A Healthy Obsession

In an otherwise quiet residential neighborhood in the Tremont section of the Bronx, health-care workers are picketing in the rain outside of Pro­mesa’s substance-abuse center over lapsed contracts and benefits packages. Inside the dingy institutional lobby of the former nursing home, a few clients wait for appointments at the methadone outpatient clinic on the ground floor. A group of young black men file through a cramped, airless hallway on their way back from the cafeteria (the nonprofit also provides job training and development, along with about a dozen other social services). In contrast to the lobby, the revamped second-floor detoxification center, designed by New York–based health-care specialists Guenther 5 Architects, comes as a bit of a shock. With its large windows, open daylit spaces, wide hallways, and warm materials, the entire floor has the feeling of a modern renovated loft—except, of course, for the more confined two-bed rooms for the five-day detoxification process.

Like most of Guenther 5’s work, including two other recent health-care projects in New York—the Maimonides Cancer Center, in Brooklyn’s Borough Park, and the Mount Sinai Children’s Center, on the Upper East Side of Manhattan—Promesa’s rapid detox center attempts to transform a clinical environment into an atmosphere of healing in the broadest sense, expanding the notion of detox­ification to include elimination of the harmful materials often used in health-care facilities and improvement of the patient experience. “We view every project as a unique opportunity to shift the typology or change the paradigm,” Robin Guenther says. “Because we’re small, we can really focus on pushing the industry’s limits and getting the most for the client’s money. I focus on the idea that it’s not reasonable to build healing environments or hospitals with materials that contain known or suspected carcinogens. That irony is just too com­pelling to not take seriously. Promesa was very much about embedding those values—access to light, interesting spatial experience, clean materials—in a project for a generally undervalued sector.”

For Guenther, who speaks widely as an advocate for healthier high-performance materials in the health-care field, Promesa’s detox center is just one small example of her larger mission to transform the country’s $41 billion health-care- construction industry into a field that’s more patient-centered and attentive to environmental health and sustainability. And because health care represents almost one-sixth of the U.S. gross domestic product, its material choices resonate well beyond the field. “The emergence of healthier materials has made the industry aware of its power to move markets through what they choose to buy and how they interact with manufacturers,” she says. “That’s been a real sea change. People realize that by aggregating their purchasing power they can have a real impact on the products that come to market. Whether it’s the textile industry, the flooring industry, or the carpet industry, there’s not a building-materials sector that doesn’t recognize the power of health care as a market segment.”

The market has also been prodded in recent years by the “Green Guide for Health Care,” a new set of environmental standards produced by advocates such as Guenther and Gail Vit­tori, of the Center for Maximum Potential Building Systems, both of whom served as coordinators. The guide was released in draft form less than four years ago and refined through a pilot pro­gram the following year; by 2006 these standards had been applied to more than 30 million square feet of health-care construction. Next year a set of ramped-up LEED guidelines for the industry will add a dimension to the rating system that considers both sustainability and environmental health. “We paid a lot of attention to the intrinsic im­portance of prevention and precaution, identifying a menu of ­twenty-first-­century materials,” Vit­tori says. “One of the things we did was to say, ‘Let’s not give credit to a material because it has recycled content if its environmental quality is a problem.’”

For the most part, these changes—focused on the elimination of mercury and potentially noxious chemicals like chlorine, present in materials such as PVC and vinyl, both commonly used in health-care settings—would not be visible to the naked eye. But at Promesa’s detox center the relationship between healthy materials and the mission of promoting wellness is expressed through artful compositions of colors and materials, the increasing diversity of which is as much a reflection of industry changes as their nontoxic composition. Funded largely by the New York State Office of Alcoholism and Substance Abuse Services, it’s a strikingly pleasant and welcoming environment by any standard, especially compared to the drab, depressing rooms for longer-term residents slated for renovation in the next phase of the project.

“This is for people right off the street who were using heroin or some other narcotic hours before,” Guenther principal Peter Syrett says. “It’s one of the last stops between incarceration and death: the end of the road. Since they’re inside almost entirely during the first three to five days, we spent a lot of time trying to bring daylight into the corridors and common areas. All of the rooms have windows. This is a group of people who are really used to not being treated well, and putting them in an environment that is a little more gracious—the material palette is a notch up from what you’d expect in a methadone clinic—is an attempt to be life-affirming.”

