Why I Support the Edna Adan University Hospital

…and Why I’m Asking You to Join Me

Originally published to The Huffington Post

by an anonymous donor

I’ve donated to support the Edna Adan University Hospital since I learned about its founder in 2011. Edna Adan is a remarkable woman who came to my attention thanks to a New York Times column written by Nicholas Kristof on Mother’s Day two years ago.

Half the Sky logo
As you may know, Kristof along with his wife, Sheryl WuDunn, co-wrote a book and started a movement, both entitled Half the Sky, dedicated to raising awareness of the worldwide oppression of women and girls and providing concrete steps to fight these problems and empower women. Towards that end, Half the Sky has highlighted a number of women-focused charitable groups committed to bettering the condition of women. Edna Adan’s Hospital is one of their featured programs. Currently, Half the Sky is partnering with The Huffington Post and The Skoll Foundation on the RaiseForWomen Challenge, a fundraising campaign designed to raise money for organizations that support women and girls. The organization that raises the most money by June 6 will be awarded an additional $40,000, the second place team will get a $20,000 cash prize, and the third place team will walk away with $15,000. If the hospital wins the first place prize, Edna will purchase her country’s first mammography machine. I am doing everything that I can financially to help Edna win this challenge, and am asking YOU to join me to help the women and children who will benefit from the hospital’s work.

So why should you give to one hospital halfway across the world? And why am I so invested in seeing Edna’s team place in the top three?

Imagine you are a woman turning sixty (as I will be later this year). You have already enjoyed a long and distinguished career in public service. You were the first woman qualified as a nurse-midwife in Somalia; a former First Lady of Somalia; and when civil war ravaged your country and forced you into exile, you worked for many years in senior positions at the World Health Organization addressing pressing maternal and child health care issues such as the need for skilled birth attendants and ending the practice of female genital mutilation.

Many in Edna’s position might have justifiably chosen to rest on their laurels. Instead, upon retiring from WHO, she decided to continue giving back to her country. While I applaud the celebrities and CEOs who have applied their wealth and/or fame to humanitarian causes, Edna is a humanitarian of a different sort — cut from the same cloth as Mother Teresa or Paul Farmer. In fact, she has been called the Muslim Mother Teresa. Instead of retiring to enjoy her golden years in comfort, she sold most of her possessions and invested her life savings to fulfill a lifelong ambition — building the first maternity hospital in Somaliland where too many women were dying in childbirth, girls were regularly being subjected to female genital mutilation and infant mortality rates were among the highest in the world.

What could a single woman possibly hope to accomplish?

Newly-trained Somaliland Midwives

Newly-trained Midwives at graduation

In the 11 years since the Edna Adan Maternity Hospital opened its doors in 2002, remarkable changes have occurred. Even though the hospital sees the highest risk cases, maternal mortality among mothers in the hospital is just one-fourth of the national average. Skilled birth attendance and facility-based deliveries have been expanded with over 14,000 babies safely delivered. The number of women and newborns receiving quality post-natal care has increased dramatically, and more than 300 women have undergone successful fistulae repairs. And in a region where the ranks of nurses and midwives was decimated during a brutal civil war, Edna has trained and/or recruited over 100 senior midwives and another 100 community midwives, 200 nurses and 250 lab technicians and pharmacists — and counting.

The list of women humanitarians who have devoted their lives (and livelihood) to helping oppressed women and children in the poorest corners of the world is relatively short — Nawal El Saadawi in Egypt, Wangari Maathai in Kenya, Yanar Mohammed in Iraq, Shitin Ebadi in Iran and of course Mother Teresa in India. Edna Adan deserves to be included in this company. She is the real deal — a tireless advocate in defense of maternal and child health, a courageous and vocal opponent of female genital mutilation and at age 75, still a real force of nature with a will of steel.

She’s my personal hero.

I hope that, like Mother Theresa, Edna Adan will continue her extraordinary work for many years to come, but she has already ensured that her hospital and her legacy will endure by training the next generation of nurses and midwives in Somaliland.

Please consider joining me in supporting Edna and her work. A donation of any size would be greatly appreciated.

300 Fistula Repairs and Counting

300 Fistula Repairs and Counting

By Tom Kraemer, MPH and volunteer at Edna Adan University Hospital

Originally published at The Huffington Post

Preventing Fistula Saves Lives. This is the theme of the United Nations Population Fund’s global Campaign to End Fistula. The Population Fund, or UNFPA, is marking the 10th anniversary of this drive by declaring May 23 to be International Day to End Obstetric Fistula. Here at Edna Adan University Hospital, we’ve been involved in the fight against obstetric fistula for years, so we’re honored that the UNFPA has asked Edna to be its partner in celebrating the first ever International Fistula Day around the world in Somaliland.

