Life is uncertain for people living on the riverine islands of the Brahmaputra basin in Assam. The topography of these islands — called ‘chars’ in Assamese — changes with every swell and fall of the river, which can wash away entire villages and livelihoods within hours.
Eight chars, for instance, were swept away in massive bank erosions last year. Balachar is one of the 83 char villages in Nalbari district that survived.
Doctors receive a warm reception at Balachar, a riverine village in Assam’s Nalbari district. (HT photo)
The people here depend on the river for fish, and for water for their paddy and jute fields. They also depend on the river for lifesaving vaccines and medicines.
Every Wednesday, two doctors come sailing down the Brahmaputra with their medicine boxes, to set up a makeshift clinic. A pharmacist, a lab technician, two auxiliary nurse midwives (ANMs) and three community health workers accompany them.
It takes more than a boat ride to get to the village, though. After a 90-minute boat ride up the river, doctors must take a 40-minute hike across jute fields to a boat crossing, then a short, wobbly, leaky boat ride across a swollen rivulet, and finally a 15-minute walk to the village centre, where they set up their day clinic under the trees. Somehow, every precious vaccine vial and pill miraculously makes it to Nalbari each week.
Bringing healthcare to marooned communities is the unique Boat Clinic Programme, run in a partnership between the Centre’s National Rural Health Mission (NRHM) and non-profit organisation Centre for North East Studies (C-NES).
The clinical staff are government employees and the medicines are provided free under NRHM, but the boat taking them to the char villages — there were 2,251 such villages across the state, at last count — is run by N-CES. “We started with one boat in Dibrugarh district in 2005 and now run 15 boat clinics in 13 districts of Assam. The programme reaches 4.5 lakh people,” says Parvez Ahmed, district programme officer at N-CES.
There are close to 200 people waiting at Balachar, and the medical team gets a rockstar reception. Within minutes, two tables and plastic chairs materialise from neighbouring huts and the makeshift clinic is ready to function.
While the boxes of equipment and medicines are being unpacked, health workers set the mood by discussing infections, vaccination and nutrition with those waiting.
Almost everyone in line claims to be very weak and demands a bottle. “They think only medicines in bottles can cure them. They’re suspicious of tablets and capsules. They are happiest when they are prescribed flavoured medicine in a bottle,” says Dr Bhumidhar Barman, 27, smiling. Barman has chosen to work in a boat clinic for a year as he prepares for his Master’s in surgery.
The real complaints are mainly of fevers and skin infections, which villagers in the chars are prone to from working barefoot in the paddy fields. “Most infections are fungal, but delay in seeking treatment leads to complications such as open lesions and bacterial and other co-infections,” says Dr Nabakanta Das, 28. Treatment is normally an ointment, antibiotic or both.
The lab is the most impressive part of the ‘clinic’. Danish Ali, 18, has had a fever for a week. Dr Barman prescribes paracetamol to lower it. He also asks the patient to get tested for P. Falciparum malaria, which sickens hundreds in Assam during the monsoon.
Clutching his prescription, Ali moves to the next table, where lab technician Sandip Kumar Das pulls out his Parahit f dipstick kit to test for malaria. A drop of Ali’s blood is all he needs for the test that rules out malaria within five minutes. Das carefully preserves the rest of Ali’s blood smears on two slides for confirmatory tests back in his health centre lab.
Ali picks up his free medicines (including a bottle of multivitamins) from the dispensary and leaves beaming, having spent less than 15 minutes on consultation, testing and dispensation combined.
Within four hours, close to 180 people have been screened and 21 lab tests done, most for tuberculosis and malaria. Some women need ante-natal check-ups and tetanus shots. “We use the goodwill we generate to counsel people about getting girls married only after the age of 18 — the average age here is 14 — and spacing out the children. Malnutrition and anaemia are common among girls and women, as diarrhoea is among infants and young children,” says Dr Barman.
With 80% of those thronging the clinic being women with young children, the doctors and health workers get a patient hearing. The men claim they are busy and have little time for talk.
“Listening is for women. I am too weak to stand here in the heat. Give me a bottle so I can go,” Hamid Ali, 37, tells the pharmacist, with his eyes focused on a pink digestive syrup he’s convinced will boost his strength till the boat clinic is back with more next week.