Flora: Adaptive Reuse Thesis Project

An Adaptive Reuse Thesis Project for Undergraduate Interior Architecture and Design

Hailee Strach - Newschool of Architecture and Design - June 2024

Flora

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Introduction of Flora: A Womens Medical Center A Thesis Presented to The Undergraduate Faculty of Newschool of Architecture and Design.

In Partial Fulfillment of The Requirements For The Degree of Interior Architecture and Design.

By Hailee Strach June 2024 San Diego, CA.

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Flora

A Thesis Presented to The Undergraduate Faculty of Newschool of Architecture and Design.

By Hailee Strach

Approved By:

Undergraduate Chair:

Date:

Studio Instructor:

Date:

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To my parents, Amber and Brett Strach.

You are the hardest working people that I know. Thank you for your unconditional love and support.

Special thanks to the Newschool Faculty for the generous commitment to helping us succeed, to my fellow Newschool classmates and best friends: Nicole, Paulina, Jess, and Victoria for the continuous support and memories, and to Myles, my wonderful boyfriend.

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Abstract

Flora is an adaptive reuse project with a focus on women’s health and wellness - as well as a second focus on interior wellness solutions - in order to create an interior environment that promotes wellbeing in all forms. The existing building of 501 West Broadway is currently an office building with vacancy issues post Covid-19, and is hypothetically transformed into a nonemergency medical building for women (or anyone assigned female at birth, regardless of gender identity). Firstly, this project aims to tackle the office vacancy rates that are a result of the nationwide sweep of a hybrid or virtual work environment as a result of the global Covid-19 pandemic. Secondly, this project highlights the fundamental and societal flaws in United States healthcare regarding

women’s health and wellbeing., and aims to provide a safe space for women to be treated - both mentally and physically - with complete respect, care, and attentiveness to any and all ailments. This also includes a Level I (basic care) birthing center, and a low-risk mental health residency program.

Lastly, the reconstruction of 501 W Broadway would require that all chosen materials provide guests with as little chemical composition as possible in order to create a physically healthy environment. This includes low - or zero - volatile organic compounds in paints, finishes, flooring, and furniture - as well as environmentally healthy solutions for thermal comfort, lighting, air quality, acoustics, and more.

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About the Title Flora: the Latin word for “flower” and also the Roman goddess of flowers.

The inspiration behind naming the women’s medical center after flowers came from several places. The first inspiration was nature itself. Nature is relentless, strong, and beautiful. I wanted to stick to this path of inspiration because I wanted the strength and beauty of nature to represent the strength and beauty of women and female bodies. More specifically, flowers are delicate - yet resilient - and beautiful, all while having different shapes, sizes, and characteristics from one floral species to another. Flowers also have a long history and association with women. Female healers of medieval and early-modern societies used flowers and other plants for their unique medicinal properties. Later on, one of the few topics women were allowed to study in the 18th - 19th century was the study of botany. This study quickly became

a part of female culture and was widely associated with women and femininity. Several influential women of the time, such as Elizabeth Blackwell, were able to publish books that contained etched, engraved, and hand-colored illustrations of plants and flowers, along with their medical uses. This helped set up the foundation for the flowers / female association that carries on today. This led me to Flora, the Roman goddess of spring and flowering plants. Flora represented the coming of spring, and the fertility of the land. She was depicted and young, beautiful, and healthy. Her role in fertility specifically represents the birthing center portion of the women’s medical center. In the context of my project, Flora is an overarching term that represents women’s strength, resiliency, beauty, and historic connection to nature.

© 2024 - Hailee Strach - All Rights Reserved.

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Table of Contents.......................

Chapter

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Introduction of Flora

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Approval Page

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Dedication

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Abstract

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About the Title

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Research: Western Medicine’s Origins and Flaws

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Adaptive Reuse and The Changing Work Environment

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Medicine and Male Bodies

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Adaptive Reuse & San Diego

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Women and Medical Mistreatment

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Medical Care & San Diego

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United States Maternal Mortality

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Existing Building

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Site

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Anonymous Experience Survey

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Programming

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..........................................................

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Flora: Level 1

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Flora: Levels 12-15

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Level 1: The Public Floor

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The Birthing Center

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Lobby

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Extended Stay Birthing Suite

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Mimosa: Restaurant & Bar

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Flora: Levels 16-20 & Conclusion

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Mental Health Residency 54 Residency Suite

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Social Space Interior Garden

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Conclusion & References 64

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Research: Western Medicine’s Origins and Flaws

“One of the biggest and most flawed assumptions in medicine is this: if it makes sense in a male body, it must make sense in a female one.”

-Alyson J. McGregor, MD. From her book Sex Matters: How Male-Centric Medicine Endangers Women’s Health and What We Can Do About It.

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Medicine & Male Bodies

“64%

of women who died after a heart attack exhibited no previous symptoms.”

Male dominance in society has been apart of almost every major aspect of life. Education, politics, wealth, and even medicine are examples of this. Going back to the third century BCE, female bodies were described as similar to male bodies - but with the genitalia turned outside-in. Women during this time of medical separation and distinction were labeled as having faulty, defective, and deficient bodies as compared to men.

Women were characterized by their ability to reproduce. This served as the purpose of their anatomy, and therefore the purpose of their existence since they were “inferior” to the mental and physical capabilities of men.

These views were ingrained into medicine as it moved through history, and personal biases and sexist ideologies were dominating the minds of doctors - who were male. The idea that women were physically and mentally inferior to men affected the treatment and the research development of women’s health. Moving forward to modern medicine, women and female bodies - despite gender identity - have suffered mistreatment for centuries at the hands of those who carry these ingrained beliefs - both men and women.

