DESINELab Student Lecture

I was recently invited to give a student lecture on healthcare as part of an ongoing series by DESINELab here in Rhode Island School of Design. I wanted to share what I talked about here in this blog to extend the conversation to a wider audience. Any kind of feedback or comments would be much appreciated.

My interest in healthcare was sparked in an advanced studio class I took with Nathan King and Olga Mesa called Future Health Systems. In this class, I realized that most of my personal efforts in trying to affect positive change, within systems like business, the food industry, agriculture, and education were all connected with healthcare, or at least my own vision of healthcare. For that studio, I proposed an ideal healthcare system for the Philippines through architecture, which you can find here. I am currently writing a manifesto for it, in the hopes of making it a reality. 

This narrow focus on a specific area of design has opened many doors for me. I recently did an internship in MASS Design Group, as one of the first RISD students to do so. I have been asked to start consulting with a group of doctors in Manila who are building about 40 hospitals and clinics across the country. The pace of my understanding and knowledge on the field has been increasingly fast due to my niche interest in specializing coupled with the demand of good designers in the field. 

Paradigm Shift in Healthcare

Healthcare has long been ignored by the majority design community. Yet, it is currently experiencing a paradigm shift in where designers are crucial components. This shift is in response to a universal effort of decentralizing and defragmentizing traditional healthcare: from reactive to preventive, from medicine to wellness, from the hospital to the home, from the wealthy to the masses. Therefore, the definition of healthcare is as complex as ever.

Traditionally it is defined as the diagnosis, treatment, and prevention of disease, illness, and other physical and mental impairments in human beings. However, a lot more attention has been focused on just diagnosis and treatment. It is traditionally delivered within primary, secondary, and tertiary care, as well as public health. 

However, projecting forward this definition, as I have mentioned, will change. Therefore, looking forward, my own definition of healthcare is the maintenance of a persons complete wellness system, which includes social, spiritual, physical, occupational, intellectual, emotional, and environmental.

For this lecture, I will be using the lens of architecture in talking about design in healthcare but I want to emphasize that any field of design is just as important. To help understand the current context of healthcare architecture, I want to quickly talk about its history. Just like design movements, healthcare has gone through several revolutions since its inception. 

Prehistory of Western Hospital Architecture

Prehistory of Western Hospital Architecture began in Ancient Greece where the concept of health was closely linked to religious rites and rituals. It emulated the model of their classical temples. In the middle ages, monastic hospitals were built that resembled monasteries like Hotel Dieu. Most hospitals until the 1700's were designed in parallel to the architecture style of their time. They were rarely designed with the pure intention of being a place for treatment. In the renaissance, hospitals were designed according to the geometrical principles that were popular at the time like the Ospedale Maggiore in Milan in 1468. Then in the 70's western countries started producing statistics that triggered the first revolution in hospital design

Ancient Greece

Middle Ages

Renaissance

First Revolution: Built Natural Healing.

Hospitals were the first buildings that were completely determined by scientific and philosophical concepts. It was inspired by the poor outcomes of existing hospital designs that pushed designers to rethink hospital design. Two concepts were brought forth in Paris: the radial system and the pavilion system. Both systems believe that healing is not derived from medicine but from being in a purified, natural environment that provided clean air. The Hopital Lariboisiere by M.P. Gauthier built between 1839 and 1854 is credited as the first pavilion hospital. Pavilions maximized sunlight and windflow. Apart from designing hospitals using the beneficial effects of nature, architects designed hospitals to become iconic. By housing medicine in such a way, it influenced the public to believe that it was important and thus provided more investment, which drove medical science. 

Second Revolution: Medical Science and Technology.

At this time period, we begin to see the shift from using nature to using technology. This shift in balance began with the invention of the x-ray. Pavilion type hospitals were replaced with block hospitals because they thought long corridors made it more inefficient. Block hospitals were good for centralizing common utilities like the x-ray which was too expensive to place in every building/pavilion. The first of this block type was the Columbia-Presbyterian Medical Center in New York by James Gamble Rogers built in 1930. However, with the introduction of the block type, we lost an essential architectural feature: the ambition to create healing environments that emulated nature.

