How Boat Clinics & Bike Ambulances Are Saving Lives in India’s Remotest Villages

No one should die because they live too far from a doctor. 

In a TEDx talk I watched recently, physician-entrepreneur Raj Panjabi attempted to drive this message home, highlighting how the lack of medical support is posing a problem for villages across the globe. But there is hope. Closer to home, changemakers on the ground are sparking revolutions in India’s hinterland — which is home to around 65 percent of the country’s population. Through simple formulae, they are ensuring health equity for all.   

1. Revamped kurma ghars

The concept, albeit archaic, still dominates the villages of India, particularly Maharashtra. Menstruating women are sentenced to a state of exile in the kurma ghar(period hut), where they must remain until they are deemed ‘pure’. The women are considered untouchable during this time. Once dilapidated, these structures had thatched roofs that offered little protection from the rain, and their lack of doors left women vulnerable to scorpions, snakes, and dogs. However, many kurma ghars have now undergone a revamp.

A Mumbai-based charity, Kherwadi Social Welfare Association, is ensuring that women retain their dignity through clean spaces equipped with beds, indoor toilets, running water, and solar panels for electricity. 

2. Boat clinics 

No longer are the residents of the Sundarbans paralysed with fear when a medical emergency strikes. They know their plea for help will be answered by the boat clinics. These clinics are the brainchild of Mohammed Abdul Wohab, a lawyer who claims that the ‘clinics’ treat a total of 34,578 patients each month. 

Right from pregnancy consultations and help with oral contraceptives to stitching wounds and treating snakebites, the clinics are equipped to deal with emergencies of all sorts. Each boat clinic includes two medical beds, a mobile X-ray, a small pathological unit, a medical storage room, and an oxygen cylinder. 

3. Palanquins for pregnant women 

As the delivery date approached, expectant couples in Uttarakhand would start to worry. They dreaded the upcoming trip to the hospital. Take, for instance, the couple Narendra and Kavita Kumar. Each hospital trip from their home in Gwalakot village meant overcoming insurmountable odds. It was a steep three-kilometre walk along a narrow, unpaved mountain path through oak and rhododendron forests. Once they reached the main road, they had to fetch an ambulance to take them to the hospital. 

So, when the government introduced palkis (palanquins) — stretchers designed to be carried by volunteers, who ferry pregnant women to the hospital — Narendra heaved a sigh of relief. Down South, another pregnant woman, G Ramulamma, living in one of Vishakhapatnam’s tribal areas, was also able to deliver her baby safely, thanks to the stretcher. 

4. Mission ICU 

Led by three friends, Dr Ashwin Naik, Maanoj Shah, and Dr Edmond Fernandes, Mission ICU is ensuring that hospitals in rural India are well-equipped to deal with emergency cases. How? They focus on skill training and resource building. 

Observing that the majority of deaths in rural India occur due to a lack of medical facilities, Mission ICU created a process that would expedite critical care. This involves training doctors in using the ICU kit, which comprises 10 beds, three ventilators, five tabletop monitors, suction pumps, a tabletop oximeter, and BiPAP and CPAP machines. To date, Mission ICU operates in around 22 hospitals in India in states like Maharashtra, Karnataka, Odisha, Kashmir, Manipur, Tripura, and Arunachal Pradesh. 

5. Bike ambulances 

The rising Maternal Mortality Rate (MMR) in Jharkhand — 165 deaths against the national average of 130, as per the Sample Registration System (SRS) 2018 report — led the state administration to innovate cost-effective solutions. One of these is the bike ambulance, which is making critical care possible in informal settlements across the state. 

True to its name, it is a bike with a stretcher, medical kit, oxygen cylinder, saline bottle holder, siren, and reflectors. The aim is to help the patient stay stable until they reach the hospital. The drivers are also trained in first aid. The panchayats (village governing bodies) keep the drivers’ numbers on hand in case of an emergency.

6. Proxy doctors  

Nearly 60 percent of existing health workers are based in urban areas. Neurosynaptic Communications’ ReMeDi (Remote Medical Diagnostics) has found a plausible solution to this gap in medical resources. The initiative empowers health technicians — with little or no college education — to act as a proxy for doctors in rural areas. 

Let’s say a patient arrives at the village centre. The health technician records the vital signs and conducts basic diagnostic tests. They input any necessary information that needs to be added to the electronic health record and send it to an offsite doctor, who makes a diagnosis. This is sent back to the clinic with a prescription or referral for further care.

7. E-doctor clinics 

India has one doctor for every 1,457 people. Shocked by the diminutive statistic, Jagdeep Gambir started the concept of nurse-assisted e-doctor clinics in Dalsingh Sarai, a city in Bihar’s Samastipur district. The aim was to extend medical services to people who live in overlooked clusters. “I saw several children who were suffering as they did not have access to timely medical help,” says Gambir.

Through his initiative, Karma Healthcare, trained nurses from the respective regions are deployed at the clinic where primary checkups are performed. “For further consultation, the nurse will set up a video call with a certified doctor. In the same clinic, there is also a diagnostic lab for running tests and a pharmacy for providing necessary medicines.” In the last 11 years, Karma Healthcare has established more than 25 ‘e-Doctor Clinics’, across villages in Haryana, Rajasthan, and Madhya Pradesh. 

8. Hospital on wheels  

In Bhusawal, a railway town tucked away in Maharashtra’s Khandesh region, the chugging of train wheels announces the arrival of healthcare. Once a coveted luxury, medical access has become a reality thanks to ‘Rudra’, a train hospital that brings healthcare to the doorsteps of railway workers. The initiative is driven by Ity Pandey, the Divisional Railway Manager (DRM) for Bhusawal, a seasoned officer with over 26 years of experience in Indian Railways. 

She conceived the idea of a ‘hospital on wheels’ to provide medical aid to injured employees. Rudra, the ‘hospital on wheels’, heads to remote railway divisions every fortnight, ensuring health checkups and specialist consultations for every person who needs it. 

9. Portable operation table 

In areas where accident cases may not be able to make it to the hospital in time, what if the operation table was brought to the site? Dinoj Joseph, a Kerala native from IIT-Bombay, designed a portable operation theatre (OT), which is foldable and can be packed into a backpack. This invention is specially designed for medical camps, organ donations, trauma care, disaster-prone regions, and rural parts of the country. 

The OT comprises an air purifier, a mini air conditioner, a portable sterile enclosure, surgical gowns, a foldable table, hand-wash units, and surgical instruments. A noteworthy feature is that the sterile enclosure is designed in a way that inside air can flow out, but outdoor air cannot enter, as the purified air is maintained at positive pressure inside. While Dinoj isn’t yet marketing the product, it is definitely a solution that could help rural India once scaled. 

Edited by Khushi Arora

Sources 

How does a pregnant woman get to hospital when there's no road? By stretcher...: by The Guardian, Published on 17 December 2020.

Pregnant woman carried to hospital in stretcher: by Times of India, Published on 27 March 2023.

How bike ambulances help patients in remote areas access hospitals: by Abhijeet Jadhav, Published on 26 February 2020.

India's Most Remote Villages Are Getting Better Healthcare With This Cloud-Based Solution: by Suparna Dutt D'Cunha, Published on 21 November 2016.