NARRATIVE (dis) PLACEMENT: The Place of Culture in Healthy Architecture

KALINA (k) VANDER POEL THESIS DOCUMENT: Masters of Architecture Degree June 2016 Portland State University

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Thesis document submitted in partial fulfillment of the requirements for the degree of Master of Architecture

at

Portland State UniversityPortland, OregonJune 2016

Narrative (dis)PlacementThe Place of Culture in Healthy ArchitecturebyKalina Vander Poel

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vThesis Committee:

Advisor Corey Griffin Associate Professor of Architecture

__________________________________ ________________ Date

Committee Member BD Wortham-Galvin Associate Professor of Architecture

__________________________________ ________________ Date

PORTLAND STATE UNIVERSITYSCHOOL OF ARCHITECTURECOLLEGE OF THE ARTS

The undersigned hereby certify that the Masters thesis of

Kalina Vander Poel

has been approved as partial fulfillment of the requirements for the degree of Master of Architecture

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ACKNOWLEDGEMENTSThis research and documentation would not have manifested as it did without the support and guidance of the faculty of the School of Architecture at Portland State University.

To Corey Griffin, who has not only guided the pursuits of this thesis, but has mentored me to be both a better researcher and student. My steadfast approach for this thesis is entirely due to your commitment to not let me waiver from my original ambitions. Thank you.

To BD Wortham-Galvin, who has provided clarity in the chaos and the constructive criticism I was so desperately searching for.

I would also like to thank Julia Suver and the Alaska Native Medical Center for being willing to host an unknowingly unprepared thesis student. Thank you for welcoming me, being patient as I ask obscure questions, and sparking a fascination for a culture and place I previously knew nothing about. Thank you to those at ZGF, Sue Ann Barton, Mark Elliot, and Nicholas Papaethemaeou, for exposing me to the rich and complex world of hospital design and professional practice.

And lastly, none of this would be possible without the everlasting support and encouragement of my family. To my best friend and spouse, Steven Althoff, thank you for your reminders to eat and sleep and your patient, steady love. To Apollo, my son, thank you for reminding me that having fun is a never ending learning opportunity.

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It seems apparent that species are only commas in a sentence, that each species is at once the point and the base of a pyramid, that all life is related.And then not only the meaning but the feeling about species grows misty. One merges into another, groups melt into ecological groups until the time when what we know as life meets and enters what we think of as non-life: barnacle and rock, rock and earth, earth and tree, tree and rain and air. And the units nestle into the whole and are inseparable from it.And it is a strange thing that most of the feeling we call religious, most of the mystical outcrying which is one of the most prized and used and desired reactions of our species, is really the understanding and the attempt to say that man is related to the whole thing, related inextricably to all reality, known and unknowable. This is a simple thing to say, but a profound feeling of it made a Jesus, a St. Augustine, A Roger Bacon, a Charles Darwin, an Einstein. Each of them in his own tempo and with his own voice discovered and reaffirmed with astonishment the knowledge that all things are one thing and that one thing is all things - a plankton, a shimmering phosphorescence on the sea and the spinning planets and an expanding universe, all bound together by the elastic string of time.

John Steinbeck (1941:93)

xPREAMBLETABLE of CONTENTS TERMSABSTRACT & THESIS QUESTIONPROPOSAL: A Process of Narrative Translation

(wha

t)PR

OPOS

AL(h

ow) NARRATIVE PROCESS STEP 1:2 Context STEP 2: Narrative32 50STEP 3: Details STEP 4: Narrative Analysis

(why

) APP

ENDICES 132 INSPIRATIONS: Curiosity

Architectural Precedents Contemporary Alaska Native Story Telling

(whe

re) CON

CLUSION 126 SOURCES: Concluding Argument

NotesIndex of FiguresBibliography

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STEP 5: Narrative Translation74 STEP 6: Design Details90 STEP 7: Building Scale112

(add

ition

al)STORIES 144 EYAK ELDER

ATHABASCAN VILLAGE BOY

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Environmental Psychology

A unified body of individuals with a common history or common social, economic and political interest living in a particular area. | Cambridge Dictionary + United States Census Bureau

Community

TERMS

Environment

People are affected by their environment through their senses. This results in both psychological and physical effects, whereas people are also the agents that create, modify, and maintain much of the material world in which we live and work; a simple description of a very complex system of cause and effect. | Cooper

Places are not just backdrops to cultural activity. Places are outcomes of that activity, and they shape practices of domestic and ritual life. It takes time to build places, to live in them, and to abandon them, just as it takes time to modify landscapes.| Rodning

A Cultural Landscape - any landscape that has been altered by man. | Rodning

The system of shared beliefs, values, customs, behaviors, and artifacts that the members of society use to cope with their world and with one another, and that are transmitted from generation to generation through learning. | Bates (Cultural Anthropology 3rd Ed)

CULTURE

PLACE

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WELLBEING

The presence of personal behavior and coping skills such as balanced eating, keeping active, smoking, drinking, and how we deal with lifes stresses and challenges all affect health when health is seen as the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. | WHO Health Impact Assessment

To care for another person, in the most significant sense, is to help him grow and actualize himself...To care for another person, I must be able to understand him and his world as if I were inside it...In caring for another person I encourage him, I inspire him to have the courage to be himself. I help him make his own decisions by providing information, suggesting alternatives, and pointing out possible consequences, but all along I realize that they are his decisions to make and not my own. | Mayeroff

Wellbeing is emergent through four inter-related spaces of resource mobilization: capabilities, social interaction, security, and therapeutic processes. | Atkinson

Healing Environment

HospitalPublic Buildings designed to help people in their struggle against illness and injury with a capacity to form a living community that functions as a means of generating social, economic and, above all, cultural integration. | Wagenaar

Key features of hospital buildings considered components of healing environments (nature, daylight, fresh air and quiet) based upon medical and psychological health outcomes. | Wagenaar

Health

Buildings with high psychosocial value are designed around basic human needs, ancient preferences, and connections to the patterns of nature and the mind. | Heerwagen

Feeling Good + Functioning Well. | Steemers

Care

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ABSTRACT

Anchorage, Alaska is home to the only tertiary hospital dedicated to Alaska Natives - the Alaska Native Medical Center (ANMC). Given the unique realities of Alaska, Alaska Natives often spend a number of days in and around the ANMC for each medical appointment. While at the hospital, individuals are removed from daily life including community and cultural activities, and as they likely flew to Anchorage, they are without a means of transport to leave ANMC campus. Amenity spaces play a crucial role in this scenario as they are a physical space in which to receive social support and connect with other visitors. It is clear the ANMC need additional amenity spaces in order to address the growing needs of Alaska Natives. As designer propose spatial solutions, the opportunity exists to incorporate culture and place into the design so spaces remediate isolation, displacement and positively affect wellbeing. This thesis proposes a process designers can utilize to make informed decisions during the conceptual design phase that recognizes the role of culture and place in healthy architecture. Referred to as a narrative translation process, this process ultimately enables architecture to serve as the critical link between place, culture, and health.

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THESIS QUESTION

How can architects bring culture and place into the design process in order to make informed design decisions as they intentionally design for wellbeing at the Alaska Native Medical Center?

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PROPOSAL: A Process of Narrative TranslationWhat does it mean to be well?

Koen Steemers defines wellbeing as feeling good and functioning well.1 This very broad yet surprisingly straightforward definition allows those interested in wellbeing a framework from which to explore and further define wellbeing. For example, a social geographer defines wellbeing as emergent through four interrelated spaces of resource mobilization: capabilities, social interaction, security, and therapeutic processes.2 Wellbeing can be subsequently defined to highlight relevancy to a specific discipline or profession, but what is especially pertinent for architecture is the established context of wellbeing: that of place and culture.

It is in place that individuals engender the means to see and embody wellbeing. Sarah Atkinsons states Wellbeing, however defined, can have no form, expression, or enhancement without consideration of place.3 Place has meaning to a specific set of people because place, too, is specific; it is through a specific geographic location that individuals can physically engender meaning of place. Place as an idea manifests when the physical place, the geographic location, receives time and physical interaction with people. As Christopher Rodning states, places are not just backdrops to cultural activity. Places are outcomes of that activity, and they shape practices of domestic and ritual life. It takes time to build places, to live in them, and to abandon them, just as it takes time to modify landscapes.4

Christopher Rodning further argues it is impossible to develop place without the presence of culture. Culture is significant to wellbeing because it is culture that dictates not only what wellbeing is but also when to feel good about our sense of wellbeing. As culture is a system of shared beliefs, values, customs, behaviors, and artifacts that the members of society use to cope with their world and with

one another, and that are transmitted from generation to generation through learning,5 it is culture that affects the world around us. In return, the world around us (ie: the environment) affects culture. Rachel Cooper states, People are affected by their environment through their senses. This results in both psychological and physical effects, whereas people are also the agents that create, modify, and maintain much of the material world in which we live and work; a simple description of a very complex system of cause and effect. The more we know about his process and the intervening variables, the more we may be able to design better places, moderate effects, and influence behavior.6 Clearly, both place and culture have an inextricable connection with wellbeing.

