Half the Sky’s Facebook page is at www.facebook.com/halftheskymovement

As you may know, we are involved in a project called Half the Sky based on the book by Nicholas Kristof and Sheryl WuDunn. Today the book becomes a movement as Half the Sky launches a new website to share stories of women and girls overcoming unimaginable challenges. Together we can shed light on the greatest moral challenge of our time – the oppression of women and girls worldwide. Learn more about how you can join the movement: http://bit.ly/J3nAAn

The achievement that we are most proud of is we have trained over 700 students, many of them in nursing and midwifery but also belonging to other disciplines such as laboratory technology and pharmacy technicians.

To me, this is the biggest gift that I can give to my people. Knowledge. Whatever progress I wish for my people, cannot be achieved unless we have the trained manpower.

The hospital is much bigger today than it was ten years ago.

The original buildings of March 2002 now have extensions that include the laboratory; the outpatient facilities; and the two new operating theaters. Staff accommodation have been extended and new toilets have been built for patients.

Most of all, we are proud and grateful that the hospital now has its own water well – thanks to France!

We have grown from being a Maternity Hospital into a referral hospital for every kind of medical problem.

First Baby born at Hospital

Our sincere appreciation is expressed for all the support that we have received to this date and we hope that the confidence that you have shown in us and the generosity that you have extended to us will continue in the years to come.

Special Thanks

These extensions and whatever progress we have made could never have been achieved without the support that we receive from so many directions.

1) Support from the government and the institutions of Somaliland who facilitate the operation of the hospital.

2) Business people of Somaliland, among whom I must thank the generous anonymous benefactor who donated our water tanker.

3) OGF group and the new Somaliland Coca Cola factory who gave us all the water free of charge when we were doing the bore hole for the well.

4) Supporter from abroad.

Friends of Edna Hospital

The Friends of Edna Hospital board tops our list of foreign supporters. They have been the lifeline of the hospital since the time of its construction to the present. FOEH board members have given us generous donations and mobilized themselves to raise funds for the hospital. They have given us the benefit of their legal background to ensure that the hospital’s tax free status is scrupulously maintained.

Nicolas Kristof

Nicholas Kristof at Hospital

At this point, I must thank Nicolas Kristof of the NY Times who has been our strongest champion, who comes and spends precious time with us and writes about what he sees, mobilizing his vast readership.

An example was the generous support the hospital received a year ago on Mother’s Day, 2011 when Nick urged that, in place of flowers and candy, his readers honor their mothers with a gift in support of maternal and infant care. That response is now helping us to cover the costs associated with the 45 midwives who are in training right now.

Electricity

This year, our wish list is headed by the solar and wind energy to generate electricity for the hospital which would reduce the extremely high electricity bills of the hospital. We pay for electricity from a private electric company, but that is unreliable so we have backup from the government’s electricity provider. That one, too, is unreliable and, because we cannot allow for a power outage – such as during a surgical operation – we have a standby generator. Somaliland has a lot of sunshine, if only we could make use of it.

Doctors Needed

Also high on our list is to find the means to recruit more health professionals that the hospital needs to teach our students and to treat our patients. Our medical schools are young and the graduates from these institutions have a long time to go before they will gain the experience and the qualifications that are necessary to run a safe and efficient hospital that sets standards for Somaliland.

God Bless You,
Edna Adan Ismail

I cannot end my message without thanking and mentioning the volunteers who have come here during these ten years. I still recall frantic phone calls from worried parents inquiring about their children when sometimes a volunteer forgets to write home. In spite of the bad reputation of Somalia, which is unfairly attached to that of Somaliland, 117 volunteers have come here to support us during these ten years.

The team covered topics from How to Optimize Use of the Ultrasound, Early Pregnancy, Ectopic Pregnancy, Basic Fetal Measurements and The 6 Steps of Doing an Obstetrical Ultrasound. Torbjørn and Alfred ended the morning with a live demo on a young pregnant woman (G8P7!).

As 22 patients had showed up early for the hands on training scheduled for the afternoon, lunch was taken in rotation as we moved directly from the lectures to the practical scanning. Four stations were set up in the Outpatient Clinic area of Edna’s University Hospital and each Trainee had a chance to do a scan as well as observe their colleagues do scans.

