Industrialized Hospitals: Recovering Lelé

hospitales industrializados

Prefabricated construction generally refers to low-quality buildings created to confront deep housing crises, such as the isolated blocks in the former Soviet Union built after World War II or the extensive polygons in Spain constructed during the last years of the Franco era. The search for low-cost, fast-track construction technologies led to experimentation with industrialized processes on a massive scale through rapid-production factories. Those buildings were a too minimal-housing design, and the manufacturing was of low quality.

Today, however, industrialization and serialization of the construction processes are a model of higher quality, significant speed and cost-effectiveness.

Looking also for speed and agility, an exceptional example emerged in healthcare architecture that has become a fundamental model of industrialization in hospital construction. João Filgueiras Lima (1932-2014), also known as Lelé, was a Brazilian architect who sought architectural and constructive solutions to be realized in a country with the size and needs of Brazil. He designed simple forms to build at low cost. The serial prefabrication that he achieved made it possible to convert sophisticated and highly technological programs into simple and delicate architecture.

Lelé was deeply connected to his country’s culture and craftsmanship and translated the influences of the architecture he studied and visited into the Brazilian context. He always had a direct and deep relationship with nature, he was an ecologist when the noun was not so worn out. And for that reason, he sought to choose the most logical geometric form for each material. He was aware that an intense and immense structural understanding of materials is necessary to be able to use them with total freedom.

Lelé is internationally known for the design and construction of the Sarah Kubitschek hospital network, although his portfolio is much more extensive. Lelé designed 10 buildings in that network: Brasilia (1980), São Luis (1993), Salvador (1994), Belo Horizonte (1997), Fortaleza (2001), Rio de Janeiro (2001), Brasilia (2003), Macapá (2005), Belém (2007) and Rio de Janeiro (2009). In this paper, we focus on the first and the last: the centre built in Brasilia in 1980 and the one in Rio de Janeiro completed in 2009.

Lelé proposes warm and comfortable spaces that improve the patient’s well-being and accelerate the healing process: a revolution in the humanization of healthcare architecture that began in 1980. Likewise, because of its concern for extreme care in the natural resources use, modular and prefabricated construction became the expression of sustainable architecture.

Prefabrication and modulation in Sarah network hospitals

In 1992, the network created the CTRS — Sarah Network Technology Centre — on a hospital site in Salvador. The main objective of this centre is to industrialize the design and construction of all the network’s buildings, which should result in lower costs and less time on site. In addition, this centre also designs and manufactures all the necessary elements for producing hospital equipment and is responsible for maintaining the network’s facilities.

The centre operates in interconnected ground-floor buildings that house the heavy and light metallurgy, reinforced mortar, and carpentry and plastics workshops.Lelé believed in integration: of knowledge, of trades, of production, so his office was located on a mezzanine in one of the buildings. He never wanted to charge fees but a salary for his work.

From this manufacturing site, industrialization is complete: from the structure, slabs and roofs of the buildings to objects and furniture for the hospitals. Under Lelé’s technical coordination, various professionals were involved in the design of each hospital in the network: architects, landscape architects, artists, civil engineers, mechanical and electrical engineers. Thus, the architectural project is developed at the same time as the structural and landscaping projects. With this, every prefabricated part is executed from the beginning, when the architectural design is developing. The level of detail of the projects is often very high: up to 10,000 drawings, some at 1:1 scale, detailing the parts and the assembly on site.

Detalle de piezas prefabricadas para el centro construido en Brasilia (1980)
Detail of prefabricated parts for the healthcare centre built in Brasilia (1980)

Not only prefabrication accelerates and streamlines the processes, modulation is a crucial part of them. The dimensions proposed by Lelé for modulating respond to cladding materials (especially flooring) under the premise of reducing waste and rationalizing consumption. They also respond to the size of the beds and the need for privacy between patients. Modulation, then, is standardized at 1.25m, although modules of 1.10 to 1.20m are also used. There is no vertical modulation (only horizontal) and it is determined according to the needs of each project.

Finally, it is important to add that the pieces are checked in the factory to avoid problems during final assembly. In specific and complex cases, such as the dome of the auditorium in Rio, the elements are assembled in the factory (without final welding), checked for assembly and possible defects, disassembled and sent to the construction site.

