'I had an unforeseen obligation yesterday and was out in the countryside where there is not much mobile connectivity,’ says Edna Adan Ismail in an email, clarifying why she could not answer my call for an interview scheduled for the previous day. ‘But we can speak tomorrow,’ she promises.
The award-winning founder of the Edna Adan Maternity Hospital in Hargeisa, Somaliland, keeps her word. Answering the telephone call at the very first ring, the 82-year-old former first lady of Somaliland tells me she was busy the previous day on some issues for the hospital she set up back in 2002. ‘Anyway, here I am, but I have a flight to take in two hours,’ she says – a hint for me to dive straight into the questions.
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It would be an understatement to say that Edna, who will be attending the Emirates Airline Festival of Literature in Dubai next month, is a busy person. When not managing her hospital, the author of A Woman of Firsts, an autobiography, travels regularly across the world giving lectures on the importance of women’s health, education and empowerment while highlighting harmful cultural practices that are putting women’s lives and health at grave risk.
To that end, within Somaliland and in the region, she is known for her relentless – and pretty much lone – fight against the horrifying practice of female genital mutilation (FGM), a practice deeply rooted in the culture and superstitious beliefs of some countries in the region.
The World Health Organization details FGM as a procedure that intentionally alters or causes injury to the female genital organs for non-medical reasons. It typically involves the partial or total removal of the external genitalia of girls, very often conducted in extremely unhygienic conditions by practitioners who have little knowledge about anatomy or women’s health.
According to 2018 figures, more than 200 million girls and women alive today have undergone this procedure that can result in not just extreme pain and shock but severe bleeding, infections, cysts and complications in childbirth, not to mention grave health issues all through life.
The pain remains
Edna knows the excruciating pain women experience during an FGM only too well – her mother and grandmother conducted the procedure on her when she was barely eight years old.
‘FGM is the worst thing anyone can imagine,’ she says, the trauma of the memory still reverberating in her voice. ‘It’s impossible to truly describe the pain, the suffering and the shock one endures.
‘An old woman who knows nothing about human anatomy or physiology is cutting the most sensitive part of a woman’s body, an area that is packed with nerves and blood vessels, with a blunt, often rusted, blade without administering any form of anaesthesia.’
Nails or thorns are then used to crudely puncture the sensitive flesh before it is sutured even as the flailing, screaming girl is held down by a couple of elders. In Edna’s case, acacia thorns were used to lance her flesh.
‘It is horrific,’ says the nurse who qualified in midwifery from the UK, one of the first women from her country to study overseas. ‘It’s a pain you’ll never forget.’
Although in her 80s today, the memory of what happened when she was eight still makes her cringe, she says. ‘I still remember it. And I still hate it.’
Edna is silent for a few seconds, as though trying to forget the past. ‘The flesh would heal,’ she says softly, ‘but the pain and the memory of that day… that will never leave you.’
How serious is the problem of FGM in the African continent today? I ask.
‘A big problem. A very big problem,’ she says. ‘It is common in at least 16 countries. There may be other countries where the practice is on a smaller scale but in 16 countries, a large percentage of the female population have been subjected to, or still undergo, genital mutilation.’
Most of these countries fall in the equatorial belt in west and east Africa. ‘Plus, there is a percentage of women in Egypt who have undergone FGM. It is not practised in other north African countries until you get to Mauritania, Cameroon and Senegal. It affects all the Somali-speaking communities in the Horn of Africa – in Djibouti, Eritrea, Ethiopia, Somaliland, Somalia, Kenya and Tanzania.’
Some countries have banned or criminalised FGM, but the practice persists, with most procedures now being carried out by health professionals, according to a 2019 Reuters report.
The war against FGM
Edna started the fight against FGM in 1976 after returning from the UK following her studies there. ‘I’ve been fighting it with everything I have – education, counselling, seeking legislation to stop the practice.
‘But unfortunately, more than four decades later there has been only a very slight decline in the number of girls mutilated. The practice is deeply ingrained in the culture and tradition of these communities.’
Edna throws light upon a study she and her medical team conducted on 4,000 women who visited her hospital for prenatal care in 2002. A detailed physical examination of the women revealed that a shocking 98 per cent of the women had experienced some form of FGM while 99 per cent of them had the most severe form – classified as Type 3.
