Problématique médicale et sociale d'une vague migratoire nouvelle sur Briançon : bilan d'une année de prise en charge et vécus des parcours de soins

Abstract : Introduction and hypothesis: Since 2015, the Briançon valley has been the site of a major migratory influx. Located on the Franco-Italian border in the heart of the Alps, the city of Briançon welcomes and cares for this significant migrant community. The health needs of newcomers are specific, multiple, have no prior description and constitute a genuine public health challenge. Briançon's Access to Health Care Centre (PASS), created in 2017, manages their health-care demands in conjunction with associative networks. This cross-sectional study, both quantitative and qualitative in nature, aims to describe the health status and requirements of migrants in border areas, in order to encourage future reflections on the objectives of PASS in the local area. Material and method: A quantitative, retrospective, observational survey, conducted from May 2017 to October 2018 and based on the data from 2,198 files at the main health-care sites (PASS, emergency unit, associations), collected ages, origins and objectified pathologies of migrant patients. A qualitative survey carried out in September and October 2018 at community centres aimed to explore representations of points of view, experiences of health-care services of newcomers and the public's own expectations for health care. Results: Of the 2,198 newcomers, who were mostly from Sub-Saharan Africa (98.3%), the majority (36%) had traumatic diseases, mostly caused by border crossings. Infectious pathology was the third reason for seeking health care (15.8%), but communicable infectious diseases were insufficiently evaluated, mainly because of those for whom follow-up was not possible. Mental health issues affected only a minority, of 3%. Fifteen semi-structured interviews were conducted with patients of diverse age, sex and origin, and representative of the source population. The interviews revealed the importance of the cultural approach during consultations, in order to shape representations and the use of care. The expression of mental suffering is complex, the European concept of psychotherapy not being accepted or perceived of as a solution for newcomers. Somatization, which is frequent, is one explanation for this problem. The difficulty of accessing health-care services in Italy leads to departures to France. The main expectation of newcomers is to be reassured about their health status through a medical consultation. Conclusion: Permanent care attendance (PASS) is appropriate for primary care, but is lacking in the areas of communicable disease prevention and mental health. It is therefore necessary to strengthen prevention for newcomers, but also to train and raise awareness among the caregivers involved in the problems that are specific to this community, and to take account of psychological suffering in all its forms by addressing it in an appropriate way.
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Chloé Lecarpentier. Problématique médicale et sociale d'une vague migratoire nouvelle sur Briançon : bilan d'une année de prise en charge et vécus des parcours de soins. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02172311⟩

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