Edna Adan University Hospital is pleased to welcome post-graduate medical students from Amoud University in Boroma. The students, who recently received their medical degrees from Amoud University, are part of Somaliland’s first Master-level medical training program. The program is a joint effort between Amoud University and SomDev and allows young doctors to continue their studies in the area of Family Medicine. There currently are six students enrolled in the three-year curriculum.
The group will receive the bulk of their training at Al Hayat Hospital in Boroma. However, in an effort to provide the students a broader range of experiences, it was decided that the trainees would take turns doing individual one-month rotations at Edna Adan Hospital. We were a logical choice because of the quality of our care, the availability of supervising physicians and our positive learning environment. Because Edna Adan Hospital typically has a heavier patient load than Al Hayat Hospital, the visiting doctors will have an increased opportunity to hone their skills.
Dr. Hawa was the first doctor to spend a month with us. She was followed by Dr. Mohamed, who joined us for the month of May. According to Dr. Mohamed, his one-month rotation flew by quickly. He not only gained a lot of experience, he also enjoyed getting to know the other doctors and volunteers at Edna Hospital. He believes his time with us was very well spent.
During his time here, Dr. Mohamed had an opportunity to work both in the maternity ward and the medical ward. He assisted on six caesarian sections and also spent time treating patients in the neonatal ICU. On the medical side, he saw a lot of patients with diabetes, hypertension and various cardiac ailments. There were also a good number of patients with respiratory and gastrointestinal complaints. Overall, the cases were similar to what Dr. Mohamed sees in Boroma, but the volume of patients is greater here, and Dr. Mohamed valued the opportunity to work with a number of different doctors. In particular, Dr. Mohamed is grateful to Dr. Matt Jones, our pediatrician, and Dr. Said, our Medical Director, for their guidance.
Dr. Mohamed was impressed with how organized and efficient our staff is. He noted that everyone knows their duty, and everyone works together for the benefit of the patients. He also had the opportunity to witness cooperation between hospitals – a patient from Hargeisa who had a hip replacement performed by Dr. Greene at Al Hayat Hospital is currently receiving follow-up treatment right here at Edna Hospital.
The transition was made easier by the fact that Dr. Mohamed was already acquainted with our Dr. Said, Dr. Shukri and Dr. Naima, all of whom are graduates of Amoud University. He also appreciated all of the encouragement that Edna herself offered him during his stay. He looks forward to his next rotation at Edna Hospital, which will occur in November or December this year. In the meantime, we wish Dr. Mohamed the best in his studies and we welcome his replacement, Dr. Sabaax, to Hargeisa.
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 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.
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.
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.
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 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.
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.
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.
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.
A little story about how things get done. In Somaliland. And on the Internet.
At Edna Hospital, we have been facing a problem of having too many newborn babies with breathing difficulties and those who are premature. As many as six infants occupy our our Neonatal Intensive Care Unit (NICU) at one time, but we have only one incubator, which is both unsafe for the babies and un-professional but we had no alternative.
We are fully aware that making premature babies share an incubator is dangerous but had no other option when we have become the only hope for the survival of these small babies in Hargeisa…
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Edna Adan University is looking for a qualified applicant for the position of Faculty of Nursing/ Midwifery & Public Health Dean in Hargeisa, Somaliland
The applicant will be expected to be the executive head of the faculty concerned acting as the academic leader; s/he will be responsible for creating and implementing faculty strategic goals.
The successful applicant will be responsible for planning, coordination, implementation and evaluation of faculty programs and services.
Those interested should email a two page CV with a one page post specific statement of their suitability and also provide 3 references, including a recommendation letter from their line manager, and copies of their certificates to ednaadanuniversity /at/ gmail.com
Download PDF file
Requirements for the Faculty Dean position:
1. Minimum Master Degree in the respective Faculty with a strong related understanding of contemporary research and knowledge.
2. Extensive teaching and managing experience in a Higher Academic institution of at least 3 years.
3. Publications in the respective faculty and related literature in areas relevant to the vision, mission and goals of the Edna Adan University.
