AFYA MTAANI-Adaptable Healthcare

AFYA MTAANI ADAPTABLE HEALTHCARE. In an honest servitude, we must allow ourselves to be entirely incomplete. We must set aside a part of ourselves that reacts to, empathizes with, and is filled by those we serve.

The AFYA MTAANI medical unit is an impressionable architecture which reacts to location,culture, change and the people it serves.

PROBLEM STATEMENT-AN HIGHLIGHT ON INADEQUACIES OF HOME AND HEALTH CARE DURING COVID 19 AFYA MTAANI ADAPTABLE HEALTHCARE. In the last months, the already daunting inadequacy of healthcare systems in Kenya has evolved into an outright emergency.

The government in the month of June launched the Home Based Isolation and Care Guidelines, for patients with Covid 19 in the management of the increasing numbers and the anticipated surge in cases.

Currently, the available data in the country shows that 78 per cent of the infected persons, admitted in hospitals are either asymptomatic or mildly symptomatic and therefore can be managed at home provided proper laid down procedures are followed.

Home-based care in the informal settlements where households share small spaces will require identification of institutions within the community that meet the recommendations for providing such care and herein. ‘Nyumba Kumi’ Initiative can play a role in supporting the care in the community. Is this sufficient?

Cities and Major towns in Kenya

13 55/95 10/32 21/40

IN EVERY 10

IN EVERY 2

Households living in these Households living in these cities live in informal cities are poor settlements

BY FORMODE

CONTINUITY OF HEALTH SERVICES DURING COVID 19 PERIOD

PER 100,000 Current ratio per pax of Nurses vs recommended

PER 100,000 Current ratio per pax of Doctors vs recommended

PER 100,000 Current ratio per pax of Clinical Officers vs recommended

Carolina for Kibera (CFK), a local health NGO; health data on continued health and education services in Kibera during the pandemic

Proportion of Poor household Households living in informal areas

Kisumu

62%

49%

Nairobi

41%

43%

Eldoret

30%

69%

Mombasa

26%

59%

Thika

18%

47%

Embu

13%

49%

Kericho

11%

71%

Kakamega

8%

48%

Kitui

6%

74%

Machakos

6%

63%

Malindi

5%

64%

Nakuru

5%

62%

Nyeri

5%

50%

Garissa

2%

47%

INFORMAL HOUSEHOLDS Propotion of households living in informal areas

3 HOUSEHOLDS CAPACITY Distribution of Urban Households by Housing type

3

OUT OF 5 Urban households have access to piped water

INFRASTRUCTURAL CAPACITY Accessibility to drinking water nationally

OUT OF 10 Urban households have no access to toilets

SANITATION (TOILETS) AT NATIONAL LEVEL

>5 KM

>10 KM

>20 KM

IN KIBERA

39.1%

Over 350,000 Residents live in 5 SQ KM

POVERTY LEVELS (% OF TOTAL POPULATION) 36 out of 100 Kenyans are poor

Of Households

19.8%

ROAD NETWORK ACCESSIBILITY

Of Households

7.7%

Of Households

PROGRAM +DESIGN DEVELOPMENT AFYA MTAANI ADAPTABLE HEALTHCARE.

FORMODE

Sustainable and adaptable health services designed specific to community requirements can transform the social economic and environmental well being of a settlement.

Health is a key area that is both cause and symptom of viscous poverty cycle.

Afya mtaani provides medical infrastructure and appropriate system design for off grid,under served communities by understanding the issues of basic health care in informal and rural contexts.

Like the ever rowing versatile and locally compatible nature of trees ,this healthcare unit approaches modularity with a keen focus on the user access,developments and empowerment.

The unit is specially designed to be utilized by governments,NGOs,private entities and individuals that work on critical health based issues in lacking areas especially during this covid 19 pandemic

Incremental Adaptable Growth Modules COVID 19 Intensive Care Unit Nursing space +Observation area/charting rooms Stack Isolation Unit Stand Alone Isolation Units

POST-COVID 19 (Modules adapt based on needs) Doctors room+pharmacy Immunization facility +Cold Storage Basic procedure facility +Lab testing facility Specialised Facility(Dental care/eye care etc)

MODULE DESIGN Breaking down the functions into modules has various positive implications • The design can be easily adapted to varying space availability • The setup can be done depending on fund availability where and entire health Centre need not be constructed all at once • Single Modules can be constructed/Attached to existing infrastructure where only certain additional facilities are required and not entire health facility.

