Violences envers les femmes : le non des femmes handicapées (French Edition)

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Violence envers les femmes: le non des femmes handicapées - on Paperback; Publisher: HARMATTAN; HARMATTAN edition; Language: French; ISBN Les femmes handicapées, leurs réalités et leurs combats sont encore largement . En façonnant les stéréotypes et les attitudes de ses membres envers les .. Pour les femmes malvoyantes et non voyantes: la publication de documents en gros . de subir des violences sexuelles que les femmes non handicapées et ce, .

Ciccone, S. This is essential for earning the trust of victims and ensuring their safety. Listen to and What dit they do in believe them. Lots a place of safety of other people have had similar if obliged experiences. Respect their Acknowledge autonomy the injustice Respect their right to The violence that take decisions that affect victims have suffered their progress when ready is not their fault and they to do so.

The individual is do not deserve violence. Normalize victimization Fail to respond to description of violence. Accept intimidation as normal in relationships. Do you have a place to go if things get worse? Speak to victims in front of other people. Speak to other care providers without victims consent about issues raised in confidence.

Call the police without their consent. Fail to take the danger seriously. Assume that if a person has put up with violence for years, it cannot be serious. Criticize victims Ask what they did to provoke the violence. Focus on them as the problem: why not just leave? During the initial interview, the issue of protection must be tackled. The effectiveness of the overall care and the quality of the relationship between the caregiver and the victim of violence depend on the latter being and feeling safe. The protection afforded during initial and ongoing care must be effective, notably as regards respecting confidentiality.

The worker also has a more general duty of care as regards the seriousness of the violence suffered and its potential reoccurrence. Respecting confidentiality throughout the care pathway protect victims from renewed violence that might arise when individuals outside perpetrator, family members, etc. Information can leak out as a result of members of staff being indiscreet. Respect for the professional code of confidentiality is paramount and only essential and relevant information may be shared with other staff directly involved in providing care There is a greater or lesser risk of violence reoccurring depending on the circumstances.

The level of seriousness of the violent situation must be assessed to determine whether emergency protection measures need to be put in place, or whether the public authorities need to be notified of the situation. In situations of heightened risk, different strategies may be drawn up in partnership with the victim. Drawing up a safety plan It is not easy to talk about the violence one has suffered and it is even more difficult to quit a violent environment.

Where there is repeated and often increasingly severe violence, such as in cases of intra-family violence90, some protection measures can be implemented in advance as part of a safety plan:. Children, who are old enough to understand, must be told of these measures so that they know what to do should the need arise.

Some countries have strategies in place to combat genderbased violence, which facilitate implementation of personal safety plans for victims of violence. In France, the law related to violence against women, domestic violence and their consequences on children has been voted unanimously by the National Assembly and the Senate on 9th July It marks in particular a new stage concerning the protection of the persons undergoing domestic violence.

It gives to the judge the means to prevent violence and their recurrence with the device of the prescription of protection of the victims. The electronic monitoring system will be also set up. This system anti-link can be ordered when a violent partner is indicted for violence or threats, punished of at least 5 years. He will allow ensuring surveillance 24 hours a day, 7 days a week, days a year. Temporary shelter for victims of violence Among the temporary protection measures that are available, the provision of temporary accommodation is often considered in extreme cases where it is essential to remove the victim from the author of violence.

Proposals are currently being developed to introduce temporary shelters for perpetrators rather than victims of violence. This measure would place responsibility for the situation firmly on the aggressor and on the aggressor alone. The victim would not have to leave home for an unknown destination nor have to see everyday life — including that of the children in the case of intimate partner violence — turned upside down.

Since the adoption in December of the federal law designed to increase the protection offered by the civil courts to victims of violence, law enforcement agencies in Germany can, where there is a clear and imminent threat, oblige anyone carrying out acts of domestic violence to leave the family home and forbid them from returning for several days. Temporary shelters may be perceived as places of protection. They may also, however, be viewed by the general population and by victims of violence as places of imprisonment, places that stigmatise or places of violence.

Some women are, therefore, afraid that staying in a shelter will mean being excluded from the community. They often dread the moment when they have to leave. Preparations must be made to mitigate the dislocation an individual experiences between life inside the shelter access to care, psychological support, balanced meals, etc. A commonly raised issue is the risk of experiencing the same violence again on leaving the shelter. MdM regional workshop on providing care and support for women victims of violence, Cairo Egypt , September Identifying victims is often problematic, as violence remains a taboo subject, particularly where it occurs within the family or where it is sexual in nature.

