MSF supports COVID-19 response in Puerto Rico already paralyzed by multiple crises

In San Juan, Puerto Rico, an MSF team conducts an infection prevention and control training for staff of a local community group, Intercambios.
Puerto Rico 2020 © Amanda Hooyber/MSF
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San Juan, Puerto Rico, July 1, 2020—As part of its COVID-19 response in the United States, Doctors Without Borders/Médecins Sans Frontières (MSF), has been providing support to health facilities, conducting health promotion activities for high-risk communities, and bringing home-based medical care to vulnerable people across Puerto Rico, the medical humanitarian organization announced Wednesday.

Puerto Rico is facing a COVID-19 outbreak as it continues to grapple with the health impacts of two devastating hurricanes in 2017 and a sequence of powerful earthquakes earlier this year. When the first cases of COVID-19 were reported in March, the island’s health care infrastructure was already under extreme strain. The Centers for Disease Control and Prevention report that as of June 30, Puerto Rico had 7,465 reported cases and 153 deaths.

“The health care system and all facilities have had to make major adjustments to operations, including deferring and delaying non-COVID-19 care,” said Sophie Delaunay, MSF project coordinator in Puerto Rico. “Telemedicine was not accessible to many people and high unemployment contributed to worsening health conditions. We realized people already in a fragile state of health were being neglected.”

Since April, when MSF teams first arrived, the organization has been helping to support the immediate needs of health facilities and communities in Puerto Rico as COVID-19 cases increased. MSF has distributed personal protective equipment (PPE) and conducted infection prevention and control (IPC) trainings for essential workers. It has brought health promotion activities and hygiene kits to communities at higher risk for COVID-19 transmission, to give them the information they need to protect themselves and help limit the spread of the virus. In mid-June, MSF formed a mobile medical team to travel to remote areas and provide home-based primary care and carry out consultations at pop-up clinics to serve vulnerable people across the island. MSF has visited communities living in Caguas, Loiza, and Utuado so far.

When officials formally put in place “stay-at-home” orders to slow the spread of COVID-19, these restricted movements meant that it was even more difficult for vulnerable people, as well as those living in isolated areas, to seek health care or follow-up care for their chronic or acute medical conditions.

“Before COVID-19, Puerto Ricans were already struggling to cope with day-to-day life, after the string of natural disasters,” said Jonathan Caldera, an MSF physician working in Puerto Rico. “Some people, such as the elderly and those with chronic conditions, find themselves in continuous need of medical assistance. COVID-19 has just exacerbated their needs and has further stressed the health system, just as we enter hurricane season.”

MSF has also worked to bolster supplies and support to Puerto Rico’s health care system. MSF identified 21 health facilities that needed PPE materials and some requested infection prevention and control training. Over two months, MSF distributed more than 20,000 PPE kits, 4,000 masks, and 14,500 face shields and conducted 60 hours of training for more than 100 participants, with 50 percent participation in "Training the Trainers" workshops.

“We were told that some emergency rooms could only provide staff with one mask per week,” said Delaunay. “In any response, it’s critical that frontline workers have the equipment and information they need to stay safe, so we set out to bolster PPE supplies and to train these workers on how to mitigate risks in health care settings as much as possible.”

At the same time, MSF partnered with community groups who were assisting the homeless, the elderly, people with substance abuse disorders, and families who have been affected by the recent earthquakes to distribute 3,700 hygiene kits. In order to give people greater agency over their health and protect the health of others, MSF—with local partners—conducted health promotion campaigns that focused on hand washing, wearing face masks, and physical distancing.

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.