- Well good afternoon.

Welcome to the Architecture for Health Friday Lecture Series.

It's great to see everybody here.

We have some fresh new faces in the audience today and I won't embarrass myself by risking missing one in the shadows, but our Health Industry Advisory Council is in town today for a meeting with us to help shape the future of the Center for Health Systems and Design.

They are extraordinarily important to us and to our work, and it's wonderful to have all those faces in our audience today.

It's great to see you here and thank you for being a part of this.

We are trying something different today.

We'll see how it works.

If you love it, please say so.

If you don't, just keep it to yourself.

I don't mean that, I really want you to hear, to hear from you, but we're doing long distance, and we're building distance into our Friday lecture series to see if we can manage content from around the world.

Stay tuned, in future lessons, we've got content coming to you from Canada, from the UK, and from France, and more of that in the semesters to come, but today, we have two speakers online to deliver their message.

And you may know that this is semester we were trying to talk about design for health in an international sense.

Well today's project and today's team is not talking about international projects, but I wanna draw a parallel for you.

To work overseas, you're in a foreign culture, foreign climate with foreign soil conditions, foreign materials used, maybe even different measurement systems depending on where you are, and so everything about what otherwise looks like another building on planet Earth can be a very, very different experience, a very international and challenging experience.

And our speakers today are going to tell us about the healthcare facility built in the northernmost city in the United States, the far, far, far north coast of Alaska.

So in many respects, though technically in the United States, it has all of the markings of an international design challenge, and I hope we can all listen to it today through that lens.

First, I wanna introduce Jason Arnold, a principal with RIM Architects located in Anchorage, Alaska.

Earned a bachelor's of architect degree from Iowa State University in 2009, previously served in the Army Reserves for 10 years, deployed to Iraq twice in support of Operation Iraqi Freedom.

Jason, thank you for your service sir.

After completing his final deployment, moved to Alaska, hired by RIM Architects.

Matt Vogel is our other speaker for today.

Matt is a retired principal from RIM Architects, and I'll let them tell you if they call it RIM or rim.

They're gonna tell us a lot about how to pronounce things in that part of our world.

34 years experience working throughout Alaska.

Extensive experience as a project manager, designer, construction contract administrator for a variety of projects, all regions of Alaska, size, complexity, institutional to commercial, industrial facilities, all sorts of things, totaling well over $1 billion of in-place constructions, and get this, this is a tease for what we're gonna hear about, performed on numerous complex facilities in extreme climatic conditions and remote locations.

Can you imagine pointing to a portfolio with those requirements?

So anyway, without further ado, Jason and Matt, welcome to the Architecture for Health Lecture Series.

(audience applauds) - Thank you.

- Thank you.

It's a pleasure being here virtually.

We're coming at you from my living room in Anchorage, Alaska this morning, at least it's morning at our time, and we're so thankful that Dr. Pentecost reached out and we're thankful to present to the Texas A&M School of Architecture, and we hope that we can provide a lot of insight on and share some knowledge about our project.

And I wanna say that I joined RIM, we pronounce it rim, Architects because we have a lot of locations all throughout the Pacific Rim, so Anchorage is our headquarters, but we also have office locations in San Francisco and Tustin, California, Honolulu, Guam, and we also do a lot of projects actually out in Japan, South Korea, so we have yet to tie up New Zealand but that's where I'm hoping to go next some day.

(laughs) But, so when I joined RIM, this project was actually well under way, and I was actually coming in and joining the team, but Matt Vogel who's now retired, but he was the principal in charge and he's gonna really help fill in a lot of the gaps of early design, but let me get my PowerPoint up and we'll go from there.

Okay.

So hope you're able to see the screen.

This is the project, this is Samuel Simmonds Memorial Hospital, and we designed, or I titled this Design for an Extreme Climate because this is so remote from anything else that I think a lot of people kind of associate with typical construction, typical design, and while we certainly, at the end of the project, need to have a functional facility that looks fairly familiar, you know, getting to that point from this location is the real challenge, and that's why we titled this an extreme sort of climate.

