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Homeland Security

For Foreigners on France's Front Line, COVID-19 Exposes Health Care Shortcomings

By Lisa Bryant April 29, 2020

Like many of their colleagues these days, Dr. Nefissa Lakhdara and her husband, Dr. Redouane Bouhalila, return home from long hours on the front lines of the COVID-19 crisis. They wash up, stuff potentially virus-tainted clothes into the washing machine, and attend to children left homebound by the pandemic, clocking up exhausting work weeks.

It's a routine without a fixed ending, as France battles a disease that has killed more than 23,000 people. But while the spouses, both medical doctors trained in Algeria, face the same health risks as their French colleagues, there is far less payback.

"We love our job and we love our patients," says Lakhdara, who works as an obstetrician-gynecologist at a hospital outside Paris. "But the system is wrong, and we're trying to get it right."

She is hardly alone in voicing such sentiments. Even as the pandemic sees the nation rallying around overtaxed health workers–with locked-down French cheering them from windows every night – it is also exposing longstanding shortcomings in France's health care system, along with simmering grievances.

That includes those harbored by thousands of non-European-trained health professionals working here. Sometimes known by their acronym PADHUE, they often earn less, have less security and rise through the ranks more slowly than their European Union counterparts.

Now, the coronavirus is powering a backlash against such inequalities.

In an open letter earlier this month to Prime Minister Edouard Philippe, a dozen of France's medical leaders, including former Health Minister Bernard Kouchner, called for the estimated 4,000-5,000 non-EU doctors working in French hospitals to be "fully integrated" into the country's health system.

Without them, "we would be totally disarmed" in fighting the crisis, they wrote in a petition that has garnered more than 40,000 signatures.

According to a union fighting for PADHUE rights, the first doctor to die of the coronavirus in France was a 67-year-old emergency room physician from Madagascar.

Filling 'medical deserts'

France is hardly the only European country heavily dependent on foreign doctors to fill health gaps–sparking criticism about uneven playing fields and brain drain from poorer countries. In Britain, where foreign doctors pay hefty visa fees and health care surcharges, some have also died from COVID-19, the disease caused by the coronavirus. Germany is trying to recruit more migrant doctors to help it fight the infection, including from among the thousands of asylum seekers who arrived in 2015.

In France, the pandemic hit public hospitals already shaken by months of protests and strikes over government spending cuts and staff shortages. While still lauded internationally, France's health system is overstretched and under-financed, experts say.

Rural parts of the country and the Paris area are described as "medical deserts" – with a dearth of health care professionals to meet the needs. Foreign staff, including many from North- and sub-Saharan Africa, are partly filling those gaps.

"They're doing the work that French doctors don't want to do, but without the recognition or the remuneration," Dr. Mathias Wargon, head of emergency services at Delafontaine Hospital outside the capital and a petition signatory, told Le Monde newspaper.

Of British and Algerian descent, Lakhdara earned her medical degree in Algeria. She began practicing in France five years ago.

She has since moved up the ranks but says her position should normally be higher. And, she said, "I'm being paid half to one-third of what I should be getting."

Lakhdara's husband, an orthopedic surgeon, passed a rigorous competition to get into the French system. Even so, he must first fill an intermediate supervisory job before being licensed here.

Now, with the pandemic still raging in France, both face a daily threat of contracting the virus.

"I personally have seen many coronavirus-infected women, taken samplings from them," Lakhdara said. "I've put myself in danger."

"But I'm not just talking about myself," she adds, but also thousands of other foreign-educated pharmacists, midwives and other health professionals who face the same situation.

A step forward?

Legislation passed last July offers a step forward, Lakhdara and others say. It would level the playing field for foreign-educated doctors already in the French system, replacing the current competition process with a review of their dossiers.

It has yet come into force. Meanwhile, a new government measure allows health centers to recruit foreign physicians during the pandemic–but only in lower, administrative positions.

"Professionally, we're recognized for our competencies and know-how," said Algerian pharmacist Dr. Farid Slimani. "COVID-19 patients are putting their lives in our hands. But when it comes to bureaucracy, there's a block."

Slimani earned a doctorate in scientific research and his pharmacology degree in France. But because his original medical degree was from Algeria, he is still considered foreign-trained, earning thousands of dollars less than his counterparts.

Now, as a pharmacist managing medical supplies for 37 Paris-area hospitals, he is plunged into the maelstrom of coronavirus logistics, scouring worldwide to procure sometimes scarce items.

"It's true there's a lot of tension right now, but it's work that gives me pleasure," he said of his seven-day work weeks.

Without foreign professionals like himself, he believes, France's hospitals would not be able to handle the pandemic.

"It's great we are applauded, it's very encouraging," Slimani adds of the nightly tributes to health care workers. "But the state really needs to step up with support."

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