The Edna Adan Maternity Hospital is a facility that has been under construction in Hargeysa, Somaliland, since the 3^rd of January, 1998.

The dream to start a hospital has been floating around in my head for as long as I can remember. Although it is difficult to pinpoint exactly when the idea began to germinate, I think it entered my head at the time of a drought ' Abaartii Siigacasse' in 1951. That was the time my late father, Adan 'Dhakhtar' was responsible for the hospital of Erigavo, as well as for the health of tens of thousands of people in destitute camps.

Each week, my father toured the camps and would return three or four days later with truck loads of people who were very sick, some of whom were on the verge of death. As a result, the Erigavo hospital had additional tents set up to accommodate the flow of patients, requiring that my father and his team work day and night to treat the sick. At that time, I was with my parents during the school holidays, and seeing how hard my father worked at the hospital, I spent much time with him to give him and his staff a hand. That is when I first heard my father saying ' I wish we had better facilities for our people ', and probably that was the first time that I myself thought of becoming a nurse.

That dream came true when in 1954, I obtained a British Government Scholarship and went to the United Kingdom to train first as a Nurse and then specialised as a Midwife.

In 1961, I returned as the first Somali qualified Nurse/Midwife, and became in charge of the female section of the Group Hospital in Hargeysa. Although the hospital was better equipped than it is now, there was still a need for a better facility.

That was also when some of us started giving lessons to nurses and dressers at the Hargeysa Nursing School.

In 1963, I married and transferred to Mogadisho and started teaching nursing and midwifery at the Health Personnel Training School near De Martino Hospital.

By 1965, I was recruited by the World Health Organization where we started a Nurse/Midwife training school in Tripoli, Libya.

In early 1968 I returned to Mogadisho where, in spite of heavy Diplomatic and State obligations as the wife of the then Prime Minister, I continued to teach midwifery and also re-arranged the maternity section of Digfer Hospital.

After the military coup of 1969, and after emerging from months of house arrest, I started a Pharmacy and domiciliary maternity service in 1971 so that I could earn a living. In 1972, I started delivering women at the Medina Hospital in Mogadisho on a part time basis. By 1973, I was made in charge of the Maternity section of Medina hospital up to 1976 when I became Director of the Department of Human Resources Development at the Ministry of Health. In 1978, I took leave without pay and went to Oman. During the six years that my then husband was Somali Ambassador in Oman, I continued to take short-term contracts with WHO and UNICEF, and worked in many African countries such as Nigeria, Zambia, Egypt, Sudan and Djibouti where in 1982, I was assigned by WHO to start the first Nursing School for that country.

Throughout those years, the idea of building a Maternity hospital for women was alive in my head. Unfortunately, however, financial, professional, or emotional circumstances were not right in my life and the hospital had to wait until 1985 which is when I started the first hospital in Mogadisho after Government approval and the necessary land were finally obtained. The rest is history as we all know the fate of that hospital. It was only after my retirement that I had the financial means and the independence to embark once again on the realization of my lifelong dream and started the second and present hospital in Hargeysa, Somaliland.

Needless to say, it took me quite a few years to get over my initial shock of losing my hospital and all my other assets in Mogadisho.

However, after seeing the state of health facilities in Hargeysa and Borama in 1991, and after witnessing the massive need our people had for a properly functioning health facility, there was no choice other than to revive the hospital dream again, this time in Hargeysa.

Plans, preparations and final decision took quite some time and were very much affected by the political and security climates of Somaliland.

To concretise the dream, engineers, architects and health planners of different nationalities were consulted and contributed the benefit of their expertise. Technical details also relied on past experiences in other hospitals within and outside the country in order to avoid the mistakes of some, and learn from the strengths of others.

As you all know, the site of the present hospital was once a military parade ground that had also been used for all kinds of acts of cruelty against human beings. After the ousting of the troops of Siyad Barre, the area became a rubbish dump, and a place that was used by squatters since no one wanted to have anything permanent to do with a place with such a sordid past. In a way, I think that it was the hand of God that had saved it from being chopped up into housing plots and also directed me to it as the 120,000 people living on the hospital side of the riverbed in Hargeysa had never ever had a hospital before.

1998.

