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>> Why scrap four downtown hospitals in order to build a superhospital in the west end's Glen Yards? An architect makes the case against the McGill University Health Centre COMMENTARY by PIETER SIJPKES McGill University is planning a radical overhaul of Montreal's hospital system: shutting down the Royal Victoria, Montreal General, Montreal Children's and the Neurological Hospitals and building a new facility at the former Glen Yards south of Vendôme metro. In this commentary, Pieter Sijpkes, an associate professor at the McGill School of Architecture, questions the approach taken by the planners. Most of us do not like to think about hospitals until we actually visit one, either as a patient or as a visitor. But in recent months the idea of a new, large facility replacing four smaller, well-established ones, has made the adrenaline flow in Montreal's "anglo" veins. And rightly so. The issue at hand is not only a McGill one. The McGill University Health Centre (MUHC) proposal is foremost an issue of the Montreal English-speaking community. And the proposal made by the planners of the MUHC is a truly radical one; it calls for the complete decommissioning of four hospitals--some almost as old as McGill University itself--and replacing them with a brand new "health park."
Superficially, the project is hard to resist. Montreal's construction industry has been short of work. Cutbacks have put thousands of health-care professionals out of work. No wonder this is big news. Design jobs, construction jobs, real estate jobs, health care jobs, consultants all over the place. How can anyone not support this much-needed vigour? More than just economics "I liken this project to the kind you used to see in the old days when a bunch of men in top hats pulled out a sterling shovel and dug a hole for a museum, a university, the Vic," remarked Dr. Abraham Fuks, Dean of Medicine, as quoted in the McGill News. Exactly. Just like the last spike at Craigellachy. And administrators love ribbon-cutting ceremonies. The problem is: a hospital is not a transcontinental railway. Unlike engineering, both medicine and architecture have humans at the centre of their focus; and man is a contradictory and complex animal, requiring a human approach. But the MUHC's approach is reminiscent of the large-scale urban renewal projects of the '60s, which replaced "slums" with inevitably larger-scale, supposedly more efficient "projects." Often executed against the will of those they were supposed to help, the projects were by and large a failure--and the infatuation with "newer," "bigger" and "better" generally tipped the scales against the renewal of existing infrastructures. The rhetoric used in the MUHC proposal is no different from that used in the past. "Modern," "cutting-edge," "up-to-date" and "efficient" are used over and over again to describe the potential of the new hospital; "old," "leaky," "too hot-too cold," "cramped," "confusing," "inaccessible" and "cannot be organized to maintain a coherent flow of patients" are the terms used to describe the state of the existing facilities. And yet, those old hospitals have been responsively assembled and modified over more than a century. Abandoning this finely woven tissue in favour of a single, large-scale operation miles away is a perilous decision. People are not cars Perusing the MUHC's documentation, I was struck on several occasions by the analogy drawn between cars and people. At first glance, this seems fair enough; in our culture cars are intimate extensions of people--the heated, cooled and "wired" cocoon of the car has become a second skin, the way a moonsuit is to astronauts. But in my view, the new hospital's designers have approached the project as if the health centre will produce new people from scratch, the way new cars are built in Ste-Therese. But what has been going on in the four existing hospitals is simply the repair of people. Would anyone support the idea of grouping all repair shops in the city in one "super repair lot" at Vendôme? Clearly not. We drive to one specialist for windshields, another for electrical malfunctions, another for body work. Centralizing these facilities would be counter-productive. In response to the new realities of health care, the English hospitals have, in recent years, taken a series of productive steps: combining administrative structures, weeding out duplication of services, improving electronic communications. In addition, modern medicine generally reduces hospital stay; as a result, the number of hospital beds the city needs is on the decline and the role of community clinics is expected to increase. But none of these changes is a good enough reason to close four hospitals, less still to build a new one from scratch. If we need fewer beds, then close one hospital and focus renewed energy on the others. Why throw the baby out with the bathwater? A public transit problem And the dislocation itself would bring a whole series of problems. It would sever the much-cherished link between the hospitals, the university, the residences (including the McGill Ghetto) and the Mountain. Ask anyone at Concordia how much they like the shuttle bus between downtown and Loyola. Public access to the current hospitals is admittedly a problem--they have never been easy to reach, particularly in our slippery winter climate. Still, public transit remains an unexplored solution to the problem. A system above, below or on-grade (or a combination thereof) will be quite a challenge to design. But that system, once built, would provide car-free access to our newly renovated hospitals--not to mention McGill's other facilities and the Mountain itself. Expensive? You bet it is. But instead of sacrificing four historic properties that were specifically located high on up on the mountain to create the "healing environment" so piously wished for by the MUHC managers, this would solve one of the overriding problems of the existing facilities and would reduce the overall level of pollution around the mountain in the bargain. Low cost, low energy and loose fit One of the most useful pieces of advice I have ever heard was a suggestion made in the '60s by a backwoods hippy as a cure for most ills of the world: "Low energy, low cost, loose fit." A reorganized, thoroughly modernized, well-connected (physically, electronically), year-round accessible network of the existing hospitals is the best way to provide health services to this city. The time to debate the issue of the English hospitals is now, when relatively little money has been spent on the large-scale replacement option. The question is of prime importance to the community and to McGill, and imaginative solutions--more imaginative than another "let's start all over again project" can be found. And let the debate not be rancourous. Going to bed sour-headed is not good for healing.
Sidebar: Superhospital - pro versus con
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In all, $200 million from the federal government (specifically for the health park's research centre), $300 million from the provincial government and $350 million in private donations will finance the proposal, which is being promoted with great vigour and conviction by the MUHC's administration.