Distribution of psychological depressions of cancer patients with ...... described in 1775 as soot and coal tar, when chimney sweeps were discovered to develop.
NATIONAL ONCOLOGY CENTER ABUJA: THE USE OF LANDSCAPE ELEMENTS IN HOSPITAL ENVIRONMENT TO ENHANCE THE PSYCHOLOGICAL RECOVERY OF CANCER PATIENTS.
BY MUSA MUHAMMAD AMINU A THESIS SUBMITTED TO THE POST GRADUATE SCHOOL IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN ARCHITECTURE
DEPARTMENT OF ARCHITECTURE FACULTY OF ENVIRONMENTAL DESIGN AHMADU BELLO UNIVERSITY, ZARIA
2011
SUPERVISOR; Arc Mas;ud Abdulkarim
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DECLARATION I, Musa Mohammed Aminu Department of Architecture, Faculty of Environmental Designs, Ahmadu Bello University Zaria, hereby declare that the work presented in this thesis is a personal academic undertaking executed authentically under the supervision of Arc. Mas’ud Abdulkareem. It has not been accepted wholly or partially previously for the award of any higher degree. For the avoidance of doubts, all quotations have been clearly distinguished with all references dully acknowledged.
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CERTIFICATION This thesis research work entailed 'National Oncology Center Abuja; the use of landscape elements in hospital environment to enhance the psychological recovery of cancer patients' by Musa Mohammed Aminu, meets the regulations governing the award of degree of Master of Science in Architecture (M.Sc. Arc) of Ahmadu Bello University Zaria, and has been approved for its contribution to knowledge and literary presentation.
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Arc. Mas'ud Abdulkareem Chairman, Supervisory Committee
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Arc. Aminu Jibril Member, Supervisory Committee
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Arc. Mas'ud Abdulkareem (mnia) H.O.D Architecture A.B.U. Zaria
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Proff. A.A. Joshua Dean, Post Graduate School A.B.U.Zaria
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DEDICATION
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This thesis is dedicated as follows; To my late mother peace be upon her soul amen. To my father who has done everything possible to bring me to this level of life. To Department of Architecture, ABU Zaria. To my country, for an approved health of the nation.
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ACKNOWLEDGEMENT
My total gratitude goes to almighty Allah for the choice of this noble profession and the successful completion of the course M.Sc. Architecture. I wish to express my sincere gratitude to my supervisors Arc. Mas’ud Abdulkarim and Arc Jibrin Aminu for their guidance throughout the research work. To a number of my lecturers; Dr. M.L. Sagada, Arc. MD. Ahmed. Arc. Badiru, Arc Salisu, Proff. W.B Qurix, and late Ogbabe to mention a few, whose support and encouragement led to the successful completion of this work.
Iam also heartily indebted to my family particularly Buhari Musa, Muktar Musa, Tanimu Sada, Nasiruddeen Musa, Amina Musa, Bilkisu Musa and Abdul"aziz Ango for their moral and financial support, I sincerely appreciate your contributions. Similarly, I want to show my appreciation to Dr. Sanusi Garba Rimi, Phm Nuruddeen Usman, Medigiri Ibraheem Atiku, Arc Nasuna Jaafar Gali Ahmad, Arc Dalhat M Dalhat, Arc Kifibakul Mahmud Adamu and Arc Mustapha Muhammad.
To the members of the club for your encouragement and assistance, and entire students of the department for being a wonderful family. My special thanks goes to the entire members of ZAYOPMO and MRCP, what can I do without you? Words cannot express my gratitude. Last but not the least Ahmadu Bello University Teaching Hospital Zaria particularly Dr Otene of Oncology Department; National Hospital Abuja; Architecture Data room and Kashim Ibrahim Library for their co operations, I say thank you all.
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LIST OF TABLE TABLE 1
Medical/health faculty/population/ catchments area.
2
U.S Mortality, 2002.
3.
2005 Estimate U.S. Cancer Deaths for Men = 295,280.
4
2005 Estimate U.S. Cancer Deaths for Women = 275,000.
5
Common type of cancer in Nigeria.
6.
List of plants used for treatment of chronic Inflammation/cancers in Hausa and Fulani folk medicine.
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Distribution of psychological depressions of cancer patients with Variables.
8
Distribution of percentage psychological depressions of cancer patients with variable
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Distribution of causes of psychological depressions of cancer patients with variables
10
Distribution of percentage cause of psychological depressions of cancer patients with variables
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Distribution of psychological depressions of cancer patients with Variables
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Distribution of percentage psychological depressions of cancer patients with variables
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Distributional causes of reduction in psychological depressions of cancer patients with variables
6
14
Distributional percentage of cause of reduction in psychological depressions of cancer patients with variables
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Comparison of cancer patients with and without psychological depressions. Controlled Group
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Comparison of cancer patients with and without psychological depressions. Experimental Group
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Comparison of psychological depressions between the controlled and experimental groups of cancer at Stage 1
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Comparison of psychological depressions between the controlled and experimental groups of cancer at Stage II
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Comparison of psychological depressions between the controlled and experimental groups of cancer at Stage III
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Comparison of psychological depressions between the controlled and experimental groups of cancer at Stage IV
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Comparison of psychological depressions between the controlled and experimental groups of
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Male cancer patients.
Comparison of psychological depressions between the controlled and experimental groups of Female cancer. Patients
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Comparison of psychological depressions between the Controlled and experimental groups 0 – 19 years.
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Comparison of psychological depressions between the controlled and experimental groups of
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20 – 44year
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Comparison of psychological depressions between the controlled and experimental groups of 45 – 64year
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Comparison of psychological depressions between the controlled and experimental groups of 65 years and above
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Distribution of leisure and cancer patients at Stage I
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Distribution of leisure and cancer patients at Stage II
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Distribution of leisure and cancer patients at Stage III
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Distribution of leisure and cancer patients at Stage IV
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Distribution of leisure in MALE cancer patients
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Distribution of leisure in FEMALE cancer patients
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Distribution of leisure in 0 – 19 years cancer patient.
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Distribution of leisure in 20 – 44 year cancer patients
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Distribution of leisure in 45 – 64 Year cancer patients
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Distribution of leisure in 65 and above year cancer patient
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Information of Cancer Cases at ABUTH, Zaria from June 2005 to June 2008.
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Schedule of accommodation
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Recommended plants
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LIST OF PLATES PLATE 1
Shows the uncontrolled growth of cancer cell
2
Shows plants in morphological variation
3
Fountain. Senate Building A.B.U Zaria
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Sculpture Garden A.B.U Zaria
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Grasses used as line
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Trees used as rhythm
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Pergola used as composite three dimensional form
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Natural Hill using earth as a sculptural material.
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Water body as landscape element
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Walk-ways; Department of Urban and Regional Planning A.B.U Zaria
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Street Furniture as sculptural component.
12
Shows the distribution of cancer patients without psychological Depressions and Stages of cancer
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National Hospital Abuja.
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Approach Elevation of Smillow cancer Hospital at Yale-New Haven.
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Rear Elevation of Smillow cancer Hospital at Yale-New Haven
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Approach view of Green Which Cancer Center.
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Site Plan of Green Which Cancer Center.
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LIST OF FIGURES FIGURE 1
Shows the mortality rate of cancer patients in developing nations.
2
Distribution of new cancer cases in Nigeria 2007 (males)
3
Distribution of new cancer cases in Nigeria 2007 (females)
4
Distribution of mortality rate of cancer cases in Nigeria 2007 (males)
5
Distribution of mortality rate of cancer cases in Nigeria 2007 (males)
6
Main causes of death in Nigeria, 2005 projection.
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Main causes of death in Nigeria Projection 2030.
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Clinical Staging of Tumor
9
Shows the percentage of preventing cancer cases.
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Preventable Cancer Cases
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Shows the difference in psychological depressions between control and Experimental groups
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Shows the distribution of cancer patients without psychological depressions and Stages of cancer.
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Shows the distribution of cancer patients without psychological stresses and gender.
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Shows the distribution of cancer patients without psychological stresses and age group
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Shows the map of Nigeria and its boarder.
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Shows the map of ABUJA
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Shows the map of ABUJA.
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Shows the sub-division of ABUJA.
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Monthly Relative Humidity (with min relative humidity)
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20
Monthly Relative Humidity of Abuja (with max relative humidity)
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Mean Monthly Rains of Abuja
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Mean Monthly Sunshine Durations of Abuja
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Mean Monthly Temperature of Abuja (with min temp)
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Mean Monthly Temperature of Abuja (with max temp)
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ABSTRACT
According to the World Health Organization (Alma-ata declaration) of 1978; Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity of a person. Cancer as the 5th causative agent of death in Nigeria which killed about 89,000 Nigerians in 2005 (world health organization, 2006) is gaining important in the country. The conceivable idea of Architectural contribution to the health of the nation is to be expressed in the PROPOSED NATIONAL ONCOLOGY CENTER ABUJA; using landscape elements to facilitate the psychology of cancer patients in hospital design. The objective of the research is to find the different psychological stresses of cancer patients and their corresponding leisure. The method used in collecting data includes; distribution of questionnaires to 64 cancer patients in the department of oncology A.B.U Teaching hospital Zaria. Moreover, the research findings include the following; There is 38% psychological improvement in cancer patients which are exposed to landscape elements to those that are not. Cancer patients have leisure to listening music, dancing, religious texts, etc The data were analyzed with the aid of statistical tools which include; pie charts, tables, bar charts and histogram. In conclusion, haven considered the result; The following is recommended in the design of oncology hospitals; To bring the indoor activities of the hospital outdoor.
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Both outdoor and indoor plants are to be used in planning the center and should posses the following characteristics; Pleasant smell, aesthetically appealing and medicinal plants. Division of nursing units should be based on gender, stage of the cancer and age variation. In the hospital, various sit-outs, sculptures and religious texts are to be provided.
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TABLE OF CONTENTS PAGE Title page…………………………………………………………………… Declaration…………………………………………………………………. Certification………………………………………………………………… Dedication………………………………………………………………….. Acknowledgement…………………………………………………………. List of Tables ……………………………………………………………… List of Plates……………………………………………………………….. List of Figures …………………………………………………………… Abstract ……………………………………………………………………. Table of Contents …………………………………………………………..
1.
CHAPTER ONE; Introduction………………………………………………………………. 1.1. Preamble ……………………………………………………………. 1.2. Problem Statement ………………………………………………….. 1.3 Aim ………………………………………………………………… 1.4 Objectives ………………………………………………………….. 1.5 Motivation …………………………………………………………... 1.6 Research Methodology ……………………………………………... 1.7 Scope of the work …………………………………………………... 1.8 Architectural Significance …………………………………………..
CHAPTER TWO; 2. Literature Review ………………………………………………………... 2.1. Historical Development of hospital ………………………………… 2.1.1. Types of health care [primary, secondary, & tertiary.] ………. 2.1.2. Hospital types ………………………………………………… 2.2. Spread of Cancer cases in Nigeria …………………………………../ 2.2.1 Introduction ………………………………………………….. 2.2.2. Cancer in Nigeria ……………………………………………. 2.2.3. Classification of Cancer ……………………………………... 2.2.4. Stages of cancer ……………………………………………... 2.2.5. Causes of Cancer …………………………………………….. 2.2.6. Prevention of Cancer in Nigeria …………………………….. 2.2.7. Treatment of Cancer ………………………………………….
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I II III IV V VIII IX XI XIII
1 1 3 4 4 4 5 6 7
8 8 11 12 13 13 17 22 23 25 28 29
CHAPTER THREE; 3. Landscaping ………………………………………………………………. 3.1 Landscape Elements & its applications……………………………….. 3.1.1 Types of Landscape Elements……………………………………… 3.2 Classification of Landscape Architecture…………………………... 3.2.1 Landscape Design & Stages………………………………………... 3.2.2 Management & Maintenance of Landscape Design………………...
31 32 32 38 38 51
CHAPTER FOUR; 4. Analysis & Discussions …………………………………………………… 53 4.1. Different Psychological Depressions of Cancer Patients based on; …. 4.1.1 Age group 4.1.2 Gender type 4.1.3 Cancer type 4.2. Effects of Landscape elements on the Psychology of Cancer Patients based on; 4.2.1 Age group 4.2.2 Gender type 4.2.3 Cancer type
CHAPTER FIVE; 5. Case Study ………………………………………………………………… 5.1 Oncology Department, A.B.U Teaching hospital Zaria………………. 5.2 Oncology Department, National Hospital Abuja……………………... 5.3 Smilow Cancer Hospital at Yale-New haven…………………………. 5.4 Green which Cancer Center…………………………………………… 5.5 Conclusions……………………………………………………………. 5.6 Space determinants……………………………………………………
78 78 79 81 83 85 85
CHAPTER SIX; 6. Site location and geographical features. 6.1. Abuja--------------------------------------------------------------------------6.2. Guzape------------------------------------------------------------------------6.2.1. Site Feasibility--------------------------------------------------------------
87 88 91
CHAPTER SEVEN; 7. Design Report……….………………………………………………………. 7.1 Design Brief…….….…………………………………………………… 7.2 Site Analysis……………………………………………………………. 7.3. Design Criteria..………………………………………………………... 7.4. Site Zoning,,……………………………………………………………. 7.5. Design Concept………………………………………………………… 7.6. Application of Research topic in the Design …………………………...
93 93 94 96 96 97 99
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7.7 Schedule of Accommodation………………………………………….. 104 7.8 Acoustics and Sound Control in the hospital …………………………. 110
CHAPTER EIGHT; 8. Summary & Conclusion………………………………………………………. 8.1. Summary……………………………………………………………….. 8.2. Conclusion ….………………………………………………………….. 8.3. Recommendation ………………………………………………………
112 112 113 113
REFERENCE / BIBLIOGRAPHY…………………………………………..
116
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CHAPTER ONE INTRODUCTION 1.1
PREAMBLE Onco is a Greek work meaning tumor while logy means study, which means
Oncology is defined as the aspect of medicine which deals with the study of tumor. A tumor is a swelling caused by inflammation on the other hand. According to the World Health Organization (Alma-ata declaration) of 1978, “Health is a complete physical, mental and social well-being of a person and not merely the absence of disease.” The impact of environment on humans (mental as well as social aspect of the health) can be evidenced very early in history as ancient paintings and other images depicted by cave dwellers point to the importance of art work and communication in the environment. It is also clear that the environment we live in is fundamental to basic human needs as emphasized in Maslow’s (1968) hierarchy of needs. In the past, when science of the medicine was less advanced and treatment less complex, the architectural requirements were less demanding. As a result of the growing complexity of modern medicine in technological advancement and the nature of the disease, hospital architecture is now seen as the mode of treatment to patients. Research shows that, certain use of colors, lighting, art, music, spiral arrangement etc can have positive healing effects on patients, from lowering blood pressure and producing calm to reducing doses of pain medication (Rich, 2002). The earliest known western hospital in Greece were elaborate, spacious temples built of marble with light flooding in through atriums and housing statues and other
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artwork, again emphasizing the importance of the built environment on people.(Hutton and Richardson 1995). Environmental psychology studies offer a clear insight into the effect of the hospital environment on several patient or health outcome factors,’ for example, one study in 1968 (Minckley) found that more analgesics were requested and dispensed to patients in noisier environments. Another, (Wilson, 1972) found that patient delirium after surgery was twice as high in a windowless intensive care unit. Ulrich (1984) found that patients (matched according to several variables) who looked out onto a number of deciduous trees in foliage experienced more positive outcomes than those whose view was of a plain brick wall. Studies focusing specifically on cancer care, building design and patients wellbeing are rare. However Coyne in his research (using 1,093 cancer patients of which 646 died) found that “no relationship between their emotional well-being and cancer progression and death” (www.WAIS-IV.COM) Moreover, an interesting qualitative study undertaken by Campbell (1991) using five Oncology patients in relation to the environment shows that, environment has a healing impact on the psychology of cancer patients. In general, hospital a days should have all necessary healing facilities ranging from medicinal tablets, radiation therapy as well as environmental therapy.