So just to give, just to kick us off-- - Jason, would you, Jason, please forgive me - Yes, sir?

- [Dr. Pentecost] for interrupting, I apologize to you.

We cannot see your slides.

- Oh.

I'm glad you let me know.

I will try the button again.

Oh, you know what?

Here we go.

How 'bout now?

- [Dr. Pentecost] There you go.

- [Jason] It's always one more button, right?

(laughs) Okay.

All right.

Here is the project, and in its setting, in its natural setting, and extreme is, it's not just the day-to-day but it was really all the details that actually make this thing work, so the, I will just say, designing in Alaska is a lot of fun.

If you like challenges and if you don't wanna just do the same detail over and over again, Alaska has a very big spread, which I know a lot of you already know.

It's a big state, you know, superimposed against the Lower 48 which we commonly refer to as the Lower up here, but you know, stretches from coast to coast, and it's 663,000 square miles of state.

You'll see here, just the dashed line kind of is actually this area, north of that is that area that the hospital serves and we'll kinda get into that a little bit more, but it's one hospital serving everything from Central Minnesota north.

But so Utqiagvik, the northernmost city in the United States, not in North America, there's a few other remote villages in Canada that are actually just a tad bit farther north, but Utqiagvik is the Native name.

Shortly after the project was completed, the local community voted to change the name of Barrow and revert back to its actual historical name, and so we'll revert back and forth between Barrow or Utqiagvik, but that is now, today it is now the city of Utqiagvik.

And so here it is.

It's entirely cut off, there's no road that connects it.

Being so far north, the ocean actually freezes, the Arctic Ocean freezes.

This is actually the city on approach from a 737.

You'll see the bluff here, and everything in front of it is the ocean frozen over and this is a nice, I would say a spring day 'cause there's some sunlight, but it's spread out on the tundra.

Inside the city itself, the main population area, says a little over 4,000 people at the time that the project was constructed, the area itself and the hospital serves about 11,000 plus residents throughout the North Slope Borough.

Polar nights, you know, the sun doesn't rise for 65 days.

It'll creep up right to the horizon but it won't quite make it.

But in the summer, we have the opposite, we have a midnight sun where 80 straight days of once the sun gets above the horizon, it doesn't quite make it down, it just does a circle and comes right back up, so you know, record lows, -56, that's really cold.

It doesn't normally get that cold but their record high of 79 degrees was a whopper and, which (laughs) is, that's probably not, that's nothing to bat an eye at there in Texas, I know, but in Utqiagvik, 79 was, that was a steamy day and really threw the locals off.

But I'm gonna actually turn it over to Matt to kinda talk about how this project really got started.

- [Matt] Thank you Jason.

This project came to us under a proposal back in 2005 through the North Slope Borough, and the, we were hired to, as the architect of record if you will and the designer of the building.

We in turn then went reached out to multiple healthcare architects to do basically the medical planning and interior to the building, and that's how basically we came on board.

A little bit about how the client works, the Indian Health Service is the funding agency that's providing the money for this project.

At the time back in 2005, this project was still 15 years in the making of trying to get on the Indian Health Service, their listing of projects, and if you go online, you'll see they have a whole ton of listing of stuff, but they can only really afford to do a little bit at a time each year.

Arizona was the largest one in front of us, their first, and they were trying to put all the Indian tribes together in one facility and it was so big that they could not design it or even phase the construction in 'cause they could never get enough money appropriated.

So that kind of moved them down to number three if you will.

Number two was Nome, Alaska, and they ran into some issues regarding early design so they had to go back to redesign, and at that time, the government was putting out shovel-ready projects, and we knew right away, 'cause we were already starting to work on our design, that we could come up with shovel-ready projects, even though the building wasn't completely designed, we could get our foundation or order our materials and things a year or so ahead of time which really kinda got us in the door, so we went from being number three up to number one, and that project moved forward and here we are.