4. Appropriate leadership, managerial skills and experience in the academic areas of the related faculty.
5. Ability to exercise sound judgment and make decisions independently.
6. Extremely flexible, and have the ability to cope with stressful situations and frustrations.
7. Ability to relate to and motivate staff effectively.
8. Excellent knowledge, skills and experience in verbal and written communication, in English language.
9. Excellent interpersonal skills; ability to establish and maintain effective working relations with people in a multi-cultural, multi-ethnic environment with sensitivity and respect for diversity.
10. High Integrity/ethics and the ability to meet the deadlines.
11. Excellent command of computer application skills.
Deadline for applications: 8th Feb, 2013
Only shortlisted candidates will be contacted.
The following article is written by Penny Armstrong to commemorate an entire year at Edna Hospital without any Maternal Deaths:
The year 2012 has come to an end at the Edna Hospital and, thankfully, this is the first year that the hospital reports no maternal deaths.
The statistics have been compiled. In and of themselves they are impressive, but it is the stories behind the statistics that intrigue me. Being in this arid land, a land of a resilient and determined people, has challenged me, astounded me, and confounded me in turn.
I would not expect that I, or others to follow, could in a short time span grasp the complexities of the life in this land; the influence of clan, the challenges of pastoral and nomadic lives, the weighing of the value of the wellbeing of mothers and babies. It would be a life long journey to understanding and, not even then, can I imagine that the subtleties would be adequately grasped.
But what is within my grasp is my comprehension of what I see on the medical front. Within the context of what I see, and what I sense as I navigate life and practice here, the statistics take on a larger meaning:
- Total deliveries: 1,271
- Total Cesarean sections: 177
- Maternal mortality :0
Here I pause, zero maternal mortality in 1,271 deliveries. Perhaps in the U.S. that number would not be remarkable in a small hospital given that high risk moms and babies are rapidly transferred to larger and more sophisticated facilities. But the zero maternal mortality figure at Edna Hospital causes me not only to pause, but to marvel. I marvel because I have experienced what comes to Edna Hospital, unannounced, often in the middle of the night; things we experience stateside, but which generally come through the door in the acute phase, not after days in the field and a rough and lengthy journey to the hospital. Conditions which must be dealt with here or not at all as there is no such thing as a transfer to anywhere else.
And so when the end of year statistics were printed and I saw the zero, I instantly thought of how many times we must have come close to adding a woman to the maternal mortality list this year; and what it took to keep that zero, a zero.
In the case of a mother of twelve it went this way:
She labored for days in the countryside, expecting to deliver, as she had so many times before, a baby by her own efforts. Her uterus tired of the work as it tried to deliver a large baby wedged in the breech position. After days, the baby died inside her and the labor stopped.
Once at Edna Hospital other complications arose when it became apparent that the uterus had ruptured posteriorly and the initial team of a doctor, an anesthesia tech, and a scrub nurse became two doctors, then three, and eventually five as doctors came from other places in Hargeisa to assist and consult. Edna herself coordinated while the Director of the newly formed BSN program came from her office to assist and brought with her additional nursing support. A second anesthesia tech arrived to assist with anesthesia and sequential transfusions. Men lined up in the halls to meet the escalating need for blood.
When the 5.5 hour surgery concluded, the mother had survived. Ten days later the abdomen opened again and this time a British surgeon, a specialist in the area of the problem, led the OR team.
Tomorrow this woman, who now walks the halls and beams at the staff, mothers and newborn babies, will leave Edna Hospital and will return to her village. In her journey I saw medical heroism, invention, and a balance sheet, the facts of which look like this:
- 30 days in hospital
- 15 units of blood
- 2 surgeries
- 6 surgeons: 1 Aussie, I Brit, 4 Somalilanders
- Total cost to family $586
But beyond these facts lies the real power of the story; the story of her journey across the desert, her children left at home, her personal strength, her resilience, and the large measure of the grace that was meted out to her and which continues to shine in her.
May 2013 continue to benefit from the ingredients that made 2012 at Edna Hospital an outstanding year.
Penny Armstrong, CNM, MSN