On any given morning in the small and dilapidated headquarters of the Valiente Bangla Association, in the Madrid neighborhood of Lavapiés, dozens of people look out and ask for Elahi. Some ask for advice on their registration procedures, others ask for Spanish classes or ask for support in their regularization process. But, for a few months, dozens of neighbors have also come here in search of a vaccine.
Vaccinate migrants without a health card: some communities move tokens to reach them, but obstacles continue
After having helped immunize almost 1,400 people – according to his figures – the word has spread. By mid-morning on Tuesday there were already eleven people who stopped by the premises on Calle Provisiones to ask about the way in which they could get the dose that they should have received months ago.
They are the ones who encountered the refusal of their health centers and believed they had no right; those who did not know how to get an appointment electronically or lack internet access; or those others who are still afraid to approach a hospital because they do not have papers.
“The obstacles for people without a health card continue to occur, but some communities have established vaccination points without a health card and have relaxed the administrative requirements required to allow access,” says Pedro Campuzano, a project technician at Doctors of the World. To ensure the vaccination of the migrant population in vulnerable situations, however, more measures are needed than to put an end to bureaucratic obstacles, according to the elaborate guides by the World Health Organization (WHO) and the European Center for Disease Prevention and Control.
In Spain, there is no coordinated plan at the national level, although some concrete initiatives have been developed at the regional or municipal level, according to Doctors of the World. One of the international recommendations is to have the participation of the migrant communities themselves in the preparation of vaccination plans that seek to reach them, such as contact with community leaders.
Sitting in the back of the room, Mohammad Fazle Elahi shows the screen of his mobile. His WhatsApp chats now look like a vaccination appointment manager: “Hello. I need help to get vaccinated, but I don’t have a health card. They told me that you get appointments,” a Bangladeshi man writes. “Good morning. Do you know how I can get vaccinated without an appointment? I have been told to write to you,” says a Latin American woman. “The president of Valiente Bangla responds quickly and gives them the solution.
Until a few weeks ago, Elahi would get an appointment at one of the municipal centers that the Madrid City Council has allocated, in collaboration with the Community, to vaccinate vulnerable people. Now it is even easier. It just sends patients a series of addresses and tells them what time to come by. Several municipal community health centers are open in Madrid for vulnerable people without the need for an appointment.
How to reach them
After facing numerous bureaucratic obstacles to getting immunized, now it is the institutions that try to find them through different initiatives. The Community of Madrid in coordination with the City Council of the capital have opened several municipal health centers to vaccinate vulnerable groups without prior appointment. The campaign is publicized through informational posters, written in different languages: “If you live in the Community of Madrid and you have any difficulty getting vaccinated, go to one of these centers without an appointment,” say the signs.
The challenge is to get these posters to reach the largest number of people before October 2, when in principle the campaign will end in some municipal centers, such as Callao. For this, the Madrid City Council has resorted to the intermediation of community leaders, as recommended by the World Health Organization in its guide to access vaccination for the migrant population. They are those references that your neighbors listen to. The ones that people trust. Those like Elahi, the president of the Brave Bangla Association.
He is a key person for people in an irregular or vulnerable situation in Lavapiés. And the Madrid City Council knows it.
That is why Elahi enters as Pedro through his house through the Municipal Community Health Center (CMSc) of Callao. She accompanies a Bangladeshi family who had not been able to get vaccinated due to having spent a few months in their country. Nurse Concha Morales and Dr. Mario Nacarino-Brabo greet the community leader as one of their team.
“At the time of this vaccination, Elahi has provided us with endless lists, not only of Bangladeshi migrants, but also Latin American or sub-Saharan African,” says Nacarino-Brabo. Those lists were so long that, at times, they exceeded the number of doses available: “I always added a few more, in case someone failed, I didn’t want a single vaccine to be wasted,” adds the president of Valiente Bangla with a laugh. He succeeded: “We can boast that we have not thrown a dose,” says the doctor.
“One day in May, I was in a parlor and I realized that there were some neighbors who paid 10 euros to get an appointment. That could not be, so we started asking people in the neighborhood and acquaintances if they had been vaccinated That is how it all began … and we have already been vaccinated 1,400, “says the founder of the organization.
At the door of the health center, the president of Valiente Bangla meets a familiar face. It’s Isdan, a 39-year-old Bangladeshi man. When he started the vaccination for his age group in the Community of Madrid, he asked at his health center if he could be vaccinated without papers, but he did not get his appointment, although he cannot fully explain why (even if he does not have papers, he should have access to health based on regulations).
