OBSTETRIC AND GYNAECOLOGY

1

CHUKWUMERIJE, M. PG/M.Sc./98/45485

OBSTETRIC AND GYNAECOLOGY SPECIALIST HOSPITAL

THIS IS A PROPOSED SPECIALIST HOSPITAL FOR ENUGU, AIMED AT

HANDLING ALL HEALTH CASES AS IT RELATES TO ‘WOMAN’

DEPARTMENT OF ARCHITECTURE

UNIVERSITY OF NIGERIA, ENUGU CAMPUS

A THESIS SUBMITTED TO THE DEPARTMENT OF ARCHITECTURE,, FACULTY OF

ENVIRONMENTAL STUDIES, UNIVERSITY OF NIGERIA, ENUGU CAMPUS

Webmaster

Digitally Signed by Webmaster’s Name

DN : CN = Webmaster’s name O= University of Nigeria, Nsukka

OU = Innovation Centre

APRIL 2001

2

OBSTETRIC AND GYNAECOLOGY

SPECIALIST HOSPITAL

OBSTETRIC AND GYNAECOLOGY SPECIALIST HOSPITAL

THIS IS A PROPOSED SPECIALIST HOSPITAL FOR

ENUGU, AIMED AT HANDLING ALL HEALTH CASES AS IT RELATES TO „WOMAN‟

3

BY

CHUKWUMERIJE, M. PG/M.Sc./98/45485

DEPARTMENT OF ARCHITECTURE UNIVERSITY OF NIGERIA

ENUGU CAMPUS.

APRIL, 2001

CERTIFICATION

CHUKWUMERIJE, M. (Miss), a Postgraduate student in the

Department of Architecture and with Registration Number

PG/M.Sc./98/45485, has satisfactorily completed the

4

requirements for Design Research Report for the Degree of

Master of Science (M.Sc.) in Architecture.

The work embodied in this Thesis Report is original and has

not been submitted in part or full for any other Diploma or

Degree of this or any other University.

----------------------------- ------------------------------- CHUKWUMERIJE, M. DR. (ARC.) CHUKWUALI, B.C.

STUDENT HEAD, DEPARTMENT OF ARCHITECTURE

----------------------------- -------------------------------- DR. (ARC.) CHUKWUALI, B.C. EXTERNAL EXAMINER

SUPERVISOR

DEDICATION

5

This work is dedicated to GOD Almighty. Indeed, He is a

faithful God.

ACKNOWLEDGEMENT

I acknowledge the efforts of all who have contributed to

the success of my programme in school, especially in this

design research report.

I therefore, wish to express my profound gratitude to the

following people:

6

My beloved and wonderful parents, Engr. & Mrs. K.E

Chukwumerije.

My supervisor and Head of Department, Dr. Arc. C.B.

Chukwuali

My siblings, Muna, Sorom, Juoro, Nnenne, Ralu and Kadu.

My wonderful friends; Israel, Iroezindu for always being

there to assist, Emma Chima, Ndubueze Uche, Chinedu,

Emeka Onyeme, Robert Affortey, Emma Udomiaye.

My aunties and uncles; Mr. & Mrs. F.C Nwosu and Mr. &

Mrs. S.C. Igbokwe

My colleagues; the entire Graduating Class especially the

ladies, Enitan, Chinelo, Grace, Ibiso, Data, Askiya and

others.

To all of you, I say a heart-felt thank you and God bless

you all.

PREFACE

Health care presents a different problem in every country,

for the way it is organized is a response to geography, climate,

economic situation and social, cultural and political

conditions.

7

Whatever their administrative organization and however

they are financed, all systems of health care delivery comprise

a range of institutions which, at least in theory, are graded

according to their degree of sophistication and specialization

and the level of care that they can provide.

Three main levels can be identified and are usually

termed: Primary, Secondary and Tertiary. Primary care

embraces the entire general health practice services,

educational, preventive

and curative, that are offered to the population at the point of

entry into the system.

Secondary care comprises the care provided by more

specialized services to which people are referred by the primary

care services.

Tertiary

Secondary

Primary

8

Tertiary care includes highly specialized services not

normally found at secondary level, including super-specialties

such as plastic surgery, neurosurgery and heart surgery.

From the above explanations of the three main levels of

health care, it is obvious that the Design Research Report,

Obstetrics and Gynecology specialist hospital, is a secondary

health care system. Hospitals are inevitably a very expensive

element in any health service and very importantly, are an

indispensable part of the provision that is made for health.

They are costly to build and equip and the money necessary to

staff and run them can be enormous. Indeed, their annual

running costs may be as much as about a third of the initial

capital cost of construction and equipping them. The running

costs of a hospital are particularly high if it needs to accept a

large number of in-patients instead of treating them as out-

patients.

Considering all these, the Obstetric and Gynecology

specialist hospital will be designed to incorporate the out-

patient department, where patients will receive their specialist

diagnosis and treatment and also in-patient (ward) department

9

where the patients are admitted only when the degree of care

is essential for their recovery.

