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Bringing Health Services to Island Communities

© UNICEFIndia/2009/Ferguson

The Akha boat prepares to leave Dibrugarh town on Chokhia Island, Assam, India. Akha,' the boat of hope', is operated by the Centre for North East Studies and Policy Research, and supported by UNICEF and the National Rural Health Mission.

By Angela Walker

CHOKHIA ISLAND, India, 7 October 2009 – When the great Brahmaputra River floods each year, millions of residents living on its roughly 3,000 islands are cut off from the rest of India.

Even without the annual floods, poverty and isolation often prevent many islanders from seeking medical assistance on the mainland.

But today, the people who live on Chokhia and 11 other islands nearby are welcoming the 'Akha' – also known as 'the boat of hope' – a fully equipped medical ship with a 10-member team on board, including a lab technician and a pharmacist.

The Akha is operated by the Centre for North East Studies and Policy Research (C-NES, and is supported by UNICEF and the National Rural Health Mission in India.

Saikia was selected by the islanders and the medical crew of the Akha to be a community mobiliser.  The money she makes allows the single mother to send her 13-year-old daughter, Rinki, to the mainland for school. “My daughter tells her friends my mother is an ASHA,” Saikia says proudly.

Saikia interviews prospective patients to get their medical history and tells mothers about the importance of getting their children immunized for measles and other childhood diseases. She dispenses folic acid to pregnant mothers and ORS to children who have diarrhea. For each mother that she refers for an institutional delivery, she receives about 400 rupees, or about $8.23.

Twenty-eight-year-old Daimo Brahma, carries her six month old son Rahul in a green sling and has come to the Akha to get her baby vaccinated.  “The doctor has told me that they will protect my baby against big diseases,” she says. If the boat did not come to her community she wouldn’t go the mainland for care, because it is too far and transport costs are too high, she says.

Rangina Gayari has come to seek help for her 18-month-old daughter who has diarrhea. “I am lucky that I can now have my children see a real doctor,” she says.

Access to basic care

"God sent this boat to us," says Dr. Bhaben Chandra Bora, who works on board the Akha. "It's a relief for the people, since access to health services has been so difficult for them. We are working for the benefit of people who have not had access in 60 years."

The vessel is completely autonomous, with its own kitchen, toilet and solar panels, which provide electricity to keep vaccines refrigerated. Dr. Bora and his team treat everything from skin infections to diarrhoea. Emergency obstetric services are also available when complications arise in delivery.

In addition to providing primary health care, the boat supports community-managed school initiatives to increase children's access to primary education in the Brahmaputra River Islands.

Community workers

Volunteer Rakesh Doley lives on Aichung Island. His family herds cattle and sells surplus milk on the mainland. Whenever the Akha is scheduled to arrive, he receives a call from the crew three or four days in advance. He then travels by canoe or on foot to alert his fellow islanders that medical services will soon be available.

"As a local person, I make a difference, because the local community knows me. I'm part of development in my community, and that's a good feeling," explains Mr. Doley. "Children have the right to health and immunization. I can share this knowledge and tell them to get immunized."

Minu Saikia was selected by the islanders and the medical crew of the Akha to be a community mobilizer. She interviews prospective patients about their medical histories and tells mothers about the importance of getting their children immunized against measles and other childhood diseases.

Ms. Saikia dispenses folic acid to pregnant mothers and provides them with referrals for institutional delivery, as well.

Maternal and child health

The role of the Akha is crucial in Assam, where the maternal mortality rate is much higher than that of India as a whole. The infant mortality rate in Assam is also higher than the national average.

"We recognize that there are populations, including those living on the islands, that are totally out of reach of basic services," says UNICEF Assam Head of Office Jeroo Master. "Our mandate is to make sure that all such communities have access to basic health services to ensure improved maternal and child survival."