The presence of symptoms has gone unnoticed for many women and females as a result of the medical field believing that women are weak, unable to withstand pain, exaggerating, lying, or simply don’t understand their own bodies. There are many layers and factors that play a role

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in this mistreatment, including race / ethnicity, gender identity, age, economical status, and more. As an overarching example, heart attacks in women are commonly overlooked, even though heart disease is the number one leading cause of death for women in the United States. This results is sudden and “unexpected” death for many of the affected women. In fact, the Journal of the American Heart Association, women are more than three times likely to die after a heart attack than men. The CDC also reports that 64% of women who died after a heart attack “exhibited no previous symptoms.” A part of the problem with showing “no symptoms,” is that there most likely were red flags in these women, but doctors were unable to catch them due to heart attack symptoms and signs being based off of male bodies.

One of the other biggest reasons for the absence of heart diagnosis is at fault of the EKG test, responsible for detecting electric signals in the heart. In several cases the EKG test has failed to detect major signs of heart failure in women due to the fact that the test was tested and developed under the male body’s standards. Also, many women never even get sent to get an EKG test because they aren’t displaying “typical” heart attack symptoms. The symptoms of heart attack in a female body are more commonly: chest discomfort, shortness of breath, unusual fatigue, nausea, digestive issues, or brain fog.

Of the same realm of examples, stroke is the third-leading killer of women in the United States - killing twice as many women as breast cancer. Manifestations of stroke in women was only recently discovered, and many physicians still don’t know the differences between male and female symptoms of stroke.

Because stroke can present itself in difficult ways - such as brain fog that comes and goes. Because of the preexisting beliefs in the medical field, womens symptoms of stroke are often brushed off, diagnosed as something else - like anxiety for example - or mistaken for other common ailments such as migraines. A study presented at the American Stroke Association International Stroke Conference noted that women were “43% more likely to report non-traditional stroke symptoms such as pain, changes in mental status, lightheadedness, headache, or other neurological or non-neurological symptoms.” These symptoms are common sensations for women who are having a stroke but less common for men, and may not be detected right away as compared to male symptoms.

1 in 5 Women

will have a stroke.

About 55,000 more Women than Men have a stroke each year.

American Stroke Association 2022

Women should be aware of these symptoms that could indicate stroke: loss of consciousness, general weakness, shortness of breath or difficulty breathing, confusion, disorientation, unresponsiveness, behavioral changes, agitation, nausea or vomiting, hiccups, headache, pain in neck or extremities, and seizures.

43%

“...women were more likely to report non-traditional stroke symptoms...”

When experiencing stroke and heart attack symptoms, it is possible that women have been misdiagnosed with anxiety - as anxiety is the second most diagnosed mental disorder in American women. Anxiety and panic attacks can mimic symptoms of cardiac events, and commonly are not investigated further. Interestingly enough, people with frequent anxiety were 26 percent more likely to have coronary disease and 48 percent more likely to die from heartrelated issues, according to a study from Tilburg University in Holland. Women are twice as likely as men to have an anxiety disorder as well.

These are just a few examples of how complicated diagnosis can be, and how symptoms can present in different ways and manage to go undetected or seen as something else. One of the main issues is that females are being understudied, which is the root of misdiagnosis and even malpractice or mistreatment.

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Women and Medical Mistreatment While understanding that many diseases and illnesses were studied and resolved based on the male body, it is important to note the cruel and unjust torture that Black female and male slaves endured at the hands of medical experimentation. Around the 1840’s and beyond, Dr. James Marion Sims was responsible for forced experimental gynecological surgeries and procedures on three female slaves, without any anesthesia and pain assistance. They were only teenagers, purchased by Dr. Sims, whose names were documented as Anarcha, Betsy, and Lucy. His autobiography recalls performing vesicovaginal fistula repair on Anarcha more than 30 times, leaving her in agonizing pain. The result of his experimentation was

the vaginal speculum, and was used only for white women to assist in pain during procedures. The horrific experience of these three women is just one unfortunate example of the history of medical mistreatment that has been ingrained into United States society. As women and female bodies have become more respected medically, physically, and mentally, it is important and necessary - to understand the history of medical mistreatment, malpractice, and experimentation regarding both men and women in order to correct our actions and beliefs moving forward. Today, many Black women - as well as all other minorities - are still experiencing disrespect and disregard in the medical field. Whether that is as employees, or patients.

2 in 5 Black Americans personally experience discrimination in a healthcare encounter.

Percent who have often or sometimes personally experienced discrimination or prejudice in their healthcare encounters based on their race and ethnicity.

42% Black

21%

5%

Hispanic

White

Beryl Institute /Ipsos PX Pulse Survey conducted August 16- September 23, 2021, among 1,010 U.S. adults.

The purpose of this thesis project is to understand the history and context of medical mistreatment and combine it with modern issues still faced by women, as these issues are resulting in death. To put it simply, women are dying. Women will continue to die at the hands of medical professionals until medical equality, respect, and research is brought up to the same standard at which male medical practices are held. This is not to say that men are not dying, and that men haven’t suffered from medical malpractice and misdiagnosis’s, but to emphasize the need for more priority on the female body’s differences from male bodies. As we stand in the 21st century, there is still an inadequate amount of medical research that involves female bodies. As of

the 2010’s, medical surveys and research documents are still failing to include female subjects which results in the failure to understand female bodily reaction to solutions such as medication trials. What is even less studied is the body of a pregnant woman. The exact changes that the body undergoes during pregnancy not only differ between women, but are understudied in medicine and science. The most common example of this is the Thalidomide drug - an anti-nausea drug used to help pregnant women get through their pregnancy. What was later discovered was the extreme birth defects in the babies caused by this drug. If the body had been further understood and studied, this may have been avoided.

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United States Maternal Mortality Mortality Rate per 100,000 Births

United States New Zealand

23.8 13.6 11.8

South Korea Canada Sweden

8.4 7.6

France

7.0

United Kingdom

6.5

Norway Germany Isreal Japan Australia Netherlands

3.7 3.6 2.8 2.7 2.0 1.2

OECD Health Data 2020

When compared to other high-income nations and developed countries, the United States has one of the highest ranking maternal mortality rates per 100,000 births. The chart above shows this comparison. Out of all the maternal deaths in the U.S., the highest ranking number of deaths occur in Black women, followed by Native American / Alaskan Native, White, Asian and Native Hawaiian or other Pacific Islander, and Hispanic. There are different reasons for the high mortality rates, including physical and mental health issues. A report in 2018 concluded that around 50% of all pregnancy-related deaths were caused by hemorrhage, cardiovascular/coronary conditions, cardiomyopathy, or infection. For Black women, the most common causes of death included preeclampsia, eclampsia, and embolism. For non-Hispanic white women the most common cause of maternal deaths were mental health related.