Care providers must therefore know how to detect these signs that point to violence and must maintain a proactive approach in dealing with it. In the context of gender-based violence, Setting up mechanisms for improving identification of victims of violence must be accompanied by provisions for their care and support either direct or indirect via partner organisations.

In victims of violence Care providers must know how to recognize these various signs, interpret some in relation to others and take account of their cumulative significance; the more of them there are, the more likely a diagnosis of violence is correct, and the more likely the violence is serious and chronic. Awareness-raising and training for professionals involved is crucial to ensure they have the necessary skills to spot these signs and thereby identify victims of violence.

Signs of a psychosocial nature Mood and behaviour state of shock, disorientation, confusion, demonstrates a slowness in their behaviour, anxiety phobias, panic attacks, avoidant responses , depression sadness, selfharming, suicidal tendencies , is on edge, insomnia, loss of appetite, memory and concentration issues, mutism, abusing psychoactive drugs, excessive concerns about hygiene, isolation, etc. The lack of staff training in identifying victims has led to serious situations arising. A year and a half after the initial consultation, the patient was admitted to intensive care for a ruptured spleen caused by blows from her partner.

Focusing on treatment for her hepatitis and hypertension, none of the doctors seen raised the issue of violence as a possible cause of her psychosomatic complaints. Testimony from one actor intervening in the frame of missions in France MdM France. Is this what happened to you as well? Some behaviour may suggest that an individual has committed, or may commit, acts of violence. Professionals must therefore pay close attention to the behaviour of a person accompanying a patient.

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When viewed in conjunction with suspicious signs already observed in a patient, this behaviour can help identify a violent situation. Given too that victims of violence and particularly sexual violence are very often stigmatised by their community, they are reluctant to reveal the violence they have suffered.

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It is nevertheless possible to explore certain avenues as a way of identifying violent situations. Wearing badges or posting notices in waiting rooms or specific areas are examples of tired and tested methods. How professionals intervene must be looked at carefully to gauge the feasibility and appropriateness of such initiatives and to adapt the way they are implemented. Screening is a method often used in medical settings for identifying victims of violence.

This method can prove beneficial both for victims of violence and the professional involved. Likewise, a few simple questions may be enough to help the victim confide. It is recommended that a screening protocol be implemented that takes account of linguistic nuances and socio-cultural determinants that apply to the given context. Before applying the screening process involving all service users, the professional staff can test it with a selection to see for themselves if the initiative proves effective. This technique for identifying victims of violence entails staff training and awareness-raising for the whole organisation providing the care.

Is this a problem that you have? Screening can contribute to early and more effective identification of violence and can encourage victims to acknowledge their situation more readily. The use of such a method could prevent incidents from escalating or reoccurring and thus reduce morbidity and mortality associated with gender-based violence. More particularly, this approach facilitates identification of victims of violence and their access to care and support services As a result of their privileged position, those providing community-based support can offer more accessible resources and have a better knowledge of the community.

They must be made aware of the issues surrounding gender-based violence and be informed of existing provision of care and support in order to be able to refer victims and perpetrators identified. Questions must always be asked as to the appropriateness of using community links and the choice of community-based provider.

Some may themselves be victims or aggressors, while others may no longer hold a privileged position in the community. The MdM programme in Liberia relied on some women with a traditionally privileged role within the community.

Today, some of the women admit that their social standing is diminishing and that their role as advisers to the younger generation is no longer so effective. They close their eyes to intimate partner violence as a result of the way they perceive the role of women in the home.

Many are also involved in harmful traditional practices carried out on girls and young women genital mutilation. Dispensing medical care provides one of the opportunities for identifying and caring for victims of gender-based violence. It is founded on ethical principles and on a sequence of essential steps — interview, clinical examinations and paraclinical tests, treatment, etc. Healthcare staff is thus often the first provider that victims encounter. An ability to identify victims of violence and the quality of their reception and care are therefore crucial for ensuring that they will continue to attend the full care and support.

Medical care is nevertheless just one opportunity among others. In this instance, the medical staff is requisitioned to dispense appropriate medical care. Ethics examine the hierarchy of values and the criteria governing choice, particularly in the field of healthcare They serve as points of reference for health professionals and a failure to observe them constitutes professional malpractice.

