A broken healthcare system has hampered Somalia’s efforts to cope with COVID-19

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UM Charles Regional Welcomes New Gastroenterologist

 

LA PLATA, Md. – Sagal Ali, MD, a physician with advanced training in internal medicine, digestive disorders, and liver diseases, is joining the University of Maryland Charles Regional Medical Group – Gastroenterology practice as the team of clinical providers continues to grow to meet the needs of the region’s patients.

Dr. Ali will work out of two convenient Southern Maryland offices located in La Plata and Waldorf, joining longtime provider Joseph R. Murphy, MD to offer increased availability for specialty gastroenterological services. She will also provide non-invasive medical procedures at the new Endoscopy Center located in the UM Charles Regional Medical Pavilion in La Plata near St. Charles Parkway, a fully-equipped facility offering leading-edge technology and comfortable accommodations for a wide variety of endoscopy procedures.

This is an exciting time for our gastroenterological team,” said UM Charles Regional Chief Medical Officer Joseph Moser, MD. “Dr. Ali is a great fit for the UM Charles Regional Medical Group - Gastroenterology practice and brings the experience needed to provide our local community with convenient care in the new Endoscopy Center.

Dr. Ali received her Doctor of Medicine degree from Morehouse School of Medicine in Atlanta after receiving her Bachelor of Science degrees in biology and psychology at Michigan State University. She completed an internal medicine residency at the University of Texas Southwestern and a digestive and liver disease fellowship at the University of Texas Southwestern Medical Center in Dallas. Dr. Ali is also a part of many national organizations, including the American College of Gastroenterology, the American College of Physicians, the Student National Medical Association, and the American Medical Association.

As a first-generation Somali American and black female physician, Dr. Ali said she believes it is important to have representation in medicine because “we are a reflection of our community.” Dr. Ali also values offering diversity of care, noting that in her training she “had the privilege of working with a wide variety of patients including the underserved and veterans.”

Dr. Ali will be providing digestive-related medical care for patients of all ages, including acute illness, chronic conditions, and routine checkups, with the goal of guiding each patient to better gastrointestinal health. “I understand that each patient is different and feel that treatment plans should be individualized to reflect that,” Dr. Ali said.

“We’re thrilled to have Dr. Ali’s expertise here in our community,” Dr. Moser said. “Now we can reach even more patients and help them overcome any digestive discomfort quickly and effectively.”

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Medic Traces Kind Nurse who Saved his Life 30 Years ago

 MOHAMMED JUMA MOHAMED, a nurse in the US, came back to Kenya last month in search of the woman who treated him 30 years ago after he was badly burned by a house fire in Somalia. He spoke to BONIFACE MANYALA.

The 1991 civil strife in Somalia will be remembered for a number of things, including the displacement of many Somali citizens, who ended up in various countries across the globe. For Mohamed Jama Mohamed, when Somalia burst into flames in February 1991, a house he was in also burst into flames ignited by petrol that was being kept there. The fire burnt his body and completely changed his life.

Mohamed, who at the time worked with the ministry of Agriculture in his country, was being accommodated at his friend’s house in Jubaland. The friend sold petrol from his premises. On the day of the incident, Mohamed and his friend were pouring gallons of petrol into buckets when someone unknowingly walked into the room with a lamp, which caused a huge fire that severely burned Mohamed in the face, back, hands and stomach. He suffered about 35 per burns on the body.

To access medication, Mohamed needed to travel to Kismayu, about 70 kilometres away. He was also facing the challenge of transportation. Because the country had erupted into civil war, sounds of gunfire being heard everywhere and transportation from one point to another was critically affected. To get to Kismayu, Mohamed hitched a ride on a pickup truck belonging to fighters.

“They placed me on the floor behind the truck where I was lying as the truck was speeding to Kismayu in the middle of the night. It was very cold and I could feel my paining body freeze... I cried hard, I was in pain, the only thing I wished for was to death,” Mohamed recalled.

