Hassan Ali Interview With Kings College Somaliland Partnership

[Deeq A.]

           Hassan Ali Daoud in the mission of saving Somaliland mothers #ReachTheNeglectedMothers

Why did you choose to study Medicine?

The number one blessing behind me to be study Medicine is my parents who were educated and they knew the importance of a doctor to the community, and they used to tell me and my siblings the benefits of being a doctor. I took my first diploma in First Aid when I was in grade 10 in high school. I liked it and it became an area I got more interested in. I had a hard time when I was joining my medical school as well, I applied for Cairo University in Egypt, and my application was not accepted. I applied again and accepted to sit for the entrance exam of the school of medicine of University of Hargeisa with 540 applicants. 3 days later, I saw my name not in the list of 44 students who were accepted.

I didn’t lose hope, and my mother advised me to Join Amoud University. I had another big challenge because there were 940 applicants and only 25 spaces available. We all had one year of foundation and by the end of the year, I was the second top student. I am now enjoying my second last year in the medical school.

• What was the first development project you got involved in?

I established a student Union in my high school, and I succeeded to publish the first publication of the school Journal, the Voice of Qalax. I visited back the next year for the event of the second publication. It was a remarkable experience for me and I still look back.

In 2012, luckily, I remember in my annual university holiday, I entered a hall that Hargeisa International Book fair event was happening, I saw the leading individuals like Edna Adam (My Role Model, the mother of Somaliland Health), Abwaan Hadraawi  (our Somali Shakespeare poet) and many others from every sector in my community gathered to discuss and debate society problems to find solutions. It was going on for 1 week.

In 2013 I volunteered in this wonderful event to understand and digest the ideas of our elder generation. From 2014 up till now I am the volunteer coordinator of HIBF (which now gathers around 100 international guests from all over the world) and I do organize more than 70 volunteers each year.

There I met with Somaliland Life Makers, a youth group from all over the world who were all Somalilanders and gathered to introduce to the youth how volunteering is important in our region. I asked them to become a member of that team, they welcomed me warmly. I became one of them, we were doing campaigns for providing shelter, food and health facilities to those who need most. We were spreading for 6 years only one message (Somaliland is not waiting others but only its people, to build invest, improve and sustain)

It was 5 months ago, when I succeeded to collect some of the active youth in Borama City and delivered them the message and we announced Somaliland Life Makers Borama team. We did the same task and provided food during Ramadan, the Muslim fasting month and clothes for Eid which marks the end of fasting.

• Tell me about your volunteering in the field of maternal health. What’s your vision? How will you achieve it?

Two years before, I started to volunteer with some other students at two big campaigns of fistula repair for almost more than 200 women per year from all over the Somali speaking regions at Borama National Fistula Hospital. We use to go to take the history, physical examinations and prepare them for the operations. The most shocking part was when you see very young women at the age of 15 years or less got married and developed obstructed labor for more than 5 days in somewhere that has no medical facilities at all. And you keep listen and some say the head of the baby came out and the rest couldn’t deliver and she kept travelling hours over the rough roads by a car (they even don’t know who will pay the rent of the car!) from that day I liked to volunteer more in the maternal health.

We are one of the countries that has the highest maternal morbidity and mortality rate in the world. My vision is to save all mothers not only in Somaliland, but the whole continent. I was asked by Micheala, a German friend of mine, what gift I’d like, once she was coming for the Somaliland Presidential Election of the past month as international observer. I chose to bring us an ultrasound machine to work for those who have less and far and can’t reach the health centers. I  have donated to my university and they they donated to the regional public hospital. I recognized it needs a long journey and time to decrease it dramatically as the developed countries, but I have been thinking about a way that the mothers of tomorrow, the mothers of 2020, those who are in the universities, colleges, and school girls can be saved. They are all using smart phones, and I want to develop a mobile app that can educate them on the important health messages, like how many times they should go for antenatal and postnatal care, and the warning signs, more over not to cut their baby girls later on and we all clear the FGM from the region as well. I feel like they are all waiting me and I have to take always more steps forward.

