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Speech Of Prof. Suleiman Ahmed Gulaid ‎President Of Amoud University At THET NHS ‎Links Conference 2006‎‎

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Speech Of Prof. Suleiman Ahmed Gulaid ‎President Of Amoud University At THET NHS ‎Links Conference 2006‎‎‎



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(Sharing Best practice: Learning from links) In association with the WHO launch of the 2006 Report (Working together for health) held on 07-04-06 at Royal society of Medicine, 1 Wimpole Street, London W1G oAE.

Chairperson, Ladies and Gentlemen,

I wish to thank THET and Kings College Hospital for invite us to the UK and to speak in this very significant and well organized conference attended by such distinguished participants. I also wish to express our deep gratitude to THET and Kings College Hospital and their outstanding lecturers and officers for their assistance at a very critical time in our history.

Ours is a situation which has probably never been experienced in Africa since independence; a country that has simply vanished from the political map of the world without direct military intervention from outside. The collapse of the Somali state was attributed primarily to the atrocities and gross mismanagement of the military dictatorship that ruled the country from 1969 to the collapse of the Somali state in 1991. While the whole country suffered immensely under this evil regime it was Somaliland - which volunteered to unite with Somalia in 1960 - that bore the brunt of this destruction. Whole cities and villages were almost leveled to the ground and most of the population was uprooted to become refugees elsewhere or internally displaced in their own country.

At the beginning of 1991 Somaliland looked as though it would simply (like the rest of the territory of the former state of Somalia) slip into anarchy and uninterrupted civil war and chaos. However something dramatic took place that was different from post-conflict situations in recent African experience. On May 1991 all of the regions and communities in Somaliland held a conference in the town of Burao and agreed to put all of their differences and disagreements aside and declared the independent state of Somaliland. This effective reconciliation was all the more remarkable as it was implemented entirely by the people of Somaliland with no external involvement whatsoever. This was followed by the landmark Borama conference of 1993 in which final aspects of reconciliation were finalized and transitional power sharing arrangements were agreed upon by all communities in Somaliland. Moreover from 1991 dramatic political transformation took place.

A new democratic constitution was approved in a referendum in 2001 and multi-party system was introduced. From 2002 to 2005. Municipal, parliamentary and presidential elections that were declared fair and free by international observers and institutions were conducted. Today Somaliland remains a haven of peace and democracy in the turbulent horn of Africa.

But peace and stability cannot be sustained –at least in our context – unless it was accompanied by other steps in basic development including the restoration of vital social services such as health, water system, education and some form of economic activities. Even before the collapse of the Somali state these aspects of Somali life were weak. According to the World Bank data base life expectancy, for instance, is only 47 years in Somaliland and infant mortality rate (per 1000 babies) is 225; crude mortality rate is more than 26 and child immunization for measles (% of under 12 months): 40%.If we compare these figures with those obtaining in neighboring Kenya, for example, we find that although the life expectancy figures are very close in the two countries, the situation in Kenya is much better with regard to all other parameters, i.e.: infant mortality, malnutrition, child immunization, etc. At the time of the collapse of the Somali state in early 1991 the following conditions prevailed in Somaliland regarding the health system:

  • Almost the entire modest health infrastructure was destroyed, damaged or abandoned as a result of insecurity or in some cases taken over by internally displaced people for shelter. Very few hospitals were functioning properly for lack of qualified personnel, equipment, drugs or insecurity.
  • Most of the country’s doctors, nurses, technicians and health managers have left the country. In a country with an estimated population of 3.5 million there remained only 98 doctors. Even before the civil war this particular part of the Horn of Africa had one of the lowest doctor/population ratios, nurse/population ratios and health facilities/population ratios. The civil war made an already bad situation worse.
  • At that particular time, there was no possibility of getting expatriate technical assistance because the country has suddenly become stateless and the Somalis themselves were leaving the country in tens of thousands mostly to Europe and North America.
  • the most serious consequence (from long-term point of view) was that all training Institutions producing health personnel and other professionals were closed

And there was no hope of obtaining new personnel to make up for the unprecedented brain drain brought about by this self-inflicted tragedy.

As one can imagine this was a very dangerous situation that could easily spark serious violence and undermine the culture of peace that has just taken root in the new state. Moreover, a survey carried out by a group of Somaliland professionals on the youth living in the main towns revealed that nearly 92% of those surveyed were planning to immigrate to overseas countries, particularly to Europe, North America and Australia under the pretext of seeking higher education - a dangerous revelation in a society where most of its professionals have already left to those countries.

