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Autonomous Medical Stores

East Timor

General

Under the Indonesian regime, there had been a central medical store in Dili and a store in every district. A pharmaceutical consultant reviewing the pharmaceutical needs of the country however proposed that only one central store located in Dili was required to supply all of the health facilities in the country. An existing building in Dili had been renovated to provide temporary facilities for the storage of pharmaceuticals and other medical supplies but this building was too small, badly built and the roof was leaking. It was proposed therefore to construct a new central medical store in Dili on a site next to the existing store. This site was not ideal as it was liable to flooding during the rainy season but no alternative could be found and the new building therefore had to be designed to take account of the site conditions as well as the climate and the brief provided by the pharmaceutical consultant.

Working with the pharmaceutical consultant, an architect’s brief for the new central medical stores (which became known as the Autonomous Medical Store) was developed. The new building was required to store drugs and other essential medical supplies. The function of the stores was to receive, check, palletise, store, pick, pack and despatch these supplies to clinic and hospitals. Materials handling equipment would be relatively simple using electric stacker trucks, manually controlled electric forklifts, etc and adequate space had to be provided for the use of these.

Accommodation and Specifications

The main store had to provide the following accommodation:

Storage space for approximately 300 pallets (1000mm wide x 800mm deep with a maximum load weight of 1,000kg per pallet and a maximum height including the pallet of 1,150mm) stored on adjustable pallet racking, two pallets per rack, in three aisles, maximum three pallets high. Pallet levels to be as follows: 1st pallet level: 600mm; 2nd pallet level: 1,690mm; 3rd pallet level: 3,380mm. The aisles between the pallet racking should be 2 metres wide (see drawing).An area for bulk storage of large items.
An area for shelving for storage of small items. The shelves were to be of galvanised steel (or similar) with three adjustable shelves (600mm deep), maximum 1.8 metres high. There had to be approximately 69 metre run of shelving units, 3 shelves high, some back-to-back (see drawing).
A receiving and unpacking area.
A packing and assembly area.
A small (2.4 metres x 3.6 metres x 2.4 metres high), secure store for narcotics and other controlled drugs. The store was to have 3 galvanised steel adjustable shelves as described above and heavy-duty galvanised steel mesh (or similar) walls and roof with a secure door.

The total area was to be approximately 1,008m² (24 metres x 42 metres) and was to be free of internal columns.

The stores were to have two roller shutter doors (3 metres high x 6metres wide) for unloading and loading trucks and the loading and unloading bays were to be protected against the rain with a canopy and raised approximately 1200mm above road level in order that fork-lift trucks could drive straight into containers and unload them.

The stores were to be naturally ventilated (as MOH did not have the budget to air-condition them) with good natural and artificial lighting. Window openings were to be protected against solar penetration by roof overhangs or canopies. There was to be ventilation at low and high levels adequately protected against the ingress of rain and birds, bats and rats. The roof and walls were to be insulated to protect the building against solar gain and the building was to be capable of maintaining a temperature below 30°C without air-conditioning.

The main structure of the buildings was to be a steel frame and the roofing was to be of ‘Colorbond’ insulated corrugated galvanised steel sheets with an integral steel colour-coated ceiling. Walls up to approximately 2 metres high were to be of block-work or concrete and walls above this level were to be of ‘Colorbond’ insulated corrugated galvanised steel sheets with an integral, steel colour-coated lining. Floors were to be of concrete with power-float, dust-proof finish.

Smoke detectors, fire alarms, fire hoses, fire extinguishers and fire exits were to be provided in compliance with Australian regulations.

The following ancillary accommodation was also to be provided:

A maintenance bay (approximately 6 metres x 6 metres) with space and facilities for charging electric vehicles, work benches, tool cupboards, etc.
A vaccine store (approximately 12 metres x 6 metres) with space for two walk-in cold rooms (20 cubic metres each), four ice pack freezers and space for packing vaccines.
Two stores (each 3 metres x 6 metres) with adjustable metal shelving for packing materials, office supplies, cleaning materials, etc.

The total area was to be approximately 104m² (6 metres x 24 metres).