Third Revolution: Hospital for the Masses.

This revolution was the product of WWII and the 'social revolution' which fostered the idea of the Welfare State. Social Security Systems were set up in most countries to safeguard the public from unemployment, disability, old age, and illness. Due to the influx of new patients, technology was focused on treatment facilities and outpatient wards. Hospital architecture became synthetic and a new type of hospitals emerged called Matchbox on a Muffin Type. The idea with this new type was that it is much easier to rebuild and redesign the ground floor than to make changes in high-rise buildings. It combines a flat spreadout building and a high rise building containing the patient ward on top. It allowed changes to occur without disturbing the patient wards. The first of this type was the Hopital Memorial France-Etats-Unis in Saint-Lo by Nelson in 1956. Since hospitals were now open to a larger population patients stopped being treated as people but collection of possible diseases or just data. This ran parallel with the capitalistic trend of the Western culture and the rise of bureaucracy. 

Fourth Revolution: Empowering the Patient.

Hospital embodies conflict between the individual, and the needs of the medical staff and equipment. This led to the invention of a neutral, industrially-built, unexpressive structure that was no longer recognizable as an individual building. An example of this would be the Medical Center of Groningen in the Netherlands which emulated the city by introducing covered streets, a huge hall, and many shops and restaurants. Unfortunately, The transition from a medicine-dominated to a management-dominated hospital has not curbed the process of institutionalization. It failed to return the hospital to the people. Technology and science that was once the main justification for hospital architecture and design is now what is driving it to the opposite direction. 

Fifth Revolution: Returning the Hospital to the People.

This revolution should initiate the return to the basic principles of decent management, empowerment of the patient, de-institutionalization, and the courage to re-conceptualize healthcare and to let it go back to its core business. We are the generation currently undergoing this paradigm shift. Healthcare is shifting from being purely reactive to preventive, but we still have a long way to go. 

Designing Forward

How can we design for this new shift towards preventive healthcare, or what we can even call responsible design? I believe the answer lies in research and evidence-based design. When I interned in MASS Design Group, I learned that there should be 4 stages in design. Traditionally especially in architecture, there are two that we mostly focus on: Design and Construction or Manufacturing. However, there should be two more stages to make design more efficient and effective. 

Prior to the design phase, there should be a pre-design phase in where you research the context holistically. RISD design students are very aware of this and most of us approach projects this way anyways. However, where I think we are lacking are looking at things from a systemic point of view. Here is where ID students do better than architecture students in my opinion. In architecture, we often use the pre-design phase as basis of form and program making, which I think is still very shallow. Pre-design must be thought of from the scale of systems all the way to the people that use the system. 

The fourth phase goes after construction or manufacturing called Impact Analysis. This is often very difficult to do because it costs money outside the traditional budgets that are given by clients. However, it is one of the most important phases because it teaches the designer what actually works and what doesn't outside the theoretical realm. Without Impact Analysis, we cannot achieve a complete feedback loop and that is why history of design has been so inefficient and ineffective. We are currently designing objects and buildings without considering what kind of futures they will create both environmentally and socially. This is a manifestation due to the lack of impact analysis of our designs. 

With all 4 phases completing a feedback loop, designers can truly achieve research and evidence-based design. This means that your design is an efficient use of resources because your design meets a real need and demand rather than a theoretical one. From this we can start designing an environment that actually suits our human needs and prevent us from being unwell and getting sick. We cannot use money anymore as an effective way to gauge the flow of resources. Why not try using wellness as a metric of developing a project and as a way to see its following success?

Origins of Filipino Photography

An investigation into the different photography methods used by the Americans during their colonial occupation of the Philippines

Abstract:

The history of photography in the Philippines is as difficult to trace as the history of the country itself. Since the Philippines has been occupied and colonized, its history has been rewritten a copious number of times. From the words of Winston S. Churchill, “History is written by the victors”. After the invasion of the Spanish, Americans, and the Japanese, the Philippine culture and history has long been disseminated. Thus, tracing the photographic history of the country has become very problematic.

