Designing Healing landscapes in Healthcare Facilities in Indian scenario

Anmol Gupta1, Sonal Tiwari2

1.Final year student, Landscape Architecture, School of Planning and Architecture, Bhopal, Madhya Pradesh, India
2.Assistant Professor, School of Planning and Architecture, Bhopal, Madhya Pradesh, India
Abstract

Winston Churchill has rightly said that We shape our buildings and later they shape us. Spaces where we
live and spend our most of the time in that space, it affects our mind, body, soul. For quite a while, the
significance of wellbeing and health has been seen related with the context of sight of green spaces, parks,
house private gardens. Each of these components is essential health making components of the city, ward,
building. Healthcare buildings have largely focussed on pathogen centric healing and need to create a
planned and organised restorative spaces for holistic healing for people. India is one of the major upcoming
destination of medical tourism, however Indian Hospitals are ill-equipped in utilising their open spaces.
Traditional healing in India greatly relied upon reconnecting man and nature as discussed in Ayurveda. The
aim of the paper is identify theory, concepts which can lead to design of healing spaces in health care
facilities in context of India. An identification of healing elements is done from various projects and theory
and there applicability is assessed in Indian scenario. An issue based case taken to describe existing open
spaces in Indian District hospital (JAH hospital group, Gwalior, M.P.) is treated and shortcomings it
experiences. In the last part of this paper three case examples are taken to describe how the nature helps
humans to forget illness. Also how built environment take advantage of open spaces. A comparative
assessment is done on the basis of elements identified theories and concept of healing space. A list of spaces
need to be introduce in healthcare facilities is carved out on the basis if researches and case studies
mentioned.
Keywords- Healthcare, wellbeing, nature, healing, hospital spaces,
landscape

1. Introduction

The role of outdoor spaces in well-being and healing has been

discussed by Ulrich, Gerald, Clare Cooper Marcus etc. Victorian
parks were set up as spots to look for outside air and rest for urban
population; the imaginative tree- lined rural areas of port day light and
Bourneville were arranged to upgrade occupants’ feeling of
prosperity; while Olmsted’s Emerald Necklace Park in Boston, USA
was intended to improve water quality and diminish number of deaths
from cholera. There is a noteworthy convention that connects
Figure 1 :Design elements of
landscape –Steps, arches ,seats,
vegeation. 1
Source: Author
landscape design and general wellbeing. Human body has association characterizes human wellbeing as a
condition of complete physical, mental and social prosperity, and not just a state with no sickness or
physical request. The subject of wellbeing is constantly significant as wellbeing is ought not simply be
limited for sick people, it is significant for healthy people.

Reconnection with Nature is an important concept substantiated by Ulrich, Wilson etc. Traditional healing
places indifferent cultures were sacred groves, rocks and caves, rivers, pools, farm houses etc. Designers
have tried to understand the essence of healing in these spaces and lead to design of better therapeutic
environment. Through time, various societies have attributed healing forces to common habitat and have
utilized sacred natural spaces for regular place and individual direction.

2. Effectiveness of nature in creating healing environment

Three important studies based on effectiveness of healing have been conducted in past which discuss the
role of natural surroundings around built environments

1. Gall bladder surgery patients were studied in their recovery rooms. Some had a view of nature while
others had a view of brick wall. It was found that patients whose rooms overlooked trees had faster
recovery time, faster hospital departure, suffered less pain than those facing a wall.
2. Researchers recorded the electroencephalogram (EEG) while persons were seated in a real outdoor
setting and viewed a hedge of greenery, a concrete fence with dimensions similar to the hedge, or a
mixed condition consisting of part greenery and part concrete. The EEG data supported the
conclusion that the greenery elicited relaxation whereas the concrete had stressful influences.

Figure 2 :View seen by subject – Built mass. Natural view, indoor plants
Source: Author
3. A school in Germany conducted another similar study, students were observed in classrooms that
contained plants and others in classrooms with no plants. It was found complaints. This provided
evidence that plants have a positive effect on the students wellbeing.

3. Methodology

A review of literature of seminal theories, evidence based design studies, and traditional healing gardens
was done to identify healing elements, spaces and their characteristics. Identification of health care facilities

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in central India was done to assess healing environments. The outdoor spaces were assesses based on
healing elements identified from literature. Site visits, questionnaire surveys led to identify core issues
which can lead to design of effective healing environment. Effectiveness of the healing spaces was done
based on elements identified form literature survey.

