Nyaya Health Telemedicine Center Design Description

“Lest this sound too general, allow me to consider maternal mortality. Gender inequality and poverty, together not apart, are the cause of almost all deaths during childbirth: half a million women die each year in childbirth, but these deaths are registered exclusively among poor women. They can all be prevented, but to do so requires that women with obstructed labor have access to modern obstetrics…I wish that when I first traveled to Haiti, in 1983, someone had told me that to advocate for human rights there we’d need to consider learning to build operating rooms and procure equipment and supplies; it would have saved us a great deal of time and made us more effective.” Paul Farmer, M.D., Ph.D. (1)

Introduction

It is not a new idea- bringing resources to poor regions of the world. Bringing technology to the illiterate and impoverished women in the Achham District in Nepal, and to their children and families, however, is an ambitious endeavor and one that inspires excitement. We hope that we can participate in this far-reaching project.

Nyaya Health, in collaboration with Advanced Micro Devices, 50x15 Initiative, Open Architecture Network and Architecture for Humanity, is bringing health services and technology to far western Nepal. Nyaya is the Nepali word for “justice, equity, logic, reason”(3); success for this project will mean that expertise for health, economic and social purposes will be accessible for the most marginalized poor women and families in the region.

Our response to the Design Challenge for the Telecommunications Center for Sanfe Bagar is the creation of a place of hope that will be physically and emotionally nurturing for the members of the community- both clients and staff.

Tea Room Concept

Our design takes shape in relation to the tea culture in Nepal, where brewing and sharing a pot of tea brings people together for conversation and warmth.
Drinking tea together is traditionally an icebreaker that makes friends out of strangers; it relieves tension in unfamiliar situations that may arise such as private and semi-private counseling sessions.
We have visually highlighted the “tearooms” within the project, which will serve as intimate spaces for gatherings, discussion, and informational or educational activities.

Materials and Sustainability

Our design consists of two, one-story, connected square structures built of concrete masonry units (CMU), adobe and bamboo on Site A. We propose using local materials, expertise and construction teams to create these structures, following the National Society for Earthquake Technology (NSET) (6) guidelines for seismic resistance. Since power from municipal sources is scarce, we have incorporated sustainable sources of power from solar panels and Ujeli stoves (7) (see below) so that the buildings may function “off the grid.”

Vernacular rather than power-based solutions to environmental conditions of high temperatures and humidity will be implemented, when possible. On the exterior, a veranda wrapping both the public and private buildings will create a cooling buffer from external heat. A clerestory space above all the enclosing walls will allow heat to escape from the interior, facilitated by ceiling fans.

Design Elements

The public building will be a multi-purpose, flexible space for computer labs, a library, meetings and classes, surrounded by a broad veranda. In the interior, two small ladders will provide entry to the larger, central tea space, which looks over into the central meeting space. Low-rise adobe stairs will provide access to the smaller tea spaces on the southwest corners of the building. These will act as more sculptural elements, housing bookshelves, and wrapping a more intimate space that can serve as a counseling room, reading area, or intimate laptop area.

The veranda on the public building will be differentiated by its depth of 15 feet (5 feet on the private building) allowing it to be used as an outdoor milling and waiting space. By its quality of shade, ventilation and visual interest and its proximity and access to the tearooms, we hope that it will be a vibrant and well-liked community area for children and adults alike.

On the exterior of the veranda columns, which surround the public building, we have added bamboo screening for privacy. The bamboo screening can be sprayed with water, as is often done in India and Pakistan, to provide a further cooling effect. Ceiling fans around the perimeter of the veranda will contribute to the ventilation of the building.

The computer labs will be accessible for children and adults. As the backbone of this project is bringing technology, IT and all the information and global communication that it opens up to this rural community, we would like to suggest the use of the XO laptop developed at Massachusetts Institute of Technology. This hardware has been designed specifically for this type of user community who would be interfacing with this technology for the first time. The technology and server will be powered by solar panels placed on the tearoom roofs on adjustable brackets so that they are able to catch the maximum sunlight at each time of day and month. The solar panels will be used in conjunction with a battery back up to avoid power and equipment failures.

