UGNAY: MODERNIZATION OF LEVEL III ORTHOPEDIC CENTER BUCAYON

Ugnay: Modernization of Level III Orthopedic Center

Applying the benefits of biophilic theory to hospital design

They say that an ailment afflicting the bones is one of the most piercing of pains. Aiding
it requires severe treatment, devotion of time and money, faith and hope. Orthopedic cases
are on the rise because of the aging population. Hence, high technology surgeries, implants
and treatments will now be offered to all Filipinos. Each of us can potentially benefit from
having a modern orthopedic center. Efficiency can give rise to profits by performing operations
quickly and safely, the new POC can serve an estimated four times more patients (Ong, 2014).
Filipinos from all walks of life who need ortho-medical attention from province travel to Manila
just to get a health care support to patients with musculoskeletal disorder and related
conditions. Without the knowledge of most people, a musculoskeletal disorder is a common
and dangerous problem everyone should never disregard, this may lead to serious problem if
not given action and medication. A specialized hospital focuses on specialized health care for
specific ailments and can help lessen health care expenses compared to general hospitals.
The Quezon city is site of the most number of hospitals with the biggest bed capacity in the
country and home to numerous wellness centers, and physical fitness centers. The
development of healthcare program aims to integrate and assess all these services to better
promote the city as medical tourism destination. According to the 2010 census of Philippine
Statistics Authority, of the 92.1 million household population in the country, there are 1,443
thousand persons or 1.57 percent had disability. The total number of persons with disability
(PWD) in the 2000 was 935,551 persons, which was 1.23 percent of the household population.

According to the Department of Health (DOH) since the development of its main
building along Banawe Avenue, Quezon City in 1963, has no major renovation or improvement
occurred principally because of budgetary imperatives. With the developing number of
orthopedic and injury cases in the country and changing innovation in both medical practices
and medicinal device industry, there is a need to enhance the POC to meet the requests on
these different fronts.

These temporary ward along hallways creates

additional blocking to other patients passing
through the corridor, making the setting not
suitable for healing. The hospital also uses
tractions in straightening patients’ bones, a very
old procedure seldom used in most Orthopedic
hospitals today.
Figure 1 Female Ward
Source: YouTube, Philippine Orthopedic: Hospital
Trauma
Date Sourced: October 24, 2018

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UGNAY: MODERNIZATION OF LEVEL III ORTHOPEDIC CENTER BUCAYON

The photo shows the present state of the

Figure 2 Out-patient Department
Source: YouTube, Philippine Orthopedic: Hospital
Trauma
Source dated: October 24, 2018
POC out-patient department. An orthopedic
hospital is likely to have patients utilizing
support like wheelchairs, support, and so
forth. In this manner it must be taken into
consideration the best possible width of
corridors, waiting areas, bathrooms, and
halls. The out-patient department in the
current POC has lesser space for wheel
chaired patients particularly along the lobby
heading off to the consultation rooms.

The statistical data shows that NCR was

Patient Catchment for POC recorded and also placed as the highest
2010 number of patients admitted in POC. While
the city is now having a great progress and
2008
is becoming more populated, this will also
2006
affect the risk of having a greater rate of
0 1000 2000 3000 4000 5000
accidents. An accident is very unfortunate, it
Provinces total NCR happens unexpectedly and unintentionally
anytime, anywhere, typically resulting to
Figure 3 Patient Catchment for POC for 5 years
Source: Philippine Orthopedic Center damage or injury needing an urgent
Date Sourced: October 1, 2018 Orthopedist health care.

Figure 4 Theoretical Framework

Date sourced: October 15, 2018

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UGNAY: MODERNIZATION OF LEVEL III ORTHOPEDIC CENTER BUCAYON

In the Philippines, there is only one public hospital where bone trauma and diseases
are treated. The POC is known as the only tertiary hospital specializing on bone trauma and
diseases. Its patients currently avail of free medicines, supplies, and therapy sessions. This is
also where orthopedic patients from all over the country are being referred to (Romero, 2015).
Maintenance for elderly patients undergoing orthopedic surgery, particularly for those
requiring emergency surgery, needs to consider an analysis of physical capacity and risks
specific to elderly individuals, in an attempt to reduce the risks. Nevertheless, these remain
high in this group. Despite the risks, procedures developed promptly have a positive effect on
these patients’ evolution. Coordinated care, composed of teams of specialists within clinical
medicine, geriatrics, orthopedics, anesthesiology and critical care, along with other healthcare
professionals, may be highly beneficial for this group of patients (Leme, 2011). With growing
costs of health care delivery everywhere throughout the world, public health services,
specifically, are reeling under the burden of shortage of funds to deal with their health care
facilities. However, providing free social insurance to the economically weaker population of a
country is the obligation of each responsible government. The objective of this research is to
help and treat orthopedic handicapped patients recover as quickly as possible in their disability
with the goal to live, learn and work in the community and to re-incorporate them once more
into society. Finally, the facility aims to offer a place for recovery and mending for the patients
with its cutting edge and best in class offices and gear. Also, it aims to enhance the delivery
of health services by transforming the POC into the country's primary center for bone and
joints disease that is at similarity with global standards and will involve the construction and
upgrade of hospital buildings and facilities, and to construct a super-specialty tertiary
orthopedic hospital at a new site. The key rationale of the same is to locate all the super-
specialty tertiary hospital in close proximity and build synergies among the hospitals.

