2017 is the Year of Climate Change and Health, a 12-month APHA-led initiative with monthly themes related to the health impacts of climate change. November’s focus is on Tribal and Indigenous Health. Today’s guest blogger is Anne Schopf, FAIA, design partner at Mahlum Architects in Seattle, Washington, and member of the Advisory Group of the American Institute of Architects’ Committee on the Environment. She writes about a unique project serving the vulnerable native populations of the Bering Strait.

anne-schopf-aiaThe Norton Sound Regional Hospital in Nome, Alaska, is the first comprehensive medical and wellness center to serve the health care needs of the Inupiat, Siberian Yupik and Yup’ik people of the Bering Strait Region of northwest Alaska. The facility, which opened in 2013, supports a system of satellite clinics in 15 coastal and island villages accessible only by air or boat. Mahlum served as design architect in partnership with Kumin Associates in Anchorage, which served as architect of record.

The 144,000-square-foot Critical Access Hospital is the first in the nation to be designed for ownership and management by, as well as service to, native tribes. Comprehensive inpatient and outpatient services are housed under one roof – surgery, enhanced diagnostic imaging, obstetrics, advanced dental care, a pharmacy and physical therapy.

The hospital includes an emergency room, offices for public health nursing, laboratory services and 18 in-patient rooms. It also features an 18-bed wing for elderly nursing care, with a salon and spa. Previously, access to this level of care required two-hour flights to Anchorage, which are often delayed due to severe weather and further postpone medical treatment.

To learn about the values, traditions and challenges facing community members, the project team traveled throughout the hospital’s 44,000-square-mile service area to meet with individual village leaders, tribal elders and clinic staff. While some challenges varied between tribes, many were very similar.

Several of the native languages are vulnerable to extinction, which adds to the fear local tribes have of losing their culture. Also, the influence of Western diet and substance abuse — as well as the increased difficulty in hunting traditional prey because of loss of sea ice — have promoted obesity, diabetes and other chronic diseases. And the limited sources of clean water are being contaminated by the melting permafrost, which exposes populations to the harmful chemicals that had previously been trapped in the frozen soil.

The tribal elders’ stories informed the architects’ design focus on integrating state-of-the-art medical technology within a calming, culturally relevant environment. Comfortable waiting areas and wide stair landings provide spaces to wait or chat with neighbors, while signage includes local dialects spoken by the diverse population of the service region. Views of the vast landscape and sea from all patient rooms and public areas promote healing and general well-being for patients and their families, who are deeply tied to the experience of nature in all parts of their daily lives.

Paintings and sculptures evoke strong themes from the region and its culture and provide visual wayfinding cues. A local native art consultant traveled across the region to select individual pieces from each village to tell a part of their story. Aerial shots of each village and community are also hung throughout the hospital.

In addition to treating the medical needs of the local people, the building contributes to climate change adaptation and mitigation. The structure is elevated to maximize wind scour under the building to help preserve the permafrost, much of which is thawing under today’s warming conditions, and limit environmental degradation. The foundation uses thermal piling to further protect the permafrost.

The hospital’s design combines several systems to protect against the elements while increasing energy efficiency. Triple-pane windows guard against heat loss while allowing in generous daylight regardless of seasonal light variation. Optimizing Alaska’s naturally low-angled sunlight to deliver natural light throughout reduces the energy load of the building. With 8 percent of greenhouse gases in the United States coming from the health sector, these — among other strategies — help ensure that hospitals concurrently promote patient and environmental health.