TABLE OF CONTENTS

TITLE PAGE:----------------------------------------------- i

CERTIFICATION:------------------------------------------ ii

10

DEDICATION:---------------------------------------------- iii

ACKNOWLEDGEMENT:---------------------------------- iv

PREFACE:-------------------------------------------------- v-vii

TABLE OF CONTENTS:---------------------------------- viii-x

PART ONE - BACKGROUND INFORMATION

CHAPTER ONE

1.1 INTRODUCTION:------------------------------------ 1-2

1.2 DEFINITIONS:--------------------------------------- 2

1.3 AIMS AND OBJECTIVES OF THE PROJECT:-- 3-4

1.4 STATEMENT OF ARCHITECURAL PROBLEM:- 4-5

1.5 SCOPE OF THE PROJECT:------------------------ 5-6

1.6 VIABILITY OF THE PROJECT:-------------------- 6

1.6.1 MEDICAL RECORDS:------------------------------ 6-11

1.7 LIMITATIONS OF THE PROJECT:--------------- 12

1.8 RESEARCH METHODOLOGY:-------------------- 13

PART TWO - LOCATION AND SITE ANALYSIS

2.1 PROJECT LOCATION:---------------------------------

2.2 HISTORICAL BACKGROUND OF ENUGU STATE:-

2.3 CULTURAL BACKGROUND OF ENUGU STATE:---

11

2.4 ENVIRONMENTAL CONDITIONS OF ENUGU STATE

2.5 REASONS FOR CHOOSING ENUGU STATE

2.6 SITE FOR OBSTETRICS AND GYNAECOLOGY

SPECIALIST HOSPITAL, ENUGU.:--------------------

2.7 REMEDIES AND ARCHITECTURAL CONCLUSIONS-

PART THREE - CASE STUDY

3.1 INTRODUCTION:-----------------------------------------

3.2 UNIVERSITY OF NIGERIA TEACHING HOSPITAL,

ENUGU:----------------------------------------------------

3.2.1 INTRODUCTION:-----------------------------------------

3.2.2 FORCES:--------------------------------------------------

3.2.3 FORMAL SIGNIFICANCE:------------------------------

3.2.4 MATERIALS:----------------------------------------------

3.2.5 FUNCTIONAL EFFICIENCY:----------------------------

3.2.6 MERITS:---------------------------------------------------

3.2.7 DEMERITS:-----------------------------------------------

3.3.0 NATIONAL HOSPITAL, ABUJA:------------------------

3.3.1 INTRODUCTION:-----------------------------------------

3.4.2 FORCES:--------------------------------------------------


3.4.4 MATERIALS:----------------------------------------------

12

3.4.5 FUNCTIONAL EFFICIENTY:----------------------------

3.4.6 MERITS:---------------------------------------------------

3.3.7 DEMERITS:-----------------------------------------------

3.4.0 MAIDUGURI TEACHING HOSPITAL, NIGERIA:-----

3.4.1 INTRODUCTION:-----------------------------------------

3.4.2 FORCES:--------------------------------------------------


3.4.4 MATERIALS:---------------------------------------------

3.4.5 FUNCTIONAL EFFICIENCY:---------------------------

3.4.6 MERITS:--------------------------------------------------

3.4.7 DEMERITS:----------------------------------------------

3.5.0 PROTESTANT HOSPITAL, HARLINGEN:------------

3.5.1 INTRODUCTION:---------------------------------------

3.5.2 FORCES:------------------------------------------------

3.5.3 FORMAL SIGNIFICANE:------------------------------

3.5.4 MATERIALS:--------------------------------------------

3.5.5 FUNCTIONAL EFFICIENCY:-------------------------

3.5.6 MERITS:------------------------------------------------

3.5.7 DEMERITS:--------------------------------------------

3.6.0 DISTRICT HOSPITAL, GORINCHEM:--------------

3.6.1 INTRODUCTION:--------------------------------------

13

3.6.2 FORCES:-----------------------------------------------

3.6.3 FORMAL SIGNIFICANE:-----------------------------

3.6.4 MATERIALS:-------------------------------------------

3.6.5 FUNCTIONAL EFFICIENCY:-------------------------

3.6.6 MERITS:------------------------------------------------

3.6.7 DEMERITS:--------------------------------------------

PART FOUR - DESIGN PROPOSALS AD OBSTETRICS

AND GYNAECOLOGY SPECIALIST

HOSPITAL, ENUGU

4.1 DEFINITION OF TERMS:-----------------------------

4.2 SOME HOSPITAL EQUIPMENTS AND THEIR

USES:----------------------------------------------------

4.3 OBSTETRICS AND GYNAECOLOGY SPECIALIST

HOSPITAL PLANNING REQUIREMENTS:-----------

4.3.1 THE RECEIVING AND CASUALTY

DEPARTMENT:------------------------------------------

4.3.2 THE OUT-PATIENTS‟ DEPARTMENT:---------------

4.3.3 THE WARD (OR NURSING) UNIT:-------------------

4.3.4 OBSTETRICS (MATERNITY) WARD UNIT:---------

4.3.5 GYNAECOLOGY (STERILITY) WARD UNIT:-------

4.3.6 ISOLATION WARD UNIT:----------------------------

14

4.3.7 SPECIAL DEPARTMENT:----------------------------

4.3.8 X-RAY DEPARTMENT:-------------------------------

4.3.9 PATHOLOGICAL LABORATORY:-------------------

4.0 MORTUARY BLOCK:---------------------------------

CHAPTER FIVE - DESIGN CONSIDERATION

5.1 SECURITY:--------------------------------------------

5.2 VENTILATION:----------------------------------------

5.2.1 FORM AND VENTILATION:------------------------

5.2.2 ADVANTAGE OF NATURAL VENTILATION OVER

ARTIFICAL VENTILATION (AIR CONDITIONING):-

5.3 NOISE AND ACOUSTIC:-------------------------------

5.4 LIGHTING:------------------------------------------------

5.4.1 ARTIFICIAL LIGHTING:---------------------------------

5.4.2 DAY LIGHTING:------------------------------------------

5.4.3 INTEGRATION OF ELECTRIC LIGHTING

AND DAY LIGHTING:------------------------------------

5.5 FIRE SAFETY:--------------------------------------------

5.5.1 FIRE COMPARTMENTS:--------------------------------

5.5.2 FIRE SUB-COMPARTMENTS (PATIENTS‟ AREAS):-

5.5.3 HARZARDOUS MATERIALS:---------------------------

5.6 THERMAL INSULATION:--------------------------------

15

5.7 ACCESS AND CIRCULATION:--------------------------

5.7.1 FOOTWAYS:-----------------------------------------------

5.7.2 ROADWAYS:-----------------------------------------------

5.7.3 ACCIDENT AND EMERGENCY:------------------------

5.7.4 OPERATING THEATRES:--------------------------------

5.8 DISABLED:------------------------------------------------

5.9 BUILDING MATERIALS:---------------------------------

5.9.1 CHARACTERISTICS:-------------------------------------

5.9.2 DENSITY:--------------------------------------------------

5.9.3 MODULUS OF ELASTICITY, TENSILE AND

IMPRESSIVE STRENGTH:-----------------------------

5.9.4 MOISTURE MOVEMENT:------------------------------

5.9.5 COEFFICIENT OF THERMAL EXPANSIONS:-------

5.9.6 THERMAL CONDUCTIVITY:---------------------------

5.9.7 SOUND INSULATION:----------------------------------

CHAPTER SIX - DESIGN PARAMETERS

6.1 DESIGN PHILOSOPHY:---------------------------------

6.2 DESIGN CONCEPT:-------------------------------------

6.3 IMPLEMENTATION OF THE DESIGN CONCEPT:--

6.3.1 FORM:----------------------------------------------------

6.3.2 BUILDING MATERIALS:-------------------------------

16

6.3.3 BUILDING STYLES AND ELEMENTS:---------------

6.3.4 LANDSCPAE:--------------------------------------------

6.3.5 ZONING:--------------------------------------------------

6.4 DESIGN ANALYSIS:-------------------------------------

6.4.1 MEDICAL SERVICES:----------------------------------

6.4.2 MEDICAL SUPPORT SERVICES:---------------------

6.4.3 GENERAL SUPPORT SERVICES:--------------------

6.5 CONCLUSIONS:----------------------------------------

BIBLIOGRAPHY:---------------------------------------

PART ONE

17

BACKGROUND INFORMATION

CHAPTER ONE

1.1 INTRODUCTION

This involves introducing the Design Research Report,

which is obstetrics and gynaecology hospital, its architectural

statement, aims and objects, scope, viability, limitations and

research methodology.

Pregnancy is not a disease (pathology) but a physiological

change in a woman.

Considering the rate of mortality amongst women which

could be as a result of the following:

18

Inability to afford high cost if delivery and treatment in

hospitals

Ignorance of the dangers of traditional treatment and

drug abuse

Ignorance of the dangers of early pregnancy and

uncontrolled abortion with teenage girls.

Lack of awareness for the need and importance of good

health on the side of some uneducated mothers

(illiterates)

This project has been introduced to solve or reduce all

these and other problems related to women i.e. diseases as

regards to the female reproductive system, pregnancy, child

delivery and training on how the mother and child will be

taken care of.

In view of this, a homely and cheerful environment will be

created or designed to achieve recovery at a faster rate.

1.2 DEFINITIONS

Gynaecology: The science with the disease of the female

productive system

19

Obstetrics: The science dealing with the care of the

pregnant women during ante-natal, child birth and few

days after child birth.

1.3 AIMS AND OBJECTIVES OF THE PROJECT

The aim of this project is to achieve a cheerful and

homely environment for the comfort and quick recovery of

patients. This is so as to eliminate or reduce mortality rate

amongst women at a low (affordable) cost, so that every family

can benefit from it. The following objectives will be used to

achieve the aim:

o Creating awareness on the dangers of using traditional

medicine for treatment, implications of the dangers of

early and unexpected pregnancy among teenage girls by

incorporating nature and awareness department.

o Achieving a homely and conducive environment by using

elements which appear friendly on the elevations

(aesthetics), good landscaping, and use of ornaments

where necessary, etc., for the psychological relieves of

patients.

20

o Selection of a suitable site located in a noiseless,

conducive and accessible area.

o Proper planning and zoning of the required functions on

site

o Provision of facilities within the environment needed for

quick recovery.

1.4 STATEMENT OF ARCHITECTURAL PROBLEM

Virtually, some of the Nigerian Specialist Hospitals lack

some necessary facilities needed for patients‟ quick recovery.

Some Hospital buildings lack aesthetics and functional spaces

because they are converted from residential, commercial, etc,

to hospital. Some are located in an unhealthy environment and

places that are not easily accessible by patients. All these

could affect the psychology of the patient which results to

delay in patient‟s recovery.

Obstetrics and Gynaecology specialist hospital requires

proper planning, design and provision of facilities needed to

achieve a cheerful and homely environment for quick recovery

of patients.

21

1.5 SCOPE OF THE PROJECT

The Obstetrics and Gynaecology specialist hospital will

incorporate the following:

Offices for Consulting doctors;

Research Department

Lecture rooms

Intensive care unit (nurseries and incubator)

Maternity

Theatres

X-Ray Department

Laboratory

General wards

Special wards

Motherless babies home

Paediatric unit

Service unit (maintenance, power house, laundry, etc.)

Mortuary and Embalmment unit, etc.

1.6 VIABILITY OF THE PROJECT

This project has been carefully considered, studied and

deemed viable considering the following records.

22

1.6.1 MEDICAL RECORDS

Maternal and Perinatal mortality and morbidity

Definition

Maternal Mortality: Death of a woman who is or had been

pregnant in the previous 42 days from causes related to

aggravated by pregnancy and its management. Examples are;

Haemorrhage

Sepsis

Abortion

Obstructed labour

Caesarean section

Sickle cell disease

Diabetis mellitus

Anaemia, etc.

Measurement of Maternal mortality:

Total number of deaths in the yearx100,000 Total number of births in a year

Because of the difficulty in accounting for all the births,

many studies use life birth. The value is written as:

x per 100,000 births per year.

23

Prevalence of maternal mortality ranges from 10 per

100,000 life birth in the Scandenavian countries to 640 per

100,000 life birth in Africa.

The rate in Nigeria is 800-1500 per 100,000 life births

per year. The rate in Nigeria shows reciprocal variation as

follows:

South west has less mortality rates than South East

South East has less mortality rates than North West

North West has less mortality rates than North East.

It also shows that the group variations are commonest in

poort, rural, illiterate, un-booked women, women who are poor

hospital users, as well as women at the extremes of maternal

age and parity.

Maternal mortality reflects adequacy of obstetric facilities

and its usage. It mirrors the general level of health in a

population.

Prevention:

Integrate maternal health into primary health care and

develop community based maternal health services

24

Involve women in community policy making

Encourage formal and informal health education of

women

Expand family planning facilities to prevent unwanted

pregnancies.

Personnel training and retaining of traditional birth

attendance.

Establishment of regional blood bank facilities

Encourage screening and referral of high risk

pregnancies early

Develop and implement a partograph monitoring

system to ensure early referral of women with

dysfunctional labour

Improve the general standard of living of the

population

Improve transportational facilities

Liberalization of the abortion law.

Prenatal Mortality: Death of foetus delivered and weighing

more than 500g or at a gestational age of 28 weeks. This death

25

may have occurred in the uterus or within 7 completed days of

delivery. It is a very reliable index of obstetric care.

Measurement of perinatal mortality: Number of deaths in the yearx1000

Total number of births

Reported as x per births per year. Common causes of

perinatal mortality.

Maternal Anemia

Ectampsia

Abruptio placenta etc.

Based on these records, the establishment of an

Obstetrics and Gynaecology Specialist Hospital in Enugu will:

Help in eliminating or reducing mortality rate

amonst women so that procreation can be

encouraged.

