ARBUENA'S TAKE ON THE COVID-19 PANDEMIC
News as recent as September still points to a steadily growing amount of cases to this day. This begs the question of whether our healthcare facilities were prepared to handle a disaster of this scale. The country's difficulties point to two particular variables: the band-aid management of the crisis and the limited healthcare structures' capacities. Principal architect of ARBUENA Architects, Ar. Allen R. Buenaventura, believes that the challenges we're facing now is a call to action for specialists in different sectors to collaborate for the nation's recovery.
The Philippines' need for specialists in different sectors to work together
After finishing with a degree in BS Architecture in 1987 and Masters in Construction Management in 2001, Ar. Allen did not think he would pursue a career in planning and designing medical facilities. He got engrossed in healthcare facilities by being sent around the Philippines and other countries to observe buildings like laboratories and schools. By being employed at the University of the Philippines Manila and being exposed to hospitals during his career, he got the opportunity to teach in the academe about healthcare architecture. Over time, he grew the confidence to practice his craft. This sparked the idea of starting his own architectural firm specializing in educational, commercial, and healthcare sectors.
Established in 1993, he started ARBUENA Architects to serve a wide range of clientele, both in private and public sectors. Since 2002, they have been providing construction services to medical professionals and healthcare providers around the Philippines. This specialization in building healthcare and research facilities, while also being among the few professionals recognized by the United Architects of the Philippines (UAP) as a healthcare architectural firm, makes them a necessary service provider for the nation's recovery.
THERE'S NO DENYING THAT THE PHILIPPINES' RESPONSE TO THE COVID-19 PANDEMIC DIDN'T REFLECT THE COUNTRY'S BEST EFFORTS IN ADDRESSING A CRISIS. BY JULY, MORE THAN 80,000 PEOPLE TESTED POSITIVE FOR COVID-19, WITH CASES DOUBLING FROM THE MONTH PRIOR. THE STAGGERING NUMBER OF INFECTED PATIENTS LED TO BOTH PRIVATE AND PUBLIC HOSPITALS IN METRO MANILA REACHING FULL CAPACITY, WITH OVER 76% OF COVID-19 WARDS OCCUPIED. THIS RAISES CONCERN FOR THE DANGER OF HOSPITALS DEVELOPING "WARNING ZONES", EVEN IN THE COMING MONTHS.
The Department of Health (DOH) is a regulatory board that facilitates different aspects of healthcare facilities' conception and management. Hospitals are unique because they need pre- approval before private institutions can set it up with the DOH's review. Before COVID-19 hit, it was the DOH's program to build more provincial and city hospitals all over the Philippines. In turn, this would entice companies and developers to venture into healthcare construction for specific facilities like dialysis centers, diagnostic laboratories, and more.
These buildings would provide a more extensive reach of specialized healthcare services to locals.
Unlike private hospitals, government- funded hospitals by the DOH are limited by budget constraints preventing them from creating sustainable and resilient facilities for the people. Thankfully, the DOH is moving more towards collaboration by prioritizing their management of these projects while outsourcing help from architectural experts.
The Philippine's learning curve in addressing the global pandemic
Ar. Allen's observation is that several healthcare facilities were ill-equipped to accommodate a large number of COVID-19 patients. This was an issue for healthcare establishments worldwide, causing major strain on healthcare workers' burden of maintaining order during a crisis. "Before the start of COVID-19, we were unaware of how to handle the management of a disaster like this." He adds, "Our hospitals and government officials are prepared for floods, typhoons, earthquakes. However, COVID-19 is a biological disaster that's completely new to the Philippines, unlike with China and Taiwan." Together with the lack of building engineering controls and laboratory testing for COVID-19, the Philippines' management of the issue wasn't as effective as it should have been.
Ar. Allen states that "The number one way for hazard assessment is by isolating the threat." Unfortunately, the world's panic-driven state, combined with the many unknown factors of transmission, made COVID-19 into a more difficult problem. Disposal of infectious waste, lack of housing for healthcare providers, and separation between infected and vulnerable individuals were the key weaknesses he witnessed during the handling of the pandemic's impact.
