Designing for Health

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At Clinica Verde, we continue to move forward in our partnership with the Ministry of Health of Nicaragua to redesign two of their rural health posts (puestos de salud) and train staff in compassionate care. Below, an interview with Amanda Martocchio of Amanda Martocchio Architecture + Design on the process of designing these puestos with members of the local community.

First, can you provide just a quick overview of where you are in the design process of the puesto project?
Our first step was to design, in collaboration with the Clinica Verde team, two Puestos de Salud prototypes: a reduced version to be implemented in rural communities with limited staffing and fewer patients; and an expanded version for more populous communities which have more clinical spaces, larger staffs, and more patient visits. Once the CV team signed off on that approach, we began to design details for a new “reduced prototype” for the rural community of Las Lagunas, to replace their existing Puesto structure that is in very poor condition. And, at the community of San Nicolas, not far from Boaco, our design focused on retaining as much of their existing structure as possible, but modifying it to better serve staff and patients. We’ve passed along these two now-developed designs to the Boaco Mayor’s Office and its Department of Construction in order for their local engineers to confirm the structural design and to prepare the construction documents for both projects’ realization. But before doing so, in response to a request from the Mayor’s Office, we produced for their use a video presentation, in Spanish, on the fundamental principles of “green building” which have informed our design approach and which we believe are central to Clinica Verde’s mission of delivering healthcare within a framework of environmental and social sustainability.

What has surprised you the most about the project?
The most welcome surprise has been the level of interest in and support for an improved Puesto de Salud from the residents within the communities where they will be located. Residents were receptive to adapting the design details, as we had hoped, to meet their specific community values. Some members of the community mentioned how they loved the exterior colors at the Clinica Verde clinic, but would like to be able to choose their own for their Puesto. Others mentioned how they would love to have their local symbols incorporated in the Puesto design. We were pleased by the degree of understanding and acceptance of sustainable design and building practices. Many citizens supported the use of solar panels and water collection, but they stressed their priority to receive basic services, like water, sanitation, and security. There were suggestions for ways in which the Puestos could deliver other important services to their communities, like providing a public washing machine so that they did not need to take the long walk to the river to do laundry. Not only did the community members seem excited about the improved health services slated for their community, but they also appeared to be interested in assuming an active role in its success.

What has been the biggest challenge/obstacle to your vision?
The biggest challenge has been the lack of existing infrastructure, including water, power, and sanitation, at the two prototype sites. Clinic Verde’s mission of delivering reliable and safe health services, let alone compassionate care, will be extremely challenged if not impossible without these utilities in place. It is our hope that the Nicaraguan Ministry of Health can furnish the prerequisite utility services so that Clinica Verde’s construction budget can focus on building the Puestos based on their successful model of compassionate care.

I know spending time with community members informed your design. Can you talk about that experience and process and how you incorporated the needs and desires of the community? Do you see this project as a co-design with the community – and can you explain that?
We had a very informative trip to Nicaragua during which we had the privilege of meeting with members of both communities (Las Lagunas and San Nicolas). These meetings were facilitated by Dr. Yolanda Paredes-Gaitan, Rafael Morales, and Mary Elizabeth Flores of the Clinica Verde staff. They did an extraordinary job of welcoming the community members and inviting them to share their ideas and vision for the Puestos to help inform our design process. Not only did we incorporate many of their ideas that were specific to the delivery of healthcare services, but, based on their comments, we were able to broaden our thinking to include other opportunities for expanding the building’s role within the community (community meetings, educational programs, community gardening, teen center, laundering facilities). For us, the success of the design will be reflected by the degree to which the community takes ongoing ownership of the Puesto, actively uses it, and cares for it. By hiring local, unskilled labor to build the Puesto and by including into the building design locally fabricated signage, community designed and produced mosaic floor design, and community selected exterior paint colors, we hope the community members begin to regard it as their own.

What’s your greatest hope for the next step – and the final vision?
Our biggest hope is that the full degree of sustainable features that we have designed will be implemented to yield the greatest positive impact within the community. Our Puesto prototype designs not only take into account low-tech and common-sensical passive solar strategies as well as basic elements of green design, but also are intended to support active electricity-generating roof top solar panels, rainwater collection and storage, and bio-intensive gardening to support the community. Our greatest hope is that the Mayor’s Office faithfully executes at the two targeted sites the two Puesto designs—for a new reduced prototype in a more rural community, and for a renovated, expanded prototype in a more populated area. Once implemented and operational we will see evidence of how good, sustainable design positively impacts health outcomes in these communities.

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