YAOUNDE, CAMEROON — The best heart care in central Africa is probably found in a sophisticated cardiac care center outside of Kumbo Town, 450 kilometers northwest of Cameroon’s capital, Yaounde. But the location is so remote and the roads are so bad that many who desperately need the superior care of the Tertiary Sisters of St. Francis can’t get there.

Thirteen-year-old Assana Mfout almost died on her way to hospital. Her heart was failing, and the journey involved riding down many bumpy roads. The St. Elizabeth Catholic General Hospital’s cardiac center is located on the remote plateaus of northwestern Cameroon. It’s the best hospital for the procedures the young girl needed.

The trip was unavoidable. Assana’s heart began showing signs of failure when she was just nine. It would beat violently from time to time. When she was 12, she could not walk for five minutes without stopping to pant. She would collapse in utter exhaustion two or three times a week. The school principal was afraid she would die on campus, so Assana was sent away from school.

In mid-February 2014, Assana Mfout was recovering in Ward V. Cameroon’s medical pace maker Each year, thousands of patients like Mfout make the uncomfortable ride to the center to receive the sisters’ cutting-edge care. Last year, doctors performed more than 100 open-heart surgeries. The center has begun implanting pacemakers and plans to introduce other procedures in the coming years. It’s the only such facility in Cameroon, and perhaps in all of Central Africa. St. Elizabeth’s is well-equipped and meets the best international standards. Its two theatres and 12-bed intensive care unit are fitted with interlacing tubes, hanging lamps, monitors and all sorts of bleeping gadgets. Its staff is well-trained and come from all corners of the world. St. Elizabeth’s care center is unique, says Sister Jethro Nkenglefac. “We were constructed solely to take care of heart patients, whose care is very complicated and needs advanced technology, equipment and consumables. In all of Cameroon, there is none like us.” That is particularly true when it comes to serving children with damaged hearts.

There is even more good news for heart patients who come here. The St. Elizabeth’s Cardiac Center charges only $3,000 for procedures – compared to $80,000 in places like the United States and Europe. But access to its services is limited. To reach to the hospital, just on the other side of the hill, Mfout had to travel along one of the country’s worst roads.

Going to the cardiac hospital is not an easy task even for someone with a healthy heart. Usually there is only one truly drivable road that links it to the rest of the country through the regional capital Bamenda. But earlier this year, sections of the Bamenda-Kumbo highway were under repair – making the drive slightly smoother than before. All other roads that lead to the center are, in the best of times, winding rugged paths through hills and valleys.

When it’s dry, the journey can last an entire day. When it’s wet, it’s common for travelers to be stuck in knee-deep mud – meaning it would take two to three days to travel between 50 to 100 kilometers. And, in the absence of adequate transportation, patients often travel by overloaded mini-buses and even motorcycles.

Why in the middle of nowhere? Sister Jethro says the remote location was chosen for several reasons. It’s close to an existing hospital that could donate staff, services and land. The climate – with temperatures dropping to four degrees Celsius – is well-suited for cardiac care: doctors say wounds heal faster in lower temperatures. But the most important reason appears to have been the desire to reach to poor rural patients. “The Tertiary Sisters, who are the brain behind all this, is a religious congregation with one of their main objectives being to attend to the poor and the underprivileged,” Sister Jethro says. “You hardly find us in the cities. You find us in the most remote parts of the world, where people really need us; where nobody goes to.”

Yet, some make the difficult journey. Sometimes, rich people come by helicopter. Others stay home, hoping that community outreach workers will come to them with medication.

Those who live in big cities can take advantage of mobile clinics run by the St. Elizabeth’s Cardiac Center. The traveling program involves transferring the entire out-patient department to a partner hospital where cardiologists, pharmacists, nurses are brought in to consult people on the spot.

Critics blame the poor access to the hospital on a mixture of politics and bad policies. The northwest, the region where the center is located, is considered an opposition stronghold, and local residents think the government punished them with bad roads. But it’s also clear that country’s health policy does not take into account the problem of accessibility. Roads are the business of the ministry of works and hospitals are overseen by the ministry of public health. Both have different priorities.

Patients are the ones who suffer from the failure to coordinate policies: the ill must decide whether the slow and tortuous trip is worth it. Many do not make it to the hospital alive.