Written by: Tom Kraemer, Edna Adan Hospital Volunteer
In many parts of Africa, the most dangerous thing a woman can do is become pregnant.
This startling but true statement describes the situation in the Republic of Somaliland, an otherwise peaceful and stable country in the Horn of Africa. For the past 23 years, Somaliland has been relatively free from the troubles that have plagued neighboring Somalia. It has a democratically-elected government, its own police force, flag and currency. People go through their daily affairs without fear of bombings, piracy, or other violence.
When it comes to maternal and child health, Somaliland has some of the worst statistics on the planet. Maternal mortality is the leading cause of death among women of reproductive age. A woman who decides to become a mother in Somaliland stands a 1 in 15 risk of death due to hemorrhage, puerperal sepsis, eclampsia, obstructed labor or other pregnancy or childbirth-related cause.
How can a country that is moving in the right direction simultaneously be burdened with such dismal health outcomes?
After a long and distinguished career with the World Health Organization, Edna decided to accept this challenge when she returned home to Hargeisa, the capital of Somaliland. At the Edna Adan University Hospital, which was established in 2002, Edna and her staff have pioneered a program aimed at improving maternal and child health as quickly and efficiently as possible.
Edna recognized that although numerous factors contribute to Somaliland’s plight—poverty, illiteracy, poor water and sanitation, lack of transportation, social barriers—the root of the problem lies in the acute shortage of human resources. The Community Midwife program was developed at the Edna Adan Hospital to alleviate this situation.
The civil war that gripped Somaliland for much of the 1970s and 1980s left the country without healthcare professionals. Currently, Somaliland has one doctor and one midwife for every 45,000 women. The 2014 State of the World’s Mothers report ranked the neighboring country of Somalia as one of the worst places to be a mother. Edna knew there had to be a solution to provide trained health workers for communities without waiting the years it takes to train doctors and nurses.
The Community Midwife program is a two-year training course that emphasizes basic nursing skills and maternal and child health. Young women are recruited from all over the country according to need, as estimated by the Ministry of Health. The women come to Edna Hospital for a combination of classroom study and clinical training. Each candidate must assist on at least 60 births before graduating. After graduation, the Community Midwives return to their home regions where experience shows they are welcomed into the community.
Most Community Midwives are assigned to a Maternal and Child Health (MCH) center. These MCHs, which are not staffed by doctors, are the primary access point for health care for the majority of the population. A Community Midwife can assist with simple births and refer complicated births to a hospital. She can also diagnose and treat common minor diseases and provide comprehensive postnatal care including immunizations. Community midwives educate the local populace on health issues such as safe drinking water, nutrition, access to family planning services and proper sanitation. She is also knowledgeable about the harmful effects of Female Genital Mutilation, a pernicious problem in Somaliland.
The program has been an unqualified success.
In almost all cases, the Community Midwives are integrating seamlessly into the local culture. The United Nations Population Fund (UNFPA), which provides essential funding, the Ministries of Health and Education, and local authorities uniformly applaud the progress that has been made. The popularity of the program has led Edna to open training facilities in two additional cities, and similar courses have been started using the Community Midwife model.
Edna has a long way to go to reach her goal of training 1,000 midwives, but the effects of the Community Midwife program are already being felt throughout the country.