Posts tagged with "Healthcare":
Convention centersBoasting boundless and easily adaptable floor space, robust loading docks for moving in and out a high volume of equipment and gear, high-powered ventilation systems, and more than a few ADA-compliant bathrooms, convention centers are natural places to establish temporary hospitals. Manhattan’s Jacob K. Javits Center, normally one of the busiest convention centers in the United States, was one of the first to undergo the transformation into a sprawling, nearly 3,000-bed capacity overflow hospital operated by the Federal Emergency Management Agency. (The Army Corps of Engineers, the New York National Guard, and a team of civilian staffers can be credited for the rapid turnaround.) A large number of other convention centers across the country are either being eyed as potential makeshift medical hubs or are currently being converted into them including the Kay Bailey Hutchison Convention Center in Dallas, the Ernest N. Morial Convention Center in New Orleans, Detroit’s TCF Center, McCormick Place in Chicago, the Baltimore Convention Center, the Los Angeles Convention Center, and the Santa Clara Convention Center in California’s Silicon Valley.
Parking garagesWhile many hospital parking structures are now home to drive-though coronavirus testing sites, in at least one major medical facility, Nashville’s Vanderbilt University Medical Center, beds are being moved into a parking garage to treat those potentially infected by the novel coronavirus at a safe distance from other patients.
This is a photo from a parking garage at Vanderbilt University Hospital in Nashville, TN: pic.twitter.com/phWMTVybVE— Roshan Rinaldi (@Roshan_Rinaldi) March 22, 2020
Sports fields/stadiumsOriginally and still largely used as a military term, field hospitals get their name from their strategic location on wide-open spaces in close proximity to sites of mass injuries and casualties such as, well, battlefields. Twenty-first-century field hospitals are now being erected on battlefields of a different kind that normally see a different sort of frenzied combat: football. CenturyLink Field, home to the Seattle Seahawks, is being converted into a large temporary treatment center by the Army and will be dedicated to treating patients with ailments not related to the coronavirus so that beds in overwhelmed Seattle area hospitals are freed up for those suffering from the deadly respiratory disease. Elsewhere in hard-hit Western Washington, another 200-bed field hospital will be erected on a turf soccer field in the Seattle suburb of Shoreline. Relatedly, football pitch-bound field makeshift hospitals are now somewhat de rigueur in countries like Brazil. A section of the famed Billie Jean King Tennis Center at Flushing Meadows, Queens–in better times, home to the U.S. Open—will also be covered into a 350-bed auxiliary medical center by New York City Emergency Management.
The field hospital at Century Link will address non COVID-19 medical needs to free up our health delivery system to deal with this virus.Thanks to partners at the federal, state and local levels for making this happen. pic.twitter.com/9juaAP5BXf — Governor Jay Inslee (@GovInslee) March 28, 2020
Decommissioned hospitalsShuttered hospitals, many of which have never been closed in the first place, are coming back to life due to the coronavirus pandemic. A wide number of bed-equipped, recently closed medical facilities—including the old Sherman Hospital in Elgin, Illinois, San Francisco’s California Pacific Medical Center, and Laurel Regional Hospital in Maryland—have already or will potentially reopen to accommodate a surge of COVID-19 patients or patients in need of other types of urgent care in overburdened areas.
So the shuttered hospital (old Sherman Hospital in Elgin, IL) where the movie "Contagion"was filmed will be reopened to potentially treat Coronavirus patients.https://t.co/vxI56HrNmp— Rational Galaxy Brain 🌌🧠 (@RationalGenius) March 31, 2020
Dorms/college campusesWith students at an overwhelming number of colleges and universities dismissed from attending in-person classes for the rest of the academic year, an ample amount of available real estate has suddenly opened up. As COVID-19 first began to spread across New York City, New York University pledged to make available some of its now-vacated dormitories for COVID treatment-related purposes if needed. Student housing at New York’s expansive system SUNY and CUNY public colleges could also be potentially turned into emergency medical facilities, quarantine units, and/or temporary housing for healthcare workers. While dorm rooms can be easily retrofitted into treatment spaces, college and universities are also considering converting or already have converted other on-campus facilities into field hospitals. The McCormack-Nagelsen Tennis Center at the College of William & Mary in Virginia, and Liacouras Center at Temple University in Philadelphia, are two examples of non-dorm collegiate spaces that will serve a new purpose during the pandemic.
Central ParkPlenty of strange, sometimes disturbing sights can be seen within Central Park. None, however, quite match the surreally sobering heights of witnessing volunteers erect a tent-based respiratory care center in the middle of New York City’s backyard. Said facility, which will have a capacity of 68 hospital beds and also include an on-site morgue, was established this past weekend in Central Park’s East Meadow by humanitarian aid organization Samaritan’s Purse in partnership with Mount Sinai Health System to “provide care for patients seriously ill with COVID-19.”
