No Emergency Healthcare for Delta Island Communities in the Sundarbans

the shore of Sagar Island
The Wire
,
Sundarbans, India

No Emergency Healthcare for Delta Island Communities in the Sundarbans

One April afternoon this year, a month before Cyclone Yaas ripped through India’s eastern states, a severe storm struck Sagardwip, a remote island on the Sundarban delta, where the river Ganga meets the Bay of Bengal.

Winds whipped up the deep dark waters of Muriganga, a distributary of the Ganga that separates the islands from the mainland, and through the leaves and treetops and the grass below.

An 80-year-old islander, who had contracted COVID-19, was gasping for breath. His son Srikrishna Das rushed him to the local hospital but the old man’s oxygen level was dipping. Doctors on duty advised that he be shifted to a better medical facility on the mainland. But the storm stood in their way, and the man soon died.

“Perhaps if we had the option of traveling by road instead of by river, we could have saved his life,” Das said.

During health emergencies, people living on the delta islands of Sundarban are often referred by local doctors to hospitals on the mainland for critical care. They then have to travel by boat across rivers because many of these remote regions are not connected by roads or bridges.

Delays are common since water travel is not permitted in bad weather, because of the danger of boats capsizing. Delays happen in periods of better weather as well, especially when the tide begins to ebb and the water level becomes so low that boats get stuck on the riverbed.

Plans to construct a bridge over a strategic stretch of the river were in the pipeline for many years before they were mired in unresolved disagreements between the state and Central governments, over logistics, costs and other issues.

West Bengal chief minister Mamata Banerjee is believed to have first suggested that a bridge be constructed for commuters between Sagardwip and Kakdwip, the closest port on the mainland, during a visit to Sagardwip before the state elections of 2016. Banerjee has been keen to develop the region as a tourist attraction; it is already a site of pilgrimage since it hosts the Sagar Mela, the second largest religious fair in the country after the Kumbh Mela.

Sagardwip’s residents also say Banerjee’s government has flushed the region with a large number of public doles. They include “free ration for all islanders and schemes for women, such as ‘Lakshmi Bhandar’ and ‘Kanyashri’, which provide, respectively, monetary assistance to female householders and financial benefits for the education of female children,” as well as has “invested in the healthcare sector,” said a school teacher. He wished to keep his identity hidden because he said he worked as a neutral observer at polling booths during elections.

For example, the Swasthyasathi scheme provides free medical insurance to all people of West Bengal – and a water ambulance service for Sundarban islanders.

Sagardwip previously had water, and air, ambulances only during the Sagar Mela. Three years ago, the state made the water ambulance service permanent, according to Sagar Block Development Officer Sudipta Mondal.

“It is now available for the region’s islanders seven days a week. Other than the four to five hours per day when the tide is low” – the timings change according to the lunar cycle – “making it impossible for the boat to ply, the service can be availed any time of the day or night,” Mondal said.

On average, according to him, three or four patients use it every day. The service’s phone number is printed in bold letters on the vessel’s sides of the vessel and people who want to book it need to call first.

water ambulance
The water ambulance used to ferry islanders to the mainland / Credit: Dola Mitra. 

“I feel dedicating at least one more boat for use as a water ambulance would go a long way toward ensuring people don’t have to wait for the one vessel to become free," Mondal added.

The water ambulance is fit with rudimentary medical equipment, including oxygen cylinders, stretchers and lifejackets. The one-way charge is a hundred rupees and includes the travel cost of one patient plus two accompanying people.

Islanders also said that the service, while helpful, is limited in its ability to deal with the magnitude of their healthcare problems.

The ambulance “alone is not enough to solve the serious issue of health emergencies in Sagardwip and nearby islands,” the school teacher said.

“Timely medical intervention is crucial, and the process of transporting the sick by the water route is not just time-consuming but also fraught with difficulties and discomfort, as far as the patients are concerned.”

A care-seeker is typically first admitted to the Rudranagar rural hospital. If they need more medical attention, they must first be moved into a regular road ambulance and driven 15 km to the island’s sole port, at Kochberia on the northeast bank. At the port, they must be shifted to a stretcher and carried to the water ambulance.

The water ambulance then ferries them to Kakdwip, the port on the mainland, where the patient is carried from the dock to another road ambulance on a stretcher, and ultimately driven to the hospital on the mainland.

