CHAPTER 1.

0: INTRODUCTION

Pascual, Jayvin John P.

MAGALANG MEDICAL SPECIALIST HOSPITAL
A LEVEL 3 HOSPITAL SPECIALIZED IN LUNG DISEASES

1.1 THE PROBLEM AND ITS SETTING

1.1.1 INTRODUCTION/BACKGROUND

Filipinos love gatherings so sometimes it is inevitable that infectious

viruses such as pneumonia will spread. Many lung diseases can affect. As in
children with childhood asthma, in middle ages many Filipinos suffer for
tuberculosis and in adults and children it is pneumonia. The major risk factors
such as childhood wasting, air pollution, and poor sanitation, falling global
poverty. If we are hospitalized we are at risk of getting lung disease like
pneumonia, all patients brought to the hospital have in strong germs, when we
give them antibiotics we are able to kill those, but what happens to the antibiotic-
resistant bacteria? They weaken the immune system of patients. And because of
the pandemic we are experiencing today. Covid-19 exacerbates those with lung
disease and increases the number of deaths today in the Philippines and around the
world.

Lung disease one of the most alarming disease. And pnuemonia is

listed at top 3 most killer disease in the world. 2.56 million people died from
pneumonia in 2017. Almost a third of all victims were children younger than 5
years, it is the leading cause of death for children under 5. And the death rate
continue to increases causes by Covid-19. Pneumonia is the infection of both
lungs. Pneumonia is an infection of the tiny air sacs of the lungs, called alveokes
breathing painful and reduces the oxygen intake. Pneumonia is caused by a
number of different infectious agents, including viruses, bacteria and fungi.
According to Philippine Statistic Authority (PSA), as of 2021 a total of 303,364
recorder deaths, 57,119 (18.8 %) are because of lung related diseases. In region 3
it is important to have a venue for persons with lung diseases to have a one-stop
shop for all their needs.

Due to lack of health facilities, the municipality of Magalang has no

capacity to provide enough health service for its current and projected Population.
While the nearest Level 2 Hospital is “TIGLAO MEDICAL CENTER
FOUNDATION” with a distance of 17.8 Km technically speaking it is too far to
transport a person with a severe condition, at the present days the problem about
heart disease cases in the Philippines tends to grow at significantly a great number
every year. Majority of the specialist that provides treatment inclined with Lung
disease is commonly found in the Metro Manila thou not all patients can travel to
Manila where most of these centres, and Specialist hospital located.

1.1.2 STATEMENT OF THE PROBLEM

The lack of Lung Disease Specialized centres is a main problem to
study. Because majority of the specialist that dealing with Health Disease are
usually found in Metro Manila. Currently patients from Region 3, particularly
from Pampanga, Nueva Ecija, and Tarlac need to travel Manila just to be consult
or undertake a surgery about their Lung Disease.

One of the main problems that rise in this study is that Magalang lack
medical facilities for its residents. Majority of the hospitals are located in adjacent
towns such as San Fernando, Angeles, and Mabalacat. However, these current
hospitals are inefficient to cater major health problems thus resulting to transfer
patients on a bigger hospital. According to Philippine Health Agenda (PHA), the
standard bed to population ratio is 1:1,000 and has a new recommended ratio of
which is 1:800. While there is a standard given, the only government hospital in
the Municipality of Magalang, Dr. Andres Luciano District Hospital, has only 25
bed capacity. With its projected 2020 population, the bed to population ratio rises
up to 1:5011 making the said hospital overcrowded. On what proponents observe,
majority of public hospitals in Pampanga suffer from problems such as lack of
man power, congestion and insufficient machines and equipment.

Major problem

 Majority of the specialist that dealing with heart related diseases are
situated in Metro Manila.
 Absences of a major health care facilities in Magalang, Pampanga.
Sub-problems

 Patients from Region 3 need to travel to Metro Manila to be treated

by Lung specialist
 High electricity Consumption of the facilities
 Carbon Emission of the Buildings

1.1.3 ARCHITECTURAL THESIS GOALS/ OBJECTIVES/

STRATEGIES
1.1.3a ARCHITECTURAL THESIS GOAL

The main goal of the proposed Magalang Medical Specialist Hospital

is to reach the recommended bed to population ratio of 1:800 by the Department of
Health (DOH). The proposed Hospital also be offering specialized services
specifically in lung diseases that are not currently offered in Central Luzon.