While the maternal death rate is high for several reasons, it is important to understand as many factors as possible.

Heart disease is a leading cause of death for non-pregnant and pregnant people alike, drawing connections to the bad food and exercise culture of the United States. With the help of female-focused doctors, nurses, and care specialists, as well as allowing medical access to all women no matter race / ethnicity, gender identity, or economical status, pregnant women and females can prevent many of the causes of death presented above. Mental health care and outreach is extremely important during these times and is necessary in order to provide women with the assistance they need to carry out a healthy and happy pregnancy.

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Anonymous Experiences Survey For emphasis on real life experiences, I asked as many women as I could reach out to in real life and over social media to take an anonymous survey asking them about their experiences in the medical world. I asked to list preferred pronouns, age, and race / ethnicity as these can be important factors that may have contributed to mistreatment.

These are the responses I received.

She/Her, Age 32

She/Her, Age 21

“I suffered for a year from horrible pains and infections. I went from doctor to doctor, all of which insisted I stay on antibiotics even though I was experiencing decreased appetite and terrible side effects. It took a year and going outside my medical network care to find someone who wanted to take a more holistic route. I was cured within weeks.”

“When I went to the doctor’s for a sports physical in high school, my male doctor completely ignored the initial purpose of my visit, and instead turned to my stepdad who was in the room with me and tried to convince him to put me on birth control since I was a teenager and “you never know what could happen.”

“Instead, without warning, numbing cream, or any type of acknowledgment, she cut off the internal growth.”

She/Her, Age 33, Hispanic

She/Her, Age 38, White

“In 2020 I suffered several mental breakdowns. At the time I was not aware of what the issue was and ended up at the Sharp Emergency room in Chula Vista twice.

During my time their I was discharged with no studies, no diagnosis, no treatment, but with a hefty bill and a hope you feel better. My primary doctor was horrified of the lack of care and could not believe that I was not at least prescribed a sedative for my nerves. My primary doctor diagnosed me with Anxiety and referred me to a psychologist who did not have appointments for the next 2 months. After a year of constant breakdowns I decided to seek care in Tijuana were they realized I was having GI issues which was most likely causing a hormonal imbalance. I also ended up paying out of pocket for homeopathy treatments and mental care, and slowly got better on my own. Thankfully I had the funds to seek for outside care but if I only had my insurance I would have most likely have driven myself crazy or worse.”

“During my (first) IUD insertion (at my 6 week postpartum follow-up), the PA found what I assume to be polyps. However, she did not tell me she found anything. Instead, without warning, numbing cream, or any type of acknowledgment, she cut off the internal growth. It, of course, immediately started to hurt and burn. As I lay on the exam bed, with my legs in the stirrups and my newborn asleep beside me, I quietly but quickly tried to look to see what the hell was going on. I remember trying to move my body in an impossible way, and saying “ow! What are you doing?!?” She looked up at me, realizing that when you cut something off a person it hurts!l and that’s when she decided to tell me that I had a growth that she needed to biopsy. I felt confused and disrespected while dealing with postpartum anxiety.”

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Anonymous Experiences Survey She/Her, Age 26, Hispanic / Latinx

“I am plus size and have therefore been and continue to be dismissed throughout my doctors appointments. For example, I went to my PCP (at the time) for bloodwork because I was feeling off. Upon receiving the results, he noted that my thyroid levels were off “but those numbers don’t reflect your body because you should be energetic and athletic,” so he ignored it. I went to a different doctor and, eventually, had to get half of my thyroid removed.

After removal, they found cancer. It was caught early so I didn’t have any negative consequences, but, if I didn’t stand up for myself, I may have still been living with cancer to this day. Similarly, a doctor recently told me, “They make reusable water bottles that you can refill to make sure you’re getting more water.” As a 26 year old in an era where reusable water bottles are literally trending online, this felt incredibly dismissive, passive aggressive, and demeaning (this was an ear nose throat doctor I was seeing for pulsatile tinnitus). I have experienced so many situations where doctors have dismissed my symptoms just to tell me that losing weight would fix everything and it’s so incredibly unhelpful, especially because I am not seeing these doctors for diabetes, high blood pressure, or the like. I’m sure plus size men experience similar mistreatments, but I think this goes further for women. Women are always dismissed, their pain ignored (i.e., IUD insertions, period cramps, etc.).

Having a space where women of all sizes are heard and taken seriously would be incredible -- though we should be sure to make it accessible to lower income people.”

“...if I didn’t stand up for myself, I may have still been living with cancer to this day.”

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Anonymous Experiences Survey He/She, White

“When I went to get my IUD, I was nervous and unsure if it was the right thing to do. When I got into the room with the doctor, I had some questions about the hormone differences between the birth control pill I was currently on and the IUD. I have always struggled with hormone levels effecting my mood during my period so I wanted to have the discussion.

The conversation was confusing because it turned out the doctor had not read my chart and did not know I was currently on the pill. I also asked if most people with an IUD do not get a period and if not, how do they know they’re not pregnant. The right answer would be that IUD is 99% effective, but she said that I could take a pregnancy test every month if I was ever unsure… After finally getting on the same page, I was looking for advice from her, and she essentially said “ well you’re here do you want to do it or not?” Her whole demeanor was very impatient and not helpful.

I decided to proceed with getting the IUD and it was a super painful experience. I think it is crazy that they don’t give you any pain medications for it. When I was struggling with the pain the doctor said “well at least you’re not giving birth”. I sat through the pain and had a few silent tears come out of my eyes.

