Somaliland: Strengthening Safe Motherhood Services


Edna Aden at workWritten by Lindsey Pollaczek, Program Officer (Africa)

Down a bumpy dirt track nearly three hours south of Hargeisa, the capital of Somaliland, Edna Adan and I crawl our way to the town of Baligubadle, just steps from the Ethiopian border.

At the Maternal and Child Health Center in this small town, which serves approximately 25,000 in Somaliland plus those from neighboring Ethiopia, we meet Sado, a 25-year old Community Midwife who has been hard at work providing health care to the mothers and children in this community for four years.

Sado was part of the first class of graduates from the Edna Adan University Hospital training program for Community Midwives, one of the remarkable programs instituted by hospital founder Edna Adan. When asked why Sado decided to become a Community Midwife, Sado said it was the lack of trained health providers in her community that made her interested in this work. Having a trained Community Midwife present in every village in Somaliland is part of Edna’s vision to reduce maternal and newborn mortality across the country.

The purpose of the Community Midwife is not to replace the doctor, who has a critical role in providing emergency cesarean sections for women experiencing complications, but to serve as a front-line health worker providing care in often rural and remote parts of the country. Until now there have been few or no health providers that can provide high quality care during pregnancy, delivery, and in the days and weeks after birth in these remote Maternal and Child Health Centers.

When Sado was undergoing her 18-month training, the hospital frequently received women in labor from the Baligubadle area who arrived with very serious complications. Many times, they arrived too late for anything to be done. When Sado graduated she knew it was important for her to return to this rural area to use her midwifery skills to help women deliver safely at a health center near their home, and to use her knowledge to refer women with serious complications early to emergency care to save their lives and the lives of their babies.

Sado says she is happy that she has chosen this profession, yet she also recognizes the many challenges that midwives face working in a remote area like this, with limited resources: “Sometimes when we can’t help a woman we feel like running away. When we don’t have the equipment or means we feel very bad. But if we run away, there will be no one, and so we stay, and we do what we can.”

Today, Direct Relief is providing a Midwife Kit to the Baligubadle Maternal and Child Health Center to help Sado in her daily work of delivering women safely. The Direct Relief Midwife Kit, one of 40 donated to Edna Adan Hospital to be distributed to the Community Midwives that are practicing in similar areas throughout Somaliland, contains essential delivery instruments, basic diagnostic equipment and medical supplies to help a midwife like Sado put her training to use. Sado quickly recognizes all of the items in the Midwife Kit, and confirms readily she will be able to put them to good use. She is very thankful for the supplies and is particularly excited to see the headlamp, which she has not had before and will be a great help when women deliver at night since the health center has no electricity.

Sado is overcome with emotion when she is asked what Edna means to her—”She is like my mother,” she says. The remarkable Edna Adan, a woman with over five decades of midwifery experience and a fierce passion for instilling knowledge in young people, wraps her arm around Sado’s shoulder. “At my age you have to pass the torch, and I choose to pass it to them,” Edna says. “You have no idea how many lives she has saved, and this is why I continue to do what I do.”