The training program is now complete and the diplomas were handed out this morning to all of the graduates. More photos will appear in this space soon. Please visit the ISOUG Blog for much more detailed information about the vitally important training program. This is the second time that ISUOG has conducted their training program here at Edna Hospital. A third training program is planned for about 8 months from now.

Following the presentation of diplomas, Edna spoke to all of the assembled thanking them for their important work (whether as trainers or as health care workers) and expressing how valuable it is for the future of the Somaliland people. She was interrupted briefly by a phone call – a crisis requiring a solution from her. Edna’s work is never done!

The goal of Sen. Gillibrand’s group is to make more women aware of the need to be involved in the decisions that affect their lives every day and to let women know that their voice matters, to give them the resources to start to get more involved and tell the inspiring stories of women who already are. She says, “I’m so proud that today, for International Women’s Day, Edna Adan has agreed to answer some of our book club members’ questions, which we’ve posted at Off The Sidelines here.”

Edna discusses how she decided, at the age of 11 or 12, to study nursing and how she broke a taboo by speaking out against Female Genital Mutilation. Describing what has contributed to making her successful in her endeavors, Edna cites her “rebellious character and the courage to speak out against what I find to be unjust.”

She also discusses in some considerable detail what the hospital is looking for in the way of Volunteers and the process that leads to their being accepted.

Thankfully, we do not have in Somaliland all of the atrocities mentioned in “Half The Sky” but whatever atrocities exist in a community should be stamped out. The one that exists and persists in my community is female genital mutilation or female circumcision. I rebelled against it first because it has affected me personally, and secondly because I am a midwife and in my profession, I see on a daily basis how women’s bodies are damaged by this practice. I guess I just reached a point in my life when I couldn’t take it anymore and I just kind of exploded. I have been fighting against the practice ever since. [more]

Following some members of Congress, and others, Edna’s presentation about FGM begins soon past the 38-minute mark.

See below for a complete video of this event.

“When it comes to female genital mutilation, I am not going to put every mother and every grandmother in jail, because FGM is done out of a sense of duty. They think they’re doing the right thing! We were trying to convince illiterate women, mothers and grandmothers, about FGM which is contrary to the teaching of Islam, but they thought it was a religious obligation, so you need to inform them about this. They thought they were doing the right thing, that it’s hygienic, which it is not; that it would improve their marriageability, which it does not because it interferes with their potential to reproduce and have children.

“And when we went back to the drawing board, we found that we had overlooked the major role that men should and must play in this because this little girl, who is being cut up, is the daughter of a father. And parents, both mothers and fathers, must join hands. And it cannot remain a feminist issue. It’s a human issue. It’s a family issue. So we began to incorporate men into this. And how I would go about it is, “You are the father. It is your daughter who is being subjected to this. And as the leader of this family, you must have a say in this family. And you must put your foot down and say, ‘My daughter will not go through this!’ Show your strength. Show your heroism. Show me how brave you are. It shouldn’t be left to – I often use this – to little old women like me. It should be the responsibility of wise men with big turbans and big beards, wise and knowledgeable men should be telling me to do something about it.

“This is how we about it. And it works better. It’s not something that we campaign against because of the particular damage that it does to the female reproduction. But it damages the human value of this girl. She must have a say and be consulted in this.”

Edna then goes on to congratulate the USA for posting a public notice on the topic of FGM at the US Consulate in Djibouti, where she had recently gone to renew her visa. People traveling from countries where FGM are endemic are now being warned that if they do this to girls while in the USA then it will be treated as a violent crime.

A little past the 57-minute mark, Edna speaks passionately about her goal to train 1000 midwives and dispatch them to isolated areas to help reduce the extremely high rate of maternal and infant mortality. “It costs us less than a cup of coffee a day to train a midwife. We train them for two years. These women go back to their communities competent, vocal and help us to fight many of the problems of women…. They can influence many of the social problems that women have. They become competent.”

Women Thrive Worldwide works to create a world in which women and men work together as equals so that they, their families and their communities can thrive.

Women Thrive Worldwide advocates for change at the U.S. and global levels so that women and men can share equally in the enjoyment of opportunities, economic prosperity, voice, and freedom from fear and violence.