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1.2
PROBLEM DEFINITION “Another challenge that needs urgent attention is cancer which is a growing health
concern in Nigeria that refuses to be conquered even in the medical world”. Abubakar M. (2007). “Because there is no existing cancer center in Nigeria, the former Fist lady Hajiya Turai Umar ‘Yar’adua recently signed a memorandum of understanding (Mou) between M.D. Anderson cancer centre, and some of the relevant bodies. The parties agree to work collaboratively with the view to establish a National cancer center in Nigeria’’ Abubakar M. (2007) “By 2020, cancer incidence for Nigerian males and females may rise to 90.7/100,000 and 100.9/100,000 respectively and also death’s rate of 72.7/100,000 and 76/100,000 respectively”.(Sola and Chioma, 2006) Considering the above quotations, one will notice the extent of cancer diseases in the country Nigeria and despite of the level of disastrous situation, no a single hospital dedicated specially for the treatment of cancer disease throughout the country. Cancer patients mostly die before their time not because of the extent of their diseases but due to some psychological depression which come due to the: (Hammad, 2008) Fear of death Interruption of life plan Changes in body image and self-esteem Changes in social role and life style Financial problem These and more others, make cancer patients to develop the following depressions: o Memory disturbance (forgetfulness) o Hopelessness o Loss of interest
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o Anger or aggressiveness o Negative mood with low energy o Poor concentration (Hammad S. 2008) My propose research study is to design a National oncology center Abuja and to use landscape elements in hospital environment to enhance the psychological recovery of cancer patients.. 1.3
THE AIM OF THE STUDY The aim of this research is to use architectural solution using landscape elements
to enhance psychological depressions of cancer patients in the Oncology hospital design. 1.4
OBJECTIVES
a)
To find out the effects of landscape elements on the psychology of cancer patients base on the; i) ii) iii)
b) i) ii) iii)
Age group Gender Stage of cancer To find out the type of leisure of the cancer patients base on the; Age group Gender Stage of cancer
1.5 MOTIVATION “Cancer is a leading cause of death worldwide; it counted for 7.9million death (around 13% of all deaths) in 2007” (World Health organization, 2008). “There are estimated 100,000 new cancer cases in Nigeria each year, observers believe that, the figure could become as high as 500,000 new cases annually by 2010” (www. HelpingHand.com) The international conference on modern cancer management (ICMCM), a multi disciplinary conference designed to provide education and networking opportunities for
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cancer researchers and cancer care professionals in Nigeria was organized by the SOCIETY ON ONCOLOGY AND CANCER RESEARCH OF NIGERIA (SOCRON) From July 21st to 25th,2008 at the Paul Hendricks Hall, College of Medicine, University College Hospital Ibadan, Oyo State, Nigeria.The theme of the conference was ‘improving outcomes in management of Advanced Cancer’ This theme was chosen because majority of cancer patients in Nigeria (more than 70%) present at an advanced stage. The conference was declared open by the Honourable Federal Minister of Health represented by Dr. Peju Osinubi the secretary of the national consultative committee on cancer control and focal person for cancer in the federal ministry of Health. She indicated that “government already has advanced plans to set-up n ultra modern National Cancer Center in Abuja within the next few years”.(www. Socron. net). The number of cancer incidence world wide and Nigeria in particular (as shown above) and the outcome of the international conference on Modern Cancer Management (ICMCM) 2008, (as above) motivated me to undertake a research on the National Oncology Center Abuja and to use landscape elements as the therapeutic tool on the psychology of cancer patients in oncology center designs. 1.6 METHODOLOGY In conducting this research, data shall be collected both from primary and secondary source. In primary source, oral interview, questionnaire and observations will be conducted (to about 64 cancer patients) at ABU Teaching Hospital Shika Zaria. The patients are to categorize into two; experimental group of about 24 cancer patient and control group of 40 patient. The experimental group has patients exposed to the landscape elements while the control group do not.
In secondary source, data shall be collected
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from published and unpublished materials like newspapers, magazines, journals, books, thesis as well as government gazette. Case studies of similar situations shall be carried out. 1.7 SCOPE OF WORK
DIAGNOSTIC(Dx)MODALITIES:
-
-Radiology -LaboratoryMedicine -SpecialProceduresSuite -SpecialtyCareClinic -Emergency -Histopathology THERAPEUTIC(Rx/INTERVENTIONAL)MODALITIES: -RadiationTherapy -SurgicalSuite -PostAnesthesiaCareUnit -DayCare/Chemotherapy -IntensiveCareUnit -InpatientUnit
CLINICALANCILLARIES: -CentralSterilization -Laundry -Dietary(Cafeteria) -MaterialManagement -Pharmacy
CLINICALSUPPORTSERVICES: -MedicalRecords -PatientRegistrationandAdmissions
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SUPPORTFUNCTIONS: -ExecutiveAdministration -MedicalAdministration NursingAdministration -Finance -ManagementInformationSystems -MaintenanceandEngineering
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CHAPTER TWO LITERATURE REVIEW 2.1
HISTORICAL DEVELOPMENT OF HOSPITAL The evolution of hospitals to modern standards dates back to the early periods of
the ancient Egyptians and Greeks. In the early times, medicine and healing were linked with gods, hence the traditional medicine man considered to form a link between man and the displeased gods. (Ajayi, 1999). In the modern sense what could be termed to be a hospital, was first seen in India in the 3rd century, Bc where the need for an area wide planning of medical facilities was appreciated and hospitals there were for sick. With the emergence of Christianity and its consequent adoption as a state religion by Emperor Constantine in 335 A.D. decreed the building of Christian hospitals. “When the crusades ended, the crusaders came back with stories of the size and completeness of hospitals in the east and enlightened their fellow countrymen on the need to have the same”. Konce lik, (1976). The eastern hospitals such as in Alexandria, Damascus, Tunis and Coretera were Moslem hospitals where a college was attached a hospital. (Ajayi, 1999). Hospitals appeared in the middle ages resembling temples merely as places where the poor are housed and cared for when sick or injured (Mas’ud, 1983). The great Almansur hospital in Cairo 1270 was the splendid of which Garrison described it as “the huge quadrangular structure with fountains playing in the fair courtyards, separate wards for important disease, wards for women and convalescents, a lecture room, extensive library, out-patient clinics diet kitchens, an orphan asylum and a
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chapel. It employed both male and female nurses. The sleepless were provided with soft music or as in Arabian nights with accomplished letters of tales”. In the Europe, the development of hospitals was also in the middle ages, there was the Abbey hospital in Switzerland built in 820 AD, which was followed by the Hotel Dieu of pains built in 820 A.D. (Ajayi, 1999). This was the first general hospital in Europe with four wards for various patients, one for convalescents, and another for maternity patients, with other auxiliary facilities other hospital in Europe during the 12th century are: i)
St. Bartholomew’s in England (1137AD)
ii)
St. Thomas in England (1207AD)
iii)
St. Mary’s of Bethlehem (1247AD) etc
The 14th century witnessed an overflow in hospital development due to the flowing reasons: 1). The church edict of 1163 which forbade clergy from performing operation. 2). Indiscriminate lumping of patients together irrespective of the type or seriousness of their illness. 3). the occasional promulgation of decrees which limited the activities of the clergy. The above mentioned factors stalled the clergy’s appetite to work but the rekindling of the quest of knowledge which the Renaissance period brought. It was during this period that the medical professions progressed due to the following; 1). Anatomy became a recognized study 2). Surgery was placed on scientific basis 3). Municipal hospitals grew in number and gradually replaced the monastic hospitals of the middle ages. The real beginning of hospital planning based on scientific and functional relationship come up in the last 18th and early 19th century with the introduction of the ‘PAVILION’
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type plan where patients are segregated into smaller groups to ensure natural light and ventilation (Peter, 1971). The mid of 19th century witnessed a positive leap-forward in hospital development with discoveries such as: a) b) c) d)
Discovery of anesthesia Scientific discoveries in treatment diagnosis and nursing of the patient Introduction of steam sterilization The principles of antiseptic The Physician and nurse reduce to be mobile treating and nursing gradually
separate, each requiring specific locations and functional relationship and the philosophy of low horizontal ‘pavilion’ type gave way to the present 20th century model of the vertical monoblock.. (Mas’ud 1983). According to Ajayi Ademiyi, “the 20th century witnessed an increased in hospital occupancy due to the following reason: i) ii) iii) iv) v)
Increase in world population Rapid growth in the field of nursing education Increased confidence in hospitals as healing homes Increased sophistication and development of human endeavours. Increased technological development and its attendant side effects. In the vertical monoblock type, the out-patients department and other facilities for
diagnosis such as Radiology and pathology departments are placed on the ground floor. (Lewernlyn and etal; 1996; Hospital planning and admin). The first floor will accommodate the surgical suite and special therapeutic facilities. The nursing units are on the upper floors while hospital ancillary services like laundry, kitchen, Central Sterile Supply Department (C.S.S.D) etc are on the ground floor. (Mas’ud, 1983) However, the monoblock require mechanical means of ventilations and vertical transport. Also there is the problem of so many lifts services for clean utility, dirty, medical staff etc. resulting in prolong waiting and also risk of mechanical failure or fire out break
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“This is not suitable in a developing country like Nigeria where there is no stable power and abundant land. The advantage of monoblock is that horizontal distances are reduced to a minimum and vertical supply of materials from ancillary to the nursing stations to the upper floors by lift services become more efficient” (Mas’ud 1983). Therefore, more suitable in developed nations. Recently, there has been a marked turn to horizontal concept even in the developed countries like United States.
2.1.1 Types of health care system Generally, there are three main levels of health care delivery system according to complexity, specialization and level of care they provide. They include; a)
Primary health care
b)
Secondary health care
c)
Tertiary health care
a)
Primary health care system; The service provided here are preventive health
care, such as anti-natal and child care. Simple diagnosis and treatment and immunization programmes (Ajayi, 1999).Examples are: aid post unit, dispensaries, simplest unit and clinics (Shamsudden, 1974). i)
The simplest unit is a person with some medical skill, however little, in each and every part of the country.
ii)
Aid-Post, or Clinic visited periodically by a medical or doctor from a health center. The clinic can see as many as 300 out patients daily and a dozen or so in patients treated during short illness or pending their transfer to hospital.
iii)
Health care: It is a health center with a doctor who administers a number of smaller satellite clinics. Each health center is responsible for a specific area and the whole country is divided up between health centers.It has limited domiciliary care of the sick and refers cases to the bigger hospitals. It also
27
provides environmental health services and beyond this, services are provided by mobile teams.
b)
Secondary health care system; Patients are referred from primary care unit for a
more elaborated and sophisticated diagnosis and treatment. Examples: General hospitals. (Konce Lik, 1976) . GENERAL HOSPITAL In the urban center, providing all forms of preventive and curative services except for complex cases which are sent to the state Base Hospitals. The general hospital serves up to 100,000 out patients annually.(Shamsuddeen, 1974).
C)
Tertiary health care system; This kind of health care provides specialized
treatment such as cardiac surgery, plastic and neuro surgeries etc. Examples of such hospitals are: specialist hospitals, teaching hospital etc. i)
Teaching Hospital: These are hospitals which provide for the training of the medical practitioners and research centers. It serve a large urban center, from 350,000 people and above. It may also have a special units which are provided on a regional bases.
ii)
Specialist Hospitals; These deal with one category of patients and provide post-graduate teaching and research in their specialty. Many of such hospitals are large and remote. TABLE 1 MEDICAL/HEALTH FACULTY/POPULATION/ CATCHMENTS AREA;
S/N
HEALTH POPULATION TO BE RADIUS OF CATCHMENT SERVED AREA (km) 10,000 – 15,000 16.1 – 24.05
1
TYPE OF FACILITY Health office
2
Dispensary
15,000 - 20,000
3.22 – 4.83
3
Maternity home
20,000 - 30,000
6.44 – 11.3
4
Health center
30,000 - 50,000
24.05 – 32.1
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5
6
Specialized hospitals: a) Dental Clinic b) Mental Health institution c) T.B. Hospital District general hospital
150,000 -300,000 200,000 - 400,000 150,000 – 300,000 100,000-150,000
48.3 – 80.5 128.8 – 161.0 96.6 - 128.8 32.1 – 48.3
7
General hospital
500,000 - 1,000,000
8.5 – 120
8
Central or state hospital
To serve entire population of state
Source; Shamsuddeen, 1974 2.2
SPREAD OF CANCER
2.2.1
Introduction
Cancer is a class of diseases in which a group of cells display uncontrolled growth (division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). ( Husaini, 2007). The problem of cancerous cell is caused by mutations or abnormal activation of the genes which control cell division. When the genes are abnormal they are called Oncogens. (Taylor and Roving, 2002). Cancer is the generic term for a large group of disease in which cells grow out of control and can spread to other parts of the body. It involves a series of mutations or changes in the genetic make – up of a cell, causing it to look and function differently from normal cells.
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Plate.1; shows the uncontrolled growth of cancer cell Source; gattefoss R. (1920)
A single faulty cell may divide to form a clone of identical cells. Eventually an irregular mass of relatively undifferentiated cells called a tumor is formed. (Tumor: originally, it meant any abnormal swelling, lump or mass. In current English, however, the word tumor has become synonymous with neoplasm, specifically solid neoplasm. Note that some neoplasms, such as leukemia, do not form tumors) Tumor cells can break away and spread to other parts of the body causing secondary tumors or METASTASES. This process is called METASTASIS. Tumors that spread and cause ill to health are described as MALIGNANT while those that do not spread are called BENIGN. (Taylor and Roving, 2002);
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FIG.1; shows the mortality rate of cancer patients in developing nations. Source; World Health Organization, 2006 Release.
According to the world Health organization, cancer is the leading cause of death world wide, it is counted that, 7.6 million people died in 2007 making the 13% of all deaths, out of which; Lung Cancer 1.4 million death/year Stomach cancer 66,000 deaths/year Liver cancer 653,000 death/year Colon cancer 677,000 death/year Breast cancer 548,000 death/year It is estimated by 2030, 12 millions people will die world wide.
(World health
organization, 2007) Each year more than 11 million new cases of cancer are diagnosed worldwide and more than 7millon people die from cancer over 70% of them in low and middle income countries. By 2020, if current trends continue, new cases will increase to 16 million per year and more than 10 million people will die (www.helpinghand.cancer com) Cervical and breast cancer are the two leading cancers in women today, while in men, the second and the third most frequent occurring cancers are those of prostate and
31
colon. For example, it is on record that one in four American’s lives is being claimed by cancer (American Cancer society, 2006) TABLE 2.
S/No
U.S Mortality, 2002
Rank cause of Death
No of all deaths
Percentage of all Deaths % 1. Heart Diseases 696,947 28.5 2 Cancer 557,271 22.8 3 Cerebrovascular Disease 162,672 6.7 4 Chronic Lower respiratory diseases 124,816 5.1 5 Accidents (Unintentional injuries 106,742 4.4 6 Diabetes mellitus 73,249 3.0 Source: U.S Mortality public use data tape 2002 National center for Health statistics, centers for Diseases control and prevention 2004. TABLE 3. 2005 Estimate U.S. Cancer Deaths for Men = 295,280
S/NO 1 2 3 4 5 6 7 8 9 10 11
CANCER TYPE Lung and bronchus Prostate Colon and rectum Pancreas Leukemia Esophagus Liver and intrahepatic bile duct Non – Hodgkin Lymphoma Urinary bladder Kidney All others parts
PERCENTAGE (%) 31 10 10 5 4 4 3 3 3 3 24
Source: American cancer society, 2005
TABLE 4.
S/NO 1 2 3 4 5 6 7
2005 Estimate U.S. Cancer Deaths for Women = 275,000
CANCER TYPE Lung and bronchus Breast Colon and rectum Ovary Pancreas Leukemia Non – Hodgkin Lymphoma
PERCENTAGE (%) 27 15 10 6 6 4 3 32
8 9 10 11
Urinary corpus Multiple Myloma Brain All other parts
3 2 2 22
Source: American cancer society, 2005
Cancer caused about 25% of all deaths in Britain in 1991 (Taylor and Roving, 2002). Remarkable differences can be found in the incidence and death rates of specific forms of cancer around the world. For example, the death rate of stomach carcinoma in both men and women is seven to eight times higher in Japan than in the United States. In contrast, the death rate from carcinoma of the lung is slightly more than twice as great in the United States as in Japan, and in Belgium it is ever higher than in the United State. Skin cancer deaths largely caused by melanomas are six times more frequent in New Zealand than in Iceland which is probably attributable to differences in sun exposure. (Taylor and Roving, 2002).
2.2.1 Cancer in Nigeria According to the World Health Organization, (WHO), there are an estimated 100,000 new cancer cases in the Nigeria each year; although observers believe the figure could become as high as 500,000 new cases annually by 2010, (who, 2007).
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FIG.2. Distribution of new cancer cases in Nigeria 2007 (males) Source; World Health Organization. 2006 Release.
FIG.3. Distribution of new cancer cases in Nigeria 2007 (females) Source; World Health Organization. 2006 Release.
34
It is feared that, by 2020, cancer incidence for Nigerian males and females may rise to 90.7/100,000 and 100.9/100,000 respectively. It has been anticipated that by 2020, death rates for cancer in Nigerian males and females may reach 72.7/100,000 and 76/100,000 respectively. (Who, 2007)
FIG.4. Distribution of mortality rate of cancer cases in Nigeria 2007 (males) Source; World Health Organization. 2006 Release.
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FIG.5. Distribution of mortality rate of cancer cases in Nigeria 2007 (males) Source; World Health Organization. 2006 Release.
In 2005 cancer killed approximately 89,000 people in Nigeria and 54,000 of those people were under the age of 70.
