In an interview with Dr Joriker Hiskes, General practitioner at the Salù pa Tur clinic in Curaçao, shares her insight of delivering medical assistance to refugees and migrants, particularly amid the COVID-19 pandemic. Unable to access public healthcare, people in an irregular status find it increasingly difficult to pay for expensive private medical treatment or checkups. Many endure illnesses, often preventable, for months before.

Salù pa Tur, a UNHCR partner in Curaçao, is the only clinic providing much needed primary healthcare, free of charge, to refugees and migrants in an irregular status on the island.

(This interview has been edited for clarity and length.)

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UNHCR: Tell us about Salù pa Tur. How was it created?

Dr. J. Hiskes: Salù pa Tur was founded two years ago by Dr. Elisa Jonsen, a young Dutch doctor who worked at the general hospital, in the gynecology department. She met a lot of people in an irregular status and without a residency permit, a lot of pregnant women who came with a lot of complications and really ill, late in the pregnancy.
Other people with diabetes and a lot of complications, people with cerebral infarcts or cardiac conditions. These are all diseases that can be prevented with adequate blood controls, treatments, and general primary healthcare interventions, if they had sought treatment at an earlier stage. She found out that even though there is primary
healthcare available, it is not free-of-charge, they have to pay for it because they lack an insurance. So, she founded Salù pa Tur, to fill that gap, and the clinic has now over 4,000 patients.

UNHCR: And what are the type of healthcare refugees and migrants require?

Dr. J. Hiskes: We provide primary healthcare – general medicine, gynecology, pediatric care. Also, because we were founded by Elisa, who has a strong background in gynecology, we tend to a lot of women here and provide pregnancy care and controls. But we also provide assistance to people with chronic illnesses, like diabetes and
high cholesterol.

UNHCR: How has the clinic helped during the COVID-19 pandemic?

Dr. J. Hiskes: During the COVID-19 pandemic we have had a lot of new patients, because we were the place where they could test for free and we also helped deliver 1,000 vaccines. These new patients have stayed with us since then. People trust us, especially since they have a lot of anxiety, they fear being arrested and sent back to their countries. At first, when we first opened, people were very reluctant to come in, but now they are aware this is a safe space.

UNHCR: How do you reach out to the community?

Dr. J. Hiskes: There are many reasons why people in an irregular status don’t seek help; fear, transportation limitations, so only see a small part of the entire population in an irregular status, and we can’t reach everyone, unfortunately. But now, we are starting a new outreach project. We are going to the streets, to places our potential
patients frequent, and we do free health checks – blood pressure, sugar levels, weight – and try to reach more people that way. We need more resources – we need a bus, we need more people helping us with it. But it’s our new goal for the coming years.

UNHCR: How many doctors do you have, or people helping in the clinic?

Dr. J. Hiskes: There are three doctors working here, and we have about 8 nurses, one pediatrician nurse helping us once a week, we have administrative staff - directors, financial workers. For the past weeks we also got some help from medical students who are in-between studies and wanted to help us, and they also participated in
the outreach project.

UNHCR: What is the psychosocial aspect to the work you do?

Dr. J. Hiskes: We know our patients have suffered a lot and that they are here for a reason. Many of them are traumatized, maybe even more than we know. Also, the state of their vulnerability is so high that their most basic needs are their main priority – food, a place to sleep, clothes. And health comes last – physical health – when they
face a serious illness or a critical condition that requires medical help, and it’s barely afterwards that they think of mental health. We do see a lot of mental health cases, and if it’s urgent, we can refer them to other organizations, but options are very limited. So, what would be really helpful for us would be to work with an in-house  psychologist to provide help and support to patients in need.

UNHCR: What type of mental health issues are you identifying?

Dr. J. Hiskes: There is a lot of stress, and that’s what I hear from a lot of people – difficulty to cope with the situation when leaving their country. This mental state also influences your blood pressure, sugar levels, and stress is a risk factor for cardiovascular diseases. Actually, we found that our patients are at higher risk of getting cardiovascular diseases at a much younger age and more often than what I’m used to seeing in Curaçao and the Netherlands.

UNHCR: Amid numerous challenges, what does Salù pa Tur hope to represent?

Dr. J. Hiskes: I think everyone should be able to access healthcare, regardless of their status and of the reason for being here and living here. And that’s what we are doing. That’s the reason we’re here. If we can help even a little bit, that’s better than doing nothing.