To create a successful timeline and history of photography in the Philippines, one must first study it in isolation. All the research and findings involved in this study is narrowed down to the American occupation and photographs that were taken during that era. During the American occupation, they used photography as a means of anthropology, surveillance, and propaganda to legitimize their colonial regime.

Introduction:

How was photography used by the Americans during the occupation of the Philippines from 1898 to 1946? The motive for this paper is to create a clearer and deeper understanding of my own country’s photographic history. Growing up in the Philippines, I was never exposed to its native photography history and I grew curious as to why. Philippine history has always been taught strictly using words and never photographs. I want to use this paper as an opportunity to rediscover what has been lost to us Filipinos. I chose to narrow it down to photographs taken by the Americans, in hopes of quarantining the unique voice of Filipino photography.

To fully answer this research question, several terms have to be initially defined and expounded. This is to create a standard terminology across this paper. A “photograph” is defined as a picture made using a camera, in which an image is focused onto film or other light-sensitive material and then made visible and permanent by chemical treatment, or stored digitally. Photography during 1898 to 1946 was limited to large, medium, and 35mm format film based cameras.

This paper explores the context in which Americans occupied the Philippines; as well as the use of photography as a means of anthropology, surveillance, and propaganda to legitimize their colonial regime.

Context

The first country to occupy the Philippines and instill colonial rule were the Spaniards, whose regime lasted from 1565 to 1898. The Spanish rule achieved the political unification of the country, which was previously divided into independent kingdoms. They were the first to establish the dispersed islands of the Philippines as one nation under one name and flag. The Spaniards implemented a nationwide public school system that aimed to educate the masses and introduced Christianity. The culture and language barrier promoted the use of imagery to convey information. Paintings and illustrations are examples of visual languages that were introduced as factual aids, which were a foreign concept for Filipinos but was easily digested.

After the discovery of the daguerreotype in 1839, the Spaniards were the first ones to introduce photography to the Philippines dating back to 1841. During that year, Don Sinibaldo de Mas arrived in the Philippines as a government diplomat for the Spanish King. He was tasked to record conditions in the colony and to relay that information back to Spain. He brought the daguerreotype with him from Spain to the Philippines. He was recorded to have taken photographs in the Philippines but unfortunately, none of it has been found.

Francisco van Camp, Indegena de clasa rica (Mestiza Sangley-Filipina), 1875

Indegena de clasa rica (Mestiza Sangley-Filipina) is one of the oldest portrait photographs recorded in Filipino history dating back to 1875, which was photographed by a Dutch photographer named Francisco van Camp. Capturing a woman of both Spanish and Filipino ethnicity symbolizes one of the main functions of photography in that setting; it was used to document the Spanish influence on the Filipino population.

In 1896, the Filipinos began to rebel against the Spaniards, culminating to the Philippine Revolution. It was in this revolution that photography was utilized in an entirely different approach. Instead of being a one sided instrument for the Spaniards, the Filipinos began to use photography to fuel their own point of view. When the leader of the rebellion, General Emilio Aguinaldo was exiled, photographer Manuel Arias Rodriguez was able to capture him in his dignified general uniform. This photograph became widely popular among the Filipino rebels and acted as inspiration.

Manuel Arias Rodriguez, Fusilamiento de Jose Rizal, 1896

Another inspiration to the Filipinos is Jose Rizal, who later became the country’s national hero. He wrote several books that exposed the crimes of the Spaniards which pushed the Filipino rebels over the edge. He was then executed on December 30, 1896. Prior to his death, Manuel Arias Rodriguez was able to capture a photograph of the scene. Just like the photo of Emilio Aguinaldo, photographs of Jose Rizal prior to his death were used by the Filipinos for the revolution.

