With one nurse for every 1,300 pupils, “58% of six-year-olds do not have the compulsory medical examination”

Les bilans de santé à la 6e année et les dépistages de la 12e année ne sont pas toujours exécutés. Midi Libre – SYLVIE CAMBON

With one nurse for every 1,300 to 2,000 students, school medicine is the poor relation of National Education. In a sector that is struggling to recruit, medical monitoring is not up to par.

National Education also has its medical desert. The latest report from the Court of Auditors in 2020 states that there is one school doctor for every 13,000 students, one psychologist for every 1,500 students and one nurse for every 1,300 students. For the 537,000 students in the Montpellier academy, there are 10,061 staff members dedicated to “student life”(senior education advisor, social worker, AESH, etc.) including 281 nurses who are over 50 years old and 35 doctors whose average age is 57. That is 1,900 students per nurse, and 15,000 students per doctor. Psychologists, for their part, are 162 to ensure the well-being and support the orientation of students.

In this context, these professionals struggle to fulfill their initial missions which are the health checks that punctuate schooling. “In 2019, 58% of 6-year-old children did not receive any physical health examination by a doctor from the National Education system”, indicates the Court of Auditors of 2020. In Aude and Lozère, we are close to zero! 62% of students benefited from the nursing screening in the 12th year.

Attractiveness crisis

“Almost half of school doctors are over 60 years old and three-quarters of nurses are over 50 years old”, warns the SNALC union. In an increasingly unattractive context, will the next generation be assured? ?

As for the Gatel bill allowing the transfer of school medicine skills to departments, it does not arouse enthusiasm among local authorities, which would add “to the tangle of responsibilities”, adds the Court of Auditors.

An option to encourage orientation towards health

Promoting health studies in the most isolated or geographically landlocked areas may be the start of a solution to see students reinvest in the medical or paramedical field. “We sometimes have students in these areas who think that health studies are not for them”,explains Sophie Béjean. At the start of the 2024 school year, the Montpellier academy, in partnership with the ARS and the Region, has set up an Ambition health studies option, on an experimental basis, on three sites (Limoux, Mende, Alès and soon Lodève) where the lack of health professionals has been identified. “It aims to encourage the orientation towards health studies, aimed at high school students in the first and final years of the general pathway living in rural areas and with a deficit due to medical demographics”. These three systems will be linked to the University of Montpellier and developed in partnership with hospitals and Nursing Training Institutes (IFSI) in the area. “Our ambition is to help future healthcare professionals settle in areas where the healthcare offering is not sufficient, particularly for primary, first-line care,” emphasizes the academy rector Sophie Béjean. “The option is a reinforced part of teaching, but it is above all meetings with professionals so that high school students can also discover the diversity of healthcare professions. For example, there are more than 200 jobs in a hospital, enough to arouse curiosity among young people." And what studies seem to demonstrate, "is that the probability of settling in a rural area depends on the school career in a local high school."

A worrying medical demographic

Faced with the worrying medical demographics, the national union of health educator nurses (SNIES-Unsa) warns. “The current number of school nurses is not enough to meet the growing needs of students”, underlines Gwenaëlle Durand, general secretary. “To avoid staff drain, it is necessary to set up diversified and enriching career prospects”.

During the presentation of the Edusanté label (see below), health professionals presented their actions carried out with constant resources, and in a “voluntary and optional” manner.

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Ten middle and high schools with the Edusanté label

Sophie Béjean, academy rector, awarded the Edusanté label (valid for 3 years) to ten schools. In the presence of Marion Rilhac, educational inspector for a Health Promoting School (EPSa), this second edition highlights the commitment of voluntary establishments to the development of a culture around health. Launched in January 2020, the approach makes it possible to articulate educational projects, teaching and activities relating to this theme. The winners are the Jean Vilar high schools in Villeneuve-lez-Avignon, Joffre in Montpellier, the Jean Bene middle schools in Pézenas, Via Domitia in Manduel and Alaric in Capendu for level 1 which rewards commitment. The Jean Moulin high schools in Béziers, Charles de Gaulle in Sète, the Louis Cahuzac middle schools in Quarante, Paul-Émile Victor in Agde and F. Mitterrand in Toulouges for level 2, which promotes a deeper understanding of actions.

At the Charles de Gaulle vocational high school in Sète, which has 450 students, Sandrine Doumas, a nurse, appreciates her luck in not having to “split between several establishments”, in a monitoring system that allows her “to report situations and pass the baton”. “In the professional world, the public is more fragile, some are losing self-esteem, the high school is there to help them regain confidence. That's what I explain to teachers”.

“We ask everything from school”

A necessary transversality, “but we ask everything from school, we should know how to do everything and make up for what we can't solve”,admits the director of projects at the ARS and partner of the Edusanté project, Pascal Durand, who said he was very “impressed”.

“Doing less, but better, we had to rise from the ashes, it's a very large high school”, explains Emmanuelle Brun, a teacher at the Jean Moulin comprehensive high school in Béziers. “We were able to train a third of the staff in PROdas, the emotional and social development program”.

In other classes with a very high level of stress, such as preparatory classes, the headmaster of the Joffre high school Olivier Briard points out the importance of medical presence. “It happens that a student is taken to the emergency room of the university hospital”.

The health system within the school deserves to be preserved “on the imperative condition of being renovated”, concludes the Court of Auditors in its report.

After the offensive, EVARS is adopted

Theoretically applied for twenty-five years in schools, colleges and high schools with at least three two-hour sessions per year, the reality of teaching about emotional, relational and sexual life (EVARS) is close to nothing.
“The text proposed last December by the former Minister of Education Anne Genetet suited us”, explains Gaelle Durand of the National Union of Nurses and Health Educators (Snies-Education). On the other hand, the version by Élisabeth Borne submitted at the end of January to the Higher Education Council, which brings together unions and representatives of parents of pupils, was the subject of at least 150 amendments.
Announced by former Minister of Education Pap Ndiaye in 2023 and initially planned for the start of the 2024 school year, this program has found itself at the center of an ideological battle “led by reactionary elected officials and associations”. These are demanding the removal of any reference to the notion of gender identity, for example, but not only, “the terms homosexuality, asexuality, heterosexuality, bisexuality have simply been deleted, the notion of gender is only addressed from high school onwards, and no longer in fifth grade”. And this, from the preamble of the text which must implement a teaching which for the moment, is received by only 15% of students.
Emotional, relational and… sexual
“It was nothing more or less than a gift to the conservatives”, Gaëlle Durand denounces. In what was announced as a real step backwards, the initial program was finally voted on January 31, without any sweetener. “The denial of sexual diversity was our red line. There is no question that the program of education for emotional and relational life should not also be sexual. This program also aims to protect certain students from domestic violence. According to the Independent Commission on Incest and Sexual Violence against Children (CIIVISE), on average three children per class of 30 students are victims of incest, hence the importance of sex education.. Explaining the concepts of consent from a young age is a necessity. “We offer cross-curricular teaching on consent, respect for the body, love, modesty and gender issues, adapted to each age. All teachers are involved. The emphasis is on equality between girls and boys. This educational framework prepares young people to evolve with respect and understanding in complex human relationships. We were led to believe that the objective was to “lighten” a text deemed too heavy!”, the union representative is indignant. Face-to-face training for teachers and staff who wish to do so, as well as protection for the latter in the event of threats that force staff to stay home because parents are opposed to such a program, have been approved. The EVARS program will be studied in March, for implementation at the start of the 2025 school year.

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