Judith Thompson is an Australian nurse, trained in London, who was actually born in Hargeisa. She came back in order to volunteer at Edna Hospital, and here is her report on her time spent with us. She brought along her husband, Dr. Rod Thompson an orthopaedic surgeon; a bunch of medical supplies from Australian Doctors for Africa; and enough money to fund the construction of our new Radiology Unit. Here is Judith’s story.
I am blessed and privileged to have been taught by and inspired by many strong women with common sense, intuition, and compassion. They include Nightingale nursing tutors and ward Sisters, Dame Cicely Saunders Palliative Care, Sister Kilian, compassionate, intuitive St John of God Sister. Inspired also by strong Cockney patients, and as a pupil midwife the long suffering Docklands mothers as I pedalled my bike complete with black delivery bag around Rotherhithe.
I absorbed more as ‘Sister Julia’ from the sometime stoic, sometime violent patients in the frantic Kings College Casualty through the Brixton riots, bombings and train crashes. Moving to Country Western Australia in 1982, I am also inspired by the coping mechanisms of suffering women, country, farming and pioneering and the strength of couples struggling with infertility.
Somaliland’s Edna Adan is another hugely energetic, truly inspirational woman. We were both born in Hargeisa Hospital, in 1951 and 1937 respectively. I was inspired by my Colonial Service Father John Hunt, who wrote the still widely used General Survey of British Somaliland. She was inspired by her Doctor Father training as a nurse and midwife at Borough/ South Bank Polytechnic London where I did Clinical Teaching. I always meant to return to Somaliland but it has taken a long time.
Edna, now aged 76, is not the typical, subservient, fatalistic Muslim, Somaliland women. She has been Foreign Minister in her own right, Prime Minister’s wife, and worked for the World Health Organization (WHO) for years. Edna is an outspoken pioneer in the struggle to abolish female genital mutilation, and change the tribal rape laws, but her primary mission is to improve the health of Somaliland women.
Most of Hargeisa was destroyed by the Somali Civil War and all the Health Care workers fled. On retiring from the WHO, Edna spent her savings and pension on building a hospital for her poor people, opened in 2001.
Somaliland’s Health statistics are amongst the World’s most dismal, reputedly both 1 in 8 neonatal and maternal mortality rates. Somaliland (the old British Protectorate) is recognised by the UN as an autonomous stable state but not a sovereign entity.
Pleas to be recognized as an independent country are ignored. Somali piracy, bombing in Mogadishu’s Turkish embassy, the Al Shebab attack in Nairobi are all shocking atrocities in which Somaliland wants no part. The World draws its collective breath and looks the other way. Medcins sans Frontier have pulled out and currently there are 200 polio cases in Somalia with minimal healthcare and now no International Aid. That is a world problem!
My husband, Rod, an orthopaedic surgeon and I had been in contact with Edna by email for a year. “Come, I need midwives and have plenty of orthopaedic patients, but no instruments!” What to do? We had a Sundowner / fundraising party at our home, mobilized longsuffering, good friends and family to cook and serve, Vintage Rock Band to play, a dancefloor, artwork and wine to auction and raffle and begged for donations.
We thank all of our generous supporters. Most of the funds raised are building the new Xray Department at the Edna Adan Hospital, which we were able to inspect daily as we could see it from our bedroom window.
Huge excitement also as we received a container of Medical equipment shipped by ADFA including donated and purchased instruments we’d collected. Rod also carried in a case of surgical instruments.
Edna is a brilliant woman with a wicked sense of humour, huge energy and charisma. She is the director, matron, engineer, architect, teacher, spokeswoman on Women’s Rights, sometime rally driver, farmer, water diviner. She bought a farm 40kms out next to the CocaCola plant (the only hi tech laboratories and green lawns in Hargeisa) to sink a well. 2 trucks of water daily supply the hospital. Sometimes the taps are empty. Sometimes there is no power so she is working on solar power.