When they arrived in Kismayu, they found the hospital packed with people who were running away from their homes trying to get a safe haven and a possible escape to neighbouring countries through the port of Kismayu. The entire hospital compound was filled with people but had no nurses or doctors on sight.

“I did not know anyone in Kismayu and the hospital had been converted into a refugee camp. There was no doctor, no nurses and no form of treatment going on. I was in pain and my face was swollen. Someone approached me and asked if I could consider using a skin pain reliever ordinarily used by veterinary personnel on animals. I used it for a couple of days,” Mohamed says.

“We continued to camp at the hospital for days as the war worsened until one day we were told to go board a ship at Kismayu that would transport us to Mombasa in Kenya,” he says.
They were over 800 people aboard the ship, which took seven days to reach Mombasa but it did not dock because of clearance issues that needed to be sorted with the Kenyan authorities.

They sat and waited in the ship for 10 days. When they were finally granted permission to dock, it had been 17 days of serious pain for Mohamed and still without treatment. In Mombasa, the refugees were taken to Majengo. That is where Mohamed tried to get medication.

He was helped by a well-wisher to travel to Nairobi from where he was eventually taken to Isiolo by a friend, who lived in Eastleigh to seek medication.

“I ended up in Isiolo for treatment finding a young nurse who looked shocked at the severity of my burns but promised to support me until I could get well,” Mohamed says.

Because he could neither speak English well nor speak a word in Kiswahili, the nurse took him to a ward with a television set so that he would not feel lonely in the course of his treatment. Mohamed remembers that every morning the nurse would bring him fruits, insisting they were important for his recovery. By then, he had undergone surgery and skin grafting. Three months later, Mohamed was informed that he was ready to be discharged.

“Because I did not have any relatives around, she took me to her house, made me tea and escorted me to the bus station,” says Mohamed.

A few months later, Mohamed was lucky to be repatriated to the United States by the United Nations High Commissioner for Refugees where he settled and went back to college to study as a surgical technician and nurse.
Mohamed, who is currently a nurse at the University of Minnesota Medical Centre, is married and has four children.

Last month, he visited Kenya after 30 years to look for Florence Lintari, the nurse who treated him in Isiolo.
With links in both the US and Kenya, he finally found Florence, who retired in 2020 and currently lives in Machakos town. Her final work station was at Machakos Level 5 Hospital.

“I am so happy to meet her again after 30 years. She didn’t even know where I went to after I left Isiolo, so I came back to look for her and thank her for treating me and saving my life. In fact, she inspired me to take up a course as a nurse so that I can help other people,” says Mohamed.

He has since established a medical charity, Health Extension, Promotion and Training Organisation (Hepto) with its head office in Minnesota, US and branches in Ethiopia and Somalia. He says Hepto Kenya office will open its doors soon and Florence will be instrumental in its administration. 

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Inside Somalia-Turkey health relations

 The downfall of Somalia's military government in 1991 led to a series of crises for the Somali people in terms of security, the economy, and social services overseen by decaying government institutions and administrations. In the aftermath of national disasters and post-traumatic ripple effects, the situation is improving at a slow pace, although there is still much room for improvement and a long way to go.

Officials cut a ribbon during a ceremony to mark 10 years of Turkish and Somali relations, in Mogadishu, Somalia, Aug. 19, 2021. (AA Photo)

In modern and federal Somalia, the health system and social care are at the heart of the pressing issues of maternal and child deaths, substance abuse, increasing cancer rates and urbanization of the health sector.

The international community provided funds so Somalia can better provide services and develop but no significant progress was made in reconstructing and restructuring the Somali health care system.

Instead, widespread bureaucratic discretion and disorganization at various levels surrounded the health sector. In 2011, Turkey launched a new win-win-based approach to Somalia, after two decades of roadblocks and a health system in turmoil.

