Primary Health Care Workers on the Frontline

Nurse Florentine Lewis is the Manager of Expanded Program on Immunization. Photo: Elias Orville Dupuis II, Makeup-Jessia Letang, Queen II Queen Makeup Artist

Just about one year after the world came to a screeching halt due to the COVID-19 pandemic, Dominica received its first supply of the AstraZeneca vaccine,a gift from the Government of India . The gargantuan task of rolling out a new vaccine fell squarely on the shoulders of the health care warriors in the primary health care system.

eMAGE DM caught up with some of the doctors and nurses at the forefront of the process.

How do you prepare to roll out a new vaccine? Nurse Florestine Lewis is a Senior Community Health Nurse (SCHN). She is also the Manager of the Expanded Program on Immunization (EPI), with responsibility for the planning and management of all the components of immunization on the island.

“Obtaining the volume of supplies needed, particularly the vaccines, needles and syringes was quite a feat. Dominica had to decide which vaccine could be safely imported to the island and the cold storage capacity,” saysNurse Lewis, who has over 13 years of experience in immunization and boasts the top Surveillance Award 2011 from the Caribbean Health Agency, (CARPHA), among other accolades.

Health administrators, she adds, also weighed legal considerations for the importation and administration of the vaccines and sourced additional cold-chain equipment including refrigerators, vaccine carriers, ice packs and thermometers. In preparation for the extensive roll-out campaign, primary health care staff received training to meet the requirements outlined by the Pan American Health Organization, (PAHO).

Dr. Lynora Fevrier-Drigo, District Medical Officer, Roseau. Photo: Elias Orville Dupuis II, Makeup-Jessia Letang, Queen II Queen Makeup Artist

Dr Lynora Fevrier-Drigo is a District Medical Officer (DMO) in the Roseau Health District. Fevrier-Drigo also serves on the National Emergency First Responders Team, is a trained forensic analyst in cases of sexual abuse and gender-based violence and is the national focal point for tubercolosis in Dominica. She has played a key role in the vaccination process.

According to Drigo, a wide cross-section of staff from the Ministry of Health was utilized- Health Information Unit staff handled vaccination registration; Red Cross volunteers reviewed registration forms; District Medical Officers conducted health assessments and were on hand to handle any medical emergency; Community Health Nurses administered the vaccine with assistance from Registered Nurses and dental services staff observed individuals post-vaccination.

The entire process was overseen by the Director of Primary Health Care.

“Our main challenge as a team is and always will be human resources. A lot of work and not enough hands to work.

“However, the COVID-19 pandemic has been expertly handled from the PHCS level because we have at our helm someone with a heart for primary care in the person of Dr Laura Esprit. During the first wave of the pandemic we followed the protocols developed by her and were able to stop the spread in quick time. Having a structure and road map to follow made light of what would have otherwise been very heavy work,” Dr. Fevrier-Drigo says.

Dr. Cleona Peters, District Medical Officer, Team Leader, Roseau. Photo: Elias Orville Dupuis II, Makeup-Jessia Letang, Queen II Queen Makeup Artist

Dr Cleona Peters, DMO and Team Leader in the Roseau Health District, points to the very real challenge of staff burnout.

“There were instances when one doctor had to cover more than one clinic or area so there was staff fatigue and burnout. But maintaining the nation’s health is the motivation which keeps us going,” says Dr. Peters, who is also a Clinician at the Infectious Disease Clinic at the Dominica China Friendship Hospital.

DMOs like Peters, Dr. Francine Jeffrey-Louis of the Portsmouth Health District and Dr. Candia Jacob of the Marigot Health District were also responsible for the supervision of mobile vaccination, vaccination of persons at home (shut-ins), at business places, as well as PCR swabbing for pre-travel screening, 5 Day PCR for people in quarantine and contact tracing, including on weekends. Many other nurses and doctors including Family Nurse Practitioners, Rachel Labon and Charmaine Julien provided valuable support.

Dr. Francine Jeffrey-Louis- District Medical Officer and Team Leader, Portsmouth Health District
Makeup: Beauty by Angie
Photography: Dylan Lowe

Family Nurse Practitioner, Charmaine Julien

Public resistance to the vaccine has proven another major challenge in the rollout process.

“Our communication strategy may have been more effective if we had more time, but unfortunately COVID is here, and time we do not have and so a good number of the population still need to be convinced to take the vaccine. We are still far from achieving our 70% vaccination goal in order to reach herd immunity,” Dr. Peters says.

For these stalwarts of primary health, safeguarding the health of the nation fuels their drive to continue.

“Most times the only gratitude we receive is the ‘God bless you’ from an elderly patient or a tight hug from a toddler. The accolades and recognition usually go to those sitting behind the desks and not those with boots on the ground because we are not the ones in the media. However, I wouldn’t trade what I do for anything in the world,” Dr. Fevrier-Drigo notes.

“Although we are tired we remain resolute to continue to provide care to our people.. We are proud of our achievements thus far and will do all we can to safeguard our lovely country,” Nurse Florentine Lewis concludes.

Their efforts, thus far, have not been in vain. Dominica is one of the few places in the world with zero COVID-19 related deaths- a glossy badge of honour to be worn by the heroes in primary health care.