The boat of life :

No suitable steel was available anywhere in the country, so this had to be ordered from Singapore, which in turn necessitated a crisis session of fundraising to pay for the import duties. Once the steel had arrived, the pace of building was furious, as the Major had promised completion within 14 months a difficult objective considering that the pontoon had to be constructed entirely by hand. And the project's problems were by no means over, for it was during 1998 that Bangladesh had two months of the worst floods of the century. Major Subhan, a soldier accustomed to achieving objectives on time, refused to be daunted by the long period when the boat was often entirely submerged; whenever part of the structure appeared above the waves, his team instantly set to work.

Because there was no mechanical winching at the boatyard, and therefore no question of sliding the pontoon gently into the river, a team of about 60 skinny workers hauled it towards the water, on some days succeeding in moving it only 10 feet. While hauling it, they sang songs that, according to Subhan, 'used a lot of vulgar languages'. He told me, 'Good words do not play a role in this particular job. Only dirty words give them encouragement.'

Finally, in February 1999, after 12 days of hauling, the 290-ton three-decked pontoon slipped into the water, finished on time and within the agreed budget. At the official ceremony it was named Jibon Tari - the Boat of Life.

Six months later I flew to Bangladesh to visit the project. The gleaming blue-and-white boat was at its third mooring, on the edge of the Gomoti River. The staff of 22 (including an administrator, three doctors, four nurses and a cook) were working at full stretch. Each mooring lasts approximately two months, and on the previous one they had treated more than 3,000 patients, and conducted more than 500 surgical operations, including 272 for the restoration of sight.

Before reaching the boat, I passed a long queue of prospective patients, waiting at the window of a hut. They were each paying a fee of 12p, which helps to filter out those who are merely curious to look round the boat. If someone is genuinely in need and completely destitute, the payment is waived. Each patient is given a colored form (yellow for orthopedic; pink for eyes; blue for ears, nose and throat), which enables the khaki-clad guards on the boat to direct him or her to the relevant screening-rooms on the lower deck.

On the same deck as the operating theatre there is a gleaming 11-bed recovery ward presided over by a senior nurse in a crisp white sari, sitting at a desk and radiating authority. After five days of sleeping on the boat I   remarked to her that the patients must be very brave, for I had never heard anyone cry out or even groan. 'The credit is ours,' she replied. 'We look after them well and give excellent medication.' The hospital boat is obviously very efficiently run, and its teething problems have been remarkably few; but inevitably the staffs are discovering that the yearly budget of £100,000 doesn't cover everything. Their pressings needs include another operating-microscope, ear-moulds for hearing aids, and post-operative shoes for children with clubfeet.

Many of the patients are severely emaciated, with the hollow cheeks and frightened eyes of the starving. Many are stunted, obviously malnourished since childhood. When talking to the patients, I   found that most of them were landless, and thus were usually more destitute than slaves. At least the latter have usually been fed and housed, whereas Bangladeshi day-labourers, even when they work, earn hardly enough to sustain life; and when there is no work, they starve. Sometimes it is necessary for a father to cut down the bamboo struts of his own small wooden home in order to sell them as firewood, and thus feed his children for a few more days.

The problem of landlessness is such that many millions of Bangladeshis are obliged to live on chats - slivers of alluvial soil rising only just above the water. One of these was visible from the boat, and Kabir, the Jibon Tari's health educator, accompanied me one afternoon to find a patient who lived there. When a boatman rowed us closer to the island it was apparent that the lives of its inhabitants are truly precarious: the tightly packed wooden houses left so little space for fields that I wondered how the villagers could grow enough food; and it was also obvious that one huge flood-wave could sweep them all away.

Kabir spotted Hussein, a 10-year-old boy who had recently had an operation to remove the metal rod that a few years before had been inserted in his broken arm. While a dense crowd gathered round us, the boy's mother told a typical story. Several years before, Hussein had fallen between two boats, causing the fracture. With the boy in agony, his family spent a day trying to raise the money for a visit to the nearest doctor, several miles away. The doctor, having charged £6, referred them to a hospital in Dhaka - a much more expensive undertaking, especially as the boy would need to be accompanied by relations in that huge, alarming city. Because Hussein's father was too old to earn a good wage, it took three days to raise the necessary sum, and the crisis had to be solved by an uncle who took out a loan of £250 at the crippling rate of 10 per cent a month. Nevertheless, even this vast sum was insufficient and, to raise another £75, the family had to sell a quarter of an acre - a third of their entire landholding. Time and again I met families like theirs who, because of a relation's ill- health, had been forced to sell their land, thus being condemned to perpetual destitution.

