MDR TB Clinic

December, 2009

Over 300,000 people in Ethiopia contract Tuberculosis every year.  It is estimated that over 5,000 of these cases are multi-drug resistant, an especially deadly variation of the disease.  TB is an airborne pathogen, infectious as an aerosol, the design of the spaces of treatment are especially significant in reducing the contagiousness of patients.  While all cases of TB are treatable, many cases require lengthy treatment regimes that require long clinic stays.  To adequately treat TB, clinics must be created that can process new patients and care for those in treatment all while providing an atmosphere with constant air changes and generous light.

The clinic is designed to filter patients and staff into a series of courts, each providing a porous space for the stages of the treatment process, from diagnosis to outpatient care.  The courts are formed by a series of parallel bars, stepping up the slope of the site and connected by a system of circulation paths.  While the layout of this clinic is specific to a particular site, the framework may allow for the configuration to be altered to fit different sites and programmatic balances.  Each bar may shrink or grow, and bars or courts may be added to the composition.

The clinic in Gondar sits on a hill adjacent to the city core.  The positioning allows the clinic to participate in the cultural landscape of the city while also being set apart as a retreat for healing.  Public functions are located along the road with increasingly private and health sensitive spaces located further up the hillside.  The primary entrance to the clinic is marked by a planar bar extending through the open building to a plaza, enclosed on three sides and open to the landscape beyond.  From this plaza, users may access the clinic that climes up the slope to the northwest or the cultural museum to the southeast.  The bars are grouped into similar programmatic elements, each grouping forming a small courtyard that has increased circulatory connections.  Between courts, the surrounding landscape is allowed to penetrate though the building composition, further distinguishing the series of programmatic changes and establishing a hierarchy of thresholds between bars and courts.   Circulation paths alternate between connecting bars to form courts and connecting courts to form the overall building composition.  The courts, defined by a pair of bars, are organized on the slope so that each court defines a flat plaza while the land between the courts slopes.  This organization increases the perception of a threshold between courts while allowing a continuous progression between elements.  The sloped landscapes between bars are allowed to grow with the natural vegetation including large trees that temper the area.  This tempered air is drawn into the clinic bars through series of chimneys, creating a constant non-mechanical and tempered ventilated space.  Each chimney structure also captures solar radiation and water to service the needs of the program below.  The bars of the building are composed of a series of regular units, defined by the structural walls and the roof canopy form.  Each unit can be arranged to meet a variety of programmatic needs, from a patient room to a laboratory.

The construction method consists of a series of foundation fins running perpendicular to the slope of the site and mitigating the elevation change.  On this series of fins, a ground slab is poured.  Walls can be poured flat and tilted into place, forming the major vertical structural element of the building.  A roof canopy is erected on top of the walls, creating a system of chimneys where ventilation is required to service the programmatic needs below.  The canopy is erected using a series of temporary supports.  The temporary support poles are places in a regular pattern on the floor but vary in height to create the roof form.  Strips of cementitious fabric are strung between supports such that a triangulated structural surface is formed.  Once the strips of fabric are in place, water is added to harden the structure and bond the strips together.  The temporary poles are removed, and the structure is finished.