The building, the Indian Health Service also defines the program for the size of population.

We had to go through quite a bit of workout to find whether that program is valid, and it turned out it was not in many ways, but we had to prove those square footages that needed to be increased, and sell that to the Indian Health Service to validate that we need more money to build this project.

Again, we're talking about 100,000-square-foot building.

It's four times bigger than the original building which was basically a wood structure built in 1964.

We're, designed it for, to last at least 50 years.

Again, it does, North Slope area covers 95,000 square miles and the dotted line that Jason showed you on the Alaska map is the range of from one village to the next, so you've got basically six villages, Point Hope, Point Lay, Utqiagvik, Atqasuk, Nuiqsut, Deadhorse, and Kaktovik, and Kaktovik's in this far range to the right and Point Hope is to the left.

That's a little over 500 miles that this area's having to cover.

Barrow's only got 4,300, or about 4,000, a little over 4,000 population.

These other villages are smaller.

So we started this project off by needing to meet with the villages, and Native healthcare is quite different than I would say your normal healthcare in the Lower 48, because you have hospitals that are available to you, you can go to pretty much any one you want.

These folks can't.

And they're also frightened of healthcare, and it's a place that they go and they're frightened of how the Western medical people perceive what they come to be healed at, but again, what they do understand is that these are very special locations, very special places.

It's a major gathering area of the community.

They'll come in and gather together just to socialize.

They come there to have their children when they're born, they come there when they need to be healed, and they come there when they die.

And so the whole facility becomes quite a spiritual experience for them and it lasts their complete life, and with that, I just wanna say that, you know, the community meetings that we had provided unique opportunity to move beyond external assumptions to direct knowledge of what is important and relevant to the people served by the hospital.

I'm gonna go into some project points.

These are really fast narratives, you folks will understand everything I'm talking about, 'cause I wanna be able to save some time for Jason to get back into some of the detail of the art of construction which is really quite important too, but I'm gonna hit some points here and you'll see some of the things and how they affect the people.

When we met in all the villages, we talked about what kind of healthcare they see providing to them, what kind of spaces do they see as important to them?

We wanted to create, the hospital itself is basically more clinical than anything else.

They do have eight in-patient rooms, an emergency department, a radiology and two LDRPs, eight in-patient rooms, and, but they got a dental clinic with at least 12 dental seats, and part of that goes back to the healthcare of the people, and so in the building, we designed the entryway to be a large gathering space, and people would always come in, they'll come in all times of the day, so we wanted to be able to isolate all the clinical space which is right off the lobby, and then at the evening when we had to shut the hospital down, that allowed the emergency department to stay open which is in the back part of the building, and so it had a relationship but it still didn't keep people from coming in and it still provided the warmth they needed.

Part of the points were consistent across all the villages, and the bullet points were along the line of, before the design, we wanted to meet with the villages to get everyone's individual opinion, 'cause they do come from different tribes, they wanted long horizontal building that didn't stand up in the tundra, in the Arctic, that stood out like a big scary building that they would go to get healed in.

We did create a two-story atrium which created that community space.

We took a lot of our signals from nature, the environment, snow, ice, color, lack of color, drifting snow, the aurora borealis, these were things that they wanted to bring into how we design the facility.

The building itself was elevated so that created some thinking of how we go about these things, that we could not put a building on the ground because it would create heat and it would into the permafrost and it would sink, and so therefore we had to life this building up and to allow the wind to blow through and the cold to continue all the way through.

We used a lot of specialized exterior lighting and interior lighting for the building to really provide the warmth that we need in the dark days, and in fact, even in the underside of the building, we use, again, a lot of LED lighting that you could put up for different events, just regular color changes which they love the color, and also like you could use pink which is what they selected for like Breast Cancer Awareness Month, they'll have pink underneath the building, so they're really embracing the facility and like the fact that they just certainly meet their requirements.