STAKE HOLDER COMFORT AND EMPOWEMNT • patients-ease of access and use • medical staff-organized internal spaces ,ample storage and other support facilities • Funder-flexibility in choosing need and resource based facilities +can opt for incremental growth of health care • Locals-empowerment through livelihoods generation(construction+maintenance) • healthy ,hygienic and comfortable

SUSTAINABILITY • Going local-use of local materials and craftsmanship • Energy-use of passive colling techniques +off grid solar power • Maintenance-Systems that are easy to maintain and replicate in case of damage

BUILD ABILITY AND MODULARITY • Technology-all components can be made by local carpenter and fabricator-no factory /pre-fabrication required • Setup-Systems are simple to understand and to install(and re-install) • Growth-modular system lets one build as per need necessary

UNIQUE SERVICES • Audio Visual aids for health awareness ,education and telemedicine services • GPS equipment that provides information on nearest health service(hospital/pharmacy/ambulance) • Intra Afya Mtaani Server which provides up-to -date information on medical stock between all centers

SYSTEM DESIGN AFYA MTAANI ADAPTABLE HEALTHCARE.

FORMODE

Performance and Design principles

Materials

Foundation Grid

The structural geometry is based on the triangle, the strongest and simplest of structural solutions. A triangular section offers high ceilings to naturally dissipate heat, as well as steep roofing for a fast water run-off. This basic structure allows for a large open-plan system without columns, with flexibility of distribution of spaces over time. Flooring is thin and cool, but where more controlled spaces are required (surgery space, toilets or medic storage) specific materials are used to create a “box in a box system� meeting the specific requirements of the function. This allows for targeted material allocation where necessary and a better use of resources

The materials used for construction are repeated in every module. This helps to keep the material selection as small as possible, as well as interchangeable. The main parts of the structure locally cut and bolt ready at the closest local manufacturer.

All facades are impermeable ply or polycarbonate. If the facade is translucent, the solar shading is derived of local materials covering a rigid modular frame.

The structure of the building is based on a grid of 3,00 x 3,00 m. This provides the use of standard material sizes in every module. Foundations can be concrete or car tire based according to context and the building is raised allowing for eventual flooding. The building structure slides into the foundation structure, permitting the building to be dismantled and moved.

Aluminum

Polycarbonates Effective Heat Deflection

Fast Rain run-off

Formica Elevated Construction for flood resilience

Cross Ventilation

Local wood

EPS Sandwich Panel

Steel Profile

Flexible access connectivity

Frame

Basic Module

The basic frame is composed of steel C sections and square tubes, easily cut to form the basic triangular structure. This basic system is also be easily raised and bolted to trusses to make the first module stable.

It is the simplicity and strength of this system that gives the efficiency in plan to the project

Additions to this basic module can be easily added by continuing the procedure and even allowing for additions once the building is constructed. This adds great flexibility to the project, which permits future growth of services to the community

Frame

Basic Module

Cladding

Modularity

FUNCTION +ADAPTATION AFYA MTAANI ADAPTABLE HEALTHCARE.

COVID 19 SEASON STANDALONE STAND ALONE ISOLATIONUNITS UNIT ISOLATION Asymptomatic patients living in high density ASYMPTOMATIC PATIENTS LIVING Areas unable to (DENSITY self isolate due toIN HIGH inadequate COMMUNITIES UNABLE TO HOME ISOLATE DUE TO INADEQUATE SHELTER WITH THEIR Shelter with their families.

FAMILIES) Each sub module contains two fully contained Isolation units with a small kitchen ,Washroom And a living/bedroom.

