“Allahu akbar…!” she mumbled repeatedly in prayer as she went down on her knees. Tears were streaking from her eyes. In her late 30s, she had just one reason to be happy-she was now dry after more than 10 years of leaking urine. Hers was one of the many success stories for fistula patients who have benefited from the operations by WAHA team at Hanano Hospital. I later came to learn from my colleagues that some of the strict adherents of Islam will not conduct prayers if they feel unclean, and she had always felt unclean from the time she developed a vescico-vaginal fistula following obstructed and prolonged labor at home. The constant flow of urine and accompanying bad smell never gave her peace. After the harrowing experience in the hands of the traditional birth attendant she had to contend with more pain, that of the loss of her baby. Now she was ready to start a new journey of regaining her dignity and her place in the society.
WAHA has had a roller-coaster experience in Hanano Hospital. Having opened its doors to the first fistula patients on 15th January 2012, Hanano hospital saw a rapid growth in the normal deliveries, Cesarean sections and fistula operations like never before. The activities reached a peak in June, clocking 257 deliveries, 46 C-sections and 30 fistula cases. The system flowed so well that fistula patients no longer needed to be notified via radio announcements, but word of mouth spread the message. Sundays, our fistula screening days, became as busy as ever, with the patients streaming in, and getting booked in for surgeries. For the first time in my work in Somalia, we received a letter of appreciation from a patient who had undergone C-section at our hospital.
Over the months, WAHA continued to receive more and more complicated cases. This is because word was out that Hanano hospital had “very good doctors from abroad”. Patients coming from other hospitals in Mogadishu as well as referrals by the traditional birth attendants flowed in with unimaginable complications. From ruptured uterus, various mal-presentations, severe eclampsia, ante-partum hemorrhage, intra-uterine deaths with obstructed labor, intra-abdominal pregnancy and many others, the activities put the whole team on state of constant vigilance. At times when overwhelmed, we could also refer to Benadir Hospital, the main government referral hospital in Mogadishu. This was an irony of sorts, because many times we received patients having escaped from Benadir Hospital to get services in our hospital.
Deliveries have had an exponential growth, from a paltry 29 in February to 257 in June, and remaining above 240 in the following months. Many of the patients presented with undiagnosed anemia in pregnancy as well as pregnancy-induced hypertension and pre-eclampsia, due to lack of attending ante-natal care clinics. This resulted in premature labors, intra-uterine fetal deaths and some progressing into life-threatening eclampsia states. On several occasions, patients were brought in gasping by desperate relatives, some never making it to the ward for resuscitation or emergency operation. During the program, over 1200 deliveries have been conducted, over 130 post-abortion care cases, over 240 cesarean sections, and over 200 obstetric fistula and other complications of incontinence repaired. In the health centers situated in the IDP camps, 5200 children below 5 have been attended to, with over 4200 women attending ante-natal clinic.
This September, WAHA began the process of handing over the activities of the hospital to the local hosts UAE Red Crescent. After almost one year of intensive activities, capacity-building for the local staff and establishing a good referral network with several NGOs and hospitals, it was time to move on to greater things. The local doctors in the program can now do Cesarean sections without assistance, as well as handle post-abortion care and manage most obstetric emergencies. The nurses and midwives are now conversant with new tools like partographs, patient cardex , observation charts and admission tools that were rarely seen or used in most hospitals in Somalia. Basic new-born resuscitation techniques now in regular use have helped save the lives of many distressed new-borns. Systems put in place in ordering supplies, follow-up and day-to-day management have made the transition smooth. Safe blood transfusion by the locally-trained lab technicians has ensured obstetric emergencies can be handled with good blood back-up.
Last week we had a well-attended Farewell Party to mark the end of our activities in Hanano. Representatives from several organizations, agencies and hospitals paid glowing tribute to the work of WAHA in Mogadishu, especially in maternal health. More compliments came from the UAE Red Crescent Director, the local staff, and midwifery school principal and students, who also presented us with gifts. WAHA will continue to support the Midwifery School, in partnership with UNFPA.
It is our sincere hope that the legacy that has been set by WAHA at Hanano will be sustained, to benefit the women and children of Somalia long after our departure. As the WAHA team zips up their boots in readiness for the next major venture, the testimony of the good works will linger in the minds of many for a long time to come!