After the ordeal was over, she left me in the room to rest and never came back. A nurse poked her head in the room and asked me if I was done and was going to leave…. I had to ask her if I could get a pad for any bleeding and she said I looked pale so gave me an apple juice. Once I felt OK I went to the Kaiser bathroom and cried and called my mom.

The whole experience was the opposite of caring and kind. Not sure what was wrong with that doctor that day, but she was so inconsiderate and unhelpful.”

“...I was struggling with the pain the doctor said “well at least you’re not giving birth”.

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Anonymous Experiences Survey

“...I was struggling to work, walk, sit, sleep, live. And all they offered me was a cortisone shot.”

She/Her, Age 24, White

She/Her

“I have had sciatica for 5 years and have seen 5 different doctors for this. On top of that I struggled with a very painful period and issues with my digestive system. I was put on birth control at 16 due to my periods and I didn’t really have a choice. I wish I was able to explore other options at that time. Regarding my back, I had told my doctors I was struggling to work, walk, sit, sleep, live. And all they offered me was a cortisone shot. My primary, and an orthopedic surgeon. I thought they would’ve cared me considering I’m so young. And every doctor said “well you shouldn’t have sciatica at a young age”. Duh? I was also asked if it was just back pain due to my cycle. But no, this is a 24/7 pain. At this point in my life I’m still at step one of what to do with my back. Doing my own research seeing if this can possibly be a form of endometriosis. Considering my 3 health issues go hand in hand with each other when it comes to endometriosis. But I have avoided doing anything about this because I will most likely be ignored or shut down like I have been in the past. So I have kinda just chosen to live with painful sciatica. And again I’m only 24.”

“Pain disorders (ie fibromyalgia) not taken seeiously by doctors. In the end, I was diagnosed with cancer and my pain was caused by a tumor - this could have been caught earlier had doctors taken my complaints seriously.”

N/A (pass as male), Age 26, White

Being denied gynecological care (assuming due to my trans status), being forced to get an invasive exam after saying no more than once, dismissing pains away as “periods” or “caused by testosterone” without actually investigating.

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Anonymous Experiences Survey

“...I was struggling to work, walk, sit, sleep, live. And all they offered me was a cortisone shot.”

She/her, Age 28, Caucasian

She/Her , Age 24, African-American

“I had my appendix removed about 6 years ago. When I was starting to wake up and in the recovery room a male nurse was asking about my tattoos (I had one of my lower hip), then I said maybe I have to pee then changed my mind and said no I don’t, he then got the pee tray and put it under me and said “just try..” I felt exposed like he was just wanting to see me naked.. I told him I don’t have to pee and that I didn’t pee and he continued to wipe me up in a manner that felt very inappropriate. He then asked if my cell phone on file was a good way for him to contact me just to make sure I was healing well.

It was a very uncomfortable and vulnerable feeling.”

“My experiences have been mostly at the gyno with doctor’s who were women of color. One time I went and I had bumps which i thought were just in-grown hairs and as soon as the doctor saw she said i had herpes, before even testing. so of course i was in distress. but then she tested it and came back it said it wasn’t herpes. causing me emotional distress for no reason.. another time a gyno was just very rough with when it came to doing my pap smear and taking blood samples. she had to stick me like five times because she kept missing the vein.”

She/Her, Age 21, Mexican

Whenever I was experiencing irregular bleeding or concerns about my reproductive health, I was advised to go on birth control without further examination.

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Anonymous Experiences Survey “I very much wanted to have a natural delivery. I changed doctors after she told me “I won’t have you in my delivery room, standing on your head and doing ‘all that crazy stuff.’”

She/Her, Age 32, Indigenous Mexican-American

“I got government healthcare for a bit so I decided to see a neurologist for my migraines. My migraines have gotten worse over the years to the point that it’s debilitating. I’m missing out on work, social settings, personal time, meals. To the point that I could not hold down even water to keep myself hydrated on a 5 day migraine bender. I finally get a referral. I take some time to get some personal notes together so I can explain to the doctor my concerns and why I want to get my head checked out. Wanting to get some answers on why my brain feels like it’s rotting when I get these horrible migraines. Appointment day comes, I get called in. He asked me what’s my name and what do I do for work. I let him know I’m a sever. He then asks me where do I work, I tell him the restaurant and he then tells me that he and his kids love that place. I try to continue with my notes and explain to him how long I’ve been having these migraines. Has me stop talking and tells me to hop on the exam table. He explained how he is going to test me. He taps my knees to see my reflexes, makes me wiggle my fingers, makes me follow his finger with my eyes, made me push against his hand and then proceeded to tell me that I’m normal. I don’t have migraines, there probably really bad headaches and then returns to talking about how much him and his kids love eating at my restaurant. Completely dismissing my concerns and my request to have my head scanned and has the audacity to ask for a discount for the next time him and his kids come in.”

She/Her, Age 53, Black

“After the birth of my first son, I very much wanted to breast feed, especially because he was born via cesarean section, which I felt bad about. At my son’s first post-natal appointment, which was a few days after his birth, the doctor told me he had lost weight and told me I needed to formula feed. I very much didn’t want to do it, but he pressured me and made me feel like I would be a bad mom if I didn’t comply. After a couple weeks, I took my son back to the pediatrician, who told me that my son was gaining weight now and, upon my asking, said I needed to continue formula feeding. He, again, pressured me and made me feel irresponsible for wanting to breastfeed. Several months later, after seeing a lactation specialist, I went back to the doctor. Upon hearing from me that I had been nursing my son for several weeks, he tugged on the bottom of my shirt so that it was taught again my chest and said, “Must be rich.” Since then, I have had two more children. Upon the birth of my second child, I told the doctor that I very much wanted to have a natural delivery. I changed doctors after she told me “I won’t have you in my delivery room, standing on your head and doing ‘all that crazy stuff.’ “

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Anonymous Experiences Survey

She/Her, Age 26, White

“I was on birth control ever since high school to regulate my period. I decided to stop taking the birth control in March 2023 because my PMS was so bad. I immediately gained weight and experienced really bad mood swings. I felt like I was going crazy. When I went to the doctor, I had to go through my primary care physician instead of my OB/ GYN. he prescribed me Metformin, which is supposed to help with the weight gain. he was pretty open about it and not very quick to place blame on me but at the same time, couldn’t seem to give me any answers. He ordered hormone test as well as a transvaginal ultrasound to test for ovarian cyst. I knew to ask my doctor about PCOS because my female therapist was the one who suspected it.

