Somaliland’s Midwife

Formerly the British Somaliland Protectorate, Somaliland was independent for only five days in 1960 before it joined its southern neighbor, then the Italian Trust Territory of Somaliland, to form the Republic of Somalia, with its capital in Mogadishu. In 1991 Somaliland broke away. Despite the war that followed, it has remained separate ever since. 

As if to contradict the title of the 2013 novel by Hargeisa-born writer Nadifa Mohamed, Somaliland can no longer be regarded as The Orchard of Lost Souls. The book’s tale of a trio of women who help each other survive the civil war is being succeeded by new stories of women such as 80-year-old midwife, educator and public-health pioneer Edna Adan, as well as others, including many of Adan’s own students. 

To find Adan in the maternity hospital and nursing school that carries her name (Edna Adan Hospital), one asks for her only by her first name, Edna. It’s all that is needed, and it’s best to come early, before she sets off on a routine 12-hour day into Somaliland’s countryside to interview candidates for the school’s incoming class. Work on the hospital had begun in the late 1990s, and it opened in 2002 with 25 beds. Even before that, Adan was already training scores of nurses and lab technicians.

Adan’s public service career includes 30 years with the World Health Organization (WHO) as well as government posts as both foreign minister and minister of family welfare and social development. Nonetheless, she modestly calls herself “the guinea pig of my generation,” as if to show that she has merely passed a test to prove a woman can succeed in a public role.

“My lesson to others is do not be afraid to do anything, keep at it,” she says, “because if it works for one of us, it will work for all of us. I am not disrespectful of male leadership. Rather, I want to be helpful to them so they will come to me convinced that I am right.”

Adan was profiled by journalists Nicholas Kristof and Sheryl WuDunn in their 2009 book, Half the Sky, as well as the eponymous 2012 documentary about extraordinary women around the world leading the charge to a better future for all. 

The daughter of a Hargeisa doctor, she was determined as young as 11 years old to pursue a medical career. She trained first as a midwife in London in the 1950s, and she returned to her homeland as its first professional nurse-midwife. The civil war, from whose damages her family did not escape, inspired her to create something for the country.

“My father’s house, the house where I was raised, was destroyed,” she says. “Building this new hospital became my way of healing after so much heartbreak.”

At the hospital now, on a typical busy day, Somali colleagues are joined by volunteers from neighboring countries Djibouti, Kenya and Ethiopia, as well as from Denmark, the UK and the US. The day might bring a complex surgery, a routine delivery, a rare lab specimen—or more. 

The needs are great. The hospital’s website notes that Somaliland’s overall public health ranks among the lowest in the world, in large part because the civil war “caused the death or departure of nearly all the country’s health care professionals.” Since then, much has been accomplished: Maternal mortality has fallen from 1,600 per 100,000 live births before the civil war to around 400 per 100,000—still nearly double the global average, according to the United Nations.

Adan looks to her own life to counsel midwifery recruits as well as their parents. She recounts a mother who came to her distressed over her daughter’s desire to study nursing in England, expressing fear that the young woman would inevitably come home in shame. “I had to convince her that, no, it is not shame; it is a great honor,” she says. “And now that same woman says, ‘I want my daughter to be like you.’”

Among the 1,500 nursing, midwifery, and lab-technician students she has trained, two in particular stand out: the hospital’s chief doctor, Shukri Mohamed Taher, and midwife leader Khadan Abdilahe of the Somaliland Family Health Association. Taher was trained as a nurse by Adan, after which she graduated from medical school and returned to the hospital, where she has performed several of Somaliland’s first-ever pediatric procedures. 

“I was 15 years old when I applied to Edna,” Taher says. “I had to lie that I was 18 in order to qualify for admission. I remember being asked in the interview what I would do if a patient vomited on me. I answered, ‘I would clean it up and keep talking to her.’”

 More than half of the clinical residents are women, Taher says, and when husbands of patients and female relatives think a female doctor might not do something right, she offers professional reassurance: “I say, ‘I’ve done this 1,000 times already.’ My mother is not surprised by my success, but she is surprised that I’m doing even more than she expected of me.”

