Roma health mediators are at the forefront of COVID-19 relief efforts
By Dena Popova
“The virus might not kill us, but hunger will for sure,” say people from the Fakulteta neighborhood in Sofia, Bulgaria. Social problems and poverty are fueling the devastating impact of the coronavirus in Roma communities in Bulgaria, months after the emergence of the health and economic crisis associated with COVID-19. According to the World Bank, COVID-19 may push more than 49 million people living near the poverty line into extreme poverty in 2020. Roma communities in Bulgaria, the EU’s poorest country, are among the most vulnerable, with an estimated 63.8 percent living in poverty currently, according to NSI.
Poverty and Other Factors Worsen the Impact of COVID
The factors that threaten public health in Roma communities predate the coronavirus and include populated neighborhoods, poor housing conditions, lack of access to health and social services, educational deficits, illiteracy, discrimination and unemployment, overcrowded households, lack of infrastructure for collecting waste, and lack of running water among many others.
Roma health mediators working at the forefront of relief efforts are disseminating COVID-19 health information and prevention materials and are assisting in testing. In times of such unprecedented crisis, the lack of well-functioning infrastructure for health and social services in these communities is painfully clear.
My work is now much harder. I inform people in the neighborhood about safety measures, but I myself am afraid because I have contact with many people through my work,” said Rakip, a health mediator for the Nurse-Family Partnership (NFP) in Plovdiv. The NFP Program has been implemented by the Trust for Social Achievement, a Romomatter Project partner, in Sofia and Plovdiv since 2016. It provides teams of family nurses, midwives and health mediators to work closely with vulnerable, young pregnant women and their families.
The work of the NFP team has continued even after the state of emergency was declared on March 13 and the subsequent lockdown, supporting women and mothers in the disadvantaged neighborhoods of Fakulteta, FIlipovtsi, Hristo Botev (Sofia) and Stolipinovo (Plovdiv). Family nurses and mediators provide support for more than 100 families. They regularly monitor their conditions and keep track of what urgent needs the families have. With an estimated 40 percent of the families reporting lost employment and more family members staying at home, malnutrition, hunger and overcrowding are serious problems.
Hunger and Overcrowding Pose Challenges to Maternal and Child Health
As a response, TSA organized a crowdfunding campaign for 100 packages of food products for mothers and young children. The program is also providing vitamins and nutritional supplements as well as prescribed medications for those in greatest need.
“They are malnourished, and breastfeeding is also affected by the poor nutrition and lack of vital nutrients. Babies are given transitioning foods that are not suitable, like soups, bread, whatever the other family members eat,” says Nelly Taseva, an NFP family nurse who works in Sofia.
Mental Health and Economic Challenges of the Crisis Shine a Light on the New Dimensions of Poverty
Women also have mental health needs. “We help guide each family on what to do in the current situation, what to do in an urgent situation with the baby, how to take care of their mental health, and how to calm down and relax in these times of uncertainty,” says Plamena, a family nurse from the Sofia team who currently works with 17 families. “Now that men are staying at home, everyone is anxious and tense, which exacerbates family dynamics,” says Raya Ivanova, who is part of the team in Plovdiv. The nurses also suspect several cases of domestic violence and are doing their best to support these women.
The economic impact of the coronavirus is detrimental to the communities. Those who worked in the informal economy, including janitors, construction workers and waiters, are suddenly without income and not eligible for any social benefits or support, according to Katya Naydenova, a health mediator for the program in Sofia. “Families who live in extreme poverty burn garbage for heating, and now that they have to stay at home, they cannot go out to collect and recycle waste, and are absolutely starving,” shares Anelia Dimitrova, Katya’s colleague.
Remittances from abroad, normally a primary source of income in these communities, are being reduced or discontinued. In search of financial support, some families are betting on their phones, other families are resorting to problematic quick loans. Health and social concerns fall by the wayside, as families struggle to deal with the immediate uncertainty about the coronavirus crisis.
In this context the NFP program support is crucial to maintaining sustainable and structured support for vulnerable, young families. As a phenomenon that endures over time and across generations, poverty exacerbates the effect of the current crisis. The NFP program works to offset these effects through its tested model of providing comprehensive home-visiting services for young mothers. These services are important, especially in times of crisis. The results of the model have been positive, with an improvement in the health of pregnant women and better early development for children. Better mental health, a culture of health and improvements in parenting capacity of young parents all represent positive outcomes that can help address the negative impacts of poverty.
Health and Social Support Networks are a Key to Supporting Roma Communities During COVID-19
The current COVID-19 crisis highlights the importance of having an existing network of empowered families, health professionals, social workers and health mediators that can work with Roma communities to address the most critical problems that emerge with force during times of crisis. It is hoped that their impact, together with solidarity and responsibility, can help these communities tackle persistent poverty.