Out of the Shadows

Radio Télévision Suisse |27min
Postproduction script

 

00:00:05,044 VO: -Geneva: 200,000 inhabitants like you and me, and 13,000 others, more or less invisible without papers and health insurance, who live precariously on the margins of society. Deprived of basic health insurance, these people, often migrants workers, but also Swiss people, find themselves helpless when they are faced with health problems.

00:00:39,134 Elisabeth: -We still have five minutes.

00:00:42,055 VO: -In the Plainpalais district, in the heart of Geneva, a small unit of the Geneva University Hospitals is dedicated to the care of these invisible people. CAMSCO: The mobile outpatient community care consultation.

0’56 Title – Out of the Shadows: Providing Healthcare to Undocumented Workers

1’01 A Report by Yannick Tenet

00:01:06,938 Martine: -Come, Madam.

00:01:08,563 VO: -The consultation is open to everyone, with or without an appointment, but space is limited. Martine, a nurse for 17 years here, manages the flow of patients.

00:01:23,910 Martine: -I gave 16 tickets. We give 30 tickets max. Eight people have an appointment, I will have to stop at 22 tickets. We can still see all the people who come in, and if we run out of tickets or no more room left, we redirect them. We can still take in the emergency cases or we redirect them to the ER if necessary.

1’27 Martine Locatelli-Sallet, Specialist nurse

00:01:53,181 VO: -30 people per day and 5,000 each year consult at CAMSCO.

00:01:59,503 Martine: -Come on, sir, come on.

00:02:06,906 VO: -Behind his counter, Antony registers patients: we have to check each identity.

00:02:14,187 Antony: -Thank you; and a passport, please.

00:02:16,934 Patient: -I don't have a passport, sir.

00:02:19,222 Antony: - You have no document with a full name, date of birth, a bus card maybe?

00:02:26,934 Antony to camera: -Sometimes, they don't have any papers on them. We try to do with the means at hand. They can write it on a post-it, or they have sometimes little cards from their homes, for example where they are. They are afraid of being reported. But we explain that the setting is the hospital, and that there is medical confidentiality.

2’36 Antony Lima, Specialist secretary, CAMSCO

00:02:56,065 VO: -Created in 1997, CAMSCO is a unique health centre in Switzerland: nothing comparable exists elsewhere for the poorest. In other cantons, only the ER and associations receive them.

00:03:08,786 Elisabeth: -Come with me.

00:03:14,077 VO: -Guilmar, a Brazilian man has been living in Switzerland for eight years. He survives on small payments. He is recovering from eye cancer.

00:03:24,497 Elisabeth: -Please come in. Hello, my name is Elisabeth, I am a nurse. How can I help you?

00:03:33,735 Guilmar: -I need a prescription. The doctor gave me these two eye drops. At the moment I'm just following up after the surgery I had.

00:03:48,643 Elisabeth: -Ok, that's why you've come? So I'll just see what's going on here on the computer. And then we'll see if the doctor can renew your prescription, okay?

00:04:00,057 Guilmar: -Ok, thank you.

00:04:02,190 Elisabeth: -I'll give you some paper to write down the prescriptions.

00:04:18,076 VO: -At CAMSCO, two-thirds of patients are female. who are working undocumented, especially in the domestic economy.

00:04:26,090 Fiona: -Take a seat here. I'm Fiona, I am a nurse. Is this your first time here?

00:04:35,093 Patient: -No, the third time.

00:04:36,866 Fiona: -Ok, why have you come?

00:04:39,819 Patient: -I come because I have pain in my back, and when I get up I have a lot of pain. My hands hurt, my elbows are burning, and my knees too.

00:04:58,248 Fiona: -Ah, there's a lot. What kind of work do you do?

Patient: -Cleaning.

00:05:05,752 Fiona: -Did you work this week?

Patient: -No, I didn't work. Yesterday I couldn't work because I was in too much pain.

00:05:15,846 Fiona: -I'm going to look at your back. Does it hurt to urinate?

00:05:21,865 Patient: -No.

Fiona: -Good, stand up. I'll stand behind you, you tell me when it hurts. I'll start at the top.

Patient: -Hurts.

00:05:32,022 Fiona: -Here?

Patient: -Yes.

00:05:33,484 Fiona to camera: -Often, people come in for these problems. They're doing ironing, they clean windows. Those who babysit also. They have the children in their arms, they carry heavy loads. And these problems drag on. They don't have time to come and consult, they run around for different jobs.

