WHO roots for strong health system in Somalia to hasten reconstruction

The World Health Organization (WHO) on Thursday urged robust investments in Somalia's fragile health care infrastructure as a means to accelerate the country's reconstruction after two and a half decades of civil strife.
Senior officials said at a forum in Nairobi that affordable health care will help Somalia deal with frequent disease outbreaks worsened by conflicts and natural calamities.

Ghulam Popal, the WHO Representative in Somalia, proposed new funding and technical interventions to help rebuild Somalia's healthcare system.

"The health care system in Somalia has suffered from continuous emergencies including epidemics of infectious diseases due to conflicts and extreme climatic shocks like droughts and floods," said Popal.

"We must accelerate action to rebuild the country's health infrastructure and strengthen response to frequent cholera and measles outbreaks," he added.

Representatives from multilateral lenders, governments and relief agencies attended the Nairobi forum that sought to explore innovative ways to broaden access to affordable health care services in Somalia.
Participants discussed Kenya's and Sudan's model of expanding health coverage and how it can be replicated in the neighboring Somalia.

Popal stressed that universal health coverage will have a positive socio-economic bearing on Somalia and the greater horn of African region.

"Regional collaboration combined with stable institutional capacity is key to expanding access to quality and affordable health care services in Somalia. Resilient health systems in the country will benefit other East African Nations," Popal said.

He urged greater investments in surveillance infrastructure to enhance timely response to disease outbreaks in Somalia.
The governments of Somalia and other autonomous regions have identified reconstruction of health infrastructure as critical to achieve peace, stability and economic growth.

Osman Isse Abdinasir, the Minister for Health in the autonomous Puntland region, said there is a political goodwill to promote access to quality health care to help deal with emergencies that undermine stability and progress.
"We are gradually recovering from the turmoil of yesteryears and revitalizing health services will be the cornerstone of development and stability," Abdinasir said.

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Somali Nurse aspiring to make New Zealand a nation where all cultures and human rights are valued

A Muslim women's forum in Auckland is creating conversation with the wider community about employment, discrimination and housing.
The forum has been organised after leaders within the Muslim community met last year and identified areas that needed improvement.
On April 29 residents, community leaders, Government ministers and local MPs would meet in Blockhouse Bay to discuss issues affecting the community.

Minister of Ethnic Communities Jenny Salesa would be attending the forum along with other MPs Carmel Sepuloni and Michael Wood. 

Salesa said she wanted to learn how community needs could be recognised.

MANDY TE/STUFF

Fadumo Ahmed says "the forum is for Muslim women to show their voices, to be political and to share who we are".

"I would like to know the barriers and challenges women are facing in our society, for example if they have access to culturally appropriate services," Salesa said.

"We aspire to make New Zealand a nation where all cultures and human rights are valued."

One of the organisers, New Zealand Ethnic Women's Trust chairperson, Fadumo Ahmed said she was excited about the forum.

JARRED WILLIAMSON/STUFF

Ethnic Communities Minister Jenny Salesa wants the forum to be an open conversation with the community.

"New Zealand is our country and where we live - we've come a long way to be part of this nation and we want to give back," Ahmed said.

"Some people believe Muslim women are silent.
"The forum is for Muslim women to show their voices, to be political and to share who we are," she said. 
"Anyone can raise questions and the forum is open to debate," she said.
The trust Ahmed works for supports migrant and refugee women and their families through enterprise, health and education. 
Ahmed has lived in New Zealand for 18 years but worked as a midwife and public health nurse in Somalia before the civil war broke out in 1991.
After waiting at a refugee camp in Ethiopia, Ahmed and her family were able to move to New Zealand under the family reunification programme as her brother-in-law had come to the country before the war.
In New Zealand, Ahmed wanted to help refugee and migrant women, especially Somalian women who had children and were single mothers after losing their husbands in the war.

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“You’re the surgeon?”:All surprising is that pursuing surgery continues to be difficult for women

Overview

Dr. Qaali Hussein is a trauma accute-care surgeon practicing in Bradenton, Florida. She received her medical degree from University of Texas Medical Branch and has been in practice between 6-10 years.