We ground our work in the realities of women living in poverty, partner with locally based organizations, and create powerful coalitions to advance the interests of the women and girls we serve.

Here is the follow-up letter from Women Thrive Worldwide:

Video streaming by Ustream

“I try to give women in my community an opportunity. They are my army, my soldiers.”

The Skirball is host to an exhibit Women Hold Up Half the Sky based on the book, Half the Sky, now extended through May 20, 2012.

A portion of the article appears below. Please click through to the complete article.

When Edna Adan Ismail, founder of the pioneering Edna Adan University Hospital in Somaliland, walked into Women Hold Up Half the Sky a few weeks ago, she exclaimed to the crowd of visitors who had gathered to see her, “I am very emotional by the way, so if I get emotional, bear with me.” She walked through the gallery, half a world away from her home in Hargeisa, and took in the stories and images of her life on display. Edna did get emotional. And impassioned. And I did, too.

As I learned in chapter seven of Nicholas D. Kristof and Sheryl WuDunn’s book Half the Sky: Turning Oppression into Opportunity for Women Worldwide, one woman dies from childbirth every minute somewhere in the world. The personal narratives they share in the book put a face to that statistic, making every heartbreaking word worth the read.

In a country like Somaliland, Kristof and WuDunn write that there are four main factors that account for such grim maternal mortality: biology, lack of schooling, lack of rural health systems, and disregard for women. This only makes it that much more impressive that against all odds Edna learned to read and write even when there were no schools for girls; was the first Somali girl to earn a scholarship to study abroad in Britain; trained to become the first qualified nurse-midwife; served as First Lady of Somalia while her husband served as Prime Minister; had a career at the World Health Organization; held the position of Foreign Minister of Somaliland; and finally reached her lifelong goal of founding and administering a hospital. Being in her presence is inspiring, and I feel proud to know that she is out there fighting for every woman’s right to good health care and education.

[continued...]

A link sent by my son – I have no idea how he came across the Edna hospital website – prompted me to apply as a volunteer for the month of October 2011, an experience I do not regret. This was an opportunity to discover Somaliland, its people, its history and its plight as it strives to obtain recognition from the international community. But most of all it was a chance to witness what determination and dedication can achieve in a difficult context, where constraints opposed by poverty, tradition and religion all converge to make provision of medical care a seemingly insurmountable challenge. That challenge has been taken up by Edna Adan Ismail who has dedicated her life to improving the condition of her countrywomen. And judging by the steady flow of deliveries in her maternity hospital, she has certainly filled a void and brought comfort and security to many who would otherwise have had their babies in far more hazardous settings.

Doctor Said with Brigitte

But there is still a lot to overcome as women are deprived of what any Westerner would consider as basic rights, are subjected to intentional burns, are required to undergo genital mutilation, to have at least 10 children to please their spouse who has the right to oppose a life-saving C-section, or any surgical procedure. Some endure the distress of watching their child develop horrific hydrocephalus for lack of a neurosurgeon, or die from a snakebite for lack of an antidote – there is none in the country, and they probably couldn’t afford it anyway, were it available; and yet many men waste their meager income chewing khat. Edna is trying to promote “child spacing,” apparently a more acceptable term than family planning; it is however forbidden to sell condoms in Somaliland.

Then there is the lack of specialized staff: visiting surgeons repair cleft lips, broken limbs, retracted burn scars, but there is no pathologist to read a biopsy specimen. The range of medications is limited.

Yet in spite of it all, there is hope. I believe the young women of Somaliland are the ones who will make their country a better place, indeed I met several who were driven by that ambition, and Edna is certainly an inspiration for them. Our role as volunteers is also to encourage and support this drive, and help them demonstrate their ability to play a responsible and independent role in their society.

I was told I was the first French doctor to volunteer at Edna hospital. I do hope others will come after me – I should mention in passing that Edna’s French is flawless. My activities included attending the prenatal clinic or the maternity ward, assisting in C-sections, doing the ward rounds, seeing outpatients, and teaching nursing students. Even if one cannot speak Somali, there is always someone willing to translate, and also much comfort to be conveyed by a smile or a reassuring hand. And the people are kind and friendly, the staff welcoming, the atmosphere around Edna’s table homely, and the turnover of international volunteers stimulating. A month was definitely too short!