4. Elements of healing in outdoor area

a. View of nature and well being

Researchers has discussed the role of green spaces in healing and well-being.

Stress Reduction theory by Roger Ulrich (1991) says that Our ability to recoup from an upsetting
occasion is upgraded by introduction to green spaces. That is a few sorts of green have quieting
consequences for people who have encountered stress. It states that scenes containing vegetation, water,
humble profundity and intricacy would have been, for countless ages, advantages to human endurance on
the grounds that such setting gave assets and the ability to envision the appearance of predators.

Figure 3 : Subject enjoying view of Mountain and valley

Source: Author
It also suggests that such landscapes help moderate and reduce states of arousal and negative thoughts and
thus reduce the psychological and physiological symptoms of stress.

Biophillia hypothesis by Edward.O.Wilson (1984)

It is the mental attraction to all that is alive and vital.

Thought that people have an inborn inclination to look
associations with nature. Biophillia recommended that
the inclination of people to concentrate on and to
Figurer 4: Evolution of Man
associate with nature and other life standards has. To some Source:google images
extent, a hereditary premise.

Theory of supportive design by Roger Ulrich (1999)

As indicated by this gardens ought to give nature

commitment (plants, creature, water, outside air) a feeling

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Figure 5 : Walking under tree canopy
Source: Healing landscape by Martha
Schwartz
of control (entryways that are effectively traversable, and territories where individuals can discover security
open doors for social help and development.

Attention restorative theory by Rachel and Stephen Kaplan

This theory proposes that exposure to nature is not only enjoyable but can also help us improve and ability
to concentrate. Nature has capacity to renew attention after exerting mental energy.

Figure 6 : A walk in park with water feature and dense vegetation in back
Source: Author

b. Traditional Indian concepts of healing: Natural elements “panchmahabhuta”

Ayurveda discusses the five elements inside the human body. We feed on Earth foods, and ultimately our
body returns to the earthly matter from which it originated. Water is our life sustaining nectar, which makes
up over 70% of our overall body mass. Fire provides heat and radiant energy to the body and is involved in
all physiological and chemical behaviour.
Air flows freely throughout the body,
giving biological functions movement, and
feeding oxygen to each cell. Space is ever
Figurer 7: Five natural elements present, remaining humbly in the context,
Source: google images
providing an opportunity to communicate
with the other elements in this way. Panchmahabhuta’ in Ayurveda make up the whole universe and
furthermore make the human body.

Why are we looking for the mountains, the woods, the rivers, the desert and the seaside? Why do we
experience well-being and serenity when observing nature’s works? What pulls us into these natural
environments. The response to all of these questions is the same. These natural surroundings strike a chord
in us; they remind us of our being an integral part of the natural world in the deepest basic way. This basic,
but profound, awareness that we are part of the natural world is at the core of five elements water, fire, air,
earth, sky.

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Earth: lie on the earth work in the garden. One will experience the fabulous plenteous quality of mother.
Permit its limitlessness and robustness to accommodate you the esperience of being focused and grounded.

Water: in a glass to drink water, tub to coast in, or sea to look at, the component water is such a great
amount of part of our life that we can now and again underestimate it. In any case, no life could exist
without it. Water awards us the capacity to stream, to renew the repositories, and to wash clean. It is valiant
and persistent wearing out the hardest stone and streaming all over the place.

Fire: sit by a chimney or in the sun or creat it in your creative mind and feel the glow. Feel how it opens you
up, opens your heart, fills you with affection and satisfaction. Permit your feelings of anguish to healing
experience love for yourself and for all the world.

Air: Breathing in natural air can recharge your body with positivity. Outside air has the ground breaking
capacity to renew your feelings, regardless of whether you have had a terrible day, week, or month. Getting
outside and taking full breaths settles the sensory system and earns quietness.

Space: An attempt to encounter outdoor space without interruptions maximize the benefits of nature.
Individuals may likewise encounter the advantages of green spaces in interesting manners. Bunches of
research accept that people have a transformative association with nature or that individuals appreciate green
spaces since they help them to remember childhood.

c. Traditional healing spaces in Health care facilities

Early Persian and later monastic gardens were essential part of their community and society. The job wasto
offer a mixture of spiritual health, education and healing. There’s a long history of using gardens for their
mental and physical support. The culinary and medicinal properties of herbs and aromatic plants have made
this, from the earliest times, a crucial part of human life. Through giving fresh air and exercise exposure.
Healing space is an open or enclosed area.

d. Healing spaces

Naomi Sachs says a healing space is composed of Active and passive healing spaces. Active healing spaces
include Active enabling gardens which focus at enhancing the physical capabilities of the user through
interaction with plants, water bodies. They also help in the enhancement of social and psychological
capabilities and Passive restorative garden assist stress reduction, support emotional and cognitive
equilibrium and enhance well-being. In this type of garden one may not need a support to move around.
They may be universal in nature or they may focus on one particular user group.

