Vieques in October

We’ve just returned from a trip to Vieques last month,  a community that’s near and dear to our IMR family. IMR has had the pleasure and privilege to support and volunteer here since Hurricane Maria in 2017. This recent trip was a small team of Ambereen and Liz Santaniello, NP, a cherished IMR volunteer and family. We conducted home visits to vulnerable populations in Esperanza, the southern part of the island, carrying on a practice that we started a few years ago. We donated medical supplies to individuals and to community organizers. These included glucometers, testing strips, lancets and other diabetic supplies, wound care items as well as other items that have been identified as necessities for the residents. Solar lights and powerful flashlights were also handed out on our home visits. Thank you to everyone who  supported our trip. We were given an update on the healthcare facility/hospital that’s currently under construction, as all are eagerly waiting it’s opening so that the residents of Vieques can get the healthcare that they’re entitled to and deserve. We’re planning a return this spring to continue our project.

Thanks so much for your ongoing support and please contact us if you’d like more information.

Return to Vieques

IMR has had the privilege to work with the community in Puerto Rico,  specifically the island of Vieques, since 2017. In the aftermath of hurricane Maria, the medical needs of the community are vast. We are thankful we’ve been able to play a small role in supporting vulnerable communities. Our last time in Vieques was in 2021 and we’re looking forward to returning in a few weeks. As everyone on the island is eagerly awaiting a new hospital to replace the one damaged after Maria, home visits and focused care for the vulnerable is more vital than ever. The population of Vieques has specific health and and psychosocial needs that are, in part, unmet.

We’re thankful to be able to play a role in partnering with community organizations to help support homebound, elderly, and vulnerable community. Our team for our upcoming trip has volunteers Liz O.  and Ana A.  as well as our ED Ambereen. We look forward to spending the week with home visits, assessments and health education outreach for several communities. We’d love to have the ability to provide plenty of medical supplies and equipment. Please consider a donation at this link!

Thank you so much and can’t wait to share our experience when we return.

Thanks as always,

Ambereen 

IMR donates medical supplies to Ukrainian partners

IMR has been working with healthcare practitioners in Ukraine in support of local efforts to provide training for war-related trauma.  Dr. Oleg Devinyak, Dean of the Medical School at the National University of Uzhhorod, has been a key partner of IMR for the past two years and also coordinates trauma education for the military and non-military populations.  During the Spring, 2024 we worked with Dr. Devinyak in providing critical equipment and supplies for his curriculum through a $10,000 donation.  Through this commitment, IMR is assisting battlefield medics as well as civilian providers to be better able to care for trauma patients affected by the war.  

IMR will continue to provide our Ukrainian partners the materials they need to maintain access to the healthcare needed by its patient populations under stress.

Our Return to Uzhhorod, Ukraine

We had our 1st visit to Ukraine in April and were thrilled to return again this past November. Our program is focused on enhancing medical education for clinicians and medical students at the National University of Uzhhorod. The IMR team, comprised of volunteer physicians who were skilled and dedicated teachers, led seminars that incorporated didactic and simulation sessions. Our efforts garnered attention locally and Josh, our co-founder and medical director, was interviewed on a news channel. This recognition not only highlights the importance of our work but also catalyzes broader awareness and support within our community. Together with our partners, we continue to aspire to equip healthcare professionals with the knowledge and skills necessary to meet the evolving needs of their communities in Uzzhorod.

Lecture sessions

Our 2024 goals are to continue to support primary care education and expand lecture topics guided by our partners at the National University. We signed a Memorandum of Understanding with the University, which reinforced our commitment, and the partnership was also featured on their website. This agreement underscores our shared values and aspirations, serving as a foundation for continued collaboration.

Thrilled to sign our agreement with Uzhhorod University

In 2024, we also hope to hold a women’s health symposium in partnership with local non-profits, including the local Zonta club Uzhhorod, Heart to Heart Ukraine, and the local regional youth leadership office that is now headed by our IMR Ukraine youth representative Mariya Y.

We want to extend our gratitude to everyone who participated and those who volunteered their time to this wonderful collaboration. We look forward to returning to Uzhhorod later this year!

Wonderful to meet the medical students

Mariya Y., our fantastic IMR Ukraine ambassador

April in Ukraine

By: Dr. Ambereen Sleemi, Executive Director

Josh and I traveled to Uzhhorrod in western Ukraine this past April, bordering Slovakia and close to Hungary. A collaboration with several local Ukranian organizations and medical teaching institutions led to a most fruitful visit. The trip was a culmination of months of planning and coordinating with partners both in the US and in Ukraine.

