JOIN USA boon for people living on islands
In Assam, boat clinics take health care to thousands who have never seen a doctor
The Mighty Brahmaputra that flows through Assam divides the state almost into two. There are thousands of freshwater islands that dot the river and for 3 million people who live on those islands one of the biggest challenge has been access to health care.
There are no doctors, no paramedics on these islands. People living there are usually poor farmers or people who have lost land due to floods and erosion. They mostly depend on village quacks and in case of a medical emergency they have to spend all their savings to hire a boat to the nearest town.
But now there is a phenomenal change in health service in the form of boat clinics. Centre for North East Studies and Policy Research (C-NES), a non-governmental trust working for social transformation in the Northeast India, decided to usher in the change.
With 15 boats covering 13 districts of Assam, a dedicated team of 236 medical professionals reaching out to nearly 450 chars (sand bars) and saporis (islands) on the Brahmaputra and its tributaries, the boat clinics initiative of Assam has taken basic health care to remotest areas.
Going by government record, char and sapori dwellers make about 12 per cent of the total population of Assam and they lived all along the stream of the Brahmaputra. Right from Tinsukia to the Dhubri there are 2,500 islands, the boat clinics till now have been able to cover nearly 2.5 million people. Every boat clinic will have a team of doctors, nurses and paramedics along with other support staff and crew.
The boats reach out to islands every month, conduct health camps, administer vaccination to children and carry out routine checkup of pregnant women apart form normal health checkup of every one living on the Island.
Every year, massive floods and equally horrific erosion by the Brahmaputra threaten their lives. Thousands of these people migrate from one island to another in search of shelter and livelihood. There is almost no sense of governance in these islands. “The main focus of the project is to ensure health facilities for the marginalised people. Most of our boats carry a team of 15 members.
This comprises two doctors, two-three nurses, a pharmacist, a lab technician, community workers and the boat crew. In every unit, we have a district programme officer who leads the team. The boat has a pharmacy and a laboratory. Whenever our team finds patients in a critical condition, they refer them to nearby hospitals. We have small boats attached to our units, which are used to shift such patients to hospitals,” said C-NES communication officer Bhaswati Khaund Goswami.
The idea of boat clinic came in 2002 when noted journalist and social scientist and C-NES managing trustee Sanjoy Hazarika witnessed a pregnant woman dying due to lack of medical facilities in Majuli in the Jorhat district of Assam, one of the largest freshwater islands in Asia. The unfolding of the tragedy in front of him shook him.
He came up with the idea of boat clinic and it won the World Bank’s Development Marketplace competition in 2004. One year later, with the prize money, the C-NES built a boat clinic and named it Akha (meaning hope in Assamese). That was the first boat clinic and it is still operational in the Dibrugarh district.
The success of the first Boat Akha grabbed attention of Unicef and it soon came forward to partner the initiative. Soon, the National Rural Health Mission (NRHM) showed interest and a public-private partnership followed.
By 2008, the boat clinics had started operating in five districts of Assam. A year later, two more were added. By 2010, there were 15 units in 13 districts — the thickly populated Dhubri and Barpeta have two units each. Every year, at least 500 health camps are held and till now18,893 camps have been organised.
“The NRHM actually lets us know which are the islands which are not covered by the regular health care set-up and send our teams there. The NRHM provides medicine, manpower and basic funds. But we need to engage a trained crew and support staff apart from the district programme officers. The boats need regular maintenance and it is expensive,” Goswami said.
Although the project is largely aimed to provide basic health care, the units have handled even critical cases. Till now they have handled 11 delivery cases. They have played an important rule in the intensive polio immunisation. In thickly populated lower Assam, mostly dominated by the Bengali Muslims, the boat clinics also conduct campaign on family planning.
Weather is a big challenge for these boat clinics. Every season brings its own challenges. In summer, the higher water level enables the boats to get closer to the villages. But the risk of flooding is high. In winter, the crew relies on bicycles to reach the villages after being forced by receded water levels to anchor the boat far from shore. “There was a time when no one in our village ever saw a doctor. We did not know what a doctor looked like. If anyone was very serious, we had to hire mechanised boats or even country-made boats. It would cost a fortune. All that pain is gone,” said Bhogeshwar Saikia, an elder of a remote island in the Jorhat district.
In Assam, these boat clinics are on a mission. They take health care to places where there are no roads, no electricity and no semblance of governance. They reach people in distant islands who have never seen their elected representatives, yet the only blessing is that these boats go where no one goes, carrying essential medicines, doctors and above all hope of survival for the most marginalised.