French Government Feels the Heat

The great European Heat Wave of summer 2003 has now itself died down, but the heat is still definitely on the government and public health authorities in France, where the Health Ministry estimates that up to 3,000 people might have died – and other sources estimate up to 5,000. Today Prof. Lucien Abenhaïm, the French directeur général de la santé – “director general of health,” or namely the professional physician filling the role in the Health Ministry similar to the US Surgeon General – submitted his resignation to Health Minister Jean-François Mattei. Only last Friday, interviewed in English by the BBC World Service, he had opined that he should not resign, and said he wasn’t particularly worried about holding down his job. Of course, many in France believe that it is M. Mattei himself who should resign in light of the public health crisis from the heat that seemed to take the government by surprise.

In its coverage today of Prof. Abenhaïm’s resignation, Le Monde revealed why the professor had now changed his mind about staying in his post.

“In the face of the current polemics about the handling of the epidemic associated with the heat wave [which is canicule in French”>, I prefer to be able to explain the actions of the [health] services serenely.” Soon after resigning, Prof. Abenhaïm went on to serenely declare on French radio that “at the moment, it has not been demonstrated that errors were committed.” Explaining himself, he continued “We announced the alert for the first time on 8 August, saying that the heat wave could have grave consequences, not excluding deaths.” Well, he’s already caught himself out there: 8 August was a Friday, and this heat wave had already gotten off to a healthy start by at least the preceding Sunday.

(I was in it too, folks, although Amsterdam-by-the-sea is definitely a nice, relatively-cool place to have to withstand this sort of thing. But we still have a serious drought problem – maybe more on this at a later day. Actually, if things get too bad, electricity blackouts could very well kick in – not caused by any system break-down, as occurred last week in the US Northeast, but by insufficient water to cool the power-generation plants. That could turn out to crimp my postings to the Internet. But, anyway, I’m due shortly to travel a bit.)

As Le Monde goes on to reveal, even as he was happy to regret the professor’s resignation in the afternoon after he had accepted it, Health Minister Mattei had spent part of the morning also on the radio, regretting that an “official” (fonctionnaire) had failed to inform him in time about the gravity of the situation – indeed, had told him on Monday, 11 August, that the situation was under control (maîtrisée). Now, who could that official have been? But this is hardly enough of an excuse for many, especially those in the opposition. Perhaps the Green Party said it best when calling for his resignation (quoted in the Le Monde article): “M. Mattei is applying the principle of precautionary treatment in his own way: saving his own head at any price, and leaving the sacrifice to others.”

There’s also a noteworthy companion article in Le Monde today: Trois questions à Gilles Brücker, or “Three Questions for Gilles Brücker,” who is the head of the French National Health Watch Institute (Institut national de veille sanitaire (INVS)). No need to get into all three questions, as the very first one cuts to the quick: “How do you explain how the INVS, of which you are the director, was unable to give any alert of the risks connected with the heat wave?” The answer boils down (oh no! Unintended pun!) to the unfortunate fact that, even though “the INVS analyzes and works with tons of epidemiological information about infectious diseases and cancer-causing problems in the environment,” a heat wave “was not integrated into our field of activities.” In other words, the INVS is only set up to react to data it is fed from other institutions – not to “data” any of its employees could grasp upon waking up on sweat-soaked sheets. Naturally, M. Brücker promises that this will change – and the horse is already out of the barn, as kitchen refrigerators are being pressed into service by hospitals all over France to hold the surfeit of corpses felled by the heat.

You can imagine that the vast majority of those corpses were not long ago elderly French citizens, a demographic cohort particularly vulnerable to the stress such weather can put on the human body. So one leading theme arising from this public health disaster is the way France treats its elderly. (Another such theme is the predilection for government officials to go away on holiday and stay there, even as such a crisis arises back home. Yet another is the influence the famous French law mandating a 35-hour work-week – for medical workers, too – could have had on making this crisis worse.) Another French daily, Libération, covers this aspect particularly well with a couple of articles. Ceux qui sont «partis» hantent les Airelles (or “Those Who “Have Departed” Haunt Les Airelles”) gives a poignant account of the situation at the Les Airelles nursing home in Paris, where eight of the eighty-seven elderly there were felled by the heat. Temperatures rising to 40º C (104º F) inside rooms whose elderly residents still are too panicked to leave; care personnel reminding their charges to drink and drink, while trying to think up gimmicks and tricks to make sure they do so; the local Franciscan monks even calling up nursing residents to urge them to drink; victims succumbing to the heat simply by falling asleep inside, at a sunny window (they then dehydrate to the point that they fall into a coma, but no one knows about their emergency until it’s too late); and then, of course, on Saturday the ninth, when seven of her charges are already hospitalized and thirty on IV, the director of the nursing home getting a visit from representatives from the préfecture (that’s the government unit in France, roughly equivalent to a state in the US) to advise her how to deal with the heat. She doesn’t know whether to laugh or to cry; for Libération she offer the comment that “They only talk about the elderly when they need them for politics. These days, the only thing you hear about is saving money on public health.”

And that is basically the point of the accompanying Libération editorial entitiled Vieillesse: la grande hypocrisie de Raffarin, or “The Elderly: Raffarin’s Great Hypocrisy.” (Jean-Pierre Raffarin is currently the right-wing prime-minister of France.) In the wake of this tragedy, the newspaper reports, Raffarin declares that he is profoundly shocked, and has proposed new initiatives to reform public health institutions. But his government’s recent record merely demonstrates a determination to save money from the services offered to the elderly – including the considerable tightening-up of eligibility for the allocation personnalisée d’autonomie, or “personalized autonomy allocation,” which makes money available to those French elderly who don’t have the financial resources to go into a nursing home, to at least hire someone to help them out where they live for a number of hours during the day. The editorial cites an estimate of 800,000 citizens who would be eligible by 2005; with the new administrative changes, many of these have been shut out of the program.

Belatedly returning from his own vacation to start to clean up the public-health wreckage, premier Jean-Pierre Raffarin declared on Saturday that “One must not remain indifferent to the closed window-shutters,” a reference to the many elderly shut-ins who died from a combination of the intense heat and neglect. But Libération replies: “Before making society bear the entire responsibility for indifference towards the elderly, the government would do well to examine its own conscience [or, in the actual idiomatic French, de balayer devant sa porte].”

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