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Conservation of Heritage Healthcare Architecture; a Case Study at Siriraj Hospital, Bangkok Thailand

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Conservation of Heritage Healthcare Architecture; a Case Study at Siriraj Hospital, Bangkok Thailand CONSERVATION OF HERITAGE HEALTHCARE ARCHITECTURE; A CASE STUDY AT SIRIRAJ HOSPITAL, BANGKOK THAILAND By Nantawat Sitdhiraksa A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY Program of Architectural Heritage Management and Tourism (International Program) Graduate School SILPAKORN UNIVERSITY 2011 CONSERVATION OF HERITAGE HEALTHCARE ARCHITECTURE; A CASE STUDY AT SIRIRAJ HOSPITAL, BANGKOK THAILAND By Nantawat Sitdhiraksa A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY Program of Architectural Heritage Management and Tourism (International Program) Graduate School SILPAKORN UNIVERSITY 2011 The Graduate School, Silpakorn University has approved and accredited the Thesis title of “Conservation of Heritage Healthcare Architecture; A Case Study at Siriraj Hospital, Bangkok Thailand” submitted by Mr.Nantawat Sitdhiraksa as a partial fulfillment of the requirements for the degree of Doctor of Philosophy in Architectural Heritage Management and Tourism ……........................................................................ (Assistant Professor Panjai Tantatsanawong,Ph.D.) Dean of Graduate School ............./..................../.......... The Thesis Advisor Dr. Donald Ellsmore The Thesis Examination Committee .................................................... Chairman (Professor Dr. Trungjai Buranasomphob) ............/......................../.............. .................................................... Member (Assistant Professor Pibul Jinawath, Ph.D.) ............/......................../.............. .................................................... Member (Dr.Donald Ellsmore) ............/......................../.............. 50056970 : MAJOR : ARCHITECTURAL HERITAGE MANAGEMENT AND TOURISM KEY WORD : CONSERVATION HERITAGE HEALTHCARE HOSPITAL SIRIRAJ NANTAWAT SITDHIRAKSA : CONSERVATION OF HERITAGE HEALTHCARE ARCHITECTURE; A CASE STUDY AT SIRIRAJ HOSPITAL, BANGKOK THAILAND. THESIS ADVISOR : DONALD ELLSMORE, Ph.D.. 264 pp. This study is a study of healthcare heritage conservation in Thailand by using Siriraj Hospital as model for proposing for conservation plan. Healthcare architecture has a long history. As a part of human culture, healthcare architecture is on a dynamic development as a result of multiple factors, for example, the changes in social and healing culture, medical knowledge, building technology, scientific achievement, pattern of healthcare utilization, and government policy. Continuous changes of health architectures have been evidenced from ancient healing culture, to the church-run facility in the Medieval, to the state-run hospital in the Renaissance, to the evidence-base data collection in the Nightingale era, to the mega-hospital in period of science and technology, and might be to the more informative, residential, decentralized oriented healthcare. A case study of Siriraj Hospital as a healthcare heritage was done by using the Hoi An Protocol for best conservation practice in Asia, section on monuments, buildings, and structures, as a guide to heritage hospital conservation. It was found that the significances, values, and authenticity of Siriraj Hospital were both in the aspects tangible and intangible heritage of functional value, educational value, historical value, social value, aesthetic value, and uniqueness value. Heritage conservation plan of Siriraj Hospital was purposed based on the significances, values and authenticity study. Program of Architectural Heritage Management and Tourism Graduate School, Silpakorn University Academic Year 2011. Student's signature ......................................................... Thesis Advisor's signature ............................................. c Acknowledgments I would like to express my gratitude and appreciation to my very kind and supportive advisor, Dr. Donald Ellsmore. He is always my resources of encouragement and inspiration. Without his support and guidance, my dissertation would not be completed. I am grateful to my mentors at work, Professor Somporn Bussaratid, MD and Assistant Professor Panom Ketuman, MD for their kindly continuous mentoring and encouraging in my work, and in my life. I am grateful to Professor Sanjai Sangvichien, MD for his help and his very kind advices. I would like to thank Dr.Nattha Saisaveoy, Namon Phongsakornpaphas, Prapapan Pompothong, Ilada Subsin, Athip Sangrungreuang, and Nakaraj Pluetrattanabha for their support and encouragement. I would like to thank my research assistances: Lakkhana Thongchot; Phutharet Phongbupha; Naratip Sanguanpanich; and Julaluck Wankeaw for their help and understanding. Without