Affection for the Starship deep-rooted

By ROBIN KEARNS*

The decision to rename the Starship hospital drew a predictably rapid and negative response from Herald readers and celebrities alike. To some, a name change seemed as outrageous as altering the name of the Sky Tower or even Rangitoto.

This is not surprising. In the decade since opening, the Starship has rapidly become an identifiable part of the Auckland landscape.

The novel name complements the unique building and quickly took hold, largely because Starship is a metaphor that works so effectively. The symbolism of the name has been augmented by symbols such as robots. Yet any other-worldly connotations of the name have been countered by children. For most users of the hospital, Starship has rapidly become part of their world rather than an alien place.

Behind every name, there is an implied norm. The Starship's name has reflected a norm that says there is a place for children in our healthcare system. In this, we compare favourably with Stockholm's Astrid Lindgren Hospital, named for the writer of the Pippi Longstocking stories and designed exclusively with children in mind.

What decision-makers underestimated about changing the Starship name was that healthcare is invariably more than a service. It is a part of the landscape.

This reality became evident when I researched the character of health services in the Hokianga. There, community clinics were clearly not only sites of medical care but also highly significant places for the community. People conversed, exchanged news, and appeared to feel better for it.

A hospital is inevitably more impersonal than a community clinic. Yet well-being is enhanced when people feel a sense of belonging - even when ill or injured. If a hospital has a welcoming ambience and elements of homeliness, users feel a sense of ownership and donors develop loyalty.

In this, the Starship has been a success. To use a term from health geography, it represents a therapeutic landscape.

It is no coincidence that the word "hospital" shares the same root as "hospitable". It is their availability to strangers at times of need that has endeared people to some hospitals. In rural communities, this link between hospital and hospitality remains strong and helps to explain the vehement opposition to closure.

The persistence of hospitals can be paradoxical. In rural areas, for instance, the best medical treatment available is often achievable by rapid transport to distant and larger facilities, at day-stay clinics, or even by telemedicine.

Yet communities throughout the Western world invariably cry foul at proposals to close hospitals. This is because hospitals are central to the fabric of community. They represent heritage.

Despite hospitals devouring an inordinate proportion of healthcare budgets, communities seek to retain them even if people visit only irregularly. They have a powerful symbolic presence in the landscape, whether in rural or metropolitan settings. Their enduring status is linked to being centres of medical power as well as places of refuge in times of greatest human vulnerability.

Recent Governments have set a policy direction emphasising services rather than the bricks and mortar of institutions. A marriage of cost-containment motives and medical advances has allowed people to be treated as outpatients and in day surgery centres.

The attempt to rename the Starship was connected to this broader goal of shifting the style of healthcare from a traditional hospital (everything under one roof) to hospital-based health services (fewer admissions, shorter stays).

Through grounding the Starship name, the Auckland District Health Board thought it could democratise hospital services and remove the euphemism that has helped to give a big-city hospital a feel-good flavour.

Instead, the practice of retaining names while reorienting services may be a wiser path for hospital reformers.

Elsewhere there is evidence of this model. Canada's largest paediatric centre, the Toronto Hospital for Sick Children, has kept its name despite its grimly descriptive tone. A foundation paralleling that at the Starship has taken off, as have a raft of playful icons including a flying pig in the hospital's atrium. It has traded austerity for a veneer of frivolity and thrived, despite the plainness of its name.

Reflecting a changed philosophy, there are abandoned wards but busy day-stay units. While still a hospital in name, it is increasingly a set of hospital-based paediatric services, including extensive use of telemedicine. Despite the shift, its "Sick Kids" nickname remains, invoking loyalty among donors, familiarity among families and pride among professionals.

Notwithstanding its unflattering name, Canadians love "Sick Kids" hospital. What does this tell us? Perhaps that tradition matters. Maybe that, despite the overdue reinvestment in primary healthcare, hospitals remain deeply significant to the public.

Perhaps this depth of regard for some hospitals also helps to explain the resistance to losing older names such as National Women's and Green Lane. These identify known places with significance for stakeholders and link the present with the past.

No wonder, then, that some advocate carrying names like Green Lane into Grafton, thus maintaining Auckland's medical heritage. While there is risk of confusion, there is precedent for such toponymic mobility; the Ellerslie Flower Show is named for its original site, despite a move to Manurewa.

To boldly go and discard the Starship name was an unwise move, despite the wisdom within hospital reform. While hospitals may be most literally bricks and mortar, their deeper symbolism will always be great.

As hospitals are transformed into collections of services, the familiarity of known places and names remains a comfort in the midst of change.

* Robin Kearns is associate professor of geography at Auckland University, where he co-ordinates the BA programme in health social sciences.