Page 1
1
CHUKWUMERIJE, M. PG/M.Sc./98/45485
OBSTETRIC AND GYNAECOLOGY SPECIALIST HOSPITAL
THIS IS A PROPOSED SPECIALIST HOSPITAL FOR ENUGU, AIMED AT
HANDLING ALL HEALTH CASES AS IT RELATES TO ‘WOMAN’
DEPARTMENT OF ARCHITECTURE
UNIVERSITY OF NIGERIA, ENUGU CAMPUS
A THESIS SUBMITTED TO THE DEPARTMENT OF ARCHITECTURE,, FACULTY OF
ENVIRONMENTAL STUDIES, UNIVERSITY OF NIGERIA, ENUGU CAMPUS
Webmaster
Digitally Signed by Webmaster’s Name
DN : CN = Webmaster’s name O= University of Nigeria, Nsukka
OU = Innovation Centre
APRIL 2001
Page 2
2
OBSTETRIC AND GYNAECOLOGY
SPECIALIST HOSPITAL
OBSTETRIC AND GYNAECOLOGY SPECIALIST HOSPITAL
THIS IS A PROPOSED SPECIALIST HOSPITAL FOR
ENUGU, AIMED AT HANDLING ALL HEALTH CASES AS IT RELATES TO „WOMAN‟
Page 3
3
BY
CHUKWUMERIJE, M. PG/M.Sc./98/45485
DEPARTMENT OF ARCHITECTURE UNIVERSITY OF NIGERIA
ENUGU CAMPUS.
APRIL, 2001
CERTIFICATION
CHUKWUMERIJE, M. (Miss), a Postgraduate student in the
Department of Architecture and with Registration Number
PG/M.Sc./98/45485, has satisfactorily completed the
Page 4
4
requirements for Design Research Report for the Degree of
Master of Science (M.Sc.) in Architecture.
The work embodied in this Thesis Report is original and has
not been submitted in part or full for any other Diploma or
Degree of this or any other University.
----------------------------- ------------------------------- CHUKWUMERIJE, M. DR. (ARC.) CHUKWUALI, B.C.
STUDENT HEAD, DEPARTMENT OF ARCHITECTURE
----------------------------- -------------------------------- DR. (ARC.) CHUKWUALI, B.C. EXTERNAL EXAMINER
SUPERVISOR
DEDICATION
Page 5
5
This work is dedicated to GOD Almighty. Indeed, He is a
faithful God.
ACKNOWLEDGEMENT
I acknowledge the efforts of all who have contributed to
the success of my programme in school, especially in this
design research report.
I therefore, wish to express my profound gratitude to the
following people:
Page 6
6
My beloved and wonderful parents, Engr. & Mrs. K.E
Chukwumerije.
My supervisor and Head of Department, Dr. Arc. C.B.
Chukwuali
My siblings, Muna, Sorom, Juoro, Nnenne, Ralu and Kadu.
My wonderful friends; Israel, Iroezindu for always being
there to assist, Emma Chima, Ndubueze Uche, Chinedu,
Emeka Onyeme, Robert Affortey, Emma Udomiaye.
My aunties and uncles; Mr. & Mrs. F.C Nwosu and Mr. &
Mrs. S.C. Igbokwe
My colleagues; the entire Graduating Class especially the
ladies, Enitan, Chinelo, Grace, Ibiso, Data, Askiya and
others.
To all of you, I say a heart-felt thank you and God bless
you all.
PREFACE
Health care presents a different problem in every country,
for the way it is organized is a response to geography, climate,
economic situation and social, cultural and political
conditions.
Page 7
7
Whatever their administrative organization and however
they are financed, all systems of health care delivery comprise
a range of institutions which, at least in theory, are graded
according to their degree of sophistication and specialization
and the level of care that they can provide.
Three main levels can be identified and are usually
termed: Primary, Secondary and Tertiary. Primary care
embraces the entire general health practice services,
educational, preventive
and curative, that are offered to the population at the point of
entry into the system.
Secondary care comprises the care provided by more
specialized services to which people are referred by the primary
care services.
Tertiary
Secondary
Primary
Page 8
8
Tertiary care includes highly specialized services not
normally found at secondary level, including super-specialties
such as plastic surgery, neurosurgery and heart surgery.
From the above explanations of the three main levels of
health care, it is obvious that the Design Research Report,
Obstetrics and Gynecology specialist hospital, is a secondary
health care system. Hospitals are inevitably a very expensive
element in any health service and very importantly, are an
indispensable part of the provision that is made for health.
They are costly to build and equip and the money necessary to
staff and run them can be enormous. Indeed, their annual
running costs may be as much as about a third of the initial
capital cost of construction and equipping them. The running
costs of a hospital are particularly high if it needs to accept a
large number of in-patients instead of treating them as out-
patients.
Considering all these, the Obstetric and Gynecology
specialist hospital will be designed to incorporate the out-
patient department, where patients will receive their specialist
diagnosis and treatment and also in-patient (ward) department
Page 9
9
where the patients are admitted only when the degree of care
is essential for their recovery.
TABLE OF CONTENTS
TITLE PAGE:----------------------------------------------- i
CERTIFICATION:------------------------------------------ ii
Page 10
10
DEDICATION:---------------------------------------------- iii
ACKNOWLEDGEMENT:---------------------------------- iv
PREFACE:-------------------------------------------------- v-vii
TABLE OF CONTENTS:---------------------------------- viii-x
PART ONE - BACKGROUND INFORMATION
CHAPTER ONE
1.1 INTRODUCTION:------------------------------------ 1-2
1.2 DEFINITIONS:--------------------------------------- 2
1.3 AIMS AND OBJECTIVES OF THE PROJECT:-- 3-4
1.4 STATEMENT OF ARCHITECURAL PROBLEM:- 4-5
1.5 SCOPE OF THE PROJECT:------------------------ 5-6
1.6 VIABILITY OF THE PROJECT:-------------------- 6
1.6.1 MEDICAL RECORDS:------------------------------ 6-11
1.7 LIMITATIONS OF THE PROJECT:--------------- 12
1.8 RESEARCH METHODOLOGY:-------------------- 13
PART TWO - LOCATION AND SITE ANALYSIS
2.1 PROJECT LOCATION:---------------------------------
2.2 HISTORICAL BACKGROUND OF ENUGU STATE:-
2.3 CULTURAL BACKGROUND OF ENUGU STATE:---
Page 11
11
2.4 ENVIRONMENTAL CONDITIONS OF ENUGU STATE
2.5 REASONS FOR CHOOSING ENUGU STATE
2.6 SITE FOR OBSTETRICS AND GYNAECOLOGY
SPECIALIST HOSPITAL, ENUGU.:--------------------
2.7 REMEDIES AND ARCHITECTURAL CONCLUSIONS-
PART THREE - CASE STUDY
3.1 INTRODUCTION:-----------------------------------------
3.2 UNIVERSITY OF NIGERIA TEACHING HOSPITAL,
ENUGU:----------------------------------------------------
3.2.1 INTRODUCTION:-----------------------------------------
3.2.2 FORCES:--------------------------------------------------
3.2.3 FORMAL SIGNIFICANCE:------------------------------
3.2.4 MATERIALS:----------------------------------------------
3.2.5 FUNCTIONAL EFFICIENCY:----------------------------
3.2.6 MERITS:---------------------------------------------------
3.2.7 DEMERITS:-----------------------------------------------
3.3.0 NATIONAL HOSPITAL, ABUJA:------------------------
3.3.1 INTRODUCTION:-----------------------------------------
3.4.2 FORCES:--------------------------------------------------
3.4.3 FORMAL SIGNIFICANCE:------------------------------
3.4.4 MATERIALS:----------------------------------------------
Page 12
12
3.4.5 FUNCTIONAL EFFICIENTY:----------------------------
3.4.6 MERITS:---------------------------------------------------
3.3.7 DEMERITS:-----------------------------------------------
3.4.0 MAIDUGURI TEACHING HOSPITAL, NIGERIA:-----
3.4.1 INTRODUCTION:-----------------------------------------
3.4.2 FORCES:--------------------------------------------------
3.4.3 FORMAL SIGNIFICANCE:------------------------------
3.4.4 MATERIALS:---------------------------------------------
3.4.5 FUNCTIONAL EFFICIENCY:---------------------------
3.4.6 MERITS:--------------------------------------------------
3.4.7 DEMERITS:----------------------------------------------
3.5.0 PROTESTANT HOSPITAL, HARLINGEN:------------
3.5.1 INTRODUCTION:---------------------------------------
3.5.2 FORCES:------------------------------------------------
3.5.3 FORMAL SIGNIFICANE:------------------------------
3.5.4 MATERIALS:--------------------------------------------
3.5.5 FUNCTIONAL EFFICIENCY:-------------------------
3.5.6 MERITS:------------------------------------------------
3.5.7 DEMERITS:--------------------------------------------
3.6.0 DISTRICT HOSPITAL, GORINCHEM:--------------
3.6.1 INTRODUCTION:--------------------------------------
Page 13
13
3.6.2 FORCES:-----------------------------------------------
3.6.3 FORMAL SIGNIFICANE:-----------------------------
3.6.4 MATERIALS:-------------------------------------------
3.6.5 FUNCTIONAL EFFICIENCY:-------------------------
3.6.6 MERITS:------------------------------------------------
3.6.7 DEMERITS:--------------------------------------------
PART FOUR - DESIGN PROPOSALS AD OBSTETRICS
AND GYNAECOLOGY SPECIALIST
HOSPITAL, ENUGU
4.1 DEFINITION OF TERMS:-----------------------------
4.2 SOME HOSPITAL EQUIPMENTS AND THEIR
USES:----------------------------------------------------
4.3 OBSTETRICS AND GYNAECOLOGY SPECIALIST
HOSPITAL PLANNING REQUIREMENTS:-----------
4.3.1 THE RECEIVING AND CASUALTY
DEPARTMENT:------------------------------------------
4.3.2 THE OUT-PATIENTS‟ DEPARTMENT:---------------
4.3.3 THE WARD (OR NURSING) UNIT:-------------------
4.3.4 OBSTETRICS (MATERNITY) WARD UNIT:---------
4.3.5 GYNAECOLOGY (STERILITY) WARD UNIT:-------
4.3.6 ISOLATION WARD UNIT:----------------------------
Page 14
14