Like Taher, Abdilahe also credits Adan with guidance that has strengthened her own will.

“I was born after the civil war,” she says, “so I didn’t see that madness, but my father suffered a stroke, and my mother almost died in childbirth with a younger sibling. I could not help either one because I knew nothing. So that is why I became a nurse.

“I took my exam five days after an appendectomy, and my teachers told me to rest in bed, take the exam the next year, but nothing could stop me. Even when I fainted on the last day and could not complete it, they let me pass because everything I had written on the first day was perfect.”

Abdilahe admits she and her colleagues often find themselves fighting combinations of misinformation and superstition.

For example, many expectant mothers do not understand the benefits of a prenatal diet, she says. “But they feed their goats spinach, so I said, ‘You should eat spinach too.’ Once I had to attend a difficult home birth of a boy whose mother was reluctant to come to the clinic, even though we begged her for the baby’s sake. Now little Abdulrahman is one year old and healthy, and I am happy to say that she brings him for routine checkups without question.”

The most difficult medical fight for Adan and her students is against the tradition of female genital mutilation, which the who condemns as a violation of human rights.

As a leader in Somaliland’s campaign to end the practice, Adan has won support from both civic and religious leaders, including the mufti, the country’s top religious authority. And they are not all.

As long ago as 1855, British explorer Richard Burton noticed that “the country teems with poets, poetasters, poetitos, and poetaccios,”—but he overlooked poetesses. That was a major omission. Somali women are leaders also in the arts of language in a society where verse, song and rhetoric are vital in both public and private discourse. Under the banner of a Somali proverb, “War destroys, peace nurtures,” Adan convened a meeting of the Somali Studies International Association in 2001 and commissioned poems for the occasion. Poet Mohamed Ali Masmas bluntly exhorted his listeners on the basis of Islamic teaching: “You need to stop this right now / and do what our religion asks of us.” 

Somali British poetess Warsan Shire, whose lyrics Beyoncé sang on her album Lemonade, wrote a poem “Things We Had Lost in the Summer”:

My mother uses her quiet voice on the phone

Are they okay? Are they healing well?

She doesn’t want my father to overhear.

Her collection’s title, Teaching My Mother How to Give Birth, is an ironic reference to the proverb, “These youth taught their mother to give birth”—meaning that the younger generation has the cheeky presumption to teach its elders something already well-known.

Modern and popular songs have also helped to empower women, or at least allowed them to sing in public from their hearts. In the 1970s, Hargeisa’s top singers were Khadra Daahir Cige, from a butcher’s family, who sang, “Our love can’t burn out even in fire,” and Sahra Axmed Jaamac, who sang, “Our love in an endless sea that none can escape.” Professor of African and Middle East history Lidwien Kapteijns of Wellesley College notes that songs are helping reshape ideas about love, equality and social institutions while nurturing post-war national identity.

Indeed Hargeisa is “the mother of Somali music,” says Radio Hargeisa’s music producer, Muhammad Dahir Hayd. “We were recording it here before Radio Mogadishu even went on the air,” he says. 

Hayd notes that the Somali language’s greatest love poet, Ilmi Boodhari, died in 1940 of a broken heart at age 32 in a fateful Romeo-and-Juliet-style romance. His story has inspired verse ever since, including Sahra Jaamac’s “My love is like the love that killed Ilmi.” Boodhari’s poetry, translated by B. W. Andrezejewski, includes lyrics still recited today:

And she was radiant in hue, like a lighted lantern

Surely she must have been imprinted on my heart

How else could I be so intoxicated by her?

Inside my breast she tick-tocks to me like a watch

Earlier this year, the album Sweet as Broken Dates: Lost Somali Tapes from the Horn of Africa was nominated for a Grammy award for historical recording. It features on its cover a 1970s-era photo of Hargeisa-born singer Hibo Nuura. Two of her most popular lyrics are “She who is successful will get her reward” and “Do not think there is another reason.” Both assert the compatibility of modernity and tradition. Now living in the us, Nuura has recently composed a patriotic anthem to her homeland. 

