As the number of cases and deaths from COVID-19 in Brazil is increasing, Doctors Without Borders/Médecins Sans Frontières (MSF) is mobilizing additional emergency teams to help fight the disease. “The challenge Brazil faces today is simply unprecedented,” says Ana de Lemos, executive director for MSF Brazil. “We are facing an epidemic that is out of control, with health systems in most Brazilian states on the verge of collapse or already lying in ruin.”
MSF’s COVID-19 response over the past year is the organization’s largest effort since we began providing medical services in Brazil in the early 1990s. Hundreds of MSF staff have been involved in treating patients with COVID-19 in Brazil—many of them Brazilians with international experience suddenly responding to a crisis in their own country. MSF has worked in several Brazilian states, assisting homeless people, migrants, indigenous communities, and people in prisons. In the north of the country, we supported the local health systems in Amazonas and Roraima states, and have just started a project in Rondonia to mitigate the impacts of COVID-19.
While still active in Amazonas state providing mental health care for health workers, the international medical humanitarian organization’s new projects in the northern region aim to prevent new cases and improve care in areas with fragile health systems and among vulnerable communities. MSF is working to support the local health system in this region, which has been overwhelmed by the rising number of patients requiring hospitalization due to COVID-19.
“In the northern states, there is proportionally little availability of hospital beds, especially for severe cases,” explains Fábio Biolchini, MSF emergency coordinator in Brazil. “That is why it is very important to enhance prevention strategies and early diagnosis of milder cases to prevent them from getting worse and needing intensive care that may simply not be available.”
An MSF team is starting activities this week in Porto Velho, the capital of the northern state of Rondônia. MSF's initial support includes increasing medical staff, improving infection prevention and control protocols, and training local staff in emergency care units (ECUs). These activities may be expanded or modified according to local needs as the situation is quickly evolving.
Normally, only emergency procedures are performed at the ECUs, and patients who require further assistance are referred to a hospital after being stabilized. With the surge in COVID-19 cases, however, hospitals are overwhelmed, and local teams are struggling to accommodate patients at the ECUs. People’s conditions range from moderate to critical, so some of them require intensive care, which is being provided in conditions that may not be able to accommodate that level of care.
MSF is also monitoring the situation outside the capital. There is concern about oxygen supply shortages as the rise in COVID-19 cases has increased demand.
In the past few weeks, MSF teams have been working in different areas in the state of Roraima, where the organization has been present since 2018 to support the fragile health system after the increasing influx of migrants and refugees from Venezuela.
In addition to our work in the state capital city, Boa Vista, MSF carried out activities in the cities of Pacaraima, on the Brazilian border with Venezuela (214 kilometers or 133 miles from Boa Vista), and Caracaraí (142 kilometers or 88 miles from the capital). In Pacaraima, the local hospital team received training in infection prevention and control and health promotion. MSF also offered mental health support to health professionals in the city. Teams are carrying out similar work this week in Caracaraí, the third largest city in Roraima.
The situation in Rondônia and Roraima is similar to many places in the northern part of the country, which historically lacks sufficient material and human resources in the medical field.
“We are closely monitoring the situation in the region," explains Biolchini. "The fact that we have professionals on the ground allows us to move quickly to a certain area to start an emergency intervention, supporting the local response capacity."
MSF also worked in Roraima state earlier in the pandemic.
MSF maintains a presence in the state of Amazonas, where the organization returned at the end of last year when the cases of COVID-19 started to spike, leading to the collapse of the health system and a serious crisis of lack of oxygen.
Until the beginning of March, MSF worked to reinforce medical assistance at the José Rodrigues ECU, which was adapted to treat critically ill patients with COVID-19, given the high demands in the region. MSF was also present in rural areas. In São Gabriel da Cachoeira, professionals supported a care unit for moderate cases. In Tefé, MSF assisted the Regional Hospital, which expanded its bed capacity to meet the growing number of cases.
After MSF contributed to the medical emergency response during a critical period of the second wave of the disease—in January and February—the project in Amazonas’ capital, Manaus, is now based on psychological support for health professionals. MSF psychologists work at Hospital 28 de Agosto, the largest health facility in the capital of Amazonas, and at the José Rodrigues ECU.
"We realized that when the peak of deaths in January and February passed, the demand for our services has grown a lot," said MSF mental health manager, Álvaro Palha. “The needs for psychological support tend to increase after the most acute phase of very serious events of the pandemic is decreasing. That is why it is so important that we maintain our presence here at this moment.”
The work of psychologists includes individual consultations and group sessions, in addition to remote assistance for health workers who are away from their duties due to health reasons. MSF also offers training for local mental health professionals, so assistance to the medical staff can continue.