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美国数百万失业人员何去何从?专家建议充实社区卫生队伍

在抗击新冠疫情的过程中,这些之前没有医学专业知识的普通人,经过培训之后可以做很多工作。

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招聘社区卫生工作者不仅可以为他们解决经济困境,还能为未来的医疗系统培养一批骨干力量,随时准备应对可能发生的疫情。摄影师:Sara Eshleman——美国海军/路透社

随着美国COVID-19确诊病例不断增加,越来越多医护人员急需个人防护设备,并呼吁增加呼吸机的部署,拯救患者生命。美国公司和个人开始使用手工缝制和3D打印的口罩,许多制造企业被改造成了呼吸机零部件生产车间。虽节奏较为缓慢,但是公共和私营部门似乎终于开始采取行动,大量生产和销售这种关键的医疗器械。在整个医疗体系不堪重负之前,医疗工作者能否及时得到防护装备?关于这个问题我们没有答案。

但即使我们继续抱着微弱的希望,认为口罩、呼吸机和其他必要设备供应紧张的情况会有所缓解,但谁能为配戴和使用这些设备的医护工作者提供支持并减轻他们的负担呢?由于全美医护人员日益短缺,来自不同科室的医生、护士和助理医师被重新分派,退休医生被紧急征召,医学院的学生也被允许提前毕业。但谁来给他们提供支持?

或许我们的邻居就可以伸出援手。在美国等许多国家,社区卫生工作者一直是流行病的第一道和最后一道防线。他们都是本地居民,没有接受过专业医学教育,只是经过培训之后被雇来帮助患者。社区卫生工作者可以提供防疫策略,帮助发现新病例,协助患者获得必要的治疗等,从而帮助抑制病毒传播。

其他国家已经证明了社区策略对于疫情防控的重要性。例如,韩国每日确诊人数从最高峰时的近1000例减少到每天不到100例。韩国的经验证明,要想达到零新增病例,需要进行广泛的社区病毒检测、快速隔离、患者治疗和严格的接触者跟踪。在利比里亚抗击埃博拉病毒期间,社区卫生工作者也是重要的一环。他们与医生和护士携手寻找病患,让他们得到治疗。

最近几周,美国每周都有数百万人因为新型冠状病毒失业,这些人可以成为社区卫生工作者,参与到抗击疫情的战斗当中。据美国劳工统计局统计,2018年,美国共有约56000名社区卫生工作者。但一份工作组报告显示,美国至少每650人当中应该至少有一名社区卫生工作者。按照这个比例计算,美国的社区卫生工作者缺口至少有50万人。所以,我们应该雇用失业人员,对他们进行培训,提供必要装备,帮助预防、检测和应对新型冠状病毒,为需要医疗和社会护理的患者提供支持。人们可以在相对安全的家里从事这份工作,或者经过培训后,可以配戴适当的防护装备在社区中挨家挨户寻找患者,并帮助他们得到治疗。

从餐厅服务员到酒吧招待,从酒店前台到航空公司的机场柜台工作人员,这些失业人员已经感受到了本次疫情对经济的可怕影响。通过雇用这些失业人员,美国可以壮大地方医疗部门、非营利组织和国家倡议组织的力量,比如参与抗击COVID-19的医疗后备队。

虽然把邻居看做护理人员和医疗辅助人员可能有些难以想象,但在抗击新冠疫情的过程中,这些之前没有医学专业知识的普通人,经过培训之后可以做很多工作。

首先,他们可以通过组织和开展社交媒体活动,宣传社交隔离政策,从而阻止病毒传播。美国各地对社交隔离政策的执行情况并不一致,尤其是在最边缘化的社区。培训当地社区里的居民担任社区卫生工作者,能让更多人遵守医生的疫情防控建议。他们还可以鼓舞人心和制定策略,改善居民的身心健康,提高人们的适应能力。

其次,社区卫生工作者可以协助发现感染者。他们经过培训,知道了新冠肺炎的表现和症状之后,就可以帮助接听医院和公共卫生部门的热线,并将疑似病例上报到检测中心。

第三,社区卫生工作者可以与正在自我隔离的轻症COVID-19患者保持联系,监控他们的症状是否恶化,并迅速上报需要住院治疗的患者。此外,他们可以与公共卫生官员合作,穿戴个人防护设备协助居家快速检测(可用之后),跟进COVID-19患者的密切接触者,监控他们的症状,并确保他们得到检测。