Fistula Surgery being performed in Somaliland

Fistula Surgery being performed in Somaliland

Obstetric fistula, while virtually unknown in the US and Europe, is one of the most devastating — and preventable — conditions faced by women in developing countries. An obstetric fistula is caused when a woman suffers with obstructed labor for a prolonged period of time, often days, without access to a medical professional who can perform a caesarian section or provide other medical relief. One cause of obstructed labor is an underdeveloped pelvis, which may occur when women give birth at an early age before their bodies are ready for the rigors of labor and childbirth. The other primary cause is incorrect positioning of the child in the womb.

When labor is obstructed, for any reason, the baby cannot be delivered without medical intervention. If care is not available, then the baby continues to push inside the womb. The end result is almost invariably a stillborn baby, and the situation can threaten the mother’s life as well. Even if the mother survives the trauma, she is likely to develop a fistula, or small hole, between her birth canal and her bladder or rectum. This fistula causes the woman’s bodily wastes to leak uncontrollably. She will likely be rejected by her husband because of her inability to bear more children as well as her incontinence; she may be shunned by the entire community.

With proper prenatal care, this tragic injury can be prevented. A qualified midwife can detect the early warning signs of obstructed labor and refer the mother to a hospital or other facility where she can get the help she needs. However, in Somaliland a skilled attendant is present at less than one-third of the births […in the capital, Hargeisa … in Somaliland, as a whole, only about 10% of births are properly attended].Edna provided this clarification The Community Midwife program at Edna Adan Hospital, which is supported by UNFPA, seeks to train 1,000 women from all over Somaliland to be qualified healthcare workers in the hopes that they will return to their homes and provide assistance to women who currently have no access to care.

Dr. Lauri Romanzi

Dr. Lauri Romanzi spent over a month in Somaliland primarily helping fistula patients. Without assistance from specialists such as Dr. Romanzi, fistula patients will have a lifetime of suffering. Dr. Romanzi’s visit was sponsored by The Fistula Foundation.

In addition, Edna has been a leader in providing relief to women suffering from obstetric fistula. Fistula repair surgery is a delicate operation requiring a skilled surgeon, a qualified support team and a proper facility. But under the right conditions, these procedures have a remarkably high success rate. Edna Adan Hospital is one of the few facilities in Somaliland where women suffering from fistula can turn for help. With support from Direct Relief and The Fistula Foundation we were able to build operating theaters where fistula surgeries are now performed. The Fistula Foundation also supports regular “fistula camps” at our hospital, where women can receive this life-altering procedure, and where local doctors are taught how to treat fistula patients. With the Edna Adan University Hospital’s help, fistula sufferers can lead normal lives — return to their husbands, rejoin their communities, raise their children and even become mothers again.

Please consider supporting the important work of the hospital through the RaiseForWomen Challenge.

Edna as Keynote Speaker on End Fistula Day

Edna as Keynote Speaker on End Fistula Day

Edna Serves as Keynote Speaker at International Day to End Obstetric Fistula

The United Nations Population Fund (UNFPA) designated May 23 as International Day to End Obstetric Fistula. This was the first year of “Fistula Day,” marking the tenth anniversary of the UNFPA’s Campaign to End Fistula. Who better to serve as keynote speaker at today’s celebration in Hargeisa than the person who has been at the forefront of the battle against fistula in Somaliland since 2002?

If you’ve been following our blog, you know that Edna Adan University Hospital was chosen to partner with the UNFPA for the first-ever Fistula Day. Obstetric fistula is a horrendous condition that is usually caused by obstructed labor in a woman who has no access to qualified health care. After several days of pushing, the baby is stillborn and the mother develops a fistula, or small hole, between her birth canal and her bladder or rectum. The result of this trauma is that the woman becomes incontinent and is likely to be rejected by her husband, family and community.

End Fistula Day

As Edna pointed out in her speech, the real tragedy of obstetric fistula is that it is both preventable and treatable, yet the UNFPA estimates that approximately 2 million women in Africa and Asia are suffering from this condition in silence. Every year, another 30,000 – 50,000 women will develop a fistula. Edna outlined what is being done in Somaliland to alleviate this burden.

