Alex Jin
HAEFA - May Newsletter 2023
HAEFA - May Newsletter 2023

HAEFA@Brown raises over $1000 though fundraising event

On April 24th, 2025, HAEFA@Brown — a newly established student chapter of Health and Education for All (HAEFA) led by Yui Miura and Aditi Dey — organized a fundraising event to support Rohingya refugees facing severe funding cuts. Recently, the World Food Programme (WFP) has nearly halved food rations for the Rohingya, reducing support from $12.50 to just $6 per person.

The event featured a powerful talk by Dr. Susan Cu-Uvin, Professor of Obstetrics and Gynecology, who shared insights from her work in global health. Attendees also enjoyed delicious homemade Bangladeshi food, henna, and handmade crafts including keychains and embroidered bags created by Rohingya and directly shipped from the refugee camps.

Thanks to everyone's generosity, the fundraiser raised over $1,000!

Inaugural ProgramStrengthening of Hypertension Detection, Treatment & Follow-up System at Primary Healthcare by Implementing HEARTS Package in Bangladesh

On January 29, 2025, the Non-Communicable Diseases Control (NCDC) Program, in collaboration with the National Heart Foundation of Bangladesh, successfully organized the Inauguration Program of the Expansion of the Bangladesh Hypertension Control Initiative. The event took place at 10:30 AM at the CIRDAP International Auditorium in Dhaka. This significant initiative, which focuses on implementing the HEARTS package for hypertension management, marked a major milestone with its expansion from 182 to 310 upazilas, effective January 2025. The expansion underscores the government’s commitment to addressing the growing burden of hypertension and improving cardiovascular health across the country.

The Honorable Advisor to the Ministry of Health and Family Welfare, Nurjahan Begum, graced the occasion as the Chief Guest. She emphasized the critical role of preventive measures, including early screening, lifestyle modifications, and public awareness campaigns, in combating hypertension and reducing the prevalence of cardiovascular diseases in Bangladesh. She commended the collaborative efforts to strengthen primary healthcare services to ensure better health outcomes for the population.

The event was attended by a diverse group of key stakeholders, including senior government officials, healthcare professionals, and representatives from implementing partner organizations. The program highlighted the collective efforts of these stakeholders in advancing hypertension control and non-communicable disease (NCD) management across the country.

A notable highlight of the event was the recognition of Health and Education for All (HAEFA) as an NCD Management Model Implementation Partner. HAEFA was acknowledged for its outstanding contributions to strengthening hypertension and NCD care at the primary healthcare level. In Noakhali, HAEFA has successfully established and operationalized NCD services across eight Upazila Health Complexes (UHCs), one District Hospital, and one community clinic. These facilities provide comprehensive management for hypertension, diabetes, and cardiovascular diseases using the NIROG electronic medical record (EMR) system.

Similarly, in Cox’s Bazar, HAEFA has expanded NCD services to 66 health facilities, including 48 Community Clinics (CC), 6 Family Welfare Centers (FWC), 1 District Hospital, 1 Maternal and Child Welfare Centre (MCWC), 2 Upazila Health Complexes (UHCs), and 8 Union Health Sub-Centers in Moheshkhali and Ukhiya. The integration of the NIROG EMR system in these facilities has enhanced patient monitoring, treatment adherence, and follow-up care, contributing to the overall strengthening of primary healthcare infrastructure in the region. These efforts have significantly improved access to quality hypertension and NCD care for communities in both Noakhali and Cox’s Bazar.

The program concluded with a renewed commitment from all participants, including government agencies, non-governmental organizations, and healthcare professionals, to intensify hypertension control efforts, promote preventive strategies, and improve cardiovascular health outcomes nationwide. The collaborative spirit demonstrated during the event reflects a shared vision of a healthier Bangladesh, where preventable diseases like hypertension are effectively managed, and the population enjoys better quality of life.

This inauguration program marks a pivotal step forward in the fight against hypertension and NCDs in Bangladesh, setting a strong foundation for future initiatives aimed at achieving universal health coverage and sustainable health development.

