CABRERA, JORENE LEI S. ARCH.

ARISTEDES DE PAZ
AR200F – E02
2012123316

PROPOSED BGHMC DIALYSIS

CENTER
Baguio General Hospital Medical Centre

ABSTRACT
This study proposes the first state-of-the-art dialysis centre that
can provide patient-centred care in Northern Luzon and nearby
provinces which will address the inadequacy of Renal centres and
Haemodialysis machines in the area and this is also an exploration of
how architecture can positively affect the Dialysis experience among
patients from the region. The proposed Dialysis centre will be the only
Dialysis facility of its kind in Northern Luzon. This study would also
tackle the layout and internal building concepts that are innovative and
useful to consider when plotting the fabric of a truly sustainable dialysis
environment. On a more architectural level, this study is intended to
explore the issues of context, space programming of existing dialysis
centres and how architecture can be manipulated to create a more
therapeutic environment and to demystify the dialysis experience. The
site is located on the Baguio General Hospital & Medical Centre as a
mediation point and the proposed Dialysis Centre can have a physical
connection with the Hospital to share existing necessary functions and
provide direct access for emergency situations.

History of the Problem

End-stage renal failure, also known as end-stage renal

disease (ESRD), is the final, permanent stage of chronic kidney
disease, where the kidney function has declined to the point that the
kidneys can no longer function on their own. According to the website
of the National Kidney and Transplant Institute (NKTI), kidney
diseases, especially End Stage Renal Disease (ESRD), are the 7th
leading cause of death in the country. As a form of management for
patients with end-stage renal failure, the two most common modern
 modalities are the Renal Replacement Therapy (RRT) that includes
kidney transplantation with drug suppression therapy and Dialysis.
Dialysis has been a big, profitable and growing business in the
Philippines due to the increasing number of patients annually.
Haemodialysis is the most common treatment option for patients with
renal failure since it takes shorter treatment time and has lesser
infection risks as it is administered by professionals. Kidney Transplant
is the best option for people with ESRD but apparently, this specific
therapy has drawbacks such as the difficulty in finding a right match for
a kidney donor, low chances of survival after the transplant, and lastly,
the specific modality is the most expensive option with estimated
annual medical cost totalling to 1.2 million pesos.

According to the Health Technology Assessment

(HTA) Study Group and DOH, 2.3 million Filipinos have chronic kidney
diseases (2% of Total Population). There's a 15% increase in the
number of patients in one year from 2015 -2016. By the end of 2024,
the projected demand for Haemodialysis machines in BGHMC is going
to increase by 100 % within 5 years based on current prevalence rates.
Due to Dialysis care, the unadjusted mortality rate among Filipino
dialysis patients have slightly dropped.

Observed Problem

However, one of the biggest issues and challenges

faced by Filipino dialysis patients nationwide are the inadequate
facilities and insufficient Haemodialysis machines in public hospitals
like BGHMC (Baguio General Hospital and Medical centre) that pose
recurring issues such as schedule disruptions and the inability to
accommodate the subsequent Regular Haemodialysis Treatments of
the Inpatients. Over the past years, BGHMC only had 30 existing
machines in their Dialysis Centre and it has become the only dialysis
centre of the whole Norther Luzon serving patients from the Cordillera,
Regions I, II, III and IV with massive increasing number of patients
every year. In Baguio area alone, there are roughly more than 500
patients within 2019. The main reason why the chosen site is BGHMC
is due to the continuous rising number of outpatients flocking from
neighbouring lowland provinces like Pangasinan have their dialysis
treatments done in the BGHMC because it's the only facility with
available HD machines. The BGHMC also forced the its dialysis centre
to open its machines three to four sessions a day due to the demand
which is currently giving doctors and nurses continuous pressure and
the DOH enough reason to promise it would expand the life-saving
facility.
CABRERA, JORENE LEI S. ARCH. ARISTEDES DE PAZ
AR200F – E02
2012123316
Nowadays, the Department of Health have often
overlooked and ignored the urgent need for dialysis centres in rural
places in our country. This problem is too visible and obvious due to the
growing number of dialysis patients needing haemodialysis treatments
and are desperately clinging to life despite having to undergo dialysis
for a lifetime. Which is why the number of dialysis patients continues to
increase, much faster than the mortality rate among kidney patients.
DOH has failed to address the growing problem of ailing patients
located in the provinces trying hard to have life-saving dialysis centres
within their midst. It is very crucial to Filipino patients for the DOH to
provide a venue for the establishment of a dialysis centre such as in
BGHMC and make this life-saving procedure nearer and more
accessible to patients around CAR. Such establishment would spare
many patients from all over Northern Luzon who travel too far and
come to wait for the chance to be hooked to the treatment machine at
BGHMC. As of 2015, there are only 562 dialysis centres in the country
in which 139 are in the NCR while the recorded number of dialysis
patients was recorded at 32,077.