4.3.7 SPECIAL DEPARTMENT:----------------------------
4.3.8 X-RAY DEPARTMENT:-------------------------------
4.3.9 PATHOLOGICAL LABORATORY:-------------------
4.0 MORTUARY BLOCK:---------------------------------
CHAPTER FIVE - DESIGN CONSIDERATION
5.1 SECURITY:--------------------------------------------
5.2 VENTILATION:----------------------------------------
5.2.1 FORM AND VENTILATION:------------------------
5.2.2 ADVANTAGE OF NATURAL VENTILATION OVER
ARTIFICAL VENTILATION (AIR CONDITIONING):-
5.3 NOISE AND ACOUSTIC:-------------------------------
5.4 LIGHTING:------------------------------------------------
5.4.1 ARTIFICIAL LIGHTING:---------------------------------
5.4.2 DAY LIGHTING:------------------------------------------
5.4.3 INTEGRATION OF ELECTRIC LIGHTING
AND DAY LIGHTING:------------------------------------
5.5 FIRE SAFETY:--------------------------------------------
5.5.1 FIRE COMPARTMENTS:--------------------------------
5.5.2 FIRE SUB-COMPARTMENTS (PATIENTS‟ AREAS):-
5.5.3 HARZARDOUS MATERIALS:---------------------------
5.6 THERMAL INSULATION:--------------------------------
Page 15
15
5.7 ACCESS AND CIRCULATION:--------------------------
5.7.1 FOOTWAYS:-----------------------------------------------
5.7.2 ROADWAYS:-----------------------------------------------
5.7.3 ACCIDENT AND EMERGENCY:------------------------
5.7.4 OPERATING THEATRES:--------------------------------
5.8 DISABLED:------------------------------------------------
5.9 BUILDING MATERIALS:---------------------------------
5.9.1 CHARACTERISTICS:-------------------------------------
5.9.2 DENSITY:--------------------------------------------------
5.9.3 MODULUS OF ELASTICITY, TENSILE AND
IMPRESSIVE STRENGTH:-----------------------------
5.9.4 MOISTURE MOVEMENT:------------------------------
5.9.5 COEFFICIENT OF THERMAL EXPANSIONS:-------
5.9.6 THERMAL CONDUCTIVITY:---------------------------
5.9.7 SOUND INSULATION:----------------------------------
CHAPTER SIX - DESIGN PARAMETERS
6.1 DESIGN PHILOSOPHY:---------------------------------
6.2 DESIGN CONCEPT:-------------------------------------
6.3 IMPLEMENTATION OF THE DESIGN CONCEPT:--
6.3.1 FORM:----------------------------------------------------
6.3.2 BUILDING MATERIALS:-------------------------------
Page 16
16
6.3.3 BUILDING STYLES AND ELEMENTS:---------------
6.3.4 LANDSCPAE:--------------------------------------------
6.3.5 ZONING:--------------------------------------------------
6.4 DESIGN ANALYSIS:-------------------------------------
6.4.1 MEDICAL SERVICES:----------------------------------
6.4.2 MEDICAL SUPPORT SERVICES:---------------------
6.4.3 GENERAL SUPPORT SERVICES:--------------------
6.5 CONCLUSIONS:----------------------------------------
BIBLIOGRAPHY:---------------------------------------
PART ONE
Page 17
17
BACKGROUND INFORMATION
CHAPTER ONE
1.1 INTRODUCTION
This involves introducing the Design Research Report,
which is obstetrics and gynaecology hospital, its architectural
statement, aims and objects, scope, viability, limitations and
research methodology.
Pregnancy is not a disease (pathology) but a physiological
change in a woman.
Considering the rate of mortality amongst women which
could be as a result of the following:
Page 18
18
Inability to afford high cost if delivery and treatment in
hospitals
Ignorance of the dangers of traditional treatment and
drug abuse
Ignorance of the dangers of early pregnancy and
uncontrolled abortion with teenage girls.
Lack of awareness for the need and importance of good
health on the side of some uneducated mothers
(illiterates)
This project has been introduced to solve or reduce all
these and other problems related to women i.e. diseases as
regards to the female reproductive system, pregnancy, child
delivery and training on how the mother and child will be
taken care of.
In view of this, a homely and cheerful environment will be
created or designed to achieve recovery at a faster rate.
1.2 DEFINITIONS
Gynaecology: The science with the disease of the female
productive system
Page 19
19
Obstetrics: The science dealing with the care of the
pregnant women during ante-natal, child birth and few
days after child birth.
1.3 AIMS AND OBJECTIVES OF THE PROJECT
The aim of this project is to achieve a cheerful and
homely environment for the comfort and quick recovery of
patients. This is so as to eliminate or reduce mortality rate
amongst women at a low (affordable) cost, so that every family
can benefit from it. The following objectives will be used to
achieve the aim:
o Creating awareness on the dangers of using traditional
medicine for treatment, implications of the dangers of
early and unexpected pregnancy among teenage girls by
incorporating nature and awareness department.
o Achieving a homely and conducive environment by using
elements which appear friendly on the elevations
(aesthetics), good landscaping, and use of ornaments
where necessary, etc., for the psychological relieves of
patients.
Page 20
20
o Selection of a suitable site located in a noiseless,
conducive and accessible area.
o Proper planning and zoning of the required functions on
site
o Provision of facilities within the environment needed for
quick recovery.
1.4 STATEMENT OF ARCHITECTURAL PROBLEM
Virtually, some of the Nigerian Specialist Hospitals lack
some necessary facilities needed for patients‟ quick recovery.
Some Hospital buildings lack aesthetics and functional spaces
because they are converted from residential, commercial, etc,
to hospital. Some are located in an unhealthy environment and
places that are not easily accessible by patients. All these
could affect the psychology of the patient which results to
delay in patient‟s recovery.
Obstetrics and Gynaecology specialist hospital requires
proper planning, design and provision of facilities needed to
achieve a cheerful and homely environment for quick recovery
of patients.
Page 21
21
1.5 SCOPE OF THE PROJECT
The Obstetrics and Gynaecology specialist hospital will
incorporate the following:
Offices for Consulting doctors;
Research Department
Lecture rooms
Intensive care unit (nurseries and incubator)
Maternity
Theatres
X-Ray Department
Laboratory
General wards
Special wards
Motherless babies home
Paediatric unit
Service unit (maintenance, power house, laundry, etc.)
Mortuary and Embalmment unit, etc.
1.6 VIABILITY OF THE PROJECT
This project has been carefully considered, studied and
deemed viable considering the following records.
Page 22
22
1.6.1 MEDICAL RECORDS
Maternal and Perinatal mortality and morbidity
Definition
Maternal Mortality: Death of a woman who is or had been
pregnant in the previous 42 days from causes related to
aggravated by pregnancy and its management. Examples are;
Haemorrhage
Sepsis
Abortion
Obstructed labour
Caesarean section
Sickle cell disease
Diabetis mellitus
Anaemia, etc.
Measurement of Maternal mortality:
Total number of deaths in the yearx100,000 Total number of births in a year
Because of the difficulty in accounting for all the births,
many studies use life birth. The value is written as:
x per 100,000 births per year.
Page 23
23
Prevalence of maternal mortality ranges from 10 per
100,000 life birth in the Scandenavian countries to 640 per
100,000 life birth in Africa.
The rate in Nigeria is 800-1500 per 100,000 life births
per year. The rate in Nigeria shows reciprocal variation as
follows:
South west has less mortality rates than South East
South East has less mortality rates than North West
North West has less mortality rates than North East.
It also shows that the group variations are commonest in
poort, rural, illiterate, un-booked women, women who are poor
hospital users, as well as women at the extremes of maternal
age and parity.
Maternal mortality reflects adequacy of obstetric facilities
and its usage. It mirrors the general level of health in a
population.
Prevention:
Integrate maternal health into primary health care and
develop community based maternal health services
Page 24
24
Involve women in community policy making
Encourage formal and informal health education of
women
Expand family planning facilities to prevent unwanted
pregnancies.
Personnel training and retaining of traditional birth
attendance.
Establishment of regional blood bank facilities
Encourage screening and referral of high risk
pregnancies early
Develop and implement a partograph monitoring
system to ensure early referral of women with
dysfunctional labour
Improve the general standard of living of the
population
Improve transportational facilities
Liberalization of the abortion law.
Prenatal Mortality: Death of foetus delivered and weighing
more than 500g or at a gestational age of 28 weeks. This death
Page 25
25
may have occurred in the uterus or within 7 completed days of
delivery. It is a very reliable index of obstetric care.
Measurement of perinatal mortality: Number of deaths in the yearx1000
Total number of births
Reported as x per births per year. Common causes of
perinatal mortality.
Maternal Anemia
Ectampsia
Abruptio placenta etc.
Based on these records, the establishment of an
Obstetrics and Gynaecology Specialist Hospital in Enugu will:
Help in eliminating or reducing mortality rate
amonst women so that procreation can be
encouraged.
