When midwife Breda Gahan moved to Sudan in the late 1980s, she quickly realised she needed to speak Arabic in order to train local health workers and help combat the number of women dying in childbirth. Having struggled to learn Irish in school, she knew approaching the language through the written word was pointless. Instead, she opened her ears and listened to the conversations taking place among the people around her in her new African home.
“I learned all the adjectives, the nouns and then just listened for verbs. I could understand it within six weeks and within eight weeks I was speaking it so colloquially that if I went to the neighbouring province, they knew where I lived by my accent,” says Gahan.
“Half the time in Arabic I couldn’t tell you what I was saying, but I knew it was the right thing. I jokingly say I remained illiterate with the illiterate people I was working with.
“Language is essential for communication, gaining trust, working with mothers, children, vaccinators, all frontline health workers.”
Securing that line of communication and trust with the midwives in Sudan was also key to improving young mothers’ healthcare, says Gahan. “Midwives are the window to every community, they know what really goes on.”
Before travelling to Sudan in the late 1980s, Gahan had never seen a woman die in childbirth. “In Sudan, there was one every week. Many times, because of FGM [female genital mutilation], the baby literally couldn’t get out. It was an abattoir, I can’t even think about it, it brings me such anger. That injustice, indignity and inhumanity. What had these women and children done to deserve any of that? But we could make that change happen, we still can.”
It’s a grey, early summer afternoon when I meet Gahan in a coffee shop on north Dublin’s Prussia Street, a short walk from her home in Cabra and not far from her appointment later that evening – a Bohemian FC women’s match on the club’s home ground.
“Close as I am, I’ve never been inside Dalymount,” she admits in a message the day before our meeting. A member of Concern Worldwide’s overseas health programmes for 35 years, Gahan is discussing her work as a nurse and midwife in conflicts and humanitarian crises across the globe. However, she also repeatedly requests that this report “focus on the issues and the work rather than me”.
Born and brought up on a farm in the village of Boolavogue in Co Wexford, Gahan never chose to be a nurse. “It chose me by exclusion of not wanting to sit in an office, not wanting to work in a bank,” she explains. “I didn’t want a sedentary job, I don’t like mathematics, I like biology, I like geography. I was also too young, I was only 16.
“My mother would be delivering the baby bonhams and I was with her, and I loved the baby lambs. When you live on a farm, you learn to be a paramedic very quickly.”
Gahan started her training in Dublin’s Mater Hospital in 1977 – a place where “the matrons were formidable women” and floors were so clean “we could literally eat or sleep on them” – before moving on to midwifery training at the Coombe. Next, she got a job as a nurse at St Anne’s, the first dedicated cancer hospital in Ireland, before moving on to the oncology department at St James’s Hospital. It was here, in the mid-1980s, that she first became acquainted with an illness which she would later study and revisit throughout her professional career.
“HIV and Aids, we were sworn to silence about it then,” she remembers. “We knew we were dealing with something quite pernicious and unrelenting, no treatment could save their lives. We could only provide compassion, pain relief and comfort.”
“The problem of shame and stigma was very real in the early days of HIV and Aids,” she says, before pausing. “Actually, the secrecy is worse now, it went underground during Covid. Testing went down, treatment went down. It’s still technically 100 per cent preventable, but there was complacency after Covid.”
Gahan was working with Aids and HIV patients in St James’s when she was offered the opportunity, in 1984, to spend two years working at a hospital in Baghdad, right at the peak of the Iran-Iraq War. She recalls how Aer Lingus “won the contract” to staff the hospital, “because we were the best nurses and midwives in the world, apparently”.
Nurses from the Mater hospital were hired for their expertise in open-heart surgery, while Northern Irish nurses were brought in “because they were the best for orthopaedic war wounds”.
The young Irish healthcare workers tended to prefer sleeping during the day so they could work through the night-time bombardments, she says. “We weren’t direct targets, it was just happenstance if the long-range missiles landed nearby. Today frontline healthcare workers are targets and under attack, that was unheard of when I started this overseas work.”
While most of her colleagues returned to Ireland following their stint working in the first Gulf War, Gahan’s overseas work was only beginning and in 1988 she moved to Sudan to work with Concern Worldwide. “I was the only white-European who spoke fluent Arabic, I knew too much of what was going on so I was placed on house arrest for a couple of weeks after the [1989] coup.”