5’44 Fiona Bajaj, Nurse

00:06:00,565 Patient: -It hurts, my back is burning.

00:06:05,804 Fiona: -I'm going to tap a little bit hard right, and you tell me if it hurts.

00:06:11,620 Patient: -Ah!

00:06:12,761 Fiona: -OK, OK.

00:06:14,893 Fiona to camera: Work is the main thing, health is put aside. And they go to the appointment when really they're bent over backwards.

00:06:27,778 Fiona to patient: We're going to do a urine test to make sure there is nothing in the kidneys. Then I will give you some pills for your back.

00:06:43,621 Elisabeth on phone: -This is Elisabeth at CAMSCO. I'm calling you because I have a patient who needs Cosopt treatment. He came to you last month Ah, an emergency. Can you still take him in around 4:30-5:00? OK. He won't be here for half an hour. Yes, he came by, but I'm called on an emergency. He can come to you, okay. Thank you.

00:07:26,777 Elisabeth to Guilmar: I'll be right back, hang on.

00:07:29,592 Elisabeth: What's going on? Where is the patient? Ah! What's going on? Be calm, be calm, come here... come here... I'm going to accompany him to the psychiatric emergency room. Come with me... sit down.

00:08:06,696 Elisabeth to camera: I follow this patient regularly with the psychiatric physician. He had forgotten to take his medication, and he came back very distressed. He put a belt around his neck to express his distress.

8’08 Elisabeth Martins-Dominati, Specialist nurse

00:08:28,478 VO: -A serious situation for this man in a city shelter. The case is debriefed with Yves Jackson, the physician in charge of CAMSCO, and of its entire medical team.

00:08:41,280 Dr Yves: -Elisabeth?

00:08:42,905 Elisabeth: -Yesterday, there was a crisis situation where the patient did not take his antidepressant treatment nor anxiolytics for one week. The patient removed his shirt, and he had...

00:09:01,621 Another doctor: -His belt.

00:09:02,646 Elisabeth: -His shirt first, and then his trouser belt, and he tried to strangle himself.

00:09:11,140 Dr Yves: -Did he have time to hurt himself?

00:09:14,645 Elisabeth: -Apparently not.

Dr Yves: -No. How did it go for you? I imagine it was a difficult situation.

00:09:20,605 Elisabeth: -It was an emergency situation, but it went pretty well. The patient was compliant, he agreed to go to the psychiatric emergency room, to be taken care of there. And he was given treatment to calm down.

00:09:38,382 Dr Yves: -So the risk of recurrence is important. What bothers me, is why he came to our premises to do an act of demonstration rather than self-harm? What did he want from us yesterday? Why did he come here to act out like this? The home where he's staying is going to close soon, there is a lot of uncertainty among those who live in this household, and those with serious long term mental health problems may deteriorate. The discussion should include the referring social worker in the home to provide residents with more safety measures. So maybe get in touch with the social team at the shelter, so that they can also discuss this aspect with him if necessary. to reduce a potentially avoidable stressor.

00:10:36,402 Dr Yves to camera: It's not just the germs, it's not just the infections, it's not only diseases that cause health damage, but there is a personal, collective, economic, social context too. And that's why CAMSCO was born on a soil that combined the medical world and the expertise provided by the HUG, with a very rich partnership in the social milieu. There is no point in treating people if you're going to put them back in an environment that will make them sick again. People must be able to feed themselves and find shelter, clothing, protection against various factors. CAMSCO is about taking care of the problems.

10’42 Dr Yves Jackson, Lead doctor, CAMSCO

00:11:26,180 Doctor: It’s painful?

00:11:27,130 Patient: Yes, when I do work, mopping, cleaning the house, now I cannot tolerate the pain any more.

00:11:36,180 Doctor: When I touch it, is it painful?

00:11:38,020 Patient: No, but when you touch it here, yes. When it’s tired and being used for work…

00:11:43,634 Dr Yves: -The risk of not simply about acting out, it is to accentuate health inequalities. The idea is to provide people in need with a medicine accessible to everyone, at a reasonable price, not to make a quality of care according to social status of the individual...

00:12:01,170 Doctor: They have an appointment for you tomorrow.

00:12:04,759 Dr Yves: …but also to be respectful of the collective stake through the costs that it generates. Health is a right. It is our duty as professionals to uphold the right.

00:12:20,037 VO: -A right that Anna, from Mauritius, has exercised at the last minute, out of breath, after ten years of a chaotic life on the edge of danger.