Edna plays hostess to the itinerant band of AID workers within her flat on the second floor of her hospital and we are virtually under house arrest as she cannot risk any AID worker being hurt. Edna presides over a United Nations Table d’Hote, including Somalilander Doctors, Ethiopian pharmacists, and Public Health Lecturers, Kenyan anaesthetists, a Dutch medical student, Swiss FGM researchers and we 2 Australians working under the auspices of ADFA, Australian Doctors for Africa, a Perth based charity. There is always plenty of goat stew, spicy goat livers, rice, water melon and oranges from her farm. The food is cooked downstairs outside on open charcoal braziers.
Being shown around, we saw Edna in full flight multi-tasking. First the Xray department being built from our fundraising. [See HERE for Construction Photos]
“No, too narrow for trolleys, move that pillar!” Before rushing off to harangue a man unloading matresses from his car. “Of course I always have room for the patients and their carers. NOT room for these bug infested things. OUT!”
Inside the hospital she is attending a patient waiting for minor surgery, before berating staff for not having an emergency theatre available. In the Maternity Ward she was busy fixing a baby on a breast whilst scolding and demanding the midwives give some hands on care and empathy in the delivery room. She spoke, everyone jumped!
Edna driving through Hargeisa’s filthy streets, trees adorned with various coloured plastic bags, mercifully not stinking as the goats had done their scavenging, recycling work. Shooting through potential spaces, ostensibly driving on the right, but many cars so old they are still left hand drive. Brightly clad smiling women alighting from buses in the middle of the road, traffic converging from all sides including donkey carts laden with water drums, apparently suicidal goats meandering, lorries with highly decorated windscreens almost obscuring all vision, laden with people and bunches of yellow plastic water containers of all sizes and shapes. Every few minutes someone would recognise our driver and the chant would start “Edna, Ha Edna!” Everyone knows and loves Edna.
Only once did I see a shadow of concern. Driving through the maze of narrow dirt tracks and pathetic humpies of the refugee camp near her hospital, the crowds looking pretty hostile. “Bother, Now I am lost!” says Edna. Suddenly, an urchin shouts “Edna, Ha Edna!” The mood changed, everyone was laughing and shouting, directions were given.
Somalilanders shout all the time in person and on the phone, sounding aggressive, but the conversations usually end in smiles and hugs, Edna tells us it is because they are nomadic people with their camels wandering the desert far apart.
Edna’s mobile rings continually. “Edna, the light bulb is broken.” “Edna, there is no water.” And from her farm, “Edna there is a snake in the room!” “What do you want me to do? You want to hold the mobile phone next to the snakes head and I will ask him to go away?” I hear the tirade down the phone.
When we did get out, it was with an armed guard Askuri complete with loaded AK 47. I felt most at risk as he sat next to me tapping it on my foot. Or when Edna, who wasn’t impressed by the need for Askuris, ensured they earned their wages by picking oranges, digging, weeding, all still with AK 47 nonchalantly slung on the back.
The nurses do the best job they can with the knowledge and equipment they have, and serving as a Regional Centre, the serious condition some patients are in when they arrive, some having travelled for days. It must be difficult having yet another new, well meaning Aid worker arriving, scolding, dogmatic, preaching and with new priorities. You don’t change the World in 5 minutes and Edna taught me.
“Baby steps.” Firstly I had to get the trust and respect of the Midwives, teaching by example, turning up each day still cleaning and advocating basic ABC and care. They would laugh saying “We cleaned yesterday” and I’d say, as I watched another fly buzz inside the incubator, landing on the 28 week premmie’s face, “Yes and we clean again today!’
And then there was “Boys don’t clean.” That was a learning curve! They found with me that “boys DO certainly clean”. And of course they make very good caring nurses too.
