Background

Amader Gram ICTs for development program of BFES (Bangladesh Friendship Education Society) which is a rural Bangladesh-based non-governmental organization with a successful track record in information and communications technology for development generally and in Cancer eHealth, herewith proposes a major population-directed initiative in Cancer on its 8.2 acre campus in Rampal of Bagerhat district. The details of this initiative are grounded in emerging critical concepts in global health, sustainable social business models in health and Amader Gram experience over recent years in creating a Breast Care Center in Khulna.

Amader Gram subscribes to such a community development model. It is a local, community-grounded organization, with substantially developed community networks. Over many years of consistent, community-oriented efforts and demonstrated success, Amader Gram has cultivated long-term relationships, the results of which include a deep and abiding trust of community members and leaders. As a local organization in a rapidly changing world, Amader Gram understands the importance of inter-connectedness, characterized by transparency and integrity, and mutual cooperation, to make significant social change possible.

Amader Gram has developed an outpatient Breast Care center in Khulna and one primary care breast problem walk in clinics in Rampal sub-district of Bagerhat in which over the last 7 years over 12000 women have been seen. The Breast Care center was designed first to be a diagnosis and treatment planning center (sliding fee for service model); it is now adding a medical oncology treatment (fixed fee model) service, a chronic medical care service for both potentially cured or benign disease patients and a cell phone based service for palliative care patients (two-way transaction-based fee models). Despite the mixed business models with this center, Amader Gram is successfully moving to have this center be a sustainable social business. In connection with this center Amader Gram has:

1. Developed the first Bangladeshi web-based electronic medical record (EMR) system, with on-line capacity to order tests and obtain results from outsourced sites.

2. Pioneered the use of on-site high-resolution ultrasound examinations.

3. Written and promulgated the use of detailed evidence-based, Bangladesh-circumstance- tailored, clinical practice guidelines (viewable at agbreastcare.org).

4. Established and conducted regular weekly international patient management tele-conferences for patients with breast cancer seen at the center.

Mission & Goal description

The mission of the Amader Gram Cancer Care and Research Center is to decrease the overall incidence, morbidity and mortality from Cancer among residents in the southwest region (Khulna Division) of Bangladesh.

The GOALS of the Amader Gram Cancer Care and Research Center for southwest regional residents are to:

1. Provide accessible, affordable and high quality cancer care leading to increased cancer cure rates;

2. Train local community members in health services skills;

3. Create information technology “solutions” for health and poverty reduction;

4. Through a public health oncology initiative—The Rampal Health Database Project–to decrease Cancer incidence rates and morbidity from Cancer, and to investigate causes of illness and monitor health in the surrounding region’s population.

This initiative is described in detail in the Plan for development book. As of May, 2017, the campus has a setup of a clinic to assist in diagnosis of Breast & Women health problems, a well-trained full time health worker groups, a WiFi tower and high speed Internet access in the campus clinic & surrounding community, and a demonstrative garden of coconut and fruit-bearing trees have been organized. To further develop this campus and to expand clinical activities at our Khulna Breast Care Center which eventually will become part of the AGCRC campus, this project needs technical & financial support for the following priority activities.

One Stop Cancer Diagnosis and Treatment Planning Clinic—initial facility

Broadly we have a plan for the development of a Cancer Center for adults. This plan is grounded in evidence-based cancer medicine and public health, and seeks to realize medical services which are affordable and of effective high quality to all regional citizens. We will focus on the commonest malignancies of men and women--breast and cervix, lung and head and neck. We will not care for patients with leukemia or brain tumors, which require specialized treatment. We now have a campus layout design, and an academic architectural team working on the specifics of the first building.

Over the last several years we have had experience with outpatient diagnosis and management of women with breast problems from which we have learned that the keys to affordable and high quality outpatient medical care are-

  • Intense application of IT (going from the current extremely poor state of medical record keeping in Bangladesh to an electronic medical record (EMR) with a diagnosis and problem list, and a visit record summary for each patient is a huge step in terms of care quality);
  • Increased use of paraprofessionals;
  • Increased use of point-of-care diagnostics (particularly ultrasound);
  • Use of evidence -based diagnostic pathways and treatment guidelines; and
  • Implementation of research (as an example our research developing a palliative m-care service).
  • Master Plan

    Our first priority is developing this center to more broadly serve women with gynecological problems or in need of palliative care. This effort will give Amader Gram further experience in structuring outpatient medical services.