Student-Led Teach-In Session at George Washington University Medical School

On May 7th, 2024, HAEFA’s George Washington Medical School chapter hosted its inaugural meeting. The meeting was presented under a teach-in format with multiple speakers composed entirely of student leadership from the organization. The teach-in topics were the HAEFA’s humanitarian and clinical services using the electronic medical record (EMR) system for the rural and underserved populations in Kurigram, Noakhali, and Cox’s Bazar districts of Bangladesh. A major focus of the topics was also on the Rohingya FDMN/refugee crisis and HAEFA’s intervention within the camps.

The six student presenters were as follows: Ishan Abdullah, Meagan Mitchell, Abdulla Ali, William Huang, Hannaka Spillman,& Omar Saadi. Highlighted during the meeting were HAEFA’s innovative see-and-treat approach for cervical cancer, community-based tuberculosis screening and treatment workflow, COVID-19 management, natural disaster aid, and the implementation of NIROG in remote and underserved areas of Bangladesh. After discussing HAEFA’s role, the goals of the student organization were reviewed, and upcoming opportunities for new members were revealed.

The talk was concluded with a reminder about how the plight of globally disadvantaged populations vastly extends past their media exposure and the duty of students today in educating themselves and others to ensure these people are continuously given the support they need, The student organization has two fundraisers planned for the upcoming months and hopes to host another dedicated teach-in session focused on HAEFA’s disaster response within refugee camps. 



HAEFA's Fight Against Tuberculosis

Tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis, is a highly contagious disease that most often affects the lungs. It’s spread through the air when people with lung TB cough, sneeze, or spit, and it only takes a few germs to become infected. Despite being preventable and curable, 1.5 million people die from TB each year – making it the world’s top infectious killer (WHO, 2023). Bangladesh is among the 30 countries with the highest burden of TB in the world, making it a major public health concern that disproportionately impacts marginalized and vulnerable communities. 

Estimated TB incidence in 2021, for countries with at least 100 000 incident cases (WHO)

The eight countries with the highest number of cases and that accounted for 2/3 of global cases in 2021, are labelled.

TB in the Rohingya Refugee Camps

TB poses an even greater risk for the Rohingya refugees due to their living conditions and minimal access to adequate sanitation, water, nutrition, and healthcare. Furthermore, “the prevalence of TB is higher in the camps as they are densely populated and overcrowded,” says Dr. Shajjad Hossain, TB Coordinator.

Camp 9

To address this, HAEFA and Partners in Health and Development (PHD) as UNFPA Implementing Partners have established a Tuberculosis screening program. The project began in Oct. 2023, under HGSP (Health and Gender Support), with the goal to increase early diagnosis and provide appropriate treatment for vulnerable populations in Cox’s Bazar. 

Project Overview

The project is implemented by three Special Community Facilitator Supervisors and 15 Special Community Facilitators (SCF) alongside 182 Community Health Workers (CHW) from PHD. The CHWs go door-to-door, screening every member of the community using an online screening questionnaire. TB symptoms are recorded, such as a persistent cough, night sweats, and fever. If the patient is flagged by the system as a presumptive case, the SCFs will collect a cough sample to confirm the diagnosis. 

Refresher training for CHW

A Special Community Facilitator (SCF) counsels a family on TB screening

Screening is optimized through an online data entry system

Currently, testing is only available at the Bangladesh Rural Advancement Committee (BRAC) and WHO facilities, but HAEFA is currently working to establish a TB diagnosis corner at Camp 9, using the laboratory's new LED Fluorescence Microscope. Upon confirmation of positive TB, BRAC provides a 6-month course of treatment. HAEFA is responsible for ensuring the patients’ health and treatment compliance, completing three patient follow-ups at 2, 3, and 6 months. 

LED fluorescence microscope at Camp 9 

Project Targets

HAEFA aims to screen 70,000 individuals by June 2024, split equally between the host community and the FDMN population. As of March 15th, 51,944 Bangladeshi and 25,723 FDMN have been screened, identifying 184 and 80 presumptive cases respectively. 

