The residents of the 10-odd islands on the outskirts of Goshree islands wait patiently for the arrival of a make-shift boat at their boat jetties. The wait is for the arrival of doctor and paramedics with medicines in the boat the islanders affectionately call ‘medicine boat’ or colloquially ‘ marunnu boat’. Among them are aged men, women, children, pregnant women and the differently abled.
The treatment of the patients starts immediately after the boat anchors.
For the isolated residents of islands like Pizhala, Cheriya Kadamakkudy, Valiya Kadamakkudy, Chennur, Chariamthuruthu, Paliamthuruthu, Moolampilly, Kothad, Korampadam and Kandanad the floating boat is the only source of health care as they have no hospitals and limited access to the mainland.
“On an average 2,000 patients are treated every month in the floating dispensary. Nearly 100 patients from four islands are being treated daily”, says Dr. Daisy Thomas the physician serving in the floating dispensary, as she clarifies by showing the outpatient register kept in the boat. The boat anchors at four jetties daily. “Patients here mainly suffer from asthma as air pollution is high on the islands. Hypertension and diabetes are also common”, she adds.
The expenses for the dispensary boat as well as the supplies are met by the National Rural Health Mission (NRHM). The initiative launched by the Prime Minister on April 13, 2005, provides accessible, affordable and quality health care to the rural population, especially the vulnerable groups.
“The floating dispensary started on February 28, 2008, is the first floating dispensary in Kerala. NRHM identifies the most difficult places where health care is not easily accessible after considering the population, income of the people and topography of the area. Thus we selected these islands for starting the floating dispensary”, says Dr. K.V.Beena, NRHM Programme Manager. Among the above mentioned islands, there is only one Primary Health Centre (PHC), functioning at Pizhala. Unfortunately, Pizhala has no road access to the mainland so far.
“The patients of these islands won’t continue their medicine if they miss the boat. They don’t bother to do clinical tests if the medicine boat fails to reach their destination jetties,” adds Bini, the staff nurse on the boat. The onboard apparatus include stethoscopes, glucometers, and sphygmomanometersThe boat will soon be equipped with a clinical laboratory. Lab technician posts have been sanctioned by the NRHM and equipment have been purchased. At present the patients do clinical tests outside and wait for one week to consult the doctor again as the boat reaches each jetty once a week.
Lack of medicines “The floating medical care centre functions directly under the control of the Medical officer at the PHC in Pizhala. The PHC requests for the supply of medicines to the Medical Service Corporation. There is no dearth of medicines and they reach the boat through the PHC once in a month’, says Dr. S. K.Aneesh, Medical Officer at the PHC.
“I have been suffering from high BP and cholesterol. Being elderly , I rely on the medicine boat for regular medical check ups and their free medicine service,” says Joseph, 69, of Cheriya Kadamakkudy. This service has led to great bonding between the people and the paramedic staff who are fondly called ‘ chetta ’ and ‘ chechi ’ .
“Except administering preventive medicines to toddlers, injections are administered for the adults inside the boat. If contingencies arise, it will be difficult to send the patients to hospitals, says Dr. Aneesh. An ambulance boat which had served earlier to bring the patients to Kochi is now anchored idly at Pizhala. The floating dispensary now faces a few challenges. It cannot reach certain jetties in Valiya Kadamakkudy due to the deposit of alluvial sediments (ekkal). Also, the staff on the boat has no facility for food and drinks and the time taken to travel between jetties is sometimes as long as two hours.. “We bring food from home and consume them on the journey between islands,” say Rahitha, the pharmacist and Ajitha, the attendant.
The boat is designed to function as a mini hospital. There is a cot for the patients. . There are chairs, wash basin, water tank and a toilet in the boat. The Hospital Management Committee (HMC) float tenders for the floating dispensary every year. A rupee for two weeks is collected from the patients as Out Patient charge and the amount goes to the HMC fund.
“I have been awarded the floating dispensary since January 2013 at a daily rent of Rs.1, 500 per day. After paying the staff and diesel charges (average10 litres of diesel per day) I get a meagre amount as profit,” says Philip, the lascar- cum-owner of the boat. “Since I also belong to Pizhala I know the difficulties faced by the natives for medical care so I don’t think about profit.” he adds.
What happens when any of the staff is absent? “They adjust the work, with the nurse distributing medicine and the pharmacist checking the BP and sugar levels of the patients. Even if the doctor is absent the substitute Dr. Sudhakar from the PHC will be on board,” says Aneesh.
The service which starts at 8 a.m. concludes at 3 p.m., and the boat sails on all days except Sundays. The service is also not available on public holidays.
