On The Road (And Brink) With French Country Doctors

A close-up look the problem of so-called “medical desertification” in rural France, where doctors are stretched to the limit and patients worry not to get sick on the wrong day of the week.

A small-town pharmacy in Brittany
A small-town pharmacy in Brittany
Laetitia Clavreul

SAINT-URCIZE - "In rural areas, it's better to be a cow than a man." This was back in February 2009, during a French Parliament debate on the Hospital, Patients, Health and Territories bill, and Pierre Morel-A-L'Huissier was being provocative. "But nothing has changed since regarding medical deserts," the Parliament member from the ruling center-right UMP party says now. "Funding grants, medical housing… regions, counties: everyone is trying to find solutions, so there's no coordination and not enough money."

But besides his role in Parliament, Morel-A-L'Huissier is also the mayor of Fournels, a small town in central France. His goal here is to create a "socio-medical" center, which unlike a traditional health facility can be certified with only one doctor rather than the minimum of two. "I keep being asked if the local doctor is going to stay," he says.

Things started changing in 2004, when Louis Cazes, the only doctor, left Fournels and its 1,700 residents. He had been there since 1976, rarely went away on holidays or weekends, was on call day and night and lived in the village.

Finding a replacement has been hard. Two foreign doctors, one from China, another from Madagascar, met with the mayor, but after seeing the amount of work, they never followed up. A couple was ready to take over under one condition: that the rent for their house and their practice be covered by the town hall. The mayor was offended by the move, considering the income the couple would have.

In the end though, the town hall did buy a house and an office that it rents out. Dr. Emmanuelle Morival has worked there for six years. She doesn't work on Wednesdays and is on call only one weekend a month. When she's working she sleeps at the practice, otherwise she lives 100km away.

Residents know doctors are overworked and are entitled to a private life, but they're worried. "On Friday nights, when the doctor leaves, I get scared at the thought of having a problem," says one retired woman, who did not want to give her name.

Everyone here has a story about how hard it is to see a doctor, especially on weekends. "We know that if we have a stroke, we won't make it," says Paulette Deloustal, Mayor of Termes, another small town in the southwest.

Fifty years ago, you also had to wait for a doctor, but now people worry that one day there won't be anyone to wait for. A replacement is no longer a guarantee. Doctors are worried, because in areas where the climate or landscape is tough, when a colleague leaves, they have to treat the patients he leaves behind. Exhaustion is not an excuse.

When one doctor left Chaudes-Aigues in June 2010, Dr. Roussel, who stayed called Dr. Armand, in neighboring Urcize and they set up a new system: when one does house calls, the other consults at the practice and they also take over each other's patients during their respective holidays.

At the beginning, residents considered Dr. Armand's decision "treason", because he would no longer exclusively care for their village. "In the end they understood that this system was the only way to have someone when I decide to leave," he says. To inspire newcomers, or at least to prevent others from leaving, doctors have to work differently. "Telling a prospective doctor, ‘you'll work alone, twelve hours a day and since the hospital is 50km away, you'll often be 911"…that won't get anyone to come!" he jokes.

Meeting in a restaurant, several doctors talk through the problem. They all know each other, because they're so few of them. "We try to fight the lack of doctors by bringing some from abroad. But at this rate, Eastern Europe will soon be running out of doctors!" says Dr. Claude Fleury from Aumont-Aubrac. In his town, a Romanian doctor has started working but no one knows if he'll stay once his contract is up.

"We have to double the number of positions available after Medical School," says Dr. Charles Laronze, 62. "We need practices where several doctors can each come in a couple of days a week. They'd have 40 on-call hours and could still enjoy time with their families," says Dr. Marjolaine Bonvoisin.

Despite the long hours working and driving from town to town, the doctors don't begrudge their city colleagues. And they don't want coercive measures to be implemented to bring them to the country.

Dr. Muriel Dousse-Douet admits she's losing faith. She thinks someday France may have to use coercion. But only on young doctors, the "old ones' won't accept that. "We can't change the rules as we go. These doctors may have all the flaws in the world, but at least they're here."

Read the original article in French

Photo - hha

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How Thailand's Lèse-Majesté Law Is Used To Stifle All Protest

Once meant to protect the royal family, the century-old law has become a tool for the military-led government in Bangkok to stamp out all dissent. A new report outlines the abuses.

