A day in the life of a midwife on Bhasan Char

Midwife supervisor Arafin Mim measures a woman’s blood pressure. — *Midwife supervisor Arafin Mim measures a woman’s blood pressure*

Six days a week, Arafin Mim starts her day at 7:00 AM to begin her shift as a supervising midwife on Bhasan Char island, Bangladesh. She oversees a team of 13 midwives across three small health posts and the island's only 20-bed hospital.

Bhasan Char, once an uninhabited island in the Bay of Bengal, now shelters over 32,500 Rohingya refugees, relocated from overcrowded camps in Cox’s Bazar. . With no prior infrastructure, the island presents significant challenges, especially for maternal and newborn health—an area where Arafin plays a crucial role.

Bhasan Char is isolated and separated from the mainland. — *Bhasan Char is isolated and separated from the mainland*

Arafin has been a midwife for four years and started working on the island in March 2023. "Bhasan Char is isolated and separated from the mainland. That’s why midwifery services are essential here," says Arafin. It’s her first time living far from her family, but she understands the importance of her role.

Midwife Supervisor Arafin Mim checks for materials at the facility. — *Midwife Supervisor Arafin Mim checks for materials at the facility*

Every day, upon arrival at the health post or hospital, Arafin inventories medicines and supplies, to ensure that pregnant women have the resources they need for a healthy pregnancy, especially iron supplements. This is crucial, as the island is 4-5 hours from the mainland by boat, with weather-dependent and infrequent supply shipments.

Bhasan Char is prone to adverse weather conditions, like flooding. — *Bhasan Char is prone to adverse weather conditions, like flooding*

Located at the edge of the Bay of Bengal, the island is highly vulnerable to climate change, with rising sea levels, cyclones, and high temperatures being common. Arafin has observed the impact on her patients, including increased hypertension among pregnant women and low birth weights in infants.

Arafin Mim tracks the progress and condition of her patients in labor and the condition of the fetus. — *Arafin Mim tracks the progress and condition of her patients in labor and the condition of the fetus*

After inventory, Arafin assesses patient needs and assigns coverage for upcoming cases. She and her team from RTM International, a Bangladesh-based NGO, supported by UNFPA, the Government of Japan, and other agencies, manage these health services. With only two gynecologists, one anesthesiologist, 32 midwives, and 84 community health and nutrition workers (CHNWs) on the island, coordination is essential. The CHNWs play a key role in sharing medical information and encouraging women to seek care.

“They are most connected to the community, going door-to-door sharing important information,” Arafin says, appreciating the collaboration with the community.

Arafin Mim measures a woman’s blood pressure. — *Arafin Mim measures a woman’s blood pressure*

Left photo, from left to right: Tamanna Jahan, Arafin Mim, and Ayenu Khai provide nutrition counseling. Right photo: Midwife Tamanna Akter distributes iron supplements. — *Left photo, from left to right: Tamanna Jahan, Arafin Mim, and Ayenu Khai provide nutrition counseling. Right photo: Midwife Tamanna Akter distributes iron supplements*

Next, Arafin 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. On average, they care for around 40 individuals per day.

*Midwife Shabana Akter Nila provides counseling on family planning options, offering choices to the woman*

“It’s important to let women know everything about their bodies,” Arafin emphasizes. “I’m supporting them, giving them information, and encouraging them to believe in themselves.”

Left photo: Midwife Nadia Nourin encourages movement and exercise during a woman’s labor. Right photo: Midwife Tamanna Jahan provides a breastfeeding consultation to a mother nursing her newborn. — Left photo: Midwife Nadia Nourin encourages movement and exercise during a woman’s labor.

Right photo: Midwife Tamanna Jahan provides a breastfeeding consultation to a mother nursing her newborn.

When women are in labor or facing complications, Arafin oversees referrals from the health post to the Bhasan Char hospital, where she and her team provide Comprehensive emergency obstetric and newborn care. Thanks to their efforts, this has reduced the need for transfers of patients to Noakhali or Chattogram hospitals. Four women required referral to mainland hospitals in the first six months of 2024.

Navy Frigates travel between Bhasan Char and Chattogram twice per week. The smaller boats, like the trawler (lower left corner) and sea truck (lower middle photo), are less reliable and can pose a safety risk. All boats are subject to weather delays and cancellations. — Navy Frigates travel between Bhasan Char and Chattogram twice per week. The smaller boats, like the trawler (lower left corner) and sea truck (lower middle photo), are less reliable and can pose a safety risk. All boats are subject to weather delays and cancellations

The challenges of Bhasan Char extend beyond medical emergencies. The island has been impacted by four cyclones in the 15 months Arafin has worked there. She recalls one night in October 2023, during Cyclone Hamoon, when a 17-year-old woman went into labor and there was no electricity.
She had a high-risk pregnancy - diagnosed with anemia and at risk of postpartum hemorrhage. Despite the challenges, Arafin and her team safely delivered the baby using a solar-powered emergency light kit, and her husband by her side.

*Midwife Nadia Nourin secures skin-to-skin contact following delivery during Cyclone Hamoon. The woman’s husband holds an emergency solar light.*

Before ending her day at 5:00 PM, Arafin reviews her team’s work, patient progress, and case outcomes. She leads daily mentoring sessions, supported by UNFPA’s network of mentors who provide bi-monthly training to 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,” Arafin emphasizes. This means maintaining patient confidentiality, privacy, and respecting the dignity and beliefs of the community.

Outside her daily duties, Arafin serves on the executive board of the professional midwives’ association, sharing knowledge and contributing to the profession globally. The dedication of Arafin and her fellow midwives has led to significant achievements - in addition to the low number of referrals to mainland hospitals, zero maternal deaths were reported on Bhasan Char since Arafin’s time on the island.

As a supervisor, Arafin Mim shows midwives Ashra Begum, Ayenu Khai, Chompa Rani Kor videos on best practices of care as a part of the ongoing mentoring of her team she manages. — *As a supervisor, Arafin Mim shows midwives Ashra Begum, Ayenu Khai, Chompa Rani Kor videos on best practices of care as a part of the ongoing mentoring of her team she manages*

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

From left to right: Tamanna Jahan, Arafin Mim, and the baby’s mother gaze at a newborn they helped safely deliver. — *From left to right: Tamanna Jahan, Arafin Mim, and the baby’s mother gaze at a newborn they helped safely deliver*

UNFPA is committed to leaving no one behind, ensuring that all women, regardless of their circumstances, receive the essential sexual and reproductive health care and support they need.

Story by AlignMHN. Photo credits: Tamanna Jahan/RTM International, Chompa Rani Kor/RTM International, Arafin Mim/RTM International, Jubayda Akter, Hira Khatun/Friendship NGO, Romzam/Health Post Volunteer, Mst Rashida, Lab Tech/RTM International.