Our exteriors used a lot of different colors and Jason will talk a little bit about that.

A lot of the fixtures, like and you'll see in this rendering here, they had like the drum fixtures hanging from the ceiling, this created a lot of connection to them because they use a lot of drums in their dancing and music, and it also, the fabrics represent very, things such as a seal and walrus skin, those were Indigenous kind of elements that we could bring into these things.

Again, the emphasis for the hospital was primarily the clinics and bringing the community in to make sure that they got the healthcare that's required and many of 'em were afraid to go, though they, our really desire to come in here, we wanted to make the places very welcome so they felt that they're important and can actually be healed there.

One thing about, and because all these villages are separated by quite a few miles, when someone gets sick and goes to the hospital, they generally come with their family, and the family will come in and they fill these rooms up, so we gotta get permission to expand the program to make the certain rooms larger, and they even have the bed that, or a couch that's in the rooms will fold out so some of the family can actually sleep in these rooms, and that was very critical to them to always have and be near their family member.

We used a lot of translucent materials on the outside of the building to get light to come through to create a transparent facility.

We used SIP panels, structurally insulated panels on the exterior of the building to create the R-value.

They're 12 inch thick.

We needed a whole lot of R-value to offset the glazing and we were able to do that and there's a whole different story behind that, but for now that's, it was important that we were able to do that 'cause no other panels were out there that thick enough, provide the R-value we needed.

The colors were incredibly important to offset a lot of the monochromatic color of basically snow, which is there most of the year, and the color really provided a big that.

We had some waves in some of our form, sheet rock and things like that, that they're dynamic and kind of represents a lot of the snow drifting and the ice patterns and things along that line.

Let's see.

We have extremes in color, or in climate, which obviously the color and light is a big deal, but in the summer time as Jason was saying, there's a lot of light all day long, so we had to provide blackout shades on some of the windows, because it became little bit too much, especially in the patient rooms and things like that.

We used purple gold brushed aluminum for some of our colors.

The CEO of the hospital, she always says that, I had to present the exterior colors and purple was one of the colors, I've never done a purple building before, but she always tells me this, it reminds her of her little mood ring, so, 'cause you can, what you can do to panels these days, you can see it one way and look at it from a different angle, it's a different color altogether.

We had other special things, we had a meditation room which is just outside of a morgue.

There's a small morgue in there, that it is needed because you need to deal with the bodies as you, to store the bodies before they need to deal with it, but anyway, the morgue was also important in their culture because they had to prepare the bodies for burial.

That's a very huge thing within their culture, and just outside of the morgue was areas where they could bring in their native foods, so they could have muktuk and mikiak and, which is fermented walrus and you could have seal and all those things, was very important that they could have their native foods when they're at the hospital, so we provided that feature also.

Signage in the building is both Inupiaq and English, and again, the, a lot of the building was done under multiple bid packages to be able to create a timeframe for budgeting so the Indian Health Service could go back and ask for more money to keep the project funded and work very much along that line.

I think with that, Jason, I would like to turn it back to you to talk a little bit about the complexities of building in the Arctic.

- [Jason] Yeah, thanks, so it's a cold place, as you all know and we kinda hinted at here, and just most of the year, we're not above the freezing mark actually, and the active layer is so narrow that the ground is permanently frozen.

And we're, you know, right now, circumpolar, watching sea ice starting to melt more and more every year but you know, the ground itself is still, throughout the year is still frozen, and when you put a 100,000-square-foot building on it, you know, one of the challenges of course in design and construction even now is recognizing where the climate's going but not knowing how soon it's gonna change, and Barrow in particular, the North Slope is changing the most.

