The emergence of this new strain of coronavirus has made it clear that, despite scientific advances and the implementation of sophisticated sanitation systems, the gap in inaccessibility to health for vulnerable populations has widened dramatically; always placing women, children, the elderly and others of lower socioeconomic status at a disadvantage.
HHI serves communities whose total population is near 20,000 people, who nearly all face multiple challenges: lack of access to quality medical care, shortage of public health services such as drinking water and public sanitation, institutionalized discrimination against the Haitian minority, and a changing health profile that increases the burden of chronic diseases in the most disadvantaged people such as the elderly, children, women, and other populations. Many people suffer from chronic, untreated diseases because they cannot afford transportation to a doctor, whose capacity may already be limited by an overburdened healthcare system. It is important to emphasize that the majority of our patients suffer from diseases such as diabetes, hypertension, cardiovascular disease, respiratory ailments, HIV, cancer, and other chronic diseases, so they are more likely to have complications related to COVID-19.
Furthermore, the cost of medicines is prohibitive, due in part to rising unemployment. Intestinal parasites caused by lack of access to clean water and infectious diseases that could be prevented by public health interventions are all too common. Lack of proper nutrition, safe places to exercise, and community investment in health education are barriers to healthy lifestyles.
Unemployment is assumed to be nearly 80%, largely due to the closure of the sugar cane refinery in 2005, combined with the recent global economic downturn and its resulting effects on tourism. Access to medical care is limited by economic, geographic and socio-cultural barriers. Hunger, lack of adequate housing, and lack of access to clean water are also widespread problems. As in the whole country, it is important to note that there are disparities in living conditions, economic opportunities, and social determinants of health, especially in the local migrant population.
In this sense, COVID-19, like any other emerging disease, amplifies gaps in poverty and access to resources in developing countries:
- Most people living in rural areas depend on the informal economy whose incomes have been interrupted by the curfew, while others still work in high-exposure areas to guarantee their livelihood. On many occasions, laid-off workers do not receive compensation or health insurance.
- Inadequate food in the house produced by the depletion of provisions can cause complications in the nutrition of children in the long term, among other conditions.
- It is nearly impossible to reach some people because some homes cannot be accessed either virtually or in person due to the lack of transportation routes such as roads or bridges, or means of communication such as telephones.
- The immigration issue is aggravated as language and cultural barriers, along with fear of deportation, make this population afraid to go to health centers.
- In addition, the situation of destitution also exposes people without sustainable or permanent housing to contagion.
Since the first suspicious cases were identified in our country, our team did not stop until all our operations were aligned to continue safeguarding the health of our patients, designing mechanisms to provide follow-up and remote care to the beneficiaries of our programs, enabling lines of emergency for people in rural areas, among countless preventive and educational initiatives as follows:
- First, since most medical centers and primary care units were to cease operations after the primary elections held two weeks ago, we expedited the process for ALL patients in our Referral Program to see their respective specialists. Most of the cases requiring urgency were satisfactorily concluded.
- Second, given the drop in access to medicines and medical items, we were able to purchase ALL of the medicines for the 150 patients in the Chronic Care Program for up to 2 additional months. Patients will have enough medication in case the quarantine is extended. The program team will be responsible for packaging and home delivery.
- Third, due to political distraction at the beginning of the month, the nation did not act properly in informing or educating citizens on what actions to take regarding COVID-19, how it spreads, or what preventive measures we could take. Based on this, we conducted two intensive workshops with our community health workers to teach them about the virus, preventive methods, what to do if one of our patients has symptoms, and the proper follow-up to give. In turn, the health promoters trained the community.
- Finally, our employees received their advance payments so that they could make the purchase of supplies, food and essential products in advance, in addition to complimentary health insurance.
Following our mission of improving community health through the strengthening of primary care services, HHI adapted its program activity to continue offering care and attention to hundreds of chronic patients. Some of our measures included:
- Using the guidelines of the World Health Organization and national and international alignments, we developed our own educational material in Spanish and Creole to continue reaching more people and spread awareness. In addition, we created a Care Kit (an antibacterial bar of soap, masks, a bottle of hand sanitizer and a brochure with information on COVID-19) for 300 families in Montellano.
- Creating a Monitoring and Evaluation system for a “COVID-19 Emergency Response and Follow-up,” so in case we identify anyone in the community with the symptoms, we can connect them with the testing services, additional care and follow-up. It is a digitized case management system.
- Implementing an internal emergency line to identify community patients who present symptoms and ensure that they took the essential measures to connect with the personnel of the Ministry of Public Health of the country.
HHI maintains a firm commitment to our community despite the challenges and adversities that have been presented to us; unquestionably, without the help or support of each one of you, we cannot carry out our work and ensure that dozens of families in precarious situations continue to receive primary care. Some of the challenges we are facing to optimize our reach are:
- The shortage of certain medicines and essential equipment in the face of massive purchases, and in turn, the limitation of receiving medications and medical equipment from abroad. To do this, we have been traveling to neighboring cities to obtain these items.
- The availability of basic care kits and an educational manual on COVID-19 to deliver to more members of rural communities.
- Since the majority of the clinical centers operating are in urban areas, it is difficult for people in rural areas to get tested for COVID-19.
- Weak clinical structures that do not have the supplies for many people.
- Clinical personnel working without protection or essential care equipment, exposing themselves to contagion.
Based on this premise, HHI has created the COVID-19 Relief for Vulnerable Communities, an initiative that seeks to guarantee continued access to disadvantaged populations to primary care and essential care services during the pandemic. How could your contribution continue to strengthen our work? How could you make an impact in our communities? Our mission is to improve community health and strengthen primary care services; therefore, we want to serve as a bridge between the most affected populations and health services. Some of the expenses that this initiative will cover are:
- Primary care services and specialized care for patients in rural areas by a family physician who will carry out home visits
- Medications, multivitamins, prenatal vitamins, and other essential items
- Antibacterial soap care kits and educational material
- Assistance to health promoters who provide primary care services and follow-up to patients in the communities
- Support to the program team to continue clinical operations in rural areas during the epidemiological crisis.
Although the gap in access to health for people facing social, economic, and political disparities is wider due to this pandemic, people like you who support our work help us serve as a bridge for the people who need it most. We cannot compensate for the difficulties this global pandemic has created for non-profit organizations like ours whose work is more crucial now than ever, but knowing that we have the support of people like you assures us that we are not alone.