NEPAL TELEMEDICINE NUCLEUS: Where technology, architecture and landscape come together to empower a community

nucleus: a central part about which other parts are grouped or gathered; a core. -www.dictionary.com

The project’s curvilinear design conveys a natural symbolism influenced by traditional Nepalese culture and the project program requirements. Spaces radiating from a nucleus, or center, represent the social structure typically found in a rural-agricultural society such as Sanfe Bagar. This social structure begins with the family, or Paribar, at the core and extends to a larger kinship network, and then broadens to the village, or expanded community. The project’s parti reflects the concentric social structure and the notion that individuals in these communities have a sense of camaraderie to help each other in times of need. Families within villages have been known to share food, alleviate labor shortages during planting and harvesting seasons through a system called Parma and, at times, bring resources together to implement village-wide projects such as building schools and irrigation ditches.

The entire spatial configuration of the Telemedicine Nucleus is organized around a central core. This building core became the technology hub and satellite tower for practical and figural reasons. The central location allows proximity to the technology required spaces it will serve, is located in the center for protection from the elements, and its placement is indicative of its high importance to the facility and surrounding community. Without the server, there would be no access to the outside world and this access is vital to the community for educational and medical reasons. To further emphasize the importance of this space, the technology and equipment located in this one room can save thousands of lives each year in the Achham district and beyond.

The focus of the project was to create an innovative, inexpensive design that would employ existing Nepalese building materials and methods to create a memorable and positive experience for the entire facility and community. With this in mind, the inspiration for this facility is design around light, views and nature for the well-being of patients, visitors, staff and physicians.

NATURE AND HEALING

“The rich mind lies in the sun and sleeps, and is nature.” –Ralph W. Emerson

The proposal dealt with subverting conventional notions between architecture and landscape architecture to challenge the conventional roles of each. Hence, through the juxtaposition of unique adjacencies, a new reality is formed. The landscape elements take on figural and spatial qualities common to architecture and the architecture developed ephemeral qualities usually relegated to the landscape; water collection troughs and planters have a structured architectural quality and organization; the softness of the landscape and garden were brought into the building (trees, flowers, plants, water and turf seating); boundaries and structure seemingly disappear with the use of high windows, the abundance of windows, and the placement of windows, openings and doors on axis with pleasant view corridors to the exterior; and several spaces usually considered indoors were transformed to an in-between space that is neither indoors, nor outdoors (reception, waiting areas, community gathering area, staff break room patio, and physician classroom). This philosophy expands upon traditional Nepalese architecture which is often “closed” and internally focused by establishing a clean, safe and open model for a special community space and place for healing.

PROJECT SITE PLACEMENT

The project was strategically placed in its particular location for several reasons. First of all, the project was placed parallel with the significant topography changes in order to keep the foundation structure at a minimum; the building is nestled within the existing topography to allow for minimal disruption in the site’s agricultural usage. Visibility of the complex to guests from distant lands was deemed an important design consideration; therefore, the complex was pulled away from the mountain edge. This also improves intra-district connectivity (WI-FI capabilities, etc.). The fine tuned placement of the facility is determined by lining up the two major entrances to the adjacent street and view corridors in order for the entrances to be seen from both the market approach bridge and when traversing down off the mountain from the street.

Although a direct physical connection to the Healthcare Clinic was not advised, proximity of the Telemedicine Center to the Clinic could prove mutually beneficial. As designed, a waiting garden is placed between both areas to accommodate patients from both clinics with one point of reception. It is proposed that the existing Healthcare entrance be reoriented to the side of the clinic on axis with the view corridor of street coming down the mountain, and that the entrance to the Healthcare clinic is through the waiting garden and what is currently the “back” of the existing clinic. The entry sequence of the current Healthcare Clinic provides no privacy and limited protection, is located adjacent to the street, and does not address any sense of arrival, safety, or comfort for a patient or visitor. The waiting garden provides privacy, safety and a pleasant environment for sick patients. What exists as the front of the existing clinic could operate as the exit or physician access or could be retrofitted for storage or another exam room to serve more patients.

The proximity of the Healthcare Clinic to the Telemedicine Center creates common spaces to be shared such as the reception area, waiting garden, restroom, staff break room, staff garden and pharmacy. The proposed pharmacy in the Telemedicine Center can accommodate both the Clinic and Telemedicine Center, and the existing pharmacy in the Healthcare Clinic could be converted into another exam room to treat patients. One more exam room equates to more patients cured, treated and lives saved.