10 years of strategy

Today marks 10 years since Turkey's arrival in Somalia. In addition to lending its strategic vision, Turkey played an iconic role in providing services, massively so in the health sector through four categorical road maps.

The first point is physical infrastructure. One undisputable, big example is the Mogadishu Somali Turkey Training and Research Hospital in Somalia's capital, honorably known as Recep Tayyip Erdoğan Hospital. The hospital was constructed by the Turkish International Cooperation and Development Agency (TIKA) to international standards and serves as the country's most affordable medical provider with a 200-bed capacity. The hospital is equipped with intensive care units for adults and children, incubators, operating and delivery rooms, as well as radiology and laboratory units. Additionally, it serves as a center for scientific medical research and training for students and health professionals.

This brings us to Yardimeli Hospital run by the Turkish nongovernmental organization (NGO) Yardımeli Association. Active in the African region, the association's slogan is: “No more child mortality, no more death for mothers." Maternal and child mortalities are one of the biggest disappointments stemming from Somalia's health system. In this regard, Yardımeli Hospital became part of the solution by improving access to maternal and child health services.

Turkey's second point was to empower the health workforce. Somalia's workforce is urbanized and badly fragmented at both the national and regional levels, with a lack of qualified people to make up the health sector. With the vision of filling this gap, the Somalia-Turkey Research and Training Hospital began licensing doctors after they completed medical training and examinations under the guidance and protocols of the Turkish Ministry of Health.

These institutions have also contributed to the decrease in unemployment in the health sector. On an international note, Somali students studying health sciences are part of the Turkey Scholarships family, accelerated by the Presidency for Turks Abroad and Related Communities (YTB). The scholarship provides free education at all levels, accommodation, health insurance, and travel and living expenses.

Health as humanitarian relief

The third point focuses on health as humanitarian relief to respond to crises and human-made disasters prone to occur in Somalia, including outbreaks, droughts and terrorist attacks. Between July 2011 and mid-2012, a severe drought affected the entire East African region. Said to be "the worst in 60 years," the drought caused a severe food crisis across Somalia, Djibouti, Ethiopia and Kenya that impacted the lives of 9.5 million people.

During the drought, Turkey massively funded humanitarian relief and provided primary care services in drought-affected areas and communities. Furthermore, Turkey has been there when the country experienced its biggest bombings, when the biggest blast in Somalia's history occurred on Oct. 14, 2017, more than 30 critically ill patients were taken to Turkey and treated at hospitals in Ankara.

In 2020, Ankara shipped COVID-19 aid to Somalia’s capital Mogadishu to help combat the pandemic. A quote from Sufi philosopher Mevlana Jalaladdin Rumi was written on the boxes in both Somali and Turkish, reading: “There is hope after despair and many suns after darkness.”

The fourth point was health tourism. People seek medical treatment abroad for many reasons, some due to a lack of advanced health care being available, while for others – even in more developed nations – the necessary care remains out of budget. With most of its hospitals accredited by Joint Commission International, Turkey is a leading actor in the health tourism industry due to its highly advanced technology, affordable care, qualified doctors and approach to health policy.

Today many Somalis have traveled to Turkey for medical tourism since the signing of the contemporary agreements between Mogadishu and Ankara, whereas in the past most would seek medical treatment in India. While receiving treatment, these patients play an important role in Turkey's economic development and its Health Tourism Vision for 2023. This may also be a good example of a win-win deal between Somalia and Turkey.

Connecting the dots to reach the final point, health systems are contingently reshaped and improved through lesson-learning and experience-sharing between countries. A strategically and resourcefully sound country, Somalia can contextually and pragmatically emulate Turkey's example of radical health sector transformation while maintaining local contexts and dynamics when designing its health system.

This could initiate a new era for advanced relationships in health care, breaking from the status quo that health cooperation is limited to humanitarian and economic circumstances.

ABOUT THE AUTHOR

PhD candidate in Health Management, Ankara University

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