By the time she arrived at the Banadir hospital in Mogasidhu, Somalia, Howa Oofay Moalim had already been in labour for nearly five days. She had traveled 250 km to reach the hospital after traditional birth attendants had failed to help her baby that was being delivered in shoulder presentation.
Howa lay on a table in the maternity ward as Dr. Marian Omar Salad performed an ultrasound. Searching for the baby’s heartbeat, Dr. Marian could not find any sign that the baby was still alive. Dr. Marian’s focus then turned to Howa’s health, as Howa was already sick from infection. “I hope she will be ok. We will do our best and we will try to save her,” Dr. Marian said. “Even though she lost the baby, there is no way that she can deliver the baby. We have to do a Caesarean section,” Dr. Marian continued.
Dr. Marian knew that Howa’s only choice was to have a Caesarean section. However, neither Dr. Marian nor Howa could make the final decision to have the lifesaving procedure. “I must get consent because I can not be responsible for someone else’s daughter,” she said. “The patient can’t give consent for her own life,” Dr. Marian explained. Howa continued to lie uncomfortably on the table until she received permission from her husband, her father, and her mother. If one of the three had refused, there would have been nothing Dr. Marian could do to save Howa’s life. “Getting consent causes a lot of delays and a lot of problems,” Dr. Marian said. “Most of the time we lose the baby during the time that we are waiting for the consent. Other times, which is much more sad, we lose the mother due to complications during that duration of time,” she continued, shaking her head. “Some opinions are changing, but a majority still need a lot of health education and guidance,” she said.
Finally, Howa’s mother arrived at the hospital and gave the final permission for her daughter to go into surgery. Howa was escorted upstairs, while Dr. Marian prepared to perform the operation. Dr. Marian had already informed Howa that her child had not survived the prolonged labour. Inside the operating theatre, Dr. Marian expected the worst. Yet, as she lifted the small boy, her eyes widened in amazement and she gasped before exclaiming, “He’s alive! Oh my God, he’s alive!”
The lifesaving 24 hour Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) facilities at the Banadir Hospital are made possible by the Somali Joint Health and Nutrition Programme (JHNP).
The JHNP is a multi-donor development programme, implemented by WHO, UNICEF and UNFPA, together with the Somali Health Authorities.
By 2016, the programme will provide over 6 Million Somalis with much needed free-access to an essential package of health services, while ensuring that a minimum of 13,000 women have access to life saving comprehensive emergency obstetric care at 24 hour referral hospitals in nine targeted regions of Somalia.
The programme is also building the Somali Health System by improving government leadership, training and deployment of skilled health workforce and providing essential medicines, vaccines and technologies.
Major development partners contributing to the Programme are United Kingdom’s Department for International Development (DFID), Government of Sweden, Government of Finland, Australian Agency for International Development (AusAID), Swiss Agency for Development and Cooperation (SDC) and United States Agency for International Development (USAID).