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BUILDING AGENCY:
Revitalising Rural Healthcare through Social Infrastructure
Rural Healthcare - Tom Robertson
In Scotland’s isolated rural communities, specialist healthcare is a challenge to reach. The current health system places most primary and specialised healthcare units within proximity to high population centres, while the outlying communities are supported by a network of smaller hospitals. These minor units are suitable for most day-to-day issues and ailments, but for major traumas and complex conditions, the afflicted individual will have to be moved to a primary location. With Scotland’s dynamic geography, travel times between these points can range dramatically, especially for those residing in one of the many remote isles. This travel requirement is particularly arduous for people living with severe conditions, chronic illnesses, or with any kind of impairment, whether physical or mental.
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A prime example of this is the Orkney isles, which currently has the highest rate of Multiple Sclerosis (MS) diagnosis in the world. Life on Orkney can be incredibly difficult for someone afflicted with MS. Strenuous symptoms such as severe fatigue, loss of balance and ataxia (loss of muscle control, affecting co-ordination, balance and speech), combined with the physical remoteness of the islands, create a nuanced series of complications for both the afflicted and healthcare personnel. This is further aggravated by a deficit of MS specialised treatments on the isles.
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For individuals living with chronic illness or other life altering afflictions, protecting and maintaining social connections becomes crucially important. Unfortunately, a common reaction to such a diagnosis’ is social withdrawal; where people, either consciously or unconsciously, remove themselves from social settings, in turn, creating a self-imposed isolation. This can be particularly challenging for those afflicted and living in remote areas.
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This social withdrawal then becomes further exacerbated due to the restrictions of social opportunities. The social infrastructure across rural Scotland is often lacking diversity. These areas excel in their outdoor spaces, the wild and rugged landscape provide ample opportunity for people to enjoy active open spaces. However, for those who are less physically capable, their options are far more limited, which can be detrimental to their wellbeing.
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It is widely accepted that daily living conditions are paramount to a person’s health and wellbeing, and social experiences are a pivotal factor in this. This has led to the development of new programs and initiatives, to improve our healthcare system and its connection with our day-to-day conditions. One such initiative being developed across the UK is called ‘Social Prescribing’. Aimed at bridging the gap between healthcare and social infrastructure, the program advocates giving healthcare professionals the authority to prescribe participation in social situations and activities, rather than just advising people to do so. This program has already shown promising levels of success, particularly with smaller scale operations, such as with Tameside and Glossop, a constituency outside Manchester.
Fig. MI.S.BA.02; Authors own, Public Opinions on Barra Healthcare
Fig. MI.S.OK.03; Orkney Ferry Services
This thesis proposes a new typology of structure, designed to integrate social infrastructures with specialised healthcare units, within a mindful and wellness focused space. The design of this facility will enable the health sector to offer various specialised options, space for different treatments, consultation spaces and research development, while the social side of the centre will provide new opportunities for social interactions within a range of typologies, such as relaxing spaces like libraries and cafes, to more physical experiences like dance and exercise classes, critically remaining as a non-stigmatised space where people of any capability are welcome. These two aspects, while able to function autonomously, will still be tightly laced together through the ideas of social prescribing and underpinned by an architecture that is thoughtful, a warm and inviting space people want to engage with. This study will utilise the case of MS in Orkney as an example of the specialised programs the centre would cater to and how it could adapt to such complexities.