Somaliland is a little tricky sometimes: Somalia, but not Somalia at all; a humanitarian emergency but not quite. Emergency response organizations like mine struggle sometimes to figure out the way forward. Mine has chosen to maintain a constant presence in Somaliland, scaling up when the drought/food insecurity/famine situation worsens and scaling down when it improves. But when the situation is better, and honestly, even when its bad, you're also exposed to the other needs in the country. Sometimes, you also get pressure from places like the Ministry of Health to expand your activities.
For us, in Somaliland, this means that we are aware of massive health care needs in the areas where we currently run nutrition programs and have been looking for ways to expand our programs to meet these needs. Meanwhile, another major NGO has decided that, while Somaliland certainly has issues, it would rather focus its activities on more acute emergencies in other countries, and is discontinuing its activities in a few months. They have been running a hospital in Ceerigabo (aka Ceerigavo or Erigavo), the capital of the eastern Somaliland region of Sanaag. The MoH does not have the capacity to run the hospital, and this organization doesn't want the effort they have put into rehabilitating and getting the hospital fully operational after years of under use to go to waste. Thus, they would like to potentially hand operation of the hospital over to my organization, which has a bit more of a focus on capacity building of health staff than the NGO that is currently operating the hospital. The idea is that we would run the hospital for some period and build up the capacity of the management and clinical staff and then eventually turn the hospital to the MoH or perhaps a local organization (or see it privatized if Somaliland's new national health policy is followed...)
Since I'll likely write proposals to donors for funding for this project as well as start it up, the NGO invited me to fly out for a few hours today to see the hospital. Ceerigabo is just 242 miles east of Hargeisa, but it's a two day drive and, especially for the second half, of questionable security for expats, especially when they use the road routinely. Since I was only going for a few hours to look around, we flew.
Let me tell you, the Ceerigabo Airport is remarkable.
After spending hours and hours on Google Earth mapping our nutrition sites in eastern Somaliland, I felt like I was pretty familiar with the landscape, but flying over it really emphasized both how beautiful and how remote it really is.
Ceerigabo is an interesting town, one of the only multi-clan towns in Somaliland, especially in the east. Though inter-clan violence is a fact of life in Somalia, Ceerigabo has remained relatively peaceful. A few months ago a small wave of violence broke out, and the clan leaders came together to put a stop to it immediately. Nonetheless, stringent security measures for NGOs working there are in place, and, like most places in Somaliland, there are remnants of the extended war.
The hospital itself is an interesting place as well, with the amazing work this NGO has done very evident--as well as the huge amount of work to be continued and some to be started as well. I quickly found my way to my favorite unit, maternity. As you might recall from when I worked in Somaliland last time, women don't usually seek medical care for childbirth until they have a serious problem. It's even worse in these rural areas. The maternity unit has a 58% complication rate (that's astronomical), and my quick tour confirmed it's a bad situation. Let me be clear here: this has nothing to do with the quality of care they are being provided and everything to do with the state women and their babies are in before they seek medical care (or before their families allow them to seek medical care). More than half of the 10 beds in the unit had women in them whose babies had been stillborn. There was a 13 year old pregnant with her first child and bleeding. Many women have 8 or 9 children already, which really increases the risk of complications.
A great moment of the day was seeing two midwives who I had worked with at Edna's hospital a year and a half ago. They were students then and now have graduated and are employed as full midwives at this hospital. They seem confident and competent and right at home, which is thrilling.
And, to answer that eternal question: what does one wear to Ceerigabo?
For us, in Somaliland, this means that we are aware of massive health care needs in the areas where we currently run nutrition programs and have been looking for ways to expand our programs to meet these needs. Meanwhile, another major NGO has decided that, while Somaliland certainly has issues, it would rather focus its activities on more acute emergencies in other countries, and is discontinuing its activities in a few months. They have been running a hospital in Ceerigabo (aka Ceerigavo or Erigavo), the capital of the eastern Somaliland region of Sanaag. The MoH does not have the capacity to run the hospital, and this organization doesn't want the effort they have put into rehabilitating and getting the hospital fully operational after years of under use to go to waste. Thus, they would like to potentially hand operation of the hospital over to my organization, which has a bit more of a focus on capacity building of health staff than the NGO that is currently operating the hospital. The idea is that we would run the hospital for some period and build up the capacity of the management and clinical staff and then eventually turn the hospital to the MoH or perhaps a local organization (or see it privatized if Somaliland's new national health policy is followed...)
Since I'll likely write proposals to donors for funding for this project as well as start it up, the NGO invited me to fly out for a few hours today to see the hospital. Ceerigabo is just 242 miles east of Hargeisa, but it's a two day drive and, especially for the second half, of questionable security for expats, especially when they use the road routinely. Since I was only going for a few hours to look around, we flew.
Let me tell you, the Ceerigabo Airport is remarkable.
After spending hours and hours on Google Earth mapping our nutrition sites in eastern Somaliland, I felt like I was pretty familiar with the landscape, but flying over it really emphasized both how beautiful and how remote it really is.
Ceerigabo is an interesting town, one of the only multi-clan towns in Somaliland, especially in the east. Though inter-clan violence is a fact of life in Somalia, Ceerigabo has remained relatively peaceful. A few months ago a small wave of violence broke out, and the clan leaders came together to put a stop to it immediately. Nonetheless, stringent security measures for NGOs working there are in place, and, like most places in Somaliland, there are remnants of the extended war.
The hospital itself is an interesting place as well, with the amazing work this NGO has done very evident--as well as the huge amount of work to be continued and some to be started as well. I quickly found my way to my favorite unit, maternity. As you might recall from when I worked in Somaliland last time, women don't usually seek medical care for childbirth until they have a serious problem. It's even worse in these rural areas. The maternity unit has a 58% complication rate (that's astronomical), and my quick tour confirmed it's a bad situation. Let me be clear here: this has nothing to do with the quality of care they are being provided and everything to do with the state women and their babies are in before they seek medical care (or before their families allow them to seek medical care). More than half of the 10 beds in the unit had women in them whose babies had been stillborn. There was a 13 year old pregnant with her first child and bleeding. Many women have 8 or 9 children already, which really increases the risk of complications.
A great moment of the day was seeing two midwives who I had worked with at Edna's hospital a year and a half ago. They were students then and now have graduated and are employed as full midwives at this hospital. They seem confident and competent and right at home, which is thrilling.
And, to answer that eternal question: what does one wear to Ceerigabo?
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