An Update from Thomas Kraemer at the Edna Adan University Hospital
Fifty prospective Post-Basic Midwives sat for the written portion of the qualifying examination on Sunday. Monday, the students underwent the clinical portion of the exam (the evaluation process consists of a written examination and a clinical examination, each worth 40% of the total grade, and an interview making up the final 20%). The curriculum is approved by the Somaliland Ministry of Health, which also sends a representative to assist with the administration of the examination. Those who pass will become registered midwives and will be eligible to continue on and earn their Bachelor of Science in Midwifery degrees from Edna Adan University.
Edna looks on during the clinical examination.
The Post-Basic Midwifery course is funded through a grant from the Edna Adan Hospital Foundation. As a prerequisite to acceptance into the program, each of the women must have already completed a three-year general nursing course and passed the examination to become a registered nurse. The participants then have nine months of training focused specifically on midwifery skills.
The Post-Basic Midwifery curriculum is a combination of theoretical (classroom) study and practical training. To complete the course, each student must assist in a minimum of 50 deliveries. At least the first 25 births must take place at Edna Hospital under the supervision of the program instructors. Once the instructors are satisfied with their students’ progress, the students will rotate through the country’s Hargeisa Group Hospital, the country’s main public hospital, and four Maternal and Child Health centers in Hargeisa.
After completing their practical training, students who pass the qualifying examination will be certified as registered midwives and will be eligible for government employment. However, the majority of the students will likely remain for another nine months of study to earn their Bachelor of Science in Midwifery degrees before entering the workforce.
A student uses a mannequin during her clinical examination.
The clinical examination took place in a large classroom that had been converted into a hospital room, complete with patient beds, scales, IV stands, hazardous waste disposal bins and patient charts. A large table was laid out like a hospital storeroom, stocked with everything from rubber gloves, blood pressure cuffs and bandages, to medications, syringes and suture kits.
Students entered the room individually and were assigned to two examiners. There were 52 possible situations that each student might be asked to handle; these situations were assigned randomly and the students were required to orally explain the proper treatment while demonstrating the requisite skills on a mannequin or role-playing with one of the examiners.
The potential situations varied greatly and students had only one chance; they had to be ready for anything. Some of the scenarios posited were general:
A 28-week pregnant woman has presented at the antenatal clinic. Identify what steps you would follow in her case. What health education would you give her?
Other scenarios were much more specific:
A neonate was brought back for admission 9 days after delivery with umbilical sepsis. What are the signs/symptoms and management of umbilical sepsis?
The doctor ordered “Give gentamycin injection 60 mg, IM Stat.” On hand, you have an ampoule labeled “Gentamycin 80mg/2ml.” How many ml will you give?
The students were graded not only on correct procedure, but also on how they went about their business—interacting with the patient, explaining what she was doing and why, calmly gathering everything she needed before beginning, and properly cleaning up afterward. It appeared that most of the students were able to carry out their assignments efficiently and confidently, and the women are well on their way to becoming qualified midwives.
This is the fourth group of Post-Basic Midwives that have been trained under Edna’s watchful eye. The course coordinator, Ayan Abdi Hussein, was among the first group of Post-Basic Midwives to graduate and has remained at the hospital to help the midwifery training programs flourish.
Learn more about Edna’s effort to train 1000 Midwives: Community Midwives: Improving Maternal and Child Health
Today is Universal Health Coverage Day, a day to advocate for universal health coverage to be a cornerstone of the sustainable development agenda and a priority for all nations. Healthcare is a necessity everywhere, but it’s especially important to advocate for healthcare in developing countries. Maternal healthcare can present a lot of difficulties, especially when only one in three women in rural communities in developing countries receives necessary care. According to the World Health Organization (WHO)’s Global Strategy for Women and Children’s Health from 2010, 350,000 women die every year during childbirth. The WHO also said that the planet needs another 3.5 million health workers to improve women and children’s health in the 49 lowest income countries.
The Edna Adan University Hospital specializes in training midwives in Somaliland*, using modern medical knowledge and techniques. Currently, most births in the country are aided by a traditional birthing attendant, a person who hasn’t gone through any sort of formal medical training. Births are often in unsanitary conditions, with no recourse if a complication arises. This takes a harsh toll on the mothers of Somaliland, with 1,044 mothers dying per 100,000 live births, which is one of the highest rates in the world.
Additionally, almost all of the following deaths are preventable:
- 289,000 women and 2.6 million newborns who died during childbirth in 2014.
- 3 million infants died within the first few months of their lives.
- A woman who is 100 times more likely to die during childbirth in sub-Saharan Africa than in an industrialized country.