I don’t think I’ll ever get over this image, not for all of the days I am on this earth. pic.twitter.com/78pTPMUvZ0— Lisa Lucas (@likaluca) March 30, 2020
FairgroundsGenerally only used at a very high capacity for a few weeks of the year, fairgrounds over a vast amount of space with the needed infrastructure—electricity, water, various buildings, arenas, parking lots the size of a small town—already in place. The Santa Clara County Fairgrounds in San Jose, California, for example, will take advantage of this advantageous arrangement and temporarily house members of the region’s sizable, highly vulnerable homeless population during the pandemic. Elsewhere in California, the Orange County Fairgrounds are being mulled as a potential site to accommodate overflow from established medical facilities in the area; it’s a similar story at the Riverside County Fairgrounds in Indio. Outside of California, the massive Washington State Fairgrounds are being considered as an emergency medical site about 30 miles south of Seattle in the city of Puyallup. In Florida, where the virus is on the verge of exploding in certain areas, a 250-bed facility is already under construction at the Miami-Dade Fairgrounds. In several states, fairgrounds and their parking lots are already being used to host drive-up coronavirus testing sites.
Hotels and motelsHotels and motels are perhaps the most versatile and, due in part to low occupancy rates brought on by the COVID-19 outbreak, the most readily available spaces to repurpose during a pandemic. Providing privacy, some level of comfort, and isolation, they can be used to treat non-critical patients recovering from the COVID-19-related illnesses, quarantine patients suspected to be infected, house exhausted, high-risk healthcare workers on the frontlines (in sometimes deluxe accommodations), and provide a temporary safe haven to vulnerable populations like the unsheltered. Officials in various cities including New York, Chicago, Seattle, New Orleans, and Oakland, California, have leased hundreds, even thousands, of hotel and motel rooms to be used in various capacities in the coming weeks, with the Army Corps of Engineers working to identify and then convert many of them into fully functional temporary medical facilities. Many, of course, have their own ideas as to which specific hotels should be used.
Back at the Javits Center, the transformation of the 1.8-million-square foot building’s cavernous exhibition halls into a Federal Emergency Management Agency-operated medical facility has been met with a positive response. And for those skeptical that the United States was capable of speedy, China-style turnaround in creating makeshift hospitals, the swift transformation of the Javits Center has proven that the Army Corps, when called upon, can get things done and get them done in an expeditious manner. (New York’s urgent need for ventilators and other supplies, however, is a whole other story.) All things considered, the temporary hospital at the Javits Center appears clean and comfortable. Individual beds contained within semi-enclosed “rooms” are shielded by three temporary walls and a curtained entrance made from seemingly the same materials formerly used to host booths in the space, while floor lamps, folding chairs, medical supplies, and side tables topped with (faux) potted plants complement the spaces. While the transformation doesn't appear to allow for individual treatment areas to include private plumbed fixtures, some online commentators have pointed out that a deficit of toilets at the Javits Center shouldn’t be a problem. “The Javits Center is an amazing facility,” ABC News reported Gen. Todd Semonite, head of the Army Corps of Engineers, as telling reporters at a press conference held last week. “Every 10 feet there's a great big steel door in the floor, you open it up in there is all the electrical; there's cold water, there's hot water and there's a place for sewers, so you can actually do things like sinks, right in the middle of a convention center to be able to make that happen.”
Samaritan’s Purse field hospital going up in Central Park. This is surreal. pic.twitter.com/j7e6JiZXro— Emily Belz (@emlybelz) March 29, 2020
Outside of New York City, the Los Angeles Convention Center, which was due to host the AIA Conference on Architecture 2020 in May, is in the process of being converted by the National Guard into a U.S. Department of Health and Human Services-run field hospital as demand for hospital beds in the greater L.A. area begin to surge. Hard-hit Santa Clara County, in the San Francisco Bay area, is also turning a large convention center into a temporary treatment center for COVID-19 patients presenting on-life threatening symptoms. Similar efforts are also planned or already underway at convention centers in Detroit, New Orleans, Baltimore, Dallas, Chicago, Seattle, and elsewhere. To help with this unprecedented effort, the American Institute of Architects (AIA) has launched a special task force to inform and offer guidance to public officials, architects, and healthcare facility operators as they convert existing buildings into temporary medical hubs at a pace never experienced before. The task force, according to a press statement, will develop a COVID-19 Rapid Response Safety Space Assessment for AIA members that includes “considerations for the suitability of buildings, spaces, and other sites for patient care. The assessment will be developed by architects with a wide range of expertise, including healthcare facility design, urban design, public health and disaster assistance.” “On a daily basis, I am hearing from our architects who feel a deep sense of moral duty to support our healthcare providers on the frontlines of this pandemic,” said AIA 2020 president Jane Frederick, FAIA. “As our communities assess buildings to address growing surge capacity, we hope this task force will be a resource to ensure buildings are appropriately and safely adapted for our doctors and nurses.”
