Nurse Monjok at the brook the ‘feeds’ the PHC

*Health centre fetches water from brook to conduct midwifery, other operations

*Ad hoc solution saves PHC as govt boreholes lack pumping machine

By Iwunze Jonathan

It was a bright Wednesday morning, and the sun adorned the sky, shining in its full glory. The road was busier than usual as over-loaded motorcycles hurtled to make round trips as they ferried traders to a nearby community market. A local solution to water scarcity would be the farthest thing from one’s mind. But it was in the heart of this journey.

We veered off the tarred road onto the untarred dusty tract and drove several kilometers through forest paths and hilly terrains. Our destination was Borum community in Boki LGA of Cross River State.

We arrived at the community and took a brief tour to access the water needs of the village, and how the Borum people are being impacted thereof.

Interestingly, we found located in strategic locations around the village, few manual-powered boreholes that appear to serve the water needs of the people. At a quick glance, this remote community appeared to be managing its water needs.

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That was not always the case, according to the Community Chairman, Prince Tony Owan. He related the struggles that his people faced for many years to lack of access to water.

He said, “Before now, we depended on our streams for water, however, much work was required to haul water from the location of the streams which were quite a distance away from the villages. Moreover, the streams also dried up mostly during the dry season leaving the villagers stranded and looking up to the sky for relief.”

The community, therefore, decided to change the narrative. “We decided to pool our resources and construct the manual-powered boreholes you noticed on your way into the community to solve our water needs. We could not continue waiting for the intervention of the government while we die of thirst. It has been some years now and we are trying to get by,” he said.

Infrastructure Challenges at PHC

Subsequently, we proceeded to the primary health care center (PHC) at Eshi, which is the only medical outfit serving the community, to observe its water infrastructure. The medical officer in charge was not on duty as she had to go for official accreditation; neither was her assistant, who we learnt, was recently bereaved.

There was, however, a patient who had just been delivered of a baby; she directed us to the staff quarters where we found Engineer Monjok, the husband of Nurse Caroline Monjok, the medical officer in charge of the PHC. He took us on a tour of the facility which revealed several inadequacies in terms of infrastructure.

There was no indication of running water supply around the facility, neither was there any in storage for use at the facility. All they had were two broken geepee tanks that were unconnected to any water source and were being used to collect rainwater for use in the PHC.

In front of the staff quarters is an old concrete tank stand that serves as a relic of an abandoned water project. Right at the entrance to the PHC is a tube well that is dry, and only houses water during the rainy season. This facility simply had no stable and standard source of water supply.

Nurse Caroline Monjok said she was transferred to Borum 18 months ago and has been managing the health centre without adequate facilities.

She said “When I first got here, there was no source of water for the PHC. The tube well you see outside was not working so we had to rely on rainwater that was stored in the geepee tanks. Time went by and the water ran out. We then had to make sure we revived the well to enable us have water. The well served the PHC and the villagers for some time until it dried up.”

Improvising

“Appeals made to the Community to help revive the well fell on deaf ears as nothing was done to make the well operational. The PHC had a regular influx of patients and water was key to sustaining its daily operations.” Nurse Monjok thus had to invent alternatives to sustain the operations of the PHC.

According to her, “Since there was no water to even wash the bedsheets and utensils used in the PHC, I and my colleague, who lives in another distant village agreed that she would always take the bedsheets and towels home to wash them and bring them back to work when they were dried. However, my daily routine would consist of getting up early with a bucket to make the long trek across hilly terrains to the nearest manual-powered borehole to fetch water. She would repeat the process until there was sufficient water for use both in the PHC and the staff quarters.”

She recalled a touching experience she had once, soon after she delivered a pregnant patient of her baby and needed water to clean up both mother and child, and the utensils used during delivery.

She said, “There was no drop of water in the staff quarters or in the PHC, so I decided to trek to one of the boreholes to get water. On reaching the borehole, people were fetching water, so I waited patiently to get some when it was my turn. To my greatest surprise, the women in whose compound the borehole was located refused to allow me fetch water, and then locked the borehole.

“Startled, I asked if they did not know who I was or the work that I do. Their response made it obvious that they knew me very well but for some unexplained reason, had decided that I was not going to fetch water from the borehole. I returned home empty handed, sad and cried bitterly about the unjust treatment I had just received from the very people whose interests I serve.”

