From time to time, until the crisis has passed, the HEPL blog series authors will be given the opportunity to provide short updates on their country/region’s continuing response to this worldwide catastrophe and their further reflections on those responses. Each update will be labelled accordingly with the original response at the bottom of each post.

View original response post

HEPL blog series: Country Responses to the Covid19 Pandemic

Surinam’s Response to the Coronavirus Pandemic – the August update

Oemar van der Woerd, Erasmus University Rotterdam
Vikas Soekhai, Erasmus University Rotterdam and Erasmus University Medical Centre Rotterdam

In the last two months, Surinam has experienced several worrisome developments related to the number of COVID-19 infections. While at the start of the pandemic Surinam was doing well in terms of number of infections as well as people in isolation, a somewhat unexpected rise occurred after the national elections took place on May 25. At the time of writing (August 5), 27 people have died due to COVID-19 complications since last March, more than 676 active cases are known and around 90 people are hospitalized. According to mainstream opinion, the national elections – which eventually took place despite some skepticism – resulted in political gatherings, queues, one-to-one interactions as well as illegal border crossings from Brazil (South), Guyana (West) and French Guiana (East) that resulted in the uncontrolled spread of contaminations. Although the government communicates that the COVID-19 situation is under control at this moment, experts from the Ministry of Health observe behavioral changes among Surinamese citizens regarding adherence to COVID-19 preventive measures. This is in line with developments in other countries in the world.

To counteract the increasing amount of infections and the threat of more, the partial lockdown and related measures have recently been (re)introduced by the newly installed President and Minister of Health. Illustrative of the current critical situation, the Minister of Health publicly stated that isolation capacities, such as hotels and other hospitals, are at their limit for infectious people who need isolation. Consequently, COVID-19 care has been expanded to other healthcare facilities to specifically focus on the treatment of infectious people. To create awareness of the urgent situation, several initiatives where launched to compensate for the lack of PPE as well as clinical personnel. The SU4SU initiative, as mentioned in an earlier blog post, has been a success in terms of creating awareness and collecting financial resources for PPE and other practicalities. Additionally, during a national broadcast on Dutch television (‘Netherlands for Surinam’) many Dutch inhabitants financially contributed to its former colony. As a result, emphasis on a lack of PPE is becoming less dominant and crucial. Instead, Surinam is facing a (threatening) lack of personnel – specifically nurses – and therefore several medical teams from highly specialized hospitals in the Netherlands flew to Surinam to assist on a local scale. Additionally, the Dutch government promised to send Surinam several life-support machines for the ICU.

Commentary

While it was expected that a transition of power would be cumbersome, the former President eventually accepted his defeat in a public speech mid-July. However, the old government complicated the installment of the new government in numerous ways (i.e., missing ICT as well as government-owned transportation cars, and hundreds of seemingly unnecessary hired government officials prior to national elections). Yet at the same time, the newly installed government is still ambitious, realizing that a lot of steps need to be taken to overcome a culture of suspected corruption and dealing with numerous international loans that complicates further economic stability. To indicate the more open-oriented attitude, the newly installed President reached out in his first week to neighboring countries, such as Brazil, the United States, as well as the Netherlands overseas, to strengthen political and economic ties that will hopefully open up collaborative public-private initiatives.

Reflecting on the Surinamese response to COVID-19, the country is unexpectedly entering a somewhat new critical phase of the pandemic. Hence, enormous challenges are ahead to prevent a further outbreak so we still have to be patient to see how the double crisis will unfold. Thus far, what stood out the most is that Surinam has experienced socio-political as well as dramatic economic developments that occurred at the same time. Surinam seems especially in relation to such a pandemic dependent on others to work its way through the crises. The first signals indicate that the double crisis is acknowledged by the new government, which is hopeful, but is also putting pressure on a society that is already facing enormous challenges on a day-to-day basis. It will be interesting to see how the newly installed government will deal with the multiple challenges it is currently facing and if rebooted international collaborations with other countries will lead to a stronger position of Surinam in the world. Although ‘a new Surinam’ – referring to the first public speech on national television from the President – is on the horizon, a lot of repair work seems necessary first.

We thank several professionals working in Surinamese hospitals and Ministries for sharing their views with us in finalizing the Surinam blog series.

