The DICE Programme
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.
DICE Impact Report >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.
Any healthcare system in the world would struggle to cope with the rapid increase of almost 1 million in population, let alone the complex health requirements of the Rohingya. In response, an incredible international and national effort has resulted in the provision of primary and secondary healthcare services for the refugees and the host population.
However, emergency healthcare is an emerging field in Bangladesh and emergency medical provision in its fullest sense has not been available to the population of Cox’s Bazar and surrounding area. Due to the structural demographics of the Rohingya refugee camps, a large proportion of emergency cases appear at primary care facilities. These facilities are currently not equipped to comprehensively and safely treat the wide variety of emergency cases arriving, in terms of equipment, training and protocols.
However, emergency healthcare is an emerging field in Bangladesh and emergency medical provision in its fullest sense has not been available to the population of Cox’s Bazar and surrounding area. Due to the structural demographics of the Rohingya refugee camps, a large proportion of emergency cases appear at primary care facilities. These facilities are currently not equipped to comprehensively and safely treat the wide variety of emergency cases arriving, in terms of equipment, training and protocols.
Doctors Worldwide has witnessed first-hand how inadequate emergency care can lead to unnecessary death. During a trainee observation session during our Postgraduate Fellowship programme, we witnessed multiple emergency cases presenting at a primary care facility. Without the correct infrastructure and training, the medical staff on duty were unprepared to deal with cases such as a seriously ill two year old child, who sadly passed away.
We have been actively working on the ground in Cox’s Bazar, Bangladesh since November 2017. In partnership with the International Organization of Migration (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.
"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.
Successful outcomes:
- EU layout rooms reorganization to achieve 360 degree access
- ABCDE crash trolley catalogued and stocked and trained up staff
- EU administrative organisation of paperwork improved with nurses
- EU patient follow up implemented with patient registry
- Working towards consistently providing escorts for high-risk patients for referrals with upper management
- Arrangement of rotating visit of senior consultants once or twice a week
- Implementing Public Health messaging with TV in waiting room
- Establishing with higher authority standardised version of essential medicines
To date, the impact of the DICE Programme has led to:
- Improved quality of patient care and clinical governance in Primary Health Care Centres (PHCCs) through mentorship and health system strengthening focusing on emergency care
- Significant improvement in triage and patient flow through training and recruitment of Rohingya volunteers in healthcare facilities to assist staff and communication
- Sufficient stocking of essential medicines for acute care needs in primary care clinics
- Improved patient flow and reduction of patient wait times through comprehensive triage training to healthcare workers responsible for patient intake in targeted clinics
- Creation of 16 easy-to-use protocols focusing on acute care management
- Empowerment of 5 Dignity Champions (a key healthcare professional who will act as a focal point for training and quality initiatives in each clinic) to ensure patient privacy and dignity in primary care clinics is improved and monitored
- One additional primary care clinic, that sees average 1,500 patients (of which are 50-75 maternal health patients) per week, was fully rehabilitated (outside and inside structure, emergency medicine stocks, triage desk, and patient flow) to serve patients better and support healthcare staff
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