Hope and Health Float on a Boat
In the pre-dawn darkness under a stormy sky, a team of doctors and paramedics quietly gather on a riverbank in Assam to leave by boat for a day’s work tending to poor villagers.
After the day’s agenda is planned over tea in Morigaon, the boat crew rev up the motor and the craft begins its journey down the Brahmaputra.
Bisecting Assam on its course from Tibet to Bangladesh, the Brahmaputra is among Asia’s biggest rivers and prone to floods.
An estimated 3 million people live on more than 2,500 islands called chars or soporis in the river. These islands are Assam’s most backward regions, without electricity, roads, toilets or health infrastructure. The boat clinic aims to meet the most pressing needs.
Pioneered by the Centre for North-East Studies and Policy Research (C-NES), an aid group, it has so far treated over a million people.
After the drizzle, the sun comes out and villagers at work in their fields wave at the team, asking them to stop. But the nurses shout back, reminding them of the date of their own monthly health camp.
An hour later, the boat docks at Panchuchar. Children run to the banks to greet the team. Medical supplies and equipment are unloaded and the crew walks 2 kilometres to reach a school in the middle of a banana plantation, the venue for the camp.
Announcements are made over the loudspeakers of a local mosque and soon, women in bright saris with bawling infants clutched to their bosoms line up for registration.
Each team holds about 15 camps every month with a focus on maternal and child health, immunization, pregnancy and general check-ups. They also raise awareness about family planning and against early marriages. Assam has the highest maternal mortality rate in India, 309 per 100,000 births.
They carry immunisation supplies as well as medicines for common ailments including respiratory infections, diabetes and diarrhoea, and distribute them free of charge. The boat lab conducts pregnancy, blood sugar and HIV tests.
Families on the islands, many of which are Muslim-dominated, are large, and infant and maternal mortality and malnutrition are major concerns.
Her repeated childbirths have made 28-year-old Taslima Khatun, a mother of four, anaemic and weak. “People were hesitant about the clinics at first. They thought it was a temporary programme. Moreover, ours is a conservative society that frowns upon check-ups by male doctors,” she says. “But the elders realised that the team accept hardships for our welfare. Now everyone attends the camp”.
A farmer’s wife, Farida Begum, who gained 10kg and boosted haemoglobin levels after treatment, credits the clinic for her recovery from weakness. “I had a miscarriage and felt vulnerable, since there was no medical help at hand,” she says. “Four years ago, we never saw a doctor, but now, we have an entire hospital at our doorstep.”
Another villager, Abdul Khaliq, agrees, saying taking elderly and pregnant women to hospitals on the “mainland” is expensive. The trip costs `1,000, a lot of money for island people.
Doctors examine patients and write prescriptions as dishevelled, half-naked children gambol around. The immunisation programme is a success, with villagers shedding their misconceptions about it, a doctor, Noor Yeasin, says.
“People here are illiterate, so we have to fight against superstitions, convince them against visiting witch-doctors and remove wrong notions like (the belief that) taking iron tablets will make babies big and cause complications during delivery,” Yeasin says.
With floods sweeping away several of the islands every monsoon, doctors provide counselling on depression and alcoholism among the displaced.
By late afternoon, the team has wound up its work and has reached the bank to leave, but decides to set up an impromptu camp there to attend to some villagers who couldn’t make it to the school.
At the end of the work-day, as many as 550 villagers have received care.
The project began in Dibrugarh district in 2005 with three staff operating a boat clinic. It has now spread to 13 districts, with 250 personnel manning 15 boat clinics. They are popularly known as “ships of hope.”
Each team comprises a district programme officer, two doctors, nurses, mid-wives, pharmacists, lab technicians and community workers.
C-NES founder Sanjoy Hazarika came up with the boat-clinics idea after he heard about a woman in labour dying for want of medical attention.
“Assam also has the worst maternal mortality figures, so I thought why not provide such a service to vulnerable communities who face social and geographical exclusion?” he says.
The aid group partnered with National Rural Health Mission and the Assam government.
C-NES chief executive Dipankar Das says the clinics are challenging to operate: staff travel in unsteady boats during monsoons when river currents are strong. In summer, they trek long distances in blazing sun, lugging supplies. Some teams also undertake five-day tours in remote areas.
“Being part of such mission needs a sense of adventure and commitment. It is exhausting. But when we see a healthy mother and child, there is deep satisfaction,” Morigaon programme officer Shyamajit Pashi says. The clinics have drawn acclaim. The Centre has shown interest in launching similar services in other states.
India’s first full-fledged hospital ship, complete with an operating theatre and labour room is being constructed, and will be launched to ply the river in the coming months, Hazarika says. It will operate in regions that lack hospitals and function as a mother ship to which boat-clinics will be able to refer cases.