Create awareness of related diseases, its prevention
and treatment
Control the rate of population explosion through the
awareness on the need for birth control
Control the rate of child abuse and homeless
children by the provision of motherless babies‟ home
Page 26
26
Improvement on the relationship between mother
and child by the provision of mother craft unit.
Maximum diagnosis and attention given to the
women for quick recovery by the locating specialist
hospital near University of Nigeria Teaching Hospital
(UNTH) Enugu for easy accessibility by Consultant
Doctors working in (UNTH)
Provision of a good site that is homely, noiseless,
cheerful and easily accessible by patients and
others.
1.7 LIMITATIONS OF THE PROJECT
This project i.e. Obstetrics and Gynaecology Hospital has
the following as limitations:
Lack of proper awareness of the diseases, their effect,
prevention and treatment.
Unavailability of enough standard hospitals for local
case studies.
Difficulty in granting permission for case study and
research by the owners of the hospital
Page 27
27
Unavailability of well equipped facilities like Theatres,
Laboratories, etc. for research.
Unavailability of documented materials for study
High level of illiteracy amongst women
1.9 RESEARCH METHODOLOGY
The sources of information for this design research report
shall be the following:
Case studies on existing local and foreign hospitals
Research
Site visit and investigation
Library (documentation)
Page 28
28
PART TWO
LOCATION AND SITE ANALYSIS
Page 29
29
2.1 PROJECT LOCATION
Page 30
30
2.2 HISTORICAL BACKGROUND OF ENUGU STATE
Enugu State derives its name from city called Enugu. The
city owes its existence to the discovery of Coal East of Ngwo
Village in Udi Division in 1909 by the geological exploration
team led by a British Mining Engineer called Mr. Kitson.
Later in 1914, another British Mining Engineer named
W.J. Leck arrived in Enugu from Onitsha, accompanied by
group of labourers led by one Mr. Alfred Inoma. The whites
settled first at Hipp Top while Alfred‟s group settled in Alfred
Camp (the present “Ugwu Alfred). The white later shifted to
what became the European Quarters now Government
Residential Area (G.R.A), especially with the construction of
the Enugu Railways Station in 1915. This became necessary
following the construction of Railway line to link the Enugu
Coal fields with the Coast at Port Harcourt for export
purposes. The African settlers then spread from the Alfred
Camp to „Ogbete‟ also known as Coal Camp.
Page 31
31
These two establishments, Coal industry and the
Railways, offered employment to thousand of people. This
encouraged migration from the hinterland for permanent
settlement in the budding coal city.
With time, Enugu widened in scope and became more
and more accommodating for people from far and near. It
became a veritable and hospitable home for many. Soon,
several surrounding towns and communities grew as satellite
to the sprawing colossus, Enug city, to the extent the natives
of the satellite towns and villages became identified as “people
from Enugu are”. This group name-tag persist till data. This
long time connection has today metamorphosed into a land
area grouping called Enugu State.
Enugu is today aptly referred to as a mother state
headquarters of the present nine states East of the Niger. It
had remained the administrative headquarters of the former
Eastern region, Eastern Nigeria, the defunct-Republic of
Biafra, the East Central State, the Old Anambra State and now
Enugu State, spanning some fifty-three years.
Page 32
32
Enugu State, like other states in Nigeria, has two tiers of
government. The state, and the Local government, which is
seventeen in number.
2.3 CULTURAL BACKGROUND OF ENUGU STATE
Culture is the totality of a people‟s existence. It comprises
devices, which have been invented by a people to adjust to
their physical and social environments.
The people of Enugu State are ethnically Igbos and are
widely known to be very resourceful and hardworking. Skilled
man-power resources are therefore readily available in almost
every field, business, management, commerce and industry.
They are friendly and sociable. They also show great respect to
visitors and those who come to lie and work among them. The
vernacular spoken is Igbo but English is widely used and a
visitor can make himself understood even in the humble
hamlet if he can speak a modicum of English.
Enugu state can conveniently be divided into two cultural
zones based on linguistic and choreographic pattern. These are
Enugu and Nsukka zones. This division however is not so rigid
as there are many cultural features common to almost all
Page 33
33
parts of the state. These cultural features are the language; the
family; the belief system and the local political organization.
The family is one common factor discernible in Enugu
State. It is the basic social unit and exerts preponderant
influence on members. It is consulted by members before any
major decision is taken and it forms the bedrock of the
individual‟s defense, respect and the maintenance of the good
image of the family forms the cornerstone of socialization
among the people of the state.
2.4 ENVIRONMENTAL CONDITIONS OF ENUGU STATE
Enugu State is influence by some environmental factors
like the following:
CLIMATE: Enugu is situated at the Eastern slope of
the undulating hills generally known as Udi hills.
Located in the tropical rain forest region of West Africa,
the city enjoys a comparatively equable climate with
temperature ranging between 22.4OC and 30.8OC.
Two major seasons dominate the area, namely, the
dry and wet season. The dry season lasts between
November and April of the following year. Hottest months
Page 34
34
(February to April) average about 30.5OC (87OF). The days
are hot and humid. Economic activities may extend up to
three hours into the night. However, a short spell of
harmattan sub-season occurring around
January/February interrupt the high humidity and
brings with it very chilly and dry winds from the Sahara
desert. The resultant effect is a dusty environment.
Rainy season lasts between April and October. The
heaviest rains fall between June and July. The annual
rainfall is between 152 and 203cm in the absence of rain
the weather is clear and cool. However, high humidity
may prevail.
GEOGRAPHY: Enugu state is one of the thirty-six
states of the country. The state came into being on
August 27, 1991, with the creation of more states by
the General Ibrahim Babangida administration.
Situated on much of the highlands of the Awgu-
Udi-Nsukka hills and the rolling lowland of Oji River
basin to the west, the state is bounded by other states
with which it shares common boundaries. It spread
southwards to the borders with Abia and Imo states
Page 35
35
and northwards to the Benue and Kogi states‟ border.
In the East and West, it is flanked by Ebonyi and
Anambra states respectively. The undulating hills of
Udi with their green vegetation of tropical forests to the
rocky promontories of Awgu and the beauty that
titillates the traveller‟s emotions.
It has rich and vast agricultural and mineral
resources and estimated population of about 2273,
560 living in an area of approximately 8727 kilometres
of land.
Apart from chain of low hills, running through Abakaliki
in the East to Nsukka in the West and then Southwards
through Enugu and Awgu, the rest of the state is made up of
low land criss-crossed by numerous steams and rivulets of
which the major ones are the Adada and Oji Rivers.
Enugu state has an altitude of about 232.6 metres
(762ft) above sea level.
Page 36
36
2.5 REASONS FOR CHOOSING ENUGU STATE
The reasons for choosing Enugu state as the project
location are as follows:
POLITICAL STRATEGY: The provision of medical
facilities in Enugu ranks second to education in order
of priority of the state government and takes a large
chunk of the annual budget. The state government is
making serious effort to ensure that hospitals and
health centres, as well as maternity homes are
provided in all the Local Government Areas of the
state.
AVALIABILITY OF A TEACHING HOSPITAL IN
ENUGU (UNTH): This project is Obstetrics and
Gynaecology specialist hospital and therefore needs
specialist Doctors, ther is a need to site the project
near a teaching hospital. This is so that the specialist
consultants can, from the University teaching hospital
Enugu, drive down to the project location, which is not
Page 37
37
far from the teaching hospital and attend to their
patients when the need arises.
GEOGRAPHICAL LOCATION ON ENUGU STATE: This
state is bounded by other states with which it shares
common boundaries. It spreads Southwards to the
bordes with Abia and Imo states and Northwards to
the Benue and Kogi states‟ border. In the East and
West, it is flanked by Ebonyi and Anambra states
respectively. This means that Enugu state is centrally
located.
It is then possible for patients from any of the
mentioned states or other states pt access the
hospital in Enugu state without much stress.
COMMUNICATION SYSTEM IN ENUGU STATE:
Enugu state has good or well-developed
communication syste. The communication system are:
A well-developed network of roads connecting
important centres and places in the state. Although
some of the roads need reconstruction. There are
main trunck roads linking Enugu to some states.
Page 38
38
These are:
o Enugu to Markudi in Benue state
o Enugu to Port Harcourt in Rives state through
Abia and Imo states
o Enugu to Onitsha in Anambra state.
2.6 SITE FOR OBSTETRICS AND GYNAECOLOGY
SPECIALIST HOSPITAL, ENUGU.
The site for the project is the trade fair layout, Phas 1.
This is accessed off Onitsha Express Road, near New Market,
Enugu. It is in Enugu North Local Government Area, Enugu
State.
The site has a plain typography with a gentle slope which
is negligible. Drainage of water on it is not a problem.
It has trees and grasses on it and it is surrounded by an
empty land, which also has trees and grasses and residential
buildings which their construction is still in progress.
The site is irregular in shape. It has two access roads:
One road in front and the other road by one of the sides.
The government has originally allocated it in the layout
plan as a hospital. It is a new developing area being handled
Page 39
39
by the Enugu State Government. Owing to the residential
buildings beside it, the site is a noisy area and so needs good
landscaping to reduce the effect of noise in the site.
2.7 REMEDIES AND ARCHITECTURAL CONCLUSION
Owing to the nature of the slope of the site, the drainage
of water on the site will be channeled in the direction of the
gentle slope, which directs the water into Awuru stream which
is near the site.
The site will be landscaped with trees, shrubs and also
the Obstetrics and Gynaecology hospital far from the main
access so as to reduce the effects of noise, which could be
detrimental to patients‟ health on the site.
Zoning of the different activities will also be used in
achieving the best result and also orientation of the buildings
on the site to reduce the harsh effect of wind, solar radiation,
glare, moisture, heat, etc. on the structures and users.
