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美國數百萬失業人員何去何從?專家建議充實社區衛生隊伍

美國數百萬失業人員何去何從金龙彩票|官网登录?專家建議充實社區衛生隊伍

Raj Panjabi,Mitchell Weiss,Raj Panjabi,Mitchell Weiss 2020年04月11日
在抗擊新冠疫情的過程中,這些之前沒有醫學專業知識的普通人,經過培訓之后可以做很多工作。

招聘社區衛生工作者不僅可以為他們解決經濟困境,還能為未來的醫療系統培養一批骨干力量金龙彩票|官网登录,隨時準備應對可能發生的疫情。攝影師:Sara Eshleman——美國海軍/路透社

隨著美國COVID-19確診病例不斷增加,越來越多醫護人員急需個人防護設備,并呼吁增加呼吸機的部署,拯救患者生命。美國公司和個人開始使用手工縫制和3D打印的口罩金龙彩票|官网登录,許多制造企業被改造成了呼吸機零部件生產車間。雖節奏較為緩慢,但是公共和私營部門似乎終于開始采取行動金龙彩票|官网登录,大量生產和銷售這種關鍵的醫療器械。在整個醫療體系不堪重負之前,醫療工作者能否及時得到防護裝備?關于這個問題我們沒有答案。

但即使我們繼續抱著微弱的希望,認為口罩、呼吸機和其他必要設備供應緊張的情況會有所緩解金龙彩票|官网登录金龙彩票|官网登录,但誰能為配戴和使用這些設備的醫護工作者提供支持并減輕他們的負擔呢?由于全美醫護人員日益短缺,來自不同科室的醫生、護士和助理醫師被重新分派,退休醫生被緊急征召金龙彩票|官网登录,醫學院的學生也被允許提前畢業。但誰來給他們提供支持?

或許我們的鄰居就可以伸出援手。在美國等許多國家,社區衛生工作者一直是流行病的第一道和最后一道防線。他們都是本地居民金龙彩票|官网登录,沒有接受過專業醫學教育,只是經過培訓之后被雇來幫助患者。社區衛生工作者可以提供防疫策略金龙彩票|官网登录,幫助發現新病例,協助患者獲得必要的治療等,從而幫助抑制病毒傳播。

其他國家已經證明了社區策略對于疫情防控的重要性。例如,韓國每日確診人數從最高峰時的近1000例減少到每天不到100例。韓國的經驗證明,要想達到零新增病例,需要進行廣泛的社區病毒檢測金龙彩票|官网登录、快速隔離金龙彩票|官网登录、患者治療和嚴格的接觸者跟蹤。在利比里亞抗擊埃博拉病毒期間,社區衛生工作者也是重要的一環。他們與醫生和護士攜手尋找病患,讓他們得到治療。

最近幾周金龙彩票|官网登录,美國每周都有數百萬人因為新型冠狀病毒失業金龙彩票|官网登录金龙彩票|官网登录,這些人可以成為社區衛生工作者,參與到抗擊疫情的戰斗當中。據美國勞工統計局統計金龙彩票|官网登录,2018年,美國共有約56000名社區衛生工作者。但一份工作組報告顯示,美國至少每650人當中應該至少有一名社區衛生工作者。按照這個比例計算金龙彩票|官网登录,美國的社區衛生工作者缺口至少有50萬人。所以,我們應該雇用失業人員金龙彩票|官网登录,對他們進行培訓,提供必要裝備金龙彩票|官网登录,幫助預防、檢測和應對新型冠狀病毒,為需要醫療和社會護理的患者提供支持。人們可以在相對安全的家里從事這份工作,或者經過培訓后金龙彩票|官网登录,可以配戴適當的防護裝備在社區中挨家挨戶尋找患者,并幫助他們得到治療。

從餐廳服務員到酒吧招待,從酒店前臺到航空公司的機場柜臺工作人員,這些失業人員已經感受到了本次疫情對經濟的可怕影響。通過雇用這些失業人員,美國可以壯大地方醫療部門、非營利組織和國家倡議組織的力量,比如參與抗擊COVID-19的醫療后備隊。

雖然把鄰居看做護理人員和醫療輔助人員可能有些難以想象金龙彩票|官网登录,但在抗擊新冠疫情的過程中,這些之前沒有醫學專業知識的普通人,經過培訓之后可以做很多工作。

首先,他們可以通過組織和開展社交媒體活動金龙彩票|官网登录金龙彩票|官网登录,宣傳社交隔離政策,從而阻止病毒傳播。美國各地對社交隔離政策的執行情況并不一致,尤其是在最邊緣化的社區。培訓當地社區里的居民擔任社區衛生工作者金龙彩票|官网登录,能讓更多人遵守醫生的疫情防控建議。他們還可以鼓舞人心和制定策略,改善居民的身心健康,提高人們的適應能力。

其次金龙彩票|官网登录,社區衛生工作者可以協助發現感染者。他們經過培訓,知道了新冠肺炎的表現和癥狀之后金龙彩票|官网登录金龙彩票|官网登录,就可以幫助接聽醫院和公共衛生部門的熱線金龙彩票|官网登录,并將疑似病例上報到檢測中心。

