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Sumit Singhal
Sumit Singhal
Sumit Singhal loves modern architecture. He comes from a family of builders who have built more than 20 projects in the last ten years near Delhi in India. He has recently started writing about the architectural projects that catch his imagination.

Drum Tower Nanjing Hospital in Nanjing, China by Lemanarc SA

 
January 23rd, 2014 by Sumit Singhal

Article source: Lemanarc SA

1. The creation of human-scale building through the unification of architecture and landscape

Nanjing Drum Tower Hospital, founded by Canadian Missionary Dr. Macklin, is located in the downtown center of Nanjing city. It is one of the most renowned hospitals in China.The earlier expansions of the hospital was driven by the development of modern medical technology as well as the increasing municipal population. Despite the remarkable scales, most of these early expansions are hardly more than simple and urgent addition and extension of existing function to meet the rapidly increasing need for medical service. As a result, the functional layout of many floors are not well organized and streamlined for the operation of the hospital as a whole. For instance, the existing outpatient department is on the east side of Zhongshan Rd, connected with the main buildings of the hospital, which is on the west side, only through a narrow underground passageway, which makes extra inconvenience to both patients and staffs.

Image Courtesy © Lemanarc SA

  • Architects: Lemanarc SA
  • Project: Drum Tower Nanjing Hospital
  • Location: Nanjing, China

Image Courtesy © Lemanarc SA

In the year 2004, in answering the rapidly surging demand for medical service by a larger and wealthier municipal population, Drumtower hospital planned to implement a new expansion using a 32,000 sqmsite between Zhongshan Rd. and Tianjin Rd. The expansion project will also be followed by a reorganization and overhaul of the existing layout and functions. According to the project, a total of 2800 beds will be served, of which 1600 is provided by the new expansion. Daily outpatient is planned to reach 10,000 people. And the overall gross floor area of the hospital is 230,00 m2. Scalewise, the project is in fact equal to the GFA of the 420m, 88-floor Jinmao Tower, the highest building of China back then. But contrary to the general expectation of a high rise hospital building, we made a seemingly surprising choice:  instead of stacking floors one upon another and resulting in a high floor area ratio, we decided to ‘lay it down’ to create a series of gardens at the floor area ratioof 5.2. Such preference for lowrise building went squarely against the design trend at that time, which is dominated by the frenzy for skyscrapers. But seen at present, it is quite sure that we have made a right decision, for the low rise plan not only reduced the stress on vertical traffic—which is a constant trouble for large general hospitals, but also creates large areas of urban space with human scales.

Image Courtesy © Lemanarc SA

2. The realization of compact efficiency by modulation

Adepartment matrix is devised according to the division of body parts and treatment methodology, which facilitates the connection among logistics, equipment and communication.(insert)

Four L shaped medical areas form a continuous enclosure that tightly connects various types of space both internal and external of the hospital. The perfect vertical correspondence among the underground pharmacy storage center, the nursery station of the inpatient department and the outpatient pharmacy greatly reduces delivery distance of medicines. The sampling points on each floor are standardized, which simplified the logistic connection in the test center. The integrated med-tech and imaging center is shared between inpatient and outpatient departments, which greatly enhanced the efficiency of medical equipment. We also designed a branched intersecting system by considering the space for patients, staffs and treatments. Serving network and served network is woven into a whole while keeping their independent operation ability. Furthermore, an integrated network with shared doctor pool and doctor flow is designed to more reasonable and economic use of medical resources and facilitate the nursing of patients.

Image Courtesy © Lemanarc SA

A system of unified basic module is applied to the dimensions of most of items, from standardized document folds, desks and chairs, reception desk, sickbeds, windowsills, doors, doorways and rooms, to clinic areas, department areas, parking and passages. All the dimensions are integral multiples of the basic module. And elementary building components made with unified modules are put together to form modulated spaces of a higher level. The modulation of various functions and needs of the hospital is a key to our design. Once clearly rearranged and configured, the functional modules are adapted to the preserved modulated spaces. The universal module is strictly followed throughout the project, from site planning to the detail design of the furniture. Modulation design process not only makes possible clear spatial layout and convenient connection, but also provides extra expansion capacity for the future developments of the hospital. By large-scaleprocurement and parallel construction, we significantly brought down the building cost. The final building cost of the whole project is merely RMB 5300 Yuan per square meter, making Drumtower hospital expansion project one of the most cost-efficient hospital projects in China.

Image Courtesy © Lemanarc SA

3. The preservation of urban memories from the crossing and overlapping of city axes 

One of Macklin’s mottos reads ‘HuaTuo cures human body, wile Holy Spirit saves human soul’. As distinct from ‘diseases’, which is a pathological concept, the notion of ‘patient’ includes a rich cultural dimension. Since the establishment of the hospital more than a century ago, Drumtower hospital can be seen as a miniature of Chinese modern history. More generally, it is also an indication of the difficult effort to find the self-identity not only by Nanjing, but also China as a westernized ancient oriental civilization. From the outset of the project, we rediscovered an ancient dating back to Ming dynasty, which is distinct from the Haussmann style north-south axis from Nationalist era that is instantiated in Zhongshan Rd. These two axes cross each other at an angle that forms the border of our site. In order to preserve the ancient axis, the project is arranged following double axes: the med-tech and inpatient area in the north follow the Drumtower axis, whereas the outpatient in the south is organized along the Zhongshan Rd. axis. Thus the two axes from different historical periods meet and cross each other in the site. The resulting stress between the axes gives a special quality to the landscape space in these areas. In so doing, we not only inherit and preserve the ‘genes’ of urban memories, but also created a series of useful and interesting spaces.