But “if there is a bridge connecting the island to the mainland, the car ambulance can go directly from the rural hospital to the hospital on the mainland,” the teacher said. “Only that would adequately address the plight of the people of the island.”

Other islanders agreed. Avijit Mondal (21) is a resident of Sagardwip’s Harinbari village. He lost his father to a heart attack in January 2020 even as he was being transferred from a rural hospital on the island using the water ambulance.

“My father was only 46, he was very active and quite fit,” Mondal told The Wire Science. However, after he complained of chest pain one day, Mondal and other relatives took him to the local hospital, where doctors said he’d have to be moved immediately to a hospital on the mainland.

“We booked the water ambulance, but the boat got stuck midway because the tide had turned low and the vessel couldn’t move. It usually takes four to five hours for the tides to turn,” Mondal recalled. “As we waited for the high tide, he stopped breathing.”

A bridge could have shortened this trip to half an hour.

map of the area
A map of places in the Kakdwip subdivision. The Matla river is at the extreme right / Screenshot credit: Google Maps

Sagardwip is the largest island in Sundarban. It has a population of nearly two lakh, over forty-three villages. Ganga Sagar, where the Ganga river flows into the Bay of Bengal and is a pilgrimage site, is at Sagardwip’s southern tip. There is a temple here for the sage Kapila. It is relatively new; there was an older one that locals say the bay swallowed years ago.

Sagardwip also has the area’s most government hospitals – three. “But these don’t have ICUs or blood banks, and are not really equipped to deal with emergencies or critical patients,” a nurse employed at one of the hospitals said.

There are also primary healthcare centres in each of Sagardwip’s eight gram panchayats. In Ghoramara, a nearby island, there is also a primary healthcare centre. “At the primary healthcare centers,” the nurse continued, “a host of rudimentary medical activity takes place, such as the administration of polio vaccines to children and pre- and post-natal care. But complicated pregnancies, deliveries and operations are not dealt with here, not to mention serious illnesses or emergencies.”

During a visit to the islands, this correspondent encountered several sick people boarding regular boats to get to medical facilities on the mainland. It was the same story on other islands in both the eastern and the western parts of the delta.

Sundarban is separated into the Indian and the Bangladeshi sides, with just a third falling on the Indian side. Here, the distance between the delta’s eastern and western ends is roughly 200 km, and takes four to five hours to cover by road.

Eastern Sundarban comprises 102 islands; some 54 are inhabited and the rest are covered in mangrove forests and are also home to the Bengal tiger (Panthera tigris tigris).

“She has just delivered a baby,” Gayatri Sardar said as she held her daughter-in-law Jyotsna’s arm with her left hand and cradled Jyotsna’s newborn with her right. “It was by Caesarean section.”

The younger woman limps, holding the side of her stomach, dragging her feet on the ground. She is clearly in pain. Both women slowly board a motorised canoe anchored at the Godkhali ghat, the principal ferry point in the eastern Sundarban from where boats leave for different islands in the vicinity.

After Jyotsna’s delivery at a hospital on the mainland, the two women and the baby are headed to Goshaba island.

Recently, the state government built a bridge connecting a part of the eastern Sundarban with the mainland, across the tumultuous Matla river. Both the river and adjoining creeks host crocodiles and snakes. And for many years, medical emergencies in this part of the land have mostly been due to snake bites and violent accidents with crocodiles and tigers.

However, healthcare workers are now growing concerned about the effects of climate change on the islands and its inhabitants.

Doctors working with the Sundarban Foundation, an NGO in Goshaba, compiled a chart that indicated an annual – but still marginal – increase in the number of heat- and salinity-related illnesses.

women board a canoe
Gayatri Sardar, her daughter and her grandchild board a canoe at Godkhali ghat, bound for Goshaba / Credit: Dola Mitra.

“While it is difficult to establish a direct connection between the slight increase in numbers of certain diseases … and global warming, there is no denying that increased heat and salinity is a growing concern in Sundarban,” Prasenjit Mandal, the NGO’s founder-director, said.

“That this will eventually adversely impact health or even … lead to health complications is entirely logical to assume.”

