On the Front Lines: COVID-19 in the US, Myanmar & Bangladesh

Dr. Tom Lee (left) and colleagues in the COVID-19 tent at Antelope Valley Hospital in Lancaster, California. Photo courtesy of Tom Lee.

Community Partners International's founder and Board Chair Dr. Tom Lee is an Emergency Room Physician working on the front lines of the COVID-19 response in Los Angeles. In this blog post, he reflects on the challenges he has seen in the last few weeks as the U.S. struggles to cope with the COVID-19 outbreak, and shares his concerns about the potential impact of the pandemic on countries with fragile health systems like Myanmar and Bangladesh.

"There is a tendency during times like these to look inwards – to our families and to ourselves. But we must also continue to look outwards – to our friends, our communities, our country and the world."

As an Emergency Room Physician at Antelope Valley Hospital and UCLA in Los Angeles, we are currently coping with the rapidly rising number of patients presenting with suspected COVID-19. The conditions we are facing remind me of the challenges that doctors like myself who work overseas face in disaster situations. The hospital has constructed a tent in the parking lot where we see patients with suspected COVID-19.

Dr. Tom Lee prepares to disinfect the Emergency Room at Antelope Valley Hospital in Lancaster, California. Photo courtesy of Tom Lee.

​We have limited access to testing, only enough for those sick enough to be admitted. For others, we advise them to presume that they might have COVID-19, return home, and come back if they feel worse. We are running out of protective equipment, and are using ovens to re-sterilize single-use disposable masks so that we can reuse them. We have little treatment to offer except oxygen, and worry about the shortage of essential equipment such as ventilators. But these concerns, while real and important, pale in comparison to the potential impact of COVID-19 on vulnerable communities in developing countries with fragile health systems such as Myanmar and Bangladesh.

In the past two weeks, both Myanmar and Bangladesh have announced confirmed cases of COVID-19. Considering the extremely limited testing capacity in both countries, most suspect that there are many more unconfirmed cases. Given how we are struggling in the U.S. to respond to the pandemic, it is difficult to imagine how Myanmar and Bangladesh will manage once COVID-19 spreads.

Right now, there is active conflict occurring in several states in Myanmar. More than 240,000 people are internally displaced and an estimated one million people are in need of humanitarian assistance. Decades of conflict, tensions and mistrust between the central government and ethnic nationality groups in many of Myanmar’s states and regions make the provision and coordination of health services more difficult. For people living in displacement camps, and the estimated 41% of the urban population living in slums, social distancing is difficult and there is often little or no access to clean water or sufficient hygiene and sanitation.

A baby receives a health check at an ethnic community clinic in Kayin (Karen) State, Myanmar. Photo: Community Partners International

The situation for Rohingya refugees from Myanmar in Bangladesh is equally concerning. At least 855,000 Rohingya refugees are sheltering in 34 camps in Cox’s Bazar that cover just 10 square miles of land – less than half the size of Manhattan. Families of up to ten or more live in small shelters made of bamboo and tarpaulin, measuring perhaps twelve feet by twelve. This density makes physical distancing impossible.

​Refugees have limited access to clean water, hygiene and sanitation. Families use communal tube wells, latrines and bathing stations that serve hundreds of other people. This presents a major challenge for transmission prevention. Restrictions on mobile internet access in the camps is hindering refugees’ access to urgently needed health information about COVID-19.

Children collect water at a tube well in a refugee camp in Cox's Bazar, Bangladesh. Photo: Community Partners International

"The next few months will place tremendous strain on health care workers in Myanmar and Bangladesh. We will be relying heavily on their resilience and strength of character. Their heroism is a beacon of hope in these challenging times."

In the midst of these challenges, CPI’s teams are on the ground in Myanmar and Bangladesh working around the clock to help our community-based partners respond to COVID-19.

In the first phase of our response, we are planning to equip 180 field clinics operated by our partners in remote and conflict-affected communities Myanmar with a package of basic essential medicines and supplies so that they can continue to function even if the supply chain is disrupted in the months ahead. These supplies include masks, personal protective equipment (PPE), hand sanitizer, and non-contact thermometers to help protect health workers.

We are supporting these clinics and training health workers to refer suspected COVID-19 cases to the nearest hospitals. We are providing community health facilities with emergency cash reserves to cover essential needs like clinic operations and patient referral costs in the coming months.

A Rohingya Community Health Volunteer in a refugee camp in Cox's Bazar, Bangladesh. Photo: Community Partners International

In Bangladesh, we are planning to support the establishment of an isolation facility in Cox's Bazar with a group of partners. It will provide care for patients with COVID-19 who are not critically ill, and will also provide a referral point to and from intensive care.

We are supporting our community partners to get the message out to vulnerable communities in Myanmar and Bangladesh to help protect them against COVID-19. Through leaflets, posters, megaphone announcements, social media and text messages, we are disseminating key messages about how communities can prevent transmission, how to spot symptoms, and when and where to seek health care.

Children in a refugee camp in Cox's Bazar, Bangladesh. Photo: Community Partners International

There is a tendency during times like these to look inwards – to our families and to ourselves. But we must also continue to look outwards – to our friends, our communities, our country and the world. Pandemics do not develop in a vacuum and have no respect for borders. It is essential that we, as Americans, continue to lead in supporting the health and development of people around the world. It is the right thing to do and will also help protect our loved ones.

​The next few months will place tremendous strain on the health care systems in Myanmar and Bangladesh, and in particular on health care workers. We will be relying heavily on their resilience and strength of character to get us through. We will stand shoulder to shoulder with them to support their lifesaving work. Their heroism is a beacon of hope in these challenging times.

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