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The French medical adventure in Yemen

France and Yemen have tied tight relations especially due to medical cooperation. It had a concrete structure composed of the French medical Mission (FMM/MMF) in Taiz and then the French-Yemeni Medical Association (FYMA/AMFY), which were both mostly built by Dr Yvette Viallard. She passed away at the beginning of 2008 and this loss led the AMFY to restructure itself and to define a new orientation. It actively suggests restarting the cooperation with the Republican Hospital of Taiz. As Dr Viallard stated in 2005 : “During more than forty years, from the forbidden Yemen of Imam Ahmed to 1992, a French medical mission worked in the Hospital of Taiz, charged of different specialities: pneumology, ophthalmology, radiology, cardiology as well as laboratory, acquiring a strong reputation of competence. During these forty years of tight collaboration, exceptional links of friendship were spun which deserve to be continued. It is the main aim of the Association that we wished to found, supported by the Ambassador of France in Sanaa and the Ambassador of the Republic of Yemen in Paris”. Doctor Barbier was the first registered French Doctor who worked in Yemen. Surgeon on the vessel “Le Diligent” in 1712, he was solicited to provide medicines for the Imam and then, to cure him. With sir de la Grelaudière, he established the first diplomatic contacts between the King of Yemen and the French King Louis XIV. The French medical presence really started in 1947 when Dr Ribollet was invited by His Majesty Imam Yahia in Sanaa. He practiced in Sanaa’s hospital, then in Taiz, where Imam Ahmed transferred the capital after the assassination of his father. Doctor Ribollet contributed to the construction of the Royal Hospital “Ahmedi”, which became the Republican Hospital of Taiz after the revolution in 1962.

Dr Pierre Camille Février arrived in May 1947 in Sanaa. Unfortunately,

he died on the 28th of October 1947. He was buried on the road to Hadda. In 2006, President Ali Abdullah Saleh ordered to mount a commemorative stone in the place where he rests.

Other doctors stayed for short periods: between 1947 and 1948. The French community of Sanaa,

including families, was then composed of a dozen members.

Entrance of the Republican

Hospital of Taiz in the early 70’s

Dr Pierre Camille Février

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Dr Claudie Fayein arrived in Yemen in 1950. She worked only few months with Dr Ribollet, before he sadly passed away and has buried there in Yemen on the 28th of September 1951. Her formation in ethnology enabled her to be part in the creation of the ethnologic Museum of Sanaa. She wrote several books on her experience, namely A French doctor in Yemen (1955).

Dr Serge Golovine was sent in mission by the French Ministry of Foreign Affairs in 1952. The purpose was to create an ophthalmologic department in Ahmedi Hospital in Taiz. Dr Vassili Andrei joined him in 1955. He headed the pneumology and phtisiology (tubercolusis) departments in the same hospital and became one of the personal doctors of Imam Ahmed. Dr Ahmed Al Hamami, currently Professor of pneumology in Sanaa University, worked with Dr Andrei in Taiz in 1973. He was the first Yemeni doctor sent in France for post graduate specialisation in pneumology, through the FMM in 1976.

Yvette Viallard, doctor in radiology, knew Dr Andrei because she had worked with him in the Hospital Boucicaut of Paris. She joined him, as sent in mission by the Ministry of Cooperation. She had as main goal to found again the French medical team in Taiz (MMF). The revolution upset the projects of administrative organisation. The small team of Dr Golovine, Andrei and Viallard went through the civil war with unsophisticated material, frequent equipment failures and often the necessity to attend to war casualties. As Dr Viallard sometimes quoted: “ the courtyard of the hospital was full of injured people and we did not have radiographic film” . She did several trips in Europe to plead for material help (radiological films and medicines). Fortunately, the collaboration with the Italian medical teams was tight and efficient. During this period, Dr Viallard had tight contact with Yemeni intellectual youth. It constituted a resourceful asset to favour the future developments of the FMM. For these actions along with the on-going medical help, despite this difficult period, she was awarded the medals of the Légion d’Honneur as Chevalier and then Officer by the French government. With the peace in 1968, the acknowledgement of the new regime enabled to foresee again the extension and the administrative assistance of the Mission. Since 1969, the Yemeni authorities had insistently enquired, through the action of the Taiz Governor Cheikh Amin Abdul Wassee Nooman, the creation of the cardiology department. Dr Jean-François Hiance, the first Active Volunteer of the National Service (AVNS) arrived in 1971 and created this department. Then, he accompanied His Excellency Cadi Abdul Rahman Iriani, President of the Republic, and became his cardiologist.