The key to preventing fistula is education-educating women about the necessity of prenatal care, educating communities about the need for skilled birth attendants, educating midwives about the warning signs of obstructed labor, and educating doctors about what to do when birth complications arise. At Edna Hospital, we are collaborating with the UNFPA to train 1,000 Community Midwives who will take their skills to all regions of Somaliland. We have a way to go before we reach our goal-the third class of Community Midwives is in training now-but we’re already seeing positive results from our efforts. In addition, Edna is training Post-Basic Midwives and B.Sc. Midwives who are building on their basic nursing and midwifery backgrounds.

End Fistula Day

Edna also told the crowd about the work being done at her hospital to help women suffering from obstetric fistula. With support from The Fistula Foundation and medical and surgical supplies from Direct Relief fistula patients have been treated at Edna Hospital since we opened our doors in 2002. Fistula repair is not a simple operation; it is a delicate procedure that requires a qualified surgeon, a trained support staff and proper facilities. Fortunately we have all of these things. Our operating theaters may be the best in this part of the world, and we’ve been blessed with wonderful fistula surgeons who have volunteered their time to help us develop our fistula program.

Of course we’re proud of the fact that we’ve helped hundreds of fistula patients over the years. These young women were able to reclaim their lives-rejoin their husbands, reconnect with their families and friends, go out in public with dignity and, in some cases, give birth again. But what we’re really excited about here is that two doctors, our own Dr. Shukri and Dr. Naima, are on their way to becoming very good fistula surgeons themselves. We expect it won’t be long before these two ladies are operating without supervision!

End Fistula Day

Edna’s keynote speech was followed by a representative of the UNFPA who spoke about the Campaign to End Fistula and the United Nations’ global role in attempting to eradicate this tragic condition. Short speeches were also made by other United Nations officials, government and religious leaders, as well as by a young woman who had fistula repair surgery at Edna Hospital who explained that she had no idea that help was available for people like her. The event was held at the Imperial Hotel in Hargeisa and attracted both local and international news media.

The event ended with a traditional Somali drama that was commissioned by Edna to highlight the fact that help is available for women suffering from obstetric fistula. A group of professional actors, joined by some of our multi-talented students, performed the story of a young woman who goes from living on the street to being welcomed back by her family and community after undergoing surgery to repair her fistula. In addition to providing entertainment for the crowd, the drama will be edited and reshown on Somaliland television as a way of raising awareness about this condition. The performance was well-received by the audience, although we suspect that our student actors have futures in healthcare, not Hollywood.

Another of our great supporters is Direct Relief.

First Ever Day to End Fistula Brings Attention, Progress, Challenges

“Two million women living with this disabling and often isolating condition after having suffered the loss of a child is an enormous human tragedy that is hidden in plain sight because the nature of the condition and where the women live,” said Lindsey Pollaczek, Senior Program Manager for Direct Relief. “Because fistula has been virtually eliminated in the developed world for more than a century, we know it can be done everywhere, and we are working to make that a reality for all women no matter their economic situation.”

You can help to support our work at this Huffington Post fundraiser www.crowdrise.com/raiseforwomen where we currently are #5.

End Fistula DayEnd Fistula Day

Edna Invited to Sponsor Fistula Day

Edna Invited to Sponsor Fistula Day

Preventing Fistula Saves Lives. This is the theme of the United Nations Population Fund’s global Campaign to End Fistula. The Population Fund, or UNFPA, is marking the 10th anniversary of this drive by declaring May 23 to be International Day to End Obstetric Fistula. Here at Edna Hospital, we’ve been involved in the fight against obstetric fistula for years, so we’re honored that the UNFPA has asked Edna to be its partner in celebrating the first ever Fistula Day in Somaliland.

Dr. Lauri Romanzi

Dr. Romanzi spent over a month in Somaliland primarily helping fistula patients. Without assistance from specialists such as Dr. Romanzi, fistula patients will have a lifetime of suffering.
Dr. Romanzi’s visit was sponsored by The Fistula Foundation.

Obstetric fistula, while virtually unknown in the US and Europe, is one of the most devastating – and preventable – conditions faced by women in developing countries. An obstetric fistula is caused when a woman suffers with obstructed labor for a prolonged period of time, often days, without access to a medical professional who can perform a caesarian section or provide other medical relief. One cause of obstructed labor is an underdeveloped pelvis, which may occur when women give birth at an early age before their bodies are ready for the rigors of labor and childbirth. The other primary cause is incorrect positioning of the child in the womb.

