“You have to leave with anger” The message from the director of the AP-HM to the Minister of Health

Mediation, this general practitioner from the northern districts of Marseille measures its “really useful” character every day. In his practice in the Cité des Oliviers, in the 13th arrondissement, Dr. Slim Hadiji thus receives patients he would never have seen without the work of associations in the field who go to meet the people furthest from the care system. Not to mention their role in terms of medical information, on the need to screen for cancer, for example. “No matter how much I prescribe, unfortunately people don’t do the exams, deplores the doctor. For mammograms, only one person in ten comes back having done it. There isn’t a single radiology center in the neighborhood, and the northern hospital is far away. »

On the move this Friday in Marseille, as part of the National Council for Refoundation in Health, the Minister of Health François Braun listens carefully to this testimony. Just like that of associations which have innovated from the first confinement, and are continuing this work as close as possible to people. “The Covid has also brought positive effects on the need to exchange between partners, notes Dr Philippe Malfait, doctor and epidemiologist at Public Health France. He posed this problem: how to direct the teams to the areas that need them the most? Priority was thus given to the neighborhoods where the virus was circulating the most. “This prioritization process, why not continue it on vaccination, cancer screening? »

Mobile teams, as in the humanitarian sector

The CorHESan system of mobile teams to fight the epidemic, deployed to concretely help families at home forced into isolation, and to fight against the low rate of vaccination against Covid-19, is now continuing in other health topics: screening for breast, cervix and colon cancers, improving vaccination coverage (not only against Covid), all in northern districts. With mediators who provide information at places of residence, or at home during door-to-door operations, as does the association SEPT (Environmental health for all). “There is a population of men who are difficult to reach, we try to meet them in mosques, sports centers, to distribute colorectal cancer screening kits to them”, says for example Karima Djelat, one of the mediators. .

“In France, we ended up abandoning this mode of public health action, based on mediation, whereas in the humanitarian field, mobile teams go beyond the populations”, notes Dr Stanislas Rebaudet, infectious disease specialist at the European hospital. And to add: “The idea is to perpetuate this type of action. CorHESan’s funding ends next July, but we would have to register for a period of at least three years, both vis-à-vis the populations, and also to assess this dynamic and produce major information for the public health strategy. The concern about the future is the same for the SEPT mediators. “Nothing worse than showing residents that there are solutions but no funding,” warns Yazid Attalah, its president.

“Well bank! »

Director General of the AP-HM, François Crémieux drives the nail a little further, by addressing these clear and precise words to the Minister of Health: “You must leave Marseille with a little anger. We can find ourselves in about ten years with still great stories and committed actions, but we have to get out and break this sad reality which is not improving despite good intentions. You need to set goals to achieve. “Behind him, an illustrated map, supporting indicators, the north / south divide on access to care in Marseille.

Objectives, the minister refuses to give any, believing that they must come from the field: “If the objective is to reduce breast cancer screening by 60%, well banco”, he says, as to send the ball back into the net. “The solutions come from the territory, we can see that very well in Marseille,” he says, wanting to be reassuring about the sustainability of these health mediation pilot projects: “It’s something that works, of course we’ll extend it. »

“We can do the same in neighborhoods in Paris or in rural areas,” adds François Braun, who also went to the Lighthouse of smiles, a reception center for children suffering from cancer, and to the open health center by the AP-HM in the heart of the city of Aygalades. “I came to see originalities in Marseille, things put in place to meet health needs, Marseille initiatives that set an example,” continues the minister. He says he saw “the whole point of health mediation”. A mission will be entrusted on the subject to Dr Philippe Denormandie.