FIG.6. Main causes of death in Nigeria, 2005 projection. Source; World Health Organization, 2006 Release (www.who.infobase.com)
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FIG.7. Main causes of death in Nigeria Projection 2030. Source; World Health Organization, 2006 Release (www.who.infobase.com)
In 2005 breast cancer is/are the most common cancer(s) found in women and prostate cancer in men. In Nigeria without doubt, breast cancer is currently the most common malignancy. Adebamowo said that “In our 1999 case seen – control study of 250 consecutive breast cancer cases seen in our oncology clinic between 1992 and 1995, we found that breast cancer patients tended to be taller, weighed more had a later age at onset of first pregnancy---” A retrospective review of breast cancers between 2001 -2005 in the university of Maiduguri Teaching Hospital cancer registry revealed that, a total of 1,216 case of cancer were registered within the study period and breast cancer accounted for 13.9%. there were 161 females and 8 males with breast cancer within the study period, giving a female
37
to male ratio of 20:1 The ages ranged between 17 to 85 years and the peak age group was 40-49years which accounted for 61 cases (36.1%). A similar research involving 116 Nigerian women with breast cancer over a fiveyear period, 1974-1979, at the University of Benin teaching Hospital, Benin, Edo State, indicated that breast cancer is mainly a disease of premenopausal and per menopausal women.(www.helpinghandcancer.com) An analysis of Adult male cancers examined every decade in Nigeria since independence confirmed that, prostate cancer is the number one cancer in nigerian men and constitutes 11-12% of all male cancers. The average age of on set of symptoms is 6471. (www. helpinghandcancer.com). Adewale notes that cervical cancer is the leading cause of cancer mortality in women worldwide and is gaining importance in Nigeria. He says; “In Nigeria the incidence rate of cervical cancer is 25/100,000. There are 32 million women aged 15 to 64 years old. If we were to conduct a one-time screen over one year, 8,000 new invasive cervical cancer would be detected” (who, 2007). 2.2.2 Types of cancer Cancer is not a single disease; more than 200 types of cancer are known (Taylor and Roving, 2002). Most of which are classified in their relation to where they are in the body. Cancer may be generally classified into 5 groups; a)
Carcinoma: This is the kind of cancer that begins in the skin or in tissue or cover internal organs.
b)
Sarcoma: It is the cancer that begins in the bone, cartilage, fat, muscle, blood vessels or other connective or supportive tissue.
38
c)
Lymphoma or Myeloma: Cancer that begins in the cells of the immune system.
d)
Leukemia: Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abdominal blood cells to be produced and enter the blood.
e)
Central Nervous System Cancer: These are ones that begin in tissue of the brain and spinal cord. (Fodde and Smiths, 2002)
2.2.3 Stages of cancer
Stage: it is a number (usually on a scale of 4) established by the oncologist to describe the degree of invasion of the body by the tumor. Generally there are four (4) stages of cancer diseases, these include: a)
Stage I: Cancer at this stage is localized, confining to a particular organ.
b)
Stage II: Here, tumor is confined to a particular structure and extended to lateral position.
c)
Stage III: Tumor has extended to a contagious structure such as from left breast to right and to all structure within the region.
d)
Stage IV: At this stage, tumor cells have broken away and spread to other parts of the body causing a distance metastasis such as from breast to brain, liver, kidney etc. (Miller, Hafez, Stewart, et al, 2003)
Note that: Cancer at stage I and II are curative, but at stage III and IV are usually palliative (to reduce the extent of the disease),(Rimi, 2008). Common types of cancer in Nigeria are: TABLE 5. Common type of cancer in Nigeria
S/NO. 1
CANCER TYPE Breast
1999 (%) 2007 (%) MALE FEMALE TOTAL MALE FEMALE TOTAL 0.8 24.5 14.0 _ 49.7 27.5
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2 3 4 5 6 7 8 9 10 11 12 13 14
Cervical Prostate Uterus Lung Bladder Kidney Colon Stomach Skin Soft tissue Ovaries Esophagus Others
_ 15.5 _ 04.0 07.3 01.6 05.0 0.80 08.9 20.0 _ _ 36.1
11.0 _ 10.0 02.0 _ 0.60 02.0 01.3 01.3 11.0 09.0 _ 24.0
06.0 08.0 04.5 03.1 03.3 01.0 03.1 01.0 04.7 15.0 04.1 _ 35.5
_ 19.00 _ 02.60 05.20 06.00 06.10 05.40 04.30 13.00 _ 0.86 37.64
15.4 _ 08.7 02.1 0.70 01.4 01.4 06.0 0.70 05.6 07.3 _ 01.0
08.5 08.5 05.7 02.4 02.7 03.5 0.35 06.1 2.32 08.9 07.1 0.40 16.38
Source: Histopathology Department, A.B.U Teaching Hospital Zaria, 2008.
Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. The growth may lead to metastasis, invasion of adjacent tissue and infiltration beyond the lungs. It is the most common cause of cancer-related death in men and the second most common in women. It is responsible for 1.3million deaths world wide annually. More than one million Americans diagnosed with skin cancer in 2007, (who, 2007). World wide, Breast cancer is the second most common type of cancer after lung cancer. It is also the 5th most common cause of cancer death in 2005 and 1% of all deaths. Breast cancer in men is approximately 100 times less common than in women, (who, 2007).
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FIG.8 Clinical Staging of Tumor Source. W.H.O (2004)
According to the American cancer society, prostate cancer is least common among Asian men and most common among black men. In the united state, it is responsible for more male deaths than any other cancer, except lung cancer. In Nigeria, 2% of men develop prostate cancer and 64% of them are dead after two years. (who, 2006). 2.2.4 Causes of cancer Cancer arises from one single cell and the transformation from a normal cell into a tumor cell is a multistage process, typically a progression from a pre- cancerous lesion to malignant tumors, (knudson, 1971). Changes in genes are called mutations and any factor bringing mutation is called a mutagen. An agent which causes cancer is called a carcinogen, (Taylor and Roving, 2002). 41
Generally, causes of cancer or carcinogens are categorized into six groups: 1). Viruses Carcinogen: About 20% of the cancer worldwide may be caused by viruses. Examples; Retoviruses, DNA viruses. 2). Heredity Predisposition ; About 5% of human cancers show a strong genetics predisposition. In other words they tend to run in families. Examples; more than 4 type of cancer including cancer of the breast, ovary and colon. 3). Ionizing Radiation; These include X-rays and particles from the decay of radioactive elements. Cancers were caused in workers with X-rays at the beginning of the twentieth century and factory workers painting the dials of watches with luminous paint containing radioactive radium and thorium. Examples; skin cancer, bone marrow cancer, lung cancer and breast cancer. 4). Ultraviolet light/Radiation; This is the most common form of carcinogenic radiation and is non-ionizing. Sunlight contains ultraviolet light and prolonged exposure to it can result in skin cancers. Depletion of ozone layer results in a higher proportion of ultraviolet light reaching the Earth’s surface. The brown skin pigment melanin offers some protection. 5). Radon Gas; Radon gas is a natural source of radiation, released from certain rocks such as granite. It may accumulate in houses in areas where these rocks are found. Examples; leukemia (cancer of white blood cells), lung, kidney and prostate. 6). Chemical Mutagens; “Fighting cancer is deeply rooted in our culture” Coyn (2000). Many chemicals are now recognized as causing cancer. The first example was described in 1775 as soot and coal tar, when chimney sweeps were discovered to develop cancer of the scrotum. Later mineral oils were also found to be carcinogenic, when shale
42
oils were used as a lubricant in the cotton-spinning mills. The workers developed cancers of the abdominal wall where their cloths had bear splashed. Workers in the synthetic dye industry in the late nineteenth century developed bladder cancer. The list of chemical carcinogens has steadily lengthened over the last 90 years and now includes the following (in addition to the above); In-organic arsenic compounds which produce skin cancer Asbestos products which cause lung cancer Some food additives such as flavours, colorings and stabilizers have been considered as possible carcinogens because they cause cancers in experimental animals. Tobacco smoke contains chemicals responsible for the lung cancer (Taylor and Roving, 2002).
FIG.9; Shows the percentage of preventing cancer cases. Source; World Health Organization, 2006 Release (www.who.infobase.com)
According to the World Health Organization, causes of cancer may also be categorized into three; a)
Physical Carcinogens: Such as ultraviolet and ionizing radiation.
b)
Chemical Carcinogens: Such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant) and arsenic (a drinking water contaminated).
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c)
Biological Carcinogens: Such as infections from certain viruses, bacteria or parasites, ( Pagano, Blaster, Buendia, et al, 2004).
2.2.5 Prevention of cancer Generally, anything we do to decrease the exposure to mutagens we are directly reducing the cancer incidence to our bodies, (Peter and George). Out of 1.7million people died in the united state by 2002, one fourth died of cancer and one third of them died with lung cancer (140,000). About 160,000 cases of lung cancer were diagnosed each year in the 1980s and 90% of these died within 3 years. Out Of those died 96% were cigarette smokers’ (Peter and George, 2003).
FIG.10.
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That means by avoiding the cigarette smoking a cancer incidence will reduce by 21% world wide and a reduction in mortality rate by one fourth in the united state of American. Control of cancer should be considered as Prevention: protection against known carcinogens Early Diagnosis: Including screening programmes. A woman whose breast cancer is diagnosed early has 80% chance of survival for 5 or more years after diagnosis. Treatment: Urgent action once diagnosis is made. (Taylor and Roving, 2002).
2.2.6 Treatment of cancer Adewale says, “Delays in screening and treatment (of cervical) cancer arise from a number of reasons including cultural constraints (such as emotional distress within), having male doctors performing tests and poor governmental funding for medical facilities.” Proff. I.M. Hussaini, University of Virginia U.S.A. states the following stages for treatment of cancer; i) Treatment depends on stage of cancer ii) More than one treatment may be used iii) Surgery iv) Radiation therapy (Radiotherapy) v) Chemotherapy vi) Hormone therapy vii) Targeted therapy Dr. S.G. Rimi, (Oral interview) states the following as the stages for treatment of cancer; i) ii) iii) iv) v) vi) vii)
More than one treatment may be used Surgery Radiotherapy Chemotherapy Immunotherapy Hormone replacement therapy The prongs of the disease depends on the cancer origin
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DEFINITIONS i)
Chemotherapy: It is the treatment of cancer with drugs ("anticancer drugs") that can destroy cancer cells. It is usually applied for cancer at stage I and II.
ii)
Surgery: It is the application of surgery in treatment of cancer. It is used for cancer at stage I, II and III.
iii)
Radiotherapy: It is the use of ionizing radiation to kill cancer cells and shrink tumors. It is used for cancer at stage II, III and IV.
iv)
Immunotherapy: Cancer immunotherapy refers to a diverse set of therapeutic strategies designed to induce the patient's own immune system to fight the tumor. It is usually use for cancer at stage II and IV. It can also be used at stage I and II.
v)
Hormone replacement therapy: it is used to improve the hormone of a body. The growth of some cancers can be inhibited by providing or blocking certain hormones. Common examples of hormone-sensitive tumors include certain types of breast and prostate cancer, (Miller, Hafez, Stewart, et al, 2003).
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CHAPTER THREE LANDSCAPING Landscaping is the art of creating land scenario with a purpose of getting a good atmosphere for human comfort using fauna, flora and hard landscape elements as the building blocks. It changes with time, ecology and therefore attracts high fees. (Musa, 2006). It is also defined as any activity that modifies the visible features of an area of land, including but not limited to: • • • •
Living elements: such as flora and fauna Natural elements: such as land forms, terrain shape and elevation of bodies of water. Human elements: such as structures, buildings, fences or other material objects created or installed by humans. Abstract elements: such as weather and lightening conditions. The physical outlook of landscape is the product of the process of nature and
human culture, which are combined in varying proportions. Garret (1964) stated in his book title “the landscape we see” that urban landscaping is composed of everything that we see or sense wherever we go within it. Produce by long and complex multiple series of disconnected decisions, beginning with the subdivision of the broken continuity of the natural land and ending with fractional of labour among the various design professions, this land is nevertheless, one single experience for each observer passing through it”. From the above quotation, it can be deduced that, the scope of landscape design is very vast ranging from residential house to the geographical region. But the most important function of landscape design is to promote the human comfort in his environment.
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3.1
LANDSCAPE ELEMENTS AND THEIR APPLICATIONS Landscape elements are referred to as the materials that are constituted in the
planning and design of an environment, (Musa, 2006). These include plants, water body, sculpture, walkways etc. The choice of these elements depends virtually on the client and designer’s taste and style, but most importantly on the climate of an environment.
3.1.1 Types of landscape elements Generally there are two types of landscape elements:
A)
a) Soft landscape elements b) Hard landscape elements Soft landscape elements; These are landscape elements use to increase the
humidity of an environment such as trees, shrubs, grasses, water bodies etc. PLANT AND THEIR APPLICATIONS Plants constitute the most important elements of landscape planning and design due to their relative importance and influence in the environment. These include: Symbiosis relationship between plants and animals. Plants take-in carbon (iv) oxide and bring-out oxygen, while animals take-in oxygen and bring out carbon (iv) oxide. Plants also create and maintain soil in which the landscape is to be laid upon by adding organic matter, keeping it in place through checking erosion. Another one is the increase in humidity to the environment by transpiration when sun strikes on them. CLASSIFICATION OF PLANTS Plants are classified in a number of ways which includes the following: Base on structural differences (Morphological way). Examples; trees, shrubs, grasses etc.
48
PLATE.2 Shows plants in morphological variation Source; Musa A. 2006
Base on climatic characteristics. Examples xerophytes, hydrophytes and mesophytes. Base on kind of habitat. Examples; aquatic and terrestrial plants. Base on the period of their life-cycle and adaptation. Examples; Seasonal and perennial plants. Base on the function they perform. Examples; medicinal and non-medicinal – plants. SOME SAMPLES OF MEDICINAL PLANTS TABLE 6. List of plants used for treatment of chronic inflammation/cancers in Hausa and Fulani folk medicine
S/no Plant names
01
02
Family names
Local Local names
Cochlospermum Cochlospermaceae Rawaya tinctorium A. Rich. Cissus ibuensis Ampelidaceae Daddori Hook
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Plant part used
Root
Leaves
Use Voucher no. Antiinflammatory/anti- 2759 cancer Anti2708 inflammatory/skin
cancer 03
Bridelia ferrugineae Benth
Euphorbiaceae
Kirnii
Stem bark
Euphorbia lateri Euphorbiaceae .ora Schum. & Thonn.
Fidda Sartse
Stem
04
05
Desmodium velutinum Willd Annona senegalensis Pers
06 07
937
Cancer/reduce bleeding and 697 relieve of pains after circumcisions
Fabaceae
Dangeree Leaves
Many cancers
166
Skin cancer/leukemia
382
Annonaceae
Gwandar daji
Vismia guineensis Hypericaceae Linn. Bauhinia rufescens Lam. Caesalpiniaceae
08
Skin cancer
Kiska wali Tsatsagii
Stem bark/leaves Leaves Cancer
1872 leaves
Fibrosis 427
09
Erythrophleum guineense G. Don Tapinanthus preusii Engl.
Caesalpiniaceae
Gwaska
leaves
Skin cancer
Many types cancer Source; M.S.Abubakar et al. /Journal of Ethno pharmacology 111 (2007)625 ・29 627 Table2 10
Loranthaceae
Kwauchi
Leaves
FUNCTIONAL USE OF PLANTS Basically, plants may be used in four different ways, which include the following: i) ii) iii) iv) I)
Architectural use Engineering use, Climatologically use, and Aesthetical use. ARCHITECTURAL USE OF PLANT Plants are used to define space e.g. walls, floors, rooms, ceilings. They are used to frame views and vista. They are used for privacy control. They are used as a design rein forcer in landscape design.
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242 of 1052
II).
ENGINEERING USE OF PLANTS
1.
Erosion Control: The plants use must poses the following qualities:
Smooth and glossy leaves for draining water. They are easily grown and developed. They can be planted by cutting some parts of their stems. They can be submerged (root) for a long period of time without dying. PRINCIPLES BEHIND EROSION CONTROL
2)
The root absorbs water. Grasses at the bank, discourage the speed of water. Canopies retain some quantity of water. The plants form a thin skin on topsoil which reduce the porosity of soil (such as spirogyra). Acoustic Control: Plant are used to buffer noise (unwanted sound) coming to the
designed portion. This includes theatres, lecture rooms, wards, offices etc. 3)
Atmospheric Purification
4)
Plants are used to trap dust particles present in the atmosphere. Some plants absorb chemicals through their leaves and stems. Such plants are used in a polluted environment, such as industrialized area, hospital, etc. Plants are use to dilute carbon (iv) oxide present in atmosphere with oxygen in an area where there is abundant of carbon (iv) oxide and bring-out oxygen. Some plants have good odour and therefore use to reduce bad odour in an area. Traffic Control.
