TV choice: Breaking the medical mould

CHILDREN'S HOSPITAL: PHILADELPHIA

Wednesday, 8pm BBC1

CHILDREN'S HOSPITAL: ST PETERSBURG

Friday, 8.30pm BBC1

Once there was medical drama. In Dr Kildare and Emergency Ward 10 the emphasis was on human relations, with good-looking actors playing doctors and nurses . And there was medical documentary, including the BBC's pioneering Your Life in Their Hands, where the subject was medical techniques, while the purpose was education and reassurance. City Hospital and Children's Hospital pioneer a new genre - holistic medical documentary - where the focus is on patients as much as procedures.

The second of these has been running for six years and probably needed a new idea. This pair of films, applying the formula to dedicated children's hospitals in America and Russia, is a good one and a fascinating piece of comparative sociology. Producer Jane Merkin went to the oldest children's hospital in the USA, in Philadelphia, which was founded on the model of the Great Ormond Street children's hospital in London. Producer Sarah Neale took up a suggestion made some time ago by a researcher on a That's Life special about a British woman doing voluntary work in Russia: if ever they were thinking about doing a Russian Childen's Hospital, the researcher said...

I talked to the two producers about their experiences. In both locations, the film crews were limited by the relatively short amount of time at their disposal. Jane Merkin regretted, for example, that they did not manage to get a heart case in their three- week stay in Philadelphia, because cardiac surgery is one strength of the hospital.

"We were looking for things that were specific to America, for example a living-relative kidney donation," Merkin said. "This is much more common there and it's a better way of donating organs. They were shocked to learn how rare it is in Britain."

Young Brenton receiving his mother's donated kidney is the central story in the film. An essential part is the reaction of Jerry, Brenton's father, who has to wait anxiously while the wife and son simultaneously go under the knife.

Both producers set out with preconceived ideas about how the subjects would react to being filmed; and both were proved wrong. Jane Merkin went to Philadelphia thinking that Americans would be used to television cameras and would not mind having a film crew in the emergency room. Not so.

"A lot of their experience around hospitals is the ambulance-chasing news crews. The staff were very open and willing, but it was much harder than I expected to film other people." In the end, once they had explained that what they were doing was not exploitative, they were usually given permission, although they were refused in all but one trauma case.

For the film crew "being British helped enormously". Foreigners, too, have their preconceptions.

In St Petersburg, on the other hand, Sarah Neale found a quite different situation. Patients may stay a long time in the Regional Children's Hospital - "average stays are three times as long as here" - and since it serves quite a large area of countryside around the city, their parents may have to travel for two hours to visit them. "A lot of children are left to their own devices in hospital and it's quite boring. There are not a lot of nurses to give emotional support and they have to deal with quite complicated procedures on their own." In the circumstances, most of the patients were only too pleased to have the distraction.

Of course the films are intended as a pair and meant to offer a contrast. In Philadelphia we have state-of-the-art equipment, well-regulated procedures and staff who could have walked off the set of ER. In St Petersburg, the buildings are dilapidated, the doctors grossly underpaid, the medicine cupboard empty and the borsch served in huge metal buckets; a boy with spinal injuries has to be transported 20 miles across a road full of potholes in an ambulance seriously lacking in suspension.

And the contrasts extend to the films themselves: while Philadelphia has Andrew Sachs' voiceover as a commentary, in St Petersburg we get jolly Jeremy Sprake talking to camera. And, like the hospital it shows, the Philadelphia film seems to run smoothly, while the St Petersburg one has a more artless feel. It also has the undisguised message. A junior doctor earning 600 roubles (about 24 dollars) a month quotes a friend as telling her: "Six years from now, it won't matter how much you had in your bank account, but the world will be a little better if you have saved the life of a child." No doubt there are junior doctors in Philadelphia who feel the same about their vocation, but they would hardly say that on camera. M.A.S.H. and ER have taught them the busy-but-cynical look that a properly laid-back and fully-in-control doctor is supposed to adopt on TV.