Expanding the Maternity Waiting Home Typology | A Prototype for Pre and Post-Delivery

MATERNITY WAITING

DANIELLE FELICIONE

SPRING 2019

PRE-DELIVERY // POST-DELIVERY

CONTENTS

5 | PROJECT QUESTION 7 | ABSTRACT 8 | THESIS 10 | DESIGN RESEARCH 14 | DESIGN STRATEGY 18 | CASE STUDY 24 | RESEARCH CONCLUSIONS 27 | DESIGN GOALS 32 | USER NEEDS 34 | DESIGN SCHEMES 40 | DESIGN PROPOSAL 74 | DESIGN REFLECTION 76 | BIBLIOGRAPHY

EXPANDING THE MATERNITY WAITING HOME TYPOLOGY A PROTOTYPE FOR PRE AND POST-DELIVERY Can providing safe and comfortable housing for expectant mothers both pre and post-delivery increase admittance and longevity of stay at maternity waiting homes?

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ABSTRACT

A REPLICABLE SOLUTION FOR THE COUNTRY It has been found that the issue of maternal and newborn mortality is one that can often times be avoided with the timely access to healthcare services and professionals1.

In Malawi, close proximity to a healthcare facility both prior to and in the days following childbirth delivery is a challenge for many pregant women, especially those in rural areas of the country2.

Women are dying because they are too far away from a healthcare facility when going into labor and therefore are giving birth without the assistance of a trained birthing attendant

and are without options in the case of an emergency3.

Furthermore, 75% of newborn mortalities occur within the first week of life4.

These facts suggest that by providing women with a space to stay at a healthcare facility in the weeks leading up to their delivery and the week immediately after, both mothers and their infants will have access to the medical attention that they need and thus, these built spaces will aid in the improvement of both maternal and newborn mortality rates.

1 Regine Unkels, Abigail Kazembe, & Broek, N. D. (2017, July 12). Factors associated with maternal mortality in Malawi: Application of the three delays model. Retrieved from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/ s12884-017-1406-5 2 Regine Unkels, Abigail Kazembe, & Broek, N. D. (2017, July 12).

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3 Regine Unkels, Abigail Kazembe, & Broek, N. D. (2017, July 12).

4 Newborn. (n.d.). Retrieved from https://afro.who.int/health-topics/newborn

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THESIS

INTRO + METHODOLOGY

DESIGN RESEARCH + PROPOSAL

INTRO

CONCLUSIONS

Maternal and newborn mortality is an ongoing global issue. In 2013, it was reported that 289,000 women had died worldwide due to causes and complications related to childbirth. Of those women, 179,000 had been from 5 developing countries . That same year it was also reported that women from Sub-Saharan Africa were at the greatest risk of mortality during childbirth, with 1 in 38 women being at risk of dying during childbirth relative to 1 in 3700 women being at risk in developed countries. In 2013 Malawi reported the highest maternal mortality rate in 6 Sub-Saharan Africa with 1 in every 34 women dying during childbirth .

Delays in the timely reaching of a healthcare facility is a circumstance shared unfortunately among many mothers 7 who have passed away or have suffered complications during childbirth . Maternity waiting homes (MWHs) are a strategy aimed at mitigating the issue of proximity to a healthcare facility by providing vulnerable mothers, including first-time mothers, women told that they were at risk for complication, poorer women, and women who live further from care in rural areas of the country, a safe place to stay close to a healthcare facility during the last 8 weeks of their pregnancy .

The goal for my new MWH model is to implement the features defined by Mass to increase user satisfaction while also planning for the future population growth by relieving current maternity wards of their programs associated with pre-delivery and laboring spaces by including those programs within my model for the new MWH. By removing those programs from current maternity wards and placing them within the program of the new MWH, we are freeing up valuable space to allow more beds to be allocated for delivery within the wards where mothers need the most direct care from a health care provider.

While maternal mortality rates have decreased with the implementation of MWHs at district and central hospitals, the numbers of infant mortalities are still on the rise in Malawi. Additionally, Malawi has made incredible strides in reducing the number of children who die before their fifth birthday. The World Health Organization (WHO) reports that, “child mortality has almost halved since 1990, but as under-five child death rates fall, new-born deaths have 11 increased as a share of overall child mortality .”

THESIS By giving these women the opportunity to present at the corresponding health care facility in a timely manner, 9 MWHs play an important role in the effort to improve maternal health and reduce maternal mortality .

