Vision for integrated care in Japan


Responding to the demands of an evolving economy and democracy have hastened problems, non more so than its rapidly ageing population. This study provides particular examples of social architecture resulting from the changing emphasis and requirements of the public health service. A snapshot range of solutions which anticipate certain methods of care are featured. They include Design for the Aged Society, Community Cancer Care, Cremation, and Medical Training. The wide spectrum of facilities visited include the latest generation of specialist health care projects such as sheltered premises and community care for the elderly, and a small scale private clinic for the sufferers of cancer. Included are the outstanding new Kaze-no-Oka Crematorium in Natatsu City by architect Fumihiko Maki and the Unified Medical and Nursing University in Saitama by the architect Rikken Yarnamoto and a view of Toyo lto's futuristic designs for the WHO Well-being and Health Promotions Pavilion for the Hanover 2001 Expo. All these are highly innovatively designed schemes within a changing health service. We are experiencing the delivery of health care not from the confinement of the mainstream hospital environment but in the wider community context. These six projects may appear to be peripheral to current services but raise possibilities and expectations for an appropriate public health service delivered in the most dignified circumstances.

St Lukes Residence
Sheltered Accommodation for the Elderly Tokyo 1995 Architects Nikken Sekkei
An Integral element of St Luke's life Science Centre which for medical care includes the famous St lukes International Hospital. Western style furnished luxury apartments with magnificent views along the Sumida river to Tokyo Bay. A waterfront location convenient for central Tokyo and ideal for an extended active urban lifestyle. With shops and leisure facilities St Lukes Towers is a magnet for people of all ages. With an Average age 72 years old St lukes residence is for tenants who have no serious impairments or diseases and are capable of looking after own needs,. Rent arrangements favour the well and fit over 60s and the brochure states that the 16 year contract ensures piece of mind in pursue of a fulfilling life. Alarm buttons are generously distributed in all the main rooms and life cycle monitors are installed over the doorways. With smart restaurants to meet fellow members of Tokyo's well to do this is regretfully a very expensive apartment lifestyle

Chikuko Cho Health Welfare
A combined day care facility for the elderly, and community centre for the town of Chikucho Ku. It is a social centre and gymnasium arranged with a unique single floor building in the form of concentric oval rings. The central green arena is enclosed by two low profile crescents shaped concrete
facades. Inside the distinctive plan is punctuated with a flowing series of open and closed spaces. Rooms radiate into the confines of the surrounding landscape arranged through and between layers of curved screen walls. This special place includes a mixture of functions, eg games room, classrooms, theatre, hairdressers, restaurant and traditional tatami mat lounge. The architect Yoh Shoie has produced a number
radical and uncompromising health centres, some inconsistent perhaps with the comfort and care of the patients. He is known for his use of contemporary materials and use of bold but increasingly organic geometry in his buildings. The concentric rooms with their transparent ceilings benefit sequentially and naturally with the sun's orbit. These curved volumes are ideal for open plan living providing both spaciousness and a necessary degree of privacy

Dobtai Clinic
Private Cancer Clinic Kamakura 1998.
Architect Norihiko Dan Architect and Assoc.
Run by Dr Dohtai a leading cancer specialist this unit is restricted to nineteen beds the maximum for a private
consultant to run. There are theatre facilities available but for major procedures the surgeon's patients have access at a main Tokyo Teaching hospital. An architect - surgeon collaboration "the surgeon knows exactly where everything goes, it was bit like designing a kitchen" Located within a steep wooded valley it presents a dynamic cantilever form enclosing a courtyard space with the potential in future to add an extra facility for the elderly. The wards facing south provide a regular square grid facade and the northern elevations to the circulation spaces
are generously glazed. A bold monumental statement this white angular form is both elegant and compact in character. Engaging the principle institutional typology of corridor and rooms, associated with hospital wards and other accommodation such as hotels, prisons, offices etc. The architect allows the two separate wing systems to collide at the apex of his building. At the centre of this collision Norihiko Dan has located a is a triangular light well and staircase. The floor to ceiling windows and barrel roof light ensures the spread of daylight throughout the wards. Leaning elevations and large slit windows encourage the perception of more room space but
with a distinct personality. The private examination rooms and theatres are distributed along the ground floor, and the services located behind a curved screen wall to the rear of the building The sculptured building with its elegant geometry, its flighty escape stairs, its bright rooms and its washi-paper artworks provides a confident profile to this community facility,

