DAYDREAMING DURING A NIGHTMARE an oncology centre of tomorrow

The continually growing group of cancer-patients in the Netherlands is faced with a suboptimal level of oncological care. There’s a growing need for order and quality care. This care can improved by grouping the expertise in twenty to thirty oncology centres throughout the Netherlands, says Sjoerd Rodenhuis, chief medical executive of the Dutch Cancer Institute NKI-AVL and oncologist at the related Antoni van Leeuwenhoek hospital in Amsterdam. Nowadays patients with a rare variety of cancer are treated at hospitals specialising in this kind of cancer. According to Rodenhuis the distinction between rare and common types of cancer should not be made. Each tumor is unique and thus should be treated as such.

This project ‘Daydreaming During A Nightmare’ is about an oncology centre placed close to the bustle of a public transport terminal in Breda, the Netherlands. Within this area people go about their usual, everyday business; catching a train, transferring to a bus, buying a newspaper and so on. By merging this everyday context with expert cancer treatment interaction emerges between two worlds. These worlds are confronted with each other and become aware of the other’s reality. The reality of the cancer patient gets a spot within everyday life, hereby breaking the taboo that shrouds cancer. People can talk more openly about the disease and possibly patients will be treated less awkward. Taking away part of the anxiety can motivate people to get a check-up early on when first symptoms surface. Being early improves chances of healing.

For this new, as yet unbuilt terminal area the city of Breda has created an urban development plan. This project tries to adhere to and respect this master plan as much as possible. Some changes are made to improve the actual design and area, most notably rounding the façade and marking the inner patch of grass as purposeful space.

Experience of the cancer patient is at the core of this design, resulting in an approach that works from the small (patient) towards the larger structure (complete design). This approach to architecture tries evade the dictating role of architectural legislation concerning such care centres. The oncology centre design is divided into scenarios: 1. Entrance, 2. Examination, 3. Chemotherapy, 4. Radiotherapy, 5. Policlinic, 6. Surgery, 7. Nursery. These scenarios are studied and designed independently, without context, at a small and personal scale. For each scenario ideas are developed for the intended experience. The designs for the scenarios take into account positive factors of Evidence Based Design, user centred design and wayfinding research. When designing at a larger scale these scenarios are taken into account at an early stage. The scenarios form the constructs of the larger body that is the programmatic grouping and resulting architectonic form.

The building at large consists of two main volumes; a central block surrounded by a ring. This block provides a strong point of entrance and recognition, while other functions reside in the ring and interact with the inner plaza and the life on the outside. The architectonic geometrical form seeks to provide order. It is this order that contrasts with the current state of Dutch cancer care and the lives of patients. And it is this new order that can fulfil a need of the patient.

The Architects for Health
First Student Health Design Award
was sponsored by

Children’s Speech and Language Clinic, with educational and research facilities, Forth Street Newcastle Upon Tyne

1.0 LINE OF ENQUIRY

Erving Goffman’s Stigma: – notes on the management of spoiled identity (1963) provides a formal analysis of the features of those who experience stigma and manage the impressions they present to each other in different settings.

Goffman writes that stigmatised people will find themselves in 3 possible kinds of places. Forbidden, out of bounds places where exposure means expulsion. There are civil places, where persons of the individual’s kind, when known to be of his kind, are treated as if they are not discredited. And back places where they need not conceal their stigma.

The 3 types of places stand juxtaposed with personal identity. The forbidden place offers anonymity, the civil a place where one can expect mutual blindess, and the back place he will be a familiar personality.

2.0 THEMATIC FRAMEWORK

The concepts that developed from Stigma, manifests itself in the planning of the buildings, and the spatial relationships created.

The 3 types of space offer differing emotional responses to those who may be ‘stigmatised’.

In the clinic, the forbidden place will offer emotional comfort, offering the children spaces to hide out of view from lots of people, or with more manageable groups, this will be in the circulation zones. The civil places, will be about the children’s visibility in groups, this will happen outside and around the building, and within formal waiting areas. And the back place, will be the first and main interface with the child, the reception and the treatment suites.

Communication, place-making and other psychological and experiential effects evolved through the large and imposing façade to the North of the site. The opportunity to create an ever changing façade from day to night, and in differing weather conditions became important to unlocking the emotional journey of the site.

3.0 FUNCTIONAL PROGRAMME – BRIEF

The ability to communicate is central to all that we do; at work, at home and in our relationships with each other. In the UK, approximately 2.5 million people have a communication disorder of some kind and many of these will have difficulties accessing education, social or career opportunities.

According to AFASIC (Association for All Speech Impaired Children), 1 million children in the UK are affected by the hidden disability of speech, language and communication impairments.

And according to the Royal Collage of Speech and Language Therapists 5% of all children in the UK are entering schools with difficulties in speech and language.

