Dropping Anchor in the Brahmaputra: The Boat Clinics of Assam

There have been very few events in my life which have not only been life-changing but also provided a great learning opportunity. A recent trip that I undertook to Assam definitely qualifies as one of those. The backdrop to this experience relates to learning more about ‘healthcare’ coupled with my need to venture out on my own to gain a practical and unique field-related perspective. It would be safe to combine the both since leaving any one aspect out would defeat the purpose of why I write this. Working away long hours at my desk for a corporation kept me thinking about how exactly the nation will improve its health indicators with the ambitious goal of achieving the Sustainable Development Goals (SDGs). I work with an American for-profit healthcare organization, which has now taken up the task to touch upon India’s public health system by selling high end sophisticated health technology solutions. Based on my limited experience and expertise, these solutions, I believe, are thoughtfully designed and work great in a well-equipped health ecosystem. However, in my view, it may be too premature to expect these practices to be implanted in nations like India where the health infrastructure in some ways is woefully inadequate. So what exactly is the immediate need of the hour when it comes to public health in India?

Apart from validating what I felt about the health scenario, I also needed to participate in a cause that would give me a chance to think on my own terms, as well as evaluate and assess the ground realities. I needed a fresh perspective and I was frantically scouting sources for any such opportunity till I came across a BBC article mentioning the award-winning boat clinic initiative by the Center for North East Studies and Policy Research (C-NES) for the populations residing on the river islands of Brahmaputra, Assam. The purpose of this initiative was to make primary healthcare more accessible to the rural population on these islands and this was fully funded by the National Health Mission (NHM) in Assam. This was exactly what I needed: An opportunity to assess how our NGOs were assiduously working for enhancing access to the public health system at the grassroots level. I contacted the team leading this initiative and in no time planned my sojourn.

July is usually a risky month and not one of the best times to venture out into the Brahmaputra due to the heavy monsoons with the prospect of the river being in full spate. Many people warned me against it, but deep down I was determined. I landed in Guwahati and made a trip to the C-NES office to meet the team and the Head of Communications at C-NES, where I was provided the context and background of the initiative. 15 boat clinics across 13 districts in the remote interiors of Assam might not sound as something gigantic at first but when we got down to the details of the operations and the tireless efforts of the paramedics staff and programme officers to make this work without fail each and every month, the effort looked more laudable and true to the claims made in the BBC report.

I devised a plan on how to go about this trip and started with the team for Kamrup, a rural district in rural Assam near Guwahati, which has a population of around 17,000 people. The team comprised of the District Program Officer (DPO), two doctors, one Auxiliary Nurse Midwife (ANM), a pharmacist and a lab technician for the blood tests.

The team was all set for a day health camp and on reaching Kaltuli village situated on an island, we set up the camp which comprised of vaccinations, medications and other necessary items. National Health Mission (NHM) usually appoints Accredited Social Health Activists (ASHA) workers in each village who are responsible for communicating important health related information to the population and who keep a record of all the patient data. These ASHA workers are trained by the National Health Mission and are in constant touch with external bodies for the successful implementation of any project. The folks residing in Kaltuli village gathered at the camp within no time after receiving the communication from their appointed ASHA worker. They were mostly women with newly born infants and children. It was as if they were waiting for the camp to be set up and were thankful that the team had arrived.

The boat clinics are responsible for a couple of services including Antenatal and Postnatal checkups, general health checkups, immunizations, vaccinations and family planning medical advice. The medicines are supplied from the National Health Mission (NHM) every month and are mostly generic formulas. For serious cases, the patients are sent to the nearest District Hospitals as referrals, and that would mostly be in the nearest town or city.

The approximate number of checkups in that one village were somewhere around 15-20 for Antenatal, 80 for general health checkups and 5-6 for Postnatal checkups. This was a Day health camp, and so, honestly speaking, I didn’t have much time to gather all that I wished by way of insights.

