Sanatorium and wellness environment of the city of Khabarovsk. Main development trends

Puzhkina Aleksandra Alekseevna Graduate student, Department of Architecture and Urbanistics, Pacific National University 680054, Russia, Khabarovsk Territory, Khabarovsk, ul. Pacific, 135, office 506g malexa.puzh@gmail.com

Kim Anton ORCID: 0000-0002-3739-5048 PhD in Architecture Associate Professor, Department of Architecture and Urbanistics, Pacific National University 680035, Russia, Khabarovsk Territory, Khabarovsk, ul. Pacific, 136, room 506g ant.kim@mail.ru Other publications by this author

Introduction. In 2020, there was an outbreak of COVID-19, which forever changed the attitude of society to healthcare. Quarantine restrictions have been introduced in many countries, including a self-isolation regime, designed to prevent the spread of coronavirus infection. Although most cities have reopened to date, the threat of a repeat of the epidemic still has a number of destabilizing and long-term effects on society. The virus has made significant changes in people's lifestyle and approaches to the organization of the workflow. During the quarantine, the lives of most people were significantly limited, which also affected the life of the city, where the usual bustle was replaced by a lull.

However, people have never stopped fighting the epidemic. The complex relationship between "disease and the city" was constantly discussed. The question of the role of urbanization and increasing urban density in the transmission of diseases has been raised again. In pursuit of progress in all areas, modern cities are developing too fast to ignore the impact that diseases or health problems of people can have on cities. Urban development cannot be separated from the organization of public health events, and the development of modern medicine and public health itself cannot be separated from the support of cities. They complement each other and fulfill a common mission to protect humanity. The analysis of urban architecture from the perspective of historical development will help to better consider the needs of residents and the moments of insufficient rehabilitation measures, including in sanatorium activities.

Modern urban planning plays a significant role in reducing the negative impact on health care associated with the growth of urban agglomerations. In many ways, the approach to the organization of the urban environment is integrated into the habits of the population and becomes cultural customs, and measures to maintain comfortable sanitary conditions become rules for public behavior and are regulated at the government level.

In the context of increasingly frequent outbreaks of diseases in the process of urbanization, public health plays an increasingly important role in the prevention, control and treatment of urban diseases. Initially, public health was focused on the study of human diseases, and not on the interaction between individual health and environmental factors. The subject of architecture and urban planning, on the contrary, focuses on human needs and its interaction with the environment in a spatially oriented framework. Over time, these two approaches began to be influenced by each other and led to the creation of a system of interrelationship between the urban environment and human health. Today, both areas continue to be studied in depth and are becoming increasingly important areas of research to address the threats faced by cities and communities ^[1]. One of the main issues raised by modern architects are rehabilitation facilities. This is especially true of sanatorium facilities within the accessibility of most of the urban population.

Literature review. The problems of the research are touched upon in many works of domestic and foreign authors. The theoretical basis of the research is based on a large number of materials on the development of the sanatorium-rehabilitation environment, observation of the evolution of sanatorium facilities and the main locations of objects under the influence of natural resources are reflected in the works of Akopyan A. S., Nikolaevich K. A. ^[2-3], in the concept of the formation of the architectural style of sanatorium facilities Gaiduk A. R., Gradova G. A., Smirnov L. N., Yarkova T. N., Kapitonenko N. A. ^[4-7], in the scientific works of foreign authors Figueres J., Warren P., Bullock N., Overy P. ^[8-11].

In all previously published works, the question of the implementation of the connection of the old historical development of the sanatorium with the new blocks is poorly studied. At the same time, there are no works devoted to the development of the concept of flexibility and variability of a sanatorium facility in the Far East, which leads to the absence of the basics of implementing a non-aging and flexible system of space-planning solutions for a sanatorium facility

1. Establishment and development of sanatoriums. Sanatoriums, as objects of architecture and urban planning, have a rich centuries-old history. In the course of evolution over the centuries, they performed limited functions, but with the growth of functionality, their architectural and planning solutions have gone a consistent way from the initial use of adapted premises to the placement of pavilions in special buildings, which applied such principles of typological organization as: decentralized, block, centralized and, finally, mixed. In the 1850s, sanatoriums served the wealthy segments of the population, while hospitals most often provided for the needs of the poor. During this period, sanatorium construction in the space-planning solution chose the model of centralized shaping, it was designed for a small number of functions. This type of solution was characterized as a variation of an inflexible form for the future development of a sanatorium facility. This period has a common course both in Russia and in European countries. All the characteristic features of sanatorium architecture of that time were especially observed in the west of Russia. So in the beginning, Sergievsky Mineral Waters were founded with one centralized building.

