Medwave 2021;21(01):e8103 doi: 10.5867/medwave.2021.01.8103
Feeling prepared to face COVID-19 pandemic among Venezuelans in Chile: findings from an opinion poll
Báltica Cabieses, Florencia Darrigrandi, Alice Blukacz, Alexandra Obach, Claudia Silva
International migration is part of a broad conceptual framework developed by the United Nations and related to human mobility. The International Organization for Migration defines an international migrant as “any person who is outside a State of which he or she is a citizen or national,” either permanently or temporarily and regardless of their legal status. Migration is a critical event in a person’s life course, during which multiple protective and risk factors for health and wellbeing interact in complex and dynamic ways. Migration is a cross-sectional social determinant of health, as individual health may be influenced by migration-related factors before, during, and after the process of migration and the social context around it.
International migration can influence health outcomes through different mechanisms. Experiencing health risks and human rights violations can negatively influence health, yet social capital and social protection can buffer negative experiences and prevent the appearance of adverse events during migration. However, many groups of international migrants experience structural vulnerability during mobility because of limited access to health care with regards to needs, both in transit and upon arrival in the receiving country,. This is especially frequent in irregular international migrants, refugees, and those migrants who live in poverty. Vulnerability can be compounded in children and adolescents, women, ethnic minorities, sexual diversities, people with chronic conditions or infectious diseases, among other groups with greater exposure to processes of exclusion and social marginalization,,. Additionally, international migrants may experience lower social protection coverage, precarious employment and unsafe working conditions, and overcrowding.
The COVID-19 pandemic may have exacerbated the different dimensions of vulnerability and marginalization that international migrants experience, depending on their particular circumstances, either because of the pre-existing factors described previously or factors directly related to the management of the pandemic, such as border closure and xenophobic scapegoating. In that sense, taking into account all dimensions of migration as a social determinant of health is paramount to a comprehensive analysis of the effects of the COVID-19 pandemic on migrant populations.
Chile has become a receiving country of international migrants, mostly migrants from other Latin American countries. According to the latest report of the National Statistics Institute and the Department of Immigration and Migration of the Ministry of the Interior and Public Security published in 2019, there were 1 492 522 international migrants in Chile, 7.7% of the national population. Venezuelan migrants represent the first country of origin of international migrants residing in Chile, with an estimated 30.5% of the total migrant population. Globally, approximately 4.3 million Venezuelan migrants, refugees, and asylum-seekers were living outside of their country of origin as of September 2019, with outflows that have been heavily increasing since 2017. This represents one of the largest modern exoduses of international migrants from Latin America in the past century, impacting the region’s national health systems´ capacity and planning directly.
In accordance with national legislation and international recommendations, the Ministry of Health in Chile has been promoting access to health services to these populations progressively, as urged by the WHO (World Health Organization) at the 61st World Health Assembly, Resolution WHA61.17 of 2008 and PAHO (Pan American Health Organization) at the 55th Directing Council of the Organization. The most important breakthrough with regards to international migrants’ access to health in Chile is the Supreme Decree Nº67 of 2016, which allows irregular migrants without a formal income to access public health services under the same conditions as Chileans who do not receive an income. Regular migrants may choose between public and private health coverage in equal conditions with regards to the locals. Considering global processes of migratory flows relevant to Chile, in 2015, the Ministry of Health in Chile launched the Pilot Health Plan for International Migrants, which was implemented in 2016 and 2017. The Plan made way for the Health Policy for International Migrants launched in October 2017 and its upcoming Action Plan. These efforts by the Ministry of Health in Chile have catalyzed the gradual expansion of the rights of the migrant population in the public health care system.
