The Brahmaputra River is one of the major rivers in Asia which flows through India, China and Bangladesh. This long and tiring journey has riverine islands inhabited by humans since a long long time. As the river flows through different channels it creates, it brings with it, seasons of aggression and peace putting human life and livelihood at great risks. For communities perilously living in flood prone areas, access to basic resources and opportunities is a perpetual challenge.
River islands especially lack basic infrastructure and services such as healthcare, education, power, drinking water and sanitation. People risk the weather and flooding rivers, and make long journeys in difficult terrains to get basic health services such as vaccination, mother and child care, medicines, minor operations, etc. Medical emergencies can be particularly harrowing. Same challenges are prevalent across the sundarbans in Bangladesh, coastal areas of Rakhine in Myanmar, the lakes of Cambodia, and many other areas.
A boat clinic takes healthcare to the doorstep of the people. Length of trips varying from a single day to several days, one of the biggest challenges that these clinics face is access to energy for powering basic health and communication equipment. Typically, all these loads are powered by a diesel generator, the use of which is limited by the amount of diesel that can be stored on the boat, resulting in the services being terminated early every day. Diesel is also difficult to procure on the islands, and the intense noise from the generator makes it difficult to work on the boat. Additionally, these loads being powered by a diesel generator is also harmful for environment and adds to the operational costs of the clinic as well as increases additional load on the boat.
CNES and SELCO Foundation collaborated to understand the specific energy needs of such a mobile health delivery mechanism. The Jorhat boat clinic reaches out to around 17,000 people through 18-22 camps per month across 34 villages. The project took into consideration the need and utility hours of various energy driven equipments – lights, fans, laboratory equipments and audio-visual devices. An optimum solar system was designed keeping into consideration usage hours, criticality of the equipments and space available on the boat for the panels.
In April 2017, with technical support from SELCO Foundation and Envo Business Solutions Pvt Ltd, the solar system was implemented and made operational. Retrofitting a boat with solar has certain technical challenges. Panels and batteries add over 500 kg, which needs to be balanced across the span - this is a worry for smaller boats than for larger ones. A waterproof space needs to be designed for batteries, panel mounting structures preferably made from aluminium to prevent rusting, and sturdy enough to withstand high wind speeds.
Centre for North East Studies and Policy Research (C-NES) in partnership with the National Health Mission, Government of Assam has been operating Boat Clinics providing primary health care to the remote island populace in the Brahmaputra and across it since 2005. The idea of boat clinics challenges conventional healthcare delivery models, which rely on a network of stationary primary health centres to which people must travel from far off places.
The Centre for North East Studies and Policy Research (CNES) works on a range of issues and areas at both field and policy levels relating to health, education and other areas of governance, participative planning and rights, water resources, environment, rural livelihoods, peace building and building better understanding among communities.
All the equipments on the boat that used to run on diesel now run on solar, which means the boat itself has more diesel available to be able to stay on the river longer.
In the evening, the services stay open till all patients are treated (especially for emergencies). The staff have more time at night to complete their work and for leisure, which has improved their wellbeing and level of satisfaction.
The boat now has a solar powered vaccine refrigerator, making it possible to also start storing vaccines, medicines and lab reagents, which otherwise had to be stored in ice boxes for a limited time.
The boat clinic is now upgrading the lab services to provide better diagnostic services to patients during their trips.
The boat clinic at Jorhat is a pilot that will be submitted to the National Rural Health Mission for institutionalisation and implementation of other boat clinics in similar need and geographies.