The river Brahmaputra which was always raging is very calm today. It seemed that slow waves in Noor village in Assam’s Bongaigaon district were preventing boats from entering the clinic. Nine-month-old Noor Khatun will be vaccinated against measles and rubella (MR) and Japanese encephalitis (JE) today. He will also be given a dose of vitamin A.
Nur Khatun’s mother, 25-year-old Munawara Khatun, was waiting at the riverside boat clinic.
Munawara Khatun is more relaxed than when he came to the boat clinic last June. At that time his house and village were submerged in flood water.
At the boat clinic, Nirupama Roy, a 41-year-old experienced nurse and midwife attends. Nirupama has been working at Boat Clinic for over a decade.
He and his colleagues were working quietly through the morning rush, updating registers, administering vaccines in the cold chain and preparing to set up a makeshift health clinic in Noor village on Khorchimari Island. Local people call this clinic ‘Charas’ or ‘Saporisas’.
In fact, this boat clinic is like a primary health center (PHC) with all the basic health facilities like laboratory, OPD, pharmacy and cold chain point.
There are also two Auxiliary Nurse Midwives (ANMs), a pharmacist, a laboratory technician, community workers and support staff.
Nirupama said with a smile, “These people, who have no other health facilities apart from the health care available on this boat, have become healthier and happier since our arrival. These children enjoy this work as much as my own children.”
Boat clinics are proving crucial in providing health facilities to remote areas of Assam.
ray of hope
Assam’s unique topography of rivers and hills creates many barriers to access to health care, especially in rural and remote areas. Many places become impassable during the monsoon season, making it very difficult for healthcare workers to reach these areas.
Most of these river islands in Bongaigaon district are constantly changing due to the flow of mighty Brahmaputra river. An island once full of cattle and greenery, can be destroyed overnight by monsoon rains. Because of this, the inhabitants may face the threat of displacement, or the island may disappear completely.
In such a situation, the boat clinic is a beacon of hope for thousands of people in Assam’s riverine islands, including Noor Khatun’s mother. The boat clinic is a lifeline for them, providing essential medical facilities to around 20 thousand people every month.
Due to frequent flooding and erosion on these islands, it is almost impossible to build and maintain permanent housing and basic healthcare infrastructure.
It can be reached only by local boats. Most of the population is poor, and due to the lack of quality maternal, newborn and child care services in these villages, morbidity and mortality are increasing.
In 2004, a local NGO, the Center for North-Eastern Studies and Policy Research (C-NES), started a boat clinic to provide much-needed medical services in the region. The United Children’s Fund (UNICEF) in India has also joined the initiative, helping build the capacity of health workers.
A team led by Sanjay Hazarika of C-NES worked tirelessly to build Akha – ‘A Ship of Hope in a Valley of Flood’.
Over the past twenty years, the boat clinic has provided essential healthcare to over 2,500 people in 13 districts. Currently, there are 15 boat clinics operating on the river, where about 18,000 to 20,000 people are treated every month.
“Ten years ago, people here faced countless hardships,” said Nirupama, “sick children did not take medicine at night, and pregnant women rarely had health checks.”
“Now, it gives me satisfaction to know that people trust us, and they breathe a sigh of relief when we arrive early.”
A story of endurance and determination
After an hour and a half journey through the turbulent waves of the Brahmaputra river, the boat clinic finally reached the shores of the Char of Khorchimari. The day was as challenging as ever: in extreme heat and humidity, they had to walk over a kilometer and a half to the makeshift health center. For medical care, they also carry essential medicines, medical equipment and other heavy items.
“When we reach there, children and pregnant women crowd around us. We check the height, weight and blood pressure of the pregnant women,” said Dr Nazrul Islam, medical officer of the boat clinic.
“Children, especially newborns, are vaccinated because they need a new dose every 28 days.”
Most people in the society know Nirupama by name. He meets Munawara Khatun and Noor Khatun and informs them about their health and Noor’s immunization programme.
Munawara is coming to the clinic to get her last two children vaccinated along with Noor. Noor is given measles-rubella (MR) and Japanese encephalitis (JE) vaccines and vitamin A supplements.
Munawara Khatun said, “All my children received vaccinations and medical facilities whenever I had any problems during birth. Doctor and ANM didi (sister) are very good. “All three of my children received vaccinations and treatment at the boat clinic.”
Village elder Muzhar Ali said, “The boat clinic has been very beneficial for us. It has proved helpful for pregnant women in our area, as it has ensured safe delivery. Due to the availability of doctors we are able to vaccinate our children on time. We are very happy.”
Source of change – Solar powered cooling unit
This is largely thanks to the innovative Solar Direct-Drive (SDD) refrigeration unit made available with UNICEF support. It has changed the face of health care delivery in the remote riverine islands of Assam.
Earlier health workers had to go to the district health center to get the vaccine. It has wasted a lot of time. A cold chain, i.e. a temperature-controlled system for vaccine storage through solar-powered refrigerators (SDDs) is now available inside the boat clinic.
This simple but effective innovation has greatly improved vaccine delivery.
“Before starting SDD, we had to go 12 kilometers to get vaccinations, which has been made easier by providing cold chain points on boats with the help of UNICEF,” says Nirupama.
