Photo essay: Akha The Boat of Hope
Ingenious Solar Direct-Drive Refrigeration units on Assam's Boat Clinics have revolutionized immunization services, reaching over three million poor and marginalized people in remote areas.
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Across the difficult riverine islands in Assam, ingenious Solar Direct-Drive Refrigeration (SD-DR) units at the Boat Clinic have entirely changed how health workers like Nirupoma deliver immunization services. Boat Clinics are reaching more than three million people, mostly poor and marginalized, living in Assam's remote and riverine areas.
Today, nine-month-old Noor Khatun will be vaccinated against Measles-Rubella (MR) and Japanese encephalitis (JE) and receive Vitamin A supplementation. Noor's mother, 25-year-old Munawara Khatun, awaits the Boat Clinic's arrival at Noor’s village in the Bongaigaon district in the northeastern Indian state of Assam. Munawara is at the health centre. Today she is more relaxed compared to her last visit to the Boat Clinic, in June this year, when her home and village were deeply submerged in floodwaters.
Onboard the Boat Clinic is 41-year-old Nirupoma Roy, a veteran nurse and midwife who has been with the Boat Clinic for over a decade. She and her colleagues are working calmly through the morning chaos, updating the beneficiary register, handling the vaccines in the cold chain, and preparing for the makeshift health clinic to be conducted at Noor's village in Khorchimari Island, locally known as chars or aporias.
The boat clinic mirrors a Primary Health Centre (PHC) and has all the essential health facilities, such as the laboratory, OPD, pharmacy and cold chain point. The paramedical staff includes two Auxiliary Nurse Midwives (ANM), a pharmacist, a laboratory technician, community workers, and support staff.
The Boat of Hope
Most of these riverine islands in the Bongaigaon district are constantly reshaped by the mighty Brahmaputra River. An island, once thriving with livestock and greenery, can be wiped out overnight, leaving its residents vulnerable to displacement and to the extent of the island disappearing altogether.
For more than three million people across the riverine islands of Assam, the Boat Clinic is a beacon of hope to people like Noor's mother. Due to continuous flooding and erosion in these islands, it's almost impossible to build and maintain permanent housing and basic healthcare structures.
Connectivity is limited to country boats. Most of the population is poor, and these villages have one of the highest infant and maternal mortality rates in the state.
In 2004, a local NGO, the Centre for Northeast Studies and Policy Research (C-NES), launched the Boat Clinics to provide much-needed medical services to the area. UNICEF joined in the initiative and supported the capacity building of health workers. A team under the leadership of Sanjoy Hazarika at C-NES worked round the clock to design and build Akha— ‘A Ship of Hope in A Valley of Flood.’
For the past twenty years, the Boat Clinic has delivered essential healthcare services to 2,500 chars, mainly in 14 districts, including Bongaigaon district, where Noor's family lives. Today, 15 Boat Clinics operate along the river, treating around 18,000 to 20,000 people monthly.
An everyday tale of grit, determination, and commitment
After one and a half hours of sailing on the difficult Brahmaputra, where low currents stalled the boat multiple times, the Boat Clinic finally reached the shores of Khorchimari char. Today is no different from the routine challenges health workers face: under the scorching sun, amidst stifling humidity, they take an arduous journey, over a kilometre and a half on foot, to the makeshift health centre. They also carry medicines, medical equipment, and other heavy supplies that are essential in providing the services they carry.
"Ten years ago, people here faced many hardships. Travelling was difficult; sick children had no access to medicine at night, and pregnant women rarely received health check-ups. Now, I feel a deep sense of fulfilment knowing people rely on us, and there is a sense of relief when we arrive early," says Nirupoma.
Nirupoma knows most of the people in the community by name. She meets Munawara Khatun and Noor, and they talk about her health and Noor's vaccination schedule. Munawara has been visiting the boat clinic for her last two pregnancies and now for Noor's vaccination. Noor receives her Measles-Rubella (MR) and Japanese Encephalitis (JE) vaccinations, Vitamin A Supplementation, and lots of love along with the vaccines.
“During the birth of all my children, I received the necessary vaccinations and medical care whenever I was unwell. The doctors and ANM didi (sister) are very good, and my three children have received their vaccinations and treatment at the boat clinic,” says Munawara Khatun.
Solar Direct Drive (SDD) refrigeration units – The Game changers
Nirupoma thanks UNICEF for the innovative Solar Direct-Drive (SDD) Refrigeration units. These SDDs have transformed healthcare delivery across the challenging riverine islands in Assam, allowing health workers like Nirupoma to reach and immunize more people on the islands than ever before.
Earlier, healthcare workers had to travel to district health facilities to collect vaccines for Boat Clinics on every visit. This extra step took valuable effort and time before they could begin their actual work at the Boat clinic. Solar-powered refrigerators (SDDs) bring the cold chain, a temperature-controlled system for storing vaccines, directly to the boat clinics.
"SDDs brought the cold chain closer to the people we serve. Now, with the SDDs, the Boat Clinics can safely store vaccines onboard, saving time for health workers - over four hours per trip- that was previously spent on transporting vaccines," says David Kiambi Mutuerandu, Chief of Supply & Procurement, UNICEF.
UNICEF has been working with the Government of India and its partners for 75 years since 1949, providing essential health services to children, women, and communities, especially those living in hard-to-reach and difficult areas.
"With the Cold Chain onboard, we can cover more islands and spend more time caring for people. It has also been a huge help for me - now I can get home earlier and spend time with my daughters," adds Nirupoma.
She feels a deep sense of satisfaction, knowing she has completed her duties and made a difference in the lives of many. Tomorrow, she’ll wake up again early to start a fresh journey on the Boat Clinic, taking critical healthcare services to the next island.