“I was not consulted,” Edna says. “I was caught, held down, and it was done. My mother thought it was the right thing to do. My father was out of town. When he came back and heard, that was the only time I ever saw him with tears in his eyes. And that encouraged me, because if he thought it was wrong, then that meant a lot.”
The cutting of Edna, who was very close to her father, led to a fierce argument between her parents and a souring of their marriage. And it is one reason Edna herself has become a passionate opponent of genital cutting. But at home, Edna’s enlightened upbringing continued. A tutor came to her home to teach the boys of the family, and her parents allowed her to hover in the background and absorb the lessons. Edna soon proved her aptitude, and so her parents sent her to attend a primary school for girls in the nearby French colony of Djibouti. There was no high school for girls, so she returned to Hargeisa to work as an interpreter for a British doctor. “It improved my English, got me into health, and whetted my appetite even more for health work,” says Edna.
In 1953, an elementary school for girls opened in another town, and at the age of fifteen Edna went off to work as a student teacher there. In the mornings she taught the girls, and in the afternoon she was taught privately by the same teacher who taught high school boys (since it would have been improper for Edna to sit with the boys). Every year there were a few scholarships for Somalis to go to Britain to study, and it was assumed that these would be for boys. But Edna was allowed to sit for the exams—in a separate room from the boys—and soon became the first Somali girl to study in Britain. She spent seven years there, studying nursing, midwifery, and hospital management.
Edna became her country’s first qualified nurse-midwife, the first Somali woman to drive, and then Somalia’s first lady, period. She married Somaliland’s prime minister, Ibrahim Egal, who became Somalia’s prime minister in 1967 after the former British and Italian Somali territories merged. She and her husband visited President Lyndon Johnson at the White House. In a photo she showed us, Edna is gorgeous as well as vivacious, and LBJ beams as he towers over her (she’s five foot two).
Edna later divorced and was recruited by the World Health Organization. She lived the good life of a UN official and was posted around the world. But she dreamed of starting a hospital in her homeland—the hospital my dad would have wanted to work in—and in the early 1980s she began building her own private hospital in Somalia’s capital, Mogadishu. When war broke out, the project had to be abandoned.
In the UN, Edna rose to be the top WHO official in Djibouti, with a lovely office and a Mercedes-Benz. But she didn’t want her legacy to be a Mercedes; she wanted it to be a hospital. The dream nagged at her, and she felt unfulfilled. She knew that Somaliland has one of the highest maternal mortality rates in the world, though precise figures do not exist because no one keeps track of deaths. So when Edna retired from the World Health Organization in 1997, she announced to the Somaliland government—which by then had won a civil war and had broken off from Somalia—that she was going to sell her Mercedes and take the proceeds, as well as her savings and pension, to build a hospital.
You tried that, said Somaliland’s president, who happened to be her ex-husband.
I have to do this, she replied. I have to do this now more than ever, because what few health facilities we had were destroyed during the civil war.
We’ll give you land for the hospital on the edge of town, he said.
No, Edna said firmly. That’s not good for women who have babies at two a.m.
There was only one available tract inside the town of Hargeisa. It had been a military parade ground for the previous government, notorious as the spot where people were imprisoned, flogged, and executed. After the civil war ended, the site had been abandoned, and Somalilanders used it as a dump. Edna initially recoiled when she visited it but also saw an advantage: It was in the poor part of town, near the people who needed her most. So Edna planned her own maternity hospital, funding it with $300,000—her entire life savings.
It was an audacious dream, perhaps a foolish one. An official at the small UN outpost in Hargeisa said that Edna’s vision was noble but too ambitious for Somaliland, and he had a point. African countries are littered with incomplete and abandoned projects, so skepticism was in order for a project driven less by balance sheets than by dreams. Another challenge in planning the hospital was that potential supporters like the UN and private aid groups are not very active in a breakaway country like Somaliland that no one recognizes and thus officially doesn’t exist.