The seemingly miles of beds being set up at Javits. It is absolutely unreal to see what the National Guard & first responders have put together here in just days. pic.twitter.com/dD0AQg4PO4— Sarah Boxer (@Sarah_Boxer) March 27, 2020
A whole new breed of architecture can help fight drug addiction and save thousands of lives every year
On January 13, 2016, police found the body of a 31-year-old man, who had been dead for “at least” 12 hours, in a car parked on Pike Street in Capitol Hill, Seattle. He had died from a drug overdose in the shadows, which is common, as drug users often are too ashamed to seek help or use in the open. In the United States, 52,404 people died from overdoses in 2015.
In the eyes of some, this man’s death would have been preventable if he had attended a harm reduction facility—a new typology emerging in the developed world. Just over 100 miles away from Seattle, in Vancouver, one such facility oversees at least one overdose incident every day, on average. In its 14 years of operation so far, the facility has seen more than 5,000 overdoses, yet no one has died there.
The facility, called InSite, is a public place where drug users can go to consume their own substances in a safe, secure, and welcoming environment in Vancouver’s Downtown Eastside. For 13 years, the self-described “supervised injection facility” was the only one of its kind operating legally in North America. As of this May, three more facilities—all in Montreal—received approval and two are scheduled to open later this year.
There are now more than 100 legally operating supervised injection facilities across the world, the majority of which can be found in Continental Europe. The first opened in Bern, Switzerland, in 1986, and many European cities have slowly been adopting similar schemes.
None currently exist in the United States, but several models operating abroad and one prototype stateside might offer clues about how to make these places palatable for a U.S. political environment that is more centered around fighting a war on drug “crime” than on treating addiction as a public health issue.
Canadian architect Sean McEwen designed InSite in 2002. With high ceilings, dark walls, and no Plexiglas inside to separate staff from visitors, the space eschews the notions of traditional medical institutions. Russell Maynard, who has been working at InSite for eight years, said that, “from a design perspective, it’s all about controlling the flow; that is more important than security.”
Three-phase-oriented circulation is a constant throughout almost all official drug-consumption spaces and can be summarized as: pre-consumption, consumption, and post-consumption.
Upon entering InSite, visitors are greeted by a receptionist. After providing a name (which can be fake), they are asked if they want to inject or detox and then are placed on a waiting list. The wait time is approximately seven minutes. According to Marilou Gagnon, a nurse at InSite and an associate professor at the School of Nursing, University of Ottawa, this is the period when InSite sees some visitors leave to shoot up outside, in a nearby alleyway, often using puddles to clean their needles.
“Needing to get a hit is like having chopped your finger off—you’re not going to want to wait very long or travel very far to fix it,” Gagnon said. Vancouver is a city of alleyways, and drug users favor them because they are discreet and easy to find. As Gagnon explained, however, this is problematic for two main reasons: Shooting up in an alleyway is unhygienic, and if you overdose, it’s not a great idea to be hidden.
Designing for anonymity and privacy, unfortunately, is paradoxical to health and well-being in the context of addiction. There is no hiding at InSite, but this is a good thing. Within the injection room, there are 13 booths, which line the interior perimeter, allowing nurses a clear line of sight into each.
These booths, each with their own lights, are mirrored to provide nurses and users with better visibility; this is particularly important for users, to help them avoid being surprised by approaching staff and when injecting into their necks. (Staff are not allowed to actually inject for users but can provide advice, prepare drugs, and clean needles, among other things.) Additionally, female users, who on average constitute a quarter of the visitors, often use the mirrors to do their makeup.
As the designer, McEwen also specified comfortable and easily cleanable chairs. “This may be the best seat users sit in all week,” he said. After injecting, users exit to a “chill-out” room, where they can speak to peers (usually former users), counselors, and nurses and find out about detox programs. Maynard stressed that visitors only enroll in such programs of their own accord.
Easing the Stigma
Politically, injection facilities are toxic. InSite went through a court case when the federal government attempted (unsuccessfully) to shut it down. “A common misconception is that people are shit-faced here; that’s not the case,” explained Maynard, speaking of InSite. “There are consumption sites everywhere for alcohol—they’re called bars. When you go into a bar, not everyone is off-their-face drunk, and that’s the case here.”
To avoid public conflict, almost all facilities have anonymous facades, with little or no signage. At InSite, zoning requirements for storefront retail meant the facility had to pretend to be a coffee shop to get development approval. More recently as a trial, the Canadian government funded the Narcomane Research and Help Center in Montreal, which provided heroin to registered users—a first for North American facilities. It was shrouded in secrecy at the time, and is now closed. “Not even the neighbors knew about it,” said its architect, Ron Rayside.
