Monday 28 November 2022

Health workers Look for older adults at bus stops and mangroves to vaccinate them in Osa

ATAPs must resort to boats, horses, and mountain vehicles to reach patients, in the midst of forgetfulness, almost no cellular signal and even opposition against vaccines

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QCOSTARICA – Asistentes Técnicos de Atención Primaria (ATAP) – Primary Care Technical Assistants – face a race against time to prevent the prepared doses of vaccines against covid-19 from being lost in the canton of Osa, in the southern part of Costa Rica.

Sometimes ATAPs must go where older adults are working to prevent them from missing the second dose. Photo: Osa Health Area

Getting a large part of the older adults in the municipality to apply the first dose was an odyssey and, now, getting them to receive the second has been an equally intense crusade.

That was what motivated Randy Arguedas, who works at Ebáis in Coronado de Osa, to look for an older adult even at the bus stop where he was about to take a bus to Palmar Norte.

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There, when he found him, he managed to give him the second dose of the Pfizer vaccine.

Arguedas said that he had left the message to the older gentleman the day before so that he could come to Ebáis to get the vaccine, but the family member who received the call forgot to remind him.

Seeing that he did not arrive for the appointment, he had to go to the older man’s house, since the doses were already prepared.

According to Arguedas, they told him that the man was not there and that they did not know what time he would be back.

The older adult, a resident of Coronado de Osa, received the second dose of the vaccine while waiting for the bus to go on an errand to Palmar Norte. Photo: Osa Health Area

“A grandson tells me that he had seen him waiting for the bus at a stop nearby. When he tells me that, I go to the stop, and there he was. When he saw me arrive, he laughed and told me ‘you are coming for me, I had forgotten’,” Arguedas recalled.

According to Arguedas, these types of situations are common and they must frequently go “fishing” for the elderly to give “to their jobs in the fields, in the pastures, or in the mangroves” to get them their injection.

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“Very often, because there are so many days of waiting for the second dose, patients in this area forget; many are older adults who work in livestock and generally we have to go about it calling to remind them.

“Some say yes, but when the time comes and they don’t show up. So, we have to run because the prepared doses have time that cannot be passed,” he said.

Lorena Villalobos, Director of Nursing for the Osa Health Area, reported that some residents do not have the resources to travel to Ebáis, in addition to the fact that there is little cellular coverage to receive reminder calls or when the elderly live alone, they forget the date they are due to return for the dose.

“Another thing that is difficult is that the health workers arrive and do not find the person; they have to go to look for them where they are, even stuck in the mud, to get them the second doses, because, otherwise, they will not come,” she added.

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Arguedas added that, in the Ebáis de Coronado, there are insured who have to travel up to two hours on foot to get the vaccine.

Many of the older adults are reached in their workplaces in the fields and immunizations are given right there. Photo: Osa Health Area

They even have to use boats to cover a coastal area where they depend on the tide to gain access, as well as horses for the mountainous area and vehicles called “mules” that foreigners lend them to reach the most complicated parts.

Another of the difficulties that health workers have faced is that, in some families, older adults feel inhibited, as their children tell them not to get vaccinated.

Villalobos recalled the case of a woman who has several children and constantly calls from her because one of them, who agrees, tells her to apply it. However, when they come to look for her in an ambulance – because being oxygen-dependent, she must get the vaccine in the hospital – and someone else has influenced her to change her mind.

I feel like I’m hunting’

The director of Nursing still remembers the message that one of the ATAPs sent her accompanied by a photo inside a vehicle.

The official told her that he had been in front of the house for hours waiting for the man to arrive to give him the pending vaccine.

Unfortunately for him, the man did not arrive and he had to run in search of another man to give him the vaccine so that it would not be lost.

In another of the anecdotes that have been shared, a similar situation occurred with a 91-year-old man who, finally, after a lot of convincing work, had agreed to get the vaccine.

When they got to his house, he backed off and there was no way to make him change his mind.

“That happened and in the middle of a torrential downpour, the companions were walking at 8 pm waking up a man who was already sleeping to not spoil those doses,” she recalled.

Villalobos argued that it is also common for them to stay at work late at night, calling to remind them of their appointments, because during the day it is impossible to reach them.

Despite this, that Health area managed to complete more than 80% of the second group and be able to start with the third, in which they have found greater consent to apply the doses.

According to data from the Caja Costarricense de Seguro Social (CCSS), as of Tuesday, May 18,  this health area had applied the vaccine to 5,609 people, 3,567 of them had already received the second dose.

“Everyone has made an incredible effort, it is like writing a book of each story, of the places where we have had to go,” said Lorena Villalobos.

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