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Tuesday, July 8, 2025

Venezuelans and the increasing demand on T&T's public health system

by

Raphael John Lall
1522 days ago
20210509
Dr Nyla Lyons

Dr Nyla Lyons

In an in­ter­view with the Sun­day Guardian, Dr Ny­la Lyons, a pub­lic health spe­cial­ist with more than 15 years of ex­pe­ri­ence work­ing with de­vel­op­ment agen­cies, gov­ern­ments, NGOs and civ­il so­ci­ety or­gan­i­sa­tions in­ter­na­tion­al­ly and across the Caribbean, dis­cuss­es her on­go­ing work with Venezue­lan mi­grants and shares some pre­lim­i­nary find­ings of her study ex­am­in­ing their health needs, use of health ser­vices and the de­mands placed on the lo­cal pub­lic health sys­tem.

Lyons is cur­rent­ly work­ing with the Med­ical Re­search Foun­da­tion of T&T (MRFTT) in col­lab­o­ra­tion with lo­cal and in­ter­na­tion­al pub­lic and pri­vate part­ners to plan, im­ple­ment and eval­u­ate pro­grammes to help ad­dress the health ser­vice needs of vul­ner­a­ble pop­u­la­tions to in­clude mi­grants in T&T.

Lyons is ad­vo­cat­ing for a pol­i­cy to ad­dress non-cit­i­zens' ac­cess to pub­lic health ser­vices.

The pub­lic health spe­cial­ist re­cent­ly ini­ti­at­ed a strate­gic part­ner­ship be­tween the MRFTT and a Wash­ing­ton-based Di­as­po­ra Or­gan­i­sa­tion to fur­ther steer re­sources and strength­en in­ter­na­tion­al col­lab­o­ra­tions to ad­dress the health needs of Venezue­lan mi­grants lo­cal­ly.

Q: Can you tell us what is known about Venezue­lan mi­grants in T&T and their ac­cess and use of pub­lic health ser­vices?

A: Be­gin­ning in 2016, T&T has seen in­creas­ing in­flows of refugees and mi­grants from Venezuela. Mi­grants have been ar­riv­ing by both sea and air. Based on what is doc­u­ment­ed, around 16,000 peo­ple were doc­u­ment­ed as part of the Gov­ern­ment Mi­grant Reg­is­tra­tion Ex­er­cise in June 2019. The UN­HCR (Trinidad and To­ba­go UN Refugee Agency) re­port­ed that the num­ber of mi­grants con­tin­ues to in­crease. 86 per cent of UN­HCR’s per­sons of con­cern are Venezue­lans, and around 19,490 refugees and asy­lum seek­ers were reg­is­tered with the UN­HCR by the end of 2020 (UN­HCR, 2021). The lo­cal pub­lic health sys­tem con­tin­ues to face in­creas­ing de­mands as a re­sult of the in­flows of Venezue­lan refugees and mi­grants to T&T be­gin­ning in 2016. By the end of 2020, 71 per cent of mi­grants who re­port­ed ac­cess­ing health ser­vices used lo­cal pub­lic hos­pi­tals (IOM Mi­grant As­sess­ment Re­port, 2020). The IOM as­sess­ment con­sist­ed of a sam­ple of 950 Venezue­lan mi­grants in T&T. In a re­cent sur­vey to as­sess the health needs of Venezue­lan mi­grants, 76 per cent re­port­ed ac­cess­ing care from lo­cal hos­pi­tals and health cen­tres. The study was im­ple­ment­ed by me, Dr Lyons and a team from the Med­ical Re­search Foun­da­tion in Sep­tem­ber 2020.

 Can you share in­for­ma­tion about your re­cent study–what was the pur­pose, who com­mis­sioned the study and how was it fi­nanced?

The study was fi­nanced through a grant from the UWI to the Med­ical Re­search Foun­da­tion in Ju­ly 2020. The study ex­am­ined the health needs, use of health ser­vices, and up­take of HIV test­ing by Venezue­lan refugees and mi­grants in Trinidad. Peo­ple of Venezue­lan na­tion­al­i­ty were re­cruit­ed and in­vit­ed to par­tic­i­pate. A health ques­tion­naire was ad­min­is­tered via tele­phone to 250 peo­ple in the months of Sep­tem­ber through No­vem­ber 2020 ie, dur­ing the COVID-19 lock­down pe­ri­od. 92 per cent of par­tic­i­pants re­port­ed ar­riv­ing in T&T over the pe­ri­od of one to four years.

