A day in the life of a midwife on Bhasan Char

Six days a week, Arafin Mim wakes at 7:00 to begin her 8:00 shift as a supervising midwife. She divides her time between one of three small health posts and the sole, 20-bed hospital on Bhasan Char island, Bangladesh, where she oversees a team of 13 midwives.

Bhasan Char, a remote and previously uninhabited island in the Bay of Bengal with no pre-existing infrastructure, is now home to more than 32,500 Rohingya refugees. Prompted by the ongoing exodus of Rohingya fleeing persecution in Myanmar and the overcrowded refugee camps in Cox’s Bazar, the government began relocating the Rohingya to the island in December 2020. Given the intersecting challenges of the humanitarian crisis, climate change, and the imminent 2030 Sustainable Development Goal (SDG) targets for maternal and newborn health, prioritizing the needs of the Rohingya community on Bhasan Char is crucial for Bangladesh.

“Bhasan Char is an isolated place where they need midwifery services most because the place is totally different and separated from the mainland,” says Arafin Mim, a midwife of four years who has worked on Bhasan Char since March 2023, marking her first time living 10–12 hours from her family in Narayanganj.

When Arafin Mim arrives at the health post or hospital, she inventories the medicines and supplies to ensure her patients have the resources they need for a healthy pregnancy, such as iron supplements. This is crucial since Bhasan Char is 4–5 hours from the mainland by boat, with infrequent and weather-dependent supply shipments.

Located at the edge of the Bay of Bengal, the small island is highly vulnerable to the impacts of climate change, such as cyclones, rising sea levels, and high temperatures averaging mid-90 degrees Fahrenheit (mid-30 degrees Celsius). Arafin Mim has observed the negative effects on women and newborns, including increased hypertension among pregnant women and low birth weights in infants.

After completing the inventory, Arafin Mim assesses patient needs and assigns coverage for upcoming cases and procedures. She and her team from Research, Training, and Management (RTM) International, a Bangladesh-based international non-governmental organization (NGO), work closely with UNFPA, UNICEF, UNHCR, and other NGOs to manage health services on Bhasan Char. Coordination is crucial due to the limited maternal and newborn health care providers on the island: two gynecologists, one anesthesiologist, 32 midwives, and 84 community health and nutrition workers (CHNWs). The CHNWs share medical information and encourage women to seek antenatal care and deliver in facilities.

“They are most connected to the community, and they are going door-to-door [sharing] important information,” said Arafin Mim. “So I think these are such fabulous collaborations with the community.”

Next, Arafin Mim and the midwives provide care for women and their newborns. They offer a range of maternal health services, including antenatal, intrapartum, and postpartum care, as well as reproductive health services such as family planning, STI management, breast and cervical cancer screenings, gender-based violence screenings, health education and counseling to approximately 40 individuals per day.

“It’s important to let [women] know everything about [their] body system,” says Arafin Mim. “I’m supporting them, giving them information, and [encouraging] them to believe in themselves.”

When women are in labor or facing health complications, Arafin Mim oversees referrals from the health post to the Bhasan Char hospital, where she and her team provide direct Comprehensive Emergency Obstetric and Newborn Care (CEmONC) and manage emergency cases. This reduces the need to transport women to Noakhali or Chattogram hospitals on the mainland. Thanks to their expertise, only four women required referral to mainland hospitals in the first six months of 2024.

The frequent, hazardous weather events also force the Rohingya residents and healthcare providers to move between the housing clusters and storm shelters on the island. In the 15 months Arafin has worked on Bhasan Char, this island has been impacted by four cyclones.

Reflecting on one poignant night on October 25th, 2023, Arafin Mim recalls when 17-year-old Shohida Begum went into labor during Cyclone Hamoon. Shohida had a high-risk pregnancy and was diagnosed with anemia and at risk of postpartum hemorrhage. Yet Arafin Mim and her team intervened, helping Shohida safely deliver a healthy baby with the aid of a solar-powered emergency light kit and the companionship of her husband.

Before wrapping up a typical day at 17:00, Arafin Mim reviews her team’s work, patients’ progress, and case outcomes. She leads her team in daily mentoring, supported by UNFPA’s network of mentors who provide bi-monthly training. This helps strengthen their skills and ability to deliver respectful, quality care to the Rohingya community.

“Respectful care is one of the core components of this profession,” says Arafin Mim. For Arafin Mim and her team, this means offering patient confidentiality and privacy and honoring the community’s dignity and beliefs.

Outside of her daily tasks, Arafin Mim serves on the executive board of the professional midwives’ association, sharing knowledge and contributing to the profession globally.

Despite the challenges, the dedication of Arafin and her fellow midwives has paid off: in addition to the low number of referrals to mainland hospitals, zero maternal deaths were reported on Bhasan Char during the time Mim has worked on the island.

“I feel the profession from the [corner of my heart],” says Arafin. “It’s about making a connection with a pregnant woman, a relationship during her pregnancy.”