Nasteha builds a bridge between the Danish and Somali health services

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After a trip to Somalia, which resulted in a marriage when Nasteha was 14-15 years old, she realized that as a privileged Dane she must use her knowledge and her values to help people in need and promote development in her native country. She does so, among other things, as a volunteer in Global Medical Aid, which donates medicine and used hospital equipment to poor countries.

Nasteha's family fled the civil war in Somalia in 1993, and she came to Denmark as a 5-year-old. After growing up in Nr. Aaby on Funen, the family moved to Aarhus when Nasteha was 13 years old and about to enter the 8th grade. But the following year, she was suddenly torn from her familiar surroundings:

"I was sent to Somalia when I was 14-15 years old, where I got married, and it was there that I realized that I am certainly Somali by origin, but mentally, thought-wise and culturally I am actually Danish", says Nasteha. "And that has somehow shaped me to want to change the way of thinking we Somalis have here in Denmark: That we will have to hold on to our culture and traditions, even though we live in Denmark and are part of the Danish society. For many years, for example, we have practiced circumcision, and it is an ancient tradition and not something you should take with you to Denmark, because you come here to get a new life and to build a future for your children. When you then send them back to maintain and preserve the culture, which actually contains a lot of negativity, I was very much against that.

After all, I got married and then had a child at 16. You could say that it was an arranged marriage, but I had also agreed to it, because I had not understood the concept of marriage at the time. But I'm happy about the experience because I've since done what I could to make the parents realize that this is not the culture we need to go back to. Now we are in Denmark, and unless you would like us to be sent back permanently, then it is not something we need.”


A new role in life

Since Nasteha came back to Denmark, she has lived in different places in the country, e.g. Viborg when she took a bachelor's degree in nursing (2011), and Odense when she wrote her thesis as a candidate in public health science (2016). In 2020, she moved back to Aarhus, where she now works at Skejby Hospital.

Already at the age of 16, Nasteha started working intensively with integration and she has, among other things, work at the Immigrant Medicine Clinic in Odense: "I found a new role in my life", explains Nasteha. "Well, it was at a young age, but it has made me decide to enter the health sector and work with Somalia and try to build a bridge and somehow also try to break down this barrier that is between the healthcare system and immigrants in general. Many refugees are, for example, illiterate and cannot navigate around society. Therefore, we have tried to create different courses and events in relation to child-rearing, in relation to integration, in relation to the municipality, i.e. which direction should you go according to what you need, whether you are unemployed and it is cash benefit or unemployment benefit. And I have also worked there as a volunteer interpreter for a number of years.

There are so many things - not only the language, but also the cultural aspects. Just the fact that you have an immigrant patient who may be in intensive care, and then 20-25 people come to visit him, where at the hospital we want the person to have peace and protection to be able to regain health. And the relatives cannot understand that, because the culture says that if there is a sick person, then it is a good thing to visit the sick person. And then there are these gaps and misunderstandings in relation to what their expectations are and what our expectations are as healthcare professionals. This is something I have worked with, to try to eliminate these cultural gaps between staff and patients with other ethnic backgrounds.”


Vision of upgrading Somalia's health sector

In 2013, Nasteha went on a trip to Somalia together with the association Somalisk Sundhedsforbund, which she had helped to establish here in Denmark. The purpose was to create a foundation for a health sector in Somalia, and health personnel from many countries were invited: "I think we were about 400 people who attended conferences and visited hospitals, and it made a huge, huge impression on me – just the beds they were lying on", recalls Nasteha. "When you have grown up in a country as well-functioning as Denmark, you don't have a chance to imagine how they live in the poor countries. What made the greatest impression on me was a woman lying with a small infant in a simple iron bed. I would think that the child was 2-3 months old, and it was lying with a drop of salt water, only covered by a scarf. I then ask what is wrong and if it is an infant, and she says: No, the child is 1½ years old and has had diarrhea for 2 weeks. Wow, that was really hard.”

This experience left a deep impression on Nasteha, and in March of last year she began looking for opportunities to help these people with equipment: "I can't go down with some doctors and try to teach them if they do not have the tools to be able to treat these patients. But when I searched online for hospital equipment donations, Global Medical Aid popped up. And then I called Hans Frederik Dydensborg (chairman of GMA), and I think our first conversation lasted 1½ hours. Here I told him about what I had experienced and what I wanted, and then suddenly we were at it. We sent the first container to Somalia in May 2021, and No. 2 was in June, I think, and No. 3 and 4 were in September.”


Major administrative challenges before GMA shipments

Before the containers with hospital equipment could be sent to Somalia, however, Nasteha had some particularly busy months preparing the shipments: "The biggest challenges were that we don't have the same work ethic, in short. This is what has pulled teeth, calling around and contacting the parties involved and getting this equipment sent off and getting it into the country and getting it delivered to the respective hospitals.