Over archingly, wellbeing is a complex phenomena that affects an individuals identity and ability to be healthy and participate in society. This is recognized across multiple disciplines, including architecture.7 Currently, architects and clients are interested in measuring a buildings capacity to affect wellbeing. New certifications are available that document and score specific design decisions believed to affect the wellbeing.8 Architectural research within the last thirty years focus on opportunities to improve wellbeing through studying and promoting biophilic responses and stress reducing environments. This research highlights the fact that it is not only the physical qualities of space but also the perceptions of an environment that impact wellbeing.9

Yet, through literature reviews and observation, it is clear there is a gap between how we design for wellbeing and the current paradigm of wellbeing. While it is recognized that culture and place significantly inform wellbeing, designing for wellbeing has an almost sterile attitude where research and design lack specificity of place and culture. It is true place may be considered for its environmental attributes pertaining to biophilic design, daylighting, and natural

1views. While these considerations can significantly affect the human condition on both a physical and psychological level,10 this approach lacks the geographic specificity that is suggested when discussing the role of place in wellbeing. Culture has even a greater disconnect from the current methods of promoting health and wellbeing in architecture. The Well Building Certification, a means to certify that a building has been purposefully designed with wellbeing in mind, does not include a single requirement to address cultural specificity.11 Oftentimes if culture is considered in the design of healthy architecture, it is through aesthetics, namely artwork and material palette.12

If we are to purposely design for wellbeing, as Rachel Coopers and others state we must do, designers must embrace wellbeing in its entirety. We need to start recognizing the role of place and culture in healthy architecture.

To figure out how to recognize the role of place and culture, we can look to a discipline that studies culture - that of anthropology. One of the ways anthropologists study culture is through direct observation ie: ethnography. Anthropologists will live with a specific set of people to engender a greater understanding of a culture through a relationship that is highly specific in terms of both place and culture.13 This process, while enabling a deep understanding of the culture and place, takes a number of years to conduct. Unfortunately, the reality of architectural practice and time lines do not allow for a full ethnographic study on most architectural projects. That being said, the methods employed in ethnography, such as immersive story telling, can be utilized to start to understand culture and place as it pertains to wellbeing.

Ethnographies typically manifest as written documents reflecting upon and representing the story of a particular lifestyle. These written documents are essentially stories.

They are narratives that attempt to show those outside a culture how and why people do certain things. Narratives can be easily expressed through visual forms familiar to architects and designers. When a narrative is delivered in visual form, it can undergo architectural analysis so social and spatial components are revealed. Key components from the original narrative can then directly translate into design, and it is in this way that we can bridge the gap between design and wellbeing.

This thesis proposes a narrative translational process designers can utilize to realize and integrate culture and place into the decision making process as they intentionally design for wellbeing. Each step plays a critical role in both knowledge and direct translational relevance for the narrative process. A narrative translational process dovetails nicely with current conceptual design methods. Dovetailing from context, the process incorporates a narrative, sensory details, and analysis. The process then begins to come to the traditional conceptual design phase through translation, design details, and finally influence at building scale (spatial programming).

The following pages in this thesis reveal the Narrative Translational Process by studying the new housing complex at the Alaska Native Medical Center. As mentioned in the abstract, the Alaska Native Medical Center is intended solely for the use of Alaska Natives. As such, it is the ideal project to explore the potentials of a narrative process. Each chapter coincides with specific steps in the process and are presented in a manner consistent with the envisioned deliverables of a real project. Each step reveals information about both the design of this project and the proposed process, but in a method akin to story telling where the reader is an active researcher. As such, I encourage you:

Immerse yourself in the process.

(how

) NARRATIVE PROCESS

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STEP1: Context

The first step of the narrative process is to conduct contextual research similar to that already expected within

the conceptual design phase of a project.

For this process, basic contextual research includes geography, census data, over arching cultural markers, history, and relevant social issues. Additional contextual research includes relationships between client/organization/entity, social conditions, place, and/or site. Site contextual research includes location, relevant amenities, and site relationships. The purpose of contextual research is to provide a cursory knowledge of the social and geographic context the design project will manifest

within.

STEP

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ALASKA

(how

) NARRATIVE PROCESS

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Arctic CircleContinuous Permafrost

Discontinuous Permafrost

Population: 291,826

Population: 31,535

Population: 31,275

Population: 8,050

Population: 7,831

Population: 7,100

% Alaska Native: 7.9%

% Alaska Native: 5.2%

% Alaska Native: 10.0%

% Alaska Native: 11.8%

% Alaska Native: 14.8%

% Alaska Native: 16.7%

% Alaska Native: 16.8%Population: 8,881

Fairbanks

Juneau

Sitka

Ketchikan

Wasilla

Kenai

Anchorage

ALASKA: a State Different Than the Rest

LOCATION & SIZEAlaska contains 586,000 square miles of land. It is located in the far north, with a significant portion of the land within the arctic circle. It is approximately 500 miles from Washington state and the lower 48 states. Alaska shares its eastern border with Canada and its western maritime border with Russia via the Bering Strait. To the north lies the Chukchi and Beaufort Seas of the Arctic Ocean. The south and southwest border of Alaska is the Pacific Ocean. Many small islands lie along this southern border.

GEOGRAPHYA large portion of Alaska is harsh wilderness. Permafrost covers approximately 85% of Alaskas land. Permafrost is thickest in the northern regions of Alaska with it extending as far as 2,000 feet below surface.3 The southern border of Alaska lies along the Queen Charlotte Fairweather Fault producing resulting in active volcanoes and frequent earthquakes.4

ALASKA & THE UNITED STATESAlaska is the largest State in the United States of America. At a 1/5 the size of the entire lower 48 states, Alaska is bigger than Texas, California and Montana combined. If Alaska were placed on top of the lower 48 states, it would stretch from California to Georgia and Minnesota to Texas. An inner-state Alaskan flight from Attu Island to BelleBay is approximately the same distance as a flight from Los Angeles to New York City (2400 miles). To put this into perspective, Oregon is the 8th largest state, yet it would need to multiply 6.7 times in order to cover the area of Alaska. A road trip from Portland to Medford, then Umatilla and back to Portland would be shorter (distance) than a one way drive from Anchorage to Prudhoe Bay.

POPULATIONWhile Alaska ranks #1 in size, it ranks 50th in population density. Alaska is the 48th least populous state with a population of 738,432 (slightly more than the population of Portland). Approximately half of Alaskas population reside in Anchorage. Alaska has .93 square miles for each person in the state.5 By comparison, New York has .003 square miles per person.6

Alaska is simultaneously the largest state and least densely populated state in the United States. In addition, Alaska has the highest native population percentage at 14%. In the United States, the next highest native/indigenous percentage state is New Mexico with 10% while the US national average doesnt quite make 2%.1 With the lowest percentage rate of Alaska Natives in cities, small village is the typical living environment for Alaska Natives.2

fig. 2

STEP

1

5

Arctic CircleContinuous Permafrost

Discontinuous Permafrost

Population: 291,826

Population: 31,535

Population: 31,275

Population: 8,050

Population: 7,831

Population: 7,100

% Alaska Native: 7.9%

% Alaska Native: 5.2%

% Alaska Native: 10.0%

% Alaska Native: 11.8%

% Alaska Native: 14.8%

% Alaska Native: 16.7%

% Alaska Native: 16.8%Population: 8,881

Fairbanks

Juneau

Sitka

Ketchikan

Wasilla

Kenai

Anchorage

fig. 1

(how

) NARRATIVE PROCESS

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ALASKA NATIVE: Living in Place

CommunityALUTIIAQ/SUGPIAQ & UNANGAX: Winter was a time for traditions involving elaborate celebrations and ceremonies. Singing, dancing and feasting took place as part of these ritualistic traditions.

YUPIK & CUPIK: Families came together and dispersed according to the seasons. Elaborate winter ceremonies emphasized the relationship among humans, animals, and the spirit world.

INUPIAQ & ST. LAWRENCE ISLAND YUPIK: Both groups believe in reincarnation and the recycling of spirit forms from one life to the next, both human and animal. This explains the elaborate treatment of animals killed, even today. Additionally, feastival time included competitive games to prove hunting ability.

EYAK, TLINGIT, HAIDA & TSIMSHIAN: High-ranking Eyak, Tlingit, Haida and Tsimshian clans and/or individuals were expected to give potlatches. Potlatches might last days and would include feasting, speeches, singing and dancing.

ATHABASCAN: The winter was when scattered families returned to their winter villages, hunted smaller animals close by and gathered for potlaches and other community celebrations.

Seas, Rivers, and LandALUTIIAQ/SUGPIAQ & UNANGAX: Historically, sea mammal hunters went to sea and coastal villages take advantage of abundant salmon.