5)
Many people do not want to walk under some trees for a fear that the fruits may fall on them. Trees can also be used to break traffic. This depends on the characteristics of the tree, its ultimate heights and planting density (spacing). Glare Control;
Glare is the condition of vision caused by spatial or temporal contrast in lighting. plants are used to control the effect of glare by planting them behind the window openings. III)
CLIMATOLOGICAL USE OF PLANT Plants are used to alter the micro-climate of an area, such as to reduce the temperature by transpiration. Trees are used as wind breakers. Some trees (plants) are used as the pesticides such as mahogany tree.
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b)
WATER EFFECTS Due to its flexibility in nature, water is the most fascinating elements of
landscaping thus it attracts attention and still forms, sharp contracts with the land and vegetation in form, colour and texture. Because it is a soft landscape element, it acts as a cooling device in unbearable hot places and offers captivating effects when reflecting images in steady state and assumes another effect when in motion. This includes; water fall, ponds, fountains etc.
PLATE 3. Fountain. Senate Building A.B.U Zaria SOURCE; Musa, A. 2006
Ponds: These are small bodies of still water or pool which are used in the gardens or parks. They allow for paddling and support of plants that cannot grow on plain soil. They are used for an aesthetic and also increase humidity of an area.
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Cascades: These are falling water from a high level which may be maintained in its natural state known as water fall or artificially influenced to attain the best effect. It causes cooling also and add natural beauty to the environment. Fountains: These are landscape elements, which make use of water as an ornamental features and work by injecting water in spray form to mimic the natural spring. B). Hard landscape elements These are landscape elements use to increase the temperature of an area. These include: rocks, walkways, concrete/steel furniture’s, sculptures etc.
PLATE 4. Sculpture Garden A.B.U Zaria SOURCE; Musa, A. 2006
Rock: It is the major factor in some regions (Jos,Obudu), minor in others and nonexisting in some. It varies in size, form and origin. Rock may be igneous, sedimentary and metamorphic rocks. Granite Rock produces radon gas which is an agent of cancer
53
hence it should be avoided. Rocks also vary in colour and texture which affect the design and consequently the user’s perceptions. Fountains: These are usually of concrete and steel structures which are used to make water as an ornamental feature. They may carry some sculptural motif depending on the culture and needs of the users. 3.2 CLASSIFICATION OF LANDSCAPE ARCHITECTURE Landscape Architecture is very much like architecture but Fauna and Flora are the building blocks and because it changes with time and place it is more complex than architecture in terms of management and cost, it is also not as accurate as architecture, (Musa, 2006) Landscape Architecture is divided into three categories: 1). Landscape design 2). Landscape science and 3). Landscape management 3.2.1 Landscape design and stages; This entails site planning, landscape planning and assessment and detail design or working drawing. Before the start of any design the components of landscape design should be notified. 3.2.1.1components of landscape design; These are of two types: a) Aesthetic component, and (b) A)
Physical Component
Aesthetic components: It is of 2 types:
(1) Elements of aesthetic component and (2) Principles of Aesthetic Component
1). Element of Aesthetic Component: In the landscape design, the following element should be recognized, spaces mass, line or outline; colour, shade, texture, scent and time as related to climate and growth factors.
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i.
Space: this is air or atmospheric volume defined by physical elements and man’s visual imagination. A space has floors which include earth, rock, grass, low planting, concrete, asphalt, stone, brick wood carpet, tiles and so on. It also has walls as in topography, rock, vegetation, vertical structures extra, and then has ceilings or roof, which are tree tops, structural coverage or sky. A space therefore is defined by the ground or floor surfaces below, obstacles that block vision horizontally and sky overhead.
ii.
Mass: They define each other and depend upon each other for usual existence, such as topographical earth forms, rock outcrops and boulders trees and shrubs groups, buildings and water form – streams lakes or water falls.
iii.
Line: Line in a landscape is used to demarcate one space from the other which may be of sharp edge paving slabs, structure, rock, shrubs, hedges, shadows, scent, grass and ivy. A line plays an important role in the way man sees, interprets and relates to scene. It also leads eye to a distance around a corner and out of
PLATE 5. Grasses used as line SOURCE; Musa, A. 2006.
55
Scene or around the scene and then back again. The pattern of form created by the lines is 3 dimensions in any given scene that is viewed, the pattern changes throughout each year day because of the changing light and shade patterns produced by the movement of the earth around the sun and the pattern is never exactly the same on one day as on any previous day, because of changes in the weather, the season and the elements of the landscape, building, topography and rocks may be maintained almost the same for substantial periods of time but vegetation changes constantly with both seasonal adjustments and annual growth. This is one reason why landscapes without vegetation seem static, lifeless and monotonous. iv.
Colour: It gives physical landscapes that final dimension of real life, definition, and interest. Colour varies the apparent sizes of the landscape spaces such as bright colours advance while dull colours recede. Colour also brings pleasure as well as displeasure; therefore, ability of the designer to select the best colour is important in landscape design.
v.
Light and Shade: Due to the sun and other lesser extent, the moon, star, fire and artificial lighting, have property of causing shadows when obstructed by some landscape elements such as trees, rocks and so on. A designer must consider the effect of light and shade resulting from placement of these elements. Light and shade are not the same in all parts of the country or the world in general. Light is welcome in cool, gray region while shade is welcome in hot, bright, desert or tropical regions which Nigeria is one of them. Therefore orientation of the landscape elements is very important in the tropical Nigeria.
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vi.
Texture: this is defined as the degree of smoothness or roughness of the surface. It is an important element of landscape design which is applied to the surface finish depending on its functions. It either soft surface texture which is used as grasses and lose sand in lawns and play grounds while bricks, concrete and stones walls, fountains exatra. It may be perceived by touch and vision or even by visual effect known as tactile textures. It is used to alter the distance sizes and even the complexity of the space in landscaping.
vii.
Time (climate and season): Unlike the static continuity or architectural and urban monuments, landscape design depends solely on maintenance. Time and climate are closely interrelated in their effects or garden and landscape spaces, because relations between temperature and moisture, light and shade changes daily through out the year, every region and locality on earth. Infact every building site has its own climate, unlike any other site in the world; therefore, landscape design for every region, locality and site is expected to be different. Therefore time, climate and seasons cause lot of variations of the origins of
landscape design, while constant maintenance determines whether the form envisioned by the original designer will endure or change over decades or centuries. 2)
Principle of Aesthetic Components: these deal with the arrangement and organizing elements of aesthetic components (discussed earlier) in this chapter as expressed in specific materials, on a specific site for landscape planning. These include the following: (i) unity and variety (ii) Rhythm and balance (iii) Accent and contrast (iv) Scale and proportion (v) Composite three dimensional special form.
57
(i)
Unity and variety: variety means a number of different items or elements while unity is the ability to join or to combine the different elements in an appropriate manar. The difficulty of achieving a sense of unity increases as the number of landscape element increases.
(ii)
Rhythm and balance: Rhythm is a sequence or repetition of similar elements such as a row of trees, it tends to emphasized direction and movement in the landscape design. While balance is the sense one gets, looking in any direction, that the elements to one’s left balance those to ones right. That means the feelings one experienced that his views are in equilibrium. This is very important in the landscape design that the rhythm and balance of all the elements must be achieved.
PLATE 6; Trees used as rhythm. SOURCE; Encyclopedia Britannica
(iii)
Accent and contrast: An accent is an element that differs from everything around it but is limited in quantity in relation to surrounding elements. While 58
contrast is when two or more different elements of almost the same quantities are juxtaposed. In landscape design, accent and contrast are more difficult to handle than rhythm and balance and therefore proper consideration should be given by a designer to achieve it. (iv) Scale and proportion: Scale is defined as the apparent size landscape space and elements while proportion is the relative sizes of all parts within an element and of all the elements within a landscape space. For example, the proportionate size of legs, arms and back of a garden bench determine the scale of the seat. And the overall size of the seat, in proportionate relation to walk width, arbor height, lawn area, tree size and so on, helps to determine the scale of the garden. (v) Composite three dimensional special form: This refers to a delineation of a block of air by physical elements, which enclosed and frame the space and established its relations with neighboring spaces, distant views and so on. A shelter form by trees or pergola structures is a typical example.
PLATE 7; Pergola used as composite three dimensional form SOURCE; Field trip
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(B)
PHYSICAL COMPONENT OF LANDSCAPE DESIGN: This also like aesthetic component is divided into: (1) natural and (2) structural
components of landscape design. 1)
Natural physical components: This consists of earth, rock, water and plants. i) Earth: It is the floor of landscape spaces, the root medium in which half of
every plant lives. the foundation for structures, the vehicle for surface and
subsurface
drainage of excess water, and a sculptural material in its own right. As a floor earth can be abstract surface. If apparently level, with just enough slope of drainage, it is ready to be covered with paving, grass ground cover, or other planting which is necessary to prevent dust in dry whether and mud in wet weather. As a root medium for plants, earth must be understood as soil. One must know the type and depth of soil before planning a landscape. As a foundation for structure, earth must be dry and firm. Desirable foundations, the exact opposite of loose, moist soil that is best for most plants, create many technical problems in the relations between structures and plants areas. As a drainage vehicle, earth absorbs a high percentage of water that falls on its surface. This absorbed water may be stored below ground or move horizontally through sloping soil patterns.
PLATE 8; Natural Hill using earth as a sculptural material. SOURCE: Encyclopedia Britannica.
60
As sculptural material, earth can be contoured to conform with functional and maintenance demands. Rolling natural hills and golf course earth forms demonstrate the potential. Slopes must not be too steep for planting to hold, unless they are structurally retained. All the above functions of the earth are related closely to the landscape design. i)
Water: This is very important in landscape design as one of the four conditions for plants photosynthesis. It also contributes to coolness, moisture, sparkle, lightness, depth, and serenity, the possibility of aquatic plants and animals and recreation. It may run through natural ponds, lakes and seas, or it may be kept in structural channels and ponds, recirculated to avoid waste.
PLATE 9; Water body as landscape element Source; Musa, A. 2006
61
ii). Rock: It is a major factor in some region such as plateau state and minor in others and non existent in some. It varies in sizes, form, colour and texture. It can be used as a ground cover, dry or in cement in vertical structures with various degrees of cutting and finishing to stimulate natural rock formations; and in sculptural groupings that emphasize the natural form of the rocks. iii) Plants: These are considered the primary materials of landscape design and may be grouped and organized for design purposes in several ways; by size (such as trees, shrubs, low plants, grass by form (vertical, horizontal, round irregular); by texture (size, shape) by colour (flowers, fruits); by seasonal effect (dry and winter periods); by environmental requirements (soil drainage, sun shade, pest) etc all of these properties affect the selection, arrangement and maintenance of plants in landscape design. 2). Structural Physical Components: These are man made structures related to the landscape design such as (i)
Earth related structures (ii) Enclosed structures (iii) Shelter
structures (iv) Engineering structures (v) Special buildings (vi) Sculptural components and outdoor furnishings. (i)
Earth related structures: These includes paving (walks, roads, terraces, patios)
and change of level structure (such as retaining walls, steps, ramps, bridges) which must be made of materials that will resist decay such as brick, store, concrete, asphalt. These provide the connections for movement and circulation and the areas for intensive gathering, social use of active recreation.
62
PLATE 10:Walk-ways; Department of Urban and Regional Planning A.B.U Zaria. SOURCE; Field work 2009.
ii). Enclosed Structures: These are walls and fences and are designed to control vision or movement or both. They may be of various heights and of many minerals such as bricks, stone, concrete, wood, metals, glass, plastic, asbestos and so on. (iii) Shelter Structures: These are designed for protection against sun, rain or wind, such as pergolas or arbors carrying vines or solid opaque or translucent roofs. Among such structures are gazebos, pavilions, garden temples, summer houses, hermit huts follies, ruins and grottoes. (iv) Sculptural components and outdoor furnishings: These have traditionally been in predictable forms and types; figurative sculpture, decorative urns and plaques, fountains, sundials, baths citizens and wells. Outdoor furnishing and equipment include all of those fixed and movable elements that tend to appear in landscape after the plans are done and installed and therefore without benefit of design control. In the garden they are seats, tables, barbecues, umbrellas, plant containers, supports and guards, as well as lights and light systems.
63
PLATE 11: Street Furniture as sculptural component. SOURCE; Field Trip 2009
3.2.1.2
Stages in landscape design
Landscape design always arises from certain objectives, desire or needs, such as construction of shelter for social activities (public park), improving the appearance of surroundings, recreational environment and so on. Landscape design has gone beyond the accidental arrangement of elements in order to achieve beauty but constitutes the expensive effect of harmony and refined imitation of agreeable forms of nature. This brought about the stages in landscape design which include the followings:
a)
a)
Site planning
b)
Site planning and assessment. And
c)
Detail design and construction Site Planning: This concern with the evaluation of an area of land in terms of its
capacity, the result is always land use plan. It also answers the questions such as why?
64
Where? and how? to design. It also contains the following; (i) Site selection, and (ii) Ste analysis (i)
Site Selection: This entails the choice of land for the landscape design to develop
some specific programs and therefore may be selected due to their locations, climates, topography, accessibility and other factors. The physical nature and qualities of site greatly influence the basic planning processes to be carried out; as such there is a need for professional advice in the search and procurement of a site. The best is that which can effectively and sufficient utilized to achieve the desire goals within a reasonable economic value. (ii)
Site Analysis: This deals with the analysis of the physical conditions of the site,
weighing the advantages of its characteristics qualities and relating these qualities with the intended purpose for which a design may serve after construction. These may include the topography where the think of the possible direction of drainage; climates where the thought of type of landscape elements arise; solar direction and radiation where the thought of orientation comes. b)
Site Planning and Assessment (Design): This stage comes up after the analysis
and is the process by which a designer is determining precisely how best to undertake his programs on site in definite materials and form. Therefore is the process of making all the specific decisions about the development, from general arrangement down to smaller details, this result in a master plan. In the landscape design, three (3) levels (or positions) should be distinguished from each other but linked in a skillful manner, these are: i)
Level above
ii)
Level zero and
65
iii) i)
Level below. Level Above: This may be a mountain, heap of earth, waterfall, concrete bed and so on, as the observer will see the overall landscape elements from the top and appreciating its values such as the arrangement of hedges/grass to give a specific meaning.
ii)
Level Zero: This is intermediate stage between level above and level below on which the observer will see elements above (mountains, concrete bed, heap of earth) in an elevational form. This may be walkways, an open space and pergolas, the observer will also appreciate the landscape pattern of level below from the top.
iii)
Level Below: It is the depressional stage from the ground level and may be swim pool, or just a plain level below the ground but which can be seen from the other levels. Here the observer will be able to see all other landscape elements of other 2 levels in elevational form.
c).
Detail design and construction: This is the transfer of all design works into the
landscape ground in order to achieve the entire theme of the designer, which means, the dreams, hopes and expectations of the client, designer, as well as the users are transformed into reality. These include the composition of landscape elements and materials to set up structures, tress planting and others. By using any available technology from the primitive handcraft to automated machine. At this stage a designer invites other members of the planning team such as masons, artists, horticulturalists, engineers and so on. A designer should noticed that in the process of construction, a man can positively improve upon nature negatively destroy it or live in peaceful co-existence with it.
66
3.2.2 Management and maintenance of landscape design Unlike the static Architecture work and urban monuments, landscape design depends solely on the constant maintenance, ranging from cleaning moving, pruning and even renovation and replacement. “The landscape maintenance is defined as the work undertaken in order to keep and restore every facility of landscape elements to an acceptable standard”, (Musa, 2006). It also commences immediately after the handover of the project by a contractor to the client for onward use. As such a designer should prepare and submit a sequential guideline on how to properly carry out the maintenance exercise when handing over the site. It is also very important that a designer should have continuing involvement with the management team because his monitoring role will help to solve the unforeseen problems more economically when arise several years after contract is completed. Annual site inspections undertaken with the landscape. Followed by a written report to clients will in most cases be sufficient to ensure that the landscape design grows, changes and evolves sympathetically to the original design vision, without such as annual check by the designer. It is highly probable that the initial capital investment in the landscape projects may be wasted through misapplied maintenance regimes. The maintenance may be daily, weekly, monthly or even annually, depending on the types of species (plants). Materials used in construction (hard landscape elements) and users. ESSENCE OF MAINTENANCE i)
To retain the value of the investments
67
ii)
To maintain a project in a condition in which it will continue to fulfill its functions.
iii)
To present a good appearance of the project, (Musa, 2006).
