Too often, the popular view of sustainability only includes the environment and its direct effect on the health of people. But sustainability reaches into every aspect of development, including education, economics, and social equity. Perkins+Will architects Doug Pierce, AIA, LEED AP (involved in the sustainable design planning and strategy) and Rick Hintz, AIA, ACHA, LEED AP (operating on the healthcare planning side of the project) are currently working on a new construction in Colombo, Sri Lanka, that is designed to address the triple bottom line by essentially taking care of itself, rather than placing more demand on the community. A public and private collaboration, the Embassy Medical Center’s (EMC) multipronged sustainability initiative includes using the presence of international firms as an educational and economic primer for local companies. With a projected completion date of January 2011, the project is being developed by Silvermere Hospitals, Ltd., and includes of a 500,000-square-foot hospital and clinic, dormitory, parking structure, and two bio-anaerobic digesters.

John Oberlin: How is Sri Lanka’s culture and society important to the EMC’s sustainable design?

Rick Hintz, AIA, ACHA, LEED AP: It was clear coming into this that they didn’t want the architecture of this hospital to be the latest John Hopkins Hospital dropped in from above, but they do aspire to have Western technology and healthcare expertise brought into the country. So our challenge was to find a way to blend their native cultural aspects with Western technology. Some aspects of their indigenous architecture are related to sustainability, such as open space, aggregated space, long eave lines, architecture that is fairly porous and takes advantage of prevailing winds, and the incorporation of vegetation and water.

Doug Pierce, AIA, LEED AP: Their culture has, to some extent, more respect for nature than we might calibrate to our culture. Also, the lack of infrastructure means that we need to build a power plant for the facility and deal with issues such as storm sewers and sewage. You have a choice to deal with these things sustainably or in a nonsustainable way; this project has essentially chosen to deal with them in a sustainable way. So the infrastructure issues, coupled with their culture, make the project much more plausible than if it was dropped into a major city in the United States right now.

Hintz: Looking at the Summer Olympics this year we saw what happens if you develop too quickly and get out in front of some of this infrastructure. Sri Lanka is still very much a third world developing country and doesn’t have that infrastructure in place, but they have a concern for air and water quality and want to create an environment that can sustain growth and development in a more holistic way.

Oberlin: They may have a unique perspective as a developing nation looking toward sustainability.

Pierce: They look at the future and see depleting fossil fuel reserves—something that we maybe wouldn’t have envisioned as a country 120-150 years ago when the sky was the limit. We burn through our resources pretty rapidly here, and they have the advantage of looking at history and saying, “Well that’s not the best trajectory to take.”

Hintz: Don’t kid yourself though; Colombo today has a great deal of traffic congestion and poor air quality. The garbage is piling up, and the water is infested. They don’t need to look too far to figure out where they don’t want to go.

Pierce: The fact that they do have pollution and these issues also opens the door for sustainability. One of the goals for this hospital in sustaining itself is to actually help with some of the pollution. We are planning to use a high-temperature anaerobic digester to sustainably deal with the city’s garbage and organic waste, and hoping to actually clean up some of the sewage problems as well. In this situation, sustainability goes much further than just doing less harm to the environment. It really becomes a generative approach where we’re taking care of a wide range of issues and creating a lot of opportunity by doing it.

Oberlin: Are you considering this to be a “living building”?

Pierce: We are looking to achieve two, or maybe three, of the Cascadia Region Green Building Council Living Building Challenge’s “petals,” such as producing all our energy renewably, dealing with all of our own waste water, and harvesting rainwater. We think of this as “regenerative design” and are calling this “Platinum plus two,” where we are pursuing a very high level of LEED Platinum plus two or three of the Living Building Challenge’s main trajectories.

Oberlin: Do the concepts of regenerative design and self-sufficiency play into how this facility will handle catastrophic events? The term “passive survivability” comes to my mind in this context.

Pierce: The sustainability and survivability aspects are all interwoven. For example, the facility will process its own sewage and water on-site, collect rainwater during the monsoon, and process rainwater for drinking, toilets, and other uses. Those same systems will be able to function in a crisis situation as well. They are doing dual duty really. The same goes for the anaerobic digester. We are looking at having two digesters, one at the city landfill and one at the hospital, so we have redundancy in the systems if one goes down because of maintenance or a crisis situation. It also helps from an economic standpoint and a variety of other reasons as well.
Another aspect that is passive that no one ever really talks about is just straight up energy efficiency and energy conservation. It’s kind of abstract, but one of the key things we’re going after is making the building energy efficient. The less energy we need, the less we have to create, and the more survivable the building is.