Pro-Democracy protest at The Criminal Court in Bangkok, Thailand

Laura Valentina Cortés Sierra

"We need to reform the institution of the monarchy in Thailand. It is the root of the problem." Those words, from Thai student activist Juthatip Sirikan, are a clear expression of the growing youth-led movement that is challenging the legitimacy of the government and demanding deep political changes in the Southeast Asian nation. Yet those very same words could also send Sirikan to jail.

Thailand's Criminal Code 'Lèse-Majesté' Article 112 imposes jail terms for defaming, insulting, or threatening the monarchy, with sentences of three to 15 years. This law has been present in Thai politics since 1908, though applied sparingly, only when direct verbal or written attacks against members of the royal family.

But after the May 2014 military coup d'état, Thailand experienced the first wave of lèse-majesté arrests, prosecutions, and detentions of at least 127 individuals arrested in a much wider interpretation of the law.

The recent report 'Second Wave: The Return of Lèse-Majesté in Thailand', documents how the Thai government has "used and abused Article 112 of the Criminal Code to target pro-democracy activists and protesters in relation to their online political expression and participation in peaceful pro-democracy demonstrations."

Criticism of any 'royal project'

The investigation shows 124 individuals, including at least eight minors, have been charged with lèse-majesté between November 2020 and August 2021. Nineteen of them served jail time. The new wave of charges is cited as a response to the rising pro-democracy protests across Thailand over the past year.

Juthatip Sirikan explains that the law is now being applied in such a broad way that people are not allowed to question government budgets and expenditure if they have any relationship with the royal family, which stifles criticism of the most basic government decision-making since there are an estimated 5,000 ongoing "royal" projects. "Article 112 of lèse-majesté could be the key (factor) in Thailand's political problems" the young activist argues.

In 2020 the Move Forward opposition party questioned royal spending paid by government departments, including nearly 3 billion baht (89,874,174 USD) from the Defense Ministry and Thai police for royal security, and 7 billion baht budgeted for royal development projects, as well as 38 planes and helicopters for the monarchy. Previously, on June 16, 2018, it was revealed that Thailand's Crown Property Bureau transferred its entire portfolio to the new King Maha Vajiralongkorn.

photo of graffiti of 112 crossed out on sidewalk

Protestors In Bangkok Call For Political Prisoner Release

Peerapon Boonyakiat/SOPA Images via ZUMA Wire

Freedom of speech at stake

"Article 112 shuts down all freedom of speech in this country", says Sirikan. "Even the political parties fear to touch the subject, so it blocks most things. This country cannot move anywhere if we still have this law."

The student activist herself was charged with lèse-majesté in September 2020, after simply citing a list of public documents that refer to royal family expenditure. Sirikan comes from a family that has faced the consequences of decades of political repression. Her grandfather, Tiang Sirikhan was a journalist and politician who openly protested against Thailand's involvement in World War II. He was accused of being a Communist and abducted in 1952. According to Sirikhan's family, he was killed by the state.

The new report was conducted by The International Federation for Human Rights (FIDH), Thai Lawyer for Human Rights (TLHR), and Internet Law Reform Dialogue (iLaw). It accuses Thai authorities of an increasingly broad interpretation of Article 112, to the point of "absurdity," including charges against people for criticizing the government's COVID-19 vaccine management, wearing crop tops, insulting the previous monarch, or quoting a United Nations statement about Article 112.

Juthatip Sirikan speaks in front of democracy monument.

Shift to social media

While in the past the Article was only used against people who spoke about the royals, it's now being used as an alibi for more general political repression — which has also spurred more open campaigning to abolish it. Sirikan recounts recent cases of police charging people for spreading paint near the picture of the king during a protest, or even just for having a picture of the king as phone wallpaper.

The more than a century-old law is now largely playing out online, where much of today's protest takes place in Thailand. Sirikan says people are willing to go further on social media to expose information such as how the king intervenes in politics and the monarchy's accumulation of wealth, information the mainstream media rarely reports on them.

Not surprisingly, however, social media is heavily monitored and the military is involved in Intelligence operations and cyber attacks against human rights defenders and critics of any kind. In October 2020, Twitter took down 926 accounts, linked to the army and the government, which promoted themselves and attacked political opposition, and this June, Google removed two Maps with pictures, names, and addresses, of more than 400 people who were accused of insulting the Thai monarchy. "They are trying to control the internet as well," Sirikan says. "They are trying to censor every content that they find a threat".

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