Ship of hope

Chimpi Bora was in pain. The 21-year-old, who is from the remote village of Bhimpara in the Jorhat district of Assam, northeastern India, started experiencing labour pains late at night and by dawn, intense contractions had begun. Tense and worried, her husband Bora sat helplessly by her side. He couldn’t take her to the hospital – floods due to the incessant week-long rains had washed away the roads leading to the nearest health centre, two kilometres away.

Now their hut, which stood barely a few metres from the fast-rising mighty Brahmaputra River, was in danger of being flooded by water. Desperate to save his wife and their unborn first child, he considered carrying her to the health centre. But the water on the now non-existent road was almost knee-high and 25-year-old Bora knew that one wrong step could prove disastrous. Not knowing what to do he stepped out of his hut and suddenly spotted something in the distance – fog lights of a boat on the river.

Hope pulsing through him, Bora rushed to the river’s edge and began shouting and waving his arms hoping the people on the vessel would see him. Luckily, they did. The boat, part of an initiative of the Centre for North East Studies (C-NES) and Policy Research, a non-government organisation, was carrying a team of doctors. It’s mission: to improve the health conditions of people in the remote region who have little access to healthcare.

Minutes later a doctor and a nurse carrying a medical kit, containing life-saving medicines, waded through the waters to Bora’s hut where they helped Chimpi deliver a healthy baby boy. After the rains abated a bit, mother and child were shifted to the boat by stretcher and transported to the nearby health centre. “The ship of hope saved my wife,’’ says Bora, crying with happiness. “If the doctors and the boat had not come by at that time I would have lost my wife and my son.’’

Thanks to a unique geographical phenomenon – a vast network of 2,500-plus islands – that characterises the river Brahmaputra in its 760km course through Assam, a majority of the 2.5 million people living in the area are often at risk of losing their lives or suffering crop, property and livestock loss whenever the temperamental river overflows it banks. It’s for these people that the boats have been lifesavers. The brainchild of Sanjoy Hazarika, a journalist, editor and filmmaker, C-NES was launched in 2000 following an incident he witnessed in his home state of Assam.

“During the course of my travels as a journalist, I came across the case of a young woman who had died in childbirth on a remote island only because her family couldn’t get her to a medical facility on time,’’ says Sanjoy. “While I was shocked and saddened, I felt such a situation was unacceptable.’’ A former correspondent for the New York Times and author of several books including the critically acclaimed Strangers of the Mist, Rites of Passage and Writing on the Wall, Sanjoy wanted to do his bit to improve the system.

“After discussions with the local people, I realised that access is the key to delivering basic services. The simplest and best way to reach those in need is by the very transport they have used for centuries – boats. And if there is a better designed and specially equipped vessel carrying medical teams, medicines and equipment, we can help save lives and radically improve the health conditions of the people.” The need of the hour was to bring medical services to the people, not wait for them, as they had many difficulties coming to the mainland for care.

Sanjoy formed a small team and got to work designing, developing and implementing the boat clinic. He then entered C-NES’s concept of the boat clinics into the 2004 World Bank’s India Development Marketplace Awards – a competition that aims to identify and support social entrepreneurs who are seeking finance for sustainable business models that can improve the lives of poor communities in India.  To his surprise he won, and Sanjoy used the award money to construct the first boat – Akha, which means Hope, in Assamese.

On May 25, 2005 the boat made its maiden journey in Dibrugarh district of upper Assam to conduct an immunisation camp with two doctors and three nurses. It was so successful that the initiative immediately got the attention and support of Unicef and the National Rural Health Mission (a government programme) in Assam, which offered to support Sanjoy’s project. Individuals and corporate bodies also chipped in, offering to foot the cost of building boats. Today there are 15 boat clinics operating in 13 districts of Assam. They are lifelines for millions of people who live on the islands.

The boats are equipped with laboratories and pharmacies, and provide basic health services including family planning, reproductive health, children’s health and laboratory testing. “We are delivering not just health care but enabling people to access their basic right to a better quality of life” says Sanjoy. The effort has reached over one million people today. Each boat carries a fully fledged medical team of two doctors, three nurses, a lab technician and a pharmacist.

All of them are paid by C-NES, which depends on the Government for support in terms of finance as well as medicines and equipment. “Funding however, remains a challenge and C-NES accepts help from individuals, business and philanthropic institutions for its corpus and activities,’’ says Bhaswati Goswami, communications director of C-NES. Regular medical camps are organised on the islands through a network of community health workers and village elders. “The goal is to take sustained health care to marginalised people particularly women and children who continue to be the most vulnerable in difficult conditions,’’ says Bhaswati.

