Florida: MSF and local health partners bring COVID-19 testing and mobile health clinics to migrant farmworkers

United States 2020 © Katie Irwin/MSF

IMMOKALEE, FLORIDA, MAY 18, 2020The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has begun working in Southwest Florida to assist migrant farmworkers who are particularly susceptible to contracting COVID-19.

The organization is working in Immokalee, Florida, on a public health education campaign and is supplementing local testing efforts. It is also providing non-COVID-19 medical consultations through community-based mobile “virtual” medical clinics.

“Immokalee is a community where as many as 15,000 to 20,000 migrant farmworkers continue to provide essential labor during this pandemic despite having a high risk of contracting COVID-19 due to crowded living conditions and limited ability to prevent infection during the course of their work,” said Adi Nadimpalli, a doctor working as MSF project coordinator in Florida.

MSF is working in close collaboration with local partners, including the Coalition of Immokalee Workers (CIW), the Healthcare Network of Southwest Florida, the Braden Clinic, and the Department of Health of Immokalee and Collier County. Over the last three weeks, MSF has conducted public health activities in Spanish, Haitian Creole, and English to promote healthy behavior and social distancing. The organization has also run five mobile clinics where it has tested 126 people, with significant support from the Healthcare Network of Southwest Florida. While the majority of the test results are still pending, initial results from the first clinics show a high positivity rate, indicating ongoing community transmission.

Dr. Nadimpalli also noted that these initial clinics have shown that there is a strong interest from community members for testing. Last Wednesday alone, 47 patients came to the MSF clinic for COVID-19 testing, many of whom had symptoms or were contacts of patients who tested positive during mass testing done the week before by the Department of Health and the National Guard. 

While there is a desire for testing by the community, accessing tests and the personal protective equipment (PPE) required to operate clinics is challenging, not just for MSF, but also for other organizations in the area as well, said Dr. Nadimpalli.  

“While confirming more positive cases might sound alarming, the fact is persistent testing and ongoing health education is the only way to break the chains of transmission and stop this outbreak,” said Dr. Nadimpalli. “Testing should be accessible to every person at a convenient time and place, in their native language, and in a safe environment.”

In addition to the mass testing conducted by local health officials and the National Guard in Immokalee two weeks ago, another mass testing drive will be held later this week in Naples, about 40 miles from Immokalee. Ongoing testing is also being provided at the Healthcare Network at the Department of Health. MSF activities will help to augment these efforts and provide another option for farmworkers who can’t easily get away from their work to get tested. The organization is also willing to work with local farms and packing houses to provide testing and health promotion on-site. MSF plans to support the Department of Health with contact tracing.

In addition to COVID-19 testing, MSF is providing free tablet-based telemedicine consultations for unmet general medical issues in private kiosks, as part of the mobile clinics. MSF depends on volunteer doctors from around the country to provide the remote medical consultations in English and Spanish, and they hope to soon add Haitian Creole.   

“The mobile clinics provide a safe space for the community to ask questions and receive accurate information to reduce stigma and rumors around the pandemic,” said Maria Plata, MSF health promoter.  “Many farmworkers in Immokalee work long hours and around six days a week. They can’t afford to take a day off to visit a clinic, so we are bringing the clinics to them.”

MSF first learned of the concerning situation in Immokalee after being contacted by CIW, a human rights organization with a long history working in the community. Since the start of the outbreak, CIW has called for specific public health interventions and policies to control the outbreak and reduce community transmission, such as increased access to free COVID-19 testing, affordable health care, and isolation facilities.

At the end of April, MSF sent a team to Immokalee to assess the situation and quickly realized that health education and testing activities needed to be ramped up immediately.

“We wanted to ensure that these workers received COVID-19 health education and testing before they started to migrate north at the end of the southern Florida farming season,” said Dr. Nadimpalli. “If we don’t reach them now, it may be much more difficult to ensure their safety. However, we’ve never worked in Florida and could not have responded in time without the support of CIW and our other local health services partners.”

MSF says it is concerned that the current testing efforts, including its own clinics, are insufficient.

“Testing has increased in bigger cities, but we’re going to have to ramp up testing right here in Immokalee in order to control the spread of the virus and meet the needs of the community,” said Dr. Nadimpalli.

MSF is an international medical humanitarian organization with programs in over 70 countries. MSF teams are preparing every project where they work to be COVID-ready as the pandemic sweeps the globe. In the United States, MSF’s COVID-19 response teams worked with migrant farmworkers in Florida; helped people who are homeless and housing insecure in New York City; supported Native American communities in the Navajo Nation and Pueblos; and trained essential workers in nursing homes and adult foster care facilities for the elderly in Michigan. In Puerto Rico, MSF has two mobile medical teams to provide care at patients' homes or at pop-up clinics and is forming a third team to handle the rise in cases. These teams are also monitoring COVID-19 patients who are asymptomatic or have mild or moderate symptoms. MSF has started a new program in Texas providing IPC trainings to staff and residents in nursing homes and assisted living facilities.