As for the building itself, the proposed Magalang Medical Specialist

Hospital's goal is to provide an ambiance that will make people or patients feel
more likely comfortable going to a hospital, which is not we feel in some of our
existing hospitals today. Modernization of the hospital this will cater different
areas of medicine. Extending the span of human life is to achieve the safest and
quality health care service the best it can through a committed allied professional
team.

OBJECTIVE 1:

To offer specialized services similar to other lung centers.

STRATEGIES:

1. Doing researches in the current need services and facilities for

lung related diseases.
2. Gather data of how much space needed to cater the number of
patients in the region.

OBJECTIVE 2:

To purpose a design of structure not only appealing to the eye

but also help a patient for a fast recovery. .

STRATEGIES:

1. Adding different areas of special facility, and modernizing the

hospital. To introduce a safe and resilient infrastructure and
applying Green Architecture.
2. Providing more open spaces and green spaces.
3. Selecting the proper color scheme not affecting the feelings of
 the people or patient inside the hospital.

OBJECTIVE 3:

To provide a level 3 hospital that will have a different approach

in design, far from what the typical hospital design is.

STRATEGIES:

1. As part of a theme “Metamorphosis” applying a new look to

hospitals in Magalang, and provide new services to cope with
the new world we are experiencing today due to the pandemic.
2. Incorporating the nature in our design from outside to inside,
more green space more relaxing ambiance.
3. Design a not typical look of a hospital but still follows the
prescribe guidelines of National Building Code and Accessibility
Law BPP 344 .

OBJECTIVE 4:

Provide a naturally lighted and ventilated area for sustainability

and energy efficiency of the structure, and adapt with its
environment.

1. Take advantage of natural lighting and natural ventilation.

2. Having water collector tank for rainwater harvesting system as
part of our sustainable design.
3. Study the Location of the project, sun path, and rain fall.
4. By applying some foreign design approach with regards to
sustainable design.

OBJECTIVE 5:

To build a Health Facility that is safe from being the source of

transmission of the any virus or illness.

1. Incorporating modern technology for the enhancement of

process of the proposed project
2. Sanitation, Filtration, Quarantine and other suitable measure for
 securing the safe of the people will use the structure.

1.1.4 SCOPE AND LIMITATIONS

1.1.4a SCOPE OF THE STUDY

The proposed project aims to provide needs and accessibility to lung

care services of the patient within the region. The development
of the project will include services and facilities that available in Lung
Center of the Philippines such as Cardiothoracic surgery.

The project will provide facilities and services that shall meet the
standards of licensing of a Level 3 Hospital given by the Department
of Health. Enhanced and designed project like this development will
accommodate the said beneficiaries which will be supported by the
local government of Magalang, Pampanga.

1.1.4b LIMITATION OF THE STUDY

The limit of this study are the following that will serve as the
boundaries of the project:

● Deployment of medical staffs and personnel such as nurse, doctors,

medical technologist, administration officers and staffs.
● The National Government will fund the proposed buildings.
However delayed time of the project due to budget constraints
● Supply of medicine and other medical equipment/tools.

1.1.5 PURPOSE / RELEVANCE / SIGNIFICANCE OF THE

PROJECT

The main purpose of the project is to provide facility that will

cater the general public by providing them an affordable and better
quality healthcare. This study will focus on researching for faster and
more efficient way for treating the patients.

The project also targets to lessen the number of untreated medical

conditions due to lack of equipment and scarcity of a public health
facility in the area.
 In addition to general healthcare, the project also intends to be
beneficial to those patients that have a lung condition within the
region. Through this proposed project, the beneficiaries do not need to
travel anymore to Manila just for quality and specialized treatments for
lung complications. With a specialized lung hospital lying on region 3,
the northern and central provinces will greatly reduce their travel time
which will give them efficiency, hence, will save their time and money.

In terms with architecture, the proposed project will be designed based

on nature. Tropical architecture will be applied to its interior detailed
up to its exterior façade. In accord with this the building will not only
help the patients but also its environment as well.

1.1.6 ASSUMPTION

The proposed project will be located in Magalang Pampanga. The

proponents assumed that the Department of Health (DOH) will fund or
support this project for there are many health related problems that
needs to be addressed in Pampanga. Furthermore, the proponents also
assumed that the complications prone with lung diseases must be given
enough attention. With the collected data and information, the
proponents envisions of what the project’s outcome.

