Nelson Mandela Children's Hospital

Nelson Mandela Children's Hospital

Winner of the 2017 premier award in landscaping in South Africa 

The landscape design of the arrival court creates a welcoming experience with colour, seating and flowering plants
Project Team
Client: Nelson Mandela Children's Hospital Trust
Architects: GAPP Architects and Urban Designers, Sheppard Robson International, John Cooper Architecture and Ruben Reddy Architects
Landscape Architects: GREENinc Landscape Architecture
Landscape Contractor: Life Landscapes

During 2011, GREENinc Landscape Architects joined the design team planning the Nelson Mandela Children's Hospital, a 200 bed specialist paediatric and academic tertiary referral hospital. The project, envisioned by the Nelson Mandela Children's Fund, relied solely on donor funding and construction was completed in May 2016. It is situated in Parktown, Johannesburg, and was previously a sports field belonging to the University of the Witwatersrand in nearby Braamfontein.

The landscape design of the hospital is firmly based on the concept and principles of therapeutic landscape design. A landscape with therapeutic value is purposely designed in a way that allows and encourages patients and their visitors to interact with nature in order to aid the process of healing. This choice to interact with nature provides patients with a sense of control at a time when their health is in the control of others. In return, this sense of control, as well as the sensory benefits of being in a garden, leads to a reduction in stress and ultimately to good health.

Project description
The hospital landscape has been designed as a series of courtyard gardens with specific functions that relate to the programming of the hospital layout. An effort has been made to include a therapeutic component into the design of every landscape area, even those located around the service areas of the building. The successful design of a therapeutic landscape rests on four pillars, namely; *visual and physical accessibility to the landscape; *ease of mobility for people with movement difficulties; *a variety of functional spaces that meet different needs; and *the provision of sensory stimulation.

External gardens
Visitors' and patients' first impression of the facility is formed by the Arrival Court. As a visit to a hospital is usually a stressful experience for children and their families, the landscape design aims to create a welcoming experience with elements such as colourful signage, seating and flowering plants. The Visitor Garden which leads from the reception areas will provide a continuation of this welcoming experience. It includes a cafe terrace overlooking a circular pond, informal seating and a large lawn area that can be used for fund-raising events.

A narrow water channel, set in a pathway and shaded by a pergola, connects the Café Terrace with the Children's Garden at the far end of the courtyard. In this space, young visitors will have the opportunity to release pent-up energy away from the controlled hospital environment. The play elements include a colourful timber climbing structure with a slide, swings, a climbing net and a chalkboard, as well as ride-on toys, bird-bath and a mounded lawn.

The Sensory (horticultural therapy) Garden and Occupational Therapy Gardens form an integral part of therapy programmes offered by the hospital. Horticultural therapy gives children the opportunity to actively participate in the cycle of nature and substitute their roles as patients with that of care-givers through activities such as planting, re-potting, weeding, pruning and 'harvesting'. 

These activities lead to a reduction in stress, resulting in happier children and ultimately, quicker recovery times. The three raised planters in the Sensory Garden allow children (standing or in wheelchairs) to easily touch, smell and harvest the plant material. The plant species in this section have been selected to provide sensory stimulation and to host ecological systems. A seating area with tables and chairs facilitates structured activities and informal meetings.

The design of the Occupational Therapy Garden accommodates play therapy, occupational therapy and nature therapy. The focus of this design is both to be visually appealing to children (thereby encouraging them to take part) and to meet the functional requirements of the different therapy programmes. Elements in this space include a sand-pit, water play basin, rubberised tricycle track and an artificial lawn area for outdoor physical therapy. A small seating area can also be used for informal meetings and therapy sessions.
The play garden is a multi-functional activity space with rubberised play surface

Internal courtyard gardens
The plan layout of the hospital differs from most conventional hospitals, as it was arranged around five internal landscaped courtyards linked by a central corridor. Together they form the 'green heart' of the hospital and ensure that every patient, visitor and staff member is exposed to as much greenery and natural light as possible. The courtyards have been grouped into active and passive healing courtyards and the design for each space has been influenced by the nature of the surrounding hospital functions.

There are three 'active' healing courtyard gardens on the ground floor level, which mostly serve as outdoor waiting and activity areas for day visitors. In-patients who are well enough are also encouraged to visit the courtyard gardens with their families or care-givers. The Day Garden is a small courtyard garden close to the reception area, inviting visitors into a forest-like setting with timber floor – and seating surfaces, surrounded by densely planted trees and flowering plants. Loose furniture will be arranged around an interactive sculpture of a toy train by artist Mary Sibande.