Ethical principles on the other hand are a general undertaking to respect human rights. Duty to treat people without discrimination This entails providing treatment and care irrespective of race, ethnicity, nationality, gender, religion or beliefs, social group, political affiliation, mores, family situation, reputation, disability, wealth and state of health.

Delivery of emergency treatment is the only criterion for prioritising care. This entails inflicting no unnecessary suffering by act or omission. Free and informed consent Service users must understand the stages of care — interview, examination, treatment, photographing, etc. Consent is considered free when it is obtained without threat, constraint or illegal incentive.

It must be informed, that is to say preceded by accurate, comprehensible and full information presented on what the proposed treatment involves. It is not enough to provide the information: it is imperative that the doctor ensures the patient has correctly understood it. Free and informed consent does not imply that it must always be explicitly formulated: for medical procedures and brief examinations that pose no significant risk to the patient, tacit or implicit consent is enough in instances where there is no doubt that it is being given.

In the case of certain medical procedures, however, national legislation requires written consent. Example: Under French law, any patient having to undergo a coloscopy must give written consent in advance consent form. Minors also have the right to receive clear and accurate information. Their opinion must always be sought and taken into account in relation to their degree of maturity and understanding Their consent alone is, however, not sufficient and their parents or other legal representative guardian exercising parental responsibility must be consulted.

In certain circumstances intrafamily violence, prostitution, sexual violence, etc. An alternative solution to informing the parents should therefore be found and a trusted adult designated by the minor should be sought for support. The interests of the child must always take precedence and guide the healthcare worker. This is even more crucial in violence cases. Medical confidentiality applies to the collection, circulation and archiving of data. No personal details should be disseminated, except between members of the same network of care providers. Multidisciplinary care and support involves different members of a network working together.

In such cases, the sharing of information is acceptable if it is done in the interests of the patient shared professional confidentiality. In terms of medical ethics relating to confidentiality, each care provider must share only necessary and relevant information. Medical confidentiality must also be guaranteed in the suitable layout of premises, ensuring a minimum of privacy for consultations. The issue of confidentiality similarly arises where an interpreter is required.

If the individual does not request a certificate, the doctor has a duty to offer one, stressing the usefulness and significance of a medical certificate. For care providers, protecting does not mean systematically reporting acts of violence of which they are aware. Such measures are only appropriate where the individual concerned has fully consented. The obligation to obtain consent may be waived for the purposes of protecting the patient: thus, the systematic reporting of children suffering abuse is often recommended. The same applies to cases of torture or other inhuman or degrading treatment involving individuals in prison.

For particularly vulnerable individuals person with a disability, dependent elderly person, person in a controlling relationship, etc. The particular circumstances of each case must take precedence over the systematic reporting of abuse. Certain prerequisites exist that ensure the quality of care dispensed. Over and above training for medical interventions, healthcare staff must also be trained to identify, receive and refer patients An ideal medical care and treatment pathway may be summarised in the following diagram: Interview Clinical examination.

General information Personal details For more information, see the two sections relating to receiving and identifying on pages and Description of incident The description of the incident, relayed by the doctor, is a transcript of what the patient says. Under no circumstances does it reveal any bias on the part of the doctor.

Where the situation allows for forensic examination to be carried out, some further information may be gathered in cases of rape washing after the assault, sexual intercourse since the assault and how often, etc. Some people prefer also to be examined by The clinical examination of victims of violence comprises three stages.

The use of a body diagram on which to record all details relating to each physical injury is recommended. This involves systematically describing the exact location of all wounds and injuries. Haematomas take a minimum of forty-eight hours to appear, particularly on black skin. The absence of physical signs does not imply the absence of violence. In such cases, some precautions must be followed: the doctor must avoid certain procedures — e.

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In any case involving a young girl, the use of instruments for genital examination is not recommended. Paraclinical tests Complementary tests must be carried out depending on the results of the clinical examination and resources available. These may involve biological tests in cases of sexual violence blood tests, HIV rapid serological test, STI screening, urine These different tests can have a forensic purpose concerning the perpetrator or the circumstances of the violence when used as part of judicial procedures Do not gather evidence that cannot be processed or used.