    Based on this experience the first building, we propose to construct on our Cancer Center Campus in Rampal (Bagerhat district) is a One Stop Cancer Diagnosis and Treatment Planning Clinic, in which we propose to apply these key lessons. This choice as the first component facility is also made because of community expectations for care, and because to develop a radiotherapy facility the government demands first some medical center operations. Based on our Breast problem clinic experience, we believe that if this building (first phase 1500 square meters) and its basic equipment are capitalized, costing approximately $600,000 for the building and $200,00 for the equipment, we can develop in a step fashion a sustainable business requiring no further outside funding, with affordable care. As we have done in our Breast Clinic, we will charge fees based on ability to pay. We are working on a detailed plan for opening this facility in a step by step fashion beginning in February 2018. We recognize that residents/patients are rarely going to come to this facility with an established diagnosis of malignancy. We expect they will present with the commonest medical conditions that we are seeing in our current Rampal Database Project: hypertension, diabetes, asthma and other respiratory conditions, back pain, head pain/ache, non-specific breast and gynecological problems, and dermatologic and ophthalmologic complaints. Thus, in effect we will need to offer general adult non-communicable disease diagnostic and treatment care. Patients with febrile illnesses, and suggested communicable diseases—diarrhea, and acute respiratory illnesses will be strongly encouraged to seek help in the Rampal Community Health Centers of Government.

    In connection with development of this first building campus facility, we plan to develop a mostly outdoors Welcome Center, and a small Urgent Care facility for individuals with acute injuries or other medical conditions.

    The next facility we propose to construct is a Radiation Therapy Center. The capitalization costs are approximately $650,000 for the building (for two bunkers for two radiotherapy machines) and $650 -950,000 for the first machine. We believe that if these capitalization costs are covered, we can develop a sustainable separate business, charging on average $400 for a course of treatment, which cost we believe can be managed by most extended families. We believe, based on our data at this time, which the reason there is a scarcity of radiation therapy facilities in Bangladesh, is that if such capital costs are not covered, the only way to have a sustainable business is to charge fees that are out of reach of most Bangladeshis. Again, we will apply the same key lessons we have learned from the Breast Clinic to this project. We think that if we can have a first radiotherapy facility created this way, we may be able to figure out models that do not involve full capitalization of building and equipment.

    Next or concurrently with the Radiotherapy building construction, we propose to build a Training Institute for Clinical Nurse Practitioners and Cancer Educators, but offering courses as well as for different technicians and cancer specialists. We have a specific proposal which has been favorably reviewed by the Japanese Government. To fund us they want us to have a functioning clinical facility where trainees can work. These are the types of paraprofessionals whom we believe can be central in facilitating high quality care at affordable prices. As an example, we have a nurse who has done over 10,000 breast ultrasound examinations--a high quality first point of care diagnostic test. This institute will be operated as an independent Amader Gram Project.

    The final two buildings we propose for the cancer center campus are an Innovation Center for Information Technology, a research laboratory for the development of solutions for cancer, community health and rural development, and a Hospital, for surgical and medical inpatient and outpatient (day) care.

    3D Visual

    Leadership

    Advisers

    Talukdar Abdul Khaleque, Member of the Parliament, Bagerhat-3 (Rampal-Mongla)

    Prof. (Dr) Syed Modasser Ali, Former Health Adviser to Honorable Prime Minister

    Syed Zahid Hossain, Businessman, Managing Director, Khulna Traders

    Begum Ferdousi Ali, Editor, the Daily Purbanchal, Khulna

    Prof. (Dr) Qamruzzaman Chowdhury, National Institute of Cancer Research and Hospital

    Dr. Syed Mozammel Hossain, Associate Professor of Surgery, Khulna Medical College

    The Governing Board

    Syed Marghub Morshed CSP, Former Secretary, Government of Bangladesh

    Mahmudul Haque, Rtd. Professor of Fine Art, Dhaka University

    Sheikh Abdul Jalil, Freedom Fighter, Rampal & Mongla Sector, Bagerhat

    Debashish Nag, Former Deputy Secretary, Government of Bangladesh

    Syed Borhan Kabir, Executive Director, Creative Media Ltd.

    Jiniya Afroz, Development Communication Specialist, Bangladesh

    The Team

    Reza Salim, Founding Director & CEO

    Sk. Bazlur Rahman, Campus Management

    Shakil Ahmed, International Relations

    Tahmina Ferdousy, Medical Program

    Khan Zahid Hossain, Research

    Toufikul Islam Shamrat, Technology

    Our Programs

    http://AG Palliative Care
    Amader Gram
    Amader Gram Breast Care e-Health Center
    Amader Gram Breast Care e-Health Center & Suggestions
    ICT & Community Climate Care Program
    Rampal Health Database

    Partners

    Government of the People's Republic of Bangladesh
    Marquette University
    STEM Translational Communication Center Bangladesh
    Mohammadi Group

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