Page 40
40
PART THREE
CASE STUDY
CHAPTER THREE
3.1 INTRODUCTION
Page 41
41
In this design research report, local and foreign case
studies are used. These case studies share the same topic
„hospital‟ but they are approached from different angles. These
case studies used are as follows:
University of Nigeria Teaching Hospital (UNTH) Enugu,
Nigeria.
National Hospital, Abuja, Nigeria
Maiduguri Teaching Hospital, Nigeria
Protestant Hospital, Harlingen
District Hospital, Gorinchem
In analyzing these case studies, certain parameters are
used.
They are:
Forces
Formal significance
Materials
Functional efficiency
Merits
Demerits
Forces: In Architecture, they are regarded as forces, which act
on a building. These include site, location, programme
Page 42
42
(activities it is accommodating). Site includes natural and
man-made conditions present within and around the site,
access, topography and views from site, etc.
Form Significance: This refers to the physical form of the
building and its relationship to Architecture of the place and
other factors, which may in one way or the other affect it.
Materials: This refers to the materials used in construction
and their meanings. These include strength, durability, weight,
lightness, etc.
Functional Efficiency: This refers to basic requirements of
the function and how the building is meeting up with the basic
requirements.
3.2 UNIVERSITY OF NIGERIA TEACHING HOSPITAL,
ENUGU
3.2.1 INTRODUCTION
University of Nigeria Teaching Hospital, Enugu was
founded in 1971. The bulk of its activities is rendered
Page 43
43
currently at its temporary site. Its permanent site is located at
Ituku-Ozalla which is at the outskirts of the city.
3.2.2 FORCES
University of Nigeria Teaching Hospital, Enugu is located
at the beginning of Agbani Road. Ogete Main Market, the
Central Police Station, Enugu Prisions, part of Coal camp and
G.R.A bound it.
The state has both natural features like tree, sullies,
green lawn and man made features like the building and paved
roads. Around the site are Pharmaceutical shops, residential
houses, hills etc. It is easy to access from any part of the town
and it has goods roads. It has varying colour readings at
different points.
The site has one major access route and so many others
into the following areas:
Administration office
Casualty unit
School of nursing
Medical students hostel
Mortuary, etc.
Page 44
44
3.2.3 FORMAL SIGNIFICANCE
Rectangular buildings of various storey heights dominate
the site.
3.2.4 MATERIALS
Materials used are long span aluminum roofing sheets,
Emenite roofing sheets, etc. on roofs, concrete on walls,
reinforced concrete columns, etc.
The whole structures look simple and are quite
functional.
3.2.5 FUNCTIONAL EFFICIENCY
The hospital has 700 beds as well as 33 costs in the new
born unit and a total of 24 wards. The beds in the Obstetrics
and Gynaecology units are as follows:
Antenatal - 12 beds
Isolation ward (antenatal) - 11 beds
Post natal - 48 beds
Labour ward - 10 beds
Gynaecology ward - 28 beds
Page 45
45
This implies that Obstetrics was has 81 beds and
Gynaecology ward has 28 beds, thereby making it 109 beds in
Obstetrics and Gynaecology unit.
The hospital offers a wide range of medial services to
patients resident in the town as well as to patients who have
been referred from other hospitals or health centre within and
outside the state.
On the average, about 76,000 patients are attended to by
the hospital yearly.
3.2.6 MERITS
The location of the hospital at the core of the city makes
it quite accessible by all.
Because it is a teaching hospital and has some special
departments, it handles referral cases from all parts of
the country.
There is no conflict in circulation because of the zoning
It is properly zones department by department thereby
eliminating the problem of identification of the various
departments
Natural ventilations mainly ventilate buildings
Page 46
46
3.2.7 DEMERITS
Because it is not well planned and designed, the erection
of the location and erection of structures are not
coordinated or organized.
It has more patients than it can handle because the
facilities provided are not sufficient for both the staff and
patients
So many entrance and exit routes give rise to insecurity
Improper location of the powerhouse beside the energy
3.3.0 NATIONAL HOSPITAL, ABUJA
3.3.1 INTRODUCTION
This hospital was officially opened in September, 1999. It
was formally known as FSP National Women and
Children Hospital, Abuja and was commissioned by Mrs.
Mariam Babangida, wife of one time Head of State,
Commander-in-chief of the Armed Forces, General
Ibrahim Babangida. The name was changed to National
Hospital, Abuja in the year 2000. The hospital project
Page 47
47
was completed by the Civilian regime and the
construction finally executed by Julius Berger
Construction Company, Ltd.
3.3.2 FORCES
The site is at Plot 132 Central District (Phas II), Garki-
Abuja. It has some natural features like green lawn, shrubs,
trees and flower and some man made features like building,
paved roads and walkways, etc. within the site. Some other
buildings and trees sound the site.
The site has one major entrance and exit accessed
respectively. The topography is a gentle slope which slopes
from the access routes down the site.
3.3.3 FORMAL SIGNIFICANCE
The site has buildings that have different geometric
shapes like: rectangles and polygons. Rectangles are less
expensive forms to construct when compared with other
geometric forms, examples, circles, etc.
Page 48
48
The vertical columns used indicate strength. The
polygons indicate balance or stability and are used in the
hospital to introduce country-yards.
The rectangular form and the arrangement of the
different units in a clustered but organized way depict the
culture of the area.
3.3.4 MATERIALS
The materials used are: Long span Aluminum Roofing
sheets on the roof (light-weight), Concrete on walls and
reinforced concrete columns, (strength and durability), facing
bricks (aesthetics), concrete and ceramics tiles for floor
finishes, etc.
3.3.5 FUNCTIONAL EFFICIENCY
The hospital has 200 beds and was initially designed as a
referral hospital. It has about 140-150 beds occupancy weekly.
The rectangular form and arrangement of different units in a
clustered but organized way depict the culture of the area.
3.3.6 MERITS
Page 49
49
The hospital is well designed and its functions zoned into
different units for easy circulation and identification.
The hospital environment is quite homely and conducive
for patients fast recovery because of the landscaping,
massing of the element in the buildings, materials used
for construction and finishes, and the forms.
The location of the hospital site is quite accessible and
has good road network
The forms used are simple and economically cheap to
construct
The roof used over the buildings reduces the seriousness
of the environment thereby giving it a homely and
cheerful touch.
Road network within the site is constructed in such a
way to control drainage of water in the direction of the
slope
Two major access routes, which serve as entrance and
exit routes respectively for all activities so as to enhance
maximum security on site.
Page 50
50
In the maternity unit, the wards (both single and general
wards) labour rooms and theaters are located within the
same area for maximum efficiency
Courtyard is used to introduce relaxation/leisure garden,
easy circulation, cross ventilation into the various rooms
and good view.
The site has area marked for future expansion
Maintenance and powerhouse located away from the
main activities to reduce noise impact on the activities
and buffered with catering department and stores.
3.3.7 DEMERITS
The conversion of the hospital from FSP (Family Support
Programme) National Women and Children Hospital
(which made it a referral or specialist hospital) to
National Hospital (General hospital) affected the efficiency
of the hospital.
The hospital is now under staffed and does not have
enough facilities to accommodate her patients
Page 51
51
This could now result to regular maintenance (which is
not cost effective) and fast dilapidation rate if the rate at
which it is used is not controlled or the hospital
expanded to accommodate more patients.
3.4.0 MAIDUGURI TEACHING HOSPITAL, NIGERIA
3.4.1 INTRODUCTION
Maiduguri teaching hospital is located in the north east
of Nigeria, a hot dry region bordering on the Sahara. It is a
Moslem area. It was designed by Architect John R. Harris.
3.4.2 FORCES
The site has one major entrance and exit routes,
respectively. It has both natural features like trees, green lawn
and man made feature like building, paved roads, etc.
3.4.3 FORMAL SIGNIFICANCE
The hospital form is got as a result of interplay or
intersection of rectangular forms of different sizes. These
Page 52
52
intersections gave rise to courtyards, which does not only serve
as a recreation area but also as a means for ventilation and
lighting within the interiors of the hospital.
3.4.4 MATERIALS
Long span roofing materials are used on the roof. It has
flat roofs with some sections of the roof covered with parapet.
Concrete is used on the walls.
3.4.5 FUNCTIONAL EFFICIENCY
The hospital has 517 beds. Men and women‟s wards are
at opposite ends of the two-storey spine. A possible future
extension to the south could provide further 256 beds. Wards
are naturally ventilated, theatres and ITU fully air conditioned
with local window mounted units and some rooms such as
clean and dirty utilities are mechanically ventilated.
3.4.6 MERITS
Wards in the hospital are naturally ventilated because of
the use of courtyard system
Page 53
53
The hospital has different block sizes which are different
units zoned to achieve maximum efficiency
There is no conflict in circulation
Noise generated in the maintenance and engineering
departments are controlled by zoning them away from the
main building.
3.4.7 DEMERITS
Distance between the women and men‟s wards may
result to lack of coordination
Flat roof used which is as a result of the climatic
condition of the region. This, effect the aesthetics of the
hospital.
The form used creates long corridors for circulation.
So many circulation spaces are involved and it is
expensive to construct and maintain
Some areas are ventilated by artificial ventilation (air
condition)
3.5.0 PROTESTANT HOSPITAL, HARLINGEN
3.5.1 INTRODUCTION
Page 54
54
Protestant hospital, as the name implies is a hospital
established by protestant in Harlingen. It is a modern hospital
designed by H. Hoekstra and G. Westerhout, the Hague and
has 120 beds capacity.
3.5.2 FORCES
The site has an irregular shape and has both natural
features like green lawn, shrub, etc and man made features
like the buildings and paved driveways. Around the site are
other natural and man-made features like buildings and tress.