In the case of paraclinical tests, abide by the protocols methods for sampling, labelling, storing, etc. Do not hand over samples to the authorities if the individual does not wish to press charges. Medical details As is the case with every patient, healthcare staff receiving victims of violence must supply clear information on the methods for taking medication and on any possible side effects. Moreover, staff must advise patients of other existing care and support services that they might need. Treating physical injuries Where there is an open, weeping wound to the skin or mucous A treatment is referred to as curative when it involves topical procedures such as cleaning, suturing wounds only when they are clean and within forty-eight hours of an attack or prescribing antibiotics when the wounds are dirty and cannot therefore be sutured.

In some victims of sexual violence, physical lesions may include fistulas. As fistulas cause serious medical complications, the physical examination requires working alongside a doctor with the appropriate expertise. Where a fistula is confirmed or suspected in a woman surviving a sexual assault, she must be referred to a centre that offers surgical treatment to repair fistulas.

Fistulas can only be repaired by surgical procedure, unless the lesion is very recent. Medical treatment must take into account these different potential consequences. Refer to national guidelines where they exist. Where such documents do not exist, medical teams may then refer to the MdM guidelines which may also be collated with those of other NGOs operating in the area.

Always opt in favour of the shortest and most readily implemented treatment. The vaccine presents no contra-indications for pregnant women or anyone suffering from a chronic illness such as HIV. It can be administered at the same time as the anti-tetanus vaccine. Screening must nevertheless be offered to any victim of rape, regardless of the time that has lapsed. If the test is negative or is refused by the individual, post-exposure prophylaxis PEP must be offered if, and only if, the rape occurred recently.

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Post-exposure prophylaxis PEP is only effective and appropriate if administered within 3 days of the sexual violence. Post-exposure prophylaxis comprises two or three antiretroviral drugs ARVs to be taken over a period of twentyeight days. Tritherapy is the preferred treatment but where it is unavailable bitherapy should be used. As prophylactic treatment is only effective in the three days following a rape, it is absolutely essential to run awarenessraising and information campaigns for the local population on the time limits prescribed for the care of sexual violence. The population must also be informed that, even if a period of seventy-two hours has elapsed, medical treatment for sexual violence remains crucial.

Treating the risk of pregnancy and pregnancy resulting from rape Emergency contraception Medical care for victims of rape involves preventing unwanted pregnancies that may result. An emergency contraceptive pill should therefore be offered. Again, this is a matter of personal choice that can only be made by the woman concerned. The doctor has a duty to inform victims of the issues surrounding emergency contraception, while taking account of how contraception and abortion are perceived in the context. It must also be explained that the emergency pill has to be prescribed within a maximum of three days following the rape, as its effectiveness diminishes over time.

The emergency contraceptive pill acts by disrupting the reproductive cycle. It does not terminate nor damage an existing pregnancy. The World Health Organisation does not consider it to be a method of abortion A positive pregnancy test reveals the presence of a hormone that is not secreted until ten days after sexual intercourse. Thus, a pregnancy detected within ten days of a rape must be the result of sexual intercourse that took place before the incident. The victim was already pregnant at the time of the incident. Moreover, the emergency contraceptive pill cannot prevent pregnancy resulting from sexual intercourse that takes place after treatment.

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The doctor must therefore recommend contraceptive use as soon as possible, if the woman does not wish to have a baby. The question of pregnancy termination If a patient is pregnant as a result of being raped, the question arises of whether the unwanted pregnancy should be terminated. Here again, knowledge of the context is crucial as regards the legal framework abortion in cases of rape not permitted, abortion for minors without the consent of legal representatives not permitted, etc. The healthcare staff may also examine the legislation for any loophole that might make a legal termination possible.

Legal exceptions nevertheless do exist for therapeutic reasons: to save the life of a woman where she is in danger, or where there is the risk of serious deformity in the unborn child. In the case of a pregnancy resulting from rape, abortion is not allowed unless the rape was an act of terrorism. Despite these prescriptions, and given that pregnancy resulting from rape can have serious repercussions on the mental health of the woman, a certain number of doctors use the loophole offered by the legal right to perform therapeutic abortions. In so far as is possible, this should include putting the woman in touch with reproductive health services emergency treatment in the event of complications, family planning advice, etc.

