RECONSTRUCTED PAEDIATRIC CLINIC, CLINICAL CENTRE UNIVERSITY OF SARAJEVO

Clinical Centre Campus was battered and shattered by the bombardment during the recent war yet the heroism of the staff permitted the continued care of patients in a time of massive adversity. In February 1995 the Paediatric Unit was relocated to the present building. The structure was typical of the war damaged areas of the Campus with substantial and dangerous internal problems. Despite these problems the patients’ treatment went ahead. On 14 April “Phase One” began; namely the work of reconstruction and conversion of the building to Paediatric use. Prior to this the building had housed the department of Nuclear Medicine, a fact which led to certain problems while the work was in progress. The task was to convert the building from such a different speciality to one which would satisfy the special requirements of Paediatrics.

The Hospital’s technical department collaborated with HMD Response’s architect to produce satisfactory plans. The logistical requirement of the plans had to include that this phase, which was for essential repairs, should allow continuing clinical activity; because this is the major referral Centre for a large part of Bosnia. The juxtaposition of the two conflicting activities of building and Clinical Paediatrics caused substantial problems for both groups. In a sense there developed a scenario akin to musical chairs with the repeated movement of clinical groups, builders and stores around a very small area, with all seeking their share of the tight space.

The building is an old one and both the effects of the bombardment and a natural degeneration have produced various major structural defects. Even before work began the foundations were “infilled” with concrete and still there is a slight slope of some of the floors. In April the roof was largely reclad and the guttering was entirely replaced. Large store room had been destroyed by shelling and needed to be completely reconstructed. In classical building parlance the first requirement was to “render the structure wind and water tight”.

After this obligatory initial work the specific clinical areas were tackled. Acute assessment and admission were situated in a completely inadequate space and the expansion of the facility was considered essential. In order to effect this change almost one half of the ground floor was converted from a mixture of old office space and store rooms to a modern clinical area. This is almost complete and, when the original facility is upgraded and combined with the newly created one, the service will be massively enhanced by the large increase in space and better working environment. The area also serves as a general outpatient department.

The coincidental development of washing and sanitary facilities to a very high standard is an axiomatic part of the construction of wards and out patient departments. The developments of the wards became the next priority and this has been largely finished to a very high standard using the concept of small numbers of beds in each room. In particular the creation of a neonatal intensive care unit allows for the care of premature infants and other newly born children with both congenital and acquired disease. In addition an intensive care unit for older children has been completed which will improve the treatment of children other than the newborn. Unfortunately, there are numerous items of equipment still unavailable which will, hopefully, be provided in the next phase of the development. This is a problem which is present throughout the Unit. Certain specific problems have arisen.

The previous use of the site as the Department of Nuclear Medicine had resulted in very large pieces of equipment being stored in the building for the duration of the war- one can hardly use the term “stored for safe keeping”! The most expensive, a gamma camera occupies a large room on the second floor and cannot be moved without the permission of the hospital Director because the Japanese Company which provided the equipment must supervise and check the transfer to another site. As a result certain work cannot be completed until the transfer occurs in about mid July. The structural problems have been referred to already but one peculiar phenomenon has occurred in a room previously used for dialysis where the walls have absorbed a large amount of slat solution and this leaks out destroying the paint cover.

The full elucidation of this problem had not been made yet and, therefore, a solution, perhaps in both senses of the word has not been found. In other parts of the building the floors have been recognised as unsafe and various coverings have proved inadequate. Perhaps one of the most difficult problems has arisen from the Professor if Paediatrics changing opinion as to the requirements of the new construction. These somewhat variable instructions have been met as far as possible but some delays are said to have occurred as a result.

When completed, the final number of beds will be 100; larger than the Unit before work (80) started but smaller than the original Centre (200) but entirely in line with the calculated needs to which tit will be subjected now that the population changes have occurred as a result of the war.

The repair, conversion and equipment costs of this project were met by the Government of the Republic of Ireland.