Create awareness of related diseases, its prevention

and treatment

Control the rate of population explosion through the

awareness on the need for birth control

Control the rate of child abuse and homeless

children by the provision of motherless babies‟ home

26

Improvement on the relationship between mother

and child by the provision of mother craft unit.

Maximum diagnosis and attention given to the

women for quick recovery by the locating specialist

hospital near University of Nigeria Teaching Hospital

(UNTH) Enugu for easy accessibility by Consultant

Doctors working in (UNTH)

Provision of a good site that is homely, noiseless,

cheerful and easily accessible by patients and

others.

1.7 LIMITATIONS OF THE PROJECT

This project i.e. Obstetrics and Gynaecology Hospital has

the following as limitations:

Lack of proper awareness of the diseases, their effect,

prevention and treatment.

Unavailability of enough standard hospitals for local

case studies.

Difficulty in granting permission for case study and

research by the owners of the hospital

27

Unavailability of well equipped facilities like Theatres,

Laboratories, etc. for research.

Unavailability of documented materials for study

High level of illiteracy amongst women

1.9 RESEARCH METHODOLOGY

The sources of information for this design research report

shall be the following:

Case studies on existing local and foreign hospitals

Research

Site visit and investigation

Library (documentation)

28

PART TWO

LOCATION AND SITE ANALYSIS

29

2.1 PROJECT LOCATION

30

2.2 HISTORICAL BACKGROUND OF ENUGU STATE

Enugu State derives its name from city called Enugu. The

city owes its existence to the discovery of Coal East of Ngwo

Village in Udi Division in 1909 by the geological exploration

team led by a British Mining Engineer called Mr. Kitson.

Later in 1914, another British Mining Engineer named

W.J. Leck arrived in Enugu from Onitsha, accompanied by

group of labourers led by one Mr. Alfred Inoma. The whites

settled first at Hipp Top while Alfred‟s group settled in Alfred

Camp (the present “Ugwu Alfred). The white later shifted to

what became the European Quarters now Government

Residential Area (G.R.A), especially with the construction of

the Enugu Railways Station in 1915. This became necessary

following the construction of Railway line to link the Enugu

Coal fields with the Coast at Port Harcourt for export

purposes. The African settlers then spread from the Alfred

Camp to „Ogbete‟ also known as Coal Camp.

31

These two establishments, Coal industry and the

Railways, offered employment to thousand of people. This

encouraged migration from the hinterland for permanent

settlement in the budding coal city.

With time, Enugu widened in scope and became more

and more accommodating for people from far and near. It

became a veritable and hospitable home for many. Soon,

several surrounding towns and communities grew as satellite

to the sprawing colossus, Enug city, to the extent the natives

of the satellite towns and villages became identified as “people

from Enugu are”. This group name-tag persist till data. This

long time connection has today metamorphosed into a land

area grouping called Enugu State.

Enugu is today aptly referred to as a mother state

headquarters of the present nine states East of the Niger. It

had remained the administrative headquarters of the former

Eastern region, Eastern Nigeria, the defunct-Republic of

Biafra, the East Central State, the Old Anambra State and now

Enugu State, spanning some fifty-three years.

32

Enugu State, like other states in Nigeria, has two tiers of

government. The state, and the Local government, which is

seventeen in number.

2.3 CULTURAL BACKGROUND OF ENUGU STATE

Culture is the totality of a people‟s existence. It comprises

devices, which have been invented by a people to adjust to

their physical and social environments.

The people of Enugu State are ethnically Igbos and are

widely known to be very resourceful and hardworking. Skilled

man-power resources are therefore readily available in almost

every field, business, management, commerce and industry.

They are friendly and sociable. They also show great respect to

visitors and those who come to lie and work among them. The

vernacular spoken is Igbo but English is widely used and a

visitor can make himself understood even in the humble

hamlet if he can speak a modicum of English.

Enugu state can conveniently be divided into two cultural

zones based on linguistic and choreographic pattern. These are

Enugu and Nsukka zones. This division however is not so rigid

as there are many cultural features common to almost all

33

parts of the state. These cultural features are the language; the

family; the belief system and the local political organization.

The family is one common factor discernible in Enugu

State. It is the basic social unit and exerts preponderant

influence on members. It is consulted by members before any

major decision is taken and it forms the bedrock of the

individual‟s defense, respect and the maintenance of the good

image of the family forms the cornerstone of socialization

among the people of the state.

2.4 ENVIRONMENTAL CONDITIONS OF ENUGU STATE

Enugu State is influence by some environmental factors

like the following:

CLIMATE: Enugu is situated at the Eastern slope of

the undulating hills generally known as Udi hills.

Located in the tropical rain forest region of West Africa,

the city enjoys a comparatively equable climate with

temperature ranging between 22.4OC and 30.8OC.

Two major seasons dominate the area, namely, the

dry and wet season. The dry season lasts between

November and April of the following year. Hottest months

34

(February to April) average about 30.5OC (87OF). The days

are hot and humid. Economic activities may extend up to

three hours into the night. However, a short spell of

harmattan sub-season occurring around

January/February interrupt the high humidity and

brings with it very chilly and dry winds from the Sahara

desert. The resultant effect is a dusty environment.

Rainy season lasts between April and October. The

heaviest rains fall between June and July. The annual

rainfall is between 152 and 203cm in the absence of rain

the weather is clear and cool. However, high humidity

may prevail.

GEOGRAPHY: Enugu state is one of the thirty-six

states of the country. The state came into being on

August 27, 1991, with the creation of more states by

the General Ibrahim Babangida administration.

Situated on much of the highlands of the Awgu-

Udi-Nsukka hills and the rolling lowland of Oji River

basin to the west, the state is bounded by other states

with which it shares common boundaries. It spread

southwards to the borders with Abia and Imo states

35

and northwards to the Benue and Kogi states‟ border.

In the East and West, it is flanked by Ebonyi and

Anambra states respectively. The undulating hills of

Udi with their green vegetation of tropical forests to the

rocky promontories of Awgu and the beauty that

titillates the traveller‟s emotions.

It has rich and vast agricultural and mineral

resources and estimated population of about 2273,

560 living in an area of approximately 8727 kilometres

of land.

Apart from chain of low hills, running through Abakaliki

in the East to Nsukka in the West and then Southwards

through Enugu and Awgu, the rest of the state is made up of

low land criss-crossed by numerous steams and rivulets of

which the major ones are the Adada and Oji Rivers.

Enugu state has an altitude of about 232.6 metres

(762ft) above sea level.

36

2.5 REASONS FOR CHOOSING ENUGU STATE

The reasons for choosing Enugu state as the project

location are as follows:

POLITICAL STRATEGY: The provision of medical

facilities in Enugu ranks second to education in order

of priority of the state government and takes a large

chunk of the annual budget. The state government is

making serious effort to ensure that hospitals and

health centres, as well as maternity homes are

provided in all the Local Government Areas of the

state.

AVALIABILITY OF A TEACHING HOSPITAL IN

ENUGU (UNTH): This project is Obstetrics and

Gynaecology specialist hospital and therefore needs

specialist Doctors, ther is a need to site the project

near a teaching hospital. This is so that the specialist

consultants can, from the University teaching hospital

Enugu, drive down to the project location, which is not

37

far from the teaching hospital and attend to their

patients when the need arises.

GEOGRAPHICAL LOCATION ON ENUGU STATE: This

state is bounded by other states with which it shares

common boundaries. It spreads Southwards to the

bordes with Abia and Imo states and Northwards to

the Benue and Kogi states‟ border. In the East and

West, it is flanked by Ebonyi and Anambra states

respectively. This means that Enugu state is centrally

located.

It is then possible for patients from any of the

mentioned states or other states pt access the

hospital in Enugu state without much stress.

COMMUNICATION SYSTEM IN ENUGU STATE:

Enugu state has good or well-developed

communication syste. The communication system are:

A well-developed network of roads connecting

important centres and places in the state. Although

some of the roads need reconstruction. There are

main trunck roads linking Enugu to some states.

38

These are:

o Enugu to Markudi in Benue state

o Enugu to Port Harcourt in Rives state through

Abia and Imo states

o Enugu to Onitsha in Anambra state.

2.6 SITE FOR OBSTETRICS AND GYNAECOLOGY

SPECIALIST HOSPITAL, ENUGU.

The site for the project is the trade fair layout, Phas 1.

This is accessed off Onitsha Express Road, near New Market,

Enugu. It is in Enugu North Local Government Area, Enugu

State.

The site has a plain typography with a gentle slope which

is negligible. Drainage of water on it is not a problem.

It has trees and grasses on it and it is surrounded by an

empty land, which also has trees and grasses and residential

buildings which their construction is still in progress.

The site is irregular in shape. It has two access roads:

One road in front and the other road by one of the sides.

The government has originally allocated it in the layout

plan as a hospital. It is a new developing area being handled

39

by the Enugu State Government. Owing to the residential

buildings beside it, the site is a noisy area and so needs good

landscaping to reduce the effect of noise in the site.

2.7 REMEDIES AND ARCHITECTURAL CONCLUSION

Owing to the nature of the slope of the site, the drainage

of water on the site will be channeled in the direction of the

gentle slope, which directs the water into Awuru stream which

is near the site.

The site will be landscaped with trees, shrubs and also

the Obstetrics and Gynaecology hospital far from the main

access so as to reduce the effects of noise, which could be

detrimental to patients‟ health on the site.