While HAEFA is well on its way to achieving the target, the program still faces challenges due to cultural misconceptions. During Ramadan, many individuals refuse to provide a cough sample, thinking that it will break their fast. To address this, community engagement initiatives have been implemented; HAEFA staff have made multiple visits to Mosques within the FDMN camps to increase TB screening awareness and transmit accurate information. 

“We visit the mosques to raise awareness among the Rohingya community about tuberculosis screening and sputum testing. With Camp Majhi's assistance, we were able to initially persuade the Imam, which made it simpler to inform the community about the significance of tuberculosis screening and to reassure them that sputum collection does not conflict with Ramadan,” says Jahidul Islam.

Dr. Jahidul Islam (left) and Dr. Asif Mazumder (right) speak at the Balukhali camp 09 Jame Masjid

Jahidul Islam (left) and Dr. Shajjad Hossain (right) speak at the Kutupalong camp 1w Lambasiya Jame Masjid

This initiative is part of HAEFA’s commitment to ensuring the health and resilience of vulnerable communities. Overall, the program stands as a significant contribution to furthering the goal of eradicating Tuberculosis worldwide. 

To read more about HAEFA’s projects, click here

An Inside Look: Working at the FDMN Camp Health Posts

Background

In October 2017, Myanmar’s Rakhine state launched a brutal attack on the Rohingya community, a primarily Muslim ethnic minority. This forced hundreds of thousands to flee to neighboring Bangladesh, specifically the southeastern district of Cox’s Bazar. Seven years since the crackdown, the population has reached nearly one million people, making it one of the world's largest and most densely populated refugee camps. Officially defined as “Forcibly Displaced Myanmar Nationals” (FDMNs), the Rohingya people are not recognized as citizens in either country, making them the largest stateless population in the world. 

Since the beginning of the crisis, HAEFA has operated two health posts within the camps, in Kutupalong and Balukhali (Camp 1W and 9 respectively). These camps have grown and adapted throughout the years, making improvements to best serve the community within the resource-limited environment.  

Boys stand outside HAEFA’s Health Post at Camp 9

Waiting room of the 1W Health Post

An insider’s view

I spoke with Dr. Fairuz Homayara Faria and Mst. Afroza Akter, to gain an inside view on what it’s like to work at these health posts. 

Dr. Fairuz Homayara Faria works as one of the two medical officers at Camp 9. Throughout the day, she counsels patients on everything from hypertension and diabetes to family planning and maternal care. Reflecting on her start at HAEFA, she recounts, “I joined HAEFA in 2021 when the pandemic was going on. It was quite a risky job but I did it anyway. I always wanted to work in this region. I had an interest in refugee camps and I always wanted to see what kind of experience they have here.” 

Dr. Fairuz Homayara Faria enters information in NIROG

When asked about what makes the Health Posts unique, she notes HAEFA’s emphasis on non-communicable disease (NCD) screening. Before seeing the physician, all patients have their vitals measured to be screened for NCDs like hypertension and diabetes.

Additionally, most prescriptions are limited to 7 days, ensuring that the patients return and are assessed weekly, to best monitor and manage their condition. Dr. Faria explains that “weekly check-ups and blood sugar monitoring don’t happen in all facilities. We have a very good follow-up system here.” HAEFA’s routine care is aided by the use of NIROG, a digitalized electronic medical record system.

She also notes how HAEFA prioritizes personalized and private consultations; “Other health workers or clinics don’t provide this kind of counseling.” 

All patients are screened for NCDs

Patient at camp 9 holds his Health record book and NIROG ID card

However, the job is not short of challenges. Dr. Faria tells me that the hardest part of her job is navigating cultural and communication barriers. “They are very stubborn about about follow-up and medicine intake.”

Akter, who has been working with HAEFA for two years, expands upon these challenges. Working as a Midwife, she counsels every female patient of reproductive age on the importance of family planning. She helps them navigate contraceptive use, providing different options such as condoms, injectable contraceptives, and oral contraceptives. This is an essential role within the camps, as the high rate of pregnancy and population growth is straining the already limited resources. Akter reiterates the complicated cultural barriers stating that, “it’s very difficult to convince them because they are very conservative.”

