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Care to migrants in Dunkirk, forthcoming article in Practice No. 46

After (and despite) the closure of the Sangatte camp in 2002, migrants are more numerous on the coast of the Channel and North Sea [1] , trying to smuggle into England by all possible means, and surviving in appalling conditions. In the region of Dunkirk, they are probably a hundred, one hundred and fifty, Afghan, Iraqi, Pakistani, and also Ethiopian, Somali, who live there, waiting, extreme physical insecurity, and uncertainty about the future full . These encampments, tarpaulins, some tents, cardboard boxes, the "jungle" (pronounced in English djingel). Des bénévoles regroupés en association [2] tentent de les aider en apportant de la nourriture, des vêtements, des couvertures, en les aidant à accéder aux douches ou à différents services. Depuis l’arrivée du « grand froid » les municipalités aussi se sont mobilisées : à Teteghem, un local communal a été ouvert ; il est bien un peu loin de l’autoroute, et le fonctionnement un peu rigide le rend peu fréquenté. A Grande Synthe, une grande tente a été mise à disposition, et reste malgré le redoux, démontée pour la tempête, remontée ensuite par les services communaux ; l’accès aux douches est autorisé. Il faut dire qu’à Grande Synthe, le campement est extérieur à la ville, il n’y a pas de rejet par la population, et les associations d’aide humanitaire sont importantes. « Ah, c’est vous docteur ? Vous venez aussi ? » s’écrie avec satisfaction le chauffeur du véhicule municipal, client du même docteur !
Pour les soins, depuis longtemps un cabinet de Médecine générale accueillait à la demande, de temps en temps, des migrants malades. Devant le nombre croissant de migrants, ils se sont regroupés en mission de Médecins du Monde, organisés [3] , et actuellement, ce sont trois « consultations » week that the volunteers, doctors and nurses arrive in three to provide various campsites. But for migrant patients, it is not always sufficient consultation per week, including the monitoring of infections of the skin, which are frequent. The conditions of care are more difficult than the converted truck that served as consulting room, long after falling down, was burned. [4] And it is in the truck Salam, or the care of Emmaus that are taking place, requiring additional transfers of equipment, which takes time and energy. Sometimes it is in the back of cars, making the conditions for examination of patients very unsatisfactory. But it's a real momentum has switched: 10 doctors [5] and as many nurses [6] over successive weeks. Caregivers are volunteers MdM, drugs and equipment are funded by MdM, used wisely, but without limitation, which is very satisfying for caregivers. The pathologies encountered are the same since Sangatte: skin problems related aux mauvaises conditions d’hygiène (gales et plaies surinfectées), traumatismes nombreux à cause des escalades et descentes périlleuses des camions, infections saisonnières, (rhumes, bronchites, otites), maux de dents. La communication avec les patients migrants est difficile car aucun ne parle français, et c’est frustrant pour les soignants de parler un anglais très limité de part et d’autre, avec parfois l’obligation de passer par un tiers lorsque le patient ne parle que sa propre langue. Mais c’est très gratifiant de sentir la confiance qu’ils ont envers les soignants bénévoles. L’autre grande frustration est de constater de près leurs conditions de life, especially hygiene, despite the work of associations.
Emergencies are accepted by the hospital in Dunkirk, under the PASS device, but how difficult to make known the staff of the hospital! And it's common to see a migrant out of the hospital with a prescription on a prescription, as if there is a pharmacy in the "jungle", while he expects the device to receive the medication "in kind" . A working group with representatives of MDM, humanitarian organizations, and the administration is working on improving of the existing, but laboriously and slowly, "at a constant cost"! It must be said that the state was funding the scheme, is bad for paying the hospital supervisor.
energy and enthusiasm exhibited by carers sobering, compared to the usual discourse of professionals. There are several elements that allow us to understand: the pleasure of working in pairs, doctor-nurse, each within its competence, and complementarity. The interest and mutual support brought by the arrival of volunteers who run concurrently meals, clothing and approaches (like going to the hospital, include the papers, help with administrative formalities if any,) is also a discovery. The migrants interviewed in the Dunkirk never speak French, with some, we can speak English: Meetings are for improvement in medical English, led by teachers, volunteers, too. There are also plans for a meeting of all stakeholders in the field on the migration component of geopolitics. It is an opening, it allows to leave the humdrum of everyday life in a manner consistent with the centers d’intérêts et les compétences des soignants. Il y a aussi, peut-être, pour certains, le rêve ancien de faire de la médecine humanitaire, qui, pour une raison ou une autre, n’a pas pu se réaliser : les enfants, le conjoint, les contraintes financières. Et là, l’étranger est à la porte, il a des besoins évidents, c’est naturel de s’en préoccuper, c’est un rattrapage sur la frustration qu’entraîne souvent l’exercice de la profession actuellement. Un des médecins dit : « Il y a quelques années, les migrants étaient à Calais, à 40 km, mais maintenant, ils sont à 300mètres de mon cabinet ! "


