The project that was inspired by Nelson Mandela’s aspiration to improve medical care for children will become a reality when it opens to patients early 2017 in one of Southern Africa’s biggest cities, Johannesburg. The funding structure and stringent requirements for a highly specialised care facility at this scale created huge challenges for the introduction of sustainability elements. At all times though, the building holds at heart the needs of its main users: children in need of healing.

The Nelson Mandela Children’s Hospital will be one of only five dedicated children’s hospitals on the African continent, including two in Cairo, Egypt, one in Kenya and one in Cape Town. As there are nearly 450 million children on the continent, the new hospital will create a much-needed facility for children in Southern Africa. Children referred to this facility will be guaranteed treatment, regardless of their economic status.

TERTIARY CARE FACILITY

In line with national government’s Modernisation of Tertiary Services plan, which aims to modernise tertiary healthcare services, the Nelson Mandela Children’s Hospital (NMCH) will operate as an academic tertiary care referral facility, providing services in speciality care areas such as paediatric cardiology, neuroscience, nephrology, as well as general and reconstructive paediatric surgery.

The project was designed as a 200-bed facility with capacity to grow to 300 beds. It includes a relatively high proportion of intensive and critical care beds, and care is taken to accommodate family members of patients from outside of Johannesburg. Twenty eight family rooms are provided on the hospital’s top floor. This facility is operated by charity organisation Ronald McDonald House.

PUBLIC FUNDRAISING PROJECT

A key feature of this project was the creation of a special public-private partnership between civil society, government and the Nelson Mandela Children’s Trust in order to fund the facility. All the funds to build the hospital were raised by the public – from corporate companies to philanthropists and ordinary citizens. Major donors included Islamic Relief, the Bill & Melinda Gates Foundation, DG Murray Trust, Nelson Mandela Children’s Fund, and Macsteel. Fundraising for the project started in 2011 and was mainly used for construction, equipment, and training of medical professionals. The total amount donated reached R880million by the time of going to print at the beginning of November but the final target is R1billion.

The capital expenditure and operational budgets are funded from different sources. The National Department of Health has committed to supporting the operational costs of the hospital related to the care of the estimated 80% of public patients, while private patients will be funded by their medical aids. General fundraising will also continue after the facility has opened.

INCREASING CAPACITY

The NMCH is set to offer highly advanced and specialised care. It is located on land donated by the University of the Witwatersrand (Wits) Education Campus, next to the Wits Medical School in Parktown, and close to several other medical facilities, including the Charlotte Maxeke Academic Hospital.

The hospital aspires to increase the capacity to treat children in the region so that waiting lists can be shortened and child mortality reduced. This will be achieved by training programmes intended to increase the hospital’s own capacity, as well as creating more qualified staff to supply the healthcare industry overall. Telemedicine, exchange programmes and research will also contribute, explains Vuyo Lutseke, head of communications at NMCH.

The hospital plans to employ 150 doctors and 450 paediatric nursing professionals, as well as provide allied health services. Due to the shortage of nurses globally – and specifically paediatric nurses in Southern Africa – the NMCH Trust secured funding for training programmes from the National Skills Fund, among others. The hospital is partnering with several universities across the country to implement the programmes, and staff who complete their training successfully will be guaranteed a job at the hospital.

A NATURAL HEALING ENVIRONMENT

The hospital was designed by a joint venture consisting of two British based and two local architectural firms. The British firms, Sheppard Robson International and John Cooper Architecture, were responsible for the conceptual design. Local firm GAPP Architects was responsible for the development of the facade and public spaces. Ruben Reddy Architects fulfilled the role of local lead architects.

The core of the design concept was to emulate a natural healing environment. The building shape resembles three connected “hashtags”, which  encompass three external courtyards between them. The inclusion of courtyards and shallow floor plans allow for much of the building to be naturally lit and ventilated. A connected hospital “street” simplifies navigation to the various departments. Patients are able to experience the outside world via views into the sunlit courtyards, thus promoting the feeling of being connected to the calming essence of nature.

