What a Difference a Person Can Make: A Conversation with Edna Adan
Edna Adan has made helping mothers and babies the mission of her life, and does so in her homeland of Somaliland, where the need is great. The area has one of the highest maternal mortality rates in the world, and Adan and the midwives she’s training are working to change that, one delivery at a time.
She’s the founder of the Edna Adan University Hospital in Hargeisa, Republic of Somaliland, and the hospital opened its doors 15 years ago. During that time, Direct Relief has provided critical supplies to enable the hospital’s mission.
Direct Relief has shipped 81 midwife kits that have enabled more than 4,000 safe births in the country.
Learning about Adan conjures up a host of “firsts:” she was the country’s first registered nurse midwife and even the first woman to get a driver’s license in the country. She was a nursing and mental health advisor for the World Health Organization, and has trained a host of midwives in their craft.
Adan spoke at Direct Relief’s Goleta headquarters on Monday, and shared her passion for the work.
Somaliland isn’t a place one can find on a map, she said, and is an autonomous region within the country of Somalia.
“You don’t hear about Somaliland, because we are just too busy rebuilding the country,” she said.
Due to the country’s civil war, many health professionals were killed or fled the area, making medical care for ordinary people difficult to access.
Adan is pictured here with midwives she’s helped train.
That’s where the 183 midwives, trained by Adan and her staff, come in.
Adan showed a picture of about two dozen midwives, many of whom are in their late teens and early 20s and will be called on to help keep mothers and babies safe as they deliver in their homes.
Giving these young women the training, and tools, they need is the key to keeping women from needlessly dying during birth.
“I want to multiply these girls to 1,000… There should be 1 million for Africa,” she said. “That’s how we reduce maternal mortality.”
A photo was shown of the young midwives carrying a small suitcase, no bigger than a small purse, that they use when they travel to help a mother deliver a baby.
That small kits contains some low-tech tools that can help increase survival exponentially, simple supplies like clamps and surgical gloves.
“That’s what we need,” she said.
Equipping young midwives with medical training and expertise is just one facet of working in Somaliland. Training midwives on how to dissuade family members about female genital mutilation, still an ingrained cultural practice in the area, is also key.
Adan is an outspoken opponent of the practice, which can make it anatomically impossible to deliver a child safely, causing a danger to the mother’s life as well as the child’s.
FGM is “endangering their lives and we have to fight it with everything we have,” she said.
Call the Midwife is helping to break the silence on FGM. Now, we need to end it altogether
I felt privileged to give my input on the scripts, and the kindness and respect they wrote into the characters involved – particularly the midwife at the centre of the storyline – gave me confidence that they would get an issue as emotionally charged as this one right. Some people might think FGM is difficult to include on mainstream television, but to me, this episode is one of the most beautiful things I have seen in years.
I watched it at a special screening last week and related to it not only as a survivor, but also because in front of me, my personal and professional lives merged. The episode is set in 1962 – ironically, the year of my mother’s birth, and tells the story of a bright young Somali woman who has come to the UK to join her husband. Nadifa is about to give birth in the East End of London – an FGM survivor, the midwives around her have no idea what to do until one steps up. I will not give away the plot, but what follows is kindness, understanding and support.
On Sunday, as I watch the show again with millions of you, I will be doing so in Bristol with my family – probably in silence – but above all, with pride and the peace of mind that the cycle of FGM has ended in my family. In spite of the bruises and tears along the way, today I can say my niece, Sofia, will know FGM as a historical act and not as a chapter in her life and story.
It used to be near-impossible to talk openly about FGM, but this is no longer the case. Forming major storylines in BBC’s Casualty, Law and Order and now Call The Midwife, and with the help of amazing newspaper campaigns, the silence on FGM has been truly shattered. It is no longer seen as a cultural practice, but rather an extreme form of violence against girls. Groundbreaking work by politicians such as Jane Ellison and Lynne Featherstone have meant that the British public finally knows what FGM is and what measures are needed to end it.
Yet, although there is now much better awareness – and strong policies at UK domestic level at least – funding has not really increased for the front-line organisations around the world, which are leading efforts to end it. Without this, we run the risk of not making progress quickly enough.
FGM is almost universal in the region of East Africa where Nadifa was born. We don’t have separate data for Somaliland, but according to UNICEF, 98 per cent of women and girls have been affected in Somalia – largely unchanged since Nadifa’s time, but is finally reducing at last for girls who are now aged 15 or under.
