Reportage de fond dans le monde des hôptaux en France et dans le monde.

Immersion dans le monde clos des hôpitaux.

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Hospitals in the world - report

Photo reporting during three months at the Henri Mondor hospital in Creteil, a suburb of Paris.

Photo reporting in France.

Immersion in the closed world of hospital emergencies, day and night. Somatic and psychological emergencies.

Physician practising a lumbar puncture. Taking of cephalic-rachidian liquid suspecting an infectious or carcinoma meningitis (cancerous).A patient suspected of having meningitis. Wearing a mask and gloves for hygiene and protection.Brain scanner. Four doctors examine the negatives of the brain scanner (TDM) of a patient victim of a vascular brain attack).Blood test. Collecting blood for several blood tests (blood group, ionogram, hepatic evaluation...)A nursing aid attending an old lady. It is also indispensable to listen to the patient.Medical office and nurse room. Exchange between medical and paramedical, day and night shifts.Medical office and nurse room. Exchange between medical and paramedical, day and night shifts.Nurse and assistant handling a drunken homeless and making him ready for the doctor’s examination.Nursing student taking blood in her first medical approach. The doctor also acts as an interpreter for the patient who does not speak french.A patient waiting inside a “box”in the emergencies, where he will be examined and treated. All the technical paraphernalia is concentrated in this space.Emergencies waiting room. A nurse discussing with a patient and a nursing aid, reassuring an old lady already perfused, with a third patient watching.A nurse giving moral and psychological support to a patient under medical supervision.

Choosing to become a doctor.... it starts one day followed by a strong desire to succeed entrance examination to first year. Then training periods go fast, and one day, here I am at the emergencies !

Ahhh emergencies.... What I really miss as an emergency doctor is not so much the medical aspect.of emergencies (quite rare), but the vital urge a patient feels to consult a doctor. I’d write doctor with a capital D considering a patient’s expectations. All those people, more or less sick, come towards a “saviour” who must know how to heal them,quickly, kindly, painlessly and for free! I see the need of each person for a listening ear and earnest concern for their problems. The patient I’m currently examining does not have an urgent health problem. So what, he has another urgent problem, something which worries him to the point that he cannot sleep although it’s 11 pm, but has the energy to wait six hours in the waiting room to see a doctor.

I remember this doctor called in the middle of the night to come to emergencies to check on a painful pathology which he knows to be mild, to hear the doctor on guard say that with a treatment against pain, it should be OK....and adds “ I know, and I’m very sorry to have disturbed you, but I needed someone to confirm”. So, lets stop criticising patients, doctors, medical staff,.and lets work together to improve the quality of treatments and working conditions.

Testimony of Louis Marie Leiber, medical student.

There is considerable work besides medical care: telephone calls, counselling, analysing test results, making appointments.Nurse and nursing aid working together. Daily collaboration between two paramedical complementary functions.Taking of blood via a catheter. Two nursing students watching.Emergency action. Efficiency of two nurses handling a delicate situation.Examining the eyes and neurological system of an old man. He seems lost, not remembering his name or age.Helping to undress an elderly person before consultation. A young trainee trying to undress an old man bereft of his faculties.Helping to undress an elderly person before examining him. This old man covered with wounds and bruises does’nt have his head.A patient waiting in a stretcher. A doctor taking care of this drunken patient who seems lost.A resident doctor taking care of a homeless. Dialogue is complicated as this man is an alcoholic.Neurological test on an alcoholic homeless.An old man arriving at emergencies after a bad fall off the stairs. A nurse is cleaning his wound.A nurse applying a dressing on the wound of an old man who fell down the stairs.

Listening, patience, concern are of prime importance in the service.

Listening and contact: two major qualities. A doctor reassuring and soothing an old man..Reajusting, under anesthesia, the knee-cap of a patient, upon arrival.Fixing a perfusion on a very old patient. More than half the patients at emergencies are elderly people.Listening, communicating and gentleness at the emergencies. A nursing aid reassures and soothes an old lady waiting since several hours.Supervised by a nurse, a young student in first year, performs a blood test .Exchange between a resident doctor and a senior physician on the follow-up concerning a patient who came to emergencies after a serious accident.Medical discussions concerning a patient. Three doctors seek confirmation of diagnosis from a senior doctor.Doctors read and interpret x-rays (cervicals) of a patient.Medical and paramedical staff: exchanging information every morning.A nurse holding the wrist of a patient to perform an intravenous perfusion.Medical office: verbal, written, telephone transmissions. Indispensable candies to bring some comfort.A nursing- aid checks monitoring on a patient (heart surveillance).