Sarah Brasilia (1980). Rehabilitation of neurological and orthopaedic pathologies

This centre combines the functions of a hospital with management, research and training. It is located in the south wing of the Brasilia pilot plan, in a densely populated area with few green open spaces.

Being the first, this building created and consolidated the concepts and techniques of the network creation process, both medically and architecturally. This centre was created with the best hospital technology of the time.

El edificio se construyó completamente con piezas prefabricadas de hormigón. En primer plano, los módulos de la cubierta del sótano permiten la entrada directa de ventilación e iluminación naturales
The building was built entirely with prefabricated concrete pieces. In the foreground, the modules of the basement roof allow the direct entry of natural ventilation and lighting

Lelé designed a high-rise block staggered in a west-east direction that allows for the controlled entry of natural ventilation and light. This arrangement of the floor slabs created landscaped terraces, which become therapeutic green spaces easily accessible to patients and technicians.

Parallel to this volume, there is a shed of prefabricated reinforced concrete pieces that facilitate the entry of ventilation and natural light. As the construction mechanisms available to prefabricate these elements were limited at the time of construction, the sections that make up this roof are designed with very marked straight lines.

The constant transformation of the equipment used by the staff and the adaptation to new technologies led to select a construction system that would allow flexible spaces so that each sector could grow independently without affecting internal circulations. Even if the number of beds increases, the rational occupation of the urban context is guaranteed.

With these in mind and the desire to facilitate future maintenance management and reduce the cost and time of works, Lelé proposed a 1.15m x 1.15m module supported on double beams resting on pillars, also double, spaced 6.90m and cast in situ.

The construction elements were standardized and prefabricated: structure, internal divisions, equipment, seals and lighting. The building’s structure, then, is made up of continuous Vierendeel beams that receive the weight of the prefabricated slabs. These beams are, at the same time, the facades. Their alternating horizontal arrangement allows blocking the view to the interior and, at the same time, allows the direct entry of natural light. This movement of the beams frees the upper part of the double height, so that landscaped terraces are formed which are also visually integrated with the upper floor through the glazed windows created in the holes of the Vierendeel beams themselves.

Sarah Rio de Janeiro (2009). Neurorehabilitation and neurosciences

This centre offers outpatient care only. It is the last facility built in the network and is located in Barra de Tijuca, a neighbourhood on the outskirts of Rio de Janeiro. The humidity and hot climate, as well as the marshy terrain and newly urbanized environment, conditioned the architectural decisions. It was essential to circumvent flooding with adequate drainage.

As in the first centre, the architecture of this unit is fundamental: the large spaces favour interdisciplinary work among the medical staff and the exchange of experiences among patients. In this case, an attempt was made to solve the problems encountered in previous hospitals.

Vista aérea del hospital Sarah en Rio de Janeiro
Aerial view of the Sarah hospital in Rio de Janeiro

In this project, the use of the natural elements of the place predominates to create a comfortable environment. Lelé created a garden with a lagoon to channel the excess water during the rainy season, thus protecting it from possible flooding and humidifying the whole environment. Parallel to this garden, he designed two large, low, horizontal naves, with the roofs configured by petal-shaped vaulted pieces.

The structure is composed of pillars, steel beams and prefabricated reinforced concrete slabs. The auditorium stands out: an inclined, half-buried sphere crowned by a dome that opens to let natural light into the interior, specifically over the stage.

Lelé proposed three ventilation alternatives: natural air, forced natural air and air conditioning. The first is produced through openings in the roof parts. The second takes advantage of the air captured by fan coils, which is cooled in the ducts located on the technical floor and is then blown into the interior rooms. Finally, the air conditioning system is only used when necessary.

Industrialized hospitals

Lelé focused on the speed and the economy of construction. He talked about optimizing the use of materials and reducing the impact of construction on the environment. Quality control was permanent, from the beginning of the design to the completion of the building, so that economic and environmental efficiency were possible.

This construction system of prefabricated elements allows flexibility in the construction stages and, above all, in future hospital expansions. This is essential in a building of this type because it must adapt to the evolution of techniques, treatments and care equipment.

Today, the BIM methodology, which is gradually becoming commonplace in the process of designing and constructing buildings, is incorporated into this prefabrication process. In addition, the construction agility of industrialization reduces emissions and the displacement of (raw) material. We advocate, therefore, to rescue Lelé’s processes to turn the industrialized construction of hospitals into an effective reality.