Turning Japanese

HDCommH HD Hospital Development Magazine September 1997

Review of three provincial community hospitals on the island of Kyushu, which demonstrate traditional aesthetic beauty as well as painstaking attention to patients' lifestyles, - design concepts could be applied in the UK.

Despite its recession, for the last five years Japan has been the second richest nation in the world. The country is technologically the most advanced place on earth and although its influence penetrates every corner of our lives we remain very ignorant about its social and cultural infrastructure. The global demand for less hostile and more patient orientated hospitals has stimulated considerable debate on which kind of environment is appropriate for healing. The demand corresponds to an increasing number of designers who have been motivated to address the physical requirements of buildings to encourage the healing process. In Europe and the US there are well-documented healing art programmes but little is known about equivalent design initiatives in Japan.

During the last decade there have been many exciting developrnents in health building in Japan (see HD Jan '95). Many of these developments appear 'to incorporate aspects of the country's unique culture. In terms of leading artists and designers in Japan, the informed Westerner is more familiar with the names and work of contemporary architects. This brief review of one recent and two established medical facilities in Japan features health buildings by three of the most famous and talented architects: Arata lsozaki, Itsuko Hasegawa and Toyo Ito. Since the bursting of the economic bubble, a number of Japans most famous architects have, in contrast to the UK, been creatively engaged in the production of social buildings. Certainly since the Great Hanshin Awaji earthquake the number of commercially driven, crazy buildings of the atelier architects have diminished in favour of more laudable portfolios. The emerging higher echelon architects often operate on smaller budgets, and consequently on more modestly scaled facilities. The following projects provide, respectively, obstetrics, mental illness provision, and services for the elderly, and are all located on the western Japanese island of Kyushu.

The Etoh Clinic Oita Architect Arata Isozaki 1985
Himself a native of Kyushu, Arata Isozaki is the eldest of the trio, a world-renowned architect of exceptional creative ability. He has produced a wide range of civic buildings in and around his home city of Oita across the inland sea from Hiroshima. The Etoh Clinic is a maternity unit of distinction. According to lsozaki, the client wanted to avoid the dismal atmosphere so common in hospitals, since his patients are not sick. The fundamental issue then was what to use as a model. One should certainly go a step further than the stereotyped images of coffee shops, clubs and hotels. In the end I came back to the abstract concepts of space, light and colour - the basic elements of modern architects in its early stages.

"Several different structural forms were placed in layers. The wards have walls with square windows in the style of rationalism, and the examination building has a cubic structure. Inside small cubes are incorporated in the form of doorframes. The facade is a curve wall. Amongst the basic cubic structure are a slope, pool and courtyard, set up in such a way that there is an unobstructed view from every angle".The unit is organised in a linear arrangement along a central spine with the public reception and diagnostic services to the front and the more peaceful patient spaces to the rear. Located at the head of the top lit barrel roof circulation is a luxuriant rectangular pool. In this region famous for its volcanic hot springs the lying-in pool is an important asset for the status of this facility, water being central to the Japanese psyche, and 'Onzen' natural springs being quintessentially Japanese.

The Sea Ward Stress Care Center Omuta Architect Itsuko Hasegawa 1989
The ever-evolving work of Itsuko Hasegawa is the product of a listening architect with an enormous amount of formal flair. Since the Kobe earthquake disaster her concerns have increasingly been for social building types such as housing and community centres, providing straightforward solutions. With her strong passion for the social agenda she will often intervene in the client's brief in favour of a collaboration with the users. Despite her soft planning approach she clearly retains a bold formal sensibility.The design of the Sea Ward Stress Care Center at Omuta, Kyushu, started as an extension to the existing Shiranui Psychiatric Hospital complex, which was overwhelmed by patient demand in an increasingly stressful society. Hasegawa was initially attracted by the chance to build new hospital accommodation that responds to social needs, and spent three years exploring the relationship between architecture and medical care. She contemplated the creation of a holistic environment for the spiritual well-being of the patient, as well as the functional relationships involving the medical profession, the patient's family and the local community.

