Saving Somali children from vaccine-preventable diseases

8 December 2019 – The first phase of a nationwide integrated polio and measles vaccination campaign has concluded in Somalia having achieved high coverage. WHO in collaboration with the Federal Ministry of Health and UNICEF launched the first phase of the campaign from 24 to 28 November 2019, targeting more than 1.7 million children under the age of five for polio vaccination and more than 1.5 million children aged six to 59 months for measles vaccination and vitamin A supplementation. This is the first time that an integrated campaign such as this has happened in Somalia. Vaccinators went from door to door to reach every child with life-saving vaccines, leaving no one behind.

The campaign was particularly focused on children in districts with high concentrations of internally displaced persons and nomadic communities due to the need to improve routine immunization coverage among these populations and reach those missed during routine immunization programmes. These population groups often have higher mobility and are therefore at increased risk for transmission of these diseases.

More than 17 000 skilled community vaccinators, frontline health workers and social mobilizers took part in the campaign. At the end of it, a total of 751,811 children had received polio vaccine (84% of the target), 671,381 had received the measles vaccine (82% of the target), 481,332 (66% of the target) had received deworming tablets and 666,182 children (82% of the target) had received vitamin A capsules. A total of 20,000 children also received their first dose (zero dose) of vaccine. The remaining unvaccinated children of the 1.7 million targeted for polio vaccination and the more than 1.5 million targeted for the measles vaccine will be reached during the second phase of the campaign in December.

During the campaign, staff from the Federal Ministry of Health, WHO, UNICEF and nongovernmental partners were deployed in different districts to monitor the campaign. All had been trained prior to the campaign on supportive supervision, conducting parent surveys and making rapid convenience assessments.

As part of campaign monitoring, 1656 households were visited and 5042 children (under the age of 5) were assessed for both polio and measles vaccination through a three-way verification process: recall, fingermark and presence of vaccination card. Social mobilization prior to the campaign demonstrated high success, with 980 mothers surveyed at vaccination sites during the campaign reporting bringing 95% of their children to the sites and 92% were aware of the campaign before it started. Only 79 fever and rash cases amongst the vaccinated children were reported by the mothers during the survey. No other adverse event following immunization were reported during the campaign.

Every year over 170,000 Somali children miss out on life-saving vaccines. This means that one in every 10 children do not receive life-saving vaccines. Unacceptably, it is often those most at risk – the poorest, the most marginalized, and those affected by conflict or forced from their homes – who are persistently missed.

Integrated vaccination campaigns are important for increasing immunity among children and avoiding the devastating consequences of these entirely preventable diseases on individuals, families, the local economy and health security in the Region.

The nationwide integrated campaign for measles and polio vaccination was funded by Gavi, the Vaccine Alliance. WHO thanks Gavi and other partners for supporting the routine immunization programme in Somalia.

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Cholera outbreak kills 7 people in SW Somalia

MOGADISHU, Dec. 4 (Xinhua) -- An outbreak of cholera has killed seven people in Somalia's southwestern region of Bakol, an official confirmed on Wednesday.

Abdullahi Mohamed Nur, deputy governor of Bakol region told journalists that acute watery diarrhea broke out in Bakol region causing the deaths.

"Cholera killed seven people, five of them are children while two others are adults," Nur said.

"No humanitarian aid has been delivered to the region, hence we appeal to the international aid agencies to provide urgent help to these local victims," he added.

Medical sources told Xinhua that many people admitted in local hospitals are suffering from diarrhea disease.

This comes amid outpour from Shabelle and Juba rivers, which caused casualties and damages in southern regions.

More than 300,000 people have since been displaced from their homes following floods which have hit major parts of the country.

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Somali police officer speaks out about living with HIV/AIDS

Bashir Osman Awad says he wants to break down the stigma surrounding HIV/AIDS/Yussuf Shire/Ergo

(ERGO) – Bashir Osman Awad is a Somali policeman heading a police station in Garowe, Puntland.  He has come out publicly to share his status as a person living with HIV/AIDS.  Bashir was recently promoted from captain to major and is leading a campaign to get Somalis to open up and break the stigma around the virus.