METHODOLOGY An extensive lit review led by medical professional from Jefferson University at the start of the semester, as well as multiple interviews (specifically with Linda Robinson) as well as case studies helped guide the design process and influence making decisions based off of research and gained knowledge as opposed to assumption. One of the case studies I closely looked at throughout the course of the semester was the Kasungu Maternity Waiting Village designed by Mass Design Group. Patricia Gruits M.Arch (Director) of Mass Design Group, along with Nathalie McIntosh Ph.D (Health Services Reseacher), Eva Oppel Ph.D.(Assistant Professor and Investigator) and Amie Shao M.Arch.(Research Director) conducted extensive research analyzing the user satisfaction of two MWHs in Malawi as it relates to the built spaces and feature of each facility. Mass Design Group then used their findings to develop a MWH at Kasungu District Hospital in Malawi that focused on providing a built space that included features such as toilets and showers, guardian spaces, safety, building maintenance, sleeping areas and private storage. All of which 10 were found in the study to be associated with increased user satisfaction .

5 Machira, K., & Palamuleni, M. (2017). Factors influencing women’s utilization of public health care services during

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childbirth in Malawi Public health facility utilization. African Health Sciences, 17(2),400–408.

9 Speizer, I. S., Kim, E. T., Lemani, C., Tang, J. H., & Phoya, A. (n.d.). Evaluation of a maternity waiting home and community ...

Retrieved from https://bmcpregnancychildbirth.biomedcentral.com/track/pdf/10.1186/s12884-018-2084-7

6 Machira, K., & Palamuleni, M. (2017). Factors influencing women’s utilization of public health care services during

10 Mcintosh, N., Gruits, P., Oppel, E., & Shao, A. (2018). Built spaces and features associated with user satisfaction in materni-

childbirth in Malawi Public health facility utilization. African Health Sciences, 17(2),400–408.

ty waiting homes in Malawi. Midwifery, 62, 96-103. doi:10.1016/j.midw.2018.03.020

7 Regine Unkels, Abigail Kazembe, & Broek, N. D. (2017, July 12). Factors associated with maternal mortality in Malawi:

11 Malawi aims to improve quality of care for mothers and new babies. (n.d.). Retrieved from https://afro.who.int/pt/

Application of the three delays model. Retrieved from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/ s12884-017-1406-5

node/2536?country=39&name=Malawi

8 Speizer, I. S., Kim, E. T., Lemani, C., Tang, J. H., & Phoya, A. (n.d.). Evaluation of a maternity waiting home and community ...

Retrieved from https://bmcpregnancychildbirth.biomedcentral.com/track/pdf/10.1186/s12884-018-2084-7

OVERVIEW Providing spaces and facilities for women and their newborns post-delivery as the WHO reports that, “1.12 million 12 newborn deaths occur annually” in the African region . WHO also reports that three quarters of all newborn deaths occur within the first week of life. Most of these deaths are occurring at home in developing countries where access 13 to healthcare is low . The proposal for the new MWHs will also expand on the current MWH model by providing built space for low-risk women and newborns post-delivery to recover, up to a week, in a space in close proximity to surgical theatres and medical care while not taking up beds within the maternity ward that could be used for other deliveries and patients within the NICU. Potential issues associated with this model might include the fact that the MWH typology will be expanding to include more programs, thus, the size of the facilities will be expected to increase, resulting in more material and labor costs and a longer construction period.

PROPOSAL

The overall program proposal for the new MWHs will include built spaces that are properly oriented and designed for passive ventilation as an attempt to keep those staying there, as they are not sick, from contracting any illnesses during their stay. These spaces will include sleeping areas for expectant mothers, as well as women and newborns post-delivery, their guardians, and their children that might have to be brought from home, private storage areas, and outdoor communal gathering spaces with seating and shading to protect from the sun and rain. These outdoor spaces will also be utilized to educate women and guardians on breastfeeding techniques, cleanliness and proper post-natal care prior to delivery. A kitchen and laundry areas for guardians as well as shower and toilet areas will also be included.

The implementation and restructuring of a new MWH model that focus on user satisfaction and is preparing to relieve current maternity wards of stresses associated with over crowdedness while also providing built space and facilities for women and newborns post-delivery will help improve the rate of both maternal and neonatal mortalities.

12 Newborn. (n.d.). Retrieved from https://afro.who.int/health-topics/newborn 13 Newborn. (n.d.). Retrieved from https://afro.who.int/health-topics/newborn

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289,000 THE ISSUE

1:38 1:34

62% OF ALL MATERNAL MORTALITIES IN 2013 OCCURRED IN DEVELOPING COUNTRIES

In 2013, it was reported that 289,000 women had died worldwide due to causes and complications related to childbirth. Of those women, 179,000 had been from developing countries14.

