0:00:19.395,0:00:21.498
Thank you.

0:00:21.498,0:00:23.977
My name is Edna Adan, [br]and I'm a midwife,

0:00:23.977,0:00:27.256
and because I'm a midwife, [br]I've come to talk to you

0:00:27.256,0:00:30.657
about the health of women and children.

0:00:30.657,0:00:34.293
My country, Somaliland, is a country

0:00:34.293,0:00:39.445
with one of the highest [br]maternal mortality rates in the world.

0:00:39.445,0:00:45.042
A country that has known [br]civil war, from 82 to 91,

0:00:45.042,0:00:49.587
during which a quarter of a million [br]of our people were lost,

0:00:49.587,0:00:54.497
and 95% of our cities were destroyed.

0:00:54.497,0:00:58.549
This, of course, was a situation that

0:00:58.549,0:01:00.797
[provoked] two things: either to turn away

0:01:00.797,0:01:04.327
and say: "I don't care, [br]I don't feel, I don't know,

0:01:04.327,0:01:07.968
I will just disappear in the horizon and [br]go settle somewhere",

0:01:07.968,0:01:10.375
in one of your great countries,

0:01:10.375,0:01:14.786
or stand firm and try [br]to do something about it.

0:01:15.746,0:01:19.068
Sixty percent of our people are nomads.

0:01:19.568,0:01:22.738
I know how difficult it is [br]to provide health care

0:01:22.738,0:01:25.258
to people who are sedentary.

0:01:25.258,0:01:28.816
But when they're nomads, [br]it makes it even more difficult.

0:01:28.816,0:01:33.059
When they're poor, [br]when the country is so wide,

0:01:33.059,0:01:35.587
it makes it very difficult.

0:01:36.737,0:01:41.682
There are also situations that arise

0:01:41.682,0:01:46.733
because any facilities [br]that existed before the war

0:01:46.733,0:01:48.184
were destroyed.

0:01:48.184,0:01:50.977
Many of the bones you see on the screen

0:01:50.977,0:01:55.409
could have been the bones [br]and the remains of health workers.

0:01:56.319,0:01:58.936
When you have had a past [br]and you were born

0:01:58.936,0:02:02.513
with a proverbial [br]silver spoon in your mouth,

0:02:02.513,0:02:04.292
the only thing I could do,

0:02:04.292,0:02:06.248
was to try and stand firm, [br]

0:02:06.248,0:02:08.584
and give back to the people

0:02:08.584,0:02:11.681
what the world had given to me.

0:02:12.161,0:02:17.574
This was why, when I retired in 1997, [br]

0:02:17.574,0:02:19.177
at the age of 60,

0:02:19.177,0:02:21.380
from the World Health Organization (WHO),

0:02:21.380,0:02:24.696
I went home and I tried [br]to put into practice

0:02:24.696,0:02:27.737
what I had been preaching [br]during all my career

0:02:27.737,0:02:32.007
as a WHO civil servant.

0:02:32.007,0:02:34.859
The site upon which the hospital was built

0:02:34.859,0:02:38.823
was one that was once a graveyard,

0:02:38.823,0:02:41.879
a military parade ground,

0:02:41.879,0:02:43.879
an execution ground,

0:02:43.879,0:02:46.457
and, eventually, a garbage dump.

0:02:46.457,0:02:50.579
In an area of Hargeisa, [br]the capital city of Somaliland,

0:02:50.579,0:02:53.317
where no hospital had ever been built

0:02:53.317,0:02:55.396
before that time.

0:02:55.946,0:03:00.617
The hospital took four years to be built.

0:03:00.617,0:03:06.384
It was four years in a country where labor

0:03:06.384,0:03:10.809
and skilled construction people [br]were very few.

0:03:10.809,0:03:15.097
But we labored on and, eventually,

0:03:15.097,0:03:18.987
the hospital was born in 2002.

0:03:19.497,0:03:22.080
That hospital today

0:03:22.671,0:03:30.608
is one where almost 12,000 children [br]have been delivered.

0:03:31.208,0:03:34.397
That child you see in my arms

0:03:34.397,0:03:37.050
was the first baby [br]that was born in that hospital,

0:03:37.050,0:03:40.033
about 10 hours [br]after the hospital was opened.

0:03:41.957,0:03:46.974
Among the 12,000, most of them were people

0:03:46.974,0:03:49.198
who had been referred to us,

0:03:49.198,0:03:53.908
or women who had found [br]something wrong with their pregnancy,

0:03:53.908,0:03:58.466
because women who think [br]they are having a normal pregnancy

0:03:58.466,0:04:00.109
have their babies at home.