Zoning of the different activities will also be used in

achieving the best result and also orientation of the buildings

on the site to reduce the harsh effect of wind, solar radiation,

glare, moisture, heat, etc. on the structures and users.

40

PART THREE

CASE STUDY

CHAPTER THREE

3.1 INTRODUCTION

41

In this design research report, local and foreign case

studies are used. These case studies share the same topic

„hospital‟ but they are approached from different angles. These

case studies used are as follows:

University of Nigeria Teaching Hospital (UNTH) Enugu,

Nigeria.

National Hospital, Abuja, Nigeria

Maiduguri Teaching Hospital, Nigeria

Protestant Hospital, Harlingen

District Hospital, Gorinchem

In analyzing these case studies, certain parameters are

used.

They are:

Forces

Formal significance

Materials

Functional efficiency

Merits

Demerits

Forces: In Architecture, they are regarded as forces, which act

on a building. These include site, location, programme

42

(activities it is accommodating). Site includes natural and

man-made conditions present within and around the site,

access, topography and views from site, etc.

Form Significance: This refers to the physical form of the

building and its relationship to Architecture of the place and

other factors, which may in one way or the other affect it.

Materials: This refers to the materials used in construction

and their meanings. These include strength, durability, weight,

lightness, etc.

Functional Efficiency: This refers to basic requirements of

the function and how the building is meeting up with the basic

requirements.

3.2 UNIVERSITY OF NIGERIA TEACHING HOSPITAL,

ENUGU

3.2.1 INTRODUCTION

University of Nigeria Teaching Hospital, Enugu was

founded in 1971. The bulk of its activities is rendered

43

currently at its temporary site. Its permanent site is located at

Ituku-Ozalla which is at the outskirts of the city.

3.2.2 FORCES

University of Nigeria Teaching Hospital, Enugu is located

at the beginning of Agbani Road. Ogete Main Market, the

Central Police Station, Enugu Prisions, part of Coal camp and

G.R.A bound it.

The state has both natural features like tree, sullies,

green lawn and man made features like the building and paved

roads. Around the site are Pharmaceutical shops, residential

houses, hills etc. It is easy to access from any part of the town

and it has goods roads. It has varying colour readings at

different points.

The site has one major access route and so many others

into the following areas:

Administration office

Casualty unit

School of nursing

Medical students hostel

Mortuary, etc.

44

3.2.3 FORMAL SIGNIFICANCE

Rectangular buildings of various storey heights dominate

the site.

3.2.4 MATERIALS

Materials used are long span aluminum roofing sheets,

Emenite roofing sheets, etc. on roofs, concrete on walls,

reinforced concrete columns, etc.

The whole structures look simple and are quite

functional.

3.2.5 FUNCTIONAL EFFICIENCY

The hospital has 700 beds as well as 33 costs in the new

born unit and a total of 24 wards. The beds in the Obstetrics

and Gynaecology units are as follows:

Antenatal - 12 beds

Isolation ward (antenatal) - 11 beds

Post natal - 48 beds

Labour ward - 10 beds

Gynaecology ward - 28 beds

45

This implies that Obstetrics was has 81 beds and

Gynaecology ward has 28 beds, thereby making it 109 beds in

Obstetrics and Gynaecology unit.

The hospital offers a wide range of medial services to

patients resident in the town as well as to patients who have

been referred from other hospitals or health centre within and

outside the state.

On the average, about 76,000 patients are attended to by

the hospital yearly.

3.2.6 MERITS

The location of the hospital at the core of the city makes

it quite accessible by all.

Because it is a teaching hospital and has some special

departments, it handles referral cases from all parts of

the country.

There is no conflict in circulation because of the zoning

It is properly zones department by department thereby

eliminating the problem of identification of the various

departments

Natural ventilations mainly ventilate buildings

46

3.2.7 DEMERITS

Because it is not well planned and designed, the erection

of the location and erection of structures are not

coordinated or organized.

It has more patients than it can handle because the

facilities provided are not sufficient for both the staff and

patients

So many entrance and exit routes give rise to insecurity

Improper location of the powerhouse beside the energy

3.3.0 NATIONAL HOSPITAL, ABUJA

3.3.1 INTRODUCTION

This hospital was officially opened in September, 1999. It

was formally known as FSP National Women and

Children Hospital, Abuja and was commissioned by Mrs.

Mariam Babangida, wife of one time Head of State,

Commander-in-chief of the Armed Forces, General

Ibrahim Babangida. The name was changed to National

Hospital, Abuja in the year 2000. The hospital project

47

was completed by the Civilian regime and the

construction finally executed by Julius Berger

Construction Company, Ltd.

3.3.2 FORCES

The site is at Plot 132 Central District (Phas II), Garki-

Abuja. It has some natural features like green lawn, shrubs,

trees and flower and some man made features like building,

paved roads and walkways, etc. within the site. Some other

buildings and trees sound the site.

The site has one major entrance and exit accessed

respectively. The topography is a gentle slope which slopes

from the access routes down the site.


The site has buildings that have different geometric

shapes like: rectangles and polygons. Rectangles are less

expensive forms to construct when compared with other

geometric forms, examples, circles, etc.

48

The vertical columns used indicate strength. The

polygons indicate balance or stability and are used in the

hospital to introduce country-yards.

The rectangular form and the arrangement of the

different units in a clustered but organized way depict the

culture of the area.

3.3.4 MATERIALS

The materials used are: Long span Aluminum Roofing

sheets on the roof (light-weight), Concrete on walls and

reinforced concrete columns, (strength and durability), facing

bricks (aesthetics), concrete and ceramics tiles for floor

finishes, etc.


The hospital has 200 beds and was initially designed as a

referral hospital. It has about 140-150 beds occupancy weekly.

The rectangular form and arrangement of different units in a

clustered but organized way depict the culture of the area.

3.3.6 MERITS

49

The hospital is well designed and its functions zoned into

different units for easy circulation and identification.

The hospital environment is quite homely and conducive

for patients fast recovery because of the landscaping,

massing of the element in the buildings, materials used

for construction and finishes, and the forms.

The location of the hospital site is quite accessible and

has good road network

The forms used are simple and economically cheap to

construct

The roof used over the buildings reduces the seriousness

of the environment thereby giving it a homely and

cheerful touch.

Road network within the site is constructed in such a

way to control drainage of water in the direction of the

slope

Two major access routes, which serve as entrance and

exit routes respectively for all activities so as to enhance

maximum security on site.

50

In the maternity unit, the wards (both single and general

wards) labour rooms and theaters are located within the

same area for maximum efficiency

Courtyard is used to introduce relaxation/leisure garden,

easy circulation, cross ventilation into the various rooms

and good view.

The site has area marked for future expansion

Maintenance and powerhouse located away from the

main activities to reduce noise impact on the activities

and buffered with catering department and stores.

3.3.7 DEMERITS

The conversion of the hospital from FSP (Family Support

Programme) National Women and Children Hospital

(which made it a referral or specialist hospital) to

National Hospital (General hospital) affected the efficiency

of the hospital.

The hospital is now under staffed and does not have

enough facilities to accommodate her patients

51

This could now result to regular maintenance (which is

not cost effective) and fast dilapidation rate if the rate at

which it is used is not controlled or the hospital

expanded to accommodate more patients.

3.4.0 MAIDUGURI TEACHING HOSPITAL, NIGERIA

3.4.1 INTRODUCTION

Maiduguri teaching hospital is located in the north east

of Nigeria, a hot dry region bordering on the Sahara. It is a

Moslem area. It was designed by Architect John R. Harris.

3.4.2 FORCES

The site has one major entrance and exit routes,

respectively. It has both natural features like trees, green lawn

and man made feature like building, paved roads, etc.


The hospital form is got as a result of interplay or

intersection of rectangular forms of different sizes. These

52

intersections gave rise to courtyards, which does not only serve

as a recreation area but also as a means for ventilation and

lighting within the interiors of the hospital.

3.4.4 MATERIALS

Long span roofing materials are used on the roof. It has

flat roofs with some sections of the roof covered with parapet.

Concrete is used on the walls.


The hospital has 517 beds. Men and women‟s wards are

at opposite ends of the two-storey spine. A possible future

extension to the south could provide further 256 beds. Wards

are naturally ventilated, theatres and ITU fully air conditioned

with local window mounted units and some rooms such as

clean and dirty utilities are mechanically ventilated.

3.4.6 MERITS

Wards in the hospital are naturally ventilated because of

the use of courtyard system

53

The hospital has different block sizes which are different

units zoned to achieve maximum efficiency

There is no conflict in circulation

Noise generated in the maintenance and engineering

departments are controlled by zoning them away from the

main building.

3.4.7 DEMERITS

Distance between the women and men‟s wards may

result to lack of coordination

Flat roof used which is as a result of the climatic

condition of the region. This, effect the aesthetics of the

hospital.

The form used creates long corridors for circulation.

So many circulation spaces are involved and it is

expensive to construct and maintain

Some areas are ventilated by artificial ventilation (air

condition)

3.5.0 PROTESTANT HOSPITAL, HARLINGEN

3.5.1 INTRODUCTION

54

Protestant hospital, as the name implies is a hospital

established by protestant in Harlingen. It is a modern hospital

designed by H. Hoekstra and G. Westerhout, the Hague and

has 120 beds capacity.

3.5.2 FORCES

The site has an irregular shape and has both natural

features like green lawn, shrub, etc and man made features

like the buildings and paved driveways. Around the site are

other natural and man-made features like buildings and tress.

It also has one main entrance and exit access.


