The immediate care center, hope in the midst of the medical desert

[CA du pays de Gex (Ain) 27 communes • 96 500 hab.] Across the doctor’s office and the emergency department of a hospital, the immediate care center (Cesim) in the urban community of Gex started its activity in early 2020. Open from 8.00 to 20.00 Monday to Friday and on Saturday morning it is always full. About fifty people are received every day. Some do not have a treating physician, or the latter is too far away or not available for at least a week.

However, the health problem of these residents, without being a vital emergency, cannot wait. “We went to Cesim several times for our 6-year-old son who had a high fever or to remove ticks from him,” says Sabah Houari.

Why go to the mess in the emergency room? Saint-Julien-en-Genevois Hospital Center is less than an hour’s drive away. “In people’s daily lives, it’s awful, it represents between four and six hours, with traffic jams, a border to cross and care, sometimes for ‘bobology.’ chairman of the urban community.

The urban area is dedicated

Since 2016, Pays de Gex has struggled to improve the care process for its residents through a territorial health contract. Nevertheless, the basic problem remains. In 2019, there were only 45 doctors per 100,000 inhabitants. The project with a company that has to respond to so-called “unplanned” care then takes shape. This need is evident from the diagnosis shared between the doctors, the hospital and the residents.

But who will wear Cesim? The volunteers are not in a hurry. In the spring of 2018, the urban area will be inaugurated. The place to install Cesim is all found: The hospital center in the country Gex, which is mainly dedicated to the care of the elderly, has vacant premises. On the equipment side, the inter-municipal authority provides Cesim with an X-ray machine, an ultrasound scanner, an innovative emergency diagnosis system that delivers blood test results in less than twenty minutes.

In the end, despite his fears, the urban area recruits its health team in just a few months without cheating any doctor from the area. “The innovation of the structure, the dedicated resources and the less hectic pace of work than in an emergency room are attractive to professionals,” comments Cyrille Boutherre, Cesim’s coordinating physician.

A strengthened team

Other projects are underway, starting with expansion work completed in late March. Cesim is now 400 square meters, almost tripling its original area. In the firing line: hiring new doctors and a nurse as well as receiving interns in internships starting in November. “Our desire is to ensure the sustainability of the structure,” said Didier Hartmann, Deputy Director – General for Health and Hierarchical Director of Cesim.

The strengthening of the team will also allow the doctors to carry out the mission of the Samu correspondents. Once trained and qualified, they will in turn be asked to leave the center to provide assistance to people in vital distress while waiting for emergencies to come.

It remains to clarify the economic model of the structure. Steps are being taken with the Ministry of Health. Cesim can not remain under the radar of social security indefinitely. Biology is also very expensive. “The rating circuits do not allow our delocalized biology to be properly taken into account, they support the activity of the DGA or our nurses or even the drugs or the small equipment.”

Contact. Didier Hartmann, DGA with responsibility for health, dhartmann@paysdegexagglo.fr

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