This article was updated on November 12, 2020.
In response to the unprecedented challenges presented by the COVID-19 pandemic, Doctors Without Borders/Médecins Sans Frontières (MSF) began working in key sites across the United States to reach vulnerable groups that often lack access to health care. We ran limited operations in the US between April and October and have now concluded these activities.
MSF teams collaborated with local authorities and community-based organizations on a wide range of projects, including work with people who are homeless or housing insecure in New York; migrant farmworkers in Florida; Native American communities in the Navajo Nation and Pueblos; and neglected and marginalized communities in Puerto Rico. Our teams also worked with staff in nursing homes and long-term care facilities in Michigan and Texas to offer training in infection prevention and control measures and support for mental health and wellness.
In New York City, MSF worked to reduce the spread of the novel coronavirus by partnering with local organizations to improve infection prevention and control (IPC) measures for at-risk groups. MSF opened temporary relief stations in Manhattan, offering free showers, toiletries, socks, and underwear and information on additional services to people who currently lack access to hygiene facilities. We have provided more than 2,000 showers. MSF has also donated over 160 handwashing stations to places like soup kitchens and supportive housing facilities and distributed 1,000 mobile phones to vulnerable New Yorkers who lack the essential technology needed to contact emergency and support services.
MSF has concluded its activities by handing over one of its temporary relief stations to Shower Power, a local nongovernmental organization. Recognizing the importance of hygiene and showers for this community, local organizations have been trying to develop this type of program and services for several years and MSF's intervention helped to lay the groundwork to allow for this work to continue longer-term.
In Florida, MSF spent two months in Immokalee, where approximately 15,000–20,000 migrant farmworkers continued to labor during the pandemic with minimal access to health care and testing. Beginning in early May, MSF ran a public health education campaign and mobile testing clinics in collaboration with the Coalition of Immokalee Workers (CIW), the Healthcare Network of Southwest Florida, and the Collier County Department of Health. In recent weeks, increased attention on the high rate of COVID-19 transmission in farmworker communities in Florida has led to increased testing efforts by county and state officials. MSF has completed the handover of its COVID-19 testing and public health program for farmworkers to the county health department and local organizations.
In the Southwest, MSF worked in partnership with local officials, community leaders, service organizations, and health care workers from the Navajo Nation and Pueblos in the southwestern states of New Mexico and Arizona that are directly addressing needs related to COVID-19. The MSF team provided guidance and training on IPC measures at a variety of medical and non-medical facilities from homeless shelters, nursing homes, and group homes to correctional facilities, with Emergency Medical Services (EMS) units, and with new police recruits. We also worked closely with local partners to expand public health information and education about COVID-19 at the community level. The MSF team developed a training program called “Teachers of IPC” and collaborated with a local organization to deliver the workshops.
In Puerto Rico, MSF worked in close collaboration with local partners to provide a range of services, including primary care consultations in homes and at ‘pop-up’ clinics for people suffering from chronic health conditions who were not going to health care facilities due to COVID-19. Our work offering home-based care and COVID-19 monitoring for people isolated at home will continue with a newly formed organization, Puerto Rico Salud, which was created by a group of MSF’s Puerto Rican staff.
When MSF began its COVID-19 response in Puerto Rico in early May, MSF helped support medical facilities with immediate needs for personal protective equipment (PPE) and provided training on infection prevention and control (IPC) measures to health care workers in order to limit the spread of the coronavirus in health facilities, detention centers, schools of nursing, and among high-risk populations. MSF helped distribute nearly 30,000 PPE items, conducted IPC training to staff at eight facilities, provided 5,000 hygiene kits, and conducted hand hygiene and COVID-19 health education workshops to high-risk groups.
In Michigan’s nursing homes and long-term care facilities—where more than 7,500 residents have tested positive for COVID-19 and over 2,000 have died—MSF coordinated with the Michigan Department of Health and Human Services and the Detroit Health Department to identify which facilities needed to improve infection control measures. MSF supported more than 50 long-term care facilities—including 31 nursing homes and 24 adult foster care homes—in Michigan between the end of May and July 31. Medical teams offered three sets of activities to help protect residents and staff: assessments and general guidance to improve infection prevention and control practices, technical on-site support and training, and mental health workshops to address the high level of stress and grief that the frontline staff face every day.
As the MSF team departed Michigan at the end of July, continuity of this model of on-site support was promoted. MSF has prepared a toolkit for schools of nursing to incorporate into their public health curriculum. We are reaching out to nursing schools nationwide to integrate this toolkit as part of the curriculum.
For more information, read Frequently Asked Questions about MSF's US COVID-19 Response.
In Houston, Texas, MSF visited 24 nursing homes carrying out infection prevention and control (IPC) assessments, conducting in-person IPC workshops for clinical and non-clinical staff, and providing more than 28 psychosocial support sessions for staff. Supporting residents and staff in nursing homes has been a high priority for MSF because the COVID-19 pandemic has disproportionately affected people living in elder-care facilities and endangered those who care for them.
MSF focused on caring for caregivers and staff based on its experience working in more than 750 nursing homes in Belgium, France, Italy, Spain, and Portugal when the pandemic first swept across Europe, leading to an alarming number of COVID-19 infections and deaths among residents and staff in long-term care facilities. When the pandemic spread in the US, about 40 percent of coronavirus deaths were among older adults living in nursing homes.