Friendship and Fellows: Teaching Asha again!

By Philippe Jeanty 

I came to Somaliland to help my little fellow Asha. For those who don’t know her here is her touching story.

I arrived at the airport and a guard comes to me and tell me something that I don’t understand. My hearing is really going down and with various accents it is very hard. So I just say yes to whatever he says and he brings me to the gate that separates the departure and arrival passengers. And there was Edna Adan.

Edna is the person who built from scratch a maternity hospital, which she continues to run and she really is the big cheese in Somaliland!! She is 83 and she hops here and there, and is constantly active. She has recruited innumerable NGOs to work in her hospital, and that is how ISUOG Outreach came to be in Somaliland , 9 years ago. We hugged thru the fence like in movies. I am impressed by her, and her motivation to champion students such as Asha.

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Philippe Jeanty – Aerial view of the farms

I finally arrived in the hospital and the country! Somaliland is very poor and very dusty and dry. But compared to 9 years ago it is much cleaner and there are many more cars, actually too many!!!

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At the airport I met Asha who had an immense smile with her pretty white teeth.

We drove to the hospital and I had the same room as 9 years ago. Surprisingly the temperature was a very comfortable 18c. I remember we had baked last time. So this was much better.

On the following days my routine went as follows:  I get woken up at 5 by the prayers that are just outside my room. I try to sleep a little more and answer emails. I have breakfast 8-8:30, then we go to the prenatal clinic a few blocks away with the hospital car. There we scan until 12:30.

The prenatal clinic is decorated with many great posters!

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Philippe Jeanty – A poster in the clinic gives good life advice.

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Philippe Jeanty – Try to protect girls from Female Genital mutilation:
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Philippe Jeanty – And don’t talk about contraception, but birth spacing 

Patients are incredibly argumentative! They ask a lot of questions about “how many months” and “fetal position” and if “the baby has moved”, they want to make sure we tell them correctly.

The patients are uncomfortable with showing their abdomen due to religious sensitivities. So, the sonographer has to scan with one hand and keep pulling the patient’s pants down with the other. This means there is often no hand left to press the freeze button!

Patients come with a crumpled sheet of paper which is their report.

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Philippe Jeanty – Patient Report 

Lunch is at Edna Hospital and it feels like a United Nations meeting. There are doctors from everywhere, but mostly from USA. Every type: emergency physicians, family practice, surgery, neurosurgery, ob, MFM, epidemiology….  every profession under the sun. Most are veterans of international assistance and have been in many places and it is interesting to hear their stories.

I have lunch with Asha who is very sweet and wants to feed me like I had never eaten before. She is both my little daughter and my mom!

At 2, I teach all the residents together for 1-2 hours. The group is very eager to learn and I have a much better impression of them than I had 9 years ago. They all got copies of the lectures on their USB drive. I spend a long time teaching them the very basics, such as how to orient themselves while scanning and although they had trouble at first, they finally got there.

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Philippe Jeanty – Asha with training doll 

After the class to the whole group, I give lessons just to Asha and we go through lectures and cases and I quiz her . This is very unusual for me to teach one on one like that, but it allows me to concentrate much better on her strengths and weaknesses.

I changed computer a few months ago and now I have a Microsoft Surface, a sort of laptop/tablet. It came with a pen to write on the screen which I thought was totally useless. However, in teaching one on one like this it is great feature because instead of asking her to point at a structure, which does not let me know that she knows the contours of the structure, I can ask her to trace the edge!

Two times we went for dinner outside but unfortunately in fancy US hotel nothing typical. We had dinner with her brother which is a very nice guy and one time with 3 of his children. The elder daughter (Fadumo) wants to become a doctor, after seeing Asha. I hope she will!

The only visiting is the 2km ride to the clinic but there are a few interesting things I had either not noted or forgotten. They do not have running water here, water is brought from 30 km away by tankers!! Each house has a tank in front of the house on short legs, and all the water used in the house is carried in small pots!

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Philippe Jeanty – The water donkey

There are goats roaming everywhere!! I asked Asha, how do people know which goat belongs to whom, and she told me people recognise their own goat!! To me, they look pretty much the same but I am no expert!

Somaliland Goat.jpg

After lunch I taught a class of 5 and I have hard time remembering their names, even though I make big effort to remember! I look at one girl and I try to guess her name right, and I was wrong! She was in fact the student from the morning but she changed head scarf and dress and I didn’t recognise her at all! All the students were making fun of me. They said: I can recognize tetralogy versus transposition in a 2cm heart but I couldn’t recognise a 160 cm woman after 60 min break!!

With Asha and her friend we made a phantom to scan the femur (a piece of straw) and we made cysts with full digits from a rubber glove. First I let them scan with the phantom visible so they could see the “femur” and align the transducer, then I hid the phantom, so they had to rely on the screen for orientation.

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I could see the concentration in their eyes, and a bit of frustration when I guided their hand in a seemingly obvious movement.

The last morning Asha bought a heart and with 2 other residents (this is their weekend) we did the dissection as usual. Note that she holds her hemostats properly ! She also does surgery !

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Asha even took advantage of the dissection to practice her suture skills.

As goodbye gift I gave her a little teddy bear for her to practice the positions of the fetus. This Teddy bear is great because it has a zipper in the back that looks like spine: perfect.

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I left her in the parking of the airport without the usual hugs but “in Rome, do like the Romans!”. She gave me a very big smile with her clear eyes and her pretty teeth, and I went in!

 

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