PIH's Emergency COVID-19 Response

by Partners In Health (PIH)
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PIH's Emergency COVID-19 Response
PIH's Emergency COVID-19 Response
PIH's Emergency COVID-19 Response
Nurse is prepped for COVID-19 vaccine in Chiapas
Nurse is prepped for COVID-19 vaccine in Chiapas

Due to the support of donors around the world, Partners In Health staff have begun to receive COVID-19 vaccines. Starting in late January, staff members in Chiapas, Mexico, began receiving their first dose of the vaccine, the first step of many in the long journey back to a post-COVID world.

When COVID-19 arrived in Mexico in late February last year, clinicians in Chiapas held their breath. The pandemic would not arrive in the southwestern state until March and, even then, would remain in the single digits for weeks. But doctors knew the worst was coming—it was only a matter of time.

“It took so long for the pandemic to reach Jaltenango,” says Dr. Selene Chacón of Compañeros En Salud, as Partners In Health is known locally. Chacón is based at the community hospital in Jaltenango de la Paz.

When the virus did arrive, it would leave no community unaffected. In late March, cases jumped from single to double digits, passing the 1,000 mark in May. By June, the surge had begun; Chiapas joined the rest of the country at the maximum “red light” level on the Mexican Ministry of Health’s stoplight map.

Compañeros En Salud has worked since 2011 in Chiapas, where it has focused on strengthening health systems in Jaltenango and surrounding rural communities. That work has included a mentorship program for first-year

 state until March and, even then, would remain in the single digits for weeks. But doctors knew the worst was coming—it was only a matter of time.

“It took so long for the pandemic to reach Jaltenango,” says Dr. Selene Chacón of Compañeros En Salud, as Partners In Health is known locally. Chacón is based at the community hospital in Jaltenango de la Paz.

When the virus did arrive, it would leave no community unaffected. In late March, cases jumped from single to double digits, passing the 1,000 mark in May. By June, the surge had begun; Chiapas joined the rest of the country at the maximum “red light” level on the Mexican Ministry of Health’s stoplight

clinicians, a community health worker program, and support for the public health system, including a community hospital, a birthing center, and rural primary care clinics.

From the moment it arrived, COVID-19 put that system to the test—challenging doctors, nurses and care delivery teams to think quickly on their feet and improvise when necessary, in response to a pandemic that often showed little sign of relenting.

As cases ticked upwards, clinicians delivered critical treatment at all hours of day and night, tending to patients as they recovered, or as they took their last breath.

That care has made an impact. Although cases are ticking upwards, as expected following the holidays, clinicians are better prepared. The mortality rate in Chiapas has steadily declined since August. And the state was no longer “red” on the stoplight map, as of mid-January.

Now, as the fight against COVID-19 continues, clinicians are leveraging their expertise and experience to respond with compassionate care, applying lessons learned over the past several months. That work has made one thing clear: investing in public health systems is crucial—for the pandemic response and beyond.

A Race To Respond

When Selene Chacón finished medical school, she took a leap of faith and decided to do her year of social service, required by the Mexican government for all university graduates, with Compañeros En Salud through its pasante program.

The program, designed for first-year doctors and nurses, placed Chacón in a rural community clinic, where she provided primary care and received training and mentorship from experienced physicians. Chacón was so moved that, after the program ended, the newly minted doctor decided to continue her work with Compañeros En Salud.

Then, COVID-19 struck.

What followed was a race to respond to a public health emergency that intensified by the day. As COVID-19 cases mounted in Chiapas, clinicians scrambled for resources that were scarce, including tests, and struggled to keep up with rapidly evolving public health guidance.

“There was not much information at the time or guidelines on how to treat patients,” says Dr. Ana Rodríguez, who supervises the COVID-19 medical team at PIH-supported Angel Albino Corzo Community Hospital. “The protocols were based on very new information.”

But that didn’t stop clinicians. In her new role as infection and control coordinator, Chacón sprang into action, working with her team to establish a triage system at the hospital and to coordinate the pandemic response across all of Compañeros En Salud’s care delivery sites. And Rodríguez, based in the community hospital’s COVID-19 unit, treated patients, trained doctors, and managed care delivery.

None of those things were small feats.

Mexico provides universal health care to citizens, but that care can be hard to access in states like Chiapas, where the majority of people live in poverty, and in rural areas, where travel can be cumbersome and costly, often on poorly paved roads. For many rural communities, the nearest hospital is hours away.

‘We Are In This Together’

Despite the initial hurdles, Compañeros En Salud has delivered care to an increasing number of patients over the past several months as resources, staffing and capacity have improved. Since April, the team has treated at least 526 suspected and 16 confirmed cases at the community hospital and clinics.