Psychological and medical clinics.

Laying a one-legged patient on a stretcher, without his artificial leg. Two nurses trying to handle a patient.Restraining an agressive patient. Several nurses and a doctor must handle this violent patient who insulted a nurse and spat on her.Doctors restraining a particularly agitated patient in psychiatric emergency.Restraining the legs and arms of a very agitated patient in psychiatric emergency.Listening to a psychiatric patient. Reassuring, soothing and restoring confidence.Listening to a stranger having no id, brought over by the police to get a medical cetificate before expulsion.


Daily care.

Adapting to patients... A doctor speaking arabic to a patient to make a diagnosis.Emergency corridors viewed from the hospital ward, through a port-hole. A nursing-aid attending to a patient.Removing the two artificial legs of a patient before medical examination.Treating a patient’s brain trauma after he fell down the stairs, perfusion and bandages..Nurse preparing a perfusion before going to the patient.Neurologic examination of a patient who attempted suicide.Evaluating the quantity of drugs taken in a suicide attempt.

Here, no social barrier.

Care to a homeless. Listening, comforting. The homeless often come to ask for a shower and get a meal..Helping to put a patient in bed. A homeless complaining about a painful shoulder.Medical ward. After examining a homeless, a doctor fills the entry form and writes down the different pathologies.X-ray examination of an agitated homeless sufferring from his shoulder.


Hippocrate

My major concern, is to re-establish, preserve and promote health care overall, physical, psychological, individual and social .

A nurse having trouble making a perfusion and a blood test to a homeless.A doctor and a nurse keeping a close eye on a homeless. The patient complaining about a shoulder pain.

Earthquake in Jakarta.

Photo reporting in Indonesia.

Indonesia waited two days before declaring the state of emergency, after the earthquake which wreaked Java island. Latest death toll amounted to 5000 persons The government called the international community for help.

An estimated 35.000 homes and buildings were destroyed. In the midst of the rubble, the rescue teams together with the inhabitants, continue to search for survivors and food

The european union has already sent three million euros to meet vital necessities. The United States promised 2.5 million dollars, China 2 million dollars as well as material support, Saudi Arabia offered 5 million dollars. Pakistan, Malaysia, South Corea, Singapour, Taiwan are some of the asian countries which have provided emergency funds, medical, food and other support together with specialised rescue teams. Canada, Great Britain, Norway and France announced flying-in tons of humanitarian aid.

A small team of corean surgeons working unrelentlessly in the small hospital of Bantul after the quake.Indonesian surgeons taking a break for lunch between two operations. More than 30.000 wounded after the quake considerably increasing every day.More than 400 patients for only a hundred beds in the packed hospital of Bantul.22 countries provided financial, material and humanitarian aid, after the quake, sending rescue teams, nurses and doctors.Doctors of the World sent a surgeon, an anaesthetist, a nurse, to cope with surgery as soon as possible.Three days later, more humanitarian aid arrived in the form of tons of food and medical supplies, tents and electricity generators.Most of the wounded suffer from fractures caused when their houses collapsed. Without care, many can die following infections due to open fractures.The three hospitals of Bantul (100 beds each), most urgently need orthopedic supplies, drugs and electric current generators.Teams of surgeons and nurses from all over the world have provided assistance in the hours and days following the quake which caused more than 5000 deaths.


The 6.3 magnitude earthquake hit southern Yogyakarta, a heavily populated area. The town of Bantul closest to the earthquake’s epicenter suffered the most..

Everywhere, the same scenes of desolation and despair. The destitute population in desperate need of water, food and tents.

More than 20.000 wounded. The european commision has rapidly decided to send 3 million euros for immediate assistance.

More than five million afghans depend on humanitarian aid to survive.

Photo reporting in Afghanistan.

Twenty years of violent conflicts, three years of dryness, famine as well as human rights violations resulting in an important number of refugees and endangering the lives of more than five million civilians. Thousands of persons move inland, by fear of an american army attack. Some have succeeded leaving the country to seek refuge in Iran (there are more than 935.512 displaced).

Doctors of the World in Afghanistan work closely with the local doctors in 4 child centers in Kabul and 3 others in Herat, dealing with more than 100.000 consultations a year in each center..

