Recontextualization of Tension and Threshold
What is healthcare? What if healthcare is not simply a medical intervention, but a collective process shaped by historical and cultural practices—a system that relies not just on individual bodies, but on the bodies of the society? A healthcare facility that is highly contextualized by its sites?
In the Gumuk Walik Medika Clinic project, we explore these questions through an iterative design process that puts all of these contexts into layered thresholds. Each of its tensions—between tradition and modernity, between ecology and access—situates and shapes our design strategies. These tensions act as generative externalities that predetermine and determine its internal configuration and material logic.
Gumuk Walik Medika Clinic was established 25 years ago, and had a chance to be the only health facility in these areas. Patients generally are the villagers from surrounding mountainous areas, particularly on the mountain slope around Grabag District, Magelang Regency: Pringsurat hills on the north, Mount Telomoyo on the east, Mount Andong and Merbabu on the northeast, and other surrounding lowland areas. Primarily work as farmers or agricultural produce traders, generally known as ‘mountain people’ by others.
Gumuk Walik Medika Clinic located in the economic center of this area, adjacent to Grabag Market—the most vibrant place and one of the important melting points. An area with the most dense traffic of people and goods, gives this clinic a high accessibility for anyone who needs medical treatment and healthcare. Although it has undergone several management changes, the main value of the clinic always persists: Preparedness, quick response, a potent healthcare, along with good communication, became the reason for the long term patient thrust. Because of that, organically this clinic was known to people as “klinik e wong Grabag” (the Grabag people’s clinic)—an impression that represents the cultural significance and its deep relations with the local people. There is also a unique cultural practice, a ‘tilik’ tradition that represents social cohesion among the villagers: If relatives get hospitalised, the villagers take turns taking care of each other attentively, a kind of social security network that existed long ago in Javanese culture.
On the other hand, historically, most of the clinic medical staff are women that actually characterised its service's nuance to be more feminine–articulated by a constant sensitivity, empathy, flexibility, and nurture for the patients. A care that positioning interpersonal relation as a basic of services. Those notions are reflected in clinic services that make emergencies a top priority, such as 24 hour patient pick up and drop service, 24 hour emergency services, and supported with outpatient and inpatient services.
Despite its potentiality, this clinic faces many problems, currently this clinic has a significant number of patients decline, caused by a combination of factors: radius based primary healthcare unavailability (there is lack of maternity healthcare, obstetrics and gynecology, and other similar services in that respective radius), unfeasible healthcare facility, lack of management resource, and facing new competitors.
On the other side, there is another tension. This 25 year old clinic building is not suitable anymore for basic standards healthcare facilities, and does not meet state’s statutory regulations—so that operation permit is threatened with revocation.
Based on intensive in depth interviews with all stakeholders (healthcare expertise, management staff, non/medical staff, and doctor clinics) we conclude that primary design goals of this clinic is how to recontextualise existing values with its historical and cultural significance, and at the same time also accommodate new potential markets. So the main program of the clinic—that is emergency services and its complementaries—must be reprogrammed and generated into a more efficient and effective streamline that focuses on mobility, capacity and preservation of patient cultural values. A development that can optimise management and facility capacity, increase competitiveness, and business development adaptivity.
Those goals face some constraints and challenges: a site context that has compound and narrow characteristics, located in a dense neighbourhood, lack of internal management capacity, and existing patients that have unchangeable preference (a cultural sense of familiarity). Altogether those constraints contest each other—we call it market threshold, social and environmental threshold, and internal management threshold—and shape a design arena that must be integrative and comprehensively solved. In doing so, we compose a concept based on trade-offs logics, that its conclusion functions as an iterative validation instrument through triangulation: Is in every design phase and its result, can negotiate between three arenas of threshold and multi-directionality of tensions, so it can mitigate building performance failure risk?
Based on those questions we conduct a set of design strategies: First, for social and environmental threshold, we focus on how this clinic design can contribute to the space quality improvement in this area and neighbourhood, such as debottlenecking of site accessibility, water (zero run off) and waste management (a closed and separatable treatment circulation), and giving respective buffer and setbacks through green spaces. Hence, the building can also have some benefits, such as natural lighting and passive cooling as the first option. Second, internal management threshold, we configure a modular program based on its core modalities and can be developed into diverse future possibilities (and also can be interrupted). In this program configuration we emphasise on streamline mobility guided by a sign system that is embedded seamlessly into its aesthetics—so the health services movement can be more effective and efficient. Third, market threshold, we put ‘tilik’ tradition as a core program, serve as an identity and constitute its design impression and expression, bring familiarity and non distinctive presence in dense and already vibrant context—particularly with the Grabag Market nuances and aesthetics.
Focusing on patient wellbeing, this design put the context as a means, and configuratively reprogrammed existing clinics into more interrelated and interconnected social and cultural values in the new design. So the healthcare facility function—promotive, preventive, curative, and rehabilitative can be developed integratively with business goals and customer satisfaction objectives, especially in more sustainable ways.
