This year was eventful. I traveled all over Somalia, from Bosaso to my hometown of Kismayo. I began my career as a surgeon under the mentorship of a prominent surgeon. I also launched an affordable community clinic to serve the underserved population of my old neighborhood in Kismayo. I began teaching second and third year medical students at Kismayo University. In the following sections, I will share some of my experiences. Each experience deserves its own blog post, but for now, this year in review will suffice.
My journey through Somalia was a tour of contrasts, with each city revealing its unique blend of opportunities and dysfunction. Let’s start with Armo, a newly established city that defies easy categorization. On the surface, it appears to be a beacon of prosperity, dominated by a single tribe and flush with wealth. Yet beneath this veneer of affluence lies a troubling lack of development. Nowhere was this more apparent than in the local hospital, where I shadowed doctors amidst a curious juxtaposition of demoralized staff and state-of-the-art equipment donated by the Somali diaspora in Australia. It’s a microcosm of Somalia’s broader struggles: potential and resources exist, but governance and accountability remain elusive.
Then there was Qardho, a city that seemed to embody the worst stereotypes of a failed state. Heavy rains transformed the streets into impassable muddy quagmires, while children swam in unsanitary floodwater, oblivious to the health risks. The adults, for their part, remained stubbornly indifferent to outsiders, as if visitors were simply another hardship to be endured.
Garowe, the capital of the region, presented yet another face of Somalia. With its new buildings and modern amenities, it offered a glimpse of what Somalia could become. Yet even here, contradictions abounded. Everything was inexplicably expensive, and the residents exuded a confidence that seemed at odds with the practical realities of their situation. It’s as if the very idea of progress had outpaced its actual implementation.
But perhaps the most striking example of Somalia’s complexities came in Galcacio. Here, the ever-present threat of tribal violence has led to a surreal normalization of firearms, with people openly carrying guns even into mosques. And yet, in this same city, I encountered the legendary neurologist Dr. Mohamed Jama, whose wisdom and mentorship offer a beacon of hope for Somalia’s medical future. Throughout my stay, I was awestruck by the Somalis’ meat-centric diet, and Galcacio took it too far by gorging on fatty camel humps as if it were its own food group.
No trip to Somalia is complete without visiting Mogadishu, the nation’s storied capital and epicenter of past and present culture. History echoes in well-preserved art deco relics, the maze of alleys in Old Mogadishu, sweeping Soviet apartment blocks, and austere government buildings. Gleaming beaches once attracted travelers from around the world.
However, the decay left by years of conflict cannot be ignored. Crumbling infrastructure, destitute beggars, and trigger-happy militia pose dangers. A prevailing ruthless mentality reflects the daily fight for survival and allure of corrupt gains. Hospitals are distressed, struggling after years of brain drain and leadership woes.
But resilience and optimism churn too, ever hopeful of a turnaround. The new government’s relative stability has led to a construction boom. Despite enduring the horrors of civil war with trademark Somali grit and good humor, locals have persevered. When I gave a lecture on heart failure to medical students, their eagerness and excitement for the future of Mogadishu deeply inspired me.
The capital is overcoming its painful history while embracing reinvention. I met tenacious elders and energetic youth who left me believing that, although scars run deep, this legendary city will reclaim its rightful place as the vibrant heartbeat of the nation. With focused development and stability, Mogadishu’s best days may still lie ahead. Its rich layers will always form a fundamental piece of Somalia’s soul.
Finally, Coming back to Kismayo, my childhood home by the sparkling Jubba River, felt bittersweet. I found a shell of what it was - buildings in shambles, people hardened and distrustful after enduring occupation after occupation when the city changed hands between competing tribes and warlords during the Civil war, and then the ensuing neglect when warlords moved on. The laidback charm remained but now it felt like a mask covering sadness.
Childhood friends lived much the same as when we were kids - stuck in circumstance beyond their control. I felt a swell of survivor’s guilt seeing old classmates struggle so profoundly when the luck of my family emigrating early after the civil war outbreak afforded me comfort and opportunities. Sometimes pity crept in too, though I regretted looking down on people proud to have scraped by against such gloom.
The saddest thing was how people’s thinking changed. There is a culture of “making do of what you have” They just try to get by and accept having very little. They can’t imagine a better future. Now that I’m a doctor, I really want to free Kismayo from this way of thinking that expects so little.
During my visit to Kismayo General Hospital, I noticed that it was the only public hospital in the region with a prestigious history. It was once the premier referral hospital for orthopedics. Interestingly, this hospital holds a special place in my heart as it was both my childhood home and the place where I received treatment for a terrifying gunshot injury. However, the building hardly resembled the place I remembered. After enduring conflict and willful neglect, only an emergency wing and a single operating theater remained functional.
The orthopedic ward had transformed into a malnutrition clinic that was overflowing with skeletal children. Despite their unthinkable suffering, their eyes still brimmed with innocence. In the pediatrics ward, every bed was crowded with cholera patients while concerned mothers hovered close. Supplies to treat diarrhea and vomiting were in short supply.
