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‘Rural Urban Framework’s hospital has kindled a new purpose for Angdong’

AR Healthcare 2016 commended: RUF’s low-budget building in rural China is a device for healing

To say that charity work is a growing trend is an understatement, when anyone can easily support a cause with memes and hashtags. But for Rural Urban Framework (RUF), a non-profit architecture practice, the desire to build a positive future is genuine. This is the raison d’être of the office: to find new models of rural development that enable ‘the social, economic and spatial evolution of villages, resisting the overwhelming process of urbanisation’. 

After more than a decade of working ‘where there is no architecture’, RUF co-founder John Lin believes that using available low-tech methods merged with contemporary ideas can extract more out of the rural fabric to benefit deprived communities. ‘Hatred of excess’ is a mantra for RUF, and no excess is afforded in the brief and budget for Angdong Hospital. In Hunan province in south-west China, an area saturated with visitors to the Zhangjiajie World Heritage Site, tourism provides this remote region’s main source of revenue. Designed to serve the farmers of Baoxing County in the north-west of the province, Angdong Hospital is the first charitable healthcare clinic in China, accessible only via a meandering mountain pass from Baojing, a town of 300,000 residents.

Angdong site plan

Angdong site plan

The Institute for Integrated Rural Development, the Hong Kong charity behind the hospital, wants to ‘foster a new attitude to rural healthcare’. The brief was developed in stages, beginning in 1995 and evolved over time. Initially, the charity focused its investment on educating children from local villages, followed by the recruitment of newly qualified doctors to bring them back to the community. For the hospital, the site in Angdong stood out from nearby villages with similar characteristics because of its strategic location, with 12,000 inhabitants from 21 smaller villages within an hour’s drive away. Currently even basic facilities such as waiting rooms are lacking in existing establishments. At Angdong, the programme includes vital outpatient treatment, focusing on preventative care for the young and the management of chronic farming-related conditions for the elderly, with 80 per cent of the population working in agriculture. Ailments also mostly concern mental wellbeing attributed to isolation due to family members migrating to the city.

Arriving in Angdong, the main road divides the village in two. Directly opposite the old government offices, now closed, the hospital is the only public building of note. Its construction was phased. It started as an L-shaped block and then, after demolition of existing facilities, both courtyard and circulation were added. Its muscular concrete frame, infilled with grey reclaimed brick from a recently demolished factory nearby, looms above the traditional grey slate village roofs. While much larger in scale than its neighbours, the colour of the brick blends the hospital into its surroundings. Because there isn’t a strong local historical style, Lin says he is interested in creating a ‘contemporary rural vernacular’ that will fulfil the villagers’ fast changing needs.

Angdong plan

Angdong plan

Ground floor plan - click to expand

Beyond the project’s treatment facilities, the charity’s ambition is to ‘reintroduce the hospital as a public-friendly institution’. This is expressed in the creation of a public courtyard encircled by a ramp and accessible to all. The architects decided to sacrifice 400m2 of buildable area on the ground level to promote a pleasant waiting space and public area. The ramp serves two purposes: it can be used for rehabilitation while guaranteeing round-the-clock access – the electricity supply here is intermittent, so a lift was not an option. This gently raised cloister envelops the courtyard’s perimeter at the base, closing the L-shaped volume on the south and east sides, and rises to the rooftop. There, the ramp generates publicly accessible stepped seating with views to the hillside. 

Visible from the street on the southern facade, the sloped slab of the ramp adds a tectonic aspect to the otherwise basic box massing. By lifting the ramp off the ground, the architects open up views from the street to the outdoor gym at the back, while the amphitheatre-like seating around the central courtyard suggests a number of potential uses for this space – from outside waiting room to impromptu soapbox – stitching the project to the urban fabric. Unfortunately, glare and heat reduce the roof space’s usability – a canopy would have made a welcome addition. This processional route raises the question as to whether a hospital is a suitable spot for public gathering. To what extent is segregation desirable to the patients’ wellbeing? In any case, intimacy was not specified in the brief – the illnesses treated at Angdong don’t require isolation, there is no cultural expectation of privacy.

‘The illnesses treated at Angdong don’t require isolation, there is no cultural expectation of privacy’

Because it is at the top of the village, capturing prevailing winds, the hospital’s passive ventilation system is extremely efficient at creating a comfortable treatment environment. You can almost feel the building breathe, with a narrow window every half metre on the saw-tooth facade – and wherever you are, you can enjoy views to the tranquil idyllic landscape. As a rule of thumb, in China there is no heating south of the Yangtze River – this does not mean the external environment is temperate. In winter months internal conditions drop, and all circulation space is semi-external, however in local homes this is also the case, so parity is at least maintained.  

Inside, wayfinding is clear, with each level corresponding to a specific treatment duration: the ground floor accommodates the reception, pharmacy and GP consultation rooms, the first floor is dedicated to short-term treatment and the children’s centre, while the second floor is used for overnight stays, with separate male and female wards, for up to 20 patients, as well as staff meeting spaces. Because of the sloped site, additional facilities are found in the basement. The absence of dropped ceilings guarantees large floor to ceiling heights and increases natural light penetration – and makes visible the air-conditioning units. The use of colour and ambient lighting in both public and external zones could have added a calming effect and prolonged the building’s use after dark. Within the building it is unclear whether building regulations for medical purposes have been addressed. A lack of handrails, shallow treads on staircases, and surfaces with basic finishes hinder cleanliness.  

Angdong section

Angdong section

Section - click to expand

The ramp’s customised concrete screen blocks are the highlight. Cast in flexible latex moulds to achieve varying aperture dimensions, they minimise sun exposure on upper floors while maximising light penetration on the ground level. If the grey recycled bricks feel a bit cold, the porous internal screen’s soft terracotta colour – the dye was donated by a Hong Kong manufacturer – is warm and the corridors are speckled in light. It is at this moment that you notice all shadows are distinct. Scanning the perforated facade at oblique angles in the courtyard below reveals a subtle yet beautifully textured grain.

Angdong medical clinic is best analysed in its context of rural hardship, kindling a new purpose for Angdong. This new building type extends the notion of care beyond basic treatment to embrace a wider social programme, welcoming the locals in, rather than segregating the patients from the outside world, and encouraging the mingling of elderly with children. The locally sourced materials impart a feeling of belonging – a fundamental factor in its acceptance by the community, particularly when China’s rapid urbanisation has produced vast quantities of generic architecture built out of standardised materials. RUF has proved that architectural ambition is not proportional to budget, and can significantly contribute to the Chinese countryside. While almost any building would have been an improvement on the previous facilities, clever architectural solutions compensate for the lack of hospital services and Angdong has surpassed even the client’s expectations. 

Angdong Hospital

Architect: Rural Urban Framework (RUF)

Design: Joshua Bolchover and John Lin

Project team: Maggie KY Ma, Mark Kingsley, Jeffery Huang, Crystal Kwan, Huang Zhiyun, Tiffany Leung, Johnny Cullinan, Tanya Tsui, Joyce Ip

Photographs: Gen Lu

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