By Selma Kalousek and Abdihakem Essa
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.
On June 11, Edna Adan presided over a ceremony to present “midwife kits” to 40 recent graduates of the Community Midwife program. The midwife kits were generously donated by Direct Relief, a USA nonprofit organization. The kits contained infant and adult resuscitation sets, blood pressure cuff, various scissors and other instruments, kidney dishes, a baby scale and numerous other items. The kits are particularly crucial to the many midwives who are posted to remote regions of Somaliland and have no access to these items. Edna is aiming to train 1000 midwives.
The ceremony was held at the Red Sea Cultural Center and was attended by representatives of the Ministry of Health and UNFPA.
We would like to share some of our photos from the ceremony:
Community Midwives awaiting kits
Community Midwives take kits back to their regional health posts
Dr. Ali Sheikh presents kits to Community Midwives
Edna with Community Midwives
Edna with Community Midwives before ceremony
MoH reprsentation led by Dr. Ali Sheikh, Director of Reproductive Health