Kaze-no-Oka Crernatoriurn
Nakatsu City Oita Prefecture 1997
Architect Fumio Maki and Associates
The cremation ceremony is performed according to a procedure that has been practised for centuries. The sequence of the ritual starts with the mourners embracing the deceased prior to wheeling the garlanded body through the furnace doors. After paying their last respects the guests retire to a tatami mat room where tea and toast are served. Within the hour the mourners return to experience the trolley being retrieved from the cooling furnace. The remaining fragments of ash-white bones are picked over to be distributed amongst the family shrines. After the ashes have been collected the guest separate and departure to a reception. Although there is a
tilting tornblike chapel of rest for Christian style services, it is the traditional Japanese ceremony on which the design of the crematorium was mainly based. Fumiko Maki's belief that a public building should be a place where people can share their collective memory of a particular time and place. The park in which the city crematorium is located contains ancient burial mounds. The building itself is partially submerged into an oval basin presenting sculptural forms of corten steel, brick and concrete. Its stoic character within the serenity of the setting indeed provide a memorable place for the mourners to pay their tributes. This processional building with its distinctive formal character, its control of natural light and use of primordial materials ranks as one of the most remarkable public buildings recently built in Japan.

Saitama Prefecture University
Department of Medical Science and Nursing Studies Architect Rikken Yamamoto
This giant joint nursing school and medical university campus Saitama is approaching completion. Rikken Yamamoto an architect of considerable social awareness has designed 'Care Plazas' for the elderly but is famous for his radical housing projects. Yamarnoto takes his bearings from the features of historical Japanese residencies with their transparent walls and a fluid transition between indoors and out. He exaggerates dimensions and creates eccentric designs, such as his elaborate roof structures. The architect dissects his buildings using human organisms with their separate self sufficient cells as his model. The key element ordering and unifying the individually designed units is a covered gallery with public staircases. The main theme of the institution is to establish greater links between the trainee consultants and nursing profession. To break down hierarchy barriers and explore ways to promote co-operation towards improved quality practice and patient care. The building itself consist of two main extended parallel academic blocks which like a stadium surround the communal inner recreation ground. Sandwich between the medical and nursing blocks are shared experimental laboratories, examination and treatment suites. Above are landscaped roof gardens containing a performance hall with sliding doors which open onto the grassed arena. Major site specific pieces of sculpture are to be located within strategic positions within the central park.

Pavilion for the World Health Organisation
Health and Well-being Pavilion Expo 2000 Hanover Architects Toyo lto & Associates
One of Japans foremost designers Toyo lto known for his light weight often flimsy structures has recently turned his attention to social building. He has designed a number of public institutions including a recently completed mountain Ota-Ku health resort for the use of inner-city school children from the “Visions for Public Health Care in Japan” Kawasaki area and the Hinagu Old Peoples Residential Home (ref. HD Aug 97.) The World Health Organisation have engaged one Japan most innovative architects on the Expo pavilion to express his vision of a futuristic environment for well-being. His designs for the Expo health pavilion is to include the use of audio therapy and massage loungers arranged along the lapping waters of an indoor lido. This is a rest pavilion in which to relax and be soothed away from the demands of an exhausting visit to expo 2000. Along with the waves of the bay shaped pool, special computerised lighting projected on to the ceiling and the translucent perforated screens to the rear of the patio will effect the atmosphere and mood of the pavilion.

As we look to the differing user and service requirements for the future, Japan with its total quality control and design innovation offers a more open minded approach to the provision of health care. Most importantly we need to explore “design-age” concepts for addressing the rapidly ageing population. Why not for instance medium-rise sheltered accommodation for the elderly who wish to continue to inhabited the centre of cities. The high quality of service achieved at the privately run St Lukes Towers with its spectacular river views suggest there is after all potential for the elderly to remain living comfortably within the most compact of urban environments. The more modest local rural council run Chikuko Cho Welfare Centre with its mixed use preventative care and day facilities is ideally located at the heart of the community. The architecture here suggest more organic forms such as stacking layers of curved volumes can provide more inspiring and flexible spaces. Everyone of course would benefit from the personal care attention provided at a smaller hospital. The Dohtai Clinic demonstrate it is even possible to treat the most serious of illnesses in the more pleasant and the less stressful clinical surroundings of a smaller building. In Kamagawa Noriho Dan is confronting and attempting to liberate his buildings from the physical restraints of the prevailing institutional corridor-based typology. A further way to achieve improved quality for the future needs of the patient is to break down the status barriers and improve communication for shared practice within the culture of carers. Integrated practice between the managerial and the caring professionals is what they are aiming to achieve at the Saitama Prefecture University.

Most of the architects featured above pay much attention to local building qualities and to the cultural peculiarities with its attendant ritual practices. As the master Fumiko Maki has proved public health buildings are capable of creating a dignified ceremonial and memorable shared occasion, which can and should rank amongst the most important architecture in modern times. Buildings which emphasise the well-being of the users, as being imagined for the Hanover Pavilion will provide a new agenda and aspiration for the designers of the next Millennium. Such a vision is indicative of the future care resources moving closer to the needs of the population


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