Abstract
This text focuses on the medical evacuation system (EVASAN) for patients from Mayotte to Reunion Island. It examines the role of the different actors involved in this particular system, which mobilizes specific professional practices and skills in a constrained geopolitical and health context. The geographical location of these two French overseas departments and their proximity in the Indian Ocean zone allow for access to care for the population of Mayotte, through these daily therapeutic circulations that require support and coordination of often complex care paths. This article identifies and qualifies the multiple and intertwined constraints - organizational, relational, structural, political and administrative - that guide the practices of professionals involved in patients’ health care pathways. We explore the impact of these constraints on their work, and highlight the adaptations, arrangements and resources they deploy to make the EVASAN work.