00:12:30,916 Anna: -I ran away from France, thinking that I could build my professional life back here, and also I ran away someone who was chasing me, who wanted to exploit me, who wanted me to sell my body.

00:12:53,724 VO: -She arrived in Geneva in the middle of the COVID crisis, without papers or connections. She had a tough time getting a job.

00:13:01,675 Anna: -They were small jobs: cleaning, a little bit of babysitting here and there, it was occasional, it was not regular. So I was always short of money. That's how I developed a skin disease: like hematomas all over, like I've been hit. I had red patches due to from all the emotional pain, and also fear in my stomach. Fear that the police will come at any moment. It's because of this that I was taken care of because I had nutritional deficiencies. I was skinny, like a person who… Who... who survives. I was then a person who survived.

00:14:02,581 Heidi: -Come in, Anna.

00:14:04,621 VO: -Heidi, with 15 years of experience at CAMSCO, accompanies her on this journey.

00:14:10,600 Anna: -How are you doing?

Heidi: -Yes, and you?

00:14:13,917 Anna: -I'm fine, but a little tired.

Heidi: -Tired? Why?

00:14:18,961 Anna: -Disturbed sleep at the moment. I have a financial problem in relation to the rent. I was so far behind because my salary didn't cover the rent. After that, I got some bad offers. Gentlemen who want me to come and massage their feet, but who are looking for a cleaning lady.

00:14:42,631 Heidi: -Don't go in there, Anna.

Anna: -With the posted rate. This always happens to me, and then it breaks me because when you wait for a little more money, and then you realize that's not the case, it will be for something else. Even if we can get money from sex, but I don't want to get into it. Not in that way anyway.

00:15:15,850 Heidi: -What do you do when you are invited to a restaurant or when someone offers you

Anna: -This type of people?

00:15:25,660 Heidi: -Yeah, what do you do?

Anna: -I block them. I keep looking and keep the hope that I will eventually find the right one.

00:15:34,251 Heidi to camera: -More and more people are in a difficult social situation. With COVID, people have less work, fewer opportunities to send money, to pay for housing and everything else and everything gets complicated.

15’44 Heidi Fowler, Specialist nurse

00:15:56,003 VO: -Here at CAMSCO, these thousands of clandestine men and women who live hidden from society, can come out into the open.

00:16:06,888 Fiona: -Hello, come over here to disinfect your hands.

00:16:11,711 Blanca: -Thank you.

00:16:13,216 Fiona: -Why have you come?

00:16:15,020 Blanca: -I've been dizzy of late.

Fiona: -For how many days?

00:16:18,444 Blanca: -15 days, I think. It was strong, but now it's okay. When I walk, it's like I'm in the air.

00:16:29,257 Fiona: -OK.

Blanca: -That worries me.

00:16:31,894 Fiona: -Let's look for an appointment. I give you No. 2, you can come up.

00:16:42,778 Anna: -I have to do a lot of jobs otherwise

00:16:49,535 Heidi: -How do you feel, you, Anna, with all this?

00:16:53,485 Anna: -Strong.

Heidi: -Strong.

00:16:55,510 Anna: -But weak at the same time. Weak because I am powerless just because of a piece of paper, of a document that... defines who I am in society. The doors will not open easily for me as long as I don't have this paper: everything is connected. I feel like I'm invisible, even though I know I exist. But I also feel non-existent.

 

00:17:32,655 Dr Yves: -Medicine is a social activity above all. Taking care of someone, whether a mother who takes care of her child, or a friend who takes care of a loved one. This creates the foundation of social cohesion, of the evolution of a society, of the structure of a society.

00:18:01,628 Delphine: -Blanca Rojas?

00:18:03,725 VO: -Blanca was a math teacher in Colombia. With a miserable pension, she joined her children and grandchildren in Switzerland. After a first application for a visa was denied, Blanca is now waiting for a second answer.

00:18:18,158 Delphine: -Is this the first time that you have come here?

00:18:21,383 Blanca: -No, the fourth time.

00:18:25,091 Delphine: -Tell me.

00:18:26,676 Blanca: -I feel like I'm walking on air. Yes, because this episode of dizziness, I've had it every year. But it passes. It lasts three or four days, and it passes. But this time I'm worried because it's been two weeks.

00:18:47,561 Delphine: -I'll take your blood pressure. Have you eaten? Have you eaten today?

00:18:54,811 Blanca: -Always.

00:18:56,055 Delphine: -And aside from cholesterol, your triglyceride level..?

