THE CHALLENGES OF ARCHITECTURAL HUMAN SCALE IN HOSPITAL ENVIRONMENTS: BRAZILIAN HOLY HOUSE OF MERCY. Moema Loures PUC-Rio - Pontifical Catholic University of Rio de Janeiro Imaginal Arquitetura moema@imaginal.com.br www.imaginal.com.br Architect and Urban Designer. Founder of Imaginal Architecture, a Brazilian office focused on healthcare architecture and design. Professor at the Architecture School PUC-Rio (Pontifical Catholic University of Rio de Janeiro). PhD in urban design at Federal University of Rio de Janeiro / École Nationale Supérieure d'Architecture Paris-Malaquais, France. Master at Federal University of Rio de Janeiro / University of Seville - Escuela Técnica Superior de Arquitectura, Spain. We envision an argument that favours human senses in hospital ambiences. We are looking for potential in an atmosphere based on the human scale; the scale of social meetings; the scale that allows patients to be well orientated; the scale of sensory perceptions. We believe that a human-scaled space is the path to encapsulate beauty and simplicity. Thus, we turn our gaze to the sensitivity of colour uses, light intensities, temperature variation, supporting orientation, way-finding system, and constant interaction of our bodies and movements within the environment in the architectural experience. We take into account the concept of a healing environment, improving sleep and reducing agitation and anxiety, as well as, increasing social relationships.

Our reference-case is the Holy House of Mercy Hospital in Juiz de Fora - Brazil - and the dialogue between architecture and ludic and its interfaces with art and design opposed to rigid institutional routines. Image 03: Endoscopy Centre. Stimulating a ludic atmosphere. The Holy House is a philanthropic hospital founded in 1854. The main building was built in 1942, has 15 floors and represents the first vertical hospital in Latin America. It is a complex with 508 beds, a consultation and diagnostics centre, emergency services, operating theatres, intensive units, a nursing centre, knowledge, logistics and technical centres, an industrial kitchen and laundry. In the Complex there is a chapel and House, both dating back to the 19th century. Image 03: Juiz de Fora Holy House of Mercy.

Over the past four years, the institution has been undergoing a period of big changes in its physical infrastructure. Important refurbishments were made to the consulting centre for the Public Healthcare System, the Hemodynamic and Endoscopy centre, the Centre of Sterile Supplies and the Coronary Intensive Care unit. Beyond this, the refurbishment of the hospitality sector includes 55 new rooms. The Holy House of Mercy also incorporates in its complex a building that was refurbished to house the consulting centre for its private healthcare system. Image 04: Consulting centre for the Public Healthcare System. The green panel supporting orientation and way-finding system. Having “the detail” as a keyword, for each work, we were learning how to approach the architecture on a human scale. The goal was always to awaken the playful in a rigorous and complex hospital environment. We start from small to reach a large scale. Just as the great masters of Dutch architecture taught us in the past, the major design challenge is to master the urban, architecture or design scales. For us the most important thing to remember in a large-scale complex is to not lose the human scale. Image 05: Coronary Intensive Care unit. Image 06: Endoscopy Centre. Designing the details.

Technology and logistics are incorporated so that they function optimally but do not dominate the atmosphere of the interior space. The first impression of the refurnishing should be that it was easy to be done, and is simple and beautiful. In this project the patient has no idea about all the fills, gases and infrastructures that are needed to keep them alive. Image 07: Hemodynamic unit. Interior space atmosphere inside a operate theatre. Image 08: Hemodynamic unit. Resting centre and the chairs panel.

The idea is to arouse curiosity of those who experience the architecture. The drawings, for example, are located in places where they are not evident, the patient will discover them. The forms are not clear, they instigate sensitive imagination. Image 09: New rooms. Drawings behind the door. Another example is the Hemodynamic project: the focus was on the notion of logical, chronological and topological time. Due to the objectivity of time on surgeries as well as the relativity of time in patient recovery, we decided to enhance this concept by creating different watches in which the exercise of seeing time becomes subjective, distracting the patient from focusing on their pain. Image 10: Hemodynamic watches. Distracting the patient and staff. In each work we also take into account the context of the whole complex, trying to bring inside the natural light. Daylight is essential for the quality and functionality of a hospital and its adjoining inner areas. Architecture is especially the spatial experience that people undergo in buildings; the relationship with the outside for us is crucial. We are always interested in light, daylight, the light on things; it gives the feeling that there is something behind all understanding.