My male primary care doctor was actually pretty helpful.

What was really sad was that when I went to get my ultrasound done, the female ultrasound technician didn’t believe that I had PCOS because she said that weight gain wasn’t a symptom of PCOS. I Explained to her that that wasn’t my only symptom and that my cycles can last up to 60 days instead of the typical 21 days. I immediately thought to myself that this woman isn’t a doctor, she could be wrong. She was very dismissive of my concern and emphasized how long she’s been doing this job and how she doesn’t think I have PCOS. She ended up finding multiple cysts on my right ovary. I left that appointment in tears feeling hopeless. All my hormone tests came back pretty normal, but the ultrasound was determined by the radiologist to show evidence of PCOS. Due to my incredibly irregular periods, weight gain and cysts on my ovary, I was diagnosed with PCOS. I had been on birth control for 10 years and the birth control was masking all of the PCOS symptoms. So as soon as I stopped taking the birth control all of the symptoms Manifested.

Unfortunately, the only mistreatment that I received was from the female ultrasound technician. Dismissive, short answers, judgmental tone, didn’t believe me.”

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“my pain was dismissed on multiple occasions when I visited the ER sobbing and unable to walk.”

She/Her, Age 31, Asian

“I have had numerous doctors dismiss my symptoms as being caused by “being overweight”. When I would ask for specific test I would have to fight tooth and nail to get them to agree. It took me years to get diagnosed with poly cystic ovarian syndrome and I still have (mostly male) doctors argue with me about that diagnosis despite my symptoms and literal ultrasounds showing cysts. Telling me “just exercise and it will go away ” instead of providing me actual treatment. A medication I was on for years ended up causing extreme GI issues and my pain was dismissed on multiple occasions when I visited the ER sobbing and unable to walk. It took six ER visits and fighting to see a GI doctor to be informed that my medication was damaging my GI tract. I was told repeatedly at the ER “oh it’s just food poisoning” or “it’s just bad menstrual cramps” all those doctors were informed about my medication I was taking and not a single one bothered to see if that was causing my issues.”

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Adaptive Reuse and the Changing Work Environment &

Site & Programming

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Adaptive Reuse & San Diego

Campus at Horton Plaza Adaptive Reuse Project Rendering - San Diego

The term “adaptive reuse,” refers to the process of reusing an existing building as something different from its original or intended use. Depending on the project or the building, adaptive reuse can be a large range of tasks, or as few changes to the building as possible. In the case of this thesis project, the shell and exterior of the building will be kept mostly untouched, while the interior is gutted and re-purposed from an office building to a non-emergency medical building. About one-third of the building will remain in office-like form, transferring from business offices to medical offices and exam rooms. The other two-thirds of the building will be split between a birthing center, and a residential / extended mental health care facility, as well as public spaces on the first floor.

After the Covid-19 quarantine, many businesses and employers made the switch to hybrid work environments in order to contain the spread of Covid-19, and provide healthier options for their employees. On top of that, many employees realized that there was no need to come into work physically when it was clear that their work load could be done online and from home. These changes resulted in an extreme vacancy of office buildings. In Downtown San Diego specifically, a near 28% of office spaces are vacant as of April 2024 in San Diego’s Central Business District. This thesis project aims to restore some of those vacant office spaces with new programming and purposes.

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Medical Care & San Diego In downtown San Diego, there is are nearly 35,000 residents and less than 10 medical centers. A few of them being Perlman Clinic and UC San Diego Health Express, or Gaslamp Medical Center. Despite having a few options, there is currently a lack of extensive care facilities in Downtown. With over 40% of the 35,000 residents being female, there are zero specialized care facilities for women, and zero mental health facilities as well.

An example of a specialized care facility for women in Downtown is Tia - a women’s healthcare clinic in Los Angeles. Tia offers primary care, gynecology, mental health, and wellness care all in one spot. Tia believes that one should be able to take care of all of their needs in just one location rather than traveling to several offices around Los Angeles to get medical assistance. Tia recognizes that women need specialized care and partners with other medical facilities to provide as much support as possible. There are currently four locations in Los Angeles, one in Phoenix, one in San Francisco, and one in New York.

“Tia is on a mission to make healthcare both higher-quality and more accessible for all, regardless of age, sex, gender, race, ethnicity, religion, ability, sexual orientation, and economic status.”

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Project Focus Building 501 West Broadway - Chosen Building for Flora The existing building is in Downtown San Diego in the Business District, neighboring Emerald Plaza and the old YMCA building across the street. It currently stands as an office building but has become partially vacant post the COVID-19 quarantine.

On the first floor lies existing tenant spaces including a City National Bank, a UPS, and a bistro. These are open to the public. Past the lobby begins the offices and firms that still reside in the building.

Built in 1989, there are 21 floors with views San Diego on every side - Including the waterfront from the south. The 21st story is listed as a “premium office tower” for private workspace. The pictured floor plan is a current plan of the second floor. For the first 3 floors, a neighboring building - the Broadway Athletic & Swim Club (partially seen above), sits in the south side of building. After the third floor, the floor plan changes and extends to sit above the southern structure.

The building is currently LEED Gold and Well Certified, as well as a Verified Healthy Building and an Energy Star Partner.

Interior shot from the SW corner of building.

Interior of current Lobby

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Site Information City Center Business District & Demographics of Downtown Population: 34,550 Residents Male: 60% Female: 40% Age Group: Median 40’s.

Largest Group: Early 30’s.

Average Income: $73,756 Housing Units: 24,744 housing units Renters: 76% Families: 70% of residents are in relationships Married: 57% Children: 10%

......................Office / Non - Residential ...............................................Residential .......................................................Parks When studying the site information of 501 W Broadway, I found it helpful to have an understanding of the nearby residents to see how close the medical center would be to residential rather than offices. I found that the residential buildings are mostly south of 501 W Broadway and that there was more residential than I thought.