When labor is obstructed, for any reason, the baby cannot be delivered without medical intervention. If care is not available, then the baby continues to push inside the womb. The end result is almost invariably a stillborn baby, and the situation can threaten the mother’s life as well. Even if the mother survives the trauma, she is likely to develop a fistula, or small hole, between her birth canal and her bladder or rectum. This fistula causes the woman’s bodily wastes to leak uncontrollably. She will likely be rejected by her husband because of her inability to bear more children as well as her incontinence; she may be shunned by the entire community.

In Somaliland a skilled attendant is present at less than one-third of the births.
With support from Direct Relief and The Fistula Foundation we were able to build operating theaters where fistula surgeries are now performed.

Fistula Surgery being performed in Somaliland

Fistula Surgery being performed in Somaliland

With proper prenatal care, this tragic injury can be prevented. A qualified midwife can detect the early warning signs of obstructed labor and refer the mother to a hospital or other facility where she can get the help she needs. However, in Somaliland a skilled attendant is present at less than one-third of the births. The Community Midwife program at Edna Adan Hospital, which is supported by UNFPA, seeks to train 1,000 women from all over Somaliland to be qualified healthcare workers in the hopes that they will return to their homes and provide assistance to women who currently have no access to care.

Placing the Spinal before Fistula surgery

Placing the Spinal before Fistula surgery

In addition, Edna has been a leader in providing relief to women suffering from obstetric fistula. Fistula repair surgery is a delicate operation requiring a skilled surgeon, a qualified support team and a proper facility. But under the right conditions, these procedures have a remarkably high success rate. Edna Adan Hospital is one of the few facilities in Somaliland where women suffering from fistula can turn for help. With the support of The Fistula Foundation, we sponsor “fistula camps” where women can receive this life-altering procedure, and where local doctors are taught how to treat fistula patients. With Edna’s help, fistula sufferers can lead normal lives – return to their husbands, rejoin their communities, raise their children and even become mothers again.

Video from The Fistula Foundation

Amoud U medical students read Kees Waaldijk obstetric fistula manual on day 2 of training in Boroma.

Amoud University medical students read Kees Waaldijk obstetric fistula manual on Day 2 of training in Boroma.

Top trainers Dr. Shugri from Edna Hospital & Dr. Muumin from Boroma National Fistula Hospital.

Top trainers Dr. Shugri from Edna Hospital & Dr. Muumin from Boroma National Fistula Hospital.

Getting set up. All of these medical students were efficient, keenly interested and coordinated their actions well.

Getting set up. All of these medical students were efficient, keenly interested and coordinated their actions well.

Visit FistulaFoundation.org
Visit DirectRelief.org

Dr. Eve Bruce Discusses her time at Edna Hospital

Dr. Eve Bruce Discusses her time at Edna Hospital

By Dr. Eve Bruce, February 21, 2013

I had read the statistics. We all have.

I knew about the problems and the need. What I did not know was how generous the people are with their loving kindness ~ and their laughter.

Awakening the first morning in Hargeisa at the Edna Adan Ismail Hospital to the sound of the Muezzin Call to Prayer, I peaked out the window where I sleep in the hospital. Beautiful women walking into the courtyard of the hospital greeted my jet-lagged eyes. Multicolored flowing robes and head coverings. Like a large group of colorful nuns.

This is a teaching hospital. Classes are in session every day on the second floor, and there are nursing students and midwifery students taking on most of the work on the wards. Young men and women studying, working hard, and filled with hope.

One nurse confided to me that her dream after completing her courses here is to go to Medical School and become a Pediatrician. Another had no idea how much she would like taking care of the newborns until we started the Neonatal Intensive Care Unit. Now she wants to specialize in Neonatal Nursing.


“Somaliland has one of the worst maternal mortality ratios in the world, estimated to be between 10,443 and 14,004 per 100,000 live births,” said Ettie Higgins, head of the United Nations Children Fund (UNICEF) field office in Hargeisa.”The infant mortality rate is 73 per 1000 births.”

(To put things into perspective US maternal mortality is 21 per 100,000 live births with an infant mortality of 5 per 1000 births)

Nursing students

Nursing students after being up all night in the Neonatal ICU ~ and ready to go take an exam!

Although they are well versed in caring for these critical babies now, all of them were scared of premie care at first. Babies that small do not usually survive here.

What I also did not know is how much I would love the babies. And the Moms. And the Grandmothers.