第三,社區衛生工作者可以與正在自我隔離的輕癥COVID-19患者保持聯系,監控他們的癥狀是否惡化,并迅速上報需要住院治療的患者。此外,他們可以與公共衛生官員合作,穿戴個人防護設備協助居家快速檢測(可用之后),跟進COVID-19患者的密切接觸者,監控他們的癥狀,并確保他們得到檢測。

其他機構已經證明了哪些做法是可行的金龙彩票|官网登录。賓夕法尼亞大學社區衛生工作者中心的IMPaCT項目金龙彩票|官网登录,在低收入社區雇用和培訓當地居民擔任急救人員,以滿足人們的社會需求。這些社區衛生工作者現在被動員起來,通過提供遠程支持和幫助安排食物配送等,幫助患者和受影響的社區應對疫情帶來的經濟影響,同時幫助宣傳對疫情防控至關重要的公共衛生信息。在受疫情影響的其他國家,醫療部門負責人對于如何在全國落實這種做法有清晰的愿景金龙彩票|官网登录金龙彩票|官网登录。在《柳葉刀》雜志上發表的一篇評論文章中金龙彩票|官网登录,英國醫療部門負責人提出在全國培養一支社區衛生隊伍,用于病毒測試、監控和積極查找病例。這支隊伍還將為150萬老年人和易感染人群提供社會護理。

美國政府應該迅速將新冠病毒救濟資金劃撥給醫療部門、非營利組織和醫療保健系統金龙彩票|官网登录,開始雇用和培訓失業的美國人擔任社區衛生工作者。慈善領域也可以為培訓提供支持金龙彩票|官网登录。酒店和航空公司等要求員工無薪休假后,如果這些員工愿意貢獻出自己的時間金龙彩票|官网登录,公司可以修改現有的培訓內容,通過公司培訓平臺將其提供給員工。入職培訓幾天內就能完成。

雇用失業的美國人擔任社區衛生工作者金龙彩票|官网登录,參與疫情防控,還能為未來帶來長遠的影響。在美國建立一支社區衛生隊伍,不僅可以解決他們的經濟困境,還能為未來的醫療系統培養一批骨干力量,隨時準備應對可能發生的疫情。當我們需要幫助的時候金龙彩票|官网登录,不必舍近求遠,因為我們的鄰居就能伸出援手金龙彩票|官网登录。

本文作者拉杰·潘賈比現任最后一程醫療(Last Mile Health)的CEO,也是哈佛醫學院(Harvard Medical School)的助理教授。

米歇爾·維斯現任哈佛商學院(Harvard Business School)管理專業教授,著有《一切皆有可能:利用大眾創業解決人類最緊迫的問題》(We the Possibility: Harnessing Public Entrepreneurship to Solve Our Most Urgent Problems)一書。(財富中文網)

翻譯:劉進龍

審校:汪皓

隨著美國COVID-19確診病例不斷增加,越來越多醫護人員急需個人防護設備金龙彩票|官网登录,并呼吁增加呼吸機的部署,拯救患者生命金龙彩票|官网登录。美國公司和個人開始使用手工縫制和3D打印的口罩,許多制造企業被改造成了呼吸機零部件生產車間金龙彩票|官网登录。雖節奏較為緩慢金龙彩票|官网登录,但是公共和私營部門似乎終于開始采取行動,大量生產和銷售這種關鍵的醫療器械。在整個醫療體系不堪重負之前金龙彩票|官网登录,醫療工作者能否及時得到防護裝備?關于這個問題我們沒有答案。

但即使我們繼續抱著微弱的希望,認為口罩、呼吸機和其他必要設備供應緊張的情況會有所緩解,但誰能為配戴和使用這些設備的醫護工作者提供支持并減輕他們的負擔呢金龙彩票|官网登录?由于全美醫護人員日益短缺金龙彩票|官网登录,來自不同科室的醫生、護士和助理醫師被重新分派金龙彩票|官网登录,退休醫生被緊急征召,醫學院的學生也被允許提前畢業。但誰來給他們提供支持金龙彩票|官网登录?

或許我們的鄰居就可以伸出援手。在美國等許多國家,社區衛生工作者一直是流行病的第一道和最后一道防線金龙彩票|官网登录。他們都是本地居民,沒有接受過專業醫學教育,只是經過培訓之后被雇來幫助患者金龙彩票|官网登录。社區衛生工作者可以提供防疫策略,幫助發現新病例,協助患者獲得必要的治療等,從而幫助抑制病毒傳播。

其他國家已經證明了社區策略對于疫情防控的重要性。例如,韓國每日確診人數從最高峰時的近1000例減少到每天不到100例。韓國的經驗證明,要想達到零新增病例金龙彩票|官网登录,需要進行廣泛的社區病毒檢測、快速隔離、患者治療和嚴格的接觸者跟蹤。在利比里亞抗擊埃博拉病毒期間,社區衛生工作者也是重要的一環金龙彩票|官网登录。他們與醫生和護士攜手尋找病患,讓他們得到治療。

