How the Cutting-Edge Tenwek Cardiothoracic Center Was Built

Earlier this year, AGC Tenwek Hospital in Bomet County, one of the most respected health service providers in East Africa, completed a state-of-the-art Cardiothoracic Centre. The new Centre is designed to offer a wide range of services including specialized heart surgeries and thoracic procedures. It boasts modern equipment such as cardiac catheterization labs, endoscopy suites, advanced imaging systems, and fully equipped surgical theatres.

In addition to patient care, the facility will serve as a training centre for cardiothoracic surgery and related specialties.

Designed by Unites States-based HFG Architecture and locally executed by Triad Architects with Ark Construction Limited as Main Contractor, the facility will be a game-changer in healthcare provision in the region.

Both Triad Architects and Ark Construction Limited shared their insights on the project with Construction Kenya Showcase.

TRIAD ARCHITECTS

Could you remind readers about the client’s brief?

The brief addressed key challenges in the western and northern regions, where oesophageal cancer and rheumatic heart disease were prevalent. Over 800 patients were waiting for surgery, and 250 children with heart conditions lacked access to treatment. Tenwek Hospital was overstretched, treating only 250–300 patients annually, making it clear that a dedicated Cardiothoracic Centre (CTC) was urgently needed.

Tenwek Hospital, a mission-driven institution, sought to address this need with a vision for the CTC to become the largest heart centre in sub-Saharan Africa, second only to facilities in Egypt and South Africa. The goal is to perform over 3,000 heart surgeries annually. The original concept remained intact, though minor adaptations were made during construction for value engineering and site conditions.

What was Triad’s role in this project?

As the architect of record, Triad was responsible for implementing the project locally, adapting conceptual designs from US-based HFG Architects. We secured local authority approvals, created detailed designs for tendering and construction, and led the consultant team overseeing the entire project.

Could you describe the Cardiothoracic Centre and its special features?

The CTC is a 176-bed Centre of Excellence (CoE) for heart and lung diseases. It’s part of a broader expansion at Tenwek, which includes doctors’ apartments and infrastructure upgrades. The hospital block spans 36,000 square metres across seven stories, including basements for parking and storage, and a ground floor housing outpatient clinics, laboratories, imaging facilities, and more. The upper floors include wards, operating theatres, ICU, and areas earmarked for future expansion.

Sustainability was a priority, with features like:

•   Passive design to reduce heat gain,

•   Rainwater harvesting (500,000-litre tank),

•   Solar water heating (300,000-litre capacity),

•   300 kW solar grid-tie system, and

•   Energy-saving measures, such as motion sensors.

Natural lighting and ventilation were integrated throughout, and locally sourced materials were used to support the community.

Special features included:

•   Healing environment with large windows for natural light and gardens,

•   Infection control using sterile materials, modular theatre systems, and seamless finishes to prevent bacterial growth.

•   Fire safety with a sprinkler system and fire ring,

•   Advanced technology, including telemedicine, IoMT, and high-tech imaging units.

4. What were the key design considerations?

Several factors shaped the design:

•   Christ-centred mission: A chapel and prayer rooms support the hospital’s motto, “We treat, Jesus heals.”

•   Healing environment: Patient recovery is enhanced through nature, gardens, and infection control technologies.

•   Efficient space planning: Patient blocks and facility blocks are logically zoned to prioritise safety and infection control.

•   Sustainability: Energy conservation, natural light, ventilation, and passive design were integrated.

•   Local materials: Wherever possible, local technologies and materials were utilised.

Projects do not always go according to plan. Budgetary and other factors (e.g. the client’s request to accommodate a new element) often lead to adjustments during construction. Did you make modifications to the original design?

From a broad perspective, no substantial modifications were made, and the project actually realized 11% savings from its original budget. However, the project encountered various challenges both local and geopolitical during construction period, including the Ukraine-Russia conflict, the effects of the COVID-19 pandemic, political instability following the 2021 Kenyan elections, and significant inflation impacting Kenya’s economy.

You were working with an experienced team of consultants and the main contractor is also top-rated. Could you give us some insights into the kind of synergy you built in order to execute this project?