0:04:00.109,0:04:04.747
So the 12,000 children [br]that we delivered in the hospital

0:04:04.747,0:04:07.787
were mainly delivered [br]because they were sent to us,

0:04:07.787,0:04:10.068
because of a complication [br]either with the pregnancy,

0:04:10.068,0:04:13.447
or with the mother, or whatever.

0:04:14.887,0:04:18.578
We remained a maternity hospital

0:04:18.578,0:04:22.028
for a little more than a day or two.

0:04:22.028,0:04:23.880
Because in your countries,

0:04:23.880,0:04:27.634
you have the luxury [br]of having specialized hospitals.

0:04:27.634,0:04:30.254
You have something wrong with your eye, [br]you go to the ophtalmologist.

0:04:30.254,0:04:33.534
You break an arm, [br]you go to the orthopaedic surgeon.

0:04:33.534,0:04:35.588
But in Africa, in my country,

0:04:35.588,0:04:38.432
if you're sick, you just go to a hospital.

0:04:38.432,0:04:43.696
So it was not possible for us to say: [br]"We are a maternity hospital.

0:04:43.696,0:04:46.927
Go and get your heart attack [br]treated somewhere else.

0:04:46.927,0:04:51.013
Go and get your diabetic coma [br]seen to somewhere else."

0:04:51.013,0:04:53.547
It's a hospital, so it's a hospital.

0:04:53.547,0:04:58.140
Men are treated, women are treated, [br]children, whatever.

0:04:58.890,0:05:05.049
We also have a facility where [br]we can do surgical interventions.

0:05:05.049,0:05:08.723
Since the 1st of January, this year,

0:05:08.723,0:05:13.577
we have operated over 500 cases.

0:05:13.577,0:05:18.298
Only 185 of them were cesarian sections.

0:05:18.298,0:05:24.467
The others, contractures, [br]cleft lips, obstetrical fistula,

0:05:24.467,0:05:30.936
thyroids and, on that site, [br]that was once a garbage dump,

0:05:30.936,0:05:35.940
we can also operate on children [br]who have hydrocephalus.

0:05:35.940,0:05:39.253
So, we can even do, not brain surgery,

0:05:39.253,0:05:42.658
but we temper, [br]we touch the brain of children

0:05:42.658,0:05:47.157
and we have done over 27 cases [br]and, thank God,

0:05:47.157,0:05:49.717
all but one have succeeded.

0:05:49.717,0:05:53.497
And the one who died [br]died of diarrhea and vomiting,

0:05:53.497,0:05:56.318
two weeks after the operation.

0:05:56.318,0:06:01.195
So, the story is: where there's a will, [br]

0:06:01.195,0:06:03.422
there's always a way.

0:06:04.442,0:06:06.899
We are also a teaching hospital.

0:06:06.899,0:06:09.618
Because it's not the bricks, the mortar,

0:06:09.618,0:06:11.680
it's not the instruments and the facility

0:06:11.680,0:06:13.849
that is going to look after sick people.

0:06:13.849,0:06:16.920
It's the skills, it's the knowledge,[br]it's the competence,

0:06:16.920,0:06:20.738
it's the efficiency of the people [br]who work in these facilities.

0:06:20.738,0:06:24.634
And unless you have doctors [br]and nurses and midwives

0:06:24.634,0:06:26.499
who know what they are doing,

0:06:26.499,0:06:28.737
who care with compassion,

0:06:28.737,0:06:33.668
who care and respect the dignity [br]of the human beings,

0:06:33.668,0:06:36.807
you cannot do anything.

0:06:36.807,0:06:40.050
We have trained over 200 nurses.

0:06:40.050,0:06:43.219
We have trained over 150 midwives.

0:06:43.859,0:06:47.767
And my passion is to multiply

0:06:47.767,0:06:50.565
those girls you see with the red capes,

0:06:50.565,0:06:53.193
multiply them by a thousand.

0:06:53.193,0:06:58.704
And why do I say that? [br]Because it is these young women

0:06:58.704,0:07:01.178
who are trained for just two years,

0:07:01.178,0:07:05.393
who go back to the districts [br]and the regions we recruited them from,

0:07:05.393,0:07:07.837
who make a difference.

0:07:09.187,0:07:14.179
Somaliland has one of the highest [br]maternal mortality rates in the world.

