Access to care for aging former workers living in an immigrant hostel / Accès aux soins d'une population d'anciens travailleurs immigrés vivant en foyer

The Chibanis represent the population of aging former immigrant workers who arrived in France in the 1970s in order to take up employment. Most of them still live in immigrant hostels, which are not appropriate for an older population. This anthropological study was conducted on Chibanis living in an immigrant hostel in the 15th arrondissement of Marseille. The objectives were to assess the medical, economic, and social characteristics of this population, to understand their access to health care, and to measure their adherence to the prevention actions of an association. 67 Chibanis aged 65 and over were included, with a median age of 77: 91% had access to a general practitioner, and 86.6% had more than two chronic diseases. More than half of the Chibanis complained of dental problems, and 20% complained of ophthalmological problems. Only 32.8% of the Chibanis included agreed to follow-up care with the nurses from the association. The population of Chibanis are isolated geographically from their families, live in poor socio-economic conditions, and often have insufficient medico-social coverage. They must "manage" their chronic diseases, as well as costly health problems such as dental or ophthalmic diseases. Improving care pathways for this population requires us to identify their specificities and all the factors hindering prevention actions.

Les Chibanis ­ "cheveux blancs" en arabe dialectal ­ désignent les anciens travailleurs immigrés arrivés en France dans les années 1970 pour exercer un emploi. Ils vivent encore pour la plupart au sein de foyers construits pour des hommes seuls exerçant une profession et non pour accueillir des hommes en situation de vieillissement. Notre travail anthropologique s'est organisé autour d'une population de Chibanis, vivant dans un foyer dans le 15e arrondissement de Marseille. Les objectifs étaient de mieux connaître cette population d'un point de vue médico-socio-culturel, de connaître les modalités de leur accès aux soins et enfin de connaître leur adhésion aux actions de prévention d'une association. 67 Chibanis ≥65 ans ont été inclus, avec une médiane de l'âge de 77 ans : 91 % déclaraient avoir un médecin traitant, 86,6 % avaient plus de 2 maladies chroniques. Plus de la moitié des Chibanis souffraient de problèmes dentaires et près de 20 % présentaient des problèmes ophtalmologiques. Seuls 32,8 % des Chibanis inclus ont accepté de réaliser un suivi par les infirmiers. La population des Chibanis, isolée géographiquement de leur famille, économiquement précaire et avec une couverture médico-sociale souvent insuffisante, doit « gérer ¼ ses pathologies chroniques, et des problèmes de santé notamment dentaires et ophtalmiques couteux. L'amélioration de leurs parcours de santé nécessite de mieux comprendre leurs spécificités et les divers facteurs qui peuvent entraver les actions de prévention.

Accès aux soins d'une population d'anciens travailleurs immigrés vivant en foyer.

The Chibanis represent the population of aging former immigrant workers who arrived in France in the 1970s in order to take up employment. Most of them still live in immigrant hostels, which are not appropriate for an older population. This anthropological study was conducted on Chibanis living in an immigrant hostel in the 15th arrondissement of Marseille. The objectives were to assess the medical, economic, and social characteristics of this population, to understand their access to health care, and to measure their adherence to the prevention actions of an association. 67 Chibanis aged 65 and over were included, with a median age of 77: 91% had access to a general practitioner, and 86.6% had more than two chronic diseases. More than half of the Chibanis complained of dental problems, and 20% complained of ophthalmological problems. Only 32.8% of the Chibanis included agreed to follow-up care with the nurses from the association. The population of Chibanis are isolated geographically from their families, live in poor socio-economic conditions, and often have insufficient medico-social coverage. They must "manage" their chronic diseases, as well as costly health problems such as dental or ophthalmic diseases. Improving care pathways for this population requires us to identify their specificities and all the factors hindering prevention actions.

Impact of societal and legal context on the blood supply of African-ancestry populations in Western countries: A review of practices and the French example.

