The local hospital in the capital here was our first port of call on our way home from the Institute of Health Sciences where we have been delivering the training. We were delighted to find virtually all of the nurse-midwives we met there were our recent or current trainees and were welcoming of our visit. The single storey individual ward buildings were spartan in the extreme. There were beds of course, and screen curtains in various states of disrepair, and a desk which served as the nurse station, but there was little in the way of equipment apart from an old vacuum extraction unit, an ancient fetal monitor which no longer provided continuous records of fetal heart rate and uterine contractions but still had functional doppler ultrasound for intermittent or, to be more precise, isolated auscultation. The true state of affairs here was revealed by the labour ward register which already shows 22 births in the first five days of March, three of them born dead. We scanned the earlier months of 2012 and saw the same 15% newborn death rate on every page. The register is completed retrospectively and usually the facts are made to fit the outcomes so all babies which fail to survive are classified as stillborn. The concept of fetal monitoring in labour and intervention for fetal distress seems largely foreign to midwifery practice here. We saw one ventouse extraction record and two breech births, one of which was 4kg and stillborn to a mother of 7. Despite the improvements evident in trainees which have attended the Life Saving Skills Course more than once, the picture on the ground belies the skills they have acquired. There is still some long way to go from the theory acquired in training to the implementation and improved outcomes.
The contrast with Edna Aden Hospital is pronounced. Beautifully clean, and smelling clean as hospitals ought and once did in UK, this humanitarian enterprise has been functional since 2002 and maintains a high standard of training and care. Encouraged by the poster in the blood bank Tom and I were inspired to donate our pint of blood and were received by a very proficient laboratory technician who completed the process of testing and painless collection in double quick time. Real mosquitos were nowhere to be seen. We had encountered them for the first time since entering Somaliland in the wards of the national hospital no doubt attracted by the aroma of blood which inevitably lingers in places where mothers deliver and where the couches and floor are not adequately cleansed afterwards. The vicinity of a hospital is not the place one wants to meet mosquitos since they refresh their payload of parasites by feeding on malaria sufferers and then spread the agents of disease wherever they acquire their liquid diet. I think I shall continue taking Lariam despite the published side effects – they have always served me well.
On our return journey to the hotel we passed the monument where an airplane on a pedestal commemorates those who died in 1988 when Siad Barre’s regime bombed his own people here in the north. One local wag posed ostentatiously in the square, proudly displaying his loyalty to the current Somaliland government emblazoned across his T-shirt. His name and phone number were written for us on a piece of paper and should anyone visiting this region wish to make contact we can let them have his details.
As darkness falls over Hargeisa the familiar sight of Venus, Jupiter, the Moon and Mars spread along the line of the ecliptic remind us of home and continue to dominate the night sky, the waxing moon travelling steadily from the brilliant white evening planets towards the red orb in the east, night after night as our sojourn passes. The moon is almost full on our last night here in Hargeisa. We have one more training day tomorrow and then we transfer for the return flight through Berbera on Friday. Soon we shall see these night lights hanging in Penllyn skies, God willing, or they say here, Inshallah.