 

The delegation from Germany donating Ultra-Sound Machine to Amoud College of Health Science

• How do you think the development of Somaliland’s health care will help in the country’s overall development?

if someone has a MI or serious condition and he or she needs PCI or other advanced procedures that we don’t have in the country, he or she needs to travel to another country to seek treatment. Some don’t have the money, some get difficulties of getting visa’s, or the passport (because we are not recognized country), if our health care is developed, we will not lose our genius babies, our heroine women and girls, our intellects and our doctors and many health care professionals. The more we build our health sector, the more we live in a better environment.

• How can Somaliland Health System be improved?

Well this is quite big question, but I believe it needs to be corrected both on an individual and institutional level, let me start with the administrative and lower health care workers, they should have the proper skills, their educational level should be upgraded by get training regularly. General physician doctors get medical license which has an expired date, we don’t have postgraduate medical studies in the country which would have saved many people. There are too many people who are just practicing medicine and running their own clinics, giving unnecessary medications to the patients and all these need quality care.

Moreover, there are too many doctors from the neighboring countries who established their own clinics and getting no observations and sending the patients unnecessary laboratory investigations Some monitoring mechanism that can allow the real professionals to provide the health services as well upgrade those who are just practicing.

We don’t have any screening, diagnostic, and treatment center for all types of cancers. We send some times the biopsy to Kenya or another neighboring country.

Fortunately we have in the country for the past years two mammography machines in the capital city. The country needs to establish its first oncology department center. If any accident happens people take the injured people and reach them to the nearest hospital. They may take the patients in a wrong position and may worsen his condition or make other multiple fractures.

Community areas have no emergency call services at all, and we really don’t have any ICU’s in the regional hospital, just an emergency department. The more shocking part is we don’t have any paramedics at all. In our ambulances, we have the driver only (sometimes, his phone may be switched off).

Getting the surgeon, the anesthetist may take us 3 hours or more and some of our patients may get serious conditions. Our public health sector is completely in the border line. Our ministry of health and the doctors they rarely organize public health awareness, we are all the time dealing with the complications in the hospital. Fortunately, Amoud University, the college of health science, has been doing community activities for more than 10 years in Borama Region. Luckily I am very proud to lead this year the community activities program of our university. More than 1000+ Medical, Dental, pharmacy, laboratory, Nursing and public health students with their supervisors go two areas where there are many poor socio-economic people lives two days in the week.

Where do you hope to see Somaliland in 5/10 years time?

I see  beautiful future studies and fellowships, and more over less patients in our hospitals. I hope this will uplift so high the quality of health sector, we will get postgraduate and will build together free health service for all. We will leave no one behind.

• Who do you hope to be in 10 yrs.?

It’s a difficult question, and no one can predict how things will be tomorrow. But I am sure of one thing, I will be a better change maker. In 2 years time, I will be doing my internship. I hope I will go round the country to see real problems that my people are encountering. I will study in what ways it could be solved. I will proceed my career to study public health or the global health to promote the universal health coverage and the sustainable development goals particularly Goal 3. I will fight until no mother dies of Infections, Anemia, Pre-eclampsia, Antepartum or Postpartum Hemorrhage and many other preventable illnesses in Africa.

• What does a typical day as a medical student involve?

It’s very tough and challenging. We go to classes 6:30 A.M till 7:30, we had some snacks for 20 minutes by 8 in the morning we all go to the ward rotations. We do patient history, physical examinations and do assessment and plan.

Doctors come and check with us and they discuss with us the most likely disease it will be, the next best step in management and the patient approach till 1 :00 P.M. we go back to our houses, at 4 PM and 6 P.M in the afternoon, some days we may have classes again and for our free time we dive our books.

One thing that is different from any other medical schools in the developed world apart from the resources and the quality of the teachers we have is, stressful life of typical medical student.

It is not coming from the medical school but it’s coming from the patients we have and the system of our health care. For example, we have two types of patients, one is very poor and one is in the middle class or rich. For those who are poor, they don’t even afford to pay the lab investigations like checking the Blood Group and or the Urine analysis or the IV cannula etc.

Sometimes we go to the hospital admin and we make them for free, but sometimes they make it for many people this day, and the hospital can’t accept more than that. We collect from our pocket money.

Our second type of patient is very rich and has many family visitors, our hospitals don’t have the machines and the diagnostic tests we could send for them. For example, No CT scans, or MRIs in our public hospitals and even not available in the private hospitals of some of the regions.

