KL: Alternative and Complementary Healthcare Centre (KLACHC) in Malaysia

FINAL DRAFT

By Farhana Mohammed Isa

KUALA LUMPUR HOSPITAL MAIN ENTRANCE

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[ Research Background] The popular demand of opinions and alternative medicine medicine besides choosing the best treatment and specialist of conventional healthcare centre in public society, is where the integration of design and innovations of alternative and complementary healthcare centre is needed in Kuala Lumpur city centre. It will be a platform and centre for all the practitioners as well as students to give the best treatment with standards and regulations set

by Ministry of Health to unsure the genuine product use and certified practitioners give treatment to public. The centre also will serve and help the conventional services of existing hospitals with the complementary medicine and treatments for the betterment of the public health. The centre is also as a hub and exhibit the local product as promoting the local herbal product to be well-known and established in the worldwide market. At the same time, it will create a hygiene space, sustainable design and different hospital atmosphere of Kuala Lumpur.

TABLE OF CONTENTS PART 1 : Defining the Problem 1.1 Defining the Topic 1.2 Defining the Main Subject 1.3 Problem Statements 1.4 Design Objectives 1.5 Design Hypothesis PART 2: Design Brief 2.1 Case Studies 2.2 Architectural Program 2.3 Site Studies 2.4 Space Requirements

Alternative and Complementary Medicine in Malaysia Complementary Medicine Dietary supplement

Chinese Traditional Medicine Acupuncture Qigong

Malay Traditional Medicine Malay Massage Postnatal care

Homeopathy

Indian Traditional Medicine Ayurveda

Herbal Medicine

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PART 1 : Defining the Problem

1.1 [ Defining the Topic ]

In the Year 2010, Malaysia with a total population of 28.3million, diversities in traditional medicine practices, one of the 12 countries in the world with mega diverse bio-resources, 185,000 species of fauna, 12,500 species of flowering plants, 1,100 species of ferns are where the great opportunity of increasing expenditure for local herbal products, the need of cheaper alternatives to current therapies and the need of exploring the newer therapies for chronic disease such as HIV, Hepatitis, Cancer, and etc. www.tcm.moh.gov.my (See Appendix)

1.2 [ Defining the main Subject ] The proposal of KL: Alternative and Complementary Healthcare Center aims to house all the alternative and complementary medicine in Malaysia as one stop centre, at the same time to promote the local herbs and therapy treatment and services to public, as well as to become a center of learning and research for future students, practitioners and public. (See Appendix 1 ) Problem Statement

1.3 [

]

This project is to integrate alternative and complementary medicine in General Hospital Kuala Lumpur into the mainstream as well as to rejuvenate the HKL master plan for future sustainability to be one of the teaching hospital of alternative and complementary medicine in Malaysia.

[Research Questions]

1.4 [Design Objectives]

1. How can architecture and built environments create a space of opportunity for public, practitioners and students to deliver the expertise in alternative and complementary medicine? [ DESIGN + INNOVATIONS + SUSTAINABLE] 2. How to built a centre with the standards imposed by the Ministry of Health and World health organisation for the alternative and complementary medicine? [RULES AND REGULATIONS] 3. How can alternative and complementary medicine be linked and connected with conventional hospital as mainstream with the ideas of healing environment and universal design ? [SPACE PLANNING] 4. Could this centre incorporate the alternative medicine courses, without local highly depend on university courses abroad with higher tuition fees or learn with uncertified practitioners? [EDUCATION] 5. What should be integrated to the hospital design to promote Asian medicinal practice of health tourism to the international level in the alternative and complementary medicine division point of view? [ ECONOMY]

[Aims]

To create a place or center which house all the local alternative and complementary medicine, at the same time creating a healthy , sustainability and hygiene space in built environment for the society. It is to promote health tourism, standardization halal product of alternative healthcare and medicine. The aim is also to provide the best public infrastructure to society, integrated Traditional and Complementary Medicine (T&CM) into the Malaysian Healthcare System and the centre can be a hub of research and development to Ensure Quality and Safe Use of T&CM practices and products to attain optimal potential in healthcare delivery

[Objectives] 1. To create spaces that provides opportunity for alternative medicine practitioners 2. To provide a cleaner, better services (WHO Standard), and easier access to the general public 3. To create quality spaces that fulfills the standard requirement of an international health facilities for alternative medicines centre 4. To design a hub for alternative medicine to linked to mainstream health facilities.

