Katherine Joyce, MPH EMT I/C spent January 2012 in Berbera conducting an Emergency Medical Services training at Berbera Regional Hospital. After her time there, she wrote a piece for the Boston University African Studies Newsletter, which was published in October 2012. Visit this website to view the piece. http://www.bu.edu/africa/files/2012/10/Newsletter_Spr-2012-FINAL_Quella-Edit.pdf The Boston University African Studies Center website is here.
Qualified Nurses in a CPR lab at Berbera Regional Hospital
In January 2012, I had the opportunity to conduct pre-hospital training for a group of nurses and ambulance attendants from various Somaliland regions; evaluate community perceptions of emergency services; work with hospital staff on an emergency facility assessment; and meet with the Ministry of Health in the capital city of Hargeisa, Somaliland.
When fellow SPH alum Ayaan Amg posted on a Facebook Alumni page that her mother, Asha Guled—the Director of Berbera Regional Hospital— was looking for people to help out on the ground, I asked if I could be of any use. After some logistical challenges—the area is not recognized by the international community—I set off for Berbera.
Berbera Regional Hospital in the Sahil region of Somaliland is a blue and white cement structure erected by the British. It was left to rot during the Somaliland struggles of the late 1980s and early
1990s and was partially refurbished by an Italian NGO. With support from internal and external NGOs, it was put back in working order by a predominantly Somalilander staff and the Ministry of Health.
Berbera is a major city in the Sahil region, with a population of approximately 100,000. Summer temperatures often reach a sweltering high of 110ºF, which makes the shimmering Gulf of Aden a welcome respite. The Gulf also offers a port that gives Somaliland some economic clout in the region, particularly with trading livestock. Two major highways merge in the city, so many traffic accident victims in the area end up at Berbera Regional Hospital. Some patients stop at Berbera en route to higher level care in Addis Ababa or Hargeisa. But, for many coming from neighboring health centers, Berbera is the highest level of care. Patients make their way to the facility by any means available— foot, taxi, car, and sometimes donated ambulance. Because of the sandy terrain, traditional ambulances that would be operable in temperate climates with functioning roads are not always the safest or quickest method of transport in Berbera.
Several clinicians live on the hospital grounds. The hospital has been facing the recent difficulty of attracting Somaliland clinicians due to the higher salaries provided by private hospitals. These are also often based in locations that are more attractive to recently graduated clinicians.
Clinicians assess a motor vehicle collision trauma with limited resources
Ahmed Suleiman is the only clinician on staff trained in orthopedic surgery. He lived in Berbera during the military conflict. During our many conversations, he expressed frustration with the hospital’s supplies and the financial waste that seemed to pervade the hospital’s operations. For instance, it seemed to defy any sort of acumen that a donor would ship a cargo container of broken equipment with antipiracy insurance rather than simply purchase them new locally. Nor did there seem to be any contingencies made for the day-to-day essentials: With no oxygen refill centers, what happened when the hospital ran out? More people seemed to be spending their money on khat (a popular plant that is chewed to produce stimulant effects)—an average of $25/day—while their families went starving. Ahmed spoke of faulty equipment and a severe lack of training when it came to the use of donated equipment. During one operation, for instance—a tibia-fibula (lower leg) fracture repair—his manual drill bit broke half an inch deep in the patient’s tibia. “Do you see?” he said. “Do you see this? They say to do this with electric power, but all I have is this manual.”
Most people I spoke to had many ideas about how to improve the health of their community and bolster Somaliland’s economy. Many of these also seem to be those very same ideas advanced by the international community—jobs, lowering the cost of health care, increased publicity of health care resources, infrastructure improvements, and so on. Many went on to note that what Somaliland needed were resources that could not be produced internally. While some people seemed to be referring to monetary resources, many were not. Recognition as an independent nation-state, for instance, did not escape mention. Also at the forefront of people’s minds was the issue of increased education in the technology and engineering sectors for the generation that was deprived during war, improved agricultural systems, mineral reserve mining, and green energy technology. Hospital staff and community members also spoke frequently about getting donations from the Somalilander and Somali diaspora. Somaliland helping Somaliland was a poignant topic of conversation.
Group of Berbera Women Say Good-bye after a Focus Group Discussion had with Katherine, Ahmed and Ali
I spent most of my time—a month in total—with hospital staff or ministry members, so I cannot speak in depth to the issue of NGOs. However, there is an NGO presence. At Berbera Regional Hospital, Health Poverty Action (HPA), WHO, and COOPI provide services related to various medications, maternal and child health, tuberculosis, and HIV/AIDS testing and treatment.
Berbera Regional Hospital is doing its best with what it has, but it desperately wants to do more. In the last three months, Dr. Bashiir Jaamac (Saaxil Regional Health Officer and former Berbera Regional Hospital Director) has sent reports of some of the hospital’s challenges and successes. The team not only met but exceeded their vaccination campaign goals for the UNICEF Child Health Days that ended in early March. HPA donated a functioning ultrasound (a major item on the wishlist) to Berbera Regional Hospital, and it has been effectively used by staff. Documentation by clinical staff of medication administration and vital signs has also improved.
But there have also been setbacks. The Berbera Mental Hospital continues to need adequately trained staff, facilities, and medications. A measles outbreak occurred in the eastern region, most likely due to vaccination refusals in some areas of Sahil. Communication between the different health centers is difficult, and data collection and analysis has proven challenging.
For now, the hospital team manages a Facebook page and a website for the hospital. They accept donations from wherever they can. I want to end with a plea from Ahmed: “I would like to add and say please try to mobilize your friends to come to Berbera to work with us … as you did (doctors, nurses, technicians, etc.).”
For more information about Berbera Regional Hospital,
please visit: http://www.sahilregionalhealth.wordpress.com
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If you would like to make a donation to or volunteer at Berbera Regional Hospital for a minimum of 2 weeks in public health, medicine, psychology, engineering, water & sanitation, environment, or other fields, please contact SomalilandHealth@gmail.com or katherine.joyce@gmail.com. Food and accommodation is provided.
sahilregionalhealth 