ARTICLES
Dr. Ruhul Abid's Journey in Establishing and Advancing HAEFA
Dr. Ruhul Abid, a professor at Brown University, co-founder and president of HAEFA and a Nobel Peace Prize nominee, discusses his journey into public health, providing aid to some of the world’s most vulnerable people, and what he is planning next for HAEFA.
By Ishaan Rahman
Health and Education for All (HAEFA) is a 501(c)(3) nonprofit organization founded in 2012 to address glaring inequalities in healthcare access in Bangladesh. In our interview, Dr. Ruhul Abid, the president and co-founder of the organization and associate professor at the Brown University Warren Alpert School of Medicine, reflected on his path into public health and his work with HAEFA.
Starting out in Public Healthcare
As a newly registered physician, Dr. Abid started his career working for Duncan Brothers, a British tea company, instead of a traditional hospital setting. Dr. Abid's initial exposure to community health was in offering healthcare screening, ensuring effective vaccination among the tea garden workers - raising its coverage from 5% to 97% - and providing routine healthcare services to the organization's employees.
“We developed antenatal checkup, screening for hypertension and diabetes using the community [health workers] in the tea-producing estates...this was often in remote places for the tea pluckers (workers) and their families,” he explained. Through this, he learned how to manage a team, motivate the staff to deliver optimum services and distribute (often limited) resources. "My experience in public health and medical fields proved invaluable in my ability to address the key questions - what are the primary issues? What resources are at disposal? What gaps are there?” He went on. “[My three years at Duncan Brothers] resonated with me in the later part of my life as well."
Building a Team
After moving to the United States and working as a fellow and then faculty at Harvard Medical School, Dr. Abid started thinking about how to give back to the community in Bangladesh. HAEFA resulted from this, an organization co-founded with his colleague at Harvard Medical School, Dr. Rosemary Duda, to provide free healthcare and education to those who needed it most, ranging from garment workers to refugees.
His initial team included many undergraduate and medical students from Harvard University, MIT and Brown University. “I always had some connection with the students,” Dr. Abid says.
Supporting Bangladeshi Garment Workers
The collapse of the Rana Plaza in Dhaka in 2013, which resulted in the tragic death of over 1,100 garment workers, gave Dr. Abid’s new project a renewed sense of urgency and importance. Around a month after the collapse, Dr. Abid visited Bangladesh to investigate the garment workers’ health and safety needs in a workplace prioritizing labor efficiency over wellbeing. “Healthcare was very much neglected,” he sadly remarked.
This became HAEFA’s first major project. A team, including Dr. Abid himself, his daughter, Dr. Duda, undergraduates and medical students, made the trip to Bangladesh. He also contacted colleagues from Dhaka Medical College, which sent physician interns to help. HAEFA’s vital work with the garment workers included screening for non-communicable diseases such as anemia, hypertension, diabetes and asthma. Alongside local healthcare workers, HAEFA also provided health education on safety and personal hygiene. The initial funding for this project came out-of-pocket from Dr. Abid and Dr. Duda.
Early during the project's initial phase, HAEFA encountered a new obstacle. Paper medical records proved too disorganized to keep track of as more patients showed up for screenings. As a solution, “We developed electronic health records (EHR) which could screen one patient in seven minutes,” Dr. Abid said. These efficient tests included BMI, blood pressure, heart rate, on-site hemoglobin, blood glucose monitoring and more. Recognizing the success of this process, the Bangladeshi government provided funds that allowed HAEFA to screen an additional 6,000 patients. The UK’s Department for International Development (DFID) also supported their work.
In 2019, Dr. Abid and his colleagues published key demographic and health data for almost 2,000 Bangladeshi garment workers in the International Health Journal. The research suggested substantial improvement in health screening services when coupled with the use of an electronic medical record (EMR) system.
Raising Awareness in the U.S.
Short on funds, HAEFA worked tirelessly to raise awareness of its work back in the U.S., fundraising at student organizations, churches, mosques, cultural centers and more. Some committed students at Brown University even sold Valentine's Day flowers to raise funds.
HAEFA entered the Grand Challenges Canada competition in 2017, which was sponsored by the Bill and Melinda Gates Foundation and the Canadian government to address global concerns. Dr. Abid joined, displaying HAEFA’s cutting-edge electronic health record (EHR), named NIROG (well-being in Bangla), and screening programs.
“Out of 900 or so organizations worldwide, there were only 43 that received funding and HAEFA was one of them,” Dr. Abid proudly states. The fund alone allowed for the screening of an additional 12,000 patients and arranging new equipment in Bangladesh. However, the "name and fame" that HAEFA acquired from this competition was even more valuable. Dr. Abid proclaimed, "HAEFA became stronger as an organization and in its endeavor."
Facing the Rohingya Crisis
The influx of Rohingya refugees created a new public health crisis at Bangladesh’s doorstep. Wasting no time, Dr. Abid and his team, including fellow Brown University Professor, Dr. E. Jane Carter, traveled to the Cox’s Bazar district in Bangladesh. After receiving approval from the Bangladeshi government to provide healthcare within the refugee camps, HAEFA encountered a new challenge. The electronic patient records, vital to their success with garment workers, would not be workable due to the lack of electricity and internet within the camps. Dr. Abid worked around this barrier by bringing large batteries charged with solar energy.
On the issue of building trust with a persecuted minority, Dr. Abid’s answer was simple: show them results they can understand. Keeping reliable records of their health screening was key to this. Crucially, though, a medium was needed between the volunteers and the Rohingya. “Another thing we did is to include a Rohingya interpreter beside our doctors…that helped us and helped the doctors explain the results and give medicine,” he elaborated. HAEFA volunteers also attended community meetings with their local leaders and Imams.
Tackling the Pandemic
The pandemic dramatically changed HAEFA’s priorities and how they would continue to operate in Bangladesh. First and foremost, Dr. Abid wanted to ensure the safety of refugees from the contagious coronavirus. HAEFA became the first organization to provide refugees and healthcare providers in the hyperdense camps with free masks and hand sanitizer. Additionally, HAEFA educated local healthcare workers in official training programs on the correct protocol to keep people safe. “The pandemic changed us totally, expanding our horizon,” Dr. Abid says.
HAEFA, in collaboration with the Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Brown University, Project HOPE and USAID/Save the Children, developed and launched an Advanced COVD-19 Clinical Management Certification Course for the physicians of Bangladesh in 2021. More than 6,000 physicians have already been trained and certified (by DGHS, Brown University, Project HOPE and HAEFA) through this interactive online course. Another significant contribution of HAEFA during the pandemic was its successful development and training of a Training of the Trainer (TOT) Mental Health Support and Resilience Course for the health workers in Bangladesh in 2021-2022. This Mental Health TOT was a joint collaboration between HAEFA and Project HOPE and has provided support to more than 7,000 health and other workers during the pandemic.
Looking to the Future
Dr. Abid and HAEFA have ambitious plans for expansion of the organization and communities that will be helped. So far, they have planned to start operations in another district, Noakhali. Furthermore, HAEFA seeks to cooperate with Bangladesh’s government to improve clinical research.
In 2020, Dr. Abid’s work in Bangladesh had earned HAEFA and himself the ultimate recognition: a nomination for the Nobel Peace Prize. Ultimately, what started as a small, self-funded organization has become a leader in Bangladesh's public health initiative. HAEFA’s story not only shines light on the obstacles faced towards achieving healthcare justice but also emphasizes the need to address deep-seeded problems within all global communities.