Sahra Halgan, who was born in Hargeisa and came of age during the civil war, sings twice a week in the capital at Hiddo Dhawr, her restaurant and music venue, whose name means “save your culture.” “During the fighting I wrapped bandages in first-aid stations,” she says. “I alternated wrapping and singing, and I remember the song everyone asked me for most often, ‘Follow Together to Fight!’ Some shaykhs complain these days about my singing, so I ask, ‘You wanted me to sing for the fighters before but not today. Why? To encourage our people then is to encourage them now.’”

Shukri Haji Ismail Bandare, minister for environment and rural development and also one of Adan’s first students, received one of four 2011 In Pursuit of Peace awards, which was presented by then-us Secretary of State Hillary Clinton on behalf of the International Crisis Group. “By nature we Somalis are strong, and by culture we are pastoralists,” Bandara says. “As women we must excel, just as we must keep our animals the fattest, and when we travel far to draw water, we must be the first to return home in order to light our kitchen fires earliest.”

“My mother was a farmer, working all the time,” she continues. “Someone once said to her, ‘You must be tired,’ and she answered, ‘I want night to be day so I can work then too.’” 

Nafisa Yusuf is executive director of Nagaad Network, a consortium for women-focused social and economic action. “The civil war destroyed men’s role in the economy,” she explains. “In our workshops for women, the question always is asked, ‘When it comes to Somali women’s traditionally subservient place in the household, what is religious injunction and what is mere cultural habit?’

“And I have the answer,” she says, “because when I was young, I always listened to my father’s mother, Saaqa. She lived to be more than 110 years old. She was always talking about weddings, and said that to be a guun, an unmarried woman, was a bad thing. I am trying to reverse that kind of thinking.”

Thoughts such as Saaqa’s are deeply ingrained in Somali society, as one might also see in the occasionally contradictory poetry of Ismail Mire, a veteran of the unsuccessful fight for independence from the British in the early 20th century. After the Somali defeat, Mire returned to his life as a pastoralist and lamented, “Wives reject their husbands, they refuse to stay at home.”

But Mire’s commanding general, Muhammad Abdilahe Hasan, famed both for his resistance to the British and his poetry, extolled the wartime valor of his countrywomen, especially his wife Maryam, for whom he asked God’s help in illness:

She has been a mother to Muslims, wherever they might be

To those fleeing from danger, countless thousands of them,

She offered a refuge, without thought for herself.

Bring unto us, O God, relief in Maryam’s plight.

Khadra Mohamed Abdi, founder of the local nonprofit Somaliland Culture and Sports Association (socsa), was born in 1967 near the Ethiopian border, and she too knows what it is like to suffer from war. 

“I was in Hargeisa at the start of the fighting,” she says, “but returned to my village, walking for two days and nights with my mother, my sister, carrying my sister’s newborn baby. No water or shelter. Nothing. After the war,” she continues, “when I returned to Hargeisa, I saw my primary school had been bombed, and I was determined to do something right away. University education was not possible then, but I wanted younger girls to have that chance someday,” she reasons, “so I thought, sport and culture go together—let’s call it ‘art.’”

In addition to passing on heritage through folk dance, song and other programs, what sets socsa apart from most women’s sports programs in the Horn of Africa is its weightlifting gym. “Our girls like to pump iron, dunk baskets and return fast table-tennis serves,” says Abdi.  

If Adan can take credit for training the country’s first generation of female doctors and midwives, she can take heart that a younger generation is no less motivated. 

Two of Adan’s current second-year nursing students, 21-year-olds Hamda Jama Ali and Hoodo Nuur Ismaa’il, also have personal stories about why they want to become midwives. As a young girl, Ismaa’il says she helped her grandmother attend to the healthy birth of her aunt’s first child. Ali, on the other hand, watched a neighbor almost die when no one could assist her delivery. Both will soon attend a birth for the first time as midwives-in-training. 

“I want to see that happy moment when everyone is relieved, the baby is healthy, the mother is tired, and all of us are together helping,” says Ali. That attitude, Adan might say, is reward enough for a lifetime.