It also has one main entrance and exit access.
3.5.3 FORMAL SIGNIFICANCE
The hospital complex form is interplay of rectangular
forms of different sizes. It also has a curve (arc) on the main
entrance of the building, which actually defines it. The
combination of the different forms brings out its simplicity.
3.5.4 MATERIALS
Some of the materials used are concrete on walls and
reinforced concrete columns especially on the entrance and
Page 55
55
few in some internal spaces. So many openings are used in the
complex to achieve vision, lighting and cross ventilation.
3.5.5. FUNCTIONAL EFFICIENCY
The hospital complex has three major sections. They are:
Main building
Nurses‟ wing
Boiler house
It also has different corridor widths for various spaces.
They are as follows:
Wards - 1.25m
Treatment wing - 2.25m
Kitchen - 3.07-2.53-1.61
Out-patients department - 2.50
Nurses‟ quarters - 1.50
Bed capacity for different departments and their positions
in the complex:
Department Floor Number of beds
Internal disease Ground 34
Surgical 1st 34
Page 56
56
Obstetrics and Gynaecology 2nd 2
Children‟s 2nd 29
TOTAL 120
3.5.6 MERITS
The major activities is the located within the same area
there making the complex a unit block
The major entrance into the building is defined with a
contrasting form
Because of the unified nature of the design, the site has
spaces for future expansion and other ventilation, view
and lighting in the interiors of the complex
One major access used to achieve security on site
Nurses‟ wing located close to the main building for easy
access and coordination for nurses when thy are on duty
Boiler house located away from the main building so that
noise generated in it would not affect the activities in the
main building.
All theatres are located on the first floor for easy
plumbing and servicing.
Page 57
57
3.5.8 DEMERITS
There tends to be conflict of activities and difficulties with
identification of departments since all are zoned in the same
block
Noise generated within the main building could affect the
activities because of the conflict in zoning the functions
The zoning of the functions could result also to conflict in
circulation.
Long and uninteresting corridors are created because of the
forms used and the pattern in the zoning of the functions.
There is no surgery theatre on the 2nd floor for emergency
cases during delivery where the delivery rooms and
maternity departments are located.
3.6.0 DISTRICT HOSPITAL, GORINCHEM
3.6.1 INTRODUCTION
District hospital is situated in Gorinchem. It is a modern
hospital designed by B.J.K Cramer, Rotterdam and has 236
beds capacity.
3.6.2 FORCES
Page 58
58
The site is irregular in shape and has natural features
like green lawn, trees, shrubs and man-made features like
building, paved roads, etc. It has a major entrance known as
„main entrance‟ and other minor access routes in the site.
3.6.3 FORMAL SIGNIFICANCE
The hospital complex is interplay of rectangular form of
different sizes. This makes it simple and defined.
3.6.4 MATERIALS
Some of the materials used are concrete on walls and
reinforced concrete columns (rectangular and circular
columns) especially in the internal spaces. „U‟ and spiral or
circular staircases are used.
3.6.5 FUNCTIONAL EFFICIENCY
The hospital complex has two major sections. The
sections are as follows:
Hospital
Nurses‟ home
It also has different corridor widths for various spaces.
The spaces are as follows:
Page 59
59
Wars - 2.15m
Treatment building - 2.40
Nurses home - 1.58m
Bed capacity for different departments and their positions
in the hospital building:
Department Floor Number of
beds
Internal disease department 1st 60
Surgical department 2nd 58
Obstetric and Gynaecology 3rd 13
Psychology and Neurology ground 9
Children‟s department ground 45
Private patients department 3rd 38
Other departments ground 13
TOTAL 236
3.6.6 MERITS
The main hospital building is located separately from the
nurses‟ home therefore making the activities defined.
Page 60
60
The site has more than one access route, which reduces the
level of security on site.
The rectangular form used gives the hospital building a
defined and simple shape
All surgery departments are located on the 2nd floor for easy
plumbing and servicing.
3.6.8 DEMERITS
Technical department, which includes powerhouse, etc. is
located within the main hospital building and the noise
generated there could disturb othe activities in the hospital
The form of the building hinder cross ventilation in some of
the functions
Various departments are grouped and located on different
floors for easy coordination thereby reducing conflict.
Uninteresting long corridors are created by the interplay of
the forms
There is no surgical theater on the 3rd floor where the
maternity department is located, for emergency purposes.
Page 61
61
PART FOUR
DESIGN PROPOSALS FOR OBSTETRICS
AND GYNAECOLOGY SPECIALIST HOSPITAL,
ENUGU.
Page 62
62
CHAPTER FOUR
DESIGN CRITERIA
4.1 DEFINITION OF TERMS
Obstetrics: The science that deals with the care of the
pregnant woman during antenatal, parturient (pertaining to
child birth) and Puerperal psychosis (a mental illness
occurring in the puerperium implying four-day blues‟ and
postnatal depression) Puerperal sepsis (Infection of the
genital tract occurring with 21 days of abortion or child
birth
Gynaecology: The science dealing with the disease of the
female reproductive system.
Casualty Department/ward: Also known as emergency
room. This is the part of a hospital where people have been
hurt in accidents are taken for urgent treatment.
Outpatient: A person visiting a hospital for treatment but
not staying overnight
Operating theatre: A room in a hospital used for
operations. While operation is a surgical procedure upon a
part of the body
Page 63
63
Pathology: The science, which deals with the cause and
nature of disease.
Laboratory: A room or building used for scientific research,
experiment, testing, etc.
X-Ray: This is a type of radiation that can penetrate solid
objects and make it possible to see into or through them. X-
rays are commonly used by Doctors to examine bones and
organs inside the body and also in treatment.
Incubator: An enclosed cradle kept at appropriate
temperature in in which premature or delicate babies can be
reared.
Nursery: A room for young children
Consulting room: A room where a Doctor talks to and
examines patients
Sterilization: Treatment, which achieves the killing or
removal of all types if micro organisms including spores. It
is accompanied by using heat, radiation, chemicals or
filtration
Recovery room: The room in a hospital where patients are
kept immediately after an operation.
Anaesthetic: A drug, which produces anesthesia
Page 64
64
General Anaesthetic: Drugs, which produces general
anaesthetic by inhalation or injection
Local Anaesthesia: Drugs, which when injected into
the tissue or applied topically cause local insensibility
to pain. This also applies to spinal anaesthetic
Anaesthesia: Loss of sensation.
Dispensary/Pharmacy: A shop or part of a shop where
medicines and drugs are sold. It is a place in the hospital,
where medicines are prepared
Diagnosis: The art or act of distinguishing one disease from
another.
Rdiography: The use of x-radiation to:
Create images of the body from which medical
diagnosis can be made.
Treat a person suffering from a (malignant) disease,
according to a medically prescribed regime (therapeutic
radiography)
Radiographer: A person qualified in the techniques of
diagnosis or therapeutic radiography
Page 91
91
Radiologist: A medial specialist in Diagnosis by using X-
rays and other allied imaging techniques.
Histology: Microscopic study of diseases.
Morbidity: The state of being diseased
Mortuary: A room or building e.g. part of a hospital in
which dead bodies are kept before being buried or cremated
4.2 SOME HOSPITAL EQUIPMENTS AND THEIR USES
Medicine trolley (cart): A cart on wheels that can be pushed
or pulled along and used for moving drugs/medicine.
Bedside Locker: A loackable cupboard beside a patient‟s bed
where things owned by the patient can be stored securely
Children‟s Cot: A bed for young, usually with sides to
prevent the children falling out.
Incubator: An enclosed cradle kept at appropriate
temperature in which premature or delicate babies can be
reared.
Suction unit: Used in removing air from a space, container,
etc. so that something else can be drawn into it.
Page 92
92
Cyclotron: An apparatus in which radioactive isotopes can
be repaired.
Operating microscope: An illuminated binocular
microscope enabling surgery to be carried out on delicate
tissues such as nerves and blood vessels. Some models
incorporate a beam splitter and a second set of eye pieces to
enable a second person to view the operation site.
Anaesthetic machine: A machine used during surgery to
cause anaesthesia
Autoclave: An apparatus for high-pressure steam
sterilization
Operation table: A patient uses this or patient lies on it
during an operation.
4.3 OBSTETRICS AND GYNAECOLOGY SPECIALIST
HOSPITAL PLANNING REQUIREMENTS
4.3.1 The receiving and casualty department:
During design of the Obstetrics and Gynaecology
specialist hospital, Enugu, this department will be functionally
related to the hospital and the out-patients‟ department.
Page 96
96
A patient (other than a paying patient or a patient sent in
by an outside doctor) is required in most hospitals, on entering
the hospital for the first time, to enter through the casualty
department. Whether he arrives by ambulance, wheel chair or
on foot, regardless of his ailment, he is received here.
Exactly where the patient is sent after the resident
medical officer has examined him depends, naturally, upon the
medical findings. The patient may be:
Admitted to the observation ward unit in the casualty
department.
Operated upon immediately, either in the theater in
the casualty department or in the out-patient‟s
department.
Admitted to the in-wards (and perhaps upon in the
major operation theatre suit).
Sent to the out-patient‟s department (to become an
out-patient)
Given first aid and sent home, possibly being
requested to return next day (He might then become
an out-patient and not return to the casualty
department).
Page 97
97
The major functions in this department are:
Surgical casualties
Casualty administration
Medical casualties
Casualty observation ward unit
4.3.2 THE OUT-PATIENT’S DEPARTMENT
This department performs two main functions:
To keep patients out of bed by diagnosis of ailment and
effecting a cure at an early stage.
Follow-up treatment after discharge from the hospital
wards.