- First Meeting of the Board of Trustees convened on the 27/12/1998

The hospital now has three floors instead of the two floors as per the original plan. The reason being due to the acute shortage of trained health workers in the country, which necessitated that training become an integral part of the services of the hospital for staff quality assurance. This way we would ensure the efficiency of our staff in order to function in the kind of facility that was being set up. Additionally, the size of the land of this hospital measures only 9,600 square meters whereas the hospital land in Mogadisho measured 15,000 square meters.

The hospital is intended to become a facility where comprehensive reproductive health care to women and children will be available on a 24 hour basis for inpatients and outpatients, and will include :

1. Prenatal, Postnatal and Family Planning
2. Treatment of Gynaecological problems
3. Investigation and treatment for infertility
4. Diagnosis and Treatment of Sexually Transmitted Diseases including HIV/AIDs
5. Counseling against harmful practices such as FGM
6. Child growth monitoring, child care and immunizations
7. Laboratory facilities, Ultrasound and Xray

1. 23 Maternity beds during the first phase with capacity for expansion to 41 beds, and eventually up to 60 beds
2. Facilities for normal deliveries
3. Obstetrical services for complicated cases
4. Neonatal care including care of premature babies
5. Surgical facilities for obstetrical and gynaecological conditions
6. Pre and Post Operative Intensive care

Research opportunities will be available for Medical and Social Scientists, and a memorandum of understanding has already been signed with the University of Uppsala in Sweden for studies and research on reproductive health. A very close collaboration exists between this hospital and the University of Amoud and University of Hargeysa. Additionally, negotiations for medical collaboration have been held with Mount Sinaii Hospital and York University, both situated in Toronto.

d) Training

Although it is a well known fact that training of health workers is very expensive, there is no option other than to carry it out as a national priority since health workers have not been trained in this country for the past 16 years. For this reason, health workers will receive training on long-term and short-term bases for as long as there will be a need for such training.

Construction cost up to 30/6/2000 was US$514,161 of which US$353,550 was my initial contribution and US$160,611 was received from Somalis in Somaliland and the Diaspora, and through contributions from non-Somali individuals or organizations such as UNHCR who donated the funds for office and library furniture.

It may be pertinent to mention here that only part of the contributions that were received were in cash. The rest were in the form of cement, steel, wood, or the use of construction equipment that otherwise would have cost us several thousands of dollars. Even more important than all the above is the support of the volunteers who have given free labour and who have donated so much of their time in the true spirit of self-help and community participation.

Much of the remaining construction items costing about US$33,000 have been bought and hopefully will arrive safely onboard the ship that has had engine failure two weeks ago and which has been lying idle in the Arabian Sea since that time.

The only major items that remain to be purchased are two thirds of the doors and windows, and the large generator that will be required for a hospital of this size.

The amount of the US$200,000 needed is for labour cost, for furniture, for medical equipment and for pharmaceutical products to make the hospital become functional, hopefully by November/December 2000.

The hospital being a non-profit -making hospital will need to charge an amount to patients on a cost-sharing principle that is comparable to, or is lower than the amount that patients are charged in existing health facilities in the country right now. The only difference, hopefully, will be that a higher standard of patient care will be provided to women and children in this hospital than that which is currently available in the country.

In similar charity hospitals that have been donated in other countries the donors have been able to put aside a substantial sum of money locked up in a Trust Fund to cover part of the running cost. Unfortunately, I do not have the millions that it would cost to make all facilities free of charge.

At present, my UN pension and the rents I collect from family property goes to the hospital. We need to have contingency plans in the event of my death when my pension would terminate. For this reason, we are now building a series of shops that are situated on the main road and which will be rented out to the public. The rent collected from these shops will be a source of income for the hospital and will lower the amount that mothers will have to pay for hospital services.

The Honorary Board of Trustees of the hospital consists of 54 individuals who are persons of good standing, who are from different nationalities and who are also representatives of all the major clans of Somaliland. Their role is to advise about the management of the hospital, and also to ensure and verify to all parties concerned the charity status of the hospital.

My most sincere thanks go to each and every one of them for their constant support and guidance as I am sure that we would not have reached where we are today without them.

The hospital will have an appointed Hospital Director who will be assisted by the Board of Hospital Administrators who will be the heads of the various departments of the hospital. Together they will be responsible for the day-to-day running of the hospital.

I would like to take this opportunity to express my grave concern for the health of our people who have been deprived of proper medical care for far too long. For this reason, we must do everything we can to promote the spirit of self-help and self-reliance without which communities cannot make a change in their state health and in the welfare of their people.