The ships of hope

sundayFloodwaters ravage the remote island of Lamba Sapori in Assam’s Dhemaji district as the monsoons rage. Trapped in their water logged home, Punyadhar and Oipuli Morang are in dire distress. Their two-year child has had an acute asthmatic attack. There is little they can do but hope. Time ticks off, each moment’s breath a greater burden on the infant. Enter Boat Clinic Shahnaz. On a return trip from a health camp, the boat spots villagers frantically waving at them to stop. Its health team swings to the rescue. Treated with adequate doses of sulbultamol, the child recovers within minutes. For Punyadhar and Oipuli, the team is no less than a godsend without whose timely intervention they would surely have lost their child.

Plying along the mighty Brahmaputra which bisects Assam, sweeping along 724 kms of its territory, before turning south into Bangladesh, are the “Ships of Hope”- from Dhubri on Assam’s south western border with Bangladesh to Tinsukia in the east. The ships have an important mission to fulfil.

There are over 2.5 million people like Punyadhar and Oipuli inhabiting the islands of the Brahmaputra. Known popularly as chars or saporis, these are among the most backward areas of Assam. The people here are so far untouched by development activities and remain marginalised, poor and vulnerable. Entire families with young children spend their days in the fields to meet their daily needs. Many live in thatched bamboo huts with a small piece of cultivable land, which is often temporary in nature, and depend on the whims of the river. There is no access to communication and people are badly hit by recurring floods. Post flood problems, losing homes and assets such as livestock are common; children seldom go to school.

The Centre for North East Studies and Policy Research’s (C-NES) innovative health initiative is aimed precisely at these vulnerable and marginalised communities. The organisation makes an invaluable contribution to their lives through specially designed Boat Clinics. The goal is to reach 10 lakh persons or one third of the flood-vulnerable population of the state by 2011.

C-NES’ unique health clinic story began with a single boat, a prototype called Akha (Hope in Assamese), also called “A Ship of Hope in a valley of flood” in Dibrugarh district in 2005; Akha received the World Bank’s India Development Market Place Award for the year 2004 for unique innovations for transforming the lives of rural communities. With funds from that award, the ship took shape at Maijan ghat, Dibrugarh. From that one boat, the initiative has been extended to include nine more.

C-NES’ Managing Trustee, eminent journalist and writer, Sanjoy Hazarika, who conceptualised the programme, says that the outreach is beyond his expectations. “We began with a simple idea, with one ship, in one district – Dibrugarh,” says Hazarika. “Today, the implementation of the programme in 10 districts with a staff of nearly 130 including 20 doctors, nurses and paramedics as well as the unstinted support we have received from NRHM and UNICEF shows that truly, there is nothing more powerful than an idea whose time has come; we are delivering not just health care but enabling people to access their basic right to a better quality of life.”

Five of the boats have been financed by the prominent editor and economist, Swaminathan S Aiyar, and named after members of his family. The boat for the Jorhat Boat Clinic has been donated by Oil India Limited (as part of its golden jubilee celebration). The remaining are hired boats. They are designed and equipped to conduct basic health care services either on the boat or on the riverbank in the char/sapori villages, with space for an out-patient department (OPD), a laboratory, pharmacy, cabins for medical staff, kitchen, toilets and crew quarters, equipped with generators, water tanks and powered by 120 hp engines. C-NES has designed and built the health ships at different sites – Dibrugarh, Jorhat, Dhubri and Nagarbera (Kamrup district) with local boat builders and materials. All safety aspects have been assessed.