Generally compared to other buildings, hospitals are highly complex and heavily serviced buildings. This necessitated the demand for high skilled teams and extensive collaboration to deliver exceptional quality and mitigate potential risks. We worked closely with 18 contractors, comprising both local and international partners, to ensure that all stakeholders were aligned and equipped to deliver high-quality results. Additionally, numerous medical equipment manufacturers were involved throughout the design and construction phases. To facilitate seamless collaboration and effective communication, we employed various tools and technologies. Notably, the project achieved BIM (Building Information Modelling) Level 3 certification, reflecting our commitment to precision, accuracy, and innovative project delivery

Could you give us a description of various areas – e.g. finishing, lighting, fittings etc.?

The CTC has different sections that can be divided into three main areas: clinical, non-clinical, and utility areas. Each section allows for different methods of finishing and construction.

• Clinical Areas: These need materials and finishes that are sterile to prevent infections and easy to clean.
• Non-Clinical Areas: Here, materials are chosen for their attractive appearance.
• Utility Areas: These require materials that are strong and versatile.

All finishes meet the Health Building Notes (HBN) guidelines.

Within the clinical areas, materials used include vinyl flooring, Corian, anti-bacterial paint, epoxy wall coatings, electrolytic steel plates, stainless steel, and aluminium ceilings. All lighting, including in surgical areas, is medical grade. Gas fittings and air conditioning systems follow Health Technical Memorandum (HTM) requirements to ensure a safe and hygienic environment for patients and staff. For the non-clinical areas, materials such as blue stone cladding, granite, full-body granito tiles, coral stone PVC-coated ceilings, and textured silicon paint are used. In the utility areas, acid-resistant tiles and PVC panels are utilized.

Most glass used is Guardian Low-E glass, known for its thermal performance properties.

Was the project completed according to schedule? Please give us the timelines.

Yes, the project was completed in April which was 3 months earlier to its official handover date on 30^th July 2024.

Every project has unique challenges. What was your experience with this project?

It’s important for the project team to go above and beyond their responsibilities to ensure the project’s success. We had the following guiding principles to help us tackle various challenges:

• “Get it right the first time”: This meant that all teams needed to carefully review all available options before moving forward. Project implementation plans were created and regularly updated. Risk registers were prepared and monitored to prevent issues, and ongoing training was provided. We also ensured that site health and safety were closely monitored for compliance. Careful planning allowed for adaptability and flexibility.
• “Eagles soar with eagles”: This principle emphasized selecting teams that were highly skilled and competitive for the different tasks. This approach enabled the team to draw on their past experiences to tackle the complex challenges that arose.

In addition, the project benefited from significant goodwill among all parties involved, making teamwork easier and helping to maintain project synergy. The client also exceeded their contractual obligations to support the project team in addressing various challenges.

Triad has been involved in many healthcare projects over the years. How special was this project?

For Triad Architects, this undertaking was a monumental feat that afforded us the opportunity to integrate a globally recognized approach into the design of every aspect of the medical center. We were able to illustrate the promise of an advanced, contemporary, and sustainable healthcare facility, which will serve as a paragon for local healthcare professionals. This project stands as a crucial platform for ongoing education and engagement, enabling practitioners to remain informed about the cutting-edge innovations and technological advancements shaping the future of healthcare.

Please share the names of the Triad team that was behind this project and their roles.

Architects and lead consultants – Triad Architects led by Arch. Julius Kibwage

Quantity surveyor – MaceYMR led by QS Peter Ndungu

Structural and civil engineers – Engplan consulting engineers led by Engineer Mercy Mugure 

Mechanical and electrical engineers – Load line engineering services led by Eng. Stephen Kimori

Please also share with us the list of the entire project team and their respective roles.

In addition to the local teams, international experts from the USA played a key role in the project’s early stages. Specifically, the following organizations were involved:

* Samaritans Purse led by Mr. Jeremy Barr, provided were the project managers and the site resident engineers. They were also the sole financiers of the project

* Health Facilities Group Architecture (HFG) USA, led by Mr. David Wright, provided expertise as international hospital architects and planners.

