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COVID-19 on the front lines: An interview with Ecuador’s Red Cross

The Ecuadorian Red Cross team delivers humanitarian aid to local communities. Red Cross photo, used with permission.

Tathiana Moreno, Essential Areas Manager at the Ecuadorian Red Cross, oversees efforts to keep the Ecuadorian population healthy every day.

According to official figures at the time of publication, there are 33,582 confirmed cases and 2,799 COVID-19 deaths in Ecuador. In Ecuador, medical personnel make up 20% of the deceased. However, similar to many other parts of the world, government figures are difficult to rely on due to a lack of efficiency or transparency.

Before joining the Ecuadorian Red Cross, Moreno worked at the United Nations Development Program (UNDP) and at the Ministry of Health. During a phone interview with Global Voices, she offered a direct look at her humanitarian work from inside one of Latin America’s pandemic epicenters. Note: The interview has been edited for clarity and length.

Gabriela Mesones Rojo (GMR): How is the Ecuadorian Red Cross managing during the pandemic?

Tathiana Moreno (TM): El primer cambio es que ya no trabajamos con voluntarios, a pesar de haber aumentado muchísimo el ritmo de trabajo. Actualmente estamos manejando fallecidos confirmados por COVID-19 y fallecidos presuntos de COVID-19, de acuerdo a la disposición mundial del manejo digno de los cadáveres. También empezamos un servicio de captación y donación de sangre a domicilio porque con las medidas de cuarentena han cerrado los bancos de sangre. Es un protocolo que sólo se está haciendo en Ecuador y la Cruz Roja Ecuatoriana provee el 80% de la sangre a nivel nacional.

También organizamos un programa de agua, saneamiento e higiene, principalmente en Santo Domingo, Santa Elena, Guayas y Cañar donde también hay un problema de dengue. En Guayaquil, la zona de mayor contagio es un barrio de clase muy alta, en el que mucha gente estaba volviendo de viaje; mientras que la zona de mayor mortalidad por COVID-19 son los barrios más pobres. Se da a entender que hay una vinculación con el acceso a servicios, principalmente la falta de agua.

Esta semana también activamos un proyecto piloto, un centro de triaje respiratorio, para ayudar a la descongestión de los hospitales en donde pueden ser atendidas las personas con problemas respiratorios. Vamos a empezarlo en Quito, y si resulta lo ampliamos a nivel nacional.

Hacemos telemedicina y apoyo psicosocial a nuestro personal y hemos afianzado nuestro apoyo a la población migrante en 22 albergues. También hemos coordinado cursos online de prevención y control de infecciones y de Bienestar emocional ante el COVID-19 y prevención en confinamiento. Todo esto conlleva una logística enorme con costos altísimos.

Tathiana Moreno (TM): The first change we made is that we no longer work with volunteers, despite the huge increase in the pace of work. We are currently handling both confirmed and presumed COVID-19 deaths in accordance with worldwide customs for respectful handling of the deceased. We also started an at-home blood collection and donation service because blood banks are closed for quarantine measures, which is a protocol that is only being carried out in Ecuador. The Ecuadorian Red Cross provides 80% of blood nationwide.

We also organize a water sanitation and hygiene program mainly around Santo Domingo, Santa Elena, Guayas, and Cañar, where they are battling a dengue problem in addition to COVID-19. In Guayaquil, the area with the highest outbreak is concentrated in a very wealthy neighborhood, where several people were returning from trips; but areas with the highest COVID-19 mortality rates are in the poorest neighborhoods. This implies a connection with lacking access to basic services — specifically access to water.

This week we also began a pilot project setting up a respiratory triage center where people with respiratory problems can be cared for in order to decongest hospitals. We’re starting it in Quito, and if it works out we will expand nationwide.

We provide telemedicine and psychosocial support to our staff, and we’ve strengthened our support for migrant populations at 22 shelters. We’ve also put together online courses on topics like infection prevention and control, emotional wellbeing in the face of COVID-19, and prevention during confinement. All this involves enormous logistical planning and very high costs.

Ecuadorian Red Cross team. Red Cross photo, used with permission.

GMR: How have you coordinated the procurement of the necessary medical equipment when reports state that there is a shortage at the national level?

TM: Está resultando muy complicado encontrar lo que necesitamos. Las ambulancias sí están usando los implementos de seguridad, pero han sido sumamente difíciles de conseguir. Antes de la llegada del virus a Ecuador, la caja de mascarillas N95 costaba $3,95. Hoy día una sola mascarilla N95 cuesta $4. El traje completo de bioseguridad (el traje, las botas, los batones, los lentes, los guantes) tiene un costo de $64. Eso quiere decir que cada atención que hacemos, que incluye a un conductor de ambulancia, paramédico y asistente son mínimo $200 que van a la basura después de cada atención. Esto no lo cubre el estado, porque la Cruz Roja se maneja con fondo propios, tanto el equipamiento como la capacitación.