In Western countries, blood supply agencies encounter impediments in providing blood groups defined as rare or of interest, notably for sub-Saharan African ancestry (SSAA) recipients. To establish warning levels and anticipate future blood needs, an estimate of the current carriers of rare blood groups, both potential patients or donors, is crucial but complex. Indeed, if the strict needs can be estimated in medical terms, the modalities of blood product collection must be considered from an interdisciplinary perspective, at the interface of biological data and social norms. Here, we aim to understand how legal choices and a set of representations of otherness may influence the supply of rare blood for SSAA populations. After examining these issues, considering different norms and limits that govern French society, we compare this data with those of four Western countries facing the same difficulties (United States, United Kingdom, Italy and the Netherlands). This work began as part as the reflections of Social Lab, an institutional programme created by the French Blood Establishment (EFS). How can we effectively improve the qualitative blood coverage for SSAA populations? There is no unique solution, but there are many more or less effective answers. Comparison across countries reveals a strong influence of the socio-political histories and ethical choices before technical and medical considerations. We consider that an institutional policy is required to resolve recruitment issues of SSAA donors sustainably. Lastly, we introduce a working group called the EFS Social Lab, which aims to set up a monitoring mechanism for donors and societal trends to make blood donation effective.

De quel agencement sociotechnique meurent les nouveau-nés d'Afrique de l'Ouest ?

INTRODUCTION: In Sub-Saharan Africa, despite the establishment of many health care programs, neonatal mortality rates remain extremely high. From a medical point of view, the main causes are obstetric, along with diarrhea and pneumonia. Understanding how these risks and pathogenic situations are constructed cannot be achieved without observing, analyzing, and understanding the underlying gestures and meaning systems. METHOD: Rather than describing obvious inequalities in the access to health care, our study aimed at questioning the different actors' operational capacities and at considering what is actually possible to improve in the most common healthcare situations. More specifically, how are births, neonatal care, and popular practices carried out in the first days of the lives of these newborns? In five countries of West Africa, a "multi-sited" anthropological study was carried out to observe the first weeks of newborns. This study not only allowed for the methodical identification of care interactions at and around childbirth in peripheral health care services, but also the popular practices related to the socialization of the child in family settings. RESULTS: Our fieldwork investigations show that neonatal risk corresponds to the combination of several sets of behavior. In obstetric services, for reasons linked to the symbolic status of the child as much as to a certain idea of the obstetric profession, the newborn remains marginal in the preoccupations of the midwives. This results in many dysfunctions (not warming the child, leaving the child in a drafty area, not feeding the child…) which constitute discontinuous risk factors.In the village and in the family, the newborn is at the center of many social practices - baths, rituals, ingestions of various "protective" products, period of seclusion, baptism… - which not only aim at conferring an identity and including the infant in the social group, but also build a set of infectious risks.Finally, while health actions build a translation space, no preventive dialogue has been established by healthcare personnel to inform people about the risks associated with certain social practices.Overall, these longitudinal follow-ups of newborns, as well as precise observations and interviews conducted with the actors on their reasons for acting, have made it possible to analyze the attitudes, gestures and social behaviors that constitute the concrete causes of neonatal risk. DISCUSSION: Describing the practices that newborns "benefit from" during their first days is essential to concretely identify and analyze the risks and reasons for high neonatal mortality. The empirical and documented approach of anthropology is essential to carry out these studies. But, more importantly, this qualitative approach must be implemented in vivo and in situ in the health services and during the training of health personnel to create a reflexivity of the caregivers and to initiate professional practices concerned with newborns. In the same way, our studies open the way for precise and documented dialogues with families which will enable the indispensable follow-up care for the newborns and ensure adapted preventive care and coherence in the care provided by the healthcare structures, the families, and the collectivities.

[What sociotechnical arrangement is responsible for newborn deaths in West Africa?] / De quel agencement sociotechnique meurent les nouveau-nés d'Afrique de l'Ouest ?