 But since the twentieth century, sanatoriums have gradually acquired the status of a symbol and embodiment of the possibilities of the modern level of development of healthcare and rehabilitation. Of course, the design and organization of modern medical facilities reflect both modern needs and the cultural heritage of the past. For centuries, the evolution of medical facilities has depended on both social and political changes and the progress of medical science. In Russia, this process coincided with the transition to a new system of government, and the sanatorium system itself has become an actual way to implement pre-medical activities and rehabilitation.

As the role of sanatoriums in the development and strengthening of health care increased, they increasingly needed state support and guardianship. In the XX century, most European sanatoriums came under state control. Also, all sanatoriums in Russia by this time had a state character and this was reflected even in a single form of architectural style techniques. So, to implement the creation of a wellness environment, standard variations of residential and medical blocks were developed, the system of sanatoriums itself became more complicated and rapidly moved to a block system. The rapid evolution of sanatoriums since the end of the XIX century is largely due to the development of a conscious attitude of the population to the preservation of their health, the creation of separate integrated facilities for the rehabilitation of people with disabilities, as well as the prevention of diseases of all systems of the human body and the general revolution in science and technology.

Starting to serve the middle class, European sanatoriums were forced to develop and show responsiveness and cordiality to visitors, which subsequently became the basis for the formation of competitive business experience and commercial approach. In the second half of the XIX century, the specialization of medicine increased dramatically and specialized medical centers appeared for the first time. During this period, some professional groups of doctors and medical centers "focused on certain parts of the body, others on diseases, others on life events, and others on age groups" ^[11].

By the beginning of the twentieth century, there was a significant fragmentation of medicine into separate specialties: "new hospital departments and research centers" ^[12]. In the first decades of the twentieth century, sanatoriums began to play the role in society that they retain to this day. As the possibilities of clinical intervention expand, medical technologies become more complex and expensive. There are separate more in-depth procedures for the treatment, rather than simply maintaining the normal course of the disease.

The peculiarity of the 1950s is that a significant activation and development of modern medicine moved into the field of development of the theory of rehabilitation in the sanatorium environment. Thus, the sanatoriums were conditionally divided into two classes. The first includes sanatorium resort towns that appeared in places rich in natural resources, where rehabilitation services were carried out. It was an advanced type of sanatorium cluster. The second class included sanatoriums located near large cities for primary rehabilitation and recreation of the working class. They were characterized by a smaller range of rehabilitation services.

The most significant changes occurred in the 1950s and 1970s in connection with the progress of laboratory diagnostics, as well as the extensive construction of sanatorium clusters regardless of natural conditions and the development of an artificial rehabilitation environment in an industrial way and according to standard projects. The main trend in the evolution of sanatoriums today can be called an increase in the number of seats and capacity due to the development of the block structure of buildings and various corridor systems, as well as an increase in the utilization rate of hospitals.

A typical approach to design and construction, of course, allowed the maximum number of people to be covered with rehabilitation assistance, but from an aesthetic point of view, sanatorium buildings, devoid of individuality, "decoration and decorative delights", began to look like faceless concrete "boxes" with "chambers-chambers" ^[13]. The sanatorium has turned into a functional "machine" designed for conveyor bodily (physical) treatment of the flow of "impersonal" population ^[13].

2. Stylistic and functional features of medical facilities in the city of Khabarovsk. The development of medical growth in the city of Khabarovsk coincided with an active transition to stone architecture, so, in particular, in the 1880s, administration buildings, educational institutions, commercial and public buildings were built, as well as the planned first hospital for 25 beds and new hospitals for road and field workers (Fig. 1). The pace the development of medical outgrowth in those years was estimated as extremely slow, the main resources were directed to the development of the military and cultural component of the city ^[14].

Figure 1. Military hospital in Khabarovsk , 1920

The architectural style of that era characterizes itself as Russian architecture ^[14], in which combined materials were used. So, despite the appearance of stone buildings, the city remained wooden for many years, the renovation of facades and new stone foundations improved the appearance of only the central part of the year, but its periphery and a few hospitals were built of wood.

The Russian style, which had the greatest development in 1900, symbolized Khabarovsk's belonging to the Far East ^[15]. From the historical point of view, the appearance of such a stylistic orientation of architecture can be associated with the spread of a unified view of the architectural appearance of new cities. The implementation of an ideal architectural community in different parts of the country remained important in this matter. The main stylistic features of the Russian style of that time were a number of features characteristic only of the Khabarovsk Territory and reflecting the color of natural motifs. Facades differ in sawn carving with geometric and zoomorphic bases. This type of carving in the Khabarovsk area is a decoration of the platbands of residential buildings, but it was also used in early administrative and temporary hospitals. The facades of that time sought to make as picturesque and unusual as possible in order to emphasize the overall "rich in sun and greenery" view of the nascent big city ^[16].