The Surinamese Response to the Coronavirus Pandemic – Update (May 2020)

Oemar van der Woerd, Erasmus University Rotterdam
Vikas Soekhai, Erasmus University Rotterdam and Erasmus University Medical Centre Rotterdam

The Surinamese strategy of responding immediately in tackling the coronavirus outbreak seemed to have worked out well. At the time of writing (May 4), the country knew zero active cases, ten confirmed, nine recovered, and one deceased COVID-19 case. Thus far, 287 persons were placed in quarantine. Compared to last month the number of persons that recovered as well as the ones placed in quarantine increased, while the number of active cases dropped. On April 24 the President announced an extension of the partial lockdown and related measures, meaning that citizens are still not allowed to engage in public between 8.00 PM and 6.00 AM. Based on a study from one of the largest newspapers in Surinam, most citizens understand the partial lockdown, while in some parts of the country obeying the social distancing rules became more problematic.

In the last week of April, the National Public Health Response team was expanded to include epidemiologists to focus on preventing an uncontrolled COVID-19 spread in Surinam. In the last couple of weeks different public-private initiatives (e.g. Surinamese for Surinam (SU4SU)) raised money to overcome the shortages in personal protective equipment (PPE) and medical devices for healthcare professionals. The Surinamese government also continues their transparent COVID-19 communication through various news outlets. While a large outbreak has luckily been avoided at the moment, Surinam faces serious issues to prevent an outbreak due to illegal border crossings with the neighboring countries of Brazil (South), Guyana (West) and French Guiana (East). Although the government took measures to stop individuals from crossing borders and accessing Surinam, local authorities reported difficulties in preventing this from happening. During a press conference on April 30, the National Public Health Response team mentioned the uncontrolled border activities as a major threat to Surinamese public health, and announced that it will open additional checkpoints at the borders to intensify border control.

As briefly mentioned in our first contribution, the country also faces another crisis. Due to the decreasing value of the Surinamese dollar and increased prices of goods and services, citizens are experiencing problems in buying enough food and supplies each week. The economy also has come to a halt, with large international housing projects being cancelled, tourism declined to practically zero, and businesses struggling to remain operational. The controversial newly installed Currency Act – which minimizes the use of foreign currencies – and the malpractice at the Central Bank of Surinam also negatively influenced the country’s economy since its cash flow is heavily dependent on foreign currencies. However, it is striking to see how much international loans the Surinamese government has took out to overcome these cash flow problems. These macro, meso and micro economic issues led to other problems that arose like the large increase in illegal gold miners in the rural areas of the country, which has been a serious problem for years.

At this moment, it seems that the national elections will take place on May 25. While the political campaigns for the elections have continued, there is some skepticism among citizens and government officials about the enormous challenges ahead in order to organize these elections given the pandemic, as well as guaranteeing that the elections are taking place in line with the International Standards of Elections. 

Commentary

Although the government communicated COVID-19 statistics in Surinam are encouraging, the question remains how the pandemic impacts the regular healthcare system. The country is still dependent on foreign medical support and its lack of ICU and testing capacity as well as persistent shortages in medicines and medical equipment will surely limit the possibilities of coping with a potential large outbreak. The pandemic also effects other parts of the Surinamese healthcare system. Government agencies report for example a large decrease in demand to participate in national vaccination programs (e.g. against measles), which negatively influences the vaccination coverage and therefore public health. On the other hand, the government is working hard on initiatives to, for example, set up a program to provide citizens with psychosocial and other help during the pandemic.

Since the Surinamese dollar keeps decreasing in value while prices of goods and services are increasing and consumer trust keeps falling, the country faces large economic challenges after the pandemic. Dealing with both the pandemic and the potential economic crisis the country is facing will be an important aspect in the upcoming national elections. What do citizens think of the Surinam’s dependence on foreign medical support? How will this impact the Surinamese healthcare system in relation to access and affordability of care after the pandemic? We will have to be patient and see how the national elections unfold and how this will impact the Surinamese strategy regarding the pandemic as well as the period after the pandemic.

Surinam’s Response to the Coronavirus Pandemic – Original post (April 2020)

Oemar van der Woerd, Erasmus University Rotterdam
Vikas Soekhai, Erasmus University Rotterdam and Erasmus University Medical Centre Rotterdam

Surinam is the smallest South American state and was a colony of the Netherlands until its independence in 1975. Concerns about the coronavirus pandemic in the country rapidly increased after March 4, when five infections were diagnosed in Saint-Laurent – a border town of neighboring French Guiana. The first case of SARS-CoV-2 in Surinam was identified on March 13, and concerned a person who had returned from the Netherlands shortly before. The first infection led to the closure of Surinamese borders to all non-essential travel via land, water, or air. Only repatriation flights are still transporting Surinamese citizens who were stranded abroad. These returnees subsequently go into government ordered quarantine. At the time of writing (April 13), the country had ten confirmed, six recovered, and one deceased COVID-19 case. The latter person passed away on April 3 after a period of hospital quarantine. Thus far, 43 persons are in self-quarantine (under government supervision), and 54 persons in government appointed locations. After the first SARS-CoV-2 infection in Surinam on March 13, the Surinamese Minister of Health visited Cuba to ask for medical support. After successfully mobilizing 50 Cuban healthcare workers, the Minister returned home and went into mandatory quarantine.