Midwife Mst. Afroza Akter

All women are counseled on family planning

More than half of all Rohingya refugees in Bangladesh (52 percent) are children

Despite facing obstacles, both women remain committed to serving this population and have undoubtedly made a positive impact. Akter mentions that while slow, she is noticing a greater awareness of family planning, with “more Rohingya taking contraceptives.”

Additionally, Dr. Faria notes that HAEFA’s service is appreciated by the community. “The patients that get treated here are very happy and have expressed so much gratitude.”

In the future, Dr. Faria hopes to return to hospital work but adds: “I have enjoyed working here for the past three years. … I will remember this experience for the rest of my life.” Akter also positively reflects on working at HAEFA, telling me that “the whole team is like a family.”

The clinical team at Camp 1W

To read more about HAEFA’s work in the FDMN camps, click here.

Introducing NIROG Plus

Empowering primary healthcare through digitalization

HAEFA has successfully developed NIROG Plus, an updated Electronic Medical Record (EMR) system aimed at enhancing primary patient care across all eight Upazilas (sub-districts) of Cox's Bazar. The HIPAA-compliant software records encrypted patient data providing doctors with a modern resource ensuring accurate diagnosis, treatment, and follow-up care. The updated version features a streamlined interface with improved order entry systems, real-time data tracking, and encoded analysis capabilities which will improve the quality and efficiency of patient care. 


Project Description

The project launched in May 2023 with the primary goal of establishing accessible and routine Non-communicable disease (NCD) screening. To date, a total of 66 EMR systems have been established (four at main health centers and 62 at community clinics in the Ukhiya and Moheshkhali Upazilas). Furthermore, HAEFA has provided all equipment needed for NCD screening, including digital blood pressure monitors, glucose meters, height and weight measuring apparatuses, etc. 

Mr. Mahfuzar Rahman registers a patient in NIROG Plus

Emphasizing preventative care and increasing access

With this expansion in modern recording technology, HAEFA ensures NCD screening at every level. The Community Healthcare Providers (CHCP) stationed at community clinics can now use NIROG Plus to assess patients’ hypertension and diabetes status, as well as cardiovascular risk.

If the patient is flagged by the system, they are referred to the Upazila Health Complex for diagnosis and treatment. This removes the need for physicians on-site and reduces the overall healthcare system burden by prioritizing continuous and local care. Dr. Asif Mazumder, EMR supervisor explains, “Early identification and intervention are now possible by data analysis, which is the cornerstone of preventive healthcare.”  

Dr. Shajjad Hossain, Medical Officer at HAEFA’s 1W Health Post further elaborates on the project’s importance. “NCD Screening allows healthcare providers to identify individuals who are at a higher risk of developing NCDs and provide them with guidance on lifestyle modifications and preventive measures. Moreover, healthcare providers can allocate resources efficiently, ensuring that those with the highest risk receive timely appropriate care and management. This will also help in reducing healthcare costs in the long run by preventing complications that would require expensive treatments.” - Dr. Shajjad Hossain

Dr. Shajjad Hossain (left) Dr. Asif Mazumder (right)

Furthermore, NIROG Plus lowers barriers to access. “This makes it easy for individuals with limited time and resources to access quality health support. They can just go to the community clinic instead of traveling far to the Upaliza’s Health Complex.” says Saim Khan, Chief Coordinator, HAEFA Cox's Bazar. 

Taking blood pressure to screen for hypertension

Screening blood glucose can help identify patients with metabolic diseases like diabetes

Committed to constant improvement

While NIROG Plus is a major advancement in HAEFA’s EMR technology, there is still room for improvement. Currently, data from 66 community clinics is synced every day, creating speed and bandwidth constraints. Therefore, the HAEFA IT team is working hard to improve syncing capabilities to ensure stable and rapid data recording. 