INTRODUCTION: In Sub-Saharan Africa, despite the establishment of many health care programs, neonatal mortality rates remain extremely high. From a medical point of view, the main causes are obstetric, along with diarrhea and pneumonia. Understanding how these risks and pathogenic situations are constructed cannot be achieved without observing, analyzing, and understanding the underlying gestures and meaning systems. METHOD: Rather than describing obvious inequalities in the access to health care, our study aimed at questioning the different actors' operational capacities and at considering what is actually possible to improve in the most common healthcare situations. More specifically, how are births, neonatal care, and popular practices carried out in the first days of the lives of these newborns? In five countries of West Africa, a "multi-sited" anthropological study was carried out to observe the first weeks of newborns. This study not only allowed for the methodical identification of care interactions at and around childbirth in peripheral health care services, but also the popular practices related to the socialization of the child in family settings. RESULTS: Our fieldwork investigations show that neonatal risk corresponds to the combination of several sets of behavior. In obstetric services, for reasons linked to the symbolic status of the child as much as to a certain idea of the obstetric profession, the newborn remains marginal in the preoccupations of the midwives. This results in many dysfunctions (not warming the child, leaving the child in a drafty area, not feeding the child…) which constitute discontinuous risk factors.In the village and in the family, the newborn is at the center of many social practices - baths, rituals, ingestions of various "protective" products, period of seclusion, baptism… - which not only aim at conferring an identity and including the infant in the social group, but also build a set of infectious risks.Finally, while health actions build a translation space, no preventive dialogue has been established by healthcare personnel to inform people about the risks associated with certain social practices.Overall, these longitudinal follow-ups of newborns, as well as precise observations and interviews conducted with the actors on their reasons for acting, have made it possible to analyze the attitudes, gestures and social behaviors that constitute the concrete causes of neonatal risk. DISCUSSION: Describing the practices that newborns "benefit from" during their first days is essential to concretely identify and analyze the risks and reasons for high neonatal mortality. The empirical and documented approach of anthropology is essential to carry out these studies. But, more importantly, this qualitative approach must be implemented in vivo and in situ in the health services and during the training of health personnel to create a reflexivity of the caregivers and to initiate professional practices concerned with newborns. In the same way, our studies open the way for precise and documented dialogues with families which will enable the indispensable follow-up care for the newborns and ensure adapted preventive care and coherence in the care provided by the healthcare structures, the families, and the collectivities.

[Introduction]. / Ce que les sages-femmes disent de leurs vies, de leur métier et de leurs pratiques de soin.

INTRODUCTION: This paper is based on two observations. First, despite multiple health programmes, access to services and quality of obstetric care remain inadequate in Africa. Secondly, although several qualitative studies have described the poor quality of admission facilities, violence during delivery and neglect of the poorest women, the reasons behind these behaviours have not been elucidated.This survey, conducted in Benin and Burkina Faso, examined midwives' experiences of their job, their obstetric practices and their lives.By including the emotional, sensorial, linguistic and social elements, this paper shows important discordances between the proposals made by programmes (installation in rural areas, strict financial management) and midwives' social and emotional duties and economic roles. It highlights the importance of gender relations in the careers of these professionals.The study also shows that the attitudes of midwives are related to the fact that childbirth is considered to be a moral act and their mistreatment behaviour corresponds to constant shifts between technical skills (fertility) and value judgements concerning expression of pain, sexuality and desire. On the other hand, midwives justify their violent practices by the urgency of the situation, especially during childbirth.The provision of care and effective implementation of programmes cannot be improved without taking into account these forms of justification and without constructing dialogues enabling midwives to develop a reflection about their social and emotional constraints, their relation to sexuality, and the reasons for their actions.

Being a midwife in West Africa: Between sensory experiences, moral standards, socio-technical violence and affective constraints.

Despite a long history of maternal health programs, the quality of obstetric care and access to facility services remain inadequate in West Africa. Although several qualitative studies have described human resource and facility constraints impacting pregnancy care and the violent or disrespectful care of women during labor, the reasons behind these behaviors have not been elucidated. In order to understand midwives' experiences with caregiving, in 2017-2018 we conducted interviews with 24 professional midwives in Benin and Burkina Faso and examined their perspectives on their profession, obstetric practices and personal lives. By including emotional, sensorial, linguistic and social elements, this paper shows important discordances between the proposals made by programs (such as rural postings and financial disbursement projects) and midwives' socio-emotional duties and economic roles. The study also shows that midwives' attitudes towards their patients are linked to their considering childbirth to be a moral act. Midwives' mistreatment of women in labor corresponds to constant shifts between technical obstetric skills and value judgements concerning expressions of pain, sexuality and desire. In addition, midwives justify their violent practices through the urgency of the situation, especially during crowning. The provision of care and the effective implementation of maternal programs cannot be improved without taking these justifications into account and without constructing dialogues enabling midwives to reflect on their social and emotional constraints, their relationship to the sexuality of childbirth, and the reasons for their practices. We advocate for more methodical research and for midwifery training to include in-depth case studies such as this one which start from the practical difficulties midwives face, making it possible to improve the midwifery profession as it is lived and not as it is imagined by fragmented, ungrounded programs.