The necessity of anticipating disasters with the appropriate response
The development of field hospitals and quarantine facilities was one of the many emergency procedures launched by the government to accommodate the overwhelming number of COVID-19 patients. Modular field hospitals set on sporting and entertainment venues, such as the Ninoy Aquino stadium and Rizal Memorial stadium, were set up to house close to 100 - 120 patients. However, these solutions were only temporary. Ar. Allen notes that not all isolation facilities had the appropriate designs that could replicate these large-scale quarantine facilities. It was only recently that healthcare establishments and public officials are learning how to isolate people properly with new information on how to mitigate infection rates.
The DOH – HEMS have been regularly conducting safe hospital inspection and assessment regularly for the past 10 years in preparation for the yearly occurrence of natural calamities in the Philippines. It was part of Ar. Allen's job in the Safe Hospital Inspectorate Team to review hospitals in preparation for these natural disasters. However, he notes that this biological threat isn't a problem that can be prepared for through inspections. An appropriate response must come from extensive replanning and administrative adjustments.
The need to establish national building guidelines in light of the pandemic Ar. Allen sees the global pandemic as a wake-up call for the Philippines' glaring lack of updated national building design guidelines. Because of this, institutions should help each other to address a crisis of this scale. He recommends specialists from the UAP to create their own standards for the development of optimized healthcare facilities.
Ar. Allen believes that it's better to create our own standard with mandatory requirements instead of limiting guidelines. "The architects are more knowledgeable to take the initiative to set those standards, not just for healthcare, but also for educational and commercial industries." Besides developing orderly procedures during a pandemic, there must also be foresight in mitigating these risks. Not all architects are familiar with the necessary fittings to address calamities in their designs, which is why there needs to be a standard that they can implement in all their projects.
Currently, our architects follow either the US Time Saver's Building Types or Neufert standards in architectural planning and design. However, Ar. Allen believes these foreign building practices don't precisely fit the Philippines' geography, climate, and human scale. This is why he envisions the production of a national design standard written by specialists in different fields of architecture, engineering, and other allied professionals organized by the UAP. It will be available for architects, both young and new, as a guide in any project. Since it's an organization standard, it will be easy to edit, revise, and disseminate to all practicing and learning members of the architectural community.
The future of healthcare establishments' architectural design nationwide
It's a common misconception that a building's sustainability starts and stops with promoting better energy efficiency. "Sustainability isn't just about saving energy; the primary function of the building we design should be a well-built structure to protect its inhabitants during disasters. We should be aware of our designs' impact, not only in the built environment, to give more importance to the protection it brings to its users." Ar. Allen adds, "In disasters like earthquakes, people are hurt due to falling debris with the risk of collapsing structures. For COVID-19, its damage comes through increased contraction inside hospitals via air transmission, this can be addressed by proper ventilation designs."
Because proper air ventilation was a key to lowering contraction rates, Ar. Allen believes architects should do more than just install air conditioning. They should learn how to create seamless airflow through an HVAC system to avoid the spreading of biological contaminants. For instance, the lack of operable windows for fresh air was one of the many issues of hospitals in the US. This is why a combination of natural and mechanical airflow will be an effective way to create air exchange.
One of his propositions for future hospitals includes developing well-planned infectious waste holding facilities for proper disposal, together with decontamination areas for used medical materials. Parallel to this should be the creation of more storage areas to hold PPEs, face masks, medical gloves, and other medical paraphernalia that are necessary to address crisis-level events.
Since high-touch areas are one of the leading causes of higher contraction rates, sensor-activated equipment will be necessary, especially for healthcare facilities. No-touch input doors that activate through smart technology and optimized sanitizing stations need to be upgraded for all medical facilities.
Architect Allen R. Buenaventura
Principal Architect, ARBUENA Architects
Besides these structural additions to hospitals, it's also necessary to include additional areas to promote safety among patients and healthcare workers. Creating provisions for the emergency department to have infectious patient zones, trauma patient zones, medical patient zones, donning and doffing areas, and isolation rooms are necessary to segregate traffic and mitigate contraction among infected and vulnerable individuals.
The unfortunate reality is that the limited technology available in the Philippines is preventing the modernization of government-funded healthcare facilities. Medical institutions in more capable countries have components that conserve energy, employ automation, and contain architectural fit-out modules that cater to industry-specific tools. Ar. Allen notes that the Philippines' access to these fit-outs is very limited since it requires ordering from foreign suppliers. However, he's hopeful that these recommendations won't fall on deaf ears by collaborating with architectural and medical specialists.