I usually meet my patients for the first time in the worst condition possible.

They’re critically ill from either an injury or a general surgical emergency. As trauma and critical care surgeons, it is common for us to treat the underlying problem first, with either emergency consent or that of the family, and then meet our patients afterwards.

When patients recover and I finally introduce myself, they are usually puzzled and confused. They ask, just to confirm, “Who’s the surgeon, again?” I initially attributed this confusion to my gender as there is always less reluctance to call my male medical students, residents, and physician assistants doctors while I am more readily identified as the nurse. When the clarification is made as to who the physician is, the confusion persists. At this point, there’s usually a double take and the question turns into “You’re the surgeon?” with a sense of disbelief.

I’ve grappled with how to respond to this question for quite some time. I usually laugh and say, “I may look 17 but I’ve got a lot of gray hair under this scarf,” referring to my hijab. There’s really not that many gray hairs but it usually comforts my patients and we move on to discussing their care.

I, on the other hand, am not comforted by these frequent encounters. I don’t take offense to the question or the reaction of disbelief in the fact that a hijab-wearing Muslim woman can be a surgeon. I’m saddened that in 2018 the question, You’re a surgeon?, is still being asked. With women accounting for approximately 50% of medical school graduates, and with more women pursuing surgery, it should not be a surprise that women from diverse backgrounds can be surgeons as well. What is not at all surprising is that pursuing surgery continues to be difficult for women, especially when childbearing is considered.

With residency occurring in the most productive years of a woman’s life, the already difficult surgery residency becomes exponentially more challenging if you add in pregnancy. There is a negative stigma about pregnant female surgical trainees. This attitude is so pervasive that many women surgeons postpone childbearing and possibly put themselves and their children at risk for complications related to advanced maternal age. In addition, some women are even encouraged to quit surgery and pursue more “family friendly” specialties when they become pregnant. I almost did not pursue surgery because of these aspects of surgical culture. I was lucky to have met Dr. John Bawduniak, a surgery resident at the time, who advised me during the application process that residency is a finite amount of time and that I should pursue my true passion. Thanks to his sage advice, I changed from applying to a “family friendly” field to applying for my true passion, general surgery. Although I enjoyed the experience of learning to operate and care for surgical patients, I did not enjoy being told to quit surgery simply because I became a mother. I have always desired to have a large family and I did not want to give up that very personal dream because of my love for surgery. I wanted both!

So although unusual, I had five pregnancies and six kids during residency and fellowship. The response to my being pregnant as a fellow was no different than the response I was given as a pregnant intern. There’s a lot to be said when it is easier to overcome language and cultural barriers than it is to deal with the difficulties of being a pregnant surgery resident. I have certainly had other challenges as a hijab-wearing Muslim surgeon. I have been called a terrorist by a patient, been given multiple lectures on what the “true religion” is, and have had patients refuse my care because of my last name and my faith but I have also had great rapport with many more patients because of my hijab.

Overall, I don’t worry about my hijab being an issue for me as a surgeon. Do we need more diversity in surgery? Certainly, and there are many opportunities for us to improve on inclusion. What worries me is the treatment of women in surgery residencies and in practice where motherhood is considered a disqualifying event, hence discouraging more women from pursuing surgery and surgical subspecialties. The reality is, most of our patients don’t really care what we look like, where we come from, or whether we took maternity leave or not. What they need is a competent surgeon to take care of them in their most vulnerable state.

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UAE shuts Mogadishu hospital amid tension with Somali government

The United Arab Emirates (UAE) has suspended operations at a hospital it ran in Somalia's capital, Mogadishu, amid growing bilateral tensions. 

Somali officials seized bags of money containing almost $10m from a plane that arrived at Mogadishu from Abu Dhabi [File: Feisal Omar/Reuters]

 The Mogadishu-based Sheikh Zayed Hospital, which offered free treatment mainly to poor and displaced people, closed late on Monday, a security officer at the facility, who did not want to be named for fear of losing his job, told Al Jazeera.

Speaking to Goobjoog, a local radio station, hospital director Dr Salim Nurane said that staff "received orders to close the hospital for good.

