Fellowship location description and medical activities
Mayotte is a French overseas department located in the Mozambique Channel. It has an estimated population of up to 400,000. However, many people from the rest of the Comoros archipelago are in the country illegally. These people often come for health reasons, with pathologies described in our medical jargon as “historical”, due to the length of time taken before consulting a doctor. In parallel with this migration, almost 77% of the population on the island of Mayotte lives below the poverty line. Running water and electricity are not available in all homes. Many people live in shantytowns made of tin houses, and a cholera epidemic is currently raging in 2024.
There is one hospital for the whole island of Mayotte and several health centers throughout the island. The main structure comprises several departments: medicine, intensive care, visceral surgery, orthopedic surgery, pediatrics, gynecology, psychiatry, radiology, rehabilitation, emergencies, etc.
Dermatology activity is divided between adult dermatology (leprosy (50 new cases per year), lupus, scleroderma, pemphigus, melanoma, carcinoma, chromomycosis, psoriasis, atopic dermatitis, hidradenitis suppurativa, lymphoma, erysipelas, toxidermia… ) and paediatric dermatology (xeroderma pigmentosum (n=25), ichthyosis, epidermolysis bullosa, atopic dermatitis, hemangioma, etc). The population of Mayotte is phototype 4-5, but many Europeans also live here. The high intensity of UV rays (11 to 15) leads to numerous neoplastic pathologies.
Being part of the French system means that patients with French nationality can benefit from all drug therapies. However, treatment is much more complicated for Comorian patients. The language and cultural barriers are also important factors in achieving adherence to treatment.
There is no private dermatologist. Only a senior dermatologist and a resident work in the hospital’s internal medicine/infectious disease unit. The team also works closely with the pediatricians and a nurse dedicated to the care of the xeroderma pigmentosum cohort. Every Monday, the team from Madagascar, Mayotte and La Réunion meet to discuss various clinical cases. The departments on La Réunion remain available on a daily basis to receive patients requiring more specialized care, if necessary.
The geo-political context linked to the large-scale immigration of Comorians to the island regularly leads to tensions. Healthcare professionals are advised to remain cautious outside working hours, and to organize themselves in groups during their personal leisure time