In flood-hit Assam, dedicated 'boat clinics' help to keep hope, good health afloat - Firstpost
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In flood-hit Assam, dedicated 'boat clinics' help to keep hope, good health afloat

It was a dark night when Memo Bhuyan gave birth to her baby at home in the flood-affected Mohmara Island in a remote part of Assam with no medical assistance whatsoever.

On seeing Bhuyan developing complications, her old mother frantically stepped out of the home seeking help. It was around 11 pm on 31 July, and Bhuyan’s baby wasn’t doing too well as the placenta had not been retracted even three hours after the delivery.

Bhuyan’s mother had located a boat named SB Swaminathan docked on the island banks, firmly anchored to the shore. A few villagers the lady met by chance at that hour had told her there were doctors and medicines on the boat.

Loud calls from people on the bank of the river were heard by the boat crew. Memo Bhuyan needed immediate help, pleaded her mother.

Indeed there was a medical crew in the boat — a miracle for the old lady and her daughter.

Medical officer Dr Ankur Baruah, who was asleep in his cabin after a long day, finishing a tough trip at Amarpursapori, was immediately informed of the situation. The medical team, escorted by the villages, started their journey on foot. The crew had to cross a river on a small country boat and walk about 30 minutes through knee-deep water and mud which were the after effects of the still receding flood waters to reach the patient’s home.

After cups of hot tea and much gratitude from the villagers for the help they rendered the young mother, the medical team headed back to their boat at 3.15 am. Memo Bhuyan could hold her baby to her breast that night, thanks to what is known as the “boat clinic” project.

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(Clockwise from top left) Treating patients on the boat; Aichung Sapori; health checkups by the medical officer inside the boat; checkups go on late into the night at Bhuragaon camp

The boat clinic, a brainchild of Sanjoy Hazarika, director, Center for North East Studies and Policy Research (C-NES), had yet again fulfilled its mission in the flood-swept regions along the mighty Brahmaputra.

While in the national media mostly it is urban flooding (read: mis-planning) in Gurgaon or a Bngaluru neighbourhood that grabs popular attention, this year the monsoon was unprecedented in Assam. The rains and ensuing rise in the river water levels inundated more area in the state than previous years. The devastation in most of the districts was news only for the hapless locals, not so much a national concern.

It was while working on a documentary film in Assam in 1996, that Hazarika heard of a pregnant woman dying on a sapori, trying to reach a medical facility; she had missed the ferry. By 2004, Hazarika, a former New York Times reporter, toyed with the idea of a 'boat clinic' — a fleet of boats, if resources permitted — that would take doctors and basic healthcare to these areas.

In a pitch to the World Bank for an innovation award, he described the boat clinic as “a ship of hope in a valley of flood”. On wining $20,000, MV Akha (meaning Hope), a wooden boat clinic, was kitted out with that prize money, and it floated out of Dibrugarh a year later.

According to Bhargab Baruah, district programme officer, Tinsukia boat clinic, this current flood affected more than 1.8 million people from 22 districts out of a total of 32 districts of the state. About 2.5 lakh people had to stay in relief camps set up by the district administrations, while many families had to take shelter on the roads, embankments, highlands etc. along with their cattle and all other belongings which could be saved.

“The families in these temporary sheds had to live in a very pathetic and unhygienic condition without having any proper sanitation and safe drinking water facilities. More than 40 people and countless domestic and wild animals died in this flood,” reported Baruah.

The attendant miseries of post-flooding — which is exactly now when the monsoon abates just a bit — are perhaps even greater than the floods themselves. Diseases, infections, unhygienic conditions abound. There is clamour for essential supplies and although the waters recede somewhat, other logistical problems crop up. Add to this the geography of the region where temporary riverine banks or chars and riverine islands or saporis dot the “landscape”. The chars can come and go or shrink, while the saporis shift with each monsoon, affecting several topographical phenomena.

As much as the boat clinics try to keep their commitments in the different areas marked out for their respective boats, the young doctors who come here for their rural placements move away for further studies within a year or two. There are two medical officers (MOs) for each boat, three nurses, a slab technician, and a pharmacist, while the strength of the boat crew varies from 3-5 persons on each boat.

