Cross River is a region in southern Nigeria where access to medical care has always been difficult. The area is remote and rural, with little to no public transportation available for communities, including an estimated 15,000 Cameroonian refugees, and a lack of sufficient access to clean water and phone network. Each year, the rainy season brings a host of additional challenges further blocking access to care. Despite the challenges, our teams remain ready to transport patients to care, rain or shine.
Doctors Without Borders/Médecins Sans Frontières (MSF) currently runs basic health care clinics for people in need of services such as prenatal care or malaria treatment, and refers serious cases to other hospitals in the area. One of our key team members involved with this work is Patrick A. Njok, an MSF driver who transports emergency patients from the MSF facility to the referral hospital.
Here, Njok explains how the rainy season impacts people’s access to care in Cross River.
Patrick A. Njok, MSF driver (left); an MSF vehicle crosses an old wooden bridge built after a concrete bridge collapsed. Nigeria 2024 © Abba Adamu Musa
1. Fallen trees
I drive emergency patients to other referral hospitals that can handle more complex issues than we can here. But in Cross river, this is not always simple. The first challenge we have is the weather. When rainy season comes, there are windstorms that knock down trees. It can happen suddenly, when you are already out on the road because the rain can come at any time. If you don’t take a machete, a cutlass, or a chainsaw with you, you can end up getting blocked by the fallen trees until the villagers can help you remove them. This can seriously delay patients getting to hospitals, which can have potentially life-threatening consequences.
Sometimes, passengers will get out of vehicles to reduce its weight while crossing old, wooden bridges in Cross River (left); an MSF-supported primary health care facility in Old Ndebeji community of Akamkpa, Cross River. Nigeria 2024 © Abba Adamu Musa
2. Waterlogged roads
The second challenge we face is the road. From May to October, when it is raining very heavily, the soil’s texture is very difficult to drive on: hilly, muddy, and slippery. Some of my colleagues have spent almost half of the day trying to dig out the car when we get stuck. Even the off-road vehicles we use sometimes struggle in the mud and become stuck, wheels spinning but not moving anywhere. We have to make sure all cars come with all-terrain tires and an electrical winch so the driver can get himself out.
3. Broken bridges
In this area, there are a lot of bridges we have to cross when we are driving around. However, these bridges were constructed in 1973, when I was still in primary school, and to this day, those bridges are still the same ones we drive on now. These are simple wooden bridges and you have vehicles crossing with a load of more than 30 tonnes. Just today, two bridges collapsed. Sometimes when we drive over these delicate bridges, all the passengers have to get out and walk across to reduce the weight.
4. High costs
When I first joined MSF, I worked hard to explain to the community what MSF is and what we do. Drivers are often the number-one advertiser for MSF, since the MSF vehicle is the first thing people see. I would encourage people to go to the MSF clinic. [I tell them,] “If you are sick, you come to the facility and MSF will treat you.” But the challenge is that in the rainy season, the price of taxis and transportation goes up. It can be around four times higher. If people don’t come to the clinic, then we cannot refer them, and I cannot drive them to other hospitals.
The current MSF project in Cross River has existed since 2021, supporting patients who have little to no access to health care. Despite the challenges, our teams are still ready to drive patients who need care to the hospital, rain or shine.
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