When the hospital was mostly built but still lacked a roof, Edna’s money ran out. The UN and other donors were sympathetic but refused to provide the rest of the money needed. That’s when Ian Fisher wrote an article in The New York Times about Edna and her dream. Anne Gilhuly, a recently retired English teacher at Greenwich High School in a wealthy suburb in Connecticut, with no particular interest in Africa or maternal health, read that article. She was teaching classics to adults in continuing education classes and pursuing her interest in Shakespeare and theater. But the article moved her, and so did the accompanying photo of Edna beside her incomplete hospital. A friend of Anne’s in Greenwich, Tara Holbrook, had also read the article, and they spoke about it on the phone.
“We were so disgusted with the plastic toys our grandchildren wanted for Christmas that we leaped at the chance to do something better for the children of the world: help some of their mothers survive,” Anne recalls. She quickly adds, self-mockingly, “Sounds corny, I know.”
So Anne and Tara contacted Edna. They asked various experts if Edna’s goal was sensible, if it was achievable. Former American ambassador Robert Oakley and others said it just might be, and so Anne plowed ahead. Soon she and Tara found out about a group of people in Minnesota who had also read Ian’s article and wanted to help. The Minnesota group included a few Somalilanders, led by a computer executive named Mohamed Samatar and a dynamo travel agent named Sandy Peterson. Sandy’s daughter had been raped at age six by a neighbor and had subsequently undergone the gamut of psychiatric counseling, mental hospitals, and suicide attempts. Sandy realized that many African girls underwent equally traumatic experiences yet received no help whatsoever. The Minnesotans had created a support organization, Friends of Edna’s Hospital, and applied for tax-exempt status. The two groups joined forces. When the tax-exempt status was granted the following June, Anne launched her appeals.
“Tara and I sent out our first fund-raising letter—mostly to women of our generation we thought would be proud of Edna for her achievements in a patriarchal society,” Anne recalled. “And they did respond.”
With help from Anne and her friends, Edna completed her hospital, after upsetting all the protocols of the construction industry in Somaliland. First, she barred workers from chewing khat, a leaf that has amphetamine-like qualities and is enjoyed by men throughout the region. The workers didn’t believe she could be serious—until she fired some of them for disobeying orders. Then Edna insisted that the masons teach women how to make bricks. They resisted at first, but she was paying the bills, so Somaliland soon had its first female brick-makers. Local merchants in Hargeisa also supported the hospital, allowing Edna to use construction equipment free of charge and even donating 860 bags of cement.
Edna in front of her hospital in Somaliland (Nicholas D. Kristof)
The result is a white three-story hospital with an English sign that reads EDNA ADAN MATERNITY HOSPITAL in front of it. There is no hint of the squalid dump it replaced. Anybody accustomed to dilapidated African hospitals would be astonished, for it gleams in the afternoon sun and has the hygiene and efficiency of a Western hospital. It has sixty beds and seventy-six staff members, and Edna lives in an apartment inside the hospital so that she can always be on call. She accepts no salary and uses her WHO pension to make up the shortfall in the hospital’s operating expenses.
“Things like this are very precious to us,” she said, holding a surgical mask, unob
tainable commercially anywhere in Somaliland. The hospital imports all medical supplies and survives thanks to gifts and hand-me-downs. The generator is from the Danish Refugee Council. The ultrasound machine is from a German doctor who had once visited; he sent his old one. The blood refrigerator is from a Somali who owed Edna a favor. The United Nations Refugee Agency donated an ambulance. The Netherlands donated two incubators. USAID, the American aid agency, built an outpatient center. Britain equipped the operating theater. UNICEF gives vaccines. WHO provides reagents for blood transfusions.
Friends of Edna’s Hospital initially gathered equipment and medical supplies in the United States and shipped them to Somaliland. Gradually the emphasis shifted to fund-raising only, to pay for equipment and supplies that Edna buys closer to the hospital. The group is also financing two of Edna’s former nursing students in medical school so that she will have two of “her own” practicing full-time as physicians at the hospital. And the Friends are simultaneously trying to build an endowment so that the hospital can survive Edna’s passing.
