Dear Michael,
I want to thank you again for all your support for the Nurses for Edna team who worked in Somaliland this fall.  Your support of this project has been invaluable and we at One Nurse At A Time can’t thank you enough.
In August 2013, Wanda Chestnut, Kim Law and Kerra Plesko, three members of the Nurses for Edna team, left for Hargesia, Somaliland.  Due to a death in the family the last nurse, Sarah David, joined them two weeks later.
Each member of the team had expressed a passion to improve women’s health around the world. For almost a year they had planned and worked.  They held fund raisers to augment the already generous grant awarded by Barco’s Nightingales Foundation for this mission. They sought free medical equipment and found ways to cover shipping costs and logistics. They sent out hundreds of appeals to friends and family to raise awareness of the plight of the Somaliland women. They did all this in an effort to make a difference in a country still struggling to recover from years of civil war.. They traveled with little personal luggage so they might fill their baggage allowances with donations of medical equipment.  The trip took more than 24 hours; they arrived exhausted, but eager to begin work.
The Hospital director, Edna Adan  requested they teach a First Aid course while they were in Hargesia. What they didn’t realize was how large the group would be – over 150 nurses, lab techs and public health students. Nor did they realize that some of their teaching would need to be done using pantomime and interpreters!
Although each member of the team expressed that the teaching experience was both frustrating and somewhat overwhelming, they also expressed that one of the best things about the trip was the positive feedback that  they got from their students. They can feel proud that they were instrumental in teaching more than 150 students  the necessary skills needed to provide basic First Aid Care for the people of Somaliland.

“My happiest moment is a culmination of positive feedback from my students and from the university. Both have expressed gratitude for and positivity towards my teaching and indicated they would happily  have me teach again. Having never taught in a classroom setting before, and having experienced numerous frustrations throughout the course, the end response was very gratifying,” Kim Law.
Besides teaching and working at the Edna Adan Maternity Hospital the nurses also worked and taught in the community at the Abdi Idan MCH Clinic. This free, government funded clinic provides multiple services including antenatal and postpartum care, low risk deliveries, a nutrition clinic, a pediatric health and immunization clinic, and lab services in one of the poorest neighborhoods in Hargesia.
While they were not able to spend as much time as they had hoped providing women’s health clinical care at the hospital, the nurses did both work, and provide supervision to student nurses, on the wards. Three of the nurses identified their biggest challenge, and saddest moments, came while resuscitating a newborn infant with no doctor to guide them.

“We tried to get one of the nursing students to go find a doctor, but she didn’t understand what we wanted. Finially, the nurse anesthetist came in and we were able to partially stabilize the baby and get it breathing. But, it was just a situation where no one in the room knew what to do and we couldn’t find anyone to help us, Kerra Plesko.
 It was during incidents like this one, and other long neonatal resuscitations that the nurses felt pummeled with a moral and ethical dilemma.

“My absolute worst experience here is the ethical dilemma I am now constantly thinking about. We’ve done a few, long neonatal resuscitations, and have been able to revive the babies, only to have them die a few days later. If they had lived they would have been severely disabled. Is it ethically responsible to do long resuscitations in resource poor countries where the risk for long term disability is high?” Kim Law
However, the nurses also expressed being positively impacted by their time in Somaliland, They came home with a greater appreciation for everything available to them at work and at home: medications, supplies and equipment.

“I now really appreciate being prepared at every delivery, having the necessary equipment ready, or even having it at all, and having qualified trained people who know the importance of quick resuscitation and being efficient with what we are doing.  I appreciated it before, but I had never seen babies die from the lack of those things. I know we live in a rush- rush society and I do believe that we need time for slowdowns often, but I also value responding to a task quickly, and Africa has shown me how valuable that can be,” Kerra Plesko
 They also came home with a greater appreciation for their knowledgeable, supportive team members at their respective work places.  Larger still, they returned with a sense of respect for the people of Somaliland and a reminder of the importance of humility.

“The people of Hargesia are so poor and despite being poor they are humble people. This experience reminded me to remain humble in all situations and circumstances,” Wanda Chestnut.
The nursing team also described moments of happiness along a difficult medical mission. Moments of showing support for each other; of early morning work -out sessions on the roof to decrease their stress; and spontaneous dancing in their rooms after working all day to the point of exhaustion. But, the most gratifying memories they report are of times they saw their hard work actually bringing change in the nursing practice at the Edna Adan Maternity Hospital:
“My happiest moment was when I went downstairs one morning after breakfast and saw the nurses and midwives put two babies in the Embrace warmers! It was a proud moment. Not only did they do it correctly, but they actually remembered to use them! It’s hard to tell when you get through  to some of the nurses, but at that moment, I knew that our in-services and  teachings had some sort of impact because the neonates were in Embrace,”  Sarah David
The  nurses report feeling proud of some of the small, yet significant, changes they brought to the Edna Edan Maternity Hospital such as putting together an emergency resuscitation kit for the med/surg ward. They are particularly proud of the part they played  in the prevention of neonatal hyperthermia.

“When we first arrived at the hospital, neonatal resuscitation were being done on an old cart with a heating pad. The babies would get extremely cold (like 34 C cold). They had two radiant warmers shoved into corners so we decided to check them out. One of them didn’t work but the other one was in beautiful shape. It took several weeks to get everyone to leave the warmer on and plugged in at all times. But eventually, with perseverance and a little duct tape, we made it happen.”Kim Law.