending process. Matter continually adapts to
survive the ever-changing environment. Be it the evolution of man, that depends on the climate
he lives in, the availability of resources he uses for survival, the culture he adopts and the
mutation of his genes; or the evolution of styles of design, art, buildings, etc. which change
from time to time to create new trends and endure in the market.

The evolution of tangible and intangible matter is in constant response to the other. It is
an endless cycle. A classic example of which is climate. Man adapts to the climate he lives
in, though it is none other than him who is responsible for the changes in the climate due
to the resources he utilizes. The best reference for this is global warming.

The Immediate environment in which man lives, works, recreates, and rejuvenates
influences his activities and capabilities. The design of a workplace can influence one’s
intellectual or productive behaviour. Design here consists of not just the aesthetic features but
also the environment comprising of climate, nature, sound, light, etc.

The thesis aims at studying this correlation between the environment and man and
addressing its impact on the physique and psyche of man. It also intends to investigate
the effect of psychology on physical well-being through control of the immediate built and
unbuilt environment.

The target study is focused on cancer patients and their needs and requirements during and
after treatment.
 BACKGROUND OF THE STUDY

Hundreds flock to clinics, hospitals, and other healthcare facilities daily. These institutions treat
‘the body’ and the patients return home. Content with the treatment received, eager to resume
their routine life. Everyone is prepared to pay ‘as much as it takes’ to ensure a complete
recovery, unaware of its reliability or after effects. In case of failure of treatment. they start
preparing themselves for dysfunction of their body. The focus in all scenarios in case of any
diagnosis is ‘the body.’

Numerous studies and researchers have established that the health of an individual is made up
of not just the body but the mind and spirit as well. It is not enough to treat a person’s body
while snubbing the mind and spirit. Is the function of a healthcare limited to diagnosing and
treating an ailment physically? Does physical treatment ensure complete recovery in all
cases? Who caters to the psychological and social aspect of treatment?

The built and unbuilt environment of a healthcare facility has a direct impact on a
patient’s medical outcome. This impact can be positive or negative; no impact is neutral.

Typical planning for medical wards is based on the Church’s acceptance of healthcare
responsibility and their priority to keep the ailing close to their spiritual self, back when they
held the reins of administration. Thus, the large general wards with beds lined up on both sides
of the altar are seen till date in our general wards with the altar replaced by the nurse’s station.

Time has progressed, and priorities have changed, but healthcare planning remains
persistent. The spatial quality is given minimal priority, or none in most government
hospitals whereas in private hospitals the emphasis is on luxury. Few cater to the
psychological and social needs of the patients or their family.
 TOPIC JUSTIFICATION
A study through time and evolution of healthcare architecture reveals the importance that was
laid on holistic treatment even before the concept of hospitals came around. Healthcare is not
all about the treatment of the body, as signposted by some sectors of medicine.

As described by Flavio Albanese, the meaning of ‘wellness’ is the balance of mind-body-

spirit. To attain this balance, it is essential to study the role that architecture plays in healthcare,
in addition to the one played by the community arid the ever-progressing technology.
 OBJECTIVE OF THE STUDY
Spaces can create hope and positivity or gloom. They can boost the healing process or add
further to an unhealthy environment leading to further amplification of an illness. For a person,
undergoing physical and mental trauma due to his ailment, this space can have far-reaching
effects. Thus, it is imperative to understand the concept of ‘healing spaces’ to efficiently
integrate this pre-requisite in healthcare design.

Treatment is complete only when all facets of health are addressed. The focus should be on
holistic treatment and not solely on efficiency or functionality of the building as is the case in
most existing healthcare institutes. This design of spatial atmosphere should not be limited to
the time the patient spends in the healthcare centre but extend to the home, workplace and any
other environment they spend quality time in. Thus, a study of healthcare environment
extending to the home and work atmosphere of a patient is essential.

The relation between space and health, vital as it is, is seldom addressed. If addressed correctly,
it would be a turning point in the medical world. Hence, it is crucial to understand the
psychological impacts of architecture on the human mind and body as also spatial
therapy.
 NEED FOR CANCER CARE
Cancer is becoming a common man’s disease, the cure for which does not guarantee life.
Hence, it is the ‘hyped’ disease overshadowing other diseases.

With less than 30% of Indian cancer patients surviving five years or longer after
diagnosis, I2 it is a disease with majority cases diagnosed in late stages and comes with
an expensive treatment procedure. This makes it even harder for the patients, especially
those below the poverty line.

The magnitude of cancer problem is increasing due to poor to moderate living standards and
inadequate medical facilities.

It is essential to comprehend and address the needs and issues of these patients and to provide
them with a better, more efficient healing environment.