We've, hitting more mega-storms, we all know about the mega-storms and they're getting bigger, carrying more heat, energy, rain, and we get plenty of them ourselves, and so trying to accommodate all of that into the design, into the construction, the wind was probably one of the bigger pieces as far as its, how it transports snow, and that snow in the summer, in the short summer months when it does melt carries that latent heat and we're trying to keep the heat off the piles and keep the building from warming that permafrost, and so all of these things were very intentional.

The shape of the building is much more similar to an airplane wing so, and facing the trade wind to get the wind to actually scour the snow and keep the underside, you know, clear and free, you know, what the snow does on top of the building can be much easier to accommodate, but what we were really trying to do is make sure that ground stays frozen, so when we got into technical design, I mean there's a lot of things about the design that had to be thought through very carefully, and a lot of prep of the site, disrupting the native soils would only further warm and heat and melt and cause a lot of trouble for construction, so what we actually do in the North Slope is you leave the native soils alone and you build a gravel path, and you put insulation in the middle of that and then you add more gravel, and this is actually just to help insulate the building and even the changing climate, you know, to insulate that permafrost and keep it frozen.

And now, and moving frozen dirt isn't easy either so, because it's permanently frozen, in order to break it up, they use sticks of dynamite.

How much was it?

It was a-- - [Matt] A pound of dynamite for a yard of material so they could stockpile it and then let it start to slowly-- - There we, there you go.

So part of the project required dynamite, boom, (laughs) to prepare a building pad on top of the permafrost so that we could-- - [Matt] The insulation too.

- [Jason] Yeah, on top of the insulation just to keep it frozen, before we could get the building foundation system even started.

So here's an aerial, and you know, the scale of this is just huge compared to the rest of the city.

You know, that's part one, and part two is actually just mobilizing and getting the construction materials to Utqiagvik.

Everything left the Port of Seattle.

Because of the, because the Arctic freezes over, the barge schedule is very limited, you only get about three barge deliveries a year and that's it for all your bulk materials, and so for the contractor, he's gotta think of everything from all the metal studs, SIP panels, all the fuel he's gonna need, all of the other equipment just to build, because there's not a Lowe's or a Home Depot down the street.

There's not a lot of large projects like this in Barrow, so even a crane, you'll see here, there's a giant crane as part of the barge.

All of this had to be shipped up.

I mean, we're talking even F-350s, you know that, just to run around the job site, and man camp kind of stuff, which we'll talk about the man camps here a little bit later, but just the operations of a construction site this large for such a small, remote village became part of the project, and you know, the, you know, once they got started, you know, so they cleared the pad, started stockpiling materials, hoping they got everything right, because if you don't it's, you have to wait another year to try and get something large.

There are some options to fly in materials with CUN-30 but you're limited to the size of the plane, you're also paying a premium for that, so you're trying to grab as much as you can but also not stockpile extra material 'cause that's, too much extra is also too costly on its own, or has a side effect being too costly up front, but, so here's the piles being driven in.

There was over 300 piles.

These are friction piles, they're not freezeback piles.

There's a couple different options up here in the North Slope, but, so they were driven in and then spent a year just being frozen before being loaded, and a lot of these were driven in with pilings that were longer, just because not knowing how far down we gotta go sometimes before we get the right type of resistance to support the building, and then at the end they cut 'em all off and get 'em level, but you know, that, this was step two (laughs) of the project.

- [Matt] The temperature of the permafrost in Utqiagvik is basically around, hovering around 19, 20 degrees, where if you go south of here like in Kotzebue, the temperature has been rising and it's getting up near 31 degrees, so they're having a lot of displacement in their buildings, so climate change is affecting the permafrost.

- [Jason] And we all, you know, have a lot of challenges, you know, in just designing the details, right, just trying to accommodate, you know, for the unknown is even more challenging in a location like this, so there was a lot of time put in the details, and even then, despite all our best efforts, there's things that change, the contractor may have forgotten something on one of those barge schedules and we're trying to accommodate a design change and you know, other things too, just from a constructability standpoint, equipment doesn't work as easily in the cold, tools don't turn as fast, hands and fingers, you know, to turn bolts and don't work at the same speed on a hot sunny day, so the length of construction is greatly increased, and that has a cost to it.

