Étude descriptive aux Urgences du Centre Hospitalier de Mayotte d

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1"!Des&premiers&peuplements&des&Comores&à&la&décolonisation&:&..............................................................&9!
2"!Les&relations&Franco"Comoriennes&en&droit&international&depuis&l’indépendance:&..............................&13!
3"!Histoire&des&migrations&comoriennes&:&.................................................................................................&15!
4"!Une&histoire&sanitaire&commune&..........................................................................................................&16!
+++7!)S)L(-(!'(!)/,L(!/#O!*N-N&()!(L!/!-/SNLL(!$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$!45!
1"!Données&épidémiologiques&comparatives&:&..........................................................................................&20!
2"!La&santé&aux&Comores&:&........................................................................................................................&20!
3"!Le&système&de&santé&à&Mayotte&:..........................................................................................................&28!
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1"!Données&sur&les&migrants&à&Mayotte&:&.................................................................................................&32!
2"!Les&motifs&de&migration&:&......................................................................................................................&33!
3"!Description&des&réseaux&de&passeurs&:&..................................................................................................&34!
4"!La&lutte&contre&l’immigration&illégale&:&.................................................................................................&36!
5"!Parcours&du&migrant&arrêté&en&mer&:&....................................................................................................&37!
T7!0()!-NV+0+L()!LQ(&/:(#L+R#()!M!$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$!6I!
1"!Circulation&thérapeutique&:&..................................................................................................................&40!
2"!Migration&médicale&:&............................................................................................................................&41!
T+7!:&()(,L/L+N,!'(!0U(L#'(*Q!$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$!88!
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1"!Critères&d’inclusion&:&.............................................................................................................................&47!
2"!Critères&d’exclusion&:&............................................................................................................................&47!
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1"!Le&questionnaire&informatisé&:&.............................................................................................................&48!
2"!Données&récupérées&à&postériori&:&........................................................................................................&49!
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1"!Nombre&de&patients&inclus&:&.................................................................................................................&53!
2"!Information&sur&l’étude&et&recueil&du&consentement&:&..........................................................................&53!
3"!Âge,&sexe&et&langue&parlée&:&.................................................................................................................&54!
4"!Catégories&socio&professionnelles&:&......................................................................................................&54!
5"!Personne&référente&pour&les&mineurs&:&.................................................................................................&55!
6"!Adresse&hors&Mayotte&:&........................................................................................................................&56!
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1"!Décideur&du&départ&pour&Mayotte&:&.....................................................................................................&57!
2"!Coût&du&transport&:&...............................................................................................................................&57!
3"!Nombre&de&personnes&embarquées&à&bord&du&Kwassa&kwassa&:&.........................................................&58!
4"!Conditions&d’arrivées&:&..........................................................................................................................&58!
5"!Lieu&d’arrivée&sur&Mayotte&:&.................................................................................................................&59!
6"!Nombre&de&jours&entre&arrivée&et&consultation&:&..................................................................................&59!
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1"!Date&de&début&de&la&pathologie&initiale&:&..............................................................................................&60!
2"!Un&traitement&a"t"il&été&initié&aux&Comores&?&:&.....................................................................................&61!
3"!Le&patient&a"t"il&été&hospitalisé&dans&le&pays&d’origine&?&......................................................................&61!
4"!La&pathologie&a"t"elle&été&traitée&dans&l’Océan&Indien&:&.......................................................................&62!
5"!La&pathologie&a"t"elle&déjà&été&traitée&sur&Mayotte&?&..........................................................................&63!
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1"!Une&demande&d’Evasan&pour&Mayotte&a"t"elle&été&faite&?&...................................................................&64!
2"!Une&demande&de&visa&a"t"elle&été&faite&aux&Comores&?&........................................................................&66!

! 6!!
3"!Un&titre&de&séjour&est"il&envisageable&pour&le&patient&?&........................................................................&66!
4"!Un&avis&ou&un&suivi&psychologique&semble"t"il&nécessaire&?&.................................................................&66!
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1"!Classification&clinique&des&patients&à&leur&arrivée&aux&urgences&du&CHM&:&...........................................&67!
2"!Mode&de&transfert&qui&aurait&été&le&plus&adapté&en&fonction&de&l’état&clinique&du&patient,&classé&à&
partir&des&critères&de&transfert&infirmier&inter&hospitalier&(TIIH)&:&.................................................................&68!
3"!Orientation&des&patients&après&leur&passage&aux&urgences&:&...............................................................&69!
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1"!Chirurgie&orthopédique&:&72&patients,&plus&14&diabétiques&:&................................................................&72!
2"!Patients&pris&en&charge&en&Réanimation&:&32&patients&.........................................................................&74!
3"!Service&de&pédiatrie&:&27&patients&.........................................................................................................&76!
4"!Oncologie&:&24&patients&........................................................................................................................&77!
5"!Diabète&:&36&patients&inclus&plus&14&hospitalisés&à&Dzaoudzi&...............................................................&78!
6"!Cardiologie&:&22&patients&......................................................................................................................&78!
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1"!Information&des&patients&et&inclusion&à&l’étude&:&..................................................................................&81!
2"!Description&de&la&population&................................................................................................................&81!
3"!Descriptions&du&parcours&de&soins&aux&Comores&:&................................................................................&83!
4"!Conditions&de&transport&en&Kwassas:&...................................................................................................&85!
5"!Les&patients&aux&urgences&de&Mamoudzou:&.........................................................................................&87!
++7!0()!%N&*()!(L!0()!0+-+L()!'(!0U(L#'(!M!$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$!I5!
1"!Les&points&forts&de&l’étude&:&..................................................................................................................&90!
2"!Les&différents&biais&de&l’étude&:&.............................................................................................................&90!
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1"!La&chirurgie&orthopédique&:&..................................................................................................................&92!
2"!Patients&nécessitant&une&prise&en&charge&en&réanimation&:&.................................................................&93!
3"!Pédiatrie&:&.............................................................................................................................................&94!
4"!Oncologie&:&...........................................................................................................................................&95!
5"!Diabétique&et&Hypertendus:&.................................................................................................................&95!
6"!Propositions&pour&l’avenir&:&..................................................................................................................&96!
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1"!Projet&d’ordonnance&sur&l’adaptation&du&CESEDA&à&Mayotte&:&..........................................................&116!
2"!Droit&à&la&santé&des&Migrants&:&...........................................................................................................&117!
3"!Le&droit&du&sol&:&...................................................................................................................................&117!
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