5. To design an institution that offer alternative medicine courses that integrates with hospital

1.5 [ Design Hypothesis]

A new healing and curing treatment and environment can be achieved trough integration of alternative and complementary healthcare centre in Kuala Lumpur Hospital. It will be a leading hospital that promote local services and products to international level.

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[ CONCEPTUAL DIAGRAM ] Go global?

International level

Local product

Second opinion

Better health Better workforce

ISSUES + OPPORTUNITY

Public awareness + wellness Healing environment

Research + development

Public+private universities

Health tourism

Cultivating Malaysian heritage

Malay massage Chinese acupuncture

Supporting facilities + integration

Economic status Practitioners + specialist

Indian ayuverda Islamic medicine

Local + international expertise

Diagram of issues/problems and the opportunities of this project. Source: Author, 2011

[ RESEARCH METHODOLOGY]

Diagram of research methodology. Source: Author, 2011

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[ REGULATING ALTERNATIVE MEDICINE ]

1.1 [ Defining the Topic ]

The use of traditional and complementary medicine is becoming more widespread. There needs to be clear regulations to address the many issues surrounding such practices (Dr Milton Lum, 2008) peer influences Lower costs

cultural health conscious

availability Educational standards, registration and licensing T/CM products Rural area

natural

middle- and high-income groups Popular interest

Alternative Medicine in Malaysia

T/CM practice

limited

Efficacy and safety issues unsubstantiated

regulation evidence

university

quality

[ WHY SHOULD WE CHANGE? ] Integrated Traditional and Complementary Healthcare Center in national healthcare: Malaysia Experiences . Source: Ramli Abd. Ghani (2009), a Doctoral thesis on Integrated Traditional and Complementary Healthcare Center in national healthcare: Malaysia Experiences , Ministry of Health, Malaysia paper presented for NORPHCAM Research Conference, Brisbane, Australia.

Side effects of drugs

The combination of Mainstream Medicine with Traditional and Complementary Medicine reduces drug side effects

Focus is on health & healing rather than disease & treatment Possible cost-savings

Promotes Individual responsibility & empowerment

REASON FOR CHANGE Consumer driven health care system

Involves doctors & patients working to maintain health by focusing on lifestyle factors such as diet, exercise, quality of rest & sleep & nature of relationships

T&CM has been practiced since 15th Century in Malaya.

In Malaysia 69.4% population used Traditional and Complementary Medicine.(IMR/IHSR survey 2004)

View patients as whole people with minds & spirits as well as bodies 6

[ Terminologies ] Kuala Lumpur [ WHY + WHERE ] Kuala Lumpur is the capital and the largest city in Malaysia by population. The vision of ‘A World-Class City’ encapsulates the ambition to make Kuala Lumpur a city that will assume a major global and sub-global role for the benefit of all its inhabitants, workers, visitors and investors. As a world-class city, Kuala Lumpur must also ensure that the infrastructure, environment, city management and cultural, social and community facilities meet the highest expectations of the majority of its residents, workers, visitors and investors. The City must be functional, livable and impart a sense of community and belonging. In addition, it must also provide a clean, healthy, safe and caring environment that caters to the needs of all. The City needs a wide range of employment and business opportunities, education, training, sufficient quality housing for all income groups and well designed, easily accessible social, sports and recreational facilities. It is of great importance to ensure that the needs of future generations are not compromised by decisions or developments related solely to present day issues.

This is relevance to the promote health tourism (Kuala Lumpur Structure Plan 2020).

Healthcare [HOW] Healthcare or health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers. It refers to the work done in providing primary care, secondary care and tertiary care, as well as in public health.

1.1 [ Defining the Topic ] Appendix

What is traditional medicine?

