Refugee Medical Aid with Immediate, Lifelong Impact
Lifespan doctors’ ingenuity behind electronic medical records access for Rohingya refugees, others in remote parts of world
In tent cities inhabited by 750,000 refugees where natural disaster and disease loom large, the delivery of primary health care is a test of fortitude. Tracking this population and the medical care they receive seems an impossibility.
But that’s exactly what Ruhul Abid, MD, PhD of Rhode Island Hospital’s cardiothoracic research team, and E. Jane Carter, MD, a pulmonologist at The Miriam Hospital, and their team are doing on the Bay of Bengal. They are focused on creating a medical record for the Rohingya refugees, a persecuted ethnic minority driven out of their homeland in Myanmar’s Rakhine State, who have been living in makeshift camps in the southeastern coastal region of Bangladesh since October 2017. They are among the 1.3 million Rohingya who have fled to Bangladesh since August 2017.
The team has pioneered a simple, portable, electronic medical record system to ensure continuity and communication in health management for tens of thousands of Rohingya refugees. Successful management of chronic illness in an individual or an entire population depends upon the collection and review of data over time. This advance in recordkeeping allows them to better care for patients and to contribute to public health.
Dr. Abid was born and raised in Dhaka, Bangladesh. He earned his medical degree and completed his training and residency in his home country. While still in his 20s, he spent three years as the medical officer on a tea plantation in Bangladesh. He provided medical care, built a network of caregivers trained to provide basic family health services and immunizations, and increased public health awareness on a large and relatively progressive plantation.
His pursuit of a career as a cardiothoracic researcher brought him to the United States, and ultimately to Rhode Island Hospital in 2011. Here, he leads a team of medical students, post-doctoral fellows and residents. They work toward developing therapies to improve coronary artery function and blood supply to diseased heart muscles immediately after heart attack.
Abid’s native Bangladesh and its health care disparities are never far from his mind.
In 2012, Abid and a former Harvard colleague, Rosemary Duda, MD, MPH, launched Health on Wheels, a health care delivery program of HAEFA (Health and Education for All), to support some of the millions of underserved workers in the garment factories of Bangladesh.
“Four million women are working in garment factories, 64 percent of them of childbearing age,” he says. “They work six days a week, and don’t have time to go anywhere for care, working long days, cooking and caring for their families. And on the day they have off, the holiday, medical centers are closed. So, we brought care to where they are.”
Immediately identifying difficulties in managing chronic conditions like diabetes, maternity care and other long-range needs for the thousands of patients they’d see in the factories, Abid sought the help of a Bangladeshi software developer he knew. They built a custom electronic medical records system dubbed NIROG, meaning “no disease” in the local language. It enables them to issue unique medical ID cards and link to a database of health information, ensuring continuity of care and multiplying their capacity to see patients with time saved in recordkeeping.
Without NIROG, they could see 100 patients in a day. Their handwritten medical notes often would not be transcribed into records for weeks. Now, they’re able to see 400 to 500 patients each day. In addition, the electronic system streamlined the time to see each patient, meeting the factory’s needs and increasing efficiency. In recent weeks, they also have implemented a fingerprint identification system, allowing tracking and linkage of records even when the patient does not have their coded health card.
Carter became involved in Health on Wheels in 2017, when Abid sought her help to implement tuberculosis testing and treatment in the factories. She is an award-winning expert in the field, having worked close to home with the Rhode Island Department of Health’s TB clinic for decades, and across the world as the director of the Brown University – Moi University Kenya Medical Exchange Program (AMPATH Consortium).
As they planned Carter’s first trip, the Rohingya crisis erupted. Her logistics experience in program field implementation in Kenya allowed them to rapidly mobilize HAEFA’s efforts to the region, and they turned their attention to adapting the lessons learned in the garment factories to care in the refugee camps. Rapid deforestation in the area required to make way for the makeshift homes – coupled with coastal monsoons – has made the threat of landslides and floods a daily reality in the camps. Unbearably close quarters make communicable disease a serious threat. There are no utilities to support a modern medical center.
Abid’s team engineered a solar battery solution to allow them to bring a bit of modern technology, working offline on tablets until they return to a nearby town, Cox’s Bazar, at night and upload the data gathered each day. NIROG brought two other benefits to care in the camps. First, epidemiographic health information is being systematically collected for the first time in decades, because when the Rohingya had their citizenship rights stripped in Myanmar in the 1980s, all health data collection (and delivery) ended for this group. In addition, HAEFA has now started to link NIROG to other NGOs in the camps to cross link information such as vaccination, TB care, nutritional support and obstetrical care.
Abid was recently approached by other nonprofit and government organizations that provide care in remote regions, and he is collaborating to share the technology free of charge, viewing it as a public health tool rather than an enterprise.
Thus far, this extension of Health on Wheels has provided primary care, vaccinations, prenatal care, and more to 31,000 Rohingya. Abid and Carter, supplemented by visiting U.S. physicians and public health experts, have grown the support network to two camp locations, and employ four doctors, four nurses, eight paramedics, two IT support staff, a project coordinator and a driver.
Carter says that the draw of the HAEFA camps is remarkable. She attributes this to their unique combination of high technology and human compassion in the midst of a devastating situation.
“The line at HAEFA is at least five times longer than at other medical camps,” she says. “We think HAEFA draws more patients for three reasons: They see the technology we’re using and receive a photo ID; they perceive the systematic approach to the evaluation, including blood pressure monitoring, glucose testing and tuberculosis screening; and our physical exams always include human touch.”