On November 17, 2014, Edna Adan University held a graduation ceremony for its first class of Nurse-Anesthetists. University President Roda Ali Ahmed; Ali Sheikh, representative of the Somaliland Ministry of Health; Professor Mark Newton, the architect of the nurse-anesthesia program; and other officials were on hand to award degrees to the seven students (four men and three women) who successfully completed the challenging course. The program was held at Hadhwanaag Hotel and Restaurant in Hargeisa and was followed by a celebration dinner.
The ceremony marked a significant milestone in healthcare in Somaliland. Anesthesia training in Somaliland is taking place only at Edna University and at Amoud University in Boroma. The program at Edna University started in February 2013 when 14 students were enrolled. Hosea Cheruiyot, who studied under Professor Newton in Kenya, signed on to serve as the primary tutor. The students underwent 18 months of study, beginning in the classroom and gradually evolving into clinical training.
The course requirements were rigorous. In addition to a challenging classroom curriculum, participants were required to spend many hours in the operating theater learning their craft. Students did rotations at other hospitals in Hargeisa and were sometimes called in the middle of the night to come in and assist in emergency surgery. Over the 18-month course of study, half the original enrollees withdrew. However, the seven students who stuck it out are now ready to begin new careers in a vital but neglected field.
To put the achievement in context, surgery has long been considered a luxury in developing countries. Traditionally, healthcare in resource-poor regions has focused on control of infectious diseases, immunization programs, and treatment of chronic conditions; little attention was paid to the development of access to surgery. It has only been within the last decade that emphasis has started to be placed on improving surgery in the developing world.
However, most of the discussion centers on the training of surgeons. While more and more programs are now being made available for physicians who want to specialize in various types of surgery, much less attention is paid to preparing nurse-anesthetists. Since most surgery, particularly major surgery, is not possible without anesthesia, the lack of qualified anesthetists serves as a profound limitation on access to surgery in many areas.
This phenomenon is particularly evident in post-war Somaliland. Although there are physicians capable of performing at least simple surgery in every region of Somaliland, many regions report a lack of qualified anesthesia personnel. In those areas, surgery is either impossible or it takes place with anesthesia administered by someone who has not undergone formal training. The shortage of anesthetists is so pronounced that each of our graduates quickly found employment in the city of Hargeisa, while most Amoud University graduates easily find jobs in Boroma hospitals; it will take quite a few more classes of nurse-anesthetists before hospitals in other regions are staffed with enough qualified personnel to meet surgical needs.
Edna Adan University admitted its second class of nurse-anesthetist students last June. Despite the knowledge that it is the University’s most demanding course of study, 17 students enrolled in the class and are enthusiastically pursuing degrees in anesthesia. While it will be several years before Somaliland will have a sufficient number of qualified nurse-anesthetists, we salute our first batch of graduates and look forward to watching them make a powerful impact in their community.