In Peru, Care For Chronic Diseases Continues Amid COVID-19

Every day, Delia Zevallos picks up the phone and dials the same number. After a few rings, a voice answers—it’s her patient, an elderly man who lives alone in Carabayllo, an impoverished community 20 miles north of Lima, Peru. And he is excited to talk to her.

“I call him every day to ask how he is and see what he's doing, and to make sure he's taking his medicine,” she says.

Zevallos is a community health worker with Socios En Salud, as Partners In Health is known in Peru. Socios En Salud has worked in the country since 1994, when it began supporting the national response to an unchecked epidemic of multi-drug resistant tuberculosis. In the years since, Socios En Salud has continued to partner with Peru’s Ministry of Health to deliver medical care and social support in Carabayllo and beyond.

Zevallos focuses her work on caring for elderly patients with chronic diseases through the Casas de la Salud program. Since 2009, Casas de la Salud has provided care, screenings, and education for patients with a range of chronic health conditions, including diabetes and hypertension.

Each week, Zevallos and her team meets with a group of 12 patients in a community space—one of four such spaces the program operates—and provides medications, screenings, and advice on how to modify nutrition and exercise, what symptoms to watch for, and when to seek care.

“This program is important, especially now during a pandemic,” says Zevallos. “Medical consultations are not taking place in hospitals, so via this program, we’re able to reach out to many people who, because of their work schedule or other reasons, can’t attend appointments in clinics.”

Recently, the program has focused on patients with hypertension and diabetes, also known as non-communicable diseases. Non-communicable diseases kill 41 million people around the world each year. And deaths from these diseases disproportionately occur in low and middle income countries, where governments and health systems have been weakened by centuries of injustice, including colonialism and imperialism.

Detecting these diseases early and providing treatment and medication is critical for patients’ health and well-being, especially in communities like Carabayllo, a historically marginalized community on the outskirts of Lima where thousands lack access to quality care.

Care Amid COVID-19

Diabetes, hypertension, and other chronic diseases, such as asthma and heart disease, put patients at increased risk of severe illness from COVID-19. Casas de la Salud has continued its critical work amid the pandemic with comprehensive safety protocols to protect patients’ health.

“It has been a big learning curve lately, but we have been succeeding little by little,” says Diego Portillo, Socios En Salud’s coordinator of Casas de la Salud and Crónicas.

Health care workers wear personal protective equipment (PPE) at all times and conduct triage when patients arrive, isolating anyone with symptoms. The weekly sessions are capped at 12 people per group and services such as mental health care are provided virtually. When COVID-19 cases surged in the summer, the program delivered medications to patients’ homes instead of requiring them to come to the community space—a service it still provides for those unable to leave home.

Even amid COVID-19, Casas de la Salud continues to bring critical care and treatment to the neighborhoods of Carabayllo. Portillo estimates that the program serves tens of thousands of people—the community space in Polvorín, for example, serves nearly 10,000.

Care and accompaniment for patients with chronic diseases is all the more crucial during a pandemic where people are urged to stay home and isolate as much as possible—a harrowing and lonely experience.

“A community health worker is someone who walks alongside the person,” says Portillo. “What is key is to build our trust with the communities.”

Nowadays, Zevallos and her elderly patient mostly communicate by phone, but before COVID-19, she would visit the man at home and accompany him to the hospital to retrieve his medicine and lab tests. She even once bought him a cake for his birthday.

“You have to treat your patients with love,” she says. “If you treat them with love and affection, they’re going to feel safe.”