As of October 2017, we at HAEFA have expanded our target demographic to include Rohingya refugees. The Rohingya have been forced out of their homeland by Myanmar and many have taken refuge in Bangladesh, where HAEFA has set up two medical centers.
Our two 11 member medical teams of physicians and health workers have been posted in Kutupalong (Camp 1W) and Balukhali (Camp 9), Bangladesh to serve the Rohingya refugees. Our team serves an average of 7,000 patients per month, for a total of more than 130,000 patients to date.
Primary healthcare centers
When the mass exodus of Rohingya from Myanmar occurred in August of 2017, HAEFA already had an efficient method for screening and treating a vulnerable population for acute and chronic infectious diseases as well as NCDs. In the face of the crisis, HAEFA quickly turned its attention to adapt its innovative EMR software system NIROG and bring it to the refugee camps. The work began with a donation of $7,000 from a local mosque in Massachusetts, which covered two camps in Kutupalong and Balukhali for about one month. The first heath centers were comprised of bamboo tents shared with the government’s health centers. Four doctors, six nurses and paramedics, eight health workers, and two IT assistants made up the first members of the team. This project has gradually grown in size and capacity, now employing 11 medical professionals in each camp as well as IT personnel, midwives, and even a night guard. The two camps together treat 250-300 patients a day for six days a week, adding up to between 6,000 and 7,000 patients per month. In addition to treating the Rohingya patients, HAEFA also treats Bangladeshi people from the host communities as they are also an underserved population with little access to quality healthcare. HAEFA keeps the data of the patients from the host community separate from that of the Rohingya refugees. As of May 31st, 2019, HAEFA has treated approximately 130,000 Rohingya patients and members of the host community.
Nirog: an Innovative Health Solution
HAEFA uses completely paperless digitized record keeping to keep track of all the patients we treat. HAEFA's innovation is NIROG, an Electronic Medical Record (EMR) system that uses solar-powered batteries and can operate without internet anywhere in the world including in remote and rural places, villages, and in the refugee camps. NIROG empowers HAEFA to diagnose, treat and follow up with patients suffering from chronic diseases including NCDs (hypertension, diabetes, malnutrition, high-risk pregnancy, gestational diabetes, PET, anemia, asthma/COPD), tuberculosis, and cancer.
In addition to using barcoded ID cards that could easily be lost by the group of people facing displacements and trauma, HAEFA developed a fingerprinting identification system to fit the Rohingya refugees’ mobility as the population frequently relocates from camp to camp due to problems such as landslides. The handheld tablets are connected to the cloud using a WIFI router that is powered by solar panels, a solution to the lack of internet and electricity in the camps. The entire system requires little to operate and maintains efficiency and organization in an environment that can be chaotic.
There are two systems in place for the treatment of HAEFA’s patients: direct treatment and referrals. Patients in need of treatment for cut injuries, bullet injuries, hypertension, diabetes, asthma, malnutrition, fever, cough, or other illnesses are able to be treated right at HAEFA’s health center in the camps. HAEFA developed a treatment protocol for hypertension and diabetes treatment based on various international protocols that were modified for the refugee population. However, due to the relatively small-scale nature of HAEFA’s operations, it is necessary to partner with other healthcare providers in the camps for specific treatments such as TB, preeclamptic toxemia (PET), severe acute malnutrition (SAM), or mental health needs. Those who test positive for TB in HAEFA’s center are referred to BRAC for treatment. All pregnant women are tested at HAEFA’s center, and those with complications are referred to the UNFPA hospitals run by the Hope Foundation. HAEFA does not have a system for child delivery, so women with both normal and complicated pregnancies are referred to hospitals for delivery. Children who have moderate acute malnutrition (MAM) are treated by HAEFA with vitamins and health and nutrition education given to the parents. Children with SAM are referred to the World Food Programme centers. When HAEFA’s doctors suspect a patient has mental health needs, the patient is referred to a government health center for care. Victims of sexual assault are referred to a women-friendly center run by UNFPA for their needs. With HAEFA’s organized testing and record keeping along with the partnership of various other healthcare organizations, the Rohingya have a comprehensive network of support to gain the treatment that they need.
Raising international awareness
An important aspect of HAEFA’s work as a US-based NGO is raising awareness for the plight of the Rohingya. HAEFA’s collaboration with universities in the US has allowed HAEFA to spread the news of the crisis and of its work to university students and faculty alike. HAEFA has worked with these institutions by presenting its work at several conferences. Harvard University hosted a conference last year titled “Bangladesh Rising” and is hosting another conference featuring HAEFA this September. Yale University also hosted a conference in 2018, UMASS Boston has hosted two panels where HAEFA has presented, and HAEFA has hosted talks at Brown University in 2018 and 2019. Through these events, HAEFA has educated audiences on the needs of the Rohingya and has gained support for the cause. HAEFA also participated in a Rohingya international conference organized by the UN Refugee Agency (UNHCR) in July 2019 in Dhaka, Bangladesh titled “Rohingya Crisis in Bangladesh: Challenges and Sustainable Solutions”.
In addition to attending conferences, HAEFA also gets the word out by publishing articles on the work being done in the Rohingya camps. With contributions from its volunteers, HAEFA has been featured in publications in the US by the Brown Medicine Magazine (2018, 2019), the Brown Daily Herald (2017), and the Daily Star (2018); in Bangladesh by Prothom Alo (2018); and internationally by the Groupe International De Travail Pour Les Peuples Autochtones (GITPA) in 2018 and the World Health Organization (WHO) in 2018 and 2019. HAEFA’s work was also highlighted in a national TV interview with Dr. Ruhul Abid which aired in Bangladesh in 2018.
A number of students and faculty have received fellowships to conduct research at the Rohingya camps in collaboration with HAEFA. A few of the student projects have focused on the diphtheria outbreak in the Rohingya camps, adherence to TB treatment, and motherhood in limbo. An American University professor, Tazreena Sajjad, is doing research on the mental health effect on the volunteers serving the population and is researching the policies and politics around Rohingya repatriation in collaboration with HAEFA. Professor of Anthropology Jean-Philippe Belleau from UMASS Boston also visited the camps and conducted 13 interviews with Rohingya patients which were included in an article on the Rohingya crisis featured on the UMASS website and published by GITPA. The outcomes of this research help HAEFA and other international organizations to improve their treatment protocols and patient care to better meet the health needs of the Rohingya people.