Over the years, the Maharashtra government has taken several initiatives and poured funds to improve the medical infrastructure in Nandurbar district. Many of these projects, which were launched with much fanfare, however, cut a sorry picture today, among them a floating dispensary and water ambulances.

Despite the state government’s efforts, Nandurbar, with a population of 16.46 lakh, has the lowest Human Development Index (HDI) in Maharashtra with health and economic disparities seriously affecting its predominantly tribal communities, who make up 70 per cent of the district’s total population.

Over a decade ago, the state government had launched two floating dispensaries to provide healthcare to nearly 20,000 tribals residing in 33 hamlets — inaccessible by road along the Narmada river. These tribals were displaced during the construction of the Sardar Sarovar project.

More than a decade later, one of the floating dispensaries has broken down beyond repair and presently lies in a godown. The other, around 20-ft long, is in a rickety shape, with medical staff as well as patients afraid to board it scared that it may capsize any moment.

“We are scared for our lives considering the condition of this boat,” one of the paramedics deputed to the dispensary said.

Each floating dispensary is to be manned by a team of four paramedics headed by a doctor. A team works for seven days continuously and then takes off for the next seven days, during which another team mans the dispensary. However, against 10 sanctioned posts, only six are filled and there is only one doctor. When the doctor takes off, the dispensary runs without a doctor.

The dispensary gets around 35 patients daily. The complaints are mostly diarrhoea, fever and skin infections. Per day, there are 1-3 cases of snakebite. The medical staff on the boat said they are unable to attend to all the patients due to manpower crunch.

“There are two sanctioned posts for doctors. But at present, we have only one. When he gets one week off after his duty on the boat, we have no doctor. The patients are left at our mercy, who often abuse us if they do not get proper treatment,” said another staff member. The staff, who are on contract, also don’t get their salaries on time.

They blame the difficult working conditions and low salary as the reason behind doctors quitting the job and finding more lucrative opportunities.

The dispensary’s OPD gets villagers from nine hamlets of Akkalkuwa. The paramedics are also responsible for conducting antenatal checkups, examining children, treating snakebites, diarrhoea and heat stroke, among others, and providing treatment to patients in a medical emergency.

As per data gathered by The Indian Express, between 2019-20 and 2021-22, a total of 9,526 patients were treated in the dispensary’s OPD and 132 were provided with antenatal care. In fact, 240 vaccinations were done at the dispensary in the same period.

All these medical services are being rendered without electricity. The generator is lying unused. “During the summer season, when the temperature shoots up, it becomes impossible to treat patients without a fan. The dispensary turns into a burning bunker. Then with our own expenses, we put up sheds on the floor for some relief,” said a staff member. At night, they treat patients with a torch and flashlight. “In cases of emergencies, it becomes extremely risky to attend to their wounds in complete darkness,” the staff member added.

The staffers, who also include two women auxiliary nurses, are forced to sleep in the dispensary in the dark. “At night, even a slight noise wakes me up as anytime we can get bitten by a snake in the darkness,” said a staff member. The staffers also buy their own drinking water.

The dispensary runs round the clock floating across different banks but doesn’t have any siren to inform villagers of its arrival. Amid the mountain ranges where finding a cellular network is a challenge, the dispensary doesn’t even have any communication mechanism to attend to emergency calls.

“There are no signboards to inform the villagers about its schedule, like on which day where it is stationed,” said Latika Rajput, a member of the state-appointed core committee and the Narmada Bachao Andolan (NBA).

Dr Govind Chaudhary, district health officer (DHO), said that under the National Health Mission, a budget of Rs 72 lakh was sanctioned for repairing the second dispensary. But now, they have cancelled it and are planning to get a new one. “We have asked the authorities to provide a new dispensary as both the boats are in a bad condition,” he said. “We are also trying to get it through some donations.”

The state government had similarly floated three ambulances for villagers. While the condition of these water ambulances is much better than the floating dispensaries, villagers complain that the facilities are not up to the mark. While each ambulance has sanctioned posts of four doctors, 2-3 posts are actually filled at any given time.

Also, due to bureaucratic apathy, procurement of medicines in the ambulances is a challenge. “We don’t have any assigned vehicles. So, if we have to procure medicines, we have to require the nearby PHCs to provide their ambulances. Due to this, sometimes, it takes over two weeks just to get basic medicines like folic acid tablets which are required for pregnant women,” complained a staff member from the ambulance.

They too are underpaid and villagers have complained that the existing staffers often remain absent from duty. To address the issues, the district has also developed an app — Kobo to help in the online tracking of the paramedics. “On a daily basis, the medical staffers will have to upload the data which will hopefully help address the loopholes,” said Dr Chaudhary.

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Rupsa ChakrabortyRupsa Chakraborty, is a special correspondent with The Indian Express'... read more