0:07:14.179,0:07:16.872
But among the 12 000 children and women

0:07:16.872,0:07:19.459
we have delivered,

0:07:19.459,0:07:21.524
we have been blessed to be able

0:07:21.524,0:07:24.202
to reduce our maternal mortality rate

0:07:24.202,0:07:27.855
to a quarter of the national average,

0:07:27.855,0:07:30.454
not because we have a magic wand,

0:07:30.454,0:07:34.914
but because we have [br]an emergency preparedness.

0:07:34.914,0:07:38.012
We can deal with a hemorrhage [br]as soon as a woman comes in,

0:07:38.012,0:07:39.802
we have an operating theater that works

0:07:39.802,0:07:41.490
24 hours a day.

0:07:41.490,0:07:45.640
It is midwives who make the difference.

0:07:46.140,0:07:49.580
Doctors? Yes! We need doctors.

0:07:49.580,0:07:51.622
But they take 8 or 9 years to train,

0:07:51.622,0:07:54.676
and for goodness sakes: [br]where am I going to get doctors from

0:07:54.676,0:07:56.404
to work in Somaliland,

0:07:56.404,0:07:59.582
a country which is [br]on the dark side of the moon?

0:07:59.582,0:08:03.541
Yes! We need graduate nurses [br]and midwives,

0:08:03.541,0:08:04.860
but we don't have them,

0:08:04.860,0:08:08.579
and we don't have the four years [br]and the five years it takes

0:08:08.579,0:08:10.746
to train a midwife.

0:08:10.746,0:08:17.772
So, what we do is that we rely [br]on the two year trained midwives.

0:08:17.772,0:08:22.182
They are a quick fix, [br]they're cost effective,

0:08:22.182,0:08:27.452
they're efficient, they're dedicated, [br]and they do not get stolen

0:08:27.452,0:08:29.720
to work in other health facilities,

0:08:29.720,0:08:31.592
because they are trained as midwives,

0:08:31.592,0:08:34.466
they remain in midwifery.

0:08:34.466,0:08:39.560
And, unless Africa [br]and countries like mine

0:08:39.560,0:08:43.496
multiply the training of these midwives,

0:08:43.496,0:08:46.210
we will continue to loose women

0:08:46.210,0:08:50.120
to causes that you have protected [br]your women from dying:

0:08:50.120,0:08:52.164
we will protect them from eclampsia,

0:08:52.164,0:08:54.079
we will protect them from infection,

0:08:54.079,0:08:56.998
we will protect them from uterine rupture!

0:08:56.998,0:09:00.482
No woman dies, in your countries,[br]of uterine rupture.

0:09:00.482,0:09:02.410
She would not be allowed to go into labor,

0:09:02.410,0:09:05.020
because somebody would already see [br]

0:09:05.020,0:09:06.890
that she has a contracted pelvis,

0:09:06.890,0:09:08.372
or that there is a disproportion

0:09:08.372,0:09:12.050
between the size of the baby [br]and the size of her pelvis.

0:09:12.050,0:09:15.786
No woman would die, [br]in your country, of infection.

0:09:15.786,0:09:17.914
You have water, you have soap,

0:09:17.914,0:09:19.905
you have equipment that is sterile

0:09:19.905,0:09:23.330
and that has been prepared [br]to be used safely.

0:09:23.330,0:09:25.451
But our women die of these causes.

0:09:25.451,0:09:28.997
Our women die of causes [br]that no woman in this day and age,

0:09:28.997,0:09:30.870
where man has reached the moon,

0:09:30.870,0:09:33.161
no woman should die of.

0:09:33.161,0:09:34.914
But we don't have the skills,

0:09:34.914,0:09:37.284
we don't have the facilities.

0:09:37.284,0:09:39.527
In our countries,

0:09:40.367,0:09:44.580
women have a one in ten chances of dying

0:09:44.580,0:09:47.154
of a pregnancy related cause.

0:09:48.174,0:09:52.102
In your countries, it's one in 4,000.

0:09:54.398,0:09:58.247
Your women are treated [br]by doctors and midwives,

0:09:58.247,0:10:00.953
throughout their pregnancy.

0:10:00.953,0:10:07.737
Only 10% of our women [br]have access to a health facility.