ENERGY CONSIDERATIONS

Given the remote area of Sanfe Bagar, windmills were proposed onsite as an alternative energy source and appropriately located across the site to best capture wind energy. Windmills are much more readily available and cost effective than may be perceived and depending on the design, their peak power production can range between 400W and 3500W per windmill. They can be purchased from a manufacturer or produced homemade. Many windmills are lightweight (great for long-distance shipping), weatherproof, maintenance free and are easy to install. Most windmills can be mounted to any sturdy pole, building or tower kit.

WATER DIVERSION

Given the Nepal monsoon rains from June to September with an average rainfall of 50 inches, careful thought and planning was given to alleviate the possibility of landslides and flooding. The project configuration developed from the need to have a water diversion strategy in order to keep dynamic water loads off the building and prevent the building from sliding down the mountain; designing a path for the water is one of the best ways to prevent water from creating its own undesired path. A series of water troughs begin at a higher elevation toward the higher edge of the site and terrace down, following the existing grades, and continue around and through the natural building forms to water swales that divert water off of the site. The swales are not uncommon to this area and are part of existing Nepalese water diversion strategies. Several water troughs navigate under the building and serve as a water feature in the waiting garden. This rainwater collection strategy can be manipulated to irrigate landscaping as needed and the use of particular water plant species can naturally filter the water. The stepped pools are ideal for an artificial wetland and water filtration strategy, where if designed correctly, it could filter the water to where it may be potable at the end of the process.

The water troughs also serve as a collection basin for rainwater runoff from the roofs and their location around the building further serves as a security buffer between the exterior and project spaces.

LANDSCAPING CONSIDERATIONS

Trees and walls were deliberately positioned around the facility to help protect the building from windstorms and provide valuable shade. Several areas utilizing this strategy include the waiting garden and semi-enclosed community gathering area. The waiting garden would include plants and flowers that may be susceptible to strong winds and full sunlight and the semi-enclosed gathering area would need to be protected on the exterior so that the spaces could remain useable during a storm and on hot summer days.

The semi-enclosed gathering area includes stepped turf seating for community meetings, gatherings, and educational functions. Woven screen walls attached between windmill structures were designed to separate the water collection trough from the gathering space.

Medicinal plants, medicinal trees and fruit trees were sited throughout the facility. The fruit trees located on the outside of the facility could be harvested and available for the larger community and fruit trees located inside the waiting garden could be monitored and consumed by staff, patients and visitors to the complex.

The use of medicinal plants and trees is prevalent in Nepal and the Sanfe Bagar climate is ideal for cultivating several medicinal plant species. The climate allows for rich biological diversity, including native medicinal plants that are an integral part of traditional eastern medicine. Several species are high in demand and natural populations are threatened in Nepal. For this reason, the medicinal plants were located in the enclosed waiting garden and in semi-secured planters between the facility and water troughs. The medicinal planters hugging the exterior walls are accessible through the windows of the facility.

NEPALESE MEDICINAL TREES

Loth Salla / Himalayan Yew
The fleshy fruits are edible and “taxol” extracted from leaves and bark is used to treat breast and uterine cancer
Dalchini, Tejpat / Indian Bay Leaf
The bark and leaves are used to make astringents, stimulants and carminatives and used to treat rheumatism, colic and diarrhea.

NEPALESE MEDICINAL PLANTS

Chiraito / Swertia

The whole plant contains “Chiratin” that is used to treat stomachaches, constipation, excess urination, eliminate parasites, prevent and treat malaria.

Kutki /Gentian

The roots are used to treat liver problems, stomachaches, fevers and used as a laxative.

Sugandhawal /Indian Valerian

The roots are used as a sedative to treat hysteria, hypochondria and anxiety.

Asurol /Malabar Nut

The leaves are used to treat coughs, chronic bronchitis, asthma, atrophy and rheumatism.

Jatamansi /Spikenard

The root oil is used as a bitter tonic, stimulant and antispasmodic.

Padamchal /Himalayan Rhubarb

The rhizomes and roots are used as a laxative, an astringent tonic for treating ulcers, and used as a laxative.

Sarpagandha /Rauvolfia Root, Serpentine

The roots are used to treat high blood pressure.

Timur /Prickly Ash

The fruit is used to treat colds and bronchial problems.

Padamchal /Himalayan Rhubarb

The rhizomes and roots are used as a laxative, an astringent tonic for treating ulcers, and used as a laxative.