YUPIK & CUPIK: Seal oil and other coastal delicacies such as herring and herring eggs were often traded by coastal villages for furs and caribou from inland villages.

INUPIAQ & ST. LAWRENCE ISLAND YUPIK: Today these people continue to subsist on the land and sea of north and northwest Alaska. Their lives continue to evolve around the whale, walrus, seal, polar bear, caribou and fish.

EYAK, TLINGIT, HAIDA & TSIMSHIAN: People depended upon the ocean and rivers for their food and travel.

ATHABASCAN: Athabascan people have traditionally lived along five major river ways. Athabascans migrated seasonally, traveling in small groups to fish, hunt and trap.

TananaKoyukon

Upper Kuskokwim

Holikachuk

Deg Xinag

Denaina

Ahtna

Eyak

Upper Tanana

Tanacross

Han

Gwichin

Alutiiq/Sugpiaq

Eyak

AthabascanSt. Lawrence Island Yupik

Tlingit

Kaigani (Alaska Haida)

Tsimshian

Siberian Yupik

Yupik + Cupik

Unangax

Inupiaq

20-40 peopleGender HousingHighly Nomadic

TRADITIONAL DWELLING

20-40 peopleSettled Costal Villages

Defined Territories

TRADITIONAL DWELLING

8-12 peopleEntrance lower than room

Temporary Dwelling for Hunting

TRADITIONAL DWELLING

Alaska Natives are not one culture, but many. There are 11 distinct cultures and 22 languages. Alaska Natives hold the common belief that they are from a land, they do not own a land. There are no boundaries marking region, culture, tribe, but rather a gradient where culture has evolved to suit environmental realities. Each of theses cultures have a deep connection to place as can be seen in the material and construction of traditional vernacular housing. Typical dwellings are partially subterranean and use resources in the region to provide enclosure.

The captions below highlight the relationship between place, culture, and living.7

STEP

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7

TananaKoyukon

Upper Kuskokwim

Holikachuk

Deg Xinag

Denaina

Ahtna

Eyak

Upper Tanana

Tanacross

Han

Gwichin

Alutiiq/Sugpiaq

Eyak

AthabascanSt. Lawrence Island Yupik

Tlingit

Kaigani (Alaska Haida)

Tsimshian

Siberian Yupik

Yupik + Cupik

Unangax

Inupiaq

40-60 peopleWinter House

Faces Water with back to Mountains

TRADITIONAL DWELLING

20-40 peopleSeasonally NomadicMobile/Highly functional dwellings

TRADITIONAL DWELLING

TRADITIONAL DWELLING

TRADITIONAL DWELLING

TRADITIONAL DWELLING

fig. 3

(how

) NARRATIVE PROCESS

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(dis)PLACEMENT

MISSIONARIES & THE RUSSIAN ORTHODOX CHURCHThe first documented Russian Orthodox Church was constructed in 1794. While the Russian American Company (a fur trading company) already had a strong hold in Alaska, the Russian Orthodox Church soon became a leading contender for the ethics, morals, and shifting lifestyle of the Alaska Native people. 8

GOLD RUSHThe Klondike Gold rush occurred between 1896-1899 when a local miner discovered gold in August 16, 1896. Approximately 100,000 prospectors flew to the Klondike region of Alaska from areas such as Seattle and San Francisco in the hopes they might become rich. This was not the first nor the last gold rush which impacted Alaska Natives relationship with place through physical impositions including population swells, transportation, subsistence alterations, etc.9

BOARDING SCHOOLSThousands of children survived the massive spread of disease in the early 1900s while their parents and grandparents did not. These orphans subsequently went to boarding schools. Other children were forced to go to boarding schools, and it is within this combined context that boarding schools are the second leading cause of major trauma among Alaska Natives (with the great death being the first). It is important to note that boarding schools run by the Bureau of Indian Affairs didnt end until the mid 1970s. This historic and cultural trauma is still being felt today.10

THE ALASKA HIGHWAYThe Alaska Highway (also known as the Alaskan Highway, Alaska-Canadian Highway, or ALCAN Highway) was constructed during World War II for the purpose of connecting the contiguous United States to Alaska through Canada. It begins at the junction with several Canadian highways in Dawson Creek, British Columbia, and runs to Delta Junction, Alaska, via Whitehorse, Yukon.

THE TRANS-ALASKA PIPELINEThe Trans-Alaska Pipeline is one of the worlds largest pipeline systems. The pipeline was built between 1974 and 1977 after the 1973 oil crisis caused a sharp rise in oil prices in the United States. Environmental, legal, and political debates followed the discovery of oil at Prudhoe Bay in 1968, and the pipeline was built only after the oil crisis provoked the passage of legislation designed to remove legal challenges to the project.11

EARTHQUAKELasting four minutes and thirty-eight seconds, a 9.2 magnitude megathrust earthquake occurred in Alaska (1964).To this day it is the most powerful earthquake recorded in North American history, and it is the second most powerful earthquake recorded in world history. Other geologic phenomena include high volcanic activity, with two note-worthy eruptions occurring within the last 15 years.12

GOLD!

HWY

TAPS

Starting with Russian contact as early as the 1700s, Alaska Natives connection to place has been consistently disrupted. These disruptions have created a new condition where Alaska Natives feel both connected to place and displacement simulatneously. Dis-placement is the alteration of the natural evolving relationship with landscape and culture. The map to the right records physical impositions that have significantly affected Alaska Natives connection to place.

fig. 5

STEP

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9

1750 1760 1770 1780 1790 1800 1810 1820 1830 1840 1850

TIME OF CONTACT

fig. 4

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ALASKA NATIVE HEALTHCARE

ALEUTIAN PRIBILOF ISLANDS ASSOCIATION APIA Chartered in 1976 in the State of Alaska. Services include health, education, social, psychological, employment and vocational training, and public safety services.

ARCTIC SLOPE NATIVE ASSOCIATION Formed in 1965, by original founders Samuel Simmonds, Guy Okakok, Sr., and Charles Etok Edwardsen, Jr. ASNA was originally created to help protect the lands of the Arctic Slope region, beginning the process that led to the Alaska Native Land Claims Settlement Act.

BRISTOL BAY AREA HEALTH CORPORATION Formed by a consortium of Bristol Bay tribes (Yupik, Denaina, and Supiak/Alutiiq - the original inhabitants of the region), in 1973 to provide comprehensive health care services.

COPPER RIVER NATIVE ASSOCIATION Special emphasis is put on physical health, mental health, and freedom from substance abuse. CRNA provides diagnosis, treatment, and education, in each of these areas.

KODIAK AREA NATIVE ASSOCIATION The Kodiak Area Native Association was formed in 1966 as a 501 (c)3 nonprofit corporation providing health and social services for the Alaska Natives of the Kodiak region.

NORTON SOUND HEALTH CORPORATION Norton Sound Health Corporation (NSHC) is a tribally owned and operated, independent, not-for profit health care organization, founded in 1970 to meet the health care needs of the Inupiat, Siberian Yupik and Yupik people of the Being Strait region.

SOUTHCENTRAL FOUNDATION Southcentral Foundation is an Alaska Native-owned, nonprofit health care organization serving nearly 65,000 Alaska Native and American Indian people living in Anchorage, Matanuska-Susitna Valley, and 55 rural villages in the Anchorage Service Unit.

SOUTHEAST REGIONAL HEALTH CONSORTIUM SEARHC is a non-profit tribal health consortium of 18 Native communities, which serves the health interests of the Tlingit, Haida, Tsimshian, and other Native people of Southeast Alaska. They are one of the oldest and largest Native-run health organizations in the nation.

TANANA CHIEFS CONFERENCE An Alaska Native non-profit corporation, charged with advancing Tribal self-determination and enhancing regional Native unity to meet the health and social service needs of Tribal members and beneficiaries throughout our region.

YUKON-KUSKOKWIM HEALTH CORPORATION The Yukon-Kuskokwim Health Corporation administers a comprehensive health care delivery system for 58 rural communities in southwest Alaska.

MANIILAQ ASSOCIATION provides health, tribal and social services to residents of Northwest Alaska.

Arctic Slope Region

Aleutians + Pribilofs Region

Bristol Bay RegionCopper River/PWS Region

Interior Region

Kenai Peninsula Region

Kodiak Region

Northwest Arctic Region

Norton Sound Region

Southeast RegionYukon-Kuskokwim Region

Anchorage/Mat-Su Region

The Indian Self-Determination and Education Assistance Act of 1975 (Public Law 93-638) authorized government agencies to enter into contracts with (and make grants directly to) federally recognized Indian tribes.13 These tribes would then have authority for how they administered the funds ultimately giving them greater autonomy and control over their wellbeing.

