When a clinic comes sailing

Construction is in progress, and the gate to the Jogighopa river is closed to outsiders. But the security guard rushes to open the gate when I say ‘Boat clinic’.

. A few metres away, young Mofidul Islam smiles as he comes out of S B Shekhar, a white-and-green boat clinic. Behind it, Naranarayan Setu, a rail-cum-road bridge over the Brahmaputra that connects Guwahati with the rest of the country, is gleaming in the bright sun.

. Mofidul is a boat assistant and is getting his vessel ready for the day trip to Kheluwapara Part-1, a char (riverine village) with about 800 residents. The place has no hospital, no electricity.

. It is 9:10 am. The sun is usually scorching and makes life difficult in the area, but a cold, soothing breeze is blowing when I visit them in early May. “You have come at the right time. The water isn’t turbulent, and the weather is good,” says Mofidul, hinting at the hazards of sailing on the Brahmaputra during the floods as also in the winters when the water level is low.

. The 62 by 16 ft motorboat has six compartments: a medicine cabin, a doctor’s chamber, an outpatient room, a room with a bed and two pairs of tables and chairs, a lab, a kitchen and the machine room.

. The downstream ride will take about an hour. I am on board with a 13-member medical team led by Monjur Hussain Mondal, Bongaigaon district programme officer of the Boat Clinic project.

. Monjur’s team has collected vaccines from two hospitals, to be administered to the children at Kheluwapara Part-1. “Let’s start,” Mondal tells ‘boat master’ Abu Sayed.

. The engine chortles and stops just 11 minutes after our journey has begun. Black smoke is emerging from the engine. A snag? “No, don’t worry,” Monjur reassures me as he gets the boat going again.

. As we sit for breakfast in the OPD room, Dr Dip Ranjan Das tells me healthcare in the region was poor before the boat clinic was introduced in 2010. “People were reluctant to get their children vaccinated. They would flee the moment they saw us,” he recalls. Things have improved. Parents bring children for their shots — immunisation is a key responsibility for boat clinics. Vaccines on board include those for tuberculosis (TB), hepatitis, measles, polio, pentavalent, and Japanese encephalitis (JE). “JE was rampant here four-five years ago,” he says.

. An MBBS graduate, Das has been working on this boat clinic for nearly seven years. He could have joined a private hospital and earned better. “Serving people in remote areas gives me a special satisfaction,” Das, an idealistic 30-year-old, says.

. After an hour, we reach Kheluwapara Part-1. Young women carrying babies in one hand and umbrellas in the other walk towards the boat clinic. The medical team quickly gets cracking, inside the boat and outside. A tent, using a plastic sheet, is quickly set up on the bank. Community workers Satyajit Kalita, Kobad Hussain and Sahjahan Ali get busy. After the women sign up for these vaccines, counselling begins.

. ‘How to maintain hygiene during floods’ is the topic of the day. “Diarrhoea is a common problem. As the monsoon is approaching, we tell the women to wash their hands with soap, and not to eat stale food,” says Kalita. He is setting up a public address system to address the island residents.

. Anaemic women

. Majeda Khatun, 16, looks pale and weak. She is sitting under the tent. She was married 18 months ago and is six months pregnant. Kalita says women like Majeda are treated as high-risk patients.

. She weighs only 35 kg. Early marriage and early pregnancies are two major problems here. Majeda says she was in Class 9 when she was married off. “I wanted to study,” she says, hesitantly.

. Azrina Khatun is barely 18 and is already a mother of a three-year-old girl and a boy born just 17 days ago. She is anaemic too. “They are helping us a lot,” she says about the medical team. Hasina Khatun, 23, was married at 14 and is already a mother of two sons and a daughter.

. At least seven women I meet had similar stories. All of them work in agricultural fields and at home. Most haven’t been to school at all. Their spouses were chosen by their parents. In-laws and neighbours taunt girls, I hear, if they don’t get pregnant within a year of marriage. “Only now have women here started taking contraceptive pills to delay pregnancies,” says Hussain.

