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Primary healthcare of death: How failed PHCs in Imo put lives at risk

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…No doctors, toilets, chairs, beds or drugs; •Women shun centres
…We are appraising all the PHCs to strengthen them — State Commissioner for Health

By Chioma Obinna

When Amara Obi rushed her 4-year-old son  to the Primary Healthcare Centre, PHC, in Obokwe in Ozuzu autonomous community, Ngor Okpala Local Government Area of Imo State, she was unprepared for what she saw.

Amara, who resided in Port Harcourt, Rivers State, had accompanied a friend to the community for a social event a couple of days earlier.

But her son had taken ill  shortly after arrival and was running high body temperature. Medicines purchased from a nearby chemist had no effect and when the  boy began convulsing later in the day, she  decided to take him to  the community health centre.

However, on arrival at the centre, Amara was shocked at the dilapidated state of the facility.

“We met just one  nurse there and even though she tried to attend to us, the place was an eyesore,” Amara recounted.

“Apart from the nurse, there was no doctor or any other medical staff. There were no beds,  no laboratory, no drugs.  I could not leave my child in that place so we left.” Amara was in dilemma.

The only other hospital within reach was in Owerri, several kilometres away through an almost impassable road that turned a 20-minute journey into an odyssey.

“I had no choice. I begged  someone to help look for a commercial motorcycle operator that took us down to Ulakwu from where we boarded a bus to Owerri. Only God saved my son,” she sighed.

Such is the daunting circumstances faced by residents of  Ozuzu autonomous community.

Although there are 29 PHCs in  Ngor Okpala,  most of them are decrepit and disused. They are like abandoned town halls. The terrible state of these facilities brings to the fore the failure of the administration to take  healthcare closer to the people, particularly in the rural areas where the majority reside.

The PHCs in Ngor Okpala are a maze of uncompleted buildings, some of which have deteriorated badly, worsened  by cracked and collapsing walls, broken windows and leaking roofs.

Some of the centres lack common clinical tools such as  scissors and methylated spirit or basic medical supplies such as cotton wool and bandages.

Patients pay for everything, from hospital card to syringes.  The centres that are meant to care for antenatal, postnatal, paediatric and management of other health complications are today a shadow of the past.

Take the PHC in Obokwe in Ozuzu autonomous community, Ngor Okpala Local Government Area of the state for instance. It was built by the community and handed over to the state government over a decade ago.

Since it was constructed and commissioned, progress at this centre has stagnated. It has not undergone any form of infrastructural rehabilitation or refurbishment of equipment.   Basic facilities including beds and chairs are lacking, those purchased are overused and expired.

At the centre there is no doctor on call but there is  a nurse and one ward aide.  Toilet and bathroom facilities are practically non-existent and no nursing room of note.  The septic tank (soak-away) apparently  under construction before the centre was handed over to the state government has been ovegrown by weeds.

The reception is in shambles, the waiting room in disarray and unbefitting of a health institution. There are huge cracks on the walls and doors, rodents run about freely, and there is no form of electricity. There is no running water.  The two obsolete beds in the open hall have no foam on them. The degree of rot is phenomenal.

Findings show that the aim of utilizing the  facility to bring primary health services closer to the community as mooted and championed by the women of the community that contributed money towards construction  of the facility has been truncated.

Today, delivery hardly takes place in the centre. This is largely because there is no conducive place where  mothers and their new babies will stay.  Most women now patronise traditional birth attendants, TBAs, that generally charge higher fees for their services.

While TBAs, averagely demand as much as  N11,000, those that patronise the centre pay no more than  N5,000 for normal delivery.

At the expansive compound Good Health Weekly visited, there were  no patients within the premises.

Enquiries revealed that most of the community members have shunned the centre, most certainly as a result of  lack of basic working tools. A source acknowledged that with no personnel or drugs available, the PHC  is worse off than a TBA Centre.

Chiamaka, a heavily pregnant woman told Good Health Weekly    that no one was  patronising the centre because there were no doctors and it only opens during the day.

“If I register there and labour starts late in the night what will I do?  The nurses don’t sleep there, moreover, they don’t have anything there,” she said with a laughter.

A source disclosed that sometimes the center opens without treating even a single patient.

“The situation is so bad. The terrible state of the centre has driven  patients away.  We have nothing to work with.  We don’t receive ordinary malaria drugs that are supposed to be free from the state government’.

Lamenting the situation, the source said their incessant complaints have fallen on deaf ears. “There are 29 health Centres in this local government, 15 are given free malaria drugs and mosquito nets.

