Territoires, mobilités et santé : comment composer et penser une offre de soins pour les populations migrantes en situation précaire ?

Cet article aborde les enjeux de santé relatifs aux populations migrantes primo-arrivantes en les interrogeant du point de vue de l’expérience des individus et des professionnels qui travaillent à leur contact. D’un côté, il interroge les déterminants sociaux de la santé et de l’accès aux soins tels qu’ils se présentant pour les migrants, en prenant en compte l’ensemble des contraintes, des ruptures, mais aussi des ressources mobilisables pour la santé et les soins. D’un autre côté, l’article interroge la façon dont les professionnels de la santé mettent en place des actions à l’égard des migrants, dans un contexte institutionnel national et local changeant : comment mettre en place des actions à destination de ces publics ? Comment faire en sorte que les organismes et structures existantes s’adaptent aux situations des populations les plus susceptibles de rester en marge du système de santé ?This article deals with health and healthcare access of migrant populations, placing the debate around the point of view of migrants (individuals and family) as well as of professionals working with them. The article questions on the one hand the social determinants of health and the determinants of healthcare access by taking into consideration the set of constraints, incoherencies and resources available for health and healthcare. On the other hand, it shows how healthcare professionals implement new forms of action destined to migrants. In a changing local and national institutional context the issue raised is how to set up actions towards migrants in the domain of health and healthcare. Further, it considers how to ensure that existing structures and organizations are adapted to the situation of a population that is, more than others, likely to remain at the margins of the healthcare system? The article studies the administrative and juridical healthcare access for migrants in France. Two main assessments can be put forward: first of all, the migrants’ pathways to healthcare are characterized by long delays before accessing primary care; second, healthcare pathways appear as “coordinated” (between emergency healthcare and common access) only when residential and administrative situations are solved and stable. Our global observations are based on fieldwork in France; they show that there are very heterogeneous ways to access healthcare for newly arrived migrants, and generally that they stay longer than other precarious populations in the circuit of emergency humanitarian health. We also notice that the difficulties in accessing healthcare for migrants are only a part of the difficulties experienced in migratory experience. We attempt to describe types of daily barriers (administrative situations, difficulties in accessing rights, negative representations of migrants within society and/or social and sanitary services, language) and to underline the necessity of taking into account the socio-spatial dimensions of healthcare access in everyday life. The article includes a methodological section explaining the fieldwork (interviews with patients and professionals) and describing the content of the interview grid (see figure 1.) The patients’ points of view are described through the use of “synthetic biographies”. These biographies underline the everyday spatial constraint obliging individuals to develop tactics and strategies to move to the city (and between cities) in order to access different services. The professionals’ points of view are analyzed in regard to their professional practices, and the way they use some “tinkering” to favor new forms of actions targeting migrants. We can observe in the fieldwork the multiplication of “go towards” practices, usually used in the medico-social field (and generally to set up actions meant to “go towards” individuals identified as precarious –in the domain of addictions or HIV-AIDS). These actions include a spatial register: actions tend to “go towards” people living in the street or in squats. These professional practices lead to a type of medicine that is institutionally framed but concern very specific professional acts. We thus analyze the way this tinkering becomes possible and how it appears in the interviews we have conducted with general practitioners. The discussion and conclusion aim at considering the different spatial inscriptions of these forms of actions in public health. We have also studied the situation of migrants in precarious situations: on the one hand they endure the deleterious effects of their living conditions, but they can also develop very original spatial knowledge and multi-situated sociability that can be analyzed as ““mobility know-how”

Les voies indiennes de l’homéopathie

Dans les sociétés occidentales, l’homéopathie occupe une place privilégiée parmi les médecines alternatives et complémentaires présentes dans le champ médical, à côté de la médecine allopathique et des remèdes traditionnels. Mais si l’on peut déjà s’étonner de sa pérennité malgré les fortes oppositions qu’elle rencontra dès sa naissance de la part du corps médical, la place qu’elle occupe aujourd’hui dans le système médical indien soulève bien d’autres questions. Nous décrivons et analysons ici l’histoire de l’introduction de l’homéopathie dans le monde indien, en identifiant, grâce aux sources historiques disponibles, les acteurs et les lieux de sa diffusion, jusqu’à sa reconnaissance légale et son intégration dans le système médical pluraliste indien.In Western societies, among other complementary and alternative medicines, homoeopathy occupies a privileged position alongside allopathy and traditional remedies. Surprisingly, although homoeopathy had to face strong opposition movements from the medical field in Europe, it seems that its introduction in India was received more positively in the long term, a point which raises many issues. In this article, we describe and analyze the introduction of homoeopathy in India and its long-term historical process, identifying actors and places of its dissemination from the 1830s until its legal recognition by the State in the 1970s and its integration in the pluralistic Indian medical system