TM: It's becoming very difficult to find what we need. Ambulances are indeed using safety equipment, but it has been extremely challenging to obtain. Before the virus arrived in Ecuador, an N95 mask box cost $3.95 USD [translator’s note: Ecuador’s currency is the US dollar]. Today a single N95 mask costs $4. The complete biosafety suit (suit, boots, batons, glasses, gloves) costs $64. That means that each care run we do, which includes an ambulance driver, paramedic, and assistant, is a minimum of $200 that goes into the trash after each use. This isn’t covered by the state because the Red Cross handles its own funding for both equipment and training.

GMR: What does working at the migrant shelters look like?

TM: Cruz Roja tiene un programa para migrantes desde hace un año y medio aproximadamente y tenemos una relación muy estrecha con la comunidad migrante. La Cruz Roja abrió una línea para la captación de donaciones para migrantes en situación de calle, vulnerables, sin redes de apoyo y dependientes del trabajo informal. El gobierno por ley ha sacado un decreto que impide poder cobrar servicios o botar a gente de una casa por temas de arriendo mientras dure el estado de excepción, pero los registros nos muestran que muchos migrantes y ecuatorianos están siendo afectados. Tenemos bastantes personas regresando a Venezuela por trocha debido a esta situación. 

TM: The Red Cross has had a migrants program for around a year and a half, and we have a close relationship with the migrant community. The Red Cross opened a line to collect donations for migrants who are homeless, who are vulnerable, without support networks, and dependent on informal work. The government, by law, has issued a decree that prevents people from charging for services or evicting people because of rent issues while the state of emergency lasts, but records show that many migrants and Ecuadorians are still being affected. We have many people returning to Venezuela on foot because of this.

GMR: Do you have a record of how many people are seeking to return to their country of origin?

TM: Nuestro registro oscila entre 40 hasta 700 personas que buscan salir por trocha diariamente. Esto no son cifras oficiales, sino que son registros que hacemos a través de alianzas con cancillería y otras estructuras migratorias. Esta situación se ve principalmente con la comunidad venezolana, porque son quienes han venido en las últimas oleadas migratorias a Ecuador. Hablamos de personas que tienen menos de un año en el país, y por ello sus vínculos de pertenencia y sus sistemas de apoyo son más débiles. La población colombiana puede tener una historia de 10 a 12 años en Ecuador y la comunidad Haitiana creció después del terremoto del 2010, así que ya están afianzados al país. En cambio la comunidad venezolana siente una vulnerabilidad y un temor muy grande. Muchos testimonios hablan de como le tienen miedo a que si mueren y son cremados en otro país y que sus familiares no se enteren.  

TM: Our registry indicates about 40 to 700 new people per day try to leave on foot. These are not official figures but records that we track through alliances with the Foreign Ministry and other migratory structures. This is seen mainly with the Venezuelan community, because they are the latest migration waves to arrive in Ecuador. We are talking about people who have been in the country for less than a year, and therefore have weaker membership ties and support systems. The Colombian population may have a history of 10 to 12 years in Ecuador and the Haitian community grew after the 2010 earthquake, so they are already more firmly rooted in the country. However, the more recent Venezuelan community feels vulnerable and fearful. Many report feeling scared of dying and being cremated in another country without their relatives being notified.

Ecuadorian Red Cross team delivers humanitarian aid to communities in populated regions across the country. Red Cross photo, used with permission.

GMR: How are the frontline medical personnel who treat patients feeling during this time?

TM: En el caso de la provincia de Guayas, una de las zonas más afectadas, tuvimos a 53 personas contagiadas, 1 fallecido y 1 en estado crítico ya en recuperación. Muchos tenían miedo de contagiar a sus familiares, así que habilitamos un espacio para que ellos pudieran hacer la cuarentena. La situación es muy dura y compleja. No es una situación lejana tampoco, estos son nuestros colegas, compañeros de lucha.

A nivel nacional tenemos un total de 4 fallecidos vinculados con COVID-19. La última persona que falleció no estaba ni siquiera en en primera línea de atención, sino haciendo telemedicina desde su casa. Pero el contagio es tan alto que igual se enfermó.

Esta situación nos ha permitido repensar la vida, nuestro papel, nuestras funciones como institución. En la Cruz Roja creemos en la humanidad, en aliviar el sufrimiento humano en toda circunstancia. Estos tiempos nos demuestran la importancia del cruz rojista y que más que nunca que nuestros principios están vigentes.

TM: In the province of Guayas, one of the most affected areas, we had 53 people infected, one deceased, and one in critical condition who is now in recovery. Many were afraid of infecting their relatives, so we set up safe quarantine spaces for them. This situation is very hard and complex. It isn’t a distant situation either, these are our colleagues and comrades in struggle.

Nationwide we have a total of four deceased personnel linked to COVID-19. The last person who died was not even on the front line, but conducting telemedicine from home. But the contagion is so high that he still got infected.

This situation has allowed us to rethink life, our role, and our functions as an institution. At the Red Cross we believe in humanity, in alleviating human suffering in every circumstance. These times show us the importance of the Red Cross, and how now more than ever our principles are valid. 

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