“Traditional medicine as define as diverse health practices, approaches, knowledge and beliefs incorporating plant, animal, and/or mineral based medicines, spiritual therapies, manual techniques and exercises applied singularly or in combination to maintain wellbeing, as well as to treat, diagnose or prevent illness.”

WHO Traditional Medicine Strategy 2002-2005 What is complementary medicine?

“Complementary medicine also sometimes referred to as nonconventional or parallel medicine, are used to refer to a broadest of health care practices that are not part of a country’s own tradition, or not integrated into its dominant health care system.”

WHO Traditional Medicine Strategy 2002-2005 What is traditional and complementary medicine?

“Traditional and complementary medicine means a form of healthrelated practices designed to Center [HOW] prevent, treat and / or manage A point or place that is equally distant from the sides or outer illnesses and / or preserve the boundaries of something; the middle mental and physical well-being of individuals and includes such practices as traditional Malay KL Alternative Complementary Healthcare Center medicine, traditional Chinese medicine, traditional Indian medicine, homeopathy and complementary therapies and excludes medical or dental practices utilized by registered medical or dental practitioners.

T&CM Division, Ministry of Health, Malaysia 2007 7

[ issues + challenge]

1.1 [ Defining the Topic ]

In the Year 2010, Malaysia with a total population of 28.3million, diversities in traditional medicine practices, one of the 12 countries in the world with mega diverse bio-resources, 185,000 species of fauna, 12,500 species of flowering plants, 1,100 species of ferns are where the great opportunity of increasing expenditure for local herbal products, the need of cheaper alternatives to current therapies and the need of exploring the newer therapies for chronic disease such as HIV, Hepatitis, Cancer, and etc

Appendix

For the past decades, traditional medicine has made significant contributions to the health care of our people. Traditional medicine continues to be patronised by the community to treat disease and maintain health. It is widely acknowledged that the use of Traditional treat maintain and / or Complementary Medicine (T/CM) is widespread and increasing. natural Malaysia’s rich tropical biodiversity is a reliable source for natural health g o v e r n m e n t products and the government is now addressing its full potential. global interest

demand tropical

Since independence, Malaysia has established and developed a modern healthcare system, which all Malaysians can be proud of. Meanwhile biodiversity quality complementary medicine has also taken root in Malaysia. The growing and safety global interest and demand for natural healthcare and the widespread medicine use of T/CM in this country, necessitates a new approach to the modern development of T/CM. This is consistent with the paradigm shift in mainstream healthcare that is taking place throughout the world. The World Health Organisation (WHO) is aware of the important role played by T/CM in preventive, promotive and curative aspects of health for a large proportion of the population, especially in developing countries, and advocates tapping its usefulness. It therefore encourages member states to support T/CM and the continuous evaluation, formulation of policies with appropriate regulations suited to their specific national health systems.

Based on nationwide survey conducted in 2004 regarding Traditional and Complementary Medicine utilization by the Malaysian public, the prevalence of the population who has ever used T/CM in their life time is 69.4 % ( 67.6 % - 71.2 %). 55.6 % ( 53.8% - 57.4%) of the population reported that they have used T/CM in the last 12 months prior to the survey. This could well be gross under-reporting, as studies around the world have shown that more than 40% of the population in many countries are using T/CM for their healthcare needs. The Ministry of Health has taken a positive and proactive approach towards T/CM to ensure its quality and safety for the consumers. It supports efforts to integrate T/CM with modern medicine and will introduce it, incrementally where appropriate, into the mainstream of our national health system.

National Policy of Traditional and Complementary Medicine, Ministry of Health Malaysia, Second Edition.2007

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[ issues + challenges]

1.1 [ Defining the Topic ] Appendix

[Networking facilities]

Research Question 1

Establishment of referral centre(s) with networking facilities for the practice, training, education, product and research development of T/CM by the Practitioner Bodies. The development of this national policy on T/CM in Malaysia will help strengthen the role of T/CM in our national healthcare system and complement our efforts towards an integrated healthcare network for the benefit of both the healthcare providers as well as the public.

