There are change efforts, and there are change efforts. Edna Adan Ismail, referred to in the Western press as the Muslim Mother Teresa, created a small revolution when she founded the Edna Adan Maternity Hospital in Hargeisa, Somaliland. From securing buy-in and permissions from Siad Barre's government, acquiring land and struggling to keep it, and designing and constructing a new building, to educating a health care workforce, attracting physicians, and attending to the health care needs of a poor population, the case sets the stage for an analysis of change management. As Edna Adan Ismail feels the impact of globalization and the demands of global standards of care from the developed world, she faces some complex problems. How would she continue to add and improve hospital operations, educate the local population of health care providers and patients, and meet the objectives and standards of international actors? The material in this case presents complex problems around efforts to innovate and implement change on a grand scale.