Dr. Ruhul Abid and his nonprofit organization, Health and Education for All, have been nominated for a 2020 Nobel Peace Prize for their efforts to bring effective, accessible health care to garment factory workers and refugees in Bangladesh. To date, HAEFA's medical centers have treated more than 200,000 patients. Photos courtesy of HAEFA

Date October 1, 2020
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Brown researcher, global health physician nominated for Nobel Peace Prize

Dr. Ruhul Abid and his nonprofit organization, Health and Education for All, are among the nominees for this year’s prize for their work to deliver medical care to garment factory workers and refugees in Bangladesh.

PROVIDENCE, R.I. [Brown University] — In the many years that Dr. Ruhul Abid has provided direct medical care to vastly underserved communities in Bangladesh, there’s one patient whom he has never forgotten.

A young girl, who appeared to be about 8 or 9 years old, came to one of the mobile medical centers Abid operates through Health and Education for All (HAEFA), a nonprofit he founded. After a brief exam and screening for common diseases — hypertension, asthma and diabetes — he learned that the girl was actually 16 and had been living with undiagnosed Type 1 diabetes for half of her life.

“She had been tested by various other organizations for tuberculosis and HIV, but no one ever thought to give her a simple blood glucose test,” said Abid, an associate professor of surgery (research) at Brown University.

During the examination, the girl revealed that she had a twin sister who died three weeks before the mobile medical center arrived in her area. “She had the same symptoms, and it was likely that she, too, was living with undiagnosed diabetes,” Abid said. “And no one ever knew.”

Now, every time Abid visits Bangladesh, which can be multiple times over the course of a year, the young woman finds him, thanks him, and they take a picture together, documenting her growth and development over the years. And it is for the positive impact on patients like this young women that Abid and HAEFA have earned a nomination for the 2020 Nobel Peace Prize, which will be awarded on Friday, Oct. 9.

While the Norwegian Nobel Committee, which awards the prize, does not release nominee names, Jean-Philippe Belleau — an associate professor at University of Massachusetts Boston — confirmed that UMass Boston’s anthropology department nominated Abid and HAEFA.

Abid, who joined the Warren Alpert Medical School in 2011 and established a vascular biology lab at Rhode Island Hospital’s Cardiovascular Research Center, founded HAEFA in 2012 with a focus on bringing health care to underprivileged people and workers in Bangladesh.

“ In six months, we screened over 7,500 people for cervical cancer. In the whole year before that, maybe 1,000 were screened. It really showed the importance of community engagement and how a well-managed system can work. ”

Dr. Ruhul Abid Founder and President of Health and Education for All

The idea for HEAFA came while Abid was still a faculty member at Harvard Medical School. But in arriving at Brown, he learned more about the Global Health Initiative — a multidisciplinary effort to address health inequities in underserved populations, particularly in developing nations — and was inspired to help build the program up.

“There was certainly an appetite for new international work,” he said.

Through collaboration with interested undergraduate and medical students, along with other Brown faculty, he was able to secure funding and focus his efforts on serving patients in dire need of medical care across the globe.

“Access to health care overall in Bangladesh is for the upper and middle classes, because they have a private system,” Abid said. “The lower classes rely heavily on government health care services, which don’t have all the resources necessary to provide for every citizen.”

This is especially true for those living in slums — home to roughly 36% of people living in large cities — for ready-made garment (RMG) factory workers, and for other physical or daily laborers, he said. With nearly 5,000, Bangladesh trails only China in the number of such factories. Not only is access to health care limited, but even if access were available, workers typically work from 7 a.m. to 8 p.m., six days a week, making it nearly impossible to find the time to go to a doctor.

Fingerprint NIROG
Using a fingerprint scanner, NIROG uploads medical records onto tablets, making follow-up care and patient tracking significantly easier than handwritten notes that can take weeks to transcribe.

