How Renovation of Cottage Hospital, Oban, will Improve Healthcare in Cross River Rural Community

Rural communities in Cross Rivers State continue to be at a disadvantage in accessing quality healthcare. Paucity of funds to cover transport cost to the cities where General Hospitals are situated, long distances to such cities and inefficient commercial transport facilities remain a barrier for the average rural dweller. Esther Oluku writes that renovation of Cottage Hospital, Oban would improve life outcomes of men, women and children of Oban community and neighbouring rural communities who would benefit from the hospital’s services

The weather beaten sign post stands to the right of the main road leading into Oban community with the inscription in capitals: “MINISTRY OF HEALTH COTTAGE HOSPITAL, OBAN/AKAMKPA LOCAL GOVERNMENT/ LABORATORY SERVICE AVAILABLE/ YOUR HEALTH IS OUR CONCERN/ WE ARE PATIENT FRIENDLY/ 24 HOURS SERVICE” surrounded by an over grown bush path begging to be trimmed. 

The property is a massive structure wearing only the remains of its former grandeur. The entrance from the main gate opens to a quadrangle with a variety of weeds. To the right of the entrance is an a generator house and to the left of what used to be an open space. There are one entrance to each side. The way forward leads to a small corridor once used as waiting area for immunization purposes with an exit leading to the out-patient-department. 

Majority of the rooms were locked but the inscription on each door head revealed what each room was meant for. There were several consultation rooms, a theatre, a laundry room, a store, a laboratory and wards with beds neatly set in white beddings visible from cracks on the door. 

There also stood three separate buildings behind the hospital. One was a staff quatres, one used to be a nurses quatres and the third was the doctors quatres. According to a former staff and resident of the community, Mrs Eno Asuquo, the hospital has been abandoned for two years.

The exact date of the commencement of hospital operations remain unclear but testimonial from another former employee who had worked at the facility for 10 years before the abandonment revealed that the hospital existed before 2012.

Sign posts within the hospital premises show a robust medical practice catering for such medical needs as; “full blood count, ambulance services, blood testing and transfusion, urinalysis, microscopy (urine and stool), surgery, blood glucose, grouping X- matching, full blood count, hepatitis antigen, pregnancy testing and in patient service” amongst others. 

The hospital also has a child specific ward, female ward and male ward catering for every classification of citizen. The ambulance services works within Oban, from Oban to Calabar town and to other locations around and outside Oban bridging the transportation service needs.

With a resident doctor on ground and trained nurses headed by a Chief Nursing Officer, Oban Cottage Hospital would assure residents adequate response to health emergencies. Howbeit, only the shadow of that once boisterous facility now remain. With this facility abandoned and the nearest General Hospital servicing neighbouring communities being a distance away, there exist a gap in access to emergency health responses for residents of Oban and it’s neighbouring communities.

Disparity in Primary Healthcare Urban-Rural Communities

In urban centers, Primary Healthcare Centers enjoy greater access and close proximity to provisions such as more number of personnel, electricity, oxygen and ambulance services and vaccines amongst other needs than PHCs in rural communities. 

For instance, in Ekpo-Abasi PHC, Calabar, the total staff strength is above 12 with about 4 to 5 persons on ground to attend to patients, electricity, close proximity to the and referral General Hospital in case of en emergency.

However in rural communities, health facilities like Oban PHC in Akamkpa LGA; Atimbo-East PHC, Ikot-Offiong, Akpabuyo LGA; and Model Primary Healthcare Centers, Mbarakom in Akamkpa LGA, the reverse is the case.

At Model PHC, Mbarakom and Oban PHC both in Akamkpa LGA, only one Community Health Worker was on ground to attend to patients when THISDAY conducted an investigative visit. Although both facilities are supported by the Basic Primary Health Provision Fund (BHCPF), shortage of personnel, inefficient transportation system and unavailability of emergency health response facilities in close proximity with residents necessitates the need to refurbish a facility, like Cottage Hospital, Oban, which offer emergency health responses to residents in rural communities of Akamkpa LGA which are farther from Calabar town.

An allegation of theft as contributing factor to hospital’s decline

Recounting the story of the hospital’s collapse, a former worker at the facility, Mr. Sunday William Bright, explained that although resident doctors were posted to the community with their designated quarters, a robbery accident which occured at some points during the hospitals thriving years, made many doctors defer from staying in their assigned quarters in the community. 

