Valentina, 5 months, sick with bronchiolitis before Christmas in Toulouse: at the heart of a health system in the woods
By David Saint-Sernin
Published on
Our health system, In Toulouse, does he resist while the epidemics are piling up and staff are under extreme strain since covid engulfed our lives almost three years ago?
“Very critical” situation
Visiting the Paris Samu, based at the Necker hospital, then at the Delafontaine hospital in Saint-Denis (Seine-Saint-Denis), Thursday December 22, 2022, the Minister of Health, Francois Brown, one mentioned one situation “very critical at the level of the health system” due to the triple winter epidemic of Covid-19, bronchiolitis and influenza, which weighs on “saturated” emergency services.
No need to live in Paris to feel the difficulty of taking care of patients during the end of year celebrations. Valentina, 5 months, your servant’s daughter experienced it at the dawn of her life.
Valentina was to spend her first Christmas with her family. It probably won’t. Like hundreds of children for several weeks in Occitania, she was overtaken by the coronavirus virus. bronchiolitis. A “carabineer” virus.
A system on a wire
Friday, December 23, 2022, supported by a formidable pediatric unit at Purpan hospital, Valentina was stabilized. It’s essential.
The following (personal) story recounts the difficulty, even the impossibility of properly caring for patients, whatever their age, in the current health system, as it is integrated.
This story will describe the disintegration of the architecture of our health system in Toulouse, one of the cities which nevertheless shines by the quality of its hospitals each year. A system that is hanging by a thread, carried at arm’s length, at the end of the care chain, by overwhelmed doctors and hospital nursing staff who bail out the boat. A staff that compensates for the shortcomings of an overall organization in bad shape. An organization can no longer guarantee normal care for patients, especially infants. In the story that follows, no one is really to blame. Everyone does what they can with the means they are given.
A cold, then difficulty breathing
Valentina, so that’s my granddaughter. She turned five months old in December. A dynamic and very smiling infant every day. A cream. A love.
Except that this Monday, December 18, she began to be taken from the nose and sneeze. No wonder his big brother had been sneezing the week before. Baby fly, suppositories: we started to cure this cold.
Except that the cold got worse despite our efforts. From the taken nose, we passed to the respiratory embarrassment. With my wife, we sought to make an appointment with our doctor.
Submerged medical offices
We live 15 kilometers from Toulouse and you would think that 15 kilometers from a big city like Toulouse, known for its state-of-the-art health services, offering the good care of a doctor is a formality.
This is not the case. In our municipality of more than 3500 inhabitants, where the population is constantly increasing, the two medical practices are overwhelmed. The doctors are competent, provide, benevolent, take care of the patients as much as possible but they are literally attacked.
Medical deserts, even in the city
In the Toulouse conurbation, it is not yet Gers, Aveyron or Lozère, but medical deserts are also everywhere. And they are where we would never have believed a few years ago.
According to statistics from the order of doctors, published in 2017, 300 general practitioners in the Toulouse area are now 5 years from retirement.
Directly to the office
This Wednesday, December 20, on the platform Doctolib, no appointment is available for several days in our medical office. My wife decides to knock directly on the doctor’s door, at the office. One of the doctors gently inserts Valentina between two patients. His diagnosis: it is therefore bronchiolitis.
The GP warns. “If it does not evolve favorably within 48 hours, you will have to come back to consult. One of the three doctors in the practice will always be in post, ”he reassures.
But Valentina’s condition is not improving despite our efforts. In the night from Wednesday to Thursday, it is the fever which makes its appearance. Not a high fever: 38.4°C. We administer one of the last two Dolipranes we have left, in the form of a suppository.
The shortage of Doliprane…
Doliprane in suppository, I did not even know before this month of December 2022. But for several weeks, in the pharmacy of my village, it is rare to be able to find Doliprane in syrup for children.
This Thursday morning, first thing in the morning, I go to this pharmacy hoping to find these precious suppositories there.
“It’s out of stock, we have no more Doliprane, neither in syrup nor in suppository. I would never have thought I would see that one day”, the pharmacist announces to me with a contrite air, inviting me to visit her colleagues in the neighboring towns.
In recent days, the press has been talking about a possible shortage of Doliprane for the month of January 2023. Except that the shortage is not coming, it is already there, affecting pharmacies one after the other as deliveries have become irregular.
