DECRYPTION – Weakened by the lack of caregivers, the care of infants takes place in “degraded” conditions.
Fire smolders in pediatrics. The seasonal epidemic of bronchiolitis which is currently raging in infants under the age of two has triggered a health crisis in hospital departments dedicated to child health. Denouncing a situation that “continues to deteriorate everywhere in France” et “endangering patients”, a delegation of doctors planned to go to the Élysée on Wednesday to ask Emmanuel Macron for measures “urgent, strong and perennial”.
A first open letter was sent to the Head of State on October 21. The Minister of Health, François Braun, responded two days later by releasing an envelope of 150 million euros (to be shared with other services under strain), the triggering of white plans and the organization assizes of pediatrics in the spring.
Critical situation in Île-de-France
“The objective is to reorganize child health sectors” the minister said on Tuesday. But these proposals are judged “insufficient” by the Paediatrics Collective, whose letter was signed by 7,000 hospital and private caregivers, as well as by all learned pediatric societies and thirty patient associations. Some services, such as the pediatric emergencies of La Timone in Marseille, are also on strike to denounce their chronic understaffing.
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“The child health system has been seriously and for a long time neglected, comments Christèle Gras-Le Guen, president of the French Society of Pediatrics and head of service at the Nantes University Hospital. Added to this this year is an acute shortage of critical care beds, many of which are closed for lack of nurses and orderlies. The state of exhaustion of hospital paediatrics is such that it is no longer able to absorb the slightest increase in activity.
Bronchiolitis, a disease caused by respiratory syncytial virus (RSV), affects around one-third of babies under the age of two each year and most often results in coughing and wheezing. In the most fragile children, it can cause respiratory distress which requires assisted ventilation and hospital monitoring. According to the latest weekly bulletin from Public Health France (data from October 17 to 23), around 4,500 infants were seen in the emergency room for bronchiolitis in one week, of which 1,500 were hospitalized, an increase in activity of 40% compared to the previous week.
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This influx of patients leads to overcrowding in the emergency services, to which parents who have not found a consultation in town turn, and who are often very worried. It also causes a saturation of many general pediatrics and critical care services, forcing transfers of young patients to other more or less distant hospitals. These medical evacuations concern in some cases children in serious respiratory distress. In Île-de-France, for example, where the situation is most critical, 31 infants have been transported since the start of the epidemic to intensive care units in other regions.
“These transfers are not insignificant for patients whose state of health is by definition very unstable.underlines Stéphane Dauger, head of the pediatric intensive care unit at the Robert-Debré hospital in Paris. And imagine the complications this creates for parents! Moreover, it mobilizes highly specialized teams for hours.”
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This lack of hospital places further aggravates the traffic jam in the emergency room, where children are held for hours in consultation boxes while waiting for a bed to become available. “In this case, we have to start care and ensure monitoring in the emergency room, which leads to degraded care for these patients.regrets Jérémy Do Cao, pediatrician at the Antoine-Béclère hospital (AP-HP) in Clamart. And it increases the wait for other children requiring urgent care.” Its service, which has ten beds closed due to a lack of nurses, has already organized 32 transfers of children to general pediatrics in the Paris region but also in Dreux, Amiens and Chartres.
For the signatories of the open letter, it is time to send “a strong signal” so that services dedicated to children regain their attractiveness to healthcare personnel. “It’s not just a financial problem.emphasizes Stéphane Dauger. We want our specificity to be recognized and for our profession to regain meaning thanks to the restoration of acceptable working conditions”. Doctors recall that other epidemics, such as the flu, await the healthcare system this winter. But it happened, according to them, “to a point of no return”.