The units are mirrored against other COVID 19 SEASON STANDALONE Foldabale each exercise Bed mat the abutting Limiting interaction possibilities with ISOLATION UNITS ISOLATION UNIT neighbor. coach A

( ASYMPTOMATIC PATIENTS LIVING IN HIGH DENSITY COMMUNITIES UNABLE TO HOME Verandah ISOLATE DUE TO INADEQUATE SHELTER WITHDN THEIR FAMILIES) 5

FD

wc

2

3

4

wc

COVID 19 SEASON OBSERVATION AND CRITICAL CARE AREA 4 MODULE OBSERVATION/CRITICAL CARE AREA

( ASYMPTOMATIC PATIENTS LIVING IN HIGH DENSITY COMMUNITIES UNABLE TO HOME ISOLATE DUE TO INADEQUATE SHELTER WITH THEIR FAMILIES)

A critical care unit for symptomatic patients with pre-existing conditions such as Diabetes that need close attendance and monitoring The sub module hosts two isolation unit,Each unit fitted with a hospitable bed,with ventilators And other monitoring equipments.

COVID 19 SEASON The stack units are highly Dependant of a Critical careISOLATION unit,shown next.

UNITS PATIENTS LIVING HIGH The units can( ASYMPTOMATIC adapt based onINneeds DENSITY COMMUNITIES UNABLEUNIT TO HOME ISOLATION And can be incrementally added ISOLATE DUE TO INADEQUATE SHELTER WITH THEIR B

The area of the unit the most frequented is the nursing space for outpatient treatment.

It covers basic medical needs such as patient reception, information and counseling Post covid 19; the care area can adapt and serve as center for small treatments as well as vaccination and other standard procedures.

COVID 19 SEASON OBSERVATION The nursing care zones can be rearranged corresponding to specific SMALL CRITICAL CARE AREA AND needs given the TEMPRATURE EQUIPMENT KITCHENopen plan structure

5

WAITING SPACE

3

2

LINKAGE POSSIBILITY TO ISOLATION UNITS

B

ISOLATION UNIT

DN

NURSING SPACE

wc

wash whb room

Verandah DN 1

2

3

4

5

A

4

3

2

ISOLATION UNIT

1

B

wash room

wc

RAMP UP

WAITING SPACE Verandah DN

LINKAGE POSSIBILITY TO ISOLATION UNITS

CORRIDOR

FD

SUB MODULE

SUB MODULE

kitchenette

INTENSIVE CARE UNIT

CORRIDOR

coach ISOLATION UNIT

FD

D

C

SMALL KITCHEN

5

CONTROLLED STORE ROOM

CORRIDOR

1

FD

Foldabale Bed

WASHROOM Accessed by disabled

FAMILIES)

coach ISOLATION UNIT

exercise mat

D

C

Foldabale kitchenette exercise Bed mat

Verandah DN 1

COVID 19 SEASON ISOLATION UNITS STACK ISOLATION UNIT

wash room

A

wash whb room

4

FORMODE

WASHROOM Accessed by disabled

NURSING SPACE TEMPRATURE EQUIPMENT CONTROLLED STORE ROOM

INTENSIVE CARE UNIT

CORRIDOR

D

C

DN

ISOLATION UNIT

coach

NURSING SPACE

( A SUB MODULE CONTAINS TWO UNITS ISOLATION UNIT EACH FULLY CONTAINED MIRRORED TO AVOID THE ABUTTING UNIT exerciseCONTACT WITH Foldabale BREATHABLE CEILING Bed TO ALLOW FOR STACK mat VENTILATION ,DOUBLE LAYER ROOF PROVIDING ADEQUATE INSULATION AT THE SAME TIME)

RAMP UP

PUBLIC ACCESS

A B

Stand alone module plan 1:50

Stack module plan 1:50

SUB MODULE

4 SUB MODULE THE CARE MODULE ( COMPOSED OF 4 SUB MODULES COMBINED TO FOR THE CARE UNIT WITH ABILITY TO ADAPT INTO AN OUTPATIENT CARE FACILITY)

C

SUB MODULE

( A SUB MODULE CONTAINS TWO UNITS EACH FULLY CONTAINED MIRRORED TO AVOID CONTACT WITH THE ABUTTING UNIT BREATHABLE CEILING TO ALLOW FOR STACK VENTILATION ,DOUBLE LAYER ROOF PROVIDING ADEQUATE INSULATION AT THE SAME TIME)

PUBLIC ACCESS

NURSING SPACE

4 module observation area plan 1:50 D

4 SUB MODULE THE CARE MODULE ( COMPOSED OF 4 SUB MODULES COMBINED TO FOR THE CARE UNIT WITH ABILITY TO ADAPT INTO AN OUTPATIENT CARE FACILITY)