It is essential that this department, be self-sufficient for
diagnosis work and the accommodation must be cramped.
Some of the major functions in this department are:
Administration
Dispensary
Medical clinic
Surgical clinic
Ante-and post-natal clinic
Page 98
98
Gynaecology clinic
Paediatric clinic
Mass radiography unit
4.3.3 THE WARD OR ( NURSING) UNIT
This is the most important element of any hospital. A
patient admitted to the wards either from the casualty
department, the out-patients‟ department or by arrangement
with the patient‟s outside doctor. The prime services however,
of an average sized acute specialist hospital are considered to
be:
General surgery
Genera; medicine
Obstetrics (maternity)
Gynaecology
The majority of beds will, therefore, be for these cases.
When commencing the plan of ward unit, it is important to
ascertain, at the onset, its size, which will be governed by the
following factors:
Page 99
99
The ailments of the patients, as some patients require
constant nursing whilst others make very few demands upon
the Nursing staff.
The maximum number of these patients that can be
properly supervised by the Ward Sister with her „Nursing
team‟.
The cost and capacity of the fittings installed in the unit.
Some fittings are costly and are adequate to cater for many
more patients than may be in the unit.
It must be remembered that many auxiliary rooms go to
the making of the ward unit and these are virtually the same
in number, not a proportional increase in cost per bed.
It will be appreciated that a hospital for 120 beds can be
designed, for example, in wither four units of beds each or in
five units of 24 beds each. The latter will, of necessity, prove
more costly, both in building and maintenance costs, including
staff, salaries etc. but, on the other hand, will permit of a more
personal services to the patients.
Each ward unit should be self-contained and free from
main traffic through it.
Page 100
100
Major wards are used in the design of the Obstetrics and
Gynaecology specialist hospital, Enugu. The wards are:
4.3.4 Obstetric (Maternity) ward unit:
This department caters for short-stay‟ patients, the
average length time spent here by mothers being twelve days,
two days of which she is ambulant.
The accommodation may be provided on one or more
floors but the septic section may be on the ground floor
approached by its own separate external entrance.
Twenty mothers, each with one baby, represents forty
persons requiring Nursing, so considering this, twenty beds
may well be regarded as a maximum for one sister (Nurse).
The Obstetric Unit will require sectionalized
accommodation for:
Reception of patients
Ante-natal patients: This constitute women who are between
2-10, 8½ months pregnant, whose pregnancy may not be
taking a normal course or is affecting other organs in the
body, (i.e. Kidneys, etc.).
Page 101
101
Delivery-theatre suite
General maternity patients
Mother craft unit: This is where during the last few days in
hospital the mothers live with, and wholly care for, their
babies under supervision before returning home. This unit
caters particularly for mothers with first babies. Not more
than 8 patients should be accommodated in any one
bedroom provided the ward unit has a large proportion of
single rooms.
4.3.5 GYNAECOLOGY (STERILITY) WARDS UNIT:
This unit can, with advantage be planned on upper
floors. There is a slightly rapid bed turnover in this ward unit.
8 beds should be considered a maximum in anyone sickroom.
Occasionally, a patient, when admitted, is found to be
suffering from an infectious disease and must be confined to
the single sickroom. To safeguard the spread of infection, a
small separate sluice room will be provided.
Page 102
102
4.3.6 ISOLATION WARD UNIT
This unit is perhaps best planned as a separate building
within the grounds of the hospital. If this is possible, it should
be situated in an isolated position and shut off from the main
hospital circulation by a well-ventilated lobby. All patients will
be accommodated in single sickrooms and perhaps suffering
from different ailments, the demands upon the Nursing staff
will be heavy. For this reason, the ward unit should be
restricted to 16-20 beds. All beds to be accommodated in
single sickrooms.
4.3.7 SPECIAL DEPARTMENTS
Operating theatre suit: Hospitals, varying from those of
100 beds and less to 800 beds and over, will all present
different operating theatre requirements but as a
preliminary guide ratio of one theatre to each fifty beds may
be adopted for sketch plan purposes. Another factor
governing the number of theatres will be the type of
hospital. An acute general hospital having a rapid bed
turnover will require more facilities than an hospital having
a rapid bed patients‟ length of stay varies between three and
Page 103
103
twelve months. The number of operations that can be
performed in one day cannot easily be assessed as
operations vary from a few minutes to a few hours.
Where several suites are required, it appears at first
glance, that it would be advantageous to construct a theatre
wing, with
Suites planned one above the other, thereby bringing into
play all the advantages of vertical planning for efficiency and
economy in services, (water, gas, electricity, anaesthesia, etc.)
With desirability to form the ward unit, not as a ward, but as a
series of sickrooms; the general ceiling heights of the hospital
will be approximately 3000mm in the clear, whereas operating
theatres will require heights varying between 3600mm and
4500mm. It becomes apparent therefore that an attempt at
vertical planning (or stacking) of theaters will lead to
intolerable differences in floor levels throughout. The top floor
will probably prove the best situation to plan the theatres
where several suites are required. It is essential that the
theatre suit or suites be planned as self-contained units,
through-traffic along the corridor. Although operating today is
performed almost invariably under artificial light (with theatres
Page 104
104
having a full air-conditioning ventilation system whereby the
windows remained closed), it is best to plan the suit (s) to
reduce heat and glare.
In addition to these things,
Two separate entrances to the theatre are essential, one
from the anaesthesia room and the other (to constitute a
patients‟ exit) from the general circulation corridor.
Direct access is required from the theatre to the
sterilizing room, dirty waste-up room and surgeons and
Nurses‟ scrub-up rooms (or recesses).
Natural daylight and ventilation is necessary, the former
during theatre-cleaning activities and the latter in the event of
a breakdown in the ventilating plant.
4.3.8 X-RAY DEPARTMENT
X-rays are used for two main purposes and the work of
this department is therefore divided into two distinct sections:
Page 105
105
Section 1: Diagnosis (referred to as Radiography)
Section: Treatment (referred to as Radio-Therapy)
Page 106
106
There are also two major principles involved in
radiography, which may be briefly expressed as follows:
Principle 1: Radiography which is the exposing of X-ray
film to obtain a permanent record, referred to as the X-ray
plate or radiograph. The radiography carried out the taking of
the radiograph whilst the Radiologist undertakes the reading
or interpreting of it.
Principle 2: Fluoroscopy, which is the direct viewing and
observation of the workings of a person‟s internal organs,
which has been made possible by X-rays. The Radiologist
and/or the Doctor in charge of the case undertake this viewing
in the main.
It can be too strongly emphasized that when planning the
X-ray department, the manufacturers of X-ray equipment
should be consulted at the very outset.
4.3.9 PATHOLOGICAL LABORATORIES
Pathology is defined as that part of medicine, which
explains the nature of diseases, their causes and symptoms.
Page 107
107
The laboratory suit is best planned in a central position
under the same roof as the hospital and not as a separate
building in the grounds.
The work undertaking in hospital laboratories embraces:
Morbid anatomy and histology
Clinical pathology
Chemical pathology
4.4.0 MORTUARY BLOCK
Every hospital, regardless of its size, will require
mortuary block. The size of this block will naturally depend
upon the bed holding and type of hospital.
The block may be planned either:
Within the building
Separate building within the hospital grounds
It is important that whatever the accommodation is
situated, it should be suitably screened from view of all
patients, Nursing staff and staff houses, etc.. Although
„tucked-away‟ on the site, there must be easy access to fit from
the hospital to permit:
Bodies being transferred from hospital to mortuary
Page 108
108
Doctors going to perform post-mortems, etc.
Other external circulations will be:
Access for relatives
Access for hearses
Other Requirements are:
- Nurses’ Quarters: These have the following:
Bed-sitting rooms, toilets, showers, cloakroom, laundry
facilities, kitchen, canteen, lounge, dining, recreation
area, storage space, etc.
- Motherless Babies Home: This is located within the
hospital site and has the following: Visitors‟ lounge,
reception room, bedrooms for the children, bedroom
for the Nurses in charge, toilets, bathrooms,
kitchen, dining, play ground, classrooms for the
children, laundry, and storage. Etc.
- Lecture and Research Department: This
department is part of the hospital building.
- Conference Rooms: These are also part of the
hospital buildings.
Page 109
109
- Services: These services are made up of some units,
which serve and support the hospital. The various
units are:
Maintenance (for maintaining the buildings within the
hospital site and other elements associated with the
buildings), kitchen, powerhouse, general storage,
laundry, etc.
Page 111
111
CHAPTER FIVE
Page 112
112
5.0 DESIGN CONSIDERATIONS
5.1 SECURITY
External security best served by good lighting and
visibility. Access routes and entrance should never be dark or
concealed and should if possible allow sufficient space to avoid
unwanted encounter.
Avoid dense planting round entrances and ground floor
windows (or use prickly shrubs). All external doors should
therefore be fitted with deadlocks and openable windows if
possible with window locks.
5.2 VENTILATION
There are two types of ventilation: Natural and artificial
ventilation. Artificial ventilation involves the use of fan; air
conditioners to ventilate are enclosed space. Natural
ventilation is the use of natural air to ventilate an enclose
space. This could be achieved by the use of some window types
like casement windows or adjustable shutters. Windows are
placed where ventilations required with sills at desired cooling
height ground shape (topography) and any nearby ponds or
Page 113
113
lakes can be used to improve natural ventilation. On sloping
sites (particularly facing south) breezes move up hill during
day, down at night. Near bodies of water cooling breezes move
from water to land during day, from land to water at nigh.
Orientation of the building on site is another good way of
improving on natural ventilation. Gardens and courtyards can
also be used.
