Every three weeks, Andrea Leiner, M.S.N. ’19, a family practice nurse practitioner working on her post-master’s certification in acute care at SONHS, travels from Naples, Florida, to Matamoros, Mexico. There the veteran-led non-governmental organization she works for runs the only clinic for thousands of asylum seekers living in crowded tents along the banks of the Rio Grande. She and her colleagues have been working day and night to mitigate the rising threat of COVID-19 surrounding this extremely vulnerable population. “Seven days per week, our medical volunteers see an average of 40-50 patients per day, already weakened by respiratory and gastrointestinal ailments as a result of their perilous journey and the conditions of the camp itself,” they wrote in a recent op-ed. On March 17, SONHS spoke by phone to Leiner, who had just crossed the border into Brownsville, Texas, for the night.
How are you, first of all? I’m drowning [laughs], but I’m healthy, so I can’t complain. I work part-time in the local emergency room in Naples, and everything is coronavirus right now. But my full-time job is working with Global Response Management (GRM). We run a clinic in Matamoros, Mexico, that serves about 2,000 to 2500 asylum seekers who are living at the base of the bridge between Brownsville, Texas, and Matamoros. They are living in a muddy strip of land packed together in small tents. As the only medical providers in camp, we are responsible if coronavirus hits. Our executive team and medical directors have spent the last week in Matamoros formulating a plan to mitigate the risk and treat those who become infected. We’re fighting the virus on two fronts—our home cities and communities, and in camp where the responsibility for a largely forgotten population weighs heavily on our shoulders.
You work in an emergency department, you did humanitarian work in Haiti after the 2010 earthquake, you helped our school run pop-up clinics in rural Jamaica, and you went through a simulation-based global aid worker training at SONHS. How do those experiences compare to what you’re dealing with now? I started volunteering for Global Response Management about six months ago after hearing their executive director and fellow nurse practitioner, Helen Perry, on an Emergency Medicine podcast. I was blown away by their work, but I knew as a single mom still working and attending UM, I wouldn’t be able to travel to their missions in Iraq and Yemen. Still, I wanted to help and volunteered to do as much as I could from my phone and computer. About two months ago, I came onboard with them full-time as part of their executive team. Now I have the dream job I didn’t even know to dream for, and all of the previous experiences prepared me for this.
Can you talk more about the planning? We did a lot of work behind the scenes over the last three weeks before we all met down there. Last week was all about implementation. Containment and quarantine are not possible in the asylum camp. And, robust testing is not happening in the areas surrounding the camp. We came up with a three-pronged approach: Prevention, Fortification, and Treatment.
On the preventative side, I spent three days with Dr. Dairon Rojas [the Cuban physician seeking asylum featured in The New York Times], speaking to each micro-community in camp. People break up into groups of six or seven tents, or by country, and do communal cooking, look out for each other security-wise with their children, etc., so we tapped into that existing cultural structure. We activated a 24-hour hotline for people to call if they have any questions, and we talked with them about trying to put a couple of meters between their tents, opening the windows and doors for ventilation, mopping the mud on the floor instead of sweeping it, and sleeping head to toe, because with COVID-19 and other respiratory ailments, nocturnal transmission is very high. If somebody becomes ill, we want them to wear a mask, and we want another person in that micro-community to either call the hotline or send a runner to the clinic. We’ll bring masks, a little kit with antibacterial soap, and register them in our electronic medical record. We also do rapid flu tests right there because that’s one of the ways we’re diagnosing, by exclusion. If you meet the symptomatology but you’re negative for flu, you need to be monitored.
For fortification, we are distributing multivitamins containing Vitamin D and Zinc to boost their defenses. We’re also asking anybody with any risk factors to self-identify at the clinic: asthma, COPD, diabetes, lupus, any immunological conditions, cardiovascular disease. We can get an idea of how many people in the population have risk factors, and we want to elevate their baseline as much as we can. For example, if they have asthma, do they have the right inhaler; do they need to be stepped-up on their dosage?
On the treatment side, people with mild to moderate illness will self-quarantine in their tents. Meals will be delivered, and they’ll have daily wellness checks. We’re giving everybody a little pulse oximeter for checking oxygenation level and pulse. We’ll come take their temperature, record that data, and monitor how they’re doing. If somebody is moderately to severely ill, we’ll refer them to the local hospital until the local hospital is full. And because the local hospital only has three beds available right now, that will probably happen pretty quickly. We’re also setting up two field hospital tents, which will accommodate 20 patients, and we will do the best we can for those who are moderately to severely ill in our hospital tent that will be staffed 24 hours a day. But the reality is that we are running a field hospital in the middle of a muddy field. We don’t have electricity. We don’t have running water. There’s no way to intubate and ventilate people.
What kind of staff do you have in place? On the clinic side, we like to have three providers—physician, nurse practitioner, PA, and three secondary staff, which are nurses, paramedics, EMTs. As hospitals and work places limit travel for their employees, we’re dealing with a lot of volunteer cancellations. On the hospital side, we need 10 staff—five daytime and five nighttime, who will be living in Matamoros and working 12 hour shifts. For that, we’re reaching into our database of people who have been to Iraq and Yemen with GRM, especially medical combat veterans who are used to these kind of high-stress, high-risk environments.
What’s the atmosphere like on the ground in Matamoros? Stressful. We’re dealing with a lot of politics. There’s a lot of denial and apathy toward the migrants. Going around to educate groups of residents with Dr. Rojas, you could see it start to register on people’s faces: ‘Oh, this isn’t a problem just in Italy. This is going to be a problem for us here, and who’s going to protect us?’ We’ve been advocating with the other NGOs and the health department to shut down all mass gatherings, the little sidewalk schools, mass food distribution, and they finally did that yesterday, so there is some progress.
How did you explain the current situation to your young daughter? She knows what I do. She knows my love for her is steadfast, and that gives her a solid foundation. She also knows there are people in the world who need help, and it is all of our duty to step in. Soon she’ll be old enough to participate, and talking about these experiences at an age-appropriate level is part of her introduction to the world.
This interview was edited for length and clarity. For more information about the work Leiner is doing, visit www.global-response.org, Facebook: @globalresponsemanagement, or IG @global.response.
