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.


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.