The hospital complex form is interplay of rectangular

forms of different sizes. It also has a curve (arc) on the main

entrance of the building, which actually defines it. The

combination of the different forms brings out its simplicity.

3.5.4 MATERIALS

Some of the materials used are concrete on walls and

reinforced concrete columns especially on the entrance and

55

few in some internal spaces. So many openings are used in the

complex to achieve vision, lighting and cross ventilation.

3.5.5. FUNCTIONAL EFFICIENCY

The hospital complex has three major sections. They are:

Main building

Nurses‟ wing

Boiler house

It also has different corridor widths for various spaces.

They are as follows:

Wards - 1.25m

Treatment wing - 2.25m

Kitchen - 3.07-2.53-1.61

Out-patients department - 2.50

Nurses‟ quarters - 1.50

Bed capacity for different departments and their positions

in the complex:

Department Floor Number of beds

Internal disease Ground 34

Surgical 1st 34

56

Obstetrics and Gynaecology 2nd 2

Children‟s 2nd 29

TOTAL 120

3.5.6 MERITS

The major activities is the located within the same area

there making the complex a unit block

The major entrance into the building is defined with a

contrasting form

Because of the unified nature of the design, the site has

spaces for future expansion and other ventilation, view

and lighting in the interiors of the complex

One major access used to achieve security on site

Nurses‟ wing located close to the main building for easy

access and coordination for nurses when thy are on duty

Boiler house located away from the main building so that

noise generated in it would not affect the activities in the

main building.

All theatres are located on the first floor for easy

plumbing and servicing.

57

3.5.8 DEMERITS

There tends to be conflict of activities and difficulties with

identification of departments since all are zoned in the same

block

Noise generated within the main building could affect the

activities because of the conflict in zoning the functions

The zoning of the functions could result also to conflict in

circulation.

Long and uninteresting corridors are created because of the

forms used and the pattern in the zoning of the functions.

There is no surgery theatre on the 2nd floor for emergency

cases during delivery where the delivery rooms and

maternity departments are located.

3.6.0 DISTRICT HOSPITAL, GORINCHEM

3.6.1 INTRODUCTION

District hospital is situated in Gorinchem. It is a modern

hospital designed by B.J.K Cramer, Rotterdam and has 236

beds capacity.

3.6.2 FORCES

58

The site is irregular in shape and has natural features

like green lawn, trees, shrubs and man-made features like

building, paved roads, etc. It has a major entrance known as

„main entrance‟ and other minor access routes in the site.


The hospital complex is interplay of rectangular form of

different sizes. This makes it simple and defined.

3.6.4 MATERIALS

Some of the materials used are concrete on walls and

reinforced concrete columns (rectangular and circular

columns) especially in the internal spaces. „U‟ and spiral or

circular staircases are used.


The hospital complex has two major sections. The

sections are as follows:

Hospital

Nurses‟ home

It also has different corridor widths for various spaces.

The spaces are as follows:

59

Wars - 2.15m

Treatment building - 2.40

Nurses home - 1.58m

Bed capacity for different departments and their positions

in the hospital building:

Department Floor Number of

beds

Internal disease department 1st 60

Surgical department 2nd 58

Obstetric and Gynaecology 3rd 13

Psychology and Neurology ground 9

Children‟s department ground 45

Private patients department 3rd 38

Other departments ground 13

TOTAL 236

3.6.6 MERITS

The main hospital building is located separately from the

nurses‟ home therefore making the activities defined.

60

The site has more than one access route, which reduces the

level of security on site.

The rectangular form used gives the hospital building a

defined and simple shape

All surgery departments are located on the 2nd floor for easy

plumbing and servicing.

3.6.8 DEMERITS

Technical department, which includes powerhouse, etc. is

located within the main hospital building and the noise

generated there could disturb othe activities in the hospital

The form of the building hinder cross ventilation in some of

the functions

Various departments are grouped and located on different

floors for easy coordination thereby reducing conflict.

Uninteresting long corridors are created by the interplay of

the forms

There is no surgical theater on the 3rd floor where the

maternity department is located, for emergency purposes.

61

PART FOUR

DESIGN PROPOSALS FOR OBSTETRICS

AND GYNAECOLOGY SPECIALIST HOSPITAL,

ENUGU.

62

CHAPTER FOUR

DESIGN CRITERIA

4.1 DEFINITION OF TERMS

Obstetrics: The science that deals with the care of the

pregnant woman during antenatal, parturient (pertaining to

child birth) and Puerperal psychosis (a mental illness

occurring in the puerperium implying four-day blues‟ and

postnatal depression) Puerperal sepsis (Infection of the

genital tract occurring with 21 days of abortion or child

birth

Gynaecology: The science dealing with the disease of the

female reproductive system.

Casualty Department/ward: Also known as emergency

room. This is the part of a hospital where people have been

hurt in accidents are taken for urgent treatment.

Outpatient: A person visiting a hospital for treatment but

not staying overnight

Operating theatre: A room in a hospital used for

operations. While operation is a surgical procedure upon a

part of the body

63

Pathology: The science, which deals with the cause and

nature of disease.

Laboratory: A room or building used for scientific research,

experiment, testing, etc.

X-Ray: This is a type of radiation that can penetrate solid

objects and make it possible to see into or through them. X-

rays are commonly used by Doctors to examine bones and

organs inside the body and also in treatment.

Incubator: An enclosed cradle kept at appropriate

temperature in in which premature or delicate babies can be

reared.

Nursery: A room for young children

Consulting room: A room where a Doctor talks to and

examines patients

Sterilization: Treatment, which achieves the killing or

removal of all types if micro organisms including spores. It

is accompanied by using heat, radiation, chemicals or

filtration

Recovery room: The room in a hospital where patients are

kept immediately after an operation.

Anaesthetic: A drug, which produces anesthesia

64

General Anaesthetic: Drugs, which produces general

anaesthetic by inhalation or injection

Local Anaesthesia: Drugs, which when injected into

the tissue or applied topically cause local insensibility

to pain. This also applies to spinal anaesthetic

Anaesthesia: Loss of sensation.

Dispensary/Pharmacy: A shop or part of a shop where

medicines and drugs are sold. It is a place in the hospital,

where medicines are prepared

Diagnosis: The art or act of distinguishing one disease from

another.

Rdiography: The use of x-radiation to:

Create images of the body from which medical

diagnosis can be made.

Treat a person suffering from a (malignant) disease,

according to a medically prescribed regime (therapeutic

radiography)

Radiographer: A person qualified in the techniques of

diagnosis or therapeutic radiography

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

Radiologist: A medial specialist in Diagnosis by using X-

rays and other allied imaging techniques.

Histology: Microscopic study of diseases.

Morbidity: The state of being diseased

Mortuary: A room or building e.g. part of a hospital in

which dead bodies are kept before being buried or cremated

4.2 SOME HOSPITAL EQUIPMENTS AND THEIR USES

Medicine trolley (cart): A cart on wheels that can be pushed

or pulled along and used for moving drugs/medicine.

Bedside Locker: A loackable cupboard beside a patient‟s bed

where things owned by the patient can be stored securely

Children‟s Cot: A bed for young, usually with sides to

prevent the children falling out.

Incubator: An enclosed cradle kept at appropriate

temperature in which premature or delicate babies can be

reared.

Suction unit: Used in removing air from a space, container,

etc. so that something else can be drawn into it.

92

Cyclotron: An apparatus in which radioactive isotopes can

be repaired.

Operating microscope: An illuminated binocular

microscope enabling surgery to be carried out on delicate

tissues such as nerves and blood vessels. Some models

incorporate a beam splitter and a second set of eye pieces to

enable a second person to view the operation site.

Anaesthetic machine: A machine used during surgery to

cause anaesthesia

Autoclave: An apparatus for high-pressure steam

sterilization

Operation table: A patient uses this or patient lies on it

during an operation.

4.3 OBSTETRICS AND GYNAECOLOGY SPECIALIST

HOSPITAL PLANNING REQUIREMENTS

4.3.1 The receiving and casualty department:

During design of the Obstetrics and Gynaecology

specialist hospital, Enugu, this department will be functionally

related to the hospital and the out-patients‟ department.

93

94

95

96

A patient (other than a paying patient or a patient sent in

by an outside doctor) is required in most hospitals, on entering

the hospital for the first time, to enter through the casualty

department. Whether he arrives by ambulance, wheel chair or

on foot, regardless of his ailment, he is received here.

Exactly where the patient is sent after the resident

medical officer has examined him depends, naturally, upon the

medical findings. The patient may be:

Admitted to the observation ward unit in the casualty

department.

Operated upon immediately, either in the theater in

the casualty department or in the out-patient‟s

department.

Admitted to the in-wards (and perhaps upon in the

major operation theatre suit).

Sent to the out-patient‟s department (to become an

out-patient)

Given first aid and sent home, possibly being

requested to return next day (He might then become

an out-patient and not return to the casualty

department).

97

The major functions in this department are:

Surgical casualties

Casualty administration

Medical casualties

Casualty observation ward unit

4.3.2 THE OUT-PATIENT’S DEPARTMENT

This department performs two main functions:

To keep patients out of bed by diagnosis of ailment and

effecting a cure at an early stage.

Follow-up treatment after discharge from the hospital

wards.

It is essential that this department, be self-sufficient for

diagnosis work and the accommodation must be cramped.

