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)