Ferrying hope on the Brahmaputra

In 1977, while forming the group Xur Bahini to gather relief for flood victims, composer-singer Jayanta Hazarika (Bhupen Hazarika’s younger brother) wrote: “Luitor bolia baan, toloi koloi nu dhapoli meliso hir hir sowode kal roop dhori loi kaak nu bare bare khediso? (O, maddening floods of Luit, where are you headed this time? Whom are you chasing again with the frightening sound of the waves?)."

Forty-two years later, these lines still ring true, with the tempestuous waters of the Brahmaputra, along with its tributary Luit (or Lohit), continuing to wreak havoc every monsoon.

The floods this year, however, are being labelled the worst in 15 years. So far, the disaster has affected around 2,801,329 people in 28 districts (according to a 23 July situation report by the Assam State Disaster Management Authority), of which 1,120,532 are children (Unicef estimate).

Some of the worst scenes of devastation seem to be playing out on the vast network of sandbars and islands situated across the 891km-long course of the river in Assam. Considered unique geographical phenomena, these chars and saporis, home to three million people, get completely submerged during the floods. In such a scenario, the only way to get relief material to them is by boat. And for 15 years, an innovative set of boat clinics has been doing just that.

Started by a trust called the Centre for North East Studies and Policy Research, or C-NES, in 2004, these floating clinics have attempted to bring basic healthcare closer to the residents of saporis, which often don’t have even a proper road. As I meet Sanjoy Hazarika, managing trustee and founder of C-NES, in Delhi, he shows me images sent by boat clinic teams across the state—of people hanging on to rafts and doctors wading through water to reach villages.

I ask him why they decided to focus on the residents of these chars and saporis. “They are among the most economically backward in Assam, barely touched by development. They remain marginalized and vulnerable, with no access to communications and are badly hit by recurring floods," he says. In these villages, most men have moved to cities and towns in search of work, leaving the women and children behind. And it is this section that forms the focus of the boat clinics’ work.

In a C-NES documentary about the boat clinics, Where There Are No Roads, one can see a group of doctors and nurses trying to pass the hour-long journey to a riverbank by playing Ludo. As soon as they reach, they offload everything needed to set up an OPD—chairs for the doctors, medicines, food and drinking water. Then begins the long wade through water to reach the villages and offer halogen tablets, medicines for pregnant women and immunization for infants.

“Last year, during the floods, we were engaged in rescue work as well. This year, we are offering medicines and relief supplies," says Hazarika. “But the clinics are at work 24x7, 365 days a year, irrespective of whether it is the pre-flood phase, post-flood, or no flood at all."

Till March, basic health services had been provided to over 2.7 million people through the 15 clinics active in 13 districts —Dibrugarh, Tinsukia, Dhemaji, Lakhimpur, Jorhat, Barpeta, Sonitpur, Morigaon, Kamrup, Nalbari, Bongaigaon, Goalpara and Dhubri. “Every year, we handle not less than 340,000 cases," Hazarika adds.

The past 15 years have seen several stories of relief and rescue. In August 2008, as the waters raged around Lamba Sapori—an island home to the Mishing community—in Dhemaji, a couple, Punyadhar and Oiphuli Morang, watched helplessly as their two-year-old daughter, Moina, suffered an acute asthmatic attack. Having seen the boat clinic pass by the sapori several times, they had some idea of its schedule. So, Punyadhar stood atop his house and waved vigorously to the SB Shahnaz, which was plying these waters. The team spotted the couple and made its way to their home, where medication was administered and the child recovered.

In the book Hope Floats: The Boat Clinics Of The Brahmaputra, C-NES’ communications officer Bhaswati Goswami quotes Arumoni Regon, 55, from Pamua village of Laika Sapori in Tinsukia. “Prior to boat clinics, pregnant women had to cross the river in full spate during floods and trudge through the dense Dibru-Saikhowa reserve forest to access health check-ups at Government health centres," she says.

It is one such instance that inspired Hazarika to set up the boat clinics. “Film-maker Jahnu Barua and I were crossing over to Majuli when we heard the tragic story of a young woman in her teens having died on the ferry due to childbirth," he says. Troubled, he started discussions with local panchayat leaders on bringing healthcare to them by boat. In the same year (2004), C-NES won the World Bank’s India Marketplace competition for the innovative concept of “A Ship of Hope in a Valley of Floods", and the prize money of $20,000 (about ₹13.7 lakh now) led to the construction of the first boat clinic.

