If We Can Train Midwives in Somaliland, Everyone Can!: Edna Adan Ismail at TEDxRC2
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0:19 - 0:21Thank you.
-
0:21 - 0:24My name is Edna Adan,
and I'm a midwife, -
0:24 - 0:27and because I'm a midwife,
I've come to talk to you -
0:27 - 0:31about the health of women and children.
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0:31 - 0:34My country, Somaliland, is a country
-
0:34 - 0:39with one of the highest
maternal mortality rates in the world. -
0:39 - 0:45A country that has known
civil war, from 82 to 91, -
0:45 - 0:50during which a quarter of a million
of our people were lost, -
0:50 - 0:54and 95% of our cities were destroyed.
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0:54 - 0:59This, of course, was a situation that
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0:59 - 1:01[provoked] two things: either to turn away
-
1:01 - 1:04and say: "I don't care,
I don't feel, I don't know, -
1:04 - 1:08I will just disappear in the horizon and
go settle somewhere", -
1:08 - 1:10in one of your great countries,
-
1:10 - 1:15or stand firm and try
to do something about it. -
1:16 - 1:19Sixty percent of our people are nomads.
-
1:20 - 1:23I know how difficult it is
to provide health care -
1:23 - 1:25to people who are sedentary.
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1:25 - 1:29But when they're nomads,
it makes it even more difficult. -
1:29 - 1:33When they're poor,
when the country is so wide, -
1:33 - 1:36it makes it very difficult.
-
1:37 - 1:42There are also situations that arise
-
1:42 - 1:47because any facilities
that existed before the war -
1:47 - 1:48were destroyed.
-
1:48 - 1:51Many of the bones you see on the screen
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1:51 - 1:55could have been the bones
and the remains of health workers. -
1:56 - 1:59When you have had a past
and you were born -
1:59 - 2:03with a proverbial
silver spoon in your mouth, -
2:03 - 2:04the only thing I could do,
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2:04 - 2:06was to try and stand firm,
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2:06 - 2:09and give back to the people
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2:09 - 2:12what the world had given to me.
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2:12 - 2:18This was why, when I retired in 1997,
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2:18 - 2:19at the age of 60,
-
2:19 - 2:21from the World Health Organization (WHO),
-
2:21 - 2:25I went home and I tried
to put into practice -
2:25 - 2:28what I had been preaching
during all my career -
2:28 - 2:32as a WHO civil servant.
-
2:32 - 2:35The site upon which the hospital was built
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2:35 - 2:39was one that was once a graveyard,
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2:39 - 2:42a military parade ground,
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2:42 - 2:44an execution ground,
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2:44 - 2:46and, eventually, a garbage dump.
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2:46 - 2:51In an area of Hargeisa,
the capital city of Somaliland, -
2:51 - 2:53where no hospital had ever been built
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2:53 - 2:55before that time.
-
2:56 - 3:01The hospital took four years to be built.
-
3:01 - 3:06It was four years in a country where labor
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3:06 - 3:11and skilled construction people
were very few. -
3:11 - 3:15But we labored on and, eventually,
-
3:15 - 3:19the hospital was born in 2002.
-
3:19 - 3:22That hospital today
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3:23 - 3:31is one where almost 12,000 children
have been delivered. -
3:31 - 3:34That child you see in my arms
-
3:34 - 3:37was the first baby
that was born in that hospital, -
3:37 - 3:40about 10 hours
after the hospital was opened. -
3:42 - 3:47Among the 12,000, most of them were people
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3:47 - 3:49who had been referred to us,
-
3:49 - 3:54or women who had found
something wrong with their pregnancy, -
3:54 - 3:58because women who think
they are having a normal pregnancy -
3:58 - 4:00have their babies at home.
-
4:00 - 4:05So the 12,000 children
that we delivered in the hospital -
4:05 - 4:08were mainly delivered
because they were sent to us, -
4:08 - 4:10because of a complication
either with the pregnancy, -
4:10 - 4:13or with the mother, or whatever.
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4:15 - 4:19We remained a maternity hospital
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4:19 - 4:22for a little more than a day or two.
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4:22 - 4:24Because in your countries,
-
4:24 - 4:28you have the luxury
of having specialized hospitals. -
4:28 - 4:30You have something wrong with your eye,
you go to the ophtalmologist. -
4:30 - 4:34You break an arm,
you go to the orthopaedic surgeon. -
4:34 - 4:36But in Africa, in my country,
-
4:36 - 4:38if you're sick, you just go to a hospital.
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4:38 - 4:44So it was not possible for us to say:
"We are a maternity hospital. -
4:44 - 4:47Go and get your heart attack
treated somewhere else. -
4:47 - 4:51Go and get your diabetic coma
seen to somewhere else." -
4:51 - 4:54It's a hospital, so it's a hospital.