Based on your study, what can you tell us about the health needs of Venezue­lan mi­grants in Trinidad? How do they ac­cess the health ser­vices they need?

Of the 250 study par­tic­i­pants, 48 per cent re­port­ed hav­ing a known health con­di­tion to in­clude hy­per­ten­sion, di­a­betes, and/or an anx­i­ety-re­lat­ed con­di­tion be­fore ar­riv­ing in T&T.  76 per cent re­port­ed get­ting test­ed for HIV over the past 12 months at a pub­lic health fa­cil­i­ty, 80 per cent in­di­cat­ed that they would vis­it a health cen­tre if they want a preg­nan­cy test and to get con­doms. Oth­ers re­port­ed go­ing to a phar­ma­cy to get a preg­nan­cy test and/or to pur­chase con­doms. 76 per cent of the study par­tic­i­pants re­port­ed ac­cess­ing care through pub­lic hos­pi­tals and health cen­tres. Just over ten per cent re­port­ed us­ing pri­vate doc­tors and phar­ma­cies, and 12 per cent re­port­ed that they re­lied on NGOs, re­li­gious or­gan­i­sa­tions, and the in­ter­net to ac­cess se­lect­ed health ser­vices and in­for­ma­tion.

The sur­vey re­sults close­ly mir­ror the ex­ist­ing health needs of peo­ple be­fore leav­ing Venezuela. In Venezuela, non-com­mu­ni­ca­ble dis­eases such as heart dis­ease, can­cer and di­a­betes are re­port­ed to be among the lead­ing caus­es of hos­pi­tal­i­sa­tions and deaths (WHO Coun­try Pro­file Re­port, 2019). An es­ti­mat­ed 120,000 peo­ple are re­port­ed to be liv­ing with HIV (2019), 79 per cent of whom are said to have lim­it­ed ac­cess to HIV treat­ment giv­en the on­go­ing eco­nom­ic cri­sis im­pact­ing the sup­ply of med­ica­tions in Venezuela.

What health risk do mi­grants from Venezuela face? Are they at risk for HIV and oth­er sex­u­al­ly trans­mit­ted in­fec­tions?

Over­all, refugees and mi­grants from Venezuela may be at high­er risks for de­vel­op­ing or wors­en­ing health con­di­tions giv­en the lack of ac­cess to on­go­ing med­ica­tion and/or lim­it­ed ac­cess to health ser­vices when they leave their home coun­try. They may al­so be at in­creased risk for con­tract­ing sex­u­al­ly trans­mit­ted in­fec­tions, such as HIV, in in­stances where there is lim­it­ed in­for­ma­tion on where to ac­cess HIV ser­vices. Their health risks may be fur­ther ex­ac­er­bat­ed by bar­ri­ers such as lan­guage and cul­tur­al dif­fer­ences as in the case of T&T. Their ex­ist­ing med­ical con­di­tions are al­so of con­cern in the con­text of the COVID-19 pan­dem­ic giv­en the re­port­ed in­crease in their so­cial and fi­nan­cial bar­ri­ers dur­ing this time.  

The full re­sults of this study and its im­pli­ca­tions for the lo­cal pub­lic health sys­tem will be pub­lished in Ju­ly 2021. Re­sources to fund a larg­er study with a rep­re­sen­ta­tive sam­ple size can pro­vide greater in­sights on the mi­grant health risks and trends in health ac­cess in T&T.

What are the im­pli­ca­tions of your find­ings for T&T? What are the costs to our pub­lic health sys­tem and how will this im­pact the cit­i­zens of T&T?

Ac­cess to, and the use of health ser­vices by Venezue­lan mi­grants and oth­er non-na­tion­als is crit­i­cal to pro­mot­ing and main­tain­ing their health, pre­vent­ing and man­ag­ing the spread of dis­ease which re­duces the po­ten­tial cost of hos­pi­tal­i­sa­tions when con­di­tions go un­treat­ed.

