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.
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