Open space plays a vital role in fulfilling the leisure needs of individuals in both official and informal
positions. Form organized walking sports to bird watching and picnics. To preserve a decent quality of life,
access to open spaces and these recreational activities are important. They are not just places to meet friends,
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work out and study nature, they also play an important role in biodiversity and conservation. Nature is made
evident to city dwellers through the protection of natural features and the promotion and retention of natural
habitats. Garden can be part of active transport systems, pedestrian, cycling and wildlife corridors

5. Indian Hospitals and outdoor spaces

Indians believe that the knowledge or medicinal plants is older that history itself, gifted hundreds of
thousands of years ago to the original inhabitants of India by Brahma, the divine creator. thus when the
Ayurveda sought to heal human suffering they were able to draw on knowledge that had already been
evolving for millennia in the forests of India.

But if we see condition of outdoor spaces in most of the Indian Hospitals, a different picture is observed
which is contradictory of above statement.

5.1 A case of Jaya Arogya hospital group, Gwalior, Madhya Pradesh

This hospital group is a government hospital

situated in the dense area of city Gwalior,
Madhya Pradesh. This hospital also known as
JAH and it was established by Late Madhav
Rao Scindia, inaugurated in 1899. In 1946 it
can accommodate 400 beds, in the main
building. An OPD for 1500 patients were made
into separate building in 1956 known as
Madhav Dispensary.

This hospital group consists of many health care Figure 8 : Site Plan og JA Hospital
buildings like Kamla Raja Hospital which is Source: Author
maternity wing, neurology block, blood bank,
intensive care unit in 1976, with the establishment
of Medical college and thus became a group of
hospitals. Also cardiology department in 2012
and recently a 200 bedded super speciality block
in 2018. At present the bed strength of hospital is

1500. There are 25 residences for doctors and

Figure 9 : People sitting on road outside hospital building
staff which were made at the Scindia estate time.
Source: Author
There are 8 hostels for Under graduate, post

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graduate and nursing student. A government medical college is across the road called Gajra Raja Medical
college.

It is one of the oldest and largest government hospital in 5 nearby districts-Shivpuri, Bhind, Morena,
Sheopur, Datia and it covers the population of the same. Daily it is visited by thousands of patients from
nearby small big towns. This hospital is not only for privilege people but 60-70% of patients are from under
privilege background. There are 6 temples which are made where an old tree is located and it shows me
when people lost hopes in their life they spend time with divine power and thus sacred spaces are carved out
by functions of people. This shows people have strong connecting with natural elements and these kind of
places need to be designed with proper master planning. As shown in Figure: 8 no master planning is done
for the campus, lot of incidental open spaces and structural open spaces needs interventions for people
providing spaces to sit, talk, wait, relax. Existing
situation is not very satisfying in terms of providing
comfort for human beings. There are many issues on
site out of them one is no proper internal connectivity.
It’s like all buildings blocks are not sited properly
when constructed. and there are plenty of road
connections unnecessarily. Even there are few
designed green open spaces which is just 10% of total
open space area around built forms but they are not
accessible by people because authorities think visitors
will make it dirty and so maintenance will be more. 52%
Figure 10 : Open space analysis of JA Hospital of open space area are unorganised, people just use
Source: Author these as there are no other places to use. Visitors face
lots of difficulty in harsh climate of Gwalior.
Even there are no place for doctors to meditate,
relax. All open spaces are non- functional and
some of them are not accessible.

There is a need to introduce proper circulation

pattern and healing environment in this hospital.
Major challenge is to deal with the psychology of Figure 11. Old trees in JA Hospital
different users. To connect all small and big open Source: Author

spaces that integrate hospital system and give benefits to users. So area need intervene in terms of spaces to
sit, eat, talk, wait, relax.

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6.CASE STUDIES

6.1 Muktangan Mitra,

Pune-primary healthcare cum drug de-addiction and rehabilitation centre

Location- Mohanwadi, off Pune Alandi road.

Designed by Ar. Sirish Beri.