As of July 20, 2020, 14 599 613 people were diagnosed with COVID-19 worldwide, and 607 746 lives were claimed, mostly in the United States, Brazil, and India. On that same date, Chile was ranked number eight in the ranking of confirmed cases, totaling 330 930 people. The global health crisis and the Chilean crisis have hit international migrant populations with greater severity and desolation in many cases, which could be explained by the difficulties that some of these groups have experienced in accessing prevention, diagnosis, and treatment measures, due to lack of information and knowledge, fear associated with their informality or discrimination and marginalization,.
The untimely experience of the pandemic for international migrant populations in Chile has not necessarily been accompanied by a deep understanding of the degree of knowledge, concerns, and needs felt about COVID-19 by these communities,. This is particularly relevant to Venezuelan migrants who have been experiencing social conflict, economic crisis, and poverty for many years before moving to another country, many of them as refugees and asylum seekers. Chile requires a better understanding of how Venezuelan migrants are experiencing and facing the COVID-19 pandemic to promote more equitable and culturally pertinent actions towards preventing and managing this sanitary crisis. To that effect, the following is our research question: “Do Venezuelan migrants in Chile feel prepared to face the pandemic, and what are the variables associated with feeling prepared?” The purpose of this study was to describe the experience of feeling prepared to face the COVID-19 pandemic among Venezuelans residing in Chile.
Risk of bias
The study participants’ average age was 38.1 years (s.d. 10.1), and 71% of the sample was female. Most of the Venezuelan participants in this study had arrived in Chile between one and five years prior (70%) and resided in the Metropolitan Region (69%); 80% achieved a university education; 53% had a job, and 45% did not but wanted to work; 64% were enrolled in the public health system (Fonasa), and 21% indicated that they did not have any health insurance (Table 1).
78% of Venezuelan participants reported receiving sufficient information about this virus and its disease, but 22% reported that the information was not understandable, and about one in four Venezuelan migrants qualified the information about COVID-19 of poor or very poor quality (23%). 91% reported feeling distressed or worried, and 72% sad or depressed because of the pandemic in the preceding week.
35% of Venezuelan participants reported feeling prepared to face the COVID-19 pandemic, and 65% reported not feeling prepared to face the COVID-19 pandemic. When looking at socio-demographic characteristics of those who reported feeling we prepared, the mean age of this group was 41 (s.d. 10.2) years old, 64% were female, 84% achieved a University education level, 71% had come one to five years ago, and 21% had come six months to a year ago, 55% had a job, and 43% did not have a job but would like to work, 59% belonged to the public healthcare system, and 21% did not have health insurance, and 72% resided in the Metropolitan region. Those who reported not feeling prepared were 37 years old (s.d. 9.6), 75% female, 79% had university-level education, and 20% had a secondary level, 69% had come one to five years ago, and 26% had come six months to a year ago, 53% had a job, and 46% did not have a job but would like to work, 67% belonged to the public healthcare system, and 21% did not have health insurance, and 68% resided in the Metropolitan region (Table 2). That is, compared to Venezuelan migrants who feel prepared to face the COVID-19 pandemic, migrants who reported not feeling prepared were younger and in a higher proportion female, with secondary education level, had arrived in Chile in the past year, do not have a job but want to work, and were covered by the public healthcare provision.
The SARS-CoV-2 pandemic hit Chile and the Latin American region with great intensity. It affected the general population, especially older people, those with a history of chronic diseases, people who suffered from excess weight, and some groups experiencing socioeconomic deprivation, including international migrants living in poverty, overcrowding, irregular migratory condition, and informal employment. On March 3, 2020, this virus entered the country through a Chilean traveler who had been vacationing on the Asian continent. Today, the COVID-19 pandemic has spread to the entire national territory and has become a national emergency. Much needs to be done in the coming months to support the health of the Chilean and migrant population residing in the country, as the pandemic’s negative consequences are still to be known.