“These centres cannot share theirs.  We have complained several times but we are yet to know why we are not given.   This has made many patients run away from us.  Most times they claim that we are too expensive.  Many of them go to the chemist for their drug needs while the pregnant women who managed to come to antenatal will end up at the TBAs to have their babies.

“It was only two months ago that the government gave us thermometers, BP apparatus and weight scale.  The ones we have been using since were provided by a man in this community who came to check his weight one morning and found out that we didn’t have. The man went back to his house and brought one for us.”

The source explained how the centre has been surviving on the magnanimity of some community members “Since the blood pressure (BP) apparatus the community bought got damaged, a Reverend Father who was fornerly in the community bought a weighing scale. We cannot boast of forceps,” she said.  Asked if immunisation actually takes place at the centre, the source said although they do that every Wednesday, the challenge is that the women are not bringing out their children.

“We usually use the town crier to go round the village for announcement; sometimes we go from house to house to tell them to bring their children but it remains a big challenge.”

One striking thing in these communities is that there are no standard hospitals.  Members of the communities are forced to travel to the capital, (Owerri) for treatment.

Ngor Okpala is arguably the largest local government in Imo State. Every politician aspiring to be governor requires  block votes to win, unfortunately, this part of Imo State lacks basic amenities including roads, potable water and functional  hospitals.

Few  kilometres away was another health centre in Oritsieze Community also in Ozuzu autonomous community, Ngor Okpala LGA of Imo State.

Facts reveal that the centre was built by  Federal Government under the previous administration.  This one is well adorned, freshly painted and built closed to the abode of the community’s late king.  These health facilities  meant to be the pillar of public health services are the curse instead.

Getting to Umukoro/Opehie Health Centre also in Ozuzu which took about 10 minutes drive with motorcycle, the sight of a fallen town hall surrounded by bush revealed the shameful and long neglect of primary health centres across the country.

Although, there was nobody around the centre when Good Health Weekly visited, investigation showed that the centre is even worse than others.

The structure wore a forlorn look of dilapidation and desolation. There is dirt everywhere. The surroundings, including the road leading up to the premises is overgrown with weeds.

Signs of farming are obvious within the open vast land but a collapsed long section of the perimeter wall and roof remain unfixed.

Arguably, PHCs are meant to provide services to people in search of medical care within their immediate environment, but no one needs a soothsayer to say that the people of Umukoro/Opehie  community see the PHC as a let-down to them. One wonders how the few women that come for antenatal sit and wait to be attended to.

The hospital has no doctor, drugs, running water, chairs, tables and beds among others.

Parts of the roofing have fallen off, while some parts are leaking. There is a nurse, but no pharmacist.

Nigeria in 1978 adopted the World Health Organization’s declaration establishing Primary Health Centres as the basic unit of public health delivery system.

Former Minister for Health, Late Professor Olikoye Ransome-Kuti, had in 1986 championed PHCs in Nigeria while the National Primary HealthCare Development Agency, NPHCDA was established in 1992, but judging from the quality  of primary healthcare delivery in the country today, these efforts have not yielded the required results.  The million  dollar question that remained unanswered is  why are our PHCs not functional?

Imo Government reacts:

When contacted, the Imo State Commissioner for Health, Dr. Angela Uwakwem, who admitted the poor state of health centres in the state said the problem was not peculiar to those communities .

“We are in the process of trying to sort out health centres generally. We are doing what we call ‘Primary healthcare under one roof’.

“So we want to strengthen the health centres.  I had three meetings last week and I am going to call series of meetings and trainings aimed at making them better.

I don’t think the problem is peculiar to that community alone but whichever way; we are appraising all the health centres  so that we will know where we can help.  We have told  health officers to bring whatever problems they have’.

On why there are no drugs in the centres, she said: “There are many things that are wrong and we are trying to reorganize the system. It’s not about Ngor Okpala.  First of all, we are trying to assess the problems.  Sometimes drugs are given to the people in charge and they sell them  and do all sorts of things.

Stating that the state has begun renovation of hospitals, she explained ‘We are trying to set up committees in the villages so that these committees can monitor what  workers are doing. It’s a whole lot of reengineering. You know I was sworn in as commissioner within the last two months.  We are trying to re-engineer everywhere but what we are doing first are hospitals to know who has what problem. Some communities have come up. Some have even done one or two renovations.  Government is doing a lot of renovations.”

She disclosed that about 27 health centres have undergone renovation and 10 new ones are being built.  “As I speak to you, 27 health centres have undergone massive renovation and 10 new ones are being built.  In some others we have bought equipment and some basic things are being given to them.

So we are coming. It is a gradual process. We have also appealed to others to write out five things that they need.  Just be patient with us, we are coming,” she stated.

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