How it works: Recognized tribal villages select a representative to administer funds. Depending upon region there may also be a subregional representative. These subregional representatives meet as members of the health board/board of directors which then bring up issues regarding health of their subregion. This is usually done annually to correspond with the allocation of federal funding.14

Below are Alaska Tribal Health Organizations recognized by the federal government.15

STEP

1

11

Arctic Slope Region

Aleutians + Pribilofs Region

Bristol Bay RegionCopper River/PWS Region

Interior Region

Kenai Peninsula Region

Kodiak Region

Northwest Arctic Region

Norton Sound Region

Southeast RegionYukon-Kuskokwim Region

Anchorage/Mat-Su Region

fig. 6

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) NARRATIVE PROCESS

12

CURRENT DISTRIBUTION SYSTEM

INDIAN HEALTH SERVICESThe Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally-recognized Tribes grew out of the relationship between the federal government and Indian Tribes (established in 1787, based on Article I, Section 8 of the Constitution).

ALASKA AREA NATIVE HEALTH SERVICEThe Alaska Area Native Health Service (AANHS) oversees one P.L. 93-638, Title V compact with 22 funding agreements, and eighteen P.L. 93-638, Title I funding contracts. The Alaska Area transfers about $480 million in Title V funds and $13 million in Title I funds from the Indian Health Service (IHS) to the Alaska tribes and tribal health organizations each year.

ALASKA NATIVE TRIBAL HEALTH CONSORTIUMThe ANTHC was formed in December 1997 when federal programs, services, functions and activities previously under the Indian Health Service were transferred to Alaska tribes who became owner-consumers of health care. Virtually all statewide Native health services are connected in some manner to the activities of the ANTHC.

ALASKA NATIVE MEDICAL CENTERLocated geographically within the boundaries of Southcentral Foundation tribe, the Alaska Native Medical Center (ANMC) operates as the gatekeeper for most of the specialty care required by Alaska Natives in all parts of the State.

REGIONAL CLINICSRegional Clinics may or may not offer acute care services and accommodation for extended stay. Subregional Clinics often focus on primary care, preventative care, pre-natal care, well-child care, and behavioral health.

SUBREGIONAL CLINICSSubregional clinics vary in size and scale but can be small and with one, perhaps two, full time nurses. Basic medical needs can be met at subregional clinics, and village clinics often house telemedicine stations.

CHA/PChosen by the village council, the CHA/P is responsible for giving first aid in emergencies, examining the ill, reporting their symptoms to the physician, carrying out the recommended treatment, instructing the family in giving nursing care and conducting preventive health programs in the villages.

SEARHC

27x18xAlaska Native Medical Center

Anchorage 57,977130,682

Sitka 15,994

Kanakanak Hospital Dillingham 5,295

Kuskokwim Delta Regional Hospital Bethel 24,746

Annette Island Health CenterMetlakatla 1,380

Norton Sound Regional HospitalNome 8,431

Maniilaq Health CenterKotzebue 7,033

Medivac

Samuel Simmonds Memorial HospitalBarrow 4,510

Chief Andrew Isaac Health CenterFairbanks 13,640

0x0x

150x256x

0x

0x

18x0x

17x0x

14x10x

Medivac

Medivac

18x0x

18x0x

Total User Population:

Even though villages join together to establish health organizations in order to receive funding, the federal government creates a series of boundaries and areas in order to strategically locate and distribute healthcare to Alaska Natives (as can be seen with the white boundary lines on the map). IHS-funded, tribally-managed hospitals are located in Anchorage, Barrow, Bethel, Dillingham, Kotzebue, Nome and Sitka. There are 58 tribal health centers, 160 tribal community health aide clinics and five residential substance abuse treatment centers.16

Below is a brief description of the entities and steps required for health organizations to receive funding. 17

fig. 8

STEP

1

13

SEARHC

27x18xAlaska Native Medical Center

Anchorage 57,977130,682

Sitka 15,994

Kanakanak Hospital Dillingham 5,295

Kuskokwim Delta Regional Hospital Bethel 24,746

Annette Island Health CenterMetlakatla 1,380

Norton Sound Regional HospitalNome 8,431

Maniilaq Health CenterKotzebue 7,033

Medivac

Samuel Simmonds Memorial HospitalBarrow 4,510

Chief Andrew Isaac Health CenterFairbanks 13,640

0x0x

150x256x

0x

0x

18x0x

17x0x

14x10x

Medivac

Medivac

18x0x

18x0x

Total User Population:

fig. 7

(how

) NARRATIVE PROCESS

14

RECEIVING CAREThe Alaska Native Medical Center, also known as the ANMC, is the only tertiary hospital providing comprehensive medical services to Alaska Native and American Indian people living in Alaska.17 The ANMC is located in Anchorage, the largest city in Alaska. While the strategic location of a singular comprehensive hospital is realistic and arguably efficient in administrative and financial terms, it means an individual must leave the village and possibly their entire region just to receive care. In this way, they are being physically displaced. The process to receive care at the ANMC is not singular displacing move, but rather a series of displacing actions.

Below is a scenario to highlight the series of actions an Alaska Native may have to go through in order to receive care. While this care scenario isnt true for every Alaska Native, it is not a-typical and is a good reference to understand the overlaying layers of displacement that are occurring.

The man books a flight to Anchorage (400 miles away from home).

The man arrives at the Anchorage Airport.

The man boards the shuttle dedicated to transporting patients to and from the hospital.

The man arrives at the hospital and checks into lodging as his appointment isnt until tomorrow.

A man is ill and isnt sure why.

So he hops on his snowmobile to go see the local CHA\P.

While friendly, the CHA\P doesnt know what is wrong either, and the doctor via Telehealth suggest a visit to the regional hospital for some scans.

The man hops back on his snowmobile and goes to the regional hospital, approximately 100 miles away.

Once again, the man is met with friendly staff and even a nice new facility. However, the doctor has confirmed he needs to go to ANMC to get treatment. Sigh.

fig. 10

1172 miles

STEP

1

15fig. 9

786 miles

589 miles330

miles

397 miles

537 miles

547 miles

720 miles

360

mile

s

(how

) NARRATIVE PROCESS

16

PLACE & (dis)PLACEMENT: an Architectural Record of (dis)connectionPlace plays a significant role in the identity and life of Alaska Natives. As Christopher Rodning states, places are not just backdrops to cultural activity. Places are outcomes of that activity, and they shape practices of domestic and ritual life. It takes time to build places, to live in them, and to abandon them, just as it takes time to modify landscapes.18

Additionally, place is inextricably linked with wellbeing. Wellbeing, however defined, can have no form, expression, or enhancement without consideration of place.20 In Wellbeing + Place edited by Sarah Atkinsons, multiple articles provide examples of how and why this is necessarily so. This leaves the question:

What happens, then, to an individuals wellbeing when they feel disconnected from place?

Images on the right focus on the relationship between the built environment and place. While the images along the top display a harmonious relationship with place, the images on the bottom of each column reflect an imposition which illicit feelings of displacement.

STEP

1

17

fig. 11

(how

) NARRATIVE PROCESS

18

PLACE & (dis)PLACEMENT: Response in Contemporary ArtContemporary Alaska Native artists respond to the realities of place and displacement felt on within their culture. Each artist is from a different geographic region in order to realize that, while Alaska is large, displacement is felt by all.

ARTISTS FROM LEFT TO RIGHT PERRY EATON - SUGPIAQ Supiaq Masks | 1980s-current NICHOLAS GALANIN - TLINGIT Rumination | 2012 DA-KA-XEEN MEHNER - ATHABASCAN Finding my Song | 2012 EMILY JOHNSON - YUPIK Dance | 2010 SONYA KELLIHER-COMBS - INUPIAQ Drawings | 2008

fig. 12 fig. 13 fig. 14

STEP

1

19

fig. 15 fig. 16

(how

) NARRATIVE PROCESS

20

SITE CONTEXTAs a statewide referral center, the Alaska Native Medical Center is strategically located in Anchorage, Alaska. Those that require the services of the Alaska Native Medical Center will likely need to travel to receive care. Alaska Native culture places a high emphasis on family. As such individuals rarely travel alone to the Alaska Native Medical Center, but rather it is standard that at least one family member will travel to support and care for the ill individual.21

Unfortunately displacement doesnt stop once the individual arrives in Anchorage. The Alaska Native Medical Center is located in the central, eastern part of Anchorage. In order to get to the Alaska Native Medical Center, the individual(s) will need to take the shuttle from the Ted Stevens International Airport located on the far west side of Anchorage and travel approximately 6.5 miles to arrive on the Alaska Native Medical Center campus.22

Amenities near the hospital campus are sparse. The nearest amenity, a restaurant, is within walking distance while everything else is beyond a 10 minute walking distance. This means individuals are, therefore, not only displaced but also isolated from activities that occur in daily life. And as people often fly, this displacement doesnt exist for the duration of a typical doctors visit but rather a number of days. 23

fig. 17

STEP

1

21

fig. 18

(how

) NARRATIVE PROCESS

22

SITE CONTEXT

6.5 miles

3.3 miles

Alaska Native Medical Center

Nearest Full-Service Grocery Store

Downtown

Ted Stevens International Airport

Alaska Native Heritage Center

1 mile radius

5.3 miles

6.5 miles

0.6 milesNearest Restaurant

The average stay for an Alaska Native is 2-3 days, and it is not unusual for Alaska Natives to stay upwards of 5 days simply to see the doctor and do some follow up appointments.24 High risk pregnancies are relocated from villages to the Alaska Native Medical Center where the woman will stay until the birth of the child - sometimes as long as 2 months. It is therefore critical that the Alaska Native Medical Center have amenities.