Préface

International audienc

L’initiative associative et les reconfigurations locales des dispositifs d’accès aux soins pour les migrants primo-arrivants

Les sociologues Estelle d’Halluin et Anne-Cécile Hoyez présentent des éléments de réflexion sur les changements qui scandent le domaine de l’accès aux soins des migrants primo-arrivants en France, et cela du point de vue des acteurs engagés sur le terrain : ONG, associations, professionnels de la santé et du social. Face aux changements et à la complexité des « paysages migratoires », face aux réorientations des « paysages politiques » (politiques d’immigration et politique de santé et du social), et face aux demandes des migrants, les acteurs de soins ont, en permanence, à réinterroger et modifier leurs pratiques

Interpreting in mental health: Social, moral and spatial divisions of labor in health care for migrants

Simultaneous interpreting in the context of mental health care for migrants faces several political issues, which result in questioning such professional practices towards patients whose mental suffering is often related to the experience of exile. Consultation sessions with migrants represent a challenge for interpreters as well. These professionals are required to position themselves in a caring relationship, while dealing with mental health professionals’ expectations together with employers’ directives, which may overlap and contradict each other. Through the prism of interpretation, the paper aims at examining the social, moral and spatial division of labour in migrants’ care, namely in the context of mental health services. The presentation is based on two separate field-works, in the cities of Rennes and Strasbourg: both regional capitals are marked by recent significant changes in migration flows and have been considered for experimenting innovative practices in promoting simultaneous interpretation in the context of mental health care.L’interprétariat dans la prise en charge des migrants en santé mentale est inséré dans de nombreux enjeux politiques qui interpellent les pratiques des professionnels à l’égard d’une patientèle dont souffrances psychiques et conditions de l’exil sont souvent entremêlées. Les consultations mettent également à l’épreuve les interprètes qui doivent se situer dans une relation de soin complexe, alors même qu’ils peuvent se retrouver face à des exigences contradictoires entre les attentes des professionnels de santé mentale et les prescriptions des associations qui les emploient. À travers le prisme de l’interprétariat, l’article interroge les divisions sociale, morale et spatiale du travail dans la prise en charge des migrants en santé mentale. Il s’appuie sur deux terrains d’enquête à Rennes et à Strasbourg, deux capitales régionales marquées par une évolution des flux migratoires, et comptant des initiatives importantes en matière de promotion de l’interprétariat professionnel.La interpretación en el cuidado de los migrantes en salud mental se inserta en muchos asuntos políticos que desafían las prácticas de los profesionales que se preocupan por un paciente cuyo sufrimiento mental y condiciones de exilio a menudo se entrelazan. Las consultas también desafían a los intérpretes que necesitan estar en una relación de cuidado compleja, a pesar de que pueden enfrentar demandas conflictivas entre las expectativas de los profesionales de la salud mental y las prescripciones de las asociaciones que las emplean. A través del prisma de la interpretación, el artículo cuestiona las divisiones sociales, morales y espaciales del trabajo en el cuidado de los migrantes, especialmente en la salud mental. Se basa en dos sitios de encuestas en Rennes y Estrasburgo, dos capitales regionales marcadas por una evolución de los flujos migratorios, y contando importantes iniciativas en la promoción de la interpretación profesional en salud mental

Un terrain « du proche ». Le militantisme et la recherche à l’épreuve de l’occupation d’une université