其他机构已经证明了哪些做法是可行的。宾夕法尼亚大学社区卫生工作者中心的IMPaCT项目,在低收入社区雇用和培训当地居民担任急救人员,以满足人们的社会需求。这些社区卫生工作者现在被动员起来,通过提供远程支持和帮助安排食物配送等,帮助患者和受影响的社区应对疫情带来的经济影响,同时帮助宣传对疫情防控至关重要的公共卫生信息。在受疫情影响的其他国家,医疗部门负责人对于如何在全国落实这种做法有清晰的愿景。在《柳叶刀》杂志上发表的一篇评论文章中,英国医疗部门负责人提出在全国培养一支社区卫生队伍,用于病毒测试、监控和积极查找病例。这支队伍还将为150万老年人和易感染人群提供社会护理。

美国政府应该迅速将新冠病毒救济资金划拨给医疗部门、非营利组织和医疗保健系统,开始雇用和培训失业的美国人担任社区卫生工作者。慈善领域也可以为培训提供支持。酒店和航空公司等要求员工无薪休假后,如果这些员工愿意贡献出自己的时间,公司可以修改现有的培训内容,通过公司培训平台将其提供给员工。入职培训几天内就能完成。

雇用失业的美国人担任社区卫生工作者,参与疫情防控,还能为未来带来长远的影响。在美国建立一支社区卫生队伍,不仅可以解决他们的经济困境,还能为未来的医疗系统培养一批骨干力量,随时准备应对可能发生的疫情。当我们需要帮助的时候,不必舍近求远,因为我们的邻居就能伸出援手。

本文作者拉杰·潘贾比现任最后一程医疗(Last Mile Health)的CEO,也是哈佛医学院(Harvard Medical School)的助理教授。

米歇尔·维斯现任哈佛商学院(Harvard Business School)管理专业教授,著有《一切皆有可能:利用大众创业解决人类最紧迫的问题》(We the Possibility: Harnessing Public Entrepreneurship to Solve Our Most Urgent Problems)一书。(财富中文网)

翻译:刘进龙

审校:汪皓

随着美国COVID-19确诊病例不断增加,越来越多医护人员急需个人防护设备,并呼吁增加呼吸机的部署,拯救患者生命。美国公司和个人开始使用手工缝制和3D打印的口罩,许多制造企业被改造成了呼吸机零部件生产车间。虽节奏较为缓慢,但是公共和私营部门似乎终于开始采取行动,大量生产和销售这种关键的医疗器械。在整个医疗体系不堪重负之前,医疗工作者能否及时得到防护装备?关于这个问题我们没有答案。

但即使我们继续抱着微弱的希望,认为口罩、呼吸机和其他必要设备供应紧张的情况会有所缓解,但谁能为配戴和使用这些设备的医护工作者提供支持并减轻他们的负担呢?由于全美医护人员日益短缺,来自不同科室的医生、护士和助理医师被重新分派,退休医生被紧急征召,医学院的学生也被允许提前毕业。但谁来给他们提供支持?

或许我们的邻居就可以伸出援手。在美国等许多国家,社区卫生工作者一直是流行病的第一道和最后一道防线。他们都是本地居民,没有接受过专业医学教育,只是经过培训之后被雇来帮助患者。社区卫生工作者可以提供防疫策略,帮助发现新病例,协助患者获得必要的治疗等,从而帮助抑制病毒传播。

其他国家已经证明了社区策略对于疫情防控的重要性。例如,韩国每日确诊人数从最高峰时的近1000例减少到每天不到100例。韩国的经验证明,要想达到零新增病例,需要进行广泛的社区病毒检测、快速隔离、患者治疗和严格的接触者跟踪。在利比里亚抗击埃博拉病毒期间,社区卫生工作者也是重要的一环。他们与医生和护士携手寻找病患,让他们得到治疗。

最近几周,美国每周都有数百万人因为新型冠状病毒失业,这些人可以成为社区卫生工作者,参与到抗击疫情的战斗当中。据美国劳工统计局统计,2018年,美国共有约56000名社区卫生工作者。但一份工作组报告显示,美国至少每650人当中应该至少有一名社区卫生工作者。按照这个比例计算,美国的社区卫生工作者缺口至少有50万人。所以,我们应该雇用失业人员,对他们进行培训,提供必要装备,帮助预防、检测和应对新型冠状病毒,为需要医疗和社会护理的患者提供支持。人们可以在相对安全的家里从事这份工作,或者经过培训后,可以配戴适当的防护装备在社区中挨家挨户寻找患者,并帮助他们得到治疗。