In cases where termination is strictly forbidden, some women may wish to turn to illegal means to obtain an abortion. They then run the risk of procedures carried out in dangerous conditions that do not guarantee their medical safety untrained staff, unsatisfactory hygiene, etc. Healthcare staff, like the population in general, should be aware that psychological consequences following an act of violence are common and can be severe These symptoms must be taken into account.

In many cases, victims of violence succeed in overcoming their emotional difficulties. Where the opposite occurs and they develop psychological problems, more complex support must be available and the doctor must be able to refer the patient to a competent professional — psychologist, psychiatrist, psychiatric nurse, etc.

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All victims of violence should not automatically be referred. Mild tranquilisers or anti-depressants may be prescribed as an option alongside psychological care, if the latter proves insufficient. Such medication must, however, be used with caution and always prescribed by competent medical staff. It should not be used to make up for inadequate counselling and psychological care.

Drawing up a medical certificate Issuing a medical certificate is first and foremost a medical procedure and is thus one of the prerogatives of all doctors. It is based on the ethical principle governing the provision of certification at the request of a patient. The format of the medical certificate is crucial and must comply with specific regulations in order to be used for legal purposes Healthcare staff must make patients aware of the importance of medical follow-up care, i.

In all instances, follow-up consultations must be an opportunity for the care provider to repeat advice and information given during the initial visit; indeed it is quite likely that patients seen just after an assault will not retain all the information provided, as a result of having suffered a traumatic experience. Medical care provided to victims of sexual violence. This investment has led to these facilities forming part of medical protocols implemented at a national level.

Lastly, hospital staff receives ongoing training on providing care and support for victims of sexual violence throughout the year. Initial consultation and follow-up HIV post-exposure prophylaxis PEP is only effective when started within ideally 4 hours and at least 3 days 72 hours of exposure, and where the person is seronegative. Whatever the circumstances, the various tests carried out must not in any way hinder the dispensing of care and treatment. The table below sets out all the tests that must ideally be carried out on a patient — male or female — who has been raped.

It examines cases where PEP is and is not available. It should, of course, be adapted to suit what is realistically possible in the field. There is a risk of the virus being transmitted when a contaminating fluid comes into contact with a mucous membrane or an open wound. For any MdM programme likely to be responsible for caring for a victim of rape, it must be confirmed upstream whether an authoritative national PEP protocol exists and, if not, one must be put in place in the service.

In the absence of a national protocol, the one below may be used as it stands, or adapted to the field resources available. Where there are questions over the prospect of follow-up care, the treatment may be prescribed immediately for a period of 28 days, to maximise the likelihood of the course being completed. The doctor may equally decide to issue prescriptions for shorter periods — once a week or every two weeks — to provide better follow-up care, to check tolerability and to reiterate prevention advice.

Ideally, post-exposure prophylaxis is prescribed for only a few days initially, after which the patient is seen again by the HIV doctor responsible to assess treatment. If the doctor decides to continue the treatment, a prescription is reissued for a period of 28 days in total. Posology see table on the following page NB: If the first dose is taken in the middle of the night, it should be followed by a dose in the morning the night dose, even if close to that of the morning, serves as a loading dose.

Before prescribing HIV post-exposure prophylaxis, remember to check possible drug interaction if the patient is taking other medication. Where vomiting occurs within 3 hours, repeat the previous dose. Note: Emergency contraception will not protect against future pregnancies: if a woman is sexually active but does not want a baby, remember to recommend a contraceptive.

STI prophylactic antibiotic treatment: Protocols must be adapted to existing national protocols. It is administered in two injections of 1. The treatment is very painful and so warn the patient to take a painkiller. Otherwise, azithromycin is adequate treatment for a case of syphilis during incubation. The programme of vaccination should be completed according to one of the two following timescales: D0, D30 and D Or.

Hepatitis C Post-exposure treatment is not recommended. Where anti-HCV treatment is available, it is important to rapidly screen for possible seroconversion in order to administer the appropriate treatment. If the person has never been vaccinated against tetanus, the following programme of vaccinations should be followed: D0, D30 and M6.

Sources — French interministerial circular dated 13th March Psychological care of victims of gender-based violence consists of any act that guides victims in their psychic and emotional reconstruction after an event that has taxed their psychological well-being. The impact of gender-based violence on mental health and its possible repercussions in the form of mental disorders show how important psychological aspects are in providing multidisciplinary care for victims of violence. While the psychological consequences of violence are especially visible in persons who have suffered from such acts directly, they can also be considered from the point of view of the community and society at large.