Under the socialist government, the path of industrialization was chosen and the urban landscape underwent changes due to the revision of the master plan. At the early stage of the historical type of development of the city, natural factors and the social structure of the urban environment, places of trade and transfer were a strong decisive factor. The industrial type of development immediately introduced its characteristic features, especially with regard to the creation of the most effective model for linking industrial clusters with residential development. By 1920, there were five medical facilities in Khabarovsk with limited functions and a small number of beds. Healthcare as an important branch was noticed only in 1927, when the potential of Hospital No. 1 grew to 240 beds in seven specialized departments ^[16]. The boundaries of the city began to expand rapidly and the chosen path of development of the city needed more medical facilities.

The main feature of the typology of medical facilities at this stage of reorganization was the transition to stone buildings. So, many hospitals moved to new buildings built according to standard projects, which allowed to increase the number of hospitals and hospitals. So by the mid-1950s, 13 hospitals and three 240-bed hospitals had already been built on the territory of the city. The increase in places in the hospital department was a temporary solution that could not help overcome the problem of a large number of sick people during industrial construction. The main motives of the new style were constructivism, but a simplified standard model, all buildings with a public function were designed taking into account the increase in volume and capacity (Fig. 2).

Figure 2. Khabarovsk Sanatorium 1955

Due to the "scorched earth" approach, the natural and climatic conditions in the city became quite dangerous, which was especially reflected in the industrial part of the city, where much more effort was needed to improve disease statistics. The main mistake of the direction of industrialization in terms of urban planning strategy was the irrelevant use of natural resources, which is reflected in our days. So the legacy of this period left big problems with the implementation of rehabilitation centers in picturesque places of the city, due to the fact that the entire southern part of the city was given over to industrial centers and today is not suitable for medical use. The transport infrastructure is convenient only for the transportation of goods, but is not suitable for clear and convenient accessibility to cultural, medical and social clusters. To date, many objects of this period have not been preserved, but the town-planning structure of the factory town continues to have a significant impact on the development of the city.

3. Sanatorium and rehabilitation environment in the city of Khabarovsk. Nowadays, the healthcare system still has the features of the previous stages, the shortcomings of which have become more noticeable over time, especially in terms of the operation of buildings. In the city of Khabarovsk, the boundaries of time lines and their main centers are clearly visible (Fig. 3). If the central part of the city is designed in neo-Russian and Russian style with elements of eclecticism, then the periphery has undergone the influence of industrialization. A distinctive feature of modern buildings can be identified stylistic and spatial solutions of buildings with a view to the future development of multifunctionality. At the same time, during the restoration and renovation of old buildings, mistakes are often made, as a result of which their operation as medical facilities becomes more complicated. So in the central part of the city, the medical center on Gogol Street 10a suffers from a lack of space and competent organization of the facade of the building. In the Northern and Southern microdistricts, problems arise due to the type of industrial development, especially with regard to transport accessibility and the scarcity of object shaping.

Figure 3. The layout of the boundaries of the city of Khabarovsk by year

For the city of Khabarovsk, the transformation of complex medical systems is associated with overcoming serious difficulties and obstacles. The structural inflexibility of medical buildings and the intensive pace of their use contrast with the active innovation processes in the field of medical technologies, machinery and equipment, means and methods of rehabilitation and treatment. Medical facilities are usually characterized by significant sustainability, which is based not only on the structural organization, but also on the cultural, regional context.

The sanatorium and rehabilitation part of the architectural heritage is the most lagging of all medical areas and cannot provide a sufficiently high level of service for competitiveness. If you analyze the sanatorium facilities of the city according to the quality of services provided and the flexibility of space-planning solutions, you can get disappointing data. Often, major repairs are limited only to repairing the facades of sanatorium complexes, but not to create a modern image of the building and rethink its interior space. In most cases, the objects have an inflexible system, which complicates the competent work on renovation.

4. Reasons for renovation of the sanatorium and medical environment. The experience of healthcare reform in other countries has led to several useful conclusions ^[17]. The introduction of the fundamentals of market relations based on competition, budget restraint and regulation proved to be quite effective. In this regard, there is a gradual increase in interest in sanatorium recreation in the city of Khabarovsk, so in 2020 people were particularly concerned about rehabilitation services, but the provision of SRO in the city cannot meet the demand (scheme 1).

