Caring after the storm: an analysis of the effects of a mobile service on access to primary healthcare in Mayotte
This research explores how inequalities, territorial constraints, and natural disasters complicate access to primary healthcare in Mayotte, and how biomedical services can be sustainably adapted to the local context.
Humanitarian and social context and issues
Before Cyclone Chido struck in December 2024, Mayotte was already facing a tense health and social situation. Having become a French department in 2011, the island remains marked by significant economic inequalities and disparities in access to healthcare. With 321,000 inhabitants, rapid growth and 77% of the population living below the poverty line, infrastructure is saturated and nearly half of the island’s inhabitants say they forego biomedical care. In addition, biomedical services, which are concentrated in Mamoudzou, remain difficult to access for residents of rural areas and informal settlements. These inequalities, inherited from colonial history, are also reflected in health migration (patients coming from the Union of the Comoros or East Africa, evacuations to Réunion or mainland France, and the arrival of mainland healthcare workers to fill the staff shortage) and the lack of consideration given to local conceptions of illness. Cyclone Chido exacerbated this situation by destroying infrastructure and various networks (water, electricity, communications) and complicating the continuity of care.
This research aims to analyse the social, structural and contextual barriers limiting access to primary healthcare in Mayotte, including persistent inequalities, the effects of Cyclone Chido and inadequate biomedical facilities. It examines how socio-economic conditions, mobility difficulties within the territory and administrative status hinder this access, while exploring the role of local conceptions of illness and associated therapeutic practices in care pathways. The project also examines the impact of the cyclone on the availability, cost and organisation of care, as well as the effectiveness of the mobile teams deployed after the disaster, in order to propose sustainable adaptations to biomedical facilities in Mayotte.
What structural, social, and contextual barriers limit access to primary healthcare in Mayotte, and how have Cyclone Chido and mobile teams affected these inequalities?
Description of the research area and research method
The research field is located in Mayotte, in the post-cyclone context, among populations that are and are not beneficiaries of the Red Cross mobile teams. The project adopts a mixed approach, combining qualitative and quantitative methods to obtain rich and cross-referenced data. Participant observation within a mobile team will enable the analysis of practices and adjustments in response to local constraints, as well as access to implicit knowledge that is difficult to express in interviews or questionnaires. This study will be supplemented by group and individual interviews and questionnaires conducted in two neighbourhoods (one benefiting from the mobile team and the other not). This second methodology will make it possible to capture both the perceptions and representations of residents during the interviews and to obtain measurable data on obstacles and trends through the questionnaires, providing a comprehensive, contextualised and nuanced understanding of the factors influencing access to primary care after the disaster.
The scientific interest of the research and for humanitarian and social actors
This research will help humanitarian and social actors better understand inequalities and barriers to healthcare access in Mayotte, notably by analysing the impact of Cyclone Chido on local vulnerabilities. It will assess the effectiveness and limitations of mobile teams (outreach programmes) and identify necessary adaptations of biomedical practices to the Mayotte context. The results will help guide field interventions, strengthen natural disaster preparedness and propose recommendations to reduce persistent inequalities in access to healthcare. At the national level, this project can also serve as a model for other overseas and island territories facing natural disasters.
This research is important because it goes beyond strictly biomedical analysis of natural disasters to show how individual afflictions and healthcare systems contribute to the creation and transformation of social relationships. In the context of Mayotte, where social inequalities and tensions are high, it aims to highlight the role of healthcare interventions in the recategorisation of individuals and the organisation of social networks. By combining health anthropology and political anthropology, the project sheds new light on how natural disasters, healthcare and social processes interact, complementing and deepening current knowledge on the social impacts of health interventions in crisis situations.
Biography
Mathilde Heslon is an anthropologist specialising in the analysis of healthcare systems and rituals in Mayotte, the only island in the Comoros archipelago that remained French after 1975 and became a department in 2011. Her thesis examined daily healthcare practices and the systems used for young people in distress, showing how these afflictions are linked to social tensions related to migration and recent departmentalisation. She analysed young people’s use of marriage alliances, affliction rituals and medico-social institutions to escape their afflictions, taking into account differences in gender and status. Her postdoctoral research examines how the pain inflicted, which is increasingly intolerable in certain rituals in Mayotte, highlights the tensions between ritual authority and biomedical institutions imported from mainland France, shedding light on the power relations specific to this postcolonial context.
Photo credit : Mathilde Heslon