Relocating to Sudan in the latter part of the 1980s, Breda Gahan, a seasoned midwife, soon understood the necessity of mastering Arabic. She wanted to be effective in her role of educating local health staff and reducing the mortality rates of women during childbirth. Although she had found it challenging to acquire Irish during her school years, she was convinced that learning through text wouldn’t benefit her. Instead, she opted to absorb the language by paying attention to the conversations happening amongst her new neighbours in Sudan.
“First, I familiarised myself with all the adjectives and nouns, following which, I started picking up on the verbs. In about six weeks, I could comprehend the language and in roughly two months, I was able to converse in Arabic so fluently that people could identify my living area just by listening to my accent,” shares Gahan.
“Although at times in Arabic, I wasn’t quite sure about what I was uttering, but I had the intuition that it was accurate. I commonly joke about remaining unlettered along with the uneducated population I worked with. Communication, which is vital in building trust with mothers, children, vaccinators, and other frontline health workers, is largely dependent on language,” she explains.
Gahan further adds, emphasising the importance of fostering a relationship with the Sudanese midwives, “They serve as the gateway to each community as they have an in-depth understanding of what actually transpires.” Prior to her journey to Sudan in the later 80s, Gahan hadn’t witnessed the death of a woman during childbirth, but that changed to one death every week in Sudan.
The reason, predominantly, she says, was Female Genital Mutilation (FGM) which made child delivery impossible. She recalls it as a slaughterhouse that still infuriates her. It was an oppressive environment marked by desecration and inhuman treatment. “What wrong had these innocent women and children committed to undergo something so horrifying? However, we had the capacity then, and we still do now, to turn everything around,” she stated.
On a typical overcast afternoon in the early summer, I found Gahan at a café on Prussia Street, northern Dublin. It was a stone’s throw away from her residence in Cabra and quite near to where she had planned her evening, a Bohemian FC women’s match at the club’s home ground.
Despite living in close vicinity, she confesses she has never set foot in Dalymount – this was a statement she made in a message a day before we had our encounter. Gahan, who has served faithfully on Concern Worldwide’s international health programmes for a span of over three decades, is engrossed in her role as a medical nurse and midwife assisting in war zones and during major global humanitarian emergencies. However, she persistently pleads for this account to shine a light on the work and the concerning issues, not her persona.
Hailing from Boolavogue, a small pastoral village in County Wexford, where she spent her younger days in the rustic settings of the farm, Gahan did not consciously choose nursing as her profession. She conveyed, “It was the one choice left standing after ruling out a regular desk job or employment in a bank. I was not looking for a stationary job. Besides, I had a distaste for arithmetic but a keen interest in biology and geography.” She was just sixteen, relatively young to decide on a career path. “Being on the farm, you end up having an unplanned training as a first responder, especially when assisting my mother in delivering piglets and enjoying my time with the newborn lambs,” she added.
Her journey as a nurse began at the renowned Mater Hospital in Dublin in the year 1977. She described the hospital as a sanctuary helmed by formidable female chiefs, where the floors were so immaculate that one could practically eat or sleep on them. Subsequently, she pursued her midwifery training at Coombe. Her job trajectory then pointed towards St Anne’s, the pioneer dedicated oncological centre in Ireland, and later, she joined the oncology division at St James’s Hospital. It was during her tenure in the mid-1980s at this place, that she was introduced to a disease that she would repeatedly encounter and scrutinise in her ensuing professional path.
Reminiscing about those times, she recalled, “Regarding HIV and AIDS, we had taken a vow of silence then. We were aware that we were grappling with something extremely virulent and relentless, beyond the reach of any cure. All we could offer was compassion, pain management and comfort.”
She voiced her concern regarding the prevalent predicament of guilt and dishonour that surrounded HIV and AIDS, especially during its early phase. Pausing momentarily, she added, “Interestingly, the veil of secrecy has intensified in the present day. With the onset of the Covid pandemic, the situation got driven underground. Subsequently, the instances of getting screened and treated for the disease dropped, despite it being absolutely preventable, technically. A further complacency set in during post-Covid times.”
Gahan dedicated her time to helping those afflicted with HIV and Aids at St James’s, before she was offered the opportunity to work in a hospital in Baghdad in 1984, amid the height of the Iran-Iraq War. She remembers how Aer Lingus secured the staffing contract for the hospital, perhaps due to the global reputation of Irish nurses and midwives.
Nurses from Mater hospital, renowned for their specialisation in open-heart surgery, were recruited and nurses from Northern Ireland also joined the team, known for their outstanding skills in treating war orthopaedic injuries. Interestingly, these Irish healthcare practitioners preferred to rest during the day and brave the night-time air raids. Gahan points out that they weren’t the intended targets, it was sheer coincidence if any long-range missiles landed nearby. Drawing a stark comparison, she notes that nowadays front-line healthcare workers are directly targeted, a scenario inconceivable during her early overseas career.
