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Thank you.

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My name is Edna Adan, 
and I'm a midwife,

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and because I'm a midwife, 
I've come to talk to you

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about the health of women and children.

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My country, Somaliland, is a country

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with one of the highest 
maternal mortality rates in the world.

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A country that has known 
civil war, from 82 to 91,

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during which a quarter of a million 
of our people were lost,

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and 95% of our cities were destroyed.

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This, of course, was a situation that

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[provoked] two things: either to turn away

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and say: "I don't care, 
I don't feel, I don't know,

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I will just disappear in the horizon and 
go settle somewhere",

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in one of your great countries,

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or stand firm and try 
to do something about it.

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Sixty percent of our people are nomads.

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I know how difficult it is 
to provide health care

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to people who are sedentary.

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But when they're nomads, 
it makes it even more difficult.

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When they're poor, 
when the country is so wide,

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it makes it very difficult.

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There are also situations that arise

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because any facilities 
that existed before the war

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were destroyed.

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Many of the bones you see on the screen

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could have been the bones 
and the remains of health workers.

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When you have had a past 
and you were born

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with a proverbial 
silver spoon in your mouth,

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the only thing I could do,

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was to try and stand firm, 


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and give back to the people

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what the world had given to me.

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This was why, when I retired in 1997, 


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at the age of 60,

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from the World Health Organization (WHO),

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I went home and I tried 
to put into practice

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what I had been preaching 
during all my career

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as a WHO civil servant.

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The site upon which the hospital was built

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was one that was once a graveyard,

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a military parade ground,

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an execution ground,

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and, eventually, a garbage dump.

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In an area of Hargeisa, 
the capital city of Somaliland,

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where no hospital had ever been built

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before that time.

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The hospital took four years to be built.

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It was four years in a country where labor

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and skilled construction people 
were very few.

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But we labored on and, eventually,

51
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the hospital was born in 2002.

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That hospital today

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is one where almost 12,000 children 
have been delivered.

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That child you see in my arms

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was the first baby 
that was born in that hospital,

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about 10 hours 
after the hospital was opened.

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Among the 12,000, most of them were people

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who had been referred to us,

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or women who had found 
something wrong with their pregnancy,

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because women who think 
they are having a normal pregnancy

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have their babies at home.

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So the 12,000 children 
that we delivered in the hospital

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were mainly delivered 
because they were sent to us,

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because of a complication 
either with the pregnancy,

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or with the mother, or whatever.

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We remained a maternity hospital

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for a little more than a day or two.

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Because in your countries,

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you have the luxury 
of having specialized hospitals.

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You have something wrong with your eye, 
you go to the ophtalmologist.

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You break an arm, 
you go to the orthopaedic surgeon.

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But in Africa, in my country,

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if you're sick, you just go to a hospital.

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So it was not possible for us to say: 
"We are a maternity hospital.

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Go and get your heart attack 
treated somewhere else.

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Go and get your diabetic coma 
seen to somewhere else."

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It's a hospital, so it's a hospital.

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Men are treated, women are treated, 
children, whatever.

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We also have a facility where 
we can do surgical interventions.

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Since the 1st of January, this year,

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we have operated over 500 cases.

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Only 185 of them were cesarian sections.

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The others, contractures, 
cleft lips, obstetrical fistula,

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thyroids and, on that site, 
that was once a garbage dump,

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we can also operate on children 
who have hydrocephalus.

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So, we can even do, not brain surgery,

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but we temper, 
we touch the brain of children

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and we have done over 27 cases 
and, thank God,

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all but one have succeeded.

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And the one who died 
died of diarrhea and vomiting,

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two weeks after the operation.

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So, the story is: where there's a will, 


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there's always a way.

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We are also a teaching hospital.

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Because it's not the bricks, the mortar,

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it's not the instruments and the facility

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that is going to look after sick people.

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It's the skills, it's the knowledge,
it's the competence,

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it's the efficiency of the people 
who work in these facilities.

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And unless you have doctors 
and nurses and midwives

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who know what they are doing,

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who care with compassion,

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who care and respect the dignity 
of the human beings,

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you cannot do anything.

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We have trained over 200 nurses.

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We have trained over 150 midwives.

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And my passion is to multiply

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those girls you see with the red capes,

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multiply them by a thousand.

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And why do I say that? 
Because it is these young women

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who are trained for just two years,

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who go back to the districts 
and the regions we recruited them from,

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who make a difference.

