The community hall in Kenminsaw village in Mawsynram block in Meghalaya's East Khasi Hills district is a bustling hub of activity. It's not weddings, plays or film screenings that are drawing residents out of their homes and fields, but monthly outreach health clinics organised by the state government.
As news spread that health workers from the Mawsynram Community Health Centre (CHC) had arrived, the hall, which can accommodate almost half of Keng Min Saw’s population of 1,389, quickly filled to capacity. The CHC team brought medicines, vaccines and monitoring equipment, and are providing free essential health services to communities near their settlements.
As news of the medical team's arrival spread throughout the village, Ken Min So Community Hall quickly filled up with patients. (Photo: Sanchita Sharma/© WHO India)
Mawsynram is the wettest place on Earth, receiving an astounding average annual rainfall of 11,872 mm. This rain is relentless, especially during the rainy season from May to October, leaving this subtropical hill community isolated for long periods of time. In these circumstances, a medical outreach clinic providing medical services becomes a vital lifeline for the community.
“The Mawsynram CHC holds monthly outreach sessions in five villages in this hard-to-reach settlement and also conducts sessions at Domsong sub-centre. Though these villages are within a five-kilometre radius of the CHC, the terrain makes travel time slow. Reaching the clinic for each session requires driving or hiking, which takes one to two hours each way depending on the rainfall,” said Dr R Suchian, medical officer at Mawsynram CHC, who is leading the medical team.
Health workers from Mawsynram Community Health Centre carry vaccines and medicines over multiple flights of stairs and bridges to reach Ken Min Saw Community Hall. (Photo: Sanchita Sharma/© WHO India)
The journey to Ken Min So village is particularly difficult due to the steep road leading to the village. The terrain forces CHC officials to abandon their car three kilometres from the village and switch to small taxis driven by local residents who are adept at navigating the steep, winding roads. “I drive with one foot on the brake – it's the only way to drive here. I have to change the brake pads on my car every two weeks,” said taxi driver B. Kongsang.
B. Lyngdoh, a women's health assistant at Mawsynram Community Health Centre, stops to chat with women weaving baskets outside their homes using locally sourced bamboo. (Photo: Sanchita Sharma / © WHO India)
The final stretch to the community hall is up hundreds of steps through the village. Along this path, families can be seen sitting together engaged in the main cottage industry of weaving baskets and making brooms from locally grown bamboo. Most of the villagers have small farms where they grow areca nut, jackfruit, black pepper, betel leaves, broom grass and bamboo.
The Khasi people of Ken Min Saw are one of the few matrilineal societies in the world where women inherit property and wealth. Ba Hoping lives in his mother-in-law's house with his wife and children, and helps the women make bamboo crafts. “Everyone in my family makes bamboo crafts – my mother-in-law, my wife, her sister and me.”
Mothers catch up after getting their babies vaccinated. The health outreach clinic is a lifeline for Ken Min Soe residents, especially between May and October when continuous rains leave them isolated for weeks on end. (Photo: Sanchita Sharma/© WHO India)
“Apart from maternal and child health services, including vaccinations, the main complaints are infections, gastrointestinal disorders and non-communicable diseases (NCDs) like hypertension,” says B. Linda, women's health assistant at Mawsynram CHC. The health teams also tackle specific local health issues, such as betel nut poisoning, a carcinogen that is widely grown and consumed.
M. Tianhun Lampen, 35, is a mother of six, the eldest just over 10 years old and the youngest 22 months old. All her children were born at home by traditional birth attendants. Nevertheless, Lampen ensures that her family receives regular check-ups at health outreach clinics. According to the 5th National Family Health Survey (2019-20), institutional births in East Khasi Hills district are low at 63.4 percent compared to the national average of 88.6 percent, but the number of people seeking public health services has been steadily increasing.
Pregnant women undergoing a health check at an outreach clinic. (Photo: Sanchita Sharma/© WHO India)
Lampen appreciates the convenience and comprehensive care the Health Outreach Clinic provides. “Here, I can get everything I need for the whole family in one place, including medications, which saves me trips to the pharmacy,” she explains. During her visits to the clinic, she gets her children vaccinated and consults with the nurse-midwife about her symptoms of fatigue, who checks her blood pressure and blood sugar levels and refers her to a doctor for further testing.
Dr R Suchian, medical officer at Mawsynram Community Health Centre, conducts a routine check-up on 35-year-old Theanhun Lampen. (Photo: Sanchita Sharma / © WHO India)
In January 2024, a measles-rubella (MR) outbreak occurred in Ken Min So and four surrounding villages, affecting a combined total of 3,625 residents. “This cluster is a high priority area for vaccination. Of the 66 suspected cases, 59 were unvaccinated. The Department of Health launched a comprehensive outbreak response, including administering additional MR doses to all children in February and ongoing monitoring,” said Dr Suchian.
The World Health Organization's National Public Health Support Network (NPSN) played a key role in the outbreak response in Ken Min Soe and surrounding villages by providing essential technical and surveillance support. NPSN regularly provides technical and surveillance support to the Government of Meghalaya with a focus on strengthening immunization services, especially in hard-to-reach areas. This support is essential to ensure effective implementation and monitoring of routine immunization programs and vaccination campaigns, including COVID-19 vaccination and MR vaccination.
A midwife checks a child's vaccination card at an outreach clinic in Ken Min So village. (Photo: Sanchita Sharma / © WHO India)
Under the Universal Immunization Programme (UIP), Government of India, approximately 26.7 million children and 29 million pregnant women are vaccinated against 12 vaccine-preventable diseases free of charge every year. UIP is one of the largest health initiatives in the world, which aims to reduce child mortality and prevent diseases through widespread immunization.