The next part of my plan was to fly to Dibrugarh, a beautiful city surrounded by lush green tea gardens in north Assam. This for me was a major eye-opener! I had a day before I began my second two-day boat clinic initiative, so I thought best to utilize that day and decided to visit the Brahmaputra Radio Community Center. This wasn’t part of the original plan as my main agenda was to cover health, but I wanted to make the best use of time in my hands. The community radio center is the hub where the radio broadcasting is carried out within a radius of 25-30 kms and with the main purpose of raising awareness on adolescent health issues, nutrition and other general health issues amongst the population in the tea gardens and river islands. The radio center will also soon be starting a community video Trying to bridge the healthcare gaps through the boat clinic initiative is one thing, but reinforcing the importance of health day in and day out on a continual basis is quite another.

The next day, I took one look at the boat clinic at Dibrugarh, and heaved a great sigh of relief as it looked quite well-equipped to handle any unforeseeable storms or weather conditions. In the worst case we always have helicopters to rescue us, said a senior doctor. That wasn’t very reassuring, but I brushed it off and thought about my goal and the larger scheme of things. After all, what is life and learning without a bit of adventure and risk?

The boat clinic, as I observed had different sections and compartments, one which was stacked with medicines and vitamin supplements, a different section for carrying out the blood tests (lab), and a couple of travel boxes with the necessary equipment for immunizations and vaccinations. Like the boat clinic team back at Guwahati, the team here comprised of doctors, pharmacists, a lab technician and two ANMs. The only difference would probably be the size of this particular motor boat which was larger and I safely assumed that it was owing to the weather conditions and the extensive travel needed unlike the day trips at Guwahati.

So off we went on both our ‘humble ship’ and very ‘large motor boat’ into the vastness of the Brahmaputra to treat patients on faraway islands. We reached one of the village islands, and the patients started pouring in one by one. I looked at the senior doctors, the pharmacists and the nurses who visited these areas each and every month without fail and wondered how many lucrative opportunities these folks must have left behind to work laboriously for such a noble cause. The senior doctors, who were nearing 60, could have joined a private hospital near their residence, but the decision to serve the boat clinics was a deliberate choice they had made. They made it their business to follow up with the patients in the rural areas just because they hadn’t seen them in a while and were genuinely concerned about their well-being, hoping that they haven’t given in to death during the long 2-3 hour boat journey to Dibrugarh in order to get advanced level of treatment in the district hospital.

And the concern doesn’t end there with the wrapping up of the clinic after 5 pm. It goes on till the wee hours of the night where we docked the motor boat near another village and had to sleep through the night. The doctors tended to old patients who walked 3 kms using their torch lights to reach the boat. Towards the end of the day, we had covered 111 patients out of a population of 583 in that village, and this excludes the patients who visited during the night. Now, where would these patients go had there not been a boat clinic in place?

I woke up to the soft pattering of rain the next morning, and woke up as a somewhat changed person. While sipping on the wonderful tea made by our cook on the boat, I took in the picturesque surroundings and contemplated about the very purpose of my work. We still had a couple of more health camps to cover at a village, but I had experienced just about enough by that point to start rethinking some of my personal goals in life. I recalled the instance where the folks in the village had delightfully served me tea with limited amount of milk in their modest little huts, and with their eyes shining with hope. Many of them thought I was a journalist and prompted me to write about some instances and problems they had faced regarding the healthcare accessibility.

I had given my word to them and stated that even though I am no journalist, I will however make an attempt to write about what I have come across in an article. I am no public health expert yet, but I do believe that the Indian health system has a long way to go and there needs to be proper policies in place starting from the ‘think tank’ level to the operational level where an ASHA worker is incentivized properly for her work.

On hitting land again, I went back to the hotel at Dibrugarh enriched with this experience and several thoughts running through my mind. ‘Ma’am, what would you like to have for dinner?’ asked the good old friendly cook. I smiled and said to him ‘Please make me some Assamese fish Tenga curry with steamed rice’.

Interacting with both the rural population in the remote areas of Assam and the boat clinic teams has been both a very humbling and richly rewarding experience for me and has given me a new direction in life and a renewed commitment to work towards enhancing access to healthcare.

Pratyasha Acharya

Disclaimer: The views of the author are personal

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