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Somaliland has one of the highest 
maternal mortality rates in the world.

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But among the 12 000 children and women

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we have delivered,

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we have been blessed to be able

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to reduce our maternal mortality rate

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to a quarter of the national average,

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not because we have a magic wand,

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but because we have 
an emergency preparedness.

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We can deal with a hemorrhage 
as soon as a woman comes in,

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we have an operating theater that works

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24 hours a day.

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It is midwives who make the difference.

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Doctors? Yes! We need doctors.

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But they take 8 or 9 years to train,

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and for goodness sakes: 
where am I going to get doctors from

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to work in Somaliland,

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a country which is 
on the dark side of the moon?

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Yes! We need graduate nurses 
and midwives,

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but we don't have them,

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and we don't have the four years 
and the five years it takes

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to train a midwife.

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So, what we do is that we rely 
on the two year trained midwives.

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They are a quick fix, 
they're cost effective,

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they're efficient, they're dedicated, 
and they do not get stolen

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to work in other health facilities,

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because they are trained as midwives,

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they remain in midwifery.

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And, unless Africa 
and countries like mine

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multiply the training of these midwives,

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we will continue to loose women

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to causes that you have protected 
your women from dying:

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we will protect them from eclampsia,

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we will protect them from infection,

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we will protect them from uterine rupture!

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No woman dies, in your countries,
of uterine rupture.

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She would not be allowed to go into labor,

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because somebody would already see 


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that she has a contracted pelvis,

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or that there is a disproportion

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between the size of the baby 
and the size of her pelvis.

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No woman would die, 
in your country, of infection.

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You have water, you have soap,

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you have equipment that is sterile

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and that has been prepared 
to be used safely.

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But our women die of these causes.

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Our women die of causes 
that no woman in this day and age,

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where man has reached the moon,

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no woman should die of.

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But we don't have the skills,

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we don't have the facilities.

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In our countries,

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women have a one in ten chances of dying

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of a pregnancy related cause.

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In your countries, it's one in 4,000.

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Your women are treated 
by doctors and midwives,

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throughout their pregnancy.

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Only 10% of our women 
have access to a health facility.

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And that is why we must have more midwives

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who can go to the regions, 
who can go to the districts,

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who can be where women 
are to help them, to screen them,

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to identify the ones 
who are having a normal pregnancy,

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and are possibly expected 
to have a normal outcome,

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or to refer these women 
to where they can be helped better.

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My hope, my ambition, is that one day

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we will have a thousand 
of these [midwives].

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And why not in other countries?

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If Somaliland can do it, 
anybody can do it.

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If Somaliland, with its limited resources,

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with its past of civil war and destruction

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can reduce its maternal mortality rate

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to a quarter of the national average

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because of the training of midwives,

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why not in other countries?

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Why not in Papua New Guinea?

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Why not in Ethiopia?

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Why not in Erytrea? 
Why not in neighbouring Somalia?

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Why not in Lesotho 
and all of these countries

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that have a very high 
maternal mortality rate?

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If it can be done in Somaliland,

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it can be done anywhere.

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My message.

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My message is to governments:

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My message is to governments 
to allocate more funds,

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instead of spending money on tanks, 
and guns, and bazookas

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and, I don't know, military hardware.

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Spend more money on health, on education,

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on infrastructure, on water, on sanitation.

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So that is one:

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education.

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The second is: educate women, 
educate girls.

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When you educate a woman, 
she is able to take care of [herself].

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I cannot imagine where I would have been

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if I had not had access 
to the education and the training

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that has helped me to help others.

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And, of course, educate the community!

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Unless the community has the confidence

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to utilize whatever 
health facilities are available,

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we will continue to lose the battle.

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One of the things 
that has really made a difference

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00:12:42,092 --> 00:12:48,151
in my appreciation of human tenacity,

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and the strength of women 
in developing countries,

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is when I see women 
who come in to our training,

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who are so timid, 
who are so dependent on others,

217
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go through a transformation 
that gives them the confidence

218
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to think, to answer, to advise,

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to guide and to help other women.

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Education is one 
of the strongest gifts we can give

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to a human being and, particularly, 
to a woman in Africa.

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My last parting suggestion is:

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Don't ever underestimate

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the capacity of a human being

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who is determined to do something.

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If I, at 60, 14 years ago,

227
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could build a hospital,

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anybody, any of you, can do it.

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I thank you all for your attention,

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and thank you for this opportunity

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to be here with you today.

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Thank you.

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(Applauses)