从餐厅服务员到酒吧招待,从酒店前台到航空公司的机场柜台工作人员,这些失业人员已经感受到了本次疫情对经济的可怕影响。通过雇用这些失业人员,美国可以壮大地方医疗部门、非营利组织和国家倡议组织的力量,比如参与抗击COVID-19的医疗后备队。

虽然把邻居看做护理人员和医疗辅助人员可能有些难以想象,但在抗击新冠疫情的过程中,这些之前没有医学专业知识的普通人,经过培训之后可以做很多工作。

首先,他们可以通过组织和开展社交媒体活动,宣传社交隔离政策,从而阻止病毒传播。美国各地对社交隔离政策的执行情况并不一致,尤其是在最边缘化的社区。培训当地社区里的居民担任社区卫生工作者,能让更多人遵守医生的疫情防控建议。他们还可以鼓舞人心和制定策略,改善居民的身心健康,提高人们的适应能力。

其次,社区卫生工作者可以协助发现感染者。他们经过培训,知道了新冠肺炎的表现和症状之后,就可以帮助接听医院和公共卫生部门的热线,并将疑似病例上报到检测中心。

第三,社区卫生工作者可以与正在自我隔离的轻症COVID-19患者保持联系,监控他们的症状是否恶化,并迅速上报需要住院治疗的患者。此外,他们可以与公共卫生官员合作,穿戴个人防护设备协助居家快速检测(可用之后),跟进COVID-19患者的密切接触者,监控他们的症状,并确保他们得到检测。

其他机构已经证明了哪些做法是可行的。宾夕法尼亚大学社区卫生工作者中心的IMPaCT项目,在低收入社区雇用和培训当地居民担任急救人员,以满足人们的社会需求。这些社区卫生工作者现在被动员起来,通过提供远程支持和帮助安排食物配送等,帮助患者和受影响的社区应对疫情带来的经济影响,同时帮助宣传对疫情防控至关重要的公共卫生信息。在受疫情影响的其他国家,医疗部门负责人对于如何在全国落实这种做法有清晰的愿景。在《柳叶刀》杂志上发表的一篇评论文章中,英国医疗部门负责人提出在全国培养一支社区卫生队伍,用于病毒测试、监控和积极查找病例。这支队伍还将为150万老年人和易感染人群提供社会护理。

美国政府应该迅速将新冠病毒救济资金划拨给医疗部门、非营利组织和医疗保健系统,开始雇用和培训失业的美国人担任社区卫生工作者。慈善领域也可以为培训提供支持。酒店和航空公司等要求员工无薪休假后,如果这些员工愿意贡献出自己的时间,公司可以修改现有的培训内容,通过公司培训平台将其提供给员工。入职培训几天内就能完成。

雇用失业的美国人担任社区卫生工作者,参与疫情防控,还能为未来带来长远的影响。在美国建立一支社区卫生队伍,不仅可以解决他们的经济困境,还能为未来的医疗系统培养一批骨干力量,随时准备应对可能发生的疫情。当我们需要帮助的时候,不必舍近求远,因为我们的邻居就能伸出援手。

本文作者拉杰·潘贾比现任最后一程医疗(Last Mile Health)的CEO,也是哈佛医学院(Harvard Medical School)的助理教授。

米歇尔·维斯现任哈佛商学院(Harvard Business School)管理专业教授,著有《一切皆有可能:利用大众创业解决人类最紧迫的问题》(We the Possibility: Harnessing Public Entrepreneurship to Solve Our Most Urgent Problems)一书。(财富中文网)

翻译:刘进龙

审校:汪皓

As COVID-19 cases escalate across the U.S., so do the desperate calls for personal protective equipment for health workers, and the pleas for ventilators they could deploy to save lives. Companies and individual Americans have taken to sewing and 3D-printing face masks, and manufacturing floors are being repurposed to make ventilator parts. There appears to be, at long last, a slow churning of public and private sector activities to produce and distribute that essential gear. Whether health workers can access gear in time before the entire health system gets overwhelmed, we don’t yet know.

But as we cling to a faint hope that masks, ventilators, and other necessary equipment might be coming in relief—who will support and relieve the caregivers who will wear and use that gear? With a growing health worker shortage nationwide, doctors, nurses, and physician’s assistants are already being reallocated from other departments, drafted out of retirement, and allowed to graduate early from medical schools. But who will support them?

