Maximiliano Braun

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1. From the Under Pressure website:

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   http://www.underpressureproject.eu/web/country-profile/france

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   France has a medium to high prevalence of MS. Overall policies and provision for people with MS are good.

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   Discrimination against people with disabilities is forbidden by French law and enforced effectively. Access to treatment and therapies is reasonably good and the health system also covers symptomatic treatment and rehabilitation.

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   The ratio of neurologists is very high, so patients can be followed closely. A quarter of people with MS work part-time and about one third full-time. French law also protects people with MS in employment and they can request flexible conditions. Early retirement with a small pension is also possible.

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   However, there is less financial support for home and workplace adaptation, compared to other countries.

2. 

   Riom-ès-Montagne, France, 02/2012 • Smoking is a risk factor for more rapid progression of MS. But the Centre Geneviève Champsaur, a residence for 36 people with severe disability, refuses to prohibit it. “We believe every resident should be free to do whatever makes them feel alive,” says Dr. Marie-Noël Lemay, “Part of that is choosing their own risks. We educate them about risks, but we will not decide what they can or cannot do.” Smoking is a daily pleasure for Francis Nicollas; others focus on choosing what they’d like to eat at each meal. Every year, each resident must identify a “Life Project” – the one thing he or she would like to achieve in that year. All staff participates in realising these goals, which range from visiting the Eiffel Tower to being strapped into a metal chair to tag along on a downhill ski run.

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     Riom-ès-Montagne, France, 02/2012 • Smoking is a risk factor for more rapid progression of MS. But the Centre Geneviève Champsaur, a residence for 36 people with severe disability, refuses to prohibit it. “We believe every resident should be free to do whatever makes them feel alive,” says Dr. Marie-Noël Lemay, “Part of that is choosing their own risks. We educate them about risks, but we will not decide what they can or cannot do.” Smoking is a daily pleasure for Francis Nicollas; others focus on choosing what they’d like to eat at each meal. Every year, each resident must identify a “Life Project” – the one thing he or she would like to achieve in that year. All staff participates in realising these goals, which range from visiting the Eiffel Tower to being strapped into a metal chair to tag along on a downhill ski run.
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     Riom-ès-Montagne, France, 02/2012 • The Centre Geneviève Champsaur was designed to be a lively place for people with very limited mobility. Open spaces and large windows let residents watch what is going on inside and outside the building. Bruno Gauthier prefers to spend his time by the main entrance, where he can greet everyone who comes or goes. The staff place him here after breakfast, then return him for meals or other activities.

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     Riom-ès-Montagne, France, 02/2012 • Meal-time at the Centre Geneviève Champsaur is carefully organised for maximum comfort. The kitchen prepares what people want, sometimes serving 20 different menus per meal. Residents who have little control over movement or make a lot of noise are served first to better accommodate the other. Carers are attentive with the eating pace of each resident.

      

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     Riom-ès-Montagne, France, 02/2012 • Carers work in pairs – in this case, Sandra Boyer (left) and Frédérique Lemmet (right) – when putting residents to bed at the Centre Geneviève Champsaur. This practice reduces strain and provides additional comfort. Bruno Gauthier’s walls are covered with pages copied from magazines and books, reflecting his keen mind and the Centre’s philosophy that every resident should create his or her own environment.

      

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     Riom-ès-Montagne, France, 02/2012 • A duck salad next to its minced twin ready to be served at the Genevieve Champseur Centre. The minced salad has yogurt as an added ingredient in order to make the overall presentation a lot more appealing. This is the center's initiative in serving the same dish to residents who may or may not be able to chew and doing so in a way that it looks appetising. The center houses 36 residents and the kitchen prepares 24 different meals; a testament to the center's willingness to accommodate each resident's needs and wants.

      

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     Riom-ès-Montagne, France, 02/2012 • Bringing a dog into the Centre Geneviève Champsaur required special training for Cash, one of the physiotherapists dog. Cash often stands still next to residents; here, he gives Sandra Charbonel the time she needs to reach out and give him a pat (a form of unconscious physiotherapy). But even a well-trained dog will instinctively go to the people who can engage most readily. For this reason, all staff are under strict instructions to ignore Cash completely: no petting, no playing, no eye contact. Once he enters the building each day, Cash is – exclusively – the resident’s dog.

      

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     Riom-ès-Montagne, France, 02/2012 • Regardless of the weather, the front door is always open at the Centre Geneviève Champsaur: independent living implies the freedom to come and go as one pleases. Philippe Godard (in electric wheelchair) insists on getting fresh air every day. Laurent Mercier, the Centre’s Activity Coordinator, watches from a distance, conscious of the fine balance between letting Philippe have his moment of “living on the edge” and being ready to step in if the situation becomes dangerous.

      

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     Riom-ès-Montagne, France, 02/2012 • Every resident at the Centre Geneviève Champsaur begins the day with a bed bath (full showers or baths are given once or twice per week). Bruno Gauthier, who is paralysed but has a sharp mind and a talkative streak, is famously picky about this routine. Emmanuelle Mercier (left) complies with his wishes and, if anything changes, will note it in his records so that other carers are informed.

      

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     Riom-ès-Montagne, France, 02/2012 • Bathed and dressed, Bruno Gauthier now waits for the “brancardier” (porter), a strong carer nurse who will transfer him from the bed to his wheelchair. Bruno likes to be first “up and around” among residents in his Living Unit (a wing of 12 rooms) at the Centre Geneviève Champsaur and no one else minds, so staff accommodate this request. He watches the TV news while waiting.

      

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     Riom-ès-Montagne, France, 02/2012 • After breakfast, Emmanuelle Mercier (right) prepares to take Bruno Gauthier through the last step of the morning routine: brushing his teeth. Like most of the 36 residents at the Centre Geneviève Champsaur, Bruno is almost completely paralysed by MS and relies on staff for every aspect of his daily care. While staff at the Centre are friendly with residents, a degree of professional distance is encouraged: they use surnames and the formal “vous” when speaking with residents and look after different people each day of a given work week.