WORLD WORLDWIDE SPAIN News Journal Update - (en) Spaine. CNT, #435: Politics, V, midwife in Mayotte: "Wuambushu continues here in a very concrete way" (ca, de, fr, it, pt, tr)[machine translation]

 To follow up on our coverage of Mayotte news, AL went to meet (by

telephone) V., a midwife who has been working for about a year, in a
dispensary in Mayotte. ---- AL: What is the situation of the hospital in
Mayotte? V: The healthcare system is extremely saturated and chronically
understaffed. The Mayotte Hospital Center (CHM) in Mamoudzou, the
prefecture, only has seven birthing rooms, the equivalent of maternity
wards with half as many deliveries in mainland France. In
hospitalization, triple rooms are systematic. Many treatments and
deliveries take place in the corridors on stretchers in full view of
everyone.

If we count all the births on the island, Mayotte is the largest
maternity hospital in Europe, with more than 10,000 births per year,
including between 400 and 1,200 in each of the four dispensaries. These
dispensaries are specific structures in Mayotte with the particularity
of operating without doctors: no anesthesiologist, pediatrician or
obstetrician-gynecologist, these maternity wards are only managed by
midwives. This makes it impossible to perform certain procedures on site
such as cesarean sections or instrumental deliveries. In the event of a
problem, patients must be transferred to the CHM by helicopter or
ambulance, and these structures are quite far away: at least a
forty-five minute drive for the most distant.

This leads to a lot of overwork for midwives, who are required to carry
out actions that do not fall within their remit, sometimes without
training. If there is a problem later, you find yourself having to
assume legal responsibility. In the event of a lawsuit, the CHM turns
against the midwives, even though these are the conditions that force
these practices: a systematic transfer to the CHM would be impossible.
But despite serious dysfunctions, these trials are exceptional because
the majority of patients are undocumented.

Photo of a stethoscope
As part of the feminized sectors, the profession of midwife faces
difficult working conditions throughout the territory, and particularly
in Mayotte.
DR
Is the hospital impacted by Operation Wuambushu? Yes, on several points.
First, for undocumented patients, greater difficulty in getting to
places of care. The gendarmes and the border police regularly carry out
checks at crossing points on the way to the hospital, which, in fact,
dissuades patients from coming, for fear of being checked and arrested.
At the very end of pregnancy, women are supposed to be protected from
expulsions (in theory from 32 weeks of amenorrhea), but not before and
the application of this law is uncertain. Mothers have already been
arrested and expelled when going to see their child in a neonatal
facility and fathers when going to register a birth. For pregnancy
follow-ups in dispensaries, certain specialized consultations should be
done in Mamoudzou, but patients no longer go there for fear of being
checked.

Secondly, the pro-Wuambushu collective in Mayotte blocked the CHM, the
dispensaries, and the Maternal and Child Protection (PMI) centers. This
blockage lasted eleven days, when the Comoros refused to take back its
nationals interned in the CRAs. The collective, made up of Mahorais with
varied profiles, had the slogan: "they block, we block". By blocking
access to public health services, according to them saturated by care
for Comorians, they forced patients to seek treatment in the private
sector or elsewhere. The orthogenics center (which performs abortions)
was blocked for a week. The collective carried out sorting at the
entrance, in theory allowing "emergencies" to pass, assessed by them.

During this entire period, the CHM did not take a position, only one
directive was transmitted to caregivers: not to enter into communication
with the collective or the press. The police regularly came to check for
any overflow, but were instructed not to let the patients pass. The
majority union of the CHM (entirely Mahorais, the metropolitans being
poorly unionized due to turnover) defended, even supported, the
collective, with, after a few days, taking a position in favor of a
"right of withdrawal mahorais" in support of the collective following
the attack on a dispensary. The collective threatened caregivers,
particularly in metropolitan France, who continued to work. Faced with
this situation, the police said they were waiting for instructions from
the prefect, who said they were waiting for the position of the ministry...

Third, recruitment is completely frozen, particularly in health. There
is currently a shortage of 100 midwives in Mayotte: there are 80 of us
for 180 positions, despite very attractive salaries. Two of the
dispensaries have been closed due to lack of staff since the beginning
of July, forcing patients to give birth on the other side of the island.

Photo of Dzaoudzi Hospital
The first hospital in Dzaoudzi, built in 1847 on "le Rocher" (Petite-Terre)
Jean-Pierre Dalbera
How is the operation perceived by the population? This is a difficult
question to understand from the mainland. Mahorais are very
pro-Wuambushu. For them, the operation responds to a demand brought
about by strikes and other actions such as the blockade of the
prefecture (with sorting of applicants for residence permits by
activists). The situation is such (insecurity, many children out of
school due to lack of space) that even "moderate" Mahorais see no
alternative to the security response. Most organizations, even so-called
"left-wing" organizations, positioned themselves in support of the
operation, such as the CGT or the local branch of LFI, breaking with
their national lines. For locals, it is almost impossible to publicly
take a stand against Wuambushu. Critical positions are almost
exclusively held by mzungus[1], which the Mahorais see as a sign of
ignorance of local realities. A caregiver petition against Wuambushu was
started, but it was signed almost exclusively by mzungus caregivers.
There were also demonstrations by professors opposed to the operation.