their help and support, my dissertation would not be completed. In addition, I am grateful to all the lecturers, oversea professors and staff of the International Program in Architectural Heritage Management and Tourism for their devoted time and invaluable knowledge. I would like to thank all of my friends who help and encourage me through the hardship of study and my work. Last but not least, I am very grateful to my parents, sister, and brothers who always give me love and support. d Table of Contents Page Abstract c Acknowledgments d List of Tables h List of Figures i Chapter 1 Introduction 1 Study site 1 Origin of the study 4 Significance of the problem 4 Goals and objectives 5 Hypothesis 5 Scope of study 5 Research methodology 6 Process of study 6 Dissertation overview 6 2 History of Healthcare Architecture Design 7 Literature review 7 History of healthcare architecture design 7 The Ancient era 9 The Medieval period 11 The Renaissance 15 The Nightingale era 21 The Minimalist megahospital 26 The Virtual healthscape 27 Trends of contemporary health landscape 27 Humanized health care 28 Forms of hospital according to the European Hospitals Heritage 29 Medical knowledge and its’ impacts on hospital and setting 32 Thai medical and hospital history 34 3 Review on Heritage Protection and Heritage Conservation Protocols 40 ICOMOS 40 The World Heritage Committee of UNESCO 40 The Burra Charter 41 e Chapter Page The Xi’an declaration on the conservation of the heritage structures, sites and areas 43 The Hoi An Protocols for Best Conservation Practice in Asia 44 The issue of significance and authenticity in the Hoi An Protocols 44 The sources of information on authenticity 47 Authenticity of an intangible cultural heritage 49 Overview of heritage conservation in Thailand 49 4 History of Evolution and Change at Siriraj Hospital 51 Basic information of Siriraj Hospital 51 Map of Siriraj Hospital 52 Orientation 55 Development sequence plans of Siriraj Hospital 60 Heritage background of the site 93 Understand the context 94 The Strategic Plans of Siriraj Hospital 122 The Vision of Siriraj Hospital 122 The Philosophy of Siriraj Hospital 122 The Mission of Siriraj Hospital 122 5 Consideration of Heritage Significance of Siriraj Hospital 123 Statements of significance of Siriraj Hospital 125 The heritage value assessment of Siriraj Hospital 127 Functional value 127 Education value 127 Historic value 129 Social value 130 Aesthetic value 130 Uniqueness value 134 Evidence of significances and authenticity 134 6 Conservation Planning and Discussion 138 Conservation planning‐Discussion 138 Need for conservation planning 138 Objective of conservation planning 138 f Chapter Page Discussion of the dimensions of values and authenticity of Siriraj Hospital 139 Ten significant heritage buildings at Siriraj Hospital 144 Discussion of how expansion could occur without impacting further on significance 159 Discussion of options 162 Some key principals of the conservation plan 163 Enhancing the hospital environment 163 Supporting academic excellence 167 Engaging the community 167 7 Guidelines for Change 169 Statement of the future conservation vision 169 The potential impacts 169 Positive impacts 169 Negative impacts and risks threatening conservation 170 The threatening factors 170 8 Conclusion 179 Significances of Siriraj Hospital 179 The heritage value assessment of Siriraj Hospital 180 The conservation plan for Siriraj Hospital as a heritage site 181 The potential impacts of the conservation plan 184 The positive impacts 184 Negative impacts and risks threatening conservation 184 The threatening factors 184 Limitation of the study 185 Concluding remarks 185 Bibliography 187 Appendices 191 Appendix A: The Hoi An Protocols for Best Conservation Practice in Asia 191 Appendix B: Power‐point Presentation for the Defense Examination 249 Biography 263 g List of Tables Tables Page 1 List of the Renaissance hospitals in Europe 18 2 List of hospitals in Thailand from 1880‐1978 35 3 Dimensions of authenticity mentioned in the Hoi An Protocols 46 4 Sources of Information on Authenticity in the Hoi An Protocols 47 5 Listing of buildings in Siriraj Hospital 95 6 Potential sources of information on authenticity of Siriraj Hospital 135 7 Authenticity on location and setting: Siriraj Hospital 140 8 Authenticity on form and design: Siriraj Hospital 141 9 Authenticity on use and function: Siriraj Hospital 142 10 Authenticity on immaterial qualities: Siriraj Hospital 143 11 Ten significant heritage buildings at Siriraj Hospital in their current condition, 2012 145 h List of Figures Figures Page 1 Location of Siriraj Hospital from the Google Maps 2 2 Siriraj Hospital from the Google Maps 3 3 Valetudinarii, the Roman military hospital 10 4 Ground floor plan of Cluncy Monastry, 1157 14 5 The plan and cross section Ospedale Maggiore, 1456 AD
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