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From the November 2003 issue of World Press Review (VOL. 50, No. 11)

France Feels the Heat

A Heat Wave Turned Disasterous

John Lichfield, The Independent (liberal), London, England, Aug. 22, 2003

Bernard Kouchner is the kind of politician other politicians detest. He insists on speaking the truth. The French left (to which Kouchner belongs) is working itself up into a satisfying fury over the unnecessary deaths of so many old people during this month’s heat wave. The toll is now estimated at more than 10,000 people, mostly over 75 years of age.

Kouchner is one of the founders of Doctors Without Borders and a former Socialist health minister. He might have been expected to lead the (partly deserved) lashing of the bungled and sluggish response of the center-right government of Jean-Pierre Raffarin. This was, after all, a government that came to power promising to be attentive to “the needs of ordinary people.”

In the first half of this month [August], thousands of ordinary French people—not all of them already sick or close to death—died because one of the most expensive and well-regarded health and social protection systems in the world failed to cope with 10 days of exceptionally high temperatures.

Why? Kouchner has made two observations on the catastrophe (which has now claimed [more than] twice as many victims as the attack on the New York twin towers). First, if he and the left were still in power, they would probably have done no better. Second, the real cause of the calamity was a collision between something irresistible and exceptional—the weather—and something banal but utterly unmovable: the French obsession with holidays and their inalienable right, as a nation, all to go on holiday at the same time.

“We are all to blame,” Kouchner said, making himself even more unpopular than he already was with his Socialist colleagues.

All over France, hospital wards were closed down this month to allow staff to go on holiday. Trolley beds containing dehydrated old people piled up in hospital corridors while large wards, filled with expensive resuscitation equipment, were locked and inaccessible, until the government belatedly declared an emergency.

Old people’s homes, where 50 percent of the casualties occurred, were operating with reduced and, sometimes, temporary staff. At one home in the Paris area, visited by French TV, there were two auxiliary staff members to cope with 60 residents during one of the worst nights of heat. Seven people died that night. Those old people’s homes, which were unable to cope, were discouraged from sending patients to hospitals, which were also unable to cope.

Thousands of other old people, living at home but too infirm or too poor to go on holiday, found their apartment blocks or neighborhoods deserted. There were no relatives or neighbors to turn to for help. Old people, especially those suffering from ailments like Alzheimer’s, are just as vulnerable to extremes of heat as they are to extremes of cold.

Some patients brought from their homes to casualty units in Paris had a central body heat of over 42 degrees Celsius [107.6 F]. There was nowhere to put them, other than the hospital corridors where the temperatures were also over 40 degrees Celsius. With the ward equipment locked away, there was not enough staff to keep the patients cool with basic methods such as damp sheets and cold drinks.

The latest figure of 10,000 dead is a guesstimate, but probably fairly accurate. The main association of French funeral directors reckons that this was the increased mortality rate in the first three weeks of this month. It is believed that there were 5,000 additional deaths in the Paris area alone.

Eight in 10 of the victims were over 75 years old. Many were ailing and weak and might have died in the coming months in any case. Many others are said by their relatives or doctors to have been relatively fit and healthy and capable of living for many more years. Either way, the victims died an uncomfortable and undignified death—in a country that prides itself on its solidarity with the weak and suffering (and frequently makes unflattering comparisons with the heartless, market-driven Anglo-Saxons).

How could this happen? The left (Kouchner apart) is blaming the government, which was, of course, on holiday. It says that the health minister, Jean-François Mattei, himself a doctor, and the prime minister, Raffarin, reacted too slowly to warnings from senior health officials. The government complains that it did not receive adequate warnings until it was too late.

France suffered the longest and the most intensively from the heat wave that settled on Western Europe in the first half of this month. With so many medical staff away (up to 30 percent in some hospitals), and so many old people’s homes understaffed for the summer, it would have been impossible for the government to prevent a catastrophe. However, if it had reacted sooner and more urgently, some old people might have been saved.

The left, still shattered by its double defeat in the elections last year, sees a perfect opportunity to destabilize the Raffarin government and its efforts to reform and slim the French state apparatus. Mattei is expected in October to put forward plans to restrain the cost of the French health service, which is almost 10 billion euros (US$10.9 billion) in the red this year.

Any proposal he puts forward will now be caricatured by the left as a further attempt to dismantle a health service that was already dangerously weakened and incapable of saving the lives of 10,000 elderly French men and women in a heat wave. The Socialists will conveniently forget that the staffing problem this summer has been worsened, although not caused, by their imposition of a 35-hour working week on hospitals, without adequate extra staff.

The French health service does not lack resources—or should not. It is a gold-plated system, but the gold plate is often applied in the wrong places. France spends 9.9 percent of its GDP on health care—in other words, one in every 10 euros that it earns—compared with 7 percent in Britain and the 8.6 percent E.U. average. The problem is that the system is overgenerous in paying for unnecessarily specialized health care and drugs for a notoriously hypochondriac nation (especially the middle classes). It does not necessarily place its resources where they are most needed, for care in the poorest areas and for the weakest members of society.

The crisis this summer is proof of a need to reform the system, not an excuse for doing nothing. But the main point is Kouchner’s point: At holiday times, the coverage of the health-care system—declared by the United Nations to be the best in the world—is dangerously thin.

In the last Easter holidays, a close friend had to have an emergency operation on her eye. No state hospital in Paris could take her in during the holiday weekend. Admissions were allowed for life-or-death cases only. Saving the sight of an eye did not qualify. She had to have her operation done in the private (and expensive) American Hospital in the Paris suburbs. France is a nation of individualists who insist on the right, individually, to do the same thing as each other, at the same time, every year.

The August holidays, especially the first half of August, are considered sacred. No government, right or left, has yet dared to challenge that right, except for the seasonal industries such as transport and tourism. After this summer’s calamity, a little extra effort will probably have to be made to staff hospitals and residential homes properly next summer. In the longer run, nothing much is likely to change.

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