I have an incurable disease; I suffer from I’ve-got-to-fix-that”, says Edna Adan Ismail, midwife and founder of the non-profit Edna Adan Hospital in Somaliland. At the age of 80 years, she has no intention of slowing down. “There’s so much to be done and why should I miss all the fun”, she says. “But I am trying to delegate more and I’m finding people who can do things very well. I don’t want the hospital to die with me.”
Adan has had a remarkable career. Her work has encompassed “delivering babies under a tree”, serving as the first woman director of the Somali Ministry of Health in 1976, and being the WHO representative in Djibouti. Somaliland declared independence from Somalia in 1991 after a civil war, although it is still not internationally recognised. Adan founded her hospital in the new state and also took up political roles as its minister of social affairs and family welfare in 2002 and as foreign minister from 2003 to 2006. The cause of women has been an enduring concern during her wide-ranging career. John Acree, Vice-President of International Programmes at International Medical Corps, calls her a “trailblazer”. “Her life-long dedication to improving access to and care for the health of mothers, children, and families has forever changed countless lives in Somaliland”, he says. But Adan downplays her achievements. “I feel I’ve received more than I’ve given”, she says. Adan now maintains a busy schedule of administering the hospital in the Somaliland capital Hargeisa and travelling the world raising funds and awareness of the many needs in her country, not least improving maternal and child health.
Her interest in maternal health spans the decades. Adan was born and grew up in Hargeisa and went to school in then French Somaliland, which became Djibouti. By the age of 11, she knew she wanted to be a nurse after helping her doctor father during school holidays with jobs such as washing forceps and changing bandages. “He was a big man at home, but at work he was so humble and kind. I admired that.” In the 1950s, she went to the UK to train as a nurse and midwife at what is now the London South Bank University. She declined a colonial office offer of a scholarship to become a doctor. “I thought it would take too long so I said no”, she recalls. “I don’t regret it because if I had become a doctor, I doubt I would have set up the hospital. God decided I should be a nurse and this meant I learned about many practicalities. A doctor needs a team around him to function effectively but as a midwife, I can work with little support from the community to deliver a baby in an isolated area.”
After working as a staff nurse at the West Middlesex Hospital, she worked as a midwife trainer for WHO in Libya in 1965, before returning in 1967, when her husband, Mohamed Haji Ibrahim Egal, became Prime Minister of the then Somali Republic. She was the country’s first qualified nurse-midwife and determined to work. “No woman had ever worked in the senior civil service before and I had to work unpaid for 22 months in a government hospital before they gave me a salary and contract. I had to work harder to open doors for women.” In 1986, when Somalia descended into civil war, she returned to WHO working as regional nursing midwifery adviser and a technical officer until 1991, then as WHO representative in Djibouti from 1991 to 1997. She has been a vocal campaigner against female genital mutilation, which was culturally entrenched in Somaliland but knowledge of its harsh impact is rising partly thanks to her.
Adan originally envisaged her hospital, which opened its doors in 2002, as a maternity hospital but it was soon treating emergency cases. The hospital now offers a range of services. “Since 2002, the most operations we did were: 12 722 paediatric consultations, 247 fistula surgeries, 77 perineal tear repairs, 178 hysterectomies, 688 cleft lip surgeries, 82 spina bifida, 366 surgeries for hydrocephalus, and 169 surgeries for club feet”, she explains. Adan adds that “no other hospital in Somaliland, Somalia, or Djibouti implants shunts in the brain to treat hydrocephalus. In addition, none of them insert them for free as we do. All are done free of charge regardless of the country the patients come from.” She looks forward to the regular “surgical camps” that take place several times a year when volunteer surgeons from abroad undertake operations over the course of a week. Alongside this work, the hospital has always provided maternal care and 22 144 babies were delivered there between 2002 and Jan 31, 2018. “Patients pay according to what they can afford”, says Adan.
As to the future, Adan says “My dream is to train a 1000-strong army of midwives in Somaliland and we are now only 460 short. If I don’t get there, those I have trained will train others and this will form the base of the pyramid in isolated locations as more nurses and doctors are also trained.” Humayun Rizwan, programme management officer for health system strengthening and primary health care programmes for WHO in Mogadishu, has visited the Edna Adan Hospital and comments “I believe she is playing a key role in improving access to [RMNCH] reproductive, maternal, newborn and child health services to the Somaliland population and contributing to human resource development.” Helping support the future of the hospital and Somaliland’s midwife workforce remains her focus. “This is why I cannot slow down. I’m in good health as far as I know so I want to continue for as long as I can be of use”, she says.
The Lancet Article
Published: 03 March 2018