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4:54 - 4:58Men are treated, women are treated,
children, whatever. -
4:59 - 5:05We also have a facility where
we can do surgical interventions. -
5:05 - 5:09Since the 1st of January, this year,
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5:09 - 5:14we have operated over 500 cases.
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5:14 - 5:18Only 185 of them were cesarian sections.
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5:18 - 5:24The others, contractures,
cleft lips, obstetrical fistula, -
5:24 - 5:31thyroids and, on that site,
that was once a garbage dump, -
5:31 - 5:36we can also operate on children
who have hydrocephalus. -
5:36 - 5:39So, we can even do, not brain surgery,
-
5:39 - 5:43but we temper,
we touch the brain of children -
5:43 - 5:47and we have done over 27 cases
and, thank God, -
5:47 - 5:50all but one have succeeded.
-
5:50 - 5:53And the one who died
died of diarrhea and vomiting, -
5:53 - 5:56two weeks after the operation.
-
5:56 - 6:01So, the story is: where there's a will,
-
6:01 - 6:03there's always a way.
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6:04 - 6:07We are also a teaching hospital.
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6:07 - 6:10Because it's not the bricks, the mortar,
-
6:10 - 6:12it's not the instruments and the facility
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6:12 - 6:14that is going to look after sick people.
-
6:14 - 6:17It's the skills, it's the knowledge,
it's the competence, -
6:17 - 6:21it's the efficiency of the people
who work in these facilities. -
6:21 - 6:25And unless you have doctors
and nurses and midwives -
6:25 - 6:26who know what they are doing,
-
6:26 - 6:29who care with compassion,
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6:29 - 6:34who care and respect the dignity
of the human beings, -
6:34 - 6:37you cannot do anything.
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6:37 - 6:40We have trained over 200 nurses.
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6:40 - 6:43We have trained over 150 midwives.
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6:44 - 6:48And my passion is to multiply
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6:48 - 6:51those girls you see with the red capes,
-
6:51 - 6:53multiply them by a thousand.
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6:53 - 6:59And why do I say that?
Because it is these young women -
6:59 - 7:01who are trained for just two years,
-
7:01 - 7:05who go back to the districts
and the regions we recruited them from, -
7:05 - 7:08who make a difference.
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7:09 - 7:14Somaliland has one of the highest
maternal mortality rates in the world. -
7:14 - 7:17But among the 12 000 children and women
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7:17 - 7:19we have delivered,
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7:19 - 7:22we have been blessed to be able
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7:22 - 7:24to reduce our maternal mortality rate
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7:24 - 7:28to a quarter of the national average,
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7:28 - 7:30not because we have a magic wand,
-
7:30 - 7:35but because we have
an emergency preparedness. -
7:35 - 7:38We can deal with a hemorrhage
as soon as a woman comes in, -
7:38 - 7:40we have an operating theater that works
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7:40 - 7:4124 hours a day.
-
7:41 - 7:46It is midwives who make the difference.
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7:46 - 7:50Doctors? Yes! We need doctors.
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7:50 - 7:52But they take 8 or 9 years to train,
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7:52 - 7:55and for goodness sakes:
where am I going to get doctors from -
7:55 - 7:56to work in Somaliland,
-
7:56 - 8:00a country which is
on the dark side of the moon? -
8:00 - 8:04Yes! We need graduate nurses
and midwives, -
8:04 - 8:05but we don't have them,
-
8:05 - 8:09and we don't have the four years
and the five years it takes -
8:09 - 8:11to train a midwife.
-
8:11 - 8:18So, what we do is that we rely
on the two year trained midwives. -
8:18 - 8:22They are a quick fix,
they're cost effective, -
8:22 - 8:27they're efficient, they're dedicated,
and they do not get stolen -
8:27 - 8:30to work in other health facilities,
-
8:30 - 8:32because they are trained as midwives,
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8:32 - 8:34they remain in midwifery.
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8:34 - 8:40And, unless Africa
and countries like mine -
8:40 - 8:43multiply the training of these midwives,
-
8:43 - 8:46we will continue to loose women
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8:46 - 8:50to causes that you have protected
your women from dying: -
8:50 - 8:52we will protect them from eclampsia,
-
8:52 - 8:54we will protect them from infection,
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8:54 - 8:57we will protect them from uterine rupture!
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8:57 - 9:00No woman dies, in your countries,
of uterine rupture. -
9:00 - 9:02She would not be allowed to go into labor,
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9:02 - 9:05because somebody would already see
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9:05 - 9:07that she has a contracted pelvis,
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9:07 - 9:08or that there is a disproportion
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9:08 - 9:12between the size of the baby
and the size of her pelvis. -
9:12 - 9:16No woman would die,
in your country, of infection. -
9:16 - 9:18You have water, you have soap,
-
9:18 - 9:20you have equipment that is sterile
-
9:20 - 9:23and that has been prepared
to be used safely. -
9:23 - 9:25But our women die of these causes.