Despite the scarcity of renal centres in the country,

several problems arise with the existing renal centres which are the
typical constrained white-washed places not known for quality
environment and the inaccessibility to the public and lack of dialysis
machine units. Most, if not all, renal centres in Metro Manila are built
with design flaws and deficiencies that aren’t simply anaesthetic,
inconvenient and some failed in keeping a sanitary environment.
Some of these Dialysis centres are rarely inspected by health
inspectors whether they commit violations. Some nurses from dialysis
centres fail to wear gloves and ignores frequent handwashing. Such
malpractices are increasing infection-related violations amongst
outpatients and could increase their risks for blood borne diseases
such as Hepatitis.

Falls in the Renal centres are also a problem that

leads to serious injuries due to outpatients feeling the side effects after
or during the dialysis treatment such as muscle cramps, fatigue,
hypotension, cognitive impairment, decreased functional status,
dizziness etc. that caused them to be disoriented and susceptible to
falling. Design factors are also problems such as the poorly lit areas,
slippery floors, toilets being too high / low and the absence of sound-
absorbent wall panels from the nurse's station and corridors.
Observed Solutions

The proposed BGHMC Dialysis Centre will be the largest

provider of patient centred dialysis and kidney disease services in
Northern Luzon. The new centre will serve up to 150 - 200 patients and
will include abundant dialysis treatment pods and isolation rooms
featuring state of the art innovative care for dialysis patients. The
design of the renal facility will be inspired by a dynamic architectural
prototype that could easily adapt to the site and programmatic
circumstance. This innovative renal facility will not be incorporating the
conventional arrangement of the dialysis treatment beds from an
inward orientation, instead, it will be strategically positioned to an
outward orientation on each side of the building's core allowing patient
views to the landscape and access to natural light. The design will
incorporate comfortable patient stations, VIP rooms, paediatric stations
and isolation rooms for dialysis treatment. There will also be private
dialysis stations with therapeutic chairs and flat screen televisions that
will allow patients to feel the comfortable environment during their
treatment. Treatment support spaces and statistic nurse stations will be
decentralized to allow appropriate monitoring of patients.

Most importantly, the dialysis centre will incorporate several sensitive dialysis
building features such as:

 The use of natural finishes and colours that mimic nature to add biophilic
elements within each space. It will be integrated with nature, with natural
daylighting and numerous landscape areas which can be very beneficial
within the healthcare facility.

 The use of solar energy systems to reduce carbon footprint will also be
installed such as solar panels and solar thermal system that produces hot
water for the healthcare facility's needs.

 In order to utilize the environment to ensure optimum efficiency,

photovoltaic solar panels will be used to exploit Baguio's tropical sunlight.
CABRERA, JORENE LEI S. ARCH. ARISTEDES DE PAZ
AR200F – E02
2012123316

 Sunshades and wide overhangs will control the amount of heat and light
allowed into the corridors.

 Easier-to-clean surfaces as well as high-quality air filters will further reduce

infection rates within the healthcare facility.

 Water system with disposal tanks designed to reduce overall water use
throughout treatment.

 The replacement of fluorescent strip lighting by energy efficient LED

lighting systems,

 Occupancy sensors in each room and high ceilings will provide a more
open and spacious feel.

 Internal plumbing that re-uses Reverse Osmosis reject water for toilets
and cleaning.

 Internal plumbing that recycles Reverse Osmosis reject water for on-site
waste of plastic wastes.

 Roof-top solar-array to solar-assist the power needs of the building,

dialysis equipment and waste-processor.

 Roof top earth, both as insulation and to support vegetable planting –

patient-tended and Reverse Osmosis Reject Watered as both as a healthy
food source for patients and staff, and as an enhancer of patient self-
esteem and engagement.

 This renal facility will always be inspected by health inspectors annually to

prevent blood borne diseases such as hepatitis

Once the renal facility becomes broadly accessible in the

Cordillera Administrative Region, it will greatly reduce morbidity and
 mortality amongst patients within the region. Falls in dialysis centre will
also be addressed by single interventions such as wristbands,
movement alarms can reduce the impact of falls. Acoustical wall panels
and sound barriers, soundproof doors will reduce noise levels in the
facility.

Conclusion
Kidney-related diseases are consistently among the top 10
most common causes of death in South East Asia which explains why
the USD300-million Philippine haemodialysis market is fast-growing but
highly fragmented. A large number of ESRD (end-stage renal disease)
patients are unable to receive medical care due to the shortage of
dialysis centres throughout the country. People with this disease that
live in remote locations often have great difficulty accessing low-cost
dialysis centres where they can get proper treatment. As a result, their
health conditions inevitably become worse, therefore more accessible
and affordable dialysis centres need to be established throughout the
country.The goal of this study is to be able to innovate conventional
dialysis centres architecturally and find new ways to incorporate
sustainable strategies into newer renal facilities that could somehow
contribute to the well-being of patients with ESRD. To address the
problems of the renal facility, we still have to identify other innovative
strategies after this study is conducted.