If We Can Train Midwives in Somaliland, Everyone Can!: Edna Adan Ismail at TEDxRC2

During her TEDxRC² talk, Edna Adan Ismail, a nurse, midwife, UN diplomat, French Legion of Honour recipient and former foreign minister of Somaliland demonstrates how hospitals like hers (which she dared to build on the site of an old killing ground and graveyard) are on the pioneering edge of training local medical professionals to meet local health challenges.

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)