In May, he found an opportunity to work in the fields in Valencia, where he has spent the last four months. There he also did not know how to get his immunization. “At first I thought it was impossible to get vaccinated because I did not have papers, but now it has been very easy,” says the man, who has lived in Spain for four and a half years and has not yet managed to regularize.
A day after asking Elahi at the association’s premises, Isdan has already left the municipal health center with a dressing on his right arm. He has received a single dose of Janssen, the vaccine chosen in the Community of Madrid to vaccinate groups considered vulnerable.
According to a statement from the Madrid City Council, Madrid Salud began on May 19 a vaccination process for people taken in in a social emergency situation and in the municipal network of homeless people residing in shelters, flats and reception centers, in pensions, homeless or cared for by NGOs or religious orders. Madrid Salud seeks to “attract and promote” the vaccination of groups when they reach their neighborhoods and associative fabric “. The Consistory maintains that this system “has made it possible to reach people who, due to their characteristics or conditions (lack of documentation, ignorance of the language, personal precariousness, homelessness and lack of a social and family support network) have not agreed to the vaccination). “From May 19 until the beginning per month, this campaign has immunized 8,000 people, according to its figures.
The guides published by the European Center for Disease Prevention and Control state that the barriers faced by the migrant population to access vaccination can vary from those linked to the required procedures themselves (such as the type of supporting document), such as the need for interpretation and cultural mediators; or geographic and transportation difficulties. “Migrants may also encounter obstacles linked to” social isolation, lack of support, discrimination and stigmatization. ”
The day laborer who convinces his neighborhood to get vaccinated
To overcome some of these barriers, the Junta de Andalucía, through Doctors of the World, has relied on Khalifs Toure. The NGO volunteer and president of the Nijar Senegalese Immigrants Association is a reference in the El Viso neighborhood (Níjar, Almería), a town with a high percentage of foreign population.
“It was important that people knew that a vaccination campaign was going to be carried out in the locality. So I began to inform people. People know me and spread the word very quickly,” the community leader explained to elDiario.es in the few minutes that he manages to get free during a long working day in the Almeria countryside.
In the summer, Toure organized a meeting in the neighborhood to answer all the doubts that his neighbors had about vaccination. “Living in remote areas, not much information reaches them. At first, people were afraid. But, with information, people were motivated. I explained to them that I was going to be the first to get vaccinated and so, little by little, they they decide to do it. ”
In a town in Pontevedra, Alba (not her real name) did not know how to get vaccinated. The woman, of Honduran nationality and in an irregular situation, works as an intern in Galicia on a temporary basis. He believed that he did not have the right to be immunized in this community because he is not registered there, but in a town in Castilla y León.
The person he works for asked months ago about his case at the health center, he explains, but they asked him for a document proving his residence in the community. In the information telephone number issued by the Xunta for people without a health card, they were not given the solution either, so they decided to wait.
In mid-September, they tried again. The obstacles no longer exist. Presenting an identification document is now enough to get an appointment, they explain, before making an appointment for the same week.
Iria Fernández, spokesperson for Doctors of the World in Galicia, identifies the reason for the change in the response obtained by Alba. “Although the Xunta had enabled a way for the population without a health card to proactively request vaccination, it did not work. There were many bureaucratic obstacles. Each case cost us a lot of time, many calls and emails,” acknowledges the worker of the organization.
After an advocacy campaign by Doctors of the World and other organizations, the Xunta de Galicia listened to their complaints. Several organizations have now promoted vaccination points for vulnerable populations, in coordination with the Public Health System in Galicia (Sergas). “Beyond these initiatives, we note that right now the entire Galician vaccination system is open and very receptive to these situations,” he adds.
To contact that population without a health card that at some point could not be vaccinated due to initial obstacles, immigrant associations are, once again, key actors in the process.
In Galicia, one of the most prominent migrant communities is the Venezuelan. For this reason, when she learned about the new vaccination points set up by Doctors of the World for vulnerable people, Ana María Fernández, spokesperson for the Venezuelan Association of the Delta, mobilized. Its members launched a campaign on social networks and called all associates who had transferred their problems to receive their dose. “The response was impressive. There were many people who were desperate because they could not get vaccinated,” he says.