I picked up the phone to hear the Western Union operator on the other end. This was the call I was expecting, and eagerly waiting for.
I was attending the annual meeting of the American Public Health Association (APHA), in Los Angeles, and the call came through on a public phone outside of the meeting’s administrative center. Fortunately, the meeting was in its second day, and the area was relatively quiet, though not completely private. I got to the phone about 10 minutes early, not wanting to be late or out of breath from running across the large area that housed the meeting.
It was 1983, and I was hoping to make a professional transition from domestic health programs to international work. My job with APHA, where I recruited and supported teams for short-term health work with USAID missions, was a window to this world, and I got to know mission health portfolios as well as key staff advising and implementing these programs. As my contract with APHA began to wind down, I entered into discussions with Margaret N., a former colleague who now headed the Population Office of the USAID Mission in Somalia. She was interested in hiring me as a Personal Service Contractor to begin preparations for a new Family Health Project, she was responsible for, and was due to come on-line in about 18 months. This call would confirm my contract, and the details of the first phase of my work in Somalia.
The operator asked if I was ready to hear the details of my contract and began reciting the scope of work, dates, contract length, my fee, per diem, housing accommodations, transportation, voucher submission requirements and payment. As she droned on, I tried to absorb the details, and she assured me that a paper version of what she read would follow. Then her voice perked up. She described the weather- hot during the day with occasional sandstorms, the erratic nature of electricity, water that needed to be boiled, vegetables that must be washed and the difficulty walking on sandy, unpaved streets. I saw Margaret’s thoroughness in the details, just as the operator paused for what seemed a long time. “Do you still want to go?” she asked. I was trying to focus on the details of the contract, and had not thought about what it would be like to work there for several weeks at a time. Her question caught me off guard, revealing perhaps her thoughts about the work conditions.
“Yes, yes,” I replied quickly. This job was important to me as it represented my first opportunity to work internationally, and I looked forward to working with Margaret, whom I liked and respected. The job also came at a good time in my life.
Eight years earlier, I returned for a mid-career program and professional degree in Public Health, which I hoped would expand my work opportunities including in the international arena. Then I got divorced, my eldest son started college, and although my youngest son, Jesse, was still in High School, his father lived close-by and he was good buddies with Carolyn, my house-mate. So, I felt he had options about where to stay while I was travelling. He was not happy about my decision, but later on I realized how deeply he felt that I had abandoned him. It took us many years to work through those feelings, if we ever did.
In preparation for the phone-call, I became familiar with the “Somali Family Health Project Paper”, a blue-print of the bi-lateral (US-Somali) project developed by AID consultants two years ago. Its purpose was to improve maternal health and child spacing and six Somali agencies would share responsibility for implementing some portion of the project. My initial job was to work with them to create an inter-agency project coordination mechanism.
Initially, I wondered why such a complicated project had been designed for a country with such limited physical and organizational infrastructure. As I began working there, however, the logic became clear. It would take a consortium of organizations, with complementary missions to build support, increase knowledge, train staff, equip clinics and provide services to improve women’s health and child-spacing practices.
During the first two weeks in- country, Margaret briefed me on each of the participating organizations, introduced me to their key staff and clarified for them what my role would be vis a vis them and the other participating organizations. After these initial introductions, I set about learning more about the individual organizations, getting to know their leaders, and determining how they would fit into the larger plan.
One of my first meetings was with Halima A., head of the Somali Women’s Democratic Organization (SWDO), and the sister of the President of Somalia, along with Gad, her assistant. SWDO was first formed as the women’s arm of the governing party, during the decade of the 1960s when Somalia was closely allied with Russia. Although Somalia had more recently turned to the West and America for support, remnants of Russian influence remained. The most graphic example, was the billboard in front of the Mogadishu airport, the first image one saw arriving in the country. It was a ten-foot high picture of a traditionally clad head-covered Somali woman, toting a machine gun with a fierce war-like expression on her face; Soviet-style Somali realism I supposed.
SWDO was highly respected for its ability to mobilize the population for demonstrations, parades, clean-ups, etc. having been created at the same time as the state and its one-party system. Halima headed the organization from its beginning and she was passionate, outspoken, bombastic and a diamond in the rough. In her early 50s, she had been involved with SWDO for more than 30 years. Gad, younger and a more recent addition to the staff, was Halima’s assistant, and would be the person I would work with on a day-to-day basis.
The USAID project was important to SWDO, because it offered the organization resources to promote the eradication of female circumcision, a deeply embedded cultural practice with pernicious health consequences for women. Halima had lost a sister to infection from circumcision, so her passion to eradicate female circumcision had deep personal roots. As we concluded our first meeting, I made plans with Gad to observe a SWDO community meeting to be held several days later.
Gad picked me up at my hotel, and as I climbed into his jeep and greeted him, he replied with a grin, “You can call me God.”