That same year it was also reported that women from Sub-Saharan Africa were at the greatest risk of mortality during childbirth, with 1 in 38 women being at risk of dying during childbirth relative to 1 in 3700 women being at risk in developed countries. In 2013 Malawi reported the highest maternal mortality rate in Sub-Saharan Africa with 1 in every 34 women dying during childbirth15.

Malawi MMR Women in Malawi are at the greatest risk of dying during childbirth with a MMR of 1 in 34.

14 Machira, K., & Palamuleni, M. (2017). Factors influencing women’s utilization of public health care services during childbirth in Malawi Public health facility utilization. African Health Sciences, 17(2),400–408.

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15 Machira, K., & Palamuleni, M. (2017). Factors influencing women’s utilization of public health care services during childbirth in Malawi Public health facility utilization. African Health Sciences, 17(2),400–408.

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WHY THREE DELAYS ARE KEEPING WOMEN FROM SAFELY DELIVERING IN HEALTHCARE FACILITIES

DISTANCE TO QUALITY DELIVERY CARE

(-) (+) FACILITY DELIVERY

Delays in the timely reaching of a healthcare facility is a circumstance shared unfortunately among many mothers who have passed away or have suffered complications during childbirth16.

(+) COMPLICATIONS

(-) EARLY NEONATAL MORTALITY

(+) 7 Lohela, T. J., Campbell, O. M., & Gabrysch, S. (2012). Distance to care, facility delivery and early neonatal mortality in Malawi and Zambia. PloS one, 7(12), e52110. doi:10.1371/journal.pone.0052110

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2

3

DECIDING TO SEEK CARE

REACHING CARE

RECIEVING CARE

Type 1 delays are influenced by the factors involved in decisionmaking; sociocultural factors; financial and opportunity costs.

Factors such as distance to the nearest healthcare facility, travel time, availability and cost of transportation; road conditions contribute to type 2 delays.

Type 3 delays include factors affecting the speed with which effective care is provided once a woman reaches a healthcare facility; shortages of supplies, equipment, and trained personnel; competence of available personnel and quality of care.

16 Regine Unkels, Abigail Kazembe, & Broek, N. D. (2017, July 12). Factors associated with maternal mortality in Malawi: Application of the three delays model. Retrieved from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/ s12884-017-1406-5

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STRATEGY

BRING A HEALTHCARE FACILITY TO WOMEN OR BRING WOMEN TO A HEALTH CARE FACILITY

While we know getting women to a healthcare facility can be difficult due to proximity, sociocultural reasons, and financial accessability, I felt that it would be much more efficient to bring women to a healthcare facility that is already up, running, and operating with staff and all of the resources than it would be to break ground in a rural location that would only be benefitting a small catchment of women. By designing a maternity waiting home at or in close proximity to existing healthcare facilities that already offer obstetric care, we are affording these at-risk women from rural areas the opportunity to get in safe proximity of the facilities and resources needed for a safe delivery prior to them going into labor.

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PROGRAM

POPULATION

MWHs SITE

Maternity waiting homes (MWHs) are a strategy aimed at mitigating the issue of proximity to a healthcare facility by providing vulnerable mothers a safe place to stay close to a healthcare facility during the last weeks of their pregnancy.

I will be adding to the existing program by extending the facility to also include spaces for women and their newborns for the first week post-delivery.

Vulnerable mothers, including first-time mothers, women told that they were at risk for complication, poorer women, and women who live further from care in rural areas of the country

The new model for MWHs is to be implemented at all district and central hospitals in Malawi - adjacent or in closest proximity of their existing maternity wards.

Mzuzu Central Hospital

Dowa District Hospital

Kasungu District Hospital

Kamuzu Central Hospital

Malamulo SDA Hospital

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17

“The design of the Kasungu MWH

incorporated features to better meet user needs compared to the standard MWH design, particularly focusing on needs related to hygiene, comfort, privacy and function.

”

-

-

CASE STUDY --

After conducting extensive research of two MWHs in Malawi, Mass developed a MWH at Kasungu District Hospital in Malawi that focused on providing a built space that included features such as toilets and showers, guardian spaces, safety, building maintenance, sleeping areas and private storage. All of which were found in the study to be associated with increased user satisfaction.