While the Alaska Native Medical Center has your traditional hospital amenities, a cafeteria, courtyards, a coffee shop, it also some unique

amenities that directly reflect culture and realities of Alaska. The Alaska Native Medical Center operates the Quyana House, a 56-room, 108-bed facility for out-of-town patients and their escorts.25 In addition there is a space referred to as the Gathering Space.The gathering space is essentially a front lobby, circular in shape, where individuals will spend hours sitting and visiting with others at the hospital. The gathering space is unique for two reasons. It acknowledges the specialized group the ANMC is servicing through the design, and it has incredibly high use, circulation and duration patterns. Traditional Dwellings:

fig. 19

STEP

1

23

Amenities on Campus

Cultural Display

Courtyard

Main Gathering SpaceCafeteriaCoffee

Patient Housing (new)

Nature Path

202 rooms

Entry

Patient Housing54 rooms

Playground

fig. 20

SITE CONTEXT: CAMPUS and AMENITIES

(how

) NARRATIVE PROCESS

24

ALASKA NATIVE MEDICAL CENTER CAMPUSThe Alaska Native Medical Center Campus is relatively isolated from high density areas of Anchorage, such as downtown etc. The campus has two natural water features and a series of walking paths along the northern edge of campus. Additional outside amenities include covered walkways that duplicate as seating, courtyards with seating for dining purposes, and a playground on the east side of the hospital. The campus also has relatively unimpeded views of the Chugach mountain range.

fig. 21 fig. 22

fig. 27 fig. 28

STEP

1

25

fig. 24fig. 23

fig. 25

fig. 26

fig. 29 fig. 30

(how

) NARRATIVE PROCESS

26

ALASKA NATIVE MEDICAL CENTER AMENITIESOnce on campus, amenities include food services, housing, and a gathering space which also serves as the front lobby of the hospital. While these amenities are highly utilized and are distinctive features of ANMC, the limited size and quantity result with amenities running over capacity on a daily basis.

Images to the right are of the Gathering Space. The Gathering Space is heavily used and has regularly scheduled events such as drumming and dancing that occur nightly.

Images on the next page are examples of the artwork on display within the Alaska Native Medical Center. While the art is inspiring and reminds individuals of their culture, it is also eerily reminiscent of Nicholas Galanins artwork depicting displacement and cultural isolation.

The image below is the front desk of the Quyana House where individuals can temporarily stay as they receive medical care.

fig. 31 fig. 32

fig. 35 fig. 36

STEP

1

27

fig. 33 fig. 34

fig. 37

fig. 38

fig. 39 fig. 40

(how

) NARRATIVE PROCESS

28

(new) HOSPITAL HOUSINGA new housing facility will expand the amenity services offered to visitors of the ANMC. The complex is typologically similar to a hotel with a high bed count (202) and supplemental areas such as a front lobby, dining, exercise room, family room, and courtyard to make the stay more comfortable and enjoyable.

This new housing facility will be the intervention site for exploring the proposed narrative translational process. The resulting design decisions are intended to modify/reimagine/reaffirm communal spaces within this housing facility engendered by analyzing place and culture through a narrative process.

fig. 41

STEP

1

29

(how

) NARRATIVE PROCESS

30

STEP

1

31

It is at this point designers would traditionally move forward with first iterations of programming, building form, and spatial layout. It is here the narrative translational process deviates from the traditional design process. The following series of steps pull from the basic contextual research (step 1) in order to identify, elaborate, analyze, and incorporate elements directly affecting wellbeing into the architecture.

(wha

t)PROPOSAL

32

STEP 2 & 3: Narrative & Details

The second step of the narrative process is to find a story. Similar to ethnography, this story (often referred to as

narrative) is based on real people, real actions, and a real place.

The purpose of the narrative is to understand a person where they are, in their life. In this way we can see which cultural elements are more or less significant than our own cultural paradigm presupposes. The subsequent narrative is visually represented through hand drawing with ink washes. While it is not necessary in the narrative process to manifest the step 2 in this medium, the medium was

selected for its ability to express depth.

In addition to documenting the narrative, it is important to record the ways in which individuals in the narrative directly interact with the environment. The act of recording

sensorial stimuli satisfies step 3, known as details.

In this case, a series of photographs were taken to capture interaction through the five senses and act as a personal

recording to trigger sensorial responses.

STEP

2 &

3

33

STEP

2 &

3

33

the SUGPIAQ FISHERMAN

(how

) NARRATIVE PROCESS

34

Barabaras and Earth Huts

Russian Colonialism: St. Nicholas Church ~1890

Masks at Chteau Muse Boulogne-sur-Mer were the source to re-establish the cultural practice of mask making for the Sugpiaq people. 26

Tatitlek, Alaska

The Exxon Valdez oil spill (1989) nearly destroyed the Prince William Sound ecosystem, traumatizing the subsistence way of life for Alaska Natives.27

fig. 42

fig. 43

fig. 44

fig. 45

fig. 46

STEP

2 &

3

35

This narrative starts in Tatitlek, Alaska where the Sugpiaq people have lived for thousands of years. The story of the Sugpiaq Fisherman is a story of subsistence living today.28

Images on the left provide visual background context for this particular narrative.

88 people

Subsistence Activity

Tatitlek to ANMC

Tatitlek

5.5 HoursOR

fig. 47

(how

) NARRATIVE PROCESS

36

A fisherman leaves his village (Tatitlek) with his son and brother to go hunt seal. As he is about to step of the dock he is acutely aware that he is leaving solid ground (literally and figuratively).

fig. 48

STEP

2 &

3

37

(how

) NARRATIVE PROCESS

38

It takes three days to travel to where seals are known to gather.

STEP

2 &

3

39

(how

) NARRATIVE PROCESS

40

The man climbs out of the boat and lays against the rocks so he can both have a good view while also not being seen.

STEP

2 &

3

41

(how

) NARRATIVE PROCESS

42

The moment he shoots the seal his brother goes to collect the seal. It is common knowledge the seal with the most meat sink the quickest, so one person must shoot while the other collects. This form of hunting is truly a codependent exercise.

STEP

2 &

3

43

(how

) NARRATIVE PROCESS

44

They go to shore to check the freshly killed seal for contamination due to the oil spill that occurred nearly thirty years ago.

STEP

2 &

3

45

(how

) NARRATIVE PROCESS

46

While they are on the shoreline, they gather seaweed for the people in their village. This particular seaweed is much loved and (now) scarce.

STEP

2 &

3

47

(how

) NARRATIVE PROCESS

48

They know they are nearly home when they sight the familiar dock and mountain range.

STEP

2 &

3

49

(how

) NARRATIVE PROCESS

50

STEP 4: Narrative Analysis

The fourth step of the process is to analyze the narrative for elements that physically and psychologically connect wellbeing to architecture through the environment. Analysis should create a hierarchy of social/cultural components, spatial relationships, and sensorial stimuli present within each moment of the narrative. Additionally, analysis should reveal repeating qualities within the

environment or culture.

Within this narrative, each moment is sequentially analyzed for three separate categories:

Componentsthe Senses

Spatial Relationships

Within each category elements are systematically highlighted through words and diagrammatic line work overlayed onto each moment. While not exhaustive, these analyses provide a basic set of elements that can directly

translate into future design decisions.