Every patient is assigned a unique ID number

Height and weight is recorded to calculate BMI and assess cardiovascular risk


Influencing national health infrastucture

The potential for this technology is immense. The Bangladesh healthcare system is still in its infancy and lags behind many other countries. A comprehensive and translatable medical record system is not well established and is almost non-existent in rural and isolated communities. By securely storing information, NIROG Plus removes the burden of manually tracking patient data and allows physicians to consult records and trends to better inform treatment decisions. Furthermore, the records can be utilized across various healthcare levels ensuring continuity of care and longitudinal management.

Dr. Mazumder states, “My strong belief is that NIROG Plus will be the stepping stone of the much-needed digital data management system that should have been established long before within Bangladesh’s healthcare system.”

To read more about NIROG, click here.

The Women Behind HAEFA's Cervical Cancer Screening Program

In honor of International Women’s Day, HAEFA would like to highlight the incredible team of female physicians and community facilitators working on Cervical Cancer Screening. This program is advancing women’s health, promoting equality, and saving lives.

The physician team. Left to right: Dr. Farah Naz, Dr. Rubaiya Shafrin, Dr. Rituproma debnath, Dr. Tasnim Jahan, Dr. Chitralekha Kar, Dr. Arpa Mollik, Dr. Nishita Paul. Not pictured: Dr. Zerin Tasnova

Overview

Cervical cancer is a significant global health concern, including in Bangladesh, where it leads to the death of approximately 6,000 women each year. Early detection can prevent this disease, but a lack of public knowledge and screening contributes to its high prevalence in the country.

In 2020, the district of Cox’s Bazar had little to no infrastructure dedicated to cervical cancer screening. Thanks to HAEFA’s efforts, free Visual Inspection by Acetic Acid (VIA) screening has now been established across every Upazila (sub-district) in Cox’s Bazar, each staffed with one medical officer (featured above) and three community facilitators.

“Wherever you go, you can find a facility with a VIA center.”

- Dr. Chitralekha Kar

Furthermore, HAEFA is committed to increasing accessibility. While VIA screening is available at the Upazila Health complexes, many women are unable to travel there due to time and resource limitations. Therefore, HEAFA implements VIA camps at the 66 community clinics in Cox’s Bazar, targeting rural and underserved populations. At each camp, up to one hundred women can be screened. 

Women wait to be screened at Matabar Para Community Clinic

Overcoming Challenges

While incredible progress has been made in improving women’s health the project still faces certain challenges. The physicians state that cultural barriers and misconceptions are the biggest obstacles, as well as implementing HAEFA’s single visit “See-and-Treat method” which consists of VIA screening and thermocoagulation if the VIA is positive.

“Women's health is still neglected. Most of the women need their husband’s permission to come to the hospital. Even if they come to the hospital, they can’t freely do any kind of investigation, even VIA which we provide free of charge. For example, after we counsel them they say, let me talk with my in-laws. If they permit me I will come again.”

- Dr. Rubaiya Shafrin

“As now we are doing see-and-treat, many do not want to do thermocoagulation, just because of cultural beliefs and their husband's beliefs. They fear they won't be able to have children or there will be some problem in their sexual life, and that’s the primary thing for which their husband needs them.”

- Dr. Chitralekha kar

The physicians also note personal experiences navigating sexism and discrimination as a doctor.

“It’s a common practice in our country to call us nurses. I am the team leader, but the person responsible for the community clinic asked me, who is the person in charge? I want to talk to him. When I tried to talk with him, his reply was simple, he said I want to talk with the male member of your team. That's it.

- Dr. Rubaiya Shafrin

Our Impact

Despite these challenges, these physicians showcase their dedication and resilience by continuing to serve patients every day.

“We can proudly say that the total 8 of the upazilas are doing their screening every single day. It’s free for all, open for all, no matter if you are Bangladeshi or FDMN.

- Dr. Rubaiya Shafrin

“[Our patients] were diagnosed with cervical cancer and now they are cancer free. This is a great achievement.”

- Dr. Tasnim Toma

“When you see moms bringing their daughters to get the Cervical cancer (HPV) vaccine, it feels good that we are working not only to detect the cancer, but we are also preventing it, creating a generation based awareness of which maybe we will see the effect in the near future.”