Oberlin: The facility is designed to handle 85 to 98% of its waste on-site. Is this mostly through the bio-anaerobic digester?

Pierce: The main element of creating gas for the facility is a high-temperature anaerobic digester. It is important to distinguish this from a waste-to-energy incinerator, which is very dirty and environmentally negative. The digester doesn’t burn anything, it actually composts. The digester has a proven track record in Europe, particularly in Germany. All the organic waste that we can get will be converted into, for a lack of a better word, an organic “pudding” that goes into the top of the digester. It comes out the bottom as fertilizer, and we will draw off the methane gas from the top. Anything that breaks down by the natural process of decomposition creates methane gas. It will then be polished up to the rate of natural gas. It is very much a living systems approach to getting your energy.
We are also looking at a small plasma arc incinerator to deal with the hazardous waste that any modern hospital produces: syringes, plastics, metals, and other material that cannot go into the digester. This incinerator’s emissions are converted into a gas, which is burned as well. It does create a small amount of ash that will probably have to be treated as hazardous waste, but basically it is a very limited, manageable amount.

Oberlin: Where are you planning to obtain this organic waste?

Pierce: A principal source of feedstock we are looking at is Colombo’s municipal waste landfill. We will also collect the sewage from the hospital and the surrounding area. The feedstock can also be supplemented with agricultural non-nutrient residues. We don’t want anyone to get the idea that we are haphazardly bringing all this stuff to the hospital. We will be preprocessing it all at the landfill and sanitarily containing it.
The single-use aspect of our culture is very destructive to the health of human beings and ecosystems, so hospitals can play an important role helping us all to rethink our relationship with not only nature, but with one another and how our use of materials and energy impacts everybody.

Oberlin: That starts to get into social equity. How does this concept fit into the overall project?

Hintz: Sri Lanka is looking to educate, train, and retain their young people. So one, the construction of this facility will create jobs. Two, instead of this being a one-time deal, Sri Lanka is looking to leverage the project’s process and use outside experts, architects, engineers, contractors, and subcontractors to not just do the work, take the money, and go home, but invest time and effort in educating and training the local workforce. When we do pack up and go home, they will have the capabilities, tools, and knowledge that can support maintaining this facility and working on other projects. Local firms are partnering with the international side of the design and construction practice. I think this is pretty clever to use architecture as a social-economic engine to spur their economy, and not just an end to itself. Part of this multipronged approach is to stabilize the companies they have within their community so that these companies can grow and offer decent healthcare for their populations and employees.

Pierce: There are other green connections to the social equity piece of this, as well. The fact that we’re pursuing an anaerobic digester to create clean natural gas is something very different for a society that runs hospitals with diesel generators nearly all the time, or for supplemental power. Diesel generators are dirty and dump pollutants onto Colombo’s population. The anaerobic digester will actually do the reverse by cleaning up the sewage and using that to create a power source. When natural gas burns it is pretty clean, and it has a very limited pollutant impact from a particulate and human health standpoint. Hospitals usually demand a city to provide them with all kinds of stuff, whereas this facility will be much more of an equitable approach. It’s not demanding that the city provide it with exhaustive infrastructure.
We are also hoping the digesters create more natural gas than the hospital needs. The surplus can seed a conversion from dirty diesel to cleaner natural gas for things such as small engines and cooking needs. Right now, cooking gas is very expensive there, so we might be able to produce gas more equitably for people to use for basic living.

Hintz: There’s also an education component to this. The intent is to establish an ongoing clinical relationship with healthcare providers outside of Sri Lanka to offer better healthcare to their population and to educate and train their workers as well. EMC plans to have a residency program and medical technology program, where locals could be trained and live in an on-site dormitory. Visiting physicians and clinical technologist would take their sabbaticals or would be attracted to teach there.

Oberlin: Any final thoughts?

Pierce: This is much more than just about the environment. It really includes the community’s economic and social aspects. The key is in ecologically based thinking.

Hintz: In the United States, healthcare executives think of their facilities as a cost, as an expense. But here is a case were a facility will actually be an asset, a driver for economic development, a source of education and training, an incentive for companies to come, and attract international money through medical tourism. It’s more than just a liability and a piece of architecture. It has inherent creative potential.