Dr Nyla Lyons

In an interview with the Sunday Guardian, Dr Nyla Lyons, a public health specialist with more than 15 years of experience working with development agencies, governments, NGOs and civil society organisations internationally and across the Caribbean, discusses her ongoing work with Venezuelan migrants and shares some preliminary findings of her study examining their health needs, use of health services and the demands placed on the local public health system.

Lyons is currently working with the Medical Research Foundation of T&T (MRFTT) in collaboration with local and international public and private partners to plan, implement and evaluate programmes to help address the health service needs of vulnerable populations to include migrants in T&T.

Lyons is advocating for a policy to address non-citizens’ access to public health services.

The public health specialist recently initiated a strategic partnership between the MRFTT and a Washington-based Diaspora Organisation to further steer resources and strengthen international collaborations to address the health needs of Venezuelan migrants locally.

Q: Can you tell us what is known about Venezuelan migrants in T&T and their access and use of public health services?

A: Beginning in 2016, T&T has seen increasing inflows of refugees and migrants from Venezuela. Migrants have been arriving by both sea and air. Based on what is documented, around 16,000 people were documented as part of the Government Migrant Registration Exercise in June 2019. The UNHCR (Trinidad and Tobago UN Refugee Agency) reported that the number of migrants continues to increase. 86 per cent of UNHCR’s persons of concern are Venezuelans, and around 19,490 refugees and asylum seekers were registered with the UNHCR by the end of 2020 (UNHCR, 2021). The local public health system continues to face increasing demands as a result of the inflows of Venezuelan refugees and migrants to T&T beginning in 2016. By the end of 2020, 71 per cent of migrants who reported accessing health services used local public hospitals (IOM Migrant Assessment Report, 2020). The IOM assessment consisted of a sample of 950 Venezuelan migrants in T&T. In a recent survey to assess the health needs of Venezuelan migrants, 76 per cent reported accessing care from local hospitals and health centres. The study was implemented by me, Dr Lyons and a team from the Medical Research Foundation in September 2020.

Can you share information about your recent study–what was the purpose, who commissioned the study and how was it financed?

The study was financed through a grant from the UWI to the Medical Research Foundation in July 2020. The study examined the health needs, use of health services, and uptake of HIV testing by Venezuelan refugees and migrants in Trinidad. People of Venezuelan nationality were recruited and invited to participate. A health questionnaire was administered via telephone to 250 people in the months of September through November 2020 ie, during the COVID-19 lockdown period. 92 per cent of participants reported arriving in T&T over the period of one to four years.

Based on your study, what can you tell us about the health needs of Venezuelan migrants in Trinidad? How do they access the health services they need?

Of the 250 study participants, 48 per cent reported having a known health condition to include hypertension, diabetes, and/or an anxiety-related condition before arriving in T&T. 76 per cent reported getting tested for HIV over the past 12 months at a public health facility, 80 per cent indicated that they would visit a health centre if they want a pregnancy test and to get condoms. Others reported going to a pharmacy to get a pregnancy test and/or to purchase condoms. 76 per cent of the study participants reported accessing care through public hospitals and health centres. Just over ten per cent reported using private doctors and pharmacies, and 12 per cent reported that they relied on NGOs, religious organisations, and the internet to access selected health services and information.

The survey results closely mirror the existing health needs of people before leaving Venezuela. In Venezuela, non-communicable diseases such as heart disease, cancer and diabetes are reported to be among the leading causes of hospitalisations and deaths (WHO Country Profile Report, 2019). An estimated 120,000 people are reported to be living with HIV (2019), 79 per cent of whom are said to have limited access to HIV treatment given the ongoing economic crisis impacting the supply of medications in Venezuela.

What health risk do migrants from Venezuela face? Are they at risk for HIV and other sexually transmitted infections?

Overall, refugees and migrants from Venezuela may be at higher risks for developing or worsening health conditions given the lack of access to ongoing medication and/or limited access to health services when they leave their home country. They may also be at increased risk for contracting sexually transmitted infections, such as HIV, in instances where there is limited information on where to access HIV services. Their health risks may be further exacerbated by barriers such as language and cultural differences as in the case of T&T. Their existing medical conditions are also of concern in the context of the COVID-19 pandemic given the reported increase in their social and financial barriers during this time.

The full results of this study and its implications for the local public health system will be published in July 2021. Resources to fund a larger study with a representative sample size can provide greater insights on the migrant health risks and trends in health access in T&T.

What are the implications of your findings for T&T? What are the costs to our public health system and how will this impact the citizens of T&T?

Access to, and the use of health services by Venezuelan migrants and other non-nationals is critical to promoting and maintaining their health, preventing and managing the spread of disease which reduces the potential cost of hospitalisations when conditions go untreated.

In T&T, registered migrants from Venezuela benefit from free emergency medical services at public health institutions including treatment for acute medical conditions, accidents, injuries, asthma, heart attacks and infectious diseases. This was reinforced during the Government’s registration and re-registration exercises (conducted in 2019 and 2021 respectively) targeting legal and non-legal Venezuelan migrants residing in T&T.

Given the increasing inflows of Venezuelan migrants and refugees into T&T, it is critical to determine and monitor the use of health services, the quantities and types of services accessed by Venezuelan migrants (and other non-nationals), and what are the costs to the Government of T&T. This is particularly important given the rapid inflows of migrants accessing care through the public health system, the potential strain on existing health resources, and its potential burden and impact on the provision of care to all (to include citizens and non-citizens).

Given your knowledge on the subject, how can T&T best address the health needs of Venezuelan migrants while minimising the risk and potential burden on our public health system?

The research findings demonstrate the need for Government to consider a policy for the provision of health services for non-citizens. Also, expanding efforts to strengthen regional and international coordination and partnerships with intergovernmental organisations, funding agencies, NGOs, civil society, and religious organisations to mobilise resources, develop effective health programmes and monitor the uptake of services. Disseminating information about the availability of health services (ie, in the public health sector, from NGOs etc) for example where to access HIV testing may help reduce the risk of the spread of communicable diseases and/or worsening health conditions which if left untreated can result in hospitalisation. The cost of hospitalisation represents a larger burden on the public healthcare system in the long run.

Tell us about the work of other NGOs in helping to address the health need of Venezuelan migrants in T&T?

In addition to accessing care through public health services, Venezuelan refugees and migrants access health services through local NGOs, religious organisations and other stakeholders. The UNHCR reported that 157 health consultations were delivered in February 2021 by a local NGO (FPATT) using telehealth and some onsite consultations. Health outreach missions are also conducted by the Catholic Archdiocese and other local NGOs are providing psychosocial support for survivors of gender-based violence and other social support services to Venezuelan refugees and migrants.

The MRFTT has formalised local partnerships with the Living Water Community and other local NGOs to implement health initiatives and outreach events offering medical services to Venezuelan migrants and refugees to include screening for diabetes, hypertension, HIV and STI testing, pregnancy testing, access to over-the-counter medications, condoms and contraceptives. The MRFTT also participates on local subcommittees with other NGO service providers to map available health services and to help streamline health outreach efforts