Radio Ergo’s local reporter in Garowe spoke to Bashir about the challenges he has faced in his personal life and how he has overcome them. 

Bashir: My life is good; I feel no pain. Since I started using anti-retroviral drugs I am OK, I am just like any other person. The only disturbing thing is the stigma. When people hear the word HIV/AIDS, they start running. The only burden is the stigma within the society. That is why I came forward to start an awareness campaign. I speak on TV stations. I am doing this because of what I have experienced.

Ergo: What have you had to endure since you first came out publicly?

Bashir: The first time, when I was diagnosed with the virus, some of the junior police officers at the station avoided greeting me. It was unfortunate to see my police officers ignoring me.  At that time, anything said to me hurt me because the condition was new to me.  Since that time, however, I am not disturbed by anything.  I share my problem openly with the country and the world. I want to talk to Somali speakers and anyone else who can understand me. I will continue this campaign. I witnessed an incident where [the body of] a person who had died of AIDS was washed with water and a broom. I have also seen someone rejected by his relatives who denied that he was theirs.  The most concerning thing is that when someone gets infected with the virus they lose all hope in life. To me, I believe that if the person trusts God, nothing will go wrong.

Ergo: How did you become infected with HIV?

Bashir: I got married in August 2016 and three months after my marriage, I felt symptoms of heartburn, fever and vomiting.  By the fourth month of our marriage I became weak. The woman apparently knew her [positive] status and was taking anti-retrovirals. I saw her taking the drugs but didn’t know what they were at the time. When I asked her, she told me they were antihistamines.  Actually I thought she was using the drugs to avoid pregnancy, so I waited to find out more information about the drugs she was taking.  Later, she started going out frequently and we started to argue.  One night she took everything in the house except my bag. In the morning, I came home with a friend of mine for breakfast to find an empty house with only my bag inside. I called her to ask why she moved out.  She told me ‘you will die, you are poisoned and you don’t even know’, and then hung up on me.

Ergo: Were there any issues between your family and hers?

Bashir: No, we had no issues. She was not from this region, but from another region in Somalia that I won’t mention. I am not giving this interview to get money, but to inform Somali people so that those getting married get more information about their partner and to tell those living with the virus to be responsible and not infect others.

Ergo: What happened after that?

Bashir: My friend suggested that she [my wife] might be HIV positive.  I became suspicious about my symptoms. So I went to the hospital. I did not know there was an HIV testing centre. I told them I had come as a blood donor and paid one dollar for the service. Then inside the room I told the doctor I hadn’t really come to give blood but wanted to get tested. The doctor carried out the test. I wasn’t given the results immediately but when I went to ask I was told the test was positive.

Ergo: How did you feel at that point?

Bashir: I was OK, I felt afraid during the pre-test counselling but once I was told I was positive I just accepted and became calm.

Ergo: What did you do then?

Bashir: People who test positive are asked to come with a relative to support them, so I called a cousin. I also have another wife and asked her to come to the centre for testing. She tested negative. She stood by my side and calmed me.

Ergo: How do you raise awareness about HIV/AIDS?

Bashir: First and foremost, I speak on the media. I started doing this recently and I will continue. My mission is to keep campaigning because I have seen that there is a problem. The problem in Somalia is that there are an estimated 11,700 people living with the condition. That is just an estimate, not the real figure.  But there are only just over 3,000 who have sought treatment. My worry is what will happen in Somalia if people don’t act on this.

Source: Radio Ergo 

Stigma impedes HIV treatment in Somalia

Promiscuity is associated with HIV/AIDS in conservative Somali society, and many hide their conditions.

Mogadishu, Somalia - In a small dark room in Mogadishu's Banaadir Hospital, a group of patients sits quietly on wooden chairs waiting to collect their monthly medication ration.

