By Dr. Sharan Abdul Rahman
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