In the maternity ward, the delivery beds were rusted and looked risky to even lie down on. The only ultrasound machine broke long ago and there are no parts to mend it. The X-ray machine emitted more radiation than necessary for diagnostic images. The two physicians working heroically in this abyss understandably limited themselves to four hours daily to avoid burnout.
When I inquired about plans to improve this distressing situation, the administrator lacked the vision and competency to lead transformative change. They accepted gross dysfunction as standard, without any medical expertise to recognize the human toll incurred daily. I left feeling hollow and distraught, but also inspired to redirect my career towards redeeming this place that is so central to my own origins.
When I decided to pursue a job at Kismayo Hospital, I expected a simple hiring process to bring my skills where they were needed. However, I discovered a convoluted bureaucratic maze that spanned from hospital leadership to the Ministry of Health and aid groups.
First, I submitted my resume to the hospital’s Director General, who barely glanced at it before sending it off to a tribal elder to get it approved. It will pass onto someone at the ministry of health who will have to assess my worth before waiting for a sign-off from the World Health Organization (or other NGO’S), which will have to pay my salary. I struggled not to scoff at each self-important gatekeeper who assessed my merits in this broken system.
Frustrated by obstacles and corruption that thwarted patient care, I withdrew my candidacy. However, luck intervened when a surgeon from a private hospital at Kismayo University Teaching Hospital became aware of my interest. He was excited by my qualifications. He invited me to train and work with him with minimal bureaucracy.
My frustration turned to fulfillment as I helped this mentor find innovative ways to care for complex cases that had been neglected for too long in southern Somalia. Our days were long, up to 16 hours, pay was meager, and equipment broke down daily, but we made a significant impact on people’s lives, attracting patients from as far away as Ethiopia. Together we worked to heal, to educate, and to bring light where there had been only shadow.
I decided to undertake a bold new venture: launching a clinic that offers quality, affordable care in my old, neglected neighborhood. However, logistics proved to be daunting, including acquiring equipment, renovating a vacant hotel into a clinical space, and navigating red tape imposed by local government.
Hiring reliable staff willing to learn modern medicine felt nearly impossible with few qualified candidates. Despite these challenges, I persevered and trained those who were eager to improve, though progress came slowly. We prioritized community outreach and preventative care over quick, profitable procedures. Some days, the need overwhelmed our capacity, forcing tough triaging decisions.
A helpful investor was invaluable, providing essentials such as modern laboratory equipment, examination tables, and ultrasound machines. Without his trust, the clinic could never have gotten off the ground. We operated on a shoestring budget, focused on revitalizing the area through healing. I aimed to practice evidence-based medicine in a setting where folk remedies were prevalent.
The clinic filled important gaps on my surgery mentor’s days off, providing non-operative care with a focus on women’s and children’s services. Together, we worked to restore vibrancy and opportunity to this neglected place that has been important to me since childhood.
Although the long days can be challenging in a resource-limited environment, glimpses of progress fuel my commitment. Word spreads about the compassionate and personalized care we provide. My waiting room is steadily filling up, proving that even with minimal means, a little bit of investment and know-how can lead to better outcomes. My hometown taught me the basics of life, and now I aim to give back the basics of health and hope.
As part of my responsibilities working at Kismayo University Teaching Hospital, I was asked to teach second and third year medical students and this filled me with immense responsibility and excitement. The chance to shape future physicians and elevate standards of healthcare knowledge proved an honor. Yet difficulties emerged from day one.
Many students demonstrated shaky foundations in core concepts like anatomy and physiology - prerequisites assumed but clearly lacking. Senior professors contributed to these gaps, favoring an antiquated lecture style of simply reading aloud textbook passages or directly translating them to Somali. Nuanced material landed with a thud.
I aimed to modernize with interactive case studies and PowerPoint visualizations. But these tactics faced skepticism from pupils accustomed to passive learning. Engaged discussion felt like a shocking new paradigm. A few overly confident older students, colleagues in age to my own parents, outright challenged my authority over curriculum changes.
Still, I pressed on - drilling basics while promoting the clinical reasoning skills too often neglected. We inched towards fruitful dialogue albeit with friction. Bright lights sparked when pupils saw principles animated through real-world examples. My nursing cohort especially impressed, deftly assessing mock patient scenarios by semester’s end.
Witnessing those aha! moments made every uphill battle feel worthwhile. Each mind finally grasping ECG readings or diagnostic flows filled me with hope for tomorrow’s care standards here. With sustainable curriculum reform and engaging pedagogy, we can overcome years of stagnation.
I don’t claim to have all the solutions. But I will meet frustration with empathy and lean on the hunger I sense among Somali youth to become changemakers. Every future doctor elevating medical education plants seeds for Kismayo’s revitalization. By embodying the curiosity I aim to instill, there is no limit to the healing potential we can unlock together.
I’m ready for 2016!