To minimize the risk of a local outbreak, schools were closed starting March 16, and almost all public transport was shut down, as well as transport to rural areas in Surinam. On March 18, the President gave a televised speech and presented the virus as “a national matter.” Gatherings of more than ten people were prohibited. At that time, 53 persons were self-quarantined. Whereas citizens were initially urged to distance themselves from each other, the President announced a lockdown during a second speech on national television on March 29. Thereof, citizens were no longer allowed to engage in public between 8.00 PM and 6.00 AM. The President considered declaring a state of emergency in the border areas if citizens did not act according to the public engagement rule. Thus far, this has not been introduced.

A few topics stand out in the Surinamese approach in response to COVID-19. First, precautions were quickly taken by the Ministry of Health to prevent the virus from entering the country, such as the installment of ten body temperature scanners at the national airport for travelers from abroad on March 4, and travel bans from March 14. The Surinam Chinese United Association (SCUA) recommended Chinese citizens to avoid travelling between China and Surinam, especially from contaminated areas on January 31. Several shops were closed voluntary, afraid of being infected from customers. Preparing for the worse, the Pan-American Health Organization (PAHO) supported the Ministry of Health through the realization of a so-called National Public Health Response team mid-January, on which virologists and government officials are represented. This expert-informed way of responding resulted in action plans in which steps are described on how to handle when a suspected case enters the country from a high-risk area, predominantly from China. Surinam and China have grown strong ties over the last decade, and the Chinese population in Surinam has steadily grown.

Despite the relatively few COVID-19 infections thus far, there are already shortages in personal protective equipment (PPE) and medical devices for healthcare professionals as in many other countries. Recently (April 9), the Association of Pharmacists released an alarming message, claiming that there is an insufficient stock of medicines, recognized as a critical weakness of the Surinamese healthcare system. To illustrate, PAHO described Surinam (and a number of other countries in the region) as ‘risk countries’ in responding to the pandemic because of such weaknesses, among others (i.e. approximately only 30 ICU beds and ventilators). As a result, Surinam is anticipated to face difficulties in detecting and controlling the virus at an early stage, a situation that has been acknowledged by the Surinam government.

There has, however, been some confusion about the number of infections, after online messages suggested that two people were infected and held in quarantine in the academic hospital on February 5. The Minister replied that such messages (‘fake news’) could harm Surinam as well as other countries in tackling the pandemic. Although government officials and representatives of the response team publicly said that they cannot guarantee full control over the outbreak, there seems indeed to be transparent communication through various news outlets. For example, a website (https://covid-19.sr/) was launched to inform citizens on a daily basis on COVID-19 developments.

Commentary

Reflecting on the Surinamese response to COVID-19, the steady low number of cases for almost a week seems to be a positive sign that no major outbreak will occur in the upcoming weeks; but there is no guarantee. The low number of cases might indicate that the strategy of responding immediately in tackling the outbreak has worked out well. However, it is too early to judge the impact of the measures taken. Critics point out that the fragile state of healthcare in Surinam, with a lack of ICU and testing capacity, shortages in medicines and medical equipment, severely limits the extent to which the State will be able to respond to a sudden increase in infections. Dependence on other countries and institutions has arisen for financial resources, medical equipment and workforce.

While the resilience of the Surinamese healthcare system is debatable, the President guaranteed – during one of his television speeches – care, sufficient nutrition and order in society during the pandemic. Yet, at the same time an economic crisis unfolds. Therefore, the current situation is described by citizens as a ‘double’ crisis. Due to malpractice at the Central Bank of Surinam in January, the value of the Surinamese dollar spiraled downwards, resulting in increasing prices (from 10% up to a shocking 200%) in supermarkets and other shops. The double crisis, and fear of a local epidemic, led to long queues for cash registers soon after the first COVID-19 case was reported. Whilst the economy is slowly grinding to a halt, new questions emerge on how the measures taken will affect the already fragile economic state of the country (with approximal 600.000 inhabitants), and especially the viability of small businesses. Moreover, to what extent is Surinam able to cope with the existing weaknesses in the healthcare system if the number of cases increases? Although no government decisions on potential postponement of the scheduled national elections (May 25) have been made, it is certain that vast challenges lie ahead for Surinam as this double crisis unfolds.

Health Economics, Policy and Law serves as a forum for scholarship on health and social care policy issues from these perspectives, and is of use to academics, policy makers and practitioners. HEPL is international in scope and publishes both theoretical and applied work.