Serenal Nadar, architect at Ruben Reddy Architects, explains how the hospital is specifically designed to incorporate the needs of children: “Several workshops were hosted with the hospital’s users: children, in order to better understand their needs. A number of artworks completed by children at these workshops have been incorporated into the graphic design of the way finding elements. Even the patient bathrooms have been designed and fitted out for the comfort of a child, with features like smaller baths and lower basins.”

GREEN BUILDING ASPECTS

The design team consulted widely with organisations such as Mediclinic and the Red Cross Children’s Hospital on how to achieve savings on operational costs by using passive design and other cost effective principles in the design of a clinical environment. Windows can be opened and non-movable aluminium louvres and integrated static shading boxes will keep out the harsh direct sunlight. Lighting and air-conditioning in the wards and outpatient departments can be controlled individually in each space. A building management system (BMS) was installed to monitor and control the electrical, electronic, fire and HVAC systems, which are critical to the functioning of the hospital. The BMS is also able to monitor overall energy consumption.

The hospital is equipped with energy-efficient lighting in public areas, toilets, surgical theatres, lobbies, wards and some external areas. Occupancy sensors further reduce energy wastage.

The hot water system employs heat pumps and energy-efficient heat recovery methods, explains Danie Grobler of Spoormaker, the mechanical engineer on the project.  “The HVAC system installed in the hospital has VRF (Variable Refrigerant Flow) technology which is designed to provide cooling and reversed cycled heating. With the system’s heat recovery technology, hot water can be generated almost for free,” says Grobler.

Regarding certification, some US donors have a condition that a project needs to be LEED accredited. NMCH project director Joe Seoloane says this was a consideration, but the considerable documentation required for a LEED submission exceeded the team’s capacity. Adhering to local green building requirements was seen to be more time and cost-effective, without compromising on the project or the environment. Unfortunately Green Star SA accreditation for hospital buildings was not yet available at the project’s design stage.

Nadar says although the project is not a LEED or Green Star rated project, the hospital does comply with the standard SANS 10400 Part XA requirements, and passive design and other green features were included. Unfortunately, due to budget constraints, several of the initially proposed green elements could not be incorporated into the building. Insulation inside the cavity walls and double-glazed windows were some of the features for which the additional costs did not weigh up to the benefits. Rainwater harvesting and greywater systems were also excluded from the project as these systems were deemed unsuitable for a hospital environment because of the risk of contamination, and because the payback period was considered to be too long.

LANDSCAPING FOR PLAY AND CONTEMPLATION

The landscaping too is tailored to the task of healing. Five internal courtyard gardens are each purposely designed for therapeutic use. The three outside courtyards are designed  for occupational therapy, horticultural therapy and children’s play, respectively. Landscape architect, Annamari Comrie of GreenInc explains: “We used hundreds of plant species, so it is difficult to highlight just a few, but we planted Fever trees in the lower ground floor courtyard for instance, as this tree is large enough to reach the windows of the floors above, while the canopy is light enough to allow light to the spaces. We planted Karee trees in the children’s play area as they are excellent trees for climbing.”

In the Occupational Therapy garden, flowers provide a sense of friendliness. Some species are Pelargonium Peltatum, Burchellia Bubaline and several agapanthus species. The plants in the Sensory Horticultural Therapy Garden are not all indigenous, as they were specifically selected for their smell, taste or feel. These include lavender, lemon trees, selected herbs, fruits and vegetables. Outside of the building, the trees and shrubs used on the Highveld Rehabilitation area on the periphery of the site include species found on the nearby Melville Koppies. Examples are the Acacia Karoo, Aloe Markothii and Ziziphus Mucronata – many of these carry specific cultural meaning and are also used for medicinal purposes across the continent.

THE FIRST PATIENTS

The commissioning phase of the hospital was completed before the celebratory opening on
2 December 2016 – three years after Madiba’s passing. “The hospital will initially be open for reduced outpatient services such as radiology and dialysis during January 2017. In the first quarter of 2017 we will incrementally introduce other services and hope to be fully operational by the end of the third quarter. This phased approach will allow us to test our systems and protocols,” says Lutseke.  Despite the project’s challenges, the new building will bear testament to Nelson Mandela’s dream, as it improves the lives of Southern Africa’s youngest generation.

Words Femke van Zandvoort

photography tristan mclaren