Health
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31/12/2020
DR
Charline Ribaud is a health mediator in priority neighborhoods of city policy in Bourg-en-Bresse. She is one of the forty-five professionals to occupy this position imagined in 2015 by the regional health agency Auvergne-Rhône-Alpes for communities and associations.
By Véronique Vigne-Lepage
Average town of 41,500 inhabitants, prefecture of Ain, Bourg-en-Bresse is far from being a “medical desert”. However, many inhabitants of its two priority districts of the city policy (QPV) give up care. At issue: poverty, isolation, lack of linguistic and digital skills… This observation, drawn up during a municipal diagnosis in 2016, led the city to respond to a call for projects launched then, for the second consecutive year. , by the regional health agency (ARS) Auvergne-Rhône-Alpes. Its purpose: to finance the creation of posts for health mediators in QPV. “The communities asked us to enter into the city contracts. We were able to do this in a concrete way by making health mediation in QPV a preferential action of the regional program for prevention and access to care for the most deprived (Praps) ”, explains Fabienne Chambe, precariousness referent at ARS. These two calls for projects made it possible to create forty-five posts of health mediators in QPV which cover 60% of the priority districts of the region.
Various profiles
This new mission has been opened to candidates from all professional backgrounds. While Roanne Agglomeration (Loire), for example, has recruited a former nurse, the city of Bourg-en-Bresse has hired Charline Ribaud, who has worked in disability and social circles. “We have very diverse backgrounds and, depending on the employer who carries the position, the mission is declined a little differently. But we have all been trained and we rely on the framing elements of the ARS and the High Authority for Health ”, assures the latter, which knows its counterparts thanks to the networking facilitated by the ARS. In 2017, the latter drew on the experience of Auvergne-Rhône-Alpes to develop a skills framework.
Each QPV health mediator begins by meeting all the local partners. “For my part, I am attached to the hygiene and public health service, where I work in close collaboration with the coordinator of the city health workshop. This greatly facilitated these contacts for me. It even allowed us to build and develop my mission together, ”explains Charline Ribaud. This is in addition to the post monitoring committee created at the initiative of the ARS and including representatives of municipal services, the department of Ain, social security and an association of health professionals.
Charline Ribaud was an educator in the field of disability, before becoming a specialized educator in a social center. But institutional cumbersome weighs on him. She stops, reflects… Before discovering the transversal and innovative profession of health mediator in QPV.
Distribution of flyers
To make yourself known to the inhabitants, the recommended method is “going to”, which Charline Ribaud had already practiced as a specialized educator. But while some of her counterparts are implementing it door-to-door, she chose to first design a flyer on her role, helped by the CCAS users’ committee: “They made me understand, for example, that people would be less reluctant to call me if I entered my name rather than an impersonal phone number ”. Today, the flyer is circulating by MMS. “When an inhabitant comes to me on the recommendation of another, everything goes faster,” she says.
It also broadcasts it when leaving schools or during “mobile cafes” organized by specialist educators, which allows it to publicize its permanence in social centers. There, she listens and disentangles the difficulties, even if it means “spending two hours explaining universal health protection. From the outset, I tell the person that she herself will present her file to Social Security, so she regains confidence in herself and in the institution, ”she explains. Often, she gives way to her computer for an online process. “This reversal of positions always causes a change,” she assures us.
Whatsapp to communicate with locals
A subject of little significance in 2015, digital technology has become a frequent obstacle to access to healthcare. During the spring 2020 containment, it became central … while the “digital spaces” had to close: “Confined at home, I started using Whatsapp to communicate with the inhabitants. Thanks to the partnership established, Social Security sent me their numbers, ”reports the mediator. Often known to the population, this application has thus enabled them to receive photos of the documents necessary, for example, for the opening of rights. “I converted them into the correct computer format and then emailed them to Social Security. But by always having the sending validated by the person and by not keeping any document, for the respect of personal data, ”she explains. Also challenged, during confinement, by families in financial distress, Charline Ribaud transmitted the information to the department: “There, I really saw my role of mediation”, she notes.
A role that it also plays fully, beyond this health crisis, to help residents go to health professionals. Having identified deficiencies in the dental follow-up of children, Charline Ribaud thus distributed information and contacts. “Now, mothers are exchanging the contact details of dentists”, welcomes the mediator. But prevention remains a “hard point”: “I give the messages to the inhabitants. But that makes them smile, they have other concerns… ”, testifies Charline Ribaud.
Mobility
She does not give up and tries to act on another lever: mobility. She thus provides advice on the bus trip to the medical and dental center, hospital or social security fund. She herself travels by public transport or, more often, with the electric bicycle provided by the city. “It makes me visible and it allows me to be sure not to be taken for a taxi by some residents struggling to become independent,” she explains. If, for their part, the positive impact of its presence is only gradually assessed, by small touches, the satisfaction of the ARS is clearly visible: the position of Charline Ribaud obtained funding this year. for three years instead of being renewed every year.
DRSophie Aulaz, hygiene and public health manager for the city of Bourg-en-Bresse
“This field observation is priceless”
“This position enables continuous local diagnosis as it provides detailed observation of the obstacles to access to care. Charline Ribaud, for example, identified problems with dental care and vaccinations for children. Families no longer know where to go because the PMI lacks doctors, general practitioners are in difficulty, there is a lack of dentists… We are transmitting this information to the ARS, but, for us too, this field observation is priceless . It allows us to have a more relevant action. The ‘go to’ method is new in the health field. It is interesting in these districts where the inhabitants are not used to talking about their difficulties. We had thought of recruiting a peer mediator, but the mission would not be possible for a non-professional, because we cannot be free from ethics ”.
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