* Professional Engineering Consultants (PEC), a global firm, brought their knowledge as international civil, structural, and MEP engineers.

* Mitchell Planning, specialists in biomedical engineering and medical equipment planning, also contributed their expertise.

* Engineering Ministries International (EMI) collaborated as engineers and trainers, providing additional support.

ARK CONSTRUCTION LIMITED

You must be thrilled with the handover of this magnificent project. Please share your sentiments following this success.

We are grateful to the client representatives, Samaritan’s Purse, for choosing and trusting us with execution and delivery of this project. We are also appreciative of the support we have also received from the consultants lead by Triad Architect and Architect Vincent Osogo and other project stakeholders including Tenwek Hospital, the Tenwek Community.

We would also like to thank our sub-contractors for the tireless efforts all through the project and the support they gave Ark Construction all through the construction period.

Ark Construction Ltd is a highly experienced contractor having completed numerous projects. But how special was this massive healthcare project?

We feel grateful and thankful to be involved in this project, given that it is first of its kind in Kenya and East Africa. The project will address the surgery needs for patients with congenital heart conditions but providing state of the art equipment and treat.

This project will also have a big impact on local community at Tenwek. We are sure the project will spur development in Tenwek and the wider Bomet County.

Please describe the resources you mobilized for successful execution of this project following your award.

We had a tower crane, batching plants, construction elevators, excavators, wheel-loader and JCB backhoe among other equipment. We also had an on-site management team; Project Manager (Jude Omondi), Structural Engineer, MEPF coordinator, Builders & Civil Works supervisor and Interior fit-out supervisor

As main contractor, you may have had several subcontractors and suppliers working for you. How did you ensure that everything was well-coordinated and that construction went according to the client’s and consultants’ expectations?

We ensured clear communication channels were established early in the project to ensure all stakeholders were updated. This prevented miscommunication and ensured the decision-making process was smooth.  We also ensured that everyone’s roles and responsibilities were clearly defined to reduce confusion and overlaps to enable efficient workflows. To enable smoother coordination of the mechanical and electrical works, Ark also had a dedicated MEP coordinator that kept following up with the sub-contractors on their works and procurement

In addition, we also ensured we had a well-planned and updated schedule that helped us manage resources coordinate tasks and timely completion of various phases of the project. We did constant monitoring of timelines, budgets and quality standards to help the team to identify potential issues.

Besides, we also held constant coordination meetings with the sub-contractors to foster a collaborative work environment to share ideas and to solve problems.

Did you use in-house manpower throughout or was it necessary to hire temporary staff?

All the management staff that was involved in the project was in-house. Casual labour and technicians were hired on need basis depending on the stage of the project we were in.

This being an out-of-Nairobi project, tell us something about availability of the materials in the Bomet area. Did you experience logistical challenges?

The only material we used that available in Bomet County was river sand and coarse aggregates.  The rest of the materials used in the project were either from Nairobi, Mombasa or imported. We faced challenges in transport and delivery of materials. However, the effects of the this was minimal because the time placed orders for the materials just before it was required. We also had adequate stores that always ensure we had adequate stock on site.

Projects do not always go according to plan. Budgetary and other factors (e.g. client’s request to accommodate a new element) often lead to adjustments during construction. Were there modifications to the original design and how did they impact project timeline?

Yes, we had minimal variations during the project, that was acceptable to all parties. The client and contractor all understood that this type of project was a prototype, and changes & variations would ensure that the end-users will have a functional building. Nonetheless, we were still able to deliver the project within the planned duration and within the budget.

You were working with an experienced team of consultants. Could you give us some insights into the kind of synergy you built in order to execute this project?

The most important item of any strong working group is communication. We fostered an environment where all team members and sub-contractors felt comfortable expressing themselves freely and accurately.

We also fostered trust and a spirit of collaboration on site. Challenges and issues were discussed openly and solutions were also a group effort.

Every project has unique challenges. What was your experience with this project?

Handling such a massive project out of Nairobi was definitely the biggest challenge. Materials and equipment delivery had to be carefully and timely planned. Getting skilled labour and accommodating them in an area they had never been to before was a challenge.