*Medicinal plant information taken from kidsgardening.com

FLEXIBLE SPACES

Part of the vitality of this project rests in the flexibility and overlap of spaces. The community areas were designed so that the library, computer lab, and gathering space can expand or contract as needed. A flexible wall is located between the library and computer lab so that when the lab is not in use for training, the computers would become part of the library. The computer lab also has a flexible wall between it and the semi-enclosed gathering space. It is suggested that the library consist primarily of computers and minimal physical books. The computer and internet access is thought to be the most complete and up-to-date library. All computers within the Library and Computer Lab will be placed on desks with wheels so that they can be easily moved between spaces. If the library was needed for a community function, computers would be moved into the computer lab to free up this space for an event. The circular library form allow the desks to be placed perpendicular to the exterior wall and to the windows to allow light to enter the space with a minimum of glare on the monitors. The library was designed with a flexible wall between it and the exterior so that the library area can spill out into semi-enclosed gathering space as necessary.

The semi-enclosed gathering space is designed with the intent that it will be accessible to the public. It is assumed that visitors to the center travel far and wide for services and their arrival may not coincide with the center operating hours. The semi-enclosed gathering space is intended to allow these guests an area of refuge until the clinic opened.

The physician’s outdoor classroom is assumed to operate with least usage compared to the other telemedicine spaces. For this reason, it is strategically located adjoining the community gathering areas and separated by a flexible wall so that it could be used for the community when not in use and vice versa. This space would be ideal for English language courses and smaller community meetings.

The visitor waiting garden is designed as a pleasant environment for all users of the entire facility. Screen walls would be employed to break up space between patients for safety and comfort. The garden’s outdoor and covered areas also help prevent the spread of infection and disease that a closed space would entail.

MATERIALS AND METHODS

The proposal dealt with investigating ways in which a building may serve as a critical framework for the questioning of Nepalese traditional architectural conventions. This process began with looking into traditional Nepalese building methods and components in order to allow for a new translation or meaning for them. It is intended that all building materials will be locally harvested and the project will be built by local craftsmen. If the need for glass arises, using bottle walls or stained glass is suggested in order to keep the materials local.

Traditional Nepalese windows usually include shutters for security and preventing water from entering spaces during the monsoon season. The proposal suggests an angled window sill and a multi-layered window that would involve one or multiple screens to keep water out but allow some light and air to enter the building without sealing off spaces. Basket weaving is common to this area; the round baskets woven for harvesting purposes will be translated into flat panels that can be used in windows. With the use of screens, the typical Nepalese window that usually maintains certain proximity from the floor to keep rain out can be elongated; i.e., a 3’ wide by 4’ high window can become a 3’ wide by 6’ high window without compromising structural integrity.

The basket weaving tradition can also be translated to the screen walls considered in the waiting garden and to the flexible walls proposed throughout the facility.

The curvilinear rooms, although seemingly more complex, actually translate the existing rectilinear Nepalese building into a naturally curving form. Its structure is made up of one wood column in the center of the space (the library and computer lab) from which beams radiate from to support the roof. The column in the center helps to alleviate the need for large timbers that may not be readily available in this area. Tree trunks will be used for the columns on the periphery that will be embedded in the wall infill. Several possibilities to infill the walls have been suggested including: combing river rocks from the river below with cement or clay; using a straw-clay mixture infill; and / or a combination of systems that would lend themselves well to the curved walls. Bricks are a possibility, but can be difficult to transport to the site and do not work as well with the curved walls. The other spaces have spans that can employ simple post and beam construction that is predominate in much of Nepal. The recommended foundation would be cement and the roof structure would be wood.

The beautiful slate tiled roofs commonly found in Sanfe Bagar will be emphasized in order to address the circular spaces and resulting conical roof forms. The irregular slate roof patterns lend themselves well to the conical roof form and will be used in a spiral fashion. The spiral pattern will be seen from the adjacent mountainside and from travelers traversing down the bordering road that leads to the river and Haat Bazaar Market. All roofs are designed with large overhangs to prevent rainwater permeation into spaces.

SPACE CONSIDERATIONS

Recommended Total Facilities Footprint: 175 m2

Proposed Space Breakdown:

Telemedicine Center

Counseling / Exam Rooms 12.5 m2

Administrative Suite 28.9 m2

Multi-Purpose Meeting Room / Break Room 10.3 m2

Staff Garden 18 m2

Staff Break Room (indoors) 10 m2

Staff Break Room (covered/not enclosed) 25 m2

Server Closet 4.9 m2

AV Telemedicine Consultation / Training Room 18.8 m2

Physician Outdoor Classroom (flexible) 30 m2 (20 m2 – covered)

Storage 5.4 m2

Pharmacy 11 m2

Waiting Garden (covered / not enclosed) 70 m2 (20 m2 – covered)

Reception (covered / not enclosed) 8 m2

Community Space

Library 38.5 m2

Computer Lab 19.6 m2

Gathering Space (covered / not enclosed) 80 m2 (30 m2 – covered)

*All covered / not enclosed spaces are approximate.

Location