Clinical Case No. 1
Ali, 30, of Afghanistan, is met at Camp Loon Plage. He collected an abscess of the left calf, the result of a wound, the doctor offered him the cut, on the spot to help him. He says he will have pain, it will then local care, but it will heal well and avoid complications. Ali agrees. The incision is sitting on a patient because he refused to lie down in the van, the gesture is painful, the patient endures it without any complaint. He is also a vagal.



Case report N°2
Samia, 22 ans, érythréenne, est arrivée avec son mari, il y a quelques semaines. Elle est enceinte de 4 mois, suivie à la consultation de PMI de Grande Synthe. A la suite d’efforts : monter et descendre des camions, chuter, courir, elle rompt la poche des eaux, ce qui expose le fœtus à l’infection et à un accouchement prématuré. Elle fait une fausse couche dans les semaines suivantes, sans avoir pu bénéficier d’une interruption thérapeutique de grossesse.

[1] Rapport de la CFDA « La loi des jungles » septembre 2008 http://cfda.rezo.net
[2] Salam www.associationsalam.org ; Emmaus Grande Synthe
[3] Through migrant coastal mission Nord-Pas de Calais Medecins du Monde,
[4] After the fire, reported in the local newspaper, a call for donations to acquire a new vehicle has collected nearly 1000 euros in the week!
[5] 9 physicians in active Liberal, and a hospital doctor
[6] Nurses are not in operation, except one who is an employee of the hospital

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letter to MrEric Besson before his arrival at Calais

Sir, In

response to your letter of April 7 and after your stay in Calais late January, here are the proposals of Médecins du Monde:

First and foremost, we ask that their access to water is established in different parts of the city lies a simple, very effective in reducing health risks, both for them and in terms of public health. In recent weeks we know, (everyone knows) that migrants from the "jungle" of Calais Tioxyde entering the plant to use showers and water points, thereby contravening Regulation of a plant classified Seveso and taking risks for themselves. A new fact has emerged in recent days: they use water discharged into a canal by the factory (white water and warm) to bathe and wash their clothes, exposing perhaps toxic risk. This is despite the information given in various languages (English, Arabic, Pashto,) by volunteers and staff associations of the PASS. They frequently complain of nausea and abdominal pain, although no link with certainty yet. Nevertheless, the risks they take in this way are nothing compared with the dangers they faced during their perilous journeys, and they take, we know, to cross the Channel. So it will not be additional screens qui vont les arrêter... Cependant ces « délits » (s'introduire dans l'usine, utiliser des eaux clairement affichées comme nocives et interdites) ne sont motivés que par l'absence d'eau potable et sanitaire à proximité de leur campement, et à l'absence de douches sur tout le territoire de Calais. Il y avait déjà recrudescence de gales, de surinfections cutanées, voici maintenant des risques de toxicité. Nous pensons que la simple ouverture de points d'eau à proximité des « jungles » supprimerait quasiment les risques toxiques. Nous ne pensons pas raisonnable d'évoquer le risque « d'appel d'air » ou « de point de fixation » pour une simple mise à disposition drinking water and sanitation.

