HAEFA and Dr Abid: Building towards universal health for all in Bangladesh

Dr Ruhul Abid is the founder and president of Health and Education for All (HAEFA) and an associate professor at Brown University Alpert Medical School and executive faculty at Global Health Initiative at Brown University.

He was a Harvard fellow and also served as an assistant professor at Harvard Medical School.

Throughout his career as a physician-scientist in the field of cardiovascular and non-communicable diseases in the USA, Dr Abid spearheaded numerous community health projects in Bangladesh.

In 2018, he was awarded the Stars in Global Health Award by Grand Challenges Canada for his relentless efforts in improving health of the underprivileged people.

Recently, he and his organisation have been nominated for the Nobel Peace Prize.

Nurjahan Begum, a garment worker, would always feel drowsy and fatigued. She had time for everything and everyone in the family but for herself. One day, she found an international organisation was providing workers with free treatment at her factory.

She visited the health camp and was diagnosed with diabetes.

Along with her, 1,909 RMG and textile workers aged between 18 and 64 were screened and treated for non-communicable diseases e.g. diabetes, hypertension, asthma, anaemia, etc.  

Of them, 19% were diagnosed with anaemia, 11.9% with hypertension, and 8% with diabetes, revealed a study titled "A disease burden analysis of garment factory workers in Bangladesh: Proposal for annual health screening" published in the Oxford journal of International Health by the US-based organisation Health and Education for All (HAEFA) in 2019.

It was the first time in the history of the garment industry that an international organisation had gotten access to factories and received permission to treat RMG workers in 2013. 

Photo: Courtesy

The person behind this noble organisation is Dr Ruhul Abid, a Bangladeshi-American physician-scientist in the field of cardiovascular and non-communicable diseases, who founded HAEFA in 2012 and has been nominated for the Noble Peace Prize this year.

Dr Abid is an associate professor at Brown University and is also serving as the executive faculty in the Global Health Initiative department at the university.

After the Rana Plaza tragedy, the grim faces of garment workers were haunting him.

"The Rana Plaza tragedy occurred in April 2013, and when our vacation started in June 2013, I asked my co-founder Rosemary Duda, an associate professor of surgery at Harvard Medical School, if she wanted to go to Bangladesh and help the RMG workers. She agreed," Dr Abid told The Business Standard.

Along with his wife and daughter Tanaz Abid, Rosemary, and an MIT student Nazia Chowdhury, a Math Olympiad gold medallist, Abid came to Bangladesh in 2013. After landing in Dhaka, they went to Dhaka Medical College Hospital (DMCH). They formed a team of 22 people with DMCH and other medical college doctors and interns.

It is still tough to get access to garment factories. There were now more restrictions in the post-Rana Plaza tragedy period.

BRAC Bank's CEO Syed Mahbub Rahman helped Abid connect with the factories.

"The first benevolent factories that gave us access were Ananta Group and Urmi Garments," said Dr Abid.

During their first visit, they collected data on 300 workers on an 11-page form in 2013. It took a lot of time to enter, analyse, and store the data. In 2015, they visited Envoy Group and Avant Garments, and collected data of 2,200 workers on a single-page form.

From the experiences of the two visits in 2013 and 2015, Dr Abid realised they needed an electronic database to keep individual patients' records.

"Before HAEFA, no one had records of the health condition of garment workers. When the Department for International Development (DFID) and the Directorate General of Health Services (DGHS) learned we were collecting data and treating these workers, they wanted to have a disease profile of the workers so that they can address their (workers) healthcare needs."

Dr. Abid felt the urgency of developing an electronic device to make their data collection and medical record retrieval process easier. In collaboration with Brown University and the funding agency DFID, Dr. Abid designed and developed a portable, individualized electronic medical record (EMR) device called "NIROG" (Disease free) in 2016.

A US-based software company Aprosoft was recruited to develop the encrypted, HIPAA-compliant platform of NIROG, which recorded medical data of those receiving treatment. The EMR devices also use fingerprint identification for additional efficiency.

Abid's NIROG is compliant with the Health Insurance Portability and Accountability Act (HIPAA) which follows international protocols and international coding of diseases (ICD10). This solar-powered EMR is capable of functioning anywhere in the world and without the internet.

The DFID and the DGHS wanted disease profile of 3,000 workers, but the EMR device made their work faster, easier and cost-effective, thus HAEFA collected data of 5,774 workers.

"The whole diagnosis takes place in four stations. In the first station, the name, age, and picture of a person are recorded, and a printed and laminated card is given to them with a scannable barcode. This station also records their height and weight. The second station records their blood pressure and heart rate, and the third station records blood glucose and hemoglobin. Doctors sit in the last station where they get the whole encrypted data and diagnose based on it, and physical exams."

The special feature of NIROG is that it diagnoses using ICD10 and prevents interaction of drugs. It flags the drug which interacts with other drugs or is contraindicated in some diseases. The data is sent to the local health authorities and DGHS for analyses.

So far, 30,000 garment workers have received treatment and monthly follow ups from HAEFA. 

Dr Abid is constantly trying to create a ray of hope for the underprivileged communities. In 2017, when he and his colleague Prof. Dr. Jane Carter came to Bangladesh again, the Rohingyas were fleeing here from Myanmar. He built two medical centres in Kutupalong and Balukhali for the Rohingyas and the local community in Cox's Bazar.