The Play Garden situated opposite the Day Garden is divided into a lower and upper terrace. The forest theme of the Day Garden is continued on the lower terrace, while the upper terrace is a multi-functional activity space, framed by flowering planting and covered by a rubberised play surface.

A raised interactive water element allows children to sail paper boats and to explore the shallow layer of water and underlying contoured stone surface with their hands. The space includes a climbing structure (called the Tree House), a life-size Umlabalaba game board and play pieces, and a chalk board structure shaped like a caterpillar. Movable flower shaped seating allows children to create interesting patterns when viewed from above.

The Family Garden at the far end of the central spine is also divided into a lower and upper area and framed by flowering planting. The floor surface is covered by rubberised flooring and colourful mosaic tiles. Visitors are welcomed to the upper terrace by a 'monster' embedded in the rubberised floor surface. The image of this monster was inspired by a clay artwork, created by a child during a workshop facilitated by the Children's Fund. Benches tiled with colourful mosaics, loose furniture and shade canopies create a comfortable experience for patients and visitors.

Tucked into the far corner, a timber and steel seating structure (called The Train) provide three colourful conversation and reading spaces that are only accessible to children. A sculptural trellis structure runs along the northern edge to the space. Small vignettes, depicting children busy with every day activities, are incorporated into the screen and provide an element of discovery and delight.

The visitors’ garden with seating, circular ponds and a lawn area that can be used for events.

The two 'passive' healing courtyards on the lower ground floor level are located next to the functions of surgery and intensive care, which make them unsuitable for social interaction and play. The purpose of the landscape design is to provide a peaceful and restorative environment where family members can experience a reprieve from their stressful circumstances. In an attempt to reconnect the occupants of the garden with nature, every surface and element was selected for its visual and sensory qualities.

The gardens are framed by a dense buffer of evergreen lowering planting, which provides a sense of privacy to the occupants of both the garden and the surrounding intensive care wards. Leaf-shaped reflection ponds, trees and seating are arranged on a light sandstone gravel floor surface. The water reflects the sun and shimmers through the dappled tree canopy when viewed from the upper floors. When mature, the trees will provide a 'green roof' for the courtyard and will also bring nature to the occupants of the floors above. A sculptural trellis structure will be placed behind a row of benches in each courtyard, to further contribute to the sense of privacy offered by the gardens.
Left: The day garden invites people into a forest-like setting with timber floors and seating. The interactive sculpture of a toy train is the work of artist Mary Sibande. Right: A raised interactive water element in the play garden allows children to sail paper boats and explore the shallow layer of water with their hands
Left: The childrens’ garden with diverse play elements. Right: Visitors are welcomed into the upper terrace of the family garden by a ‘monster’ embedded in the rubberised floor surface.

Landscape installation
Ida-Marie Strydom of Life Landscapes was responsible for overseeing the the hard and soft landscape installation, describing it as "technical and intricate, with a huge amount of detail and so many different components." 

Included in their contract were the following: artevia paving, wall construction, timber decking, steel works, drainage channels, water feature construction, plant and tree installation, play structures, hydroseeding and irrigation.

She says that every part of the project has its own distinct look, feel, character and purpose and this is what made it complex, also calling for careful and precise co-ordination to ensure a planned working process. Work was undertaken in the following order:

the courtyards were installed first (hard landscaping, waterproofing and lastly planting);  this was followed by the main entrance planting, including a sculpted lawn area, tree planting in the parking area and construction of the attenuation ponds; the lower parking area and berming on the western side of the site;  the visitor garden was installed last. 

Planting required particular attention due to the fact that the plant palette was extensive and material had to be pre-grown. In some instances, substitutes were brought in where plants originally specified by the landscape architect were not available. Strydom says: "Annamari (Comrie) had an initial wish list but where we couldn't find what she wanted, we suggested alternatives and she was very accommodating."

The day garden invites people into a forest-like setting with timber floors and seating. 