Shoel, a boy who broke his leg when he fell out of a tree, was on his way to a hospital on land when he heard about the Jibon Tari; Mohammed Nurul Islam, whose sight has been restored in both eyes after an infection left him totally blind.

Hussein - accompanied by his uncle, brother-in-law, mother and a cousin -spent eight days in Dhaka, where the metal rod was inserted into his arm. Six months after returning to the village, the rod was due to be removed, but there was no way the family could raise another £350. The income from their land had been reduced because of the sale, the father was now too weak to work, and creditors were pressing for £40. Without the hospital boat, the heavy rod would have remained in Hussein's arm for the rest of his life.

The most affecting operations were those on the eyes. As the result of a gift of 500 intra-ocular lenses by their maker, Rayner, a large number of patients were now receiving ophthalmic surgery, the majority for cataracts. Most found that they had partial vision restored after only one day, and almost all would be able to see clearly after six weeks.

After we returned to the boat, Kabir introduced me to one of them, Mohammed Nurul Islam, a stunted young man in a clean, brown-patterned nylon shirt. Not long ago he had been completely blind. Like many other villagers, he wasn't sure of his age, and at different times said he was either 20 or 25 years old. He told me that, before going blind, he had been a rickshaw driver, earning about £1 a day. After paying for the rent of his rickshaw, this left him just enough money to buy rice for himself and his wife, and very occasionally some fish or vegetables. Four years ago, however, he lost his sight after a thorn pierced his eye when he was climbing a date tree. The eye became infected and the infection spread to the other eye. Becoming totally blind, he thought every day about suicide.

Before he could do the deed, he heard that the Jibon Tari had docked only a few miles away. By the time of my arrival, an operation had already restored the vision in one eye. He was now waiting for the other to be done, with every prospect of complete success. Why then, I asked, did he still seem so miserable?

The story was appalling. 'My father died when I was five, my mother died, when I was 12. When my father was alive we had to sell most of our land to pay the dowries of my three sisters, and then, to buy medicine when he was dying, we had to take a loan of £13 against our one remaining field. Unable to repay the loan, we lost everything. Now our family's main wage earner is my uncle but, as he is only a day-labourer earning 50p a day, he can't help us much. When I became blind I couldn't work, and we had to beg from neighbours. It is many months since we have been able to eat any fish, and recently our only food has been wild plants picked by my wife.

'Nor were my sisters able to help during my years of blindness. The husband of my elder sister died when he was very young, so she became destitute. The husband of my middle sister was a ne'er-do-well and we never knew that he had already been married three times. He soon deserted her, and she also became destitute. My youngest sister works as a live-in maid in the local town, earning only about £4 a month, so she can't help us.

'I can't afford corrugated iron for our roof, so the rain pours in, and makes ill and us wet. I had the greatest difficulty in raising the bus fare to get here; my uncle could lend me only seven pence, so I had to beg for the remaining eight pence off my neighbours. My only shirt is just a rag with holes and, because I wanted to look decent for this boat, I had to borrow this one.'

Even Kabir, accustomed to distressing stories, was affected. He rushed out of the room, muttering, 'I am going to get him one of my shirts.' I longed to give Mohammed enough money, so that perhaps he might have his first happy moment for years; but I was also very aware that charities - quite rightly - strongly disapprove of ad-hoc donations by visitors.

Nevertheless, temptation soon overcame me, and from my pockets I extracted about £15 worth of Bangladeshi takas, which I passed across the table. Mohammed took the money, and then froze in disbelief. His arm stayed outstretched, clutching the crumpled notes. I gestured wildly at him, desperate that the money should be hidden before I was found out. His arm remained rigid. After more frantic gestures by me, he slowly stuffed the bundle of notes into his top pocket. He then turned his head sideways, his shoulders trembled and tears gushed down his cheeks.

Kabir returned to the room with a folded, blue cotton shirt, and gave it to Mohammed, who became a bit less miserable. I continued my questions, asking him how much his wife might earn as a day-labourer during the next potato harvest. Although I guessed this would be about 50p a day, Mohammed seemed not to have any idea. So Kabir, teasing him, suggested a ridiculously high figure: 'I expect she will probably earn something like £2 a day.'

Mohammed became visibly animated by such an absurd notion. 'Goodness, no, of course not,' he replied. 'It will be nothing like that.' And, briefly, he smiled.

Published in the Telegraph Magazine, UK 22 July 2000