For over 60 years, Bethesda Medical Center has provided Haitians with critical services, treating HIV and TB and delivering pre- and post-natal care and family medicine. But in recent years, it has outgrown its campus. That’s when the Bethesda team invited Phoenix, Arizona, design studio August Green to meet with them on the ground to envision a new site — to serve both the city centre of Cap-Haïtien and the rural areas surrounding it — as well as a new future for the medical institution.
Together, they are planning a completely self-sustaining and off-grid place of safety — even in times of emergency. This would be no easy feat: The clay terrain of the site, in a zone prone to earthquakes and hurricanes, rests only two metres above the water table. To address this challenge, the designers opted to design single-storey buildings with broad footprints and no overhead concrete slabs.
Instead, the numerous facilities (which include five clinic buildings, a guesthouse, a director’s house and a reception building) are composed of earth blocks made on-site — with the help of the local community — and supported by a steel basket weave that threads through them. The structures are topped with a multi-layer roof lined with bamboo and fortified by steel trusses. All areas except for the lab, X-ray room and pharmacy are to be naturally ventilated through a solar chimney system equipped with skylights and whirlybirds; below the skylights, translucent polycarbonate panels reflect and diffuse daylight throughout the interiors.
The ambitious plan also extends to the spaces between the buildings. Since getting to the facility and waiting to see doctors — not to mention visit family members — is often an all-day event, the designers have made the courtyards throughout the campus a thriving connective tissue. An outdoor kitchen area with a well and an abundance of edible plantings — breadfruit, plantains, avocados, almonds and morangas — is intended to provide sustenance for both patients and the community. In this way, the landscape works to feed, shade and shelter the site, while the buildings provide life-saving care.
Not only is the vision for the new Bethesda Medical Center a winner for its conceptual design, it’s also an exemplar of a strong sustainable ethos. The team at August Green approached the site — in Cap-Haïtien, Haiti — as a series of systems: ecologies, buildings, hardscapes, stormwater landscapes, power grids, waste treatment and freshwater delivery. In so doing, they have imagined a truly self-sufficient campus, one that generates all its own energy, water and even food. The entire place runs on solar energy (aside from a backup emergency generator) and funnels its grey water into irrigation for its lush plant life, which is further supported by multiple stormwater-management bioswales integrated throughout the site.
Central to the design of these complex systems was the guarantee of human comfort. To keep patients and doctors safe from heatstroke and fatigue in the blistering heat of Haiti, the team needed to ensure that they could reliably cool the public and interior spaces throughout the campus without the use of air conditioning. Using computational fluid dynamics modelling, they learned how to harness wind flow through a series of courtyard buildings surrounded by high and low planting layers that provide further shade (while delivering sustenance in the form of plantains, avocados, almonds and more). To erect the buildings, the team opted for one-foot-thick earth blocks, which act as a thermal mass that cools the air, while open vented blocks allow fresh air to flow inward. Inside the facilities, pitched ceilings reflect light and allow hot air to rise and be carried out through chimneys composed of prefabricated skylights and whirlybirds.
At its heart, Bethesda Medical Center represents a holistic approach to sustainability, where long-term generational use, healthfulness and economic prosperity for the people and the community have been considered in full.
Team Kyle MertensMeyer with Matthew Shields, Zoia Pushkova and Yingnan Ting (August Green); Ryan Eley (RWE Builds); Kos Komorowski, Ana Kuznietsova and Yurii Muzyka (Kaleidoskope)
August Green approached the Bethesda Medical Center site as a series of systems to create a self-sustaining and off-grid place of safety