501 West Broadway is within walking distance to bus stops and the trolley, and is within walking distance to many residential buidlings downtown.

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Programming 20. Residential Mental Health

16. Residential Mental Health 15. Birthing Suites 12. Birthing Suites 11. Birthing Classes 10. Family Counseling 9. Family Planning 8. Reproductive Mental Health 7. Menopause Care 6. Oncology 5. Endocrinology 4. Neurology 3. General Wellness / Exams 2. Birth Control & Sexual Health 1. Public Floor Bottom Program

Middle Program

Top Program

- Lobby / Main Entrance - Public Restaurant - Retail Store / Gift Shop - Public Gym (with membership) - Athletic Classes - Chiropractic Practice - Massage Therapy

- Medical Care Offices - Birthing Classes - Birthing Center and Suites

Psychiatric Care Offices Mental Health Residency Therapy & Group Therapy -

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Residential Mental Health Care

Birthing Center

Medical Offices

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Flora: Level 1 The Public Floor

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Level One - Public Floor The purpose of level one is to serve as the public floor, where as the rest of the building would require some form of appointment or prior planning. Level one has an atrium inspired lobby, filled with native or local plants, and provides seating areas and a cafe. The lobby is open to all who wish to come in. Just past the lobby and behind reception is a retail store / gift shop meant to supply visitors with gifts for family and friends in the birthing center, as well as visitors to the mental health residency floors. Level one also has a restaurant with the purpose of attracting people to the building to discover the benefits, and providing a healthy food dining option for the residents of downtown San Diego. Further into level one is a public gym (with it’s own entrance), as well as other athletic classes such as boxing, yoga, and pilates. Lastly, the public floor provides chiropractic and massage therapy spaces.

1. Lobby and Cafe 6,580 Sq Ft 2. Restaurant and Bar - 3,097 Sq Ft 3. Gym 4,109 Sq Ft 4. Retail Store 1,805 Sq Ft 5. Athletic Classes (total) 3,432 Sq Ft 6. Chiropractic 1,047 Sq Ft 7. Massage Therapy 1,155 Sq Ft Total Public Space - 21,225 Sq Ft

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Floor Plan West Broadway

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Lobby The main entrance to the building is through the atrium inspired lobby. In the lobby are local and native plants, surrounded by seating areas to accompany the cafe. The seating and plants are three steps down from the ground floor.

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1. Walnut Wood Planks Flooring 2. Oak Wood Planks Flooring

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Lobby Area: 6,680 Sq Ft

Interior Wellness Solutions 1. Air: Mechanical Ventilation System - Uses outdoor air and internal CO2 sensors to remove toxins from the internal environment.

2. Thermal Comfort: Chilled Beam Systems throughout the building helps to heat and cool with the use of water (energy efficiency).

3. Sound: Considering the high ceiling and hard materials combination, the plants help absorb some of the noise. The drywall is also reinforced with acoustical foam to help control some of the sound.

All paints, woods, sealants, and other materials are low or no VOC’s in order to provide a healthy and near toxin-free environment.

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Lobby

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Mimosa - Restaurant & Bar Mimosa - the name of a flower and popular drink - is a health conscious breakfast, brunch, and dinner restaurant and bar that provides a refreshing environment of bright colors and patterns. Sitting just across from the Guild Hotel, Mimosa uses a mix of bright tiles, woods and fabrics to offer a new and popular food spot to the Business District area of downtown San Diego.

26’ 8” 17’ 2”

16’ 0”

25’ 7”

21’ 10”

32’ 6”

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28’ 5”

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1. Heavy Duty Porcelain Tile - Flooring 2. Honeycomb Ceramic Tile - Bar Counter Top 3. Sealed Terracotta Tile - Flooring

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4. Heavy Duty Porcelain Tile - Flooring 5. Sealed Oak Wood - Stairs and Custom Booth / Bench Seating

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Mimosa - Restaurant & Bar Area: 3,097 Sq Ft

Sound Absorbtion Panel Wooden Slat Panels for Sound

Interior Wellness Solutions 1. Lighting: Window covers to control sunlight from the front of the restaurant. Circadian Lighting System to help regulate internal clock once the sun goes down.

2. Air: Mechanical Ventilation System - Uses outdoor air and internal CO2 sensors to remove toxins from the internal environment.

3. Thermal Comfort: Chilled Beam Systems throughout the building helps to heat and cool with the use of water (energy efficiency).

4. Sound: Sound in restaurants can be overwhelming, which is why a ceiling sound absorption panel is installed above a section of the seating. The slat wood panels at the bases of the walls also help reduce echoes and other unwanted noises, along with the upholstered furniture.

All paints, woods, sealants, and other materials are low or no VOC’s in order to provide a healthy and near toxinfree environment.

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Flora: Levels 12-15 The Birthing Center

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The Birthing Center What is a birthing center?

Generally speaking, a birthing center is a medical space that is usually separate from a hospital, and is more accommodating for different birthing styles and practices. Birthing centers usually promote natural births with the help of midwives and doulas. Midwives are people who have medical training for the birth process and focus on delivering the baby, while doulas focus on the needs of the mother; providing mental, emotional, and physical support during labor. Birthing centers range from re-purposed homes, to hospital environments that are located on - or near - the same property as the main hospital.

What are the benefits of a birthing center?

Typical advantages of a birthing center include a personalized birth experience, more control and independence over the labor process, lower rate of medical intervention - including cesarean sections, and often a home-like feeling that hospitals ordinarily do not provide.

What does Flora offer?