Although dejected that several years of campaigning had not been able to make a significant impact on the issue, Edna refused to give up, instead stepping up her fight. ‘We enhanced our education of community outreach programmes, spoke with religious leaders, imams of mosques, political leaders among others,’ she says.
In 2016 when they repeated the survey among 4,000 women, they discovered that women with Type 3 FGM had reduced to 76 per cent. ‘But sadly there was no difference in the numbers of those with Type 1 and Type 2 FGM. The practice is too deeply ingrained,’ she rues. ‘So when we talk about total abolition I think we are over-optimistic.’
Isn’t it shocking that it is women who are doing this to other women? I ask.
‘Yes, you are right,’ she says. ‘That’s why I’ve decided to tweak our campaign. I want fathers and grandfathers to get involved in this battle against FGM. To me, the reason women are doing this is because they think they are doing the right thing for their daughters. They think they are ‘purifying’ their daughters by making them undergo this ritual. But that is absolutely wrong.’
A six- or seven-year-old is the purest person created, she says. ‘There is no need to ‘purify’ her. She is innocent. Physically and emotionally she is as pure as she can be. According to practitioners, FGM is done to ‘preserve the virginity’ of a girl. But that is an absolute falsehood. The virginity of a girl is preserved by her moral upbringing.’
The octogenarian campaigner is keen to include fathers and grandfathers in the fight as they are considered the ‘head’ of the family and the ones likely to be more educated than the women folk.
‘The fathers should be the ones who will protect their daughters, protect their bodies… take a stand to prevent any damage happening to their little ones’ bodies. Fathers, grandfathers, imams and political leaders of these communities should take a firm stand on this,’ she exhorts.
Until now, FGM has been considered a woman’s issue and senior menfolk in the family were forced to stay out of it. ‘They have no say in what is done to the bodies of their little daughters,’ she says.
Edna herself is proof of that. Her mother and grandmother performed FGM on her when her father, Adan Ismail Guleed, a highly respected doctor in the country, was out of town.
Edna recalls how her father was horrified when he returned and saw the condition of his daughter. ‘It was the first and only time I saw tears in his eyes,’ she says.
‘My father was furious that it was done to me. That was proof to me that what was done was wrong... It should not be done to anybody.’
Being a child at the time, she was not aware of what she could do to address the problem. Brought up to believe that talking about genitals and private parts of the body is shameful and taboo, ‘I was told to keep my mouth shut’.
Pursuing health care
But even at a young age, Edna had pretty much made up her mind – to pursue a career in the field of medicine so that she could help improve the health and well-being of poor and illiterate women in her country.
And she was showing all signs that she was cut out for it: She would spend her free time in the small hospital where her father practised, running errands for him like rolling bandages, helping him wash instruments, holding the hands of patients while her father cleaned their wounds…
‘Even at that time my dream was to build a hospital. A hospital my father would have been proud to work in. A hospital that could help all the sick people in the area.’
But Edna was not just a dreamer; she was also a fighter – against systems and age-old rituals that went against the grain of her beliefs and logic.
One of Edna’s first fights as a young woman was against the patriarchal education system prevalent in Somalia at the time. Keen to get a good education and thanks to her father’s staunch backing, she went on to become the first Somali woman to study nursing in Britain. While there she also learnt to drive and when she returned to her country, became the first woman to possess a driving licence in Somalia.
There are more firsts to her credit: she became the first female director of Somalia’s Ministry of Health and would go on to become the first woman minister in the Somaliland government before she joined the United Nations.
During her time at the World Health Organization as a representative of Djibouti, she helped pass legislation outlawing FGM, spoke at a UN session, and met with former US president Bill Clinton and former UN secretary general Kofi Annan, among several other dignitaries on the issue.
On the personal front, she married Mohamed Haji Ibrahim Egal, who became prime minister of Somalia and later president of Somaliland. But during it all she continued to nurture her dream of building a hospital where the poor would be treated free of cost – a dream that would be realised after she retired from the WHO.