Some of the major functions in this department are:

Administration

Dispensary

Medical clinic

Surgical clinic

Ante-and post-natal clinic

98

Gynaecology clinic

Paediatric clinic

Mass radiography unit

4.3.3 THE WARD OR ( NURSING) UNIT

This is the most important element of any hospital. A

patient admitted to the wards either from the casualty

department, the out-patients‟ department or by arrangement

with the patient‟s outside doctor. The prime services however,

of an average sized acute specialist hospital are considered to

be:

General surgery

Genera; medicine

Obstetrics (maternity)

Gynaecology

The majority of beds will, therefore, be for these cases.

When commencing the plan of ward unit, it is important to

ascertain, at the onset, its size, which will be governed by the

following factors:

99

The ailments of the patients, as some patients require

constant nursing whilst others make very few demands upon

the Nursing staff.

The maximum number of these patients that can be

properly supervised by the Ward Sister with her „Nursing

team‟.

The cost and capacity of the fittings installed in the unit.

Some fittings are costly and are adequate to cater for many

more patients than may be in the unit.

It must be remembered that many auxiliary rooms go to

the making of the ward unit and these are virtually the same

in number, not a proportional increase in cost per bed.

It will be appreciated that a hospital for 120 beds can be

designed, for example, in wither four units of beds each or in

five units of 24 beds each. The latter will, of necessity, prove

more costly, both in building and maintenance costs, including

staff, salaries etc. but, on the other hand, will permit of a more

personal services to the patients.

Each ward unit should be self-contained and free from

main traffic through it.

100

Major wards are used in the design of the Obstetrics and

Gynaecology specialist hospital, Enugu. The wards are:

4.3.4 Obstetric (Maternity) ward unit:

This department caters for short-stay‟ patients, the

average length time spent here by mothers being twelve days,

two days of which she is ambulant.

The accommodation may be provided on one or more

floors but the septic section may be on the ground floor

approached by its own separate external entrance.

Twenty mothers, each with one baby, represents forty

persons requiring Nursing, so considering this, twenty beds

may well be regarded as a maximum for one sister (Nurse).

The Obstetric Unit will require sectionalized

accommodation for:

Reception of patients

Ante-natal patients: This constitute women who are between

2-10, 8½ months pregnant, whose pregnancy may not be

taking a normal course or is affecting other organs in the

body, (i.e. Kidneys, etc.).

101

Delivery-theatre suite

General maternity patients

Mother craft unit: This is where during the last few days in

hospital the mothers live with, and wholly care for, their

babies under supervision before returning home. This unit

caters particularly for mothers with first babies. Not more

than 8 patients should be accommodated in any one

bedroom provided the ward unit has a large proportion of

single rooms.

4.3.5 GYNAECOLOGY (STERILITY) WARDS UNIT:

This unit can, with advantage be planned on upper

floors. There is a slightly rapid bed turnover in this ward unit.

8 beds should be considered a maximum in anyone sickroom.

Occasionally, a patient, when admitted, is found to be

suffering from an infectious disease and must be confined to

the single sickroom. To safeguard the spread of infection, a

small separate sluice room will be provided.

102

4.3.6 ISOLATION WARD UNIT

This unit is perhaps best planned as a separate building

within the grounds of the hospital. If this is possible, it should

be situated in an isolated position and shut off from the main

hospital circulation by a well-ventilated lobby. All patients will

be accommodated in single sickrooms and perhaps suffering

from different ailments, the demands upon the Nursing staff

will be heavy. For this reason, the ward unit should be

restricted to 16-20 beds. All beds to be accommodated in

single sickrooms.

4.3.7 SPECIAL DEPARTMENTS

Operating theatre suit: Hospitals, varying from those of

100 beds and less to 800 beds and over, will all present

different operating theatre requirements but as a

preliminary guide ratio of one theatre to each fifty beds may

be adopted for sketch plan purposes. Another factor

governing the number of theatres will be the type of

hospital. An acute general hospital having a rapid bed

turnover will require more facilities than an hospital having

a rapid bed patients‟ length of stay varies between three and

103

twelve months. The number of operations that can be

performed in one day cannot easily be assessed as

operations vary from a few minutes to a few hours.

Where several suites are required, it appears at first

glance, that it would be advantageous to construct a theatre

wing, with

Suites planned one above the other, thereby bringing into

play all the advantages of vertical planning for efficiency and

economy in services, (water, gas, electricity, anaesthesia, etc.)

With desirability to form the ward unit, not as a ward, but as a

series of sickrooms; the general ceiling heights of the hospital

will be approximately 3000mm in the clear, whereas operating

theatres will require heights varying between 3600mm and

4500mm. It becomes apparent therefore that an attempt at

vertical planning (or stacking) of theaters will lead to

intolerable differences in floor levels throughout. The top floor

will probably prove the best situation to plan the theatres

where several suites are required. It is essential that the

theatre suit or suites be planned as self-contained units,

through-traffic along the corridor. Although operating today is

performed almost invariably under artificial light (with theatres

104

having a full air-conditioning ventilation system whereby the

windows remained closed), it is best to plan the suit (s) to

reduce heat and glare.

In addition to these things,

Two separate entrances to the theatre are essential, one

from the anaesthesia room and the other (to constitute a

patients‟ exit) from the general circulation corridor.

Direct access is required from the theatre to the

sterilizing room, dirty waste-up room and surgeons and

Nurses‟ scrub-up rooms (or recesses).

Natural daylight and ventilation is necessary, the former

during theatre-cleaning activities and the latter in the event of

a breakdown in the ventilating plant.

4.3.8 X-RAY DEPARTMENT

X-rays are used for two main purposes and the work of

this department is therefore divided into two distinct sections:

105

Section 1: Diagnosis (referred to as Radiography)

Section: Treatment (referred to as Radio-Therapy)

106

There are also two major principles involved in

radiography, which may be briefly expressed as follows:

Principle 1: Radiography which is the exposing of X-ray

film to obtain a permanent record, referred to as the X-ray

plate or radiograph. The radiography carried out the taking of

the radiograph whilst the Radiologist undertakes the reading

or interpreting of it.

Principle 2: Fluoroscopy, which is the direct viewing and

observation of the workings of a person‟s internal organs,

which has been made possible by X-rays. The Radiologist

and/or the Doctor in charge of the case undertake this viewing

in the main.

It can be too strongly emphasized that when planning the

X-ray department, the manufacturers of X-ray equipment

should be consulted at the very outset.

4.3.9 PATHOLOGICAL LABORATORIES

Pathology is defined as that part of medicine, which

explains the nature of diseases, their causes and symptoms.

107

The laboratory suit is best planned in a central position

under the same roof as the hospital and not as a separate

building in the grounds.

The work undertaking in hospital laboratories embraces:

Morbid anatomy and histology

Clinical pathology

Chemical pathology

4.4.0 MORTUARY BLOCK

Every hospital, regardless of its size, will require

mortuary block. The size of this block will naturally depend

upon the bed holding and type of hospital.

The block may be planned either:

Within the building

Separate building within the hospital grounds

It is important that whatever the accommodation is

situated, it should be suitably screened from view of all

patients, Nursing staff and staff houses, etc.. Although

„tucked-away‟ on the site, there must be easy access to fit from

the hospital to permit:

Bodies being transferred from hospital to mortuary

108

Doctors going to perform post-mortems, etc.

Other external circulations will be:

Access for relatives

Access for hearses

Other Requirements are:

- Nurses’ Quarters: These have the following:

Bed-sitting rooms, toilets, showers, cloakroom, laundry

facilities, kitchen, canteen, lounge, dining, recreation

area, storage space, etc.

- Motherless Babies Home: This is located within the

hospital site and has the following: Visitors‟ lounge,

reception room, bedrooms for the children, bedroom

for the Nurses in charge, toilets, bathrooms,

kitchen, dining, play ground, classrooms for the

children, laundry, and storage. Etc.

- Lecture and Research Department: This

department is part of the hospital building.

- Conference Rooms: These are also part of the

hospital buildings.

109

- Services: These services are made up of some units,

which serve and support the hospital. The various

units are:

Maintenance (for maintaining the buildings within the

hospital site and other elements associated with the

buildings), kitchen, powerhouse, general storage,

laundry, etc.

110

111

CHAPTER FIVE

112

5.0 DESIGN CONSIDERATIONS

5.1 SECURITY

External security best served by good lighting and

visibility. Access routes and entrance should never be dark or

concealed and should if possible allow sufficient space to avoid

unwanted encounter.

Avoid dense planting round entrances and ground floor

windows (or use prickly shrubs). All external doors should

therefore be fitted with deadlocks and openable windows if

possible with window locks.

5.2 VENTILATION

There are two types of ventilation: Natural and artificial

ventilation. Artificial ventilation involves the use of fan; air

conditioners to ventilate are enclosed space. Natural

ventilation is the use of natural air to ventilate an enclose

space. This could be achieved by the use of some window types

like casement windows or adjustable shutters. Windows are

placed where ventilations required with sills at desired cooling

height ground shape (topography) and any nearby ponds or

113

lakes can be used to improve natural ventilation. On sloping

sites (particularly facing south) breezes move up hill during

day, down at night. Near bodies of water cooling breezes move

from water to land during day, from land to water at nigh.

Orientation of the building on site is another good way of

improving on natural ventilation. Gardens and courtyards can

also be used.

5.2.1 FORM AND VENTILATION

The total form of a hospital building and the relationship

of its different part will be influenced by many factors; one that

is likely to be fundamental is the policy to be adopted for its

ventilation. The form that a naturally ventilated hospital can

take will be affected by the climate, but in tropical countries, it

will be dominated by it. In these locations it is desirable to

plan for the maximum exposure of occupied spaces to the

prevailing wind that is compatible with shading from the sun

and also to separate parallel blocks of building sufficiently

widely not to shelter one another from the breeze.