They're all HIV positive. The medicine they are given is anti-retroviral (ARV) drugs.

The female patients wear a face veil while the men cover their mouths with scarves and mostly look down, dodging eye contact. They all avoid answering their phones when at the hospital, as they don't want someone in the room or nearby to recognise their voices.

In Somalia having AIDS or being HIV positive means doing everything in one's power to stay invisible. The identity of HIV/AIDS patients at Banaadir Hospital is kept secret. Nurses call the patients using identity numbers instead of names.

A father of five children, Abdirahman - whose surname was not used to protect his identity - said he contracted HIV from his previous wife who passed away in 2001. He has good reason for wanting to stay anonymous.

"I was naïve and told my neighbours I'm HIV positive when I was first diagnosed, expecting they will sympathise with me," said Abdirahman, shaking his head in regret.

Hours later, all my neighbours moved out and my children were kicked out from the local school because their father is HIV positive.

Soft-spoken with a greying goatee, Abdirahman, 43, looks older than his age. He found out he had the virus after going to the hospital for tuberculosis treatment.

Sitting opposite him is 25-year-old mother-of-five Rahma. She contracted HIV when dentists at her local clinic used unsterilised equipment to remove a bad tooth. She was diagnosed HIV-positive 11 months ago and is still coming to terms with her condition.

I'm still in shock of why this happened to me and why they did this to me," Rahma said, tears filling her eyes. "I only told my husband and we agreed we won't tell no one else, even our parents. If we tell our families they will abandon us and our children.

Aggresive awareness campaign

Somalia's health system has been destroyed by the civil war that's raged for more than 20 years. The capital Mogadishu has many hospitals - both private and those funded by international organisations - but until recently none offered free treatment to HIV-positive patients.

Patients in Mogadishu used to go to Merca, a town more than 90 kilometres away, to seek treatment. Most couldn't afford the fares for the journey. Recently a local organisation, South Central Relief Network (SCRN), opened its first office in Mogadishu's Banadir Hospital to cater specifically to HIV/AIDs patients. Currently it provides free treatment to 132 patients who are HIV positive.

"The number of people with HIV in Somalia is increasing," said Mohamed Siad, head counselor at SCRN. "We now receive between five to seven new patients a day. They are referred to us from the hospital."

The exact number of people living with HIV/AIDS in Somalia is unknown.

According to the Somali government, one percent of the country's estimated nine million population is HIV positive. In 2011, UNAIDS estimated the number of people living with HIV in Somalia to be 35,000.

The number of patients coming to SCRN in their Mogadishu clinic is increasing, thanks in part to an aggressive awareness campaign.

"We are a private hospital and to treat HIV positive or AIDS patients will be economic suicide". -Dr Abdulkadir Sheikh, Hanano Hospital, Mogadishu

"We have placed advertisements on TV and local FM radio stations to raise awareness, to tell people they don't have to suffer in silence," said Mohamed, who himself is HIV positive.

But the awareness campaign is not without its challenges.

"Some TV channels and radio stations refused to accept our ads for fear of been stigmatised," said Mohamed.

Most of those coming to the HIV/AIDS clinic in Mogadishu are too poor to buy the medication elsewhere.

Those who can afford to travel abroad for treatment usually do so, in order to keep their condition private.

"People come to us to do blood tests. They then call to ask for the result," explained Omar Abdi of the Fathu Rahma Laboratory and Pharmacy. "If they're positive they never come back but go to Kenya for treatment."

Private hospitals and pharmacies in Mogadishu avoid stocking HIV/AIDs medication.

"We are a private hospital and if those patients not suffering from HIV or AIDS found out we treat people with AIDS or HIV in our hospital, they will all discharge themselves and we won't have any patients and we won't have any business after that," said Dr Abdulkadir Sheikh of Hanano Hospital.

"We are a private hospital and to treat HIV positive or AIDs patients will be economic suicide."

