The three main buildings of HUH are located on university-owned land among periph-eral buildings of RSWS. The land of the university campus is extensive (estimated 130Ha) and it was noted that the land for the construction of RSWS had been granted from university land. Inspections of the HUH buildings already completed and opera-tional confirm one aspect of the stated vision of HUH to provide 'infrastructure for high quality clinical care delivery'.
4.2.1 The Site
Access to the site is good along Jl. Perintis Kemerdekaan which is the main axis from central Makassar city to the airport. The university is approximately equidistant from both. Entry to the site and the main distribution road are crowded as this is the one main entry to Hasanuddin University, Hasanuddin University Hospital and RSWS.
It is unfortunate that the three main buildings of HUH are not contiguous. Apparently it was the original concept but unachievable due to land ownership problems. However, it could be argued that the prominent location of Building A, with advantages of visibility and access, may have presented problems later for the construction of the additional buildings, access roads, parking and technical services - as the surrounds are quite congested. The location and juxtaposition of Building E,F and Building B,C,D are oth-erwise quite appropriate. There is a minor problem at present with the lower parts of the Building B,C,D site flooding which could be rectified with proper drainage and mainte-nance. Once Building B,C,D is complete there is scope for limited expansion to the north. Road access for patients, visitors, staff and emergency vehicles is good while road access around the buildings for maintenance, fire-fighting and delivery vehicles is appropriate.
Figure 4.2: HUH infrastructure allocations
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EPOS Health Management4.2.2 Building A
Building A was completed in 2009 at an estimated cost of IDR 71 billion.
The building is of reinforced concrete construction consisting of six levels with a central lift / stair core, central longitudinal corridor and rooms to each side. A staff dining room and kitchen are located on the roof level.
The building was originally designed solely for teaching activities but was later modified to contain limited clinical activities.
The building is in good condition with only minor maintenance repairs required to re-place broken floor tiles, small areas of damaged ceiling and some re-painting to refresh it to a high standard. It was reported that the central fire alarm panel is faulty and has been provisionally disconnected. There is no central genset for emergency power alt-hough there is an appropriate genset room in the building.
One unusual aspect of the building is that part of the ground and first floors are utilised by the fire brigade. Apparently there was a municipality-owned fire brigade building on the site and the HUH Building A was built over it - retaining the fire brigade building in place.
L1 (Ground Floor) - Ophthalmology Clinic accessed by a dedicated entrance at the south end of the building. This unit contains several consultation and examination rooms and sees approximately 50 patients per day. It is a teaching unit and a base for outreach programs. The clinic contains two operating theatres in quite good condition with associated patient holding areas and recovery areas. Adjacent is a small sterilising unit which - although it also processes goods from the main surgical unit in Building E,F - has a less than satisfactory layout and standard of equipment. The ophthalmology surgical unit undertakes approximately 60 operations (mostly cataracts) per month.
The main building technical services are also located on L1, comprising of the trans-former, main switch room, genset room, PABX, engineering control room, water stor-age tank, pressure pumps and fire hydrant pumps.
Figure 4.3: Building A
Figure 4.4: Ophthalmology OT
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L2 - Dermatology Clinic in a relatively small space with several consultation rooms. It would appear that dermatology patients mostly attend Wahidin Hospital. On L2, directly above the Ophthalmology Clinic is the Ophthalmology inpatient unit with 1 x VIP bed, 6 x Class 1 beds, 8 x Class 2 beds and 6 x Class 3 beds, total 21 beds.
L3 - Teaching areas including the departments of Orthopaedics, Surgery, Obstetrics and Gynaecology, and Paediatrics.
L4 - Library, teaching areas for the departments of Psychiatry, Neurology, Dermatology and Ophthalmology. Also located on L4 is a Telemedicine Unit which is composed of an open-planned call centre and a simulation room. The unit is more health system and case management-oriented than standard telemedicine units in that it is networking primary and secondary health facilities to HUH.
L5 - Teaching areas including the departments of Anaesthesia, Nutrition, Internal Medi-cine, and Clinical Pathology.
L6 - Research Laboratory, Stem Cell Centre and Fertility Clinic. The Fertility Clinic is in an area of the building which has been recently reconfigured and renovated specifically for the clinic. The standard of the work is good and there are some large items of medi-cal equipment in place but not yet in use. Currently the clinic has two staff and treat approximately 100 patients per year. Development of the Fertility Clinic is only in its early stage but the size, configuration and quality of the facility will support the planned 'centre of excellence' level.
4.2.3 Building E,F
Building E,F was completed in 2011 at an estimated cost of IDR 150 billion. The build-ing contains five levels with the structure designed to take a further two levels of wards at a future date. The building was built in three stages over three financial years. The building contractor for the first and second stage was PP - an established national con-tractor and the concon-tractor for the third stage was Adhi Karya - another established na-tional contractor.
The building is a large podium structure for the lower three levels with two ward wings superimposed for the upper levels. It is a reinforced concrete structure with a central lift / stair core currently containing two lifts but with provision of another two lifts when the additional two floors are built.
Figure 4.5: Fertility Clinic Laboratory
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EPOS Health ManagementThe building currently contains the main user areas for HUH with a constant stream of patient, visitor and staff movement. The building is in good condition and presents well.
The functional layout of the building and its supporting technical services are quite suit-able for the activities - ranging from outpatient consultation to sophisticated diagnostic and treatment interventions. The plant areas and technical services are in equally as good condition as the more visible public areas.
