PROVIDENCE — Protests over a recent coup in Myanmar have left ordinary citizens like students, teachers, and medical workers at conflict with military forces. The minority Muslim Rohingya have long suffered persecution from Myanmar authorities, causing them to flee their homeland for neighboring Bangladesh.
There, more than one million Rohingya live in overcrowded, unsanitary settlement camps near Cox’s Bazar.
“It’s inhumane living in an 8 feet by 10 feet room with six people. Husband, wife, and kids are living in the same room,” said Dr. Ruhul Abid, a Brown University associate professor, cardiovascular researcher at Rhode Island Hospital, and faculty member at the Center for Human Rights and Humanitarian Studies at Brown’s Watson Institute.
In 2012, Abid founded Health and Education for All (HAEFA), a nonprofit through which he and his team give free health care to the Rohingya refugees. Since 2017, they see on average 7,000 Rohingya per month at two medical centers in the camps. A major fire that erupted in the camps last Monday ― within walking distance of HAEFA’s Balukhali medical center — left more than a dozen dead and thousands of Rohingya homeless. Members of HAEFA’s medical team have been attending to the injured at a nearby hospital.
While the camps have electricity during the day, there’s no Internet service. So Abid, supported by Brown and Rhode Island health care giant Lifespan Corp., created a simple, portable, electronic medical record system called NIROG. It’s based on the Bangla word for “good health.”
NIROG is a handheld tablet, operated by solar-powered batteries, which works without the Internet. HAEFA uses it to fingerprint and take photos of each patient, register them with a barcoded ID card, and input their diagnosis. Later, the files are transferred to a secure, HIPAA-compliant database server, to ensure easy retrieval of medical records and continuity of care.
Abid’s work earned worldwide attention when he was nominated for a Nobel Peace Prize in 2020.
“The organization he created has helped, cured, saved dozens of thousands of people. Not just the Rohingya, but also the ultra-poor in Bangladesh. It’s not ‘cheap’ treatment. It’s really top-quality treatment. I saw that by myself when I worked in Balukhali, one of the Rohingya refugee camps,” said Nobel nominator Dr. Jean-Philippe Belleau of UMass Boston.
Abid would like to find a way to bring NIROG’s inexpensive technology to underserved communities in Rhode Island.
“My plan would be to target the population in Rhode Island that will not go to the hospital or for a regular checkup,” he said. “NIROG’s strength is to screen and diagnose the patients who wouldn’t be diagnosed otherwise. The underserved don’t seek help unless there’s a dire necessity because taking a day off of work means lost wages,” he said.
It would most benefit Rhode Island’s low-income, disabled, elderly, and immigrant communities.
But first, Abid must first seek approval from the Rhode Island Department of Health. One of the advantages of NIROG is that it does not require a nurse or doctor to operate. A community health worker can hold screenings at homes, public housing, or community and immigration centers. Preventative testing could uncover silent killers like high blood pressure and diabetes. It also can flag chronic problems like asthma, heart disease, anemia, and mental health issues.
Funding for HAEFA comes from individual donors and foundations. Abid thinks there’s a similar opportunity to finance NIROG through public and private funding in Rhode Island.
Dr. E. Jane Carter, a physician at the Miriam Hospital in Providence and professor at Brown who administered care with HAEFA, says she, too, sees value in NIROG.
Like hospitals in most states, Rhode Island hospitals use electronic record systems, Carter explained. But the data does not follow the patient — it’s linked to the health care system.
“HAEFA built a system that is easy for patients to access. We see now with the COVID-19 vaccine rollout, how difficult it is for many of our most vulnerable patients to access the system,” she said.
In the refugee camps in Bangladesh, workers use the portable tablet to screen for high blood pressure, diabetes, tuberculosis, malnutrition in children, and pregnancy complications. Most aid organizations only administer to immediate concerns like wounds and infections, but HAEFA physicians are able to diagnose, treat, and provide follow-up care.
For most Rohingya, their encounter with HAEFA is the first time they’ve received compassionate, quality care.
Hasina Akhter, 40, is a Rohingya patient at HAEFA. (Her name has been changed to protect her privacy.)
“We have lost everything. We lost our family, money, and land. Going back to normal life is only a daydream now,” she said.
“They give me medical treatment and advice. I am happy that I get the treatment so easily here. Before coming here, I never have had treatment for my chronic diseases.”
Every week, about 25 to 30 Rohingya patients are monitored for possible COVID-19 symptoms, as well as contact tracing of their family members and neighbors. Toilets and showers are shared by upwards of 25 families, which increases the spread of an infectious disease like COVID-19.
A series of virtual COVID-19 training, coordinated by Brown University students in partnership with Project HOPE, were given to hundreds of health care providers at the camps and across 20 different organizations throughout Bangladesh.
Building patient-physician trust is essential to delivering meaningful care to the Rohingya. It’s a critical lesson that can be used to support health, and goodwill, in our own vulnerable communities, said Abid.
“Persecution and genocide in Myanmar made them fearful of detachment from the family. If a patient is taken to a hospital for tests or treatment for COVID-19, the rest of the family thinks that the patient will never return or may even be killed. Such is the intensity of their mistrust and stigma,” explained Dr. Bushra Naz, HAEFA medical officer and project coordinator.
“We counsel them and provide as much detailed information in their own language through our interpreters who sit with HAEFA doctors in the camps to interpret symptoms and treatment in the Rohingya language.”
While support and logistics for local use of NIROG may be distant, Abid and his team continue to provide for the wellbeing of the Rohingya.
“We want to improve the lives of the people who have nowhere else to go and the mainstream world has almost forgotten about them. We will continue to serve them until the world can give back their human rights,” said Naz.