In July, Compañeros En Salud partnered with Angel Albino Corzo Community Hospital to open the Respiratory Disease Center, a 5-bed facility equipped with oxygen concentrators to treat patients with severe COVID-19—care that once would have required a long, costly journey to another hospital at least two hours away. Within weeks, the center saw its first patients and helped them recover and return home to their families.

Compañeros En Salud also worked with hospital leadership to introduce a new policy that allows family members to visit their loved ones with personal protective equipment—the only hospital in the area that offers such visitation. That decision has been crucial in helping patients recover and fighting the disinformation about the virus that once ran rampant, encouraging more people to seek medical care.

“Patients now have more information and less stigma,” says Rodríguez.

She has seen that shift first-hand. Nowadays, patients come to the hospital early on, when their symptoms are still mild, instead of waiting until they worsen—a sign that gives clinicians hope that communities now have a better understanding of the virus and when to seek care.

“At Compañeros En Salud, we are already more prepared,” says Chacón. “We already have experience, and this is a strength.”

Still, the doctor urges caution. “We cannot lower our guard,” she says. “There will still be peaks…people must know that we are still here and we are in this together.”

PIH doctor holds baby Naphtal in Sierra Leone
PIH doctor holds baby Naphtal in Sierra Leone
CHW's spread information in Immokalee, FL
CHW's spread information in Immokalee, FL
Supporters of the People's Vaccine, Cambridge, MA
Supporters of the People's Vaccine, Cambridge, MA
Community health workers in Lima, Peru
Community health workers in Lima, Peru
Mother and child at home visit in Malawi
Mother and child at home visit in Malawi

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A staff member with Socios En Salud, as PIH is known in Peru, does a door-to-door mental health screening with a patient after a chatbot app connected them.
A staff member with Socios En Salud, as PIH is known in Peru, does a door-to-door mental health screening with patient Nancy in a neighborhood near the capital, Lima, after they were connected by the Bienestár app.

Maritza has been a singer for years; but when her mother died of lung disease, the music lost its meaning.

It was a loss that the resident of Callao, Peru—a rural community outside of the capital of Lima—describes as devastating. Maritza, a single mother who shares a home with her daughter, grandson, and 85-year-old father, recalls not being able to sleep or concentrate on things that usually brought her joy. It felt like something was missing.

It wasn’t until she began speaking with a psychologist through Socios En Salud, as Partners In Health is known in Peru, that things began to turn around.

“Today, I feel more relieved,” says Maritza, who speaks with her counselor on the phone. “She understood me, despite the distance, and knew how to treat me.”

Maritza is one of nearly 5,000 Peruvians who have accessed mental health services through PIH since the start of the pandemic. This mental health support comes as part of PIH’s COVID-19 response in Peru, where PIH has provided more than 22,800 COVID-19 tests and offered more than 3,000 people social support, including medicine, food, and housing assistance.

“When we connect people, both physically and emotionally, within a community or a family [with] the resources they need, we will be providing them better opportunities,” says Carmen, director of mental health in Peru.

PIH has worked in Peru for more than 20 years. Its mental health work there has included providing tuberculosis patients with psychological support, establishing a safe house for women living with severe mental health conditions, and training local residents as community health workers, who refer patients to mental health centers and connect them with care.

During COVID-19, that work has adapted to also include group and individual counseling for families mourning the loss of loved ones, as well as an innovative messaging app called Bienestár. The app, run by PIH’s team of local psychologists and community health workers, offers mental health screenings and connects patients with care virtually. It currently serves three of the communities where PIH works.

Catherin, who supervises PIH’s work in the Trujillo community, says mental health is crucial for everyone. That’s because it’s never just one person who is affected. Mental health has ripple effects—on a family, a household, and a community.

“It is essential for a person to be concerned about their mental health,” says Catherine, “because this action can be replicated at home with their entire family and so, little by little, be concerning for overall health.”

Stigma, says Carmen, is also a barrier to accessing mental health care. Yet people have to realize they are not alone in experiencing difficulties. “Emotions are part of being human,” she says.

Carmen Contreras is director of mental health in Peru.Carmen is director of mental health in Peru. 

Carmen has seen SES’s mental health work evolve over the years. That journey has been both professional and personal—especially this year.

“A close relative of mine nearly died from COVID,” she says. “It was actually very difficult for my family. I spent a month dealing with that…we were all devastated.”

Much of that devastation came from the fact that her family, like many others affected by COVID-19, didn’t know how to tell other relatives when their loved one’s condition was worsening.

“With COVID, we need to work on that,” says Carmen, whose relative has since recovered. “It’s not just oxygen, or saturation, or the lungs; it’s also how we deal with our emotions.”

A pandemic and the uncertainty it brings—from work to health care to housing—takes a toll not only on physical health but on mental health. That makes a mental health response to the pandemic all the more vital.

For Maritza, the journey has been difficult. But she is making music again.