To ease that burden, Abid and HAEFA developed in 2016 an electronic medical record system called “NIROG,” the Bengali word for “healthy.” Essentially, it is digitized record-keeping software uploaded onto tablets using fingerprint identification and barcoded photo ID cards for patients, making follow-up care and patient tracking significantly easier. NIROG is fully solar-powered, portable and does not require electricity or internet access to work.

“The most satisfying part is that this technological development enables us to go to remote corners of the countries and to the RMG factories to examine patients, screen for diseases, diagnose and treat chronic cases with a follow-up system,” he said. “In Bangladesh, there is no effective system like that in general.”

Through HEAFA’s mobile medical centers, more than 200,000 people have been treated directly, and the organization is currently training more people within the communities to use the NIROG system. Before NIROG, care providers had to take handwritten notes that often would not be transcribed into records for weeks. Since implementing the system, HAEFA has been able to treat nearly five times as many patients as before.

The seeds of the idea to create an effective approach to delivering on-site care to patients were planted in a tea garden. After graduating from medical school some three decades ago, Abid spent time working as a physician in a Bangladeshi tea garden — one of the first doctors to work there of his own volition.

The conditions were dire. Contaminated drinking water and illness ran rampant in the tea gardens, and many children of the workers were dying due to diarrhea and preventable diseases such as measles. 

“This really made an impression on my mind that I have to do something for the underprivileged people,” Abid said. “It was something of a mission. I chose Bangladesh not just because I’m from there, but because I have easy access to it.”

At first, many told Abid that it wasn’t worth his time — that workers would not come to his medical centers.

“Not true! They were coming in flocks,” he said. “In six months, we screened over 7,500 people for cervical cancer. In the whole year before that, maybe 1,000 were screened. It really showed the importance of community engagement and how a well-managed system can work.”

Since 2019, Abid and Dr. Susan Cu-Uvin, a medicine and public health professor who directs the Global Health Initiative at Brown, have led a “see-and-treat” cervical cancer screening program in the northern Bangladesh district of Kurigram — an effort backed by the United Nations Population Fund.

"Working with women in the rural areas where there is not much preventative health care is what I find most fulfilling and purposeful," said Cu-Uvin. "They are so stoic, strong, and happy and grateful despite poverty. We have lost so much of appreciating the simple things in life. They have not lost it."

At the country's factories, Abid said that once the HEAFA team successfully persuades factory owners to allow the doctors to perform health screenings, the rest is relatively easy: The factories have electricity and internet, and Abid says the workers are eager to have access to health care.

The other population HAEFA serves, Rohingya refugees, is a bit tougher.

The Rohingya are an ethnic group, the majority of whom are Muslim and who have lived in neighboring Myanmar for centuries. In 2017, a deadly crackdown by Myanmar’s government made hundreds of thousands of Rohingya flee into Bangladesh as refugees. Currently, more than 1.3 million refugees are living in a 4,000-acre area, often with entire families inhabiting the same 8-foot by 6-foot canvas tent.

“These are refugees coming from war,” Abid said. “They speak a different language, they come from a different culture, and they have suffered from so many physical and emotional injuries that they are very scarred. So they’re very afraid.”

He explained that the refugees have very little trust in authority, whether it be a government or a hospital. “It’s very difficult to succeed unless we can engage their own community members,” he said.

In recent years, HAEFA has established two medical centers in the Rohingya camps. The organization employs interpreters and community and religious leaders to convince the refugees to seek medical care.

“Once you establish trust, the patients come,” Abid said. “People from other camps with separate medical systems will come to our centers because they know we have NIROG, and they know they won’t have to tell us their story and entire medical history every time they visit.”

And Abid hopes to see NIROG expand beyond Bangladesh. He’s currently in talks to bring it to Nepal and to areas with high populations of Syrian refugees. A bit closer to home, he said he’d love to implement NIROG in Rhode Island.

Any health worker — it doesn’t have to be a doctor or nurse — who is trained to use the system could easily take NIROG to schools, adult learning centers, refugee community centers and other gathering places to encourage residents to get screened and treated before falling severely ill, he said.

“Awareness and access — that’s what I want to bring wherever I go,” Abid said.