Although numerous colleagues opted to return to Ireland after their tenure during the first Gulf war, for Gahan, this marked merely the beginning of her international career. By 1988, she had headed to Sudan to collaborate with Concern Worldwide. She stood out as the only Caucasian who was proficient in Arabic, which unfortunately resulted in her being placed under house arrest for a few weeks after the 1989 coup due to her substantial knowledge about unfolding events.
Her command over Arabic also gifted her a unique view into the everyday lives of Sudanese women, an understanding not often granted to foreign healthcare workers. In Sudan, she was perceived as neither male nor female, but as a unique entity of sorts. Many Sudanese had never encountered a westerner before, and a lot were even unfamiliar with Ireland.
Gahan recalls numerous nights spent traversing forests and navigating rivers, accompanying traditional midwives on their calls to aid in childbirth, even in the turbulent period following the military coup. She profoundly notes that the birth of babies isn’t halted by incoming long-range missiles. Today, she often ponders the thoughts that circulate in the minds of pregnant women in war-stricken Palestine around their delivery. The fear instilled by the war, she admits, is impossible to fathom, as conflict has a powerful, disruptive effect.
Gahan, after over three decades, continues her intimate association with Sudan professionally as a health counsellor to the Concern team in the country. Sudan’s already beleaguered medical system, following escalating assaults on medical facilities has been left in tatters, warns the World Health Organisation. The civil unrest, which began 15 months ago, has led to the loss of several lives while fuelling starvation among about 750,000 denizens. In June, Samantha Power, an Irish native and the head of USAID, labelled the Sudanese situation as the world’s “largest humanitarian crisis”.
When queried about Sudan being referred to as the “forgotten war”, Gahan poses a larger question in response – why isn’t anyone questioning about the forces behind the war? She believes that the extensive economic exploitation she has observed in Africa over the past three decades should be addressed, with the US, UK and China at the forefront, majorly affecting the economically weak and unheard.
Her professional experience spans various nations, including three years in Mozambique, witnessing widespread HIV and AIDS, and initial years of the 90s in Cambodia, observing rampant TB and aftermaths of warfare and privation. According to Gahan, reliable healthcare information and providers are vital for a society to function properly.
She reiterates that education works like social vaccination, its usefulness determined by its source’s credibility. Her experiences in Cambodia reveal that people place their faith in health workers they trust. The contrasts in information she received from the health ministry and trusted women leaders in Cambodia further bolster her belief.
Gahan remains persistent in her efforts to reach the UN’s Sustainable Development Goals (SDGs) adopted close to a decade ago. The global community, represented by more than 150 global leaders, are unified in their commitment towards the eradication of worldwide poverty by the year 2030. When questioned about her continued belief in the principles and resolve to realise these objectives, especially amidst daily news about conflicts in places like Gaza and Ukraine, her faith remains undeterred.
The Sustainable Development Goals have served as an effective path, notably in eradicating the extreme poverty that strips away dignity and humaneness, and perpetuates injustice. Progress has been made since 1990, with over a billion less people experiencing extreme poverty. However, a staggering 700 million people remain in such conditions, highlighting the persistent challenge.
Despite considerable growth in the world’s population since the beginning of my career, the development and expansion of healthcare systems haven’t kept pace, leading to difficulty in meeting targets. This is true even for my own homeland, Ireland.
Conflict remains a significant obstacle. It’s disheartening to witness the current situations in Afghanistan, Palestine, Ukraine, Sudan, and Yemen. Those responsible for these conflicts must be held accountable. Peace, in my view, is the ultimate remedy for all of humanity.
My nearly forty-year-long tenure with Concern has been a blessing, despite the fact that I’ll forever be barred from returning to certain places like Sudan and Iraq. Their realities have drastically changed, denying me the opportunity to relive those experiences.
Being born in a safe environment like Ireland is a fortune that shouldn’t be overlooked. Birthplace is an entirely random occurrence. If I had been born in Sudan, Cambodia, Mozambique, or Bangladesh, I almost certainly wouldn’t be alive today, let alone sharing this conversation. This privilege should not blind us to the hardships of war and hunger endured by countless others globally.
This year, I’m looking forward to my official retirement from the post of Overseas Health Programme Advisor and HIV Technical Assistance Team Lead at Concern. However, responding to queries about my future plans, I affirmed that I’ll continue to work with the Sudan team and will keep engaging with Irish NGOs. Retirement, in my perspective, is not about stepping aside but transitioning to overcome a new set of challenges. “I have learned more than I have imparted and gained more than I can ever contribute,” I assert.
“I am indeed eager to persist with my work in some capacity. No one inquires about Mary Robinson’s retirement plans, although I’m not asserting we stand equally,” she remarks, grinning. “I am merely evaluating my options to discern how I can offer my contributions in the future.”