Frontline social workers provide vital support to improve health
Yura has been a social worker for many years. “When I started working in social services, I was mainly interested in family therapy,” she says . “In time, I found out that supporting communities to become resilient and self-reliant is an extremely rewarding experience.” A year ago, she joined the Council of Refugee Women in Bulgaria (CRWB) – a civil society organization created in 2003 to support the integration of refugees and migrants. “Guiding through people from refugee and migrant backgrounds on health-related procedures in their host country is a way to empower them to find solutions to health issues,” explains Yura. And this is particularly vital for those fleeing from armed conflicts and humanitarian crises. As they search for safety and better life opportunities, both adults and children go through many traumatic experiences as a result of often prolonged stays in refugee camps, limited access to health care, and the dangers they face as they travel through volatile areas. By the time they finally reach a safe destination, they are often in very bad physical and psychological shape. “In Bulgaria, refugee children arrive with their parents or – in some cases – unaccompanied. Psychological problems, infectious diseases, medically unobserved pregnancies and, in particular, a lack of immunization, are common problems that have a negative impact on their health and wellbeing.” Radostina Belcheva, Project Coordinator and Deputy-Chair of CRWB The CRWB partners with UNICEF Bulgaria to provide general health checks and referrals, as well as life-saving vaccines in line with children’s immunization schedules, and equips parents with information on health risks, entitlements and how to access medical services. “As part of the ‘Strengthening Refugee and Migrant Children’s Health Status in Southern and South-Eastern Europe’ (RM Child-Health) project co-funded by the European Union’s Health Programme, we work with our partners to ensure that children can follow immunization plans and that their vaccination status is updated in their immunization documents. These are crucial steps in ensuring good health . ” Diana Yovcheva, Programme Officer with UNICEF Bulgaria Working directly with refugees, Yura consults families that want to access health services. “Some cases are easier than others”, she says, recalling a consultation with Ahmed*, a 45-year-old father of six children, who fled Syria in 2020 and received humanitarian status in Bulgaria. A chef by profession, Ahmed settled quite well in the host country, found a job in a restaurant and, after some time, managed to reunite with his wife, his four sons and two daughters. “Ahmed was referred to the CRWB by friends and he came in for a consultation on the immunization process with his youngest baby girl, Yasmina, only one year old” explains Yura. During their meeting, the social worker provided information about the health system in Bulgaria, the role of a general practitioner, and how people with refugee status can access medical services including vaccinations for their children. Although Ahmed’s baby girl had been vaccinated before her arrival in Bulgaria and had an immunization passport, the father urgently needed to update her vaccination status to synchronize her vaccinations with the recommendations of the national immunization calendar. “I contacted the Regional Health Inspectorate and helped Ahmed to provide the necessary documents and find a translator, as the documents were in Turkish”, says Yura. Subsequently, she helped Ahmed schedule an appointment with a medical doctor and Yasmina received her next vaccine. Parents often lack the necessary vaccination documents. According to Yura, “Sometimes children have not had any vaccinations, or they have been vaccinated in their country of origin, but their immunization cards have been lost or destroyed.” Such cases require additional consultations, research and coordination, as well as testing for antibodies and immune responses when it is not clear whether the child has been vaccinated. “By empowering parents to familiarize themselves with the immunization plans and procedures we help them become proactive in following up on their children’s health." Yura, Social worker To address the COVID-19 restrictions and keep active communication with refugees and migrants, the CRWB and UNICEF developed leaflets in Bulgarian, Arabic and Farsi with details about the health system in Bulgaria and the importance of vaccinations, and regularly provide health-related information via social media. “The role of communication in immunization is essential. Our frontline staff interact on a daily basis with beneficiaries, but we have also used other means [such as a Facebook group dedicated to health-related topics] to keep the information flow going, particularly during the COVID-19 pandemic . ” Radostina Belcheva, Project Coordinator and Deputy-Chair of CRWB Logo - Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe This story is part of the Project Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe, co-funded by the Health Programme of the European Union (the ‘RM Child-Health’ initiative). The content of this story represents the views of the author only and is her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the European Health and Digital Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains .
"During crisis we realized, health is the most important thing."
