Puerto Rico: As COVID-19 cases rise, MSF ramps up its response

MSF and local partners have conducted health promotion campaigns that focus on handwashing, wearing masks in public, and physical distancing. We commissioned street murals to promote these important health messages in the busy areas of San Juan near shelters.
Puerto Rico 2020 © Amanda Hooyber/MSF
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Update: On September 30, Doctors Without Borders/Médecins Sans Frontières (MSF) completed its COVID-19 emergency response activities in Puerto Rico after more than four months of providing medical and humanitarian assistance to some of the most vulnerable communities on the island. Four doctors and nurses working with the MSF team have started their own medical aid organization, Puerto Rico Salud (PRS), to continue our model of home-based primary care and monitoring for COVID-positive patients. MSF’s home-based care model was designed to serve people who have little to no access to health care, including marginalized and isolated communities. The MSF medical team saw more than 1,200 patients, mostly older adults suffering from chronic conditions such as diabetes and hypertension, which can make them even more vulnerable to COVID-19. 

Over the duration of the project, MSF also helped distribute more than 30,000 items of personal protective equipment (PPE), provided 5,000 hygiene kits to homeless people and others living in poor or isolated communities, conducted hundreds of health promotion sessions for at-risk communities, and provided infection prevention control (IPC) trainings for frontline health workers at eight facilities. All of this work was done in close collaboration with community-based organizations and local health providers.  

San Juan, Puerto Rico, August 19, 2020With Puerto Rico seeing a sharp increase in coronavirus cases  over the past month, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has expanded its response on the island, providing primary care consultations in homes and clinics to people with no access to medical services and monitoring the symptoms of COVID-19 patients.

MSF formed two medical teams in Puerto Rico to provide home-based and clinic-based care for people suffering from chronic health conditions who had been unable to or fearful of going to health care facilities due to COVID-19. As demand has been increasing, MSF is in the process of dispatching a third medical team. With the number of coronavirus cases growing exponentially in the territory, the number of patients enrolled in MSF’s COVID-19 monitoring program keeps increasing.  

“We are still learning so much about this virus, and we know how quickly people can go from moderately ill at home to extremely sick and in need of emergency care,” said Rolando Betancourt de Leon. “Through this program, we are monitoring people’s health to make sure it’s safe for them to remain at home, and providing them with the information they need to take care of themselves and to know when it’s necessary to call for help.”

In San Juan, Puerto Rico, MSF doctor Jonathan Caldera and MSF nurse Rosa Cifrian walk through La Peninsula to provide home-based medical care for people who lack access to health services.
© MSF

As of August 18, there have been at least 27,713 cases and 346 deaths in Puerto Rico since the beginning of the pandemic, according to the Centers for Disease Control and Prevention. During the week of August 14, there have been an average of 645 cases per day, an increase of 46 percent from the average two weeks earlier.

In San Juan, MSF works in collaboration with several Puerto Rican organizations. For example, Coalición de Coaliciones offers COVID-19 testing to homeless people at a fixed site, while MSF sets up a pop-up clinic nearby to provide medical consultations. If someone tests positive, they can enroll in MSF’s COVID-19 monitoring program.

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The COVID-19 monitoring program is a 14-day, mobile phone-based system in which patients can self-enroll via text or WhatsApp. The patient monitors their symptoms daily and reports the results by phone to an MSF nurse. MSF provides referrals to mental health and social workers, if needed. If the case is severe, MSF refers the patient to a hospital. Teams also support patients to receive prescriptions through primary care doctors.

“Testing positive for COVID-19 can be extremely scary for anyone, especially if you are managing your own symptoms at home or relying on family,” said Betancourt de Leon. “The care we have been able to provide helps relieve a lot of that anxiety—because our patients know they are being monitored by medical professionals, and because they now have the information they need to manage their symptoms and limit transmission to their families.”

MSF medical teams also provide home-based care and carry out consultations at fixed clinics for patients suffering from chronic health issues. As MSF prioritizes services for the most vulnerable people, its medical teams in and around San Juan work with homeless people, drug users, and the elderly. They travel to remote areas in the east (Humacao, Fajardo, and Loíza), west (Arecibo and Utuado), and south (Ponce) of the island where people with chronic health conditions live in isolation.

Map_JPG_Puerto Rico Covid-19 Response
© Carrie Hawks

“During an acute emergency, such as what we are seeing with COVID-19, chronic health issues can go ignored in neglected or vulnerable communities,” said Betancourt de Leon. “People with high blood pressure or diabetes or HIV, for example, might not be able to get to their regular medical appointments, or they might not be able to get their prescriptions refilled and stop taking their medicines. With these clinics for people with chronic health conditions, we are trying to prevent COVID-19 from causing another type of health emergency.”  

When MSF began its COVID-19 response in Puerto Rico in early May, MSF dealt with the immediate needs for personal protective equipment (PPE) and training on infection prevention and control (IPC) measures to limit the spread of the coronavirus in health facilities, detention centers, schools of nursing, and among high-risk populations. MSF has helped distribute nearly 30,000 PPE, conducted infection prevention training to staff at 22 facilities, provided 5,000 hygiene kits, and is continuing to provide hand hygiene and COVID-19 health education workshops to high-risk groups.

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.