And so, and complexities too, and materials that need to be installed at certain ambient temperatures, well, we don't have those temperatures, so you know, in order to, say, get roofing down or get a mastic or tape or glue or paint, you know, sometimes that required a tent and fuel and a heater, and so contractor gets it all set up, and then of course, that wind comes up and knocks it down, (laughs) so, and when your tent's gone you can't really do a whole lot of work until you fix the problem, so the contractor was certainly faced with a lot of challenges just trying to put the building together, and we were also challenged with how to come up with different types of details or accommodate the situations that the guys in the field, the men and women in the field had to endure just to try to keep going.

It's not like we could wait for that warm, sunny day, just, it didn't happen.

- [Matt] This is the reason why this building cost over $1,000 a square foot 10 years ago, so.

- [Jason] Oh yeah, 10 years ago, yeah, and today's prices, - And that was when they fitted, yeah, yeah.

- jeez, who knows?

A common strategy in, throughout all of Alaska is we do have their short building period, so you know, you try to hit the ground running in early spring, get footings and foundations done, then you try to at least enclose the building, get the roof on, get the siding up or at least just get some of the panels up for the exterior wall, and then that allows you to build inside and perform a lot of work and at least work in a more comfortable environment.

- Heated environment.

- [Jason] Yeah.

You know, it doesn't work perfectly, but it's kinda the best you can do, but you still got guys, you know, working, you know, in wind-driven snow and frosty conditions, there's frost outside, there's frost inside 'cause if you do get the building heated, you're a little warmer but then you're also, you've got more condensation that forms on the surfaces, sometimes you're cleaning surfaces to prep for the prep of the prep of the surfaces to do a finish or a material, the next layer that needed to get added.

And just yeah, the, so I mentioned the workers here a little bit, how hard it is, there's also not a whole lot of Motel 8s sitting around in Utqiagvik, so part of the projects required a man camp, so some of those barges included a bunch of conexes and they were put together and became Hotel Barrow, yeah, (laughs) - Sleeping quarters.

- [Jason] Hotel Samuel Simmonds Hospital, and it included a chow hall and cooks and their surplus food for, you know, six months of the year, and so these are all kinds of things that are actually attached to the project.

I know you've heard of some remote other projects like in combat zones and especially where there's military combat, and I've seen a lot of those, and this is a very similar setup.

So where're we at in time here?

Six minutes still.

You know, even as we were going, and like I said, we're being challenged constantly with different shop drawings or a shortage of materials, and hey guess what, I don't have it, we can't order it for six months without a premium, what else can we do, and how else can we solve a problem and, you know, how was that gonna ensure that the building is still gonna function as intended?

So we were constantly faced with that, and large team always problem-solving, and always thinking outside of the box and saying, hey, I've got X, Y, and Z on the site, even though we asked for A, B, and C, but let's come up with a solution, and keep the project moving 'cause we've got people standing around trying to get it done.

So there was a lot of collaboration, a lot of back and forth, and a lot of just, a lot of things you wouldn't necessarily think about, you know, how that frost would creep in and how a contractor would need to accommodate or deal with it or take time to clean it off, (laughs) so that he could do the work that needed to get done.

So all of, all again, part of this project, here we could see the snow drifting, we were talking about that wind earlier, and if you recall, there was a slide here showing the snow studies, so snow studies were done well in advance, a model was made.

We hired a consultant who had a little, who blew a sand video, a test, and modeled it out, and it performed exactly as expected, and this is cool to see, it actually, it's not, you know, snow is piling up but it's, it was anticipated and we designed for it and accounted for it, and-- - [Matt] This particular photo, if I can, Jason did, a lot of people are looking at this scene and seeing it as something wrong, but as the drifted snow was there, it doesn't provide load on the windows, but it moves around.