"We receive between 200 and 300 patients a day, who get all services and medicine available in the hospital for free," Nurane added. 

On Monday, the UAE said it would end its military training mission in Somalia.

This came after reports said that Somali officials had stopped a plane from the Gulf country from leaving an airport in Somalia's Puntland region following the refusal of Emirati military instructors on board to hand over their luggage to be scanned and searched.
Sunday's incident came just days after Somalia's government seized several bags of money containing almost $10m in cash from a Royal Jet plane that arrived at Mogadishu Airport from Abu Dhabi.
Royal Jet is an airline based in Abu Dhabi, servicing the luxury market between the UAE and Europe.
Somali authorities said they were investigating where the money came from, where it was going and the individuals involved.

"The security forces noticed the suspicious bags and handed them over to the concerned departments," Somalia's security ministry said in a statement.

UAE's foreign ministry said in a statement late on Sunday that the incident earlier this month at the airport "flies in the face of diplomatic traditions".

Last month, Abu Dhabi agreed to train security forces in Somaliland - a region in northern Somalia seeking secession from the rest of the country. UAE also signed with Somaliland a 30-year concession to manage Berbera Port in the semi-autonomous region. It has also started building a military base in the port city.

Somalia dismissed the agreement between Abu Dhabi and the northern Somali region as "non-existent, null and void" and called on the United Nations to take action.
Speaking at the UN Security Council last month, Abukar Osman, Somalia's ambassador to the UN, said the agreement between Somaliland and the UAE to establish the base in Berbera is a "clear violation of international law".

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Dr. Habeeb: Raising the standard for mental health care in Somalia

Mogadishu - In 2005, Dr. Abdirahman Ali Awale – or Dr. ‘Habeeb’ as he is commonly known – was walking down a street in the Somali capital when he saw something which changed his life: the reaction of some local residents to a small group of girls suffering from mental illness.

I saw five young girls being chased and insulted on the streets of Mogadishu by a mob,” Dr. ‘Habeeb’ says. “That was when I realized that mental health was an issue of big concern in my community.

The cruel treatment meted out to the girls that day prompted the 58-year-old psychiatrist, from Shibis district in Mogadishu, to do something about it.
With the help of supporters, he opened the Habeeb Mental Health Hospital in 2005, specializing in the treatment of mental illness and personality disorders – and one of Somalia’s first such establishments since the start of the civil war in 1991. He admitted 30 patients soon after opening.

Since then, Dr. ‘Habeeb’s’ medical practice and services have grown, expanding beyond Mogadishu. He now runs ten other psychiatric centres throughout the country, in Buhoodle, Caabudwaaq, Gaalkayo, Cadaado, Belet Weyne, Marka, Beled Hawo and Kismaayo.
“Our branch in Beled Hawo, in the Gedo region is called the ‘Habeeb Triangle Mental Hospital,’ in reference to patients who are admitted from Somalia, Kenya and Ethiopia,” he says. “Patients with a history of drug and substance abuse are also brought in from the United States.”
The facilities provide outpatient consultation, and most inpatient cases are treated for bipolar disorders, schizophrenia, anxiety, depression, dementia, epilepsy, psychosis and conditions associated with substance abuse, among others.

Asides from the centres, Dr. ‘Habeeb’ also makes house calls, providing treatment for patients at home and in their communities.

“Mental health is sometimes symptomatic of problems a patient may be experiencing at a certain time. Sometimes, the patients just need treatment of the underlying issues causing them mental anguish,” he notes.

High incidence of mental illness following war

The state of mental health in Somalia has been on the back burner of health priorities for decades. Mental health disorders peaked in the Horn of Africa country during its civil war in the 1990s, but after the war ended there were limited resources to deal with them.

According to an analysis by the UN World Health Organization (WHO) carried out in 2010, it was estimated that the prevalence of such disorders was higher in Somalia than in other low-income and war-torn countries, with one person out of three affected by some kind of mental illness. Causes for this included overall insecurity, war trauma, poverty, unemployment and substance abuse. It also found that mental health had been an underfunded and neglected sector in Somalia due to poor allocation of resources by the donor community as well as by public health local authorities.

