COVID-19 arrived in Suriname when the country was just beginning to review its medical policies and to develop a national health information system.[1] With  limited experience in health emergencies, Suriname faced a challenge in responding to the new virus, while maintaining essential health services throughout the country.[2] However, it was not alone in these efforts. Since the start of 2020, PAHO/WHO has been supporting the Government of Suriname to prepare and respond to the outbreak in line with PAHO/WHO guidelines and the COVID-19 National Preparedness and Response Plan later developed. The response focused on four main areas: saving lives; protecting health workers; slowing the spread; and strengthening epidemic intelligence.[3]

A large part of Suriname’s terrain is covered by tropical rainforest. In remote villages live indigenous and maroon communities and migrant populations, who often work in the goldmining, forestry or logging industry. Availability of health care facilities is limited to specific locations, while a combination of hard-to-reach localities and cross-border movements makes it difficult to provide essential health services. So, during times of health emergencies, people living in the interior become some of the most vulnerable. And this was true for COVID-19, having a high impact on livelihoods especially among the Maroon communities living along the Eastern border, often living and working on both sides of the border along the Marowijne river. Per March 2021, the epidemic had caused many cases among the Amerindian population with a relatively high infection rate of 2708 per 100 000, compared to 1555 per 100 000 for the country overall. The case fatality ratio among the Amerindian population is also higher with 5.1%, compared to 1.9% for the country overall. With the increasing cases in bordering countries and the existing gold mining in the interior, migrant populations played an increasing role in the possible spread of the disease. All these factors emphasized the importance of the need for a sustained, heightened surveillance and case detection capacity among these vulnerable populations in the interior.

There are two main providers of care in the interior: The Medical Mission, a foundation that provides primary care services and is subsidized by the Government; and the National Malaria Programme, whose service delivery workers conduct screening, testing and treatment for cases of malaria and is a known and well accepted entity among the migrant population communities. These two entities were key partners in the response to COVID-19 in the interior.

Slowing the spread through active surveillance

Together, PAHO/WHO and the Ministry of Health organized a series of training sessions for health workers, who work in the epidemiology department and manage the public health helpline of the rapid response teams. The sessions focused on active surveillance, case investigation, use of Antigen Rapid Detection Tests and contact tracing. They also addressed data analysis and identifying areas with high disease incidence in villages and border regions. This knowledge, in turn, facilitated the work of surveillance missions to high-risk communities, with the objective to test and manage cases, communicate potential risks, but also to learn about challenges faced by the communities. Where the outreach was limited due to lack of infrastructure, PAHO/WHO facilitated the Medical Mission and the Malaria Programme’s access  to these rural and migrant communities.

The Malaria Programme also played another important role. Its service delivery workers, already familiar with the migrant populations, were sensitized to the symptoms of COVID-19 so that they could support surveillance of not only Malaria, but also COVID-19 during field activities in hard-to-reach areas in the interior. The TropClinic, initially established to provide affordable malaria-related care to mobile migrant communities in Paramaribo, extended its services to other infectious diseases, and most recently, to COVID-19.

The use of the PAHO donated rapid antigen tests on site, also resulted in higher testing capacities resulting in increased detection capacity and improved access to health services for the vulnerable population, including the Spanish and Portuguese-speaking communities in Paramaribo and the interior of Suriname. Knowledge obtained through contact tracing and genetic sequencing from the last epidemiologic wave identified the importance of the need for early case detection among the groups working in the gold mining industry and shows the importance of an inter-programmatic approach to surveillance of COVID-19. 

Cooperation between programmes for inclusive communication

The risk communication and community engagement followed the inter-programmatic approach, as well. With the support of the education sector and other UN agencies, PAHO/WHO developed manuals, printed, electronic and audio materials that supported community leaders to spread the message on preventive measures. With a guiding motto of leaving no one behind, communication materials captured and addressed the needs of different groups, in different languages.

Finally, the general public learned about and engaged with the public health measures through the “MoHanA” campaign. Composed of the initial letters of the public health measures - Mondkap op translated from Dutch to Wear your mask; Handen wassen to Wash your hands; and Afstand houden to Keep a distance - “MoHanA” reminds people in an easy way to observe these measures. The campaign had a special song, video, dance and a challenge to demonstrate implementation with prizes for the most creative winners.