Office accommodation, toilets, etc were to be provided as follows:

Reception area (approximately 6 metres x 6 metres).
Sales office with space for a cashier and the finance manager (approximately 4.8 metres x 6 metres).
Warehouse manager’s office (approximately 4.8 metres x 3 metres with good views of the warehouse floor).
General manager’s Office (approximately 4.8 metres x 3 metres with good views of the warehouse floor).
Male and female toilets (approximately 4 metres x 3.5 metres).
Kitchen (approximately 2 metres x 4.8 metres).
Dining room for 20 people (approximately 6 metres x 6 metres).

The total area was to be approximately 180m² (6 metres x 30 metres). The corridor between the general manager’s office, warehouse manager’s office and the finance/sales office were to have full height glazing to both sides to enable supervision of the packing and assembly area from the offices. The offices and ancillary accommodation were to be air-conditioned.

A separate flammable store (area approximately 36m²) was to be provided on the site. The store was to be well ventilated and capable of maintaining a temperature below 30°C without air-conditioning.

A suitably sized, soundproofed standby generator with automatic switching for the vaccine stores was to be provided.

The existing security post at the entrance was to be renovated.

A wood-fired incinerator for destroying damaged and expired drugs was to be provided similar to the ‘BEST’ clinical waste gasifier.

The site was to provide adequate concrete paved parking and manoeuvring space for trucks to load and offload and parking space was to be provided for four ten-tonne trucks and six four-wheel-drive vehicles.

There was to be paved pedestrian access to the main building from the main road. There was also to be the possibility of installing petrol and diesel storage tanks and pumps at a later date.

The site is very wet and was to be filled beneath the footprint of the building and the paved areas with suitable fill (the main building was to be raised above existing ground level to enable off-loading from trucks directly on to the loading bay). Adequate paving and storm drains were to be provided around all buildings and paved areas, draining if possible to the large drain adjacent to the site.

The site was to be fenced to match the existing fence around the adjacent site, a new pair of steel double gates was to be provided and the fence between the existing and new sites was to be removed.

The existing timber and steel bridge over the main drain running alongside the access road was to be replaced with a new bridge capable of carrying a truck and trailer carrying a loaded 6-metre container and the access road to the bridge from the main road was to be paved.

Implementation.

I produced a detailed sketch plan based upon the architect’s brief and a preliminary budget (which, I am happy to say, turned out to be very accurate; no mean feat given the circumstances in which it was produced). We then advertised for bids from consultancy firms to produce final designs, working drawings and bidding documents. The contract was won by an engineering firm from Tasmania (Pitt and Sherry) who already had an office in Dili and who produced a final design for the buildings and bidding documents.

The only changes to the design that they proposed were to extend the unloading area outside the store and provide it with a roof and to omit the ventilation panels at the foot of the external walls to the main store that I had proposed and replace these with ventilation ducts below floor level with gratings in the floor. These had the advantage that air drawn into the ducts from either end would be naturally cooled before being drawn up into the building and out through the louvres in the lantern roof. Checks on the temperature after the building was constructed confirmed that the temperature in the buildings even during the hottest season remained below 30°C.

There was no main soil drainage near the site and therefore it was necessary to construct a septic tank to deal with effluent from the toilets. The problem with this was that the ground water level during the rainy season was only a few centimetres below ground level and therefore standard soakaways would not work. As the floor level of the building was 1200mm above ground level, the engineers proposed constructing the septic tank above ground level and providing raised mound ‘transpiration’ soakaways, which, after they were extended, seemed to work.

Conclusions

The construction contract was won by a Japanese contractor who performed very well. The buildings were constructed with the minimum delay and to a very good standard of construction and finishes and initially the building provided adequate space for the materials that had to be stored there.

The size of the main store had been kept relatively small by the pharmaceutical consultant in order to reduce costs and was based upon the management of the store ordering pharmaceuticals and other materials at regular intervals and breaking down, packing and delivering these materials to the other health facilities in the country as soon as possible after they were received.

Unfortunately the company who were hired to manage the stores did not seem capable of performing these tasks and their contract was terminated. The second company who were hired also were not capable of ordering and delivering materials as was originally intended and it was eventually decided therefore to extend the main store to provide further accommodation for materials while they were being packed and despatched.