The ‘Doctors Worldwide Improving Care in Health Emergencies’ (The DICE programme) is a 9-month programme running between April and December 2020 with the aim of introducing emergency care within the Rohingya refugee camps, Cox’s Bazar Bangladesh. Working in 10 clinic facilities in partnership with the UN-IOM, and utilising DWW’s expert emergency doctors and nurses from around the world – including Bangladesh – the DICE programme involves training local Bangladeshi doctors, nurses and medical assistants on emergency medicine, developing protocols and strengthening the infrastructure to provide emergency care during a health emergency. Currently emergency medicine as a discipline does not exist in Bangladesh. This programme aims to support local initiatives in developing emergency care.
The mass migration of almost one million Rohingya Refugees has placed unprecedented strain on the existing health care services in Cox’s Bazar and surrounding areas. The existing health care system has had to withstand periodic mass migration of Rohingya Refugees as well as cope with the challenges of providing healthcare to the host population. Any healthcare system in the world would struggle to cope with the rapid increase of almost 1 million in population, let alone the complex health requirements of the Rohingya. In response, an incredible international and national effort has resulted in the provision of primary and secondary healthcare services for the refugees and the host population.
However, emergency healthcare is an emerging field in Bangladesh and emergency medical provision in its fullest sense has not been available to the population of Cox’s Bazar and surrounding area. Due to the structural demographics of the Rohingya refugee camps, a large proportion of emergency cases appear at primary care facilities. These facilities are currently not equipped to comprehensively and safely treat the wide variety of emergency cases arriving, in terms of equipment, training and protocols.
Doctors Worldwide has witnessed first-hand how inadequate emergency care can lead to unnecessary death. During a trainee observation session during our Postgraduate Fellowship programme, we witnessed multiple emergency cases presenting at a primary care facility. Without the correct infrastructure and training, the medical staff on duty were unprepared to deal with cases such as a seriously ill two year old child, who sadly passed away.
We have been actively working on the ground in Cox’s Bazar, Bangladesh since November 2017. In partnership with the International Organization of Migration (IOM), we have been able to respond to the Rohingya Crisis through capacity building and health system strengthening benefiting the local community as well as the Rohingya people. To date, over 900,000 patient consultations have benefitted and thousands more daily.
The DICE programme aims to bridge the gap between primary care and secondary care by providing hands-on clinical supervision training for Bangladeshi doctors, nurses and medical assistants who are regularly managing acute or life-threatening conditions within 24/7 primary care facilities. By supporting and utilising the local response through our DICE training, we will strengthen the current response on the ground.
The programme is spaced out over 9 months involving 4 full days per week of on-site clinical supervision and hands-on training/learning through logbook assessments, introducing protocols, developing emergency care infrastructure, clinical audits and patient consultations. There will be an additional 1-day per week of face to face learning/lectures away from the clinical sites for didactic learning, case-based discussion and simulations.
In November 2019, whilst Doctors Worldwide was providing guest-mentoring in a clinic in the Rohingya Refugee camps, 2 babies were brought in as emergency cases within the space of 10 mins. One of the babies, a 6-week old newborn, was having a fit, whilst the other baby, a 2 year old toddler was in cardiac arrest. Our faculty on site was an Emergency Medicine Consultant who was able to intervene and support the local doctor. Sadly however, the baby in cardiac arrest had already died. Similar stories are occurring in multiple health facilities within the camps and beyond, involving critically ill and injured adults and children. This is in part due to the lack of structured emergency care training as a discipline in Bangladesh, which urgently needs developing.