The DICE Programme
Doctors Worldwide has been active in Bangladesh since November 2017 responding to the Rohingya Crisis in partnership with the International Organization of Migration (IOM).
Doctors Worldwide has actively been working on the ground in Cox’s Bazar, Bangladesh since November 2017. In partnership with IOM we have been able to respond to the Rohingya Crisis through capacity building and health system strengthening benefiting the local community as well as the Rohingya people. To date, over 900,000 patient consultations have benefitted and many more daily.
Timely and critical interventions can help save lives by enabling and building emergency care systems in the camps and surrounding communities. This is extremely vital in the current COVID-19 pandemic. For example:
- In the absence of a controlled response, large and overcrowded refugee camps such as in the Cox’s Bazar region could experience high attack rates and mortality. COVID-19 positive cases in Bangladesh are growing
- 179 Rohingya women are dying out of 100,000 from preventable causes related to pregnancy and childbirth (almost two and a half times higher than the worldwide target for maternal mortality)
- Babies are dying from preventable and treatable causes such as sepsis
Emergency care is an essential global focus as evidenced by a recent resolution adopted by the World Health Assembly (WHA72.16) in May 2019. Without effective emergency care systems, universal health and essential components of Sustainable Development Goal 3 (maternal mortality ratio, neonatal mortality, under-5 mortality and deaths and injuries from road traffic accidents) cannot improve any further. Other time-critical illnesses like COVID-19, sepsis, heart attacks, and strokes can only benefit from early interventions.
Emergency care is currently not a specialised field in Bangladesh. From a medical and public health perspective, further provisions are needed to introduce and deliver emergency care. Timely and critical interventions through training and health systems strengthening can help enable and build the emergency care systems and save lives.
Doctors Worldwide Improving Care in Health Emergencies (The DICE programme) is the introduction and delivery of emergency care within the Cox’s Bazar region of Bangladesh through health systems development and training with a focus on patient management and clinical audits at all levels of care in a humanitarian response.
DICE is a 9-month programme. Between April and December 2020, we will be working in 10 facilities and utilising expert emergency doctors and nurses from around the world including Bangladesh to implement the programme with local Bangladeshi healthcare staff. In partnership with IOM clinics, we will introduce and build emergency care in refugee camps and communities in Bangladesh.
Due to the current COVID-19 global situation, all our teaching will be conducted remotely for the time being.
We will be utilising online teaching tools and platforms to engage with senior clinical managers, doctors, and nurses registered in the course until it is safe to deploy experts to Bangladesh.
The training will be spaced out over 9 months involving 4 full days per week of on-site clinical supervision and hands-on training/learning through logbook assessments, clinical audits and patient consultations. There will be an additional 1-day per week of face to face learning/lectures away from the clinical sites for didactic learning, case-based discussion and simulations.
The DICE programme aims to bridge the gap between primary care and secondary care by providing hands-on clinical supervision training for Bangladeshi doctors, nurses and medical assistants who are regularly managing acute or life-threatening conditions within 24/7 primary care facilities. Doctors Worldwide will do this through audit and quality improvement training contextualised to the field, as well as specialised emergency medicine training that provides life-saving techniques for primary care doctors.
Outcome / Goal
The COVID-19 situation has only increased the need for support and training to frontline primary care providers. It is imperative that low-resourced settings and humanitarian response plans roll out evidence-based, long-term strategies to mitigate COVID-19 epidemics and future epidemics, starting now. By supporting and utilising the local response through our DICE training, we will strengthen the current response on the ground.
Doctors Worldwide will contribute to the development of the healthcare system in the Rohingya camps and host community with the aim of reducing overall patient morbidity and mortality through the provision of better patient management through emergency care. We will train doctors, nurses and medical assistants in specialised emergency medicine topics, improve facility governance, introduce clinical audits and provide face-to-face clinical supervision training.
In partnership with IOM, the DICE programme contributes to the development of Bangladesh’s health system in emergency care in response to the Rohingya crisis as well as introducing and building long-term emergency care provisions for the local host communities.