As medical association, our "demands" are fairly simple and are based on notions of right to health as part of French law:
- Anyone in the area and whatever their administrative status shall be entitled to access to care (the right to health)
- devices that must be put in place for "transit migrants" are those that exist in common law: the essence
PASS (Permanence Access to Health Care)
but also their logical complement the healthcare hostel beds. It should be noted that the 6 LHSS allocated to Calais are notoriously inadequate.

We had discussed these topics at the roundtable in January. Medecins du Monde, after that of Calais, trying to get PASS efficient, independent of the Department of Emergency Services, including Dunkirk, where discussions with management stalled, to the chagrin of access to healthcare for migrants. PASS allows even a mobile to reach out to patients. Both devices are obviously intended to generally more precarious (and for example to the public as much SDF), as also
accommodation structures (public homeless ...)
- With respect to minors: France owes them protection and as such they must be accompanied and cared for in appropriate centers for young migrants who currently do not exist in the Calais.
- Dissemination of information on the rights of such persons when they are in transit through French territory is essential (information that should be translated into major languages spoken by migrants) and asylum procedure, access to devices Care ... Objective information could also limit those, erroneous, which is provided by third parties.
- Migrants seriously ill should receive
d'une régularisation pour raisons médicales.
- D’une façon générale, les formalités
administratives doivent être accessibles à Calais et non, en l’espèce, à Arras, ville distante de 100 km, ce qui crée des difficultés voire des impossibilités pour des personnes malades.

- Il nous faut aussi, bien sûr, demander l'abrogation de la circulaire du 21 février 2006 portant sur les conditions d'interpellations des étrangers en situation irrégulière. Cette circulaire qui mentionne les lieux d'interpellation comme les hôpitaux, les accueils des associations remet en cause les principes fondateurs de la déontologie médicale.

.... Signed: Dr. Martine Devries, Dr. Philip Pluvinage, Dr. Benoit Savatier, mission officials migrants Coastal 59/62 Doctors of the World

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toxicity of water used by migrants in Calais

Doctors of the World Mission
Coastal Migrants 59/62
Calais April 16, 2009
Re: Toxicity of waters used by migrants in Calais
To: "Monsieur the director of the DASS-Pas de Calais
Mr. Deputy Director of Public Health division
copies to: Madam Mayor, Calais, Mr Max Thérouanne Matujewski
Mr. Sir, the Director,
I am a doctor, head of mission of Medecins du Monde migrants Calais is for this reason that I write.
past few weeks we know, (everyone knows) that migrants from the "jungle" of Calais Tioxyde entering the plant to use showers and water points, thereby contravening Regulation of a plant and taking classified Seveso risk to themselves. A new fact has emerged in recent days: they use the water discharged into a canal by the factory (white water and warm) to bathe and wash their clothes, exposing perhaps toxic risk. This is despite the information given in various languages (English, Arabic, Pashto,) by volunteers associative and staff of the PASS. They frequently complain of nausea and abdominal pain, although no link with certainty yet. Nevertheless, the risks they take in this way are nothing compared with the dangers they faced during their perilous journeys, and they take, we know, to cross the Channel. So it will not be additional screens that will stop them ... However these "crimes" (enter the plant, using water as shown clearly harmful and forbidden) are motivated by the lack of drinking water and sanitation close to their camp, and the absence of showers throughout the territory of Calais.
The mission of Medecins du Monde migrants who work for the care and the health of migrants here wants to emphasize the importance of access to water for basic survival of human beings. In cities of the south, there are fountains all places.A Calais, there is no point of water easily accessible. I want to warn you about the health risks faced by migrants as a result. There was already resurgence of mites, skin superinfections, here are the risks of toxicity. We believe that the mere opening of water points near the "jungles" virtually eliminate toxic hazards. We do not reasonable to discuss the possibility of "pull factor" or "attachment point" for a mere provision of safe water and sanitation.
Please accept, Sir, the assurances of my best. Dr Martine
Devries
12 rue suitors 62100 Calais
martine.devries @ wanadoo.fr
0688751885 0321344064

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Already more than 6 months: What HALDE?