STANDALONE UNIT

WASHROOM

STANDALONE UNIT

ISOLATION UNIT

CORRIDOR

ISOLATION UNIT

INTENSIVE CARE UNIT

Waste Mangment cistern

Stand aloneSTANDALONE module section WASHROOMA 1:50 STANDALONE UNIT

UNIT

4 module observation area section D 1:50

Stack module section B 1:50 ISOLATION UNIT

CORRIDOR

ISOLATION UNIT

INTENSIVE CARE UNIT

FUNCTION +ADAPTATION +GROWTH AFYA MTAANI ADAPTABLE HEALTHCARE.

FORMODE

Adaptable isolation care for symptomatic patients with pre existing conditions

Isolation Unit

Isolation Unit

Isolation Unit

Isolation Unit

Critical care /observation area

Isolation Unit

washroom

Isolation Unit

Waiting area

Washroom accessed by the disabled

1

Temprature controlled room

Temprature controlled room

2 3

DN

corridor

4 5

corridor DN

corridor

5

Intensive care unit

DN

4 3 2 1

Isolation Unit

Isolation Unit

Isolation Unit

washroom

Isolation Unit

Combined Health Facility plan showing the critical observation area and isolation units merged 1:50

Combined Health Facility elevation showing the critical observation area and isolation units merged 1:50

Nursing space

Isolation Unit

Ramp up

Isolation Unit

Nursing space

SUSTAINABILITY+THERMAL PERFORMANCE AFYA MTAANI ADAPTABLE HEALTHCARE.

FORMODE

COVID-19 spreads through direct contact or indirect contact with a contaminated person, object, or airborne droplet. Simple design principles can thus be used to curb the spread of infection and make our health centers, homes, and workplaces healthier for living even today.

Thermal stratification in this built form is enhanced in the geometry of the pitched roof design, causing Stack Effect

Flooring is thin and cool, but where more controlled spaces are required (surgery space, toilets or medic storage) specific materials are used to create a “box in a box system” meeting the specific

Cross Ventilation achieved through narrow plan layout, high ceiling and raised floor Wind driven ventilation, where the air flows into the building due to the differences of air pressure between the outdoor and indoor environment.

Thermal Performance-Stack Ventilation

TThe air in a room is often thermally stratified, and the air temperature at occupant level can be significantly higher than the exhaust temperature.a better use of resources Stack effect is the condition of vertical air movement when the cool air has been warmed up by human activities and operations of indoor machinery, and the warm air move vertically and its discharged from the building through the permanently ventilated openings in the roof’s pitch.

Air entering a building that is not air-conditioned tends to rise, because it warms up and its density decreases, and therefore its weight, is lower than that of the outside air.

The warm air escapes through the opening at the top, and is replaced by the outer, colder and heavier air, which enters from the bottom.

Thermal Performance-Cross Ventilation Natural ventilation is a key design strategy implemented. Airborne transmission is the most dangerous for a few seconds after leaving the host, so ensuring an adequate airflow across spaces is a simple and effective measure to reduce possible infections—though droplets, once they settle on surfaces can remain infectious for much longer Natural light is often overlooked in the prevention of disease outbreaks. Daylight influences air quality, because the high-energy ultraviolet rays in direct sunlight is a natural disinfectant because it breaks DNA bonds and helps to kill germs. Beyond that, natural light has psychological health benefits and contributes to faster recovery. Third, reducing the spread of germs from person-to-person through commonly touched surfaces is key.

NARRATIVE AFYA MTAANI ADAPTABLE HEALTHCARE.

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NARRATIVE AFYA MTAANI ADAPTABLE HEALTHCARE.

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NARRATIVE AFYA MTAANI ADAPTABLE HEALTHCARE.

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NARRATIVE AFYA MTAANI ADAPTABLE HEALTHCARE.

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FORMODE mas con menos Kipkemei Kiplelgo Symon skiplelgo@gmail.com Musyoki Charles Mbatha mbathacharles561@gmail.com Mubothi Brian Murimi mmubothi@gmail.com Njeri Malcom Mwathi mwathimalcom@gmail.com