Therefore the project seeks to establish a speech and language clinic for children, with an educational and research facility on site too. The primary objective of the clinic, is to improve the quality and provision of services, and to provide a benchmark facility which will empower children in their respective environments, encourage close relationships with nature, include positive distractions and avoid environmental stressors such as noise, unpleasant smells, having a positive impact on the education achievement and the health of a child.

The clinic will offer – assessment, both formal and informal, observation and discussion; intervention by other linked professionals (psychiatrists, audiologists, dentists); Individual or group therapy sessions; Parental advice; Parent/carer training; School visits; Spaces for play.

The types of spaces which are included in the clinic in particular are -

EXTERNALLY

• public square and separate green space is designed to improve the children’s development, encourage use by various groups, reflect the history of the site (the Town Wall remnants), and promote community pride
• courtyards within the building provide imperative closed safe zones for the children’s playground,
• external green areas act as natural gardens for pedagogic as well as aesthetic purposes.

INTERNALLY

• reception area is a small and familiar place, the receptionist becoming a friendly familiar face, on a first name basis, the building allows intellectual access, psychologically and navigationally
• variety of waiting areas, formal and informal
• formal waiting areas are small enough scale to not become anonymous in, but are large enough to feel that you blend in
• waiting areas and outdoor spaces should be paired as interaction and learning occurs in both environments, furnishings should be moveable and scaled for children of different age and needs
• play areas are places to be noisy/climb/hide, to imagine, to run freely inside and out/textures and smells are important
• circulation zone acts as an overspill for waiting, play and other public areas and to become a populated zone in itself, it also offers crevices and seating areas on smaller scales, resting and pausing spaces are generous, wait, play and assessment areas are easy read from the circulation zone
• assessment and treatment suites are designed for their specific needs, these are to be calm, with views to the outside world, reduced sensory overload.

The educational facility will include the school of education communication and language sciences (currently housed within campus at University of Newcastle), which will accommodate the teaching facilities specifically for the speech and language sciences degrees. This will provide all facilities including classrooms, lecture theatre, library, education resource centre, clinics, labs and a recording studio. The research facilities are to be the base of research carried out in the field of Child Language. The building will contain and support both the case and clinical based research projects.

4.0 SITE

The site is in Newcastle, and is an historically rich area of land to the East of the old Town Walls.

The proposition is to demolish the existing casino and derelict buildings, to provide the Children’s Speech and Language Clinic, with educational and research facilities. The site has obvious boundaries on all sides, to the North is the Railway line, to the West is the largest remnants of the Town Wall, to the South the natural typography slopes steeply down towards the Quayside, and to the East is Clavering Place and Hanover Street.

The imposition of the railway line to the north and the possible views to the south led to a parti-diagram of creating a barrier to the north of the site, to act as a buffer for noise and create a protective ‘arm’ in tandem with the Town walls. The Town walls become part of the enclosure for the children’s external play areas, adding texture, both historical and physical to their experience at the clinic.

The orientation of the site has great potential in the summer months for public use and proposing a mix of vistas, views, green space and a public square will greatly encourage city people to visit and utilise it, leading to a more populated development where interaction can be used to integrate the building with the community.

5.0 TECHNOLOGY

The technological issues that the project focus on, are in terms of structure and materiality, how the two relate between the two buildings. The educational and research facility are housed in their own block, which correlated in scale and massing to the surrounding context, and the clinic is a much smaller domestic scale building.

The materials for both buildings and the structural system types were to be the same in each building to be read as an architectural language together. The differentiation appears in the detailing of the two buildings.

The clinic has more exposure of the assemblage of the components of the building, almost showing the inquisitive mind of a child, how things are put together, to reveal the expression of the structure and the connections between materials. The education and research block is more finished in detail, with less expression of connections etc, as a more mature building than the clinic. Through this the block would appear to be established and adult, technologically advanced and more institutional in scale and finish. The clinic is more deconstructed, in plan, finish, scale and geometry.

The Architects for Health
First Student Health Design Award
was sponsored by

• Ann Noble – AfH (Chair of the judging panel
• Alexander Philips – Brookfield Europe
• Claudia Bloom – AfH and Avanti Architects
• Jay Gort – Cambridge School of Architecture and Gort Scott
• Professor Bas Molenaar – TU Eindhoven and EGM Architects
• Jonathan Pugh – 2007 AfH Student Prize Winner
• Dr Ganesh Suntharalingam – North West London Hospitals NHS Trust

• Suleiman Alhadidi – University of Jordan
• Geoffrey Chinnery – University of Western Australia
• Michael Dillon – University of Kent, UK
• Sarah Gilby – Manchester School of Architecture, UK
• Alberto Juarez – Universidad Iberoamericana, Mexico City
• Shirly Kujawski – Israel Institute of Technology
• Nicholas Lowe – University of Edinburgh, UK
• Sophie Morley – University of Brighton, UK
• Elaine Neish – University of Newcastle Upon Tyne, UK
• Ma Yuan – Texas A&M University, USA
• Chi-Hang Chim – Eindhoven University of Technology, the Netherlands

The Architects for Health
First Student Health Design Award
was sponsored by