AGENT THAT CAUSE DEFECT OF LANDSCAPE DESIGN a)
Environmental factors: These include solar radiation, precipitation, air constituents, solid and liquid contaminants, exatra. These may affect the rate of plants growth, timber and concrete elements such as the walkways, furniture, kiosks and so on.
b)
Biological Defect: Some fungi, such as wet dry rot; insects such as beetles, pests and bacteria’s may affect both the soft and hard landscape elements. These may dealt with the use of pesticides, insecticides, fungicides etc.
c)
Construction fault: poor supervision, workmanship and technology are the main faults of landscape design and maintenance. Lack of analysis and understanding landscape design components mat arise as a result of inadequate skill of the designer which eventually affect the management and maintenance of the design after the work has been completed.
d)
Defects in the landscape element: this affect the management and maintenance of the design such as defect in concrete, timber and other landscape elements.
d)
Users fault: If the users are not considering the way and manner to use the project according to specifications of the designer, it may lead to the rapid devastation of the project which eventually causes the complexity in the management.
68
CHAPTER FOUR ANALYSIS AND DISCUSSION The aim of the research is to find out the effect of landscape elements on the psychological depression of cancer patients and to use it if the result is in positive direction in the design of National Oncology Centre, Abuja. 4.1 DIFFERENT PSYCHOLOGICAL DEPRESSIONS OF CANCER PATIENTS After conducting the research or obtaining the responses of the two groups of cancer patients at ABU Teaching Hospital Zaria, of which 40 patients are in the control group and 24 in the experimental, the following results are obtained.
69
TABLE 7; Distribution of psychological depressions of cancer patients with variables;
CONTROL GROUP PSYCHOLGCAL DEPRESSIONS OF CANCER PATIENTS
TOO MUCH FEAR MEMORY DISTURBANCE (FORGETFULNESS) LOSS OF INTEREST HOPELESSNESS NEGATIVE MOOD LOW ENERGY (WEAKNESS) QUITNESS LOW APPERTITE ANGER /AGRESION
STAGES OF CANCER GENDER
AGES
STAGE I
STAGE II
STAGE III
STAGE IV
MALES
FEMALES
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
4 4
3 3
9 8
4 5
11
11
3 3
5 6
1 0
6 5
3 4
23 24
8 7
3 1
3 5
4 5 5 4
3 2 2 3
9 10 8 11
4 3 4 2
11 10 13 13
3 4 1 1
6 5 5 6
0 1 1 0
7 7 6 8
2 2 2 1
23 23 25 26
8 8 6 5
3 2 4 4
4 3 5
3 4 2
8 10 8
5 3 5
12 12 12
2 2 2
6 5 5
0 1 1
6 7 6
3 2 3
24 23 24
7 8 7
4 3 4
0-19
20-44
45-64
65-
NO
YES
NO
ABOVE YES NO
12 13
5 4
11 12
3 2
3 3
0 0
3 4 2 2
14 14 14 15
3 3 3 2
10 12 11 12
4 2 2 2
3 2 2 3
0 1 1 0
2 3 2
12 14 12
5 3 5
11 11 11
3 3 3
3 2 3
0 1 0
HOBBY;-
Musics /singing Musics /dramar Reading travelling
4 0 2 1
3 2 2 1
5 5 1 1
2 3 0 0
4 4 2 2
10 6 3 1
70
2 0 3 1
6 3 2 2
5 5 0 0
1 2 0 0
Ceremonial Activities Playing Watching movies
0
2
3
0
2
3
0
3
2
0
2 1
0 1
0 0
0 0
1 0
1 2
2 1
0 1
0 0
0 0
2
2
2
1
2
5
1
3
2
1
0 0 1 1
2 0 5 2
0 0 3 9
0 0 0 6
2 0 2 3
0 0 7 15
0 0 0 1
1 0 3 6
1 0 3 8
0 0 1 3
ACTIVITIES INTRESTED IN ;-
Playing with my kids Office work Visitation Homework Religious act.
SOURCE; Field work 2009
71
TABLE 8; Distribution of percentage psychological depressions of cancer patients with variables;
PSYCHOLGCAL DEPRESSIONS OF CANCER PATIENTS
TOO MUCH FEAR MEMORY DISTURBANCE (FORGETFULNESS) LOSS OF INTEREST HOPELESSNESS NEGATIVE MOOD LOW ENERGY (WEAKNESS) QUITNESS LOW APPERTITE ANGER /AGRESION
CONTROL GROUP STAGES OF CANCER (%) GENDER (%)
AGES (%)
STAGE I %
STAGE II %
STAGE III %
STAGE IV %
YES
NO
YES
YES
YES
57 57
43 69 43 62
31 79 38 79
21 83 17 67 21 100 0 56
33 74 44 77
26 50 23 17
50 71 83 76
29 79 23 86
21 100 0 14 100 0
57 71 71 57
43 29 29 43
31 23 31 15
21 29 7 7
78 78 67 89
22 22 22 11
26 26 19 16
50 67 33 33
18 18 18 12
29 14 14 14
57 43 71
43 62 57 77 29 62
38 86 23 86 38 86
14 100 0 14 83 0 14 83 0
67 78 67
33 77 22 74 33 77
23 67 26 50 23 67
33 71 50 82 33 71
29 79 18 79 29 79
57 29 14 0
23 15 15 8 15
36 36 7 7 21
33 50 0 0 0
44 44 22 22 22
32 19 10 3 10
33 0 50 17 0
35 18 12 12 18
36 36 0 0 14
33 67 0 0 0
29 14
0 8
0 0
0 0
11 0
3 6
33 17
0 6
0 0
0 0
69 77 62 85
NO
79 71 93 93
NO
100 83 83 100
NO
0 17 17 0
MALES %
FEMALES %
YES
YES
NO
74 74 81 84
NO
20-44
0-19 % YES
50 33 67 67
NO
% YES
82 82 82 88
NO
45-64 % YES
71 86 79 86
NO
% 65ABOVE YES NO
100 67 67 100
21 100 0 21 67 33 21 100 0
HOBBY;-
Musics /singing Musics /dramar Reading travelling Ceremonial Activities Playing watching movies
72
0 33 33 0
ACTIVITIES INTRESTED IN ;-
Playing with my kids Office work Visitation Homework Religious act.
29
15
14
17
22
16
17
18
14
33
0 0 14 14
15 0 38 15
0 0 21 64
0 0 0 100
22 0 22 33
0 0 23 48
0 0 0 17
6 0 18 35
7 0 21 57
0 0 33 100
45-64
SOURCE; Field trip 2009
TABLE 9; Distribution of causes of psychological depressions of cancer patients with variables;
CAUSES OF PSYCHOLGCAL DEPRESSIONS TO CANCER PATIENTS
FEAR OF DEATH INTERRUPTION OF LIFE PLAN CHANGE IN BODY IMAGE CHANGE IN SOCIAL ROLE FINANCIAL PROBLEM
CONTROL GROUP STAGES OF CANCER GENDER
AGES
STAGE I YES NO
STAGE II YES NO
STAGE III YES NO
STAGE IV YES NO
MALES
FEMALES
0-19
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
65ABOVE YES NO
4 5
3 2
8 6
3 4
12 10
3 5
4 5
2 1
5 6
3 3
23 20
8 9
3 4
3 2
11 10
5 5
11 9
3 5
3 3
0 0
3
4
7
4
12
4
4
2
5
2
23
10 2
4
12
5
10
4
2
1
3
4
7
4
10
5
4
2
6
4
18
11 3
3
11
5
10
4
2
1
7
0
10
0
13
2
6
0
7
0
29
2
0
15
0
12
2
3
0
73
6
20-44
OTHER CAUSES;
-lack awareness -discrimination
3 0
4 1
6 3
3 5
5 3
11 6
10 4
4 5
2 0
0 0
SOURCE; Field trip 2009
TABLE 10; Distribution of percentage cause of psychological depressions of cancer patients with variables
CONTROL GROUP STAGES OF CANCER (%) GENDER (%)
CAUSES OF PSYCHOLGCAL DEPRESSIONS TO CANCER PATIENTS
STAGE I % YES NO
FEAR OF DEATH INTERRUPTION OF LIFE PLAN CHANGE IN BODY IMAGE CHANGE IN SOCIAL ROLE FINANCIAL PROBLEM
STAGE II % YES NO
STAGE III % YES NO
STAGE IV % YES NO
MALES % YES NO
AGES
FEMALES % YES NO
0-19 % YES
(%)
20-44 %
45-64 %
NO
YES
NO
YES
NO
50
67
29
79
21
65-% ABOVE YES NO
57 71
42 73 29 55
27 75 45 63
19 67 31 83
33 50 17 56
30 67 30 61
24 1 27 67
33 59
29 64
100 0 36 100 0
42
57 64
36 75
25 67
33 50
20 67
30 33
67 71
29 71
29 67
33
42
57 63
37 63
31 67
33 56
44 55
33 50
50 65
29 71
29 67
33
0
81
13 100 0
70
0
6
0
85
15 100 0
38 19
50 83
50 30
29 36
67 0
100 0
91
42 0
36 9
88
100 0
88
OTHER CAUSES;
-lack awareness -discrimination
33 18
SOURCE; Field trip 2009
74
59 24
TABLE 11; Distribution of psychological depressions of cancer patients with variables
PSYCHOLGCAL DEPRESSIONS OF CANCER PATIENTS
EXPERIMENTAL GROUP STAGES OF CANCER GENDER
AGES
STAGE I
STAGE II
STAGE III
STAGE IV
MALES
FEMALES
0-19
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
TOO MUCH FEAR
1
MEMORY DISTURBANCE (FORGETFULNESS) LOSS OF INTEREST
0
2 3
2 2
4 4
3 2
6 7
2 3
3 2
2 2
5 5
6 5
1 0 0 1
2 3 3 2
3 1 3 3
3 5 3 3
5 5 3 5
4 4 6 4
3 2 2 3
2 3 3 2
4 2 2 2
3 5 5 5
0 1 0
3 2 3
3 2 2
3 4 4
3 4 3
5 5 6
2 3 1
3 2 4
2 3 1
5 4 6
HOPELESSNESS NEGATIVE MOOD LOW ENERGY (WEAKNESS) QUITNESS LOW APPERTITE ANGER /AGRESION
20-44
45-64
65-
NO
YES
NO
YES
NO
ABOVE YES NO
10 0 11 0
1 1
5 4
7 7
2 2
5 6
1 1
2 2
8 6 6 10
8 10 10 6
0 0 0 0
1 1 1 1
5 5 6 6
7 7 6 6
4 2 2 4
3 4 4 3
3 1 0 2
0 3 3 1
6 7 5
9 0 9 1 11 0
1 0 1
5 4 4
7 8 8
2 4 1
4 3 6
1 1 1
2 2 2
HOBBY;-
Musics /singing Musics /dramar Reading travelling Ceremonial Activities Playing
2 1 2 1 0
4 0 3 2 1
3 1 4 1 2
3 0 2 0 1
6 1 6 3 1
6 1 5 1 3
1 0 1 0 0
6 0 8 1 1
3 1 2 2 3
2 1 0 0 0
1
0
0
0
1
0
1
0
0
0
75
Watching movies
0
0
1
0
0
1
0
0
1
0
0
2
1
1
2
1
1
1
1
0
0 0 0 0
0 0 0 1
0 0 2 3
1 0 1 1
1 0 1 2
0 0 2 3
0 0 3 1
1 0 0 2
0 0 0 2
ACTIVITIES INTRESTED IN ;-
Playing with my kids Office work Visitation Homework Religious act.
SOURCE; Field trip 2009
TABLE 12; Distribution of percentage psychological depressions of cancer patients with variables
PSYCHOLGCAL DEPRESSIONS OF CANCER PATIENTS
EXPERIMENTAL GROUP STAGES OF CANCER (%) GENDER(%) STAGE I %
TOO MUCH FEAR MEMORY DISTURBANCE (FORGETFULNESS) LOSS OF INTEREST HOPELESSNESS NEGATIVE MOOD LOW ENERGY (WEAKNESS)
AGES (%)
STAGE II %
STAGE III %
STAGE IV %
MALES %
FEMALES %
0-19 %
YES
YES
YES
YES
YES
YES
67 40 71 60
60 29 40 29
71 38 71 31
62 0 69 0
100 42 100 33
58 25 58 25
62 33 75 33
67 67
33 0 0 33
67 100 100 67
50 83 50 50
44 44 67 44
40 60 60 40
43 71 71 71
50 62 62 38
100 100 100 100
58 58 50 50
38 50 50 38
0 100 100 33
76
0 0 0 0
NO
YES
67 33 67 29
50 38 38 62
NO
YES
67 33 100 33
57 29 29 29
NO
42 42 50 50
NO
50 25 25 50
NO
65-
33 0
60 40 40 60
NO
% ABOVE
NO
56 56 33 56
NO
45-64 %
YES
50 17 50 50
NO
20-44 %
YES
100 0 0 67
NO
QUITNESS LOW APPERTITE ANGER /AGRESION
0 100 50 033 67 33 0 100 33
50 33 67 44 67 33
56 40 56 60 67 20
60 29 40 43 80 17
71 38 57 44 83 31
56 0 100 42 56 100 0 33 69 0 100 0
50 25 58 50 67 13
50 33 38 33 75 33
HOBBY;-
Musics /singing Musics /dramar Reading travelling Ceremonial Activities Playing Watching movies
67 33 67 33 0
67 0 50 33 17
33 11 44 11 22
60 0 40 0 20
86 17 86 43 17
38 6 31 6 19
100 0 100 100 0
55 0 67 8 8
38 13 25 25 38
0 0 0 0 0
33
0 0
11
0 0
17 0
0 6
0 0
0 0
0 13
0 0
33
11
20
29
6
100
80
13
0
22 33
20 0 20 20
17 0 17 29
0 0 13 19
0 0 25 8
13 0 0 38
0 0 0 67
ACTIVITIES INTRESTED IN ;-
Playing with my kids Office work Visitation Homework Religious act.
0 0 0 17
SOURCE; Field trip 2009
77
67 67 67
TABLE 13; Distributional causes of reduction in psychological depressions of cancer patients with variables
EXPERIMENTAL GROUP CAUSES OF PSYCHOLGCAL DEPRESSIONS TO CANCER PATIENTS
FEAR OF DEATH INTERRUPTION OF LIFE PLAN CHANGE IN BODY IMAGE CHANGE IN SOCIAL ROLE HEALING CAUSES; - landscape elements
-watch/ clock -telephone/ gsm
STAGES OF CANCER GENDER
AGES
STAGE I YES NO
STAGE II YES NO
STAGE III YES NO
STAGE IV YES NO
MALES
FEMALES
0-19
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
65ABOVE YES NO
2 3
2 2
5 2
2 4
3 4
5 3
1 3
3 2
4 2
3 4
7 10
9 7
1 0
1 2
5 5
6 6
3 4
4 3
2 3
1 0
1
2
3
4
5
3
4
1
4
3
9
7
1
1
5
6
4
3
3
0
1
3
3
3
3
5
2
3
3
4
6
10 0
2
5
6
3
4
1
2
2 1 0
0 0 1
10 6 2
4 3 1
6 4 2
7 3 2
3 1 0
6 5 3
14 6 2
SOURCE; Field trip 2009
78
20-44
45-64
6 4 2
2 0 1
TABLE 14; Distributional percentage of cause of reduction in psychological depressions of cancer patients with variables
EXPERIMENTAL GROUP STAGES OF CANCER (%) GENDER (%)
CAUSES OF PSYCHOLGCAL DEPRESSIONS TO CANCER PATIENTS
STAGE I % YES NO FEAR OF DEATH INTERRUPTION OF LIFE PLAN CHANGE IN BODY IMAGE CHANGE IN SOCIAL ROLE HEALING CAUSES; - landscape elements
-watch/ clock -telephone/ gsm
STAGE II % YES NO
STAGE III % YES NO
STAGE IV % YES NO
MALES % YES NO
FEMALES % YES NO
AGES (%)
0-19 % YES
NO
20-44 %
45-64 %
YES
YES
NO
NO
65-% ABOVE YES NO
40 60
40 71 40 29
29 38 57 50
62 20 38 60
60 57 40 29
43 41 57 59
53 50 41 0
50 45 100 55
55 43 45 57
57 67 33 43 100 0
20
40 42
57 62
38 80
20 57
43 53
41 50
50
45
55 57
43 100 0
20
60 43
43 38
62 40
60 43
57 35
59 0
100 45
55 43
57 33
80 60 20
86 57 29
88 38 25
60 20 0
86 71 43
82 35 12
86 57 29
67 0 0
SOURCE; Field trip 2009
79
100 0 50 0 0 50
67
4.2 EFFECTS OF LANDSCAPE ELEMENTS ON THE PSYCHOLOGY OF CANCER PATIENTS TABLE 15; Comparison of cancer patients with and without psychological depressions.
Controlled Group Psychological Depression Causes No. Yes No. of No No. Yes 273 86 106 359
No. of No 50 156
SOURCE; Field trip 2009
% Yes = 273 X 100%
% Yes 106 X 100%
359
156
= 76%
68%
% No = 86 X 100%
% Yes 50 X 100%
356
156
= 24%
32%
TABLE 16 ; Comparison of cancer patients with and without psychological depressions.
