Obstructions, road blocks and slow progress

Here we are in Hargeisa after a smooth transit from UK. We arrived yesterday on the ECHO flight – run by and for the delegates and donors of the EC who are working in Somaliland – in a 16-seat twin-engine Beechcraft which takes 3 and a half hours from Nairobi without a toilet. That’s fine, and we were forewarned and suitably dehydrated, but could be problematic on the return journey if we don’t watch what we eat and drink.

Rather proud of the national flag

We arrived on a holiday in celebration of Somaliland independence 21 years ago. The festivities were largely over but flags were still flying and some bunting remained over the hotel entrance. They are proud of the national flag as are most newly emerging states.

As I write it’s raining lions and jackals in the midst of a thunder storm and I’m feeling thankful for wireless internet. Lightening strikes can’t leap across a wireless connection can they. Can they? The sound of the rain on the roof is accompanied by another noise which I cannot locate or diagnose but it has a remarkable resemblance to the sparking of an electric arc or fly zapper and I’m hoping it’s some large drops of water hitting the floor rater than water in the switches and electric fittings but I can’t find any leak and I’m not chancing the light switches even though it’s gone rather dark outside. My accommodation in the Maansoor hotel is a single room in a small villa in the grounds – there are a large number of these and they offer a degree of privacy and solitude not provided by the regular rooms in the main building, so I am very grateful despite the heavy rainfall overhead.

Speed bumps

Once again a good level of security is provided – the sleeping policemen on the approach roads (lazy soldiers, they call them here), the barrier manned by alert armed guards in the morning (they insist on all the car windows being open as we drive through as they can’t see the occupants through the darkened and reflective glass) and manned in the afternoons by lazy guards who are awake but less alert and more careless after chewing khat all day, and the concrete blocks painted with zebra stripes to prevent a vehicle breaking through to the residential areas – but this time there is a new security force. The giant tortoises in the grounds (which I never saw last time I came and which I suspect are close allies of the mad antelope which attacks stray white men) have joined forces to create their own road-blocks – mobile speed bumps but actually not very mobile or speedy. They arrange themselves at intervals across the drop-off zone in front of the hotel and have to be forcibly moved on a few feet at a time by a patient but tired-looking hotel porter. They are too big for him to lift and the lack of wheels means that their feet scrape noisily in protest with each heave and shove.

Today was our first training session. We have fewer participants than expected – 3 doctors, one midwife and one nurse – but they are eager learners and rightly so for responsibility comes rapidly here. Bashir was one of the first Somaliland medical graduates in 2009 and he is already Hospital Director in Berbera – he does most of the Caesarean Sections there. Mahfuz is a second year intern and is leader of the Sahel Medical Emergency Team (Sahel is the district of Somaliland targeted by the current training programme). Abdisalan was a nurse on our March course and is now in charge of a dozen staff in a Rural Health Centre with several beds. Our topics today were Caesarean delivery, obstructed labour and ruptured uterus and we spent some time talking about progress in labour, or the lack of it. The maxim is ‘Where poor progress becomes no progress and no action is taken, labour becomes obstructed’ and the consequences can be disastrous here.  Perhaps the worst is the all too common scenario of the newly married adolescent girl who’s fortunes turn from expectation of motherhood and a lovely new baby to total incontinence, walking with a stick, family rejection and social exclusion, and the painful memory of a dead baby with no expectation of future fertility or health due to extreme birth injuries. There is hope for such as this thanks to the wonderful work of places like the hospital for poor women with obstetric fistula in neighbouring Ethiopia, but this kind of outcome can and must be avoided.

A rather smug camel

We travel by taxi to the Ministry of Health where we have been provided with a training room and we have a short walk to the hospital next door for the clinical component of the course. Our journey today was interrupted by several obstacles. A large contingent of armed soldiers had closed the road to the hospital and our driver made a detour through various back streets. There we encountered a posse of camels ambling along and interrupting the traffic from both directions. Once we safely negotiated passage through this animal hazard we came upon the soldiers again who prevented further progress by car. Our driver left his taxi by the roadside and, pulling rank as far as he was able on the strength of two visiting western doctors, obtained passage on foot and escorted us along the closed road as far as the Ministry of Health. Soldiers lined the route on both sides as the President was due and they were detailed to provide safe and speedy passage for His Excellency. Sure enough, the headlights, horns and whistles heralded the approaching motorcade and a couple of dozen vehicles sped by – blue and white police vehicles, army pick-ups with soldiers hanging all over the back and several smart 4x4s whose drivers and passengers waved cheerfully to the sporadic crowd. Can you have a sporadic crowd? I can’t find a better way to convey the sparsity and unenthusiasm of the locals who waved and saluted and the majority of those responding were the soldiers whose livelihoods depend on the existence and occasional appearance of the President. He had been opening the local Sprite factory – not a place that manufactures old Austin Healeys under licence from British Motors, nor a producer of Imps and Faeries but a very important offshoot of the parent company in Djibouti providing essential soft drinks in a very dry and temperate country. Aside from bottled water, we drink Coke and Sprite with all our meals thanks to the President and his men. We also heard that the President has learned a trick from Tommy Cooper – he habitually travels with three black cars in the motorcade which change places frequently so that no-one can be sure which if any vehicle he is in or who is waving at the absent crowd – you never could tell which cup the little ball would be under and all along it was behind Tommy Cooper’s left ear.

So there we have it. We have started but not yet progressed much. I have my thirst quenched but my appetite for more action is whetted. And you have your first dispatch from abroad, as promised, and I will try and keep in touch, Inshallah. Weather, connection and tortoises permitting.


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