Undeterred however, she got up and headed for an isolated surface water body that was across the hills and located deep inside the forest. It was a round trip of almost 40 minutes depending on stamina and agility. That water body became her new source of water supply. At least she would not meet with resistance asides the pains it would take her to make the trip.

‘The Journey of discovery’

She took us on a ‘journey of discovery’ to the water source. The walk was long and tiring and walking up and down the steep hills did not make it any fun. Finally, we got to a junction, and veered off the road into a forest.

Our destination was a 10-minute walk from the diversion, and it featured narrow paths and steep hills. After a while, we arrived at the small surface water body which is sheltered by trees and does not amount to much at first glance. The water, though clear, appeared stagnant and we could not seem to locate its source. We would later learn that of all the brooks located in the community, it’s the only one that rarely dries up.

Thus, the water body (Abang Kache), served as the last resort of sustenance when the boreholes broke down. No wonder it is sacred to them as is evident in their laws forbidding anyone to wash in the brook.

The question of how safe the water was for consumption was answered by ASP James OJ (rtd), a resident, who spearheads issues relating to community development.

He noted that water-related diseases like cholera and diarrhea are common in the community, especially when the boreholes break down and the community must resort to water from the brooks.

Nurse Monjok’s determination to manage the operations of the medical Centre despite limited infrastructure and lack of water supply and support is clear proof that ‘where there is a will, there is a way.’

In collaboration with the chieftains of the Borum community, she has been able to get the community to foot the cost of reviving the hospital’s tube well, to resolve the urgent water needs of the healthcare Centre.

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So doing, they were able to restore the water facility of the clinic at least pending the government’s intervention to resolve the community’s water needs.

Monjok believes that with the right efforts, the attention of key players and the government can be gotten to resuscitate the abandoned PTF water project meant for the clinic. The facility needs a pumping machine to function but currently sits as a relic in the premises of the PHC.

“Facility amenities are the most basic essential features and utilities that enable primary care facilities to be ready and able to provide quality, person-centered primary health care.

“Facility amenities are a core component of a health facility’s readiness to provide services,” noted the PHCPI, a partnership of country policymakers, health systems managers, advocates and others who are passionate about catalyzing primary health care improvements in low- and middle-income countries.

According to the World Health Organisation (WHO)’s Building Blocks of Health Systems, “Essential facility amenities include electricity, safe water, exam rooms with privacy from sight and sound, light sources, sanitation facilities (such as flush or pour toilets to piped sewer system or septic tank, pit latrines, and/or composting toilets), communications equipment (such as cell phones, landline telephones, and/or shortwave radios), computers with internet or network connectivity, and access to emergency transportation.”

Since the PHC was grossly lacking in many respects, we could not help but wonder what role it plays in the pursuit and actualization of SDG 3 thus, ensuring adequate health and well-being for the Borum people without running water, or to say the least, any water source at all.

A 2019 study by the Joint Monitoring Programme for Water Supply, Sanitation and Hygiene, reports that in urban areas of Nigeria, some 65% have basic water service (improved, available on premises), 30% have limited water service (improved, but not available on premises), and only 5% have no water service (no facility or unimproved).

In contrast, in the rural areas, some 38% have access to a basic water service, 26% to limited water service, and an interesting 37% have no water service. In hospitals or health centers around Nigeria, the report shows that 92% have an improved water source, while 8% have no water source.

UNICEF defines Basic water supply as water from an Improved source within 30 minutes round trip collection time; while Limited water supply is water from an improved source over 30 minutes round trip collection time; Unimproved water supply on the other hand is water from an unimproved source that does not protect against contamination.

“In 2017, 785 million people still lack a basic water service and among them 144 million people still collected drinking water directly from rivers, lakes and other surface water sources. The data reveal pronounced disparities, with the poorest and those living in rural areas least likely to use a basic service,” according to UNICEF.

Without a doubt, these statistics reflects the unfortunate living and operating conditions of a good number of the Borum people, and its PHC.

Jonathan, WASH, Solutions and Data PhotoJournalist.

Vanguard News Nigeria