To provide heat and facilities for preparing tea and simple meals in the public space, we propose the use of an Ujeli stove, which can be used to pasteurize water, and generate heat and electricity while maintaining a smoke-free environment. It can provide up to five hours of electricity by converting heat energy generated by three hours of cooking. We would consult with Engineers Without Borders-Nepal on the installation and implementation of this stove. Ceiling fans would cool the space when needed.

Cultural Considerations

For health and possible economic benefits, we also propose the development of kitchen gardens (11) on the site. This would have the potential for improving the nutritional and health status such as the “night blindness” that can occur in pregnant women as a result of Vitamin A deficiency. In addition, the gardens plots we identify on our site plan could function as physical loans to the women of Achham, similar to microfinance loans, to provide long-term economic returns.

The residence is intended for the staff of 8 men and women. Individual bedrooms will be provided, and men’s quarters will be separate from those for the women, in consideration of cultural norms. A communal living room and kitchen with an Ujeli stove will be in the central area, and separate bathrooms for men and women will be located adjacent to the building. The bathroom facilities will be provided as a separate outhouse building in keeping with traditional practice in the area. We plan to use rainwater collected in a tank next to the outhouse for toilet plumbing, which will be tied into an underground stone and concrete septic tank. We also propose to have a larger tank for rainwater collection on the ends of both buildings’ sloped roofs. This water can be filtered for potable indoor uses and used for the irrigation of the proposed kitchen garden plots.

We anticipate that by primarily using materials that are easily accessible in the region and techniques that are familiar to local contractors, we will be able to complete this project within the allotted budget. The XO laptops are very reasonably priced.

The Design Team

We are a group of women, designing for women in Nepal. We range in ages from our twenties to our fifties, and come from diverse cultural, ethnic and professional backgrounds. We share a strong interest in the potential for improved physical, emotional, economic, and social status to have broad political implications in the world. As one member of our design team wrote when asked about her decision to participate in the project: “Having seen the harsh conditions on the Pakistani side of the Himalayas, I felt compelled to work for this community. The project for me was about providing new life options via education and improved health care to impoverished women who have been stuck in the cycle of economic dependence for far too long.” Another commented: “There are so many people in this work who don’t even have a shelter to live in; what can I do about this, as a designer? We are learning so much about Nepal, the life and culture; it made me reflect on how we live, too (it’s mind-boggling…)”.

We look forward to meeting the women of the community to learn, first hand, what they want, to refine our design, and to develop ongoing relationships in order to modify our responses as this project expands. The long-term success will depend on the participation of the community. We hope to become, and remain, part of that community.

As the architect Stephen Verderber wrote about designing in New Orleans after the devastation of Hurricane Katrina: “Architecture- the art and science of making a building- is essentially an act of optimism.”(12)

References

1.Farmer M.D., Paul. “Challenging Orthodoxies in Health and Human Rights.” American Public Health Association. 134th Annual Meeting and Exposition. Boston. 5 November 2006. p.4. .

2.Newar, Naresh. “They Don’t Get Rich, They Get HIV. “Achham Nepali Times Issue #353. 15 June 2007. < www.nepalitimes.com>.

3.Kramer, Karl-Heinz. “Definition of Nyaya.” Nepali-English Dictionary. South Asia Institute. University of Heidelberg. 14 April 2007. p. 90. .

4.Minke, Gernot. Building With Earth: Design and Technology of a Sustainable Architecture. Basel: Birkhauser. 2006.

5.Velez, Simon. Grow Your Own House: Simon Velez and Bamboo Architecture. Weil am Rhein: Vitra Design Museum. 2000.

6.National Society for Earthquake Technology. .

7. “Lighting Up the Nepalese Villages. Engineers Without Borders- Nepal. .

8.Robinson-Pant, Anna. Institute for Education. UNESCO. Why Eat Green Cucumbers in A Time of Dying: Women’s Literacy and Development in Nepal. July 2000. .

9.Marberry, Sara O. Improving Healthcare with Better Building Design. Chicago: Health Administration Press. 2006.

10.Zurick, David. Illustrated Atlas of the Himalaya. Lexington: University Press of Kentucky. 2006.

11.B, S. Health Specialist, Western Nepal. Personal Interview. 24 February 2008.

12.Verderber, Stephen. Compassion in Architecture: Evidence – Based Design for Health in
Louisiana. Lafayette: Center for Louisiana Studies. 2005. p.5

Location