STEP

4

5151

NARRATIVE ANALYSIS

(how

) NARRATIVE PROCESS

52

STEP

4

53

THRESHOLD

step

Established Relationships

ARCHITECTURAL PHENOMENA action Social ConditionComponents

(how

) NARRATIVE PROCESS

54

DEEP WATER

wood plank

Lapping

SON

ROPE

MOSS

timber

metal

door handle

Creek

Hum

VISION touch Smellthe Senses

STEP

4

55

SOLID

YIELDING

UNSTEADY

intimate

vast

transitional

Private

Semi-private

Open

GROUND scale/relationship Personal(space)Spatial Relationships

(how

) NARRATIVE PROCESS

56

HORIZON

wait

Time: Reinforce Relationships

ARCHITECTURAL PHENOMENA action Social ConditionComponents

STEP

4

57

WATERS EDGEtool

Voice

MOTION

HILL

SKY LINE

Drone

metalarm

VISION touch Smellthe Senses

(how

) NARRATIVE PROCESS

58

TURBULENT

close

Open

TRANSPORTING

CONSTANTdistant

Shared

GROUND scale/relationship Personal(space)Spatial Relationships

STEP

4

59

BOUNDARY

poiseCo-dependence

ARCHITECTURAL PHENOMENA action Social ConditionComponents

(how

) NARRATIVE PROCESS

60

SEDEMENTARY ROCK

BASALT ROCK

PLANT LIFE

trigger

rough rock

Splash

Crunch

Breathing

VISION touch Smellthe Senses

STEP

4

61

IMPARTIAL

impact

Visiting

SHIFTING

LOWrambling

GROUND scale/relationship Personal(space)Spatial Relationships

(how

) NARRATIVE PROCESS

62

CONNECT TO NATURE

pull

Co-dependence

ARCHITECTURAL PHENOMENA action Social ConditionComponents

STEP

4

63

EQUIPMENT

seal

Grunt

HAND

SEAL

WATER

floor

Rub

Slurp

VISION touch Smellthe Senses

(how

) NARRATIVE PROCESS

64

PLANAR

extending

Private

ROCKY

secondary

immediate

Transitional

Vast

GROUND scale/relationship Personal(space)Spatial Relationships

STEP

4

65

LINE

peel

Co-dependence

ARCHITECTURAL PHENOMENA action Social ConditionComponents

(how

) NARRATIVE PROCESS

66

DRIFTWOODmuscle Crunch

SEAL

SHORELINE

skin

sea shore

Creek

Lap

VISION touch Smellthe Senses

STEP

4

67

SHEETbalanced

PublicCOMPOUND

ELEVATED

Semi-Public

Open

Private

GROUND scale/relationship Personal(space)Spatial Relationships

(how

) NARRATIVE PROCESS

68

HAND|DETAIL

crouch

Co-dependence

ARCHITECTURAL PHENOMENA action Social ConditionComponents

STEP

4

69

KNIFE

ground

Slice

GROUND

FOOD

HAND

knifefood

Breath

TrickleCrunch

VISION touch Smellthe Senses

(how

) NARRATIVE PROCESS

70

UNDERFOOT

intimate

Indiscriminate

ATTACHED

BACKGROUNDillimitable

At ease

GROUND scale/relationship Personal(space)Spatial Relationships

STEP

4

71

CONNECT TO NATURE

return

Return

ARCHITECTURAL PHENOMENA action Social ConditionComponents

(how

) NARRATIVE PROCESS

72

HOMELAND

Splash

RANGE

DOCKFAMILIARS BOAT

Creek Voice

VISION touch Smellthe Senses

STEP

4

73

SOLID

human

EmbracingWELCOMING

FAMILIAR

middle

vast

GROUND scale/relationship Personal(space)Spatial Relationships

(how

) NARRATIVE PROCESS

74

STEP 5: Narrative Translation

The fifth step of the narrative process is to translate key the elements from the original narrative into a design intervention. Specific attention should be given to the

analysis (step 4) and details of sensory stimuli (step 2).

Within this narrative, each narrative translational drawing is comprised of two moments from the original story. Larger themes for each new narrative translational moment are based on specific elements revealed through the analysis

of the original narrative.

To ease the translational process, a series of rules govern how and where elements manifest in a design. For this narrative, the following rules provided a systematic translation found to be useful in the decision making

process.

Over-arching story: How are the actions in the story contributing to wellbeing? Answer: Determines amenity required

(Personal space + Architectural Phenomena) + Typology = Location of influence (Programmatic moment)

Location of influence (Programmatic moment) + (Action + Social Relationship) = Scale Hierarchy + Ground Hierarchy

(Scale Hierarchy + Ground Hierarchy) + Details of senses = Place-ness established through context

STEP

5

75

STEP

2 &

3

FROM STORY TO DESIGN

(how

) NARRATIVE PROCESS

76

A man leaves his room and steps into the hallway.

STEP

5

77

(how

) NARRATIVE PROCESS

78

The presence of family and fellow visitors in a space that reminds him of traveling (to hunt) and makes him feel like he is about to take a culturally supported journey.

STEP

5

79

(how

) NARRATIVE PROCESS

80

He ventures to the exercise room, an amenity space in the new housing complex,

STEP

5

81

(how

) NARRATIVE PROCESS

82

where codependence and high exertion are manifested through both the architecture and the actions in the space.

STEP

5

83

(how

) NARRATIVE PROCESS

84

Before going back to his room, he and his brother pause outside the exercise room. Built in seating reminds him of traditional vernacular and the work that that happens once you get to shore.

STEP

5

85

(how

) NARRATIVE PROCESS

86

This place has an unimpeded connection with the outdoors and nature; it is where the landscape most directly engages with the five senses.

STEP

5

87

(how

) NARRATIVE PROCESS

88

As the man returns to the floor of his room, he steps off the elevator and lands in an embracing space. The view outside establishes his relationship to place, and the conversations he hears are in his native language.

STEP

5

89

(how

) NARRATIVE PROCESS

90

STEP 6: Design Details

The sixth step of the narrative process is to locate instances where the narrative translation can influence design details. These details are located within the new narrative moments, and directly reflect specific sensorial details

engendered from analysis.

The following details are primarily influenced by the original narrative analysis. The location of each detail reinforces the connection between original narrative and

new narrative as it follows the same linear path.

Details are methodically highlighted in the new narrative similar to that of a traditional call-out method found in architectural drawings. Call outs provide the most basic detail drawing and captures of analysis in order to quickly link design details with location and narrative reference.

STEP

6

91

NARRATIVE TRANSLATION in DETAIL

(how

) NARRATIVE PROCESS

92

The handrail located within hallways directly translate the sensorial stimuli of departing on a journey of exertion as experienced by those in the original narrative. Just as the boat provides the means for the individuals to be propelled through space, the hand rail enables individuals to confidently transition down the corridor.

Specific attention was given to the shape and size of the handrail, the connection to the supporting substructure and relationship to the wall. Each detail directly corresponds with the shape, size, touch, and perceptual connection to the boat as a tool for living.

Handrail

STEP

6

93

(how

) NARRATIVE PROCESS

94

The mechanics of the door was selected for design details as these are the locations where individuals experience a heightened awareness of the architectural phenomena known as threshold. As an individual passes through a threshold, sound and touch are the primary sensory stimuli located within the door handle

and door hinge. The door hinge, in this case, includes a modified connection where clear plastic spaces enable individuals to see the pin of the hinge. The door handle is a evolution of the handrail with a partially shown circular shape to reflect the two sided nature of doors.

Door Hardware

STEP

6

95

(how

) NARRATIVE PROCESS

96

As the new narrative moves into the exercise room, the detailing of a climbing wall connects physical exertion realities to the visual elements of the original narrative with spatial qualities of

codependence. The climbing wall is specifically tailored to reflect natural rock formations found locally in color, texture, and form.

RockWall

STEP

6

97

(how

) NARRATIVE PROCESS

98

This detail highlights the subtlety of boundaries that exist within the original narrative. Between the codependent space (the larger volume space and the compressed space with a low, planar ceiling) a floor change reinforces both spatial qualities as well as provide a function boundary for varying activities. In this case the boundary

line is a track system separating wood flooring and a thin slab concrete floor with exercise mats resting on top. The track system itself is the mechanism for a retractable wall system, a temporary vertical boundary.

Boundary Condition

STEP

6

99

(how

) NARRATIVE PROCESS

100

The equipment storage is a significant detail to consider as it has material and spatial qualities that directly relate to the location and placement of equipment within the original narrative. In this particular case, the storage responds to the functional need of spatial requirements for storage affiliated with exercise spaces.

Doors for each storage space can be fully pushed into the storage space, revealing a clean opening without catches or extrusions. Larger storage spaces are located on the upper portion of the storage wall as they are intended for longer duration storage of staff and therapists equipment.

Equipment Storage

STEP

6

101

(how

) NARRATIVE PROCESS

102

A grass roof is located above the extruded space of the exercise room. A window enables viewers to see native grasses growing on the roof while being inside. Not only does this harken to traditional vernacular in which earthen materials were used to construct subterranean dwellings, but it also provides a connection to both

sky and grasses within a single viewing angle. These aspects of the grass roof reinforce elements found within the original narrative such as boundaries of codependent spaces, transitional spaces with coinciding vast, extending spaces nearby.

Grass Roof

STEP

6

103

(how

) NARRATIVE PROCESS

104

Recessed seating directly relates to the crouching action found within the original narrative. The location and material selection of the recessed seating are selected to connect back to the experiences and spatial relationships of the original narrative. The length and height of each seat is proportional to typical steps so as

to provide an easy means of access for those wishing for vertical circulation. Additionally, recessed seating was a common focal point in traditional vernacular housing with especial relevance for times of celebration and gathering.