6' - 0"

10' - 0"

-

11' - 0"

-

MASS DESIGN GROUP

8' - 7 3/16"

MOH MWH PROTOTYPE

-

6' - 0"

9' - 0"

MASS DESIGN GROUP MATERNITY WAITING VILLAGE AT KASUNGU DISTRICT HOSPITAL 18

17Seda, Edwin (2016, July 02). Kasungu Maternity Waiting Village / Mass Design Group. Retrieved from http://www.archidatum.com/projects/kasungu-maternity-waiting-village-mass-design-group/

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“Everyday life in rural Malawi takes place largely outdoors. In the Maternity Waiting Village, mothers and their family members and attendants spend their days in the courtyards and covered outdoor spaces.�

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18 Seda, Edwin (2016, July 02). Kasungu Maternity Waiting Village / Mass Design Group. Retrieved from http://www.archidatum.com/projects/kasungu-maternity-waiting-village-mass-design-group/

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“

Each room of the Maternity Waiting Village is developed around a simple scheme of buttressed columns, connected together to form different practical elements: walls, doors, as well as benches and storage areas. Birthing is not an individual experience in Malawi but a communal activity, and these elements accommodate the family and attendants who travel with mothers to seek care; benches become sleeping spaces, and built-in storage allows them to keep their belongings. The columns support a system of wood trusses that extend the roofline beyond the gabled ceiling of each building. The saltbox and butterfly roofs of the two modular bedroom units are aligned with complimentary geometries to better capture and redirect rainwater.

�

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19 Seda, Edwin (2016, July 02). Kasungu Maternity Waiting Village / Mass Design Group. Retrieved from http://www.archidatum.com/projects/kasungu-maternity-waiting-village-mass-design-group/

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RESEARCH CONCLUSIONS

WOMEN AND NEWBORNS ARE DYING AT HOME AFTER SAFELY DELIVERING AT A HOSPITALS The Maternity Waiting Village in Kasungu was successful in that by focusing on providing for user needs, more women were inclided to take advantage of the facility.

Mass addressed the issues related to pre-natal conditions, however there was no space provided intentionally for mothers and newborns post-delivery.

It is important to consider providing spaces and facilities for women and their newborns postdelivery as the WHO reports that, “1.12 million newborn deaths occur annually� in the African region20. WHO also reports that three quarters of all newborn deaths occur within the first week of life. Most of these deaths are occurring at home in developing countries where access to healthcare is low21.

20 Newborn. (n.d.). Retrieved from https://afro.who.int/health-topics/newborn

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21 Newborn. (n.d.). Retrieved from https://afro.who.int/health-topics/newborn

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GOALS EXPAND ON MASS’ MWH MODEL BY PROVIDING BUILT SPACE FOR LOW-RISK MOTHERS AND NEWBORENS POST DELIVERY Due to poor and uncomfortable conditions, most women leave the hospital within 24 hours post delivery. By taking what we have learned from MASS on how to design a space to make women want to get to the facility earlier by designing to increase user satisfaction, we can similaryly design spaces in which women and newborns feel comfortable enough in to stay and recover, up to a week, post delivery. The requirements of this space are that it must be in close proximity to surgical theatres and medical care while not taking up beds within the maternity ward that could be used for other deliveries and patients within the NICU.

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INTERVENTION

BABY IS BORN

GET WOMEN TO THE HEALTHCARE FACILITY EARLIER AND KEEP THEM THERE LONGER

MOTHER DIES DUE TO COMPLICATIONS

WOMEN HAVE POOR ACCESS TO CONTRACEPTION

WOMAN BECOMES PREGNANT

BABY IS BORN MOTHER AND BABY ARE TOGETHER

WOMAN LIVES FAR FROM CLOSEST HEALTHCARE FACILITY AND CANNOT PRESENT IN TIME

MOTHER DIES DUE TO COMPLICATIONS

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MOTHER AND BABY GO HOME

MOTHER AND/OR BABY DIES DUE TO COMPLICATIONS

CONTRACTIONS BEGIN

INTERVENTION

The goal is to intervine in such as way that gets more women to a healthcare facility in time for her to go into labor in the company of trained medical staff, and to minimize the number of women and newborns that are dying at home after delivering at a healthcare facility.

WOMAN DELIVERS AT HEALTHCARE FACILITY

INTERVENTION

BABY IS BORN

MOTHER AND/OR BABY DIES DUE TO COMPLICATIONS

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2 WEEKS SEVERAL HOURS

WAITING

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1 WEEK

24 HOURS 4+ HOURS

LABOR

BIRTH

RECOVERY

POST-DELIVERY

2 WEEKS

4 HOURS

01 WEEK

-PROXIMITY TO CARE -SLEEPING AREA -EDUCATION -COMMUNAL SPACE -STORAGE -HYGIENCE -SPACE FOR GAURDIANS -KITCHEN AND LAUNDRY FOR GUARDIANS

-CAN STAY IN DELIVERY BED UP TO 1.5 HOURS AFTER DELIVERY TO BE MONITORED, REST AND EAT

-SHELTER IN CLOSE PROXIMITY TO CARE WHERE THEY CAN STAY UP TO ONE WEEK POST DELIVERY -EDUCATION -COMMUNAL SPACE -STORAGE -HYGIENCE -SPACE FOR GAURDIANS -KITCHEN AND LAUNDRY FOR GUARDIANS

