Edna Adan Ismail is, to be blunt, a hero.
Born in Hargeisa, Somaliland, in the Horn of Africa, Adan is the former Foreign Minister of Hargeisa. She also worked for the World Health Organization as the regional nursing adviser, and the technical officer for maternal and child health.
She was the first woman in her country to be a trained nurse-midwife, and the first woman to obtain a driver’s license, not to mention the first lady of Somalia and the autonomous region of Somaliland.
Her lifelong dream, however, was to open a hospital in her homeland.
That dream was finally realized in 2002, when she built and founded a hospital using her own money. With land next to a dump—the only space available to her through the government—Adan opened what has become a beaming beacon of hope in a country hit hard by civil war. Through the hospital, women and children can get lifesaving, yet often basic, healthcare in a region that has some of the highest maternal death rates in the world.
Goleta-based Direct Relief International first started working with Adan’s hospital in 2005, and since then has provided more than $1 million worth of medicine and medical supplies to give the staff the resources to do their jobs well.
Adan will be in Santa Barbara this week, speaking for free at UCSB’s Campbell Hall on Thursday, October 7, at 7 p.m. She exchanged e-mails with The Independent this past week, the result of which is below.
How the hospital came to be seems to be worth a story in itself. What possessed you to take on such an undertaking?
To build a hospital has been my life-long dream since I was a teenager and often assisted my late father Adan Ismail. [Adan Ismail, also known as “Adan Doctor” and “the father of health care” was the most senior Somali Medical Assistant. He started training Somali auxiliary nurses, a project he continued until his death in 1961.] Since my country had been a British protectorate, my father was decorated by King George VI and awarded the British Empire Medal for his services to the Crown.
As the first Somali qualified nurse and midwife, my intention to build the hospital intensified after the Civil War between my country, Somaliland, and Somalia when most of the health facilities in my country became destroyed and most health workers either died or fled the country.
As someone who had received so many privileges in life, there was really no other option for me but to build the hospital and show my people that much depended on their own initiative, self-help, and determination. I strongly believe that the hospital is the best thing that I have ever done.
Can you talk about the struggle over the years to get the hospital built in Somaliland?
My first application to build the hospital started in Somalia before our two countries separated. The government of Somalia at that time refused to grant me the license to build the hospital in Somaliland and insisted that it be built in Mogadisho. Since I did not want my lifelong dream to die un-tried and un-tested, I agreed to build the hospital in Mogadisho. I bought the land and started the construction which progressed until the perimeter wall around the 15,000 square meter site was complete, the land was filled and raised to the level of the road, water and electricity brought to the site, store rooms built, the ground floor excavations completed and 120 concrete pillars erected. The works to that point had consumed over $150,000 of my funds when the Somalia civil war broke out. That project and all that had gone into it have been lost.
It was after I saw my home town Hargeisa in 1991 and saw the destruction that had taken place in my country’s capital that I overcame the anger which had resulted from the loss of my first hospital in Mogadisho, and decided to build another hospital but this time in Hargeisa. Regretfully, I had to wait for some years until I could put my financial situation in order again and also wait for my imminent retirement from the World Health Organization.
Can you paint us a picture of what the region was like prior to the hospital, and what sort of impact the hospital has made on the health of the region?
Somalia and Somaliland had engaged in a civil war that started in 1982 and ended in 1991. During those years, 95 percent of the main cities of Somaliland became destroyed. A quarter of a million of our people were killed in this war and over one million of our people sought refuge in camps in Ethiopia and Djibouti. Mass executions of civilians, who were then put into mass graves, have been discovered and documented by the United Nations. The American Human Rights Watch published a report entitled “A Government at war with its own people.”
