Healthcare for the Underserved: Workplace, On-site Health Screening for the Garment Factory Workers in Bangladesh Since 2013
After learning about a ready-made garment (RMG) factory building in Bangladesh that collapsed and killed a large number of workers, Dr. Abid decided to found HAEFA (Health and Education for All; www.haefa.org). Using his previous experience as a primary care physician in the tea plantations in Bangladesh, he designed a plan to screen and link factory workers for common non-communicable diseases: diabetes, hypertension, COPD, malnutrition, and preeclampsia. TB is also common in Bangladesh, but highly stigmatized. Abid added TB screening to his program, hypothesizing that linking TB with common diseases would reduce stigma.
Working in clothing factories in Bangladesh is difficult; the emphasis is on productivity, not workers’ rights. To negotiate with employers, HAEFA had to guarantee it wouldn’t disrupt productivity levels. The entire interaction with the worker occurs within seven minutes in a very systematic manner. The HAEFA model became a series of four stations: registration; height and weight; blood pressure and finger stick for blood sugar and hemoglobin analyses; and physician examination, including TB screening questions. Information at each station is collected on an Android tablet in a prescribed format (think Electronic Medical Record; EMR) and each patient has a unique identifier and bar-coded ID card. Patients who need follow-up care are linked to existing services in the community. Abid’s initial work in 2016, funded through the UK’s Department for International Development (DFID) and Brown University’s Global Health Initiative, screened 5,776 factory workers and 1,200 rickshaw pullers in Bangladesh. This DFID fund helped Abid develop his customized EMR, which he named ‘NIROG’, meaning ‘without disease’ in Bangla language. NIROG is solar-powered and can function without internet.
In 2016, HAEFA provided health screening and treatment to 1,200 rickshaw pullers in Gulashan, Dhaka, Bangladesh in collaboration with the Gulshan Society and Dhaka (North) Mayor late Anisul Haque.
Two final year AMS medical students, Greta Solinap and Joseph Wawrzynski, published an original research article on 2,000 RMG workers health status (International Health Journal, 2019).
Refugee Healthcare: A Humanitarian Crisis- the Rohingya from Myanmar (since 2017)
Since October 9, 2017, Abid and his Global Health teams at Brown University and at HAEFA have been working in the southernmost corner of Bangladesh, known as Ukhiya, Cox’s Bazar, to provide free healthcare to more than 1 million Rohingya refugees, a displaced ethnic minority from Myanmar. Since August 2017, after a crackdown by the Myanmar army 650,000 Rohingya from Myanmar have crossed over the Naf River to reach Ukhiya, and the Bangladesh government has designated the area as a campsite and has assisted in bulldozing the forest, setting up temporary shelters, building streets, providing food and water delivery, and coordinating international relief efforts. The trees have been replaced by canvas and bamboo huts as far as the eye can see. The pit toilets fill within days. Water holes have been drilled in central areas.
Early in the crisis, Abid and his global health team members at HAEFA and at Brown recognized both the need—as well as the applicability—of their model in the camp. Through Abid’s contacts in Bangladesh, HAEFA asked the offices of the Directorate General of Health Services (DGHS) and the regional governor (District Commissioner) to set up two medical centers in the camps. The NGO got permission to set up their camps in conjunction with the government camps. And since then, Abid and his team members in the USA and Bangladesh have been providing healthcare in the middle of the largest humanitarian crisis in the world today. Until December 31, 2018, they have provided free healthcare, medicines and referral services to more than 66,000 Rohingya and host community members. In collaboration with Brown University Global Health Initiative, Abid’s global health team members will provide healthcare to 72,000 Rohingya refugees in 2019.
Medical students, residents and undergraduate students from Brown University have been working on different healthcare and research projects in the Rohingya camps. The research focus includes non-communicable and cardiovascular diseases including hypertension, diabetes, malnutrition, high-risk pregnancy, gender-based violence (Olivian Cummings), mental health, and Tuberculosis (Jason Tsichlis), Diphtheria (Dr. Nasifa Nur), etc. Two undergraduate students’ teams at Brown have been closely working to support the Rohingya efforts of the Global Health team; One team has been working to improve quality of life and reduce landslides in the camps using a novel vetiver grass plantation project (led by Cristina Taylor and Layla Beckhardt). The other team has founded a club for the “Solidatiry with the Rohingya People – Brown students for HAEFA” under the leadership of Oliva Cummings, Huy Nguyen, Briana Chung, and Phoebe Kennan). Global health research projects for the students and medical residents are funded through Brown University Alpert Medical School, Watson Institute, Brown Global Health Initiative, etc.