-
9:25 - 9:29Our women die of causes
that no woman in this day and age, -
9:29 - 9:31where man has reached the moon,
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9:31 - 9:33no woman should die of.
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9:33 - 9:35But we don't have the skills,
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9:35 - 9:37we don't have the facilities.
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9:37 - 9:40In our countries,
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9:40 - 9:45women have a one in ten chances of dying
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9:45 - 9:47of a pregnancy related cause.
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9:48 - 9:52In your countries, it's one in 4,000.
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9:54 - 9:58Your women are treated
by doctors and midwives, -
9:58 - 10:01throughout their pregnancy.
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10:01 - 10:08Only 10% of our women
have access to a health facility. -
10:08 - 10:12And that is why we must have more midwives
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10:12 - 10:15who can go to the regions,
who can go to the districts, -
10:15 - 10:21who can be where women
are to help them, to screen them, -
10:21 - 10:24to identify the ones
who are having a normal pregnancy, -
10:24 - 10:28and are possibly expected
to have a normal outcome, -
10:28 - 10:34or to refer these women
to where they can be helped better. -
10:34 - 10:38My hope, my ambition, is that one day
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10:38 - 10:41we will have a thousand
of these [midwives]. -
10:41 - 10:44And why not in other countries?
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10:44 - 10:47If Somaliland can do it,
anybody can do it. -
10:47 - 10:51If Somaliland, with its limited resources,
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10:51 - 10:54with its past of civil war and destruction
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10:54 - 10:57can reduce its maternal mortality rate
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10:57 - 11:00to a quarter of the national average
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11:00 - 11:03because of the training of midwives,
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11:03 - 11:05why not in other countries?
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11:05 - 11:07Why not in Papua New Guinea?
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11:07 - 11:09Why not in Ethiopia?
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11:09 - 11:13Why not in Erytrea?
Why not in neighbouring Somalia? -
11:13 - 11:16Why not in Lesotho
and all of these countries -
11:16 - 11:20that have a very high
maternal mortality rate? -
11:20 - 11:22If it can be done in Somaliland,
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11:22 - 11:23it can be done anywhere.
-
11:23 - 11:25My message.
-
11:26 - 11:29My message is to governments:
-
11:31 - 11:37My message is to governments
to allocate more funds, -
11:37 - 11:42instead of spending money on tanks,
and guns, and bazookas -
11:42 - 11:45and, I don't know, military hardware.
-
11:45 - 11:51Spend more money on health, on education,
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11:51 - 11:56on infrastructure, on water, on sanitation.
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11:56 - 11:58So that is one:
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11:58 - 12:00education.
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12:00 - 12:05The second is: educate women,
educate girls. -
12:05 - 12:10When you educate a woman,
she is able to take care of [herself]. -
12:10 - 12:13I cannot imagine where I would have been
-
12:13 - 12:17if I had not had access
to the education and the training -
12:17 - 12:21that has helped me to help others.
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12:21 - 12:25And, of course, educate the community!
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12:25 - 12:28Unless the community has the confidence
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12:28 - 12:32to utilize whatever
health facilities are available, -
12:32 - 12:35we will continue to lose the battle.
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12:36 - 12:42One of the things
that has really made a difference -
12:42 - 12:48in my appreciation of human tenacity,
-
12:48 - 12:51and the strength of women
in developing countries, -
12:51 - 12:56is when I see women
who come in to our training, -
12:56 - 13:02who are so timid,
who are so dependent on others, -
13:02 - 13:07go through a transformation
that gives them the confidence -
13:07 - 13:11to think, to answer, to advise,
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13:11 - 13:15to guide and to help other women.
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13:15 - 13:20Education is one
of the strongest gifts we can give -
13:20 - 13:24to a human being and, particularly,
to a woman in Africa. -
13:25 - 13:30My last parting suggestion is:
-
13:30 - 13:34Don't ever underestimate
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13:35 - 13:40the capacity of a human being
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13:40 - 13:44who is determined to do something.
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13:44 - 13:47If I, at 60, 14 years ago,
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13:47 - 13:49could build a hospital,
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13:49 - 13:52anybody, any of you, can do it.
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13:52 - 13:54I thank you all for your attention,
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13:54 - 13:56and thank you for this opportunity
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13:56 - 13:58to be here with you today.
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13:58 - 13:59Thank you.
-
13:59 - 14:00(Applauses)
- Title:
- If We Can Train Midwives in Somaliland, Everyone Can!: Edna Adan Ismail at TEDxRC2
- Description:
-
During her TEDxRC² talk, Edna Adan Ismail, a nurse, midwife, UN diplomat, French Legion of Honour recipient and former foreign minister of Somaliland demonstrates how hospitals like hers (which she dared to build on the site of an old killing ground and graveyard) are on the pioneering edge of training local medical professionals to meet local health challenges.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDxTalks
- Duration:
- 14:11
Nhu PHAM
Such an inspiring talk.
And thank you for such an amazing transcription.