1.1.7 DEFINITIONS OF TERMS AND CONCEPTS

CONCEPT AND TERMS

Green Architecture philosophy of architecture that

advocates sustainable energy
sources, the conservation
of energy, the reuse and safety of
building materials, and the siting
of a building with consideration of its
impact on the environment.

Biophilic Design is a concept used within the building industry

to increase occupant connectivity to the natural
environment through the use of direct nature,
indirect nature, and space and place conditions.
 Bed Capacity the number of beds which a hospital has been
designed and constructed to contain

Bed to Population Ratio The ratio of hospital beds to the

population.

Cardiothoracic surgery is the field of medicine involved in

surgical treatment of organs inside the
thoracic cavity — generally
treatment of conditions of the
heart, lungs, and other pleural or
mediastinal structures.

Green Spaces refers to the areas where there are grass,

bushes, plants and trees.

Morbidity refers to condition of being diseased.

Mortality the state of being subject to death.

Scarcity the state of being in short supply; shortage.

Specialized Hospital hospital that provides a limited range of

services

Covid-19 an acute respiratory illness in humans caused

by a coronavirus, capable of producing severe
symptoms and in some cases death, especially
in older people and those with underlying
health conditions. It was originally identified in
China in 2019 and became pandemic in 2020.

Pandemic is an epidemic of an infectious disease that has

spread across a large region, for instance
multiple continents or worldwide, affecting a
substantial number of people.
 Tertiary Level Hospital is a hospital that provides tertiary care,
which is health care from specialists in a
large hospital after referral from primary
care and secondary care

ACRONYMS:

DOH – Department of Health

ROI – Return of Investment

PHA – Philippine Health Agenda

PSA – Philippine statistic Authority

CLUP – Comprehensive Land Use Plan

TCT – Transfer Certificate Title

1.2 REVIEW OF RELATED LITERATURE

1000 Patients share on one Bed in Government Hospitals

By: Jefferson Antiporda,

TMT Published on February 14, 2018

THE number of Filipinos covered by the Philippine Health Insurance

Corporation (Phil Health) has increased but the public has yet to enjoy the
full benefits of the government health care program for lack of facilities and
equipment in government hospitals, the Senate found on Tuesday.

At the hearing of the Senate Committee on Health and Demography on

pending House bills seeking to increase bed capacity of several government
hospitals, Sen. Joseph Victor “JV” Ejercito said public hospitals in various
parts of the country cannot provide enough beds for patients

Citing data from the Department of Health (DOH), the senator said of
the 17 regions, only Metro Manila and Northern Mindanao have met the
ideal number of population to hospital bed ratio of 1/800.

Ejercito said the current bed to population ratio is 1:1,121

The situation is worse in the Autonomous Region in Muslim Mindanao

where the bed to population ratio is 1:3,898.

To reach the ideal ratio, the government needs additional 42,856

hospital beds to add to the existing 88,394. The senator warned that the gap
will widen by 2022 when the population is expected to hit 115 million.

Ejercito said the Department of Health would need P228 billion by

2022 to be able to increase bed capacity in government hospitals.

As chairman of the Senate Committee on Health and co-chair of the

finance committee, Ejercito said he would try to ensure that the DOH has
enough budget to reach the 2022 target.

“The program does not only involve procurement of additional

hospital beds, it also involves infrastructure particularly expansion of
existing hospitals to accommodate more patients,” the senator explained.

“We need to prioritize this growing problem of overcapacity in

hospitals. This problem has been existing for so long now,” he added.

Top 3 killer disease in PH

By Ma. Teresa Montemayor

Pneumonia is the infection of both lungs. In the past decade, it

claims the lives of 57, 089 Filipinos every year.

“It is mistaken by some as caused by lung cancer but pneumonia is not just
due to lung cancer, anybody with a compromised immune system like
elderlies, diabetics and patients undergoing dialysis they are considered at a
high risk of contracting pneumonia,” medical oncologist Denky Shoji dela
Rosa told PNA.
 Dela Rosa explained that there is also a hospital-acquired or healthcare-
related pneumonia which affects patients who have been confined hospitals
for a long time.

“If we are hospitalized we are at risk of getting pneumonia, all patients

brought to the hospital have in strong germs, when we give them antibiotics
we are able to kill those, but what happens to the antibiotic-resistant
bacteria? They weaken the immune system of patients,” she said.