The logical connection between high design and high environmental standards is particularly obvious at the Maimonides Cancer Center, Brooklyn’s first comprehensive cancer-treatment clinic. The biggest problem here was the awkward site, a practically windowless two-story Brutalist concrete building that originally served as a check-processing center. A large part of the front facade was occupied by the entrance to an underground parking lot, and the limited floor area as well as the heaviness of linear-accelerator machines used for radiation treatment and diagnostic PET/CT scanners required that the rest of the basement be retrofitted to accommodate oncology labs. Strange ceiling heights that once facilitated armored-truck deliveries made the task of creating an intimate ­environment for healing nearly impossible. In any other part of the country, it would have made more sense to find an empty lot and start from scratch.

But Guenther 5’s more than 20 years of practice in New York have made the firm adept at making the best out of bad situations, so for a building that deserved to be demolished, they accomplished plenty of nice touches focused on soothing the patient’s experience during the deeply unsettling process of cancer diagnosis and treatment. “Everybody who comes to a cancer center, either with a highly suspicious abnormality or an established diagnosis of cancer, experiences the stress differently,” says Dr. Jay S. Cooper, director of the center. “Some people are hostile, devastated, lost, or just don’t know how to cope with it. Although it’s important for us to talk with them about medical care and the specifics of what we’re going to do—whether it’s surgery, chemotherapy, or ­radiation—they get immediate cues from where they are, so we tried to make a building that says to them, ‘We care about you, and we want you to understand that at the end of this process you will live.’”

Most of what was done to create a feeling of comfort is not particularly exciting architecturally: floor-to-ceiling windows were added to the front facade to open up the lobby, skylights were in­­stalled on the second floor, a sunken garden brings light into the oncology waiting room in the cellar, and a fish tank and a water feature serve as tokens of peaceful domesticity. Small family rooms with couches and lounge chairs allow for private consultations and places to be alone. Artworks portraying a bridge, a rainbow, seashells, and a beach—along with upholstery and wall-coverings in oranges and browns—contribute to an overall style reminiscent of a Midwestern living room. It’s a bit staid, but effective in terms of creating a patient-centered experience. “A lot of clinical spaces have a hard edge to the materials,” Syrett says. “They’re superdurable, but there’s no tactile or visual quality to them. When you’re coming weekly or biweekly for chemotherapy, you’re a regular visitor—it’s part of your routine. We tried to make a life-affirming place with a tenor that was more spalike than clinical.”

The nontoxic material choices are equally prosaic: slate and Venetian plaster for textured surfaces in the lobby, bamboo in the waiting areas, and linoleum flooring and polyolefin plastic wall-coverings in the clinical areas. But together they add to the homey feel that predominates. “We had a doctor who was aware of sustainability issues, and when you brought up information he agreed instantly,” says Chris Youssef, an interior designer at Guenther 5 and the firm’s young missionary for green materials. “The facilities people actually changed the standard products they use to accommodate him; he was looking for something that wasn’t very traditional in health care—something more residential looking—so it was easier to come up with nontoxic materials.”

Youssef spends a lot of time researching materials and verifying their green labels; he even quit two firms because they wouldn’t exclude chlorine-based plastics from projects. “It is part of my work ethic: evaluating products to see how toxic they are or how they relate to health in the environment,” he says. “We look at materials through several different criteria to find out how toxic they are to the environment and to people, whether through their production, end-of-life-cycle, or the off-gassing of hazards.”

New York is far from typical for health-care design, but Youssef’s ethic is increasingly becoming part of the practice of hospital-building nationwide, with giant health-care systems such as Kaiser Permanente—a partner in the development of the “Green Guide”—attempting to eliminate toxic products from their facilities and pushing suppliers to change their practices. “Sustainability is just about at the tipping point in health care, and people are starting to understand not only the meaning of it but the range of benefits that spring from green building,” Guenther says. “The pursuit of hospital environments that are more healthy, are patient-focused, and create intentional moods to mitigate and destress the core medical experience is a very pervasive market trend, and it’s about time if you ask me.”

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