A Watershed

Boat clinics in Assam bring healthcare to the poor

Begum Khatun,a 28-year-old heavily pregnant woman from No 1 Balagaon,a hamlet in Balagaon char,hopes to have a safe delivery this time. I have had a miscarriage and lost a child during delivery earlier. We never had a doctor around. Now,we dont just have a doctor,but an entire hospital coming to our village, she says. Khatun was among 106 villagers who attended a boat clinic camp in the village school on February 28. The camp was held three kilometres away from the river,where the boat clinic was anchored.

No 1 Balagaon is located in a char,Assamese for an island in the middle of the river,in this case,the Brahmaputra. The nearest government health centre is 15 km away,at Chhaygaon town on the riverbank. To reach it,villagers have to traverse 3-4 kilometres of sandbars,sail 30-40 minutes on a boat,walk another kilometre on foot,and take a 30-minute ride in a van.

To provide villages such as No 1 Balagaon access to healthcare,the Centre for North East Studies and Policy Research C-NES,an NGO,launched a boat clinic called Asha in Dibrugarh in 2005. Later,they partnered with the National Rural Heath Mission NRHM to introduce 12 more such clinics in the last five years. With roads non-existent,boats are the only means of transport. We run 15 boat clinics in 13 districts of Assam,and have so far provided healthcare services to over 10 lakh people living in remote islands, says Ashok Rao,programme manager,C-NES.

The boat clinic is a mini-hospital. The Chhaygaon one has two doctors,three nurses,a laboratory technician,a pharmacist and three community workers,with a district project officer supervising the clinic. When the river is full,we can take the boat right up to the villages. But in the dry months,from November to March,we have to anchor the boat on the shallow riverbank and take our equipment and medicines to the village where we set up a temporary camp in a school or in the headmans house, says Hiranya Deka,the clinic supervisor.

Some boat clinics,which are equipped with two OPDs,a pathology lab and a nurses room,have also often served as makeshift emergency delivery wards. It was during the high floods in September last year that a 21-year-old woman gave birth to a healthy baby inside the boat clinic at Bhimpora chapori village in Jorhat district, says Rao. Though primarily intended to provide mother-and-child healthcare,the boat clinics now also treat male patients.

Healthcare in char areas is rare. While there is only one primary healthcare centre for 51,704 people in the char areas,one sub-centre caters to at least 20,000 people in the middle of the river. While there are about 24.9 lakh people living in the 3,608 sq km of char areas in Assam,the literacy rate among them is about 19.31 per cent,against the state figure of 73.18 per cent. The level of awareness is also very low, says Mulla Mohammad Jinnah,a 27-year-old community worker with the boat clinic,who hails from the Kaltoli char,about 14 km northwest of Balagaon. A graduate,Jinnah and two other community workers help gather residents for the monthly clinic day in each of the five villages,and keep an eye on whether people are taking the prescribed medicines distributed to them.

Thanks to frequent visits by boat clinics,women in the char areas now know about family planning. In our last clinic,of the 43 women patients,some 10 asked for oral contraceptives, says nurse Arzooara Begum.