Image 11: Central of Sterile Supplies. Looking for the health of the staff. Image 12: New rooms. Natural light all over. What made this possible was that the board of directors imposed no restrictions on the spatial orientation and was always supporting the architects’ decision. The close relationship with nurses and doctors translating their needs in architectural terms was also essential to achieve our goals. An integrated approach has resulted in our participation for the whole project process, since the first ideas and desires of doctors, nurses and boards right up until the units had started work. We have an architecture office inside the hospital and we work together with the engineers and the construction team. We are immersed in the construction site and in the hospital ambience.

This methodology of completed immersion in the hospital is giving us the opportunity to sense the character that surrounds it, we are able to feel the Hospital behind-the-scenes. Architecture not only to create functional and well designed spaces but also to provide possibilities to animate human instincts and habits by interacting with all of the human senses. Image 13: Corridors. Architecture and engineering side by side. Illustrative image. Image 14: Immersing in the construction site.

The most important aim of the architecture is the creation of an atmosphere inside and outside the building that helps the patient to recover as quickly as possible and to make the stay as pleasant as possible. We believe that the architecture can reduce the stress-levels of a hospital, medical errors and hospital infections. Gradually, we approach the concept of living. By inhabiting space, individuals can sense the character that surrounds them. We argue that architecture and space are designed and built for people to use and experience. This feeling of presence, well-being, harmony and beauty is incorporated into the hospital ambience. This year we started the first ideas to build a Holy House of Mercy Hospital extension. Our main idea is to create a big boulevard that connects to the hospital. This space can give the visitors, staff and patients a clear sense of spatial direction. Image 15: Diagram of Holy House of Mercy Hospital extension. The big boulevard in red. At the same time, the boulevard is not just a circulation area but also a public space. A “between space” where you can stay to cast a quick glance outside, to talk with other patients or just to have a coffee. A space for socialising, meeting places for family and friends. The boulevard idea came together with a high level of daylight and a maximum support for the professionals and minimum inconvenience for the patients. Image 16: Juiz de Fora Holy House of Mercy Corridors. Place to take a break.

Some concepts came from an exchange trip we did to the Netherlands, vising more than 15 hospitals and some of the most important offices focusing on Hospital Architecture. What we had seen was well planned and designed buildings, with similar costs of Brazil’s reality. Unfeasible is the use of certain prefabricated elements with high technology and industrial logistics of demountability and adaptability. This experience brings ideas and architectural solutions that can be leveraged in Brazil, altogether with respect for Brazilian’s cultural diversity, traditions and landscape. Image 17: Den Bosh Hospital Boulevard. Many questions about hospital architecture came to the forefront and were beginning to influence our projects: How the aging population impacts on hospital settings? How telemedicine impacts in reducing hospital beds? Why corridors are often narrow and monotonous and can give rise to common areas for patients and visitors to meet, as a living room? How natural light is utilised throughout the history of architecture and can drive design decisions inside a hospital? We ask ourselves how we are shaping the infrastructure of the future, knowing that healthcare is changing very fast; a hospital that does not become outdated within a few years but where, in the future, new care concepts and technical developments can be added. At the same time, the only certainty we have is that the human scale will always be essential in architecture and in promoting the speedy recovery of the patient. Human scale will always be the challenge of architecture.

(…) what I am designing will be part of a place, part of its surroundings, used and loved, discovered and bequeathed, given away, abandoned, and perhaps even hated - in short,

that it will be lived in, in the wildest sense.” Peter Zumthor1. Image 18: A concept room based on human scale.

                                                                                                               1  Peter Zumthor Works. Buildings and Projects 1979-1977.  

Image 15: A concept room based on human scale.