As in many other countries, mental illness in Somalia is associated with a strong social stigma, which means that many patients continue to suffer neglect and forced confinement inside their homes and other institutions. Keeping mentally ill people in chains and shackles has been an all too common practice.
“Unless we stop the stigma associated with mental health issues, we will not be able to properly treat and care for these patients,” Dr. ‘Habeeb’ says.
The psychiatrist believes that Somalia’s mental health burden can only be reduced with proper treatment and medical care of patients, as well as changing people’s perceptions of psychiatric illness.

“There is a need to integrate mental health care within the mainstream health and social education services to aptly respond to this health burden,” he says.

To that end, the physician has endeavoured to raise awareness of mental health issues through advocacy campaigns across the country.

“I used to go to 16 secondary schools and give one-hour lectures on mental health, explaining that mental disorders are not unique to Somalia and that they are curable,” he notes.

His outreach activities in schools expanded to include the training of select students in mental health treatment to help with free medical camps for sufferers of mental illness.

In recent years, the UN has provided support in various ways. This includes the provision of training for mental health professionals, as well as initiatives such as the WHO’s ‘Chain Free Initiative,’ which aims to restore the rights and dignity of mentally-ill persons by advocating for chain-free hospitals, chain-free homes and a chain-free environment that offer an improved quality of life.

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On World Health Day, African Nations from East to West Struggle to Improve Basic Health Care

Internally displaced women at a distribution point at Salama IDP Camp in Galkayo, Somalia (drought-hit Mudug region). September 10, 2017. Photo by Faaris Adam and used with permission.

As the World Health Organization (WHO) marked its 70th year anniversary on Saturday, April 7, 2018 with World Health Day, African nations continue to struggle to improve basic health care, often facing serious health crises that hardly make the headlines.
Poor basic health conditions within nations like Somalia in East Africa and Nigeria in West Africa contradict WHO's core founding principles:

The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

Somalia's mental health crisis on the rise

Due to the long term trauma of civil war in Somalia, mental health is a massive problem compounded by the lack of public health facilities to deal with psychiatric illness. Somalia holds one of the world’s highest rates for mental health issues, with approximately one in three Somalis suffering from some form of mental illness, according to a WHO report.
Those with mental illness face extreme social stigma such as intentional isolation, restraint, and imprisonment because society fears they may hurt people or themselves.
Says Warsame, a pastoralist who lives in the rural area of the Mudug Region:

[a] 42-year-old took his sister to the clinic to find a treatment after being ill for years, Safiya had been ill for two years, and I decided to take her to the patient care center in Galkayo.

There are very few facilities available to treat people with mental illness throughout the country and the condition of these centers is grossly inadequate, often being too small for patients to get enough medicine.
Ahmed Bali, a psychiatric nurse at Galkayo Mental Health Central, the only center in Galkayo to care for people with mental illness, explains:

This center is public and is built by the community, and patients are all women and not charged for the services that we provide including accommodation and foods but the patients’ medicines are purchased.

Bali adds that in Somali culture, people with mental illness are called “Ninka Waalan” (Mad Man in Somali) and children often throw stones and insults as well.

Nigeria's youth suffer from drug addiction and a doctor shortage

According to recent reports, Nigeria in West Africa currently faces two serious health challenges: the menace of drug abuse and the brain drain of health professionals to Western countries.
Nigerians have seen a significant rise in drug dependency, especially among youth. According to Nigerian scholar Umar Lawal Yusuf and his colleagues, drug abuse is:

a disorder that is characterized by a destructive pattern of using a substance that leads to significant problems or distress. Teens are increasingly engaging in prescription drug abuse, particularly narcotics (which are prescribed to relieve severe pain), and stimulant medications, which treat conditions like attention deficit disorder and narcolepsy. Drug abuse or drug dependence (as preferred by the world health organization), is defined as ‘a state of psychic or physical dependence, or both on a drug, following administration of the drug on a periodic or continuous basis.’

