18. Health Care

18.1      General Medical Facilities

Taking the Irish health service as an example, a 472 bed hospital is required to serve a population of approximately 180,000 people (ref. 58). This gives us a figure of approximately 381.356 people per bed. Scaling this down for a population of 10,000 people we arrive at a figure of just over 26 beds. However, given the stresses both physiologically and psychologically on DL4 residents and the relative isolation of the station, this figure seems a little conservative. The settlement’s medical facilities would not only have to provide for the treatment of bioastronautical conditions but also deal with all conventional medical practices as well. Given these considerations, it would seem wise to double the normal number of beds per person, as such 55 beds would seem acceptable. NASA research suggests that a surface area of 58m2 per bed is required for the provision of adequate medical care (ref.37). This figure includes all administrative, treatment, surgical, obstetric and psychological facilities. This figure is also approximately in line with the 61m2 per person provided for in terrestrial hospitals (ref. 85).  A compromise of 60m2 per bed was chosen for DaedalusaL4.

18.2      Emergency Medical Facilities

While the above facilities would be able to deal adequately with all of the day to day medical needs of the station, one must also consider additional measures that could be instigated in the event of a large scale medical emergency. In the case of a large scale industrial accident or other such occurrence the normal capacity of the hospital may be inadequate to cope with the number of casualties. Therefore, it would seem wise to have a contingency plan to be put into operation if required. It is conceivable that some casualties could be evacuated to Earth, however this process has several disadvantages. Not only would the travel time be quite lengthy but also most critical patients would be too ill to travel. As such it is essential to have the necessary space and equipment, onboard the settlement, to temporarily expand the medical facilities. As space it at a premium it is not possible to simply leave an area empty to facilitate expansion.  It is proposed that several of the larger community areas, e.g. - meeting halls, could be used to house and treat non-critical casualties in the event of an emergency. It might also be wise to ensure that a number of the station’s inhabitants not working in the hospital have basic first aid training to allow them to assist in these areas. All seriously ill personnel could then hopefully be accommodated in the existing hospital facilities.

18.3      Psychological Concerns

The psychological effects of living in an enclosed off-world habitat cannot be underestimated. There are several documented psychological conditions (ref. 37) associated with living in an isolated or enclosed environment. In addition there could well be other conditions that will only become apparent as the station’s community try to adjust to life in space. As a result not only would potential residents need to undergo exhaustive psychological testing before departure but a large amount of energy and effort needs to go into maintaining the mental health of the residents once they are on board DL4.

Two of the more common conditions associated with living in an unusual enclosed environment such as a space station are ‘Solipsism Syndrome’ and ‘Shimanagashi Syndrome’.

A.     Solipsism Syndrome

Some environments are conducive to the state of mind in which a person feels that everything is a dream and nothing is real. The sufferer believes that everything is in the imagination and there is no reality outside their brain. As a psychological state this is clearly highly unpleasant. Life becomes a dream or rather a nightmare from which a person can never awaken. Even a person’s friends and colleagues are not real, they are part of the dream. A sufferer becomes lonely and detached from reality. This eventually leads to chronic apathy and indifference.

This state of mind can easily be produced in an environment in which everything seems artificial. In a structure such as a space station it is desirable from a purely technical standpoint that everything should be exactly controlled and maintained. From a psychological point of view however, this would be very bad for the mental well being of the inhabitants.

There are several means to alleviate the tendency towards solipsism on the settlement:

1.       It is important for the resident to have a sense of a world larger than what is seen. This can be achieved by provided long lines of site and views of natural objects (see 2 External Design, 10.4 Recreation).

2.       Certain things must exist beyond the control of each individual. There must be some level of unpredictability to balance out the monotony of everyday life. This can be easily achieved be allowing pets (even electronic ones) aboard DL4 and also allowing plants some degree of natural growth beyond human control.

3.       Something must exist which grows and changes. From this point of view it is important that residents see plants growing and developing. It is especially useful if individuals can feel that they themselves have personally contributed to that growth.

B.     Shimanagashi Syndrome

‘Shimanagashi Syndrome’ can best be summed up as follows. If a person from the mainland spends a few years on an isolated island, even though it may have large cities and modern conveniences, they feel a strange sense of isolation. They begin to feel left out and intellectually ostracised even though life on the island may be very comfortable.

It is quite possible that residents on DaedalusaL4 may well feel this same sense of isolation. While the community may not be isolated in terms of communication, they are definitely so in terms of physical travel, as travel to Earth may be both time consuming and costly.

There is unfortunately little that can be done to combat ‘Shimanagashi Syndrome’. If several stations were built, travel between them would be relatively inexpensive and would allow people to experience life in different communities. Until this is the case, careful monitoring of susceptible individuals will be required to ensure that they do not develop this condition.