Healthcare Design - August 2020 - 16

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AYALPATA HOSPITAL delivers free, high-quality health-

care to more than 100,000 patients a year in Achham,
Nepal, and its six surrounding districts-one of the
country's poorest and most remote regions. It's managed by nonprofit healthcare organization Possible
Health, which is based in New York and Nepal and collaborates with the Ministry of Health & Population of
Nepal in a public-private partnership.
Dr. Bikash Gauchan, Bayalpata Hospital's healthcare director, says when
he joined Possible Health a decade ago, the hospital comprised many dated
buildings with no insulation or climate control, allowing indoor temperatures to range between approximately 40 and 100 degrees Fahrenheit. Additionally, the aged site had no formal sanitation system, electricity was
unreliable, and access to clean water was limited, further impacting the organization's ability to provide healthcare services to patients.
To improve care, Possible Health reached out to Sharon Davis Design
(SDD; New York), a firm that works primarily with nonprofit and nongovernmental organizations, to upgrade and expand the campus. During SDD's first trip to Nepal, the design team witnessed doctors running
between the emergency room and surgery, through crowds of waiting
patients and families, many of whom often arrive without appointments
after traveling many hours on foot. "Clear circulation and sufficient
waiting areas for patients became drivers of our design," says Sharon
Davis, principal at SDD. "This goal influenced our approach of breaking
down the scale of the complex with multiple, smaller buildings, grouped
around private courtyards, with plenty of access to outdoor spaces, including balconies, as well as protection from the elements through courtyards and shading canopies."
Construction began in late 2014, with the new 45,500-square-foot facility opening this past spring. The rural 7.5-acre campus includes five
medical buildings with 70 beds for outpatient, inpatient, surgery, prenatal, dental, and emergency services, plus clinical functions, such as pharmacy, radiology, and laboratory spaces. There's also an administrative
block with staff offices and a 60-seat cafeteria.
The site's natural topography was used to locate the buildings, with
the administrative building at the highest point, overlooking the medical campus. Due to the remoteness of the hospital, many of the hospital's
staff and their families live on-site, so the project also included 10 single-

AUGUST 2020

TOP: The upper courtyard

of the administration
block houses staff offices,
doctors' offices, and a
cafeteria, while the surgery building (on left) has
a more private courtyard
reserved for families of
patients needing serious
medical treatment. ABOVE:
Waiting areas and
walkways are covered to
provide shaded seating
for patients and family
members. On a busy day,
up to 500 people come
to the hospital to see the
medical staff.

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family houses and an eight-bedroom dormitory
in a secluded area downhill from the hospital,
says Tyler Survant, project director of SDD and
project manager for Bayalpata Hospital.
Inspired by the region's building traditions
(including two- and three-story houses in Achham constructed of mortared stone and finished with paint and an earthen stucco), the
medical spaces are finished on the interior with
stucco. Rammed earth, a local building technique, was used to construct the housing.
The project is a unique model to Nepal and
has been recognized by local health policymakers, according to Dr. Bikash. "Many of the
ministers from the Nepal government come
to our hospital to learn our systems, to learn
our physical space and infrastructure, including this rammed earth technique," he says.
"Recently it has gained interest, not only inside Nepal but internationally, because of the
physical infrastructure but also the healthcare
services that our organization is delivering."
-Tracey Walker, managing editor

ELIZABETH FELICELLA

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Healthcare Design - August 2020

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