If the Ministry of Health prepares documentation that this is a donation to a certain hospital, then it has to go through the Ministry of Finance and then to the Ministry of Foreign Affairs, and then each party takes several weeks to get things in place. For an outsider it is difficult to get through, but here I could draw on my Somali background, because I had to e.g. find the various clans and chiefs that were important to us in the cooperation to get the containers through. The Ministry of Health, for example, is divided into states, so I had to get hold of both the federal and state health ministers to get the customs papers in order. It took 3-4 weeks to get through to him and I had to talk to about 50 people before it worked out and it was very frustrating.

After all, it was the first time we delivered something to Somalia, and it was so big that ministries and the federal president were involved. They also had a little difficulty understanding that it was me as a woman who came and said that this is how it should be. But now they have accepted that it is on GMA's terms and based on our values and visions that things are donated, and that our expectation is that they get their things under control. This means, for example, that they pay for the transport themselves, so that they themselves contribute and get 'ownership' and feel that they have to do something to get something - instead of just waiting to get a 'handout', which I have been against for many years. So the administrative tasks were a challenge, but it all worked out in the end. And it was also a learning process. I can look back on the fact that I faced these challenges, but ok, there was a solution, and now I have this and that person with whom we can communicate.”


Key requirements from Global Medical Aid

GMA's container No. 2 arrived June 2021 in Kismayo in Jubaland on September 28, 2021, and Nasteha went down there in October to help open it up and deliver the contents to the hospital that had applied for the equipment.

"They were very grateful for everything: wheelchairs, walkers, etc.," says Nasteha. "So just seeing that an ultrasound scanner, which we no longer need here in Denmark, is appreciated in another country that doesn't have one, it was an indescribably good feeling. After all, I myself work in a hospital, and we follow the smallest things that can promote patient safety and raise the quality of treatment, while they need very basic things that they cannot get. So to see things that were just lying in a warehouse in Skibby being welcomed like a child receiving Christmas presents, it was indescribable.

However, they had a little difficulty understanding that I was so direct in my demands that things should be delivered to specific locations and installed where it was agreed. Then they ask: 'Yes, but where is the MAN who sent it?' you are not right. It has been something else in Somalia. But it got where it needed to be, and I helped install and even instruct in how to, for example, set up a Venflon (venous catheter) and saline, and how to set up the ultrasound scanner and switch it on. I think it's a really good thing to follow your shipments all the way to the door, also for our own sake. When I left here again in February 2022 to follow up on the last containers - primarily an overall visit to the hospitals to which we had delivered equipment - I noticed, for example, that there were some treatment centers that had received equipment from ‘Recycling for development’, who could not operate these machines. No documentation had been required that the hospital had the necessary skills, so I had to spend 1½ days training them in some basic processes. There is no one who works like GMA in relation to Somalia - whether it is the Danish Refugee Council or ‘Recycling for development’. I want documentation that the hospitals have 24-hour electricity and sufficient numbers of nurses and midwives, etc., but the local NGOs do not ensure that the conditions and skills to operate the equipment they provide are actually present in the respective countries and areas.


Ready to take the next step

Thanks to the collaboration between Nasteha and Hans Frederik Dydensborg, the president of Jubaland has invited them to Somalia to discuss new initiatives. In the near future, it is expected to send two containers to a huge hospital near the capital Mogadishu, which has previously received an X-ray machine, a surgical microscope and a whole lot of beds. The hospital is now ready to receive larger equipment, as they have both the resources and the skills to handle it. But Nasteha's plans go much further: "I hope that in the future we can go one step further and get doctors, nurses, medical and midwifery students to Somalia, Burundi, Kenya, so they can see what it is that we do here in Denmark, because we are so privileged that it doesn't matter that we throw away an entire CT scanner because we now have the latest model. And if, for example, we take a catheter into a living room, we cannot use it elsewhere, even if the packaging is unbroken and the contents completely intact, but these are just the rules we have for hygienic reasons here in Denmark. That is why in my department we have something called the 'Afrikakasssen', where we put this kind of thing. But no one knows what this 'Afrikakassen' is really about: where does the content go and who will use it, etc. But it will go - and regardless of whether it is Ukraine, Kenya, Burundi, Burkina Faso or something else second – there are people who need something as basic as a plaster, which they otherwise cannot get hold of.

I have taught for several years at the UCL Lillebælt nursing education, and there are many young people in our little bubble in Denmark who do not know how these people live. So to take them down there and give them a course in the local conditions, maybe do some research on the small children, so that they can see, for example, that it's just diarrhea they're suffering from, they're not sick, they just need some salt - and sugar water to be able to recover their energy again. Or experience these women who are in labor out in the forest for several days with complications and the child comes out and is dead. That's what I've been trying to figure out, but haven't really known how to proceed with. So I try not only to donate equipment, but also to further develop and raise the quality we have here in Denmark and transfer it via GMA in collaboration with my organization, the Arte Foundation, which both here and in Somalia is trying to build something within the healthcare system. This could be done, for example, by getting doctors and nurses to install the equipment and learn from them in connection with the delivery of a container. But there are plenty of other options…”.