The value of architectural minds for natural disasters and risk aversion
The DOH is very strict on compliance with their regulations, especially after dealing with COVID-19. Ar. Allen believes that they'll have a straight attitude in revising their DOH Design guidelines in the future. However, he's not simply inactively waiting for the government's response; he's also taking his own initiative to research our own and other countries' international guidelines to apply it in his learning and teaching process.
Although he's committed to his practice's service on private and government projects, that doesn't stop him from pursuing his teaching endeavors. He is currently a part-time faculty in Mapua University since 2016. He was a lecturer at the University of the Philippines Manila College of Public Health at the same time the Campus Architect of UP Manila campus in Malate, Baler aurora, Palo Leyte, and Koronadal South Cotabato. All campuses are Health Science Centers where he served from 2003 until 2018.
Currently, a growing trend among architects is to look for collaborations and joint ventures. Besides getting projects through these avenues, Ar. Allen sees it as the best time for architects and building experts to expand their knowledge and to see their role in the nation's recovery. "Since you have time, use it to study and research the things that you don't usually do. The pandemic's impact isn't all a loss. There's an opportunity to learn and adapt." says Ar. Allen. He makes it a habit to attend webinars from the UAP and also from experts abroad to enrich his own lectures.
Ar. Allen held webinars addressed to the UAP Vancouver British Columbia Chapter and UAP Manila Arizonian Chapter. His presentation was titled "RT-PCR COVID-19 TESTING LABORATORY
PLANNING & DESIGN – PHILIPPINES" which discusses international and local building guidelines, COVID-19 laboratory planning and design back in August and October. His most recent talk was about the "New Normal in the Built Environment" during a Joint Virtual Training of Police Engineering Management Course (PEMC) for PCOs and Police Engineering Course (PEC) and at the Mapua School of Architecture's Nationwide Architecture Week last December. "I realized that I had to do my part to educate my co-architects." He adds, "I make it a point that what I teach is reviewed with the specialists I know because I am responsible for what I'm teaching."
The importance of adapting better organizational and architectural solutions
The government's response on the pandemic continues to be more progressive by the day. The Department of Public Works and Highways (DPWH) is taking initiatives to expand healthcare infrastructure to expedite the construction of additional hospital facilities in Metro Manila. This signals the development of more healthcare-related construction throughout the country.
"We must envision ourselves as potential users of the buildings we'll create in the same way the university trained us how to think and address situations. For me, I want hospitals to be built well and
for them to be a standard that others can follow." Ar. Allen adds that "We need to educate people, with what little we know and to share it for those who need it." Through constant communication between experts in different fields, he is hopeful that transparency and openness to learn will lead to progressing the nation's healthcare architecture. He believes that once DOH releases its guidelines, the new design guidelines will be reviewed by professionals to back up their updated regulations.
The development of these solutions brings to light a very simple, yet oftentimes undervalued, practice of maintaining good communication between contractor and client. Ar. Allen believes that transparency is essential for architects and clients. "Instead of avoiding cutting down costs by hiding inefficiencies and vulnerabilities. You need to be open to the client by backing your view with facts and solutions, and the client should be open to hearing your opinion so that they can make provisions for necessary changes to address potential problems." says Ar. Allen.
Currently, Ar. Allen is continuing work on sustainable and resilient healthcare facilities and the building of COVID-19 laboratories to help process more patients across the nation. By using the knowledge he's gained over the years and continuing to learn new things, he's positive that the Philippines will get back up after the COVID-19 crisis.
"If we only stick to temporary remedies, we'll go back to where we started." He adds, "We need to adapt permanent solutions to address future pandemics." He calls on experts to do their part in developing and implementing organizational and architectural changes that will benefit the nation in facing calamities in the future.
"IF WE ONLY STICK TO REMEDIES, WE'LL GO BACK TO WHERE WE STARTED." HE ADDS, "WE NEED TO ADAPT TO ADDRESS FUTURE PANDEMICS." HE CALLS ON EXPERTS TO DO THEIR PART IN DEVELOPING AND IMPLEMENTING ORGANIZATIONAL AND ARCHITECTURAL CHANGES THAT WILL BENEFIT THE NATION IN FACING CALAMITIES IN THE FUTURE.