Based on her extensive enquiries and personal experience, Hasegawa proposed selecting a site along the shoreline of the estuary. This would provide a soothing open vista of water and reflecting light, plus the benefit of the natural rhythms of tides and the motion of waves, helping to make one feel part of nature. Borrowing scenery and nature in this way is informed by the traditional landscaping technique known as Shakkei. Sea Ward is a low budget building which in order to blend in with the existing architecture and landscape took the form of a mysterious cluster of houses. To provide a clear view of the estuary all patient rooms are placed along the water in a segmented linear pattern that approximates to a gentle amorphous curve. The building is bathed in reflected light from the water surface providing an airy, warm and relaxed ambience. The standard patient room has four beds, but to provide privacy plus cornmunal space is equipped with a modular furniture system, three doors and window by each bed. The nurse stations are discretely located, and washrooms, circulation spaces and the large terraces are arranged with a distinct nautical impression. In common with many Japanese hospitals each ward room has a communal balcony which in some cases operates as an alternative exit route in case of fire. Such balconies are similar to the veranda space or engawa' of a traditional house.

The dimensions and proportions of each and every room plan, wall elevation and ceiling are different - each space therefore has its own distinctive characteristics; a rare achievement in the planning of medical institutions. The architect's holistic approach with this experimental therapeutic space is attracting attention from the academic medical fraternities. It represents a pioneering treatment not by medication but in raisins the spirits of patients, by release from physical confinements and synchronisation of their rhythms with those of nature in the design. The unit has become the subject of research into the relationship between architecture space and psychiatric care that found that the patient length of stay has been significantly reduced. The only casualty is commercial, as less time and medicine means less profit!

Hinuga Aged Peoples Home Hinuga, Yatsushiro City Architect Toyo Ito
The project is situated on reclaimed land beside the habour in the fishing village of Hinuga, on the coast of the Shiranui Sea. Accommodating fifty senior citizens, the building is 100 m long, with rooms arranged along a central circulation spine to maximise sunlight. The dayrooms, dining rooms, bathrooms and other common activity spaces are positioned according to accepted walking distances and frequency of use. This is a surprisingly bright and colourful building for care of the elderly, designed by the master of lightweight structures Toyo Ito, who has an extensive portfolio or radical and extraordinary buildings.

The home for the elderly, with the exception of his nearby Le Corbusier type fire station, is an unusual venture into social institutions for Ito. Hinuga has an uncompromising and outstandingly sleek modern horizontal volume, but with a dynamic, extrovert and celebratory quality more reminiscent perhaps of a holiday villa. Simultaneously its Japanese origins are evident in the structure, from its translucent lattice screens to canopies and elegant posts. The functional accommodation conforms to a linear circulation arrangement, with creative interventions being applied to the formal entrances and interstitial spaces. The detailing and treatment of incidental leftover spaces adds fascination to this building, and it is in the margins, the void known as Ma, where the essence of Japanese spatial art forms is found. The contrast of rectangular solids and curves in the open ovals provide the joy to make this a building of distinction.

A variety of one and two bed accommodation is provided, and more than half of the wards are made up of tatami mat rooms with foldaway futon mattresses. Providing these rooms is entirely consistent with the routine living habits of the older local country community. Levels of comfort and privacy are not the universal qualities such as those that modernist principles promote, but are specific to local customs and climactic conditions. Toyo Ito's attention to detail in the interiors makes this building convivial despite its 'modernesque' intrusions. In addition, the flat roof utilises metal decking with hidden beams to emphasise the lightweight form of the roof. Spaces, materials and colour are organised in a loose arrangement to achieve a soft blending of boundaries. And features such as the courtyard and the garden offer a stage-like setting with distant countryside views and sea vistas. The home operates as a large family residence or long-term fifty room hotel, as well as a medical and educational facility. It has a relaxed atmosphere that invites non-residents to casually drop in. The meeting rooms open out on to the broad grass pitches, which promote activity such as croquet, a spring film festival, summer fireworks display, the autumn harvest festival and kite flying in winter.

Kyushu, the ancient gateway to the Orient, demonstrates the influence of the West's modernist dictates, which have determined the design characteristics of the main urban Japanese hospitals. These three small provincial but innovative community hospital projects in Kyushu may however signal a reversal of this trend. The design ideas present in the facilities outlined above may incorporate the unique cultural qualities of Japan, but they are surely not too exotic to he emulated here in the UK


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