Stigma of AIDS

In Somalia, HIV/AIDS is associated with promiscuity and in conservative Muslim society, it's proving difficult to convince many to come out and seek treatment.

"Because of our religion and people wanting to protect their family name, no one wants to have the community thinking they go around sleeping with everyone, especially prostitutes," Mohamed said.

The new internationally recognised government, which took office in September last year, has encouraged patients to get treatment despite the social stigma attached.

"We offer training to hospital staff, we also do the same for the community to increase their knowledge of HIV/AIDS," said Sadia Abdisamad, HIV/AIDs National Program Manager at the department of health.

"We have put billboards in the city, placed ads on radios. Our focus is to increase awareness to try and stop the spread of the disease, and to make people come out and seek treatment without fear of been stigmatised," she said.

Despite such attempts by the government and local organisations, it may be a long time before the stigma and fear associated with HIV/AIDs in Somalia is overcome.

"Somalis are more scared of HIV than bombs, so fearful they will not accept to be in the same building as someone with HIV," said Abdirahman.

Now, all he wants is to be left alone in peace to look after his five children. "I'm very weak and in the final years of my life, I want to be left alone to raise my kids without harassment," he said.

Re-published: This article was printed in September 29, 2013 by Aljazeera.com 

2019 top Holiday Impact Prize Kristof goes to support the lifesaving hospital of Edna Adan

’Tis the season for giving, when those of us in the rich world hand each other overpriced scarves that no one much wants.

So every fall I offer an alternative holiday gift guide with suggestions for “gifts with meaning” that save or change lives. This year’s recommendations come with something extra: A reader has pledged $1 million so that for each of the next 10 years, a charity I find most worthy will receive $100,000. In addition, $50,000 will be split among three runners-up, thanks to a few other large donations. And judging from the past, readers will send in many more donations to these groups. We’ve made that easier through a new website.

Ms. Adan, right, conducting an informal clinic with her midwives and trainees in the village of Habaswayn, in Somaliland.Credit...Lynsey Addario/Getty Images

This year’s top prize goes to support the lifesaving hospital of Edna Adan, a Somali midwife who fights for women’s health, trains doctors and empowers women in her native Somaliland. I’ve seen her work on the ground in two visits to Somaliland, and I’m awed by what she does.

Edna scandalized Somaliland by learning to read at a time when girls were barred from even elementary school there. She later studied in Britain, became a nurse midwife, enjoyed a highflying career with the World Health Organization — and then used her savings to build a maternity hospital that opened in Somaliland in 2002.

Then she started a university and medical school that is training a new generation of Somali doctors and medical workers, 70 percent of them female. Edna sent me a photo this year of an all-female surgical team: a woman surgeon, a woman nurse and a woman anesthetist. It’s breathtaking to see in a country that once barred girls from getting any education.

Edna draws no pay from her hospital; instead, she subsidizes it with her United Nations pension. Somaliland remains one of the world’s most difficult places to be born female and has one of the world’s highest rates of maternal mortality.

“It makes you so angry,” she said, recounting the case of a woman who arrived at the hospital unconscious with a retained placenta. Because the husband was traveling and couldn’t authorize her to leave the house, the family waited five days to seek medical attention. “So she died,” Edna said. “She became a statistic.”

Edna is working to empower women in every way she can. After she cared for a disabled woman who had been raped by a taxi driver, Edna pushed for a law against rape. Previously, rape victims were typically forced to marry the rapist, or compensation money was paid between the families, with the rapist getting off scot-free. With Edna’s help, Somaliland this year adopted a law that punishes rape with up to 31 years in prison.

Almost all Somali girls are subjected to an extreme form of genital mutilation: All the genitals are cut away, and the raw flesh is sewn shut with wild thorns, leaving a tiny opening for urine and menstruation. After marriage, the flesh is cut open.

Edna herself was held down and cut when she was 8 years old, and she has been campaigning against the practice since 1976; initially, this got her arrested. But she has made progress, and this year the Somaliland Ministry of Religious Affairs issued a fatwa condemning this extreme form of genital cutting.

