"Our goal was to vaccinate 6,000 patients," says Rolando Betancourt León, president of Puerto Rico Salud. “Now we are aiming for a little more and vaccinating people who are homeless, people with mental or physical disabilities, bedridden patients, and those in communities with difficult access to health services.”
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This April, Doctors Without Borders/Médecins Sans Frontières (MSF) began supporting efforts led by the local health organization Puerto Rico Salud to bring COVID-19 vaccines to vulnerable and hard-to-reach communities on the island. People who already had inadequate access to health services have lagged behind in receiving COVID-19 vaccinations through the health system. Puerto Rico Salud took a new approach, sending mobile teams to vaccinate people in remote or marginalized communities, as well as people who are homeless or living with chronic diseases. "Health care providers still lack the means to ensure that hard-to-reach people are vaccinated, but together we are showing a way to overcome these challenges," explains MSF coordinator Sophie Delaunay. "This model must be scaled up further in Puerto Rico to ensure that neglected and vulnerable people are not missed."
Photographer Gabriella Báez joined Puerto Rico Salud as they began this three-month vaccination campaign.
Puerto Rico Salud grew out of MSF’s work in 2020 to provide home-based care and monitoring for people with COVID-19 in remote or marginalized communities. Puerto Rican members of the MSF team went on to form an independent organization to continue to provide vital health services to underserved groups.
“Puerto Rico Salud does not discriminate against any type of community,'' says Carla Sofía González Levalle, a co-founder of Puerto Rico Salud and the current community service coordinator. “The focus of Puerto Rico Salud is really to help the most [vulnerable] communities, the most remote places, those that are the most marginalized and that no one is currently serving.”
“[In] Puerto Rico, there is a great need for primary health in our communities," says Carla. "Clinics or people who focus on going to the community are limited. We have many bedridden people [and] many caregivers [in] remote communities. [For these people to] make arrangements to be transported to a hospital or to a vaccination area is a very difficult and complicated process."
“We know these vulnerable communities, and we offer help," she adds. "We [can meet] with the community leader and coordinate everything to provide medical services [and] bring the vaccine to the people."
The vaccination campaign is a collective effort. The Puerto Rico Department of Health is providing the COVID-19 vaccines, and the Colegio de Profesionales de Enfermería de Puerto Rico is aiding in the safe storage of the vaccines. “We are currently collaborating with a lot of nonprofit organizations … coming together to see how we can vaccinate as many people as soon possible,” Carla says.
“We are trying to reach communities that are difficult to access in the mountainous area,” says Rolando. “The roads are very difficult to transit and they are far from health centers.”
“Logistics is a very important factor in the entire vaccination project carried out by Puerto Rico Salud,” says Carla. “[This] is why it is important to have constant communication with the community leader, so that he or she knows how to identify those people that [we] will be vaccinating and providing medical services.”
COVID-19 vaccination efforts are progressing in Puerto Rico, although rates have generally lagged behind most of the US, according to data from the US Centers for Disease Control and Prevention. As of May 7, Puerto Rico Salud had administered 5,587 doses of COVID-19 vaccine. MSF is supporting Puerto Rico Salud’s efforts through June 2021. “As the pandemic continues, we know these efforts can be lifesaving,” says Sophie Delaunay, MSF coordinator in Puerto Rico. “It is critical to ensure that people who have not had access to COVID-19 vaccinations can receive them.”