5.2.1 FORM AND VENTILATION
The total form of a hospital building and the relationship
of its different part will be influenced by many factors; one that
is likely to be fundamental is the policy to be adopted for its
ventilation. The form that a naturally ventilated hospital can
take will be affected by the climate, but in tropical countries, it
will be dominated by it. In these locations it is desirable to
plan for the maximum exposure of occupied spaces to the
prevailing wind that is compatible with shading from the sun
and also to separate parallel blocks of building sufficiently
widely not to shelter one another from the breeze.
5.2.2 ADVANTAGE OF NATURAL VENTILATION OVER
ARTIFICIAL VENTILATION (AIR CONDITIONING)
Page 114
114
Natural ventilation: Air movement can have an important
bearing on the incidence of infection, especially if air removed
from an infected area is blown or sucked into another part of
the building through ventilation or duct systems.
Unfortunately, the installation of full air treatment does not
always achieve a reduction of the incidence of outbreaks of
infection. Many hospitals that are dependent for their
ventilation on throwing open windows and doors have less
frequent outbreaks than those with full air conditioning.
In design and construction, natural ventilation will
produce a relatively high ration of external wall to floor area. It
will be likely to increase the cost of the building fabric
although reducing that of its services and running costs.
- Air Conditioning (Artificial ventilation): Air conditioning is
generally recognized as of the highest priority in the
operating theatre suite. Air conditioning in this context
means the ability to control the air temperature both
above and below the ambient temperature and also to
control the humidity, with sterile filtration in addition.
Page 115
115
An artificial environment of „pure‟ air throughout the
building, however well filtered and tempered is no guarantee
against infection.
Air conditioning is expensive and also it is a constant
consumer of energy and extremely demanding servant.
Unnecessary dependence on wholly artificial means of air
control can impose intolerable difficulties when sophisticated
systems breakdown and prompt and efficient maintenance
cannot be relied upon. Total dependence upon it can quickly
render a building uninhabitable in such circumstance.
Whether in a temperate or tropical climate total air
conditioning makes a high ratio of internal spaces to external
wall and permits a compact building form that may thus
reduce the site area that is necessary and will tend to lead to
economy in the cost of the actual fabric of the building but not
to that of its artificial lighting and other services or of its
maintenance.
5.3 NOISE AND ACOUSTICS
Page 116
116
Sound is measure in decibels (Db). Noise is an
unorganized sound, has irregular vibrations and it is an
unpleasant sound. Increase of 10Db gives approximate
doubting in loudness.
High levels of noise can lead to damage to hearing. At
lower levels noise interferes with verbal communication. At still
lower levels may be disturbing or annoying. Acoustic design
controls intrusive noise and by choice of materials,
dimensions, etc.
For many buildings and environmental situations,
equivalent continuous sound level (1eq) expressed in Db (a) is
adequate predictor.
Upper limit of 90dB (A) leq has been suggested for 8-hour
working day.
Interference with speech communication from intrusive
noise depends on distance between talker and listener, and or
whether voice normal or rose. Thick walling porous materials,
panel absorbents cavity resonators, corridor, lobby, etc can be
used to reduce or control noise in buildings. This implies that
surfaces of room partly reflect and absorb sound according to
nature and construction of surface.
Page 117
117
Problem in large open areas; telephones and other
electrical and mechanical equipment can be noise than
acceptable. Design for 40-45 Db by day and 35-40Db at nigh
in multi-bed wards; 1-bed wards should be 35-40 Db at all
times. Planting of trees can be used to reduce external noise.
Orientation of the building zoning, etc. can also be used.
5.4 LIGHTING
Visual performance depends on total perception of space:
involves quality of light as well as total amount. Indices to
cover different aspects of lighting have been developed. They
distinguished between artificial and day lighting.
5.4.1 ARTIFICIAL LIGHTING
Important are quantity of light (luminance) and glare,
also reflectance of surfaces being lit. The tasks and its relative
importance against lighting its background and the whole
reflectance and colour of surfaces affect general brightness and
distribution of light in room.
4.4.2 DAY LIGHTING
Page 118
118
Windows in building have 2 main visual functions: to let
light in during daylight hours and to enable people to see out
or in. They permit entry into a building of solar energy: direct,
by absorption and retardation by reflection from sunlight
surface. Windows are also source of heat loss. As source of
illumination, daylight has many pleasant directional qualities.
When visual tasks might need to be carried out anywhere
in interior building lighting and task lighting may be provided
by same installation.
4.4.3 INTEGRATION OR ELECTRIC LIGHTING AND
DAY-LIGHTING
Even in well day lit room, electric light has to be used
when daylight fades, especially, some afternoons. Electric
lighting should be designed to provide luminance
recommended for particular tasks carried out in interiors, but
not less than 30Lx on average over working plane.
Windows need not be designed to achieve maximum
penetration of daylight; more attention can be paid to any
providing wide uninterrupted windows rather than high and
above or between windows with exterior seen through them by
Page 119
119
maintaining light colour and arranging for some wall washing
by artificial lighting.
5.5 FIRE SAFETY
Most building regulation contains clauses on minimum
allowable distances between adjacent building and type of
construction acceptable to resist fire for given periods of time;
some state distances and conditions for escape routes.
Up to 2 hours needed to evacuate 600 patients from 2-
storey, 4 hours from 11-storey building: Exhausting exercise
for rescuers. All health buildings that contain high proportion
of bedfast, disabled and confused patients should be low rise,
preferably with patients restricted to ground and first floors.
There are now more stringent fire safety measures based on
fire resistant compartments: System makes it possible to move
patients short distances, if necessary in beds, to section sealed
off by fire door from smoke or fire in adjoining section.
Design guidance on size of fire compartment and sub-
compartments, together with maximum acceptable lengths of
escape routes in wards, operating theatres, laboratories, etc.
are indicated.
Page 120
120
5.5.1 FIRE COMPARTMENTS:
The following are the requirements:
1-storey building must not exceed 300m2.
Multi-storey building must not exceed 2000m2.
Horizontal distance to alternative routes must not exceed
64m.
Horizontal distance in single direction to exist must not
exceed 15m
Travel distance within escape stairway must not exceed
45m long going
5.5.2 FIRE SUB-COMPARTMENTS (Patients area)
Floor area must net exceed 750m2
Horizontal distance to alternative routs must not exceed
32m
Horizontal distance in single directional exist must not
exceed 15m
Maximum occupancy; 40 patients
5.5.3 Hazardous Materials
Page 121
121
Some equipment and substances used in examining,
diagnosing and creating patients radioactive, explosive or
highly inflammable. Care is taken to check that where these
substances used design, construction, detailing and service
installations comply with specific statutes and regulations.
5.6 THEMAL INSULATION
Moisture inside buildings arises from such sources as
external air, breath of occupants, cooking, washing, flueless
gab and oil heaters. Warm air can hold more moisture than
cold air.
In terms of comfort, people affected almost as much by
temperature of surface which surround them as by that of air.
It is important to distinguish between ventilation rates,
which affect air quality by diluting contaminants and air
movement, which may affect thermal comfort. If air movement
in room exceeds about 0.2mls high room temperature is
required to provide equivalent comfort. In normal temperature
environment effect of humidity on perceived warmth very
slight, but if people very hot (as during very active work or in
Page 122
122
very warm environment) high humidity will aggravate
discomfort. Air movement over skin will be beneficial.
High standard of thermal comfort requires:
Surrounding surface temperature higher than air
temperature
Air temperature at head lower than at floor level: Low
temperature gradient
Air movement just perceptible but variable and with no
draughts
Humidity not very important except at temperature
above 21oC: should not exceed 70% nor be less than
30% thermal response of building depends on:
Area and orientation of glazing: large areas of glazing
facing sun give quick response.
Reflectivity of external surfaces were exposed to sun.
High reflectivity heat gain from sun and reduces
responses
Mass of building structure and position of thermal
insulation: mass inside insulation gives long response
time; light weight building have short response time
position, size and type of windows and response of the
Page 123
123
building. Also, the positioning of trees around the
building especially ground floor.
5.7 ACCESS AND CIRCULATION
Spaces are required around for access and circulation of
people, prams, wheelchairs, trolleys, etc. Access to building or
groups of building also for private cars, delivery vans, moving
vans, trucks, etc. Space is required for parking, short or long
term. This design will ensure adequate visibility but discourage
vehicle speeds; parking spaces clearly marked provision will be
made for clear zone free from parked cars to allow vehicles and
pedestrians to circulate comfortably.
5.7.1 FOOTWAYS
Shortest routes will be provided between buildings and
services are kept separate from heavy trafficked roads. It will
be wide enough to avoid need for pedestrians when passing to
step out into carriageway or planted areas and where
necessary for occasional access by emergency vehicle. E.g.
ambulances.
Page 124
124
5.7.2 ROADWAYS
Size and Geometric characteristics of vehicles determine
dimensions of roadways, junctions, turning and parking
spaces. Carriageway minimum of 48000mm allows wide car
and service vehicles to pass each other with overall tolerance
of 500mm and allowance made for increase in width of larger
vehicles at bends and allowance made for increase in width of
larger vehicles at bends and for their turning and
maneuvering.
5.7.3 ACCIDENT AND EMERGENCY
This department needs to be on good access roads with
drive-in entrances for ambulances, sheltered from wind and
rain by covered ways and baffle walls. Entrances should have
2 sets of automatic fail-safe doors to prevent draughts, with
enough space to maneuver stretchers and trolleys.
This department will have direct access for patients on
trolleys to all parts of hospital, particularly radiology, plaster
room, surgical and short stay wards.
5.7.4 OPERATING THEATRES
Page 125
125
Crucial to design of high technology operating and
delivery suites, 2 basic types single corridor and double
corridor or „race track‟. Single phase 1 corridor leading to all
operating/delivery room, used for patients, staff and
equipment: Sterility maintained in each user of corridor and
within theatre itself.
