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HEALTH

French doctors reveal the ‘psychological harm’ to monkeypox patients

The monkeypox virus may cause intense pain but the psychological scars of the illness can be just as devastating, say sufferers in France and those who are treating them.

French doctors reveal the 'psychological harm' to monkeypox patients
Monkeypox information at a health centre in Montpellier, southern France. Photo by Pascal GUYOT / AFP

“You do not come out unscathed from a disease that has hurt you so much… as well as the additional burden of discrimination,” said Corentin Hennebert, one of the first cases in France.

Since May the virus has rapidly spread across the world, overwhelmingly among men who have sex with men, provoking fears of a repeat of the stigma faced by gay men seen during the AIDS epidemic.

Nathan Peiffer-Smadja, an infectious disease specialist at the Bichat-Claude Bernard Hospital in Paris, who has coordinated research on monkeypox patients, said the “psychological distress is linked to several aspects” of the disease.

Monkeypox can be very painful, particularly due to lesions which commonly appear on the genitals, anus or face.

READ ALSO Who is eligible for the monkeypox vaccine in France?

The “after-effects, particularly aesthetic”, are distressing for many who fear they could be left with long-lasting scars, Peiffer-Smadja said.

Then there is the impact of being suddenly hit by “a disease people had never heard of” after two years of the Covid pandemic, with the three-week monkeypox isolation period reviving bad memories of lockdowns.

A small number of patients can develop internal lesions, particularly inside the anus, which can be “extremely painful”, Peiffer-Smadja said.

That was unfortunately the cases for Hennebert.   

“I constantly had the impression that razor blades were being thrust into me – I can’t think of any other comparison, (the pain) was so strong,” the 27-year-old told AFP.

Before he was given the powerful painkiller tramadol, he lost seven kilos in just three days because he was not eating.

“All I could think about was the pain,” he said.

“And I’m not the only one, others have contacted me to tell that they were at the end of their tether, that they were crying all the time.”

After recovering, Hennebert went on to become the spokesman for a group of monkeypox patients demanding swifter action against the disease.

Sebastien Tuller, a 32-year-old LGBT activist, said he was “very anxious” when monkeypox lesions began to appear on his face.

“It was really ugly and I didn’t know what to do,” he said.

Michel Ohayon, head of the Paris sexual health centre 190, said that “as soon as a disease is visible, it is frightening because it becomes potentially stigmatising.”

He compared the monkeypox lesions to those from kaposi sarcoma cancer, a visible “symptom of AIDS”.

The global monkeypox outbreak has “reawakened the trauma of HIV” despite the disease being far less deadly, said Nicolas Derche of the French LGBT group SOS.

“For HIV-positive people, this has revived some very rough things,” from fear of a diagnosis to reliving past discrimination, said Vincent Leclercq of the French group AIDES.

Tuller said he received a torrent of insults and derogatory comments when he went public about having monkeypox.

“There is a lot of residual homophobia and this has a real impact on mental health,” he said.

“Many don’t say they have – or have had – monkeypox, fearing being stigmatised,” he added.

Young people who have not yet come out are put in a particularly difficult position, as are those afraid of having their sexual orientation revealed to their employer because they have to isolate for three weeks, he said.

Nearly a quarter of the calls to a French monkeypox helpline this month were about psychological issues, the group that manages the line told AFP.

Some gay men have avoided any sexual activity for months out of fear of the disease, further impacting mental health, LGBT groups said.

France has been at the forefront of the vaccination campaign for monkeypox, vaccinating more than 50,000 people so far and offering the vaccine to a relatively wide group of at-risk people.

Recently vaccination centres close to the border have seen an influx of people travelling from Belgium, Switzerland, Italy and Spain, where vaccination policies are more restrictive and supplies of the vaccine lower.

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HEALTH

The different ways you can make a doctor’s appointment in France

Booking a medical appointment in France can be time-consuming – especially if you are new to the country and are looking for an English-speaking doctor.

The different ways you can make a doctor's appointment in France

You do not need a carte vitale to book a doctor’s appointment in France – anyone who needs medical help while in the country is entitled to it, but you may not be entitled to any reimbursement if you are not part of the social security system.

Booking a GP’s appointment can be as simple as phoning up your friendly neighbourhood GP, or using an online service such as Doctolib. 

It helps a lot, if you have a médecin traitant – an attending GP, who adds you (and your family, if they can) to their list of patients. 

READ ALSO Explained: How to register with a doctor in France

It is not always easy to find one. Some parts of the country are short of GPs, which means doctors’ lists can fill up very quickly. But it is important that anyone who lives in France is registered with a named GP, especially if they have a carte vitale.

As well as being the main point of contact between patients and the medical profession in all its guises, it is financially responsible to be registered with a GP in France.

Reimbursement on consultations is typically 70 percent through the French healthcare system, but just 30 percent for anyone without a declared doctor. Meanwhile, top-up mutuelle health insurance companies usually require you to declare a médecin traitant and if you don’t, you may not be able to receive reimbursements on certain treatments.

Bear in mind, it is your responsibility to register with a local médecin traitant. But, even after you have done so, you can still make an appointment with any doctor, anywhere in France, and arrange specialist treatment, if you need it. 

READ ALSO 5 things to know about visiting a doctor in France

How do you go about making a GP appointment in France?

There are several options.

Some health centres – more often in larger towns and cities – operate a walk-in policy. But expect waits to be lengthy. Do not, however, assume that your GP operates a system like this.

You can phone for an appointment. This is another very common method. Your GP will have their own system for making appointments – which may even include something that looks, to the uninitiated, very much like a casual walk-in policy. 

Some may have an assistant to deal with booking appointments and other administration. Others may deal with appointments themselves, and may – for example – operate some sort of triage system based on voice messages from patients. 

What about online booking systems?

And many practitioners are now attached to websites, such as Doctolib. As of 2023, about half of all GP appointments in France were made using Doctolib.

READ ALSO How to use: French medical website Doctolib

Be aware that other online booking systems are available. Doctolib is one of the best known, but your GP may be attached to another system, like the health ministry approved site ‘LeMedecin.Fr’.

This website also has a feature where you can take an immediate online consultation with whatever doctor is available at that moment. By clicking ‘Consultez en vidéo maintenant’ you will be connected to the next doctor who is free. This option may involve an additional charge between €5-10 on top of the price of the consultation, and you will be expected to pay when booking.

If you have any trouble with either of these websites, you can go through the list of registered generalists per département on the ‘Ameli’ website. If you use this option, you will need to call the doctor to see if they are open or available for appointments.

In terms of wait times, online systems have helped to significantly reduce the delay between booking and getting an appointment.

According to a 2023 study by Doctolib, about half of all GP appointments were available within three days from the time of booking on their platform.

Similarly, you can use online platforms to check the medical professional’s qualifications and languages spoken, as well as filter based on the doctor’s English abilities. However, this should be taken with a grain of salt because not every medical professional with English listed on their Doctolib page speaks fluent English. 

An increasing number of doctorsoffer video consultations, known as télémédecine in France. This allows professionals – particularly those in more rural areas – to diagnose less serious conditions remotely. This type of consultation is usually only available from those medical practices that are attached to online booking systems. 

Some pharmacies have also begun offering walk-in télémedicine consults, using ‘Medadom’ machines. More information here.

What about specialists?

In France, you book your own consultations with specialists, even if you are referred by a doctor (your GP may offer a recommendation, but won’t always). The good news is that many specialists do use online booking services. Those that do not usually have assistants to take care of the appointments.

READ ALSO: Urgent care: How to get non-emergency medical treatment in France

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