We met with Dr Volodymyr Smolenka, rector of the Uzhhorod National University and renowned neurosurgeon, as well as Dr. Oleg Devinyak, the dean of the medical school. We got an in- depth tour of the medical school, including the simulation lab and classrooms, with an overview of curricula and how students education has been affected by the ongoing conflict.

Dr. Smolenka in the OR

Dr. Oleg (medical school dean) Mariya, Josh, and Ambereen

A tour of a local lab that gives much support to victims of the war followed by a visit to the National maternity hospital gave further insight into the challenges of supporting medical needs during these difficult times. We also met the head of the Ob/Gyn department and staff, hearing concerns of the care of the local population and IDP’s who have come to this city to flee the war.

This was followed by a meeting with the local Ukraine non-profit community organization Heart to Heart, which gave important insight into how orgs have pivoted to meet the needs of the community, those wounded by war as well as IDP/s, many who have made their way to Uzhhorrod, swelling the pre war population substantially. A tour of a local warming centers supported by Zonta’s Ukrainian clubs during fuel and electrical outages this past winter, was another illustration of how the conflict affects all in Ukraine.

Thankful to meet with Uzhhorrod’s National law school Dean Yaro and faculty to discuss how local laws and the medical community can support women who are survivors of both intimate partner violence and rape as it is being weaponized in this war. As IMR is committed to caring for the vulnerable and marginalized, this issue is important for us to support in any way we can. We learned much about legal and law enforcement guidelines and will plan to work collaboratively to further how the medical community can collaborate in these efforts.

Dean Yaro and the law school faculty

Press conference with local partners and local journalists

We were invited to speak to members the local Zonta Uzhhorrod and Lviv clubs, med students and community members on IMR’s past and ongoing work and how we fit into partnerships in local projects. We also presented at a local press conf (watch it on youtube in Ukrainian ) along with our local NGO colleagues and answered questions about our plans to work with the local medical and community groups to support medical education and community health, including our goal to work with local Zonta chapters and Heart to Heart to care for women who are survivors of IPV and rape.

We’re returning this November to work with local medical institutions to enhance medical education and provide support to a new pilot program providing women IDP’s gynecologic and psychologic care. We extend a heartfelt thanks to all who welcomed us so warmly and a special thanks to Mariya, our IMR Ukrainian youth ambassador in Uzhhorrod and Pete Bober, Zonta member. We thank you for your ongoing support and have much more to do! Please consider a donation here.

A quick update on our PPE project

As Covid-19 cases rise to over 9 million and we pass the tragic mark of over 228,000 people who’ve died in the US, we have continued to provide weekly personal protective equipment (PPE) deliveries to our NYC healthcare partners for the last 7 months. All current data shows that COVID cases and hospitalizations are increasing here in NYC. This is supported by what we’ve heard from the doctors and nurses we check in with weekly. We are fully committed to supporting our partners through this next wave of cases. From our ER partners in Queens, “We are definitely seeing more cases coming into our hospital.”

The requests have ranged from respiratory mask and isolation gowns, along with face shields. We expect the needs to change over the next few months. Each partner site has unique PPE needs and we hope to be able to keep our emergency supply cabinet stocked to meet this need. 

Thanks to everyone who has supported our work. We couldn’t have done it without you! We’d like to continue to be able to support our healthcare workers. Please consider a donation.

In other news, we’re so proud of one of our partners, Nurse Amy Sullivan from Wykoff ER who was named one of Time magazine’s 100 most info people for 2020. Congratulations Amy and a big cheer to all healthcare workers around the globe doing the most amazing work of caring for all who’ve been suffering through this pandemic. 

Updates from Vieques

Our 5th medical trip to Vieques (and 6th to Puerto Rico) since Hurricane Maria wrapped up a few days ago and was a resounding success. We were joined by a team from the University of Connecticut’s Department of Family Medicine and partnered with local community based organizations and organizers.

Photo Credit: Ambereen Sleemi

Health and Wellness for Vieques Youth

An important focus of this visit was to enhance health education and wellness for the adolescents on Vieques. Working at the local public middle and high school, 2nd year Family Medicine resident physicians gave presentations to over 60 students about hygiene, nutrition, substance-abuse, bullying and more. They did a great job! 

Photo Credit: Ambereen Sleemi

Prevention of chronic diseases is vital, especially here in #Vieques.  Rates of preventable illness are much higher than mainland Puerto Rico and the US.  People who live in Vieques are eight times more likely to die of cardiovascular disease and seven times more likely to die of diabetes than others in Puerto Rico. Vieques has a 30 percent higher rate of cancer than the rest of Puerto Rico, and nearly four times the rate of hypertension. In addition, the effects of Hurricane Maria had a profound affect on the mental health of inhabitants; thus there is a crucial need to confront this with a concerted effort.  Feedback from students and teachers was remarkably positive and we hope to build on this initiative to give students more knowledge about their health and well-being. A trip to the Vieques Boys and Girls Club made sure younger students also participated in focused health workshops. We also made our first visit to the Vieques Senior Center, bringing supplies, conducting well checks and speaking with seniors and administration about their specific needs. 