Cet article mobilise la sociologie des mouvements sociaux, l’ethnographie des mobilisations, et la géographie sociale. Il articule une approche socio-spatiale des mouvements sociaux avec une dimension réflexive sur les liens entre recherche et militantisme. Aussi, cet article organise la restitution de l’expérience de ses trois auteurs. Après avoir présenté les éléments de contexte qui ont conduit à l’occupation d’une université par deux mouvements d’occupation distincts (une occupation étudiante ; une occupation par « le Collectif » – un groupe militant de soutien aux personnes sans-papiers), l’article détaille les liens entre espaces de l’occupation et pratiques militantes, en illustrant comment l’université occupée est devenue un « terrain du proche » déstabilisant les rapports de luttes, de dominations et de négociations pour les membres du Collectif. Enfin, l’article revient sur la façon dont ce « terrain du proche », sensible et familier, vient mettre à l’épreuve les postures de recherche et les routines professionnelles. Finalement, ce travail réflexif montre combien l’occupation défait les routines militantes et les pratiques de recherche, en contraignant leurs interactions à un nouveau type de cadrage.This article steps on sociology of social movements, ethnography of mobilisations, and social geography. It articulates a socio-spatial approach of social movements with a reflexive dimension on the links between research and activism. Also, this article proposes the restitution of the experience of its three authors. After presenting the contextual elements that led to the occupation of a university by two distinct occupation movements (a student occupation; an occupation by "the Collective" - ​​a support group for undocumented immigrants), the article details the links between spaces of occupation and militant practices, illustrating how the occupied university has become a “fieldwork of closeliness” destabilizing the relationships of struggles, dominations and negotiations for the members of the Collective. Finally, the article questions the way in which this sensitive and familiar “fieldwork of closeliness” challenges research postures and professional routines. Finally, this reflective work shows how the occupation undoes militant routines and research practices, forcing their interactions into a new type of framing

Représenter la dimension spatiale des contextes d'exercice des professionnels intervenant auprès des migrants : le cas des interprètes