Margot Young, a law professor at the University of British Columbia, is interested in this aspect of the typology. She argues that the sight of InSite fuels the “larger political goal of putting injection drug addicts ‘in the sight’ of policy makers and governments.”
The sight of InSite, though, is in need of work. According to Maynard, the facility is operating at above full capacity, sometimes seeing more than 1,300 visitors a day; Hannah Leyland, a Master’s student covering InSite in her thesis, described it as looking “low budget,” noting chipped paint. InSite has annual operating costs of $2.15 million. A 2010 study into its financial wellbeing touched upon how the facility’s hygienic provisions prevent HIV infections. The study concluded that if InSite were closed, HIV infections would increase by 46 percent, costing Canadian taxpayers $12.9 million (CDN$17.6 million).
Ad hoc America
In the U.S., however, a cheaper solution is more politically viable. Dr. Gregory Scott, a visual sociologist, who has 17 years of experience in the field of drug-use harm reduction, is pursuing this route. He is traveling the U.S. with SAFE SHAPE, a “pop-up public health exhibit” that acts as a mock safe-injection site.
Scott designed SAFE SHAPE with architect Andrew Santa Lucia, of Portland, Oregon–based firm Office Andorus. The ten-square-foot pavilion uses two-inch-thick aluminum tubes to compose a white frame over which a bright-white, translucent spandex shell is stretched. It weighs less than 100 pounds and can be broken down and packaged into four ski bags and two storage tubs, allowing it to be easily transportable by plane.
“For me, design and aesthetics become heavily politicized in terms of the stigma associated with drug addicts,” said Scott. He wanted something that didn’t leap out at people as a place for users, instead adopting a “high-design” look that, semiotically, didn’t reference preconceived ideas surrounding drug addiction.
“Using a taut skin, we were able to produce a bright image that stands out in almost any landscape and becomes an icon,” explained Santa Lucia.
So far, only one SAFE SHAPE has been built. Scott erected the pavilion in Chicago as an actual consumption facility for both injectable and smokable (usually crack cocaine) drugs, albeit temporarily and illegally. Despite its small size, SAFE SHAPE is able to cater to two injectors or three smoking users at a time. The latter is a rarity for the harm reduction typology, due to issues of ventilation. SAFE SHAPE’s varied-height apertures, however, allow for such use.
Additionally, its size may be an advantage in terms of providing a safe place for drug consumption that can cater to drug users quickly and efficiently, but one thing SAFE SHAPE doesn’t provide is permanence. Many visitors to drug-consumption spaces do not have registered addresses, and time spent in such facilities can provide private moments to feel at ease and escape street life.
Another site that caters to smoking users is H17, in Copenhagen, Denmark. Occupying a former slaughterhouse in the gentrified, artsy district of Vesterbro, H17 cost $4.4 million and opened in August. It is more than 1,000 times larger than SAFE SHAPE and was designed by Copenhagen firm PLH Arkitekter. To Scott, “H17 is a fine example of bringing design and function together for the purpose of interrupting a criminalizing, moralizing discourse that really does harm people.”
PLH used a technique the firm calls “nudging” to encourage visitors on a linear path through the building and to separate pre- and post-consumers. “There are no 90-degree or smaller corners,” explained Lars Toksvig, a partner at PLH Arkitekter, which worked on H17. The facility’s entrance is open and employs a palette of cool “calming” colors.
The injection booths at H17 are wide and mirrored, and each has a hole on its stainless-steel desk that allows easy and safe disposal of used syringes, etc. A chill-out space is also provided, where inflatable furniture and warmer colors create a calm and less-clinical environment. “When we looked at precedents, we found many were insufficient in size,” said Toksvig. “When they get too small, users can become stressed inside and outside. It is important to cater to this.”
What is Next?
In Canada, some architecture firms are becoming more familiar with designing injection sites. Rayside said his Montreal practice, Rayside Labossière, has worked on five such facilities, most recently Spectre de Rue and CACTUS, both in Montreal and on course to open this year.
Meanwhile, back in the U.S., in Seattle, King County Executive Dow Constantine and Mayor Ed Murray granted approval for two injection sites, officially known as “Community Health Engagement Locations.” The two facilities could be America’s first. Currently, officials are in the process of finding the right locations and working out funding.
However, according to Mark Townsend, former executive director of the PHS Community Services Society, NIMBYism can slow proceedings. “Ideally, you want these spaces established before there is an overdose epidemic,” he said.
In addition to saving lives, drug consumption facilities can serve as paradoxical stepping-stones toward detox. They bring the very real work of designing for harm reduction into the public eye, while also providing private, dignified spaces that benefit both users and nonusers. Though these facilities are sadly only born out of crises, the progress in their design represents a change in public and political attitudes, an area in which the U.S. still has a long way to go.