While the main focus of the initiative – in partnership with National Rural Health Mission (NRHM) and UNICEF (in Dibrugarh) – has been on women and children, its benefits accrue to the population at large in ten districts across Assam – Dhubri, Barpeta, Nalbari, Morigaon, Sonitpur, Lakhimpur, Dhemaji, Jorhat, Dibrugarh and Tinsukia. In these districts, the boat clinics are reaching the poor and marginalised, with sustained health care for the first time in their lives – many have not seen a doctor, a stethoscope or a syringe ever. At a Dhemaji camp, an elated health team was informed by villagers that the first child in their village whose mother was under the team’s supervision for her prenatal check ups was named “Doctor”- a good reflection of how much the teams have managed to penetrate and make their presence felt and appreciated. Besides medical services, the psychological aid the programme has brought to these scattered communities is adding to their overall well being. Problems of alcoholism, depression and hopelessness abound in the islands, specially dejection at losing whatever little owned, year after year to the river.

In Dibrugarh’s Karmi Chuk sapori, 25 year old Phaguni Payeng, married to a daily wage earner and a mother of four , lived in constant dread of another pregnancy. Repeated childbirths had made her weak, anaemic and unable to work in the fields to supplement the meager family income. Each year,the river would sweep away her temporary home. Only the previous year she lost her only cow and entire belongings. Her life looked unbearably bleak- until a neighbour told her about Akha and the health camps.

The health team has since provided Phaguni with an awareness of and education on family planning methods. The team supplies her with iron tablets in the regular camps, which she attends without fail. It conducts immunisation programmes and regular medical check ups for her children. C-NES’ district community organiser and educational coordinator have convinced the couple about putting their children to the C-NES – UNICEF promoted feeder bridge course school in the vicinity. Her husband was given veterinary training and they have managed to buy two cows. Today, an optimistic Phaguni asks fellow villagers to attend the camps and follow what the team has to say.

Each district has a total strength of 14 team members. This includes one District Community Organiser (DCO), two Medical Officers, one general nurse cum midwife (GNM), one pharmacist, one laboratory technician, two auxiliary nurse midwives (ANMs), two community workers and four crew members. The Project Management Unit has five members at the Guwahati office and one in Delhi for coordination and data analysis. The ships go to the islands for three to five days at a stretch, with doctors and paramedical staff. Camps usually begin at 9 AM and continue with a brief break till 3 PM, when the team boards the ship for the next destination. After a night’s rest, they set out for the next camp. Sixteen-to-20 camps are conducted on an average month. Local communities and leaders are involved in the conduct of the camps, which are often held in difficult conditions, with teams battling floods and erosion in the monsoons and shallow routes and long walking distances to remote villages in winters.

“At times, we walk 10 km or more just to get to a village and hold a camp,” said a Medical Officer. “But the experience is enriching, since the villagers see us as people who are bringing an improvement into their lives – this is visible from our many visits. It is exhausting work but also deeply fulfilling.”

From Sadiya to Dhubri, children, women, and the elderly crowd the boat clinics with health queries and for general check ups. Laboratories which include auto-analyzers and pharmacies in the boats become functional as soon as the health camps start. Nurses take position in a separate enclosure near the check-up booth that caters to children and women for immunisations, ante natal care (ANC) and post natal care (PNC).  Diarrhoea, dysentery, ear and skin infections (both caused by prolonged exposure to river water, especially among children who are not in school), anaemia and fever are common ailments. Most are preventable- the health team gives them a lesson or two on maintaining personal hygiene.

There has been a distinct change in attitude, with increasing numbers of young mothers with babies clinging to their backs coming to the immunisation centres. Continuous visits and interactions by the health team with residents have created this transformation. Gone are the days when the very idea of an immunisation team coming to their homes was met with suspicion. There are examples of women asking for family planning, because they did not want more children since this could pose a danger to their health. At the close of camps, Medical Officers conduct an interactive session where they speak of the need for family planning, the importance of women’s health and that of spacing children. Their audiences listen with rapt interest.

The Boat Clinics have a more popular name – they are called the “Doctor’s Boat” by the children of the islands. They run along with the boat from the riverbank, waving their hands in keen anticipation as the boat passes by their sapori and continue doing so till it becomes a mere speck in the horizon. And the river quietly flows by…

(Some names have been changed)

Bhaswati K Goswami
(The Assam Tribune – August 30, 2009)

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