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.

Inspired to Make a Difference in Maternal Health

Inspired to Make a Difference in Maternal Health

by Sarah David

Originally published to The Huffington Post

As a registered nurse, I love to connect with my patients on a human level, positively impact their health, and empower them through education. It is rewarding to interact with patients and see their physical and mental health improve. But I’ve always wondered if there was more I could do beyond the walls of a hospital.

Then a friend suggested I read Half the Sky: Turning Oppression Into Opportunity For Women Worldwide. I pored through the book and within a few days, I felt like my questions had been answered. Reading about the stories of Urmi Basu, Edna Adan, and Somaly Mam showed me that anyone can be an “agent of change.” We can make a difference in one person’s life or in a whole community. We can address an issue, raise awareness, or even provide a solution. These powerful stories of women from across the globe shed light on my own life and I began to ask myself, “How can I be an agent of change?”

One issue in Half the Sky that resonated with me was the inadequacy in maternal health and maternal mortality rates internationally. What Nicholas Kristof and Sheryl WuDunn pointed out was unbelievable: While child mortality rates have plunged and longevity increased, maternal mortality rates in 2005 have barely budged with one maternal death every minute. Lifetime risk of maternal mortality in poor countries like Sierra Leone and India is one thousand times greater than countries in the West!

Working in a hospital that treats all patients despite their ability to pay made it very difficult to stomach the struggle that pregnant women face when accessing health services in poor countries. Determined to get involved, I reached out to One Nurse At A Time, a non-profit that encourages and empowers nurses to volunteer abroad. They connected me with five other women who have the same craving to use our skills as nurses to give back to patients in need and raise awareness about health disparities.
nurses-for-edna
Under the umbrella of One Nurse At A Time, us five nurses joined forces and used our inspiration from Half the Sky to form Nurses for Edna. Together, our group will travel to Edna Adan’s Maternity Hospital in Hargeisa to team up with Edna and her local staff to serve the women of Somaliland. Edna has stated that teaching is the greatest need, so Nurses for Edna will share nursing knowledge, theory and skills with the local staff and nursing students. We have been asked during our first trip to provide a course in Basic First Aid and General Physical Assessment to the nursing school. We will also supervise student nurses working on the hospital floors.

Our vision for Nurses for Edna is to create a pathway for other nurses to get involved and become “agents of change.” We aim to raise awareness of Edna Adan’s hospital and the life-saving work her hospital provides. The time is ripe for a new liberation movement to empower women worldwide. Inspired by Half the Sky’s agenda, Nurses for Edna is joining the movement and hopes to prove that we can make a different whether big or small.

Please follow us on this journey as Nurses for Edna travels to Somaliland! We encourage you to get involved. For more information on how you can help, please see our Nurses for Edna page.

Sarah-David7

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.

2012: A Full Year with No Maternal Deaths

2012: A Full Year with No Maternal Deaths

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.

Proud mother

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.

Mother and child

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

Mother with new Baby

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

Edna Adan Ismail: a Somali Inspiration

Edna Adan Ismail: a Somali Inspiration

The following profile was written by Joanne Butcher, BA Politics, University of Sheffield, and published here: Edna Adan Ismail: a Somali Inspiration

Born in Hargeisa in 1937, Edna Adan Ismail is one of Somaliland’s most prominent public figures. From 1954 to 1961, she studied in Britain – the first Somali woman to do so – to become a nurse and midwife. After working as a civil servant, she held the position of Minister for Family Welfare and Social Development and most notably held the title of Somaliland’s Foreign Minister from 2003 until 2006. Throughout the 1980s, she served as advisor to a range of councils at the World Health Organisation before retiring in 1997 when she dedicated her life to her most recent project: the Edna Adan University Hospital.

Alas the gravity and magnitude of Ismail’s career is lost in simply detailing her achievements. It’s important to remember that Edna Adan, as a young girl growing up in Somaliland, was not expected to go to school or acquire any qualifications. “Britain used to select boys from secondary schools to study in England and in 1952 or 53. The very first school for girls was opened in Somaliland and I was a pupil-teacher at the time,” she remembers.

It was a year of waiting before she and another girl were finally sent off to study nursing. “We were the only two [Somali] girls in London at the time. It was very challenging; it was a great opportunity to study something that I certainly felt very passionate about. I loved learning, I loved studying and to be given this opportunity was a great gift, and I loved every minute of it.”

However, on returning to her homeland, she found her dreams of making a Florence Nightingale debut were squashed by the newly independent Somaliland government. “I was the only woman, the only qualified female nurse running all the female section of the hospital,” she explains. “So that was challenging, and of course there were very few doctors and many of the emergencies and the medical care that was needed was beyond the training of a nurse. Very often I just had to substitute for what a doctor would have done, because there would be no doctors. So, very often you just had to do what you had to do.”