Women – most of whom are over 60 and many of whom use their pensions to help fund their work – are having the most success in ending FGM on the African continent. They are rarely talked about. Edna Adan quit a highly-paid job at the WHO to set up a hospital in Somaliland and is on the road to training 1,000 midwives as part of her work. In the Puntland region of Somalia, Hawa Aden Mohamed runs the Galkayo Education Centre for Peace and Development, which teaches over 2,000 disadvantaged girls and makes sure that they are protected from FGM. It is a constant battle and Hawa’s life and wellbeing is often at risk.
Some donors and women’s organisations do understand though what’s needed. An international group called Donor Direct Action has set up a fund for African activists, which is named after my late friend and colleague, Efua Dorkenoo, a leading figure in the anti-FGM movement for over three decades. Their rationale is simple – we need to break free from funding international ‘middle-men’ and get as much funding to the frontlines as we can, to enable inspiring women around the world to be able to do even more. It seems like a simple solution because it is.
Leading anti-FGM campaigners on the African continent and around the world know how to do this work. They can be trusted to make the most of every single penny. It’s time we made it easier for them to just get on with doing it.
Ending FGM is finally a tangible reality for the first time I can remember. The UK is twinned with Somaliland in my heart, and we cannot end it in one place but not the other. In making this happen, women like Nadifa and girls like her baby – but born in 2017 – will have a much better chance of living safe and fearless lives on their own terms.
Call The Midwife Deals With FGM In ‘beautiful And Sensitive’ Story, Says Activist
The anti-female genital mutilation campaigner who helped the creators of Call The Midwife on a storyline has said the episode mirrors her personal experience of FGM but is “beautiful and sensitively done”.
Nimco Ali, the co-founder of non-profit organisation Daughters of Eve, was the victim of FGM as a child and worked closely with show bosses on the BBC drama series.
She said she hopes the story will have a “positive effect” in the fight against it.
An estimated 200 million girls around the world have been put through the procedure, which involves the partial or total removal of parts of the female genitals for non-medical reasons.
Sunday night’s episode of Call The Midwife will highlight the plight of a pregnant Somali woman who is fighting for her life in the aftermath of an FGM procedure.
Nimco told the Press Association that viewers will relate to the character and her storyline, and praised the writers for their sensitivity around the topic.
She said: “I think viewers will see that this is a young woman just like many of them, who needs kindness and understanding.
“The fact that she is given both means so much. I think that’s the most touching aspect of it.
“It mirrors my own personal life in many ways and brings to life what has happened to so many women while giving birth, after having undergone FGM.”
Nimco said: “It is a beautiful episode and very sensitively done. It is hopefully going to have a very positive effect.”
She said: “The writers really wanted to listen – they came to the first meeting passionate about the issue but really wanted to tell the story of a young north Somali woman as true as they could.”
Writers also enlisted the help of campaigner Edna Adan, the former foreign minister of Somaliland and the founder of a maternity hospital in the country.
Nimco said: “(She) was a great help in giving, really, details information about what the midwife could expect having delivered many women with FGM herself.
“The story is told sensitively and there is no judgment, so for them it was about bringing it to life with these key details.”
The episode of Call The Midwife is set against the terror of the Cuban Missile Crisis, as the sisters of Nonnatus House listen to US president John F Kennedy’s ultimatum to Russian president Nikita Khrushchev.
Jessica Neuwirth, founder of international women’s group Donor Direct Action, said it is “fantastic” that shows such as Call The Midwife and others, including Casualty and Law And Order, are bringing the issue into the mainstream.
She said: “Awareness of FGM has increased dramatically in recent years in the UK, but activists working on the front-lines to end it are still not able to access the funds they need to scale up their work in countries such as Somalia, where prevalence is 98%.
“We need to fund efforts locally to end FGM globally and the UK and other governments need to do more to make this happen.”
Donor Direct Action runs an anti-FGM fund for frontline groups, which are ending the practice in Somalia and around the world.
Charity Barnardo’s, which runs the National FGM centre in partnership with the Local Government Association to prevent new cases of FGM in the UK and also support survivors in England and Wales, has spoken about the Call The Midwife storyline.
The centre’s director, Michelle Lee-Izu, said: “FGM, was a shocking discovery for midwives in the latest episode of the BBC TV drama, Call the Midwife, set in the 50s and 60s.
“What’s even more shocking is that this physically and emotionally damaging practice still goes on in the UK today. Despite FGM being illegal here since 1985 there still hasn’t been a single prosecution.
“Barnardo’s is tackling the issue by working with communities through training and education programmes at the National FGM Centre, run in conjunction with the Local Government Association.
“Agencies must also work better together to prevent FGM from happening by identifying girls at risk and helping to prosecute those who fail to protect girls from this type of abuse.”