Research shows that the drug abuse varies but that the most common ones mentioned in Yusuf's study are: alcohol (illicit gin or beer), cocaine, nicotine, phencyclidine (commonly referred to as PCP), and sedatives or anxiety drugs.
In addition, some Nigerian youths have also taken to the abuse of prescription drugs:

Everyday, over a 500,000 bottles of codeine are consumed by young Nigerians across the country, same with the intake of tramadol, rohypnol, marijuana, and other opioids, an alarming trend that has subtly eaten deeply into the Nigerian fabric with children of all classes having a field day abusing these drugs. But parents, stakeholders and the society continue to live in self-denial as a time bomb waits to explode.

Recent reports reveal that “over three million bottles of codeine syrup were consumed daily in Kano and Jigawa states” in northern Nigeria.
This Facebook video released by Tony Rapu shows some Nigerian men injecting heroin into their bodies in Lagos, Nigeria [warning: graphic video]. Nigeria youth are even “mixing methylated spirit and [Coca-Cola] coke to get high”:

Mixing this spirit with coke might douse the bad taste but it doesn’t change the fact that in a bid to get high, young people are slowly doing irreparable damage to their own bodies. Drug abuse has now become a hydra-headed monster. As appealing as the idea of placing stringent rules on the sale of drugs may seem, it is too obvious that it does nothing to solve the problem.

God please what's happening to this generation? pic.twitter.com/rkrv6BeWN7

— Adekeye . E. Tosin (@cutekimani) February 2, 2018

But drug abuse alone isn't the problem — there are so few doctors to cure them. The Medical and Dental Council of Nigeria is empowered to register doctors, but the exact number of doctors practicing in Nigeria remains a mystery.
Some reports claim “about 80,000 doctors and dentists in Nigeria including foreign trained personnel” registered in Nigeria.
However:

out of these 80,000, there are some people who are dead, some have left the country, some no longer working as doctors and some have stopped renewing their practicing licences. Some of the older doctors have been given a ‘life time practicing certificate.’

To make matters worse, many Nigerian doctors are heading to the United Kingdom or the United States for better work opportunities. As of 2015, Nigeria faces a major shortage of qualified doctors according to WHO's recommended doctor/patient ratio:

The World health Organisation (WHO) standard ratio is one doctor to a community of about 600 people while the nurses ratio stood at one nurse to four patients and one environmental officer to 8,000 people.

Folashade Ogunsola, a professor with the Association of Colleges of Medicine of Nigeria estimates:

We will need about 237,000 medical doctors and we have about 35,000 working in the country today.

A survey entitled Emigration of Nigerian Medical Doctors, conducted by NOIPolls and Nigeria Health Watch, questioned 705 doctors residing in the country and abroad as well as 26 medical doctors who participated in in-depth interviews.
Some key findings were alarming:

A large proportion (83 percent) of doctors who filled the survey and are based abroad are licensed in Nigeria, indicating that they had completed their medical education in Nigeria before departing beyond the shores of Nigeria.
All respondents (100 percent) to the survey know medical doctors who presently reside in Nigeria, who are currently seeking work opportunities abroad. Furthermore, about one in two (48 percent) have between five to 15 friends and colleagues working in the medical profession who moved out of the country within the last two years.
Almost nine in 10 respondents (88 percent) disclosed they are seeking work opportunities abroad. Most respondents cited high taxes and deductions from salary (98 percent), low work satisfaction (92 percent), and poor salaries and emoluments (91 percent) as challenges doctors face that make them consider moving abroad.
The United Kingdom and the United States are the top destinations where Nigerian medical doctors seek work opportunities.
Improved remuneration (18 percent), upgrade all hospital facilities and equipment (16 percent), increase healthcare funding (13 percent), and improve working conditions of health workers were the top suggestions respondents proffered in mitigating the challenges doctors are facing.

Akinola Olabisi, a doctor who recently emigrated to the United Kingdom, explains why he left Nigeria:

I considered the working conditions in Nigerian hospital where I initially worked as unsuitable. I had to cope with hectic working conditions made more difficult by the lack of basic hospital equipment, hostile working atmosphere, and measly salaries that were unpaid for several months. I was also not particularly motivated by the oppressive style of medical mentoring in many postgraduate training institutions. I do not intend to come back to settle in Nigeria.  Poor remuneration tops the list of my reasons for leaving. The vast majority of Nigerian doctors earn so little compared to their counterparts in other African countries. It is shameful to hear what some doctors are paid, especially in the private hospitals. Also, hospitals are unacceptably short-staffed and the available hands are severely overworked. This undoubtedly takes its toll on productivity and quality of health care.