Many patients had little education and certainly no antenatal care. I nursed pathetically grateful fistula patients and at least two with full blown eclamptic fits every week. Edna took us out to breakfast to celebrate Eid, the end of Ramadan, everyone dressed in their bright finery. Everyone, including Edna was giving out little presents of money to children and those whom have helped them during the year. Returning to the hospital, I found a packed delivery ward. Three mothers about to deliver, each with between 2 and 8 female attendants milling around. 6 emergency C sections in that 24 hours.
Prem baby with respiratory distress syndrome and severe rib recession. Finding one woman, bandages on her hands and cottonwool up her nostrils, I thought I had the wrong patient. 34 weeks pregnant, painlessly bleeding for a week, she had continued cooking, sweeping and fetching water. She had no platelets. Her Hb was 2.1 and amazingly she and her baby survived. 5 Premature babies less than 28 weekers in Special Care, with only 1 phototherapy unit, 2 incubators and one “hot box” (warming electric light bulbs underneath, but you had to be careful, not TOO warm.)
The babies had CPAP continuous positive airways pressure with oxygen nasal prongs, one end bubbling through an ordinary water drink bottle. Whilst bubbling it was working! Reciprocal learning, we worked together and learned from each other. Necessity is indeed the Mother of Invention
Edna took us to the gala closing of the International Hargeisa Book Fair. Firstly, the panel consisting of cabinet ministers, Doctors, Sultans, elders, tribal leaders, religious leaders and lawyers, apologised to the huge crowd in attendance. “Now you are all here, we have to talk about two very important women’s issues, FGM, Female genital mutilation and rape. Please listen. FGM must stop and if a 13 year old girl is raped, then the ridiculous tribal law says the man who raped her must marry her must stop.”
Edna gave an inspirational, impassioned speech which was well received, loudly cheered and applauded. All the leaders were agreed. Edna remains optimistic for the future for women in Somaliland who need education and healthcare. She needs help, support and a succession plan. Edna is an energetic, vibrant, inspirational lady with a brilliant mind and the compassion of a midwife. I am humbled to have helped her just a little.
Further donations to an ongoing worthy cause are always welcome and can be made fully tax deductible through ADFA Australian Doctors for Africa a Perth based charity, now, excitingly, recognised by Ausaid.
Thank you all again for your generous support and wishing you a Happy Christmas and Healthy Fulfilled 2014
Report for ADFA
Dr Rod and Judith Thompson
March 22nd 2013
Sundowner fundraising event Australind. Graham Forward attended and spoke. Funds in excess of $20,000 raised. Financial Donations, Auction, silent auction, raffles. Food and drinks. Vintage Rock Band, dancefloor. Lots of fun was had by all. Huge support from family, friends and generous donations from many SW families, businesses and artists.
Thank you to all supporters.
Funds raised allocated by ADFA to new Xray department Edna Adan Hospital Hargeisa Somaliland where previously no radiology was available.
Monday 29th July – Monday 26th August
Flew Dubai Berbera and were met by Edna’s driver for what should have been 3 hour roadtrip but storms, flooded tug (Dry river bed) extended this time closer to 6 hours. (A Somaliland Sultan was swept away and drowned at this river crossing 2 weeks later whilst we were in Hargeisa.
Teaching opportunities on daily Ward Rounds, tutorials and in operating theatre in a Clinical setting both at the Edna Adan Hospital and at Hargeisa General Hospital. Ramadan is best avoided for surgery as most medical staff and all students in all faculties are away. The maternity side however was extremely busy.
Networking with NGO’S. Omer, who supervised the unpacking of the ADFA container. We also had dinner with Omer, the Minister of Health, and a Doctor doing research from London.
“Judith worked as midwife in Delivery, Special Care, Post natal Antenatal, Operating Theatre and educator. Edna’s advice of baby steps “was invaluable. There is a reputed 1 in 8 both neonatal and maternal mortality rate. The Edna Adan Hospital acts as Regional Hub receiving many very sick patients from Hargeisa and also from, the Bush up to 4 days travelling.