• How has Medicine Africa and the kings Somaliland partnership helped to enhance your learning?

The first time I heard of Medicine Africa was my first year 2013, I joined a dinner event for saying good bye to the teachers from UK ( I remember the teachers Dr. Lora and Dr. Alexander), and as well the students from University of Hargeisa in the 2 weeks of interactive learning of psychiatry.

I signed up that day and I use to see the different sectors of Aqoon program. The students in UK and students from here in Somaliland discussing about cases. The clinical reasoning tutorials is the best tutorial we get from kings college and medicine Africa, it builds our thinking and our approach to the patients.

• How do teaching sessions from UK based doctors help improve your learning of a topic?

The tutorials starts from the communication skills course and later we go to the courses we are feeling we don’t have any teachers in that field like the Radiology course. The sessions are interactive, the teacher is asking, students are answering and the teacher is explaining and commenting finally. We all take part together and its one of our most interesting classes we get in the week. We are very happy to have senior professional doctors from NHS, volunteering their valuable time to teach students how to interpret the basics of some diagnostic machines that even don’t exist in our settings.

• What inspired you to start up your blood transfusion project? How is It going?

It was November 2016, when I was in the maternity ward and we received a patient with Antepartum hemorrhage and she was transferred from an MCH with an ambulance. Her initial blood level was 7.5 which is low amount of blood and was still bleeding, after we stabilized her and we asked to get blood transfusions, we didn’t get it earlier, and the doctors said her blood group named B- is not found widely.

Her pregnancy was always at risk because we had rare B- individuals. We have a booklist of donors in our lab, and we called two men. The first one said I donated one month ago and the other one said I am quite far from the city.

The doctors have seen the condition of the baby which was worsening and prepared quick emergency C-section. The family took a car and got the man and he donated one bag. The lady came out after an hour from the surgery and she asked the doctor, Is my baby alive? He said we couldn’t save the baby.

Later on, the mother developed postpartum depression, and it took us a week to keep her mood up. I took an attention of why we don’t have in the hospital a blood bank so that we give the transfusions earlier.

It was not that much longer, a week later when again we received the end of the day a mother with postpartum hemorrhage(bleeding during/after childbirth) and she was shivering and conscious, but completely blue lips and very pale hands.

After we stabilized her condition and sent urgent investigations, results came out with a blood level of 2 grams/dl. Luckily her blood type was O- and she found 3 units of transfusions, she got the transfusions and she was getting better hour by hour.

I left the hospital and went my classes worrying about her condition, next morning I came early and went directly to see her. I saw an empty bed and rushed to the nursing office and they told she passed away two hours ago! And it was very hard moment, I was remembering her history and she was bleeding for 4 days somewhere close to the border of Somaliland-Ethiopia, she was telling me she couldn’t find a car and family was quite poor and found late time.

That day I decided whatever it takes to me, I will establish Borama Blood Bank. After long run in the social media and tweeting for 1 month, I found my intermediate classmate Marwa Mohamed, who is registered nurse graduate from Edna Adan university.

We calculated the money of the machines and it was $10,000. We use to tag the different sectors of the community, local politicians and ambassadors. Finally, we met with Nimco Ali who has already fought for ending FGM and she said to us “you guys, what you are looking for is exactly drops of hope, and I am ready to help you”.

We started a gofundme page (https://www.gofundme.com/dropsofhope) during the UK campaign of the #Callthemidwife. Thanks to the 130 UK citizens who had participated the donations. Later on I remembered one reason that the mother was died was include no transportation. And we again look for a donor and again Nimco has found a donor from UK who has paid the money of the Ambulance. Thanks to Nimco Ali as well who has turned my dream into reality and now saving Somaliland mothers.

The journey was quite long and the hospital admin found a temporary machine from Hargeisa. Then I started a blood donation campaign from my medical school. Students were donating their blood. The unforgettable moment was, when the first donor, Mawlid, a lady suddenly appeared and said, I need a blood transfusion.

We gave her and she said, I have been looking for this type of blood for 4 days. I was there and encouraging students to donate. For the past two months, I was very busy on finding the equipment’s and finally we found it from china with $14,000. So now the items are in the procurement stage and will be sent upon completion.

Reach Hassan Ali at talktohassanali@gmail.com