A member of Halima’s tribe, and a distant cousin, Gad had been groomed to work for SWDO since he was in his teens. Now, in his early 30’s he would serve as a key person on this project, representing Halima on a day-to-day basis. He was high energy, bubbly, extremely likable, and as omnipresent as God. He had an in-depth knowledge of SWDO and its levers of power, and I told him that if SWDO could make a dent in the cultural imperative to circumcise girls when they turned 8 or 9, he would earn the title.
We drove towards the edge of town until we came to a clearing where about fifty women were seated on the ground under the shade of a large acacia tree. Most of the women were in their 40s and 50s, but there was a smattering of young women nursing their babies as well as a few toddlers. The meeting had already started, and there were several older women standing at the front of the crowd. Gad translated for me, as these women shared personal stories and testimonials about why young girls should not be circumcised. The women listened respectfully, but after each presentation they shouted counter-arguments in favor of circumcision, as the other women on the ground nodded their heads in agreement.
“No one will want to marry them,”
“They will become prostitutes and outcasts”
“Every Somali woman is circumcised”
“The men expect it”
“We have always done it”
“We have to do it, the girls want it, all their friends do it”
On the way back to the hotel, Gad and I reflected on the challenging road ahead, and the ways in which the USAID project could help SWDO carry out its educational effort to counter traditional views about circumcision. We identified materials that could be used including models of circumcised and uncircumcised genitalia, as well as people who might have credibility in getting the message across. I had no illusions about the difficulty of changing long-standing culturally supported beliefs and practices, but I was also encouraged by SWDO’s ability to gather women for educational sessions, as well as by their commitment to building awareness of the harmfulness of the practice.
As I got to know Somali women, I heard stories about the difficulties they faced trying to change the traditional practice. Amina, a graceful and attractive woman in her late 30s, had lived abroad for a number of years, where her husband had been posted as a Foreign Service Officer. When her daughter was “of age”, she decided not to circumcise her. She leaned close to me and whispered, “My mother doesn’t know. I could never tell her. She would accuse me of being a bad mother.”
Fatima did her nurse’s training in India, and came back to Somalia with Western ideas and a critical eye. She declared she would never circumcise her daughter. When her daughter turned 9, however, and all her classmates were being circumcised, she begged her mother to arrange one for her. Fatima was terribly conflicted; she wanted to please her daughter but opposed the practice. Ultimately, she decided on a compromise to mollify her daughter and avoid ostracizing her from her friends. She would do a “symbolic circumcision, where the knife just nicks the labia, but there is no cutting. That seemed like the perfect solution, though Fatima had difficulty finding someone to perform this”foreign” procedure.
Two years later, I attended another SWDO presentation. Gad was the presenter and this time he had plaster models, which the project had purchased, to graphically show what circumcision involved. The women were transfixed; murmuring, shaking their heads and sighing as he showed the procedure on the model. It was as if it was new to them, although probably every woman in the audience had been circumcised. I was puzzled by how little women who had been circumcised understood about what was done, though they experienced the consequences every day of their lives, when they urinated, had intercourse or gave birth.
Hawa M., married to the Minister of Education, was head of the Women’s Education Department of the Ministry of Education. She was refined, soft-spoken, articulate and bright. She presented herself well and her dress and head scarf were carefully coordinated, though when we met in her office, her scarf was always around her neck rather than covering her head. That signaled to me that she was modern and westernized, or at least that was the message she wanted to give me. She was also one of the project’s strongest advocates, committed to including health and family planning in the non-formal education component of her department, as well as using the sewing machines provided by USAID project to expand income-generating opportunities for women.
Over time, Hawa became an informal leader of the project. Periodically, when I was in-country she would invite all the project’s women leaders for lunch at her home, a palatial structure, typical for influential and politically connected families. The pleasant afternoons sitting in the shade, combined social chatter with more serious thoughts about the work that engaged us. Her cultural sophistication became apparent to me at our first lunch. I was about to sit down when Hawa said, “No, not there Myrna, here” pointing to another place similar to the first. When I sat down, however, I realized that my setting alone had silverware, where none of the others had. Hawa had correctly guessed I had not yet become completely comfortable eating with my hands, Somali-style.
The Curriculum Development Department (CDD) of the Ministry of Health was another project partner. Hassan O., an imam, highly respected by his colleagues, who formerly headed up a Madrasa (a religious school) was the Director. Modest and unassuming, he kept his head covered and dressed traditionally in an abaya. But in his quiet way, he was fiercely committed to helping Somali school children gain the necessary tools to understand the world in which they would live.
With the help of Mike S., a science curriculum expert, they would develop, produce and distribute a new curriculum on population education for their primary schools, training teachers in the new material. This effort was part of a larger project supported by the Danish Aid agency to revamp the system’s entire science curriculum.