When he set up the centres in those areas, he did not have electricity supply. He used truck batteries to operate the EMR device initially for a few days, and then improvised NIROG to have solar-panels that help run the whole system for the first two years. Now, they have electricity and the treatment is being given by a 22-member team in full swing.

Abid and Prof. Dr. Susan Cu-Uvin, along with the DFID, the DGHS, the United Nations Population Fund (UNFPA), and Brown University are screening patients for cervical cancer in Kurigram with the "See and Treat" method.

This thermocoagulator-based method uses Mobile Optical Detection Technology (Mobile ODT) to identify early lesions of cervical cancer and provide accurate treatments during a single visit.

From October 2019 to March 2020, they screened and treated 7,500 women aged between in 30 years and 60 years in Kurigram.

Dr Abid had to face difficulties and challenges in his public health career.

After completing MBBS and internship from Dhaka Medical College in 1988, he joined Duncan tea garden. He began his humanitarian career in Nalua and Amo tea estates in the remote corners of the country.

He was one of the first few doctors from Dhaka who willingly worked there. During his tenure, measles among children, and tuberculosis, leprosy, diarrhoea and pre-eclamptic toxaemia, along with obstructed delivery, were the most common diseases among the workers, which caused fatalities.

The workers, however, initially declined to take any vaccination. They believed this "daktar sahib" (doctor) from outside would harm them in the name of immunizing them.

During the disastrous floods in 1988, cholera and diarrhoea broke out, and many people fell sick. The tea estate people used to drink water from wells that were contaminated with different viruses and bacteria.

Dr Abid then planned to take up an awareness-building programme. He trained a few local representatives from the community.

He contacted Kulaura Health Complex and brought a few health workers to train the local compounders. These local representatives of the community went to every house and disinfected the wells with chlorine.

Within three months, the rate of diarrhoea infection declined. He also treated a young patient suffering from tetanus successfully by borrowing oxygen cylinder from the nearby health complex and by procuring antibiotics and sedatives locally.

Pleased with his outstanding performance, Duncan posted him as the in-charge of Lungla Central Hospital in 1989. He felt happy as he thought he might be able to work independently.

He designed another programme. He contacted the health department (NIPSOM) and Duncan head office to start an immunisation programme in 10 tea estates under Duncan.

"Many children died because of measles and other preventable diseases. But the vaccination programme was not available in those areas at the time. Women refused to take treatment from men. After observing them for a few days, I figured they only listened to married women who were also mothers. So, I made a plan with the help of Prof. Dr. Quamruzzaman of Dhaka Community Hospital and Prof. Dr. Mahmudur Rahman of National Hospital to train one woman for 100 families who would go to their houses, give vaccines and encourage them to come to the hospital for ante-natal check-up, and screening for tuberculosis, leprosy, hypertension and diabetes," Dr Abid vividly recalled the days.

The visionary leader wanted to provide tea garden workers with health cards. His comprehensive plan was to keep records of diseases in the cards. But Duncan, as a corporate company, calculated the costs and found it would cause them to incur significant costs.

"For the first time, I learned how to calculate profit and cost management. I researched and found that if a worker takes leave for 10 days, they would get paid 70% of their salary. Since most of the workers were women, they would not come to work if their children fell ill. So, if we could ensure good health for them, their work hour and productivity would increase. It would rather bring profit and would create a positive image of Duncan."

Duncan's CEO late Mr Subhan, a dynamic leader in the tea industry, gave the plan a go-ahead. The project was successful. The female Community Health Workers fed high potential vitamin A capsule to children and vaccinated them. "The immunisation rate reached 97%, while it was 67% in the whole country in 1991."

Dr Abid, for advancement in his medical career went to Japan and received his PhD in molecular biology and biochemistry, from Nagoya University. Then, he moved to the US, completed his fellowship at Harvard Medical School, and settled down there.

Even though he was away from his motherland for quite a long time, the urge to help the marginalised community of his own country was still in his mind. Hence, he formed HAEFA.

So far, 30,000 RMG workers, 150,000 Rohingyas and locals, and 1,200 rickshaw pullers have received medical diagnosis and free treatment from HAEFA.

Abid also provided Covid-19 competency Training-of-Trainers (TOT) training to 1,200 health workers of the Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka Medical College Hospital, Kurmitola General Hospital, icddr,b, ICVD, NHF, the World Health Organisation, Save the Children, and Bangabandhu Sheikh Mujib Medical University. This TOT has been organised by HAEFA in collaboration with the Project Hope and Brown University in Dhaka, Rajshahi, Kurigram, Pirojpur, Jhalokathi, Bhola, Cox's Bazar and many other districts through webinars.

Abid and his colleagues in Bangladesh are already in talks with the Bangladesh Garment Manufacturers and Exporters Association (BGMEA) to scale up HAEFA's health coverage to garment workers through capacity building of the local RMG factories. Also, his organisation along with the DGHS has a plan to take their services to the community level in 64 districts.

Dr Abid has a dream of helping Bangladesh achieve the Sustainable Development Goals to ensure universal health coverage (UHC) for all by helping the underprivileged community.