As the Dhemaji medical team proceeded to conduct a health camp at Pakhoriguri sapori (island village) they are stopped by a few villagers, “An emergency” they said, reports Vinta Nanda

21st April 2020, started early, like any normal day for the C-NES Boat Clinic health teams. The Dhemaji Boat Clinic team in Upper Assam, bordering Arunachal Pradesh, was prepared for another long day ahead. Times were uncertain and challenging. Along with routine health checkups, the Boat Clinics have also been tirelessly fighting the battle against the raging COVID-19, spreading awareness to prevent the pandemic in the far-flung Brahmaputra river islands, remote and underdeveloped. Regular awareness sessions are extremely critical for the insular river islanders amongst whom the clinics deliver basic health services and more supported by the National Health Mission (NHM), Government of Assam.

As the Dhemaji medical team proceeded to conduct a health camp at Pakhoriguri sapori (island village) they are stopped by a few villagers, “An emergency” they said.

Her parents were bringing Silaboti Boro, a pregnant 19-year-old, in a country boat to the nearest mainland hospital, from Udaypur village of Mechaki Sapori, because all roads were closed due to the nationwide lockdown in the district. Silaboti’s husband was far away in Chennai, she had started labor pains in the boat itself and the family was not being able to contact the 108-ambulance service despite frantically trying to.

The very sight of the “Doctor’s Boat” from afar was a godsend. It was noon. The young Medical Officer, Dr. Modhusmita Hazarika and Auxiliary Nurse Midwife (ANM) Mohima Boro had no time to lose. They had to make a quick decision. There was no way they could take her to the nearest health center. It would be too late. It had to be here, now on the country boat itself. The surface was cleaned, necessary hygienic precautions taken. Gloves were put on and the duo swung into action.

Exactly 26 minutes later, at 12.26 pm, a healthy baby boy weighing 3 kg was born much to the delight of the family. A little star was born on a country boat. 

The Boat Clinics of the Brahmaputra

For centuries, the Brahmaputra has swept along its long journey from Tibet to the Bay of Bengal, touching the lives of tens of millions with its enormous power and majesty - physically, culturally and economically.  Every year, millions of people are displaced and extensive property; crops and livestock are destroyed in annual floods in Assam and in downstream Bangladesh. Health problems are acute. Water-borne diseases affect many. A major problem is access to medicines and sustained health care.

An extraordinary and unique geographical phenomenon characterizes the river in its 891 km course through Assam: a vast network of islands, home to the most vulnerable.  More than 2.5 million people live on some 2,500 of these islands in Assam- chars or saporisas as they are locally called. They are found along the river from the state’s northern border with Arunachal Pradesh to the southwest where the Brahmaputra enters Bangladesh. They represent a significant reality, comprising 8 percent of the total population of the state of 30 million.

It was only last month in March, nudged by Sanjoy Hazarika, that we visited one of the boat clinics in Kamrup, Assam and met Bhaswati Kaund Goswami, Communication’s Officer Center for North East Studies (C-NES), who said to us, “Most islands totally lack basic infrastructure and services; from health to schools, from power and roads to drinking water and sanitation. In June 2004-2005, C-NES launched a unique initiative to tackle this challenge; to bring better health facilities to communities in the Brahmaputra valley. A team under the leadership of Sanjoy Hazarika, Managing Trustee worked round the clock to design and build Akha – described also as “A Ship Of Hope In A Valley Of Flood” – to provide mobile health services to the poor and the marginalized on the islands in District Dibrugarh. The focus was on immunization of children, pregnant women and new mothers as well as treatment of vulnerable adult groups”. She also told us that the concept won a World Bank Award for innovation aimed at bridging rural gaps.

The idea started small in Dibrugarh, in partnership with the district administration. Later, following a similar strategy, it expanded its services to Dhemaji and Tinsukia. UNICEF then came into the picture to build capacity and training. The National Rural Health Mission, Government of Assam, then proposed a collaboration seeing this as a major opportunity to give sustained health care to those millions who have been beyond ‘normal’ reach.  A unique Private Public Partnership was signed in January 2008 with NRHM. Bhaswati told us, “The Boat Clinics work in 13 districts of the state — Dibrugarh, Tinsukia, Dhemaji, Jorhat, Lakhimpur, Sonitpur, Morigaon, Kamrup,  Nalbari, Bongaiaon, Barpeta, Bongaigaon and Dhubri. A total of 15 Boat Clinics are operating along the river, Barpeta and Dhubri having an additional unit each to cater to a larger population”.

The work of the Boat Clinics has led to remarkable results: On an average 18,000 – 20,000 people are treated every month in the districts, individuals who were earlier beyond the reach of government programs because no doctors or paramedics would go on a regular basis. The only time, villagers say, they would see a doctor on site was during an emergency like a major flood. Otherwise they had to travel long distances at great cost and risk to get treated. Today, the services come virtually to their doorstep, courtesy a network of dedicated and extremely hard working team of medical personnel and organizers who function under arduous conditions:  bad weather, a challenging river and the difficulties of social and geographical exclusion. It has not been easy – but it is now an established program that has not only found acceptance but extensive support.