Recessed Seating

STEP

6

105

(how

) NARRATIVE PROCESS

106

This detail focuses specifically focuses on the transition between something solid and permeable. Like the line between sea and shore, boundary conditions between what is solid and what is not often shift and move. Rather than strict lines reinforced through architectural phenomena such as enclosure, this detail graduates

the sound and movement of a singular material over the length of a floor. Visual cues within the larger environmental context suggest that this detail is one of many details that gently transition from one state of being to the next.

Floor Transition

STEP

6

107

(how

) NARRATIVE PROCESS

108

Akin to the dock, the bench detail combines practicality with visual cues for place recognition. Material selection, temporary gathering space storage, and visual permanence informed the form and layout of the bench detail. The back structure of the bench is particularly important as it directly connects individuals with visual

stimuli similar to that of water. the surface of the blue striated acrylic reflects the view out the window, bringing both nature and the mountain range into the building. Finally the bench is pulled away from the edge of the return space in order to provide a welcoming and effective temporary gathering space.

Bench

STEP

6

109

(how

) NARRATIVE PROCESS

110

This detail most aligns with traditional wall details in that it highlights connections between elements. Particular emphasis is given to the ceilings and the structure as it allows transition between the two. The ceiling (left) for the temporary gathering space is similar to the actions and form of bringing a boat to a dock. The ceiling (right) for the hallway space is low with varying depth and light qualities -

similar to those found when looking into a large body of water from a boat or dock scenario. The link between the two is the structure of the building, providing support and transition between these two corresponding events. Similar to traditional vernacular style, the vertical structure has the capability to be aesthetically altered in order to represent far-distant and near-distant stories.

Ceiling Changes

STEP

6

111

(how

) NARRATIVE PROCESS

112

STEP 7: Building Scale

The seventh step of the narrative process is to begin to place the new narrative and design details into the building. The intent is that the building will be influenced by the insertion of the new narrative. In return, the new narrative will be influenced by the building.

The building, in which this particular new narrative is being inserted, is the new housing complex at the Alaska Native Medical Center. The new housing complex already has programmatic spaces similar to where the moments in the new narrative could occur. As such, it is the ideal building to use as a means to explore this last step in the narrative translational process.

Rather than being labeled in the traditional programmatic way, spaces are delegated by culturally relevant actions and values of Alaska Native people today. These labels are not the epitome of Alaska Native values, beliefs, etc, but rather they are recurring elements found through research that match with existing expressed design intent.

STEP

7

113

CelebrateStory Telling Connect Exercise

ReturnThreshold

Family

INFLUENCE the BUILDING

Travel

(how

) NARRATIVE PROCESS

114

Amenity spaces above directly relate to the new narrative proposed in this process. Threshold (left) is the first narrative moment where the individuals in the story leave the temporary residential room and enter into the hallway - a semi public space. Exercise (next page) is the exercise room that reflects the actions and social conditions of subsistence activities through codependent social spaces.

Connect (above) is the transitional space the individuals in the new narrative visit after the high exertion activities of the exercise room. Here there maintains a connection to the ground, nature, and each other. Return (next page) is the last moment in the new narrative where individuals can pause and visit before continuing back to the residential unit.

Threshold Connect

STEP

7

115

While the narrative translational process has been utilized to divulge the potentials and relevance found within the story of the Sugpiaq Fisherman, it can be used for any culture. The Alaska Native people are not one culture, but many. There are twenty two different languages and eleven distinct cultures that are organize themselves into five larger groups based on geography and cultural similarities. The five

groups are: AthabascanEyak, Tlingit, Alaska Haida, TshimsianUnangax and Alutiiq/SugpiaqYupik and CupikInupiaq and St. Lawrence Island Yupik

ReturnExercise

(how

) NARRATIVE PROCESS

116

2,454 people

Language Activities

Cordova to ANMC

Cordova

isshuh

She is the last living Eyak speaker. With age has come a regret of not teaching the language to her children. So now, she meets with a linguist every week in the story room of the new ANMC housing, and the audio system (ceiling structure) records their conversation. Sometimes the linguist video tapes her. Between this work and recent public attention, She has hope that the eyak (Cordova) people will be able to revitalize the language of a people that have witnessed many hardships but still endure.

EYAK ELDER: Language & Story Telling

STEP

7

117

Each culture has the potential to influence design decisions within the narrative translational process. To elaborate this, stories for each larger group has begun to be explored for translational qualities that can manifest in the new housing complex at the Alaska Native Medical Center. Like the Sugpiaq Fisherman, each story is based on

a specific person, in a specific place, with specific cultural events.In the case of the Eyak Elder, the influence of the story manifests largely through interior moves that support the act of story telling at varying scales. Architectural qualities harken to sensorial stimuli experienced from living in the south eastern portion of Alaska.

Story Telling

(how

) NARRATIVE PROCESS

118

4,373 people

Family Activity

Tatitlek to ANMC

Barrow

The Inupiaq mother is about to have another baby. She is staying in the new housing at ANMC until it is time to deliver. Being pulled away from home is difficult, but she is comforted by being able to do some of the things she regularly does at home. She is currently sewing a traditional baby garment in the family room. Others are sitting in the swing chairs that remind her of the blanket toss. Traditional foods are being prepared by a family, and while it isnt the same as home, she feels like she is part of a family here too.

INUPIAQ MOTHER: the Significance of Family

STEP

7

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The story of the Inupiaq Mother exemplifies a deep connection with the tundra. Elements such as wind, air, grass, and motion bind together with the significance of family as geographic and climatic realities require. As such, the family room has no specific program but is rather a space

that enables family to participate in multiple activities together. Specific attention is given to the ability to cook, sit, gather, and play in groups rather than isolation. This qualities directly correspond to the current lifestyle of those in the far northern area of Alaska.

Family

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6,363 people

Dance Regalia

Bethel to ANMC

Bethel

She is a dancer with national recognition. Growing up in a traditional home and the benefit of a supportive school, she lives in both the contemporary world and traditionally Alaska Native world. She reflects this in how she dances. Telling stories in abstracted movements and props, she promotes healthy communities and place-based art as a means to mend isolation and displacement. While she currently lives out of the state, she frequently goes to the ANMC to visit family and dance traditional dances for the patients.

YUPIK DANCER: Dancing and Drumming

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A series of diverse areas and sounds reflect the variety of substance and actions present in the Yupik/Cupik area. For example, the sound of rocks being pushed around illicit a connection with the many waterways

in the area. The overriding functionality, mobile quality, and size of the celebration room harken to the history of an adaptive lifestyle.

Celebration

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182 people

Holy Cross to ANMC

Holy Cross

6.25 Hours8 days

A village boy seasonally volunteers at the Alaska Native Heritage Center (Anchorage). He lives in Holy Cross, and as he dislikes flying, he will start his journey by taking a fishing boat up the Yukon River. Between navigating the river and visiting family, the journey on boat will take 8 days. Once he reaches Fairbanks, the village boy can drive (automobile) to Anchorage. The journey, which may seem far and long, is a reality for Alaska Natives even today. In-state migration is high and entire families may move from one village to another for a period of time.

ATHABASCAN VILLAGE BOY: Semi-Nomadic Life Today

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While initially appearing disregarded, the courtyard space of the new housing complex speaks directly to the realities of what it means to be a semi-nomadic people in Alaska today. Specific viewing angles and location of topographic changes translate from the spatial attributes and

environmental stimuli found in the Athabascan story. Rather than being a highly articulated and customed garden, the natural landscape with native plants and foliage are more familiar and therefore comforting for those traveling to the Alaska Native Medical Center.

Travel

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(wha

t)PROPOSAL

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Solidify through Participatory Design

Ideally the additional stories of the Eyak, Inupiaq, Yupik and Athabascan cultures would become as fully realized as the original narrative of the Sugpiaq Fisherman. These stories and subsequent design proposals are shown to illustrate the potential for other stories to be taken through the narrative translational process in the future.

It is at step seven that designers would dovetail back into the traditional conceptual design process. Designers would seek out feedback from stakeholders and the dedicated user-group on the results engendered from the narrative translational process. Based on feedback, subsequent design decisions and iterations would solidify the narrative process into the project.

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CONCLUDING ARGUMENTThis thesis shows, through the exploration of the Alaska Native Medical Center (new) Housing Complex, how a narrative translational process can be implemented within the conceptual design phase of a project. When done effectively, the process will theoretically remediate displacement and isolation, ultimately improving wellbeing. Buildings utilizing this process will have a direct connection to the physical and cultural context of the original environment of the intended inhabitants, thereby continuing essential place connections. Ideally, social spaces will be more comfortable and familiar because they embody physical and cultural elements realized through the analysis of a narrative based on real people, real actions, and a real place.14

Utilizing the narrative translational process is beneficial for all parties involved in the design project. Designers benefit from having in-house experts on culturally specific influences as well as a deeper connection to the intended occupants of the design project. Hospital administrators benefit because as wellbeing is improved patients length of stay is less, pain medication is reduced, and readmission is less frequent.15 The intended occupants benefit because they are surrounded with spatial, sensorial, and architectural elements that encourage positive social actions pertaining to their specific culture. This not only provides continuity of the wellbeing context, but it can improve the state of wellbeing through the combination of health services, healthy architecture, and culturally/place conscience design.