National Policy of Traditional and Complementary Medicine, Ministry of Health Malaysia, Second Edition.2007

[ world health standards]

Research Question 2

Countries face major challenges in the development and implementation of the regulation of traditional, complementary/alternative and herbal medicines.

These challenges are related to regulatory status, assessment of safety and efficacy, quality control, safety monitoring and lack of knowledge about TM/CAM within national drug regulatory authorities.

National policy on traditional medicine and regulation of herbal medicines WHO , Geneva, 2005

[1Care System]

Research Question 3

The reforms were being planned for the healthcare system is namely the 1Care System. The 1Care would continue the legacy of universal coverage but with the additional benefits of an integrated and personalized healthcare delivery system. This would improve affordability and sustainability because a single healthcare practitioner would be charged with the needs of each individual and family. This improves medical history records and improves doctor-patient relationship, saving time as well as lives as doctors would be more informed on their patients needs and history.

Reported by Nishyodhan Balasundram ,2011 of the lecture note from Datuk Seri Liow Tiong Lai, Datuk Zakaria Sulong & Dr. Rosman Abdullah “The Malaysian Healthcare System: Changes to Come”

[Research & development]

Research Question 4

“In 2001, herbal industry gives major contribution to the country, RM2bilion to the economy and in the past eight years, the industry's contribution has increased four-fold or RM8 billion.

Local universities are also increasingly aggressive conduct various studies on herbs such as Universiti Teknologi Malaysia UTM, find compounds in which control obesity and is expected to hit the market soon. “ Herbal industry produces many new entrepreneurs, 2009

[Herbal Industry]

Research Question 5

“The potential of herbs in curing diseases and maintaining good health there is a great return on investment. Continuing efforts are needed to develop the herbal industry in the country . This is done not merely to produce herbal products but also to promote biological heritage products .We would like to see herbal products as icon of Malaysia to attract tourists.”

Sakinah Yaakob, East Coast Economic Region (ECER) Secretariat, 2008

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[ TCM Services ]

2.2 [ Architectural Program]

Provide spaces for treatment

Provide spaces for learning Figure2: Source, adapted from Traditional and Complementary Medicine Division blog, www.tcm.moh.gov.my/blog , retrieved 24th July 2011

[ TCM Education ] 13 STANDARD AND CRITERIA T&CM MODALITIES 1.

2.

Bachelor in Traditional Chinese Medicine Bachelor in Traditional Chinese Medicine (Acupuncture) Bachelor in Malay Medicine Bachelor in Complementary Medicine (Natural Medicine) Bachelor in Complementary Medicine (Chiropractor) Bachelor in Homeopathy Bachelor in Ayurvedic Medicine Diploma in Acupuncture Diploma in Malay Massage Diploma in Islamic Medical Practice Diploma in Aromatherapy Diploma in Reflexology Diploma in Natural Medicine

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4.

5.

6.

7.

8.

9.

10.

11.

12.

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KL:ACHC SERVICES & TREATMENT ZONE EXHIBITION INSTITUTION R&D COMMERCIAL ZONE HERBS PRODUCTS HEALING GARDEN FITNESS AREA

Source, Traditional and complementary medicine, Ministry of Health, Malaysia www.tcm.moh.gov.my

[ Healing products ] i. ii. iii. iv. v.

Fruits and vegetables Spices and condiments Vitality and virility Immune system Aromatherapy and essential oils

Source,Healing Herbs of Malaysia, Felda, 2006

Provide commercial and exhibition spaces

Provide outdoor spaces for exercise and fitness activities

[ Healing outdoor environment ] i. ii. iii. iv. v.

Reflexology path Healing and sensory garden Herbs and spices garden Fitness stations Open space for tai chi, yoga, qigong

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[ key Location]

1.

2.

3.

4.

