Transcriber: Marie-Claude Bélanger Reviewer: Nhu PHAM
Thank you.
My name is Edna Adan, and I'm a midwife,
and because I'm a midwife, I've come to talk to you
about the health of women and children.
My country, Somaliland, is a country
with one of the highest maternal mortality rates in the world.
A country that has known civil war, from 82 to 91,
during which a quarter of a million of our people were lost,
and 95% of our cities were destroyed.
This, of course, was a situation that
[provoked] two things: either to turn away
and say: "I don't care, I don't feel, I don't know,
I will just disappear in the horizon and go settle somewhere",
in one of your great countries,
or stand firm and try to do something about it.
Sixty percent of our people are nomads.
I know how difficult it is to provide health care
to people who are sedentary.
But when they're nomads, it makes it even more difficult.
When they're poor, when the country is so wide,
it makes it very difficult.
There are also situations that arise
because any facilities that existed before the war
were destroyed.
Many of the bones you see on the screen
could have been the bones and the remains of health workers.
When you have had a past and you were born
with a proverbial silver spoon in your mouth,
the only thing I could do,
was to try and stand firm,
and give back to the people
what the world had given to me.
This was why, when I retired in 1997,
at the age of 60,
from the World Health Organization (WHO),
I went home and I tried to put into practice
what I had been preaching during all my career
as a WHO civil servant.
The site upon which the hospital was built
was one that was once a graveyard,
a military parade ground,
an execution ground,
and, eventually, a garbage dump.
In an area of Hargeisa, the capital city of Somaliland,
where no hospital had ever been built
before that time.
The hospital took four years to be built.
It was four years in a country where labor
and skilled construction people were very few.
But we labored on and, eventually,
the hospital was born in 2002.
That hospital today
is one where almost 12,000 children have been delivered.
That child you see in my arms
was the first baby that was born in that hospital,
about 10 hours after the hospital was opened.
Among the 12,000, most of them were people
who had been referred to us,
or women who had found something wrong with their pregnancy,
because women who think they are having a normal pregnancy
have their babies at home.
So the 12,000 children that we delivered in the hospital
were mainly delivered because they were sent to us,
because of a complication either with the pregnancy,
or with the mother, or whatever.
We remained a maternity hospital
for a little more than a day or two.
Because in your countries,
you have the luxury of having specialized hospitals.
You have something wrong with your eye, you go to the ophtalmologist.
You break an arm, you go to the orthopaedic surgeon.
But in Africa, in my country,
if you're sick, you just go to a hospital.
So it was not possible for us to say: "We are a maternity hospital.
Go and get your heart attack treated somewhere else.
Go and get your diabetic coma seen to somewhere else."
It's a hospital, so it's a hospital.
Men are treated, women are treated, children, whatever.
We also have a facility where we can do surgical interventions.
Since the 1st of January, this year,
we have operated over 500 cases.
Only 185 of them were cesarian sections.
The others, contractures, cleft lips, obstetrical fistula,
thyroids and, on that site, that was once a garbage dump,
we can also operate on children who have hydrocephalus.
So, we can even do, not brain surgery,
but we temper, we touch the brain of children
and we have done over 27 cases and, thank God,
all but one have succeeded.
And the one who died died of diarrhea and vomiting,
two weeks after the operation.
So, the story is: where there's a will,
there's always a way.
We are also a teaching hospital.
Because it's not the bricks, the mortar,
it's not the instruments and the facility
that is going to look after sick people.
It's the skills, it's the knowledge, it's the competence,
it's the efficiency of the people who work in these facilities.
And unless you have doctors and nurses and midwives
who know what they are doing,
who care with compassion,
who care and respect the dignity of the human beings,
you cannot do anything.
We have trained over 200 nurses.
We have trained over 150 midwives.
And my passion is to multiply
those girls you see with the red capes,
multiply them by a thousand.
And why do I say that? Because it is these young women
who are trained for just two years,
who go back to the districts and the regions we recruited them from,
who make a difference.