“We have 15 boats in operation in 13 districts with the districts which have a large char/sapori proportion, Dhubri and Barpeta, having two units each. Each team has the following breakup, but because doctors come and go, the team sizes vary; also all may not have their full complement of nurses,” Hazarika says.

In this scenario, Bhaben Chandra Bora is a great help to the project, Hazarika said. Bora wanted to be an engineer but his parents packed him off to Dibrugarh’s prestigious Assam Medical College.

“It took me a few years to love this profession,” Bora admitted, embracing life on MV Akha, as the boat travelled upriver on the Brahmaputra from Dibrugarh. He has been working with the project for eight years.

While in this part of the country, health challenges are staggering, the Maternal Morality Ratio (MMR) is nothing short of abysmal. The MMR is 300 for Assam — the highest in the country. Hazarika pointed out that the worst indices are in the tea garden areas among tea garden tribes, not the char/sapori population. There has been significant improvement in the latter regions in the past years, owing to the boat clinic missions.

“In the areas that we serve, maternal mortality cases have, I believe, significantly dipped as also infant mortality. We started in 2005 with assistance from district administrations first in Dibrugarh and then Tinsukia and Dhemaji, thanks to the foresightedness of the district commissioners at the time,” Hazarika says.

Programme manager Ashok Rao stressed that the core focus of the medical attention via the boats is to improve the nutrition and health status of expectant mothers and those who have delivered their babies, reducing their vulnerability. Also a priority is ensuring that thousands of children complete the full immunisation cycle on time (routine immunisation figure is 174,597 children from 2008 to March 31, 2016. Yearly average after all 15 boat clinics units were in service were 25.000 children during 2011-12 and 27,604 during 2015-16).

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(Top L& R) Health camps conducted by the Dhemaji Boat Clinic; (above L-R) Flood relief camp at Lamajan Bazaar; flood relief camp at Lamajan Bilpar under Jonai BPHC

“Floods and displacement do cause disruption but we try to follow this cycle very closely,” Rao said.

And if one understands the composition of the chars/saporis, the vulnerability of people’s lives and properties during monsoon acquires immense proportions.

“Majuli, the world’s largest river island and the cultural and spiritual hub of the state which had a land mass of 1,250 sq km, shrunk to 352 sq km, as per the estimate in 2014. Like Majuli, there are about 2,400 such small and medium island villages on the Brahmaputra inhabited by a population of about 3 million,” Rao said. Their fate during the high floods this year can be anybody’s guess, if it were not for the boat clinics that make their rounds even in inclement conditions.

Hazarika is of the opinion that floods must be declared as a national disaster instead of states being given a few allotments here and there and expected to manage of their own.

“This is an international issue as most of the large river leaps into Assam from the Himalayan region and Tibet. Better information sharing is required even within India where Himalaya river data is classified,” he said, stressing on the need for a clear understanding that large dams are the worst idea to inflict on the Brahmaputra and its neighbouring rivers.

“A river needs a basic level of flow and water to survive, a river has its rights too,” he says.

Pressing issues apart, what is a boat come to people from faraway if it were not meant to be a fun thing for the kids of char/saporis?

C-NES is now looking at ways to reach out to school children with basic colouring and sketch books, etc. Hazarika said he would like to see a pilot project in one district of an “education boat” which functions as a library and resource centre (with a computer and WiFi) which children of different ages can access. This may double up as an adult literacy centre at night. More outreach ideas are in practice already, requiring a strong commitment.

After all, the char/sapori children reading rhymes such as:

Halodhiya soraye baodhan khai/ Xaudor puteke nao meli jai/ Nao-e bule tulung bhutung, bothai bule bao/ Godhulite godhulite doba kubao (Translation: The yellow birds peck on deep-water paddy/The merchant’s son sets sail on a boat steady/The boat tosses and turns; the oars say row on/As dusk falls, we beat the drums and go on. Courtesy: Dibyajyoti Sarma)

would immediately relate to the image of the boat, a life-saving entity in their lives, and a bright hope to row on for.

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