To understand this situation, it is important to say that a lot of work
has been done by the State to build a nationalist feeling and a national
romance. This takes, for example, the form of comics published in
conjunction with different institutions (the prefecture, the
departmental archives, the Regional Directorate for Women's Rights and
Equality), widely distributed on the island and carrying a fictionalized
history of Mayotte, colonization and its departmentalization. All this
translates among the Mahorais into a very strong pride in being French,
backed by a negative vision of the Comoros, who allegedly made the
"error" of refusing to become French in 1975. Despite a strong mix of
people, there has a very strong distinction in the speeches between the
Mahorais, the Comorians, the Malagasy and the Mzungus. The operation has
exacerbated these divisions

What differences in working conditions do you notice compared to
mainland France? Above all, a huge lack of means: the premises are very
insufficient and unsuitable, more so than in mainland France. The
situation is critical given the number of births. We only have one
operating theater close to the delivery rooms, whereas at least two or
three are needed. The ambulances are defective and dangerous, new ones,
promised for a year, are just beginning to be in service. For a time we
only had one ambulance on duty, with no alternative in case of
simultaneous emergencies. A heliport should be built at each dispensary:
as it stands, helicopter transport is only accessible during the day and
requires an ambulance to reach the takeoff locations.

The understaffing is massive. Currently we operate with 15 guards per
month per person (compared to 11.6 normally), and many overtime hours
(at least one hour per guard). It is impossible to recover them by
asking RTT or to ask leave for lack of personnel. The teams are
exhausted. In an internal study carried out at the beginning of July by
midwives in dispensaries to challenge the general director, the question
"Are you going to renew your contract?" 80% of midwives replied that
they intended to resign or not renew within the next six months. The
closure of dispensaries forced caregivers to come to work in Mamoudzou,
with journeys sometimes lasting more than an hour on dangerous roads and
without a proposal to develop the CHM on time, which led to many
stoppages. disease. Currently the teams rotate thanks to the Health
Reserve (teams who come for three weeks) and short contracts from the
ARS with midwives who come for a maximum of two months. There are almost
no more one-year contracts.

Do you see any gaps in access to care between the different populations
on the island? Yes. The first thing to say is that AME (State Medical
Aid) does not apply to Mayotte: patients in an irregular situation must
pay part of their care (5 euros for a dispensary consultation by
example), a measure intended to prevent the "draw of air" that
accessible care would cause. The conditions of access to social security
are also tougher than in mainland France.

There is no private clinic in Mayotte. Some of the wealthiest people
seek treatment in Reunion or in mainland France (including for
childbirth). We therefore have a three-tier system, between people in an
irregular situation, the Mahorais, and the richest who can seek
treatment elsewhere.

Aerial photo of the Mayotte Hospital Center
The Mayotte Hospital Center is a structure composed of a central
hospital and four peripheral hospitals. It hosts over 10,000 births
annually.
MHC
A previous issue of AL mentioned ARS directives concerning the
systematic offer of sterilization to Comorian women. What does this look
like on site? In truth, there was no on-site implementation or
communication. It is surely more an announcement effect of the ARS. In
any case, it would be very complicated to put in place in practice given
our material conditions. In fact, it is already complicated to respond
to requests for tubal ligation for practical and administrative reasons.
Expanding the practice is quite fanciful.

Behind this subject, for me, there is also the question of a
paternalistic and patriarchal vision and practices of care. In fact, we
often make a lot of decisions, appointments, on behalf of the patients,
who have complete confidence in us. We try to avoid being too
paternalistic, but some doctors can take advantage of this. Consent
forms are signed quickly and without too much explanation. Patients
don't always understand. And at the same time the lack of means makes it
sometimes difficult to do better.

There is also a cultural gap between mzungus and locals in the way of
healing: there are many local alternative medicine practices (massages,
herbal medicine), but this is not taken into account at all. Extreme
turnover makes it impossible to develop a practice that adapts to the
population (almost no one stays for more than two years, with contracts
often lasting two or three months).

Are solidarity initiatives being organized locally? Frankly there are
few initiatives. Associations of lawyers exist to defend Comorians, but
there is a lack of means for that too. I mentioned the anti Wuambushu
movements of caregivers or teachers, but they often face a feeling of
illegitimacy: the people of Mayotte reproach them for not knowing, or
even not liking Mayotte. Not understanding the insecurity and the need
for the operation.

How are metropolitan opposition movements perceived in Mayotte? We are
quite cut off from the discourse of the metropolis. Mayotte Première,
the local public channel, only broadcasts pro Wuambushu Mahoran speeches
and does not talk about critics. This lack of relay means that critical
speeches about the operation are not widely heard, even among people who
are sensitive to it, demonstrations of support in mainland France, for
example, are not relayed and I only learned of their existence very
late. To this disconnection is added the specificities of the local
context which make it difficult to transpose metropolitan discourses. An
opposition will in any case be referred to a lack of knowledge of the
territory by most Mahorais.

There is a very strong feeling of abandonment and disinterest on the
part of the metropolis. We have the feeling that every six months the
metropolitan press starts talking about the problems in Mayotte for a
week before forgetting it again, whereas here these problems are
everyday life. When the media talk about it, we suddenly receive
messages from relatives asking us if everything is fine, whereas here it
is as usual in fact. It's the same for Wuambushu, which we no longer
talk about in the press but which continues here in a very concrete way.
We have the feeling of constantly falling into oblivion.

Comments collected by N. Bartosek (UCL Alsace)

See as well:

Operation Wuambushu in Mayotte: the extremism of neocolonial inconsistency
Against the racist state: No to Operation Wuambushu!
State racism in Mayotte: Obsessed with women's bellies
No to Operation Wuambushu in Mayotte

To validate

[1]Mzungu: "European" in Mahorais, refers to white people, generally
from metropolitan France.

https://www.unioncommunistelibertaire.org/?V-sage-femme-a-Mayotte-Wuambushu-continue-ici-de-facon-tres-concrete
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