To raise the funds required, she pooled in her family’s money and cashed in her pension from the UN. ‘I also sold off all my jewellery and my Mercedes and a lot of my stuff… I thought, what would I do with a microwave oven and a washing machine in Somalia where there is no electricity for several hours in the day; what is the point of a Mercedes when there are no proper roads. Or mechanics. Or even fuel…’
Finding that money not sufficient, she added the honorariums universities paid her for her lectures – ‘I get around $17,000 a year for my lectures’ – and accepted donations from well wishers and Somali diaspora from across the world.
Financial help also came in from a foundation called Friends of Edna’s Hospital.
The next challenge was finding a plot of land. After much pleading with authorities she was given an abandoned garbage dump, and in 2002, at the age of 65, Edna realised her dream of constructing a hospital.
‘Building it was relatively easy,’ she says. ‘Maintaining it and running it efficiently is the difficult part.’
Free treatment for poor
She clarifies that the hospital does not offer treatment free of cost to all patients. ‘Only poor patients are treated for free. Those who can afford are charged for the treatment, scans, lab tests and for the room.’
I ask what lessons she gleaned from her time with her father in his clinic that came in useful in her own hospital.
‘Compassion,’ she says. ‘And respect for the sick. He was always very kind, soft and gentle when dealing with patients. He would listen to all they had to say, try to instil confidence and trust in themselves, support them wholeheartedly… He was generous with his time, energy, knowledge and money. These were lessons I could never have learnt in a classroom. If I can be even a fraction of how good he was, I’d be happy.’
Over the past 17 years, more than 1,200 midwives received training and some 25,000 babies were delivered in the hospital. ‘Somaliland today has the largest proportion of midwives per capita in any African country,’ says Edna proudly. ‘We have seven such midwife training centres across the country.’
Her hospital has also trained over 400 pharmacists, 300 lab technicians and has an accredited medical school that is now training doctors. ‘We are now in the top three medical schools in Somaliland’, she says.
There has been another major achievement. ‘All midwives are women, most nurses are women, several doctors and surgeons are women, 70 per cent of health professionals are women. We have been able to put women on the map of Somaliland.’
Bringing about change is no easy task. A problem may appear difficult, she says. ‘But the best way to solve it is to stick with it constantly. That is how you can bring about change.’
The big moments have been several during her journey educating people and providing them with health care. ‘Right now there’s a patient in my hospital whose life we managed to save,’ she says with pride, recalling the case.
The impoverished woman first arrived at the hospital a couple of months ago pregnant full term but during the check-up, the foetus was found to be dead. ‘We did a scan to confirm and gently broke the news to her,’ says Edna. ‘We wanted to induce labour and get the dead baby out but she said she would go home, promising to return in a day.’
But that was the last the hospital saw of the woman, until two months later when she was wheeled in in a barely conscious state. ‘The dead baby was still inside her and she had turned toxic,’ says Edna. ‘In all my years in health care, I’d never seen a case like hers. We were sure she would die.
‘But we got working on her, cleaned her up, conducted surgery and removed the dead foetus. She needed several blood transfusions and a lot of antibiotics, but she is now healing and will be able to return home in a few days.
‘These are the moments when I feel all the hard work has been worth it. When we can save one life. She will continue being a mother to her children, a wife to her husband and a member of her community. That is the kind of woman I’ve built this hospital for. For a woman who is poor, ignorant, afraid and who would have died if proper care was not given.
‘I’d gladly give away all my Mercedeses and jewellery and money if I can save even one life.’
Edna firmly believes that the world is not meant just for those with big muscles but for the ones with big hearts as well. ‘It’s the muscles of the heart that I want to grow; not the biceps that we use to punch someone in the face.’
Edna Adan Ismail’s idea of an empowered woman
‘She is one who has been given access to her rights, like right to the integrity of her body, access to education and the right job opportunities she is qualified to have. A woman who is respected as a human being, has a say in her community that she lives in, is a part of the decision in what place she lives.
‘An empowered woman has the right to control what happens to her body. No one else can take decisions about what happens to her body or inside her body without her consent. You don’t violate her, you don’t punch her just because you are bigger and taller and stronger, but you make her bigger and stronger and you respect her. That’s the woman who is empowered – who has access to economic empowerment, professional empowerment, academic empowerment. Respect is the basis of everything.’
Edna Adan Ismail will be speaking at the Emirates Airline Festival of Literature in Dubai, on from Feb 4-9, 2020.