The site where I was allowed to build the hospital had once been a military parade ground, a place where military “punishments” were carried out. It later became a dumping site for the trash of the neighborhood. It was also in a part of the city of Hargeisa that was the least developed and where there had never ever been a hospital before I built this hospital. This was the reason it could not remain as a maternity hospital, as other sick people came to us for treatment. Today, it has become a leading referral hospital in the region and receives patients from all corners of Somaliland as well as from neighboring Somalia and the Ethiopian 5th Region. The hospital has also inspired others to also invest in health care and several small hospitals and clinics are being started by various groups and individuals. There is nothing I like more than to be invited to open a new health facility started by people who also felt the need to do something for their people.
Although we are a long way away from where we would like to be, we are nevertheless making headway in the right direction when it comes to looking after the sick in Somaliland.
What struggles do you still encounter on a regular basis?
To run a hospital, pay for water and electricity, pay staff salaries (doctors and senior expatriates cost a lot, and need tickets to and from their countries at least once or twice a year), keep the grounds clean and secure, pay for repairs, reagents for laboratory, and medicines and for disinfectants—it all has to come from somewhere. Since the people who come to us for help or who come to deliver with us are among the poorest, the income we receive is often several thousand dollars short of the running costs of the hospital. That is when I have to cover the shortfall. I can keep doing this while I am alive; God knows what will happen when I will no longer be here which is the reason I am trying to train those who will take over from me and instill in them as strong a sense of responsibility as I can. There are also the “Friends of the Edna Adan Hospital” who are working on an Endowment Fund to take over from me after I have gone.
Regarding the fees we collect from patients which are on a not-for-profit basis, the fee we charge for operations is one third of what private doctors charge. Very often, when the person is so poor, we do not charge at all and sometimes have to even give some small sum of money to take home to live on for a short while. Another example is that we charge our student nurses $10 a month as tuition fees when the government nurse training school and other institutions charge between $15 to $60 a month. I insist that we keep our fees low and our quality the highest standard attainable in Somaliland because I firmly believe that the gift of knowledge is the most precious gift I can leave for my people.
Some of our problems I can deal with but for others we are still looking for solutions:
a) Water is a big problem in my country. Finding a source of underground water and having a borehole would be a great help
b) The hospital spends much money on paying electricity bills and for fuel for our generators when the city power is out. Having solar lighting (from the ever present sun above us) would help us reduce our use of fossil fuel and encourage others to use renewable energy.
I read somewhere you use your pension to support the hospital. But groups like Direct Relief are also pitching in to the cause. Can you explain your work with Direct Relief and how they are helping your mission there?
My pension, and also any fees I collect from speaking or teaching engagements help to cover shortfalls in running expenses.
However, the support we get from Direct Relief is far more valuable than my humble pension because we receive valuable medical supplies, equipment, and dressings that are not available here and which we would not have the money to buy if they were available. Right now, we have been assisted to build new operating theaters; partial funding has been received from the Fistula Foundation for this and also equipment and instruments to make one theater functional. This assistance was received through Direct Relief.
What are some of the greatest issues facing the health of women around the world right now?
Poverty and ignorance are the two worst enemies of people in developing countries. I am convinced that with improved education, women would be able to take better care of their health and that or their children and families.
In my country, Somaliland, the lack of political recognition has a very negative impact on the health and welfare of our people as it prevents us from having the benefit of bilateral assistance from anywhere.
It sounds like you are working around the clock and have no plans to retire. What are your plans for the future of health in Somaliland? For women and children’s health in general?
I hope to continue to enjoy what I am doing for as long as I can. There is so much that needs doing!
I traveled out of Tunis yesterday afternoon, spent the night in Dubai airport, took a flight from Dubai to Berbera in Somaliland in the morning, traveled for two hours by road from Berbera to Hargeisa where I arrived at noon. Had a quick lunch, slept for two hours, and still at my desk at 9 p.m. on Friday night. Will probably work for only another hour as I am beginning to feel tired. Tomorrow is another full day and I travel out again on Sunday morning. That’s how my life has been since I retired in 1997’ and built this hospital.
Anyway, at 73, there’s not much else I can do!