Key Location Key Plan Site Plan Location Map

2.3 [ Site Studies]

1

[ key plan]

Approximately

7.5 acre 30485m²

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[ Site plan]

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[ Site Descriptions]

[ Location Map]

The 150 acres of prime land of Jalan Pahang, Kuala Lumpur is where Hospital Kuala Lumpur is situated. It was opened during 1870 as a district hospital and have gone through 4 phases of renovations and still upgrading their facilities until now. HKL is been chosen as a potential site because of its location at the city of KL as means of attractions. The site has many advantages such as near to public transportation, just 5minutes walk from Chow Cit LRT. It is also situated near by National Theatre, National Art Gallery, Titiwangsa Lake, and Kampung Baru village, and Sports Stadium that make it more viable..The HKL started functioning towards teaching hospital and specialist centre started on 1973 until now, and expanding their wings of supporting facilities, such as National Heart Institute (IJN),National Blood Centre and National medical academy.(See Appendix)

4 KLCC

[ Site Context ] Dietary Dept

Psychiatric , neurosurgery and neurology dept.

Orthopedic clinic Stadium Mosque

Condo

KL international Hotel

Pediatric Dept.

KL Tower

UKM

Grand Season hotel Chow Kit LRT

UUM

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[issues on site]

2.3 [ Site Studies]

[ Traffic + circulation ]

Appendix

Bus/taxi stand KL Monorail Ingress/egress highway Intercity road Two way circulation One way circulation

[ Inadequate parking bays ] Opportunity: the improvement of public transport in a future will reduce the private car from entering site

0m

[ Open space + parks] Opportunity: Collaboration of parks with the future centre can incorporate with the physical outdoor exercise

100m

200m

[ Building typology] Housing Shop lots Office Government land Recreation/vacant land Malay reserve Opportunity: To enhance and revive the Kampung Baru land and generate income to people with the collaboration of local medicine 12 products

2.3 [ Site Studies] Appendix

[ Linkages ] from the site to other buildings 1

2

3

2 1

4

3

Existing linkage All pedestrian linkages are covered and according to universal design standards. But, there is still the lack of safety because the internal road is heavy use during day time Potential solution: Despite zebra crossing, the design of bridge linkage is proposed.

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WHO + WHY [ The Team ]

[Client Vision] Appendix

[ The Programme ]

FUNCTION | People.Relationship.Activities

Malaysian Chinese Medical Associations (MCMA)

Federation of Chinese Physicians and Medicine-Dealers Association of Malaysia (FCPMDAM)

Federation of Chinese Physicians & Acupuncturists Association of Malaysia (FCPAAM)

Source: Author, 2011 Diagram adapted by Pena & Parshall (2001) problem Seeking, 4th Edition, an architectural programming primer,: John &Wiley Sons,USA.

Malaysian Association of Traditional Indian Medicine (PEPTIM)

[ The Site ] FORM | Site.Environment.Quality

Malaysian Homeopathic Medical Council (MPHM)

Persatuan Kebajikan dan Pengubatan Islam Darussyifa’

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2.1 [ Case Studies]

PART 2 : Design brief

2.1.1 Australian Institute of applied Sciences(AIAS), Australia [ EDUCATION + TRAINING + SERVICES ]

Appendix

Concept: AIAS is providing natural health courses for more than 20 years, such as natural medicine, beauty therapy, sport and fitness, hair dressing, massage therapy, aged care and hospitality college. AIAS also provides clinic and salon services for public and students. The campus includes state-ofthe-art facilities such as modern labs and classes, extensive library, relaxation facilities (study area, gardens) , ample www.aias.com.au parking.

Strategy : Aims as a one stop centre of learning and services for student and public.

2.1.2 MINES WELLNESS CITY, Selangor, Malaysia [ HEALTH+ WELLNESS RESORT]

www.mineswellnesshotel.com.my

Concept: An eco-wellness development of Mines Beach Resort Sdn Bhd. Mines Wellness City provides for those that seek resort style health services, wellness getaway, traditional therapies, fitness, health food, retail, green homes, physiotherapy and rehabilitation.

