Putting Western health history in Mayotte into perspective
The health and social policy carried out in Mayotte since 1841, the date of the island’s cession to France, and especially since the construction of the first hospital on the island at DZAOUDZI, from 1847 and completed in 1892, is based around two major periods. An initial period which spanned from 1841 – 1975, marked by a timid and limited health presence, in a society which lived to the rhythm of rainy seasons, diseases and destructive epidemics. These years were dominated by the fight against major endemics. A second part which began as soon as the island was taken back into direct administration by France, from 1976 to the present day, and which has focused for more than forty-five years on the establishment of a health and social policy. insufficient, given the public health standards expected in France.
A timid and limited health offer.
As long as Mayotte lived in the administrative indifference of colonization and the regimes of Madagascar and the Comoros, which dispatched the powers of France to the Mahorais, the question of the development of the island hardly merited being asked. It is clear that during this more or less long period, Mahorese society was abandoned, scattered in small hamlets made of huts with walls made of dried earth or plant-based materials. She lived to the rhythm of the rainy seasons, diseases and destructive epidemics in a time endured since she had no outlet.
The Western health presence remained limited for a long time to a doctor, located in Dzaoudzi, within the hospital grounds. Hospital activity was essentially limited to the inhabitants of Petite-Terre. At that time there was no sanitary facilities on Grande-Terre and connections between the two islands were often difficult. If we have to go back to this period, malaria was the first disease and wreaked havoc especially among white people. Lymphatic filariasis, responsible for elephantiasis of the lower limbs and hydrocele, affected 80% of men. Typhoid and syphilis were common. Leprosy was the most feared chronic infectious disease. The flea quid (maroantody), a parasite which only spared those who wore shoes, in other words, few Mahorais because children and adults walked barefoot, left its mark on the minds of the population. Finally, tuberculosis caused high mortality.
Furthermore, the recurrent epidemics of smallpox but also malaria, having caused numerous victims, remained vivid in the memory of the devastation caused. The smallpox epidemic of 1898 was responsible for 2,300 deaths and was the cause of the disappearance of the village of CARONI.[1]. These epidemics have led to one-off prevention measures and vaccination response campaigns. This was the beginning of mosquito control measures, vaccination rounds against smallpox, evacuation of smallpox patients to lazarets installed on the BOUZI islet and in the center of the island at COMBANI and of lepers in the leprosarium located on the the island of MTSAMBORO and weekly rounds of nurses who traveled in a sedan chair (fitaco) in Grande Terre.
An insufficient health policy
After more than a century of uncertainty, the paradise image of this welcoming island in the South Seas did not hide its difficulties in health and social matters since its resumption of direct administration by France in 1976. The first year was used to carry out an essential census of the population and homes. A census whose paint numbers have long been visible on a certain number of doors in Mayotte. At the end of 1976, after a population awareness campaign, a major domestic control campaign, combining several insecticides together with chemoprophylaxis, was conducted by the Basic Health Service and the Fight against Major Endemics (SSBGE). ) as part of the fight against malaria and filariasis.
The socio-economic imbalances of the island, aggravated by poverty, demographic growth, the weight of traditions and lifestyle habits, traditional medicine (still current), have sometimes been positive factors and sometimes obstacles. difficult to lift for this Western health policy under construction. The Department of Health and Social Affairs (DASS) was established in 1977. The establishment of doctors in rural areas with a network of dispensaries was reinforced by (VAT) Technical Assistance Volunteers. This device foreshadowed the current extra-hospital system. The MAMOUDZOU hospital, which had 50 beds and had a minimum technical capacity, was built in 1979. A specific Maternal and Child Protection (PMI) program was implemented in 1980. Vaccination coverage, family planning and the fight against malnutrition constituted the foundations of this new health policy launched in Mayotte, ratified by deliberations of the General Council.
Although this situation seemed privileged compared to that of the countries in the region, Mayotte’s membership in the French group should not have allowed such situations of deficiency. Only a few liberal doctors are established. The medico-social sector remains embryonic, social security is still specific, the criterion for affiliation is not that of work but of legal residence in the territory. There is no State Medical Aid and illegal immigration is permanent. In this context, how can the Mahorean health system evolve? Should we keep dispensaries? What articulation should be proposed in a newly created medical-social sector? In social matters, faced with the legal and regulatory void linked to the legislative specificity before the departmentalization of the island in 2011, the political authorities of Mayotte, the President-Deputy BAMANA and the Honorary Senator Marcel HENRY had clearly expressed the choice of carry out collective social protection actions rather than requesting the payment of individual benefits. As a result of this preference, positive results are obtained in terms of family planning and a reduction in home births. This choice deserves to be highlighted.
This is evidenced by the fruits brought to the population, through family planning campaigns “ Bassi Kandré Karamba » for birth spacing carried out in 1985 and “1, 2,3 Bass” for the limitation of births organized in 1994.
Furthermore, the evolution of the lifestyles of the Mahorais since this takeover by France, combined with traditional sociological behaviors, have favored the progression of so-called diseases of civilization. The prevalence of diabetes in Mayotte is estimated at more than 12%. 55.9% of adults aged 15 and over are overweight or obese. High blood pressure is estimated at 38.4% and without forgetting kidney failure, cardiovascular diseases and cancers which have also developed. To this epidemiological transition were added problems such as malnutrition due to vitamin B1 deficiency in young children, revealed by an epidemic of beri-beri, a unique phenomenon on French territory since its eradication. The latter was the cause of the deaths of around twenty infants in 2004.[2].
So the time has come to do things differently
The light provided by this paradoxical situation which causes malnutrition of overload and excess to coexist (obesity, diabetes, etc.) and malnutrition of deficits and shortages (marasmus, kwashiorkor, etc.), questions the evolution of dietary practices in this territory which has experienced rapid changes which are reflected in social, political and economic relationships, but also in the evolution of accessibility to food consumption in its individual, social, cultural or religious dimensions. Nutrition has become a major health issue, equality in healthcare and social justice. However, there is a real difficulty in promoting a change in dietary behavior in Mayotte for the following reasons: low availability of fruit and vegetable products on the market; a cost of products which is not always accessible to the basic population; unorganized and unproductive market gardening and fruit growing; an essentially artisanal fishing activity and difficult production conditions (scarcity of water resources).
This situation makes it essential to put in place a real agricultural and commercial policy in the territory to better respond to the food supply of the population. Finally, the persistence of numerous infectious diseases linked to water and hygiene, as well as certain nutritional diseases, raises questions about the limits of a response to health needs based solely on services which aim to treat the consequences linked to inappropriate behavior of the population on the one hand, and to bad political orientations on the other. They suggest that improving the health status of this Mayotte population would involve the economic and social development of Mayotte, through education, by strengthening the health system of Mayotte to bring it closer to the standards of the mainland, but above all through political orientations aimed at promoting public health and community health and empowering the population to take responsibility for their own health.
Salim MOUHOUTAR – Author and Speaker
[1] https://www.mayottehebdo.com/actualite/sante/1898-la-variole-a-mayotte-decime-2-300-personnel/
[2] https://www.mayotte.ars.sante.fr/beri-beri-pour-lutter-contre-la-morbide-je-varie-mon-alimentation