SEVERAL HOURS -PROXIMITY TO CARE / WARD -ABILITY TO BE MONITORED BY NURSES TO DETERMINE STATUS / PROGRESS -COMFORTABLE PLACE TO WAIT UNTIL DIALATED ENOUGH TO BE MOVED TO DELIVERY WARD (7-8 CM 1ST BABY) (5-6 CM 2ND+ BABY) -SPACE FOR GUARDIANS

24 HOURS -A COMFORTABLE SPACE HIGHLY MONITORED MY NURSES AND STAFF -SPACE FOR GAURDIANS

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WAITING

USER NEEDS DESIGNING SPACES THAT EVOLVE WITH THE MOTHERS CHANGING NEEDS Essentially there are two different users that will be populating this facility, mothers and their guardians. While a mother is just one person with needs that need to be satisfied, her needs change throughout the duration of her stay. This suggests that her built space should change and adapt with her.

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LABORING

RECOVERY

POST-DELIVERY

-SLEEPING AREA -COMMUNAL SPACES / OUTDOOR -ADVOCATES / VISIBILITY -EDUCATION -STORAGE -VIEWSHEDS / NATURAL LIGHT -PASSIVE VENTILATION -ACCESS TO TOILETS, SHOWERS, AND SINKS

-CLOSE PROXIMITY TO DELIVERY WARD -BED TO WAIT IN -MONITORING FROM NURSES -PRIVACY -SPACE / CHAIR FOR GUARDIAN -SPACE TO WALK AROUND -ACCESS TO TOILETS AND SINKS

-CLOSE PROXIMITY TO DELIVERY WARD -SLEEPING AREA -SPACE FOR BABY -MONITORING FROM GUARDIANS/MOTHERS -PRIVACY -SPACE / CHAIR FOR GUARDIAN -ACCESS TO TOILETS AND SINKS -EMERGENCY SUPPLIES

-SLEEPING AREA -SUPPORT -ADVOCATES / VISIBILITY -EDUCATION -STORAGE -VIEWSHEDS / NATURAL LIGHT -PASSIVE VENTILATION -SPACE FOR BABY -ACCESS TO TOILETS, SHOWERS, AND SINKS

COMMUNITY OUTDOOR SPACE, COMMUNITY SPACE GATHERING SPACE

PRIVACY OUTWARD FACING VIEWS FROM BEDS PRIVATE STORAGE

ADVOCACY BENCHES FOR GUADIANS BY BEDS VISUAL CONNECTION ACCESSABILITY

REST PRIVATE SPACES FOR REFUGE AREAS TO WALK OUTSIDE OUTDOOR BENCHES PRIVACY IN SLEEPING AREA FOR MOTHER AND BABY 33

1

POST AS CRITICAL ADJ. This scheme suggests that if we are to seperate all of the housing by use, that post-delivery housing be in the closest proximity to the delivery ward / clinical care as it is during that time that the most urgent complications are expected to arise.

DELIVERY

WASH

COMMUNITY

LAUNDRY

KITCHEN

SCHEME 34

SEPERATION OF USER GROUPS (PRE, POST, GUARDIANS) + COMMUNITY HEALTH, OUTDOOR SPACE, SUPPORTING FACILITIES 35

2

COMBINING PRE AND POST-DELIVERY HOUSING BENEFITS OF DESIGNING THE HOUSING TO ACCOMMODATE THE WOMAN WHILE SHE IS WAITING AS WELL AS AFTER THE BABY IS BORN IS BENEFICIAL IN THAT THE WOMAN DOESN’T HAVE TO WORRY ABOUT RELOCATING ALL OF HER BELONGINGS AND CAN STAY WHERE SHE HAS ALREADY MADE HERSELF COMFORTABLE.

DELIVERY

COMMUNITY

WASH

LAUNDRY

SCHEME 36

COMBINING PRE AND POSTDELIVERY HOUSING

KITCHEN

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3

NO SEPERATION OF USER GROUPS THIS SCHEME PROVIDES HOUSING THAT COMBINES PRE/POST DELIVERY TOGETHER IN ONE SPACE AND ANCHORS THE MODULE WITH GUARDIANS. EACH MODULE WILL BE DESIGNED WITH ITS ONE GARDENING SPACE TO GROW FOOD. EACH MODULE IS MEANT TO BE ABLE TO SUPPORT/SUSTAIN ITSELF, BUT WHEN ORGANIZED TOGETHER CREATES THE SENSE OF COMMUNITY AND A VILLAGE THAT THE WOMEN ARE ALREADY ACCUSTOMED TO.