Experimental Group Psychological Depression No. Yes No. of No 79 127 206
Causes No. Yes 45
No. of No 47 92
SOURCE; Field trip 2009
% Yes = 79 X 100%
% Yes 45 X 100%
206
92
= 38%
49%
% No = 127 X 100%
% Yes 47 X 100%
206
90
80
= 62%
51%
No of respondents for landscape = 20 % of positive response
=
20 x 100% 23
=
87%.
Psychological Depression
Psychological Depression
Psychological. Depression NO
No
Controlled group (Without Landscape)
Experimental group (With landscape)
FIG.11; Shows the difference in psychological depressions between control and Experimental groups. SOURCE; Field trip 2009
If one considers the above analysis, one will notice the significance difference between the responses of the two groups due to the effects f landscape elements. There is 38% increase in no psychological depressions in the experimental group even with the short period of time; the research proved to be a success one. The objectives of the research are; (a) to find out the effects of landscape elements on the psychology of cancer patients based on: - Age group - Gender type - Stage of the cancer (b) To find out the type of leisure of cancer patients before and after the disease based on:
81
- Age group - Gender - Stage of cancer Based on the research and the analysis, the following results are obtained; (a) Effect of landscape elements on the STAGE OF CANCER; TABLE 17; Comparison of psychological experimental groups of cancer at Stage 1;
Controlled group Yes No 38 25 63
depressions between the controlled and
Experimental Group Yes No 4 23 27
SOURCE; Field trip 2009
% Yes = 38 x 100% 63
% Yes = 4 x 100 27
60% % No = 25 x 100% 63
15% % Yes = 23 x 100 27
40%
85%
TABLE 18; Comparison of psychological depressions between the controlled and experimental groups of cancer at Stage II;
Controlled group Yes No 81 35 116
Experimental Group Yes No 21 33 54
SOURCE; Field trip 2009
% Yes = 81 x 100% 116
% Yes = 21 x 100 54
70% % No =
35 x 100% 116
39% % No = 33 x 100 54
30%
61%
82
TABLE 19; Comparison of psychological depressions between the controlled and experimental groups of cancer at Stage III;
Controlled group Yes No 105 21 126
Experimental Group Yes No 33 47 80
SOURCE; Field trip 2009
% Yes = 105 x 100% 126
% Yes = 33 x 100 80
83% % No = 21 x 100% 126
41% % No = 47 x 100 80
17%
59%
TABLE 20; Comparison of psychological depressions between the controlled and experimental groups of cancer at Stage IV;
Controlled group Yes No 49 5 54
Experimental Group Yes No 21 24 45
SOURCE; Field trip 2009
% Yes = 49 x 100% 54
% Yes = 21 x 100 45
91% % No = 5 x 100% 54
47% % No = 24 x 100 45
9%
53%
83
-
100 -
80
-
60
-
40
-
20
-
Controlled group
- - Experimental group
Stage I
Stage II
Stage III
Stage IV
Stages of cancer FIG.12 Shows the distribution of cancer patients without psychological depressions and Stages of cancer. SOURCE; Field trip 2009
The above bar – chart shows the effects of landscape elements in the psychological depressions of cancer patients based on stages of cancer. It shows that landscape elements have more effects on Stage I than II and more on II than III and then IV. GENDER TYPE TABLE 21; Comparison of psychological depressions between the controlled and experimental groups of Male cancer patients.
Controlled group
Experimental Group
Yes
No
Yes
No
58
19
20
43
77
63
SOURCE; Field trip 2009
84
% Yes = 58 x 100% 77 75% % No = 19 x 100% 77 25%
% Yes = 20 x 100 63 32% % No = 43 x 100 63 68%
TABLE 22; Comparison of psychological depressions between the controlled and experimental groups of Female cancer patients.
Controlled group
Experimental Group
Yes
No
Yes
No
215
64
59
84
279
143
SOURCE; Field trip 2009
% Yes = 215 x 100% 279 77% % No = 64 x 100% 279 23%
% Yes = 59 x 100 143 41% % No = 84 x 100 143 59% Controlled group Experimental group
100 -
80
-
60
-
40 -
20
-
Males
Females Gender
FIG.13; Shows the distribution of cancer patients without psychological stresses and gender. SOURCE; Field Trip
85
The above shows that, landscape elements have more effects on the psychological depressions of male cancer patients than females. BASE ON AGE GROUP TABLE 22; Comparison of psychological depressions between the controlled and experimental groups 0 – 19 years.
Controlled group Yes No 28 26 54
Experimental Group Yes No 1 8 9
SOURCE; Field trip 2009
% Yes = 28 x 100% 54 52%
% Yes =
1 x 100 9 11%
% No = 26 x 100% 54 48%
% No = 8 x 100 9 89%
TABLE 24; Comparison of psychological depressions between the controlled and experimental groups of 20 – 44year
Controlled group Yes No 120 33 153
Experimental Group Yes No 44 63 107
SOURCE; Field trip 2009
% Yes = 120 x 100% 153 78% % No = 33 x 100% 153 22%
% Yes = 44 x 100 107 41% % No = 63 x 100 107 59%
TABLE 25; Comparison of psychological depressions between the controlled and experimental groups of 45 – 64year Controlled group Experimental Group Yes
No
Yes
No
101
24
23
38
125
61
SOURCE; Field trip 2009
86
% Yes = 101 x 100% 125 81%
% Yes = 23 x 100 61 38%
% No = 24 x 100% % No = 38 x 100 125 61 19% 62% TABLE 26; Comparison of psychological depressions between the controlled and experimental groups of 65 years and above
Controlled group Yes No 24 3 27
Experimental Group Yes No 11 17 28
SOURCE; Field trip 2009
% Yes = 24
x 100%
% Yes = 11 x 100
27 89% % No = 3 x 100% 27 11%
28 39% % No = 17 x 100 28 61% Controlled group
100 – Experimental group
80 –
60 –
40 -
20 -
0 – 19
20 – 44
45 – 60
65 - above
Ages FIG.14; Shows the distribution of cancer patients without psychological stresses and age group. SOURCE; Field Trip 2009
87
The above shows that, landscape elements have more effects on the psychological depressions of cancer patients from 0 – 19 years than any age and then between the ages of 45-64 than between 20 – 44, then 20 – 44 and then 64-above has the least effect than the rest.
b). to analyze the type of leisure of cancer patients before and after the disease based on; • Stages of cancer • Gender • ages I). STAGES OF CANCER TABLE 27; Distribution of leisure and cancer patients at Stage I
Leisure Control * Music singing * Reading
%
/dancing/ 57 29
* Playing with my kids
29
Experimental * Music/singing/Dancing * Reading *Music and Drama
67 67 33
Architectural solution
Recommendation
Birds of good sound (musical sound) Sit –out/common room/ news paper Sculptures of a mother, father and children
* Birds of good sound *Sit – out/news paper/novels *Sculpture of people in form of drama
* Birds of good sound * Sit-out/Newspaper Sculpture in form of Drama
SOURCE; Field trip 2009
TABLE 28; Distribution of leisure and cancer patients at Stage II
Leisure Control * Music singing
%
/dancing/ 23
Architectural solution
Birds of good sound
88
Recommendation
* Home work *Playing with my kids
38 15
Experimental *Music/singing/dancing
67
*Reading
50
* Playing with my kids
33
Sculpture of a mother * Birds of good sound cooking, father holding a child Birds of good sound
* Sculptures of a mother, father and children. Sit-out for reading news paper *Sit-out for reading news paper Sculptures of a mother, father and children.
SOURCE; Field trip 2009
TABLE 29; Distribution of leisure and cancer patients at Stage III
Leisure
%
Architectural solution
Control Group * Religious Activities
64
* Music/singing/Dancing * Music and Drama
36 36
*Ceremonial activities
21
Sculpture of Iman and pastor (Religious text) Birds of good sound Sculptures of people on * Sculpture of Iman, drama pastor and religious books Sculptures of people dancing, * Birds of good sound cooking, etc.
* Homework Experimental * Religious Activities
21 33
*Musics/Dancing/Singing 33 *Reading 44 *Ceremonial activities
22
*Homework
22
Sculpture of Imam Pastor/religious books
Recommendation
and * Sit –out for reading newspaper and religious book
Birds of good sound Sit-out or reading religious *Sculpture of people books cooking, dancing, etc Sculptures of people dancing , cooking, etc.
SOURCE; Field trip 2009
89
TABLE 30; Distribution of leisure and cancer patients at Stage IV
Leisure
%
Architectural solution
Controlled group. * Religious Activities
100
*Musics and Drama
50
Sculptures of Imam, Pastor and Religious Texts. Sculptures of peoples and Drama Birds of good sound *Sculpture of Imam and pastor/Religious Texts.
*Musics/Singing/Dancing 33
Experimental *Musics/Singing/Dancing 67 *Reading 40 *Religious Activities
20
*Playing with my kids
20
*Ceremonial Activities
20
Birds of good sound Sit-out for reading newspaper and religious books Sculptures of Imam and pastor/Religious texts. *Sculptures of parent and children Sculpture of people on drama
Recommendation
*Birds of good sound *Sculptures of parent and children *Sculptures of people on Drama *Sit out for reading Religious books /Newspaper.
SOURCE; Field trip 2009
II). TYPES OF GENDER TABLE 31; Distribution of leisure in MALE cancer patients
Leisure
%
Architectural solution
Controlled Group * Music /Singing/dancing/ * Music and Drama
44 44
* Religious Activities
33
*Reading
22
*Travelling
22
*Ceremonial activities
22
Birds of good sound Sculpture of people in Drama Sculptures of Imam/Pastor and Religious texts Sit-out for reading novels/newspapers, etc. Pictures of people on traveling Sculptures of people in ceremony
*Playing with my kids
22
Recommendation
*Birds of good sound *Sculptures of Imam, pastor, and religious texts Sculptures of parents and *Sit-out for reading
90
kids Experimental Music/Dancing/Singing
86
Reading
86
*Travelling
43
*Religious Activities
29
*Playing with my kids
29
newspaper/religious books.
Birds of Good sound
*Pictures of people on traveled Sit out for reading *Sculptures of novels, newspaper father and his kids Pictures of peoples on traveled Sculptures of Imam, pastor and Religious text/books Sculptures of parent and children
SOURCE; Field trip 2009
TABLE 32; Distribution of leisure in FEMALE cancer patients
Leisure
%
Architectural solution
Controlled Group *Religious Activities
48
Recommendation
*Music/Singing/Dancing *Homework Experimental Group *Music/Singing/Dancing
32 23
Sculptures of pastor, Imam *Sculptures of Imam, and Religious texts Pastors and Religiosu books Birds of good sound Sculpture of a lady cooking *Birds of good sound
38
Birds of good soung
*Reading
31
Sit-out for reading newspaper
*Religious
19
*Ceremonial Activities
19
Imam, Pastor and religious texts Sculptures of people on Ceremony
*Sculptures of lady cooking *Sit-out/religious book/newspaper
III) Ages of cancer patients TABLE 33; Distribution of leisure in 0 – 19 years cancer patient.
Leisure
%
Architectural solution
Recommendation
Controlled Group * Reading
50
*Music/Singing/Dancing
33
Sit-out for newspaper/novels Birds of good sound
*Sit out for reading
91
reading
novels, Newspaper *Ceremonial Activities
33
*Musics and Drama
18
* Homework Experimental Reading
18 67
*Musics/Singing/Dancing *Homework *Experimental Group *Music/Singing/Dancing *Reading
55 25 100 100
*Travelling
100
*Playing with my kids
100
Sculptures of people in Drama Sculptures of people on Drama Sculpture of a lady cooking Sit-out for reading newspaper/religious texts Birds of good sound Sculpture of mother cooking Birds of good sound *birds of good sound Sit-out for reading *Pictures/sculptures of novels/newspaper people on traveled. Pictures/sculptures of people on traveled Sculptures of parents and children
SOURCE; Field trip 2009
TABLE 34; Distribution of leisure in 20 – 44 year cancer patients
Leisure
%
Architectural solution
Controlled Group Religious Activities
35
*Music/Singing/Dancing *Playing with my kids *Ceremonial Activities
35 18 18
Sculpture of Imam, Pastor and religious texts Birds of good sound Sculptures of parents and kids Sculptures of peoples’ ceremonial
Recommendation
SOURCE; Field trip 2009
TABLE 35; Distribution of leisure in 45 – 64 Year cancer patients
Leisure
%
Architectural solution
Controlled Group Religious Activities
57
Sculpture of Imam, Pastor and religious texts Birds of good sound Sculptures of people on *Sculpture of Imam, drama Pastor and Religious texts *Birds of good sound
*Musics/Singing/Dancing 36 *Musics and Drama 36
Experimental Group
92
Recommendation
*Religious Activities
38
*Music/Dancing/singing
38
*Ceremonial Activities
38
Sculptures of Imam, Pastor *Sculpture of people and religious texts on Drama Birds of good sound *Sculptures of people on ceremonial act. Sculptures of people on ceremonial act
SOURCE; Field trip 2009 TABLE 36; Distribution of leisure in 65 and above year cancer patient
Leisure
%
Architectural solution
Controlled Group *Religious Activities
100
* Musics and Drama
67
Sculpture of Imam, Pastor and religious texts Sculptures of peoples in drama Birds of good sound Sculpture of a mother *Sculpture of Imam, cooking and Pastor and religious texts A father holding a child *Birds of good sound
*Musics/Singing/Dancing 33 *Playing with my kids 33
*Homework Experimental Group *Religious Activities
33
Musics/Singing/Dancing Musics and Drama
67
67
Recommendation
Sculptures of Imam, Pastor Sculptures of a mother and Religious texts cooking and a father holding a child Birds of good sound Sculptures of people on *Sculptures of people Drama on Drama
SOURCE; Field trip 2009
93
CHAPTER FIVE CASE STUDIES Case studies of some existing Oncology Hospital in abroad and centers in the country conducted by the author furnished the necessary data required to analyze and make comparison and deductions as to the work loads of the professional medical staff, nature and degree of occurrence of some cancer cases, required number of beds per head of population effectively served and other relevant information. 5.1 Case study no. 1 Center of excellence, Department of Oncology, A.B.U. Zaria • • • • • • • • • • •
Location: Shika, Zaria, Nigeria. No. of beds: Out of the 650 beds in the whole hospital, 55 are of cancer patients. No of operating theatre: 3 No. of consultant Doctors: 4 No. of resident Doctor: 4 No. of senior Nurses: 3 No. of junior Nurses: 7 No. of paramedical professionals: 8 No. of non-professional – personnel: 5 Surgical cases = 65% (85% occupancy) Average Length of stay = 25 days
Table 37 Information of Cancer Cases at ABUTH, Zaria from June 2005 to June 2008.
Year 2005 2006 2007 2008 Total
Male 1123 1625 1738 1189 5675
Female 269 3207 3411 2176 10963 Source; Health Information Management Unit, ABUTH. 2009
94
Total 3292 4832 5149 3365 16638
Plate 12. Department of Oncology A.B.U Teaching Hospital Zaria SOURCE; Field work 2009
Merits (i) (ii) (iii) (iv)
Presence of courtyards Natural lighting is commendable Good location Good pedestrian circulation
Demerits (i) (ii) (iii)
Lack of variable landscape elements No proximity between the nursing units and the treatment zones. No basis on the used landscape elements
5.2 Case study no. 2
National Hospital Abuja. It was originally made as Pediatric Hospital, but due to the lack of Hospital in Abuja, it is now being used as a National Hospital.
95
• Location: Abuja, Nigeria. • No. of Beds: 250 Department of Oncology • • • • • • • •
No. of operating theatre: 2 No. of Consultant Doctors: 5 No. of Resident Doctors: 5 No. of Senior Nurses: 4 No. of Junior Nurses: 10 No of Paramedic /professionals: 6 No. of non-professional professional No of professional personnel: 7
PLATE 13. National Hospital Abuja. SOURCE; Field trip 2009
96
Merits (i) (ii) (iii)
Good landscaping Natural lighting is recommended Good location
Demerits (i) (ii)
Poor pedestrian circulation Inadequate parking spaces
5.3 Case Study No. 3 Smilow Cancer Hospital @ Yale New Haven This is one of the selected networks of 38 comprehensive Cancer Centre in the World (Robert A; Dean, Yale University School of Medicine). • • • • •
Location: Park Street, South Frontage Road, Yale, USA. Designer: Shepley Bullfinch Richardson and Abbott. Size: 14 Storey building Area: 497.000 ft2. No of beds: 944 beds.
Plate 14; Approach Elevation of Smillow cancer Hospital at Yale-New Haven. SOURCE; Field Trip.