In Herat, women waiting in one of the 3 child health centers administered by Doctors of the World in Afghanistan.Only 12% of the afghan population have access to health structures. One doctor for 50.000 patients. Doctors of the World on duty provides health care for this particularly vulnerable population.


Only 12% of the population has access to medical care. One doctor for 50.000 persons (in France one for 300), 6 million persons have no access at all, only 15% of pregnant women will have access to medical care during their pregnancy, 25% will die at childbirth, 70% of children have no medical care. Two out of five children will die before being one-year old.
Except in urban areas, Afghanistan has no health care.

Young girl and her mother waiting in a public dispensary run by Doctors of the World. In this country, 70% of children have no medical care. Two out of five will die before the age of 1..

Nepal has the third highest child death- rate in the world.

Photo reporting in Nepal.

Nepal, its himalaya summits, hindou temples and budhist monasteries. This country attracts a growing number of tourists by its fascinating culture and awesome landscape. 42% of the population is below poverty level. Political instability does’nt make things better. International aid, humanitarian and other associations attempt to support this state on the verge of bankruptcy. Doctors of the World priority is to cut down the child death- rate, which is the third highest toll in the world.
7:30 in the morning, in the middle of cornfields, a group of 20 women are gathered in the shade of a small temple. It’s the monthly meeting of Mother’s Group of Jailbire, a small village one reaches by a footpath down a hillside. Doctors of the World have created over 250 mother’s groups in this region of Sindupalchowk, northern Nepal, with the object of making women aware of pregnancy and infantile care. “Before, the ombilical cord was cut with any sharp instrument, and the newborn was traditionally bathed immediately after childbirth, even in cold weather. It was also believed that maternal first milk was not good, so the newborn was not breast fed right away, but given a spoonful of honey symbolizing the sweetness of his new life. As, unfortunately, a baby is unable to swallow, serious problems would arise” said 28 year old Indira Adhikavi, 3 children.
In those villages, women traditionally give birth on their own without medical help, sometimes assisted by their mother-in-law, in a dark room, isolated and badly aired. After their marriage, women are under their husbands and in-laws authority, and decisions relative to pregnancy and child health are taken by the mother-in-law. This is why beyond basic information, Mother’s Group try to emancipate women by helping them acquire some financial and economic independence, and increase their responsibilities. Micro credit gives them more freedom of action. Ramala Khadka, 7-months pregnant, has decided to give childbirth in a health center. “Before, I did’nt know I even had the possibility to do so.” But for the time being, she has to return to the fields, work is waiting. Maybe no maternity leave, but at least she will not be alone to give birth.

Text: Flora Barré Journaliste

In Nepal, the maternal death-rate averages 7.4%, according to the international health organization. The child death-rate is high in those mountainous regions within many hours of walking from town.Making women aware of pregnancy and child health, as well as appropriate tratments, is one of the major aims of Doctors of the World.In those villages, women traditionally give childbirth alone, with no medical aid, and sometimes assisted by their mother-in-law, in a dark , isolated and badly aired room in the house.Monthly meeting of Mother’s Group, amidst a flock of goats and a small temple. 252 groups of twenty women deal with micro credit.


Ramala Khadka, 26.
A big smile slightly embarassed, to hide her shyness. Ramala Khadka is from a very poor family of Jailbire, a mountainous area in northern Nepal, difficult to reach. She works in the fields and her husband is a stone-breaker in the construction business. Under his authority, sometimes violent, she realizes the importance of belonging to this Mother’s Group and since 10 months, regularly goes to the monthy meetings. With the financial and psycholoigical support of this group, she is capable of managing some money on the side, has access to relevant information, and free discussions with women.
7-months pregnant, she seriously follows the maternal-infancy program and advice. She proudly says that she has attended the recommended three pre-birth visits, which she had not done for her 7-year old son. She recalls all the recommendations: anti-tetanus vaccination, iron supplements. Although it was normal until now to give childbirth at home, she now wishes to have her second baby in a medical home. She puts aside 20 roupies a month (0.20 euro cents), and plans to demand a small loan to meet childbirth expenses.

In the hillside villages of Sindhupalchok, micro credit, an original community approach to develop the awareness of women to medical assistance during pregnancy and at childbirth.Ramala Khadka smiling, but slightly embarassed by her shyness, belongs to one of the poor families of Jailbire, a mountainous region in northern Nepal, difficult of access.

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