A self-effacing man, Ruhul Abid was moved by the poor state of healthcare services at the Rohingya camps in Cox’s Bazar. This physician extraordinaire and his organisation HAEFA have set up an efficient high-tech healthcare system in Kutupalong and Balukhali camps and have many more plans in the pipeline. Having passed out from Dhaka Medical College, Ruhul Abid went on to obtain a PhD degree in molecular biology from Japan, then completed a fellowship in vascular medicine at Harvard University and is presently an associate professor of cardiothoracic surgery and a faculty member at the Rhode Island Hospital and the Alpert Medical School of Brown University in the US. He spoke to Prothom Alo about what HAEFA has achieved at the refugee camps and his vision for the future.
Prothom Alo: You and your organisation HAEFA have set up an efficient digitalised healthcare system in a number of Rohingya refugee camps in Cox’s Bazar. How did it all start?
Ruhul Abid: I was already involved in a project providing health services to women workers of the readymade garments industry. [See:<https://en.prothomalo.com/economy/news/178152/Taking-health-to-the-RMG-workers>] Then last year, in July 2017, I came on a visit to Cox’s Bazar with my wife and daughter. On our way to Teknaf by the Marine Drive, I noticed slums by the roadside and inquired about this. I was told Rohingyas lived here. They had come to Bangladesh from as far back as 1990, 2012, 2016 and then there was the fifth exodus from August last year.
I wondered what could be done. I realised if I was to do anything for them, I would need funds and so set to task upon my return to the US. I first received a donation of US$7000 from a mosque in Boston where I live. That would cover two camps for at least one month. I contacted young doctors in Bangladesh and returned. We set up two simple centres comprising four bamboos and a cover overhead, sharing space with the government centres at the Kutupalong and Baulkhali camps. We rented apartments for our four doctors, six nurses and eight health workers and also rented a 12-seater van. That is how it all started.
Prothom Alo: So what sort of health services have you been providing and how is it any different from the existing government health services?
Ruhul Abid: We have an organisation called HAEFA - Health and Education for All, founded by myself and Rosemary Duda of Harvard Medical School. So as a HAEFA initiative, we started running these centres which began functioning on 9 October last year. We were to introduce ournovel electronic medical record system (called NIROG) there where patients first went to one table where their height and weight were taken and entered into a tab where their BMI was also calculated and recorded. At the next table their blood pressure and heart rate was measured and entered into a tab. At the third table their blood sugar and haemoglobin count was measured and also entered. The doctor at the fourth table simply opens a port on his/her tab and has access to patient’s details. The main diseases treated are hypertension, diabetes, asthma and tuberculosis. Other ailments treated are anaemia, high risk pregnancies, mental health and more.
Prothom Alo: What sort of mental health problems do you find among these Rohingya refugees?
Ruhul Abid: They are suffering from post traumatic stress disorder (PTSD). They have seen their parents killed and other indescribable atrocities. They need counseling. We cannot offer extensive treatment in this context.
Prothom Alo: Can you tell us more about the hi-tech health check system you have introduced here in the camps and further details?
Ruhul Abid: We mostly treat non-communicable diseases. These problems include blood pressure, blood glucose, hypertension, diabetes, tuberculosis and such. If tuberculosis is suspected, we refer them to the BRAC centre for sputum test. Now we have developed a referral system. We have trained two girls in the Kutupalong and Balukhali camps. They collect the sputum and take it to the centre.
We use a longitudinal patient tracking system. Each patient is issued a card with a bar code. All details are entered on the card and medication is prescribed accordingly. When they visit the next week, the bar code is scanned and everything shows up. I can see their records sitting in Boston or in Balukhali and can prescribe the next medication accordingly or adjust the dose or whatever.
Another thing is that the patients may lose their cards. After all, given the circumstances in which they live, they have far more pressing concerns that preserving their cards. So we have introduced a fingerprinting system. They just place their finger on the scanner and their records and details show up. At the end of the day when about 300 cases are seen, all data is uploaded in the Azurecloud.
