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Inside a Covid-19 Isolation Unit in Bangladesh’s Rohingya Refugee Camp

In a brand-new isolation center, doctors and midwives provide everything from Covid-19 testing to labor and delivery services.

Health care workers at HOPE for Bangladesh's field hospital conduct a surgery. (Photo courtesy of HOPE for Bangladesh)
Health care workers at HOPE for Bangladesh's field hospital conduct a surgery. (Photo courtesy of HOPE for Bangladesh)

HOPE for Bangladesh’s brand-new Covid-19 isolation center, created specifically for Rohingya refugees in the country, has a special purpose.

“This is where we can offer labor and delivery for the Covid-positive mothers, where other isolation centers in the camp nearby don’t have that kind of service,” explained Iftikher Mahmood, a Miami-based physician who oversees the Bangladeshi organization.

The isolation center is located inside the Rohingya camp near Cox’s Bazar, where more than 800,000 refugees currently live, and where the HOPE Foundation for Women and Children of Bangladesh already has a dedicated field hospital.

Covid-19 has been slow to gain a foothold there, even as cases in Bangladesh have topped 175,000. Dr. Mahmood attributes the relatively low number of cases among Rohingya refugees both to the presence of the World Health Organization and NGOs working fervently in the area and to restricted mobility into and among different areas of the camp.

But it’s arrived nonetheless. There’s been at least one Covid-19-related death, and a number of confirmed cases.

And the HOPE isolation center has risen to the occasion, working quickly to acquire medical materials, establish clinical procedures, and train staff.

The center currently has 16 admitted patients, and treats an additional 50 per day on an outpatient basis. They’re swabbing people who show up with symptoms of the coronavirus, and reaching out to a contact-tracing team in the event that one shows up positive, according to chief medical officer Dr. Ismail Idris.

A health worker swabs a child, testing for Covid-19. (Photo courtesy of HOPE for Bangladesh)
A health worker swabs a child, testing for Covid-19. (Photo courtesy of HOPE for Bangladesh)

Thus far, they’ve placed patients with respiratory distress on oxygen support, provided antibiotics and other medications, and, in one case, delivered a baby for a mother with Covid-19 symptoms in a dedicated labor room.

Direct Relief has provided funding, personal protective equipment, and supplies for the isolation center, as well as connecting Dr. Mahmood with two physicians with experience addressing major public health concerns in low-resource settings.

One of them. Dr. Larry Stock, has worked in international emergency medicine and global public health for 30 years, including a stint in Liberia during the West Africa Ebola outbreak.

“The building is beautiful, and I think they built something which is really special,” he said. “They’re giving people a place to rest and heal up.”

In addition to building a sophisticated facility, Dr. Stock said, HOPE for Bangladesh has a vital tool in its belt: trust. “We saw this with Ebola,” when people were much more likely to consent to treatment and to participate willingly in containment measures if they trusted public health organizations and NGOs, he said. “I think HOPE…[has] several years now of building a relationship with the community.”

Staff members at the Covid-19 isolation center examine a patient. (Photo courtesy of HOPE for Bangladesh)
Staff members at the Covid-19 isolation center examine a patient. (Photo courtesy of HOPE for Bangladesh)

In addition to the isolation center and field hospital, which are located in the camp itself, HOPE operates a separate hospital in the district of Cox’s Bazar. The organization also trains between 20 and 30 midwives each year.

According to Dr. Idris, Covid-19 has profoundly changed life in the camp. “Now people are becoming conscious day by day about their personal hygiene, lifestyle, avoiding social gatherings and [receiving] services if someone is having symptoms,” he said.

But social distancing continues to be a challenge. Many of the refugees live in small structures with several family members.

“We don’t have hotels. We don’t have community centers. We don’t have any place where they can be separated,” Dr. Mahmood said. The isolation center allows symptomatic patients to receive care while also preventing transmission.

Asked if he anticipates seeing the disease spread through the camp, Dr. Mahmood was thoughtful. “The way that the people are living there – it’s so unpredictable. No one can predict what can happen,” he said. “Everybody is…getting ready for the worst. Hoping for the best, but getting ready for the worst.”

The fact that the camp has seen relatively few cases compared to the country at large reassures its residents, Dr. Mahmood explained. “They used to be very, very afraid before, but now I think they feel reassured,” he said. “They know that in their community, the damage has not been the same.”

He hopes that the isolation center will make a difference. “This is the best we can do: set up 50 beds in addition to our original 50 beds” in the field hospital, he said.

Health workers prepare a dose of medication. (Photo courtesy of HOPE for Bangladesh)
Health workers prepare a dose of medication. (Photo courtesy of HOPE for Bangladesh)

The staff at the isolation center are uniquely positioned to provide Covid-19 treatment to pregnant women, Dr. Mahmood said, precisely because they are locals with an established history of working among this population.

“We don’t promote this job. We promote our organization as…something we do to serve the community,” he explained.

And when it comes to having providers who are willing to stick it out even in the face of the pandemic, that feeling of wanting to serve makes a difference.

“This is the time to serve, so they are not questioning,” Dr. Mahmood said. “And they are not afraid or anything like that.”

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