Launching and Sustaining a Healthcare Design Revolution in India

Can the dream become a reality?

Former Prime Minister I. K. Gujral, while addressing the 1998 Science Congress at Hyderabad, made the following remark. ‘I see before me the bottled water kept for dignitaries on the dais. It reminds me of three classes of Indians: one who can afford bottled water; others who manage to get some water in their taps or in a nearby tap or a pump irrespective of its quality or regularity of supply; the third set of Indians are those for whom drinking water is a daily problem and who will be ready to drink any polluted water.’ He went on to say that for such a situation to persist after fifty years of independence was a national shame. If we do not improve matters on this front, and the related one of healthcare, ten years down the road we might be saying the same thing.

That was in 1998. Fifteen years down the road, at the start of 2014, I can feel the beginnings of a stirring of pride in being a healthcare facility designer in India. My colleagues and myself are engaged in a quest to create life-enhancing environments in the healthcare industry, and we feel like a special group of people. We design specialized cardiac care facilities for the first class of Indians mentioned above, and with equal passion and commitment we design primary health care centers for the second class. Working, as we are out of our ivory towers in India’s premier metropolis, we are unable through design to address the problems of the third class of Indians defined by Mr. Gujral. There is, however, a quickening of excitement, a feeling that things are changing.

It is all about change. We are living through an unprecedented time in our country’s history. Every institution, organization and person is experiencing change at a quicker, deeper rate than ever before. Change can be frightening and uncomfortable, but because every institution is breaking down, it is also an opportunity for dream-makers to recreate their environment. The societal structures we are living in today are breaking down for a reason. They are breaking down because they are mechanistic; they are not connected (unplugged!), and they are not holistic. All of our boxes, hierarchies and physical structures that are not connected to the mission of an organization or to how human beings actually live and work and move are breaking down.

In the first half of the twentieth century, if at all the modern era had a central image, it was that of a kind of non-image – a void – and if the era had a quotation that summed it all up, it was the Irish poet William Butler Yeats’s lines “…things fall apart; the center cannot hold; mere anarchy is loosed upon the world.” It was a time of intellectual chaos, and we needed “map-makers”, the priest’s of the new “post-modernism” era to chart this depthless new world without a center. In architecture it was a new vision that was provided by the voice of Charles Jencks with the publication of his book “The Language of Post-modern Architecture” (1977).

The soulless healthcare facilities that the ‘50’s and ‘60’s produced in the Western countries were the products of an architectural style named ‘Modernism’, which began with the Bauhaus school founded by Walter Gropius in 1919 in Germany. The school believed that buildings should be functional. They thought that the new architectural designs should be intelligent, cold and calm – pure creations of the mind – manifestations of men creating their own universe. Modern architecture attempted to pare down line, space and form to their pure essentials.

What it all boiled down to was cityscapes full of concrete and glass boxes. But then the supposed perfection of the immutable mathematical laws of harmony itself broke down into non-Euclidean geometries and incompleteness theorems. The utopias of Modernism, such as Brazilia, flopped. And the joyless, functional concrete and steel hospitals that these architects produced, which terrorized a whole generation of hapless patients, were rejected by a society increasingly conscious of the power it possessed to choose and determine what it was that it was buying.

Jencks defined Postmodernism as “…double coding: the combination of Modern techniques with something else (usually traditional building) in order for architecture to communicate with the public…” Jencks was talking about connectedness, about being plugged in!

Postmodern healthcare facilities must use both new techniques and old patterns. They have to transcend the modernism they are mired in. They can quote from the past, but with irony. They can parody the past. They can use pastiche. Double coding stages the dissonance and play between our past and our present. This dissonance can be ironic, humorous, parodic, playful, allusive – all qualities of good literature – and similarly it makes the “reader” of the hospital building reflect.

To launch and sustain this post-modernist healthcare design revolution, we have to design with the intention of destroying the sense of alienation the public at present feels from current healthcare delivery buildings, design with the intention that we will through our design skills touch a familiar image in the minds of our users (patients, visitors and staff), be playful or joke with them through built form. We must engage their intellect like Calvin and Hobbes do with the readers of the their comic strip.

In “The Fifth Discipline Field Book” Peter Senge writes, “This gap between our vision and current reality is creative tension.” If we view it as creative tension versus problems, then that creative tension can fuel the energy we need to close that gap. Think of a rubber band. When it is slack it is not very exciting. This is what happens to people and a society that are resigned to their lot. We cannot be constrained by a “it cannot happen here, this is India” mentality. A good designer understands that s/he is terribly flawed, but focuses on everyone else’s gifts. We may have made a lot of mistakes, but we need to get up quicker, stronger and wiser.

I have been through difficult times in my life. I have had to struggle very hard with questions like, ”What do you believe in? What are you here for? What is your purpose and what do you want to do with your life? What has sustained me is hope, and a strong feeling that one day, through my efforts, something beautiful will manifest itself in this world. This has been my dream.

Make it yours. There was a time when we thought we could change the world. Keep the dream alive.