“The adverse impact of salinity in water and soil is very evident in diseases like skin ailments which, in my experience, shoot up significantly soon after a region has been inundated with sea water after cyclones and floods,” Dr Prafulla Safui, a medical practitioner associated with the NGO, said. “Its adverse impact is more difficult to diagnose when the effect is internal, like when it causes a rise in blood pressure.”

"We cannot currently state with any certainty that there is a connection but over a period of time, it should become more evident,” he added.

Dr Safui also said the region’s poorer people rarely rush to see a doctor when their symptoms are mild – as is typical across the country. “They usually only visit the physician with serious complaints, and often diagnosis of ailments like hypertension would be a side issue,” according to him.

“Headaches and neck pain have become our constant companions,” Sujit Mandal, a resident of a village in the eastern Sundarban, said. “But who has the time to complain?”  The 28-year-old construction worker laughed it off, but his wife, Shampa (26), remarked, “Actually, he complains all the time, but he will not visit the doctor.”

The Sundarban chief medical officer, Debashis Roy, sent out a questionnaire in October to rural hospitals in the region at the request of this reporter, asking for details of certain diseases that could be traced to higher heat and/or salinity. Their responses didn’t indicate even a marginal rise in the incidence of such illnesses.

One explanation for this gap between what health workers expect and what hospitals are recording could be that villagers don’t rush to care facilities unless they’re having an emergency.

“After getting information from all concerned,” Roy said, “it can be stated that apprehensions about salinity of water and soil at the coastal areas of Sundarban adversely impacting health in the region cannot be supported by conclusive evidence.”

A doctor at a hospital in Goshaba echoed him: “There is no upward [trend]. People of this region are not unused to, if not being resilient to, conditions of heat and salinity in the air, water and land. It would be difficult to establish a perceptible rise.”

But others said they noticed changes. “In my decade-long practice, I feel there are more people today who are arriving with complaints of vertigo, trembles and other symptoms associated with hypertension and high blood pressure than earlier,” a nurse at Sagardwip said. She didn’t wish to be named because, she said, she isn’t the hospital’s official spokesperson and could only comment on her own observations.

“Checking the blood pressure is a mandatory part of check-ups, when patients drop in for medical treatments. I have noticed an upward trend.”

But whatever the impact on their health, many islanders are quite aware that they are, or will be, among the worst affected by climate change. “We have been battered by cyclones and storms, and the rising sea is swallowing our land,” Gouranga Mete, a resident of Ghoramara, said.

“We have never witnessed so many cyclones or storms before,” the school teacher from Sagardwip added. “Nor so many floods or so much rain.”

The bridge from Sagardwip is apparently held up because the state government, helmed by chief minister Mamata Banerjee’s Trinamool Congress (TMC), doesn’t get along with the Bharatiya Janata Party (BJP) at the Centre. At the same time, representatives of both parties seemed to agree that the bridge would be a good idea.

But when posed this fact, a TMC spokesperson rebutted, “Why is the Centre not coming forward with the funds? After all, this kind of a project cannot take off without the involvement of the Central ministry of road transport and highways.”

Prime Minister Modi with West Bengal's Chief Minister, Mamata Banerjee
West Bengal Chief Minister Mamata Banerjee and Prime Minister Narendra Modi / Credit: Press Trust of India. 

“Construction of the bridge is extremely important,” said BJP spokesperson and leader of the opposition in the state assembly Suvendu Adhikari. “For the benefit of the people of Sagar Island, I am ready to bring up the issue with the Central government, but the proposal needs to come from the state government.”

Once the two parties agree to bury the hatchet, “there are important issues that [will] need to be worked out,” an engineer of the state’s Public Works Department said; he was part of a team that built another bridge nearby.

(He requested anonymity citing nondisclosure clauses in his contract of employment with the government department he works for.)

What issues? The bridge will have to be built across a span of 4km, which is quite long. Because of its proximity to the bay, the structure will also have to be accustomed to tidal ebbs and flows. The bridge’s height and arch will be determined by the maximum height of ships passing through at high tide.

Importantly, both Indian and Bangladeshi ships will use the water route for trade.

So including the project report, the engineer added, “the approximate cost of construction will be no less than 1,000 crore rupees”.


This story was published with the support of Internews’ Earth Journalism Network. It was originally published in The Wire Science on 28 November 2021 and has been lightly edited for length and clarity.

Banner image: Sagar Island, where the Ganga meets the sea in West Bengal / Credit: Lecercle via Flickr

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