Help could come from a neighbor. In many countries, including the U.S., community health workers—local residents without professional medical degrees, hired and trained to support patients—have been a first and last line of defense for epidemics. As a community health worker, a neighbor could help stem the tide of the pandemic by offering prevention tactics, aiding in the detection of new cases, and supporting patients in accessing the care they need.

Other countries have shown how vital community-based strategies are to achieve viral suppression. For instance, South Korea, which reduced COVID-19 transmission from its peak of nearly 1,000 cases per day to less than 100 per day, has shown that getting closer to zero cases requires widespread community-based testing, rapid isolation, care for the sick, and rigorous tracing of contacts. Community health workers were also an essential part of the Ebola response in Liberia, where they teamed up with doctors and nurses to find the sick and get them into care.

And now, with more than 3 million Americans having lost their jobs last week, those unemployed as a result of the virus can help fight it as community health workers. The U.S. had about 56,000 community health workers in 2018, according to the U.S. Bureau of Labor Statistics. But, based on a task force report that showed that countries should have at least one community health worker per 650 people, the U.S. needs at least 500,000 more. They should be hired, trained, and equipped to prevent, detect, and respond to COVID-19, and support patients with health and social care needs. Some could do this work from the relative safety of their own homes, and others, with the right protective gear and training, can go door-to-door in their neighborhoods to identify the sick and help them get medical care.

And by hiring unemployed people already feeling the dire economic impact of this pandemic—from restaurant servers and bartenders to people who staffed hotel check-ins and airline gates—the U.S. could bolster the ranks of local health departments, nonprofit organizations, and national initiatives like the Medical Reserve Corps involved in fighting COVID-19.

While the idea of viewing neighbors as caregivers and health care support might stretch the imagination, there is much that Americans without prior medical expertise could be quickly hired and trained to do in the fight against COVID-19.

First, they could help with prevention by organizing and carrying out social media campaigns that promote social distancing. The implementation of social distancing remains uneven across the country, especially in communities that are most marginalized. Training the people from those communities as community health workers would result in an uptake of following the recommended practices. They could also encourage and outline strategies that promote mental and physical health and resilience.

Second, community health workers could aid in detection. They can be trained to learn the signs and symptoms of COVID-19 to help staff the hotlines run by hospitals and public health departments and refer possible COVID-19 patients to testing centers.

Third, community health workers can support the response by calling people with COVID-19 who are in self-isolation with mild symptoms and, with supervision, monitor them for worsening symptoms and support rapid referral of people who require hospitalization. In addition, in concert with public health officials, they could support rapid home-based testing (once available) while wearing personal protective gear, following up with those who’ve been exposed to a COVID-19 patient to monitor their symptoms and ensure they get tested.

Others have shown what’s possible. The University of Pennsylvania’s Center for Community Health Workers IMPaCT program hires and trains residents to act as first responders to the social needs of those in low-income neighborhoods. These community health workers are now being mobilized to help patients and affected communities deal with the economic fallout from the virus by providing telesupport and helping to arrange food delivery, while reinforcing public health messaging that’s critical for prevention. And in other COVID-19-affected countries, health care leaders have a vision of how this could be implemented at a national scale. Last week, in an opinion piece for The Lancet, health care leaders in the U.K. proposed a national program to train a community health workforce to deal with testing, surveillance, and active case finding. This community health workforce would also provide social care for the 1.5 million elderly and vulnerable populations.

Funds from the government’s coronavirus relief bill could be channeled to health departments, nonprofits, and health care systems to start training and hiring unemployed Americans as community health workers immediately. The philanthropic sector could also support training programs. And corporations, such as those in the hospitality and airline industries, with furloughed workers who want to volunteer their time, can adapt existing training content and deliver it online through their corporate training platforms. Workers could complete the onboarding programs in days.

Hiring unemployed Americans as COVID-19 community health workers today would have lasting effects. A U.S. community health corps could provide economic salvation and form the backbone of a future health system that is always ready to fight the next epidemic. And we wouldn’t have to look far for help—we’d only have to look next door.

Dr. Raj Panjabi is CEO of Last Mile Health and an assistant professor at Harvard Medical School.

Mitchell Weiss is a professor of management practice at Harvard Business School and author of We the Possibility: Harnessing Public Entrepreneurship to Solve Our Most Urgent Problems.

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