Return to Somaliland’s Edna Adan Hospital

Before he was even in medical school, Austin Forbes, OMS IV, was providing aid in any way he could. In 2013, he had been volunteering at a Ugandan orphanage and had just co-founded Gratis Humanitarian Aid Network. He was searching for a hospital in an underserved part of the world and one that was logistically difficult to supply when he learned of Edna Adan, former Foreign Minister of Somaliland, who had founded a hospital in Somaliland. SD Forbes visited the Edna Adan Hospital unannounced, hoping to meet Ms. Adan (which, to his surprise, actually worked). Following their meeting, he began collecting donations and returned to the hospital three years later with a shipping container full of medical supplies and equipment.

In early 2019, SD Forbes again returned to Edna Adan Hospital, bringing with him Clarke Snodgrass, OMS IV, and Kaia Jystad, OMS IV…and a donation of over 400 surgical tools to enhance the neurosurgery and general surgery capabilities of the hospital. The students stayed at the hospital for a four-week international elective in Obstetrics/Gynecology and Surgery. During that time, they assisted in dozens of deliveries and C-sections (which took place mostly at night due to Ramadan). The students adapted to this cultural change by waking up in the middle of the day and began working when the fast broke in the evening, often assisting in labor and delivery until the early morning hours. “The midwives knew to call us at any time,” said SD Forbes. “These all night stints were some of the most rewarding work I have ever done.”

While on rotation, medical students are often exposed to difficult cases that have a profound impact on them. For the trio, it was that of a man whose condition deteriorated quickly. The patient presented with a major gastrointestinal bleed, was given a blood transfusion, but within six hours began to decompensate. He was in respiratory distress with agonal breathing, had a massive hematochezia, and a thundering jugulo-venus pulse. “Using a portable ultrasound that I had brought, [we] identified a massive right pleural effusion and pericardial effusion,” said SD Forbes. “It was at this point that the three of us began to get ready to revive the patient in the event of cardiopulmonary arrest.”

As the patient’s condition continued to deteriorate, SD Forbes and Jystad realized there was no crash cart at the ready. Twenty minutes before the patient arrested, they found a metal cart and quickly gathered supplies from around the hospital: an automated external defibrillator (AED) which they found in a locked closet, epinephrine, intravenous (IV) fluids, syringes, and more. Unfortunately, soon after, the patient’s breathing and heart rate ceased.

“I immediately called a code, and a dozen people rushed into the room to begin the Advanced Cardiac Life Support (ACLS) protocol,” said SD Forbes. SD Snodgrass ran the code, while SDs Forbes and Jystad administered medicine, managed the IVs, ensured proper bagging and compressions, and ran the AED. Unfortunately, after thirty minutes, the patient passed away. “Although we were not successful, we worked as a team and gave [the patient] the best chance that we could.”

One thing that SD Forbes did not anticipate when he first selected SDs Snodgrass and Jystad to accompany him on the trip was that they would become an extraordinary team. As one local physician remarked to SD Forbes, they worked seamlessly together. “It felt at times like we could read each other’s mind,” said SD Forbes. “When things became serious, we consistently fell into perfect harmony.”