“We lack everything here”

“Girls, get a stretcher ready, we have code orange!” In a fraction of a second, the maternity team of the Mayotte Hospital Center (CHM) is on the bridge. The thirty-minute countdown is triggered in order to perform an emergency caesarean section. In the corridor, a midwife covers a bed on wheels with a white sheet and goes to the room indicated. Once the anesthesiologist is present, head for the only operating room on the floor. Luckily, it’s empty. In the nursery, the pediatrician carefully prepares a resuscitation table. “Everything has to be ready when needed”he says, looking for a probe.

>> REPORT. Operation “Wuambushu” in Mayotte: in the largest slum in France, Comorians fear “civil war”

Less than twenty minutes later, a midwife comes running out of the operating room, the baby in her arms. “How are you ?”says a worried nurse. “No”, replies the young woman in flip-flops and a green outfit. The newborn lacks oxygen. “Hello young manwhispers the pediatrician above the medical cradle. Come on, it’s good, keep it up!” After thirteen long minutes, the screen finally displays a figure close to normal. Caregivers can breathe…just minutes before the next birth.

In the middle of the Indian Ocean, the CHM looks like a giant liner. Since the 1960s, the only hospital center in the department has been trying to meet the health needs of a population of nearly 300,000 inhabitants. A growing number and “highly underrated”, affirmed in June 2022 the Court of Auditors. Over the years, a multitude of buildings with disparate shapes and colors have been built in the city center of the capital, Mamoudzou, connected by wooden walkways. A simple white panel specifies the beating heart of this exceptional hospital: the maternity ward. It is the largest in France, with more than 9,000 births in 2021, according to the Directorate of Research, Studies, Evaluation and Statistics. “A whole class is born every day in Mayotte”believes Julien Fontaine, midwife coordinator.

“I still had to give birth in the hallway”

Seen from the inside, the premises do not translate the vertigo of the statistics. “We only have seven delivery rooms here.explains Céline Magny, part of the obstetrics gynecology department. In Bordeaux, for 6,000 births per year, they have 13!” A structural problem that goes beyond births. So, “all disciplines combined, the number of beds (full hospitalization) per 100,000 inhabitants varies from 139 in Mayotte to 900 or more in Cantal and the Hautes-Alpes”according to the Ministry of Health (PDF). “In the maternity ward, the bed occupancy rate is 140%, all the rooms are doubled, even tripled”adds Céline Magny, whose the accent betrays the 15 years spent in the maternity hospital in Pau before joining Mayotte. “We lack everything here.”

Stretchers must be installed in the corridors of the maternity ward. In one, a young woman is writhing in pain, barely soothed by her mother’s hand on her arm. “We had to take stretchers in outpatient surgerybreathes a nurse. Sometimes there are even in front of the elevator.” Curtains are regularly drawn in the passageways to maintain a semblance of privacy. “Two days ago, I still had to give birth in the hallway”recalls a midwife who had been there for less than two years.

Under these conditions, certain recommendations from France have great difficulty in being applied in Mayotte. In the small maternity nursery, ten babies are sometimes brought together and some find themselves in the same cradle.

“Normally, we should watch a woman who has just given birth for two hours, but here we often need the room much more quickly.”

A CHM nurse

at franceinfo

All teams would dream of “pushing the walls”. An almost impossible mission in downtown Mamoudzou. So, to unclog the hospital center, many mothers are sent to one of the four clinics spread over the archipelago, just hours after the birth of their child. “We also have to transfer them before the end of the day, otherwise they will spend four hours in traffic jams, Céline Magny breathes. When you don’t have flashing lights, it’s the cross and the banner to cross the island.”

This part of Tetris permanently weighs on the working conditions of the centre’s 2,200 agents. At the maternity ward, as in the other services, the turnover and the lack of staff is glaring. More than half of the members of the medical team work as contract workers, two-thirds of them on short contracts, identified in 2020 the Court of Auditors.

In the midwifery office that day, a 26-year-old midwife advances to dean. “I’m one of the oldest even though I’ve only been here two years”explains the young graduate who still rents “awesome atmosphere” of service. In front of their computers, his colleagues are only there for contracts of three, six or twelve months. In the toilets, the photos and first names of dozens of midwives who have passed through the CHM cover the walls up to the ceiling.

In these difficult conditions, the teams on site have to face a unique challenge in France: the explosion of the population. Between October 2020 and October 2022, Mayotte is the only French territory whose number of daily births has increased, details INSEE. By 2050, between 440,000 and 760,000 inhabitants should thus live on the archipelago, according to the regional health agency (ARS).

The explanatory factors are multiple, including a particularly high number of children. “With 5 children per woman in Mayotte, fertility is increasing and still far exceeds the metropolitan average (1.9 children per woman)”wrote INSEE in 2019. “We have both very young mothers, but also older mothers who have a lot of children,” notes Rakfia Mouhoutar, midwife coordinator for nine years in Mayotte. Almost all of them have one thing in common: a precarious life and reduced access to care. “Pregnancy is often the only time they will see a health professional”notes the frame.

In the archipelago, nearly 80% of the inhabitants live below the poverty line, reports INSEE. More than 20% declare themselves to be in poor or very poor health, compared to 7% in France and Corsica, underlines for its part the ARS. “It’s emergency medicine more than everyday medicine”, analyzes an internal service.

“We are not going to run away from our misery”

One of the patients at the hospital suddenly approaches a midwife. His pain is visible on his face. Problem: she does not speak French. This is the case for many people here, especially those from neighboring Comoros. In 2016, 75% of women who gave birth in Mayotte were foreign, according to the ARS.

Caregivers and childcare auxiliaries then put on their second hat. “Here, we have two jobs: carer and translator”, explains one of them, before reassuring the patient in shimaoré, one of the languages ​​spoken in Mayotte. Their assistance is essential to the proper functioning of the maternity ward. “I was born here, says a childcare worker who has more seniority at the CHM than the four midwives in the service combined. It’s our home. We are not going to run away from our misery.”

Comorian women who come to give birth at the CHM have often been settled in Mayotte for a long time, with or without papers. They are barely more than 10% to arrive in the French department during their pregnancy, notes the ARS. Despite this, it remains very difficult to set up a follow-up before delivery. “Many Comorian women live alone in a banga [case en tôle] with their children and cannot come to the consultations”, explains Céline Magny. It also happens that the fathers are expelled during the hospitalization of the mother.

Exceptions in French law

Once the baby is born, other challenges remain for the medical team to overcome. “There are a lot of identity theft, so that the child obtains French nationalitynotes a health executive. A few days ago, a father came to ask me for a blank to modify his birth certificate.

“Demography in Mayotte means that all public services are dysfunctional” said the Minister of the Interior and Overseas, Friday, April 21, on franceinfo. Gerald Darmanin intends to multiply the expulsions of undocumented migrants during of a vast operation launched at the end of April and baptized “Wuambushu”, “recovery” in Mahorais. He also wants tighten the conditions for access to French nationality in Mayotte. A new exception in French law, which comes on top of the absence of state medical aid (AME) and universal medical coverage (CMU), recall the senators in a report on the archipelago delivered in July 2022 Among the foreigners living in Mayotte, only pregnant women, minors and people in need of emergency care have access to free care.

Despite the continuous influx of patients in the waiting room, the atmosphere remains strangely silent in the maternity ward. “Here, the women complain very little, they do a lot of the work alone, it’s lucky for us”, notes a midwife. But behind this apparent calm, births continue at a frantic pace. Barely time to take a lunch break for one of the professionals when two newborn babies landed in the nursery.