We were lucky to find Mike. Born in Nigeria to physician parents, he moved to England with them when he was in his early teens, and received his university education there. Having grown up in both the first and third worlds, he navigated these worlds seamlessly. He was a master science teacher and innately understood how to incorporate a scientific approach to health education in an African-Islamic society. Because Mike was African, he was trusted by the Somalis, and often served as our Informant and interpreter of what was happening in the country. He could adroitly penetrate the reserve and social distance the rest of us experienced in our interactions with Somalis.
One day, Mike and I were returning from a meeting, and I was driving the project jeep emblazoned with the USAID logo on its front doors. Out of nowhere, a policeman stepped into the street and signaled me to pull over, which I did. In my rear-view mirror, I saw taxis and other vehicles behind me, also being pulled over.
The policeman approached the passenger side of the car, where Mike was sitting, but said to me, “You were going down a one-way street.” One way street, I thought to myself, I have driven down this street dozens of times. I was just about to reply when Mike put his hand gingerly on my arm and said, “Let me take care of this.” He must have seen me taking on a huffy look.
He engaged the policeman in friendly banter and said, “I’ll bet you haven’t had your tea today and would really like some.” I was puzzled and thought, what’s with Mike and tea, in the middle of a traffic summons. The chatter went back and forth for a while longer. Then Mike turned to me and said, “Our friend here hasn’t had his tea yet today, so we are going to treat him to some,” as he reached into his pocket and pulled out a 200-shilling note, less than five dollars. The policeman’s face broke into a broad smile, nodded to Mike and me, and backed away. How artful, I thought.
I didn’t realize it then, but that incident was the beginning of a breakdown in the order that had governed the country until then. It was followed by other lawless incidents, and periodically the sight of young boys being rounded up and forced, by soldiers with machine-guns to board trucks. We had heard that different political factions were carrying-out forced conscriptions, but it sadly hit home when several sons of USAID-Somali employees, were taken. Within a year, the country had broken out into civil war.
Our work with the Ministry of Health (MOH) was challenging. Our counterpart, Dr. R. was out of the country frequently, spending 4-6 weeks at a time in Italy, where her husband, also a Russian trained physician, worked. Light skinned, small, thin, agile and in constant motion, R. met her husband in Russia where they both trained as physicians, and set up a practice together in Italy. Having once ruled Southern Somalia, Italy was hospitable to Somali professionals, and many moved back and forth between the two countries. After living for several years in Italy with her husband, Dr. R. returned to Somalia to look after her aging parents, while her husband remained in Italy.
Her frequent absences created a leadership vacuum, which made it difficult to shake the lethargy pervading the Ministry. In addition, Dr. R., like other MOH physicians worked part-time for the Ministry, usually four hours a day, seeing their private patients in the afternoon, usually at the same government clinic where they worked in the morning. The government allowed this as compensation for the poor salaries they paid the doctors. An Egyptian physician, I once overheard, described it, saying, “The government pretends to pay us, and we pretend to work.” Unfortunately, that was true in much of the developing world, including Somalia.
At the same time, the “front-line” nurses and clinic staff felt they were over-burdened, and lacked time to add family planning. Most saw “Child Spacing for Healthy Mothers and Babies”, as a slogan rather than a call for them to be proactive in their patient services. In some cases, their diffidence came from a conflict between their personal situation and beliefs, and their professional responsibilities. Several were in polygamous marriage, where the number of children they bore affected their standing in the family and with their husbands. They didn’t see women as free to make decisions about the number of children they would bear.
It took almost two years of USAID pressure for Dr. R. to hire Dr. Asha, a young dynamic, politically astute doctor, to oversee the child spacing program under Dr. R.’s supervision. In her mid-thirties, Dr. Asha was tall and thin with an upright carriage who entered a room with a graceful glide. Combining Arabic and African features, she personified for me, the beauty of Somali women. Regularly visiting the clinics, her presence and support began to make a difference, and little by little changes could be seen in staff engagement and services provided.
My respect for Dr. Asha grew even more when I learned her personal story and the hardship she was enduring. Her husband was in prison as a political dissident, and she and her family lived under threats and constant surveillance. Her three-year old son was living in Baidoa, a city in southern Somalia, a 4 -hour drive from Mogadishu, being cared for by her parents.
Several years later, when the raging civil war had caused much of the Somali professional class to emigrate, I was pleased to learn that Asha and her husband had been admitted to the U.S as political refugees, and that she was working for one of the international health organizations in Washington. Occasionally, our paths crossed at international maternal health meetings and I was pleased to see how well she was doing.
In addition to funding existing government organizations, the USAID project created The Somali Family Health Care Association (SFHCA). They were to become the lead organization to make information and maternal health and family planning services more accessible and widely available.
