(BDT_29_011) New Mulago Hospital - Building Types Online

Description

Mulago has been the location of a hospital since the 1910s, becoming a teaching hospital attached to the newly opened Makerere College where medical training had begun in 1923. Over the ensuing years, the hospital grew to become the main consulting hospital for the indigenous population in the Uganda Protectorate and eventually exceeded its capacity which finally reached 650 beds. Plans were made to develop a new hospital to cater for the growing demand. The building that was subsequently constructed was the third in a series of proposals for the site, the first having been abandoned during the onset of the Second World War. The second proposal, designed by Rees Phillips of Saxon Snell & Phillips Chartered Architects in 1947, was approved and site clearance had started when it was aborted as well, despite the support from the Colonial Development and Welfare Fund.

The third design for the New Mulago Hospital began in 1955, to be built on a 11.3-hectare site to the west of the Old Mulago Hospital. Unusual for the time, the appointed architects were given an office in the Old Mulago Hospital enabling them to meet members of the hospital planning committee on a regular basis. Construction started in September 1958. The New Mulago Hospital was designed to consolidate the services offered at two hospitals, the Old Mulago Hospital which served the African population, and Nakasero Hospital which attended to the European and Asian communities. New Mulago Hospital was to be a general hospital serving all races, as well as a teaching hospital for the newly established University College of East Africa.

The mammoth project of 49,244 square metres was completed within four years. It had been decided early on to use materials that could be sourced locally and could be built with local labour and available machinery, as well as simple finishes. The result was a structure that was built with in-situ concrete, with small spans, and infills made from hollow clay blocks or concrete blocks. The project responded to the site, with the three blocks sitting on the three terraces that had initially been fashioned for the second design scheme. Each terrace had a 3.6-metre rise, resulting in three blocks with four, five and six storeys. The series of three distinct blocks running north–south along the terraces and cascading down the slope was a departure from earlier hospitals in many parts of the tropics, which largely comprised low-lying pavilions surrounded by gardens and trees, joined together by covered walkways. The design of the new hospital was to improve internal conditions for patients and medical staff alike.

The easternmost block is where the main entrance is located, with the casualty department on the ground level, and the outpatient admissions on the first floor, accessed via a stunning elevated curved driveway. The four-storey out-patients block includes accommodation for interns and doctors on-call. The middle block was five storeys tall, comprising the clinical departments, maternity units and a private wing, each with their own operating rooms. The third and westernmost block is for the general wards, with the operating theatres on the ground floor. A key feature of the project was the imposing western façade with the patient wards enjoying views to the valley below and to Makerere University College on the opposite hill. The irony is that all beds faced inward.

While the building does appear as an imposing 198-metre block, it actually comprises three smaller units of about 55 metres separated by breezeways, day spaces for patients and vertical circulation. These spaces aid the thermal performance of the building and provide links to the outdoors, acknowledged as a critical component of the healing process. They also acted as noise buffers between the different wards. The entire project was designed to be bright and airy, a theme carried through from the main entrance hall, as a double-height lobby, through to the wards, with their expansive operable windows affording patients views to the outside.

The cost-conscious design made use of simple finishes, with precast terrazzo panels for the external wall, window sills and shading canopies. The terrazzo contrasted with external surfaces finished with cement plaster and paint and granite rubble. The granite rubble provides a textural contrast to the smooth terrazzo and rendered and painted surfaces. Air conditioning was restricted to essential spaces, such as the operating theatres, with most spaces relying on natural ventilation in line with the Tropical Modern DNA of the building. Mitigating the sun was through horizontal shading devices protruding above all windows, with deep reveals and vertical shading providing additional protection for east and west-facing façades.

While the initial intention had been to demolish Old Mulago, those buildings were retained as the need for medical services grew exponentially, and new departments were required, including the Uganda Cancer Institute. As the main referral hospital in Uganda, New Mulago exceeded the capacity it was designed for. Significantly the designers had not envisioned any extension to the building, given the nature of the site and the fact that it would be difficult to add a wing while the hospital was in operation. Nevertheless, over the past decade, extensions have been made, though not in keeping with the original design intentions and thus compromising its integrity. The structure itself over the years suffered from extensive wear and tear due to years of poor funding as a consequence of civil wars. But it still stands as a testament to the ambitions of the designers to create a hospital that could offer the best medical services available and give medical students the same opportunities as they would get in Europe. As an architectural endeavour, the New Mulago hospital stands as a landmark project signifying the value placed on modern medical care and medical education in Uganda.

Project Credits
Structural Engineers: Ove Arup and Partners
Quantity Surveyors: Davson and Ward
Mechanical Consultants. Gasston and Barbour (in association with G.H. Buckle and Partners)
Electrical Consultants: Kennedy and Donkin (in association with Barlow, Leslie and Partners)

References

Alderdice, A. A. and Sydney, M. B. (1963). “The New Mulago Hospital”. The Lancet 282 (7301), pp. 237–240.

Foster, W. D. (1974). “Makerere Medical School: 50th Anniversary”. The British Medical Journal 3 (5932), pp. 675–678. https://www.jstor.org/stable/20470416

Uganda Ministry of Health (1962). Mulago Hospital, Kampala: Report on the Planning and a Description of the Completed Building. Kampala: Uganda Ministry of Health.

Figure-ground plan, scale 1:10,000