During the same time of the Philippine revolution, America was at war with Spain over Guam and Cuba. American president McKinley offered to give aid to the Filipino rebellion. With the help of American troops, Emilio Aguinaldo, who would be the first Filipino president, declared the independence of the Philippines in 1898. Unfortunately, Filipino dreams of independence were crushed when the Philippines was transferred from Spain to America after the Treaty of Paris in 1898.

America needed the Philippines to gain control of Asia due to its highly strategic geographic location. However, they encountered several difficulties in gaining public support due to their exhaustive war against Spain. The masses were not motivated to send more troops to the Philippines for colonial control because they didn’t know anything about them. America then sent photographers to the Philippines as a means of anthropology, surveillance, and propaganda to legitimize their colonial regime.

Anthropology

In the early years of their occupation, barely any information about the Philippines was available in both written and photographic form. Frank D. Millet, one of the American writers that wrote about the Filipino-American war stated “the literature concerning the islands was phenomenally scarce…The Philippines, however, remained outside the kodak zone. He believed that photography would bring the Philippines into the realm of knowledge for Americans. In return, photographers would be the one to dictate the image of the Philippines. Therefore, America sent photographers to capture images of Filipinos and their respective environment, to help educate their own citizens back home. Two of the most essential photographers for the anthropological study of Filipinos were Dean Conant Worcester and Dr. Jenks.

Dean Conant Worcester was a member of the United States Philippine Commission from 1899 to 1901. Prior to his membership, Worcester had already travelled to the Philippines a couple of times. His first travel to the Philippines was on 1887, when he was invited by his university’s chair of the Department of Zoologist, Joseph Beal Steere. In his first trip, his interest with zoology brought him to photograph the Philippines with an anthropological intent. He wanted to capture everything to use for study. With the photographs taken on his trip, he published the book The Philippine Islands and Their People. It is one of four books that he published using photographs of the Philippines.

His photographic account of the Philippines was expansive, but not thorough. How does one achieve to portray a whole country through photographs? His decisions on whom and what to photograph disregarding his intent, framed the ideas of Americans of the Philippines. However, when one is to discuss intent and photography, Worcester was a constant opponent of Philippine independence and a firm believer in the colonial mission. He argued that “for their unfitness for self-government at the present time is self-evident.” His photographs were a reflection of his stance.

Dean C. Worcester, Head of Stairway occupied by First Philippine Commission. Manila, 1899

During his first travels to the Philippines, Worcester photographed the meetings between the members of the First Philippine Commission. He focused his camera on the ornate architecture of the city, as seen in his image of the Head of Stairway occupied by First Philippine Commission. In here, we can see him capturing the architecture as part of an anthropological study due to its point of view and lack of activity.

Dean C. Worcester, Portrait of Man and Woman in Costume with Ornaments, 1902

However, after discovering the hill tribe men, also known as Igorots, he focused all his attention to photographing them. He was instantly attracted to the Igorots, due to their seemingly remedial culture, and his original intent of showing Filipinos and their “unfitness”. Instead of pointing his camera towards the growing metropolitan cities like Manila, He chose to photograph the Igorots as the image of the Philippines. He photographed these hill tribe men in great detail amassing about 5000 photographs. Worcester was one of the first photographers to photograph subjects in nudity as part of an anthropological study.

Worcester’s anthropological studies and his photographs were a vital contribution to the Philippine’s first census that was published in 1903 by Dr. Jenks.

Albert E. Jenks, or commonly known as Dr. Jenks was a self-taught ethnographer that was hired by the Bureau of American Ethnology and was sent to Manila in the Philippines in 1902. His 1905 publication, The Bontoc Igorot was a milestone in American anthropology for being the first ethnographic study of a non-American Indian group by an American anthropologist.

Surveillance

As seen with the publishing of the first census, photographs were used to gather information not only about the anthropology of the people but also as data for the military. Prior to the American occupation, the Philippines was not a completely unified nation as they had previously believed. There were still some rebellions in the south caused by the Muslim population. Using photographs, they learned much about the Filipinos. Americans gathered information using photography as proof and evidence to anchor their tactics to fight the rebels. Since cameras were so scarcely available, they took advantage of it in the battlefield.

