When a clinic comes to sail

Construction is ongoing and the Jogighopa River Gate is closed to outsiders. But the security guard rushes to open the door when I say “Ship Clinic”.

A few meters away, the young Mofidul Islam smiles as he gets out of SB Shekhar, a white and green clinic boat. Behind, Naranarayan Setu, a rail-road bridge over the Brahmaputra that connects Guwahati to the rest of the country, shines in the bright sun.

Mofidul is a boat assistant and prepares his boat for the day trip to Kheluwapara Part-1, a char (river village) with about 800 inhabitants. The place has no hospital, no electricity.

It’s 9:10 a.m. The sun is usually scorching and makes life difficult in the area, but a cool, soothing breeze blows when I visit them in early May. “You came at the right time. The water is not turbulent and the weather is good,” says Mofidul, alluding to the dangers of navigating the Brahmaputra during floods as well as during winters when the water level is low.

The 62-by-16-foot motorboat has six compartments: a medicine cabin, a doctor’s room, an outpatient room, a room with a bed and two pairs of tables and chairs, a laboratory, a kitchen and the engine room.

The journey downstream will take about an hour. I am on board with a 13-member medical team led by Monjur Hussain Mondal, Bongaigaon District Program Manager of the Boat Clinic project.

Monjur’s team collected vaccines from two hospitals to administer to children in Kheluwapara Part-1. “Let’s get started,” Mondal told “boat master” Abu Sayed.

The engine chuckled and stopped just 11 minutes into our trip. Black smoke comes out of the engine. A hitch? “No, don’t worry,” Monjur reassures me as he puts the boat back in motion.

As we eat breakfast in the OPD ward, Dr Dip Ranjan Das tells me that health care in the area was poor before the boat clinic was introduced in 2010. “People were reluctant to get their children. They ran away as soon as they saw us,” he recalls. Things have improved. Parents bring their children for their vaccinations — vaccination is a key responsibility of boat clinics. Vaccines on board include those against tuberculosis (TB), hepatitis, measles, poliomyelitis, pentavalent and Japanese encephalitis (JE). “I was raging here four or five years ago,” he says.

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

After an hour we reach Kheluwapara Part-1. Young women carrying babies in one hand and umbrellas in the other walk towards the ship’s clinic. The medical team cracks quickly, inside the boat as well as outside. A tent, using a plastic tarp, is quickly pitched on the bank. Community workers Satyajit Kalita, Kobad Hussain and Sahjahan Ali are busy. Once women register for these vaccines, counseling begins.

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

Anemic women

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

It weighs only 35 kg. Early marriage and early pregnancy are two major issues here. Majeda says she was in class 9 when she got married. “I wanted to study,” she said hesitantly.

Azrina Khatun is barely 18 years old and is already the mother of a three-year-old girl and a boy born just 17 days ago. She’s anemic too. “They help us a lot,” she says of the medical team. Hasina Khatun, 23, got married at 14 and is already the mother of two sons and a daughter.

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

Inside the boat, Das takes care of newborns, pregnant women and elderly men. Fever, colds and skin conditions are common.

In the OPD ward, two nurses, Nirupama Roy and Adori Khatun, administer vaccines to children. Vaccination schedules are shared by Accredited Social Health Activist (ASHA) Marjina Khatun and Anganwadi worker Majeda Khatun. They are government contractors. ASHA workers maintain a database of pregnant women and newborns and coordinate with boat clinics. “We tell women to take iron tablets and eat eggs, fish and vegetables,” Nirupama explains.

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

A condom dispenser box at the entrance of the boat helps. “They hesitate when we distribute 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 laboratory. Technician Ranjan Jyoti Baishya says their hemoglobin level is between 9.5 and 10.5. This is below the normal level of 11.

Ajufa Khatun, 30, who has had tuberculosis since March, walks in. She was referred to a DOTS (Directly Observed Treatment, Short course) center in Bidyapur, on the other side of the river. His tuberculosis was detected in a nautical clinic.

As of 1:50 p.m., the clinic treated 64 patients – 38 women and 21 children, mostly newborns.

life in tanks

Kheluapara is one of around 2,000 chars (river islands) in Assam, home to more than 25 lakhs, mostly Bengali-speaking Muslims.

The Chaporis are smaller islands located in eastern and northern districts of Assam such as Dibrugarh, Jorhat, Majuli, Lakhimpur and Dhemaji where indigenous communities live. Boats are their only means of transportation.

This led to the establishment of nautical clinics. The first in the state was launched in Dibrugarh in May 2005.

I walk down an alley in Kheluapara while the medical team waits for other patients.

“Please come in,” said Surman Ali, an elderly farmer, smiling. Ali is one of the few villagers to have received a free solar energy kit from the government. He uses three lights and two fans in his two-room tin-roofed house.

The inhabitants of the chars grow 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 provide fresh vegetables to the towns, but the irony is that the women and children in the tanks are not getting adequate nutrition,” says Das, the ship’s doctor. “Sometimes we buy and transport fresh vegetables from here.”

The boat starts its return journey to Jogighopa at 2:00 p.m. The OPD room is now a dining room.

Bengali-speaking Muslims living in the tanks are often suspected of being illegal migrants from Bangladesh. The development of these areas remains neglected. “But most say their names are in the NRC (National Citizens Register),” Monjur says.

The return trip is not easy. A strong headwind slows the boat. “During flood season, the journeys can get scary,” says Das. The team, however, did not face a major disaster situation.

The boat touches the shore of Jogighopa at 4:15 p.m.

The next morning, the boat will travel to Usungar Char, a three-hour drive. The team follows the same routine every day and takes a break on Sundays. “We go out on Sundays for emergencies,” Monjur says as I say goodbye and head back to Guwahati.

Instantaneous

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

The nautical clinics were started in 2005 by journalist Sanjoy Hazarika, who founded the Center for Northeast Studies and Policy Research.

The National Health Mission has supported the nautical clinic since 2008.

15 nautical clinics are operating in 13 districts of Assam.

The Bongaigaon Nautical Clinic provides health care to over 15,000 people living on 22 islands.

Ship doctors treat 15,000 to 20,000 people every month.