97
Levels and functions (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x)
Basement Floor; Radiation Oncology Ground floor; Women’s Centre Gynecology and Breast Cancer). First Floor; Diagnostic Imagin Second Floor; Surgical Services Third Floor; Ambulance procedures , etc. Fourth and Fifth floors; Mechanical Space Sixth floor; Pediatrics Oncology, Medical Oncology, Satellite Pharmacy. Seventh Floor; Alpheresis, Medical Oncology Infision Eight and Ninths Floors; Shelled Spaces 10th, 11th, 12th, 13 and 14th floors: In-patient Oncology Units.
Plate 15. Rear Elevation of Smillow cancer Hospital at Yale-New Haven. SOURCE: Field work 2009.
Merits (i) Presence of Large courtyards (ii) Good pedestrian circulation Demerits (i) (ii) (iii)
Far distance between the nursing units and the treatment areas. Poor natural lighting Non-attractive composition
98
5.4 Case Study No. 4 Greenwich Cancer Centre • • • • •
Location: Perry ridge, Green which Size: 3-storey building Area: 9.2 acre (37,000m2), the building occupies acre (36,000m2). Medical sub-departments; 32 No. of beds; 174 beds.
Plate 17; Approach view of Green Which Cancer Center. SOURCE; Field trip 2009
99
Plate 18: Site Plan of Green Which Cancer Center. SOURCE: Field work 2009.
Levels and functions i. Ground floor; ii. First floor iii. Second floor iv. Third floor
Belle Haven Conference Admission/out patient blood Ambulatory Surgery Unit Administration
Watson pavilion Helmseley Helmsley building Watson pavilion
Merits (i) Good natural lighting (ii) Good location (iii) Good landscape Demerits (i)
Lack of proximity between the wards and the treatment area.
100
CONCLUSIONS From the statistical data drawn from these four hospitals, the following important conclusions are made; (a) Lack of proximity between the nursing care units and the treatment areas which may increase the psychological stresses of cancer patients who is receiving treatments from the wards’ (b) Inadequate pedestrian circulation which causes the roaming about of the patients who is not familiar with that hospital and, can increase one’s psychological stresses. (c) Lack of variable landscape elements in the hospital could create imbalance which violate the principle of aesthetic component of the landscape design, hence, can influence psychological stresses to the cancer patients. (d) Inadequate parking spaces could bring about any-how parking which will mess the environment consequently affects the psychology of the patients in the hospital. (e) Lack of basis on the used landscape elements which may lead to the deterioration psychology of cancer patients.
5.6 Space determinants (1) Number of Out-patient clinics; Assume three (3) patients referred per day from each of the 36 states of the federation. If a consultant takes an average of 15 minutes per patient, then per day he would see a total of 32 patients for 8 working hours per day.
101
The number of doctors in OPD Clinics = 3 x 36 = 3 doctors. That means we need 3 consulting room. 32 (2) Number of operation theatres; the number of hospital beds has been considered as 250. Then in a 250 hospital beds, (65% are Surgical and 21 days average length stay) 160 bed for surgical and 90 bed for medical. No. of operating theatres to serve 160 beds; No. of operations per years =
160 x 85% occupancy x 365/21 days average stay
=
2363 operations per year.
No. of operations /day
=
2363 365 days
= 6 operations /day No of operating room = 5. In addition to that, there are recovery room, general office, doctors station, sterilization room, equipment and surgical dressing rooms.
102
CHAPTER SIX AREA OF STUDY The site is located at Guzape; a new developing district bounded to Asokoro in phase I Abuja. 6.1 ABUJA Abuja, estimated population about 3 million (Jibril, 2009), is the capital city of Nigeria in western Africa. When it was decided to move the national capital from Lagos in 1976, a capital territory was chosen for its location near the center of the country. The planned city was located in the center of what is now the Federal Capital Territory. Abuja is located at 9°10' North, 7°10' East (9.1667, 7.1667). Abuja the capital of Nigeria occupies a total area of 713km2 (275.3sq mi), lying South of Suleja town. The territory is surrounded by Niger, Plateau, Kwara and Kaduna States. (abujacity.com, 2008)
FIG 15. Shows map of ABUJA. SOURCE; Abuja city.com 2008
103
FIG 16. Shows the sub-division of ABUJA. SOURCE; Abuja city.com 2008
6.2 GUZAPE DISTRICT Guzape, a district next to Asokoro, with architectural challenging topography and state of the art infrastructure.The climate data of any site are very important tools for the design. For a comfortable living environment will most often depend on maximizing the aspects of the environment which reduce heat and the effect of humidity and protect from rain and dust.
Thus for a successful exercise, architects must plan with climate at all
areas of designs.
104
FIG 17.Shows Guzape District ABUJA. SOURCE; F.C.D.A 2009
Therefore the following climatic data of FCT Abuja as they affect the national oncology center at Guzape district Abuja are analysed below. Humidity is low during the dry season coupled with high afternoon temperatures. This accounts for the desiccating effect of the dry season. During the raining season, the relative humidity is high and temperature is slightly lower and this creates a heat trap
105
thereby making the place uncomfortable hot. The following are the recommendations deduced; fig . a) b) c)
Design solutions must make for proper ventilation Use of artificial ventilation should be considered Water fountains, pools or ponds and other cooling landscaped elements which are soft would aid in heat elimination.
The further away from the coast a place in the more the general number of sunshine hours. Abuja is exposed to about 12,500 sunshine hours annually. During the dry month (November – April), the monthly variation in the amount of sunshine follows the general trend of an increase from 275 hours over the city site. The approach of the raining season, reduces the sunshine hours due to cloudiness. This decline becomes intense as the rainy season progresses and reduces to its lowest in August causing possibly a temperature inversion over the city site. The recommendations are as follows: a)
Proper orientation eliminates or reduces the amount of offensive sun’s rays into the building which if not protected causes glare. b) Adequate sun shading devices should be used on east and west side elevations. The tropical maritime air mass and the tropical continental air mass dominate the climate of the sites. The tropical maritime is formed ever the Atlantic Ocean to the south and is therefore warm and moist. It moves generally inland in a south-west to north-east direction. The tropical continental air mass is developed over the Sahara desert and therefore is warm and dry and blows in the opposite direction. In June, the northerly flow of air component has weakened and only the southerly flow predominates and brings a lot of rain. In September, the tropical continental begins to intensify over the territory and the north east trade becomes more dominant from
106
October to March bringing with it day but cloudiness dues to laden conditions associated with hamattan. The following recommendations are therefore made; a) b)
Trees should be planted as wind breakers at the site Openings shall be made with due regard to wind direction for proper ventilation. 6.2.1 Site Feasibility and Viability The chosen site has a lot of potentials when taking into account the kind of project being proposed. The following factors are therefore considered; a)
Accessibility; The site is easily accessible from the prominent and existing airport
expressway where the access road to the proposed site is linked. b)
Size; The land allocated to this project in the Guzape District is enormous and can
accommodate all facilities with large landscape and future expansion opportunities. c)
Infrastructure; The site has been provided with basic infrastructures for modern
facilities to be installed. There is direct link of the site to water supply, electricity, sewage disposal system, telecommunication and drainage systems due to its proximity to Asokoro and Central area. d)
Land use and Adjoining Sites; The site is appropriate for the project as one of
the site snapped out for the proposed project in the part development because of the nearness to supporting facilities adjoining the site, such as the hotel and motel sites, the park service facilities and public parking facilities. The hotel could be patronized by the patients from the proposed adjacent hospital, so also the proposed shopping mole.
107
FIG 18. Shows land use map of ABUJA. SOURCE; F.C.D.A. 2009
108
CHAPTER SEVEN DESIGN REPORT 7.1 DESIGN BRIEF; The proposed National Oncology Center Abuja comprises of 5 basic portions which include; out patients Unit, In patients Unit, Healing Gardens Diagnostics Unit, and Emergency unit. These 5 are condensed into the following function units; (a) Diagnostic modalities (I) Laboratory medicine (ii) Special procedure suite (iii) Emergency Unit (iv) O.P.D (v) Histopathology (b) Therapeutic modalities; (i)
Radiation therapy
(ii)
Surgical suit
(iii)
Post Anesthesia care unit
(iv)
Day care/chemotherapy
(v)
Intensive care unit
(vi)
Inpatient Unit
(C) Clinical ancillaries; (i)
Central sterilization
109
(ii)
Laundry
(iii)
Beds unit
(iv)
dietary
(v)
material management
(vi)
pharmacy
(d)
Clinical supports;
(i)
Medical Records.
(ii)
Patient Registration and Admission.
(e)
Support Functions;
(i)
Executive Administration
(ii)
Medical Administration
(iii)
Nursing Administration
(iv)
Finance
(iv)
Management information systems.
7.2 SITE ANALYSIS The proposed site is located at Guzape district close to Asokoro in Abuja. it is rightly located at the center of the district bounded by 3 access road, and is 105,600 Square metre in size. It is sloping towards South-West, hence; surface drainage and sewage should take into cognizance. The climate is classical savanna which is characterized by low humidity and rainfall which lasts for a few months of the year. Cold night and hot days alternate for 6 to 10 months in a year, while hot discomfort occurs for 3-9 months; hence the form of building
110
should reduce solar radiation. Walls and floors should be of high thermal capacity of over 8 hours, Openings should be composite, 20 t0 30% of wall area. Wind direction is considered in locating waste disposal, to divert smell from residential units. Fire breakers are also being corporate to prevent wind from spreading fire from one part to another. longer side of the building are facing N-E direction to reduce heat discomfort. North-East Trade winds comes between November and March, cold, dry and dusty, Openings are minimized on this direction, so trees and shrubs are to be used to filter air and serve as shielding device.
Site Analysis Sunset: Accompanied by glare and heat discomfort which are undesirable for human comfort. Space s such as corridors, store s and stairs should be zoned to the west end.
South-West Trade Winds: Between April and September brings rain fal l and cool breeze windows should be maximized on the S-W si de. Wind pre ssure should be created through small e xternal windows and l arge i nternal windows. Recre at ional facili ties should be zone d for maxi mum use of S-W Winds.
Veget ation: densely veget ation with few existing tree s. Site should be well landscaped and more trees shoul d be planted to reduce solar radiati on and avoid soil erosi on
North Orientation: Wind dire ction must be consi de re d in l ocating waste disposal to divert smell from resi dential units. Fire breakers should al so be incorporated to pre vent wind from spreading fire from one part to another. L onge r side of buil dings should face N-E di rection to reduce heat discomfort.
Soil: Soi l type is of good load beari ng capacit y average top soil excavation of 150mm shoul d be carried out to remove decompose d organic matter
Climate: The cli mate i s classified as savanna and i s characterized by low humidity low rainfall e xperienced for a few months of the year. Cold night s and hot days al ternat e for 6 - 10 months in a year. While hot discomfort occurs for 3 - 9 months he nce the form of the bui lding should reduce solar radiati on, walls and floors shoul d be of hi gh thermal capacity of over 8 hrs openings shoul d be composite , 20 - 30% of wall area
North-East Trade Winds (Hammattan): Between Novembe r and March. Col d, dry and dusty windows shoul d be minimized on N-E si de . Trees and shrubs should be used to filter the ai r and serve as shield
Topography: Sit e is ste eply sloping towards South-West. Surface drainage and sewage should take into conside ration direction of the slope.
S unrise: Considerations sh ould be made on the site layout, arrangement of plots and orientation of buildings to minimise build ing surface exposed to the east side. This w ill reduce discomfort caused by glare. Shading devices and appropriate landscaping should b e incorporated to reduce this effect
Access
FIG 19. Shows land use map of ABUJA. SOURCE; field work. 2009
111
Considerations should be given on the layout and orientation of the buildings to minimize exposure to East, this will reduces the discomfort cause by glare. shading devices and landscaping are to be considered. 7.3 DESIGN CRITERIA The criteria of the design occurs from the site constraints which include microclimate considerations, topography possibilities, the complex operations of the national hospital and most importantly is the findings of the research during the course of my studies. I have found out that landscape element has a healing impact on the psychology of cancer patients by about 38%. The concept of the design is a mono-block using a system of courtyards to provide avenues for planting trees and other landscape elements, using plants for treatment of cancer as recommended in this book. Adequate planting serve for: (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x)
Defining a space Frame views and vista Acoustic control Atmospheric purification Traffic control Glare control Wind breakers Shading device (sun shielding device) Alter the micro – climate of an area Erosion control
7.5 SITE ZONING The site is being divided into a different hierarchy of spaces; which is public, semi-public and private. • • •
Public zone: is the area free to general public. Semi public: is the area restricted to people for a particular purpose. Private zone: will be ‘no go’ area for general public except staff and special visitors.
112
PRIVATE
PUBLIC SEMI PUBLIC
7.6 DESIGN CONCEPT The design concept comes from the fact that, cancer patients have psychological stresses, so the centre is design to reduce the lone-ness of cancer patients, hence; a mono-block hospital concept with open courtyards and gardens is adopted.
The process of activities in the hospital, evolved to a monoblock as shown bellow;
113
Plate18; Mono-block hospital concept. Source; Field work 2010.
114
7.7 APPLICATION OF RESEARCH TOPIC IN THE DESIGN I have attempted to bring the indoor activities outdoor, such as; • • • • • • •
Waiting areas, Cafeteria, G.O.P.D Consultations, healing gardens, terraces, Vertical circulation, in an open landscape environment.
The design however incorporates the concept of contiguity principle which is now gaining a worldwide recognition. In this theory, all closely related functions of the various hospital departments should be tied together in a horizontal, contagious plane. In this manner, a long travel distance between related departments is reduced and vertical movements using staircases, elevators etc. are minimized. 7.7.1 Healing Garden in the Proposed Hospital, Abuja. The proposed center contains four healing gardens; two within the hospital courtyards bounded by the 4 walls and two by the side of nursing unit. A water feature is the main focus throughout these gardens. The water feature symbolizes “The Cycle of Life.” Meaning the revival of life. This is because water is a symbol of life of which a blind can hear its sound and a dump sees its falls. Seating in the garden varies from movable chairs and tables to a curvilinear seat-wall, allowing for different levels of comfort and positions in sun and shade. Raised beds contain plants that have low water and maintenance requirements. Another major elements featured in these gardens are; outdoor consulting spaces for the out patients during dry season, royal huts, art, concrete walkways, seats, fauna and flora. These gardens have level zero as in ground level; level below as in ponds and level above as in hilly area. The basis of the design was a series of garden rooms connected by paths. Garden
115
rooms were created to contain the various activities provide on the site. The road leading to the retreat is marked by a pergola that announces the visitor is entering the site. Beyond the garden gate is the fountain marked by a large sculpture located at the center of each garden. From the findings I recommended that, the plants to be used should have pleasant smell, medicinal and aesthetically appealing. 7.7.2. Out-Patient Care Unit Hospital outpatient services are being increasingly utilized by the population as an essential element in the contribution of hospitals to the total health picture of the community. Cancer patients at stage III and IV needs only palliative care hence they are mostly categorized in outpatients department. Most importantly hospital beds are expensive and cannot be supplied to all those that need diagnosis and treatment in the hospital. In the outpatient department, the waiting is partly outside, using beams and columns to create a large semi-opened space for the patients to interact with medicinal and aesthetic plants within and outside the space. 7.7.3. Laboratory Department This department is the busiest and often the largest of adjunct facilities where numerous diagnostic and research tests are carried out. It is concerned mostly with the preparation and processing of blood, urine and faecal samples it is often separated from the treatment and nursing are areas, the connection to the other departments being through a special prieumatic tube dispatch system.
116
7.7.4. Surgery Departments It is situated on the 3rd floor just close to the sterilization department on the mortuary unit. It is the surgical operations centre within the hospital as a centrally located examination and treatment unit for used by various specialist departments. The reasons for this are; better utilization of space, equipment and staff; better patients
provision
through centralized service functions under the management of specialists, and hygiene considerations. In the surgical department, treatment is given to the patients whose conditions have been diagnosed but cannot be cured solely with medication. It is close to the nursing, recovery room and the central sterilization units due to
the extensive
interaction among these departments. Moreover, it is placed in isolation
because of the
hygiene precautions require the surgical department to be isolated from the rest of the hospital operations. The Number and size of operating rooms is determined by the total number of surgical beds in the nursing units and the nature of operations to be carried out. A
simple
formula for determining the number of operations per year is as follows. Total No. of surgical beds X % of bed occupancy X 365 days / average length of stay 7.7.5. Central sterilization Department This is where all hospital instruments are prepared. The majority of instruments are used by the surgical department (40%), surgical intensive and internal intensive care (15% each). For the design of National oncology center Abuja is placed just next to the surgical department and accessible from accident and emergency.
