DIBRUGARH, Assam, India - Healthcare has long been a problem in much of Assam, a remote state in northeastern India, especially for people living on the many 'chars', or small islands, along the river Brahmaputra that flows through the hilly region.
Not only are there more than 2,000 river islands, they are also many hours from the nearest hospital – and even the nearest road – making it hard for pregnant women to get basic antenatal check-ups, or for mothers to get vaccinations like polio drops for their babies.
It was an enterprising journalist, Sanjoy Hazarika, who had the idea of "boat clinics" after hearing about a woman who had died in childbirth because she couldn’t reach hospital in time. Hazarika decided "the service should go to people rather than people coming to the service".
The first boat clinic named "Akha", or Hope, set sail in 2005 from Dibrugarh district. Doctors say the boats have played a major role in saving the lives of mothers and newborns.
The boat clinics now operate in 13 districts in Assam. A team of 250 people divided into 15 units, each with one boat, travel almost every month to these far-flung corners of the state to provide basic healthcare to a population of about 1.2 million. Each unit includes doctors, nurses and community workers. The floating clinics are now a joint venture between C-NES, a trust run by Hazarika, and the government's rural health mission.
In the sweltering summer heat, this unit is making arrangements for a trip. Boxes of medicines and vaccines are hauled aboard the ferry. Bags stuffed with bottles of vitamins are stored in one of the cabins. Piles of documents, among them antenatal cards, are stacked on a shelf. Soon the boat starts chugging along the Brahmaputra.
Over the next three days, it makes stopovers at the islands of Mesaki, Charkholia and Harlua Balua in Dibrugarh district. The distance from Dibrugarh to Mesaki is covered in three hours. As soon as the boat reaches the island, a makeshift tent is set up near the bank and scores of patients line up for examination and treatment.
Rombha Rava, a farmer, carries her nine-month-old son, Gonokanto, in her arms. By the time she reaches the clinic, her clothes are wet and her feet are covered in mud. Her son has had a fever for five days.
The nurse puts a wet cloth on the baby’s forehead to bring down his temperature. “I have not managed to reach hospital even once,” says Rava. If it weren’t for the boat clinics, she would have had to travel for seven hours by boat to reach the nearest hospital.
Illiteracy, ignorance and gender discrimination are still prevalent in this region, and when the boat clinics began operating, some residents were unwilling to seek help from trained medical staff, says Arup Saikia, the boat clinic district programme officer.
“Six years ago people wouldn’t even come out of their homes to meet the nurses or the doctors. They would rather visit their local traditional healers,” says Damayanti Das, a nurse who has worked with the clinics since 2008.
Breaking through cultural barriers is still a challenge, she says. For example, 21-year-old Sangita Yadav is pregnant and has come to the clinic for a tetanus shot. She refuses to remove her veil during her consultation with Das.
But Das says attitudes are changing as they teach people how polio drops, vaccines and medicines can help their babies fight illness. Here, an Accredited Social Health Activist (ASHA) worker from a local village is giving polio drops to a baby.
The boat clinics also run immunisation programmes. Pentavalent vaccine, DPT vaccine along with hepatitis B, polio and vitamin A drops are made available for babies free of cost. “The boat clinics are our only hope,” says Urmila Yadav, a local ASHA worker from the river island of Charkholia.
Along with the immunisation programmes, the team conducts routine antenatal check-ups.
Sarita Yadav, 23, walks carefully down a flight of stairs on the boat. She had her first child - a boy - last November. Within months she had become pregnant again. “Did you take the contraceptive pills we had given you earlier?” asks Nandita Kalita, the nurse examining her. Yadav wobbles her head to say no, her eyes downcast. It is too early for her to get pregnant again, Kalita tells her.
Kalita stretches her eyelids to look for signs of anaemia. “They are colourless,” she says. Yadav’s blood reports indicate her haemoglobin level is low. Yadav is being referred to the nearest hospital for delivery.
Before the intervention of boat clinics in these isolated areas, pregnant women died unreported because of complications such as severe anaemia, high blood pressure, strokes, obstructed or prolonged labour, excessive bleeding and high fever. Now, the women are encouraged to give birth in hospitals and the ASHAs from their villages are asked to keep in touch with them, Dr Saikia says.
The team also maintains a record of newly married couples and the local ASHAs are required to keep in close touch with them. Early recognition of risky pregnancy cases, their treatment, monitoring and encouragement for a hospital delivery, have reduced maternal mortality in the district, he says, though no official figures were available.
Boat clinic doctors say health problems they handle include malnutrition among children, many of whom are vegetarians and do not eat fish or meat. Children also suffer from fever and upper respiratory conditions. They live in mud houses so they catch cold as the weather here is windy, says Dr Juganto Kumar Deori, a clinic doctor.
Other health problems include hypertension and fungal infections, as most of the people who work in these flood-affected areas are farmers, often working in muddy or water-logged conditions. They are given bottles of Gentian violet solution.