Ahmed M. S., an experienced executive who spoke excellent English was appointed Executive Director. Originally from Somaliland (Northern Somalia), a former English colony, Ahmed was designated by USAID to function as the project’s secretariat, overseeing the coordination of its activities. He also was my counterpart, the key person I worked with to ensure the implementation and coordination of project activities. Within a short period of time we developed a rapport and became good colleagues, who tried to be straightforward and honest with each other. However, the difference in our positions, I representing the funding agency and he the implementing agencies, was always there in the background, and although he might share with me disappointments with USAID and how particular activities were conducted by his counterpart organizations, his criticism was muted, and I understood his perspective and loyalties.
We never got down to serious business, however, until he served me a cup of sweet and spicy Somali tea, which was the perfect drink for the country’s hot and dry climate. When our work was done, our conversations often veered to religion, frequently comparing beliefs and practices in Judaism and Islam, finding greater similarities than we imagined.
In his late 40s, Ahmed was dark-skinned and good-looking with a soft-spoken easy way about him. He usually wore white open collar-shirts, which gave him a formal appearance, suitable to his prior position as headmaster of a private school for children of the Somali elite.
One of SFHCA’s role was to coordinate individual agency efforts to promote knowledge and attitudes about female circumcision, child spacing and family planning. Towards that end we sought to provide them with the audio-visual and print equipment that would facilitate that effort, and I spent hours poring over catalogs to find just the right equipment for the Somali situation. We had just about completed furnishing the AV studio, when the civil war broke out. Months later I learned that SHFCA’s offices had been looted, and the clinical and educational equipment destroyed or taken. All of our efforts had been in vain.
About five years ago, I picked up the ringing phone and heard Ahmed on the other end. I was so excited to hear from him that he was in the U.S and calling from Maryland. My “Somali grapevine” had never mentioned that he had left Somalia, as many other Somalis had during the civil war. I had assumed that he had gone north to his farm, where an independent, safe and functioning state had been declared. He invited me to lunch and gave me the address of an IHOP in Prince George’s County.
Ahmed looked the same, still wearing the open-collared white shirt, though he had acquired a small paunch in the intervening years. We were both glad to see each other, and we quickly began to catch up. He had been in the states for about 4 years, living mostly in Atlanta with his wife and son, who owned an IHOP franchise, as did the son in Maryland, where we met. His daughter was a doctor in Italy, where she had trained, and his youngest son was in Denmark. He now had two grandchildren, and though the family was geographically scattered, he was looking after them in the grand manner of a paterfamilias.
When we finished our lunch, he asked, “was there anything else I wanted?” I looked at him longingly and said, “If it were possible I would love a glass of Somali tea,” thinking at the same time how improbable that would be in an IHOP. He got up from the table, went back to the kitchen and about five minutes later his son, whom I had briefly met once in Somalia, brought it to me. The tea was the same, the setting so different. Abdu was grown now, but a young teen when I first met him. It reminded me of how much time had passed.
Ahmed said he was leaving in a few days for a business trip to the Gulf States, where he might remain for a time. He did promise to call again when he was next in D.C. Sadly, we never connected, though I did once try to reach him at the number he gave me, and it was out-of-service. Seeing him and knowing he was doing well, however, helped to bring some closure to my Somali experience. A few weeks later I shared with Margaret, who had hired me for the Somalia job, my incredulity about Ahmed and his sons’ connections to IHOP. I knew she wouldn’t be surprised. We often marveled at Somali resilience and their business acumen.
Experienced development workers say you fall in love with the first country you work in. That certainly was true for me. As I analyze my experience, there were three things that I especially loved about Somalia and working there.
First, my Family Health project with its consultants and technical advisers was only one project within a much larger USAID Development Plan for Somalia. Staying at the USAID Guest House, with a variety of consultants and advisers passing through, provided a window into a wide range of projects, and an opportunity to converse with consultants in very different fields. There were the farmers from the Midwest working to improve Somalia’s livestock exports, engineers surveying land for a possible dam, nurses training traditional birth attendants, and CDC staff come to estimate the number of condoms to be ordered, given demand and storage deterioration. Dinner conversation was rich with shared insights, stories and lots of humor about “The Innocents Abroad.”
Then there was the experience of working in a culture so different from mine, trying to decipher the inter-personal clues and figure out how to push ahead and remain respectful. I learned something every day. It was humbling to realize how little I knew about the Somali way of life, and how enriched I was when they shared some tidbits from their lives. Our aspirations were similar, though our cultural contexts so different.
Perhaps most important was a life lesson: we do the best we can, but ultimately don’t control the outcome. Words of wisdom succinctly captured in a title of a book I once owned, Man Plans and God Laughs. Most Somalis knew that; they lived it every day of their lives. And so, “Inshallah, May Allah will it,” was always on their lips.