The show’s creator Heidi Thomas has previously said she wanted to write about FGM for a long time but had to wait until the timeline of the show reached the 1960s.
I’ve known about Edna for a long time, because she is really well respected among the Somaliland diaspora in Canada and around the world. So when I came to Somaliland on vacation with my mom and sister last year, I was already thinking about how I could help the hospital. I met with Edna and she told me that the hospital’s Research Coordinator was leaving and that I could help out in the research department. I accepted. So at the end of our vacation, I stayed on while my mom and sister went back to Canada.
I am one of 16 advisers responsible for organizing undergraduate students who are in the last year of completing their degrees in nursing, midwifery, public health, and as medical lab technicians. Everyone in their final semester at EAUH has to write a formal thesis that includes data collection and data analysis. There are about 120 students working on their thesis this year.
I just recently decided to extend my stay for three more months, because taking off in the middle of the semester would leave students hanging, especially students working on their thesis.
I also teach an Introduction to Chemistry course to pre-med students at EAUH. If you are not from here, teaching can be challenging, you have to learn the culture, often students are reluctant to ask questions in English, but we’ve grown to understand each other over time.
My other task is to oversee a long-term FGM study going on at the hospital itself. In the morning I am there collecting patient records on FGM – what this means that we collect data on the FGM status of mothers delivering here, and possible FGM-related difficulties to mother and/or child during delivery – the goal is to demonstrate the impact FGM has on maternal and newborn health compared to other Muslim countries that do not practice FGM.
I have also been working on the latest EAUH hospital newsletter that has put me in position of writer, photo and text editor.
My personal observation as daughter of Somaliland diaspora is that as a woman here you almost always have to prove yourself. People create assumptions that you don’t know something, and you have to push your way into the male-dominated workforce. It’s not dissimilar from a Western country per se, but here the sexism is more blatant and more obvious, though on the whole, it’s less of a problem than I had expected.
Unlike most volunteers who live at the hospital, I’m staying with my extended family. My parents have been very encouraging about my stay here. I have just graduated from college and my parents told me that this is the time to explore and see where I want to end up.
My dad is very big on education and that plays a huge role in his support of what I am doing here.
Coming from Canada, which has socialized and inexpensive health care, seeing first hand how people struggle to pay for medicine required to treat them, and sometimes to keep them alive was startling. And then to see Edna say: “oh they can’t afford it, let’s give it to them for free,” was inspiring and moving.
It takes a lot of money to run the hospital, but Edna is still willing to put everything aside for her patients. Regardless of the financial strain, regardless of the time it takes — she’s up all hours of the night — and, till recently, running the hospital full time while delivering babies… She’s really a big role model for women in Somaliland and I’m enjoying seeing how she works up close.
The plight about a set of conjoint male twins born at the hospital seven months ago really touched me. I interviewed their mother recently, and saw what a strong woman she is. This was her first pregnancy. She and her husband are very poor, and I remember the father going to Edna asking for any help she could provide. It was a very trying time for the parents and Edna took them in for several months for free. Some time later, the possibility of a surgery that would separate the twins came up, and the father asked whether that meant that one of the boys would die and said he would not, could not, choose between his two sons and said that one needed the other to survive and that the family would not opt for surgery. In saying that, the element of humanity was added to the concept of medicine, which too often in the West is so much about data and probabilities and percentages.
I will remember this hospital as a place filled with great local people that have amazing potential and as a place of hope that Somalilanders will continue the excellent work Edna started and that I’ve had the privilege to observe first hand.
Length of Volunteering: 9 months (Ethil originally signed on for six months, and recently extended for another three).
Recent graduate from the University of Calgary: B.Sc in Chemistry
I met Edna in 2014 when she came to the University of Pennsylvania to accept her honorary doctorate. I was very impressed with all that she had accomplished. And she expressed that there was always a need for doctors at her hospital in Hargeisa. From that meeting, it took two years until I was finally able to make the trip happen.
What surprised me is the high volume of high-risk OB. It’s not as though I haven’t seen high risk OB before but this was like OB on steroids – many patients with preeclampsia, for example. Rare in the US, severe preeclampsia is rampant here. I also saw many more cases of placenta previa.
In addition to high-risk obstetrics the hospital’s doctors are also dealing with pediatrics, internal and family medicine. That’s mind-blowing to me, because back home you have a family practitioner, a pediatrician, and then there’s the OBGYN. Here, one doctor is all those things! So I felt my own limitations in that I could do the OB, but when there was an adult or pediatric patient I felt like my ability to contribute was limited. It certainly gave me an appreciation for all that the doctors do — you essentially have highly trained generalists who can provide medical care to a population across the board. In the West, where we are more specialized, each medical professional offers much more circumscribed care.