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7.7.6. Nursing Unit The patient care unit is the building where the hospitalized patient is accommodated from admission to discharge, is considered as one of the most important units in the hospital design followed by the doctors’ workshop- diagnosis and therapeutic departments. The various nursing units in the National oncology hospital Abuja are categorized as follows; (a)
Ground Floor; Ward I and II, are the males’ wards with cancer at stage I, II and III, IV respectively. Emergency unit; is for both males and females with cancer at stage III and IV
(b)
First Floor; Ward III and IV; are females’ wards with cancer at stage I, II and III, IV Pediatrics unit; for children Gynecology Unit
This is because the number of female cancer patients is twice the number of males in Nigeria. . To maintain an adequate level of supervision, each care area should have two nursing stations placed together caring for about 30-40 patients. The arrangement of the rooms is dependent upon the class, type and seriousness of the illness. The following nursing area should be distinguished; normal nursing area (at ward I and III) special care area (ward II and IV) and intensive care area (ward V). Special sculpture garden is placed at the center of the wards containing some birds that give pleasant sounds as music so that all other wards could benefit from the contents of the garden. Another green garden is at the fore front of the wards which is viewable from the wards through the wall windows. At the back of the wards are also gardens so that a patient lying on his bed could see and perceive the landscape environment.
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Total number of Beds; Wards = 155 Beds Emergency Unit = 35 Beds Gynecology unit = 30 pediatric Unit = 30 Beds Total number of Beds = 250 Beds
7.7.7 Ancillary Service This department supplies all necessary sterile products required by the following departments; surgical suite, pathology, labs, nursing unit and out-patient departments. 7.7.8 Laundry All soiled and dirty line mostly from the nursing units and operation suites are brought and handles in the laundry where they are washed, mended, marked and redistributed. Therefore in the laundry; receipt, sorting, weighing, washing spinning, beating out, drying, pressing ironing, sewing and storage are issued. In this design, the laundry has two work areas by way of its functions; (a)
Dirty work area: - Here soiled and dirty materials are treated. Sorting compartment to handle the various types of soiled material which are the fed to washing machines
(b)
Clean work area: - Here all the treated mended, stored and redistributed to various department.
This unit is closed to the central bed unit and wards for easy communications
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7.8 SCHEDULE OF ACCOMMODATION TABLE 38. Schedule of Accommodation
Department
Area (m2)
Total Area/ Dept.
240 180 80 40 400
940
OUTPATIENT (O.P.D) - waiting Area - Entrance Lobby - Consultation room - Doctors Common - Registry PHARMACY - Dispensary - Seminar room - Changing - Store
400 40 100 20
- Consultation room
40
- Admin
60
- Nursing station
90
- Chemotherapy room
150
- Seminar room
40
- Recovery rooms
100
- x- ray room
90
- Toilet
12
- Record station.
40
1182
EMERGENCY UNIT - Waiting - Consultation
100 45 200
120
- Emergency ward - Toilets
15 360
PATHOLOGY MUTIARY
AND
- Admin
75
- laboratories
120
- Post-motern room
12
- Resting
30
- Coffin stand
25
- Cold room
9
-
Dressing area
12
-
waiting
60
-
Entrance Toilets
35 379
RADIOLOGY UNIT - Admin
90
- waiting
18
- Simulator room
36
- Toilets
12
- Demonstration
16
- mould room
16
- changing cubicles
5
121
- Gastric
10
- Consultation
16
- Bones
21
- control room
12
- Film processing
12
- Film room
9
- Theatre room
22
- Record
30
- Laboratory room
70
- Seminar room
100
- Brachy room
12
CLINICAL LABORATORIES - admin
70
-
seminar room
120
-
waiting
60
-
toilets
15
-
Hematology
16
-
Serology blood
16
-
Urine/ stool
12
-
Cold room
9
-
Sick room
9
365
122
-
Cytology
Area (m2) 9
-
Change room
24
-
Glass
-
Sample room
12
-
Weighing
12
-
Preparation
12
-
Endoscopy
12
-
Consultation rooms
12 12
Total Area/ Dept.
-
Reserve rooms
21
-
Sampling submissions
18
225
Area (m2) 150
Total Area/ Dept. 150
100
100
CENTRAL STORE
CENTRAL KITHEN RAMP ROOM WARDS Doctors
toilets Stations
75 100 150
Nursing
Stations
123
Patients
rooms
GYNECOLOGY BREAST UNIT
4000
4225
AND
-
waiting
100
-
admin
90
-
changing
Area (m2)16
-
consultation
16
-
Temporary ward
200
-
Theatre room
32
Total Area/ Dept.
16 -
Equipment
-
Blood Sample
12
-
Nursing station
30
Seminar room
75
1125
INTENSIVE CARE UNIT waiting Nursing Station
1000 1122
. 2000 I .C. U ward Consultation room Toilets LAUNDRY - waiting -
admin
200 15
3210
100 90
124
-
collection center
110
-
wet room
100
-
Dry room
80
380
ADMIN BLOCK - Finance and supply
- Nursing unit - Maintenance - Clinical zone - Admin Information unit
40
50 45 75 70 68 45
375
Chief medical director STERILISATION UNIT
-
Delivery store
30
-
Precleaning room
30
-
Resting Toilets
30 15
-
Parking
25
-
Operating store
20
-
Sterilizes store
35
-
Changing
35
-
220
SURGERY UINIT -
Waiting
60
-
Recovery
16
125
- Surgical room
Dressing 14
-
General Office
12
-
Sterilization rooms
18
-
Wash rooms
20
-
Preparation
25
-
Discharge
-
Anesthesia
20
-
Operating room
16
-
Doctors station
24
-
Nursing station
30
15
270 Source; field work, 2010 . 7.8
APPLICATION
OF
RESEARCH
FOR
SOLVNG
UNWANTED
SOUND IN THE HOSPITAL Sound is generally controlled by minimizing noise at its source, by isolating or muffling structure- borne reverberations caused by impact, by providing sound reducing walls and floors between the sources of noise and the patients and by applying absorbents to surfaces in areas where noise is likely to occur. But most of the common sounds absorbing surface treatments are considered by the medical professionals as the germharboring possibilities. This make architectural approach necessary to solve the above problem by using plants climbing walls on the interior walls and the well-seasoned
126
timbers as skirting to act as the noise absorbents in the hospitals especially around the corridors, openings and noisy departments moreover, thin non-porous films over soft absorbent material- over come the floors. A cork tile with pleasant looking surface can also be used as the sound-absorbent material in the corridors. All doors should be fitted with silent closers and swinging doors are recommended in very busy rooms. Ceilings of various absorbent materials should be used in the hospitals. The demarcations of hospital departments using sound insulating plants will also reduce the sound penetration from the neighboring departments and bye-pass patients. So also the design concepts of locating waiting ad consultation areas outside the main building (around the noise-absorbents such as trees) will reduced in the finishing and fittings should be considered to see if some resilient material could be used to replace a hard one. The insulation of walls between rooms in general, except where neither requires profit a kitchen, occurs next to a room requiring care rooms, the insulation should be at least 45 dB. Floors between wards should prefer ably have an overall insulation of 50dB. Noisy departments such as central kitchen, stores, incinerator, boiler, generators house and the animal quarters are sited in remote areas to prevent noise disturbance.
127
CHAPTER EIGHT CONCLUSION AND RECOMMENDATIONS 8.1
SUMMARY
The thesis has been divided into eight chapter, one dealt with the general introduction to the thesis theme, chapter two literature review which examines the development of hospitals and spread of cancer cases in Nigeria chapter three dealt with the general aspect of landscaping, Chapter four analyzed the Data gotten from the field work while chapter five examines some of the oncology centers both within and outside the country Nigeria. Chapter six dealt with site appraisal while chapter seven contains the design report. The last chapter dealt with the summary and conclusion The thesis attempted to find out the relationship between the landscape elements and the psychology of cancer patients in hospital design. After the field work the following results were obtained; 76% of cancers patients which are not expose to landscape elements have psychological depressions, meaning 24% do not have. 62% of cancer patients which are exposed to landscape elements have no psychological stresses, meaning 38% have. The research shows that, the effects of landscape elements decreases as the stage of cancer increases. Landscape elements have more effects on the psychology of male cancer patients than females’ Landscape elements have more effect on the psychology of cancer patients between the ages of 0-19year follow by 45-60 then 20-44year and lastly between 65-above. Cancer patients have the following leisure; I. Listening to music and dancing
128
II. III. IV. V. VI.
Playing with kids Religious activities Music and drama Ceremonial activities Reading
8.2 CONCLUSION The thesis has dealt with the complex problems associated with the design of oncology hospital, data has been collected and examined from the ABU teaching hospital and the result shows that the research is successful. In fact, a sure and lasting solution to the problems is certain with careful implementation of all the findings, analysis and inferences in various topical chapters of the thesis. The thesis found out that in oncology hospitals, the use of healing garden is necessary and division of nursing unit should be base on gender, age group and stage of cancer. 8.3 RECOMMENDATIONS After haven observed the result or findings of this research, I recommend the following in the design of oncology center; 1). As much as possible, the indoor spaces should be converted to outdoor spaces such as; Waiting areas Cafeteria Terraces Receptions G.O.P.D Consultations. Stair cases Leisure areas etc. 2). Rehabilitative gardens should be incorporated in the design 3). Division of nursing units should be based on gender, stage of the cancer and age variation. The nursing units should be divided into; Adult nursing unit Breast and cervical unit Pediatric nursing unit
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In general; females nursing unit should double the males nursing unit Adult nursing unit should be 6 times the pediatric nursing unit. 4). both outdoor and indoor plants are to be used in planning the center and should posses the following characteristics. Pleasant smell Aesthetically appealing Medicinal plants N.B Indoor plants should not be used extensively which may be a medium of collecting germs. 5). some of the recommended plants are;
TABLE; 39 RECOMMENDED PLANTS;
S/NO
1 2.
3
4 5 6
7
8
Common name/ botanical name Snake plant / Sansavieria trifasciata peppermint
CHARACTERISTICS ODOUR AESTHETIC MEDICINAL Pleasant pleasant -remove smell volatile organic substance Mint smell appealing Clears unwanted guest e.g. lice, bugs and mice. Rawaya / Anti-cancer Cochlospermum smells tinctorium A. Umya / Cannabis Pleasant Anti-cancer sativa L. smell /Hypoxis Mint-odour pleasant Anti-cancer hemerocallidea L Epazote plants Good pleasant Heals cuts and flavour burns . Christmas tree pleasant -has positive effect On headaches & fatigue Lavender flower Scent lines pleasant Get rid of bruises
130
SOURCE Lawson H. (1931) Bill and John (94)
Abubakar, etal (2007) Konduru, Grieson and Afolayan (2007)
Gattefoss R. (1920)
9
10
/ Cissus ibuensis Hook /Rose, litchen, cinnamon, cedar, Good Pinyon, jasmine flavour Juniper, cupress e.t.c. Aloevera emollient,
good
appealing
Abubakar, etal (2007)
Gattefoss R. (1920) Heals wounds, laxative. Antispasmodic, Roberts, M.( 1990) promotes menstrual flow.
11 12
Antinflammatory/ skin cancer
Angelica arcangelica (Umbelliferae
SOURCE; Field work 2010
6). In Landscaping the National Oncology Center Abuja, the following should be incorporated; Sit-out for reading newspapers, novels and religious texts. Sculpture of a large clock. Birds of pleasant sound.
131
REFERENCE/BIBLIOGRAPHY Abubakar, Hussaini, Musa, et al., (2007); “The perception and Practice of Traditional medicine in the treatment of cancer and inflammations by the Hausa and Fulani tribes of Northern Nigeria” Faculty of Pharmacy, A.B. U., Zaria. Ajayi, A.O. (1999); Redevelopment Proposal For National Orthopedic Hospital. Unpublished M.Sc thesis Department of Architecture, A.B.U., Zaria. Akerele, O., (1988). Medicinal plants and primary health care: An agenda for action. Fitoterapia, 59, 355–363. Akenfenwa, A.J (1992). Health Resort, Abuja; Unpublished M.Sc. thesis Department of Architecture A.B.U Zaria. Ackerman, D. (1990); A Natural History of the Senses, Vintage Books. New York, U.S.A American cancer society Journal (2006) Adams, J. ( 2002); The Herb Quarterly, “The Fragrant Garden” pg. 44-48 EGW Publishing Company. Concord, CA. Appleton, J. (1996); The Experience of Landscape. John Wiley & Sons. England. Abuja FCC (2005); Federal Capital Territory Nigeria. Retrieved August, 20,2009 from www.statemaster.com Abuja FCC (2005); Federal Capital Territory Nigeria. Retrieved August, 20,2009 from www.fgguidlines.org Abuja FCC (2005) , Federal Capital Territory Nigeria.. Retrieved August, 20,2009 from www.Abuja city.com Bill W. and John C. (1994); Plants and absorbing Conterminants. London. 132
Ebon, O.M., (2004). National Cancer Institute, Ibadan; providing a suitable environment for the cancer management. Unpublished M.Sc. thesis, Department of Architecture, A.B.U Zaria. Francis, M., Lindsey, P., and Jay S. R. (1994), The Healing Dimensions of People Plant Relations: Proceedings of a Research Symposium. Center for Design Research. UC Davis, California. Grierson, D. S. and Afolayan, A. J(1999); An ethnobotanical study of plants used for the treatment of wounds in the Eastern Cape, South Africa. J. Ethnopharmacol. 67, 327–332. Gattefoss R. (1920); Cosmetic Properties of Plants; France. Gulma, A. M. (2007); Addressing Problem of Women in Nigeria. Hooper H. and Jackson W.B. (1911) Landscaping. Encyclopedia Britanica (11th edition) (vol. 19, pp. 27-500) U.K Howard, J., (1999); General Climatology, 4th edit, Critchfield, western Washington University, U.S.A. Jibril I, U. (2006) ; Resettlement Issues, Squatter Settlements and the Problems of Land Administration in Abuja, Nigeria’s Federal Capital. (5th FIG Regional Conference Accra, Ghana, March 8-11, 2006). Retrieved on 2008-08-10 from www.fig.net Koduru, Grieson and Afolayan (2007); “Ethobotanical information of medicinal plants used for treatment of cancer” Current Science, 92, 906-908. Eastern Cape Province, South Africa.
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Kola W. D (1995); Aesthetic, domestic and nutritional use of plant resources in Niger State: an ethnoarchaeological study. Centre for Nigerian Cultural Studies Ahmadu Bello University Zaria, Nigeria. Koncelik, J.A.(1976); Designing the Open Nursing Home. London. Lichtenstein, Holm, Verkasola et al. (2000); “ Environmental and Heritable Factors in the Causation of Cancer. Sweden, Denmark and Finland” N England J. med 343 (2). Life of poverty in Abuja's wealth news.bbc.co.uk. BBC News, Tuesday, 13 February 2007. Retrieved on 2007-08-10. Miller, Hafez, Stewart, et al., (2003); “Prostate Carcinoma presentation, diagnosis and staging; and update from the National Cancer Data Base” Berlin Springer, 1399. Germany. Minckley, B. (1968); A Study of noise and its relationship to patient discomfort in the recovery room. Nursing research, 17, 247-50. U.S.A. Menning Wc (1948); Recreation and mental health Recreation; 42; 340-346 London. Mas’ud, A. (1983); National Eye center, Kaduna. Unpublished M.Sc. Thesis, Department of Architecture, A.B.U., Zaria. Musa, M.A. (2006); Landscape in the Tropical Nigeria. Unpublished B.Sc. Project, Department of Architecture, ABU. Zaria. Neufert E. (1980); Architects’ data. Granada publishing Ltd London. Nilsen, R. (1991), Helping Nature Heal: an introduction to environmental restoration. Ten Speed Press. Berkeley, CA.
134
National Population Commission, (2007). Nigerian Population. Retrieved 15th July 2009 from www.wik.nigdemorgraphy.png Peter and George (2003); Understanding Biology. 2nd Ed. Cambridge University, London. Roberts, M.( 1990), Indigenous Healing Herbs, Southern Book Publishers, South Africa, pp. 1–285. Shamsudden O.A. (1974); General Hospital Koridu. Unpublished M.sc. thesis Department of Architecture ABU Zaria Taylor and Tolving (2002); Biological Science. 3rd Edition. Cambridge University, London. Ulrich, R. S. (1984), “View Through A Window May Influence Recovery From Surgery.” Science, Vol. 224, pp 420-421.USA Weddle, A.E (1976); Techniques of Landscape Architecture. Heinemann, London. Wilson, E. O. (1984), Biophilia. Harvard University Press. Wilson, E. O. (2002), The Future of Life. Alfred A. Knopf, a division of Random House, Inc. United States. WHO, (1998), Regulatory situation of herbal medicines. A worldwide review, Geneva, Switzerland, pp. 1–5. WHO,(2007), Spread of cancer cases in Nigeria. Retrieved 29th june, 2008 from www.who.infobase.com WHO,(2007), global cancer cases. Retrieved 20th September, 2008 from www.who.infobase.com
135
WHO,(2007), Spread of cancer cases in Nigeria. Retrieved 20th September, 2008 from www.helpinghand.com WHO,(2007), global cancer cases. Retrieved 25th October, 2008 from www.globalheathframework.net.
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