Academic journal article
By Datta, Nira
Bulletin of the World Health Organization , Vol. 86, No. 10
Scientific and social advances may have affected aspects of their work but these general practitioners continue to play a vital role in delivering primary health care to France's rural population. Reporter Nira Datta and photographer Chris Black went to the village of Genouillac to see how the doctor's role had changed in 50 years.
In 1958, World health magazine reported on Dr Edmond, a country doctor in Genouillac, in the central French region of Limousin. On the occasion of the journalists' visit, the doctor had just sat down with his family to Sunday lunch when he was called away to treat a patient in his household surgery. After donning his white coat, the doctor made an incision in the patient's right hand, extracted a wood splinter, before disinfecting and bandaging the wound. The emergency over, the doctor returned to the empty dining room, hoping the doorbell and telephone would remain silent long enough for him to finish his solitary meal. "For 40 years it's been like that day and night. I can't call my soul my own. I belong to them," he said.
Edmond--shown here in two pictures by French photographer Robert Doisneau--was carrying on a centuries-old tradition of round-the-clock primary health care in rural France. Since the time of King Louis XIV (1638-1715), the country doctor has been an integral fixture of French rural life, attending to the basic health needs--and more--of villagers. That tradition is carried on today in Genouillac--a village of some 575 people--by Dr Rend Nicolas. The world in which he operates is much changed from Edmond's time, but despite the major advances in medical care, and the social, economic and cultural forces that have impacted on life even in remote communities, the work of the French country doctor, at its core, remains much the same. Country doctors still offer the personal, one-to-one care that hospitals and specialist clinics cannot. Empathy, trust and an intimate knowledge of individual case histories--these are their stock in trade.
Several developments, however, have threatened to erode the role of the country doctor. The advent of tarmac roads and telecommunications, for example, have brought advanced scientific treatments within reach of otherwise isolated villagers. But perhaps the most pressing problem has been the difficulty in recruiting young doctors. The French government has been working on ways to attract more doctors to the countryside to counter what the Lancet described as "a dramatic decline in practitioners in an increasing number of rural regions". In a 2001 article, the Lancet suggested perceived harder working conditions were dissuading young doctors from settling in rural areas. In central and south-western France, in particular, hundreds of practices closed between 1996-2001 when the local doctor retired.
Genouillac is a case in point. Five of the seven doctors practising in the region are over 50, including Nicolas himself. Indeed, the ageing of rural doctors is part of a larger challenge--providing health care for an ageing population. Much of Nicolas's daily work involves treating the elderly. The work of country doctors such as Nicolas is in danger of being diminished also as a result of operational changes and the more litigious, aspirational world we live in, according to Dr Guenael Rodier, who completed a medical degree in his native France and now works as a programme director at the World Health Organization (WHO) in Geneva. He refers to today's French rural doctors often having to wear a "legal straitjacket" and no longer able to take initiatives for fear they could be challenged.
"I come from a rural part of France," he says, "and when I was back there recently, one of my nephews had a cut that needed a few stitches. I could have done this myself but I didn't have any equipment, so I had to take him to the emergency room in the hospital. No general practitioner would have been willing to do it because they don't want to take the responsibility (because of the legal implications). …