It is very different practicing medicine here. You make things work with the supplies available. There are no ventilators. We make bush CPAP contraptions for the premature babies from bottled drinking water ~ this skill was passed on to me by a volunteer Midwife, Geraldine Lee, from Seattle who was so attached to the babies that she recruited me to care for them the minute I met her (she was leaving the next day).

Two incubators / four premies: we fill bottles and gloves with warm water to try to keep their temperature up the best we can. I had no idea how much work it was to do the NICU nursing until I took over myself when they were short staffed one day because the students had an exam. I’ll never take the nursing care for granted again! Especially here where everything takes longer and we do not have all the bells and whistles available in hospitals in industrialized countries.

"Tiger" in NICU

Somehow, hearing all the statistics and the push for women’s empowerment in Somaliland, I expected downtrodden women. Now I understand that it takes a tough cookie to make it here. These women (and men) are for the most part smart, beautiful – and very feisty. This in spite of the fact that a woman cannot even sign for her own procedure, but rather requires her husband’s consent.

neonatal-intensive-care-unity-152

And then there is Edna. A force of nature. When I first emailed her asking if there was anything I could do if I came as a volunteer doctor, I warned her that I am 58 years old. She laughed, if you can do that by email, and said that she was older than that when she started this hospital. And I came.

Nursing Student

Second year nursing student caring for baby in Neonatal Intensive Care.

So many stories. So many happy stories. The premies who get stronger and stronger. Their mothers. Their grandmothers. The baby boy who was transferred to us from another hospital here with seizures and aspiration pneumonia as well as no urine output and failing kidneys who eventually became well and went home with his family.

Beautiful Hassan

Beautiful Hassan who had aspiration pneumonia with poorly functioning kidneys and seizures from birth. Here he is with his beautiful and very happy mother.

My first (and only) premature baby death was completely unexpected. She was a newborn, and the baby I was least concerned about in the unit. I happened to be right there in the room when she stopped breathing, and the anesthesiologist happened to stick his head in right while I was suctioning and beginning the resuscitation. Both of us working on her could not bring her back.

Eve Bruce

I went to the next room where her mother was recovering from her Caesarian Section to tell her that her little baby girl had died. She put her arm on mine and told me not to cry. She took the time to console me. Or maybe we consoled each other. Not so much as doctor to patient, but as mother to mother. I think that was the moment that I fell in love with this country and its people.

Then there are the deliveries. The very real danger that each woman goes through each and every time she becomes pregnant. Each expectant mother knows other mothers who have died in childbirth. They all know the risks they are taking. And yet with the infant mortality as high as it is, the average woman becomes pregnant 10 times in her lifetime with the hopes that she will bring two or three children to adulthood.

Young mothers bonding with their premature babies.

Young mothers bonding with their premature babies.

The Ethiopian woman who travelled so far with her six and five year old in tow, leaving her three year old in the care of her blind mother. Coming so many miles with the desperate hope that someone might fix her broken life. Crying as she held my arm after I examined her in the operating theater, more of her story unfolding. She went into labor with her fourth child, but three days later she was still in labor and only then taken to a hospital where the dead baby was removed surgically. Immediately afterwards, the urine began to leak continually from her vaginal area and down her legs as her now seven month relationship with her vesico-vaginal fistula began. As if that wasn’t enough, she already had a deformity in her left leg and foot and after the obstructed labor she found she had a foot drop in her right “good” foot. Prior to this she could walk with a limp, but now she can not walk without great difficulty, and only while holding on to someone. Her husband left her and their three children to fend for themselves. Destitute and broken, we are her last hope.

Yes, there is great tragedy, great suffering and great need. Yes there is much work to do together for empowerment of women here, to create opportunities which engender freedom and equality. And yes, there is a unique soul to the people of Somaliland that burns brightly and warms the embers of your heart when you visit. May it burn ever more brightly, and may these bright, brave and strong women see their own little girls grow to be educated and healthy self sufficient loving mothers and grandmothers.

Dr. Eve Bruce

Eve Bruce, MD – herself a mother of four and grandmother of nine – is volunteering at Edna Adan Ismail Hospital in Hargeisa Somaliland. She is happy to report that funds have been coming in and the hospital is well on its way to being able to purchase another incubator.

Read more about the NICU

But that is just the beginning, or as Edna says “like a car without tires or petrol.”

We need oxygen concentrators and many other supplies to keep a premature or sick baby alive. Only when Maternal Mortality decreases, life wrenching complications of lack of healthcare and obstructed labor disappear, prenatal and child care becomes widely available, and infant and child mortality normalizes will there be any opportunity for higher education, freedom, equality and empowerment.

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