Brigitte Herant Dunais, MD
Speracedes, France

She described how important is the training of midwives to the goal of reducing high rates of maternal and infant mortality.

If Edna, beginning at the age of 60, in a war-ravaged and unrecognized country can accomplish her goal to build a hospital and use it to train midwives then anybody with determination can do the same elsewhere.

Edna’s goal is to train 1000 midwives and return them to their communities. Watch the video below:

And, you can read this news article from Geneva: Edna in Geneva.

We all remember when in 2000, the hospital was still under construction and just a shell with no roof, no doors and no windows. That is when the Friends of the Edna Adan hospital was established as a USA Registered Charity which has been supporting us ever since.

It was also the Friends of the Edna Adan Hospital who sent us the first of several shipments of supplies which have sustained us and helped us to achieve whatever we have done ever since.

With our most since appreciation for all the generosity and support we have received from you during the the past 12 years.

~ Edna Adan Ismail

The story is told in greater detail in Nicholas Kristof’s book, Half The Sky. You can click the button below to jump directly to the part of the story where some American women and some immigrants from Somaliland get together to form a new charity with the express purpose of helping Edna to complete the construction of her hospital.

As our friends know, Edna started out as a Maternity hospital but in 2011 we’ve seen many new services and procedures that have changed the lives of people in Somaliland. Here are some of the examples of the 514 operations performed since January, 2011:

• 185 Caesarian Sections
• Repair of 86 Cleft lips and palates
• Repair of 54 Obstetrical fistula and perineal tears
• Insertion of Shunts for 25 children with Hydrochephalus
• Repair of 5 Myelomeningocele/Spina Bifida and three Hemangioma
• Release of 89 contractures resulting from burns and other injuries
• Performed 10 Hernia repairs
• Performed 9 Thyroidectomy
• Three Cholecystectomy
• Five Hydrocele
• Four Hypospedia
• Two Colonostomy
• Two Appendectomy
• Two Mamectomy
• Below-knee Amputation
• Removal of Brachial cyst, Mandibular tumour, Nephrectomy, Spleenectomy
• Numerous other General surgery

As announced earlier, our old theatre was no longer adequate for all the surgical operations that were needed. We therefore put together as much funds as we could, and with additional support from the Fistula Foundation, Direct Relief and the Friends of the Edna Adan Hospital, the long-awaited theatres were built and opened on the 6th of January 2011.

The opening ceremony was officiated by the First Lady of Somaliland, the Minister of Health, other government Ministers and many dignitaries attended the ceremony.

General repair and Construction of New Buildings.

With support from France, we have carried out general repair and painting of the hospital, completed the construction of three more rooms for patients, six new patient toilets, and six more rooms with en-suite toilets for our guests, staff and volunteers.

So far this year, while the above was going on, have also carried out the following:

• Delivered 1147 babies
• Admitted and cared for over 4000 patients in general wards
• Treated 15,000 outpatients

Guests, Visiting Dignitaries and Volunteers

Between January and November 2011, we delivered 1127 women and, sadly, have lost 6 of them. (Mortality Rate = 383/100,000)

French, American, German teachers

The visit of New York Times Columnist/Author Nicholas Kristof and film star Diane Lane in May to film for their portion of the 6-hour PBS documentary version of the book Half the Sky will remain a very memorable one.

We have also had volunteers from the UK, USA, Australia, Germany, France, Canada, China, Somaliland, Somalia, Norway, Finland and India who each gave weeks out of their lives to help the people of Somaliland.

The “Water Well”

With support from France, we carried out three Geological surveys before we found water, and started drilling the new well; installed the casings, pumps and pipes, constructed the water tower and built the shed to house the new generator.

Finally, on the 16th of November 2011 was the day we had our first water from the well! This has now ended our years-long reliance on water being purchased and trucked in.