Dela Rosa added that pollution could be a factor in contracting the disease
but it all depends on how weak or strong the immune system of a concerned
person is.

“So, it is important to emphasize that there are adult vaccinations, the flu
vaccine which is given every year, anti-pneumonia vaccines so adults would
decrease their likelihood of contracting the infection. It is avoidable to a
certain extent but pneumonia is a common exit of many patients,” she said.

Lung Center of the Philippines

The Lung Center of the Philippines (LCP) (Filipino: Ospital ng Pilipinas

sa may sakit sa Baga) is a government tertiary hospital specializing in
the cure and prevention of lung and other chest diseases, located on Central,
Quezon City, Philippines. The center receives budgetary support for its
operations from the national government. It was constructed on public
land donated by the National Housing Authority. The Lung Center has a
hospital bed capacity of 210

The LCP was established on January 16, 1981, by President Ferdinand

Marcos under Presidential Decree No. 1823 as a non-profit non-stock
corporation.The building is identified with what is referred to as the
Marcoses' "edifice complex,"defined by architect Gerard Lico as "an
obsession and compulsion to build edifices as a hallmark of greatness."

The Lung Center was placed under the administration of the Ministry of
Health (now Department of Health) by President Corazon Aquino on July
29, 1986, under Executive Order No. 34. The purpose of its creation was to
provide health care that specifically targets lung and pulmonary disease.
A fire on May 16, 1998, destroyed much of the LCP's build and equipment.
The fire, which started on 2:20 a.m., claimed 11 lives with nine more
missing. Calixto Zaldivar, the director of the Lung Center of the Philippines,
was indicted on October 19, 1999, for criminal negligence. He was accused
of ignoring advice from fire inspectors to install safety equipment at the
Lung Center.

The Lung Center of the Philippines was reopened on March 1, 1999, and a
new LCP building partly funded by its fire insurance began construction.

The Lung Center runs one of three monitoring stations run under an air
quality monitoring project in Metro Manila.

KhooTeckPuatHospital(KTPH)
By: Nirmal Kishnani
Published: September 8, 2017

Singapore’s Khoo Teck Puat Hospital (KTPH) might well be the most
biophilic hospital in Asia. In no other healthcare institution of this scale are
elements of form, space and landscape so explicitly tied to the goal of
human well-being—the very definition of biophilic design.

The KTPH competition brief, from the onset, asked that the new hospital
ought to be a ‘healing environment’, an idea that drew from early research in
environmental psychology, linked to biophilia, and which was prescient of
trends in Southeast Asian design where architects like Vo Trong Nghia
(Vietnam) and Woha (Singapore) experiment with deep integration of plants
and architecture.

That brief set-in motion a biophilic quest that expanded into five principles:
 Sight, visual access to greenery and water;
 Smell, selection of scented plants;
 Sound of falling water;
 Diversity of plants, birds and butterflies;
  Community, public space situated within blue-green areas.

The first concept sketch by winning team, CPG Consultants, showed a V-

shaped configuration of blocks, delineating a central court. The ‘V’ opened
to the north, letting in breezes that first skim over an existing storm-water
pond adjacent to the hospital site. To tap into this natural airflow, the
envelope of the buildings had to calibrate permeability and shade. The goal
here was that patients could access natural light, cooling breezes, and views
without risk of solar glare or rain entry.

The heart of the development, which makes these principles work, is the
green court. Designed to be ‘forest-like’, it includes water features with
aquatic species and plants that attract birds and butterflies. The greenery
cascades to upper levels of the buildings and down into an opento-sky
basement, creating the impression of architecture that is deeply enmeshed in
a garden.

At the upper levels, balconies with scented plants bring the experience to the
patient’s bedside, literally.

The green plot ratio of KTPH – an indicator of how much greenery there is
in a development – is 3.92; in other words, the total surface area of
horizontal and vertical greenery combined is almost four times the size of
the land that the hospital sits on. This is remarkable for a development in a
dense urban setting. As a proportion of total floor area, blue-green spaces
account for 18%. Forty percent of all such spaces are publicly accessible. In
post- occupancy measurements, the microclimate of this court was some
2oC cooler than spaces just outside the hospital. In 2005, mid-way through
design, the KTPH team expanded the hospital’s blue-green footprint by ‘
adopting’ the adjacent storm water pond. Collaborating with other
government agencies, the hospital team worked out a cost-sharing
arrangement whereby the pond – turned into a park – would serve multiple
groups from the hospital and neighborhood. The concrete edges of the pond
were hacked away, and new aquatic plants were introduced to clean the
water and create habitats. A walking trail was added, linking the park to the
hospital and a nearby residential estate. The pond, following the revamp,
 increased blue-green space available to KTPH patients and visitors by 400%.