A structure adding to the healing procedure of the medication who is addicted. It has kept up a harmony
between the feeling of opportunity by visual permeability and disciplinary control. Visual association with
nature is built up from the patterns, the terraced overhangs and the seating, urge the patients to open up.
There are spaces for physical and visual connection. Site inclining towards south as it is planned by common
landform of the site. The façade of the structure includes inviting passageway in stone irregular rubble
masonry. Building is encompassed by huge trees and open air seating for guests. Raised planters are
arranged in window bottom to give association with nature.

Figure 12 : Sketch of Muktangan by Sirish Beri

There is a little encased arranged open air theatre of 150 seating, inhales light and ventilation in structure, it
ties the different functions together, making a feeling of space. It is likewise utilized as cooperation space
and centre point. Passageway have abundant measure of light and ventilation and visual availability with
open area theatre. Overhang of general ward open into open area theatre, giving visual cooperation. Opening
in the hall give light and ventilation in holding up territory. Clearstory windows in the contemplation
corridor give light inside from top opening.

6.2 Sambhaavna Clinic Trust, Bhopal

Location – Bhopal, Madhya Pradesh. It was built by Architect Jeeth Type.

Arranged on a two section of land real estate parcel only two km. from the Union Carbide Plant, the centre.
This trust has a evolve after a trageic story of industrial calamities. The evening of December second, 1984,
a Union Carbide Plant in Bhopal, started releasing 27 tons of the fatal gas methyl isocyanate. The gas spread
all through the city. Million of people were presented to the gas and 25000 have died as result of exposure.
15000 individuals despite everything experience the ill effects of afflictions briught about by the accident
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and the ensuing contamination at industrial plant site. As a result, the loss of life keeps on rising decades
later. The sickness are in sight, respiration, neurological, neuromuscular, gynaecological, regenerative and
endocrine system.

The bushes, trees and climbing plants encompassing Sambhavna, while adding to an alleviating domain for
gas – influenced patients, are strongly functional.

Figure 13 : Site plan of Sambhaavna, Bhopal

Source: Author

Many have a particular use in Ayuvedic prescription the conventional Indian system utilized at Sambhavna-
and they develop around 90 sorts of herb in their nursery. Small trees of Ricinus communis, useful for
alleviating pain in the chest, limbs and joint. Among flowers we can discover the heart formed leaves of
Tinospora condifolia, a plant utilized drug to disperse various types of fever. Visitors to herb garden can
discover plentiful shade, underneath the trees, and unwind in the natural cottage where they will discover an
earth hearth for making tea. With herbs all over the place. Individuals seeking treatment end up surrounded
by diversity of medicinal plants and when the plants are blossoming. The space creates a sweet fragrance
under the warmth of the sun. I can presume that: however, the user of the spot, be it staff, the patients, or the
visitors don’t understand the mental advantages of the spaces around them, it is clear to us that these spots
are going about as healing sapces around them. It is clear to us that these spaces helps in decreasing
pressure, mind preoccupation, control noise pollution, upgrades air quality, enhance microclimate, Buffer of
trees are controlled and furthermore relaxes mind, body
and soul.

6.3. Jindal Nature Cure Institute (JNI)

It is a charitable naturopathy centre which treats patients

with a drugless routine. The institute of naturopathy and
yogic sciences (INYS) was founded in the year 1978
under a trust, at and around the edge of Bangalore. The
name and style of INYS was subsequently changed to
Jindal Nature Cure Institute (JNI) in Oct, 2007.
Figure 14 : Site sketch of JNI
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Source: Author
Throughout the years, JNI has become an easily recognized naturopathy and yoga emergency clinic in a
campus set up in ecological settings of around 30 acres of land of lavish greenery in Bangalore city. It gives
prevention and avoidance of serious diseases through non- obtrusive, drugless treatment which joins nature
fix with yoga and different drugless regimens. The site is covered with lush greenery. All the
accommodation are surrounded with green areas to provide a peaceful and calm environment to the
residents. Beautiful walkways and pathways connect the built forms. Sawan bagh is the primary green zone,
developed using the native plants and trees. There are two water fountains designed one at the entrance and
other as a part of the sawan bagh. The time square is an eye- holding element of design. It also signifies the
lifestyle in the premises as all the therapies and activities are time bound. The use of natural lake by the side
is done my developing a shaded structure on the edge. Gazebos serve as shading spaces and a stout space.

