Description d'un réseau informel de soins primaires au sein d’un désert médical : exemple du cirque de Mafate (La Réunion)

Abstract : Background : the Cirque de Mafate is a tourist attraction of Reunion island. Located in a very remote region of the island, the Cirque is accessible by foot or helicopter only and has a limited access to medical care. There are 900 people living in the Cirque and 90,000 hikers are visiting the region each year. The lack of medical supplies, the low number of general practitioners and the geographic isolation are significant barriers to implementation of health care centers in the Cirque. In this context, we believe that an informal health care network is taking place for people who need medical care. Considering the centrality of refuge keepers in the Cirque, we make the hypothesis that they play a key role in this network. Objective : the objective of this study is to highlight this informal health care network, to describe its structure and understand how the actors of the network interact with each other. Methods : a cross-sectional study was conducted over a period of 7 months among 40 refuges. Self-administered questionnaires were filled out by refuge keepers each time they were consulted for medical advice by the local community or the hikers. Results : A total of 61 completed questionnaires were collected. Refuge keepers were frequently visited by people who needed medical care, especially in the villages of Nouvelle, Roche Plate, Aurère and Marla. 96% of the injured people were hikers, 7% of whom were addressed by another refuge or someone else. The majority of medical interventions (85%) were trauma-related. 97% of the refuge keepers played a role in disseminating information or distributing medical supplies. 75% of the medical consultations were carried out autonomously, otherwise the use of external assistance was required, usually the SAMU. The SAMU proceeded to the evacuation of 89% of the individuals who asked for medical assistance at the refuges. Conclusion : an informal network of primary care has been developed in the Cirque of Mafate where access to health care is difficult for the local community and visitors hiking in the region. Supported by the refuge keepers, the network links the hikers to the official health care system of the island. Some refuge keepers seemed to be more involved in the network, i.e. even taking care of injured people when addressed by another person. Despite the small number of completed questionnaires, this study provides us some insights into how access to primary care in the Cirque of Mafate could be optimized. Further studies are needed to further investigate the characteristics, the motivations and the expectations of the refuge keepers. This would allow us to better understand the actors of the network in order to support their activities. Indeed, we could consider integrating it into an official health care network. Refuge keepers could be selected to keep medical equipment and supplies, and to have a special link with the SAMU. The use of telemedical consultation could also make the delivery of drugs more controlled.
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Master Thesis
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Submitted on : Tuesday, February 13, 2018 - 6:47:18 PM
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Charlotte Robert. Description d'un réseau informel de soins primaires au sein d’un désert médical : exemple du cirque de Mafate (La Réunion). Médecine humaine et pathologie. 2017. ⟨dumas-01708586⟩

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