Typical Birthing Centers

Flora offers four floors of birthing suites, each equipped with a queen or king sized bed, a birthing tub, changing tables, bassinets, a spacious bathroom and shower, and extraordinary views of downtown San Diego. There are nurses and midwives positioned near every room to assist with delivery, as well as two emergency C-section rooms per floor. The goal of the Flora Birthing Suites is to allow pregnant women to have full control over their labor and birth, while having several different options and areas to deliver in the room; as well as providing a modern birthing center that is a comfortable mix of home and hospital. Each room is 300-500 square feet and allows plenty of space for partners and fathers to help with the delivery process, as well as room for nurses and midwives to navigate the delivery without impeding on the privacy or independence of the mother. The mother may choose to only want midwives on standby, or may feel better with as much assistance as possible.

Each floor has two extended stay suites. These suites allow the mothers and partners / fathers to stay for up to two weeks. The other suites have a typical 2-3 day stay time. In the case of emergencies that Flora is not equipped to handle, mothers will be transported to the Sharp Coronado Emergency Department as it is the closest ER to Flora.

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Floor Plan: Levels 12-15

11 Beds per Floor

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Extended Stay Birthing Suite The extended stay birthing suite is very similar to a one bedroom apartment. When booking the extended stay suite, the family can stay for up to two weeks, starting before the babies due date and staying until the two week mark.

This option is good for first time mothers who want the extra help from hospital staff, or repeat mothers who want extra quality time with their newborn. Partners are expected to stay in the suites with the mothers, and 1-2 kids may stay as well. The suite contains a basic kitchen for the opportunity to keep and make your own food, as well as a spacious bathroom in order to accommodate for the demands of active labor (room for mother, partner, nurses / midwives, and equipment if necessary). The extended stay suite also has a small balcony to provide private outdoor space.

11’ 2”

12’ 2”

12’ 4”

15’ 7”

12’ 1

11’ 10”

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1. Cement Tiles - Outdoor Flooring 2. Luxury Vinyl Walnut Planks - Flooring

10’ 10”

3. Heavy Duty Porcelain Tile - Flooring

13’ 12”

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Extended Stay Birthing Suite Floor to Ceiling Height: 10’

Area: 632 Sq Ft (Room) 282 Sq Ft (Kitchen) 167 Sq Ft (Bathroom)

Wooden Slat Panels for Sound

Interior Wellness Solutions 1. Lighting: Circadian Lighting System to help regulate internal clock and body signals to sleep. Curtains on every window for sun control.

2. Air: Mechanical Ventilation System - Uses outdoor air and internal CO2 sensors to remove toxins from the internal environment.

3. Thermal Comfort: Chilled Beam Systems throughout the building helps to heat and cool with the use of water (energy efficiency).

4.Sound: Acoustic Panels on the walls for birthing suites as well as wooden slat panels. 6-8” walls between rooms for sound privacy. Floor plan of entire level designed to interrupt sound travel up and down the hallways.

All paints, woods, sealants, and other materials are low or no VOC’s in order to provide a healthy and near toxinfree environment.

A birthing room should have minimum of 200 Sq Ft, clear dimension of 12’ 0”.

California Building Code 1226.11.1 Birthing Service Space

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Flora: Levels 16-20 Mental Health Residency

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Mental Health Residency Mental Health Residency Overview Flora is providing a residency program that consists of mental health assistance with the use of therapy, group therapy, psychiatry, support of independence and socialization, personalized treatment plans, and more.

Flora’s residency program is for low-risk applicants that require only a minor need for assistance. Flora allows time to get back on track, avoid burnout, start a recovery process from trauma, treat anxiety and depression, or just simply get away from the world when it becomes too much.

Other Residency Programs

There are five floors of residency, each with 12 rooms, two gyms, a social garden, a dining hall, and therapy spaces with on-floor psychiatrists and therapists. Each room has one queen bed, a lounge chaise, a bathroom, and a desk space. There is 24/7 staff to maintain daily scheduling and patient wellness. Patient monitoring is minimal due to the low-risk nature of the space, but daily check-ins are required by patients; meal times and required therapy sessions are also apart of daily routine.

The social garden is an indoor / outdoor garden up kept by patients. The garden requires detail, focus, and care, as well as teamwork and socialization. The space can be used at any time to get fresh air or to spend time with fellow residents.

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Floor Plan: Levels 16 - 20

12 Beds per Floor

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Mental Health Residency Suite The women’s mental health residency suite is about the size of a studio apartment, measuring at 345 Sq Ft. Each suite has their own bathroom, shower, and closet, along with a chaise lounge and a desk space with built-in shelving for personal storage. To the left of the door is an entryway table to not only provide storage, but to help guests feel more at home. Residents do not have locks on their doors, and are not permitted to have substances of any kind nor any unauthorized belongings. Hobby items such as painting, reading, knitting, etc, are encouraged. The stay may range from one week to a couple of months depending on the guests needs.

18’ 0” 6’ 10”

10’ 6” 6’ 8”

10’ 4” 6’ 0” 1.

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1. Oak Wood Planks - Flooring 2. Heavy Duty Porcelain Tile Flooring & Shower

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Mental Health Residency Suite Area: 345 Sq Ft (Room) 88 Sq Ft (Bathroom)

Floor to Ceiling: 10’

Interior Wellness Solutions 1. Lighting: Circadian Lighting System to help regulate internal clock and body signals to sleep.

2. Air: Mechanical Ventilation System - Uses outdoor air and internal CO2 sensors to remove toxins from the internal environment.

3. Thermal Comfort: Chilled Beam Systems throughout the building helps to heat and cool with the use of water (energy efficiency).

4.Sound: White noise sound system to promote relaxation. Floor plan of entire level designed to interrupt sound travel up and down the hallways.

All paints, woods, sealents, and other materials are low or no VOC’s in order to provide a healthy and near toxinfree environment.

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Social Space Interior Garden This interior garden is on the North East corner of floors 16 through 20, and provides the temporary residents with an indoor/outdoor social space. The garden is up-kept by residents as a part of a hobby and teamwork to keep the plants healthy. The wooden areas that surround the plants act as seats and sit enough room for 2-3 people at a time.

There are glass railings nearly 7’ high to keep residents safe while still allowing fresh air to come in at the top.

53’ 1”

52’ 4”

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1. Flagstone Rubble - Flooring 2. Oak Wood - Seating

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Social Space Interior Garden North-facing view of interior garden.