With the shortfall of medical infrastructure and the complexity of modern healthcare
facilities, cancer patients are more than ever in need of an architectural intervention.
Healthcare facilities need to be designed to the benefit of the patient and not just the
system.
 MEDICAL MIGRATION FOR CANCER CARE

Cancer care options for the well-to-do are available in abundance as opposed to affordable
options for the financially disabled. The patients belonging to the latter category face
hardships and difficulties every step of the way from making their way to cities for
affordable treatment to survival in those cities during their treatment.

Patient who are traveling to a different city for affordable cancer treatment end up spending
months in the city, Thus, they are medical or temporary migrants in the city. These patients
sometimes opt for outpatient facilities when inpatient beds are occupied.

In hospitals such as the late Memorial Hospital (TMH) in Mumbai, where the daily load
In the OPD is 4,000 patients, inpatient beds are perpetually fully booked. Thus, patients
have no option but to opt for outpatient services. It falls upon the city’s infrastructure
and services to cater to these outpatients.

Cancer is a costly as well as physically and psychologically wielding disease. With the horror
of cancer already looming over the patient’s family, an additional factor of financial burden
worsens the situation. Thus, providing affordable and beneficial facilities for them needs to be
undertaken.

On analysing the stated data, ii is evident that the TMH in Mumbai caters to the largest
group of low-income cancer patients. Thus, Mumbai has been chosen as the site for
further study.
 SHORTCOMINGS OF THE CITY FOR THE
‘OUTPATIENT’

Due to the crunch of space in Mumbai city, even though quality affordable healthcare options
are available, the infrastructure to support medical migration is far less than required.

With the growth of healthcare institutes catering to the ‘outpatients,’ the demand for supporting
Infrastructure Is over saturated and incessantly growing .

Patients visiting Tata Memorial Hospital (TMH) for affordable treatment can barely afford two
meals a day, let alone accommodations in a high priced real estate area such as Parel.

Some government and private organizations have set up dharamshalas, attempting to provide
stay at normal or no costs. The aim of these lodgings is focused on accommodating maximum
numbers. In their attempt to do so, they compromise of the quality of living.
Utilizing every inch of space leads to disregard for the need of amenities and nursing facilities.
Despite these attempts, the numbers are not met, and many are forced to travel to Navi Mumbai
for cheaper accommodations or set camp on the streets outside the hospital.

Such is the case outside TMH, where patients reside on the footpath despite their medical
conditions. With no one else to turn to, they live by the roads till they get ticked off the waitlist
at the dharamshalas. Individuals and organizations have organized the distribution of food and
other necessities as a daily routine for the benefit of these outpatient. The footpath is buzz with
activity and occupied at any point in time, day or night.
SCOPE & LIMITATIONS OF THE STUDY
Research on healthcare and its environment provides an opportunity to identify the missing
elements in the prevailing system. With the community preparing for a change in healthcare
and demanding a patient-oriented and holistic environment, this study helps to understand
these concepts theoretically.

It is to be kept our mind that it is not the building itself that fuels healing but the ethos of
both the community and architecture along with technology that enhances the
contribution of a built environment to the healing process. The built environment merely
plays its role as one of the members, but only gives results when all the members perform
together.
 DESIGN INTENT & SITE

The executed study leads to a proposal for a cancer caring institute situated amidst the typical
urban context to address the needs of medical migration. The proposed institute offers
housing and a caring centre for the medical migrants.

The proposed project aims to avoid disruption of regular routine, at the same time provide a
healing abode.

On analysing the statistical data of medical migration for cancer treatment and the short
comings of the existing facilities, the proposed site is located in Mumbai.

Patients in a healthcare facility are often
fearful and uncertain about their health,
their safety and their isolation from normal
social relationships. The complex environ-
ment of a typical healthcare centre adds on
further to the traumatic situation stress can
suppress a person’s immune system and
dampen their emotional and spiritual
resources, thus, hampering their recovery
and healing.
Researchers have identified four key
factors that can measurably improve
patient outcomes if implemented in the
design of a healthcare environment:
WHAT IS
THERAPEUTIC
ENVIRONMENT?
1. Reduce or eliminate environmental stressors
such as noise, crowding, odour, pollution, etc.
2. Provide positive distractions for example,
view of nature from patient rooms, lobby, waiting
and other ‘high stress’ areas; access to nature by
means of healing gardens, chapel or meditation
room; artwork, music, pets and other activities or
elements that allow for a sense of stimulation
which can help nurture a patients sense of positive
well-being.
3. Enable social support by means of spaces
where patients can engage with others easily, for
example, non-fixed seating, round tables, etc.
4. Offer a sense of control over the immediate
environment such as quantity of light, noise,
visual content, ability to locate, etc.