Catherine Devoldère
A very important place given to the paramedical professions 
Paediatrician Dr. Catherine Devoldère manages the Paediatric-Neonatology unit at Abbeville hospital in the territorial department of the Somme. She also sits on the administrative board for the association Sparadrap, which designs and distributes media on childhood pain prevention at hospital.
How do you perceive the health care system in Portugal following this research trip ?
It was very rewarding to notice such differences in the health care system of a country so close to home! Indeed, Portugal has distributed health care centres, equivalent to our ‘maisons médicales’, bringing together doctors, nurses and dentists, over the entire territory. This enables proper care before resorting to the hospital and helps to relieve the emergency services. Health care is free. It nevertheless seems that surgery hours are concentrated in the morning and that doctors see private patients in the afternoons.
On the other hand, in Portugal as in England, there is a lack of freedom in the choice of general practitioners. Every doctor is allocated a set number of patients. Consequently, some people, following a change of address for example, are left without an ‘attending physician’.
These difficulties bring about a two-tier medical system. There is a very developed private sector with a great range of prices and medical insurance not being able to cover the difference, as is often the case in France. Some families even pay a monthly fee to ensure paediatric healthcare for their child!
Another element attracted my attention: the drug delivery system. In Portugal, drugs are given out directly! And I didn’t hear anyone mention that doctors’ prescriptions are checked… That seemed strange.
Are Portuguese work methods, statuses and professional skills similar to those of French paediatricians?
I got the impression that a very important place is given to the paramedical professions. In the Portuguese healthcare centres we visited, nurses, paediatric nurses and midwives give consultations. This was of great interest to me since I have set up nursing consultations for monitoring diabetes, obesity, asthma, migraines and neonatology at Abbeville Hospital. This system is tricky since this type of consultation is not recognised in France and therefore unpaid. On the other hands, this is easily doable in Portuguese healthcare centres thanks to a completely different financial mechanism. Paediatricians are organised in a very similar way to their French colleagues, other that the fact that the former have visibly fewer holidays due to a longer working week.
In neonatology, similar measures are taken to protect babies from sound and light pollution. The equipment, material, and unit structures we visited – neonatology, intensive care, paediatrics – were familiar. If I had to work in Portugal, I wouldn’t feel too disorientated! Finally, I very much appreciated their solution to the “white-coat syndrome”: in Lisbon, white uniforms are livened up with nature or cartoon drawings.
How do they deal with childhood pain in Portugal?
The ministry has drawn up a National pain plan, but the use of a 50:50 mix of nitrous oxide and oxygen, an anaesthetic that relieves pain, is not yet in widespread use. The situation in Portugal reminds me of France fifteen years ago, when it was only used in cancer-paediatric units. Since then, its use has become widespread. It is true that in France, pain relief for children is ten years ahead of that for adults.
I am now looking to translate information leaflets drawn up by the association Sparadrap to send them to Portugal. This is one of the legacies of this trip: meeting Portuguese professionals has made us want to exchange the best or most innovative of both our methods, and, beyond that, strive to harmonise our practices.
