Designing Healing. A Conceptual Model for Promoting a Healing Health Care Environment in Tanzania

Doktorsavhandling, 2009

Better health services are a basic human right of approximately 40 million people in Tanzania, calling for an improved architecture of Health Care Facilities (HCFs) so as to provide a healing health care environment that supports wellness as well as diagnosis and treatment. Healing design concepts of medical and architectural researchers are in line with life styles, contemporary architectural styles and social cultural systems in the western world, while in Tanzania, although cultural heritage is emphasized as the backbone of sustainable development, very little effort has been made to incorporate cultural elements and vernacular architecture into contemporary HCF designs. Instead, HCFs built using new methods and skills have been imposed upon local communities without consideration of their culture. In Africa, sickness is a cultural event involving whole families and sometimes communities, suggesting that healing health care environments must accommodate cultural aspects of space and architects must integrate these in their designs. Thus the theoretical point of departure for the thesis is the conceptualization of a healing environment as a cultural phenomenon. In addressing the healing environment in a Tanzanian context, this thesis investigates current HCFs in Tanzania from the perspectives of the patients and the architect. It also examines the elements of vernacular architecture, hypothesizing that these provide the cultural identity of a locality as well as physical comfort and social support. Further, it assumes that the quality of physical comfort needed for healing is a function of an efficient physical environment. Therefore, a Design Healing Model is proposed using a matrix design, demonstrating how future architects can integrate cultural aspects in their HCF designs. Both quantitative and qualitative methods were used to obtain the data. A cross sectional survey of nine hospitals in Mwanza and Dar-es-Salaam in Tanzania involving a total of 1109 patients was complemented by a case study in Zanzibar to obtain data on Swahili vernacular architecture. The thesis consists of nine chapters organized in four parts. Part one constitutes an introduction, which presents the framework of the research and its background, while part two explains theories and methods, containing the theoretical and conceptual framework as well as research methodology. Part three gives the results and discusses them. First the results from the researched hospitals are presented, and then they are discussed in relation to the literature that has already been surveyed in part two. The results of the survey of Swahili Architecture are then presented and discussed. Finally, part four presents the conclusion, which suggests the future perspective for designing hospitals or HCFs in Tanzania using the Designing Healing Model (DHM) and the author’s recommendations.