The fast growing population of , is putting immense pressure on several key infrastructures, natural ecology and most importantly the health of the city. This project focuses on the concept of ‘holistic health’ in the devel- opment of the city of Kumasi. The project strategies are tested within two sites: the new peri-urban municipality of Asokore , in which a pilot project in sus- GROWING tainable cultivation and waste manage- ment is proposed, and a rural site near the town of that encompasses the design of a specialty tertiary hospital CANOPIES for the West African Health Foundation.

BY SCOTT ARCHER, SAMARTH DAS, VANESSA ESPAILLAT AND SAGI GOLAN

2013 GRADUATE ARCHITECTURE AND URBAN DESIGN STUDIO AT COLUMBIA UNIVERSITY, GRADUATE SCHOOL OF ARCHITECTURE, PLANNING AND PRESERVATION IN PARTNERSHIP WITH THE URBAN DESIGN LAB, THE EARTH INSTITUTE AS PART OF RE-ENVISIONING HEALTH IN KUMASI: SPATIAL STRATEGIES The comprehensive system comprises various elements of holistic health, such as the healthcare system, traditional herbal medicines, aspects of eco-therapy, allopathic pharmaceutical industry as well as waste man- agement. This project aims to evolve a strategy that synthesizes these elements in order to have a meaningful impact on the overall health of the city of Kumasi.

Kumasi’s landscape consists of a series of ecological corridors that trans- verse the city, creating green connections through its fabric. These lands fall under the traditional Chief’s authority but are presently threatened by the encroachment of housing, informal commerce, agriculture and industry. These corridors, as key areas of productive canopies and sustainable har- vesting, are safeguarded while contributing to the region’s economy.

The pharmaceutical industry has been noted as an essential area of invest- ment for the city of Kumasi. Favorable governmental policies coupled with human knowledge capital emerging from Kwame Nkrumah University of Science and Technology (KNUST) provide the city with competitive advan- tages in developing this industry locally. The increase in demand for tra- ditional herbal medicines suggest cultivation of an industry focused on the production and distribution of these herbs—85 percent of which grow within the region’s semi-deciduous climate. A formal distribution corridor along the Tamale-Accra road, along with the upgrading of the airport, places Kumasi centrally within the nation and the sub-Saharan region.

Severe environmental degradation and frequent epidemics give the city the urgency to develop new treatments and drugs. The eco-corridors are also threatened by poor waste management. Providing a new system of collection as well as co-composting household and human wastes can begin to reduce the contamination of the city’s waterways. Currently filled with various types of waste, these waterways are distributing water-borne disease through direct human contact, dispersed agriculture irrigation and fostered mosquito proliferation. The cleaner irrigation water and newly produced compost would create higher yields for farmers as well as dimin- ishing the spread of these diseases.

Enhancing the overall approach of holistic health, nature embedded within urban and architectural environments can provide exceptional healing effectsand healthier lifestyles. This strategy is manifested within the design of the specialty hospital for the West African Health Foundation (WAHF) in the rural town of Juaben. Designed as a series of programmatic nodes inter- woven with open-air circulation, courtyards and a productive landscape, the hospital’s patients can take advantage of the broadened ideas of holistic health. The intersection between the ecological and architectural canopies stresses the importance of nature penetrating the formal volumes of the hospital. Through its design, the building embodies the values of holistic health and aims to become an image that inspires future developments. ADVANTAGE FOR HOLISTIC HEALTH IN KUMASI A PRODUCTIVE SYSTEM FOR THE ECO-CORRIDORS

Kumasi—once known as the Garden ture have had adverse effects on the strengthening community networks City of West Africa—faces a great chal- quality of the waterways and urban and reinforcing the importance of lenge to preserve and utilize its lush productive lands. cooperation and education through protected lands along its waterways. waste management and medicinal These lands have become key envi- For these reasons, bottom-up coop- plant production strategies. In the dual ronmental infrastructure. The rapidly erative models of development play political system, traditional authori- increasing population and the informal an important role in improving the ties have complete ownership of the encroachment of extensive agricul- socio-economic conditions of the land and therefore play an important tural production has inflicted immense residents and local communities. role in the land provision. The modern pressure on the eco-corridors. Illegal The organizational system provides government will continue to have a housing and chemicals used in agricul- both economic and social benefits— managerial role within the strategy. SUSTAINABLE ECO-CORRIDORS