- Dr. Rubaiya Shafrin

A mother attends a VIA camp at her community clinic

HAEFA is creating generation based awareness to prevent cervical cancer in the future

The author would also like to recognize Dr. Nilufar Parveen who oversees the program as the National Clinical Coordinator, Dr. Susan Cu-Uvin who spearheaded the program, and the many community facilitators who are the key members of the program, working within the community to raise awareness, empower individuals, and bridge healthcare gaps. 

Additionally, in honor of International Women’s Day, we would like to recognize all the women who work and support HAEFA - we could not do it without you. 

HGSP all team meeting

To learn more about our Cervical Cancer screening program, click here

To meet one of our Community Facilitators, click here

Meet Amena Akter: A Dedicated Community Facilitator

Amena Akter, HAEFA community facilitator

Amena Akter, originally from Ukhiya, Cox's Bazar, embodies a commitment to community engagement and social impact. With a Bachelor's degree in English from Cox's Bazar Government College and a background in science from Ukhiya Government High School, Amena's journey has been characterized by her passion for driving positive change.

Before working with HEAFA, Amena worked as a Community Mobilizer at the Danish Refugee Council (DRC) and Center Facilitator at Young Power in Social Action (YPSA). She gained immense experience in grassroots mobilization and community engagement, actively raising awareness about gender-based violence, fostering resilience and cooperation, and empowering individuals through access to essential resources and skills.

In February 2022, Amena joined Health and Education for All as a Community Facilitator. In this ongoing role, she works to increase access to cervical cancer screening and treatment, collaborating closely with physicians and community members to bridge gaps in healthcare and education.  

"Empowering communities is essential for fostering long-term resilience and growth. I believe in the power of community-driven initiatives to create meaningful impact."

She’s excited to continue working with HAEFA stating, “I am eager to continue my journey of making a difference, empowering communities, and contributing to a brighter, more equitable future.”

Learn more about HAEFA’s work in cervical cancer screening here.

New Child Play Corners Enhance Patient Experience

Health and Education for All (HAEFA) has established new Child Play Corners at the Kutupalong Camp 1W and Balukhali Camp 9 Health Posts, enhancing the healthcare experience. 

Children play at the new child-play corner in Camp 9

Children can now safely play in the designated and child friendly space while their guardians wait for treatment in the waiting room. This thoughtful addition not only ensures a stress-free experience for guardians, but also creates a playful and nurturing space for the children. HAEFA continues to prioritize holistic well-being, making every visit to the health posts a positive and inclusive experience. 

These health post upgrades were featured in the Jan. 2024 Health Sector Bulletin for Cox’s Bazar District. See the post here.

New Cervical Cancer Screening Training and Research Center

The cervical Cancer Screening Training and Research Center of Dhaka Medical College Hospital (DMCH), was inaugurated on February 20th, 2023, with the aim to become the regional training hub for cervical cancer in Bangladesh, providing training to providers from various districts and upazilas of Bangladesh.

The opening ceremony was graced by esteemed guests, including the Director General of Health Services (DGHS), Professor Dr. Abul Basar Mohammad Khurshid Alam (DG), and Additional Director General (Administration), Professor Dr. Ahmedul Kabir (ADG), who joined in the ribbon cutting ceremony to officially launch the center. The center has also received support from Brown University Global Health Initiative, Health and Education for All (HAEFA), and the United Nations Population Fund (UNFPA)'s technical facilitators, who are providing their expertise to ensure the center's success.

The center has also received support from the Brown University Global Health Initiative and the United Nations Population Fund (UNFPA)'s technical facilitators, who are providing their expertise to ensure the success of the center. In addition, these organizations are also involved in capacity building and strengthening public healthcare facilities for cervical cancer in nine upazilas of Kurigram District and six upazilas of Cox’s Bazar District. The center's primary focus is on capacity building and training of service providers to improve the quality of cervical cancer screening and treatment in Bangladesh. By providing a centralized location for training, the center will be able to offer accessible and effective services to those in need.

Read more about it here!


 

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