You could wake up and come in the morning and see the snow this way and then it'll be different in the evening, and it became kinda fun, and the window's designed to absorb this.

We knew that from the drift studies, and we decided, nope, let's just keep the windows.

It becomes quite an entertaining thing in the winter time.

The only option to that would've been a sheet rock wall, and that's no fun.

- [Jason] And yeah, yeah, staring at more wall is not, you know, and this location where it gets so dark, you know, that's not what, that's not very responsible, at least (laughs) as architects, we accept the challenge.

(laughs) Right, so, but yeah, the logistics and the site management, the conditions, the day-to-day, just how to think through, try to be 10 steps ahead and think through what's gonna happen and then of course what does happen, it never failed to make it an entertaining project.

There was never a dull day, that's for sure.

But it, at the end, it actually, you know, we were successful, and it all came together.

After many hours and a lot of problem-solving, you know, we got those colors that we were looking for.

We got the building to glow and provide something really unique for the community, you know?

People were so excited for this to open up 'cause they'd been looking at it for years, and then they finally got to come inside and you know, see the finishes and you know, there's a cafe like there in the entryway, and you know, it became a place to hang out, it became a community hub, and it really responded to the needs.

It also felt like it belonged.

- [Matt] Well, and they had more medical providers now that you have a building that's four times bigger than the other one, and that gave the confidence in the local people that they are getting better healthcare, and that was a huge perception.

- [Jason] Yeah, yeah, it was no longer the fear of, you know, being worked on by a witch doctor or something crazy, it was-- - [Matt] This picture is an interesting one because it's the dental clinic.

When we first started working on this thing, the head of the dental department, she'd worked for six years just to repair teeth to get it back to normal.

The diet in the Native population has really gone down in the last 30 years, from eating a high fat, protein diet to sugar.

- Subsistence, yeah, subsistence.

- They got away from subsistence food, so now there's, you know, heart problems, they're seeing dental problem.

It took her six years just to get the people to the point where now she can do regular maintenance.

Well, that was the serious thing, working on people that teeth pulled and things, we put the dental clinic upstairs and they're staring over the tundra through those windows so they have a very relaxing location to go to the dentist I guess.

(laughs) - Well, yeah.

It's actually, you know, you wouldn't think about it, but it is, yeah, every location has its beauty, right, and the tundra is no different, and there's a lot of different transitions.

They're very subtle, but they're very important too, and they're important to the community and it's really cool to see, you know, yeah, see the building try to fit in but, and also not fit in because, you know, we've got the warm wood colors and we've got those purple panels, you know, but, and there's a lot of light that comes out of the building but it became a very welcomed addition to the community, as a community space, as a, you know, a place full of light inside and outside, allowing the light to come in and sharing that light out to the community to kind of invite people in, you know, provide the shelter that it needed to provide, the services that it needed to provide, and really stand up against the environment and say hey, I'm here and I'm not going anywhere for at least 50 years, if not more, we hope, but, and that's it and we'll stop there.

And with thank you, thank you for allowing us to be here and I guess we've got a few minutes for questions, so we'd love to hear from anybody.

- Jason and Matt, thank you so much.

That was fascinating.

Are there questions here in the audience or questions online, those that joined us virtually?

How is, how old is the building at this point and where have you seen the strongest wear and tear?

- [Jason] (sighs) Let's see, it was-- - [Matt] Building's about 10 years old now.

- [Jason] Yeah, just about, yeah, 10 years old.

The wear and tear, well I know mechanical is always, they did a lot of dialing in of the mechanical, 'cause that, it's a big system, large volume of air, and of course you're drawing in very dry, Arctic air and trying to heat it, trying to get it 40% relative humidity and, but I think they're-- - [Matt] Tweaking that system.

- [Jason] I think it's just, it's fine tuning that.