I found it took time to get to know the staff. Although they were always friendly and smiling, I found that only by working alongside the staff, doing Clinical teaching, were the best results achieved. Edna Adan has many AID workers from different countries, all with their own ideas, philosophies, priorities and goals. It took a few days for them to realise that I was going to keep on coming back and STILL get them cleaning and caring and with emphasis on ABC. The staff and patients tended to be very fatalistic if things went wrong.
Only by consistently emphasising the need for basic hygiene and thinking ahead with preparation of equipment for potential Emergency care did we progress. I found it best to carry around my own bulging pockets in my scrubs, antibacterial hand gel, scissors, dermafix (gentler for premature baby skin), butterfly needles, saline, stethoscope, thermometer, fetal stethoscope. A neonatal pulse oximeter needed.Somaliland women were on the whole very stoic in labour, most receiving no analgesia and not making a sound. I encouraged the midwives and students by example to give back massage, help the Mothers into different positions and to give hands on care and empathy to the labouring women. I taught the grandmothers and their other support woman to do this and they were mostly receptive.
In Labour Ward, the three delivery beds were not at all ideal, do not go into an upright position. I helped the woman to sit rather than be flat on their back which surprisingly seemed to be the norm. I encouraged the midwives to check full dilatation of cervix as found many Mothers were encouraged to push when the Grandmother said they were ready and often started pushing, without a fully dilated cervix. The female anatomy was often challenging due to FGM,(female genital mutilation) grades 1, 2, 3, 4.
Powerpoint presentations of care to the qualified midwives and nurses in an effort to emphasise firstly the things they were doing well but to encourage them to improve standards and teach the students the correct things in a Clinical setting.
Antenatal Clinic SOPHA
A teaching opportunity here to educate re FGM, taking folate and good antenatal care. Sadly the ladies seemed only to be presenting here in the third trimester. This is a good facility which needs to be promoted and Women encouraged to trust and use. Perhaps the timing of the free folate could be when the woman gets married, as we saw large incidence of spina bifida babies. In the hospital saw large percentage Eclamptic fits, roughly 2X per week and women with placenta praevia who had been bleeding for up to a week. This resulted in patients presenting with Hb of 4, one of 2.1.
Pre pregnancy education and Antenatal Education could make a huge difference to neonatal and maternal mortality and FGM rates.
Attended the “arrival” of the ADFA container arriving from Perth. This was very useful as it is unpacked and dumped in a side street and the various beneficiaries are notified by Omar a helpful NGO. The different hospitals and NGOS arrive with their vehicles, and there is a bit of a scrum to grab the boxes. We were able to sort some of these viz, boxes of surgical equipment for Hargeisa General Hospital and some for the Edna Adan Hospital. Also material and sewing machines etc for NGOS women’s groups, and some clothing for the orphanage. As the Ultrasound machine emerged there was great excitement, it was for the Edna Adan hospital and was very gratefully received.
We attended the Hargeisa Orphanage 3 times and supervised the allocation of clothing. This was very well received and obviously very much needed.
Accompanied Edna to the “Gala dinner” of the Hargeisa Book Fair week and there were many International visitors including some from UK, Holland and America. There was a panel consisting of Doctors, Lawyers, Sultans, tribal leaders, Immams, religious leaders. Political leaders including Cabinet Ministers were present. The crowd was told that actually there was important business to discuss now that all these leaders and important people were present. This focussed on 1) working towards eradicating FGM, and 2) Changing Tribal Law – if a girl is raped, the Tribe says the man who has raped her must marry her [punishing who ?]
Some Urgent Needs Identified
- Surgical training for Doctors.
- Pre pregnancy and Antenatal education.
- More Outreach Clinics for this education in remote areas.
- Try and gain trust from population, particularly the grandmothers, for these Clinics. Getting Grandmother “on side” made huge difference when going for best practice with Mothers.
- Getting folate to Mothers pre pregnancy.