Wilma den Hartigh
Johannesburg’s inner city suburb of Hillbrow has become home to a new world class maternal and child health facility. The Shandukani Centre, one of the largest non-hospital based clinics in Southern Africa, will provide expert healthcare and treatment to vulnerable women and children, right on their doorstep.
Visiting the Shandukani Centre for Maternal and Child Health, it is hard to believe that this modern, beautifully renovated building was once completely derelict and unsafe.
What used to be the old Van Niekerk operating theatre (built in 1927) of the former Johannesburg General Hospital in Hillbrow, has been transformed into a public facility of which inner city residents can be proud.
The Shandukani development is an important project for the inner city. Hillbrow is a high-density neighbourhood, estimated to be home to about 800 000 people. Over the years the area has become plagued by poverty, overcrowding, a thriving sex worker industry, crime and above-average rates of HIV and infectious diseases.
The new facility, equipped with modern furnishings and the latest high-tech equipment, forms part of the Hillbrow Health Precinct (HHP), a world first in the fight against HIV and related diseases, poverty and urban renewal in Johannesburg’s inner city.
Speaking at the official handover ceremony, Gauteng MEC for Health Ntombi Mekgwe said the facility is a positive and progressive initiative. “What we thought was a pipe dream is now a reality,” Mekgwe said.
Shandukani, a Venda word for ‘change’, is an appropriate name for the new healthcare facility that is breathing new life into Hillbrow. “We are thrilled to have this name because what we are doing here is all about change,” said project manager Yael Horowitz.
The facility is improving access to pre- and post-natal medical care for women and children, while simultaneously bringing about urban renewal by restoring several once-beautiful historical buildings as centres of medical excellence.
“The project is already making a huge difference to the medical footprint in the inner city,” Horowitz said.
In addition to its role as a maternal health facility and working labour ward, equipped with the latest technology, Shandukani will also be a base to train healthcare providers, community workers and researchers.
The centre has just opened its doors, and already 30 babies a day have entered the world here. Professional nursing staff will deliver about 300 babies each month at Shandukani.
It is estimated that 30% of women visiting the clinic are HIV positive, and the centre expects to prevent transmission of HIV to about 85 newborns every month.
Also based at Shandukani is a top research team working on a range of health-related topics including HIV/Aids, TB, maternal and child healthcare, infectious diseases, reproductive health and social science.
According to the specialist conservation architects working on the project, Henry Paine & Partners, the value of the buildings at the HHP, including Shandukani, lies not only in the historic style and design.
Many people have a strong connection with the hospital, which served all of Johannesburg’s communities at some time in its history. The precinct has an historical association with many medical students, doctors and nurses who learned their profession at this teaching hospital.
The buildings also tell a story about development of healthcare and medical technology. When the Johannesburg General Hospital was in its prime, it offered progressive medical care and was in the same league as other well known hospitals around the world.
Now that the once dilapidated building has been entirely revitalised and is a fully functional clinic facility, it can continue to make advances in the field of medicine.
Improving public healthcare
Speaking at the handover function, Minister of Health Dr Aaron Motsoaledi said Shandukani can make an important contribution to improving public healthcare delivery.
“There is a lot of scepticism about whether public healthcare in South Africa will ever change, but we are more determined than ever before to have such a change,” Motsoaledi said. “This centre is part of that change.”
He added that South Africa, unlike many other countries, has a quadruple burden of disease including rising maternal and child mortality and HIV/Aids, which is the “biggest public health crisis that the country has ever faced”.
He said the new Shandukani facility is a solution to these challenges. “We have to strengthen our healthcare system and re-engineer primary healthcare. Shandukani is part of this.”
Motsoaledi commended the corporate partners for their contribution, totalling R28-million (US$3.4-million). “For the companies involved, you are on the right track,” he said.
Comfortable and inviting
Horowitz explained that they wanted to create more than just a maternal facility – the centre had to be welcoming and comfortable.
This is why the development of external public spaces such as courtyards and overflow waiting facilities was a priority.
Courtyards and walkways have been landscaped with large deciduous trees, making these areas cool in summer and warm in winter. The main courtyard area also has benches and a beautiful mural painted by Bronwyn Moore.
Many seemingly little details make a big difference to people’s experience of the facility, such as benches along the pathways where pregnant women walking up the hill can rest.
“Everything we’ve done here is about dignity for all people,” Horowitz said.
Extensive renovations and greening
The Shandukani facility recently won the Colosseum Conservation Award for exemplary work in conservation of heritage buildings in the inner city.
To be eligible for the award, the project had to fulfil renovation criteria as set out in national and provincial heritage policies. The Colosseum Award came about in 1982 during the struggle to save the Colosseum building – a ten-story residential building located in the heart of Johannesburg – from demolition.
Shandukani’s historical significance meant that much of the structure had to be preserved, but at the same time the architects wanted to add a modern edge and introduce greening elements.
Undertaking such complex renovations was no easy feat, but they got it right.
Kylie Richards of Henry Paine & Partners explained that older buildings were often built with the local climate and site conditions in mind, meaning that running and operating costs were significantly lower.
“A good example of this is the incredible floor to ceiling height of 3.8 metres at Shandukani,” she said. “These large volumes with their high windows result in fantastic levels of natural daylight, reducing the need for artificial lighting.”
The thick masonry walls, the high ceilings and many large opening windows together contribute to a comfortable indoor climate in Johannesburg, a relatively hot African city.
Devices used to further enhance the environmental sustainability of the project include a ducted fresh-air system, instead of traditional air conditioning. This will help to reduce operating energy costs. Rooms that are not occupied at night have motion sensors so that lights are automatically switched off.
Richards said that wherever possible existing finishes, structures and historical features have been kept as part of the building and re-used. “There is nothing more ‘green’ than recycling an old building.”
According to Horowitz, 60% of all wood used in the renovations was recycled from original roof rafters.
The large overhang of the second floor acts as a shading mechanism for the large north-facing windows below it. Aluminium filigree screens shade the most exposed portions of glass, acting both as privacy screens for consulting rooms and as a means to reduce heat.
To honour the important history of the building, architects incorporated extraordinary photographs of the original building and operating theatre into the overhang. Inside, original signage recovered during the renovations are displayed prominently on the walls in the foyer.
Floor finishes such as natural cork tiles were installed on the second floor and Marmoleum sheeting was used on the ground and first floors.
“All the floors are bright green which introduces an element of fun,” Horowitz says.
The building’s historical status means that the architects couldn’t alter original internal arches, and to get around this limitation service cabling was placed in steel cable tracks suspended from the ceiling, adding a futuristic edge to the centre.
Henry Paine describes Shandukani as one of his favourite projects ever. “It offers everything. Social benefits to the community, history and heritage, and interesting construction,” Paine said.