Limited resources and high-risk patients are a challenging combination for a visiting doctor not used to similar conditions. For example, an ultra-sound may not be readily available. Or, in another example, the whole idea of [fetal] viability, that was the first big shock to me — that a 30-weeker may not be considered viable. Back home, we’re more like 24 weeks.
Steps to do a caesarean section are universal – don’t cut anything, know how to tie a knot — but after being here I can see why surgical camps [where surgeons from abroad bring along their own operating team] work so well because the visiting surgeon transplants himself with equipment and ancillary help, which is totally different from the “let me see what you have” experience of a doctor who arrives on her own, like I did. The greatest hurdle I encountered was the language. I didn’t anticipate what the communications barrier there would be between the patients and me.
What moved me the most was seeing people work together. Especially in emergency situations, pulling together to help someone survive. And the compassion people have for each other, the willingness to pull limited resources together, and that includes the doctors.
I really like that women in Somaliland come together and are really there for the laboring woman. They are THERE from the moment she gets to the hospital to the moment she’s delivered. They eat together and pray together, that sisterhood and that womanhood is something special that you don’t often see in the States. These are strong women, most going through labor without pain medication. Not that they don’t feel discomfort, but they manage somehow.
The best experience I had, I guess the highlight of my stay, was the feeling you get when you think you’ve been able to impart a bit of knowledge or information that someone will be able to use. It’s almost like a relay race and like you allowed it to continue. Demonstrating, or showing by doing, is more useful than simply doing a procedure –and hopefully someone will be a little wiser, more adept, and that new skill can be used in the future.
From a personal point of view, just being in Somaliland, a country that was bombed in ’91 and has been rebuilding itself out of the rubble, has been an extraordinary experience. I’ve never been in a country that had been so freshly devastated. The overriding question in Somaliland and in the hospital, for that matter, is how do we go from here. The streets of rubble, the expats, the [Somaliland] Diaspora coming back…which way is up?!
I will remember Edna’s hospital as a beacon of light, as a dynamic process and as an ever-evolving effort to improve healthcare. The whole experience opens your eyes in a way that an experience in the US or UK just would not.
Dr. Sharan Abdul Rahman
Matriculated at University of Pennsylvania, undergraduate
Yale Medical School and University of Pittsburgh School of Business
I read the book Half the Sky [by Nicholas Kristof and Sheryl WuDunn] and then we happened to learn about Edna’s hospital in a Women’s Studies course at my university. We were learning about different waves of feminism and the discussion turned to feminism in developing countries. That’s when our professor started to talk about Edna and her battle against female genital mutilation (FGM) and oppression of women.
At the time I was a mentor for a group of junior high school girls in a pilot program and the whole point of it was to encourage and empower them to reach their intended goals. And that’s when we happened to be learning about Edna and it propelled me into action – I was mentoring these girls, and I wanted to transfer that to a community setting outside the US. And that’s one of the things I got to do by working with local staff of a small non-governmental organization (NGO) with a focus on women’s health that Edna’s hospital works with.
After I leave here I will be studying international law and human rights. Coming here has shaped my view of what I will be studying. In other words, it shaped HOW I want to address the issue of human rights: I like the idea of working with local governments, as opposed to NGOs because I feel like my experience here showed me that development is really dependent on how well a government operates. One of the issues I think about a lot are human rights — how you give people dignity and allow them to prosper and so much of that is reliant on government. As a lawyer I would like to work with governments in developing countries and consult them on these issues.
One thing I learned that I didn’t grasp before I came to volunteer for Edna is the impact of culture on daily life. In the work that I hope to do, I will have to be very sensitive to the culture I’ll be working in. Understanding and being sensitive to the culture of any given country is paramount before you can affect change or help improve the lives of its people. Before coming here I did not quite grasp how important it is to get involved with a local community and how, in order to do that, you must be responsive the country’s culture.
One piece of practical advice: I wish I had brought more comfy clothes, sweatpants, sandals and casual wear in general.
Samantha Ashley Heley Age 27 Student, Bachelor of Sociology from BYU January 2017- March 2017 Non-medical volunteer. Helped to fine tune administrative record keeping; created HR filing system for employees; did community outreach and trained local staff to ensure outreach becomes self-sustaining.
Samantha Heley at a Hargeisa orphanage. EAUH has recently established a relationship with the orphanage where university students will do community service for extra credit, accompanied by Edna’s volunteers like Samantha.