Strategy : aims as a one-stop destination for both modern and complementary medicine for local and international people with local medicine practices

2.1.3 The Oriental Medical Science Museum, Korea [ EXHIBITION ] Concept: The Oriental Medical Science Museum is located across from Gyeongdong Market, famous for selling oriental medicinal related products. The Museum has oriental Medical Science exhibition hall, an Experience Oriental Medicine hall, seminar rooms, Children Experience Program Visitor Lounge, Museum Shop, It Center + Library, Visitor Experience Room an other supporting Facilities Strategy : Aims to educate people on herbal medicine of korea

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2.1.4 Herb Island, Korea

[ RECREATION + COMMERCIAL]

2.1 [ Case Studies] Appendix

Concept: The Herb Indoor Botanical Garden offers over 180 different herbs while the Outdoor Botanical Garden showcases a dazzling array of herbs surrounded by nature. Additional attractions include the Herb Museum, Living & Herb Exhibition Hall, Herb Restaurant, Herb Barbecue Restaurant, a café, a bakery, a gift shop, Aroma Therapy Center, Venetia Village, Herb Studio , Mini Zoo, and an outdoor performance hall.

Strategy : Aims as a full relaxation and healing getaway place during weekend with affordable price.

2.1.5 TCM + rehabilitation dept – Putrajaya Hospital [ HOSPITAL]

Concept: TCM Unit started to operate on 3rd March 2008 by offering traditional Malay massage and acupuncture treatments for post stroke and chronic pain patients. The treatments intend to help improve stroke patients’ rehabilitation and reducing the pain in chronic pain patients.

Later on 1st October 2008, the unit has added herbal treatment to cancer patients as an adjunct to conventional cancer treatment. Malay traditional post natal care is introduced on 17th July 2009.

TREATMENT PROVIDED A) TRADITIONAL MALAY MASSAGE B) POSTNATAL MASSAGE C) ACUPUNCTURE D) HERBAL TREATMENT

Strategy : Aims to integrate T&CM into the Malaysian modern healthcare system.

2.1.6 Kyung Hee University Oriental Medical Hospital [ HOSPITAL+ EDUCATION] Concept: is based on Traditional Chinese Medicine(TCM), also called Korean Traditional Medicine. Nowadays in Korea there is a great amount of experimentation in fusion medicine, which combines traditional medicine with modern medicine in many ways. The education system of oriental medicine in Korea is a 6 year course which is equal to that of western medicine in Korea.

The curriculum includes Western medicine, Chinese medicine as well as Korean medicine. When students graduate from medical college they take a national examination in order to receive the oriental medical doctor's license. Graduate schools of oriental medicine confers doctoral and master degrees. The Korea Institute of Oriental Medicine established in 1994 is a national institute for research from the basic principles to the clinical applications of oriental medicine. In Korea, there are 11,000 oriental medical doctors, 130 oriental medical hospitals, and 7,000 oriental medical clinics to diagnose and treat patients. The Oriental medical16college of Kyung-Hee University was first established in 1965 and as of February 2005, has 4,556 graduates.

[ Conceptual Functional Spaces]

2.4 [ Space Requirements] Appendix

Entry / reception Gallery Souvenir / Herb products

Ground Floor Visitor experience room Registration

Waiting lounge Core Herb cafe

Healing outdoor spaces / pond / garden

Billing Consultation Room

bakery Open space – Yoga, Qigong Services

First Floor IT Centre / Library

Administration Office

Auditorium Seminar hall Consultation Room

Roof garden

Core Research & development

Second Floor Auditorium Classroom

IT Centre / Library Roof garden

Seminar hall Classroom Core Research & development

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[ References] Sakinah Yaakob,( 2008,September 23) Malaysia has potential to be region s herbal hub, New Straits Times, pp42

Khairunnisa Sulaiman, (2009, February 13) Herbal Industry produces new entrepreneurs, Utusan Malaysia, pp10 Ernst E. (1995). "Complementary medicine: Common misconceptions". Journal of the Royal Society of Medicine 88 (5): 244–247 Bratman, MD, Steven (1997). The Alternative Medicine Sourcebook. Lowell House. p. 7 Ramli Abd. Ghani (2009), a Doctoral thesis on Integrated Traditional and Complementary Healthcare Center in national healthcare: Malaysia Experiences , Ministry of Health, Malaysia paper presented for NORPHCAM Research Conference, Brisbane, Australia.

WHO General Assembly on TM/CAM 2003 http://www.myhealthcare.gov.my/ http://corporate.tourism.gov.my/

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