Built by Italian NGO EMERGENCY, the Children’s Surgical Hospital in Uganda will provide broad access to surgical care for children in Uganda and throughout the African continent. The building was designed by Renzo Piano Building Workshop, TAMassociati, and the EMERGENCY Field Operation Department. The group collaborated with many other professionals, including Milan Ingegneria (structural planning) and Prisma Engineering (plant design).
The idea for the hospital grew out of a meeting between Gino Strada, surgeon and founder of EMERGENCY, and Renzo Piano, one of the most highly regarded architects in the world.
“I like to think of Africa as a laboratory for the future, not just as a place of suffering and forgotten wars,” explains Piano. “Gino asked me to design a ‘scandalously beautiful’ hospital. He used that phrase because, for some people, the idea of offering beauty and excellence to everyone, especially poor and marginalized people, is scandalous. However, in all the African languages, and in Swahili in particular, the idea of beauty is always linked to goodness. There is no beauty without goodness.”
So, thanks to the support of the Ugandan Ministry of Health, EMERGENCY’S Children’s Surgical Hospital recently opened its doors in a lush, green setting, some four thousand feet (1200 m) above sea level on the banks of Lake Victoria. The team from the Renzo Piano Building Workshop and Studio TAMassociati worked together to design the hospital. Offering medical and surgical care to children up to the age of eighteen, the facility is seen as fundamental for the development of Uganda as well as Africa as a whole.
The need for a center specializing in children’s surgery in Uganda and neighboring countries was highlighted by the African health ministers from the African Network of Medical Excellence (ANME). This network, launched by EMERGENCY in 2009, aims to develop the healthcare systems of its member countries and bring free quality healthcare to all Africa.
“The best way to help Africa is to do the same things there that we’d like to have here in Italy,” says Gino Strada, surgeon and founder of EMERGENCY. “We went to Uganda with all the skills, equipment, and technologies necessary to provide high-quality surgery in an extraordinary facility. We’re all part of the human community. We’re all ‘equal in dignity and rights,’ as the Universal Declaration of Human Rights says. We have a responsibility to provide exactly the same level of care for African children as we do for Italian children.”
The project is of strategic importance for the entire country, having tripled the number of surgical beds available in Uganda for children. It’s therefore become a point of reference for surgical treatment right across Africa. The facility will also train a new generation of doctors and nurses, who’ll be able to raise the standard of pediatric care throughout Uganda and, possibly, beyond.
Uganda was among the first members of ANME. The country has a population of some 45 million people, around half of whom are under fifteen. With only four children’s surgical hospitals, Uganda was seen as the ideal country for this project.
The Ugandan government made the hospital site available free of charge and contributed twenty percent to the building costs. It’s also undertaken to cover twenty percent of running costs every year.
The project covers an area of 104 thousand square feet (9700 m2). The facility will have three operating theaters, 72 beds (six for intensive care and sixteen for sub-intensive care), as well as a series of laboratories and outpatient clinics.
The walls of the Children’s Surgical Hospital were constructed using pisé, an ancient rammed earth building technique. The roof was built by Italian company Zintek using high-quality zinc, titanium, and copper sheeting, mounted above the main structure on simple steel scaffolding, which also supports photovoltaic panels.
The hospital complex comprises three parallel buildings and a fourth building that marks the eastern edge of a large inner garden, the focal point of the project. Occupying a single level, the smallest building houses the entrance and reception area. The other buildings have ground and basement levels. The south wing of the complex houses clinics, diagnostics, and outpatient services. The ground floor of the northern section has the wards, and spaces for play and entertainment, with classrooms for training healthcare professionals, offices, and a canteen at basement level. The fourth building houses the intensive care unit, three operating rooms, and, at basement level, a pharmacy and services for medical, paramedical, and support staff.
Thema was in charge of the technical analysis and design of customized solutions for the main façade, as well as all the windows and secondary façades. The façade itself is a hybrid, designed to meet static, performance, and aesthetic requirements. The aluminum profile structure was designed so that it dialogues with the steel scaffolding to produce a single structure, which doesn’t in any way affect the air permeability of the façade. Schüco systems were used for the windows and façades throughout the hospital.
Every room has a large full-height window offering views over the garden. The garden itself, inspired by the nearby Entebbe Botanic Gardens, is intended to contribute to the wellbeing of patients and aid their recovery. The glass used in the façades and windows was supplied by AGC and chosen for maximum transparency and to offer patients views over Lake Victoria. The window shadings, supplied by Pellinindustrie, comprise Venetian blinds integrated into the windows and were chosen both for hygiene standards and for minimal maintenance. Extra shading was created using Resstende external roller blinds, which were fitted into the pisé walls using a specially designed system.
The garden forms the heart of the complex. It began life during the construction phase using air pruning, with the plants grown above the ground in large pots made of wire mesh and jute. Thanks to the climate here, the plants have doubled in size in the space of two years.
A major focus of the design was the indoor and outdoor leisure and play areas. Play is seen as a key part of the healing process and a way to make a child’s hospital stay as pleasant as possible.
The construction of the facility was made possible through the collaboration of several companies, whose work was coordinated by Theatro. By working together, they completed a project that both the architects and client have described as “polyphonic,” in which ethics and aesthetics merged to achieve the shared goal of “simplicity without compromising the quality of the result.”
