Sinlung /
25 April 2012

Lifeline On A River: Assam's Boat Clinics

Doctor inspecting a baby at a boat clinic in Assam The state of Assam in northeast India has the highest maternal mortality rate (MMR) in the country. One of the reasons for the abysmal figures is that over three million people live on tiny islands along the Brahmaputra River without proper health infrastructure.
Boat clinics on the river, an initiative of the Centre for North East Studies and Policy Research (C-NES), have been working to lower the alarming figures. But the latest challenge they face is climate change.
Healthcare for islanders

Murari Yadav is paddling his boat on the Brahmaputra River. His boat has taken off from a narrow strip of water. He navigates through the early morning traffic on the river. Boats pass by with people eager to get across to the land for their day’s work. Yadav is also helping people get to work.

He’s ferrying a team of doctors and supporting medics from the C-NES to an island about 40 kilometres from Tinsukia, a commercial town in upper Assam. They are heading upstream on the river to get to a remote island called Amalpur. Today, they will be setting up a camp there for villagers of the Missing tribe.

Floating clinics
Sanjoy Hazarika, founder of C-NES, came up with the idea of delivering medical aid to the needy along the Brahmaputra River. Once while he was travelling on the river, he heard a story about a pregnant woman on an island who died while waiting for transport.

“This is really unacceptable in this day and age that people have to die for lack of care. So I thought, instead of people going for the service, why not take the service to them?” Hazarika says. Today the boat clinics, which began in 2005, work in 13 districts in Assam along with the government organisation, the National Rural Health Mission (NRHM).

Poor infrastructure
Back on the river, the C-NES boat has reached the bank. It’s taken two hours on two boats. But the journey isn’t over yet. The team has to endure an arduous tractor-ride to reach Napun village, where they will be setting up camp.

Villagers, most of them women and children, have already queued up at the clinic. Narintari Chantalya, is pregnant with her eight-month-old baby. She remembers the last time she delivered a baby boy. “I was in labour four days. It was very difficult. They finally took me to a hospital far away,” she says.

Maternal mortality
Narintari is still scared from her experiences and so are many others. They have all heard of women dying while giving birth. Assam has the highest maternal mortality rate in the country at 393. The doctor presiding over the camp, Dr Ritesh Kalwar says Narintari’s haemoglobin levels are very low. “She is anaemic,” he says. “I’ve prescribed her iron tablets and hopefully they should do the work. She is due to deliver the baby in a few weeks, so she should be careful,” Dr Kalwar adds.

Once the patient leaves, he says, awareness among villagers about their health is very low. “They have myths about some things. For instance, they believe that taking iron tablets will make the baby too big causing complications during delivery,” he says. On that day, Dr Kalwar treats 110 patients at a go.

Environmental hurdles
But illiteracy and logistics are not the only problems faced by the boat clinics. Their growing concern now is climate change. In the past couple of years, the boats have not been able to reach many islands due to lowering water levels on the Brahmaputra River.

As he ferries the medical team across the river on land, Murari Yadav, the captain of the boat says he’s seen the river change a lot. “I’ve been riding boats since I was 13. But I can tell you the river is not the same these past years. The water levels have gone down and the river has grown wider,” he says.

He’s right. The Brahmaputra is widening at an alarming rate of five metres every year. If it continues at a regular rate, saving lives on the islands will become more and more difficult for the boat clinics.

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