In T&T, reg­is­tered mi­grants from Venezuela ben­e­fit from free emer­gency med­ical ser­vices at pub­lic health in­sti­tu­tions in­clud­ing treat­ment for acute med­ical con­di­tions, ac­ci­dents, in­juries, asth­ma, heart at­tacks and in­fec­tious dis­eases. This was re­in­forced dur­ing the Gov­ern­ment's reg­is­tra­tion and re-reg­is­tra­tion ex­er­cis­es (con­duct­ed in 2019 and 2021 re­spec­tive­ly) tar­get­ing le­gal and non-le­gal Venezue­lan mi­grants re­sid­ing in T&T.

Giv­en the in­creas­ing in­flows of Venezue­lan mi­grants and refugees in­to T&T, it is crit­i­cal to de­ter­mine and mon­i­tor the use of health ser­vices, the quan­ti­ties and types of ser­vices ac­cessed by Venezue­lan mi­grants (and oth­er non-na­tion­als), and what are the costs to the Gov­ern­ment of T&T. This is par­tic­u­lar­ly im­por­tant giv­en the rapid in­flows of mi­grants ac­cess­ing care through the pub­lic health sys­tem, the po­ten­tial strain on ex­ist­ing health re­sources, and its po­ten­tial bur­den and im­pact on the pro­vi­sion of care to all (to in­clude cit­i­zens and non-cit­i­zens).

Giv­en your knowl­edge on the sub­ject, how can T&T best ad­dress the health needs of Venezue­lan mi­grants while min­imis­ing the risk and po­ten­tial bur­den on our pub­lic health sys­tem?

The re­search find­ings demon­strate the need for Gov­ern­ment to con­sid­er a pol­i­cy for the pro­vi­sion of health ser­vices for non-cit­i­zens. Al­so, ex­pand­ing ef­forts to strength­en re­gion­al and in­ter­na­tion­al co­or­di­na­tion and part­ner­ships with in­ter­gov­ern­men­tal or­gan­i­sa­tions, fund­ing agen­cies, NGOs, civ­il so­ci­ety, and re­li­gious or­gan­i­sa­tions to mo­bilise re­sources, de­vel­op ef­fec­tive health pro­grammes and mon­i­tor the up­take of ser­vices. Dis­sem­i­nat­ing in­for­ma­tion about the avail­abil­i­ty of health ser­vices (ie, in the pub­lic health sec­tor, from NGOs etc) for ex­am­ple where to ac­cess HIV test­ing may help re­duce the risk of the spread of com­mu­ni­ca­ble dis­eases and/or wors­en­ing health con­di­tions which if left un­treat­ed can re­sult in hos­pi­tal­i­sa­tion. The cost of hos­pi­tal­i­sa­tion rep­re­sents a larg­er bur­den on the pub­lic health­care sys­tem in the long run.

Tell us about the work of oth­er NGOs in help­ing to ad­dress the health need of Venezue­lan mi­grants in T&T?

In ad­di­tion to ac­cess­ing care through pub­lic health ser­vices, Venezue­lan refugees and mi­grants ac­cess health ser­vices through lo­cal NGOs, re­li­gious or­gan­i­sa­tions and oth­er stake­hold­ers.  The UN­HCR re­port­ed that 157 health con­sul­ta­tions were de­liv­ered in Feb­ru­ary 2021 by a lo­cal NGO (FPATT) us­ing tele­health and some on­site con­sul­ta­tions. Health out­reach mis­sions are al­so con­duct­ed by the Catholic Arch­dio­cese and oth­er lo­cal NGOs are pro­vid­ing psy­choso­cial sup­port for sur­vivors of gen­der-based vi­o­lence and oth­er so­cial sup­port ser­vices to Venezue­lan refugees and mi­grants.

 The MRFTT has for­malised lo­cal part­ner­ships with the Liv­ing Wa­ter Com­mu­ni­ty and oth­er lo­cal NGOs to im­ple­ment health ini­tia­tives and out­reach events of­fer­ing med­ical ser­vices to Venezue­lan mi­grants and refugees to in­clude screen­ing for di­a­betes, hy­per­ten­sion, HIV and STI test­ing, preg­nan­cy test­ing, ac­cess to over-the-counter med­ica­tions, con­doms and con­tra­cep­tives. The MRFTT al­so par­tic­i­pates on lo­cal sub­com­mit­tees with oth­er NGO ser­vice providers to map avail­able health ser­vices and to help stream­line health out­reach ef­forts

 

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