It took the government nearly two years to finally concede defeat. “I refused to quit,” she declares. “I just worked for 22 months without a salary. I just stuck to my guns and eventually, they had to give in. I was appointed to the civil service. So, to me, that was a victory because that opened the door to women to be appointed to the senior civil service.”

While working for both the World Health Organisation and the United Nations, Edna Adan had made several attempts to set up a hospital of her own. However, efforts were often thwarted by the political climate. The civil war with Somalia had left Somaliland completely ravaged. Medical professionals had either fled the country during the conflict or been killed by enemy forces. Hospitals had been destroyed in the fighting, leaving the country with one of the highest maternal and infancy mortality rates in the world. “I just recycled my whole life,” she explains. “I just turned everything I could dispose of into cold cash and started to build a hospital.”

Edna Adan’s credentials as a nurse, a midwife and a health advisor, made her one of the most qualified people to set up a medical centre. But, according to Ismail herself, it was the memories of her father that truly stirred her to establish the Edna Adan University Hospital.

“My father was someone who was known as the father of healthcare in Somaliland,” she recalls. “As a teenager I would be home for the holidays, from school in Djibouti, and I would be hanging around the hospital, giving him a hand. And I would often hear him complaining about a piece of equipment, and I just made a kind of mental, subconscious promise that one day I would build the kind of hospital my father would have liked to work in.”

The Edna Adan University Hospital started life as a maternity hospital. After four years building on what used to be a garbage dump, the hospital was opened in 2002. For over a decade, the hospital has taken in literally thousands of patients and, to this day, continues to expand. Despite her position as both the founder and director of this monumental institution, Ismail remains humble about her contribution. “I’m doing less and less legwork,” she notes.

But Ismail is kept busy by the cascade of political issues that still flood the hospital. Gender politics still lie at the heart of what she does in Somaliland. The hospital, along with educating women to become nurses and midwifes, is using its influence to try and stop female genital mutilation – a tradition still practised in parts of Somaliland. “The more we do, the more we see that more needs to be done,” she admits. “What we’ve done now is a drop in the ocean.”

However it’s not just within the walls of the hospital that women are treated unequally. Ismail remains as passionate about gender equality as she was as a little girl. It’s important to note that when she was young, only boys were educated in Somaliland. “At that time, education was considered undesirable for a girl,” she explains. “Friends and relatives would come and say ‘God has given you one daughter and you are teaching her to read and write? What good will come of it? She will disgrace you!’ I grew up with that and I was always trying to prove to them that education was good.”

When she sat in Cabinet in the new millennia, she was the only female minister around the table. Even now there are only two women elected to Parliament and just one female in the Senate. “This is what I’ve had to fight all my life and we continue to fight because it needs to be fought. Somebody’s got to speak for these voiceless women. Somebody’s got to stand their grounds. If I had that opportunity to do that then I must do it. It’s a responsibility that I must accept.”

There’s no doubt that progress has been made. Once upon a time women were not even allowed to drive cars, and Ismail agrees that the changes that have occurred have made her optimistic about the future for women in Somaliland. “I would like the change to be bigger and I would like more women to keep that pressure going,” she says. “The world needs both men and women. Because it’s not a question of men or women, it’s a question of both men and women doing a job together to make the world a better place for humankind. That’s all.”

Throughout her life, education has been at the core of everything she’s accomplished. Her thirst for learning has fuelled her career and now she intends to impart her wisdom onto others in hopes that they will continue her mission. “My real gift that I wish to leave for my people is the gift of knowledge; for them to love knowledge – to encourage them to seek more knowledge.”

As always Ismail practices what she preaches and has dedicated her later life to encouraging young women to join the profession. She notes that it is still hard to persuade Somali families to let their daughters study but over time Ismail has persuaded masses of girls to take the opportunity to become a nurse or midwife. “These are exciting years,” she exclaims. “I am proud that the first lady of Somaliland today was one of those young students, young women who we talked into taking up nursing in those days.

There’s still a mountain ahead for Edna Adan Ismail, but she’s still enthused by the belief that people need change and its these young women who are able to deliver it them. “I want to be a role model, to show them that anyone can do it and so can you,” she explains.

Her love for what she does and her ability to convey such a wealth of knowledge onto others is what has made Edna Adan such an influential and compelling teacher. “I feel blessed at 74 that I can still do that. An old woman following her lifelong passion. And loving every minute of it.”

The preceding profile was written by Joanne Butcher, BA Politics, University of Sheffield.

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