Somehow, improbably, it all comes together. At three o’clock one morning, a man arrived, pushing his wife in a wheelbarrow. She was in labor. The team leaped into action and rushed the woman into the delivery room. Another time, a nomadic woman gave birth in the desert and developed a fistula. Her husband couldn’t stand her smell and constant wetness, and stabbed her in the throat; the knife went through her tongue and stopped at her palate. The other nomads stitched her throat together with needle and thread and carried her to Edna’s hospital. A visiting fistula surgeon patched the woman together again, from her throat to her bladder.
As Edna roams the hospital, she’s like the weather in October: alternately stormy and sunny. One of her hospital’s major roles is training a constant stream of midwives, nurses, and anesthetists, and she is constantly grilling the trainees in English, because she wants them all to speak English fluently. In the hallway, she pauses to upbraid one nursing student about an error, ensuring that she’ll never make that mistake again. A moment later, Edna is all empathy as she talks to a fistula patient who sobs as she describes how her husband forced her to leave their home.
“I’m a woman, too!” Edna tells the girl, holding her hand. “I feel like crying myself.”
Once a man drove through the hospital’s front gate with his wife in labor in the backseat. The baby emerged just as they arrived, and so the man tried to drive right out again.
“No! No!” Edna shouted at him. “You’ll kill your wife. The placenta still has to come out.”
“I won’t pay you,” the man shouted back. “I’m leaving.”
“Close the gate!” Edna shouted to the guard, blocking the car from leaving. Then Edna turned to the husband.
“Forget about the payment,” she said, and she pulled out the placenta right there in the backseat before opening the gate and allowing him to go.
Somali superstition holds that burning a baby on the chest will prevent tuberculosis, so Edna constantly has to guard against mothers sneaking their newborn babies out of the hospital to burn them. At least once, a mother burned her new baby in the hospital kitchen.
Edna delivering a breech birth in her hospital (Nicholas D. Kristof)
The American backers of the hospital have been venturing out to Somaliland to see what they have wrought. Sandy Peterson, the travel agent, was the first to travel to Hargeisa. Then others went as well, including Anne Gilhuly and her husband, Bob, who visited when Edna was doing double duty as Somaliland’s foreign minister a few years ago. Anne e-mailed us:
Swimming with her, with all our clothes on naturally (except for Bob, who could wear a bathing suit because he was a man), in the Gulf of Aden at Berbera, in that warm turquoise water with the pink mountains in the distance and her bodyguard marching up and down the otherwise absolutely deserted beach with his machine gun, is a lot more interesting than playing bridge at the local Y.
Anne also saw the tougher side of Edna. Once a senior nurse waited too long before calling in the doctor to perform a cesarean. Believing that the nurse had endangered a woman’s life, Edna erupted in full fury and gave the nurse such a ferocious tongue-lashing that Anne and Bob were shaken. Afterward, they decided that Edna was right: If she was going to save patients and change attitudes, she had to be ferocious.
“Edna was determined that that would not happen again, that they had not been sufficiently sensitive to the woman’s condition,” Anne recalled. “In her hospital there must be total attention paid to each individual. I definitely felt chastened. The incident brought home the extent of the task Edna has set for herself and how hard it is for us to comprehend fully what she is up against.”
CHAPTER EIGHT
Family Planning and the “God Gulf”
Whenever cannibals are on the brink of starvation, Heaven, in its infinite mercy, sends them a nice plump missionary.
—OSCAR WILDE
Rose Wanjera, a twenty-six-year-old woman in Kenya, showed up at a maternity clinic one afternoon. She had a small child in tow, and her stomach bulged with another on the way. Rose was sick and penniless and had received no prenatal care. She was an unusual visitor to a slum clinic because she had attended college and spoke English. She sat in a corner of the squalid, dimly lit clinic, patiently waiting for the doctor, and told us how wild dogs had mauled her husband to death a few weeks earlier.