Pisé, or rammed earth, is a building method that’s been used for eons all around the world. Because of its low cost and eco-sustainability, it’s recently been attracting a lot of interest. It’s a simple building technique that needs little more than earth and straw. For the Children’s Surgical Hospital, this traditional technique was brought up-to-date, with the result proving to be a major advance on the basic practice. Milan Ingegneria looked after this side of the project. After extensive laboratory tests, and technical and scientific research, the firm successfully turned this earth building technique into a modern, safe construction system.
While in Italy, rammed earth has never been widely used, in Africa it’s been common since the dawn of human history. With support from CRATerre, a Lyon-based research lab that’s been researching raw earth construction for many years, the team from Milan Ingegneria analyzed numerous old homes, still in excellent condition, in local villages. This helped the engineers gather important information regarding the original construction technique and valuable insights for its development.
Besides this historical investigation, the team needed to find out what the current regulations are regarding earth as a building material. Surprisingly, the only country that appeared to have any standards in place regarding earth building was New Zealand.
The designers turned next to improving the technical performance of the material. Adding sand and aggregates to the soil taken from the onsite excavation (silty clay) didn’t produce a material that met the required safety and resistance values. At this point, the engineers turned to the ancient Egyptians, who added straw to the mix. They replaced the straw, however, with polypropylene fibers and immediately obtained a better performing material. Then, thanks to input from Mapei, the mix was further improved with the addition of chemical binders, namely, Mapesoil 100, a powdered stabilizing agent that improved the mechanical performance of the soil during consolidation as well as adding water resistance. The final structure was stronger and with greater resistance to humidity than it otherwise would have been.
The final mix used for the walls of the hospital comprised silty clay from the site excavation, dried and cleaned of organic impurities; aggregate to improve compressive strength; Mapesoil to consolidate the soil; a small amount of cement to help trigger the setting process; one inch (2.4 cm) long polypropylene fibers to prevent microcracks due to shrinkage; and a small amount of fluidizing agent to improve the workability of the mix. Finally, the wall was protected using a transparent xylan-based impregnating agent, which was absorbed by the outer surface to create a hydrophobic layer that prevents water absorption and retention.
The final result achieved by the Milan Ingegneria team exceeded all expectations, with the material easily outperforming all building requirements. It also proved to be ideal for a range of different uses and constructions beyond this project.
The designers performed numerous laboratory and on-site tests on the material, including abrasion, compression, ultrasonic, aging, and shrinkage tests. Passing the tests was the greenlight for moving on to the construction phase, which required further study and experimentation. The walls, which are never less than two feet (60 cm) thick, were built up with six inch (15 cm) layers of the mix, compacted down to three inches (8 cm) with rammers. A few days after the walls were completed, the protective agent was applied to protect them from weathering. Later, concrete beams were installed to support the floors, lintels, doors, and windows.
Thanks to this building technique, besides being built using recyclable materials, the hospital has considerable thermal inertia. This means that the complex as a whole will consume less energy to maintain thermo-hygrometric comfort levels.
The experience of Milan Ingegneria in the development of the rammed earth technique represents an important case history that underscores how updating traditional construction methods through technology is not only feasible but also highly desirable for a better, more sustainable future.Video courtesy of Emergency - 2018 edition
Besides the pisé technique, the design team took advantage of the abundance of solar energy available at this location near the equator to improve the project’s eco-sustainability. The raised roof is fitted with 2500 photovoltaic panels, occupying an area of some 39 thousand square feet (3600 m2). It also creates a considerable amount of shade below, helping to reduce the consumption of fossil fuels. To further increase energy savings, LED lighting was used throughout in conjunction with motion detectors. Schneider Electric, responsible for optimizing the electrical system, installed systems that guarantee a continuous supply of energy at all times and under any conditions.
Hot water is produced using solar thermal collectors. The production of cold air and humidity control were refined with an air handling unit that uses the outside air to provide environmental comfort without the need for traditional banks of all-air systems. Green and outdoor areas are watered using rainwater tanks.
Location: Entebbe, Uganda
Completion Date: 2021
Project Owner: EMERGENCY NGO Onlus
Architects: Renzo Piano Building Workshop & Studio TAMassociati
Design team: RPBW - G.Grandi (partner in charge), P.Carrera, A.Peschiera, D.Piano, Z.Sawaya and D. Ardant; F.Cappellini, I.Corsaro, D.Lange, F.Terranova (models) - TAMassociati - R.Pantaleo, M.Lepore, S.Sfriso, V.Milan, L.Candelpergher, E. Vianello, M.Gerardi - EMERGENCY Field Operations Department, Building Division - Roberto Crestan, Carlo Maisano.
Consultants: Milan Ingegneria (structure); Prisma Engineering (MEP); Franco and Simona Giorgetta (landscape); GAE Engineering (fire consultant); J&A Consultants
Photography by Marcello Bonfanti, Courtnay Robbins, Archivio Emergency, Emmanuel Museruka – Malaika Media
All images courtesy of Renzo Piano Building Workshop & Studio TAMassociati, Milan Ingegneria