Dossier n° 11 - L’Arche de Zoé : un exemple d’incompréhensions autour de « l’orphelin »

L’affaire de l’Arche de Zoé oblige à interroger une nouvelle fois les incompréhensions qui peuvent exister entre les acteurs locaux et des acteurs humanitaires extérieurs, animés par des projets a priori généreux fondés sur leur système de valeurs. Quels enseignements tirer de cet épisode médiatique, politique et juridique exceptionnel ? Le 25 octobre 2007 les six membres de l’association L’Arche de Zoé sont arrêtés alors qu’ils s’apprêtent à quitter le Tchad avec 103 enfants. Il en est de mê..

Dossier n° 11 - L’Arche de Zoé : un exemple d’incompréhensions autour de « l’orphelin »

L’affaire de l’Arche de Zoé oblige à interroger une nouvelle fois les incompréhensions qui peuvent exister entre les acteurs locaux et des acteurs humanitaires extérieurs, animés par des projets a priori généreux fondés sur leur système de valeurs. Quels enseignements tirer de cet épisode médiatique, politique et juridique exceptionnel ? Le 25 octobre 2007 les six membres de l’association L’Arche de Zoé sont arrêtés alors qu’ils s’apprêtent à quitter le Tchad avec 103 enfants. Il en est de mê..

"Un, on te prend. deux, on t'efface.trois, on t'affiche" : le processus de dépersonnalisation des photographiés de l'humanitaire

International audienceQue nous apprend le processus de fabrication des photographies de " bénéficiaires " sur le droit à l'image dans l'humanitaire ? Au Kirghizstan, l'image est l'objet d'une négociation de l'aide. La fabrication d'"authentiques victimes " y est centrale comme dans les campagnes de l'église protestante allemande. L'analyse d'affiches conclut à un commun objectif : effacer l'altérité du " béné ficiaire " pour permettre un lien avec le " spectateur ". Le caractère factice de l'authenticité se révèle lorsque le photographié conteste l'image. L'exigence de l'égalité surgit alors comme condition aux projets pour les droits de l'Homme et offre des pistes pour une gouvernance de l'éthique du numérique

Corps transformé, corps dissimulé: Femmes vivant avec le VIH/SIDA au Maroc

Finding out about one’s HIV positive-status is an event that disrupts the couple’s ties and family cohesion. When HIV diagnosis occurs too late, AIDS can disintegrate the family, cause the death of parents as well as children, shatter the bonds of solidarity and trust within the couple, and make the family vulnerable.In this article, we propose to evaluate the way in which women living with HIV/AIDS in Morocco perceive their bodies and how they deal with bodily changes on a daily basis

Dernières recommandations européennes sur les dyslipidémies

Les dernières recommandations de l’European Society of Cardiology (ESC) introduisent plusieurs nouveaux concepts intéressants pour le praticien. Le patient « en bonne santé apparente » est différencié de celui à risque spécifique (diabète, insuffisance rénale et hypercholestérolémie familiale). De nouveaux outils de calcul du risque cardiovasculaire sont proposés (SCORE2 et SCORE2-OP). Les cibles de LDL-C proposées sont spécifiques à chaque groupe avec, en règle générale, une valeur < 1,8 mmol/l pour les patients à haut risque et < 1,4 mmol/l pour ceux à très haut risque. La présence de modificateurs de risque, les comorbidités et les préférences du patient modulent l’approche thérapeutique, qui repose habituellement sur le respect des règles hygiénodiététiques et, au besoin, l’administration d’une statine.The latest ESC recommendations propose several interesting new concepts for the practitioner. The recommendations distinguish between the «apparently healthy» patient and the patient at specific cardiovascular risk (diabetes, renal failure, and familial hypercholesterolemia). New risk calculation tools are proposed (SCORE2 and SCORE2-OP). The proposed LDL-C targets are specific to each group, as a general rule, < 1.8 mmol/l for individuals at high risk and < 1.4 mmol/l for individuals at very high risk. Presence of risk modifiers, comorbidities and patient preferences modulates therapeutic approach which is usually based on optimizing lifestyle and statin medication when necessary

“It depends how one understands it:” a qualitative study on differential uptake of oral cholera vaccine in three compounds in Lusaka, Zambia

