The Rohingya healthcare experience: A case for disparities in care
By Franklyn Rocha-Cabrero, MD
The Rohingya presence has been tolerated in Cox Bazar by the Bangladesh government. Unfortunately the government does not recognize the Rohingya as refugees, which legally limits any political asylum rights or claims. They are not recognized as citizens of Myanmar nor Bangladesh, with no clear legal avenue to integrate as citizens of any nation. Their ability to obtain a passport, education, or healthcare is severely limited. They heavily rely on international non-profit organizations to meet their needs for shelter, clean water, food, basic education, and healthcare. In summary, the Rohingya political crisis in modern times is a consequence of the past military conquests for resources between powerful nations. They are indefinitely in need of humanitarian aid, including healthcare services.
As medical doctors hoping to learn more about the Rohingya, my wife Dr. Claudia Alejandra Alvarez and I, had the opportunity to travel to Bangladesh as delegates of a humanitarian organization, called Humanity Auxilium. We visited multiple Rohingya camp healthcare facilities and witnessed the sustainable healthcare programs on the field.
Access to healthcare services has remained a challenge for the approximately 1 million Rohingya Muslims in refugee camps in the southern part of Cox Bazar, Bangladesh. Given that they have no rights as displaced citizens of Myanmar to government healthcare services, they heavily depend on non-profit organizations to receive their basic healthcare services. Healthcare services provided included access to free medication in a local pharmacy, mobile dental care services, maternity ward services, urgent care, basic on-site laboratories, psychotherapy, shelter from gender-based violence, among others. Specialist care is more limited with dependence on a referral system to local hospitals close to the Rohingya camps.
The Primary Care Centers have a versatile and efficient care model system, with COVID-19 precautions station, hygiene station with restrooms, a nursing led triage station, a record logging of patients and their clinical conditions, at least two physician consultant offices (at least one woman and man, for comfort of patients and to respect religious beliefs and customs), mental health psychotherapy office, on-site dispensing pharmacy, on-site maternity/women’s health ward, a vaccination station, on-site urgent care/emergency room and very small inpatient ward, and an isolation room. Some clinics had access to on-site ultrasound (mostly used for obstetric cases). Otherwise, if CT or XR was needed, direct referral systems were in place with local community hospitals to provide access to radiological diagnostics if needed.
The dedication, compassion, empathy and professionalism of the staff, physicians, nurses, pharmacist, and other ancillary staff was evident. Hundreds of patients are seen per day with immediate paper prescriptions given at the end of visit. A major incentive for continuity with the Rohingya and follow up every 1-2 weeks is to receive refills of their medication – for free. The most common physical diseases encountered by this community include tropical skin diseases (scabies, fungal-pityriasis versicolor, eczema with pruritic, seborrheic dermatitis, cellulitis, etc.), viral and bacterial diseases (dengue, chingunkuya, malaria, otitis media/externa, laryngitis, etc.), pulmonary disorders (COPD, pneumonia, asthma, allergies), gastrointestinal/genitourinary diseases (gastroenteritis, UTIs, hemorrhoids, unspecified abdominal discomfort), diabetes, hypertension, and joint pain.
As a neurologist, I noticed the most common neurological disorders included unspecified generalized weakness, headaches, neck/low back pain, unspecified vertigo/dizziness, insomnia and neuroophthalmological conditions. Mental health disorders were evident including post-traumatic stress disorder, major depression, and anxiety stemming from their traumatic experiences in Myanmar. We had the privilege with patients’ consent, to listen into various psychotherapy sessions with cruel accounts of babies being burned alive, women being raped for hours in front of family members, military style execution of men/children, mutilation of body parts by sharp objects and bullets, among other horrific stories.
Even presently, women and children continue to be vulnerable to domestic and sexual abuse in their camps, as some men in the Rohingya refugee camp deal with mental health issues related to the trauma experiences in Myanmar, lack of employment and inability to financially support their family given their political situation. Non-profit organizations have responded by providing programs to shield women against gender-based violence, including vocational training (e.g. sewing clothes), support groups, emergency hot-lines, and gynecological services related to sexual violence.
They also have a clear vision to address social determinants of health with limited resources, which can be a learning lesson for Western nations attempting to build sustainable programs for refugee and border immigration health programs.
Challenges faced by this population related to the healthcare services they receive include lack of health literacy, long wait time for services, language barriers, geographical restrictions, lack of immediate access to advanced diagnostics for complex patients, distrust of patients of the medical system, ease of access to alternative medicine (shaman or priest), lack of certain specialized expensive medications, among others. Regardless of the challenges, the non-profit organizations on the ground, including Humanity Auxilium, Helping Hands for Muslim Humanity, Janosera Kendra, Association of Workers for Alternative Rural Development (AWARD), Turkish Red Crescent, and Doctors Without Borders, have provided support for this vulnerable population.
Our host managed a myriad of programs to improve the life of the Rohingya, including addressing social determinants of health. Throughout our visit to field offices and corporate headquarters of our host organization, we saw structured accountability, honesty, integrity, transparency, record keeping, and results-driven reports that are key for continued operation and funding of these programs. Staff and local healthcare workers are provided a fair competitive wage, transportation, housing accommodations (if needed), home cooked meals, and administrative support (access to computers, Wi-Fi, problem solving).
Our hosts were very friendly and provided snacks, meals and shared insightful presentations of their progress on the field.