“It has been very beneficial for me to have a psychologist by my side,” she says. “Now, I can breathe. I don’t feel pain in my chest. The oppression that I had I was able to lift thanks to the specialist’s help.”

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A mural in Haitian Creole in Belladere
A mural in Haitian Creole in Belladere

Following the first confirmed COVID-19 case on March 19, the Haitian government announced the closure of the country’s main point of entries, including ports, airports, and the border with the Dominican Republic.

For more than 15 years, Zanmi Lasante (ZL)—as Partners In Health is known in Haiti—has been providing health care at the border in Belladère at the Hôpital Notre Dame de la Nativité. In early March, ZL collaborated with the region’s health director to place a medical team at the Elias Pina-Belladère crossing, where migrants pass daily. As part of those efforts, the team has collected demographic and health information related to COVID- 19 and taken migrants’ temperature.

Despite the official closure of both sides of the border, native Haitians have self-deported by the hundreds daily in cramped buses, where they are unable to maintain social distancing and often travel without personal protective equipment, such as masks and gloves. Health experts fear that this unprecedented migration could fuel the transmission of the virus throughout Haiti.

ZL has been involved in all aspects of the fight against COVID-19 but is uniquely positioned to respond to this need for screening along Haiti’s eastern border. Leadership and staff believe that prevention, especially stopping transmission through rigorous testing and contact tracing, remains essential for control of the pandemic.

Below, ZL staff working in Belladère talk about the process travelers undergo at the border, the reactions they’ve received so far, and why they believe this work is important in stopping the spread of COVID-19 in Haiti.

 

When did border testing in Belladère begin?

Testing at the border began on April 7.

 

Tell me about the COVID-19 screening process for travelers arriving in Haiti.

Upon arriving at the border, they are welcomed and invited to disinfect their shoes and wash their hands. Those who don’t have a mask are given one. Then they sit down in order of arrival while giving priority to pregnant women, travelers with children, and the elderly. They receive an educational session on COVID-19.

Afterward, travelers go see a service provider, who is equipped with a tablet and a thermometer, and respond to a questionnaire. After the questionnaire is completed, they are invited to come to the lab, where pre-test counseling is done, and the test is completed.

Using rapid diagnostic tests (RDTs), trained personnel place a drop of the traveler’s blood onto a device that tests for antibodies, which are produced in individuals whose immune systems have successfully fought off the virus.

After about 15 minutes, RDT test results are available. If the test is negative, ZL staff reinforces advice on how to prevent the transmission of COVID-19, and the traveler is able to leave.

 

How many people have already been tested? And how many have tested positive?

As of this week, more than 1,750 people have been tested, with 39 positives. Of this last group, four travelers were confirmed positive for COVID-19 through a PCR, or polymerase chain reaction, test conducted later at a higher-level facility.

 

What is the process for those who are positive?

We proceed with meticulous counseling while informing them that they are suspect cases and that another confirmatory test is mandatory. For this reason, they must be referred to ZL’s University Hospital in Mirebalais or to the ZL-supported hospital in Hinche to be quarantined and await results from a PCR test. PCR tests are only being analyzed by the National Lab in the capital of Port-au-Prince.

 

Why did ZL decide to start testing at the border?

ZL leadership wanted to determine the maximum number of suspected cases passing through the Belladère border and, using that knowledge, help stop or reduce the spread of the virus throughout Haiti.

 

What type of reception has ZL staff received for this border screening?  

In general, people accept being tested. However, they often arrive in large numbers from a long journey—sometimes lasting several hours or even several days. If they could, they would avoid all screening to be able to continue on their journey home. We did have a case were two people who were in quarantine in Hinche escaped. But luckily, we were able to find them, talk to them about the importance of quarantine, and welcome them back into care.

 

What are people's reactions to being tested? 

This only poses a problem when the people being tested are asymptomatic, get a positive result, and must be placed in quarantine. They don’t want to be placed in quarantine, because they don’t think they are infected and just want to go home.  

 

Do staff feel nervous about being exposed to people who may test positive?

Staff doing the tests aren’t nervous about being infected, because they have proper personal protective equipment. Nevertheless, some are precautious and want to know their status before returning home so that they don’t put their families in danger of infection.

 

How do staff feel about the importance of this work?

Knowing that there are a lot of people who are infected in the Dominican Republic, they believe the work they are doing at the Belladère border is extremely important. It is important to know travelers’ status because there is an imminent risk that they may be infected and subsequently may spread it to the Haitian population.

Zanmi Lasante staff train on COVID-19 Tests
Zanmi Lasante staff train on COVID-19 Tests

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Partners In Health (PIH)

Location: Boston, MA - USA
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Twitter: @PIH
Project Leader:
Annie Niland
Boston, MA United States
$796 raised of $50,000 goal
 
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