A nurse eventually called her, and she lay on a cot. The doctor examined her, listened to her abdomen, and then announced that she had an infection that threatened her life and that of her unborn baby. He enrolled her in a safe motherhood program, so that she would get prenatal care and help with the delivery.
The clinic that Rose visited represents an unusual outpost of a consortium formed by aid organizations to provide reproductive health care for refugee women, who tend to be among the most forlorn and needy people on Earth. The consortium includes CARE, the International Rescue Committee, and AMDD, Allan Rosenfield’s organization at Columbia University. This particular clinic was run by another member of the consortium, Marie Stopes International—but then George W. Bush cut off funds to Marie Stopes and the entire consortium, all around the world, because Marie Stopes was helping to provide abortions in China. One might have understood cutting funds to the China program, but slashing funds for the consortium in Africa was abhorrent.
The funding cut forced Marie Stopes to drop a planned outreach program to help Somali and Rwandan refugees. It had to close two clinics in Kenya and to lay off eighty doctors and nurses—precisely the staff who were looking after Rose. She became one of untold victims of American abortion politics that effectively eliminated her only source of health care. “These were clinics focusing on the poorest, the marginalized, in the slums,” said Cyprian Awiti, the head of Marie Stopes in Kenya.
This incident reflects the “God Gulf” in American foreign policy. Religion plays a particularly profound role in shaping policies on population and family planning, and secular liberals and conservative Christians regularly square off. Each side has the best of intentions, yet each is deeply suspicious of the other—and these suspicions make it difficult to forge a broad left-right coalition that would be far more effective in confronting trafficking and overcoming the worst kinds of poverty. The great battleground in these conflicts has been whether to fund organizations like Marie Stopes that have some links to abortions.
Driven in part by conservative Christians, Republican presidents, including both Bushes, instituted the “gag rule,” barring funds to any foreign aid group that, even with other money, counseled women about abortion options or had any link to abortions. As a result, said a Ghanaian doctor, Eunice Brookman-Amissah, “contrary to its stated intentions, the global gag rule results in more unwanted pregnancies, more unsafe abortions, and more deaths of women and girls.”
One of the prime conservative targets has been the UNFPA, which works to promote family planning, maternal health, and newborn survival. United
Nations agencies tend to be inefficient and bureaucratic, far less nimble and cost-effective than private aid groups, and probably do more for the photocopier industry than for the world’s neediest—but they’re still irreplaceable. Just recall the operating theater in Zinder, Niger, where the doctor saved Ramatou and her baby; that hospital was equipped by UNFPA. Conversely, Prudence may have died in part because a UNFPA maternal health program in Cameroon didn’t have the resources to reach her hospital.
When UNFPA was created in 1969, the Nixon administration was a strong supporter, and the United States government the biggest donor. But in the 1980s American antiabortion activists began to target UNFPA. Although the organization does not perform abortions or fund them, critics noted that it advises China on population issues and that China has a coercive family planning program. UNFPA did make the disgraceful mistake in 1983 of awarding its Population Award gold medal to Qian Xinzhong, the head of the Chinese family planning program, who was then presiding over a brutal family planning crackdown involving forced abortions. The Chinese Communist Party leaders themselves were sufficiently embarrassed by Qian’s zealotry that they fired him a year later.
The United States government had no mechanism to punish China for forced abortions, so instead it pummeled UNFPA. In 1985, President Ronald Reagan reduced funding for it. Then George H. W. Bush and George W. Bush both eliminated U.S. funding for the agency. Representative Chris Smith, a New Jersey Republican, led the fight against UNFPA. He’s a good man who genuinely cared about Chinese women and was horrified by coerced abortions. He wasn’t trying to score cheap political points in criticizing UNFPA, since most New Jersey voters had never heard of the agency. This was an issue that Smith genuinely cared about.
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