Home Visit Program 

Our teams continued our Home Visit Program, this time focusing on households in Esperanza.  Well-visits and home checks include assessment of home safety, roof/plumbing checks and food security.   

Photo Credit: Marc Baptiste

We were able to follow up with Claribel, who recently lost her husband after a long ailment. On our last visit, she was awaiting roof repairs and solar panels- happy to report she has both now thanks to local support. 

Photo Credit: Ambereen Sleemi

Photo Credit: Ambereen Sleemi

Photo Credit: Ambereen Sleemi

In addition, we identify the needs of caregivers who look after their homebound loved ones. Caregivers like the Solis family, which is dedicated to tending to their bedridden mother for years. They’re doing an amazing job, as were all the families caring for their loved ones here. Some need supplies, others need roof/floor repairs. Working with community organizations, we’re able to help connect needs to resources.  

Photo Credit: Marc Baptiste

NEEDS ASSESSMENT 

Continuing our partnership with local organizations/activists in Vieques, including Vieques Love, BiblioCeiba and Kathy Gannett, is vital to bring care to residents on this island. During our trip, we met with folks from Sociants--a digital platform designed to identify social determinants of health—to discuss a much-needed and overdue needs assessment on VIeques.  Participating in this initiative will allow for collection of important data that will inform our work to bring better medical care to Vieques. 

Thanks to our entire team who provided incredible preventive health education,  medical expertise and support for our work to bring the best care possible to Vieques. We thank Marc Baptiste, a remarkable photographer for lending his talent to document our work and the people for whom we care. To John and Amy Boggs and Laila O’Neal—we’re thankful you joined our team. To Drs. Guajardo, Rivera and Blumenfeld, thanks for bringing your U. Conn family to join ours. Go Huskies!

By: A. Sleemi, MD, MPH, Executive Director

Returning to Destra

10/24/19

UPDATE

The political pressures in Haiti have increased to the extent that IMR has found it too unstable to conduct our follow up trip during the pre-arranged dates. We have maintained close contact with our partners in-country to monitor conditions in realtime, so we expect to be returning soon. Throughout the process, our ties have remained strong in Leogane and continue to work in offering assistance however we can.

As soon as we know when we able to return, we will announce dates. In the meantime, IMR is working with local personnel towards assisting however we can in supporting the community of Destra.

-Josh Schiller

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IMR will be returning to the Destra region of Leogane at the end of September.  This marks the first follow-up visit after we initially engaged the area in January, 2019, and we are poised to further the relationships we have forged over this time.  IMR has collaborated with GOALS Haiti since the outset and they’ve facilitated community outreach as well as provided storage for our medications.

We will be continuing our mission to provide training to local practitioners with two days of classroom training, followed by two days of bedside correlation during clinic.  During our last trip, we met Jessumene Jean Paul, a former nursing student and resident of Destra, who showed extraordinary dedication to the people of Destra.  After attending our seminar, she was actively engaged throughout our clinic using the skills that she had learned earlier in the week along with initial training she received during nursing school before she had to discontinue due to financial constraints. Her devotion to the craft of healthcare provision as well as to her childhood home made her an excellent addition to the IMR family as a collaborator.  Since then, IMR has funded her re-entry into nursing school to continue honing her clinical skills. She has also been assisting IMR by conducting home visits to follow-up with patients in the community that had been identified as higher risk during our first clinic.  

In the meantime, IMR has formed another multi-disciplinary care team from Brooklyn, comprised of several branches of medicine, including Emergency Medicine, Internal Medicine, and Psychiatry.   Like last visit, we will have a mix of nurses and physicians with expertise in both adult and pediatric care, along with practitioners who have professional experience in EMS/pre-hospital care and global health.  This trip will make the return to Haiti for some on the trip, while being the first for most; that being said, everyone is excited.  

In addition, IMR will be forging new alliances with local healthcare providers while in-country.  In addition to our relationship with St Boniface in Fond-des-Blancs, we will be inviting the staff of the Raisin Foundation Health Center in Leogane to teach with us and join in our clinic.  This may lay the ground work for an expanding collaboration in the near future.

Our trip will be September 23-28.  We are all looking forward to it. 

By: Josh Schiller, MD, Medical Director

Giving birth should not cost your life: Labor and loss in Haiti

“We have a problem, her blood pressure is really high, she has a severe headache and swelling. Oh, and she’s in her third trimester.” These are words that would make any clinician caring for a pregnant woman very concerned. 

