Tribal Health Lodge

In ancient Cherokee lore, when the earth was new, the water spider cleverly brought fire and light to the people, illuminating their world and providing a source of sustenance. That symbol, depicting a spider surrounded by brilliant flames, is at the center of the $81 million Cherokee Indian Hospital — illustrating the rich tradition of the Eastern Band of Cherokee Indians in Cherokee, North Carolina.

Owned by the Cherokee Indian Hospital Authority and the Eastern Band of Cherokee Indians, the 149, 000-square-foot replacement hospital was guided by the drive to create a hospital and wellness center that embraces culture and geography. The project became even more challenging when the principal players chose an Integrated Product Delivery (IPD) that added another delicate facet to the work. 

According to senior project manager and healthcare contractor Marshall Scott, of Birmingham-based Robins & Morton, with the all-in commitment of IPD, the entire construction team shared in the project’s risk and success.

“All of the trades and the designer and owner risked a lot on the project, including everybody’s profits, ” Scott says. “We were able to over-deliver and make more profit, but if it had gone south, we could have lost it all.” 

Cherokee Indian Hospital was completed 92 days ahead of schedule with $7 million in value-added features. The IPD team included 30 contractor and vendor companies owned by tribe members and certified by the Tribal Employment Rights Office, achieving $19.8 million in local participation.

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“Naturally, it puts everybody’s focus on where to help out and shore each other up, ” Scott says. “There was a strong teamwork and partnership approach from everyone there. If anyone saw somebody struggling through lack of manpower or equipment, there was always someone to help. A roofer might help a plumber, and a plumber might help with concrete. There were many examples of that taking place on the job site. It takes a special client to do this well, and Cherokee certainly had that.”

Set against the backdrop of the Great Smoky Mountains, the hospital was to become a seamless part of the environment, while celebrating the physical, mental and spiritual health of the Cherokee people it serves. Hospital CEO Casey Cooper placed emphasis on the Southcentral Foundation’s Nuka System of Care, a relationship-based healthcare system created, managed and owned by native people of Alaska to achieve physical, mental, emotional and spiritual wellness. 

“You have one core team of physicians capable of giving you a very broad but effective healthcare program, ” Scott says. “To me, that’s phenomenal. It makes perfect sense. Few rural communities like Cherokee have a state-of-the-art hospital, and it feels good to leave that behind.”

From inception to ribbon cutting, Scott carefully moved mountains, or at least a portion of one in the chain of the Smokies, excavating rock to extend the building site. During construction, Robins & Morton moved more than 600, 000 cubic yards of earth to make a comfortable site for the structure.

“Part of the Cherokee culture is a really strong connection to the land, ” Scott says. “We wanted to design and construct something consistent with the natural surroundings. We wanted it to be consistent with the culture with a free flowing feel inside and outside.”

To accomplish that, Scott’s team utilized exposed steel beams in the main lobby, creating the effect of the underside of a tree canopy in the forest. The pattern of posts and branches is seen throughout the hospital décor. Combined with moss green hues, leaf-patterned carpets and wood finishes, the effect is reminiscent of being among the trees. 

“It’s a two-story atrium that wraps around, and it feels like you’re looking up at a tree canopy, ” Scott says. 

In the earliest stages, one of the designers received a gift from the Cherokee tribe, a basket designed by Maddie Wildcatt, which became an inspiration for the crowning touch on the project, a rotunda combining elements of the basket design and tribal history. Inside that element, the terrazzo floor pattern features the imagery of the spider and a river of tiles flowing through the facility to continue the narrative of the Cherokee. 

“We incorporated a design element to mimic that basket, ” Scott says. “You couldn’t just hang pictures of Cherokee art on the wall; it was important to incorporate art into the project. The baskets are an integral part of Cherokee art.”

Also synonymous with the culture is the relationship to the land and an overriding sense of joy in nature. Blended skillfully with the stream-like terrazzo pattern are rocks that make up a hopscotch path, an ideal distraction for children.

“The atrium or mall terrazzo floor pattern starts at one end and goes to the other — it really tells a story, ” Scott says. “You go down the river and see things native to the area — turkey footprints, animal tracks — to be consistent and keep some of that local nature and feeling in the building. We have a lot of local craftsmanship in the facility itself. We had local craft training, too, and we held classes so that the Cherokee people could learn to do the trades.

“We used native stone for columns all the way around the building and inside the atrium area, ” Scott says. “The stone was harvested from a rock quarry on the reservation, and local native masons installed it. We worked with them to get that part of the project scheduled. It was a challenge, because there were a limited number of craftsmen who can install that work. We had to plan accordingly and get started very early to be sure they could get their work done.”

That native stone and Cherokee manpower are just one example of the many cooperative elements of the project. 

“It’s a monument to self-determination and an illustration of the magnitude of what can be accomplished when healthy, cooperative relationships are forged together by the simple principle that we all exist to be significant in the lives of others, ” Cooper said to a reporter after the grand opening. 

That culture drove the design of hospital rooms, from varied forest colors to family-sized sitting areas in patient rooms.

“When someone in the Cherokee nation becomes ill, culturally, they have the whole extended family show up, ” Scott says. “It’s important to be at the hospital — it’s very important in the healing process to have family close by in their culture.”

The rooms accommodate both family visits and mountain vistas.

“It’s very comfortable, as well, ” Scott says. “There are hospice suites with two patient rooms adjoining to provide a living area on the other side of the wall from the patient room. It’s very comfortable for the family because they can have an area nearby to decompress while a loved one is in poor health.” 

Scott says the Cherokee business model is different than most with elders, those most highly esteemed, speaking to allow others to hear voices of wisdom. From the plant operations to the board of directors, Scott says the Cherokee nation had the direct lines of communication open to allow almost immediate answers and access. 

“If I had a question for someone on the board of directors, I could call them, ” he says. “It was a refreshing approach.” 

It was that sense of unification that drove the project from beginning to completion. The facility now includes 20 inpatient and rehabilitation suites; primary, eye and dental clinics; emergency department; procedure suite, and pharmacy. 

“The bigger piece of this project was just being in Cherokee and getting to hear their side of history, ” Scott says. “It’s inspiring and motivating to get the opportunity to sit down and talk to people from Cherokee. We tried very hard to get everyone on the project to understand this was not another building. There was something very special about it.”

Cara Clark is a Birmingham-based freelance writer for Business Alabama

Text by Cara Clark

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