This project will educate visitors and the users, that impairment isn't the finish of life.
There are certain facilities which can assist the disabled with improving its mobility and lifestyle
with the end goal to return to the world with certainty. As well as educating the public the
advantage office of nature approach design for health care facilities. This facility will add to
the change of human services in the locality and additionally giving opening for work to the
jobless. The study has its advantage for the designers and planners designing healthcare
facilities specialized in orthopedic diseases. Updating our health care facilities with
considerations of healthy and eco-friendly environment will be a great change to the traditional
health care in the Philippines. The clients or patients utilizing such facilities with healing
environments demonstrates that mending and recovering from their hindrances is
substantially quicker. Considering eco-therapy in Healthcare Facilities is advantageous to both
users and medical personnel in terms of financial, increase staff efficiency, and decrease the
stay of patients in the office. Positive interactions of patient and medicinal staffs assume a vital
job in accomplishing a healthy environment. The study will likewise benefit researchers
specifically of healing environment studies and the study of nature's mending in the human
body. Patients with Orthopedic cases are the primary user of this project because according

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to the Socio-Economic Physical Profile (SEPP) of Quezon City, the Orthopedically

handicapped persons are the most number of PWDs served with 2,041 cases or 19.90% of
the total number of PWDs served in the catchment area. Secondary users are the doctors and
allied professions, since the main project is a hospital, they are the one who will develop and
treat patients that will suit to their needs and to provide fast recovery given a specific therapy.
The students and/or medical practitioners will be the tertiary user because their end goal is to
understand what their future careers will be. They will experience different cases/rounds to
provide them with sufficient knowledge about the path they’re taking. The scope of my study
is will be focusing on the necessary needs of the proposed new Philippine Orthopedic Center
located at East Ave, Quezon City, the basic concepts of architectural plans and issues to
ensure that the design is feasible for the site. It focuses on the zoning, building structure and
department facilities orientation, road networks and accessibility in relative to the existing site
condition. This will be limited to the standard requirements of a tertiary level hospital, based
on Department of Health and Bureau of Licensing and Regulation technical requirements. The
researcher delimits the percentage or number of users, patients and conditions shall be
different from time to time and the construction materials of the facility that is being used in
the building. The project’s structural, electrical, plumbing, and mechanical system shall be
limited to basic concepts only. The intensive computation is out of the scope of the designer
and the study laws are limited to Specialty hospital.

In 1839, the Lexicon Medicum mentioned the “healing powers of nature”, contending
that numerous ailments could be cured without the assistance of medicines, just by focusing
on air, food, rest, physical activity, and state of mind. Therefore, nature was viewed as
restorative and capable of affecting the health of individuals and helping their recovery. In
modern times, however, the built space has been conceived and designed by giving nature a
role that is not only marginal, but also irrelevant to the health and happiness of individuals
(Kellert, 2012). Biophilia is an idea that reveals that individuals are instinctively associated with
all other living systems. Biophilic design depends on the idea of biophilia with sustainability,
and it conveys nature, urban design and architecture. Green building is one of the outlines
that have adjusted biophilia more currently and has thus enhanced the living condition of
people. This can be proofed, for example where some human building has its very own energy,
light and water. In the meantime, there is conservation and purification of a similar water.
Opportunities to interface our natural affinity with nature can be accomplished inside and also
outside, more often than not through the offering of sensory stimulation from, or interactive
cooperation with natural elements. The innovation without a doubt, will upgrade good health
of the workers with regards to green building. Also, treatment of water and energy preservation
will be made simpler. This is one of the innovations that have made structures attractive. “Even
though the healing powers of nature’s attributes are understood by healthcare designers, they
are often poorly applied. For example, by design, most metropolitan hospitals are deep-plan
buildings that feature large areas of enclosed interiors, which have the unique disadvantage
of isolating occupants—medical staff and patients alike—from visual contact with a natural
exterior,” Navarrete said. Typically, the opposite of Biophilia is Biophobia. It is critical to

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separate between uses of this term. Biophobia is utilized to portray an evolutionary

advantageous negative reaction to things in nature that represent a risk, for example is toxic
animals or a precipice. The term is additionally once in a while used to indicate an aversion to
all things in nature. Such a reaction is found out and its regularly present in those just
comfortable with for the most part fake conditions (Salingaros, 2015).