More than 6 months after filing an appeal requesting the cancellation of a circular Social Security prompting doctors to bring claims against their patients receiving the CMU qui ne respecteraient pas leurs traitements, la HALDE n'a toujours pas donné suite à la demande du CoMeGAS.

On comprend certes le malaise de la HALDE.

On imagine que consigne a été donnée en haut lieu à la HALDE d'attendre la fin de la discussion du projet de loi HPST dont un des chapitres évoque les refus de soins illégaux des professionnels de santé aux plus pauvres de notre société. Mais il est probable que la HALDE n'ait pas besoin de consignes pour se soumettre par elle-même aux contingences politiciennes.

" La HALDE ne serait-elle qu'un des alibis de la normalité des pouvoirs ? "

C'est la question que pose Georges Yoram Federmann, a psychiatrist member of COMEG, in his article "Hippocrates ? I heard hypocritical" appeared in issue 24 of SINE-Hebdo this week

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I give my free care to the needy ... and never requiring a salary on top of my work. "This excerpt from the Hippocratic oath is so familiar that nobody realized he was gutted to the point where one wonders if the imposition of future doctors, least in France, swear at the thesis defense to exercise is not a gesture of suspicion towards them.
Indeed, if society was really sure of them, he would not have this requirement because the unconditional hospitality in medicine would go without saying!
Referral to the Halde (High Authority against Discrimination and for Equality) by Comega (Collective of general practitioners for access to care) for the second time in two years, about the refusal of care opposed by some health professionals to the beneficiaries of universal health coverage (CMU) shows that many doctors continue to consider, with many policies, poverty as a kind of divine punishment which strikes those who have sinned or unworthy. Since the Middle Ages.
Medicare itself, since June 2008, allows physicians to make a complaint or claim against the beneficiaries of the CMU that "certain behaviors are considered abusive: missed appointments, unwarranted delays, treatments not followed, exorbitant demands .
past, so it was thought that "crazy" and venereal owed their status to having committed a foul. One might wonder if today ce type de conviction n’est pas toujours à l’œuvre dans notre société « moderne-parce-que-matérialiste », qui n’arrive pas à admettre qu’elle puisse, dans son espace démocratique idéalisé, générer de la pauvreté, de la souffrance, de l’exclusion, du malheur et de la mort.
Plutôt que de se demander comment former, durant leurs dix années d’études, les futurs médecins à exercer leur jugement et leur discernement pour offrir dans leurs cabinets un accueil inconditionnel « à la Hippocrate », on va chercher à culpabiliser, à criminaliser même, les pauvres, les demandeurs d’asile, les unemployed at the end of law, single mothers ...
So when teachers and pedagogues they decide to convince the doctors (and to convince themselves) that poverty is not a fault or a mental illness but the consequence ideological and political dysfunction? When they
will emphasize the importance of preventive medicine, as is the case in Canada, where the importance of the environment has really taken into account until the oath of future physicians. We know in fact that, as regards the determinants involved in improving health, about 60% are related to factors of physical, social and psychological (work, family, country ...), 30% to biological factors (diabetes, cholesterol ...) and only 10% are related to the healthcare system! The
Halde was created 30 December 2004 and publishes opinions and criticisms extremely rich, often high profile. But it has only advisory powers and interventions sometimes remain unanswered. She becomes the guarantor of a good general awareness that allows the expression of the contempt powers to the poor and the marginalized, necessarily lazy fraudsters calculators and profiteers. The
Halde would she think of alibis for the normality of powers?