Where the lay and the technical meet: Using an anthropology of interfaces to explain persistent reproductive health disparities in West Africa.

Despite impressive global investment in reproductive health programs in West Africa, maternal mortality remains unacceptably high and obstetric care is often inadequate. Fertility is among the highest in the world, while contraceptive prevalence remains among the lowest. This paper explores the social and technical dimensions of this situation. We argue that effective reproductive health programs require analyzing the interfaces between technical programs and the social logics and behaviors of health professionals and client populations. Significant gaps between health programs' goals and the behaviors of patients and health care professionals have been observed. While public health projects aim to manage reproduction, sexuality, fertility, and professional practices are regulated socially. Such projects may target technical practices, but access to care is greatly influenced by social norms and ethics. This paper shows how an empirical anthropology that investigates the social and technical interfaces of reproduction can contribute to improved global health.

Determinants of refusal of A/H1N1 pandemic vaccination in a high risk population: a qualitative approach.

BACKGROUND: Our study analyses the main determinants of refusal or acceptance of the 2009 A/H1N1 vaccine in patients with cystic fibrosis, a high-risk population for severe flu infection, usually very compliant for seasonal flu vaccine. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a qualitative study based on semi-structured interviews in 3 cystic fibrosis referral centres in Paris, France. The study included 42 patients with cystic fibrosis: 24 who refused the vaccine and 18 who were vaccinated. The two groups differed quite substantially in their perceptions of vaccine- and disease-related risks. Those who refused the vaccine were motivated mainly by the fears it aroused and did not explicitly consider the 2009 A/H1N1 flu a potentially severe disease. People who were vaccinated explained their choice, first and foremost, as intended to prevent the flu's potential consequences on respiratory cystic fibrosis disease. Moreover, they considered vaccination to be an indirect collective prevention tool. Patients who refused the vaccine mentioned multiple, contradictory information sources and did not appear to consider the recommendation of their local health care provider as predominant. On the contrary, those who were vaccinated stated that they had based their decision solely on the clear and unequivocal advice of their health care provider. CONCLUSIONS/SIGNIFICANCE: These results of our survey led us to formulate three main recommendations for improving adhesion to new pandemic vaccines. (1) it appears necessary to reinforce patient education about the disease and its specific risks, but also general population information about community immunity. (2) it is essential to disseminate a clear and effective message about the safety of novel vaccines. (3) this message should be conveyed by local health care providers, who should be involved in implementing immunization.

A new condition specific quality of life measure for the blind and the partially sighted in Sub-Saharan Africa, the IOTAQOL: methodological aspects of the development procedure.

In Mali, blind and partially sighted people represent 1.2% of the population. Good quality and low cost ophthalmologic care is available, but, unfortunately, is insufficiently taken advantage of. In order to contribute to the analysis of this situation a valid and reliable questionnaire was needed to take the patient's perspective into account. Because of face validity concerns, it was not possible to merely translate an existing questionnaire. Thus we decided to develop a new questionnaire directly in one of the main languages of Mali: Bambara. This involved the setting of a study team composed of social and health science specialists, the majority of whom were native Bambara speakers. The overall project consisted in the iteration of three main steps (1) Conceptual clarification and operationalization of this concept. (2) Qualitative steps: qualitative interviews, focus groups and content analysis. (3) Quantitative steps: statistical analysis of an initial try-out survey (143 participants) and a validation survey (420 participants). This approach yields satisfying results. Indeed, the final version of the IOTAQOL has good psychometric properties. Thus, this interviewer administered instrument can be used to measure health-related quality-of-life in Mali and the methodology that we used could serve as a basis for similar projects.