Interestingly, a Canadian doctor communicated with me, wanting to use our records to help them in verifying the accounts of certain refugees who seek entry in Canada, showing gunshot wounds and other assault wounds. Just fingerprint scanning can verify the records. So the potential of this system is vast.
Prothom Alo: How has the response been from the camp people in terms of number?
Ruhul Abid: Overwhelming response. From 9 October last year till May this year, we have had a total of 31,000 patients. On average we see around 6,500 to 7,500 patients a month. It is all free of cost.
We are so well established in the two camps now that patients from other camps are sent here. If they are diagnosed to have diabetes or high blood pressure, they are invariably told. “Go to HAEFA!”
Prothom Alo: Didn’t you face any problems in implementing this project?
Ruhul Abid: Naturally there are problems but these simply have to be resolved. For example, there is no electricity in the camps. How do you charge your laptops, tabs and other equipment? First I brought in a huge generator from a friend of mine in Dhaka, but after two days we had to shut it down. It was so loud and noisy that we couldn’t hear the patients speak! We have now installed solar panels and this charges our wi-fi router, laptops, tabs and everything.
Prothom Alo: What sort of cooperation have you received from various quarters in terms of funds and other facilities?
Ruhul Abid: We have assistance and funds from mosques, churches, synagogues, temples, and individuals in the USA and around the world including Bangladesh. We have received technical and expert assistance from Brown University Global Health Initiative. Brown University Students for HAEFA and Muslim Students’ Association at UC Berkeley have been working to raise awareness of the Rohingya issue and to help with fund raise in the USA.
PricewaterhouseCoopers Foundation has erected two buildings, semi durable structures which shelter the patients and our medical team members from the sun and rain. I must also mention the Semnani family Foundation of Salt Lake City in Utah for their generous support and contribution. They have provided funds for a van and may follow up with sustainable funds for this project. That would be extremely helpful as it is always a pressure to arrange funds. Recently, Monem Economic Zone (MEZ) in Bangladesh has promised significant funding support and medicines for the next one year. I also must mention the DG Health Abul Kalam Azad. He has been most cooperative and is a forward-looking man. He is providing tabs and laptops to the government doctors in the camps and so we can train them with our NIROG (digital medical record system) and give them access to our digitalised records of the patients to work in cooperation.
Prothom Alo: What about the host community’s health concerns?
Ruhul Abid: That is certainly a matter of concern and the local people of the host community are treated at our centres too. They welcomed the refugees with open arms on humanitarian grounds, but resentment would be inevitable as they see the rampant deforestation to accommodate these people, and the aid and services to which they have no access.
It is very serious to take health concerns into cognizance here at the camps. For example, Bangladesh has no diphtheria cases at all. It has almost been eradicated globally. But after the citizenship rights of the Rohingyas were snatched away in 1982, they have had no immunisation coverage. They are a virgin population where immunisation is concerned and hence there was a diphtheria outbreak. This happens where there is a breakdown in the health system. For example, in Venezuela, where there is complete chaos at the moment, there has been an outbreak of diphtheria. In the camps here, there were 7,000 diphtheria cases detected, resulting in 42 deaths. In the host Bangladesh community there were 700 cases and no deaths. With concerted efforts we managed to control the situation successfully. The high immunisation rare amongst the host population protected them.
Prothom Alo: What next, Dr Abid?
Ruhul Abid: I have plans for a digital ecosystem. For example, a woman is pregnant and is being checked at the camp at HAEFA health centre. Later she goes to the UNFPA clinic for delivery. Her fingerprint will be enough to show if she is diabetic, or has hypertension or tuberculosis or whatever. They will be able to access her medical records. Such a system can be widespread. Doctors in an MSF hospital may be able to have access to a patient’s records through this digital ecosystem. This is my dream. If it is successfully implemented at the camps, we can certainly scale up similar digital system that would connect community health clinics in the rural areas to upazila and district health centers and hospitals in Bangladesh.