. Inside the boat, Das attends to newborns, pregnant women and elderly men. Fever, cold and skin ailments are common.

. In the OPD room, two nurses, Nirupama Roy and Adori Khatun, administer vaccines to children. The immunisation schedules are shared by Accredited Social Health Activist (ASHA) Marjina Khatun and anganwadi worker Majeda Khatun. They are government contractual workers. ASHA workers maintain a database of the pregnant women and newborn babies and coordinate with the boat clinics. “We tell the women to take iron tablets and eat eggs, fish and vegetables,” says Nirupama.

. They also tell the women to maintain a gap of at least three years between pregnancies. “Things are changing gradually. Earlier it was common for a woman to have six-seven children. Now the number is three on an average,” says Marjina.

. A condom vending box at the boat’s entrance helps. “They hesitate when we hand out condoms. So we keep them in a box,” says Monjur. Some women pick up the condoms on the way out.

. Five pregnant women are in the lab. Technician Ranjan Jyoti Baishya says their haemoglobin levels are between 9.5 and 10.5. This is below the normal level of 11.

. Ajufa Khatun, 30, suffering from TB since March, walks in. She is referred to a DOTS (Directly Observed Treatment, Short course) centre at Bidyapur, across the river. Her TB was detected at a boat clinic.

. By 1:50 pm, the clinic has treated 64 patients — 38 women and 21 children, mainly newborn.

. Life in the chars

. Kheluapara is among about 2,000 chars (riverine islands) in Assam, where over 25 lakh people, mostly Bengali-speaking Muslims, live.

. Chaporis are smaller islands in eastern and northern Assam districts such as Dibrugarh, Jorhat, Majuli, Lakhimpur and Dhemaji, where indigenous communities live. Boats are the only mode of transport for them.

. This led to the setting up of boat clinics. The first in the state was launched in Dibrugarh in May 2005.

. I stroll down a lane in Kheluapara while the medical team waits for more patients.

. “Please come in,” Surman Ali, an elderly farmer, says, smiling. Ali is among a few in the village to have received a free solar power set from the government. He uses three lights and two fans in his tin-roof house with two rooms.

. People in the chars cultivate paddy, jute, sugar cane and vegetables. The sandy land becomes more fertile after the floods, and farmers then grow pulses, almonds, wheat and vegetables. "They supply fresh vegetables to the towns but the irony is that the women and children in the chars don't get proper nutrition," says Das, the boat doctor. "Sometimes we buy and carry fresh vegetables from here."

. The boat starts its return journey to Jogighopa at 2 pm. The OPD room is now a dining hall.

. Bengali-speaking Muslims living in the chars are often suspected to be illegal migrants from Bangladesh. Development of these areas remains neglected. "But most say their names are in the NRC (National Register of Citizens)," says Monjur.

. The return journey is not smooth. A strong head wind slows down the boat. “During the flood season, journeys can get scary," says Das. The team, however, has not faced a major disaster-like situation.

. The boat hits the Jogighopa bank at 4:15 pm.

. The next morning, the boat will travel to Usungar Char, three hours away. The team follows the same routine every day, and takes a break on Sunday. “We go out on a Sunday in case of an emergency," says Monjur as I bid goodbye and head back to Guwahati.

. Snapshot

. Assam has over 2,000 chars (riverine islands) and chaporis (riverine sandbars).

. Boat clinics were launched in 2005 by journalist Sanjoy Hazarika, who founded the Centre for Northeast Studies and Policy Research.

. The National Health Mission has been supporting the boat clinic since 2008.

. 15 boat clinics operate in 13 districts in Assam.

. The Bongaigaon boat clinic provides healthcare to over 15,000 people living on 22 islands.

. Doctors on boats treat 15,000 to 20,000 people every month.

When a clinic comes sailing

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