04-FEB-B-5

OUR FINAL DAY IN HARGEISA SOMALILAND

AS WE MEET WITH THE HARGEISA HOSPITAL BOARD AND TAKE A VERY QUICK LOOK AROUND

BEFORE DEPARTURE HAVING EMERGED FROM OUR CLINICAL CRUSH, AS WE PACK OUR WAY BACK

TO ADDIS ABABA, ETHIOPIA

February 15, 2004

What we have here is a failure to communicate.

One of the reasons we were obligated to get back to Hargeisa before this morning from our Berbera clinical activities is the meeting we would be having with the Regional Hospital Board of the Hargeisa Group Hospital. Our Maansoor Hotel owner host Abdelkadel had offered the facility but also the Business Center for our use in meeting with them and had especially pointed out that the fax and phone would be free for our use. So, we knew that we had a meeting her and would have to be back for the conference at ten o’clock on Sunday morning.

I had tried to send out another postcard or two and an email message saying we were leaving from Somaliland, and that I was starting up a new chapter in the Horn of Africa saga by beginning the program n Ethiopia while the students were now “on safari” and were planning an earlier departure to get to Kenya on holiday. While I waited in the lobby for the Regional health board and its chairman all of whom should be familiar since we had all met at dinner three nights before, I was introduced to a man in traditional Somali dress who turns out to be Interior Minister Osman. I thought perhaps he was joining the board meeting, but he had no knowledge of it, and wished us well.

The students are already in “Safari mode.” They were ready to blow off this final meeting and had arranged with Ibrahim at the desk to get a guided tour of the markets we had driven by each morning but had never entered. It is a little dicey taking photographs in Somaliland, and I have been filing up rolls of film shooting from the hip in the interesting scenes that have unfolded around me, but it will help to have a guide who can defuse some of the situations we will be entering. Besides, I was interested in getting a Somaliland CD for Virginia to go with the current Ethiopian CD I had got in Addis Ababa for her course to be offered in music from around the world. We stopped in the market and walked throughout the dusty streets dodging the water carts and weaving around the Khat stands. The two most frequent items in commercial trade seemed not to be Somaliland currency but the two commodities here that are a substitute for gold: water, carted around in donkey pulled 55 gallon drums on cartwheels and parceled out in the vegetable oil plastic jugs suspended on the back of the barrels, and the second trade item is Khat. The Meru, the finest of the products from Kenya, is sold at a premium price, but all of the market goers seem to be brandishing this small bundle of Khat as they “rush home with their treasures.” Of course, nothing will do but that the three seniors should have a go at this experimental designer drug, but I reminded them of two things—the insecticide with which the Ethiopian brand is laced, and the fact that the accommodations at the Somaliland jails could best be appreciated by seeing what the best of their hospitals offered.

There were money exchangers siting next to bundles of Somaliland currency stacked a half meter high. The currency seemed perfectly secure in its primitive “lock box” since no one seemed worried that a handful of it could go missing. It is hardly worth the trouble to count and is most often weighed. When bundles are accepted as given when one bill is folded at right angles over a thousand of its fellows you can presume that no one is too fussy about the accuracy of the count.

We wandered around the up market stalls which actually had covers and awnings, with Chinese made plastic shoes or the kinds of manufactured goods that came from cottage industries. The CD’s I saw were all unmarked and pirated. Bundles of used clothing were sold by the bale to the middle man and then opened up for the rummage sale aspect on the open street. It was a typical African scene but in an urban desert as opposed to the rutted rods of gooey mud I am more used to in the equatorial rainforest setting.

THE MISSED MEETING

AND THE WISH LIST

Upon return I checked first to see if there had been a meeting with anyone present. No one had come so we sat in the Conference room as I wrote out postcards and the guys got on their running gear to go for a late morning run. As I sat there alone with the troops having changed to running shorts, the Chairman of the Regional health Board came in, wondering what had happened to us, and why we had not been at their meeting in the hospital where we were expected. They had even sent a car for us when we had not appeared despite the clear signal that we all got that it was to be held here.