For thousands of pregnant women in Kazakhstan, pregnancy coincided with the pandemic and the introduction of quarantine measures, which can vary from week to week. UNICEF estimates that around 116,000,000 children will be born worldwide during the pandemic.1 During the pandemic, 498,367 children were born in Kazakhstan (March 2020 - April 2021)2. From the very first months of pregnancy, a woman's life changes dramatically, and quarantine, self-isolation and additional precautions can limit access to medical services or add stress to women in labor. Aigerim is 40 years old; during the pandemic she was pregnant with her fifth child. Aigerim wanted to plan the birth the following year, but in early September 2020, she found out that she was expecting a baby. From the first days of pregnancy, Aigerim was registered at the district polyclinic at her place of residence in Nur-Sultan. 2021_Newborn_Family_Karaganda Aigerim with her newborn son ”I had constant access and contact with gynecologists and midwives. I got all my tests on time and I went to my routine check-ups," she says. Until the seventh month of pregnancy, Aigerim and her family lived in Nur-Sultan, and then moved to Karaganda, where she was transferred to the city polyclinic No. 1. Aigerim planned to give birth at her place of residence in the Karaganda Regional Perinatal Center. She didn't need to take a PCR test before giving birth. When frequent contractions occur or amniotic fluid is released, the woman in labour will have to call an ambulance or go to the hospital on her own. The PCR test will already be taken at perinatal centers. ”I was told that if a woman has any symptoms, she is taken to a separate quarantine zone. If not, then she gives birth and waits for the test results, " says Aigerim. The quarantine zone is a separate ward where a woman will give birth alone and will not have contact with other women in labor. If doctors do not detect COVID-19, then the woman in labor goes to the general ward. According to UNFPA Kazakhstan , in the event of a confirmed infection or suspected infection with COVID-19, health care workers should take appropriate precautions to reduce the risk of their own infection and that of others, including by wearing protective clothing. Aigerim herself had COVID-19 in June 2020, three months before the start of pregnancy, but did not feel any significant changes in her health or the possibility of becoming pregnant. According to Aigerim, this pregnancy went the same way as the previous ones, and she hardly noticed any changes in the situation and the new reality of quarantine measures. 2021_Newborn_Family_Karaganda Aigerim with her children The only difference Aigerim observed is in the work schedule and the timetable of the clinics. In the past, pregnant women had to wait 2-3 hours in a queue at the polyclinics; now, the reception is conducted strictly by appointment and there are no queues in the corridors. “I guess I was doing so well because I was prioritizing my health. It is very important for a woman," she says. "In the current time of crisis, we all realized that the most important thing is health and only a strong immune system can cope with the virus." Aigerim, being a nutritionist, always carefully monitors her well-being, so she did not worry about the upcoming birth. ”I had no concerns about my health, " says Aigerim. "I’m constantly checking my thyroid, haemoglobin, taking vitamins and eating right". In addition to maintaining immune function, Aigerim followed the necessary precautions to avoid contracting the virus. She avoided public places, shopping centres and other crowded places, and washed her hands frequently and thoroughly throughout the day. 2021_Newborn_Family_Karaganda Aigerim and her children reading a book Due to the pandemic, she was forced to go for walks only on the streets or in parks, in order to have minimal contact with passers-by. And masks and sanitizers have already become essential items when leaving the house. Aigerim already had four children. Her fifth pregnancy was going well, and in April she gave birth to a baby boy. "The birth went well. I am very happy and glad that my child was born healthy. I finally have him in my arms” " says Aigerim. Aigerim was discharged two days later, and her recovery is proceeding calmly and with her family. “I would also like to thank the doctors in the polyclinics. Despite the introduction of quarantine measures, they handled stressful situations perfectly and dealt with issues quickly, correctly and in a timely manner,” says Aigerim. Cooperation with the European Union allowed UNICEF to support the healthcare system of Kazakhstan during the COVID-19 pandemic by equipping it with the medicines and diagnostic devices necessary to effectively combat the coronavirus. Funded by the European Union Humanitarian Aid. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union. European Union cannot be held responsible for them.