The narrative translational process isnt a quick architectural exercise; it is not done in a day. The knowledge garnered from the process isnt easily compressed into an informational slideshow with bullet points and pictures, nor can it be easily packed into a brochure or cultural brief. That being said, the narrative translational process does have the depth and holistic understanding of a

culture that most, if not all, briefs and slide shows lack. Furthermore, the amount of time it does take to utilize the narrative translational process conveniently fits into the time frame of an architectural project. More specifically it dovetails nicely within the conceptual design phase so both context and spatial programming directly benefit from the narrative translational process.

The narrative translational process aligns within the unique skill set of an architect. The process for the Sugpiaq Fisherman and the Alaska Native Medical Center have been delivered primarily in the media forms of hand drawing, photography, computer graphics, and collage. It is possible, however, to use any media/making form that is useful for the architect in order to reveal an understanding of the relationship between culture, place, and wellbeing. Rather than mandating a specific deliverable style, the significant contributing factor for the narrative translational process is the presence of the architect as it is the architect (and their hand) that defines, distills, and determines the relevancy of the narrative.

It is also important to note that while the steps in the narrative process stay consistent, the research focus and deliverables should change based on culture and place. For example, analyzing GROUND as a spatial quality component may not be relevant for other cultures or narratives. It is the steps, not the solutions, that are proposed within this thesis document as a means to address culture and place as architects design for wellbeing.

It is urgent architects begin to address wellbeing in its entirety. The current healthcare model in the United States encourages a traveling (ie: displaced) patient. From specialty hospitals servicing children with cancer to rural community members that must drive to receive preventative care, the reality is it is not uncommon for patients to receive healthcare outside of their established

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context of wellbeing (place and/or culture).16 With the rapid increase in human population, more individuals are experiencing the realities of being a displaced patient.17 Rapid population growth also means new hospitals and new facilities. Architects are hired to design these facilities, and as we look to the future, we must design intelligently and intentionally. As Rachel Cooper states, if we do not design environments that take into account the impact of the environment on our health and wellbeing we will not deliver the desired outcome for the planet or its inhabitants.18

Regardless of if the project is a hospital or not, regardless of if the project has anything to do with healthcare, we must start thinking about and recognizing the role of culture and place if we are to intentionally design for wellbeing. Architects are in the unique position to illicit change, and the narrative translational process is a viable option that should be explored and tested for its potential to positively affect wellbeing.

NEXT STEPS

The narrative translational process is tested, in a way, for accuracy and success during the process itself. Designers bring the findings from the narrative translational process to the client and intended occupants (step 7). At that time the client and intended occupants will provide feedback, and it is this feedback that will either reaffirm or redirect design decisions. In addition, the narrative translational process is intended to be tested post occupancy. Post occupancy analysis provides an excellent framework in which to test the effectiveness of utilizing a narrative translational process. Accuracy of understanding cultural norms and influences can be studied through qualitative methods such as surveys, interviews, and team meetings. Success of design proposals can be observed through fieldwork and sensors that collect data on human behavior

and the physical environment. Analysis of clinical data such as length of hospital stay, re-admission, and levels of pain medication are viable means to study improvements in wellbeing.

Additionally, the inclusion of pre occupancy analysis would not only imprint a tangible reality of culture and place for the architects, but it would also start the conversation about the role of culture and place early on in the project. This is an essential part of the design process as it provides a comprehensive understanding of the project within the context of wellbeing.

Through a full incorporation of research and analysis, a feedback loop is created so the successes within the narrative translational process is continually refined. Future utilization of the narrative translational process and future projects benefit from the feedback loop, ultimately resulting in a greater percentage of buildings that successfully address wellbeing in its entirety. Only when we do this can we repeatedly, positively affect health and wellbeing for all cultures.

The implications of architects taking on this type of work is multifaceted. Repeatedly using the narrative translational process would (in theory) not only affect occupants wellbeing, but it would also impact the theories on wellbeing. By recognizing, studying, and testing place and culture, architects would also directly be influencing the study of place and culture in other disciplines and professions, thereby affecting change on a scale far larger than this single thesis student can foresee.

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1 Koen Steemers, Architecture for Well-being and Health, D+A Magazine 23 (2015): 5.2 Sarah Atkinson, Sarah Fuller and Joe Painter, Wellbeing and Place, in Wellbeing and Place, (Ashgate Publishing Group 2012), 6.3 Ibid, 8.4 Christopher Rodning, Place, Landscape, and the Environment: Anthropological Archaeology in 2009, American Anthropologist 12 (2010) 184.5 Daniel G. Bates and Ellito M. Fratkin, Cultural Anthropology, (Boston: Allyn and Bacon, 2003), 14.6 Rachel Cooper, Elizabeth Burton, and Cary L. cooper. eds. Wellbeing and the Environment: Wellbeing - A complete Reference Guide, Volume 2. (Somerset, NJ, USA: John Wiley & Sons, Ltd., 2014), 80.7 Nic Marks and Sam Thompson, Measuring Wellbeing in Policy, New Economics Foundation, 2008, http://www.neweconomics.org/publications/entry/measuring-well-being, 5.8 The Well Certification Guide Book, International Well Building Institute (2016).9 Stephen Kellert, The Biological Basis for Human Values of Nature, in The Biophilia Hypothesis (1993), 46.10 Koen Steemers, Architecture for Well-being and Health, D+A Magazine 23 (2015) 8.11 Conversation Alan Scott. Director, YR & G. 12 William Browning, Catherine Ryan and Joseph Clancy, 14 Patterns of Biophilic Design, Terrapin Bright Green llc, (New York: 2014), 40.13 Daniel G. Bates and Ellito M. Fratkin, Cultural Anthropology, (Boston: Allyn and Bacon, 2003), 27.14 Susanne Siepl-Coates, Social Spaces at the Vidar Clinic in Jarna, Sweden and their Role in the Healing Process, The Architecture of Hospitals, (University Medical Center Groningen The Netherlands) 13-15 April 2005.15 Jain Malkin, A Visual Reference for Evidence-Based Design. (Concord : The Center for Health Design, 2008) 140.16 Andrew R. Cobern, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield. Choosing Rural Definitions: Implications for Health Policy in Rural

Policy Research Institue Health Panel, March 2007, 4.17 Maura Graff and Jason Bremner, A Practical Guide to Population and Development, Population Reference Bureau, June 2014, 14.18 Rachel Cooper, Elizabeth Burton, and Cary L. cooper. eds. Wellbeing and the Environment: Wellbeing - A complete Reference Guide, Volume 2. (Somerset, NJ, USA: John Wiley & Sons, Ltd., 2014), 67.

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1 http://www.census.gov/2010census/popmap/; 2 Eddie Hunsinger and Eric Sandberg, The Alaska Native Population: Steady growth for oringial Alaskans through years of change, Alaska Economic Trends, 2013, 13.3 Permafrost Map: Permafrost Zones, USDA Natural Resources Conservation Service Alaska, 2002, http://www.nrcs.usda.gov/wps/portal/nrcs/main/ak/technical/dma/.4 Quaternary Faults and Folds Map, Division of Geological and Geophysical Surveys, Alaska Department of natural Resources, http://maps.dggs.alaska.gov/qff/#-17900000:9100000:35 QuickFacts, United States, United States Census Bureau, 2010estimates, http://www.census.gov/quickfacts/table/PST045215/00.6 Ibid.7 Cultures of Alaska, Alaska Native Heritage Center, http://www.alaskanative.net/.8 The Russian Orthodox Mission, Alaska History and Cultural Studies, (Alaska Humanities Forum 2016), http://www.akhistorycourse.org/russias-colony/the-russian-orthodox-mission.9 What was the Klondike Gold Rush? National Park Service Learn About the Park, https://www.nps.gov/klgo/learn/goldrush.htm.10 Jim La Belle and Stacy L Smith, Boarding School: Historical Trauma among Alaskas Native People, National Resource Center for American Indian, Alaska Native, and Native hawaiian Elders, (Department of Health and Human Services, Oct. 2005) 11.11 The Trans-Alaska Pipeline, Alaska Public Lands Information Centers, http://www.alaskacenters.gov/the-alyeska-pipeline.cfm.12 The Great Alaska Earthquake and Tsunami of March 27,1964, Earthquake Hazards Program, (USGeological Survey, US Department of the Interior, April 2016), http://earthquake.usgs.gov/earthquakes/events/alaska1964/.13 Regulations: Public Law 93-638 Indian Self-Determination and Education ASsistance Act, as Amended, Department of the Interior Bureau of Indian Affairs and Department of Health and Human Services Indian Health Service, (1996) 2.14 Correspondance, Julia Suver, Alaska Native Tribal Health Consortium, 2015.15 Epicenter. Ala