The river island dwellers of Assam rely on boats everyday for a smooth life.
They are, after all, the only connecting link to the mainland-the source of essential supplies and services, such as education and health. Yet, when a particular kind of boat turns up every few weeks at their embankment, the excitement in the air is palpable. "It's the boat clinic!" someone shouts, and the words ring through the air, quickly gathering people. Carrying doctors, paramedics, medicines, even a laboratory, to tend to their health related complaints, the boat clinic is a ray of hope for the island dwellers, and, not surprisingly, nicknamed the 'boat of hope'.
Started in the year 2005 with a single boat, Akha (hope) in the Dibrugarh district of Assam, the boat clinic initiative by the Centre for Northeast Studies and Policy Research (C-NES) was in response to the poor healthcare that island dwellers are exposed to. With no health facilities, poor communication to the mainland-made even more difficult during the monsoon floods-and diseases aplenty, especially affecting the vulnerable lot, women and children, such an initiative spelt the idea, 'if they cannot come, the hospital can come to them'.
The clinic's success got the attention and the subsequent support of the National Rural Health Mission (NRHM) and Unicef, driving it to a public private partnership (PPP) that helped the programme spread to 13 districts of Assam.
The boat clinics' success can be gauged in the changing attitude of the people, who first eyed the entire initiative with suspicion, before being convinced about its intention. Take the case of Amiya Begum of the Baleswar sapori in the Nalbari district, about 70 km from Guwahati.
"Initially when the boat clinic used to come, there was curiosity, but we didn't have much faith in it. Most of the elders opined that it was a temporary thing and wouldn't do us any good," recalled the 25-year-old mother of three.
"But they kept returning, with medicines, and people who went to them were treated of their problems. Slowly our confidence grew, and now whenever the boat clinic comes we rush to be ahead in the long queue," she smiles.
Amiya's friend, Shama, added that there was also some hesitation to get pregnant women checked by male doctors.
"But when we saw the doctors' and the nurses' dedication, the way they explained things to us, that veil too lifted," Shama said. "Over and above, now we are being regularly checked, treated of our ailments, and given free medicines, without having to pay Rs.10 one way for a boat ride to the mainland hospital. We are poor people and most of the times, unless it's an emergency, we avoid going to the hospital altogether".
The boat clinics' typically work model is to organise health camps in the villages on the islands. Word is spread about the camp through the ASHA, and although general health check-ups are done by the doctor-if need be the case is referred to specialists on the mainland-it's maternal and child health that is the focus. According to the staff on board, the visits are also usually timed in accordance to immunisation dates.
According to NRHM data, the boat clinics have organised 13,316 health camps since 2008 until this year, providing 60,085 women with ante---natal care, 15,694 women with post-natal care, and 123,342 children with routine immunisation, among others.
Such has been the effect of these boat clinics, that even in Majuli-the world's biggest river island on the Brahmaputra-which, unlike other river islands, has a Community Health Centre (CHC) and health sub centre, people wait eagerly for the clinics' visit.
"The closest health sub-centre from our village is four kilometers away and there is a river in between. In fact that sub-centre caters to 15 villages and of them 14 are on this side of the river," said Deboshree Das of Samuguri village in Majuli. The boat clinic, she says, is a better and more convenient option because it can come close to the villages, especially when the water level rises in the monsoons.
Riturekha Baruah of C-NES who oversees the boat clinic programme in the Jorhat district, says that the team also assists in childbirth. "Communication is difficult in the saporis, and many times because of an emergency, a woman cannot go to the hospital for delivery. In such cases we have assisted in childbirth," she said. Assam has been fighting one of the country's highest maternal mortality ratio at 328 per 100,000 live births.
The clinic also encourages family planning-an especially tough task given high levels of illiteracy among the island dwellers, and superstitious beliefs. "For this (family planning) we have to step beyond our immediate duties and work towards changing attitude of people, building trust, and removing misconceptions. We also discourage girls from being married off young, and talk about spacing between kids," said Minhazuddin Ahmed, a doctor with the boat clinic.
Among the most common ailments affecting the island dwellers are water borne diseases and skin infections.
Undoubtedly, life is very different, and difficult, for the nearly 30 lakh people living on the 2,500 river islands in the Brahmaputra in Assam. But the boat clinic team too faces challenges to reach the target community.
According to Dipankar Das, CEO of C-NES, trouble can arise both in the dry season and monsoons. In the dry season the water level has to be at least four feet for the motor boat to function, and on one instance "the team had to walk 10 km to reach the village". Similarly there have been times when the boat clinic got stuck in thunderstorms and floods and had to be rescued by experts.
"Gaining access to healthcare used to be a privilege earlier. Now with the boat clinic, we have been blessed with hope for a better life," smiled Anjana Das, an island dweller in the Dibrugarh district while talking to the Charkha Development Communication Network.