Long before the war was officially declared over, albums of photographs of bombed churches, cannons, Manila landmarks, and massacred Filipino “insurgents” were already being published in 1899. It was crucial for America to place the Filipino’s under the “Kodak zone”. They even solicited photographs from their own soldiers. Governor-General W. Cameron Forbes said that “If a photograph were needed, this bureau not only took it, but filed it away so that it might be available in the years to come”. The archive that they gathered of the Philippines was not just a collection of photographs but also a collection of scrutinized surveillance subjects.

America also sent the Thomasites to the Philippines, a group of five hundred American Teachers in 1901. They were to establish a new public school system, to teach basic education, and to train Filipino teachers, with English as the medium of instruction. The teachers not only taught the Filipinos but learned about their inherent culture as well. One of the Thomasite, Philinda Rand, took photos that show many aspects of Filipino life in Silay and Lingayen. These photographs became another tool for surveillance, as the teachers were requested to report back to show their progress.

Benito Vergara author of Displaying Filipinos (1995), argues that both travel literature and official colonial documents, both appropriate photography as an instrument of surveillance.

Propaganda

Ultimately, the American government used all of the previously mentioned types of photography for propaganda. Like previously stated, America needed the Philippines to gain control of Asia. The waning interest of the public became detrimental to that cause. Photography was vital for the manipulation of the public interest.

The power of photography is in its innate capability of making people believe and its capacity to be invested with truth. Yet, the amount of possibilities to disorient the meaning behind a photograph is limitless. Manipulation can occur in almost every part of the process of taking a photograph, for example, posing. In most of the photographs taken by Dean Worcester, which was brought back and shown to the American populace, the Filipino tribe men stood beside Americans. They were posed to look subordinate to the Americans as they stood awkwardly, half naked. However, when photographed alone and by a different photographer, the tribe men stood proud and dignified.

These photographs reflect the pre-construction of meaning specifically predicated on a colonial ideology, or also known as “White Man’s Burden”. Murat Halstead a war correspondent said that “It was foreordained since the beginning when God created the earth, that we, the possessors of this imperial American zone, should be a great Asiatic power.” Due to the technology of being able to reproduce and circulate these photographs, it was easy for the government to persuade the public that they were needed to intervene in the Philippines.

All these ideas and photographs regarding the splendor Filipino colonialism reached its peak in the 1904 St. Louis World Fair. Dr. Jenks was appointed supervisor for the Philippine exhibit at the St. Louis world fair. This exhibit was the culmination of the anthropological research and photographs that he and Worcester took while in the Philippines.  The exhibit cost over one million dollars and consisted of 47 acres of space, 130 buildings, 70,000 exhibits, and 1,200 Filipino “natives”. The Filipinos were put in displays as if animals in a zoo, and were further exploited through the exhibit, travelling around America for a year due to its popularity.

The meticulous collection of photographs and foreign objects proves the American government’s deep surveillance of the Philippines. The exhibit was also divided among the different types of Filipinos, creating a focus on stereotypes, which is revealed with Daniel Folkmar’s Album of Philippine Types. This in return, made the ethnology of the Philippines easier to digest for the American viewers. The President of the Exposition, David R. Francis wrote, “From this school many millions of Americans will return to their homes, elated with a better appreciation of humanity at large and a far higher and prouder estimate of their own country and countrymen".

To further entice positive public opinion on colonialism, photographs of Americans educating and improving the Filipinos and their lives widely circulated. Photographs from the Thomasites for example, portrayed the impact of their public education system. These photographs were shown after the immense circulation of photographs that showed the inferiority of Filipinos.

Conclusion

In conclusion, the image of the Philippines and its inhabitants, in the point of view of Americans were intricately constructed by the American government, using photography for anthropology, surveillance, and propaganda to legitimize their colonial regime. From the words of Christopher Pinney, “those who controlled the representations [exercised] domination”.

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Sources

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Kroeber, A.L., People of the Philippines. New York: Anthropological Handbook Fund. 1928

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