LAUNDRY

WALKABLE PROXIMITY TO DELIVERY WARD AT CENTRAL OR DISTRIC HOSPITAL FROM MWH

WASH

COMMUNITY

WASH

KITCHEN

SCHEME 38

CREATING A COMMUNITY BY ORGANIZING MIXED USER GROUP MODULES AROUND CENTRAL SUPPORT FACILITIES 39

PROPOSAL MATERNITY MODULE The proposed maternity module was carefully designed to funtion and adapt with the mother as her needs as a user evolve and develop throughout her stay at the maternity waiting home. Each outward facing sleeping unit is seperated by 4’ tall partitions to give the sense of privacy while also providing uninterupted ventilation to pass through the building. The partitions provide visual privacy while preventing auditory and circulatory isolation in the case of an emergency. The 10’ x 10’ sleeping units are organized within the structural bays of the building and each include a bed for the mother, a bench for her guardian, and space for a bassenette once the baby arrives as well as views to the outdoors.

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MATERNITY MODULE

MATERNITY MODULE SOUTH ELEVATION SCALE: 1/8” = 1’ - 0”

SOUTH ELEVATION PLAN PLAN DIAGRAMS

MATERNITY MODULE CIRCULATION DIAGRAM SCALE: 1/16” = 1’ - 0”

MATERNITY MODULE GUARDIAN BENCHES / OVERFLOW DIAGRAM SCALE: 1/16” = 1’ - 0”

PRIVATE CLOSED STORAGE SEMI-PRIVATE SLEEPING UNIT

SEMI-PRIVATE OUTDOOR SPACE

PUBLIC OUTDOOR SPACE

MATERNITY MODULE PLAN SCALE: 1/8” = 1’ - 0” 42

MATERNITY MODULE PRIVACY DIAGRAM SCALE: 1/16” = 1’ - 0”

MATERNITY MODULE PROGRAM vs STRUCTURAL GRID DIAGRAM SCALE: 1/16” = 1’ - 0”

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_SLEEPING AREAS _SHOWERS _TOILETS _KITCHEN

11' - 0"

8' - 7"

MOH MWH

10' - 0"

STANDARD MATERNITY WAITING HOME

6' - 0" 10' - 0"

MASS MATERNITY WAITING HOME AT KASUNGU

11' - 0"

8' - 7"

_SLEEPING AREA _SHOWERS _TOILETS _PIT LATRINES _PRIVATE STORAGE SPACE _CENTRAL COURTYARD _KITCHEN _OPEN AIR SLEEPING AREA FOR GUARDIANDS

10' - 0"

MASS MWH

6' - 0"

6' - 0" 10' - 0" 6' - 0"

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8' - 7"

_PRE-DELIVERY WAITING HOMES _PRIVACY, OUTWARD FACING BEDS AND PARTITIONS _RECOVERY SPACE + POST-DELIVERY WAITING HOMES _FORMAL + INFORMAL GUARDIANS SLEEPING AREAS _SPACE FOR BABY _PRIVATE STORAGE SPACE _COMMUNAL GATHERING/EDUCATION _TOILETS, SHOWERS, SINKS (+ PIT LATRINES) _KITCHEN _LAUNDRY

10' - 0"

NEW MWH

NEW MATERNITY WAITING HOME MODEL

6' - 0" 10' - 0" 45

MATERNITY MODULE

SECTION SECTION PERSPECTIVE EXPLODED AXON

CORRUGATED METAL ROOF

3”X3.5” C-CHANEL

METAL TRUSS

2”X1” PURLINS

NUTEK ACCOUSTIC CEILING PANELS

MATERNITY MODULE WEST SECTION 1/8” = 1’ - 0”

LOAD BEARING MASONRY COLUMNS RING BEAM ON 8 “ LOAD BEARING MASONRY

LOUVERS

MATERNITY MODULE SECTION PERSPECTIVE

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MATERNITY MODULE EXPLODED AXON

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PROPOSAL GUARDIAN MODULE While the proposed guardian module was designed to be compact, as guardians typically aren’t afforded formal shelter and accommodations at district and central hospitals, it also aimed to emphasize the culture’s relationship with the outdoors by providing covered outdoor space on the second level. The intended use of this space is to be a place where guardians and mothers can gather together in a semi-private setting that is seperate yet connected to the public ground level. Benches are provided on the second outdoor level that can double as sleeping areas for guardians as it is common for mothers to bring more than one guardian with them to a healthcare facility. The covered outdoor second level can also be used to hang and dry clothes, especially in the rainy season.

