Lipstick on a Pig

Perugia's new "Silvestrini" Hospital was inaugurated last month. For the occasion a slick new entrance canopy was added and part of the facade was painted red. The main building was built in the 80's and inaugurated in 1985 but since then Perugia has had two hospitals, the old in-town Policlinico of Monteluce, and Silvestrini, on a hill about 6km. from the town center. With the closing of Monteluce last December, all medical facilities have been tranferred to Silvestrini, now renamed "Santa Maria della Misericordia, Polo Ospedaliero Unico di Perugia". New buildings have been added and more are coming The medical school of the Perugia University has moved to the new hospital, although classrooms, residence halls and most student apartments remain back in the Monteluce neighborhood on the northeast side of the city.

The "new" unified Perugia Hospital is just one of a number of new hospitals in Umbria. I have no quarrel with the medical services provided by these hospitals and have faith in the qualifications and skills of the doctors working in them. It is to be hoped that the unification of the hospitals will create efficiencies in the provision of medical care.

At the recent inauguration the Umbrian politicians were in a self-congratulatory mode of celebration as unwarranted as it was unsurprising. I've googled and googled to find out who was responsible for the design but it seems to be a well kept secret. The opening of new hospitals follows a pattern, which is questionable at best. In Perugia, just as in Città di Castello, Gubbio, Orvieto, and soon for Todi and Marsciano, new hospitals have been built well outside the cities served, and the old hospitals in town have been closed, with mixed but mostly negative consequences for the cities.

While I'm not a hospital designer, I do know that hospital design is complex and the techical requirement make the buildings among the most expensive of all building types. The costs involved and the need for frequent expansion conspire to make most hospitals less than architectural jewels. Without doubt it's easier to design and build on virgin land than to renovate and enlarge existing facilities. Silvestrini was built 25 years ago and the consolidation was determined at least a decade ago. Roads to this new hospital have not been completed yet. The unshaded parking lots cover almost all the space around the buildings. They are being expanded ever outward but for years have been inadequate even for the old building. I have commented before on the horrible traffic patterns of lower Perugia. Highway signage is possibly the most confusing in the world and this inability to indicate directions has been extended right into the maze-like interiors of the hospital. There are various reception desks throughout the hospital, but ask a person staffing one of these posts where a certain office is and you'll get a wave of the hand and "to the right at the end of the hall", the hall simply leading to another maze of unmarked or badly marked corridors.

The worst of the planning involved mass transit, or the lack thereof. Most hospital patients not arriving by ambulance are almost certainly going to get to the hospital by car, and doctors, having busy schedules and high self esteem, will always arrive by car. Many other people, nurses, technicians, cooks, and visitors, could reasonably get to the hospital by public transportation

In this decade, a Mini Metro was planned and built to take people in small cars from the main train station (and intermediate points) to the city center. People on the political right hate it because it was an iniative of the center left government, while those on the left praise it because it's an iniative of their government. The critics claim that it is underutilized, noisy and cost way too much (€98 million to build and €25,000 daily to operate). The left takes pride in the fact that the Pritzker Prize-winning architect, Jean Nouvel, was engaged to design the stations, and that it is an innovative means of urban transportation. There is merit in all of these views. The scandal is that this little Metro, conceived, designed and built in this century, does not go to a hospital that has been under construction for twenty-five years. There are plans to extend it to the hospital, just as there are plans to complete the roads, enlarge the parking lots, and eventually add a little landscaping, but why was this not done before the hospital took over the functions, such as the medical school, that were housed at Monteluce.

Seven years ago, Prof. Umberto Veronesi, a world renowned oncologist who had been appointed Minister of Health, wrote a wonderful description of a model hospital, which he wanted to be the basis for all new hospitals in Italy. The plan was brilliant and humane. Unfortunately, the realization of new hospitals in Umbria has not lived up to the model, especially with regard to the integration of the hospitals into the community. My concern is less about how well the new hospitals function than about the impact of the suburbanization of the hospitals on the affected cities. The world is facing the duel challenges of energy shortage and climate change. Italy's hospital planners act as if we're in the 1950's. There is a plan, drawn up by the competition- winning German architects Bolles Wilson, for the Monteluce property. The plan calls for a hotel, new housing, shops and meeting spaces. Will it be realized in this time of economic crisis? The hospital brought large numbers of well paid workers, students and visitors to Monteluce every day. They will soon be gone. Will the new plan fill the void? What will bring new residents and workers to the emptied-out neighborhood?

Who put the lipstick on the pig? Cynics on the right say it's the left-wing government that wants to paint everything red. Others say it was Jean Nouvel, who also painted the trim of the MiniMetro the same red. The Perugia soccer club's colors are also red and white. Does it matter? Lipstick or not, the pig is still a pig.