As a child, Anietie Donatus was happily drawn to arts, with a canny fascination with paintings and sculptures. Often, he would get his hands in the sand, moulding shapes with other children. Following his passion, he learned the craft, fulfilling his dream of becoming a sculptor and earning a living.
Today, Mr Donatus is a shadow of his once bubbly self: frail, sapped and devastated, evidence of his long-drawn struggle with tuberculosis—an illness he said had cost him everything he worked for.
“It started seven years ago, like malaria,” he recalls. “One day, I felt very feverish with lots of coughing. I took some antimalarial drugs, but I did not get better.” After regular visits to the closest health facility—a primary healthcare centre (PHC) in Nto Edino, some nine kilometres away—Mr Donatus said he got better but could not keep up with his treatment due to the distance and his inability to afford the cost of transportation to the PHC.
“This sickness has affected me, as I do not get called for jobs as often as I used to. I can’t even feed well or solve my family’s needs. It has been hard living like this,” the 32-year-old father of two said, adding that the ailment had exposed him to discrimination from people, including prospective clients and friends.
Tuberculosis (TB) is one of the world’s leading causes of death, with Nigeria accounting for the highest number of cases in Africa and 4.6% of the global TB burden. The disease is commonly found among populations with restricted access to healthcare, like in the Usaka Annang community, where residents like Mr Donatus have to travel long distances to access medical care.
This runs foul of the Nigerian government’s commitment to achieving Universal Health Coverage (UHC), one of its strategic policies to make basic healthcare service delivery accessible to citizens through the instrument of primary healthcare centres.
Located in Obot Akara local government area, Usaka Annang is one of the border communities in Akwa Ibom State, within walking distance of neighbouring Abia State. It is home to the Usaka forest, an abandoned tourist attraction rich in rivers, flora and fauna. It hosted two editions of the Gulder Ultimate Search reality show organised by the Nigerian Breweries.
Despite a large population of over 11,000 people across its five settlements, the community has no access to basic healthcare services, exposing residents to various health risks and leaving a trail of hardship and suffering.
Residents keen on getting medical attention must journey about nine kilometres to Nto Edino, the closest primary health centre. The General Hospital in Ikot Ekpene—32 kilometres away—would be the best bet for serious issues. The journey is further compounded by the poor condition of the roads leading to Usaka Annang, most of which had been made unmotorable by erosion, a nightmare for residents with medical emergencies. Others who cannot afford the long trips resort to self-help for their healthcare needs, mostly with herbs and drugs purchased at patent medicine stores.
“Many of us do not have money to go to the hospital, so we take native medicine [local herbs],” said Magdalene Clement, who had been ill and confined to her bed for most of the previous four days—a situation she claimed was worsened by the recent intense downpour and the chilling breeze it wrought.
“Sometimes I feel extremely cold and feverish, and it gets worse when it rains. So when the sun comes out like this, it makes me feel better,” said the petty trader and mother of four. “If I take the small money I have to transport to the hospital or buy tablet medicine, which one will I eat with my family?”
Rather than buy drugs from the local patent medicine stores within the village, another resident, 45-year-old Bernadette Etok-Akpan, insisted it was safer to get to the PHC in Nto Edino for treatment. “It is not good to risk your life because some of the drugs they sell here, especially those counting ones, may have expired. So I should find money and go there because I know they will give me good drugs,” she said.
Due to their inability to afford the means to access healthcare in neighbouring communities, many residents have been subjected to untold hardship and suffering, which has culminated in the loss of their livelihood.
From 64-year-old Christiana Ephraim and Mercy Lambert, 59, suffering from stroke and the twin maladies of rheumatism and stroke, to Rita Mark, Grace Andrew and Alice Paulinus—women in their 60s battling visual impairment to 29-year-old Nsidibe Essiet and Blessing Akpan, it is a litany of ailments, from youth to the elderly in Usaka.
“We are suffering here. It is as if the government has abandoned us,” Ndarake Otuekong, chief of Usaka Annang, one of the villages in Usaka, lamented. “If the health centre in our community was working, I am sure our people would not suffer this way. Many people in this community are not old; sickness has made them look that way.”
Their closest access to basic healthcare service delivery in the Usaka community comes from a monthly outreach visit by the primary health centre staff in Okpo Eto, some nine kilometres away.
“We visit Usaka Annang and Usaka Nto Akan once every month, usually at the end of the month,” said Elizabeth Nkom, head of the health centre in Okpo Eto. “Originally, we carry out the outreach for immunization, but because we know the condition of the communities, we also attend to other health challenges that people present us.” Mrs Nkom noted that she and her colleague visited five villages—mostly without access to healthcare—for their monthly outreach, namely Okpo Eto 2, Nto Ekpe, Atan Ibong, Usaka Annang and Usaka Nto Akan.
PHC Usaka Annang: Abandoned for over 30 years
While the people of Usaka continue to grapple with various ailments, a primary healthcare centre project in their community has remained abandoned and desolate for the last 30 years. The 14-room facility is now home to insects, rodents, and reptiles, unable to serve its intended purpose.
“As you can see, nothing is working here. The health centre has remained like this since the 90s [1990s] when it was abandoned; the project’s construction still needs to be completed in the first place. So the facility has never been operational for even one day,” Utomobong Ukabi, chairman of the community’s joint council, said. The council oversees Usaka Annang and Usaka Nto Akan, twin villages that make up the Usaka community.