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GUARDIAN MODULE

GUARDIAN MODULE FIRST FLOOR PLAN SCALE: 1/8” = 1’ - 0”

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FIRST FLOOR PLAN SECOND FLOOR PLAN PLAN DIAGRAMS

GUARDIAN MODULE FIRST FLOOR CIRCULATION DIAGRAM SCALE: 1/16” = 1’ - 0”

GUARDIAN MODULE FIRST FLOOR STORAGE DIAGRAM SCALE: 1/16” = 1’ - 0”

GUARDIAN MODULE SECOND FLOOR BENCH DIAGRAM SCALE: 1/16” = 1’ - 0”

GUARDIAN MODULE SECOND FLOOR STRUCTURAL GRID DIAGRAM SCALE: 1/16” = 1’ - 0”

GUARDIAN MODULE SECOND FLOOR PLAN SCALE: 1/8” = 1’ - 0”

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GUARDIAN MODULE

SECTION SECTION PERSPECTIVE EXPLODED AXON CORRUGATED METAL ROOF

3”X3.5” C-CHANEL

METAL TRUSS

CONCRETE BENCHES FOR GUARDIANS AND OVERFLOW GUARDIAN MODULE SOUTH SECTION SCALE: 1/8” = 1’ - 0”

GUARDIAN MODULE SECTION PERSPECTIVE

6” HSS COLUMN

CONCRETE FLOOR ON METAL DECK

LOAD BEARING MASONRY COLUMN BAR JOISTS

RING BEAM ON 8 “ LOAD BEARING MASONRY WALL

OPERABLE AWNING WINDOWS

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GUARDIAN SECTION EAST SECTION SCALE: 1/8” = 1’ - 0”

BREEZE BLOCK WALL

GUARDIAN MODULE EXPLODED AXON 53

GUARDIAN MODULE

TECHTONICS 6” HSS COLUMN STEEL KNIFE PLATE STEEL PLATE

CONCRETE RING BEAM

8” MASONRY WALL

GUARDIAN BENCH

3

GUARDIAN MODULE ELEVATION DETAIL AT STEEL COLUMN SCALE: 1” = 1’ - 0” CONCRETE FLOOR ON METAL DECK STEEL BAR JOIST

CONCRETE LINTEL

OPERABLE AWNING WINDOW

4 GUARDIAN MODULE AXON DETAIL AT STEEL COLUMN SCALE: 1” = 1’ - 0”

2 GUARDIAN MODULE PLAN DETAIL AT STEEL COLUMN SCALE: 1” = 1’ - 0”

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1

GUARDIAN MODULE WALL SECTION AT STEEL COLUMN SCALE: 1” = 1’ - 0” 55

PROPOSAL MODULE CLUSTER The maternity and guardian modules are organized in such a way that allows the guardians to always be in close proximity to the mothers, while also allowing the different users their own private spaces. The thought behind this was to prevent guardians from waking resting mothers throughout the day and to provide more privacy for mothers who may desire it. The space between the modules provides semi-public outdoor space that links the two modules together while connecting them to the outdoors and rest of the site.

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MODULE CLUSTER

PLAN

MODULE CLUSTER PLAN SCALE: 1/8” = 1’ - 0”

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MODULE CLUSTER

CLUSTER ELEVATION

MODULE CLUSTER ELEVATION SCALE: 3/16” = 1’ - 0”

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PROPOSAL MODULE ARRANGEMENT The site for the MWH consists of a series of module clusters containing the maternity module, guardian modules and gardens organized around central public courtyards and supporting facilities including the kitchen, bathrooms, and open air covered gathering spaces that can be used as an opportunity for educating mothers and their guardians on maternal health as well as personal hygiene and newborn care, etc.

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MODULE ARRANGEMENT

SITE PLAN OPEN AREA FOR DRYING LAUNDRY

MATERNITY MODULE LAUNDRY GUARDIAN MODULE

KITCHEN

BATHROOM

GATHERING + EDUCATION

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MODULE ARRANGEMENT SITE PLAN SCALE: 3/64” = 1’ - 0” 65

MODULE ARRANGEMENT

PLAN DIAGRAMS

MODULE ARRANGEMENT WALKWAY DIAGRAM SCALE: 1” = 50’ - 0”

MODULE ARRANGEMENT MATERNITY + GARDENS DIAGRAM SCALE: 1” = 50’ - 0”

MODULE ARRANGEMENT PUBLIC vs PRIVATE DIAGRAM SCALE: 1” = 50’ - 0”

MODULE ARRANGEMENT GARDIANS + SUPPORT DIAGRAM SCALE: 1” = 50’ - 0”

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PUBLIC SEMI-PUBLIC SEMI-PRIVATE