I think it took a lot to fine tune it.

The biggest wear usually for a lot of these buildings, actually in the doors, the entry doors.

When those winds come up and people are trying to get in, you know, it can either, either the wind's helping you open that door, maybe a little aggressively, or it's trying to slam that door shut and that's usually where the most wear and tear is, is the door hardware.

- [Matt] What you don't see on these photographs, we take air from underneath the building and it goes along the outside wall and up into the mechanical rooms, 'cause we didn't want to have ducting things like that exposed or it looks like something's boxing it in, but we were able to really hide that within the shell of the building if you will, and again, it just took a little bit of time mechanically to tweak those, so you could preheat some of that air before it reaches to the units and then is supplied throughout the hospital.

- Other questions?

I have a sort of a public health question, Matt and Jason.

The idea of designing a community hospital for a small community, how did you go through deciding which services to include, which ones could not be justified?

What was your conversation like between stabilize and treat versus stabilize and transport?

It's an industrial community, how much emphasis did you place on occupational injury, and when do you decide that those injuries exceed those capabilities?

How did you set the limits for what you wanted to handle on site and what you wanted to move on?

- That's an excellent question, and that really is something that's been researched a lot.

When Alaska has received a benefit of many health hospitals, we've got it in Kotzebue, Nome, now we've got it in, up north on this one, we've got Bethel, we've got one in Southeast Alaska, and the Indian Health Service really programs these things incredibly detailed for those kind of reasons, and like in Barrow, we have the flights out, I mean they can only take certain amount of emergency type situations, they stabilize a patient, they put 'em on a plane and they fly 'em to Alaska Native Medical Center.

Alaska Native Medical Center is in Anchorage and that's another new hospital that was built, oh, 30 years ago or more but it's a huge, huge complex, and that's where the first line of defense is, well first line of defense is at the existing hospital there in Barrow, then you go to your local one which is in Anchorage, and if those situations burn or hurt or other situations occur, they send 'em down to Seattle in Harborview and places like that, but it is a very, and that's the frustrating thing for years, they would get into an emergency situation and all they could do was medevac somebody out if the flights were coming in or going out.

Lot of times, the flight, the places are closed down, we can't get a piloted plane in or out, and, but it is very, very, very expensive, so they were able to off-weight some of those costs as it relates to doing a new building, but they do have it figured out as to what level of medical care they can provide that generally keeps the community healthy, that we do have radiology and low-level birthing units in this hospital also.

- I would say, I'd add in that there's two parts to that as well that, probably that the more significant piece is the doctors, the nurses who are gonna, who are available to do that type of work.

They're typically not available and don't live in Utqiagvik, and this is a huge challenge for a lot of Alaska, is that doctors and nurses, and of course now we're seeing this after the pandemic, it's really prevalent everywhere, but just having that talent available, and they'll do like rotations where they're up for a month or couple months and they're not necessarily living permanently in these locations, the doctors come in on rotations.

So attracting the staff-- - That was the hardest thing.

- Is probably one of the bigger challenges, right, and certainly yeah, the other part is just the conversations with the community leaders about what, trying to prioritize because you cannot have everything but certainly what are the things that are most critical in the mind of the community, because that's, it's more successful when they're at the table.

- In the old hospital, they had the providers' housing right connected to the hospital.

They do not have it in this one, because the Indian Health Service wasn't gonna fund it at that time, but, so they had to, the borough had to quickly come up with some housing, local housing that people could, they could develop and get places for people to live and provide the kinda healthcare they needed.

You're basically quadrupling the amount of healthcare that was there before, so it was a big pressure on 'em.

- Well that's fascinating, really, really interesting.

Thank you so much for joining us and sharing that beautiful project.

Our time is up, and so we're going to bid you farewell, but thanks so much for joining us and sharing.

We learned a great deal.

Appreciate it.

- We appreciate you (audience applauds) having us, thank you.

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