Health care workers travel two hours by boat to reach Fulkakata village in Assam state, northeastern India.

Braving the Waters

Health care workers provide services in hard-to-reach river communities in northeastern India, with support from UNICEF and the Johnson & Johnson Foundation. 

As a frontline health care worker, Parmeswari Adhikari is used to early mornings and long days. It's the boat ride to her work in the chars, or islands, of the Brahmaputra River in Assam State, northeastern India, that she finds most taxing.

Mobile health teams provide health care in hard-to-reach, high-poverty communities

For the past two years, Parmeswari has worked at the Tharigram Vita outreach center in the chars. "It takes me one and a half hours by boat and another 45 minutes on foot to reach my center," she says. When the waters recede after the rainy season, Parmeswari spends less time on the boat and more walking across the hot sand. 

From the outreach center, Parmeswari and her coworker Beauty Bolo Roy visit villages to provide nutrition, vaccines and regular health checks for conditions such as anemia, malnutrition and waterborne diseases. When necessary, they make house calls or refer patients to the riverbank health clinic that serves 15 local villages.

Health care in a hard-to-reach, high-poverty region is made possible by the diligence of these mobile health teams, working alongside accredited social health activists (ASHAs), who act as person-by-person links between the health care system and villagers, and community workers who administer the social security and social welfare benefits that help cover health services.

UNICEF-supported health worker Parmeswari Adhikari carries vaccines packed in cold-chain carriers to remote villages in Dhubri district, Assam state, India.
Transporting vaccines in an insulated cold-chain carrier bag, health worker Parmeswari Adhikari walks the final leg to reach Fulkakata village in Dhubri district, Assam State, northeastern India. © UNICEF/UN0804045/Baruah

Insulated cold-chain carriers protect vaccines en route

On this visit to the village of Fulkakata, the team is hosting a weekly health care day, itself a logistical feat. Before arriving by boat, Parmeswari and Beauty traveled in the early morning hours by bus to a district health center in Dhubri to obtain and log vaccines. After loading them into cold-chain carrier bags provided by UNICEF, they took a rickshaw to a boat bound for the chars.

Health workers conduct a village health care day in Fulkakata village, Dhubri district, Assam, India.
Health workers Parmeswari Adhikari and Beauty Bolo Roy, along with members of their team, conduct a village health day at Fulkakata village on Dec. 7, 2022. © UNICEF/UN0804052/Baruah

Sharing guidance on healthy eating, hygiene and vaccines during weekly village health days

The ASHA on the team, Amina Khatun, hosts the health care day in her home. The location was selected with input from village leaders, who also encourage participation by everyone in the village. "Today, we will do vaccinations, provide medicines and offer advice on family planning, healthy eating and hygiene," says Parmeswari.

The health event stretches across the next three hours. "I was here for my injection today. The health workers checked my blood pressure and blood sugar. They also gave me iron and calcium tablets," said Khalida Parveen, one of more than 50 women arriving for services. 

Along with administering tests and vaccines, "Beauty and I spend a lot of time talking to family members," says Parmeswari. The entire team, she says, works to build acceptance of health care services and explain their necessary steps, stages and follow-ups, while battling skepticism and resistance.

Health worker Parmeswari Adhikari discusses the importance of vaccines with a woman in Fulkakata village, Dhubri district, Assam, India.
Explaining the health care services available is a critical part of improving health outcomes in villages in the chars, says Parmeswari Adhikari, shown here at the Fulkakata village health day. © UNICEF/UN0804047/Baruah

Support from the Johnson & Johnson Foundation has helped the program reach up to 300,000 people with health care services and information in the past 2 years

The work is grueling and often proceeds painstakingly, one villager at a time. But the reach is significant. "In the past two years, if we talk about direct reach, we've connected with around 250,000 to 300,000 people through this program," says Dr. Annapurna Kaul, a UNICEF India health specialist. The program is made possible by support from the Johnson & Johnson Foundation. 

Parmeswari and Beauty start their journey back at 3 p.m. On the boat, they talk about the give-and-take of the river itself — fertile soil to grow jute or mustard and an ample supply of freshwater fish, as well as severe floods that repeatedly uproot families from their homes. They also look back on the challenges and exhaustion they faced during the height of the COVID-19 pandemic, such as going for days without returning home to their families.

These days, life is back to its more familiar — if demanding — routine. Parmeswari will be up again at 3 a.m. tomorrow, to make breakfast for her children before heading out for another day on the front lines.

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Health care workers travel for hours by boat to reach remote villages on chars, or islands, in the Brahmaputra River, Assam state, northeastern India. © UNICEF/UN0804043/Baruah