‘I can still feel it now’: UBC doctor volunteers at Rohingya refugee clinic in Bangladesh

When Dr. Karen Arnold first arrives in the Cox’s Bazar district of Bangladesh to volunteer as a clinician, she is overwhelmed by what she sees. The reality of the Rohingya refugee camp hits hard.

“Even though I thought I was prepared, having seen and read about what it would be like, actually seeing the camp in person had a huge impact. I can still feel it now,” she recalls. “The camp went on as far as the eye can see.”

Arnold, a family practice physician and clinical instructor in the faculty of medicine’s department of family practice, volunteered in November 2018 with non-governmental organization MedGlobal to provide medical care to Rohingya refugees living in the Kutapalong refugee camp. The Rohingya, a Muslim minority, fled mass military-led persecution in Myanmar and now more than 900,000 live in the Cox’s Bazar area.

Rohingya refugees await medical care

Standing in the heat on a mud hill leading to the primary care clinic, Arnold and her fellow medical volunteers were faced with the gravity of the situation in southeastern Bangladesh.

“Not too far in the distance we could see Myanmar,” Arnold says. “It had a powerful impact due to the enormity of the camp structures and also because we could feel the proximity of where these people had escaped from.”

Each morning, Rohingya refugees lined up on benches outside the clinic awaiting medical care. The clinic, made from bamboo and plastic sheeting, sees up to 300 patients per day — some have walked two hours to get there.

Before arriving at the camp, medical volunteers like Arnold undergo an orientation, including information about common illnesses and infections as well as cultural and religious practices specific to Rohingya. Bengali and Rohingya staff are the first points of contact for patients. Then clinicians, including volunteers and local staff, make assessments and provide treatment.

Paying it forward

In the summer of 2019 Arnold returned to Bangladesh. This time, she volunteered with team members from Canada and the United States teaching the Helping Babies Breathe course to local health practitioners.

On this trip, MedGlobal’s diverse team of volunteers included nurses, family medicine physicians, pediatricians, and a paramedic. Led by Dr. Lia Harris, a pediatrician and UBC clinical instructor, the MedGlobal team partnered with the government of Bangladesh and the United Nations Population Fund to teach the neonatal resuscitation course.

Dr. Karen Arnold

“It’s well known that the neonatal death rate is very high in these refugee camps, with many of the births occurring without a skilled birth attendant,” Arnold says. “Helping Babies Breathe is specifically designed for resource-limited environments like Cox’s Bazar.”

The course has been shown to reduce neonatal mortality by up to 47 per cent and fresh stillbirths by 24 per cent.

During Arnold’s trip, volunteer trainers taught Helping Babies Breathe to more than 200 physicians and midwives. Thirty-six of these clinicians were also trained to become course instructors themselves. Moving forward, the goal is for new instructors to pass on their knowledge and educate even more participants. This will grow the community of trained health practitioners and help facilitate a decline in neonatal death rates in refugee camps like Kutapalong.

Arnold also took part in a medical interpretation pilot project during her time in Bangladesh. A group of educators from California facilitated a project on Transcultural Medical Interpretation for Rohingya medical interpreters who worked as translators at the clinic. Arnold added the physician perspective at the end of this project.

Ensuring accurate translations is crucial to proper medical care. Even a slight discrepancy in translating between English and Rohingya can result in incorrect diagnoses. For Rohingya, their language has various words to describe sensations in different parts of the body – correctly representing these details in translations means providing accurate and comprehensive care.

“Each clinician was assigned a Rohingya translator and we worked with the same person during our entire trip,” Arnold says. “We really developed a great working relationship.”

Two-way learning

Back in Vancouver, Arnold is a clinical instructor with experience teaching medical students, as well as family medicine residents and public health residents in the Downtown Community Health Clinic where she has been working for 13 years.

“Teaching for days at a time in Bangladesh helped me hone and revise my skills,” Arnold says. “I hope this experience has given me the background to be an even more effective instructor going forward.”

Arnold is deeply grateful for all the people who live and work in Cox’s Bazar community despite such limited resources. She returned to Canada with a sense of appreciation for the knowledge she gained from Rohingya living in and around the camp.

Rohingya refugee children in the Cox’s Bazar area

“It is crucial for us all to be open to learning from others,” she says. “This was a true knowledge exchange during our trip to Bangladesh. We learned about the resilience of the human spirit from Rohingya refugees. Despite their suffering, they remain kind and care for their children well.”

MedGlobal and partner organizations plan to evaluate the impact of the team’s training in Bangladesh and monitor how skills developed during the training sessions are used in practice.

As one of more than 3,700 clinical faculty in the department of family practice, Arnold supports the UBC faculty of medicine by fulfilling the faculty’s contract with society – to improve health of populations and transform health for everyone. And for Arnold, that work extends to the global community.

“Reading the news is one thing, but meeting people who have been victims of attempts at genocide and seeing how resilient a community can be, that really impacted me,” Arnold says. “I learned a great deal about the culture. And I learned that all humans can all connect, wherever and whoever they are.”

Photos are courtesy of Ruth E. Kaiser during a volunteer trip in November 2018, and Karen Arnold in June 2019, at the Rohingya Medical Clinic in Bagladesh. All photos were taken with consent.