Since its opening in 2010, engagement of the community-at-large has been a

priority. Residents living nearby enjoy the hospital’s public spaces alongside
patients and staff. The KTPH team encourages this, citing its role as public
health educator. This has led to the activation of these spaces with
community programmes such as line dancing, tai chi and Zumba. Volunteers
– mostly retirees – tend to rooftop gardens alongside KTPH staff. Produce
from this farm finds its way to the hospital kitchens; some is sold to cover
costs.

1.3 THEORETICAL/ CONCEPTUAL FRAMEWORK

Incorporating of Biophilic Design to project will helps the patients for fast
recovery. Research shows the incredible benefits of Biophilic Design is
mounting. Interventions that incorporate nature are linked to decrease stress,
enhance creativity and accelerated recovery from illness. It helps link people
to the environment also enhance visual comfort of the patients. “Biophilic
Design improves both physiological and physiological health which is
especially important as people spent an average of 90% of day indoor” by
Edward O. Wilson

Tropical architecture is all about achieving thermal comfort through the

use of passive design elements like sunshades, cavity walls, light shelves,
overhangs, roof and wall insulation and even shading from large trees to
block the sun. It can look very traditional, ultramodern or even high-tech.

Green Architecture philosophy of architecture that advocates

sustainable energy sources, the conservation of
energy, the reuse and safety of building materials, and the
siting of a building with consideration of its impact on the
environment.
Figure 1. Theoretical / Conceptual Framework
\

1.4 METHODOLOGY OF RESEARCH

The proponent follow systematic methods to achieve best results for the
study.

SITE SELECTION

The proponent research for a specific site in the region where they
can find and examine a definite problem.

IDENTIFICATION OF THE PROBLEM

 After selecting a site I need to identify the problem which can be
solved architecturally. Following are medium used to find such problem.

 T V NEWS
 Online Articles
 Trusted News Program in Social Media

GATHERING OF INFORMATION

Next, I need to gather information and data relevant to the problem to

come up in a possible solution.

The proponent collected information and data from different

government agencies and offices concerned with the problem. Following are
sources of data the proponent gathered from them:

Magalang Municipal Hall, Pampanga

 Land use map / Zoning Map

 Comprehensive Land Use Plan
 Tax Declaration
 Zoning Certification
 Copy of Lot Title ( Register of Deeds)

Department of Health

 Recommendation for the funding of the proposed project.

 Health Statistics of Region 3
 Mortality and Morbidity
 Checklist for designing general hospital
 Plans and Programs regarding health care

Online Articles

 Philippine Health Agenda

  Mortality rate of the Philippines
 Related Literature and Articles about Heart Disease
 Profile of Magalang, Pampanga

Architectural Programming

 Building Laws and Standards for the project

 Photos of the present site condition
 Study of the site ( Sun path, Noise Pollution, Air Quality, Access Road )

1.5 BIBLIOGRAPHY

1000 Patients share on one bed in Government Hospitals

By: Jefferson Antiporda, TMT

Published on Manila Times – February 14, 2018

‘1,000 patients share one bed in govt hospitals’ | The Manila Times

Top 3 killer disease in PH

By Ma. Teresa Montemayor

Published on Philippines News Agency – November 1, 2018, 10:54 am

https://www.pna.gov.ph/articles/1052723

Lung Center of the Philippines

https://en.wikipedia.org/wiki/Lung_Center_of_the_Philippines

KhooTeckPuatHospital(KTPH)

Singapore’s Khoo Teck Puat Hospital: Biophilic Design in Action | Human Spaces
(interface.com)

Cause of deaths in the Philippines(Premiliminary): January to June

2021
Total Deaths
 DENNIS S. MAPA, Ph.D.
Undersecretary
National Statistician and Civil Registrar General

https://psa.gov.ph/content/causes-deaths-philippines-preliminary-january-
june-2021