[vimeo http://www.vimeo.com/54052286 w=500&h=281]
Assam, a state in northeast India, has the highest maternal mortality rate in the country.
The lack of medical infrastructure is one of the main reasons why.
Over three million people in Assam live on islands around the Brahmaputra River, which flows across the state.
For many islanders, boat clinics – a joint NGO and government initiative – are the only means of healthcare.
Asia Calling’s Gayatri Parameswaran and Felix Gaedtke stepped on deck in Assam.
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It’s seven in the morning and we are on a boat on the Brahmaputra River in Upper Assam.
There is regular morning traffic on the river.
Dozens of boats are ferrying people from the islands to the land for their day’s work.
Our boat is different from the others on the river.
It works as a clinic – an innovative medical unit that provides healthcare to people living on the river islands.
There’s a pharmacist, a lab technician, three nurses and medical supplies on board.
The doctor on duty today is Ritesh Kalwar.
“Today we are going to Amarpur area. There, we’ll visit a couple of villages to set up medical camps. We have to travel quite a lot today. We’ve already travelled an hour on the jeep. And now, there’s a three-hour boat journey and then we have to travel 8-10 kilometres on the tractor to reach one village,” says Dr. Ritesh, of the long day. “We’ll set up a camp there and when that’s done travel on the tractor again to another village and then on the tractor back to the boat and back to land. That’s all,” he laughs.
These floating clinics are the brainchild of Sanjoy Hazarika who founded the NGO, the Centre for North East Studies and Policy Research, or C-NES.
“As I was travelling on the river, making a film on the river, I was travelling from Tibet right down to the Bay of Bengal and in Assam, we happened to stop by on an island called Majholi – it’s one of the larger river islands in the world. And there I heard the story of how a young woman, who was heavily pregnant, she died while waiting for transport to a hospital on the other side of the river,” recalls Sanjoy.
“And I said to myself that 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?”
The boat clinics first started in 2005.
Today they provide medical help to islanders in 13 districts across Assam with help from the government’s National Rural Health Mission (NRHM).
For people living on remote island villages, boat clinics are the only form of health care.
“In one situation, I remember, one boat clinic was coming back from a camp and on a small island, they saw a couple running, holding a child, waving to them. So they thought it was a problem, they pulled up and stopped the vessel. They found the child was having acute respiratory stress and was turning blue and they had the right medication, they had skills to deal with it,” she says.
“Within a few minutes, the child revived and survived. And they’ve gone back and seen the child. And so, they asked, ‘How is it that you knew we would come?’ So he says, ‘We know by your regularity. We know that if you go on such and such day, on the third day you will return. And that’s what we were hoping.’”
Back on board, the medical team has reached Napun village after four hours of travel.
More than a hundred patients – mainly women and children – have already gathered at a school classroom, where the medical camp will be set up.
The patients start lining up to see the doctor.
Nayanmuni Sukram, a heavily pregnant tribal woman, is one of them.
“There are no doctors in this area, so we have to come here for our check-ups. The last time I came, they did a urine test for me and said I am pregnant,” says Nayanmuni.
“Now I am here to find out when I am going to have the baby. When I had my first baby, it was very difficult. I was in labour for four days. I am scared what will happen this time around.
Nayanmuni’s fears are valid.
She has heard many stories of mothers dying while giving birth.
Assam has the highest maternal mortality rate in India – 390 out of every 100,000.
Nayanmuni’s is waiting for an antenatal check-up with Dr Kalwar.
He finds her haemoglobin levels low, prescribes her iron tablets and stresses that she should go to the hospital for the delivery.
But getting to the closest hospital involves several hours of walking and a boat or a tractor to get there.
Many women choose to give birth in the village with help from midwives instead.
Nayanmuni says it would best if the boat clinic arrived while she was in labor.
At the pharmacist, Nayanmuni collects her iron tablets and returns home to rest.
She’s expected to deliver her child any time next week.
Dr Kalwar has seen more than a 100 patients today, but they don’t always agree with his prognosis.
“The main challenge with the patients is that they are not willing to take medication. They have some myths. They still believe in quacks and say that they will only take the medicines we prescribe along with some traditional herbs,” he says.
“But our job is to try and be patient with them and make them aware of the benefits of medicine. We tell them, ‘Look, your haemoglobin levels are so low, it has to be at least this much. You have to take these pills to be healthy.’ Most of the challenges we face are due to their lack of awareness.
The boat clinics are facing another formidable hurdle -- climate change.
The Brahmaputra River is growing wider and shallower every year.
Due to the drop in water levels, the boats are finding it more and more difficult to reach the islands.
Murari Yadav is the captain of our boat today.
As he navigates the boat back, he tells us he has been sailing on the river since he was a teenager.
“I can remember from long ago, from the year 1988. Water in the river continues to drop and drop. The water in the river has never seen such depth since those days. Now the river is very wide,” says Murari.
“The water levels are going down every year. We used to be fearful of the current in the river in those days, but now, we just hope that it rains enough so we can plough our boats through.
Studies suggest the Brahmaputra is eating away five metres of land every year.
As water levels drop, this steady stream of healthcare is also under threat.