Named Akha, which means hope in Assamese, it was built with local raw material with the help of boat-builder Kamal Gurung. Made of wood, it is 65ft in length and equipped with an OPD, a lab, cabins, toilets, water supply and a generator. Fourteen more have been added since.

These 15 clinics offer curative care, early detection of locally endemic communicable and non-communicable diseases, reproductive and child care, family planning services, basic lab services and awareness-building sessions.

“For people in some of these saporis, it often takes 8-10 hours to reach a hospital. Yahaan hospital hota toh bohot accha hota (a hospital would have been welcome). But that’s where the boat clinics help fill the gap," says Urmila Yadav, 45, an accredited social health activist, or ASHA worker, in the Charkholiya ward No.1 of Dibrugarh district. She liaises between the residents and the clinics, passing on information about the date of the clinic’s arrival, imminent check-ups and emergencies.

How do these boat clinics function during floods? Shaarang Sachdev, head (emergency medicine), Fortis Escorts Heart Institute, Delhi, who undertook relief work in Kerala last year, draws parallels between the two states. “The areas affected the most in Kerala were away from the hospital. It was a challenge to get medicines, sutures and other equipment to them. Although the government tried its best to communicate in the time of the crisis, a little advanced intimation to those who were suffering could have enabled us to bring respite to a lot more people," he says. When it comes to Assam, these boat clinics already have the experience of reaching remote areas, and can aid the relief work better.

Tafikul Islam, 26, who has worked on the Barpeta boat clinic unit 1 for over nine months, has been counselling people on emergency measures. “We know that every year the floods will occur. So, we give a stock of medicines for viral fever, diarrhoea and gastroenteritis to the local ASHA workers to use during the floods," he says.

The 250-strong team comprises two doctors per boat. Some, like Dr Islam, a graduate from the Assam Medical College, Dibrugarh, do a stint on the boat to gain experience in rural areas. “We also have doctors who have retired from government service. On each boat, we have one-two auxiliary nurses, a lab assistant and a pharmacist. The programme management team sits in Guwahati, and we have coordinators in each district called district programme officers—out of these, at least five are women," says Hazarika. Their salaries and boat repairs are supported by the National Health Mission, with which the C-NES entered into a public-private partnership in 2008.

It has been a challenge to convince people to adopt modern healthcare methods. Arup Kumar Saikia, district programme officer, Dibrugarh boat clinic, says the education rate in the chars is dismal—a mere 19.31% (according to Hope Floats), well below the state literacy level of 73.18% (Census 2011), and people still believe in rituals to cure illnesses. “It took us three years to get people to understand the significance of modern medicine," he says.

Besides these clinics, organizations such as Rural Volunteers Centre, or RVC, are also helping out in the relief effort. Some of them focus on children, who form a major chunk of the population affected each year. There are currently 659 relief camps, housing 103,934 people. According to Unicef estimates, 41,574 of these are children.

So RVC has started Suraksha, a child-inclusive disaster risk reduction programme, in Dhemaji and Majuli, with technical support from Unicef Assam. It is activating child-friendly spaces in emergencies (CFSie) in designated relief camps. CFSie, in the context of Assam, is defined as a place designed and operated in a participatory manner where children affected by natural or man-made disasters, including armed conflict, can be provided with a safe environment and integrated services, including recreation, education, health and psychosocial support.

The various teams and individuals involved in relief work are now gearing up to tackle the post-flood challenges. Mumbai-based film-maker Reema Borah, who is from Assam, has been carrying out relief efforts at an individual level, in camps located in some of the most devastated areas in Morigaon. “It is after the flood waters recede that the real crisis will start in the form of infections and mud-related diseases. We will be working with adolescent girls on menstrual and hygiene issues," says Borah.

Nasima, 31, an auxiliary nurse on the Barpeta boat unit, concurs. “Floods ke baad, bohot gandagi ho jaati hai. It stinks everywhere," she says. So the team hands out phenyl and bleaching powder, besides medicines, as well.

“This year has seen a long, enduring wave of floods. We make sure all boats are in good condition and carry life jackets. Brahmaputra is not a river to be trifled with. It not only changes its course but also its speed rapidly. The teams do their work at great risk and with a great sense of commitment," concludes Hazarika