Scheme 1. The layout of the boundaries of the city of Khabarovsk by year

The analysis of factors affecting the health of the population and, as a result, the functioning of sanatoriums, allowed us to identify the main ones: the change in the age composition of the population (the aging of the nation), the change in the structure of the morbidity of the population and rapid technological progress. Of particular importance are studies on the optimal configuration of sanatoriums, as well as on the impact on the professional behavior of sanatorium staff. Considerable attention is paid to the improvement and the degree of need for rehabilitation services in the city. In case of dissatisfaction with these requirements, you can notice a high rate of treatment in hospitals and polyclinics. As a result of the analysis of the sanatorium system of the city, the main parameters affecting the rehabilitation environment are rapid technological progress and the composition of the population. These points are especially relevant for the renovation of the sanatorium environment of the city. 

5. The main trends of modern medical and rehabilitation facilities. Approaching the question of the implementation of a modern approach to the architecture and urban planning of sanatorium facilities in the realities of the city of Khabarovsk, it is worth highlighting that the experience of organizing sanatorium systems in different countries is quite limited. Therefore, for the Far Eastern region, and in particular for the city of Khabarovsk, relevant options for creating space-planning solutions should be developed. This statement is based on a combination of aspects, but, first of all, the complexity of the study is due to the variety of regional mechanisms and approaches to the organization and design of sanatoriums in different countries: from the calculation system for measuring capacity, quantity, radius of access, effectiveness of the sanatorium to the socio-economic role, orientation and dominant function in providing rehabilitation care.

Traditionally, when considering the effectiveness of sanatorium systems in the city, the indicator of temporary use of a stationary place is taken into account. The length of hospital stay is taken into account in conjunction with the effect of rehabilitation. Of course, the tendency to reduce the length of hospital stay entails changes in patient care, in the use of medical and support staff. Healthcare buildings today are mainly designed according to individual projects, which allow taking into account the complex of regional features of the area (climatic, urban, cultural, social, demographic, etc.). From the above, a small percentage of new and individual SRO developments in the city of Khabarovsk can be distinguished. The time itself for inpatient treatment tends to decrease, and many residents of the city do not find it advisable to travel too far from home to receive treatment. It is worth introducing an individual approach to the implementation of sanatorium renovation and construction, as well as at the beginning of the pre-project analysis, it is worth taking into account the morphology of the city. Abandoning the typical design of medical facilities has also allowed architects to build medical buildings in a new architecture that can accumulate, shape and broadcast an environment that itself has the potential of a healing nature. 

An integral part of the projects of the newest sanatoriums being built in economically developed countries is the introduction of environmental practices, principles of sustainable architecture ^[18]. This approach clearly illustrates that the hospital building is capable of being autonomous, resource- and energy-independent, harmonious in relation to the surrounding nature. This trend is one of the key ones, as it is aimed at the construction of large medical buildings and complexes that allow saving on operating costs, which is relevant in the conditions of the energy crisis in most countries of the world. In the Far Eastern region, the introduction of the practice of building such complexes is at an initial stage and requires an individual approach due to difficult climatic conditions and, as a result, the inability to use a number of practices used in a milder climate.

When designing new sanatorium buildings and complexes in the city of Khabarovsk, the main problems include: the need to create a project that initially provides for various scenarios for further development (expansion of all or the formation of multifunctional medical structures that allow combining different levels of rehabilitation care) and the definition of additional functions for them. If we talk about the reconstruction of existing medical facilities, then in addition to all the problems listed above, the main difficulty is added — in most hospital buildings built in the twentieth century, as a rule, there is no planning flexibility due to the use of wall structural systems, as well as a significant number of corridors designed exclusively for the function of horizontal communications between various rehabilitation departments. The problem also lies in the dominance of the functional component in the projects of medical buildings and insufficient attention to the need to solve the problem of aesthetic, psychological and spiritual comfort of patients and staff of the medical facility. All these problems of designing and reconstructing hospital systems are generalized and, of course, can change in space and time. But to implement the therapeutic environment, it is worth starting with the renovation of the old system and in the future create three new SRO facilities in the city limits. Thus, it is possible to create a competent health improvement system and add a new version of the tourist route for the development of the city.

Conclusion. From the analysis, it can be concluded that the medical buildings built in different epochs of the city's formation correspond to the main stylistic motives of the dominant styles: classicism, Russian style, eclecticism, constructivism. But the modern standards required now from these buildings cannot be fully implemented, thanks to the old style techniques and inflexible approach in the implementation of the object. The main thing that medical buildings in the city of Khabarovsk cannot provide is the therapeutic influence of architecture and design.

There is no ideal model, the same way of organizing a rehabilitation system cannot be used in its "pure form" — adaptation to regional peculiarities, socio-economic and political opportunities of each particular state, as well as taking into account demographic indicators and the dynamics of progressive diseases is necessary.