Findings by the Centre for Journalism Innovation and Development (CJID) revealed that a project for the construction of the health centre in Usaka Annang was initiated in 1989 by the Akwa Ibom State government under the directive of the then military governor, Godwin Abbe, an army colonel.
The contract for the project was awarded on May 23, 1989, by the State Tenders Board to Messrs Palmarol (Nig.) Ltd., a construction company based in Ikot Ekpene, according to official documents seen by CJID. Valued at N626,218.00, the project was slated to be completed within 90 days. The first Interim Payment Certificate (IPC) for N170,041.86 was raised and settled in March 1990, and so the work began.
“Unfortunately, the project was abandoned when the contractor had an accident following a bridge collapse at Abiakpo/Nto Ekpe/Usaka road in July 1991, resulting in the loss of 200 bags of cement, a spare tyre and other tools. At the time of the incident, the project was 41% completed and valued at N256,274.60,” said Benson George Ino-Ekenem, the state’s Commissioner for Health and Social Services.
In a memo to the state’s Finance and General Purpose Committee, dated March 11, 1992, Mr Ino-Ekanem said the contractor wrote to the Ministry of Health to obtain approval to proceed with the project and revise the contract in view of the high cost of building materials.
“The Department of Lands, Housing and Surveys was requested to assess the value of work already done as of October 1991 and estimate the amount required to complete the project and provide other vital facilities necessary for effective functioning of the centre. The Department recommended revising the contract to N1,666,687.60 to complete the health centre and provide essential equipment and a 5kva lister generator to power the facility.”
Mr Ino-Ekanem recommended the approval of the revision of the initial contract sum of N626,218.00 to N1,396,687.60 by the state’s Finance and General Purpose Committee, based on the evaluation and report from the Department of Lands, Housing and Surveys. He also requested the release of an additional sum of N270,000 to purchase hospital equipment and a generating plant to facilitate the early commissioning of the health centre.
However, none of these recommendations were considered by the Akpan Isemin-led administration. Subsequent administrations followed suit, ignoring calls to complete the health centre project in Usaka and restricting its people’s access to quality basic healthcare.
Beyond the 41 per cent work done by July 1991 as certified by the state government, the contractor continued the project’s construction, completing the building’s plastering and roofing. During a visit in August 2023, The CJID observed that the facility was built and completely roofed. However, it had now deteriorated, with parts of the roof and ceilings tumbled down—evidence of decades of neglect.
Otu Robert Akpan, chief executive of Palmarol Nig Ltd., the contractor of the project, said despite setbacks arising from the loss of materials following an accident at the community’s bridge and a long-drawn communal clash between Usaka and the neighbouring Umu-Okpo community in Abia state, he obtained approval from the government to continue the project due to the importance of the facility to the community, while waiting for the revision and payment of outstanding bills.
“I have not been paid my outstanding fees up till today. I remember we still had some building materials left at the site, like sand and gravel. I wrote many letters to different governors over the years but did not get any response.” the octogenarian said.
The CJID confirmed various correspondence from the contractor appealing to the Akwa Ibom state government and its agencies for the completion of the project and payment of outstanding fees. Letters were sent to the offices of the governors Godswill Akpabio and Udom Emmanuel, their deputies, the Ministry of Health, the Inter-Ministerial Direct Labour Coordinating Committee and the Secretary to the State Government.
Mr Otu noted that the facility had also been vandalised and looted. “The doors and windows we fixed, even fittings, were stolen from the facility by people,” he said. In one of those incidents, he said students illegally accommodated at the facility building by one Anthony Paul Essien in 2013 vandalised its doors, locks and some window glasses.
Dashed hopes: Akwa Ibom State Government keeps mum
To revive the health facility and bring succour to the suffering population, the Akwa Ibom State Government allocated N30 million to complete the PHC in Usaka Annang in 2018, followed by another N30 million in 2019. The project was domiciled under the state’s Ministry of Health.
A review of Akwa Ibom State budgets also shows that a cumulative N190 million was assigned to complete the project between 2014 and 2017. However, steps still needed to be taken towards project execution.
The CJID sought to engage with the state government that initiated the project but has not received a response.
A freedom of information (FOI) request was sent to the state’s Ministry of Health, which is in charge of the project, to draw attention to the project and request information on project status and budgetary releases. The FOI request, although acknowledged, had yet to be responded to at the time of filing this report, even after the expiration of the FOI response window as stipulated by law.
‘Come to our aid’ — Usaka Annang community begs the government.
The poor healthcare condition in Usaka Annang over the years remains a serious concern. Residents are helpless but say they remain resilient and do not give up, hanging on to the hope that their situation will somehow improve.
“We have written several letters as a community to the government over the years with no results or improvements, not even responses. But we are still hopeful that the situation will improve,” Mr Ukabi, who heads the community council, tells CJID. “We will keep writing and calling the attention of the state government, our state government, to our condition here in Usaka Annang.”
He appealed to the Akwa Ibom state government to look into their plight and come to their aid.
“We are appealing to our governor, Pastor Umo Eno, to come to our aid. The suffering of our people is too much. Our people are sick and dying. As a man of God, I believe that he will have compassion for our people and do something to end the suffering we are passing through in Usaka so that we can also benefit from His Arise Agenda, even if that is the only thing he will do for us,” he said.
Apart from Usaka Annang and Usaka Nto Akan—the twin communities in Usaka—the primary healthcare centre, when completed, will serve the healthcare needs of over seven other villages, including Afia Usuñ, Usuñ Atan, Ndon, Okporo Ukana, Abama, even up to Mgboko, Nenu and Umuopara Egbelu, in neighbouring Abia State.
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