4. Gardenized architecture with modern technology

In the atrium of the inpatient department, spotlights made of steel and matt glass are integrated into the roof truss. With natural and artificial illuminating from above, the atrium reminds the visitors of the purity and sublime one experiences in the interior of a cathedral. While the small balconies cantilevering from the facades surrounding the atrium in irregular patterns reminds us the choir on both sides of the cathedral aisle.

Hospitals are places where newborns come to the world and the deceased leave it. It witnesses the most important rituals of life. It is an island of care and love for the sick and the weak between the mundane and heaven. In our project, the metaphor of island is emphasized by the partial isolation of the main buildings from the surrounding.

In etymology, the term ‘hospital’ as the same root as ‘hotel’, both of them come from Latin hospis, literally meaning ‘guests’. It means that in Western tradition, hospital is essentially related to the merciful action of gathering and treating of patients. On the contrary, in traditional Chinese, the concept of hospital, i.e. ‘医院’ (yiyuan), is a combination of two characters, one means ‘healing’, and the other means’ garden’. In contrast to the ‘gardens’ in Western culture, which constantly represents a “internalized nature” and has become a symbol of highest good, in Chinese traditional understanding of garden emphasizes the symbiosis relation between patients and residence. Out of this consideration, we designed three levels of gardens that can be shared throughout the hospital.

Layer 1: The six large gardens formed by the building volumes can be shared with hospital and the public. To the north, the courtyard enclosed by both the new and the existing parts of the hospital provides for staff, patients and the public with tranquil places for rest and recreation. A roof garden resulted from overlapping of north and south volumes is facing Tianjin Rd to the west of the site, it serves as an sheltered entrance space. In due correspondence, we also create a double floor space in the east entrance on Zhongshan Rd. Emergency area is located in a gardenized corridor linking Tianjin Rd and Zhongshan Rd, which is accessible from all the directions. The atrium surrounded by outpatient department is itself a huge greenery area. While the outpatient lobby beneath is naturally illuminated by a dozen bamboo-planted light wells, which brings sunlight—together with beautiful shadows of bamboos—to the lower area. Last but not least, the open plaza in the south is presented to the public, especially college students of the nearby Nanjing University.

Layer 2: The second layer of gardens is composed by scores of smaller light wells scattered evenly throughout the hospital. From med-tech, inpatient and emergency, tp outpatient and conference areas, these light wells not only brings in skylight and therefore save the energy, but also help creating gardenized spaces.

Layer 3: The third and the most intimate layer of gardens are those on the facades: the project provides each room with an small vertical garden right in front of windows.

Thanks to the ubiquitous presence of garden, external interfaces of traditional Chinese architecture become multi-layer and multi-functional green spaces. At least six layers are instantiated in the interface, they are:  light, wind, landscape, plants, usage and filter. Inspired by such layers of gardens, we intend to ‘translate’ these separated layers into the facades of the new buildings. Instead of papers, we use translucent glass on the bay window, which provides soft and bright natural illumination to the insides. In the place of traditional bamboo curtains, we use perforated aluminum panel as sunshade. Furthermore, green plants are woven in front of every window on the facade, which reminds us window frames in traditional Chinese architecture.

 Light

The bay windows are made of matt glass panel, through which the smooth and soft light provides the indoor space with better lamination than normal windows and therefore help reduce illumination energy consumption.  In the mean time, the translucent panel also guarantees privacy for the ward.

Wind

Between the recessed and bay windows in each facade unit, we integrated on each side a side an opening window, which allows for natural ventilation parallel to the façade. During the summer, the lateral air flow dissipates the heat near the windows, and prevent the overheating of the room inside.

View

The glass panels on the recessed windows forms different frames optimized for viewing. Together with the asymmetric shapes formed by surrounding bay window, it provides unique relationship with the exterior landscape.

Plant

Taking advantage of the longitudinal areas between recessed windows and bay windows, we designed a planting box, so that plants like ivy could grow in this space, which are watered by drip irrigation technology.

Usage

The internal space of the windowsill has the same height as tables. In clinics, windowsills become natural extension of clinic desks and serves as extra areas for storage of books and documents. In the wards, however, they provide spaces for flowers, which also contribute to the gardenization of indoor environment.

Shading

The outmostlayer of the façade is made by a hangingsystem of perforated aluminum panel with similar translucency with that of matt glass. Itcovers the entire façade creating an efficientshading system. Nanjing is one of the hottest cities of China in summer, local building usually consume a lot of energy for air conditioner. Benefited from the external shading, the new hospital, which is mainly arrange on the east-west axis, save a significantly amount of energy in this respect.

Although the new expansion of Drumtower Hospital exceeded 10,000 daily visitors during its first month after completion.we can hardly feel the noisy and crowdedness that are daily routine in many other hospitals. The sunshine and gardens are everywhere in sight. Instead of using skylight as a symbolized expression of grandiose and sublime, we try to let it seep smoothly into every corner, illuminating what is going on there everyday. Of course we are not able to cure all the diseases, but it is within our ability to treat all the people in the hospital kindly and mercifully. In the year 2012, the new expansion of Drumtower Hospital was voted by Nanjing citizens as the first of ten most remarkable landmark architectures—an honorable fact that speaks quite a lot for itself.Drumtower hospital’s design has won the award of WAN for the year of 2013, in the section of Healthcare Architecture. it is the only hospital design which got this award in the region of China.

It seems to the architect that in the era of ‘de-architecturization’, the building behavior will finally evolve and become the instrument of making gardenized architectural contexts. In other words, architecture will once again become the bearer of garden. The Drumtown expansion project therefore can be seen as a pleasant step in this direction.

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