The pandemic revealed health care gaps in rural communities everywhere. We teamed up with undarkmag to profile health care workers in villages in Zimbabwe, Ecuador and upstate New York to find out how. 📽️
Throughout the pandemic, the SARS-CoV-2 virus has laid bare weak points in the world’s health care systems. This has been true in arguably every country and every community, but the fractures have been especially apparent in rural areas, where poor access to health care long predated the pandemic.
This reporting project was created in partnership with Undark and produced with the support of the International Center for Journalists and the Hearst Foundations as part of the ICFJ-Hearst Foundations Global Health Crisis Reporting Grant. As a village health worker, Chinenyanga oversees and responds to the health needs of people in Makusha Township’s Ward 9. She works at the local clinic. Her tasks include education around tuberculosis, home-based care for the elderly, monitoring pregnant women, and health awareness programs—especially on Covid-19 vaccines. The position required three weeks of training conducted by the Ministry of Health and Child Care, which coordinates health workers.
Enforcing Covid-19 protocols can be draining for Chinenyanga. Every day she has to convince the rural villagers, mostly small-scale gold miners in the area, many of whom are skeptical of vaccines, to mask up, practice physical distancing, sanitize, and avoid gatherings at places like pubs, where people tend to forgo prevention measures.
“If you come from a health background you will realize those who have succeeded in building universal health care or a viable health care system, it is not the specialist doctors,” he says. “Wherever there is a successful health care system, it is actually the basic community health care, the one that in some countries where they don’t even earn salaries. Those are the people fighting to just get recognized. Those are the people who manage the fundamental work.
Even larger hospitals in Zimbabwe don’t always provide oxygen to every patient, especially if the patient can’t pay. “You must have money upfront,” Hadebe says. “And how many people can access that? So, it’s a dire situation.” “I think it is important, especially in remote locations, we come up with innovative strategies to take vaccination to the people,” he adds. “We know there are certain hard-to-reach areas where we can even use motorbikes to make sure that people can be vaccinated where they are, in their communities.”In addition to resource shortages, Chinenyanga has experienced another serious challenge most days in her work: vaccine misinformation and disinformation.
As Chinenyanga wraps up her day, after visiting several homes, she agrees that social media has contributed to misinformation. The people she serves in the Makusha community often share with her unproven remedies to treat Covid-19. She lists some of the misinformation that she’s seen so far. “People believe in steaming, that it helps. They also believe that eating Zumbani,” a woody shrub that grows in the country, “also prevents Covid-19,” she says.
Topa Pila, 25, and her team arrived in Hoja Blanca, a village of 600 located in the heart of Ecuador’s Esmeraldas province, in September 2021. As freshly graduated health care professionals, they all are required to serve an ao rural, working one year in a rural community in order to get their professional license or advance into postgraduate courses in medicine. Topa Pila’s team is the third deployed in Hoja Blanca since the start of the pandemic.
Before the Ministry of Public Health’s selection system placed Topa Pila for her service, she had never been to Hoja Blanca, and it took her more than eight hours to get there. She says that when she first arrived at the modest health care station, she thought, “This is going to collapse.” Even under better conditions, remote health care outposts are only equipped to provide primary care. Anything more serious requires referral to the district hospital, which in Hoja Blanca’s case means a 300-mile round trip to the parish of Borbn.
Initial plans to track and trace Covid-19 cases faltered; the country had barely any machines to process PCR tests, the gold-standard Covid-19 tests. “During the first days of the pandemic, samples collected in Guayaquil were taken to Quito by taxi,” Sacoto says, because that was the only place PCR tests were being analyzed. But public transportation to rural communities is limited, so even the few rural residents who had access to tests sometimes waited two weeks for test results.
Lately, there have been signs of improvement. After taking office in May 2021, the government of Guillermo Lasso has accelerated vaccination efforts against Covid-19, approved a new program to tackle children’s malnutrition, and announced a Ten-Year Health Plan to improve health equity. Just 910 people live in Otego, which sits along the Susquehanna River in Otsego County, a pastoral landscape of rolling hills and narrow creek valleys. Barreto lives on a dead-end road, a single street with pastureland on both sides. The downstairs waiting room looks like it could be anywhere in rural America—a row of identical burgundy chairs against a pale beige wall, kids’ art hanging above.
In Barreto’s office, after 40 minutes chatting with Gates and Tator about their health concerns, Barreto swabs both patients, walks them out, and then calls a courier to pick up the tests. While he waits, he pulls up the Otsego County webpage. The Covid dashboard shows 7,235 total cases, and the county recently broke its record for most active cases, at 386. Before December, that number had never climbed above 300.
Sparsely populated regions like central New York, which have smaller health departments and hospitals, are easily overwhelmed during surges, says Alex Thomas, a sociologist at SUNY Oneonta who studies rural health care. Otsego County has fewer than 10 public health staff working on Covid, and 14 ICU hospital beds. Neighboring Delaware County has no ICUs.
In Otsego County, dealing with the fallout of Covid became a community effort. Volunteers sent up a local Facebook group to share information and services; it quickly had more than 1,000 members. The local hospital organized an ad hoc “County Health and Wellness Committee” that met biweekly on Zoom.
Barreto guides his minivan to the interstate and then climbs out of the valley to visit Al Raczkowski, age 88. A former combat medic, Raczkowski still struggles with PTSD, has partial heart failure and some dementia, and requires weekly visits from nurses and therapists through a palliative care agency.
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