UBS Fluvial enables vaccination against Covid on Marajó Island

The vessel equipped with a refrigerated environment, vaccination room, dentistry and emergency care enables vaccination against Covid-19 in places that traditional health centers cannot reach.

Named UBS Fluvial, the boat travels through the waters of the Pará River until it reaches the top of the Guajará River, for example, where there would be no immunization against the disease if it were not so.

The same happens at the top of the Canaticu and Piriá rivers, also on Marajó Island. The boat that works as a mobile health unit travels for hours to reach the most distant communities of Curralinho (PA), where it is anchored when not sailing.

The boat has refrigeration, which ensures that vaccines that need to be stored at low temperatures, like Pfizer’s, can reach areas far from the city.

The immunizing agent is the only one recommended by Anvisa (National Health Surveillance Agency) for children aged 5 years. Until Coronavac’s approval for children and adolescents, it was also the only one used in the campaign for the 12 to 17 year old audience. It is also recommended by the Ministry of Health for booster doses.

The unit’s route prioritizes places that do not have refrigeration to take doses of Pfizer, since the other immunizers can reach communities in conventional vessels, says José Raimundo Farias, municipal secretary of Health.

“As we are entering a phase where we will be with Pfizer a lot, even with all the difficulty we prefer to stay with her because the interval is shorter”, he explains.

To circumvent the dependence of this immunizer in childhood vaccination, the municipality intends to use Coronavac to vaccinate children in distant regions of the city. Thus, health agents are able to take the vaccines to the top of the rivers without relying on refrigeration, which makes the unit unnecessary and increases the agility of the campaign.

The coordinator of Health Surveillance in the municipality, Danieli Matos, explains that another factor that influenced the decision was the intensity of the adverse reactions that each vaccine can cause.

Because they take hours to reach the top of the rivers, health professionals are unable to stay in the communities to monitor possible reactions and, therefore, need to give preference to immunizers that have fewer side effects.

“With Coronavac, the adverse reaction is milder so we will prioritize [para] rural children. If we were to just continue with Pfizer, it would also be more difficult for the adverse reactions,” he explains.

The UBS is anchored in schools and places to which riverside people can reach by boat to receive immunizations. Sometimes, the municipality or the school charters boats to pick up the residents.

Before leaving the city, health workers get in touch with teachers and community and religious leaders and ask for help to notify them of the days when the vaccine will be administered. In addition, the news is broadcast on Rádio São João FM, the main means of communication in Curralinho.

The distance between the houses of the riverside people and the traditional UBS became an impediment to the search for medical care. In the so-called rabudinhos, boats used by riverside dwellers with a small engine at the stern, it takes at least eight hours from Curralinho to the top of the Guajará River, the farthest place where the unit provides assistance.

UBS Fluvial makes trips that last four days, one for travel and three for service. Each trip costs around R$30,000, money that mainly pays for fuel for the boat and food for employees. Since the beginning of vaccination, efforts have been focused on immunization against Covid-19, but with each departure the team takes at least one specialty to better enjoy the trip.

The unit has a smaller boat that acts as an arm in home care. In the tributaries of rivers where the UBS does not pass due to the size or level of the water, the speedboat (a kind of boat) takes the health agents to provide care.

Maria Santana Melo de Souza, 98, depends on home care to get vaccines against Covid-19. Blind from glaucoma, she hasn’t left her home for a few years.

On an afternoon in early December last year, health agents Maria Alves Borges and Nathasha Miranda went to their home to apply the booster of the immunizing agent. Even with the help of family members, Dona Santana could not reach the UBS in Curralinho, due to her limited mobility.

Idalvina Correia, 86, also needs the visit of health agents to get the vaccines and for basic care. That afternoon, Borges and Miranda went to her house, on the banks of the Pará River, to administer the third dose of the vaccine.

As she was taking a corticosteroid, she could not receive the immunizing agent. The trip, however, was not lost.

Miranda took the opportunity to apply the flu vaccine, which was also late. Because she does not have a boat to go to the city and has difficulty walking due to a fracture in the pelvis, without home care, Dona Idalvina would not be able to receive the immunizations.

So far, 73.5% of the population of Curralinho has already received the two doses of the vaccine against Covid-19. The most applied immunizer in the city is Pfizer, with about 5.1 million doses. Among the riverside population, the percentage of those who have already received the second dose is 99.8%, and the booster dose is 2.9%, according to data from the Secretary of Public Health of the Government of the State of Pará.

Michele Rocha El Kadri, a researcher at Instituto Leônidas and Maria Deane from Fiocruz (Fundação Oswaldo Cruz) Amazônia, says that UBS Fluvial represents a policy designed exclusively for the Amazon region, understanding that rivers are not a barrier to access to health, but rather a connection.

“UBS brings this mark of overcoming the discourse of the Amazon as a very complex place, as a place of lack, as a great void. It shows that it is a different territory and that it needs specific policies and actions for this territory”, says the researcher.