UNICEF procures healthcare supplies worth over KGS 12 million to help the Kyrgyz Republic respond to COVID-19
delivered personal protective equipment worth over KGS 12,000,000 to the Ministry of Health and Social Development. UNICEF provided 8,000 medical masks, 12,500 pairs of nitrile gloves for vaccinators, 20,000 pairs of gynaecological gloves, and 11,350 units of antiseptics for healthcare institutions and medical workers. UNICEF procured Personal Protective Equipment (PPE) on behalf of the Ministry through its Supply Division based in Copenhagen, hosting the world's largest humanitarian warehouse. The Ministry of Health and Social Development will use these essential supplies to support its ongoing vaccination efforts to respond to the pandemic and protect frontline healthcare workers. Gynaecological gloves are also being delivered to maternity facilities in Bishkek, Osh and Batken to improve the safety of mothers, newborns and medical staff. In addition, UNICEF procured 890,000 medical masks to ensure safe vaccination against COVID-19. " UNICEF is working around the clock to deliver essential supplies globally to respond to COVID-19. It includes the provision of vaccines, syringes, immunization equipment, medicines and personal protective equipment. In close collaboration with the Government of Kyrgyzstan, we are providing these protective supplies to maternities and hospitals so that everyone can be protected ", said Yulia Oleinik, UNICEF Deputy Representative in Kyrgyzstan. UNICEF will continue to support the Government in the COVID-19 response by delivering COVID-19 vaccines through the COVAX facility, procuring cold chain equipment for vaccine storage, providing essential supplies for frontline workers and supporting the socioeconomic measures to ensure that every child can survive and thrive. The handover of the supplies to the maternity house in Bishkek, Kyrgyzstan UNICEF Kyrgyzstan
“I’d settle for a year being sick, as long as it’s not her, not for a single day”
Little Varya was 3 years old when Alexei and Nastya Naumov adopted her from an orphanage. They had long dreamed of children, when they found this girl who looked so much like Alexei Naumov. Nothing could stop them: neither difficulties, nor Varyusha's diagnosis – HIV, which the orphanage told them about right away. Varya Varya at the New Year celebration Nastya and Alexei decided that they wouldn’t conceal their now 9 year old daughter’s diagnosis. It is better to put all the cards on the table, than constantly have to look over their shoulder, they say. The parents always emphasize: they have never regretted their decision. In November 2018, when Varya was in the first grade, she fell ill with scarlet fever. The family had just moved to Almaty from Atyrau. Nastya Naumova brought her daughter to two pediatricians, but they did not suspect anything. And then their infectious disease specialist at the AIDS center confirmed the diagnosis. ‘Guys, you have scarlet fever,’ she said. “It seemed to me that this was a forgotten disease, that it is simply impossible. Varya has recovered, but I was still afraid. And as it turned out, not in vain,” says Nastya. The Naumovs were warned that live vaccines are contraindicated for a child with HIV. “I was afraid that Varya would get infected,” Anastasia says. “I didn’t know how the virus would work with her diagnosis, how it would affect the body. And, thank God, for a long time she was able to avoid infection. But, as it turned out, not measles.” In Kazakhstan all children diagnosed with HIV usually receive a medical contraindication for vaccination, which applies to the so-called live vaccines against measles, mumps and rubella. Although in accordance with the WHO clinical protocol, a vaccine against measles, mumps, and rubella (MMR) and other measles-containing vaccines (MCV) should be considered for HIV-infected patients who are asymptomatic or mildly immunosuppressed, as per the routine national schedule. For infants with high risk of exposure to the measles virus, an additional dose of single-antigen measles vaccine administered at 6–11 months of age is recommended, followed by a first dose of routine MMR or another MCV at age 12 months or older (with a minimum interval of 1 month between doses).1 Parents can learn more about each vaccine, included into the National Vaccination Calendar, at a special website dedicated to children routine vaccination: EGU.kz In February 2019, when Varya was preparing to go to school, she noticed red dots on her legs: hemorrhagic vasculitis. Nastya and Varya were immediately taken to the hospital; they thought it was an allergy. For 3 weeks the child was not diagnosed, doctors had not realised that it was measles. Anastasia Naumova shares her story Anastasia Naumova shares her story Later, it turned out that hemorrhagic vasculitis was Varya’s body's reaction to measles. The incubation period was already in progress. But the doctors the Naumovs visited did not understand this. Their infectious disease specialist arrived at the hospital only after Varya's temperature rose to 40 degrees, and diagnosed her with measles. Varya and her mother were taken to the infectious diseases hospital. Varya at the hospital with measles Varya at the hospital with measles “I will never forget the following 10 days…,” Nastya says. Varya fell seriously ill. She was burning with a fever, crying from pain at night. There was nothing Nastya could do to help her child. “I have hardly slept these ten days. I would lean on the table, doze off, the timer would go off - I set Varya's temperature to be measured every hour. And you can't do anything - the treatment is symptomatic,” Nastya says. The complications were the worst. Varya had right-sided pneumonia, so severe that she could not swallow saliva. How would Nastya give her pills? Water? Food? “I was almost shoving this pill into her mouth, and Varya cried and shouted: ‘Mom, it hurts! Mom, don't!’ Almost two years have passed since that moment, and I am still shaking. I’d settle for a year being sick, as long as it’s not her, not for a single day. When you see that your child suffers so much simply because someone did not give her the vaccine, how would you feel about it? I have no words,” Nastya says. In total, they spent about 6.5 weeks in the hospital. During their stay the hospital was full. Children and many adults - all with measles. Fortunately, Varya pulled through. Emaciated, she weighed 17 or 18 kilograms, weak, but alive. Varya does not mention her illness. Nastya noticed that after the illness Varya started having problems studying. Apparently, this ten day long fever affected her cognitive abilities. “I believe if opponents of vaccination ever saw how people bear measles, they would think about it. It's a shame that children who have medical contraindication are at risk,” Nastya says. The Naumovs then vaccinated their daughter (with those vaccines that are not contraindicated for her) in an ordinary district hospital. “The child has HIV infection, an incurable disease, but even she did not have a reaction to the vaccine,” Nastya says. In 2019, there was an outbreak of measles in Kazakhstan with 16,871 cases, of which 13,326 (78.9%) were laboratory confirmed.2 19 children and two adults dies from the disease. Among the victims of measles, 8 children were not vaccinated due to medical contraindications. In 2020, 3,270 cases of measles were registered, of which 2,265 were children under 14 years of age. False contraindications and medical exemptions have been identified as one of the main causes of missed opportunities to vaccinate against measles during the root cause analysis conducted by UNICEF Kazakhstan. The analysis was the part of the UNICEF Kazakhstan Measles Outbreak Prevention Program funded by the US Agency for International Development (USAID). “We sincerely thank USAID for partnering in such an important program for children's lives to prevent a measles outbreak in the future and strengthen the immunization programme in Kazakhstan. We believe that this project will help save and preserve the lives and health of Kazakhstani children and families," said the UNICEF Representative in Kazakhstan Arthur van Diesen. The Program provided technical support to analyze the causes of the measles outbreak, study parents' views on vaccination and awareness campaigns, as well as recommendations for improving the supply of vaccines and building the capacity of healthcare workers for immunization. For example, UNICEF is providing a series of trainings to address false contraindications in cooperation with the Association of Family Doctors of Kazakhstan in Aktobe, Atyrau, Eastern-Kazakhstan, Kyzylorda, Turkestan, Karaganda oblasts, Almaty and Shymkent.
Safeguarding the health of refugee and migrant children during COVID-19
, the initiative has supported UNICEF’s efforts to improve the immunization process for refugee children and migrants by strengthening the assessment and monitoring process. As a result of such efforts, refugees and migrants have been included in the national COVID-19 Immunization Plan.
Support for frontline workers: Implementation of health policies for refugee and migrant children
“I find the tool for identification of unaccompanied and separated girls [UASGs] very useful since the indicators included are clear and help us recognise UASGs more quickly.” A frontline worker in Serbia welcomes a new tool to identify refugee and migrant girls Two girls are talking to each other. The ‘RM Child-Health’ initiative has supported work across five European countries over the past year to equip those who work directly with refugee and migrant children and adolescents with all the skills and resources they need to turn health policies into concrete action. In its first full year, this 27-month, co-funded €4.3 million initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, has enhanced the knowledge and skills of frontline workers to maximize the impact of their work with young refugees and migrants. The initiative promotes and supports multi-disciplinary approaches and teams to address the complex causes of health problems among refugee and migrant children, from trauma, anxiety and over-crowded conditions, to lack of hygiene facilities and immunization. As a result, support from the ‘RM Child-Health’ initiative builds trust between refugee and migrant families and a wide range of frontline workers, including health service providers.