I learned about Edna and her hospital from an excerpt of Half the Sky that I saw as part of a show at a museum in California. Edna’s message on the video resonated with me, particularly that the fetal and maternal mortality in Africa was so high. I’ve been doing ultrasound for 25+ years with extensive experience in OB GYN.
There is few times in your life that you can actually affect the outcome for generations by teaching. And this was one of them.
I initially emailed Edna and it took me three years following that email to create a meaningful amount of time to make the trip to Somaliland.
Turning thought into actions was inspired by Edna’s vision and commitment to saving lives, educating women, battle against FGM, improving the lives of those who cannot improve their own lives, sometimes by turning one stone at a time.
What I’ve learned since coming here is you must maximize what you have to work with. I always say: I’ve done so much for so long with so little that I am now qualified to do anything with nothing.
One piece of practical advice: Bring something for self-entertainment.
Vicky Glover, 59/Phoenix, Arizona, USA
Registered Diagnostic Medical Sonographer (RDMS)
Registered Vascular Technologist (RVT)
Radiographic Technologist (RT)
Radiology Phoenix, Arizona
Vicky Glover teaches a nurse midwife how to do a sonogram at Edna Adan University Hospital.
HARGEISA, Somaliland – It was early in the day and Dr.Shukri Mohamed Dahir of the Edna Adan University Hospital (EAUH) had already successfully completed four hydrocephalus surgeries — shunt procedures – on infants, all under the age of 12 months.
Each shunt surgery took approximately an hour, and Dr.Dahir had purposefully planned all four to take place on the same day.
“I schedule the surgeries so that all infants and their mothers get post-op care in the same room, away from other hospital patients. This significantly reduces the risk of infection that is high among post-op hydrocephalus patients, “Dr.Dahir said.
Before seeking professional medical help, parents often pay traditional healers to burn the babies’ swollen heads with hot sticks in the belief that they will shrink to normal size. The procedure does not work, but because in a small percentage of infants hydrocephalus stops on its own (arrested hydrocephalus), families continue to seek out traditional healers in the belief that this will ‘cure’ their babies.
“Most untreated infants become mentally and physically impaired as the condition worsens, causing blindness, deafness full paralyses and premature deaths,” Dr.Dahir explained.
The tiny patients had to travel long distances to receive medical treatment; three came from neighboring Somalia, and one from a remote region of Somaliland.
For eleven months-old Cabas Dahir Xasan it took a grueling two days and nights by car, to get to the EAUH hospital from the town of Cadaado (Adado) in central Somalia.
Cabas’s family tried the traditional method first — scabs from the burns and healed fresh skin where the scabs had fallen off, still visible on his head.
“We tried four times with four different healers. It did not work. A doctor in Mogadishu recommended Edna’s hospital, so we came here,” Cabas’s mother, Fadumo Muxumed Cilmi, 25, said.
But most parents, as Dr.Dahir explained, find out about Edna’s hospital by word of mouth, like Layla Macalin Mohamed, 27, mother of seven months old Asma Abdilaahi Ali, who flew to Hargeisa from Somalia’s capital, Mogadishu.
“I met a man at a bus stop who told me about Edna’s hospital when he saw my baby,” said Ms. Mohamed.
“In the last five years the number of parents seeking medical attention for this condition has increased from 125 to about 400 a year at our hospital because of our reputation and patients spreading the word,” Dr.Dahir confirmed.
In Mogadishu, if at all possible, the procedure costs some $2000 per patient, not including medications, post-op in-patient care and accommodation, while the same surgery can cost as much as $15,000 in places like India or Malaysia – not including travel expenses and only affordable for a tiny fraction of the region’s population.
In contrast, EAUH offers this surgery free of charge.
“Even if they wanted to pay, it would be maybe with a $20 bill.They could not afford more, so why kill a tree and make paper out of it,” said Dr. Edna Adan Ismail, founder and head of the EAUH.
Ms.Adan’s fingers fly over a calculator. “To give you an idea, the 400 surgeries done at EAUH for free would have cost an equivalent of $6 million abroad.”
In all four cases the families, too poor to afford the shunt surgery, raised fund to tralve to Hargaisa from family and friends.
Hydrocephalus is widespread in the region mostly due to infections in utero, or contracted during and post-delivery, as well as by poor to non-existent antenatal care and insufficient quantities of folic acid in the diet of the pregnant mother. Often, babies born with hydrocephalus also have spina bifida, a birth defect that involves the incomplete development of the spinal cord or its coverings. In such a case, EAUH performs additional surgery to address it.