L’article, pluridisciplinaire, revient sur des recherches menées sur le déploiement de l’interprétariat médico-social en France. Il offre, tout d’abord, une lecture des enjeux actuels soulevés par l’interprétariat médico-social du point de vue de la santé publique. Il présente ensuite le déploiement des interprètes médico-sociaux sur deux territoires, à partir de données issues de l’activité de deux associations différentes, en s’appuyant sur une cartographie d’agendas de professionnels. Enfin, il propose, de manière complémentaire aux analyses sur la portée territoriale des interventions dans le champ de l’interprétariat médico-social, de prendre en compte les différentes mobilités sociales et spatiales engagées dans l’expérience et la pratique des interprètes. Articulant une entrée par la santé publique, la représentation cartographique et l’enquête qualitative par entretiens, l’article montre combien saisir les enjeux autour du métier d’interprète implique de porter un regard conjoint sur les mobilités ou les trajectoires sociospatiales.The article comes back on two research projects related to medical and social interpreting. The research is pluridisciplinary and involves geography, sociology and public health. It is based on a partnership with two non-profit organisations (Réseau Louis Guilloux (RLG) in Rennes and Migrations Santé Alsace (MSA) in Strasbourg), which provide medical and social interpreting services. A territorial question arises here on two levels: a first one in regard to the territory covered by the RLG and MSA actions; a second one related to the interpreters who move between different establishments according to the requests addressed to their employing association. The article is divided in three parts. The first one, developed from the point of view of public health, reflects the current issues raised by medico-social interpreting, which reveal differences between the terms the law and the realities of its implementation. The second part comes back on the cartographic representation of the deployment of medical and social interpreters in the two study areas. Finally, the third part presents sociological and territorial scopes of interventions in the field of medical and social interpreting. The public Health system and the interpreter The Health System Modernisation Act of 27 January 2016 includes a section emphasising the importance of health and social interpreters who intervene professionally in the public health system. Article 90 lays down the principle according to which ‘linguistic interpretation aims to improve access to the rights, prevention and care of people remote from prevention and care systems, taking into account their specificities. “This law shows the effects of the mobilisation of 9 French associations that have, since 2010, carried out advocacy work for the recognition of the profession of interpreter as a profession in its own right. From a public health point of view, medical and social interpreting is a major challenge in terms of reducing social and spatial inequalities in health, especially for allophone immigrant people. Indeed, it is seen as facilitating prevention, health promotion and access to healthcare for a population that is often far from the health care system. The deployment of the interpreting services from two structures: how to map it? We built a database out of MSA and RLG interpreter agendas. In order to target a precise and comparable sample, we selected the diaries of six interpreters working in the three most mobilised languages (two interpreters in Arabic, two in Russian, and two in Albanian). The distribution of their interventions follows a logic of metropolisation and, as a result, the scale of intervention of the interpreters is concentrated on the city and agglomeration Rennes or Strasbourg. MAP (coming soon) The cartography reveals working conditions marked by mobility around metropolitan territories, in a multiplicity of health or social institutions, which underlines the multiple skills of these professionals. Cartography also reveals strong territorial differentiations and even territorial inequalities at certain scales. The RLG, for example, which has set up a network of interpreters to irrigate the entire region of Brittany, sees most of its activity, in fact, concentrated in the metropolitan areas of Rennes and secondarily in Brest. The rest of the Breton territory is marginally covered, with a polarisation towards cities (Lorient, Vannes, Saint-Brieuc), even though interpreting needs exist in many other places, especially in rural areas where, on the period studied, dozens of housing solutions were opened to accommodate people. The realities of the business Medico-social interpreting is a highly feminised profession: in 2015 at MSA, 65 out of 81 interpreters were women; at the RLG, this is the case of 14 out of 19 interpreters. Then, the vast majority of interpreters, as mentioned above, are immigrants (in the sense of INSEE, that is to say that they were born foreign in a foreign country) or born in France of immigrant parents. As highlighted by the cartographic part of the study, interpreters are asked to practice in a plurality of institutions with different interlocutors, which implies heterogeneous interpreting situations and the mobilisation of a wide range of language practices (related to the medical field, asylum, early childhood, etc.). Thus, an interpreter can ensure in one day a pediatric consultation, an intervention in shelter for asylum seekers then go to a cancer department where the medical appointment will concern a diagnostic announcement. To the emotional and intellectual charges thus induced, is added the confrontation with specific or divergent expectations of the professionals. Moreover, for the interpreters, the sociospatial breakdown of their interventions is a source of great temporal uncertainty: the daily practice of their profession is punctuated by the constraints related to travel, most of which are carried out by public transit in urban areas. A comparative perspective at the European level of the place of interpretation in public health systems could better question the French specificities highlighted in the article

Représenter la dimension spatiale des trajectoires de soins en contexte migratoire.: Quand les espaces de vie et espaces de soins impliquent des prises en charge médico-sociales mobiles

International audienceCette communication s'appuie sur les travaux en cours du projet ANR MIGSAN 1 (2016-2019), dans lequel nous examinons les expériences de santé et les trajectoires de soins des populations primo-arrivantes en France. L'approche de l'équipe, pluridisciplinaire, vise à replacer les trajectoires du soin à la fois dans leurs dimensions spatiales et sociales. Après avoir rendu compte du socle théorique et des méthodologies déployées dans le projet, nous détaillerons trois volets de la recherche dans lesquels la question de la représentation de la dimension spatiale se pose avec acuité : comment rendre compte de la place des espaces de vie du quotidien dans les trajectoires de soin des migrant.e.s ? Comment représenter les mobilités des professionnel.le.s mobilisé.e.s auprès des migrant.e.s ? Et enfin comment et pourquoi représenter cartographiquement les ressources spatiales disponibles en matière de santé et de soins, telles qu'elles se présentent pour les migrant.e.s ? ABSTRACT This paper steps on the research work led in the MIGSAN project 1 (2016–2019), in which we examine health experiences and healthcare trajectories for newly arrived immigrants in France. The approach of the research team is pluridisciplinary and aims at replacing health-care trajectories in their spatial and social dimensions. Firstly, we will come back on the theoretical frame and the array of methodologies developed in the project. Second, we will focus on three particular aspects of our research in which the representation of spatial dimensions is acute: how can we report the importance of daily living spaces in immigrants' healthcare trajectories? How can we represent the mobility of healthcare professionals implied alongside immigrants? And how and why can we represent, using cartography, spatial resources in the domain of health and healing as they appear for immigrants