Saving mums and babies

What makes the boat clinics initiative truly praiseworthy is the fact that it has been able to tackle the high maternal mortality rate in Assam, which at 490 per 100,000 in 2004-2006 was one of the highest in India. Since the clinics began operations in 2005, there has been a marked decline in the number of deaths. The most recent figures show that it is down to 390 per 100,000 – a vast improvement, but still higher than the national average of 212 per 100,000.

For most pregnant women living on the islands in Assam, visiting a doctor is a daunting task. Those on Laika Island, for instance, have to first travel in a country boat over the moody Brahmaputra River, then tread a couple of kilometres through dense forest braving wild animals, snakes and blood-sucking leeches before reaching a health facility. Not surprisingly, most women avoid pre and antenatal check-ups and prefer to deliver at home – a reason for the high maternal death rate.

The launch of the boat clinics has been a huge boon to the women who now wait for the arrival of the white boat with the doctors. “It has truly changed our lives for the better,’’ says Arumoni Regon, a village elder in Laika. Apart from helping to reduce the maternal mortality rates, the floating clinics have also helped improve the health conditions of people living on the islands.

Bangshidhar Doley, a farmer from Madhupur village in Tinsukia district of upper Assam was severely anaemic due to a poor diet. “His haemoglobin count was a mere 2.2,’’ says Dr Aaron Momin, a doctor on the boat. Normal levels in grams/decilitre for men is 14-17. “After being treated by the Tinsukia Boat Clinic, his haemoglobin count improved to 9.4.’’

‘Deeply fulfilling’

Medical officer, Dr Bhaben Borah says, “At times, we walk 10km or more just to get to a village and hold a camp. But the experience is enriching since the villagers see us as people who are bringing an improvement into their lives. It is exhausting work but also deeply fulfilling.” Children, women and the elderly crowd the clinics with health queries and for general check-ups. Nurses work in a separate enclosure near the check-up booth that offers children and women immunisations, antenatal and postnatal care.

Diarrhoea, dysentery, ear and skin infections – caused by prolonged exposure to river water, especially among children who are not in school – anaemia and fever are common. Most are preventable. The health team gives patients a few lessons on maintaining personal hygiene. “Most of the villagers had never seen a doctor, a stethoscope or a syringe,’’ says Bhaswati of C-NES.

“In fact, we recently received a report from a camp at Dhemaji district where an elated health team was informed by villagers that a child born in their village whose mother was under the team’s supervision for her prenatal check-ups was named Doctor – a gesture of appreciation for helping her during a difficult period in life.’’ A routine day for the medical personnel on the boat clinics begins early. After a heavy breakfast for the long day ahead they set off with medicine and camp essentials to a destination, very often, in an interior village on an island.

The conditions are challenging – if it is summer, the sun is scorching. If it is monsoon season, doctors and nurses wade through flooded villages infested with leeches and snakes. Each clinic is open for about three to four hours where, on an average, around 150 people are treated. Most evenings are spent meeting with the local community and village elders, showing them educational films on hygiene, family planning and health.

During summer, time permitting, they also organise games such as football, cricket and volleyball on the sandy river bank. Rainy evenings are spent playing indoor games or watching movies. The team has had a fair share of adventures as well. “In June this year, when floods ravaged Assam, a small team on board the Swaminathan named after its donor, prominent editor-economist, Swaminathan S Aiyar, was helping the marooned people when their boat’s engine failed on the river.

“For six days they were stranded on the boat in the middle of the raging river. With all communication systems failing, the team was forced to spend sleepless nights as the boat rocked and heaved because of the strong waves. “With drinking water running out after the fourth day, most of the team began to suffer from dehydration. It was on the sixth day that an Indian Air Force helicopter spotted the boat and rushed to airlift the team.

“But the committed team was back at the same area the next week to complete the camp schedule,’’ says Bhaswati. According to C-NES, last year alone, 58,945 people benefitted from the various medical camps organised by the floating clinics. “When I launched the floating clinics, my aim was to reach one million people by the end of 2012, and we have already achieved that,’’ says Sanjoy.

The Indian government is keen to use the model in a few other states. A hospital ship with an operating theatre, recovery rooms and wards is on the drawing board. “It should be launched in a year or two,’’ Sanjoy says.

With additional inputs by Bhaswati Goswami

http://gulfnews.com/life-style/general/ship-of-hope-1.1111401