In Quezon City, Philippines there is an existing Orthopedic Center which is the only
public hospital specializing bone and trauma diseases. The Philippine Orthopedic Center
(POC) was initially located in Mandaluyong, Rizal by the Americans in 1945 as Philippine Civil
Affairs Unit (PACU) No. 1 to deal with civilian setbacks during the liberation of Manila and its
rural areas. After it was turned over to the Philippine Government, its name was changed to
Mandaluyong Emergency Hospital and its capacities were diverted to care for accident victims
and orthopedic cases. The name was later changed to National Orthopedic Hospital in 1947.
In 1963, the hospital was moved to its present area in Quezon City with a 500-bed limit that
was consequently expanded to 700 to respond to the orthopedic and rehabilitation demands
of the expanding number of patients. After the passage of Batas Pambansa Blg. 301 in 1982,
the doctor's facility was renamed National Orthopedic Hospital and Rehabilitation Medicine
Center and its health programs were extended and included activities complementary to
orthopedic. By ideals of Republic Act No. 6786 marked in November 29, 1989, the hospital is
now called Philippine Orthopedic Center (Information Memorandum-MPOC, 2012)

The table shown on the left

side are the information of
the existing POC given the
patient load and
characteristics.

Figure 5 Patient Load and Characteristics

Source: Information Memorandum-MPOC, 2012
Date Sourced: October 23, 2018

The Philippine Orthopedic Center is situated at Banawe, Quezon City. With respect to
the site, it is not situated along the major road making it not a risk to high density road traffic
because of large number of patients referring POC. The site is likewise encompassed with
commercial establishments like convenience stores and fast-food chains making it more
helpful for the patients and their families/visitors. The location of the POC has enough open
space surrounded by trees that gives shades for the pedestrians and also for the patients. The
major entry and exit in the facility are easily be identified through signages. In spite of the
expanding demand of patients to be catered, the POC practice to allow each patient in need
particularly the indigent or poor people. Developing trends in hospital planning may explain
the issues in hospital planning of spaces and emphasis on patient focused hospital. Whenever
occurred in POC, progression in medical sciences may change the nature of services given

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by the hospital. Because of increasing demand for Orthopedic Healthcare in country, the
administration stresses that the country’s leading tertiary care center for Orthopedic
Healthcare and Rehabilitation Medicine will be unable to withstand the huge number of
patients they would need to cater. Observer to this phenomenon are the patients consulting
at the Out-patient department. Patients at the OPD were stuck at the waiting area right outside
the consultation rooms. The hall along the consultation rooms likewise functions as a waiting
area. The population of the country increases rapidly overtime, so as the demand for
orthopedic healthcare and rehabilitation medicine. Upgraded expectation for patients may
likewise rise. Emphasis on improved ambulatory care may also take place. The need for
modernization of the POC (by way of development of the proposed new hospital) is also clearly
congruent with the past and current health sector initiatives undertaken by the Government to
facilitate improvements in medical services delivery. At the same time, there has been an
impending need to establish a “Center of Excellence‟, providing comprehensive health
services for the prevention and treatment of musculoskeletal and neurological diseases,
provision of trauma care as well as rehabilitation services, which is at par with the other
privately run, world class health care facilities in the country (Information Memorandum-
MPOC, 2012).

Definition of Terms:
1. Musculoskeletal disorder- are injuries and disorders that affect the human body's
development or musculoskeletal framework.

2. Orthopedic- is the branch of surgery concerned with conditions including the

musculoskeletal framework.

3. Specialty hospital- subclass of a hospital that is primarily or exclusively engaged in the

care and treatment of specific ailments and diseases (orthopedic)

4. Modernization- the process of adapting something to modern needs or habits.

5. Bone Trauma- a bone crack might be the result of high-power effect or push, or
insignificant injury damage because of certain medicinal conditions that weaken the
bones.

6. Rehabilitation- the action of restoring somebody to health or ordinary life through

preparing and treatment after imprisonment, addiction, or illness.

7. Disability- a physical or mental condition that limits a person's movements, senses, or

activities.