I sat through the recapping of the meeting they had had and the guys were restlessly looking at their watches, and then without a word, one by one, each slipped away to go out running. The chairman detailed the deficits they had in the Regional health Board’s view of the HGH. They needed more doctors. The only way they could get doctors would be by paying them more then the maximum salary of forty dollars US per month which was hardly a way to keep their attention for very long. I pointed out that we could hardly be expected to operate and leave critically ill patient sin the institution and return in mid-afternoon to find a complete absence of any health care personnel whatever, the longest lasting nurse having left at eleven o’clock having completed their day. When I sought someone who could tell me anything about a patient the most I could hope for would be a family member since they were the only attendants for all but a morning period when some of the staff could be found, but not consistently.

I had told them about what could be expected from a collaboration and affiliation with such a center as GWU. The university is a treasure trove of advice, eager personnel, but the last thing one should approach a university expecting to find is a big pile of money that they would be eager to shovel in to such an infrastructure as a basic salary support to keep the autoclave going for another 50 years or to subsidize a doctor’s salary when they are busy maximizing their opportunities anywhere but in the public hospital at which they have a paper commitment. Of the majority of the causes of “sub-optimal performance” in hospital staffing, equipment, information systems, journals, and medicines and surgical equipment updates, a University in general, and I as an educator volunteer donor could do little: that problem is poverty and scarce resource allocation. We can collaborate in training and in upgrading standards, but infrastructure is the responsibility of the community.

I was alone in my diplomatic missions now, since the students had all left to do what they had wanted, after moving up their departure for Kenya to tonight from Addis Ababa, they were already on their holiday safari, and were clearly uncomfortable prolonging what they viewed as an already overtime commitment that ended last night as we drove out of Berbera. We had sorted out some of the medical packs and were leaving a good deal of the obstetric supplies and two bags of the surgical gear here with the Edna Aden and Hargeisa Group Hospital respectively, while I was carrying two bags on with me to Gondor where I would distribute journals and some surgical supplies, and at Addis where I would give out most of the rehabilitation supplies for Mother Teresa Clinic though Rick Hodes whom I had hoped to meet on arrival in Addis.

FAREWELL TO OUR “PEOPLE PERSONS”

AND OUR EXTENDED FAMILY AT MAANSOOR

We were pulling out from the hotel in the vehicle when we were on the road out of the compound when I spotted Abdu coming down the road to say goodbye to us. He was our most faithful attendant and had been mother henning us, making each service special. His people skills were remarkable. He eventually realized that much of what we said to him was in the nature of good-natured kidding, and I believe he realized that best when I had congratulated his boss on the staff he had—much more than from the envelope of US currency we left with them as a tip. We posed for final photos of him as he sadly wished us farewell, and thanked us on behalf of all the Somali recipients of our care. We were lucky to have him

We were even luckier to have the Foreign Minister herself holding court in the Hargeisa airport VIP suite who made everything for us much easier. We had caused a violation of our visa since we had entered the country on a visa with a tourist (if you can imagine such a term being applied to a Somaliland stay) visa that expired in two weeks and we were extended illegally beyond that. One of the local gendarmes, a woman, had shuttled back and forth from Edna Aden and had cleared it all up, and she had influenced the group to allow us to check in and join her in the VIP lounge. There I saw a poster on the wall showing British Somaliland, and its postage and currency, and then a photo op moment when the signing of independence had taken place—the Somaliland president being Edna Aden’s former husband. The dark days are also represented, when the ground zero of center Hargeisa was a close mimic of Hiroshima after Siyad Barre’s civil war. But there is hope, and the gems and flowers of Somaliland are also pictured. Edna saw me admire the poster and immediately sent her driver to her office to retrieve one as a gift to me. She then signed it with her title as the foreign minister.

I had carried a cop of “Out of Assa: Heart of the Congo” which was already checked in inside my duffel bag for the Addis flight. No problem. At a summons from Edna, the director of Air Ethiopia in Hargeisa accompanied me to the checked in baggage. I insisted he be the one to open my bag and retrieve the book, since I did not want any suspicion that I might be introducing something in to the bag after it had passed through its security screen. Again, no problem. Edna had cleared the way. I retrieved the book and inscribed it to her. We four took photos on the tarmac exactly where we had been only a few weeks before, which seemed like forever for these now seasoned veterans, and we waved farewell to Edna and her midwifery team who had accompanied us to the airport—Stacie and Rhoda among them

So, “Hale and Farewell Somaliland”—an applicant to nationhood, and a self-starter to come from far behind even by African standards! I have the feeling I shall be back soon. And, now, another Theatre is opening---another opening of another show! Welcome to Ethiopia!

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