By Ugonma Ogbu
When 28-year-old Oluchi Nworie arrived at Agbaja Unuhu Health Centre in Ebonyi State, she was in the middle of a high-risk labour. The Community Health Extension Worker (CHEW) on duty checked her pulse, tried to stop the bleeding, and urged her family to arrange transport to the Federal Teaching Hospital Abakaliki (FETHA). With no ambulance in sight, Oluchi was ferried on a motorcycle across four kilometres. She arrived, but her baby didn’t survive.
Oluchi’s story is one of many. In emergency care, every second counts. But in Ebonyi’s rural primary health system, seconds often stretch into hours, while lives hang in the balance.
What Emergencies Look Like in Ebonyi PHCs
Emergency cases at Primary Health Centres (PHCs) in Ebonyi State are commonly linked to everyday medical issues, maternal complications, childhood illnesses, road accidents, and untreated infections.
“In my two years here, I’ve seen children convulsing on benches, pregnant women bleeding while we wait for transport, and accident victims brought in on bikes or even wheelbarrows,”
— Mrs. Chinelo Nwankwo, CHEW, Izzi LGA
Leading the list of critical challenges are maternal and neonatal emergencies such as asphyxia, eclampsia, postpartum hemorrhage, and obstructed labour. Other threats include severe cases of community-acquired infections like, yellow fever, meningitis, and tetanus, which PHCs are ill-equipped to manage.
Visits to PHCs in Afikpo South, Izzi, and Ezza North revealed glaring deficits: no oxygen, no ambulances, no emergency wards. In many centres, common complications quickly become life-threatening due to drug shortages, poor equipment, unstable power supply, understaffing, delayed referrals, and inaccessible roads.
Deplorable state of a Health Facility in Ndiegu, Abakaliki
“Sometimes we use our phone torchlight to stitch wounds at night. We do what we can with what we have,”
— Health staff, Akpoha PHC (anonymous)
Unfortunately, what they have is painfully limited.
The Limits of Primary Care
PHCs are designed for frontline services which include, malaria treatment, health education, antenatal care, and basic wound management. But the system’s fragility becomes evident during emergencies.
“We are not built for surgical or critical care,” said Mrs. Nwankwo. “But when you’re the only option, people expect miracles.”
Many PHCs lack even the basics like gauze, gloves, IV fluids, stretchers, or sterilized instruments. There are no standardized Emergency protocols, and staff rarely receive specialized training.
Referral System in Crisis
When PHCs are unable to manage a case, patients are referred. But the system is riddled with gaps. Only 2 of the 20 PHCs visited in this report had an ambulance, and just one was operational. Referral notes are handwritten on loose sheets or passed verbally, while there is no follow-up or communication with receiving hospitals.
Image of non-functional Emergency Vehicle in a Health Facility in Afikpo South LGA
“We referred a woman with a breech baby to the teaching hospital. She was delayed, questioned, and kept waiting for over an hour. The baby eventually came out stillborn,”
— Madam Celestina, OIC, Abakaliki
“We refer patients to Ndubia General Hospital, but it’s too far. People avoid it,” said Mrs. Nwezenyi, OIC in Izzi. “The nearby mission hospital doesn’t provide feedback either.”
These gaps contribute to avoidable tragedies and fuel mistrust in the system.
The Human Toll
The emotional cost is high. Health workers feel overwhelmed and unsupported.
“We carry guilt even when it’s not our fault. The community sees our faces, so we take the blame,”
— Mrs. Nwankwo
Families often bear the financial burden, paying for drugs, transport, and emergency services, and pushing many into debt or despair.
Improvisation or Instinct? Survival Without Tools
With no structured system to fall back on, healthcare workers often resort to desperate measures.
“Most times we use phone torch for light at night. When we run out of bandages, we wash and reuse cloth, and we make salt-sugar solution when ORS is unavailable,”
— Mrs. Nwankwo
“The first delivery I conducted a few days after resuming here, there were no gloves. I used my bare hands and disinfectant. Thankfully, both mother and baby survived,”
— Mrs. Nwezenyi, OIC, Izzi
“I once used my car to rush a woman with a ruptured placenta to the hospital at 3 a.m.,”
— Madam Celestina
Government Response:Promises and Plans
The Ebonyi State Primary Health Care Development Agency (ESPHCDA) acknowledges the problem.
“We’ve told PHCs not to perform caesarean deliveries until we have the equipment and personnel,”
— Dr. Philip Emeka Ovuoba, Executive Secretary, ESPHCDA
The agency says efforts are underway: emergency-trained nurses, mobile referral systems with GPS, solar-powered cold chains, and revitalized PHCs to act as emergency hubs.
“We’re not where we want to be, but we are making progress. Funding remains a major challenge,” Ovuoba said.
What Can Be Done
Health experts recommend a multi-pronged approach, which include: equipping PHCs with emergency kits (gloves, IV fluids, oxygen, resuscitation gear), deploying functional ambulances in all LGAs, standardizing and digitizing referral forms and systems.
These solutions further imply the need for training and re-training of PHC staff in basic emergency stabilization, installation of solar power to ensure 24-hour services and the mobilization of communities to create emergency health funds or cooperatives.
Conclusion
Ebonyi’s PHCs are often the first and sometimes the only point of care in rural emergencies. Yet, they remain ill-equipped and overstretched, forced to operate with the barest minimum.
Without any real investment and coordinated reforms, more lives will be lost for lack of a stretcher, an oxygen tank, or a working phone line.
As Dr. Ovuoba succinctly put it: “No woman should die giving life. We can do better, and we will.”
Credit Statement:
This story was produced for the Frontline Investigative Program and supported by the Africa Data Hub and Orodata Science.