The natural canopy in Kumasi’s Therefore, strategies of remediation newly productive lands will be secured semi-deciduous forests hosts over 150 and prevention should be employed by the herbal cooperatives, freeing species of native plants, which have a throughout Kumasi’s eco-corridors to the governmental powers from the variety of nutritional benefits, herbal protect this important infrastructure. insurmountable task of patrolling and uses, and can be used in the medicinal A system of bioswales, co-compost- enforcing protection zones. The public and construction industries. Environ- ing, and herbal production can be health impacts and economic benefits mental degradation and unsustain- used as a measure to prevent informal will be tremendous with cleaner water able harvesting have made many of encroachment into these lands. supply for downstream irrigation, a these plants extremely rare, while the nutrient-rich topsoil, a new herbal demand for the same continues to rise With the cooperation of both the tra- economy, and the reestablishment of in local markets. ditional and political authorities, these a diverse ecological canopy. ECO-CORRIDOR IN PERI-URBAN

Stone LAND READJUSTMENT OF AGRICULTURE SELECTIVE HARVEST MEDICINAL COOP- WASTE CO-COMPOSTING PROCESS: Bioswale Wier Forebay Swale PLOTS: CONSOLIDATION OF GOVERNMENT ERATIVES: RESTORATION OF PRODUCTIVE REPLENISHMENT OF SOIL AND WASTE PROTECTED LANDS LANDSCAPES MANAGEMENT

Garden City Hospital Primary School

Kumasi Academy Kumasi International Airport

Asokore Mampong Municipal Assembly Offic

LEGEND

Organic & Human Waste Collection Points Railway Line Co-Compost Lots

Bioswales & Wet Bottom Ponds

Cooperative Lot

Agriculture Land

Asokore Mampong—the first indepe - The eco-corridor strategy is based down rainwater runoff and naturally dent municipality to be created within on an environmental remediation cleanse it before releasing it into the Kumasi Metropolitan Assembly (KMA) plan, which restores the important waterway. boundaries—currently faces complex natural canopy, replenishes the eroded land tenure issues and environmental soil with co-composting process of Once the water and waste systems degradation, along with poor systems human and organic waste, collects have been put in place, the medicinal of service management and provi- and cleans the rainwater runoff and plant cooperatives would begin the sion. Asokore Mampong needs to sets up an economy of medicinal herbs process of selective harvest of medic- implement collaborative governance production. This system is devised inal plants, thereby transforming the structures that bring together partners through a series of wet-bottom ponds waterways into productive eco-corri- from all sectors of society. and terraced bioswales that slow dors for the municipality. HEALTHCARE INNOVATION: HERBAL MEDICINE DEVELOPMENT HEALTHCARE INNOVATION: TELEMEDICINE

BENEFITS OF TELEMEDICINE

Herbal plant cultivation and Develop herbal medicine dosage and Collection of raw materials; production sustainable harvesting codes; consolidate Trade Related As- and distribution of pharmaceuticals pects – Intellectual Property Rights

HEALTHCARE INNOVATION IN KUMASI POTENTIAL ROADBLOCKS

Equipment breakdown License issues across jurisdictions

Poor Internet access Instability of electricity supply

TYPES OF TECHNOLOGIES

Various agencies such as the School meeting this demand. The WAHF cine in the , performing of Medical Sciences at KNUST, the hospital provides an ideal platform for the role of bringing specialist health- Dept. of Pharmaceutical Sciences and research and development into dosage care to rural areas in Ghana. Two types Herbal Medicine along with the Centre and codes for the herbal medicine of consultation can be followed— the for Scientific esearch into Plant practice in the country. store and forward and the two-way Medicine provide an immense knowl- interactive method. The technology of edge capital key to further the herbal Telemedicine is the use of informa- telemedicine can be used effectively medicine industry. Eighty percent of tion and ICT to deliver health care for multiple purposes such as psychi- Ghana’s population relies on herbal in settings where access to medical atry, internal medicine, rehabilitation, medicine and over 150 native herbal services is insufficient The hospital cardiology, pediatrics, obstetrics, plant species can be tapped into for would serve as the base for telemedi- gynecology and neurology. WAHF HOSPITAL SIGNIFICANCE BUILDING DESIGN STRATEGIES