Basement Level - The land falls away to the rear of the building which enables road access to the greater part of the basement. It contains the departments of Kitchen, Laundry, Mortuary and plant areas (medical gas, water tanks, fire booster pumps) to the west of the transverse corridor and lift core, with Medical Imaging and Radiotherapy to the east. Medical Imaging contains rooms designed for general X-Ray, CT Scan and MRI. At present there are general X-ray and fluoroscopy installations - no MRI or CT.
The Radiotherapy Unit contains two bunkers for linear accelerators of which one is equipped, a CT Scan simulation room and a brachytherapy room.
L1 - Matching street level at the front of the building this is the main entrance level and public foyer to the building. It contains a retail outlet, bank, dispensing pharmacy, in-formation / reception and Administration. On the other side of the transverse corridor is a Cancer Clinic, Laboratory and a further Administration area. There is an extension of the transverse corridor to form a link to L1 of the unfinished building, Building B,C,D.
L2 - This is the upper podium level for Building E,F and is again connected to Building B,C,D by an extension of the transverse corridor. The connection is quite generous in proportions and distances are short. This greatly advantages the functional relation-ships between both buildings, particularly on levels 1 and 2.
L2 contains a Chemotherapy unit with 22 bed spaces, a large auditorium and flexible teaching space / seminar rooms on one side of the main corridor with a Surgical Unit, Sterilising, Intensive Care and Dialysis Unit on the other side. The Surgical Unit con-tains four operating theatres (three of which are quite large at 50m²) and a 6 bed re-covery area. The associated Sterilising Unit, which is well-designed and of a reasona-ble size, is poorly equipped with no large capacity pass-through sterilisers installed.
The EPOS Team was advised that goods are sterilised in the small sterilising unit on L1 of Building A and transported in sealed boxes. This is not an ideal situation to ensure sterility and needs to be addressed.
In the original design the Intensive Care Unit contained a high care section and an intensive care section. The high care section has since been designated for use as the Dialysis Unit which presents a problem trying to maintain clean conditions. Access to the Dialysis Unit, who are mostly outpatients staying for treatment over several hours, is via the same corridor that links the OT Suite to the ICU. The Dialysis Unit contains 8 beds at present while the ICU contains 8 beds. There is no specific paediatrics ICU section, children are mixed with adults.
Figure 4.6: Building E,F
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L3 & L4 - These are two ward levels with another two typical ward levels planned for the future. From the central lift / stair core there are two wings each with a 'race-track' ward design. The south wing designed as a ward for private patients with a mix of 1-bed and 2-1-bed rooms, while the north wing is designed for public patients with 4-1-bed and 6-bed rooms.
In reality the number of beds is somewhat lower as the hospital adapts to the demand for more single-bed rooms. In one private ward the 2-bed rooms were being used as 1-bed rooms giving a total of 18 1-beds available for the ward, reportedly with an 80%
BOR. In the public ward some of the 6-bed and 4-bed rooms were being used as 1-bed rooms for private patients (The Indonesian health system designates room types as VIP = 1-bed, Class 1 = 2-bed, Class 2 = 4-bed and Class 3 = 6-bed). In the ward that was configured for public patients 39 of the available 54 beds were occupied and it was reported that they usually had an 80% BOR.
4.2.4 Building B,C,D
Building B,C,D is the unfinished build-ing which was begun in 2011. It is a reinforced concrete structure com-posed of a podium with basement and two user levels followed by four levels of wards. Overall, including the base-ment, it contains seven floors. It is quite a large building with a gross floor area of over 36,000m². So far the build-ing has been built in six construction stages corresponding to each financial year but with greatly varying FY fund-ing allocations. After visual inspection a meeting of building professionals esti-mated it to be between 55 and 60% complete, while calculations for the preparation of cost estimates in this report show it to be about 45% complete.
The reinforced concrete foundations and superstructure were completed in 2011 and 2012. As it has been exposed to the elements in the interim period there has been some deterioration which will require rectification before being covered up by finishing works (refer to Structural Engineer's report in Chapter 4.4.3). The floor of the building basement is flooded by rainwater runoff to a depth of a few centimetres. It is thought that this could be quite easily fixed by either clearing out existing drainage lines or mak-ing better provision for drainage.
Figure 4.7: Building E,F; Intensive Care Unit
Figure 4.8: Building B,C,D
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EPOS Health ManagementSome areas of the building have been completed either through hospital operational needs or to take advantage of available funding. At times funding constraints - both the amount of funds and the time limitations for spending the funds - have meant that the building procurement process is rushed, smaller contractors are employed and time to complete the work is too short.
On level 1 of the building, which corresponds to street level at the front, the Emergency Department is complete and operational (although only operational to a limited degree due to lack of equipment). On levels 3,4,5 and 6 the ward block on the south side is complete but not operational. The lifts have not been installed to transport patients between floors and sewer drainage has not been connected.
Extensive areas of building façade treatment have been installed, some with windows incorporated, some without. From the outside this gives the impression that the building is more complete than it really is. Installed façade includes levels 1,2 and 3 at the front and levels 3,4,5 and 6 at the rear. Some of the façade treatment has deteriorated and will require rectification.
Currently works are underway to finish approximately half of level 1 which includes Medical Imaging, Laboratory, Clinical Pharmacy and the Neuro Cebero Vascular Unit.
The work is valued at about IDR 15 billion. It is unlikely that it will be finished before the end of the financial year (end December).
A more detailed Functional Overview of the buildings is given in Annex 18.