There are many possible therapeutic responses to genderbased violence. Choosing the right ones will depend on the psychological suffering of the victim, as well as on the resources available in the context. Ideally, two complementary approaches a psychosocial approach and a medical approach must be accessible for the psychological rehabilitation of all victims of gender-based violence. Regarding psychic suffering, it is important to point out that this is not the same as mental illness.

The concept of empowerment must be also taken into account in cases of gender-based violence, given the fact that in this type of violence, power relationships are at the core of the link between the victim of aggression and the aggressor. The community dimension of empowerment involves individuals that act collectively in order to have greater influence and greater control over factors of health and the quality of life in their surroundings They go along, they lose confidence in themselves, and they feel shame and searing guilt, often believing that they deserved what happened to them.

Such guilt, along with an interiorisation of violence that can affect their very identities, is one possible reason so few victims come forward to seek the assistance of healthcare professionals. This results in a disruption of her psychological condition. Psychic suffering in victims of violence can show up in several forms. Some examples of psychological reactions to acts of violence:. My nerves are shot.

I feel out of breath. I hate him. I hate everything and everybody. My husband is going to ask for a divorce if he finds out, and my family will take away my children. What do people think when they look at me? Each person reacts in his or her own way to a potentially traumatic event. On the other hand, the lack of visible reactions after the event is not necessarily an indicator of the future traumatic impact. Psychotraumatic reactions depend on the nature and context of the event degree of violence, suddenness, duration of the act, whether it is repeated, threats made by the attacker, whether known or not to the victim, etc.

Resiliency is thus a primordial aspect in the psychological rehabilitation of victims of gender-based violence. Resiliency consists of a balance between, on the one hand, stress and difficulties and, on the other, the ability to cope with the situation and the availability of a source of support It is not about underplaying or overplaying those reactions and after-effects but, rather, individualising them, if we want to properly evaluate and help the victims. The impact of violence on the family and community Gender-based violence has psychological consequences on the persons who have suffered from it directly.

Consequences of violence spread first of all within the family For example, negative emotions can spread from victims of violence to members of their families. Emotional instability and psychological suffering felt individually can affect couples and families. Some family members or persons around the victims may have been witnesses to acts of violence and may therefore suffer psychologically. These persons can then be considered direct victims of the traumatic event Similarly, some family members may themselves be the aggressors in the case of conjugal violence, abuse, incest, etc.

In such cases, consideration must be given to the family dynamic that contributed to such violence, in order to better grasp the behaviour and reactions of each family member to the act of violence. The act of violence can also lead to negative reactions in the persons surrounding the victim. This is especially true in cases of sexual violence. Victims are often blamed, which exacerbates their feelings of shame. While such reactions are not justifiable, they can be considered as a way for the family to express its own suffering, as it has been indirectly affected by the violence. Comment transmettre ce que je sais?

Tout cela fait que Mathieu me ressemble. Physiquement, il me ressemble beaucoup il parait. Je veux bien le croire. Vous vous souvenez? Alors, certes, cela ne vole pas haut. Il veut voir les images. Sans doute. Bien entendu, le transfert sera plus faible vers Nathan que vers Mathieu.

Mais ils ne devraient franchement pas. Je ne fais aucune distinction entre les 2. Le handicap constitue un vrai business pour certains. Mais non. Bienvenue dans la matrice. Vous allez le voir. A vous de choisir. Sinon Nathan tomberait en permanence de sa chaise.

Donc option indispensable. Ma femme est une sorte de Mac Gyver. Mais surtout 48h au service du web pour tous. Sans le Web, nous serions encore plus ignorants et fragiles. Je suis admiratif. Je respecte son point de vue mais je ne changerais pas le mien! Un jeu jouable par le plus grand nombre : aveugles, malvoyants, voyants, sourds.

Nous sommes en Laissez-moi vous raconter. Les guillemets ont disparu autour du mot chance. Il a repris son sens premier. Cela donnerait une bonne image au programme de recherche. Sinon, tant pis. Les simulations semblaient prometteuses! Douche froide. Si seulement nous avions su. Je lui fais donc une confiance totale. Oui mais on explique maintenant pourquoi.