The laboratory Dr Gérard Petit and his team (laboratory)

Dr Viallard in her Department (1968)

Dr Vassili Andrei

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From 1973, the teams of radiology, cardiology and pneumology were strengthened; the ophthalmology was assumed by the Yemeni action. The necessity to have biological results of good quality led to the creation of a laboratory for analysis in 1975 by Dr Paul Hachet and Jacques Fleurentin.

From this year, the FMM fully worked under the attentive and friendly direction of Yvette Viallard. The Departments operated much like the best of French hospitals with a senior doctor heading them. Its notoriety increased in the surrounding areas, to the north of the country and even reaching until Saada. The Mission was led to cure numerous Yemeni personalities. The services of the FMM had become services of references for the whole country (constitution of files for abroad), while the Yemeni medicine was still embryonic. At that time, the Italian mission had closed and the Russian and Chinese missions assured only basic medical or surgical care. Concerning hospitalisation, the pneumology department was composed of around three hundred beds and the Cardiology Department, around one hundred.

The Mission, through the French Ministry of Foreign Affairs, ensured the purchase and the

distribution of several medicines, unavailable in Yemen. Technically, the capacities were improved by the arrival of new materials coming from France for the departements of radiology and cardiology. The FMM was composed of a dozen French permanent members in Taiz (doctors, pharmacists, biologists, radiology technicians, nurses and Arabic-speaking secretaries). Similarly, the pneumology department started to integrate Yemeni doctors, trained essentially in USSR and Romania. It engaged various training programs for technical staff, laboratory assistant and nurses. The first technician, Abdu Wahab al Husseini, left Yemen for a formation in the General Company of Radiology (CGR) in 1974. Medical conferences were organised with the visits of French experts in parasitology (Pr Moulin), neurology (Pr Dumas), cardiology (Pr Tricot) and infectious and tropical diseases (Pr Lafaix). Following Dr Ahmed al Hamami, several Yemeni doctors went to France in the years 1980’s for their specialization, most of them with French governemental grants. Among them, Pr Husna Al Kadri (biologist, University of Sanaa), Dr Adel Mahyoub (chief of departement of radiology in the Al Thawra hospital in Sanaa), Dr Abdallah Abdo, Dr Abdu al Hamadi, Dr Abdul Rahman al Murish (cardiolologists in Taiz hospitals), Dr A’Wali Al Akwa (ophtalmologist in Sanaa), Dr Mohamed al Fatish (surgeon). They respected their commitment to practice in Yemen but also to maintain a part or the whole activity in public hospital of the country. Some of them unfortunately died (Dr Abdulaziz Abdu, Dr Fadel Afif, Dr Ahmed Daifallah, all cardiologists). Many other Yemeni doctors from Aden were also trained in France for specialization in internal medicine, surgery, ophtalmology, and epidemiology.

In 1986, the mission went out of the hospital: a project of epidemiology and analysis of tropical diseases was created in Wadi. The FMM participated through the action of one of its doctors, Olivier Barbançon, which installed and operated the first CT-scanner in the Al Thawra Hospital, located in Taiz (Hail Saeed foundation). The new technological approaches in imaging (scanner and echography) enabled the realisation of scientific publications. Unfortunately, the international situation did not permit Dr Viallard to fulfill her dream of progressive take-over of Yemeni doctors trained in France. Unexpectedly, the FMM was closed in 1992. The Yemeni doctors trained in France became operational only in 1993 and they arrived in destabilised services. After Dr Andrei’s retirement, he continued to stay in Taiz in order to support the action of his students. He died in Taiz in 1989. He was buried, according to his request, in a public garden close to Taiz. The Yemeni authorities acknowledged the long determined motivation but also the assertiveness of Dr Viallard by decoration her with the Medal of Labour. She also received many thanks from the highest authorities of the State as well as the proposition of the Yemeni nationality.

Dr Andrei, his staff and Dr Yacine Alkoubati (director of the Hospital), 1983

Cardiology Department (Dr Hiance, Dr Elmrich and Dr Léandri, 1980)

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The AMFY/FYMA was created in 1990 in order to support the threatened MMF, to pursue its action, and to accompany the Yemeni colleagues. It is a non-profit, non-confessional, and non-political association aimed at maintaining the capital of friendship, resulting from thirty years of common work. Its main goals were :

� To support hospital activity where a technical cooperation was still necessary � To bring an helpful and friendly collaboration to Yemeni health professionals � To organize post-graduate teaching programs.