Leaf-shaped reflection ponds in the quiet garden. The water reflects the sun and shimmers through the tree canopy when viewed from the upper floors.
Notewothy points include the following:

  • the second courtyard is a play garden where EPDM rubber safety flooring has been installed. This is a durable synthetic rubber suitable for a variety of applications. It occurs in the play garden, family garden and occupational therapy garden;
  • a narrow, pebbled water feature in the play garden is made of steel, with a stone layer cut into the shape, giving children the opportunity to float objects in the water;
  • both the play and family gardens are roof gardens where a lightweight soil mix was required due to weight restrictions, and polystyrene was used as a void filler as it weighs less than soil. There are wheelchair ramps in both the family and play gardens, and skylights occur in the former;
  • in the visitor garden there is both polished and exposed aggregate artevia paving and the bubbling sound of water in a circular pond is gentle and soothing;
  • a west facing embankment is planted with veld grass and a mix of indigenous trees; there are three attenuation ponds on the site – two north of the building and one south of it.

Pathway and landscaping around the attenuation pond. Hydroseeding with rye grass was undertaken in this area.
Hydroseeding was undertaken by Thabakholo Environmental Solutions and veldgrass was sown on the embankments to prevent erosion. Erosion control blankets were also used for this purpose and the hydroseeding brought an aesthetic value to the area, making it visually pleasing when looking from the road. It is a cost effective and efficient method to regulate, minimise and /or eliminate erosion. 

Soil Saver by Kaytech was placed to prevent erosion and veldgrass was used as this area is designated for rehabilitation. GREENinc wanted the project to contribute as much as possible to the local ecology and the erosion control properties of veldgrass are an added benefit on this steep embankment. 

The seedmix used was Cynodon dactylon, Digitaria eriantha, Chloris gayana and Eragrostis curvula. Rye planting was included in the mix as the hydro seeding was carried out during the winter period. Strydom says that despite the complexity of the project, it was a privilege for their company to be involved with it and they are very proud of the end result.

Hard landscaping
Keith Nevin of Hard Landscape Enterprises was responsible for paving, mosaic tiling and construction and installation of water features. He says the contract was an interesting one, with all the different finishes required in the various courtyards and perimeters. Brickwork and levels were critical for execution of the final finishes. 

"The courtyards came alive once all the finishes, decking, planting, water features and mosaics were installed," he says. Paving in Nevin's scope of work was an exposed concrete finish in the form of pathways around the building and a large area in one of the courtyards. In the main exterior courtyard, Nevin built and installed a water feature with granite coping which worked well with the exposed concrete pathway on either side.

Safety flooring
Jeremy Stewart of eamless Flooring Systems installed PLAYSaFE ® safety flooring in three of the children's play areas. The product offers shock absorption and significantly reduces the risk of fall-related injuries, making it suitable for day care centres, municipal playgrou nds, sports fields, athletics tracks and as a safety matting in retirement homes. It is also suitable in landscaping applications and aquatic parks where water splash occurs. 

Stewart, chairman of the South African Sports Play Industry and an international expert in playground safety, explains that fall protection flooring is a legal requirement in all play areas in South Africa where children could fall more than 60cm. The product addresses all issues associated with traditional safety surfacing such as cracking, fading and surface temperatures, and can be tailored to suit individual project specifications such as slip resistance, drainage and multi-use games areas.

The flooring is mixed on site by combining imported EPDM rubber and their specially designed, flexible UV stable resins. It is poured onto the floor, applied in a wet pour technique and hand-troweled across the floor by skilled installers. 

Properties of the flooring include the following:

    • suitable for indoor and outdoor applications;
    • it can be applied over existing floors and different sub-strata;
    • it is long-lasting, weather resistant, fire retardant, low maintenance, slip and skid resistant;
    • it is hygienic, anti-allergic and resistant to fungal growth;
    • it complies with environmental and health standards as well as international soil protection and contaminated site regulations;
    • it is recyclable with no known toxic effects;
    • the same rubber is used on Olympic sports tracks worldwide as it reduces impact on joints and provides running comfort. 

GREENinc specifically chose this product as it offers a palette of 24 colours which are UV stable and will not fade over time. The longevity of the colours is what sets it apart from all other available rubberised floor surfaces.

The purpose of these therapeutic garden spaces is to provide relief from the stress and emotional trauma of a hospital environment. The landscape design intent is to create welcoming garden spaces for children that will bring joy into their lives and assist in bringing them back to good health.

Design information by Annamari Comrie, GREENinc Landscape Architecture

Photos by Karyn Richards, Landscape SA Magazine.

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