When graduate nurse Jeanette Martínez signed up to work as a contact tracer, she wasn’t prepared for the intensity of the job – or the emotional support patients would need.

“There was a lot of sadness and loneliness” among the people she spoke to on the phone, she said. Dealing with that was part of the landscape, along with teaching patients how to manage Covid-19 and avoid transmission between family members.

Another person might have shrugged it off. Martínez, on the contrary, picked up a backpack and started heading out into the field to care for patients in their homes.

There’s no disputing the success of Puerto Rico’s vaccination efforts. The island is more than 80% vaccinated at this point, thanks in part to widespread vaccination sites, events, and outreach. But omicron cases have spiked nonetheless, making outreach work more essential than ever, and there’s also no question that some people, most notably bedridden patients and older adults, have been left behind.

The organization Puerto Rico Salud, a grassroots organization founded by health workers, has been bridging the gap, doing vaccinations and outreach work in hard-to-reach communities across the island. Martínez is one of their members.

For many of those who haven’t received a vaccine, a lack of transportation or overall mobility is often the problem. For Martínez and her colleagues, vaccinating these individuals at home is often the solution.

Through the Puerto Rico Department of Health, Direct Relief donated 40 emergency response backpacks to first responder organizations on the island including Puerto Rico Salud, to ensure first responders are fully equipped to address health needs in the field.

Making the journey

On a recent Tuesday, Martínez drove up to Felicita Nieves’ house in the community of Cacao Centro in Carolina. Nieves lives with her two adult sons, and cares for both them and herself. Alfredo, her younger son, has several disabilities, including limited mobility.

And while their community isn’t as remote as some, “doctors don’t want to come here, and [Alfredo] doesn’t walk,” Nieves said.

Families like Nieves’s “are part of my everyday,” said Martínez. It’s not part of the job, but she collects donations to bring groceries to patients she knows need them.

Nieves was glad to receive the groceries and have her two sons vaccinated without leaving home. She had been able to visit a vaccination site in Carolina using public transport, but it would have been too difficult to prepare Alfredo for the journey.

Finding people, earning trust

Identifying patients who need help is challenging. So is coordinating visits. Martínez begins by calling patients on lists provided by Puerto Rico’s Department of Health, and tries to schedule visits to the same municipality close together to maximize her time.

But getting to the patients is top priority. Martínez regularly overcomes scheduling hiccups and searches out patients who can’t accurately tell her where they’re located.

Martínez recalled speaking to a patient who didn’t believe she would actually show up to administer a vaccine. He’d heard such promises before, but no one showed up. “I guarantee you I will come,” she said. And she did.

“I always say to myself, ‘I have to get there. I gave the patients my word’,” she said.

Even if she arrives at her destination, some people won’t answer the door or don’t trust her. Most aren’t vaccinated. “There is a lot of misinformation,” Martínez said. But if the patient agrees, she has the vaccine ready – and she’s happy to give willing family members the jab as well.

Martínez emphasized that this outreach effort goes beyond vaccination. “That time you stay with the patient… you give [them] support and company,” she said. “The happiness that person felt because someone heard his claim” is hard to overestimate.

While the Covid-19 vaccination has been the focus of Puerto Rico Salud’s efforts, the organization is also collaborating with other grassroots organizations to provide primary healthcare services in marginalized communities across the island.

For Martínez, having one of the Direct Relief-issued emergency medical backpacks means feeling safer. “We go on these outings by ourselves, so if there was an emergency, I have all the equipment I need to manage the situation,” she said. “It’s a treasure.”