This same case study by the WHO found that 500 midwives educated and deployed in Bangladesh could save 36,000 lives over the course of 30 years. 87 percent of the essential care for women and newborns can be performed by an educated midwife.
The midwives that the hospital trains are disbursed throughout the country after their education is complete. They serve a vital role in Somaliland society, helping to form a protective web across the country so that women in any part of Somaliland can have a trained medical professional on hand for a pregnancy. Midwives can assist in births in rural areas and help to funnel difficult pregnancies back to the hospital. The hospital hopes to train 1,000 midwives to cover the country. We have currently trained 400.
The other part of providing adequate maternal health care is access to proper supplies. The Edna Hospital has expanded its facilities, including a radiology department which was built this year. It also uses improvised technological devices, such as an oxygen mask that runs through a water bottle, so that it bubbles when oxygen is flowing. Continued support can help the hospital and the midwives it trains to reach more women and children in need, because everyone, and especially mothers, should have access to affordable healthcare.
* Somaliland is the former British Protectorate which borders between Djibouti and Ethiopia.
This post was featured in Girls’ Globe website
Edna Adan Hospital Foundation post ‘Fighting Maternal and Infant Mortality in Somaliland’ was featured in the Huffington Post via Girls Globe.
Somaliland’s leading lady for women’s rights: ‘It is time for men to step up’
Edna Adan has dedicated her life to building her country’s first maternity hospital, and campaigning against FGM. Now she is looking for new allies in the fight against gender violence
theguardian.com, Monday 23 June 2014 02.00 EDT
Edna Adan Ismail, the former first lady of Somalia, in front of the maternity hospital she built in Hargeisa, Somaliland. The hospital has since been completed. Photograph: David Gough for the Guardian
Edna Adan has led a life filled with firsts. The 76-year-old was the first woman from Somaliland to study in the UK and the first qualified-nurse midwife in her country, as well as the first female foreign minister and one of the first in the world to speak out publicly about the horrors of female genital mutilation (FGM).
Now she is experiencing another first: a cautious hope that the balance of power is finally tipping in the fight against violence against women and girls, particularly against FGM. But this veteran campaigner knows too well the dangers of over-optimism.
Edna Adan Ismail is honored to have been awarded a Doctorate of Humane Letters from the University of Pennsylvania at UPenn’s 258th commencement ceremony and she has been named the inaugural recipient of the Renfield Foundation Award for Global Women’s Health from UPenn’s Nursing School which includes a grant in the amount of $100,000 in support of her work to improve healthcare for women in the Horn of Africa.
The Renfield Award recognizes demonstrated leaders whose work has had significant impact in improving the lives and health of women and comes at the conclusion of the Healthy Cities: Healthy Women Conference Series which aims to promote discussions about re-envisioning our communities to make them universally safer, healthier and more livable.
Penn Nursing Dean Afaf Meleis – herself a trailblazer in global women’s health issues – presented the award to Edna who went on to describe to those assembled the devastation in Somaliland following the brutal civil war which left some 95% of homes, hospitals, and schools in ruins.
The 5th Annual Women in the World Summit was held in New York City on April 3-5, 2014. This event brought inspirational women leaders from around the globe who shared incredible stories of overcoming hardship and oppression. Initially, you may feel overwhelmed, and at times teary-eyed by the challenges facing girls and women around the world, however you may also feel determined to continue the good fight, and in my case, defeating the high occurrences of maternal mortality in the developing world.
Day 2 of the summit included a panel discussion “Breakthroughs in the Fight Against Maternal Mortality” which was moderated by Soledad O’Brien and included Edna Adan Ismail, Director of Edna Adan University Hospital, along with Kenneth Frazier, CEO of Merck, and Princess Sarah Zeid. This is Edna’s 2nd appearance as a panelist in this summit. All three panelists play a major role in combating maternal mortality.
Nora Yussuf Sultan Ali volunteered at Edna Hospital for 7 weeks in early 2012. She is a recent graduate of Johns Hopkins University, having majored in Public Health Studies. Prior to attending law school in the fall, she wanted to spend time volunteering abroad. She thought the best place for her experience would be at Edna Hospital.
Unlike most volunteers at the hospital with a background in medicine, nursing, or midwifery, Nora found it took a little time to find the best way to help. “I came with a set plan of things I wanted to achieve – working on female genital mutilation (FGM) research, teaching English, working with children but I soon realized there were more pressing needs.” The pressing needs led Nora to change her game plan.
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.
We have had many volunteers – 117 at the last count – who come during the summer for varying lengths of time and with different interests. We are always looking for medical doctors – particularly OB/GYN’s – and for nurses who can help us teach our student nurses.
The volunteers we welcome are those who are either trained in or studying any of the various health professions such as nursing, midwifery, medicine, biochemistry and so on.