„Race track‟ arranges room in „circular‟ fashion with
outside corridor or room for staff and equipment, presume
sterile corridor for patient trolleys 2/45m wide; others 1.5m
wide.
It is an advantage to avoid the routes for visitors being
combined to any great extent with other internal circulation,
for instance, and to arrange that potential traffic past critical
areas such as operating suites is minimized. It is also desirable
that infected and dirty material, which is being removed for
processing or disposal passes along routes which neither cross
those constantly in use by patients and staff nor pass sensitive
clinical areas. The latter includes theatres and surgical wards,
maternity departments, immunity from infection.
Walking distances for Nurses and Ambulant patient
should be as short as possible. Maximum distance from bed to
Page 126
126
toilet should be 12m and from Nurse to working room to
furthest bed approximately 20m.
5.8 DISABLED
Particularly requirements to be considered when
designing for physically disabled are:
Ambulant Disabled
Wheelchair Users
Access is by level or ramp approach, minimum width
1200, maximum slope 1:12 preferably 1.20 gradients greater
than 1:12 need rest areas 1200mm long at 900mm intervals,
those in excess of 1:20 at 18m intervals.
For Ambulant disabled 900 wide enough for entrance
halls and passages. For wheelchair users entrance hall has
minimum width of 1200mm, depth 1800mm, preferably
1200mm throughout. Lobby between 2 set of doors will need
be 1500mmx1500mm clear of obstructions to allow freedom to
maneuver chair.
5.9 BUILDING MATERIALS
Page 127
127
In selecting the building materials for the hospital design,
significant physical characteristic would be taken to
consideration. This helps to access how access how
manufactured products specified and constructions designed
perform in use. Precise values influenced bys such factors as
temperature, moisture content, surface condition, internal
structure. These usually determined by means of standard
rest, which may take into account conditions of use.
5.9.1 CHARACTERISTICS
The following affect the choice and use of building
materials. They are:
5.9.2 Density
This enables mass of material to be calculated
5.9.3 Modulus of elasticity, tensile and impressive
strength
This gives indications of structural performance, modulus
of elasticity indicating stiffness.
5.9.4 Moisture Movement
This is expressed as percentages. Generally, lightweight
and fibrous and some cement-based materials show
Page 128
128
dimenstional changes when wet or dry; such need be
accommodated in design; movement may be reversible or only
happen on first use.
5.9.5 Coefficient of thermal expansions:
Change in temperature may cause materials to expand or
contract; such movement again may need to be
accommodated: express by coefficient.
5.9.6 Thermal conductivity:
Ability of a material to conduct heat.
5.9.7 Sound insulation:
Ability of a material to absorb sound
5.9.8 Some building materials and their thermal
conductivity values:
MATERIALS THERMAL CONDUCTIVITY (k) W/MoC
Brickwork common 0.7
Glass 1.05
Steel 50
Timber 0.15
Page 129
129
Sand cement 0.53
Dense concrete 1.5
CHAPTER SIX
6.0 DESIGN PARAMETERS
6.1 DESIGN PHILOSOPHY
Hospitals are an indispensable part of the provision that
is made for health because there will always be a proportion of
patients who need the particular skills and equipment that can
be concentrated in them and because they are essential
centres for medical and health education and research.
The principle of referral of patients from a lower level of
care to a higher level as a method of sorting them according to
their need for specialist diagnosis or the nature or degree of
their disabilities is universally recognized and also important.
However, Obstetrics and Gynaecology specialist hospital
is proposed for Enugu, so that awareness or pregnancy,
Page 130
130
disease that affect the female productive system. Womanhood,
child abuse, etc and their implications can be created, causes
of these disease diagnosed and treated, further exposure to
such attack of diseases prevented, so s to reduce or control
natality rate amongst women and promote procreation.
6.2 DESIGN CONCEPT
Patients could easily become institutionalized in wrong
environment: accent on self-help and rehabilitation in setting
as like home environment as possible without impairing
quality of nursing care.
Pregnancy is not a disease and mothers-to-be must not
be allowed to look upon it as such: In consequence, Obstetric
and Gynaecology specialist hospital, Enugu will be designed to
give a „homely‟ and cheerful atmosphere.
The most important factors to be taken into account in
the overall plan form of a health centre, whatever its size are
simplicity and clarity in the circulation becoming confused to
both patients and staff, even visitors.
However, it is desirable to combine homely, cheerful
environment and clarity with an atmosphere, which is
comfortable and human in scale.
Page 131
131
All these will encourage fast recovery of patients. Care
should be taken not to keep patients in hospital longer than is
absolutely necessary.
6.3 IMPLEMENTATION OF THE DESIGN CONCEPT
The design of Obstetric and Gynaecology specialist
hospital, Enugu, will reflect the design concept in the following
areas:
6.3.1 Form: This implies the use of traditional form
(rectangle) that is familiar to the people or inhabitant of the
land.
6.3.2 Building Materials: This implies the use of some
locally available building materials, which depict a home
environment in the design. Some of these materials are
concrete, brick, etc.
6.3.3 Building Styles and Elements: This involves the
use of some building styles and elements like pitch roof and
courtyards which depict culture, shading devices where
necessary, casement windows, etc.
Page 132
132
6.3.4 Landscape: Trees, shrubs, stones, etc, will be used
in the external environment to enhance the Anaesthetics of the
whole environment.
3.3.5 Zoning: This implies grouping related
functions/activities and locating them to different units but
well linked to one another with circulation spaces for
intercommunication and clarity.
6.4 DESIGN ANALYSIS
A hospital comprises three categories of accommodation:
Medical Services: These provided diagnosis and
treatment for inpatients and outpatients.
Medical Support Services: This is essential for
sustaining the medical services and closely related to
them functionally.
General Support Services: These are responsible for
general administration, the supply of food, linen and
stores, the energy, piped supplies and mechanical aids.
Each of these three categories is made up of a number of
6.4.1 Medical Services
Page 133
133
Outpatients Clinic
Accident and emergency
Short stay wards associated with accident and emergency
Diagnosis radiology
Radiotherapahy
Operating department
Pathological Laboratories.
These show the principal departments and the various in-
patients wards.
6.4.2 Medical Support Services
Pharmacy
Central Sterile Supply
Medical Library
Central Medical Records
6.4.3 General Support Services
Central Administration
General Supply and Disposal
Linen Supply and Disposal (Including Laundry)
Mortuary
Catering
Page 134
134
Engineering services (including maintenance and
transport)
Staff Quarters
The arrangements of the functions in the hospital in a
linear form demands a lot of space on the site and in a large
hospital may result in travel distances that are unacceptably
extended. It can also be said that, in some forms, this
arrangement encourages the isolation of specialties in separate
units and may create physical and psychological obstacles that
inhibit intercommunication.
The tendency of individual medical discipline to merge
with one another or to become inter-dependent suggests the
need for an integrated planning and patterns, which are
looser. The former moment in history. The looser forms permit
not only ebb and flow difficult and sometimes possible to
anticipate.
This diagram shows the three main categories of
accommodation in hospital and their relationship to one
another.
Page 135
135
The arrows show that the three categories of
accommodation in a hospital are interdependent of one
another, implying that none can exist on its own.
In the design of Obstetric and Gynaecology hospital, the
functions will be planned and designed in such a way that
they will be zoned according to their respective services, still
interdependence on one another and connected with
circulation spaces for intercommunication.
Medical Support Services
General Support Services
Medical Services
Page 136
136
CONCLUSIONS
Hospitals are an indispensable part of the provision that
is made for health because there will always be a proportion of
patients who need the particular skills and equipment that can
be medical and health education and research.
Obstetrics and Gynaecology specialist hospital is a
secondary care of health care system where care is provided by
more specialized services to which people are referred by the
primary care services.
The principle of referral of patients from a lower level of
care to a higher level as a method of sorting them according to
their need for specialist diagnosis or the nature or degree of
their disabilities is universally recognized and accepted.
Hospitals are inevitably a very expensive element in any
health service, for they are costly to build and equip and the
money necessary to staff and run them can be enormous. If a
hospital is to perform its function efficiently in the delivery of
health care it is clinically satisfactory to do so. This is because,
Page 137
137
running costs of a hospital are particularly high if the in-
patients have to stay for a long time then en hospital‟s
expenses are increased and its components, some simple,
some extremely complex, each have time scale which covers
useful design life. Careful planning and design can group
components with similar characteristics grouped together so
as to be adjacent to both those they serve and those with
similar structure and service characteristics to effect good
intercommunication, interdependency of functions and quality
services.
Page 138
138
BIBLIOGRAPHY
Anthony Cox and Philip Groves, Design for Health Care, Butterworth and Co. Ltd., 1981
Boun Centrum, Rotterdam, General Hospitals: Functional Studies on the Main Departments, Elsevier Company, Amsterdam, 1961.
Churchhill Livingstone Pocket Medical Dictionary, Fourteenth Edition, Edinburgh, 1987.
Ernst Neufert, Neufert Architects‟ Data, Alden Press Oxford, London, 1970.
Guy Aldis, Hospital Planning Requirements, Pitman Press, New York, 1954.
Helen Liebeck J., Elaine Pollard, The Oxford English Mini Dictionary, Fourth Edition, Clarendon Press, Oxford, 1997.
N.P. Iloeje, A New Geography of West Africa, Longman Group Limited, London, 1972.
Social Studies 2, Heinemann Educational Books (Nig.) Ltd. And Comparative Education Study and Adaptation Centre, University of Lagos, 1979.
Tourist Guide Map, Enugu and Environs.