Whether it's psychiatric illness and stigmatization in Somalia, the rising epidemic of drug abuse of Nigerian youth or the exodus of Nigerian doctors to the West, the state of health across the continent remains precarious.

Written byFaaris Adam

Written byNwachukwu Egbunike

 

Source:  Global Voices

Somaliland herbal cosmetics firm shows the way for entrepreneurs

Riyan Organic Cosmetics is doing a roaring business in natural skin and hair care products, made from local plants and herbs in Somaliland.
The business’s owner and founder, Muna Magan, graduated in science and nutrition from Westminster University in UK in 2014 and returned to Hargeisa to set up her dream company in 2016.

Mid ka mid ah kareemada ay soo saarto Muno/Ilyaas Cabdi/Ergo

Muna grows her own organic plants and herbs, such as aloe vera and Moringa trees, at her farm in Haro-hadley village, 50 km north of Hargeisa. She has a workforce of 19 people, including 13 women, with jobs ranging from planting to manufacturing to sales and marketing. The jobs pay between $60 and $200.
One of her aims in setting up business was to provide opportunity for local women.

“My main aim is not making a profit but showing women that they can make an independent living,” Muno said.

“I hope to export these Somali products abroad so we can compete with the rest of the world.”

She makes around 50 products a week that sell locally in a very short time.
Dr Nuh Botan, who works in Hargeisa hospital, is involved in researching and testing the products to ensure they do not harm the skin or general health of people. He said:

 they are much safer than imported products, and they have found that some have healing and health promoting properties.

Young people form the largest consumer base for Riyan Organic products. Ahmed Abdirahman has been using oil made from the local Moringa tree for five months. He told Radio Ergo his hair had become much healthier.

The ministry of commerce in Somaliland encourages young entrepreneurs to come up with business ideas, and offer support for business start ups.  Osman Ahmed Ali, a ministry official, said agri-business holds a lot of economic potential.

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EU donates €3 million euro to drought-ridden Somalia

The European Union, through the European Commission’s Civil Protection and Humanitarian Aid department, on Wednesday announced it has provided €3 million toward UNICEF’s humanitarian response for children and women caught in Somalia’s prolonged drought.After several failed rainy seasons and a massive loss of crops, livestock and livelihoods, on 2 February 2017, a pre-famine alert was issued for Somalia by the UN humanitarian coordinator.

With early, scaled-up response led by the authorities and supported by the international community, famine was successfully averted.
However, some 5.4 million people continue to require humanitarian assistance, including 2.8 million children.
The crisis triggered measles and cholera outbreaks, affecting 20,000 and 78,000 people, respectively, the majority of them children.
Over three million children, out of a total of 4.9 million, were out of school by the end of the year, and gender-based violence against women and children has been on the rise.

The new grant enables UNICEF to provide lifesaving treatment for children suffering from severe acute malnutrition, procure emergency water, sanitation and hygiene (WASH) supplies to help communities prevent disease outbreaks.
The donation will also assist children and women affected by gender-based violence and unaccompanied and separated children and ensure children displaced by drought have safe and protected learning spaces to continue their education.
 
In 2017, EU humanitarian funding enabled UNICEF to reach some 43,000 children suffering from severe acute malnutrition with lifesaving treatment, and 11,000 patients, most of them children, with treatment for acute watery diarrhoea/cholera.

“The EU and its humanitarian partners contributed to preventing famine in 2017, thousands of Somali children were spared a senseless death,” Christos Stylianides, the European Union’s Commissioner for Humanitarian Aid and Crisis Management said in a statement issued in Nairobi.

“But it is clear that many Somali families are still very fragile due to relentless succession of droughts and displacement. Through our renewed partnership with UNICEF, the EU remains committed to helping the children and women most impacted by these crises,” he added.

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