Gahan’s fluency in the language also gave her an insight into the lives of normal Sudanese women which most foreign healthcare workers never experienced. “I wasn’t even treated as a woman there – I wasn’t male, I wasn’t woman, I was a third sex almost. In Sudan they’d never seen a westerner and many of them had never heard of Ireland.”
She spent many nights traipsing through forests and wading through rivers while accompanying traditional midwives on their call-outs to deliver babies, even in the months after the military coup.
“Babies don’t stop being born when the long-range missiles are coming. In Palestine today, what does a pregnant woman think about most coming up to her delivery? I can’t imagine their fear because in war, everything collapses. Conflict is the great disrupter.”
Thirty-five years on, Gahan is still deeply connected to Sudan and works as a health adviser to the Concern team operating in the country. Just this week, the UN’s World Health Organisation warned that increasing attacks on hospitals in the besieged nation had left the Sudanese healthcare system “hanging by a thread”. Thousands of people have been killed in the fighting since civil war broke out 15 months ago, while 750,000 are on the brink of starvation. In June, Irish-born Samantha Power, head of USAID, described the situation in Sudan as “the single largest humanitarian crisis on the planet”.
Asked whether references to Sudan as “the forgotten war” bother her, Gahan responds that the bigger question is why “nobody is talking about who is behind this war. The economic colonisation I’ve seen in Africa over the past 30 years is staggering, why aren’t people talking about that? It’s the US, it’s the UK, it’s China. It’s most distressing because it’s the poor and voiceless who are most affected.”
Having worked in Cambodia in the early 1990s – where she witnessed widespread TB and “people coughing up blood after years of war and deprivation” – and, after spending three years in Mozambique, where she witnessed further prevalence of HIV and Aids, Gahan says trusted health sources and information are key to a functioning society.
“Education is a social vaccine but we need to hear it from people we can trust and believe in. It’s the trusted health workers that people believe. When I worked in Cambodia, I’d hear one thing from the ministry of health but I’d hear something else from the trusted women leaders.”
Gahan also continues to campaign for the achievement of the UN’s Sustainable Development Goals (SDGs) which launched nearly a decade ago and saw more than 150 world leaders agree to eradicate global poverty by 2030. Asked if she has lost faith in the idealism and determination behind these targets, particularly in a world where the atrocities in Gaza and Ukraine fill our daily headlines, Gahan shakes her head.
“The SDGs have been a great pathway, especially when it comes to ending the indignity, inhumanity and injustice of extreme poverty. The good news is that compared to 1990, more than a billion fewer people are living in extreme poverty. But the numbers are still sobering – there are 700 million people still living in extreme poverty.
“The world’s population has grown massively since I started in this work, and it’s harder to reach targets because the health systems haven’t developed and expanded in terms of capacity, even here in Ireland.
“War is still the great disrupter, people need to be held to account. It saddens me today when I see the reports from Afghanistan, Palestine, Ukraine, Sudan or Yemen. Peace is the best medicine for all people.”
Gahan describes her own work with Concern over nearly four decades as a “privilege”, particularly because she will never return to some of the countries where she once lived. “I probably can’t go back to Sudan or Iraq, they’re a different world now. I’ll never get that experience again,” she says.
This “privilege” also means she can always return to the safety of her home in Ireland. “Nobody should take privilege from the happenstance of geography of their birth,” she adds. “It’s completely happenstance I was born white Irish and European. If I had been born in Sudan, I wouldn’t be sitting here talking to you now. I probably wouldn’t be alive. Or probably not if I was born in Cambodia or Mozambique or Bangladesh.” A person’s place of birth is “completely incidental” and should not mean that person loses sight of the realities of war and hunger faced by so many on this planet, says Gahan.
This year, the Wexford woman will formally retire from her role as Concern’s overseas health programme adviser and HIV technical assistance team lead.
Asked whether she’s planning a break, Gahan quickly responds that she still works with the Sudan country team and has no intention of stepping away from her various partnerships with Irish NGOs. “I’ve learned more than I’ve ever given and received more than I’ll ever give,” she says, adding that retirement does not mean stepping away, but is a “transition” to a new set of challenges.
“I do want to continue this work at some level. Nobody ever asks Mary Robinson when is she going to retire, not that I’m on the same level as Mary Robinson,” she adds with a smile. “I’m just transitioning to see what I can do and how I can contribute going forward.”
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