So, a little about the hospital. Somaliland has some of the highest maternal and neonatal mortality rates in the world, with about 4000 women dying each year and 1 in 8 babies born each year dying in the first 28 days (the neonatal period).
Edna Aden Maternity and Teaching Hospital for Women was started by a former World Heath Organization worker, Edna Aden Ishmael, a trained midwife, to attempt to address this problem. She started the hospital by donating her UN pension and selling many of her assets, and later obtained the support of organizations including UNICEF and WHO and many individual donors. Many of these individual donors were introduced to the idea after Nicholas Kristoff wrote about her at nytimes.com; he also wrote about Edna in his recent book Half the Sky: Turning Oppression Into Opportunity for Women Worldwide (thanks for the heads-up on that that, Jess!). I stumbled onto the hospitals website looking for maternity-related volunteer opportunities in Africa last fall, and only found out this spring that she's a pretty famous lady. She's even been knighted by France! This is the front entrance to the hospital:
The hospital opened in 2002 and has been hugely successful, with about 10,000 babies now having been born here. It has also now expanded to provide other types of medical care in addition to maternity care. One of its greatest successes, though, is the training it provides in nursing, midwifery, and laboratory techniques. Edna-trained midwives are gradually spreading across the country--that's what will really serve to bring Somaliland's maternal and neonatal mortality rates down. There are two groups of midwifery students here. One group is called "post-basic students", and they are doing a year of specialized midwifery after a previous nursing curriculum. They are mostly from Hargeisa and will probably continue to work in the city after they are finished. The second group are community midwives, who are young women drawn from around the country to spend a year training in their communities before returning to their own communities as trained community midwives. This is where the community midwives live while in Hargeisa, behind the main hospital building:
Though I could say good things all day about Edna and this hospital, there are also huge challenges that Somaliland faces in improving maternal and neonatal health. The hospital has been a leader in changing some of this, but other things it continues to struggle with. After my first day, I have a lot of ideas about areas where I can do some work. Edna is very hands-off her volunteers: she really lets people decide what THEY want to do. I came with the idea that I would spend some time doing clinical stuff to the extent I was able and then some teaching to the nursing students about epidemiology (just some basic public health tools they could incorporate into their practice.) A few things I've noticed right off the bat that I'm hoping to become involved with:
-Women need a lot of support with breastfeeding, and the midwifery students need help learning how to support them with positioning, how often to feed the baby and how to address common breastfeeding issues. So it looks like I'll spend some time teaching these students how to teach breastfeeding, and providing direct support to moms in the meantime, since I've gotten a lot of breastfeeding teaching experience in the last few months!
-It's been a pretty long time since the birth statistics were updated, and none of the staff here know how to do any statistical analysis with them, so I will probably try to get a system in place for regular updating, since pretty good handwritten records are kept of births and birth outcomes, as well as teach a few people some basic stat techniques.
- I will probably be doing a lot of teaching to the community midwives, both clinical and classroom. It seems funny that I should be teaching stuff that I haven't technically even begun studying, but we receive remarkable educations in the US and with just the nursing curriculum I've had so far, along with my clinical experiences in the US, I'm able to share a lot of really cool information with these community midwives. Never thought I'd say it, but, well-done, NYU.
-Potentially trying to help the hospital set up a study, or at least design a study for them, looking at female genital mutilation (FGM) and the use of routine episiotomies (as opposed to as needed episotomies). This would be very cool, because this is a perfect population and location for this kind of study, since Edna estimates that 97% of women who deliver here have had some type of FGM performed on them. There's no evidence that routine episiotomies offer any better outcomes than as needed ones for women with FGM...but there's really very little evidence at all.
That's a lot, so we'll see, but basically I'm really excited to be here and think there's a lot I'm going to learn :) Today I just did rounds in the morning (which took almost 4 hours, due to several non-maternity patients being very unwell and needing acute medical interventions while they were being rounded on), then some time in the antepartum unit assisting with breastfeeding and then helping with a neonatal resuscitation class for the midwifery students in the late afternoon.
For my nursing buddies, interesting stuff I saw today: dehisced c-section incision, significant newborn heart murmur, hypovolemic shock (non-maternity- a young adult male, no indication as to why he was in shock. Possibly internal bleeding. His HR was 20 when he was brought in.)
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