After three pharmacies, we end up finding this famous Doliprane, a basic drug that has become a treasure.
No on-call GP
After administration, the fever stabilizes, Valentina’s condition seems to improve. The day passes but at bedtime, the discomfort reappears. Our baby is moving all over the place. A hiss appears. The ribs are hollow when breathing. All the symptoms our doctor told us to watch out for as an alert.
It’s past 9 p.m. We call 39 66 to find a doctor on call. The person tells us that there is none. “After 9 p.m., there is no longer a doctor on duty in your area…If I could send you one, I would.” At night, 15 kilometers from Toulouse, general medicine is therefore now absent. The person on the phone switches us to Samu 31.
At night, in Haute-Garonne, it is therefore the Samu 31 which responds to hundreds of calls from people disarmed in the face of the disease, without local medical support.
The heavy responsibility of the Samu
It is therefore up to the Samu to sort out the patients who only continue to receive medical advice, those who need to see a doctor before their case worsens and those who continue to be hospitalized.
It is a heavy task and a great responsibility to determine, from a distance, on the sole observations of the interlocutors, what should be done. However, it is on this single Samu-parents pair, on the basis of a telephone consultation, without auscultation, that the health of our children is played out, even at a young age, at certain times of the day. Maximum constraint.
Based on our observations, the dispatcher, despite the acceleration of our daughter’s breathing, her agitation, the obstruction of her bronchi, the dispatcher tells us that this case is not an emergency. “As long as she eats, it’s fine…”, we summarize by way of consultation.
His condition is deteriorating
Barely hung up, we plan to make him do respiratory physio on Friday morning, make an appointment with a specialist (appointment that we will not ultimately honor).
But around 2:30 a.m., Valentina wakes up even more congested. Despite our efforts, we can see that we no longer relieve her. New call at 15. Long waiting minutes. Finally an interlocutor but still no on-call doctor of course. “Go to the emergency room? It’s up to you to decide “.
Emergencies are fermenting outside Toulouse
Emergencies, there are not many around our commune. Lavaur closed its service during the holidays and does not have pediatric emergencies. The Union clinic closed its service precisely for the night.
Purpan emergency room
Despite the embarrassment, our daughter sketches a smile. She looks good. And on our side, we parents, have a hard time discerning the seriousness of his condition. When in doubt, we go to Purpan. “I am announcing your arrival in the emergency room”, tells us the Samu regulator.
How many parents feel a bit abandoned in the middle of the night, facing their sick child? No doubt there are many…
The decision was the right one, Purpan’s service immediately taking care of Valentina with the greatest reactivity and the greatest kindness in the world. And immediately detecting a real respiratory distress of our child.
Our child saturated
Voltage, temperature, everything that could not be done remotely is checked. The pediatrician arrives to check. She sees that Valentina is in respiratory distress.
Use of aerosol and aspiration of nasal secretions stuck between the throat and the nostrils, which we could not have aspired despite our good medical will, we explain the staff.
We shouldn’t have waited any longer. Valentina was wearing herself out struggling even though she didn’t show. After being sucked in, Valentina was probed so that she could be fed and thus regain her strength. She may not escape artificial oxygenation. She’s going to spend her first Christmas in the hospital. The main thing is that she is now better.
So goes the price in charge of our infants in France in 2022, from the shortage of Doliprane to the absence of local medicine at night fifteen kilometers from Toulouse.
Always a composer on the 15th before going to the hospital: the instructions of the CHU
Always a composer on the 15th before going to the hospital, this is the instruction given by the Toulouse University Hospital. Here is what the CHU told Actu Toulouse a few weeks ago about the overflow of pediatric emergencies:
As soon as things appear, it is necessary to act. Comment ? By consulting the child’s usual doctor or pediatrician. If they cannot be reached, residents of Haute-Garonne can call SOS Médecins (24 hours a day, 7 days a week on 05 61 33 00 00) or an emergency medical center (La Faourette on 05 34 46 54 76 or la Cité de la Santé on 05 61 59 22 12) Patients living outside the department are invited to contact the hospitals closest to them: Albi, Auch, Montauban, Foix-Pamiers… In the event of an emergency (and even in doubt ), it is necessary to systematically contact the SAMU (by dialing 15). It is the SAMU who, depending on the emergency, will direct (or not) the patient to the hospital.
Clear on paper. But in reality…
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