5.2.2 ADVANTAGE OF NATURAL VENTILATION OVER

ARTIFICIAL VENTILATION (AIR CONDITIONING)

114

Natural ventilation: Air movement can have an important

bearing on the incidence of infection, especially if air removed

from an infected area is blown or sucked into another part of

the building through ventilation or duct systems.

Unfortunately, the installation of full air treatment does not

always achieve a reduction of the incidence of outbreaks of

infection. Many hospitals that are dependent for their

ventilation on throwing open windows and doors have less

frequent outbreaks than those with full air conditioning.

In design and construction, natural ventilation will

produce a relatively high ration of external wall to floor area. It

will be likely to increase the cost of the building fabric

although reducing that of its services and running costs.

- Air Conditioning (Artificial ventilation): Air conditioning is

generally recognized as of the highest priority in the

operating theatre suite. Air conditioning in this context

means the ability to control the air temperature both

above and below the ambient temperature and also to

control the humidity, with sterile filtration in addition.

115

An artificial environment of „pure‟ air throughout the

building, however well filtered and tempered is no guarantee

against infection.

Air conditioning is expensive and also it is a constant

consumer of energy and extremely demanding servant.

Unnecessary dependence on wholly artificial means of air

control can impose intolerable difficulties when sophisticated

systems breakdown and prompt and efficient maintenance

cannot be relied upon. Total dependence upon it can quickly

render a building uninhabitable in such circumstance.

Whether in a temperate or tropical climate total air

conditioning makes a high ratio of internal spaces to external

wall and permits a compact building form that may thus

reduce the site area that is necessary and will tend to lead to

economy in the cost of the actual fabric of the building but not

to that of its artificial lighting and other services or of its

maintenance.

5.3 NOISE AND ACOUSTICS

116

Sound is measure in decibels (Db). Noise is an

unorganized sound, has irregular vibrations and it is an

unpleasant sound. Increase of 10Db gives approximate

doubting in loudness.

High levels of noise can lead to damage to hearing. At

lower levels noise interferes with verbal communication. At still

lower levels may be disturbing or annoying. Acoustic design

controls intrusive noise and by choice of materials,

dimensions, etc.

For many buildings and environmental situations,

equivalent continuous sound level (1eq) expressed in Db (a) is

adequate predictor.

Upper limit of 90dB (A) leq has been suggested for 8-hour

working day.

Interference with speech communication from intrusive

noise depends on distance between talker and listener, and or

whether voice normal or rose. Thick walling porous materials,

panel absorbents cavity resonators, corridor, lobby, etc can be

used to reduce or control noise in buildings. This implies that

surfaces of room partly reflect and absorb sound according to

nature and construction of surface.

117

Problem in large open areas; telephones and other

electrical and mechanical equipment can be noise than

acceptable. Design for 40-45 Db by day and 35-40Db at nigh

in multi-bed wards; 1-bed wards should be 35-40 Db at all

times. Planting of trees can be used to reduce external noise.

Orientation of the building zoning, etc. can also be used.

5.4 LIGHTING

Visual performance depends on total perception of space:

involves quality of light as well as total amount. Indices to

cover different aspects of lighting have been developed. They

distinguished between artificial and day lighting.

5.4.1 ARTIFICIAL LIGHTING

Important are quantity of light (luminance) and glare,

also reflectance of surfaces being lit. The tasks and its relative

importance against lighting its background and the whole

reflectance and colour of surfaces affect general brightness and

distribution of light in room.

4.4.2 DAY LIGHTING

118

Windows in building have 2 main visual functions: to let

light in during daylight hours and to enable people to see out

or in. They permit entry into a building of solar energy: direct,

by absorption and retardation by reflection from sunlight

surface. Windows are also source of heat loss. As source of

illumination, daylight has many pleasant directional qualities.

When visual tasks might need to be carried out anywhere

in interior building lighting and task lighting may be provided

by same installation.

4.4.3 INTEGRATION OR ELECTRIC LIGHTING AND

DAY-LIGHTING

Even in well day lit room, electric light has to be used

when daylight fades, especially, some afternoons. Electric

lighting should be designed to provide luminance

recommended for particular tasks carried out in interiors, but

not less than 30Lx on average over working plane.

Windows need not be designed to achieve maximum

penetration of daylight; more attention can be paid to any

providing wide uninterrupted windows rather than high and

above or between windows with exterior seen through them by

119

maintaining light colour and arranging for some wall washing

by artificial lighting.

5.5 FIRE SAFETY

Most building regulation contains clauses on minimum

allowable distances between adjacent building and type of

construction acceptable to resist fire for given periods of time;

some state distances and conditions for escape routes.

Up to 2 hours needed to evacuate 600 patients from 2-

storey, 4 hours from 11-storey building: Exhausting exercise

for rescuers. All health buildings that contain high proportion

of bedfast, disabled and confused patients should be low rise,

preferably with patients restricted to ground and first floors.

There are now more stringent fire safety measures based on

fire resistant compartments: System makes it possible to move

patients short distances, if necessary in beds, to section sealed

off by fire door from smoke or fire in adjoining section.

Design guidance on size of fire compartment and sub-

compartments, together with maximum acceptable lengths of

escape routes in wards, operating theatres, laboratories, etc.

are indicated.

120

5.5.1 FIRE COMPARTMENTS:

The following are the requirements:

1-storey building must not exceed 300m2.

Multi-storey building must not exceed 2000m2.

Horizontal distance to alternative routes must not exceed

64m.

Horizontal distance in single direction to exist must not

exceed 15m

Travel distance within escape stairway must not exceed

45m long going

5.5.2 FIRE SUB-COMPARTMENTS (Patients area)

Floor area must net exceed 750m2

Horizontal distance to alternative routs must not exceed

32m

Horizontal distance in single directional exist must not

exceed 15m

Maximum occupancy; 40 patients

5.5.3 Hazardous Materials

121

Some equipment and substances used in examining,

diagnosing and creating patients radioactive, explosive or

highly inflammable. Care is taken to check that where these

substances used design, construction, detailing and service

installations comply with specific statutes and regulations.

5.6 THEMAL INSULATION

Moisture inside buildings arises from such sources as

external air, breath of occupants, cooking, washing, flueless

gab and oil heaters. Warm air can hold more moisture than

cold air.

In terms of comfort, people affected almost as much by

temperature of surface which surround them as by that of air.

It is important to distinguish between ventilation rates,

which affect air quality by diluting contaminants and air

movement, which may affect thermal comfort. If air movement

in room exceeds about 0.2mls high room temperature is

required to provide equivalent comfort. In normal temperature

environment effect of humidity on perceived warmth very

slight, but if people very hot (as during very active work or in

122

very warm environment) high humidity will aggravate

discomfort. Air movement over skin will be beneficial.

High standard of thermal comfort requires:

Surrounding surface temperature higher than air

temperature

Air temperature at head lower than at floor level: Low

temperature gradient

Air movement just perceptible but variable and with no

draughts

Humidity not very important except at temperature

above 21oC: should not exceed 70% nor be less than

30% thermal response of building depends on:

Area and orientation of glazing: large areas of glazing

facing sun give quick response.

Reflectivity of external surfaces were exposed to sun.

High reflectivity heat gain from sun and reduces

responses

Mass of building structure and position of thermal

insulation: mass inside insulation gives long response

time; light weight building have short response time

position, size and type of windows and response of the

123

building. Also, the positioning of trees around the

building especially ground floor.

5.7 ACCESS AND CIRCULATION

Spaces are required around for access and circulation of

people, prams, wheelchairs, trolleys, etc. Access to building or

groups of building also for private cars, delivery vans, moving

vans, trucks, etc. Space is required for parking, short or long

term. This design will ensure adequate visibility but discourage

vehicle speeds; parking spaces clearly marked provision will be

made for clear zone free from parked cars to allow vehicles and

pedestrians to circulate comfortably.

5.7.1 FOOTWAYS

Shortest routes will be provided between buildings and

services are kept separate from heavy trafficked roads. It will

be wide enough to avoid need for pedestrians when passing to

step out into carriageway or planted areas and where

necessary for occasional access by emergency vehicle. E.g.

ambulances.

124

5.7.2 ROADWAYS

Size and Geometric characteristics of vehicles determine

dimensions of roadways, junctions, turning and parking

spaces. Carriageway minimum of 48000mm allows wide car

and service vehicles to pass each other with overall tolerance

of 500mm and allowance made for increase in width of larger

vehicles at bends and allowance made for increase in width of

larger vehicles at bends and for their turning and

maneuvering.

5.7.3 ACCIDENT AND EMERGENCY

This department needs to be on good access roads with

drive-in entrances for ambulances, sheltered from wind and

rain by covered ways and baffle walls. Entrances should have

2 sets of automatic fail-safe doors to prevent draughts, with

enough space to maneuver stretchers and trolleys.

This department will have direct access for patients on

trolleys to all parts of hospital, particularly radiology, plaster

room, surgical and short stay wards.

5.7.4 OPERATING THEATRES

125

Crucial to design of high technology operating and

delivery suites, 2 basic types single corridor and double

corridor or „race track‟. Single phase 1 corridor leading to all

operating/delivery room, used for patients, staff and

equipment: Sterility maintained in each user of corridor and

within theatre itself.