0:10:07.737,0:10:12.414
And that is why we must have more midwives

0:10:12.414,0:10:15.495
who can go to the regions, [br]who can go to the districts,

0:10:15.495,0:10:20.920
who can be where women [br]are to help them, to screen them,

0:10:20.920,0:10:24.051
to identify the ones [br]who are having a normal pregnancy,

0:10:24.051,0:10:28.441
and are possibly expected [br]to have a normal outcome,

0:10:28.441,0:10:33.501
or to refer these women [br]to where they can be helped better.

0:10:34.051,0:10:38.163
My hope, my ambition, is that one day

0:10:38.163,0:10:41.207
we will have a thousand [br]of these [midwives].

0:10:41.207,0:10:43.596
And why not in other countries?

0:10:43.596,0:10:46.782
If Somaliland can do it, [br]anybody can do it.

0:10:46.782,0:10:50.542
If Somaliland, with its limited resources,

0:10:50.542,0:10:54.141
with its past of civil war and destruction

0:10:54.141,0:10:57.497
can reduce its maternal mortality rate

0:10:57.497,0:11:00.117
to a quarter of the national average

0:11:00.117,0:11:03.328
because of the training of midwives,

0:11:03.328,0:11:04.925
why not in other countries?

0:11:04.925,0:11:06.850
Why not in Papua New Guinea?

0:11:06.850,0:11:08.690
Why not in Ethiopia?

0:11:08.690,0:11:12.509
Why not in Erytrea? [br]Why not in neighbouring Somalia?

0:11:12.509,0:11:15.664
Why not in Lesotho [br]and all of these countries

0:11:15.664,0:11:19.532
that have a very high [br]maternal mortality rate?

0:11:19.532,0:11:21.507
If it can be done in Somaliland,

0:11:21.507,0:11:23.191
it can be done anywhere.

0:11:23.191,0:11:25.108
My message.

0:11:25.888,0:11:29.078
My message is to governments:

0:11:31.477,0:11:36.602
My message is to governments [br]to allocate more funds,

0:11:37.302,0:11:42.398
instead of spending money on tanks, [br]and guns, and bazookas

0:11:42.398,0:11:44.610
and, I don't know, military hardware.

0:11:44.610,0:11:50.638
Spend more money on health, on education,

0:11:50.638,0:11:55.511
on infrastructure, on water, on sanitation.

0:11:55.511,0:11:57.561
So that is one:

0:11:57.561,0:11:59.799
education.

0:11:59.799,0:12:05.141
The second is: educate women, [br]educate girls.

0:12:05.141,0:12:09.931
When you educate a woman, [br]she is able to take care of [herself].

0:12:09.931,0:12:13.012
I cannot imagine where I would have been

0:12:13.012,0:12:16.570
if I had not had access [br]to the education and the training

0:12:16.570,0:12:21.152
that has helped me to help others.

0:12:21.152,0:12:24.655
And, of course, educate the community!

0:12:24.655,0:12:28.411
Unless the community has the confidence

0:12:28.411,0:12:31.950
to utilize whatever [br]health facilities are available,

0:12:31.950,0:12:34.922
we will continue to lose the battle.

0:12:36.242,0:12:42.092
One of the things [br]that has really made a difference

0:12:42.092,0:12:48.151
in my appreciation of human tenacity,

0:12:48.151,0:12:50.952
and the strength of women [br]in developing countries,

0:12:50.952,0:12:55.780
is when I see women [br]who come in to our training,

0:12:55.780,0:13:01.932
who are so timid, [br]who are so dependent on others,

0:13:01.932,0:13:06.731
go through a transformation [br]that gives them the confidence

0:13:06.731,0:13:10.895
to think, to answer, to advise,

0:13:10.895,0:13:14.879
to guide and to help other women.

0:13:14.879,0:13:19.643
Education is one [br]of the strongest gifts we can give

0:13:19.643,0:13:24.190
to a human being and, particularly, [br]to a woman in Africa.

0:13:24.780,0:13:30.275
My last parting suggestion is:

0:13:30.275,0:13:33.990
Don't ever underestimate

0:13:35.260,0:13:39.875
the capacity of a human being

0:13:39.875,0:13:43.502
who is determined to do something.

0:13:43.502,0:13:47.221
If I, at 60, 14 years ago,

0:13:47.221,0:13:48.930
could build a hospital,

0:13:48.930,0:13:51.930
anybody, any of you, can do it.

0:13:51.930,0:13:54.023
I thank you all for your attention,

0:13:54.023,0:13:56.257
and thank you for this opportunity

0:13:56.272,0:13:57.965
to be here with you today.

0:13:57.965,0:13:59.121
Thank you.

0:13:59.121,0:14:00.412
(Applauses)