Upgrading of Juaben Hospital

Maternal & Child Care

Modular Roof Panels

Skilled Doctors

Bamboo Space Frame

Specialized Training / R&D

Massing Sustainable Harvesting of Medicinal Plants

Providing Jobs for Local Inner Courtyards Circulation and Women Courtyards Public Circulation

Private and Contained Circulation

Usage & Dosage Codes / Herbal Clinic

With an extremely high maternal and and retaining skilled doctors, WAHF of Juaben—where women from the FORM GENERATION child mortality in Ghana and a severe creates a holistic approach to the town would be employed in the herbal brain drain in Kumasi’s health system, role of the hospital. This approach is and therapeutic center. The town the West African Health Foundation not only programmatic but also uses itself will cater to visitors that come (WAHF) Hospital has the opportunity herbal medicine as part of the healing to the hospital by providing lodging to become a leading hospital locally in process by developing codes of dosage and dining facilities. The hospital’s Kumasi as well as internationally in the and usage in the research and devel- economic model provides health care larger sub-Saharan region. opment center within the hospital. for high income patients, who in turn would subsidize lower income patients Focusing on these health issues and The hospital plays an important and provide funding for the up-grading providing specialist care, while training role in its relationship to the town of the existing district hospital. 1.Existing Topography + Canopy 2.Utilizing Topography 3.Site Layout SITE PLAN

Comprehensive understanding of leads into a more private in-patient at integrating the formal programs of SITE CHARACTERISTICS 1 – Training Center + Auditorium 12 – Operation Room + Morgue (below) the functioning of a hospital through facility with operation theaters, single the hospital with the healing aspect Site Area – 10 Acres (4.03 ha) 2 – Pharmacy, Administration 13 – Intensive Care Unit (I.C.U) various case studies helped in evolving patient rooms and wards for men, of natural landscapes. The court- 3 – Blood Bank, Research & Dvlpt. 14 – Single Patient Rooms a plan that deals effectively with issues women and children. Stressing on the yard becomes a formal element of Total Build Out Area of Hospital – 4 – Rental Space, Research & Dvlpt. 15 – Cafeteria of efficien , adjacency of programs, importance of herbal medicine, a ther- organization and orientation for users, 9000 sq.m 5 – Emergency Room, Imaging 16 – Main Kitchen + Dining privacy and security. The plan orga- apeutic center is located towards the setting up a rhythm of movement Total No. of beds – 250 6 – Reception + Registration 17 – Hotel nizes the most public elements of the end of the site, along with short-term and circulation through the hospital. 7 – Consultation Rooms 18 – Herbal Therapeutic Center hospital—primarily the diagnostic hotel rooms for patients’ families. It allows natural light to flood the Phase 1 8 – Emergency Room extension 19 – Outdoor Rooms and consultation centers—to be easily corridors and rooms while facilitating Area – 4000 sq.m 9 – StaffComfort P1 – Staff + Doctor +Visitor Parking accessible by the majority of visitors. Through each stage of its develop- cross-ventilation of air in the private Total No. of beds – 50 10 – Services P2 – Visitors’ Parking This initial out-patient department ment, this plan has constantly aimed rooms and public spaces. Budget for Phase 1 – $15 million 11 – Wards : Men + Women + Children S – Shuttle Drop-O SECTIONAL UNDERSTANDING OF THE WAHF HOSPITAL

PROGRAMMING THE ACTIVE ROAD-SIDE EDGE

COMPOSITE CONCRETE + BAMBOO STRUCTURE SOLAR + RAINWATER HARVESTING

SECTION THROUGH RAINWATER HARVESTING SYSTEM (SECTION C-C’)

The entrance facade of the hospital area for vehicles is beyond a controlled and bamboo. Bamboo grown on site becomes a key feature in asserting entry point restricting the gathering of proves to be a highly economical the presence and identity of the informal hawkers around such areas. material. It serves to allocate spaces hospital on the main -Juaben Publicly accessible programs such as for future growth of the hospital and road. The image of the hospital as a the pharmacy and the blood bank are can be used in various stages of con- leading center for training as well as also located along this edge, for users struction. The project also capitalizes research and development is asserted who only need these services. on the heavy rainfall by collection in by locating these programs on this storage tanks for irrigation purposes edge. The entrance to the building The hospital is envisioned to be made as well as the strong sunlight by sets back into a large fore-court that of a composite structure of local capturing and storing solar energy in ENTRANCE COURT TO THE HOSPITAL receives pedestrians. The drop-off materials such as landcrete, concrete inverters for restricted uses. SECTIONAL UNDERSTANDING OF THE WAHF HOSPITAL

