VZCZCXRO5116
RR RUEHROV
DE RUEHDJ #0841/01 3001710
ZNR UUUUU ZZH
R 261710Z OCT 08
FM AMEMBASSY DJIBOUTI
TO RUEHC/SECSTATE WASHDC 9631
RUCNIAD/IGAD COLLECTIVE
RHMFIUU/CJTF HOA

UNCLAS SECTION 01 OF 02 DJIBOUTI 000841 
 
SIPDIS 
 
DEPT FOR G/IWI AND AF/EX 
 
E.O. 12958: N/A 
TAGS: KWMN PREL KPAO PHUM PINR DJ
SUBJECT: DJIBOUTI'S NOMINATION FOR THE INTERNATIONAL WOMAN OF 
COURAGE AWARD 
 
REF: STATE 99729 
 
¶1. Embassy Djibouti nominates Ms. Zahra Moussa Bouh for the 
International Woman of Courage (IWOC) Award.  For nearly two 
decades, Ms. Bouh has played an instrumental role and has been an 
important leader in the promotion of women's health in Djibouti. 
Since 1992, she has served as a midwife, nurse anesthesiologist, and 
as supervisor of Djibouti's Balbala hospital. 
 
¶2. As a midwife, nurse anesthesiologist, and supervisor of a 
hospital located in one of the poorest areas of Djibouti, Ms. Bouh 
is an unsung hero in the fight to reduce Djibouti's high infant and 
maternal mortality rates.  For almost two decades, she has tackled 
the challenges posed by Djibouti's extreme urban poverty, large 
nomadic-pastoralist population, and lack of basic healthcare 
infrastructure.  By providing personal medical counseling and 
training to scores of women, Ms. Bouh has been at the vanguard of 
helping Djiboutian women face and overcome complex cultural, social, 
and health challenges. 
 
¶3. For Djibouti's urban poor and nomadic pastoralists, home delivery 
with the help of family members or an untrained midwife is the norm. 
 However, because of the extremely high incidence of female genital 
mutilation (FGM) in Djibouti, complications and hemorrhaging during 
childbirth are common.  Over 90% of Djiboutian women have undergone 
some form of FGM, and the most common practiced form in Djibouti is 
infibulation, the most extreme type of FGM.  Outside of Djibouti 
City, healthcare infrastructure simply can not provide anything but 
the most rudimentary interventions.  Medication cannot be stored 
properly, so even a relatively simple complication, such as an 
infection, often condemns both the mother and infant to death.  In 
the event of a hemorrhage or crisis situation, there is little hope 
of transporting the patient to urgent care facilities in time. 
 
¶4. Chronic water sanitation issues and cultural practices lead to 
further problems after childbirth.  Extended breastfeeding is not a 
common cultural practice in Djibouti, and women often mix milk 
powder with unclean water, leading to infant diarrhea, malnutrition, 
and death. 
 
¶5. On the cultural front, Ms. Bouh targets local elders and 
community leaders in this predominantly Muslim country to convince 
pregnant women to come to the hospital for delivery.  At the 
hospital, she runs a comprehensive education program on the benefits 
of breastfeeding and the dangers of unsanitary water and living 
conditions.  This includes programs aimed at new mothers to 
demonstrate how good personal hygiene can help save the lives of 
their infants. 
 
¶6. Ms. Bouh has also been active in enhancing access to healthcare 
for women with HIV.  In an environment where HIV is heavily 
stigmatized, she runs HIV education and social awareness and 
outreach campaigns to convince HIV-positive women to come to the 
hospital for treatment. 
 
¶7. Structurally, Ms. Bouh has worked tirelessly with the Government 
of Djibouti, the Ministry of Health, local community leaders, 
elders, and social workers to change current practices.  Ms. Bouh is 
a member of a key committee that drafted and submitted a National 
Disaster Management Plan.  She has pushed the Ministry of Health to 
issue payment waivers and make reduced-fee services available for 
the indigent, providing services for free or at cost.  In addition, 
she has modernized the pharmacy management protocols at Balbala 
Hospital to ensure that medicines are properly stored, cataloged, 
and disposed of.  This has had the added benefit of reducing waste 
and corruption, and making medicines close to expiration (within 
limits) available to women in need free of charge. 
 
¶8. Ms. Bouh's activism is remarkable in many ways.  While 
steadfastly reaching out to improve the lives of individuals and 
groups of her fellow country-women in a real and immediate way, she 
has also made great efforts to push for the structural reforms that 
will have an even wider and longer-lasting impact.  Her work is both 
tangible, and transformative.  Leading by example and hard work, she 
has made a crucial contribution to two of her country's most 
difficult challenges: the basic health of its people--and the 
empowerment of Djiboutian women who can act as a positive force for 
development and social change. 
 
¶9. Biographical information: 
 
Name: Zahra Moussa Bouh 
Date of Birth: 15/12/1972 - Dikhil 
Martial Status: Married - 5 children 
Tel: (253) 82-26-32 
 
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PREVIOUS POSITIONS 
------------------ 
 
DJIBOUTI 00000841  002 OF 002 
 
 
 
1993-99:  Midwife 
1999-2004:  Nurse anesthesiologist 
2004-06:  General Supervisor, Intensive Care Unit, Peltier Hospital 
 
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CURRENT POSITION: 
----------------- 
 
August 2006:  Supervisor of Balbala Hospital and surrounding health 
centers 
 
Ms Zahra occupies several positions: 
- Supervisor of Balbala hospital, 
- Midwife two nights per week at Dar El Hanan Maternity Hospital 
- Nurse anesthesiologist for caesarian surgeries 
 
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EDUCATION & TRAINING 
-------------------- 
 
1988-92: Midwife school, Djibouti 
2000-02: Diploma of Nurse Anesthesiology, Dakar, Senegal 
2002-2004: Diploma in hospital management 
2007: Seminar on reducing child mortality, Rabat, Morocco 
2008: Conference on disaster management, Egypt 
 
WONG