最近幾周,美國每周都有數百萬人因為新型冠狀病毒失業,這些人可以成為社區衛生工作者,參與到抗擊疫情的戰斗當中。據美國勞工統計局統計,2018年金龙彩票|官网登录,美國共有約56000名社區衛生工作者。但一份工作組報告顯示,美國至少每650人當中應該至少有一名社區衛生工作者。按照這個比例計算,美國的社區衛生工作者缺口至少有50萬人金龙彩票|官网登录。所以,我們應該雇用失業人員金龙彩票|官网登录,對他們進行培訓金龙彩票|官网登录,提供必要裝備,幫助預防、檢測和應對新型冠狀病毒,為需要醫療和社會護理的患者提供支持。人們可以在相對安全的家里從事這份工作,或者經過培訓后金龙彩票|官网登录,可以配戴適當的防護裝備在社區中挨家挨戶尋找患者,并幫助他們得到治療金龙彩票|官网登录。

從餐廳服務員到酒吧招待,從酒店前臺到航空公司的機場柜臺工作人員金龙彩票|官网登录,這些失業人員已經感受到了本次疫情對經濟的可怕影響。通過雇用這些失業人員金龙彩票|官网登录,美國可以壯大地方醫療部門金龙彩票|官网登录、非營利組織和國家倡議組織的力量,比如參與抗擊COVID-19的醫療后備隊。

雖然把鄰居看做護理人員和醫療輔助人員可能有些難以想象金龙彩票|官网登录,但在抗擊新冠疫情的過程中,這些之前沒有醫學專業知識的普通人金龙彩票|官网登录,經過培訓之后可以做很多工作。

首先,他們可以通過組織和開展社交媒體活動金龙彩票|官网登录,宣傳社交隔離政策金龙彩票|官网登录,從而阻止病毒傳播。美國各地對社交隔離政策的執行情況并不一致金龙彩票|官网登录,尤其是在最邊緣化的社區金龙彩票|官网登录。培訓當地社區里的居民擔任社區衛生工作者,能讓更多人遵守醫生的疫情防控建議金龙彩票|官网登录。他們還可以鼓舞人心和制定策略,改善居民的身心健康金龙彩票|官网登录,提高人們的適應能力。

其次金龙彩票|官网登录,社區衛生工作者可以協助發現感染者。他們經過培訓,知道了新冠肺炎的表現和癥狀之后,就可以幫助接聽醫院和公共衛生部門的熱線,并將疑似病例上報到檢測中心。

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其他機構已經證明了哪些做法是可行的。賓夕法尼亞大學社區衛生工作者中心的IMPaCT項目金龙彩票|官网登录,在低收入社區雇用和培訓當地居民擔任急救人員,以滿足人們的社會需求金龙彩票|官网登录。這些社區衛生工作者現在被動員起來金龙彩票|官网登录金龙彩票|官网登录,通過提供遠程支持和幫助安排食物配送等金龙彩票|官网登录,幫助患者和受影響的社區應對疫情帶來的經濟影響金龙彩票|官网登录,同時幫助宣傳對疫情防控至關重要的公共衛生信息金龙彩票|官网登录。在受疫情影響的其他國家,醫療部門負責人對于如何在全國落實這種做法有清晰的愿景。在《柳葉刀》雜志上發表的一篇評論文章中金龙彩票|官网登录,英國醫療部門負責人提出在全國培養一支社區衛生隊伍,用于病毒測試、監控和積極查找病例。這支隊伍還將為150萬老年人和易感染人群提供社會護理。

美國政府應該迅速將新冠病毒救濟資金劃撥給醫療部門金龙彩票|官网登录、非營利組織和醫療保健系統,開始雇用和培訓失業的美國人擔任社區衛生工作者。慈善領域也可以為培訓提供支持金龙彩票|官网登录。酒店和航空公司等要求員工無薪休假后金龙彩票|官网登录,如果這些員工愿意貢獻出自己的時間金龙彩票|官网登录,公司可以修改現有的培訓內容,通過公司培訓平臺將其提供給員工。入職培訓幾天內就能完成。

雇用失業的美國人擔任社區衛生工作者,參與疫情防控金龙彩票|官网登录,還能為未來帶來長遠的影響。在美國建立一支社區衛生隊伍,不僅可以解決他們的經濟困境金龙彩票|官网登录,還能為未來的醫療系統培養一批骨干力量,隨時準備應對可能發生的疫情。當我們需要幫助的時候,不必舍近求遠金龙彩票|官网登录,因為我們的鄰居就能伸出援手。

本文作者拉杰·潘賈比現任最后一程醫療(Last Mile Health)的CEO金龙彩票|官网登录,也是哈佛醫學院(Harvard Medical School)的助理教授金龙彩票|官网登录。

米歇爾·維斯現任哈佛商學院(Harvard Business School)管理專業教授,著有《一切皆有可能:利用大眾創業解決人類最緊迫的問題》(We the Possibility: Harnessing Public Entrepreneurship to Solve Our Most Urgent Problems)一書。(財富中文網)

翻譯:劉進龍

審校: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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