The DICE Programme

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11 primary care clinics benefited.

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394,940 patient consultations benefited to date.

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45 comprehensive training sessions completed.

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115 doctors, midwives and nurses trained.

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The ‘Doctors Worldwide Improving Care in Health Emergencies’ (The DICE Programme) was implemented over 2 cohorts in 2020-21 with the aim of introducing emergency care within the Rohingya refugee camps in Cox’s Bazar, Bangladesh.

View from the Camps

In November 2019, whilst Doctors Worldwide was providing guest-mentoring in a clinic in the Rohingya Refugee Camps, 2 babies were brought in as emergency cases within the space of 10 minutes. One of the babies, a 6 week-old newborn, was having a fit, whilst the other baby - a 2 year old toddler - was in cardiac arrest. Our faculty on site was an Emergency Medicine Consultant who was able to intervene and support the local doctor. Sadly however, the baby in cardiac arrest had already died.

Similar stories are occurring in multiple health facilities within the camps and beyond, involving critically ill and injured adults and children. This is in part due to the lack of structured emergency care training as a discipline in Bangladesh, which urgently needs developing.

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Why was the DICE Programme Needed?

The mass migration of almost one million Rohingya Refugees has placed unprecedented strain on the existing health care services in Cox’s Bazar and surrounding areas, which were already struggling to cope with the challenges of providing healthcare to the host population. Moreover, emergency care was still an emerging field in Bangladesh and without the correct infrastructure and training, the local healthcare workers would have struggled to offer the services that their patients required.

"The DICE programme’s features and perspective has helped me to improve my knowledge and skills mainly in emergency management. The DICE programme has also developed my confidence and thinking power and taught me how to be a good leader and work well in a team" - DICE Participant

"DICE has taught me how to deal with health emergencies in low resource settings. Serving in health emergencies with the available assets has become easier after receiving training from the DICE course" - DICE Participant

The DICE Programme In Action

The DICE programme is an emergency medicine training programme that aims to bridge the gap between primary care and secondary care by providing hands-on clinical supervision and training for Bangladeshi doctors, nurses and medical assistants who are regularly managing acute or life-threatening conditions within 24/7 Primary Healthcare Centres (PHCCs) across Cox’s Bazar. From April 2020-21, with the support of IOM, we developed their emergency care infrastructure and delivered weekly training on emergency care at 4 x 24/7 PHCCs and an additional 7 Health Posts (HPs). Through the DICE programme training and mentorship, we strengthened the emergency care available in the camps whilst strengthening the primary care interface to overall improve the quality of care.

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