Visit to Chars in Brahmaputra river, August beginning

Dear all,

I owe a bit of an email as well, having had an eventful week.

The first thing was a 2 day trip to 'island chars' in the Brahmaputra river
running about 2 hrs. to our east. A 'char' is basically a glorified
sandbar, some 'surviving' 1-2 years, some 5-10. All are impermanent, as one
we saw testified: drawing up to it in a boat, from a distance we could see
what looked like thicker and thinner columns coming up out of the water
about 10-15 ft. out from the shore. I thought they were the remains of an
old dock. We also saw a 3-story school perched seemingly quite precariously
on the edge as well.

When we got closer, we saw that the columns were in fact the remains of
latrines, about 6 concrete rings stacked on top of each other, on top of
which is set the 'toilet' (Asian squat toilets, if you must know). But they
were just sticking up out of the water because the land around them had
eroded away in the past year. It turned out that when we got off our boat
transport onto a mud road, we found out the road used to run in the middle
of the island, but was now just next to the 10 ft. 'cliff' of mud where the
island continued to wash away.

The school is currently surrounded by sand bags, but actually empty of
children because of the unsafeness of its location on the cliff as well. We
found out about 1 km of land had eroded, so the school was previously in the
middle of the island, but now on the edge. In another spot we saw 2 little
peninsulas, one of which still had a house on it, the other just had a
haystack. The haystack site used to have a house too, but people told us
they had packed up the tin for the walls and roof of the house, along with
all their belongings, and moved to another char, since the one they were on
(the one we were visiting) was eroding too fast.

We visited three chars in all, (pronounced* chohr *as opposed to chahr, from
the British influence of spelling everything that sounds like aw as 'a',
since they is how they pronounce their a's). We stayed one night on a
hospital boat moored on one of them. It moves around to different ones,
depending on the current and the status of erosion of wherever it is. It
was quite the nice boat: 2 operating rooms, 2 small wards of 4 beds each,
which they only use when visiting groups of surgeons have surgical 'camps'
(meaning doing lots of cases right on top of each other). They did eye
camps and cleft lip camps, and sometimes burn scar release or other plastic
surgical cases. But the rest of the time, they just have regular medical,
pediatric, and antenatal, together with eye and dental clinics, all in
separate nice little exam rooms. There was 1 doctor, 1 paramedic, 1 nurse,
1 each eye and dental techs. Quite a well run ship, providing completely
free care courtesy of Emirates Airlines!

We visited another, and took a walk, during which we discovered the reality
of living on a sandbar (depending on size, the average char has about
1200-1500 people living on it--most of whom were born on some one or other
char). That reality was having to wade through water on a regular basis,
because during the monsoon season, now, there are canals running here and
there throughout what looks from a distance like dry land. Then we heard
then when it is the dry season, there still aren't roads, because the
connections between the sandbars are yes, you guessed it: more sand.
Apparently it gets wicked hot during the hot times of year, so it is even
harder for people to get around, because they have to walk for several
kilometers to get to the remaining water so they can get on boats.

People told us, very matter-of-factly, that their trip to get places are
'not long': usually from 1 1/2 to 4 hrs. to go to the clinic, or to go
shopping! As I mentioned above, their houses actually looked to us
relatively 'pukka' (solid) because they were almost all made out of tin (as
opposed to the more common mud or woven bamboo more common around us). The
people around us who have tin are relatively well-off, but in these river
chars, there has been so much relief work because of the annual flooding
being particularly bad there, that the relief organizations always give away
tin, since it is durable and portable. So they aren't rich, but kind of
looked rich to us, with different perspective of what is 'normal' around us.

They lease farming rights from local political powerful people, who control
the very fertile sandbars. These are supposed to be by constitution and
local law, kept for common good, in particular for the use of the poorest.
It IS used by the poorest, but they have to pay leasing rights, or
share-cropping. They are more or less (on at least a few years by few years
basis) in constant state of transition of everything to some new char
growing up out of the river--and when they move, they then have to get to
know completely different local power-brokers.

We were there because in our new project, part of the Char Livelihood
Project, is to help NGOs set up health services for the char population.
The places we visited were part of 'Phase 1', while LAMB will be working on
Phase 2, extended the work up the river closer to us. We saw some of the
challenges when we visited: they need better birth attendants (as the ones
who have already been trained live on the mainland, rather than the chars,
hence are rather too far away to be available for household deliveries--and
the women rarely leave the chars), better clinical protocols (we gave them
ours), and better follow-up of actual changes being made (there is lots of
activity data, but not as much 'so what?' data about % of population with
low birthweights, # of maternal and infant deaths). So the challenges just
keep coming.

Speaking of which, I am going to Dhaka again to discuss a couple of other
UNICEF projects, one tomorrow (Sunday) one Monday-Wed. We aren't really
sure how contentious the negotiations will be, but I am trying to be
prepared by reading through the documents we already presented. I will also
pick up a new short-term obstetrician from Australia, and have a meeting
with Interserve leadership team. It will be a packed week, and I only found
out about all the potential meetings on Thurs., after being gone Mon. night,
Tues., and Wed. at the chars. So Thurs. I ran around to change the call
schedule, plan travel, and organize a place to stay (phone calls, texts,
emails, etc.). Such is life...

love, Kris