Travels abroad

During the past year, I have also travelled a lot and have visited the following countries and undertaken the following missions:

• World Health Organization (WHO)  Temporary Advisor during the WHO General Assembly in Geneva in May where I was required to make several presentations on MDG4/5 goals concerning Maternal and Child Mortality.
• WHO Temporary Advisor in July, again for WHO in Geneva on Maternal Mortality
• Durban, South Africa attended the triennial International Congress of Midwives where I made a presentation during the Plenary Session
• In September 2011, was invited by the UN Secretary General to attend and be part of a Panel in New York to address the Millennium Development Goals and maternal mortality.
• On 17 November, I was invited by Amnesty International to be part of a Panel to discuss Human Rights and women’s health
• On November 27th, was invited by TEDxCRC2 to make a presentation in Geneva on maternal mortality and how the Edna Adan Hospital is addressing this major problem through the emergency preparedness we have in place and the training of midwives.
• Also visited the Skirball Exhibition in Los Angeles where exhibits from the stories contained in Nicholas Kristof’s book “Half the Sky” which has a chapter on the Edna Adan Hospital were shown.
• During the year, we have been presenting to whoever would listen, our ambition to train 1000 Community Midwives for Somaliland and how the 162 who we have trained so far have helped in a very practical and cost effective-way to dramatically reduce to one quarter the national mortality rate of the women who were referred to our hospital. We are confident that if these women had come to us sooner than the majority of them did, we could have prevented the death of a much larger number of them.

Addressing TEDx conference, Geneva, 2011

Meeting Members of Parliament in London

Collaboration with International Organizations:

We have continued our collaboration with International Planned Parenthood Federation, Medecins Sans Frontieres, Save the Children Fund, United Nations Fund For Population Activities, World Health Organization, UNICEF, Tropical Health and Education Trust, Women and Health International (WAHA) and ISUOG who has donated two Ultrasound machines and carried out a training for fifteen of our doctors and midwives.

Doctors from WAHA, Kijabe Hospital, Vanderbilt University, AMREF and others have come to operate on our patients.

With much appreciation.

National Responsibilities

To make my life busier, the President of Somaliland appointed a Commission for Higher Education for our country and has added me to this Commission.

Students who have Graduated from our Hospital during 2011

Parents, Friends, Teachers at Graduation

• 42 Community Midwives
• 33 Post-Basic Midwives
• 103 Pharmacists
• 60 Laboratory Technicians
• Our very-0wn two female medical doctors have also graduated!

Students Currently in Training

• For the first time in Somaliland, we are training 26 Midwives who are studying for the Bachelor of Science Degree in Midwifery
• 68 Student nurses
• 34 Lab Technicians
• 80 Pharmacists

Plans and Needs:

• We need to make more extensions to the hospital.
• The cost of electricity is increasing all the time. For this reason, and also to be kinder to the environment, we are looking for Solar Power to light the hospital. We would be happy to install Solar Panels for all to see that our hospital is going as ‘green’ as we can in order to encourage others to also follow suit.


Dr. Dirk Grotuesmann with premature infant, "Tiger"

• We need a new ambulance: our eleven-year old ambulance donated to us by UNHCR is dying on us. A second-hand one we received four years ago is too low and cannot negotiate well the rough terrain of Somaliland.
• Expand our training Department to include the Bachelor of Science Degree in Nursing.
• Continue the Bachelor of Science Degree for Midwives.
• Continue and expand the Community Midwife Training and assist other training Schools in Somaliland to start the training of Community Midwives in their District as the best way to reduce the high Maternal Mortality rate of our people.
• If we can find the right Tutors, we plan to start new training programs for the Bachelor of Science Degrees in Public Heal, Nutrition, Microbiology, Hysto-pathology and other courses.
• If we can find the necessary expertise, start a Dental Clinic as part of our hospital as this service is very much needed by our people.
• We are looking for a hospital Matron or Ward Manager.
• Finally, we are desperately looking for an Obstetrician/Gynecologist to replace our great Obstetrician who will be moving on and leaving us in February 2012.

Appreciation and Thanks

We would like to take this opportunity to thank Direct Relief, Fistula Foundation and IMEC who donated supplies to us.

Everybody at the Hospital, including our newest set of twins, thanks you for your support.

We also wish to thank the individual benefactors who made donations to our hospital on Mothers’ Day following the New York Times article by Nicholas Kristof who appealed for us. Your generous donations have helped us perform the largest number of surgical operations ever performed in our hospital in any one year as well as help us expand our training programs.

On behalf of the women we assist, the babies we deliver, the patients we treat, the students we train, and the community we serve, Thank You.

Blessings, Edna Adan Ismail
December, 2011, Hargeisa, Somaliland