Somaliland has one of the highest maternal mortality rates in the world.
But among the 12 000 children and women
we have delivered,
we have been blessed to be able
to reduce our maternal mortality rate
to a quarter of the national average,
not because we have a magic wand,
but because we have an emergency preparedness.
We can deal with a hemorrhage as soon as a woman comes in,
we have an operating theater that works
24 hours a day.
It is midwives who make the difference.
Doctors? Yes! We need doctors.
But they take 8 or 9 years to train,
and for goodness sakes: where am I going to get doctors from
to work in Somaliland,
a country which is on the dark side of the moon?
Yes! We need graduate nurses and midwives,
but we don't have them,
and we don't have the four years and the five years it takes
to train a midwife.
So, what we do is that we rely on the two year trained midwives.
They are a quick fix, they're cost effective,
they're efficient, they're dedicated, and they do not get stolen
to work in other health facilities,
because they are trained as midwives,
they remain in midwifery.
And, unless Africa and countries like mine
multiply the training of these midwives,
we will continue to loose women
to causes that you have protected your women from dying:
we will protect them from eclampsia,
we will protect them from infection,
we will protect them from uterine rupture!
No woman dies, in your countries, of uterine rupture.
She would not be allowed to go into labor,
because somebody would already see
that she has a contracted pelvis,
or that there is a disproportion
between the size of the baby and the size of her pelvis.
No woman would die, in your country, of infection.
You have water, you have soap,
you have equipment that is sterile
and that has been prepared to be used safely.
But our women die of these causes.
Our women die of causes that no woman in this day and age,
where man has reached the moon,
no woman should die of.
But we don't have the skills,
we don't have the facilities.
In our countries,
women have a one in ten chances of dying
of a pregnancy related cause.
In your countries, it's one in 4,000.
Your women are treated by doctors and midwives,
throughout their pregnancy.
Only 10% of our women have access to a health facility.
And that is why we must have more midwives
who can go to the regions, who can go to the districts,
who can be where women are to help them, to screen them,
to identify the ones who are having a normal pregnancy,
and are possibly expected to have a normal outcome,
or to refer these women to where they can be helped better.
My hope, my ambition, is that one day
we will have a thousand of these [midwives].
And why not in other countries?
If Somaliland can do it, anybody can do it.
If Somaliland, with its limited resources,
with its past of civil war and destruction
can reduce its maternal mortality rate
to a quarter of the national average
because of the training of midwives,
why not in other countries?
Why not in Papua New Guinea?
Why not in Ethiopia?
Why not in Erytrea? Why not in neighbouring Somalia?
Why not in Lesotho and all of these countries
that have a very high maternal mortality rate?
If it can be done in Somaliland,
it can be done anywhere.
My message.
My message is to governments:
My message is to governments to allocate more funds,
instead of spending money on tanks, and guns, and bazookas
and, I don't know, military hardware.
Spend more money on health, on education,
on infrastructure, on water, on sanitation.
So that is one:
education.
The second is: educate women, educate girls.
When you educate a woman, she is able to take care of [herself].
I cannot imagine where I would have been
if I had not had access to the education and the training
that has helped me to help others.
And, of course, educate the community!
Unless the community has the confidence
to utilize whatever health facilities are available,
we will continue to lose the battle.
One of the things that has really made a difference
in my appreciation of human tenacity,
and the strength of women in developing countries,
is when I see women who come in to our training,
who are so timid, who are so dependent on others,
go through a transformation that gives them the confidence
to think, to answer, to advise,
to guide and to help other women.
Education is one of the strongest gifts we can give
to a human being and, particularly, to a woman in Africa.
My last parting suggestion is:
Don't ever underestimate
the capacity of a human being
who is determined to do something.
If I, at 60, 14 years ago,
could build a hospital,
anybody, any of you, can do it.
I thank you all for your attention,
and thank you for this opportunity
to be here with you today.
Thank you.
(Applauses)