So, readers, consider a gift to the Edna Adan University Hospital — and help save a woman’s life.

With the $100,000 prize money that comes with this column, along with what more readers contribute, the hospital plans to buy a machine to produce oxygen — an essential that every hospital needs for babies and adults struggling to breathe. Edna also hopes to start a lab to examine biopsies and Pap smears for cervical cancer, and to train staff members to operate it. There is now no place in the country to read Paps, and biopsies are given to someone flying to Ethiopia to hand-carry to a hospital there.

If your holiday giving preferences run elsewhere, the three runners-up will also make excellent use of your contributions. So consider these causes:

FIGHT CERVICAL CANCER. This is a disease that kills more women worldwide than childbirth yet gets much less attention. Cervical cancer is also a painful and humiliating way to die: It is sometimes diagnosed partly by the stench from rotting flesh. What’s more, cervical cancer is relatively cheap and easy to prevent with HPV vaccination (less than $5 a shot in developing countries) or a screen-and-treat protocol for precancerous lesions.

I suggest the Maya Health Alliance in Guatemala, also known as Wuqu’ Kawoq, which works with indigenous Maya villagers. As individuals, we can’t change America’s harsh policy toward Guatemalan migrants, but we can help save the lives of Guatemalan women from cervical cancer. An American doctor, Kirsten Austad, donates her time at the Maya Health Alliance, making the organization’s work particularly cost-effective. Nobody need die in the 21st century of cervical cancer.

FIGHT WORMS AND BLINDNESS. If cervical cancer is a horrific and easily preventable disease for women, a counterpart that strikes men is a parasite-caused disease called elephantiasis. It swells up the scrotum to such huge proportions that men must use wheelbarrows to carry their private parts. It also causes monstrous swelling of the feet of men and women alike so that they look like elephant legs, hence its name.

This disease survives only because the people who suffer these horrors are impoverished. The End Fund is working mightily to eradicate elephantiasis and other “neglected tropical diseases,” including river blindness and trachoma, both excruciatingly painful causes of blindness. They, too, have cheap and simple solutions.

The End Fund also targets intestinal worms, which prey on hundreds of millions of children in poor countries. We deworm our pets in America, but poor children can’t get dewormed even though the cost is less than 50 cents per child; it’s one of the highest-return investments available.

HELP CHILDREN LEARN TO READ. The earlier organizations help needy people half a world away, but Reach Out and Read supports disadvantaged preschoolers right here in the United States. It coaches parents on the importance of reading to their children every evening and gives away children’s books, often to homes without a single kid’s book.

Reach Out and Read is astonishingly cost-effective — about $20 per child per year — because it piggybacks on pediatricians who donate their time. The idea is that pediatricians should not only prescribe antibiotics for ear infections, but also prescribe reading to set up the child for a better future.

So the organization distributes children’s books to the doctors, who hand them out to low-income families with instructions about how to read to a child. If the parent is illiterate, he or she is advised to turn the pages and tell a story using the pictures.

Parents want the best for their kids but sometimes weren’t read to themselves, don’t have a children’s book in the home and have no idea of the benefits of reading to a child. Randomized trials show that despite its low cost, Reach Out and Read has a big impact in getting kids ready so that they can shine in school.

Donations to all these organizations are tax-deductible for Americans. And, of course, there are many other organizations large and small that do outstanding work, too.

I focus in this giving guide on small organizations that readers probably haven’t heard of, but you can also give a flock of chicks to a needy family for $20 through Heifer International, support a refugee at Rescue.org or underwrite a girl’s education for $143 at CARE. Check out FocusingPhilanthropy.org, GlobalGiving.org and Givewell.org for other giving ideas backed by robust evidence.

