Acute life-threatening emergencies, such as injuries resulting from a road accident or medical complications during pregnancy, are time sensitive.
Notably, as opposed to preventive medicine, health emergencies have a very limited window of time for the early recognition of its severity, medical decision-making and the necessary actions to prevent death and disability, irrespective of the patient’s age, gender, location or condition.
The three core components of emergency medical care include care in the community, during transportation and on arrival at the health facility. Often times emergency physicians, surgeons and obstetricians need to refer patients to facilities where availability of equipment, more skilled staff, among other medical resources to ensure continuum of care towards the patient’s rehabilitation, will enhance chances of survival.
In Cox’s Bazar, Bangladesh, there are significant challenges in implementing a fully functional referral system from the camps to secondary/tertiary care facilities which at times lead to delays for patients in accessing lifesaving medical care. In response, WHO is joining forces with Health Sector partners to strengthen Cox’s Bazar referral pathway for emergency medical and obstetric care through updating Standard Operating Procedures (SOPs) for referrals and transfers for emergency care and other care that requires referral from the Rohingya refugee camps.
A Rohingya refugee, Nur Begun has just become a mother of three but in her lifetime she has had five full term pregnancies. In Myanmar she lost two of her babies, but in Cox’s Bazar doctors never let go the idea that she would get to see her newborn reach adulthood - WHO Bangladesh/Tatiana Almeida
On 28 January 2021, Nur Begun delivered a healthy child following what her doctors considered a very complicated labour during which her life, and that of her son, were at risk. Her referral to Hope Field Hospital, in the refugee camp, where a dedicated medical team did everything humanly and medical possible to ensure her survival, is the reason why she is here today to tell her story and hold her child as tightly as she can.
“On that morning, as soon as the labour pains begun, I started bleeding. I wasn’t so worried about the pain but the fear of losing another child was taking over all my thoughts. I also have a 2-year-old who very much depends on me”, recalls Nur Begun.
“Nur’s health condition had everything to support the decision of a caesarean section as the right procedure in her situation: she presented placenta previa {meaning that a normal vaginal delivery would not be possible}, hemorrhage and labour pain”, says her doctor at Hope Field Hospital, Gynecologist and Obstetrician, Dr Akash Mazumdar.
Also a Gynecologist at HOPE Field Hospital, Dr Bipasha Akter with Nur Begun at the female ward of this referral hospital for maternal health in Camp 4, Ukhiya, Cox’s Bazar - WHO Bangladesh/Tatiana Almeida
Now one month old, Md Ayaz was born perfectly well and healthy following two and a half hours caesarean section. However, Nur continued bleeding in the recovery room and had to be taken back to the operation room. This time her health condition was more fragile, and doctors had to race against time to get blood supplies in order to ensure her survival during the second surgery.
“We were running against time and asked for the help of blood donors among the host community. Young Bangladeshi came to donate blood and I will never forget this moment when our team clapped as they walked out. They were the ones who saved Nur and allowed us a happy ending on that very challenging - but also memorable - day, not only for Nur and her family but for us at the hospital”, tells Dr Akash Mazumdar.
In its mission to provide quality health services to the most marginalized populations in rural Bangladesh, HOPE Foundation is using education and community outreach to provide compassionate health care to Cox’s Bazar vulnerable communities. In addition to the services provided in the Rohingya refugee camps, the HOPE Foundation has also a referral facility for emergency obstetric care for the host community.
WHO Head of Sub-Office, Dr Kai von Harbou, visiting the HOPE Foundation Hospital, the hospital’s facility in the host community, in Ramu, with Country Director, Dr Zahiduzzaman, in February 2021 -WHO Bangladesh/Tatiana Almeida
“Hope Foundation is an important partner in the provision of maternal health and a key component of the referral pathway for obstetric emergencies for Rohingya refugees as well as host population in Cox’s Bazar. In addition to the clinical services provided, Hope Foundation also plays a key role in the training of Midwives in the district to bring maternal health to more and more women”, tells WHO Head of Sub-Office, Dr Kai von Harbou.
On February 9th, the Health Sector Coordination team organized a referral workshop in partnership with IOM and UNHCR to discuss pertinent challenges in referring patients including management of associated expenses, practical and administrative barriers and coordination challenges to ensuring well-coordinated patient referral and transfer system.
“During the workshop, subsequent action points related to addressing barriers to referral and increasing efficiency were agreed for further implementation. The Health Sector will continue to work closely with Government and partners to revise existing SOPs and build capacity where needed. In addition, constant monitoring of challenges and supportive supervision will allow us to keep building the quality of the system in place and enhance patients’ chance of survival, and health and well-being in Cox’s Bazar”, says Cox’s Bazar Health Sector Coordinator, Dr Egmond Evers.
Since April 2020, the Health Sector Coordination meetings, like many others, have shifted to an online platform. The Health Sector coordinates 80 partners who support the government health response in the Rohingya crisis - WHO Bangladesh/Tatiana Almeida
In addition to improving and refining the existing referral mechanism from Primary Health Care Centres (PHCs) under the Minimum Essential Health Service Package for Primary Healthcare Facilities in the Rohingya camps, which has been endorsed by the Government of Bangladesh, the provision of safe blood and its products is an important part of day-to-day life saving interventions.
However, due to resource constraints in Cox’s Bazar, there remains an ever-increasing demand for safe, effective and quality blood. The HOPE Field Hospital where Nur Begun was referred to is one of the few facilities in the district with a blood bank with capacity to carefully select donors, screen donations as well as a laboratory to perform compatibility testing and ensure quality of blood.
To bridge this gap, WHO has just supported the establishment of well-organized blood transfusion services at the Ukhiya and Teknaf Upazila Health Complexes (UHCs) which will grant access to safe blood in Cox’s Bazar and enhance the district’s capacity to save lives.
At the HOPE Field Hospital, Medical technologists Jannatul Mawa (left) and K. M. Sanaullah (center) collecting blood from Mijanur Rahaman, a 29-year-old blood donor - WHO Bangladesh/Tatiana Almeida
“As part of the steps to increase availability of blood and lifesaving commodities while dealing with shock due to excess bleeding, obstetric haemorrhages during child birth, among other conditions, WHO has just completed the refurbishment work of the newly established Blood Bank and Transfusion Centers at Ukhiya and Teknaf Upazila Health Complexes. WHO is also providing an orientation of standard practices to improve the quality of blood transfusion services in the district”, says WHO Public Health Response Consultant, Dr Simon Kaddu Ssentamu.
A humanitarian imperative to ensure access to emergency medical and obstetric care, and life-saving interventions, the provision of emergency surgical care and the setting up of blood transfusion centers in Cox’s Bazar represents the beginning of a more comprehensive view of health in a district home to vulnerable Rohingya refugees and host communities.