Dr. Cohen-Overbeek’s thoughts on the final day of the trip:
“Last night we went out to a restaurant with Edna and her senior obstetrics staff.
Chuck Cavanaugh from the US arrived the day before and joined us – it was his first time in Somaliland. Over the past four years he created Edna´s website, particularly established to gain funds. We celebrated Alfred’s birthday and Edna brought a huge decorated cake. After coming home, all the pre and post tests on 1st and 2nd trimester obstetrics, 3rd trimester obstetrics and gynecology scanning were corrected in order to present these results in the morning.
Most trainees showed an important improvement over the past 4 days (figure 1).
It became evident that pre test knowledge on 1st and 2nd trimester obstetric ultrasound was least present which may reflect that the majority of pregnant women only attend antenatal clinics in the third trimester and doctors and midwives alike are more confronted with problems during that period. The accumulation of post test results reached for all three tests approximately the same level. Trainees and trainers should be very pleased with this outcome.
On the last morning we assembled again on the rooftop terrace. All problems with the local bugs were overcome and we enjoyed the clear blue sky and the daily omelet and were kept company by small very pretty grey / white birds who seem to carry a little hat. Torbjorn, who from all of us knows the most about nature, unfortunately cannot identify this little creature.
Alfred started the teaching with an impressive lecture on post partum hemorrhage and its management. Very useful information particularly for this region as the problem is encountered much more often here than in the western world. Blood not being available, only if the family members donate this, makes the management also quite different from that which we are used to. Talking with the midwives Hattie and Lesley, who are on this outreach coarse and both work in different projects of MSF in Somaliland, enlightened us on the way pregnancy and health is dealt with in Somaliland families. The different ethical approaches need to be respected but are an eye-opener.
Finally all tests were presented and the answers discussed. Julian took on the first and second trimester and as he hadn´t made the questions it proved occasionally quite a challenge, only enlivening the discussions among the trainees. Lisbet had prepared all certificates and in a small ceremony everyone was presented with it. Edna helped the team with pronouncing all names the right way. The last afternoon was again spent with hands on scanning and many patients turning up. This week I have been really impressed with the gained skills of many trainees either on their first or second course. The little portable SonoSite NanoMaxx machines make very good images and although at this stage a detailed fetal heart scan is not required it could be easily done on them.
The day ended with a tour of the local market where we acquired traditional ministoves for incense, camel bells and belts. On the way back we noticed to our great surprise that the river, which was completely dry 2 days ago, was flowing with water as a result of thunderstorms in the west. Unfortunately as it was very dark we cannot provide evidence with a picture. Tomorrow the team will head home except for Torbjorn who stays another week and goes to a project in Erigavo. Good luck and we look forward to your news.”