Amphitheatre serves as a place for yoga sessions and discussions under open sky. It was intentionally
designed on the side adjacent to the lake, giving a beautiful view and flow of fresh air. A therapy that
involves the pressure on feet in varying degrees of temperature. It is ideally located in the premises, easily
accessible from all the accommodation buildings and by the side of a walking track.

7. Comparative Assessment

There is a need of a approach which removes the fears and disorientation of patients that may hinder medical
treatment, the hospital need to be seen as a necessarily comforting and stress-free environment, created with
a broader, patient-oriented sense that encompasses both master planning and landscaping. Here two
comparison tables are given which assess the above cases on spatial values and design elements of outdoor
spaces.

Table 1: A comparison on spatial values

Source Author

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 Table 2: Comparison of design elements
Source: Author
8. Conclusion

Nature plays an effective role in people’s life. Various experiments have shown that nature have power of
healing people from sadness, weakness. Nature around us as a sky, fire, earth, water, air is wellspring of
living cheerfully. These five elements are truth of life. Nature gives a space where we can interface
profoundly both with ourselves and outside ourselves. Health is something we all strive and for this
healthcare building are made but a visit to these spaces is a sad and fearful experiences. But to maintain
health and wellbeing people need to visit health centres. A summary of healing spaces and elements can be
created by focussing of elements on well-being of external and internal environment.

Figure : 15 how to attain complete development

Source: Author

Indian healthcare facilities offer opportunity to work for society’s prosperity, however frequently this part
stay immaculate and focus stay around built form as it were. Indeed, even there are acceptable case
examples in Indian but they are at small scale, for specific ailment and only privileged people can visit it,
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Thus, there is a need to introduce green spaces in government healthcare system too inclusive universal
access that is for all age gatherings, privileged and under privilege people, capacities, social gatherings and
so on. The structure and tedious, condition in and around the medical buildings makes a negative effect on
clients. In addition, the green regions of hospitals are old and non- utilitarian. Outdoor spaces of healthcare
institutes are as significant as inside. Especially in scenic and increasingly green areas as a profitable
supplement to the inside spaces. Since there is absence of appropriately gardens in hospitals, there is an
interest of the equivalent.

As said by Clare Cooper Marcus the most significant component in healthcare open spaces is genuine
natural vegetation, flowers and may be a quiet water component. Healthcare condition ought to be intended
to access to physical highlights that have power of stress reduction. Healing gardens ought to likewise be
arranged where noises of city don’t interrupt. Healthcare facilities and plants that empower patients to be
mended and remain healthy and influence their psychology. It is very important that hospital garden used by
patients, staff and visitors are designed to suit the needs of the users in terms of their positive benefits to the
psychological and spiritual growth of the users. Through case studies a program can be made for healthcare
facilities like a restorative walk, a large designed open space, water feature, places for contemplation and a
mandatory children garden.

9. References

1. Public Health and Landscape by George Bull, Landscape institute, Charles Darwin house, London.
2. What are the design principles of Healing Gardens by Azadesh Shahrad
3. Attention restoration and stress reduction: two mechanisms underlying the health benefits of exposure to
green spaces by William C. Sullivan
4. Therapeutic landscapes by Karolina Doughty
5. What is a healing garden? By Sima Pouya
6. The landscape of hospitals areas by Arash Zahedan and Sarah Golestani Eraghi
7. Healing Garden’ Design by Dr. Heshan El Barmelogy
8. Landscapes for contemplation by Aanchal Vidyasagar
9. Visit of Sambhaavna Clinic Trust in BhopaL, India
10. The role of hospital in a changing environment by Martin Mckee and Judith Healy
11. A study on healing effects of hospital gardens by Tugba Duzenli, Serap Yimlaz, Emine Tarakci Eren
12. Garden in healthcare facilities: uses,, therapeutic benefits and design recommendations by Clare Cooper
Marcus and Marni Barnes
13. Healing gardens in hospitals by Clare cooper Marcus
14. Health benefits of Gardens in Hospitals by Roger S. Ulrich
15. Hospital outdoor landscape design by Gokcen Firdevs yucel
16. The landscape of hospital areas – continuity of treatment by Arash Zahedan, Sarah Golestani Eraghl
17. A review of Panchmahabhuta practiced by M. Ulaganathan and C. Tamilchelvi
18. Public welfare department, medical section, JAH Group, Gwalior, Madhya Pradesh
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19. Healing Architecture: An approach tpwards healing environment by Shivani Tondon and Ketan Jain
20. Hospital outdoor landscape design by Gökçen Firdevs Yücel

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