INTEGRATION OF ARCHITECTURAL CANOPY WITH ECOLOGICAL CANOPY (SECTION A-A’)

PASSIVE COOLING SYSTEM OF BUILDING

SOCIAL CORES- THE ROLE OF THE COURTYARD (SECTION B-B’)

In the design of the hospital the parts of the building. Primarily a space deploys fresh cool air within the concept of an architectural canopy frame that allows for the variations in building floor to eep the overall that integrates the building with the the roof, the structure is comprised of temperature in control and a cleansing ecological canopy is focused on. This bamboo members with pre-fabricated living machine that filters gr ywater new architectural canopy provides metal joinery. Modular sections allow and feeds it back into the flushing shade, facilitates ventilation, collects for the extension of the roof structure tanks in the toilets of the hospital. rainwater and hosts solar panels along with the future expansion of the oriented for capturing maximum formal programs of the hospital. In conclusion, the design of the sunlight. The canopy becomes the hospital aims to promote the well-be- visual identity of the hospital and is Other systems in the building include ing of its patients through the values an element that unifies the various a passive cooling mechanism that of holistic health that it embodies. HEALING AND PRODUCTIVE HOSPITAL ENVIRONMENT A GROWING HOSPITAL: PHASING STRATEGY PROJECT BIBLIOGRAPHY

Adarkwa, Kwasi K. and Post, Johan. “The fate of the Tree: Planning and Managing the Development of Kumasi, Ghana.” Ghana, Woeli Press, 2011. Addo-Danso, Shalom Daniel. Survival and Growth in a Moist-semi Deciduous Forest in Ghana: Comparison of Monoculture and Mixed-Species Plantations. Freiburg, Germany: Albert-Ludwigs University, 2010.

PHASE 1 Existing orange Berger et al. Strengthening Pharmaceutical Innovation in Africa. Council on Health Research for Development grove preservation (COHRED) & New Partnership for Africa’s Development (NEPAD), 2010. Betnar, Bret. “Sh*tscape: Mumbai’s Landscape In-between.” University of Pennsylvania, 2010. New forest canopy planting Bonsi, Richard. Adoption of Bamboo in Ghana’s Forest Products Industry: an investigation of the Principal Exporters and institution. Blacksburg: Virginia Tech, 2009. Bamboo growing on site for the future hospital Center for Scientific esearch into Plant Medicine. Biennial Report - 2003/2004. Mampong-Akuapem, Ghana: 2004. phases Cofie, Olufunke and Doulaye Kone. “Co-composting faecal sludge & organic solid waste: Kumasi, Ghana.” Case PHASE 2 study of sustainable sanitation projects. Germany: Sustainable Sanitation Alliance, 2009. Ghana Ministry of Health. Ghana National Drug Policy Report. Second edition. Accra: Ghana National Drugs Programme, 2004. Medicinal planting Hogan, Lucas and Graham Charles Archer. Development of Long Span Bamboo Trusses. San Luis Obispo: California Polytechnic. Bamboo harvested and Millenium Cities Initiative. “Invest in Ghana: Focus Kumasi.” 2008. used in hospital construction Obiri, B.D. and A. Addai. “People and Plants: A survey of Economic Botanicals on the Kumasi Central Market.” Ghana Journal of Forestry, Vol. 21-22 (2007): 50-71. PHASE 3 Orozco, Manuel. Diasporas, Development and Transnational integration: Ghanaians in the U.S., U.K. and Germany. Institute for the Study of International Migration and Inter-American Dialogue, 2005. United Nations Industrial Development Organization. Investment Opportunities In Ghana. Investment Forum Full natural Ghana, 2003. canopy growth Youpele, Sabina, “The Use of Traditional Medicine Abroad. The Ghanaian Experience.” February 22, 2013. http:// www.modernghana.com/blogs/215499/31/the-use-of-traditional-medicine-abroad-the-ghanaia.html.

PHYSICAL MODEL IMAGES