As Dr Yvette Viallard summarized: “to create a structure of friendship between the Yemeni and French medicine, using, preserving and glorifying our beautiful common capital”.

The AMFY is composed of 80 Yemeni and French members. Most of the French members are former members of the FMM of Taiz. Most of the Yemeni members are doctors or scientists, which were partly specialised in France.

Since its creation, the AMFY has integrated some friends, attached to the French-Yemeni collaboration for health. It has continued during several years to bring medical material. For instance, a generous member of the AMFY gave new ultrasound equipment to the cardiology department of the Republican Hospital of Taiz in 2004. Between 1990 and 1999, the FYMA organised numerous seminars in Yemen (the French-Yemeni Medical Meetings), focusing on some topics of common medical practices in the country.

Since 2000, FYMA’s actions focuses on post-academic medical formation, associating the reception in France of Yemeni doctors, short missions of accompaniment by French experts as well as the organisation of formation programs in Yemen. These actions were divided in two parts. First concerned medical imaging, especially echography, which has expended a lot in Yemen but suffers of an heterogeneity of operators’ qualification. Training courses in echography have been organised from 2000 to 2004, with practical workshops for Yemeni doctors coming from different Yemeni governorates, with the partnership of the World Federation of Ultrasound in Medicine and Biology (Pr Michel Claudon and Dr Adel Mahyoud). Therefore, in 2002, the FYMA contributed to the foundation of the Yemeni Society of Ultrasound and its affiliation to the international societies of echography. Another important theme of work is the development of interventional cardiology in Yemen. All these actions were supported by sponsors : Total Yemen, Crédit Agricole-Indosuez Sanaa, Alcatel, as well as different manufacturers of cardiologic material. Other projects concern epidemiology and public health. For instance, the FYMA, especially Pr S. Briançon of Nancy, participated in an important study coordinated by Dr Ahmed Mottareb of Sanaa, demonstrating the relation between consumption of Khat and myocardial infarction. Recently, the Association’s goals evolved to answer the necessities of the Republican Hospital of Taiz, which became academic. Nevertheless, the Association wishes to contribute to the development of the public medicine in Taiz and the aim remains to maintain the technical quality. Finally, it desires to participate in the academic teaching in the new University of Taiz.

Dr Moh. Al Kebsi, during his fellowship in Cardiology in Versailles

with Dr Georges and Dr Livarek

Seminary in Aden with Pr Lasjaunias and Pr Al Kahf

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Nowadays, the concrete result of this French medical adventure is represented through the activity of the department of cardiology, radiology and the laboratory of the Republican Hospital of Taiz. These departments have been the basis of the FMM and they are still functioning. The departement of cardiology is led by a Yemeni doctor formed in France. This departement is working well. Problems of personal and budget have limited the development of units for intensive care and coronarography. The AMFY wishes to participate in this particular development. In radiology, the equipment is old. The Association seeks sponsoring to improve the capacities of this department. The laboratory is also deficient in personal and material, on which the Association also wishes to intervene.

From the beginning, all the French participants have appreciated the quality of Yemeni society and its welcome. Their adventures in Yemen have transformed their life. It is obvious that the action of the FMM and the FYMA/AMFY have partly impacted the evolution of the Yemeni medicine. The AMFY remains active; and is ready for new adventures. It proposes to focus its action in Taiz, particularly in the Republican University Hospital. The former house of Dr Viallard, transformed in French Cultural Center due to the action of Yemeni Authorities, embodies this engagement.

To summarise briefly in figures the French medical association’s adventure in Taiz, 45 years of continual presence from which more than 30 for Dr Viallard, who had devoted her whole life to the unwell people of Yemen, 68 people who took part in the adventure, 16 Yemeni doctors who obtained their complete specialisation in France, ministerial grants for post- academic formation obtained by 10 doctors, 3 doctors whom passed away and have been buried in Yemen, the name of 3 French doctors written on the wall of the republican hospital of Taiz (Yvette Viallard, Vassili Andrei and Gérard Petit), 35 scientific publications, from which 9 thesis, 15 original articles and 9 oral presentations.

If you wish to have more information, participate to this adventure or donate materials and funds, please contact the association by email admin@amfy.fr or have a look on the website www.amfy.fr .

Marie Hiance Jean-François Hiance

Jean-Louis Georges

Version validée de l’article publié dans YEMEN TODAY, édition de septembre 2008, p 36-39 Final version of the artcile published in YEMEN TODAY, september 2008, p 36-39

French-Yemeni Medical Meeting in December 1999

Dr Yvette Viallard, founder of the FMM and the FYMA / AMFY