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PROFILE-Somaliland midwife puts women's rights at heart of hospital

Source: Thomson Reuters Foundation - Mon, 2 Dec 2013 14:19 GMT
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Edna Adan Ismail, founder of the Edna Adan University Hospital in Somaliland. THOMSON REUTERS FOUNDATION/Katy Migiro
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HARGEISA, Somaliland (Thomson Reuters Foundation) – Patrolling the wards of the hospital she founded in the breakaway enclave of Somaliland, Edna Adan Ismail held the hand of a teenage girl about to have a fistula repair operation, urging her to be brave.

She rubbed the back of a woman in labour and demonstrated how to breathe during contractions. She bent down to make eye contact with each patient, squeezing their shoulders, making them laugh, stroking children's heads and admiring newborn babies with a soft "Masha'allah" – "Thanks be to God".

Occasionally, she paused to correct her staff or to shoo away relatives lingering in the wards of Somaliland's first maternity hospital.

"If I see a patient, I always have to see all of them. I cannot just see one. It's not ethical," Edna said, hurrying down the corridor of the hospital, a white lab coat over her long yellow and turquoise flowered dress.

It's an approach that owes much to the influence of her doctor father, Adan Ismail, who had Edna washing forceps and making bandages out of old bed sheets as a young girl.

"He taught me compassion. He taught me generosity. He taught me the value of looking after the sick," Edna, now 76, told Thomson Reuters Foundation. "One of his favourite expressions was 'if you cannot do it with your heart, your hands will never do it'."

When in 1950, Edna's father was called away to work in a relief camp for people suffering a severe drought, dubbed the 'Season of Red Winds', he left little notes for his then 12-year-old daughter asking her to make sure patients received their medication or had their sutures removed.

"I had no idea what these medicines were for but I was the boss' daughter, so I would just go to whoever was in charge of the hospital and say,'By the way, Dad wanted you to remove these'," Edna said.

And she vowed, one day, to build the kind of hospital that her father would have wished to have.

SURVIVING CHILDBIRTH

Since the Edna Adan University Hospital first opened its doors in 2002, patients have come from as far as Mogadishu, more than 800 km (500 miles) south, and neighbouring Ethiopia, to seek treatment in the best-equipped general hospital around.

Edna and her medical team have delivered more than 14,000 babies and treated more than 140,000 patients for problems ranging from dysentery to diabetes.

On a continent where hospitals are often dingy, dark places, Edna's hospital is clean and modern despite the lack of development elsewhere. There are no tarmacked roads outside Somaliland's capital Hargeisa, and water has to be trucked to the hospital every day.

Edna said it had been a lifelong dream to open a hospital in her native Somaliland - even more so when she saw how civil war had ruined the healthcare system in the enclave, which declared independence from Somalia in 1991.

"Those midwives, and nurses, who had been trained in Somaliland or Somalia before the war had either fled the country or died," Edna recalled during a break at the hospital where she lives in a modest apartment and shares meals with her staff.

The legacy of war means that Somalia has some of the worst infant and maternal mortality rates in the world. Even today, one baby in eight can expect to die before the age of five and about one in 12 women die in childbirth.

But not in Somaliland.

Experts give Edna much of the credit for Somaliland's maternal mortality rate being a quarter that of Somalia. One factor in Somaliland's relative success has been her hospital's focus on training a generation of midwives.

In Africa, fewer than 50 percent of births are attended by a skilled health worker- contributing to high maternal mortality rates. But over the years, Edna has trained 300 midwives, largely paying from her own pocket, and sent them to help women give birth safely in the most remote parts of the country.

She also gives refresher courses to government midwives.

"Every midwife working in every corner of Somaliland has come through this hospital," she said in her impeccable Queen's English, acquired while training as a nurse and midwife in London in the 1950s. She had come on a scholarship from the British colonial office - the first Somali girl to do so.

The hospital also attracts surgeons such as Lauri Romanzi from New York University who visits twice a year to take part in 'surgical camps' - in which visiting surgeons provide free treatment for everything from cleft lips and clubbed feet to hydrocephalus and fistula, a devastating childbirth injury that leaves women leaking urine or faeces.

PIONEER

Among Somaliland's 4 million people, Edna's name is well known and much respected as pioneer in health, education and women's rights.

At a time when there were no schools for girls in British Somaliland, she taught herself to read and write. She also persuaded her parents to send her to school in neighbouring Djibouti - defying cultural expectations placed on all Somali women to get married and start producing children as soon as possible.

She did marry, later, and in 1967, her husband, Mohamed Haji Ibrahim Egal, became prime minister of Somalia. As the glamorous First Lady, Edna was feted by U.S. President Lyndon Johnson at the White House, dined with Chancellor Kiesinger in West Germany and kept a pet cheetah at home in Mogadishu.

But by 1969, there was a coup that brought dictator Mohamed Siad Barre to power and Marxist revolutionaries had shot her "capitalist" pet. Civil war engulfed the country while Edna was away working for the World Health Organisation, training nurses and midwives across the Middle East.

When it was safe to come home to Hargeisa in 1997, Edna, aged 60, decided to cash in her life savings, sell her most valuable possessions and start building a maternity hospital on a garbage dump. She persuaded her ex-husband, then president of an 'independent' Somaliland, to donate the land to her.

When she ran out of money, she embarked on a fundraising trip, even begging local traders in town for cement.

Even being appointed Somaliland foreign minister in 2002 did not stop her working at the hospital. She simply converted the third floor into her ministry and continued running the hospital.

Having cracked various glass ceilings, her advice to other women is simply: "Don't just take it lying down and say 'oh but I am a woman, I need to accept what comes to me'. Don't be fatalistic about your future, your career. Aim for it. Go for it. Fight for it. Campaign for it. Study for it. Compete for it and get it. Otherwise, it’s not going to happen."

Armed with the energy of women half her age, Edna hopes to train 1,000 midwives for the entire country; a second generation of Ednas to continue her legacy.

"What I want to leave behind for my people is not only a building, not only four walls and bricks and beds. I want to leave people who are trained, who are compassionate, and who are as passionate about what they are doing as I am," she said.

"What is most inspiring is when I see those young women who could barely look you in the face when you ask their name, who would be so timid, who get trained and go back to their village and start practising midwifery."

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