Maine’s definition of health care worker includes everyone from physicians to housekeepers

By Kathreen Harrison

The global COVID-19 pandemic has elevated health care workers to the rank of superstars in cities and towns all around the world. In some places, people gather on balconies or lean out windows to applaud health care workers as they finish shifts. In other places, churches toll bells to thank the workers. At the SM Mall of Asia in Pasay City, Philippines, a message of appreciation is plastered across the huge globe that stands out front. Heartfelt expressions of thanks fill Facebook and Twitter feeds as the world recognizes the heroic efforts that front line health care workers are making, in very difficult circumstances, to beat the odds and save lives in the battle against the new coronavirus.

At an April 13 briefing, Commissioner Jeanne Lambrew of Maine’s Department of Health and Human Services (DHHS) said approximately 100,000 people are employed in healthcare in Maine. That’s a big chunk of workers in a state with a total population of 1.3 million. Dr. Nirav Shah, Director of Maine’s Center for Disease Control (CDC), said on April 8 that, “In Maine, the term ‘health care worker’ is defined extremely broadly, and encompasses anyone who could potentially come into contact with a patient in a medical setting.” According to Dr. Shah, Maine’s definition includes everyone from physicians and nurses to housekeepers and food service workers.

And in Maine, as around the U.S., significant numbers of immigrants fill the health care ranks in hospital settings, group homes, and long-term care facilities. New American Economy reports that immigrants comprise 14% of Maine’s home health care workers, 19% of Maine’s physicians and surgeons, and 14% of Maine’s Licensed Practical and Licensed Vocational Nurses. Nationally, according to Migration Policy Institute, 29% of physicians, 22% of nursing assistants, 38% of home health aides, and 25% of personal care aides were foreign-born in 2018. And these numbers don’t include all the workers Dr. Shah included. Clearly, the contributions of immigrants during the pandemic have been enormous.

“We recognize the value that every single worker at a hospital has …(and) we believe they deserve the respect of being included in the definition of health care worker,” said Dr. Shah. “The work that housekeepers and food service workers and everyone else who works in a medical setting does is just as vital as the work of doctors and nurses.”

Dr. Shah is all about health equity, whether in respect given to different levels of workers along the health care chain, or when talking about health care in the general population. He has made a special point of meeting several times with immigrant leaders since the health care crisis began, seeking to listen and respond to questions and concerns particular to immigrant populations. Among those concerns have been accessibility of Personal Protective Equipment (PPE) for health care workers and availability of training materials in translation.

Initially, when the COVID-19 outbreak started in Maine, agencies had to scramble to find materials in translation that they could use to train staff, not all of whom read English. There is widespread agreement that, in the future, DHHS and other Maine state agencies and departments need a system in place to provide linguistically appropriate material from the start, so that in a crisis such as the one we are experiencing, where time makes a difference and immigrant health care workers’ lives are at stake, materials will be obtained or produced quickly by DHHS. At this point, a limited amount of materials are available in translation through the DHHS website. 

Meanwhile, at the first signs of the outbreak, immigrant and nonprofit leaders started working to translate materials about how to stay safe and prevent spread. As Governor Janet Mills and mayors announced emergency measures,  a cadre of volunteers and interpreters provided by non-profits such as Catholic Charities, Maine Access Immigrant Network (MAIN), and Hope Acts created videos and translated the various mandates for non-English-speaking Mainers.

Agencies have had to struggle to obtain PPE also. But now, according to Kristine Jenkins, Cumberland District Public Health Liaison for the Maine CDC, group home workers are considered Tier I, which means they are in a priority category.

On April 10, Jenkins said that the CDC has been getting requests from group homes and has been filling the orders. Maine’s formula for distributing the much-coveted PPE supplies is to give 50% to hospitals, 30% to congregate settings (including group homes and shelters), and 20% to other groups of health care workers, such as first responders. Because of limited supplies of PPE both nationally and in Maine, “No one is getting 100% of what they ask for,” Jenkins said. She added that while a number of group home residents and staff have tested positive for the virus, the number of immigrant health care workers overall who have tested positive is not known at this time.

Group homes and mental health agencies employ significant numbers of immigrants in Maine. Westbrook City Councilor Claude Rwaganje, who is also Executive Director of ProsperityME, estimates that a few thousand immigrants work in group homes and mental health agencies, and that a number work in multiple group homes and for multiple agencies. Some positive cases have now been reported among residents and staff in group homes, though nowhere near the numbers reported in long-term care facilities.

On April 8, Dr. Shah explained that health care workers are more at risk of both acquiring and transmitting COVID-19 than are the general population. Nationally, on average approximately 20% of health care workers test positive. In Maine on April 16, the number of health care workers testing positive for COVID-19 was 173 individuals, which is just slightly over the national average. The total number of people in Maine testing positive on that day was 796.

Dr. Shah is disturbed by trends reported in other states, where poor and minority populations are suffering disproportionately from the virus. At a meeting with immigrant leaders on April 14, he said it is too early to identify any trends or disparities in relation to race or socioeconomics in Maine because our sample size of positive cases is still very small. But he added, “Let’s hope we don’t see those trends replicate themselves in Maine.” 

Speaking about the ways in which the COVID-19 crisis has impacted the state, Dr. Shah said, “There will be ways in which how we go about living our lives will never be the same as before. We will have a finer sense of how we are all interconnected across the globe – and in that way not returning to normal is a good thing. And we will have a finer sense of what health care really does. Only in times of stress and emergency does the work of public health professionals become visible.” 

What remains to be seen is whether the contributions of immigrants to the public health effort will be recognized and remembered once the current health crisis has passed.