After the theft, Bright said that doctors travelled from the city to the hospital daily or stayed at the community to treat patients on selected days per week before going back to the city on weekends.

Having worked at the hospital as a gate keeper for 10 years before it’s abandonment, he said: “The first doctor I first met her was Dr. Dibu and the one after him was Dr. Ima. The third doctor posted here was Dr. Eno. After Dr Eno, Dr Efah was posted here but he did not stay. I don’t know what happened.”

Mrs. Asuquo who spoke with THISDAY said: “Doctors and nurses were living in these buildings. Then later, the place was become somehow. Patients were no more coming to the hospital. Nurses who travelled for weekend on coming back realized that people had entered their quarters and stolen some of their things. Since then, they refused to stay at the quarters. Instead, they come from their homes in Calabar. The stay for two or three days and go back.

“Later, the doctor that was posted started coming from Calabar to Oban. There is no light. They were coming but later they refused coming and the staff also. From once in a week till they stopped coming altogether. 

“When the thieves came, some apparatus were stolen. When patients come, there was no  equipment to check their system. This cottage hospital is a state facility. With the assistance of the United Nations, a primary healthcare center was built in the village. The health center does not have a qualified nurse. Last September, the government came from Calabar to use the facility for an outreach programme. They cleaned the place, used it for the period of three days and then they left.”

Position of the police

Superintendent of Police (SP) Ini Johnson, the officer in charge of Akamkpa Local government debunked the claims of theft at Cottage Hospital Oban describing it as false stating that no record of theft at the hospital 3xists in their archives. 

He also opined that health workers may have deserted the facility because of it’s location in a rural area. He said: “There was no time they reported a case of robbery or theft in that facility. Most of the healthcare workers don’t want to work there because it is a remote area. I have called our personal to check the files between 2022 and 2023 and there was no report of any kind from that hospital.

“No such incident happened. How would robbers go and rob the place? The community are the ones benefitting from the hospital. Even when I called the youth leader, he was just laughing at me that how would they allow a robbery in that place when they are the ones benefitting.”

State Government’s Position

When the Commissioner of Health, Cross River State, Dr. Henry Ayuk was quizzed about the abandonment of the State owned Cottage Hospital, Oban, which would assist in closing healthcare gaps in Akamkpa LGA, he stated that the state government is working to renovate the facility.

Ayuk, who spoke through his media aide, Mr. Kingsley Agim, said that the state government acknowledges that the facility needs renovation and plans are underway to ensure that the facility is revived 

“Cottage Hospital, Oban, needs total renovation as it is in a bad shape and the present administration is trying to assist or renovate hospitals and put them in good state and Oban has also been marked for renovation. It is something that is going on gradually. By the turn of the new year 2025, the renovation will commence.”

Speaking on the staff strength in rural health centers, he said: “Another issue we had is shortage of medical personnel because every medical personnel wants to stay in the city. That was another problem but the government has just employed 200 medical personnel and the Governor is going round to ensure that they are deployed to health facilities across the state.”

THISDAY’s Observation

THISDAY observed that in 2023, the state Ministry of Health budgeted N17,321,585.18 for the operation of Cottage Hospital, Oban, the first year when respondents claimed the hospital was abandoned. In 2024, a proposal of N2,320,532.54 million was made with a budget of N3,009,096.00 set aside for the facility this year.

Although health posts exist in neighbouring villages and a PHC exist in Oban, health emergencies which require the attention of a doctor, blood transfusion, or surgery would take hours to access with an inefficient transportation service. 

To get patients from Oban and neighbouring communities from their location to the Akamkpa General Hospital would take a minimum of 3 hours 10 minutes and a transportation cost of N54,000 to and fro by cab. An alternative route would be to take the patient to the Calabar General Hospital with a travel distance of at least 1hour 30 minutes. In this alternative case, the patient would still be required to pay cab fare of N42,000 minimum to and fro.

With a national minimum wage of N70,000, and with many rural dwellers being farmers and petty traders, this situation may mean that they are outrightly cut out of emergency healthcare services.

Strengthening health systems for equitable access

Amidst scare resources, there exists a dire need for equitable distribution of healthcare services between urban and rural areas, action steps targeted at reviving already existing and abandoned structures must be prioritized to advance citizens right to life.

Renovation of Oban Cottage Hospital will bridge this critical gaps in access to quality healthcare, provide essential health emergency needs, and culminate in access to electricity for communities in the region which in turn will power communication systems and enhance efficiency in health responses with its in-house ambulance services thus saving more lives.