Imagine spending months anticipating the birth of your child, whether it be your first or your fifth. Because of your geography or lack of funds, you have no access to a clinic or to medications, blood tests, ultrasounds, or medical support to guide you through this universal process. For most pregnancies around the world, thankfully the outcomes are joyful. But in a number of cases, the situation can turn catastrophic. 

High blood pressure in pregnancy (pre-eclampsia), hemorrhage, and infections are the most lethal causes of maternal mortality around the world, including Haiti. In Haiti, almost 60% of women give birth without a skilled attendant. This translates to a patient population that is high risk and the highest maternal death rate in the Western Hemisphere (World Bank, 2017). If there’s a complication during childbirth, the results can be dire for mom and newborn. 

Road to Destra

Magdala being transferred to St Boniface Hospital, a few hours south of Destra

When we partnered with GOALS Haiti in Destra, our mission was to train primary healthcare workers and provide medical care to the people who call this northern coastal village home. There is affordable healthcare that is geographically close by, however in an area where poverty and inequality are the norm, getting basic healthcare is almost unattainable. During the January pilot launch of our clinic, we saw nearly 200 people, ranging in age from eight months old to 99 years old. One of them was Magdala J., a mom of three who was pregnant with her fourth child and obviously towards the end of her pregnancy. Magdala gave birth to her other three children with no skilled care at home, as almost all the women did in Destra. However, this pregnancy would be different from the others. She came to the clinic because she was experiencing headaches, swelling and generally not feeling very well. The baby had been moving fine and she was able to do her daily work and care for her children. She just felt a little off. Thankfully, she came in that day and had her blood pressure checked. It was abnormally high. This can reflect a condition called preeclampsia (or toxemia), one of the top killers of pregnant women in the world. The treatment is delivery— a life-saving measure for mom and baby alike.  When asked more specifically at the clinic, it turns out Magdala was exhibiting the most common symptoms of preeclampsia: headache, swelling, visual changes, and upper abdominal pain. Since we have an ongoing relationship with St. Boniface Hospital, an institution that provides very low cost/free care, we made arrangements to have Magdala transferred that day. Our colleague at St. Boniface, Dr. Germinal, is a capable and skilled OB/GYN so we knew she would be in good hands. 

Born too soon

We got word a few days later that she had an emergency cesarean delivery and the baby was transferred to the neonatal intensive care unit, which is rare in that region. Luckily,  she was in a hospital that could perform an emergency delivery safely and had a nursery that could take care of a premature baby that had been stressed in utero by the effects of preeclampsia. It was estimated that Magdala was around 32-33 weeks pregnant when she delivered, an age when many babies born in Haiti do not survive. We returned to Haiti recently and followed up on the baby who is now healthy, at home and both are doing fine. We're thankful that we held the clinic in January and that Magdala had confidence in our ability to care for her— she and the baby both survived a condition that is life-threatening. 

Through our partnership with GOALS Haiti, we were able to educate the community about health issues such as Magdala’s, and we’ll continue to involve local citizens who will be part of our efforts to bring better healthcare and awareness to Destra. We look forward to our return this September.

Ambereen Sleemi, MD, MPH

All photos used with permission.

IMR and GOALS Haiti launches partnership

In mid January 2019, a medical team from International Medical Response (IMR) travelled to the Destra community for a training seminar for local healthcare practitioners, followed by a clinic.  The IMR team was comprised of physicians, nurses and EMS techs, with this venture representing the inauguration of what will likely be an on-going collaboration between GOALS and IMR.  This initial trip was highly successful--ten trainees were tapped from the local community to engage in a day-long training seminar, and then assisted with patient care in the following days in the clinic.  Nearly two hundred patients were seen, ranging from eight days old to 97 years, many of whom had rarely seen a physician prior.  IMR also identified a one of the trainees to serve as the local healthcare agent in Destra for follow up care, with remote support from IMR until the planned return in July 2019.   

In addition to the large number of patients who were cared for at the clinic, we had two big saves that otherwise may have resulted in lives being lost.  As IMR and GOALS continue to work in partnership, we hope to establish an ongoing presence in Destra.  IMR's primary goals are to build a network of healthcare agents on the ground to address the concerns of the community, and to create a triage system by which we can direct patients to the appropriate care they require. 

This would not be possible without the support IMR has received from GOALS; they have been instrumental in providing the guidance required to addressing community needs directly.  We look forward to building on this trip, and creating a reliable service to the people of Destra. 

Jonathan Kaplan MD, Volunteer Physician

Joshua Schiller MD, IMR Medical Director