This study shows that Venezuelan migrants in Chile present low levels of preparedness with regards to the sanitary crisis, as only 35% of respondents reported feeling prepared. Receiving good quality information about the pandemic and how Venezuelan migrants deal with mental health symptoms like anxiety and depressive symptoms are important factors for feeling prepared to face COVID-19 in Chile. Both dimensions are potentially modifiable to influence better health care for migrants in times of pandemic. These results are consistent with what is being presented by international evidence in the context of the international migrant population’s situation facing the COVID-19 pandemic.
Our findings suggest that increased attention towards the health of Venezuelan migrants in Chile and the region is needed. The data documenting how Venezuelan migrants are coping with the COVID-19 crisis is scarce, yet available evidence suggests that they are struggling. Reinforcing measures to support Venezuelan migrants during and after this sanitary crisis has been recommended,. Actions related to protecting their health and healthcare are urgent and should be based upon the pillars and principles of public health, human rights, solidarity, and equity. Further actions towards universal health coverage and a transnational approach to continuity of care are needed. As the Venezuelan exodus has proven in recent years, the regional health care agenda should leave no one behind. Structural inequalities and deficiencies of healthcare systems in many Latin American countries quickly reappear when massive movements of people within the region and sanitary crises take place. Discriminatory and xenophobic situations tend to increase, as countries and healthcare systems are tensioned and exhausted by their incapacity to provide solutions when they are needed. The COVID-19 pandemic is a huge stressor, but it can also become an opportunity for creating and implementing novel strategies to deliver and maintain health care in our region, in which regional cooperation might be a large part of the answer.
There is consensus that the COVID-19 pandemic is exacerbating the precarious situation of migrant populations globally and Venezuelan migrants regionally. Some authors even indicate that ongoing global efforts to support international migrant groups in the wake of the pandemic have failed in their task,. Prevention measures aimed at international migrants, regardless of their immigration status, age, country of origin, or employment status, has been outlined as a priority issue for global public health,. This is of great relevance given the barriers that have been identified worldwide for the access and use of healthcare by the migrant population during the COVID-19 pandemic and the measures promoted by health authorities at the global level. Additionally, the evidence accounts for a general lack of information regarding COVID-19 in the migrant population globally,,,. Furthermore, for some migrant groups, most countries’ social distancing and hygiene improvement measures are challenging to comply with.
The general scientific literature on the field has documented that migrant populations present worse health results than the national population in various areas, including mental health. Under non-pandemic conditions, the international migrant population generally presents higher rates of common mental health disorders such as depression and a lower quality of life than the local population. These health issues are being exacerbated during the current COVID-19 crisis. In that sense, there is a need to ensure that migrant populations can access physical and mental healthcare and information relevant and culturally sensitive,. Little is known in the Latin American region about how Venezuelan migrants are experiencing and coping with the COVID-19 pandemic. This study aims to provide novel descriptive evidence on this subject, as the Venezuelan exodus to countries in the Latin American region continues to raise challenges and pitfalls.
The study presents some limitations. First, this is a descriptive and cross-sectional study based on an opinion poll that does not allow any causal interpretation. Second, the online application of the questionnaire allowed a broad scope in a short amount of time but did not allow us to add more sensitive questions. Hence, this study is only exploratory and should be improved through more detailed quantitative and qualitative studies in the future. However, to the best of our knowledge, this is the first study in Venezuelan migrant populations dedicated to describing how they face the SARS-CoV-2 pandemic. We hope that future studies will delve into these general results and that, despite its limitations, study findings will be considered for decision-making regarding the Venezuelan population in Chile and the region, regarding the issues of access, protection, and prevention in health, both during the current health crisis and future ones.
We conclude that Venezuelan migrants in Chile present low levels of preparedness regarding the sanitary crisis, as only 35% of respondents reported feeling prepared. Receiving good quality information about the pandemic and how Venezuelan migrants deal with mental health symptoms like anxiety and depressive symptoms are important factors for feeling prepared to face COVID-19 in Chile. These elements need further attention in Chile in the management of the present pandemic and the preparedness and response of future ones.
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