Abstract Background The Zambian Ministry of Health implemented a reactive one-dose Oral Cholera Vaccine (OCV) campaign in April 2016 in three Lusaka compounds, followed by a pre-emptive second-round in December. Understanding uptake of this first-ever two-dose OCV campaign is critical to design effective OCV campaigns and for delivery of oral vaccines in the country and the region. Methods We conducted 12 Focus Group Discussions (FGDs) with men and women who self-reported taking no OCV doses and six with those self-reporting taking both doses. Simple descriptive analysis was conducted on socio-demographic and cholera-related data collected using a short questionnaire. We analyzed transcribed FGDs using the framework of dose, gender and geographic location. Results No differences were found by gender and location. All participants thought cholera to be severe and the reactive OCV campaign as relevant if efficacious. Most reported not receiving information on OCV side-effects and duration of protection. Those who took both doses listed more risk factors (including ‘wind’) and felt personally susceptible to cholera and protected by OCV. Some described OCV side-effects, mostly diarrhoea, vomiting and dizziness, as the expulsion of causative agents. Those who did not take OCV felt protected by their good personal hygiene practices or, thought of themselves and OCV as powerless against the multiple causes of cholera including poor living conditions, water, wind, and curse. Most of those who did not take OCV feared side-effects reported by others. Some interpreted side-effects as ‘western’ malevolence. Though > 80% discussants reported not knowing duration of protection, some who did not vaccinate, suggested that rather than rely on OCV which could lose potency, collective action should be taken to change the physical and economic environment to prevent cholera. Conclusions Due to incomplete information, individual decision-making was complex, rooted in theories of disease causation, perceived susceptibility, circulating narratives, colonial past, and observable outcomes of vaccination. To increase coverage, future OCV campaigns may benefit from better communication on eligibility and susceptibility, expected side effects, mechanism of action, and duration of protection. Governmental improvements in the physical and economic environment may increase confidence in OCV and other public health interventions among residents in Lusaka compounds

A rapid qualitative assessment of oral cholera vaccine anticipated acceptability in a context of resistance towards cholera intervention in Nampula, Mozambique

Introduction : While planning an immunization campaign in settings where public health interventions are subject to politically motivated resistance, designing context-based social mobilization strategies is critical to ensure community acceptability. In preparation for an Oral Cholera Vaccine campaign implemented in Nampula, Mozambique, in November 2016, we assessed potential barriers and levers for vaccine acceptability. Methods : Questionnaires, in-depth interviews, and focus group discussions, as well as observations, were conducted before the campaign. The participants included central and district level government informants (national immunization program, logistics officers, public health directors, and others), community leaders and representatives, and community members. Results : During previous well chlorination interventions, some government representatives and health agents were attacked, because they were believed to be responsible for spreading cholera instead of purifying the wells. Politically motivated resistance to cholera interventions resurfaced when an OCV campaign was considered. Respondents also reported vaccine hesitancy related to experiences of problems during school-based vaccine introduction, rumors related to vaccine safety, and negative experiences following routine childhood immunization. Despite major suspicions associated with the OCV campaign, respondents’ perceived vulnerability to cholera and its perceived severity seem to override potential anticipated OCV vaccine hesitancy. Discussion : Potential hesitancy towards the OCV campaign is grounded in global insecurity, social disequilibrium, and perceived institutional negligence, which reinforces a representation of estrangement from the central government, triggering suspicions on its intentions in implementing the OCV campaign. Recommendations include a strong involvement of community leaders, which is important for successful social mobilization; representatives of different political parties should be equally involved in social mobilization efforts, before and during campaigns; and public health officials should promote other planned interventions to mitigate the lack of trust associated with perceived institutional negligence. Successful past initiatives include public intake of purified water or newly introduced medication by social mobilizers, teachers or credible leaders

Innovative vaccine delivery strategies in response to a cholera outbreak in the challenging context of Lake Chilwa ::a rapid qualitative assessment

A reactive campaign using two doses of Shanchol Oral Cholera Vaccine (OCV) was implemented in 2016 in the Lake Chilwa Region (Malawi) targeting fish dependent communities. Three strategies for the second vaccine dose delivery (including delivery by a community leader and self-administration) were used to facilitate vaccine access. This assessment collected vaccine perceptions and opinions about the OCV campaign of 313 study participants, including: fishermen, fish traders, farmers, community leaders, and one health and one NGO officer. Socio-demographic surveys were conducted, In Depth Interviews and Focus Group Discussions were conducted before and during the campaign. Some fishermen perceived the traditional delivery strategy as reliable but less practical. Delivery by traditional leaders was acceptable for some participants while others worried about traditional leaders not being trained to deliver vaccines or beneficiaries taking doses on their own. A slight majority of beneficiaries considered the self-administration strategy practical while some beneficiaries worried about storing vials outside of the cold chain or losing vials. During the campaign, a majority of participants preferred receiving oral vaccines instead of injections given ease of intake and lack of pain. OCV was perceived as efficacious and safe. However, a lack of information on how sero-protection may be delayed and the degree of sero-protection led to loss of trust in vaccine potency among some participants who witnessed cholera cases among vaccinated individuals. OCV campaign implementation requires accompanying communication on protective levels, less than 100% vaccine efficacy, delays in onset of sero-protection, and out of cold chain storage