COVID-19: Providing care to vulnerable people in Brazil

As COVID-19 continues to spread around the world, many people are unable to shelter in relative safety. With increased infection rates among homeless populations in Brazil, Médecins Sans Frontières (MSF) teams are adapting activities to provide aid to the most vulnerable.

MSF staff conduct health promotion activities and basic consultations in Rio de Janeiro, in areas where access to public health services is scarce. © MSF

When COVID-19 began to spread in Brazil, those in upper and middle classes were the first to become infected. With the virus now being spread throughout the general population, those at particular risk are those without a safe place to shelter or without access to adequate hygiene.

People who are unemployed face daily challenges in securing regular meals, as well as access to soap and clean water. Those fortunate enough to have a roof usually share the same room with several people. The most vulnerable live in the streets, where following physical distancing guidelines is impossible. In Boa Vista, in Roraima state, tens of thousands of people unable to access the official shelters and are living in spontaneous settlements or on the street. They have little or no access to healthcare and basic hygiene and are particularly exposed to contamination. Many people have to continue their activities to try to make ends meet, despite the potentially deadly risk.

Countering misinformation

To provide assistance to vulnerable groups in Boa Vista, our teams are focused on providing assistance to Venezuelan migrants and asylum seekers by regularly visiting the informal shelters to provide hygiene and physical distancing guidance to residents. Together with partner organisations, we are working to expand access to water in formal and informal shelters and distributing hygiene kits. The work of medical professionals in Boa Vista gives special attention to people with pre-existing diseases, as they are more susceptible to infection. MSF staff are also providing training on infection prevention and control measures to health teams that will work at the field hospital set up by the state government.

Our efforts in São Paulo and Rio de Janeiro are concentrated in sites attended by the homeless population. Our teams are providing medical consultations for screening of COVID-19, and referring patients in more serious conditions to hospitals. We're focusing on homeless people, migrants and refugees, drug users, and the elderly. The work also includes education on hygiene measures and is being carried out in partnership with local authorities and organisations that are already involved with the street population in São Paulo.
“If we are unable to identify them early enough, patients in more serious condition that are on the street will die on the street,” said Ana Letícia Nery, MSF´s Project Coordinator in São Paulo.

Water and sanitation areas set up at MSF’s health promotion activities for the homeless in Rio de Janeiro. © Mariana Abdalla/MSF

In addition to the complexity of the pandemic itself, Brazilians are also enduring a lack of information, scepticism, and even denial of the existence of COVID-19. The disagreement between President Bolsonaro, who criticizes limitations to movement and business activities, and the State and city governments who have tried to implement necessary restrictions, has created a confusing environment. The contradictory views are obstructing the adoption of life-saving physical distancing measures.

The experience of other countries where the pandemic arrived before Brazil has shown the importance of adopting physical distancing measures,” says Ana de Lemos, Executive Director of MSF-Brazil. “It is important that we slow down the rate of contagion as much as possible so that we can reduce the number of serious cases that reach the hospitals at the same time. “At times like this, it is crucial to have a clear orientation, but unfortunately we have witnessed the diffusion of contradictory guidelines that hinder compliance with the necessary measures.”

Supporting the healthcare system

A consultation during MSF’s health promotion activities for the homeless in Rio de Janeiro. © Mariana Abdalla/MSF

Our work in Boa Vista was originally established with the aim of supporting the local health system and helping it cope with the increasing demand. With the pandemic, MSF is maintaining this project and adapting activities to help overcome the challenges brought on by COVID-19.  

“Even before the arrival of the pandemic, Roraima's health system was already fragile, and this situation has worsened things even more,” says Michael Parker, MSF Project Coordinator in Boa Vista. “We are working to try to lighten the burden on the local system, both in relation to COVID-19 and other diseases.” 

Physical distancing is essential to reduce the pace of infection and avoid further collapse of the Brazilian health system.
MSF nurse during screening activities with Warao people (indegenous group from Venezuela) at a shelter in Manaus, Brazil, May 2020.

Local hospitals in Manaus, the capital of Amazonas state, have managed to increase their numbers of intensive care unit (ICU) beds, but unfortunately, mortality rates linked to the disease remain high. Over the last several weeks, mortality rates have reached alarming levels in the capital and throughout the state.

To reduce the number of people dying, MSF will start working at Hospital 28 de Agosto, managing 12 ICU beds for critically ill patients and 36 beds for moderate cases and will provide the medical staff to care for patients with COVID-19. Our teams are also preparing to provide similar support to other hospitals in the city.

MSF has already been working in six shelters for refugees and homeless people in Manaus to provide health promotion sessions, hygiene support to help prevent COVID-19 transmission, and medical consultations and screening to identify people who might have COVID-19. By the end of this week, in partnership with the state government, our teams will set up an isolation and observation centre for vulnerable people with milder cases of the disease, who do not need hospitalisation.

MSF teams will also launch a response this week in remote areas of rural Amazonas, to support quality medical care for patients with moderate and severe cases of COVID-19. Our teams intend to work in at least two locations, one of which is the municipality of São Gabriel da Cachoeira.

The health of indigenous communities who struggle to reach healthcare is of major concern, and MSF is consulting with indigenous leaders and organisations to guide assistance for these communities.

Slowing the spread of COVID-19 is another important component of MSF’s response in Amazonas state. Reducing the rate at which people are infected will lower the number of critically ill patients who require medical attention at the same time, alleviating the burden on the health system.

For this reason, health promotion to disseminate correct information on preventive measures is essential. We are planning to increase our health promotion activities in both urban and rural areas. To reach people who live in remote areas, our teams are preparing to train community leaders, who can then pass on this knowledge to their communities.