BACKGROUND The environmental degradation following crude oil exploration in the Niger Delta has resulted in poverty for local rural dwellers. For those who are ill, if herbal treatments and/or self-medication with orthodox drugs are unsuccessful, the only alternative is expensive medical treatment in clinics. Surgical patients in a rural clinic may have to stay beyond than the normal 7 days if they are unable to pay their hospital bill; because this limits bed availability, there is an impacts on the hospital's economic management. This study aimed to determine the pattern of hospital bill payment among rural surgical patients in a rural Nigerian community, including the sources of finance for bill payment, in order to determine ways to resolve this issue. METHODS This cross-sectional study was conducted in a rural community in the Niger Delta area (Bethesda Clinic Ngo) over 5 years (2005-2009). RESULTS In the 5 year study period, 3712 patients were seen, of which 229 were surgical patients who consented to the study. Their ages ranged from 4 to 97 years (mean 45.6 ± 13.5 years) and most were fish farmers (79.91%), secondary-school leavers (56.33%) and of the Christian religion (86.03%). The association of these characteristics with a greater than 7 day hospital stay was statistically significant (p < 0.05). The most prevalent surgical procedure was herniorrhaphy but the longest staying patients were those who had an ectopic pregnancy (23.32 ± 7.52 days), cesarean section (19.51 ± 6.73 days), appendectomy (18.46 ± 6.82 days) and exploratory laparotomy (17.33 ± 8.32 days). The hospital bill ranged from US$33.3 to $500, with a mean of $105.7 ± 0.043. Their sources of finance for the hospital bill were multiple but mainly personal savings (71.18%). Few (3.06%) had knowledge of the National Health Insurance Scheme, but when informed about it 84.28% were willing to enroll. CONCLUSIONS The sources of finance for payment of hospital bills were multiple but the most common were personal savings and family members.