Interior Wellness Solutions 1. Lighting: Natural Lighting and open air to allow proper access to vitamins from the sunlight.

2. Air: Natural Air Flow from aove the railings creates a breezy environment in the garden.

3. Thermal Comfort: Natural Air Flow helps regulate the thermal comfort levels to get a mix of sunlight and air.

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Conclusion & References

Flora is a non-emergency medical facility dedicated to women’s health. Women’s health has been long overlooked and ignored, and only recently has medical research started to make discoveries about the important differences between male and female bodies. It is important for women to have their own medical facility that understands these differences and is established under a concept of medical equality and care. Using adaptive reuse, Flora will reside in 501 W Broadway in downtown San Diego. The interior of Flora is designed to be inviting and comfortable, rather than the sterile and negative feeling that many medical facilities carry. The goal of the interior was to provide a space that felt more like a home than a medical facility, but still provided the cleanliness and organizational skills of a regular facility. A home-like environment will help the patients feel more comfortable and less nervous, which helps with the vulnerability that is often required during a doctors visit. Flora is also designed to keep health in mind at all times, and uses as many healthy materials and interior solutions as possible for a healthy building standard. 501 W Broadway is already LEED Gold and Well Certified as it stands, making it a great starting point for Flora.

American Stroke Association: A division of the American Heart Association. www.stroke.org. (n.d.). https://www.stroke.org/ Bigg, M. (2024). This won’t hurt: How medicine fails women. Hodder Education.

Cleghorn, E. (2022). Unwell women: Misdiagnosis and myth in a man-made world. Dutton.

Dusenbery, M. (2019). Doing harm: The truth about how bad medicine and lazy science leave women dismissed, misdiagnosed, and sick. HarperOne, an imprint of HarperCollinsPublishers.

Feldman, S. (2022, April 7). The data behind racism in Healthcare. Ipsos. https://www.ipsos.com/en-us/knowledge/society/The-Data-Behind-Racism-inHealthcare McGregor, A. J. (2021). Sex matters: How male-centric medicine endangers women’s health and what we can do about it. Quercus Editions Ltd. OECD data. theOECD. (n.d.). https://data.oecd.org/

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About Me

My name is Hailee Strach and I am graduating in 2024 with my B.A. in Interior Architecture and Design at 22 years old. I have been interested in design and arts since I was a little girl. I decided there was no other topic I would happily want to get a degree in if it weren’t in the creative field.

Growing up I lived in five different states, seven cities, and 12 different houses up to this point. Being able to experience different areas and see how each environment changed from one another inspired me deeply and will be something I carry with me forever. Some of the most influential cities I have lived in have been San Diego (of course), Chicago, San Antonio - the River Walk is beautiful - and my wonderful home town, Grand Rapids. The differences in every city subconsciously taught me that there was so much more to see and learn about in the world when it came to buildings, houses, and the history of it all.

However, despite the creative inspirations I have picked up over time, I owe my creative drive to my mother. She showed me that it was 100% okay to pursue a creative field and that success from it was as valid - if not more rewarding - as anything else. My hobby and skills for painting were driven and supported by her, and now my degree and path of life are the same. I could not be more grateful. Thank you, mother.

To my future self, I hope you have worked your way up to be a creative director or senior designer. I hope you have a healthy family (and all the cows, goats, birds, and cats you could ever need), and lastly, I hope you are happy. Love, Hailee.

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Flora She/Her, Age 32, Indigenous Mexican-American “January 2023, I was pregnant with my first. Two days shy from 11 weeks. I started spotting Saturday, come Sunday I was still spotting and starting to have some cramps. Late Sunday early Monday morning it got worse, woke my partner up around 3 am and told him to get dressed we have to get to the emergency room. Told the lady at the front desk that I think im having a miscarriage, I’m 11wks and I started spotting and the cramping is getting worse. She didn’t have any urgency to get me seen. Told me to have a seat in the waiting room and wait for my name to be called. Almost two hours went by and I was called to have a vaginal ultrasound to see if “anything was there” their words. Physically and emotionally the most painful exam. They sent me back to the waiting room and told me again to wait until I hear my name being called.

One hour went by, three hours, five hours, almost seven hours later I’m called. Bleeding and miscarring in the wheelchair they had me in. I stood up and walked myself to the door where they admit patients. My bottoms soaked in blood. The nurse then asked me what brings me in. I tell her my reasons, I let her know that I’m bleeding heavy now and if she may bring me some pads. At this point I was left in the room for two hours not being seen. The doctor finally comes in with the nurse and a student and begins to explain to me the process of what the inside of my vagina would look like if my body passed the pregnancy and tries to set up for another vaginal ultrasound. I told her I already had one and that the doctor said the results should have returned quickly. She was stunned that I already had an exam done and said she will look for them and return back. Again I was left alone in the room for another 3 hours. I buzzed the nurses button a few time because my pain was starting to become unbearable. It felt like she was ignoring me because I could hear her talking in the hallway to the security guard and other nurses about some ER drama that happened on her last shift. I took one of the pee pads they put on the bed and made myself a makeshift pad to collect all the bodily liquids. At this point I was mad and helpless that these women didn’t give a fuck about me or my situation. I saw all the bits that were my baby and their home in the dirty hospital toilet getting flushed away. Returning back to my room I could see my blood trail to the bathroom from my room.

I’m waiting for the doctor to return. She then walks in and lets me know that they lost my ultrasounds and she is going to have to manually check me to make sure that everything is passing how it’s supposed to.

At this point I’m in shock,emotionless, I’m helpless, tired, in physical pain. I remove my soaked bottoms, remove the makeshift pad beside me and put my feet in the stirrups. The nurse walks in and just stares at my makeshift pad and then looks down where the doctor is. Doctor announces that my cervix is open and everything is looking how it’s supposed to. Waited for a few more hours and then got discharged. To top it off, I was supposed to start my new job in a new career that Monday morning. Instead I miscarried in a hospital emergency waiting room counting the minutes to get help seeing the saddest sunrise. “