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MODULE ARRANGEMENT

GUA

SITE SECTION PERSPECTIVE

RDIA N SEM

I-PU B

LIC O

UTD

OOR

MAT ERN IT Y M O DU

LE

PUB

LIC G

ATH ER

ING

A ND

EDU C

ATIO N

MAT ERN IT Y M

ODU

LE

GUA RD I A

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N

MODULE ARRANGEMENT SITE SECTION PERSPECTIVE SCALE: 1” = 20’ - 0”

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MODULE ARRANGEMENT

SITE DIAGRAMS

MODULE ARRANGEMENT SOLAR POTENTIAL DIAGRAM SCALE: 1” = 50’ - 0”

MODULE ARRANGEMENT WATER RUNOFF DIAGRAM SCALE: 1” = 50’ - 0”

MODULE ARRANGEMENT PREVAILING WINDS DIAGRAM SCALE: 1” = 50’ - 0”

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MODULE ARRANGEMENT VEGETATION DIAGRAM SCALE: 1” = 50’ - 0”

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MODULE ARRANGEMENT

MODULE ARRANGEMENT KITCHEN WATER CORE DIAGRAM SCALE: 1/8” = 1 - 0”

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KITCHEN AND BATHROOM WATER CORE DIAGRAM

MODULE ARRANGEMENT BATHROOM WATER CORE DIAGRAM SCALE: 1/8” = 1 - 0”

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DESIGN REFLECTION

RESEARCH INTENT, RESULTS, CONSIDERATIONS FOR FUTURE DEVELOPMENT

I believe that my proposal for expanding the maternity waiting home typology is one that would benefit the women that it aims to serve while doing a better job at enticing women to take advantage of its facility. We know that the current prototype for Maternity Waiting Homes is greatly under utilized due to its lack of comfortability, privacy, and features that aim to increase user satisfaction.

My research was focused on understanding what those features are that will attract women to properly utilize the facility as well as understanding how these features could best be built and organized in this setting. The results of my project I believe reflect my understanding of the program and ideal accommodations to best serve their needs as a user during their stay. However, I believe I was lacking in my research and thus made some assumptions in the design process as to the organization that would best benefit the women as well as some of the technical building strategies that would help make the constructability of this facility the most feasible, economical, and beneficial to the local community. Given the luxury of more time, I would have liked to figure out the constructability of this facility and understand where all of the materials would be coming from as well as what kind of costs it would require.

In terms of design, I would have liked to have spent more time really figuring out how the water on site is being managed. At this point in time I have only made suggestions as to the slope directionality of the roofs in terms of water mitigation but would have loved to have gotten into detail on how it is being harvested on site and used in the kitchen, laundry, and bathroom facilities. I equally would have liked to have spent more time understanding how the light is working on the site and calculating the solar collection potential. In terms of overall design decisions, it would be great getting feedback from people who work in the medical profession in Malawi on if they think my design proposal would be beneficial to the healthcare system there, as well as hearing from women on whether or not they would find the space comfortable and could see themselves utilizing the space in the future.

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Lohela, T. J., Campbell, O. M., & Gabrysch, S. (2012). Distance to care, facility delivery and early neonatal mortality in

Malawi and Zambia. PloS one, 7(12), e52110. doi:10.1371/journal.pone.0052110 Machira, K., & Palamuleni, M. (2017). Factors influencing women’s utilization of public health care services

during childbirth in Malawi Public health facility utilization. African Health Sciences, 17(2),400–408.

Malawi aims to improve quality of care for mothers and new babies. (n.d.). Retrieved from https://afro.who. int/pt/node/2536?country=39&name=Malawi

BIBLIOGRAPHY

Mcintosh, N., Gruits, P., Oppel, E., & Shao, A. (2018). Built spaces and features associated with user satisfaction in

maternity waiting homes in Malawi. Midwifery, 62, 96-103. doi:10.1016/j.midw.2018.03.020 Newborn. (n.d.). Retrieved from https://afro.who.int/health-topics/newborn Regine Unkels, Abigail Kazembe, & Broek, N. D. (2017, July 12). Factors associated with maternal mortality

in Malawi: Application of the three delays model. Retrieved from https://bmcpregnancychildbirth. biomedcentral.com/articles/10.1186/s12884-017-1406-5 Seda, Edwin (2016, July 02). Kasungu Maternity Waiting Village / Mass Design Group. Retrieved from http:// www.archidatum.com/projects/kasungu-maternity-waiting-village-mass-design-group/ Speizer, I. S., Kim, E. T., Lemani, C., Tang, J. H., & Phoya, A. (n.d.). Evaluation of a maternity waiting home

and community ... Retrieved from https://bmcpregnancychildbirth.biomedcentral.com/track/ pdf/10.1186/s12884-018-2084-7

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