In order to cope with the precarious situation steps are taken by different actors in Somaliland including the government of Somaliland, local community leaders, both local and international NGOs and UN organs in restoring the heath system. Good examples were Edna child and maternity Hospital in Hargeysa, rehabilitation of the regional hospitals and establishment of health centers in some rural locations. While these were laudable and necessary steps and addresses the basic health needs of the population but the question was what about the future. The main limitations of these initiatives were that they were utilizing the same 98 doctors and the limited and dwindling number of nurses who remained in the country.

The most important step in laying down the foundations of viable health systems was the establishment of Amoud University whose primary mission was to train professionals for the weakened and precarious health and educational systems. In particular the creation of the Faculty of Medicine and Surgery at the beginning of 2001 began to revive the health system in Somaliland. All opinions pointed out that without a continuous training programme the health system will simply come to stop sooner or later. This pioneer institution is now looked upon as a great source of hope for beginning of the revival of the health system in the country. The first group of locally trained doctors will graduate next year and start their mission of serving the people of Somaliland. These students are already making contributions while they are studying in the local hospitals and their impact will be felt throughout the country as more doctors come out and join the system every year

As the curriculum is community based medical education that involves as central strategy involvement in the hospitals and community from the day of admission till the completion of their medical studies. The students are associated with the communities with Agropastorlist activities so that they could be exposed to the communities they will work for after studies. Daraymacaane village was chosen as training site. Each student is attached to 2-3 families and follows closely the condition of each member of the family on regular basis.

The purpose is to give the student an opportunity to come into contact and forge a close link with the community learning clinical skills as well as creating a sense of responsibility among the students.

The establishment of this medical school is a very significant step forward in a country that is gradually recovering from a tragic comma; a country in which most of it’s trained doctors have immigrated to other countries. But as one can expect there were gaps in the programme of this faculty. This is expected in a country which is not politically recognized and which does not receive significant external assistance or investment. In view of the above facts the intervention and assistance by King’s college hospital and THET is proving extremely useful and critical. This intervention is different from past models in which aid was passed as handouts in a way practice and in many cases unaccompanied by local inputs and often supplanted those efforts. Here King’s and THET are complementing and supporting local efforts that are already in place and which are producing the intended results

This is based on the realization that local efforts and inputs are a necessary but may not be a sufficient factor in attaining the final goal and at least during the first year’s external assistance is absolutely essential. The combination of the local inputs and those of King’s and THET are extremely effective even though limited in scope and are becoming a success and model for aid agencies in Somaliland

Kings College team assists the Faculty of Medicine in three fundamental aspects:

  • Filling the gap that existed in the Faculty’s teaching capacity. Team members teach units identified by the faculty where no local lecturers are available,
  • Reviewing the curriculum and programme of the faculty. Because of their experience an expertise the team from the Kings College Medical School update their counterparts in Amoud Medical School and advice on the curriculum,
  • Assisting the faculty in student assessment- a very crucial factor in this new experiment.

Members from Kings College Hospital and THET management personnel have become household names in our community These should be the heroes of today’s world rather than those who scare and destroy. They are assisting us most effectively in changing the lives of young men and women who only yesterday were characterized by despair and who could have become a source of instability rather than a source of hope for the people of Somaliland

We were particularly impressed by the compassion and dedication of these volunteers in spite of the difficult conditions in Somaliland that are obviously different from what they got used to here in the UK. This relationship between Kings College Hospital and THET on the one hand and our institutions on the other hand is a unique model that is more effective than other joint ventures in our context. KCH team plans its work in such a way that they supplement and complement the efforts of our personnel rather than come with preconceived plan that does not take local needs and conditions into consideration.

We are also grateful to WHO whose offices in Somaliland and Kenya are supportive of our efforts

We are here in London, and in this conference to tell the story of this outstanding partnership between the two UK institutions – KCH and THET and our institutions in Somaliland. We express our gratitude to all those individuals, institutions and governments of good will who assist them in this magnanimous act of helping the people of Somaliland in their moment of greatest need.

We are also coming here to make most earnest request to donor institutions and governments to continue assisting THET and KCH team for the continuation of this outstanding mission. The only constraint we have in this partnership is that the team’s duration of stay in the field is very short with regard to our needs and we hope that it will be possible for them to stay longer

Finally on behalf of Amoud University, Edna Hospital and Hargeysa Group Hospital, I wish to express our gratitude to THET and Kings College Hospital for their outstanding contributions to the restoration, revival and further development of Somaliland’s health system and once again request all individuals, institutions and governments of good will to help our nascent state through these two marvelous institutions.

Thank You.


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