Hope Floats
Manoj Pegu looks at the rising Brahmaputra with anxious eyes. The monsoon season has brought with it a heavy downpour. Another week of incessant rain would result in a bout of flooding in the secluded Konkurmukh island in Assam, where he lives.
But the 40-year-old is not bothered about getting marooned. Since childhood, he has managed to deal with floods. He is worried about his wife Anita, 33, who is due to deliver a baby any moment now. If he fails to take her to a hospital in either Lakhimpur or Jorhat town, the lives of both mother and child would be at peril.
The only means of transportation are the small boats called bhutbhuti. But the high tide makes it impossible to venture out.
Konkurmukh, home to 300 residents, has neither power nor roads. There is no healthcare facility. Not even a doctor in the vicinity. The nearest clinic is located at Lakhimpur, a two-hour boat ride away. The district headquarters, Jorhat, is another six hours.
Given the situation, the easiest thing for Manoj to do is to leave everything to fate. At best, he could leave his wife in the hands of the local quack.
As the clock ticks away, Manoj turns restless. Suddenly, as if it was an answer to his prayers, he hears the distinct drone of a diesel engine in the distance. Hope kindles as he sees a big boat coming his way.
As the double-decker SB Nahor moves parallel to the erosion-hit bank of Konkurmukh, Manoj shouts at the top of his voice, “Hunkale ahok doctor sir, nurse baideo, mur ghorot delivery case ase, emergency case (Doctor sir, nurse, come quickly. I have an emergency delivery case at home).”
His cry for help catches the attention of the boat master, Sashi Pamegam, who promptly informs the lower deck. As the master anchors the boat, Manoj rushes in with folded hands and tears in his eyes and requests help. Soon, a doctor, a nurse and a community worker run out of the boat with an emergency kit. They follow Manoj through the marshy track and paddy fields in knee-deep water — a stretch of about 5 km from the riverbank.
Once they reach the hut, Dr Pranab Pegu realises that even a slight delay in delivery would risk the life of mother and child. The nurse instructs the community worker to rush back to the boat and get more equipment.
But time is running out and Dr Pegu decides to go ahead with the delivery with whatever he has at his disposal. Twenty minutes later, the house reverberates with the cry of the newborn. The proud father breathes a sigh of relief and hugs the doctor. “You are a godsend,” he exclaims. He names the newborn Pranab, after the doctor.
“This kind of emergency can be challenging for any doctor,” Dr Pegu explains later. “I am happy that I could conduct a safe delivery. For the people living in this river island, healthcare is a big challenge and the fact that we could make a little difference gives us immense satisfaction.”
The boat clinic is the initiative of the Centre for North East Studies and Policy Research (C-NES), a non-governmental trust working for social transformation in the Northeast.
With 15 boats covering 13 districts, a team of 236 medical professionals reach out to nearly 450 char (sand bars) and sapori (islands) on the Brahmaputra and its tributaries. Three million people — 12 percent of the state’s population; mostly peasants and fishermen — live on nearly 2,500 island villages on the Brahmaputra. The boat clinics cater to 2.3 million of them.
Every year, massive floods and equally horrific erosion by the Brahmaputra — which cuts Assam into almost two equal halves — 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 sapori, which appear as tiny dots on the mighty river when seen from the air.
“The main thrust of the project is to ensure health facilities for the marginalised people,” says C-NES communication officer Bhaswati Khaund Goswami. “Most of our boats carry a team of 15 members — two doctors, twothree 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 local hospitals. We have small boats attached with our units, which are used to shift such patients to nearby hospitals.
Often, we face challenges in the form of emergencies in adverse conditions. Our team has performed as many as 15 emergency deliveries during a flash flood. Our focus is on the mother and the child.”
The story of the origin of these boat clinics is as captivating as its functioning. In 2002, noted social scientist and C-NES managing trustee Sanjoy Hazarika witnessed a pregnant woman dying due to lack of medical facilities in Majuli, one of the largest freshwater islands in Assam. Hazarika was shaken by the tragedy that unfolded in front of his eyes. He was appalled by the stark contrast of the country spending crores of rupees on the healthcare of mothers and children, while people were dying due to lack of basic healthcare in the remote sapori of Assam.
That death spurred Hazarika to come up with the idea of boat clinics. The idea went on to win the World Bank’s Development Marketplace competition in 2004. One year later, with the prize fund, C-NES built a boat clinic and named it Akha (hope). It is still operational in Dibrugarh district.
The idea was an instant hit among the rural folk in Dibrugarh. Unicef took notice and came forward to partner the initiative. Soon, the National Rural Health Mission (NRHM) showed interest and a public-private partnership followed.
“In 2008, the boat clinics were operating in five districts,” says C-NES CEO Dipankar Das. “In 2009, five more districts were added. In 2010, we were operating 15 units in 13 districts — the thickly-populated Dhubri and Barpeta have two units each.
We have units all along the course of the Brahmaputra in Assam.”
Last year, the boat clinics visited 428 saporis, twice a month, for conducting routine health check-ups.
“Our action plan is decided in accordance with the nrhm guidelines,” says Das. “They let us know which saporis are not covered by the regular healthcare 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.”
Apart from the weather, the mission faces plenty of challenges. “The boats need regular maintenance and it is an expensive affair,” says Das. “Being a non-government trust, we also face fund crunches. We need adequate resources to reach out to more people.”
The boat clinics have changed the lives of people such as Nileshwar Mili. “Some of my friends had never even seen a doctor in their lifetime,” says the 76-year-old village elder from Kachikata sapori. “Thanks to this project, at least our healthcare is taken care of.”
Mili recalls the ordeal of shifting a pregnant woman from a village in upper Assam’s Tinsukia district to a hospital located 35 km away. She had to be carried for miles through the dense jungles that are part of the Dibru-Saikhowa National Park, infested by militants and wild animals. Thanks to the boat clinics, such stories are rare nowadays.
In thickly-populated lower Assam, the boat clinics are also used for health awareness outreach programmes. In many villages, it is the only means by which the people get to know about family planning.
“In such places, immunisation and family planning advisories have made a big impact,” says Mehbub Alam Hazarika, the district programme officer at Dhubri. “People had no idea about such issues. Initially, we faced some resistance but later on they realised the significance of family planning.”
Adds Hazarika, “We have introduced a screening system to find out if any of the children are yet to be immunised.”
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.
The flash floods in June 2012 were the most challenging. Almost every district in Assam was under water. The boat clinic in Tinsukia braved the flood to reach the marooned people in a remote island. Wearing raincoats, the team attended to more than 300 patients.
A boat clinic makes two rounds of a sapori in a month. The villagers get everything — doctors, paramedics, lab tests and medicines — under one roof and free of cost.
Each time a boat clinic embarks on a new journey, there are thousands of hearts beating with a hope that the doctor will come calling and ease their pain.
http://www.tehelka.com/boat-clinics-provide-healthcare-to-3-million-people-in-assams-river-islands/#.VA6hxPmSySq