THE ROLE OF THE USER

Questioning the place of the user within our organisation is nothing new. Since the "French Doctors" on “Île de Lumière" in 1979 and through our programmes today, we are continuing to contact and work with at-risk populations that play a role in our witness-bearing and political and humanitarian advocacy approach.

This philosophy based on action is at the very heart of our mission statement. It must not simply become a well-meaning but unintelligible discourse. It has worth only if shared, pooled and tested together.

Médecins du Monde bases the development of its programmes on placing users at the heart of complex actions, with the aim of supporting them in building their own capacity to act. While between 1979 and 1989 our position was more that of “dispensing aid, knowledge”, the HIV epidemic saw us move towards a participatory model. Committed to providing assistance to users of psychoactive substances, Médecins du Monde then decided to work alongside them, focusing on sharing needs and knowledge. Since 2000, this model –which was confidential and specific to certain programmes– has slowly spread throughout the organisation. And, today, a community process model has emerged here and there. This new model invites us to question the actual development of the user’s place since the creation of Médecins du Monde. Has the user shifted from being a passive stakeholder to a stakeholder that shares the thinking and decision-making processes within the programmes?

SHARING AND CONSENT APPROPRIATION AND RECIPROCITY

The implementation of a community-based approach – which assumes the appropriation of the shared model by users and organisation members – integrates in particular a communication and advocacy function aimed on the one hand at obtaining recognition for the needs of individuals or groups of individuals and, on the other, at being a force for social change. In this way, many of Médecins du Monde’s programmes in France and overseas are already implementing the principles of the Ottawa Charter for Health Promotion and its operational implementation.

While we repeatedly ponder the place of the service user, should we not ask ourselves where Médecins du Monde fits into the systems of the individuals we meet? Because these individuals are organised in groups that are more or less structured (slums, squats, camps, organisations for people who use drugs and sex workers, etc.). This involves questioning the notions of reciprocity, acceptance and interaction which promote

While we wish to place the user at the very heart of the decision-making process, on an equal footing within the fabric of our organisation, few users from our programmes have felt themselves able to fully integrate themselves in Médecins du Monde and take up the place that we have nevertheless been inviting them to occupy. This situation means that consideration needs to be given to new voluntary paradigms that will enable users to be genuinely involved. As we assert once more, the sharing of decisions and, therefore, of power, of cooperative spaces, of shared decision-making spaces, are vital in order to move forward.

The sharing of reflective processes brings us back again to how we qualify users, their experience-based knowledge, to “doing with” rather than “doing for”, to learning the codes of the other and their constraints, to sharing knowledge. The social dimension of our actions, for example, as a factor and characteristic of precarity, can lead to conflicts of interest, differentiated approaches and non-verbalised objections. In medico-social action, user consent and sharing must therefore go hand-in-hand. Consent therefore becomes an objective, the fruit of the sharing, and not a means that would in some way neglect the principles of initial free and informed consent or therapeutic alliance with the care-giver.

returning individuals to their life paths. A position that will enable us to construct less costly and more effective socio-health policies in collaboration with the relevant individuals.