NICHOLAS KRISTOF’S NEWSLETTER

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Somali-Swedish entrepreneur redefines the pharmaceutical market in Somalia

ElmiMedic in Hargeisa, Somaliland was founded by Rhoda Elmi, a member of the Somali diaspora in Sweden. ElmiMedic’s core business is focused on pharmaceuticals both prescribed and over the counter medicines, and health-related products. They have since then expanded their product range to include hygiene, beauty products and more.

    Founder of the ElmiMedics, at her main business outlet in Hargeisa.

Sometimes in 1982, Rhoda went to Sweden to reunite with her father who was living in Sweden. Conscious of the healthcare shortage in her home country, Rhoda pursued a Bachelor of Pharmaceutical Science in Gothenburg University where she successfully graduated. She then worked as a Manager in one of the pharmaceutical parastatals in Gothenburg where she gained a quite experience on pharmaceutical products.

Early 2013, Rhoda, a mother-of-one, returned to Hargeisa to visit her family along with her son. Its during her visit that Rhoda experienced firsthand problems faced by people living in Somalia regarding quality of medicine available in the country. Her son had stomach complications, so she took him to a health facility in Hargeisa. To her surprise, her son was prescribed with two medication – one of the medication was manufactured in Pakistan and have been banned by the European union. The second medicine was intended to cleanse the kidney and not the stomach. She felt a deep urge to do something about this problem.

In Africa and particularly in Somalia, its widely believed that people with low-income or even in hard-to-reach areas have health issues because they cannot access medical services on time. However Rhoda believes that there’s more than meet the eye in country where there’s no regulation and legislations on the pharmaceutical goods coming into the country. This has led to a market flooded with poor quality and counterfeit medicines, putting lives of people at risk.

I always had the dream of giving back to my community.  I started by looking at the types and quality of medicines in our shelves. They were cheap but poor quality and by far, below the international standard. I felt something urgent ought to be done

“I always had the dream of giving back to my community and I thought I could do this through my education. I started by looking at the types and quality of medicines in our shelves. They were cheap but poor quality and by far, below the international standard. Some of the products are no longer acceptable in European countries but our people here continue to be prescribed over. Such products have since aggravated conditions of people seeking medications. I felt something urgent ought to be done” says Rhoda.

Rhoda checks over her products in Hargeisa on Novermber 6, 2019.

Armed with only her vision, a strong determination and just about few thousands of dollars, she started ElmiMedic’s in Hargeisa, Somaliland’s biggest city in 2013. In very short period, ElmiMedic’s got a footing in the market, thanks to the quality of the products she shipped from Sweden. In 2018, Rhoda applied the Somali Swedish Business Programme (SSBP) which luckily considered her business and first injected about $20,000 to expand her business.

The funding from the SSBP programme enabled Rhoda to expand her business, thereby opening a branch in Jigjiga yar – a suburbs of Hargeisa which has large Somali diaspora community. Today, Rhoda’s business employed 9 full-time workers, 5 female and 4 male workers who support her in running her business. She supplies pharmaceutical good to neighboring towns of Borama, Burao and even to Somalia’s capital city Mogadishu. Tapping into the growing market for pharmaceutical products, Rhoda plans over the next few years, to spread her business across the country and in Jigjiga, a city in the Somali region of Ethiopia.

In an environment without quality control, reputation is of great essence to us. Over the past few year, my business have attracted thousands of customers and this is because of the quality of the product we brought in to the country. I want to thank Forum Syd and the donor for helping me realise my dreams. I am so grateful for the support and Its my hope that you continue supporting people with business ideas to flourish says Rhoda.

As a woman in a male dominated society, Rhoda’s success isn’t without hurdles which she faced heads on. The challenges faced by women who have embraced entrepreneurship are vast and often very different than those experienced by their male counterparts. There are few women-owned businesses in the country denying the right support network to lean for mentorship and support. There’s little microfinancing opportunity for female as most banks have stringent microfinancing requirement that favor men over women. Rhoda’s defied all social expectations and rose to become a hope to thousands of women and girls who look up to her as business role model.

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