„Race track‟ arranges room in „circular‟ fashion with

outside corridor or room for staff and equipment, presume

sterile corridor for patient trolleys 2/45m wide; others 1.5m

wide.

It is an advantage to avoid the routes for visitors being

combined to any great extent with other internal circulation,

for instance, and to arrange that potential traffic past critical

areas such as operating suites is minimized. It is also desirable

that infected and dirty material, which is being removed for

processing or disposal passes along routes which neither cross

those constantly in use by patients and staff nor pass sensitive

clinical areas. The latter includes theatres and surgical wards,

maternity departments, immunity from infection.

Walking distances for Nurses and Ambulant patient

should be as short as possible. Maximum distance from bed to

126

toilet should be 12m and from Nurse to working room to

furthest bed approximately 20m.

5.8 DISABLED

Particularly requirements to be considered when

designing for physically disabled are:

Ambulant Disabled

Wheelchair Users

Access is by level or ramp approach, minimum width

1200, maximum slope 1:12 preferably 1.20 gradients greater

than 1:12 need rest areas 1200mm long at 900mm intervals,

those in excess of 1:20 at 18m intervals.

For Ambulant disabled 900 wide enough for entrance

halls and passages. For wheelchair users entrance hall has

minimum width of 1200mm, depth 1800mm, preferably

1200mm throughout. Lobby between 2 set of doors will need

be 1500mmx1500mm clear of obstructions to allow freedom to

maneuver chair.

5.9 BUILDING MATERIALS

127

In selecting the building materials for the hospital design,

significant physical characteristic would be taken to

consideration. This helps to access how access how

manufactured products specified and constructions designed

perform in use. Precise values influenced bys such factors as

temperature, moisture content, surface condition, internal

structure. These usually determined by means of standard

rest, which may take into account conditions of use.

5.9.1 CHARACTERISTICS

The following affect the choice and use of building

materials. They are:

5.9.2 Density

This enables mass of material to be calculated

5.9.3 Modulus of elasticity, tensile and impressive

strength

This gives indications of structural performance, modulus

of elasticity indicating stiffness.

5.9.4 Moisture Movement

This is expressed as percentages. Generally, lightweight

and fibrous and some cement-based materials show

128

dimenstional changes when wet or dry; such need be

accommodated in design; movement may be reversible or only

happen on first use.

5.9.5 Coefficient of thermal expansions:

Change in temperature may cause materials to expand or

contract; such movement again may need to be

accommodated: express by coefficient.

5.9.6 Thermal conductivity:

Ability of a material to conduct heat.

5.9.7 Sound insulation:

Ability of a material to absorb sound

5.9.8 Some building materials and their thermal

conductivity values:

MATERIALS THERMAL CONDUCTIVITY (k) W/MoC

Brickwork common 0.7

Glass 1.05

Steel 50

Timber 0.15

129

Sand cement 0.53

Dense concrete 1.5

CHAPTER SIX

6.0 DESIGN PARAMETERS

6.1 DESIGN PHILOSOPHY

Hospitals are an indispensable part of the provision that

is made for health because there will always be a proportion of

patients who need the particular skills and equipment that can

be concentrated in them and because they are essential

centres for medical and health education and research.

The principle of referral of patients from a lower level of

care to a higher level as a method of sorting them according to

their need for specialist diagnosis or the nature or degree of

their disabilities is universally recognized and also important.

However, Obstetrics and Gynaecology specialist hospital

is proposed for Enugu, so that awareness or pregnancy,

130

disease that affect the female productive system. Womanhood,

child abuse, etc and their implications can be created, causes

of these disease diagnosed and treated, further exposure to

such attack of diseases prevented, so s to reduce or control

natality rate amongst women and promote procreation.

6.2 DESIGN CONCEPT

Patients could easily become institutionalized in wrong

environment: accent on self-help and rehabilitation in setting

as like home environment as possible without impairing

quality of nursing care.

Pregnancy is not a disease and mothers-to-be must not

be allowed to look upon it as such: In consequence, Obstetric

and Gynaecology specialist hospital, Enugu will be designed to

give a „homely‟ and cheerful atmosphere.

The most important factors to be taken into account in

the overall plan form of a health centre, whatever its size are

simplicity and clarity in the circulation becoming confused to

both patients and staff, even visitors.

However, it is desirable to combine homely, cheerful

environment and clarity with an atmosphere, which is

comfortable and human in scale.

131

All these will encourage fast recovery of patients. Care

should be taken not to keep patients in hospital longer than is

absolutely necessary.

6.3 IMPLEMENTATION OF THE DESIGN CONCEPT

The design of Obstetric and Gynaecology specialist

hospital, Enugu, will reflect the design concept in the following

areas:

6.3.1 Form: This implies the use of traditional form

(rectangle) that is familiar to the people or inhabitant of the

land.

6.3.2 Building Materials: This implies the use of some

locally available building materials, which depict a home

environment in the design. Some of these materials are

concrete, brick, etc.

6.3.3 Building Styles and Elements: This involves the

use of some building styles and elements like pitch roof and

courtyards which depict culture, shading devices where

necessary, casement windows, etc.

132

6.3.4 Landscape: Trees, shrubs, stones, etc, will be used

in the external environment to enhance the Anaesthetics of the

whole environment.

3.3.5 Zoning: This implies grouping related

functions/activities and locating them to different units but

well linked to one another with circulation spaces for

intercommunication and clarity.

6.4 DESIGN ANALYSIS

A hospital comprises three categories of accommodation:

Medical Services: These provided diagnosis and

treatment for inpatients and outpatients.

Medical Support Services: This is essential for

sustaining the medical services and closely related to

them functionally.

General Support Services: These are responsible for

general administration, the supply of food, linen and

stores, the energy, piped supplies and mechanical aids.

Each of these three categories is made up of a number of

6.4.1 Medical Services

133

Outpatients Clinic

Accident and emergency

Short stay wards associated with accident and emergency

Diagnosis radiology

Radiotherapahy

Operating department

Pathological Laboratories.

These show the principal departments and the various in-

patients wards.

6.4.2 Medical Support Services

Pharmacy

Central Sterile Supply

Medical Library

Central Medical Records

6.4.3 General Support Services

Central Administration

General Supply and Disposal

Linen Supply and Disposal (Including Laundry)

Mortuary

Catering

134

Engineering services (including maintenance and

transport)

Staff Quarters

The arrangements of the functions in the hospital in a

linear form demands a lot of space on the site and in a large

hospital may result in travel distances that are unacceptably

extended. It can also be said that, in some forms, this

arrangement encourages the isolation of specialties in separate

units and may create physical and psychological obstacles that

inhibit intercommunication.

The tendency of individual medical discipline to merge

with one another or to become inter-dependent suggests the

need for an integrated planning and patterns, which are

looser. The former moment in history. The looser forms permit

not only ebb and flow difficult and sometimes possible to

anticipate.

This diagram shows the three main categories of

accommodation in hospital and their relationship to one

another.

135

The arrows show that the three categories of

accommodation in a hospital are interdependent of one

another, implying that none can exist on its own.

In the design of Obstetric and Gynaecology hospital, the

functions will be planned and designed in such a way that

they will be zoned according to their respective services, still

interdependence on one another and connected with

circulation spaces for intercommunication.

Medical Support Services

General Support Services

Medical Services

136

CONCLUSIONS

Hospitals are an indispensable part of the provision that

is made for health because there will always be a proportion of

patients who need the particular skills and equipment that can

be medical and health education and research.

Obstetrics and Gynaecology specialist hospital is a

secondary care of health care system where care is provided by

more specialized services to which people are referred by the

primary care services.

The principle of referral of patients from a lower level of

care to a higher level as a method of sorting them according to

their need for specialist diagnosis or the nature or degree of

their disabilities is universally recognized and accepted.

Hospitals are inevitably a very expensive element in any

health service, for they are costly to build and equip and the

money necessary to staff and run them can be enormous. If a

hospital is to perform its function efficiently in the delivery of

health care it is clinically satisfactory to do so. This is because,

137

running costs of a hospital are particularly high if the in-

patients have to stay for a long time then en hospital‟s

expenses are increased and its components, some simple,

some extremely complex, each have time scale which covers

useful design life. Careful planning and design can group

components with similar characteristics grouped together so

as to be adjacent to both those they serve and those with

similar structure and service characteristics to effect good

intercommunication, interdependency of functions and quality

services.

138

BIBLIOGRAPHY

Anthony Cox and Philip Groves, Design for Health Care, Butterworth and Co. Ltd., 1981

Boun Centrum, Rotterdam, General Hospitals: Functional Studies on the Main Departments, Elsevier Company, Amsterdam, 1961.

Churchhill Livingstone Pocket Medical Dictionary, Fourteenth Edition, Edinburgh, 1987.

Ernst Neufert, Neufert Architects‟ Data, Alden Press Oxford, London, 1970.

Guy Aldis, Hospital Planning Requirements, Pitman Press, New York, 1954.

Helen Liebeck J., Elaine Pollard, The Oxford English Mini Dictionary, Fourth Edition, Clarendon Press, Oxford, 1997.

N.P. Iloeje, A New Geography of West Africa, Longman Group Limited, London, 1972.

Social Studies 2, Heinemann Educational Books (Nig.) Ltd. And Comparative Education Study and Adaptation Centre, University of Lagos, 1979.

Tourist Guide Map, Enugu and Environs.

Documents

OBSTETRIC AND GYNAECOLOGY