00:19:01,279 Blanca: -I've had high levels for four years.

00:19:04,704 Delphine: -But other than that, no health problems?

00:19:09,022 Blanca: -Gastritis. I have a swollen stomach.

00:19:14,961 Delphine to camera: -There's a lot of epigastralgia. It's gastric acidity that occurs when people are stressed. They didn't have that before. When they arrive in Switzerland they develop that, and it's related to a situation stress, lack of work, etc.

19’22 Delphine Dubied, Nurse

00:19:38,951 Heidi: -We made an appointment with the psychiatrist, remember?

00:19:43,949 Anna: -Yeah, but I didn't go.

00:19:46,214 Heidi: -Okay, what about the skin problems?

00:19:49,574 Anna: -The appearance of the skin... It's getting thicker and thicker, it's not like before. Is it possible to have an X-ray of the lungs because I have mucus a little bit weird, with a little bit of blood, some blood trickles. I don't know if it's due to smoking.

00:20:11,619 Heidi: -Anna, I'm going to make appointment with a doctor, a doctor who works with us, for the lungs, for the skin. For the whole thing, right. So he does a check-up, and then we'll see for this lawsuit thing with the social worker.

00:20:35,516 Anna: -If I knew that I would be prosecuted I shouldn't have done any treatment, but I was very bad. I'll pay for it the day when my situation stabilizes to avoid problems with my naturalisation. I don't want to get into trouble with the law here in Switzerland.

00:20:57,529 Heidi: -We'll call the social worker, and we do everything else.

00:21:02,417 Anna: -I'm very worried.

00:21:04,362 Dr Yves: -By removing an essential element of uncertainty and stress, which is secrecy, we improve health through more decent living conditions, working conditions and a more compliant attitude towards the labour law, a capacity to integrate society in a freer way. These social and political determinants of health have a very fast effect on people's health.

21’23 Dr Yves Jackson, Lead doctor, CAMSCO

00:21:35,701 Anna: -I can't let go.

00:21:38,168 Heidi: -No, you're not allowed to let go.

00:21:41,263 Anna: -No, not anymore.

00:21:43,328 Heidi: -You'll get there.

00:21:45,273 Anna: -I have to keep staying strong.

00:21:48,245 VO: -In Geneva, these social determinants have hardened. 500 undocumented people were given visas in 2021, compared to 1,260 in 2020: a 60% decrease.

00:22:01,712 Blanca: -My son lives in the canton of Vaud, and maybe because of my illness, I will go and live there with him. Because they are worried. They see that the dizziness and my age. I don't work any more, they are the ones who support me.

00:22:24,712 Delphine: -We'll wait a little bit, and resume the tension.

00:22:29,502 Blanca: -I'm very worried about this. When I get sick, I say to myself: "I have to go to the doctor, but how do I pay the bill?"

00:22:40,415 Delphine: -In the emergency room, did they take your blood pressure?

00:22:43,448 Blanca: -I said to myself, "I'm going back to Colombia because I don't have a license." I could go there, but how do I get back?

00:22:57,355 VO: -Her tourist visa expired long ago, she could be refused any further entry into the territory in the future. Stay or leave: this is the question on Blanca's mind.

00:23:10,905 Blanca: -Colombia, it's my country, that's clear. We are in a terrible situation. In Colombia, we can't get out. And when you are old, if you have a phone, they attack you, they kill you. If you have shoes, Reeboks for example, they steal your shoes, they can kill you. Here... I am very grateful to Switzerland, very much so. But it would be better if I had a permit, and I could pay for my health care.

00:24:11,066 Delphine: -I'm not too worried from an emergency standpoint.

00:24:15,735 Dr Yves: -Among our target population, some people have almost no resources, and we support that by providing free services. But all the people who can contribute do so. This is our idea of fairness: the costs should be borne by everyone.

00:24:38,045 Delphine: -Here is your hospital appointment, it's not here.

00:24:42,110 Blanca: -Should I pay?

Delphine: -No, you don't. Come on, let's move on.

00:24:52,588 Delphine: -I've always loved my job, but at CAMSCO I find the reasons why I wanted to be a nurse in the first place. Here we are less in the emergency, we're much more in depth, in the links, in the care. It's rewarding for our profession.

25’10 Delphine Dubied, Nurse

00:25:15,580 Interviewer: -Would you change your place there?

00:25:18,245 Delphine: -No. Never.

25’36 Credits:

Yannick Tenet
Pascal Gauss
Nicolas Ducret
Roland Joseph