Postgraduate Fellowship

Background

The Rohingya people have suffered under decades of discrimination and lack of access to basic rights and services such as healthcare with high rates of attacks reported in 1978, 1991-92, and in 2016. Recently, In August 2017, a widespread attack in the Rakhine state of Myanmar (Burma), including murder, torture, rape, sexual violence, enslavement, triggered over 700,000 Rohingya refugees to flee to its neighboring country of Bangladesh. The UN Chief of Human Rights has reported it as a textbook example of ‘ethnic cleansing’. From a medical and public health perspective, there are immense requirements in the control of communicable disease, management of non-communicable disease and injuries, support for mental health and psychological trauma, as well as understanding reproductive health and coping with the effects of gender-based violence. These requirements are further challenged by the lack of health literacy amongst the Rohingya population stemming from decades of denied healthcare access. Following on from a pilot run held in February 2018, DWW launched the PGF officially in July 2018 with its first cohort of 24 Bangladeshi doctors.

Programme In Action

In 2018/19, Doctors Worldwide trained approximately 99 local Bangladeshi doctors over 4 Cohorts working within the Rohingya camps and host communities

The estimated impact benefited over 900,000 patient consultations with doctors trained through the PGF by the end of 2019r. The PGF training programme involved 423 hours of classroom sessions and 787 hours of clinical shadowing over the entire PGF.

The PGF is centered around the delivery of 8 independent modules:

1. Health in Humanitarian Emergencies
2. Triage and Acute Care Management
3. Communicable Diseases
4. Non-Communicable Diseases and Palliative Care
5. Mental Health in Humanitarian Emergencies
6. Sexual and Reproductive Health, Family Planning and Gender Based Violence
7. Clinical Assessment, Professional Practice, and Communication Skills
8. Leadership and Governance (NEW)

The teaching incorporates a wide range of methodologies including:

• ELearning
• Didactic Lectures
• Group Discussions
• Case-based Scenarios
• Simulated Exercises With Props
• Clinical Supervision

In addition, several other certificates as part of the PGF programme were provided upon completion:

1. The London School of Hygiene & Tropical Medicine certificate in Health in Humanitarian Crises (online via FutureLearn)
2. The WHO Emergency Triage Assessment & Treatment (ETAT) certification
3. Basic Life Support (BLS)
4. mHGAP for mental health
5. Minimum Initial Service Package (MISP) Certification for Sexual Reproductive Health (online via IAWG)

Doctors Worldwide recruited international medical experts with primary care, emergency medicine, mental health, sexual and reproductive health, maternal health, and pediatrics backgrounds to deliver the training and clinical mentorships.

The long-term impact of the PGF in low-middle income countries includes better healthcare outcomes in Bangladesh for both the local host and refugee/migrant population as doctors will be better equipped to meet their health needs now and in the future. As these doctors work alongside their peers, and as they progress into leadership roles, the benefits of this training will also be passed on to their colleagues as well as the wider health settings within which they practice and operate.

Impact

• Trained 99 medical doctors over 4 cohorts representing nearly half of all the medical doctors in the Rohingya camps.
• Benefited over 900,000 patient consultations with doctors trained through the PGF.
• Held 201 sessions (787 hours) of clinical shadowing conducted by Doctors Worldwide medical faculty.
• Issued 594 additional professional certificates including MISP for Reproductive Health, ETAT, BLS, and LSHTM Health in Humanitarian Crises (online).
• Represented by 36 NGOs, iNGOs and GOs across the trained cohorts.
• 138 sessions (423 hours) of teaching conducted by DWW medical faculty.
• Seen over a 20% increase from baseline knowledge demonstrated by each participant, on average, in addition to new skills learned.
• Recorded over 1,500 workplace-based assessments in personal logbooks including case-based discussions, directly observed procedural skills, mini-clinical evaluation exercises, and reflective practice by DWW medical faculty
• Deployed 26 expert faculty of doctors from Doctors Worldwide including primary care, emergency medicine, paediatrics, OBGYN, mental health, and more
• Created a clinical support group for 179 Bangladeshi doctors run by Doctors Worldwide

Our PGF doctors have reported:

• Increased confidence in patient management from real-time clinical shadowing
• Improved patient experience, diagnosis, and treatment through national and international medical standards of teaching
• Demonstrating leadership in the clinics they serve e.g. introducing and teaching triage to their clinical team

Overall, our long-term, comprehensive training has:

• Increased the skills & knowledge of local doctors who make up the majority of the doctors in the camps
• Given access to international standards and best practice
• Enabled primary care doctors, i.e. frontline responders (who are almost always the local host community) to manage and respond to the crisis